Complejo Hospitalario Universitario Of Santiago

Santiago de Compostela, Spain

Complejo Hospitalario Universitario Of Santiago

Santiago de Compostela, Spain
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Ferreiro L.,Complejo Hospitalario Universitario Of Santiago | Porcel J.M.,Hospital Universitario Arnau Of Vilanova | Valdes L.,Complejo Hospitalario Universitario Of Santiago
Archivos de Bronconeumologia | Year: 2017

Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates.The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself.In cases refractory to medical treatment, invasive procedures will be necessary, for example therapeutic thoracentesis, pleurodesis with talc, or insertion of an indwelling pleural catheter. Little evidence is currently available and no firm recommendations have been made to establish when to perform an invasive procedure, or to determine the safest, most efficient approach in each case.This article aims to describe the spectrum of diseases that cause pleural transudate, to review the diagnostic contribution of pleural fluid analysis, and to highlight the lack of evidence on the efficacy of invasive procedures in the management and control of pleural effusion in these patients. © 2017 SEPAR.

Vidal C.,Complejo Hospitalario Universitario Of Santiago | Rodriguez V.,Complejo Hospitalario Universitario Of Santiago | Armisen M.,Complejo Hospitalario Universitario Of Santiago | Linneberg A.,Copenhagen University | Gonzalez-Quintela A.,Complejo Hospitalario Universitario Of Santiago
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

This study investigated the sensitization pattern of crustacean-allergic patients according to tolerance to molluscs. Thirty-one patients with anaphylaxis to crustaceans (14 with mollusc allergy and 17 with mollusc tolerance) were studied using skin prick tests (SPTs), specific IgEs (sIgEs) and SDS-PAGE immunoblotting. IgE-reactive shrimp proteins were identified by proteomic analyses. Patients with mollusc allergy presented more frequently SPTs positive to molluscs and higher sIgE titres in response to both molluscs and crustaceans. Shrimp-sIgE and rPen a1-sIgE values of 1.57 kUA/l and 4.38 kUA/l, respectively, showed positive likelihood ratios of 4.3 and 10.9 for the identification of mollusc allergy. Patients with mollusc allergy reacted more frequently to tropomyosin in immunoblots than did patients without it (93% vs 35%, respectively, P = 0.004). Reactivity to proteins other than tropomyosin (n = 14) was not different between the two groups. Among patients with crustacean anaphylaxis, patients with mollusc allergy and mollusc tolerance show a different pattern of sensitization, something that may help identify them. © 2015 John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Gonzalez-Juanatey J.R.,Complejo Hospitalario Universitario Of Santiago | Millan J.,Hospital General Universitario Gregorio Maranon | Alegria E.,Servicio de Cardiologia | Guijarro C.,Fundacion Hospital Alcorcon | Vitale G.C.,Merck And Co.
Revista Espanola de Cardiologia | Year: 2011

Introduction and objectives: Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. Methods: DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n = 22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. Results: Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n = 2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters. Conclusions: Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement. © 2010 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved.

Justicia J.L.,Stallergenes Iberica | Cardona V.,Hospital Universitari Vall dHebron | Guardia P.,Hospital Universitario Virgen Macarena | Ojeda P.,Clinica de Asma y Alergia Dres | And 5 more authors.
Journal of Allergy and Clinical Immunology | Year: 2013

Background: Satisfaction with treatment is a patient-reported outcome shown to be associated with the patient's health-related decisions and treatment-related behavior, thereby influencing the chances of successful treatment, and is especially relevant in long-term treatment, such as allergen-specific immunotherapy (AIT). Objective: We sought to assess the psychometric properties of the Satisfaction Scale for Patients Receiving Allergen Immunotherapy (ESPIA) questionnaire so as to determine the satisfaction of patients receiving AIT treatment. Methods: An observational, longitudinal, multicenter study was performed on patients with allergic rhinitis (AR) undergoing AIT treatment. Sociodemographic, clinical, and patient-centered health outcomes data were gathered at the study visits. Feasibility, reliability, validity, and sensitivity to change of the prevalidated version of the ESPIA questionnaire were assessed. Results: Four hundred twenty-nine patients were included (52.2% women, 33.6 years of age, 54.5% of the cases with intermittent AR and 62.5% with moderate AR). Low levels of missing items and ceiling/floor effects were found for the overall score of the ESPIA questionnaire. The overall Cronbach α value and intraclass correlation coefficient were 0.90 and 0.92, respectively. The overall score for the ESPIA questionnaire was strongly associated with months receiving AIT, AR type and intensity, presence of conjunctivitis, self-perceived health status, effect of AR on daily life, and expectations about the AIT treatment. The pattern of correlations obtained with other patient-centered health outcomes was consistent with expectations. The ESPIA questionnaire also showed good sensitivity to change for improved health status. Conclusion: The ESPIA questionnaire to assess patient satisfaction with respect to AIT treatment presented satisfactory psychometric properties for its use in clinical practice. © 2013 American Academy of Allergy, Asthma & Immunology.

