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Batorova A.,University Hospital | Holme P.,University of Oslo | Gringeri A.,Centro Emofilia Angelo Bianchi Bonomi | Richards M.,Leeds General Infirmary | And 3 more authors.
Haemophilia | Year: 2012

Continuous infusion (CI) of factor VIII (FVIII) is an effective method for replacement therapy in haemophilia. Recently, concerns have been raised regarding association of CI with the development of inhibitors. The aim of this study was to gain information on the current practices in Europe regarding CI and the true inhibitor incidence after this mode of therapy. In a cross sectional study performed in 22 Comprehensive Care Centres (CCCs), we evaluated CI techniques, treatment protocols, efficacy, safety and complications of CI including inhibitors. Thirteen (59%) CCCs reported a total of 1079 CI treatments, given peri-operatively or for major bleeds, in 742 patients. Most centres used 'adjusted dose' CI aimed at median target FVIII level of 0.8IUmL-1. CI was haemostatically very effective with a low incidence of complications: median incidence of postoperative bleeding was 1.8%, six centres observed phlebitis in 2-11% of CI treatments. Only nine (1.2%) patients developed inhibitors (0.45% of 659 severe and 7.2% of 83 mild haemophilia patients). Additional analysis of inhibitor patients revealed several confounding factors (low number of prior FVIII exposure days, high steady-state factor levels during CI, high-risk genotype). In this unprecedentedly large cohort, CI treatment appears to be an effective and safe treatment that does not increase the risk of inhibitor development in patients with severe haemophilia. Thus, previous small case series reports suggesting that CI may increase inhibitorsb cannot be confirmed. Inhibitor risk in mild haemophilia could not be evaluated as the influence of other, potentially confounding, risk factors could not be excluded. © 2012 Blackwell Publishing Ltd.


Perez-Pereira M.,University of Santiago de Compostela | Fernandez P.,University of Santiago de Compostela | Gomez-Taibo M.,University of La Coruña | Gonzalez L.,Complexo Hospitalario Universitario Of Vigo | And 3 more authors.
Early Human Development | Year: 2013

Background: Previous studies indicate that VLBW preterm children obtain significantly lower scores than full-term children in all the NBAS clusters. However the samples studied usually presented additional medical complications. Aims: The present study aims to compare the results obtained by low-risk preterm and full term children in the NBAS, and relate possible differences to biological and contextual factors. Method: Early neurobehavioral development of 150 preterm (PR) children is compared to that of 49 full term children (FT). The children were assessed at the age of 15. days (corrected age for preterm children) with the NBAS. Biological and environmental variables were collected through an extended interview with the mothers as well as medical data. Results: Significant differences were found between preterm and full term children in the following areas: motor, range of state, and regulation of state. Differences were also found in relation to birth weight in these same three areas, following a parallel pattern. These differences between the two groups were not, however, necessarily more favorable for the FT group; the PR group had higher results in the motor and range of state areas, and lower results in the regulation of state area. The mothers' smoking habit had a negative effect on infants' regulation and orientation. Conclusions: No general maturation delay in this particular sample of preterm children was found. © 2012 Elsevier Ltd.


Etxaniz A.,Complexo Hospitalario Universitario Of runa | Pita E.,Complexo Hospitalario Universitario Of runa
Revista Espanola de Anestesiologia y Reanimacion | Year: 2016

Bleeding is the most common preventable cause of death in trauma patients. Acute traumatic coagulopathy is a specific condition with a different pathophysiology from other causes of the massive bleeding. An early identification of the coagulopathy is fundamental to implementing rapid treatment. There have been many changes in the management of massive hemorrhage, for example, the administration of the tranexamic acid and the use of balanced transfusion ratio. This review presents these practical points, some of them with scientific evidence, in order to achieve a beneficial effect for patient outcomes. © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.


