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Alcázar de San Juan, Spain

Barril G.,Hospital Universitario Of La Princesa | Quiroga J.A.,Fundacion Estudio Hepatitis Virales | Arenas M.D.,Nephrology | Espinosa M.,Nephrology | And 14 more authors.
Journal of Clinical Microbiology | Year: 2014

Amplification of hepatitis C virus (HCV) RNA from blood detected occult HCV infections in 30.9% of 210 HCV-seronegative dialysis patients with abnormal liver enzyme levels that had evaded standard HCV testing practices. Isolated HCV core-specific antibody detection identified three additional anti-HCV screening-negative patients lacking HCV RNA amplification in blood who were considered potentially infectious. Together, these findings may affect management of the dialysis setting. Copyright © 2014 American Society for Microbiology. All Rights Reserved. Source


Gonzalez-Cervera J.,Hospital General de Tomelloso | Angueira T.,Hospital General de Tomelloso | Rodriguez-Dominguez B.,Hospital General de Tomelloso | Arias A.,Research Unit | And 2 more authors.
Journal of Clinical Gastroenterology | Year: 2012

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated, esophageal disease characterized by esophageal dysfunction and eosinophilic inflammation, manifested mainly as dysphagia and frequent food impaction. EoE is recognized into the spectrum of food allergy, but food sensitization studies used not to be efficient to identify the triggering food, because of what patients are frequently treated with topic steroids or even endoscopic esophageal dilation. Herein, we describe 3 adult patients-all suffering from EoE, but with different sensitization patterns-who were treated successfully with elimination diets. Allergy tests indicated no food sensitization for patient 1, but challenge with milk and wheat were positive. Food IgE-mediated allergies were found in patients 2 and 3; inflammation was resolved with food elimination. Lack of food allergy sensitization does not exclude the possibility of food allergies as a cause of EoE; elimination diets must therefore be considered as an effective diagnostic and treatment tool. © 2012 by Lippincott Williams & Wilkins. Source


Abarca-Olivas J.,Hospital General Universitario Of Alicante | Cortes-Vela J.J.,Complejo Hospitalario la Mancha Centro
Radiographics | Year: 2015

In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach. © RSNA, 2015 • radiographics.rsna.org. Source


Sanchez-Ferrandiz N.,Complejo Hospitalario la Mancha Centro | Fernandez-Gonzalez S.,University of Navarra | Guillen-Grima F.,University of Navarra | Perez-Fernandez N.,University of Navarra
Auris Nasus Larynx | Year: 2010

Objective: To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Ménière's disease. Methods: This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Ménière's disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method. Results: Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%. Conclusion: After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the "dizziness index". © 2009 Elsevier Ireland Ltd. Source


Albeniz E.,Complejo Hospitalario de Navarra | Fraile M.,Complejo Hospitalario de Navarra | Ibanez B.,NavarraBiomed Fundacion Miguel Servet and Red de Investigacion en Servicios de Salud en Enfermedades Cronicas | Alonso-Aguirre P.,Hospital Juan Canalejo | And 41 more authors.
Clinical Gastroenterology and Hepatology | Year: 2016

Background & Aims: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. Methods: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the β parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. Results: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; . P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; . P ≤ .05), aspirin use during EMR (OR, 3.16; . P < .05), right-sided lesions (OR, 4.86; . P < .01), lesion size ≥40 mm (OR, 1.91; . P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; . P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. Conclusions: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding. © 2016 AGA Institute. Source

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