Lamas M.J.,Complejo Hospitalario Universitario of Santiago | Duran G.,Complejo Hospitalario Universitario of Santiago | Gallardo E.,Complejo Hospitalario of Pontevedra
Expert Review of Anticancer Therapy | Year: 2011

This Phase II clinical trial investigates the activity and safety of FOLFOX-cetuximab in the first-line treatment of colorectal cancer. This turns out to be an active regimen which allows a high rate of conversion and radical metastectomy. Overall response rate is concordant with those previously reported. The toxicity profile is also similar, and cutaneous toxicity severity seems to be a marker of activity. Retrospectively, the authors analyze the status of KRAS and BRAF in a subgroup of patients, only in 50%. KRAS appears mutated in 37%, and BRAF does not present as mutated in any of the remaining wild-type KRAS patients. KRAS mutation correlates with shorter overall survival and possibly time to progression. The sample is too small to find mutations in BRAF, or to convincingly establish the role of both biomarkers. These data demonstrate an active regimen that is first in line to be confirmed in larger Phase III trials. © 2011 Expert Reviews Ltd.

Soto-Varela A.,Complejo Hospitalario Universitario Of Santiago | Soto-Varela A.,University of Santiago de Compostela | Santos-Perez S.,Complejo Hospitalario Universitario Of Santiago | Santos-Perez S.,University of Santiago de Compostela | And 2 more authors.
Audiology and Neurotology | Year: 2013

A prospective study of patients diagnosed with 'single-canal' benign paroxysmal positional vertigo (BPPV) was performed. Demographic, etiological and prognostic differences between patients with posterior, horizontal and superior canal BPPV were studied. A total of 614 patients diagnosed in a period of 11 years and with a follow-up period of at least 1 year were included in the study. The posterior semicircular canal was affected in 543 casas (88.4%), the horizontal in 39 (6.4%) and the superior canal in 32 (5.2%). Final status at the end of the follow-up period was better in posterior canal BPPV (95% cure) than in horizontal or superior canal BPPV (87% cure in both cases). This may be explained by two facts: a poorer initial response to repositioning maneuvers in anterior canal BPPV than in BPPV involving the other two canals, and a poorer response to maneuvers in recurrences of horizontal canal BPPV. © 2013 S. Karger AG, Basel.

Vazquez J.L.,Complejo Hospitalario Universitario Of Vigo | Pombar M.A.,Complejo Hospitalario Universitario Of Santiago | Pumar J.M.,Complejo Hospitalario Universitario Of Santiago | Del Campo V.M.,Complejo Hospitalario Universitario Of Vigo
European Radiology | Year: 2013

Objective: To present an optimised low-dose multidetector computed tomography (MDCT) protocol for the study of children with cranial deformity. Methods: Ninety-one consecutive MDCT studies were performed in 80 children. Studies were performed with either our standard head CT protocol (group 1, n = 20) or a low-dose cranial deformity protocol (groups 2 and 3). Group 2 (n = 38), initial, and group 3 (n = 33), final and more optimised. All studies were performed in the same 64-MDCT equipment. Cranial deformity protocol was gradationally optimised decreasing kVp, limiting mA range, using automatic exposure control (AEC) and increasing the noise index (NI). Image quality was assessed. Dose indicators such us CT dose index volume (CTDIvol), dose-length product (DLP) and effective dose (E) were used. Results: The optimised low-dose protocol reached the following values: 80 kVp, mA range: 50-150 and NI = 23. We achieved a maximum dose reduction of 10-22 times in the 1- to 12-month-old cranium in regard to the 2004 European guidelines for MDCT. Conclusion: A low-dose MDCT protocol that may be used as the first diagnostic imaging option in clinically selected patients with skull abnormalities. Key Points: • MDCT is a very useful tool in the study of skull lesions • Low-dose MDCT minimises child exposure to ionising radiation while maintaining image quality • Low-dose MDCT should be considered as the first imaging option in selected patients © 2013 European Society of Radiology.