Varela A.B.,Complexo Hospitalario Universitario Of runa | Blanco Rodriguez M.M.,Complexo Hospitalario Universitario Of runa | Boullosa P.E.,Complexo Hospitalario Universitario Of runa | Silva J.G.,Complexo Hospitalario Universitario Of runa
European Journal of Gastroenterology and Hepatology | Year: 2011

Palmoplantar tylosis is a focal nonepidermolytic palmoplantar hyperkeratosis, which is inherited as an autosomal dominant condition. Two types have been described: an early onset type B tylosis, which occurs in the first year of life and is usually benign, and type A tylosis, which occurs between the ages of 5 and 15 years. Type A tylosis has been associated with a high incidence of oesophageal carcinoma in three families in England, Germany and the USA. This study describes an additional family from Spain with tylosis A, without any known relation to those described before. © 2011 Lippincott Williams & Wilkins, Inc.


Carames B.,Scripps Research Institute | Carames B.,Complexo Hospitalario Universitario Of runa | Carames B.,University of La Coruña | Olmer M.,Complexo Hospitalario Universitario Of runa | And 2 more authors.
Arthritis and Rheumatology | Year: 2015

Objective Aging is a main risk factor for osteo arthritis (OA), the most prevalent musculoskeletal disorder. Defects in autophagy, an essential cellular homeostasis mechanism, have recently been observed in OA articular cartilage. The objectives of this study were to establish the constitutive level of autophagy activation in normal cartilage and to monitor the temporal relationship between changes in autophagy and aging-related degradation of cartilage in a mouse model. Methods In GFP-LC3-transgenic mice, green fluo rescent protein (GFP)-light chain 3 (LC3) is ubiquitously expressed, and the accumulation of GFP puncta, repre senting autophagosomes, was quantified by confocal microscopy as a measure of autophagy activation. Expression of the autophagy proteins autophagy-related protein 5 (ATG-5) and microtubule-associated protein 1 light chain 3 (LC3) was analyzed by immunohistochemistry. Cartilage cellularity, apoptotic cell death, and cartilage structural damage and changes in synovium and bone were examined by histology and immunohistochemistry. Results Basal autophagy activation was detected in liver and knee articular cartilage from young (6-month-old) mice, with higher levels in cartilage than in liver in the same animals. In 28-month-old mice, there was a statistically significant reduction in the total number of autophagic vesicles per cell (P<0.01) and in the total area of vesicles per cell (P<0.01) in the articular cartilage as compared to that from young 6-month-old mice. With increasing age, the expression of ATG-5 and LC3 decreased, and this was followed by a reduction in cartilage cellularity and an increase in the apoptosis marker poly(ADP-ribose) polymerase p85. Cartilage structural damage progressed in an age-dependent manner subsequent to the autophagy changes. Conclusion Autophagy is constitutively activated in normal cartilage. This is compromised with aging and precedes cartilage cell death and structural damage. © 2015, American College of Rheumatology.


To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment. We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update we review the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die. There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression. Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group.


Avila-Alvarez A.,Complexo Hospitalario Universitario Of runa | Del Cerro Marin M.J.,Hospital Universitario Ramon y Cajal | Bautista-Hernandez V.,Complexo Hospitalario Universitario runa
Current Vascular Pharmacology | Year: 2016

Pulmonary hypertension is among the causes of low cardiac output syndrome after neonatal and pediatric cardiac surgery. In the setting of transient postoperative myocardial dysfunction, even a moderate elevation of pulmonary pressure can result in heart dysfunction and circulatory collapse. Although, specific pharmacological manipulation of pulmonary vascular resistance is frequently required in the perioperative period, there is no widely standardized management. In this review, a systematic literature search of PubMed and MEDLINE databases using relevant terms was performed. All clinical trials and relevant manuscripts, along with important physiological, pharmacological, and evidence-based considerations involving the use of pulmonary vasodilators in the management of low cardiac output syndrome after cardiac surgery were reviewed. This article addresses the fifth of eight topics comprising the special issue entitled “Pharmacologic strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery”. © 2016 Bentham Science Publishers.