Lamas M.J.,Complejo Hospitalario Universitario of Santiago | Duran G.,Complejo Hospitalario Universitario of Santiago | Gomez A.,Complejo Hospitalario Universitario of Santiago | Balboa E.,Molecular Medicine Unit | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: 5-Fluorouracil-based chemoradiotherapy before total mesorectal excision is currently the standard treatment of Stage II and III rectal cancer patients. We used known predictive pharmacogenetic biomarkers to identify the responders to preoperative chemoradiotherapy in our series. Methods and Materials: A total of 93 Stage II-III rectal cancer patients were genotyped using peripheral blood samples. The genes analyzed were X-ray cross-complementing group 1 (XRCC1), ERCC1, MTHFR, EGFR, DPYD, and TYMS. The patients were treated with 225 mg/m 2/d continuous infusion of 5-fluorouracil concomitantly with radiotherapy (50.4 Gy) followed by total mesorectal excision. The outcomes were measured by tumor regression grade (TRG) as a major response (TRG 1 and TRG 2) or as a poor response (TRG3, TRG4, and TRG5). Results: The major histopathologic response rate was 47.3%. XRCC1 G/G carriers had a greater probability of response than G/A carriers (odds ratio, 4.18; 95% confidence interval, 1.62-10.74, p =.003) Patients with polymorphisms associated with high expression of thymidylate synthase (2R/3G, 3C/3G, and 3G/3G) showed a greater pathologic response rate compared with carriers of low expression (odds ratio, 2.65; 95% confidence interval, 1.10-6.39, p =.02) No significant differences were seen in the response according to EGFR, ERCC1, MTHFR-C677 and MTHFR-A1298 expression. Conclusions: XRCC1 G/G and thymidylate synthase (2R/3G, 3C/3G, and 3G/3G) are independent factors of a major response. Germline thymidylate synthase and XRCC1 polymorphisms might be useful as predictive markers of rectal tumor response to neoadjuvant chemoradiotherapy with 5-fluorouracil. Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.

Tics are repetitive, sharp, rapid, non-rhythmic movements or utterances that are the result of sudden, abrupt and involuntary muscular contractions. Stereotypies are repetitive, apparently impulsive, rhythmic, purposeless movements that follow an individual repertoire that is specific to each individual and that occur under a variable time pattern, which may be either transient or persistent. Both are included in the Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5), among the neurodevelopmental disorders, and together with coordination development disorder go to make up the group of motor disorders. For tics, the categories of 'Tourette's disorder', 'chronic motor or vocal tic disorder' and 'unspecified tic disorder' have been maintained, whereas the category 'transient tics' has disappeared and 'provisional tic disorder' and 'other specified tic disorders' have been incorporated. Within stereotypic movement disorder, the DSM-5 replaces 'non-functional' by 'apparently purposeless'; the thresholds of the need for medical care are withdrawn and replaced with the manual's standard involvement criterion; mental retardation is no longer mentioned and emphasis is placed on the severity of the stereotypic movement; and a criterion concerning the onset of symptoms and specifiers of the existence or not of self-injurious behaviours have been added, together with the association with genetic or general medical diseases or extrinsic factors. Moreover, a categorisation depending on severity has also been included. © 2014 Revista de Neurología.

Salgado E.,Complejo Hospitalario Universitario Of Santiago | Maneiro J.R.,Complejo Hospitalario Universitario Of Santiago | Carmona L.,Complejo Hospitalario Universitario Of Santiago | Carmona L.,Camilo José Cela University | And 2 more authors.
Joint Bone Spine | Year: 2014

Objective: To systematically analyze literature with the aim of examining whether rheumatoid factor (RF) is a predictor of response to tumor necrosis factor (TNF) antagonists in rheumatoid arthritis (RA). Methods: A systematic review and meta-analysis of observational studies were conducted. All studies on the association of baseline RF (titer and/or status) and response to any TNF antagonists, or with enough information to estimate this association were included. Qualitative analysis and meta-analysis using random-effects approach by type of outcome response and RF test was performed. Risk of publication bias was also evaluated. Results: The systematic review included 18studies of 4163identified articles, involving 5703patients with homogeneous baseline characteristics. The most common outcome to assess response was European League Against Rheumatism (EULAR) response criteria, normally merging good and moderate categories as response. The weighted mean difference (WMD) of baseline IgM RF titer in meta-analysis was higher in the non-responders group [-101.58 (95% CI -156.58,-46.59) I2=0.0]. Combined odds ratios (ORs) of positive IgM RF, positive IgA RF, and positive IgG RF to achieve good/moderate response were 1.08 (0.80, 1.47), I2=40.9%; 0.83 (0.39, 1.73), I2=39.8%, and 1.30 (0.48, 3.51), I2=62.9%, respectively. We did not find an association between a positive IgM RF and EULAR good response or remission. Conclusions: This meta-analysis does not support baseline IgM RF titer as a predictor of response to TNF antagonists in RA. However, this conclusion is hampered by high heterogeneity in the studies included in this meta-analysis. © 2013.

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