Emberton M.,University College London | Gomez-Veiga F.,Complexo Hospitalario Universitario Of runa | Ahmed H.,University College London | Dickinson L.,University College London
Actas Urologicas Espanolas | Year: 2013

Context The current management of localized prostate cancer is a therapeutic challenge with different options including active radicals or active follow-up. The aim of this paper is to analyze the feasibility and validity of the «Focal» active treatment versus the concept of active follow-up or Radical Treatment. Evidence acquisition We reviewed the literature on the various diagnostic methods, advantages, and difficulties of active follow-up and Radical Treatment, versus focal therapy with the possibilities of defining characteristics of aggressiveness and patient selection. Evidence synthesis The mesh biopsy techniques along with multiparametric magnetic resonance imaging and association of factors such as tumor size, length of affected cylinder and Gleason are parameters that allow us to define location and definition of clinically significant tumors and subsidiary of focal therapies. Conclusions The definition, location and aggressiveness of prostate cancer in low-intermediate risk tumors can be defined avoiding radical therapies with their side effects or the risks of underestimating tumors as in active follow-up without the minimum side effects. © 2012 AEU. Publicado por Elsevier España, S.L. Todos los derechos reservados.


Ferrer-Barba A.,Complexo Hospitalario Universitario Of runa | Gonzalez-Rivera I.,Complexo Hospitalario Universitario Of runa | Bautista-Hernandez V.,Complexo Hospitalario Universitario runa
Current Vascular Pharmacology | Year: 2016

Postoperative low cardiac output syndrome has been shown to have both a central and a peripheral vascular involvement. Therefore, inodilators which provide with a combination of positive inotropic and vasodilating therapy, conceptually should be an ideal form of treatment. However, contradictory data on these drugs exist. Phosphodiesterase inhibitors (e.g. milrinone) and more recently calcium sensitizers (e.g. levosimendan) have been most commonly used groups in the clinical setting. This review will summarize the pharmacology of inodilators with a special foccus on current clinical evidence. This article addresses the sixth of eight topics comprising the special issue entitled “Pharmacologic strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery”. © 2016 Bentham Science Publishers.


Vidal-Casariego A.,Complejo Asistencial Universitario Of Leon | Calleja-Fernandez A.,Complejo Asistencial Universitario Of Leon | De Urbina-Gonzalez J.J.O.,Complejo Asistencial Universitario Of Leon | Cano-Rodriguez I.,Complejo Asistencial Universitario Of Leon | And 3 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2014

Background: Acute radiation enteritis is a common adverse effect related to radiotherapy (RT). Glutamine is an immune modulator and antioxidant amino acid that can exert a protective role in patients receiving abdominal or pelvic radiation. The aim of this study was to test if glutamine prevents radiation enteritis during RT. Materials and Methods: Double-blind, randomized, controlled trial including 69 patients who needed RT because of pelvic or abdominal malignancies and received glutamine (30 g/d) or placebo (casein, 30 g/d). Enteritis was evaluated according to the Radiation Therapy Oncology Group scale, intestinal inflammation using fecal calprotectin, and gut integrity with citrulline. The incidence of enteritis was analyzed by Kaplan-Meier curves, and the hazard ratio (HR) was calculated using Cox regression. Results: Patients were predominantly male (65.2%), with an average (SD) age of 66.6 (9.9) years, with urologic (44.9%), rectal (24.6%), or gynecological cancer (23.1%). More patients developed enteritis with glutamine than with the placebo (55.9% vs 22.0%; P =.002), with an HR of 1.59 (95% confidence interval, 0.62-4.05). There were no differences in final calprotectin levels (glutamine, 57.9 [85.8] mg/kg vs placebo, 54.0 [57.7] mg/kg; P =.182) or the number of patients with values >50 mg/kg (glutamine, 58.1% vs placebo, 54.6%; P =.777). Final citrulline levels were similar between groups (glutamine, 26.31 [10.29] mmol/L vs placebo, 27.69 [12.31] mmol/L; P =.639), without differences in the number of patients with <20 mmol/L (glutamine, 24.1% vs placebo, 25.0%; P =.938). Citrulline concentration was reduced during RT with placebo but remained unchanged with glutamine. Conclusion: Glutamine does not prevent the development of enteritis during RT. © 2013 American Society for Parenteral and Enteral Nutrition.

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