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Llocnou de Sant Jeroni, Spain

Perez M.,Complexo Hospitalario Universitario runa
Revista chilena de infectología : órgano oficial de la Sociedad Chilena de Infectología | Year: 2013

Clostridium difficile is the most common cause of infectious diarrhea in adults healthcare institutions. Recent studies have shown an increase in the incidence, severity and recurrence of C. difficile infection (CDI). Factors associated with the patient and medical care provided contribute to establishing colonization and, in some cases, subsequent progression to symptomatic disease. The availability of new microbiological techniques has contributed greatly to improving care for these patients. A diagnostic algorithm is provided for cases in which CDI is suspected based on current evidence regarding the effectiveness of microbiological and radiological methods. In cases in which CDI is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment of CDI is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin. Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. Infection prevention and control strategies can interrupt the transmission mechanism. This manuscript reviews current evidence on the approach of this entity from a multidisciplinary point of view. Source

Blanco R.,Complexo Hospitalario Universitario runa | Fajardo M.,Hospital del Tajo | Parras Maldonado T.,Hospital Universitario Ciudad Of Jaen
Revista Espanola de Anestesiologia y Reanimacion | Year: 2012

Objective: The Pecs block (pectoral nerves block) is an easy and reliable superficial block inspired by the infraclavicular block approach and the transversus abdominis plane blocks. Once the pectoralis muscles are located under the clavicle the space between the two muscles is dissected to reach the lateral pectoral and the medial pectoral nerves. The main indications are breast expanders and subpectoral prosthesis where the distension of these muscles is extremely painful. Material and methods: A second version of the Pecs block is described, called ''modified Pecs block'' or Pecs block type II. This novel approach aims to block at least the pectoral nerves, the intercostobrachial, intercostals III-IV-V-VI and the long thoracic nerve. These nerves need to be blocked to provide complete analgesia during breast surgery, and it is an alternative or a rescue block if paravertebral blocks and thoracic epidurals failed. This block has been used in our unit in the past year for the Pecs I indications described, and in addition for, tumorectomies, wide excisions, and axillary clearances. Results and conclusions: The ultrasound sequence to perform this block is shown, together with simple X-ray dye images and gadolinium MRI images to understand the spread and pathways that can explain the benefit of this novel approach. © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Source

Fernandez Gomez E.,Complexo Hospitalario Universitario runa
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2012

Congenital pseudoarthrosis of the tibia (CPT) is an uncommon disease presenting a tibial nonunion since birth and frequently associated to neurofibromatosis type 1. Surgical management by wide excision of the pseudoarthrosis and sustitution of the defect with vascularized bone in an early stage has proven to be the most effective technique in terms of bone consolidation. We present a clinical case of a 22-month-old patient with CPT treated successfully by reconstruction with a free vascularized fibula graft with an excellent functional result. Source

Cillero-Pastor B.,FOM Institute for Atomic and Molecular Physics | Eijkel G.B.,FOM Institute for Atomic and Molecular Physics | Kiss A.,FOM Institute for Atomic and Molecular Physics | Blanco F.J.,Complexo Hospitalario Universitario runa | Heeren R.M.A.,FOM Institute for Atomic and Molecular Physics
Arthritis and Rheumatism | Year: 2013

Objective Information about the distribution of proteins and the modulation that they undergo in the different phases of rheumatic pathologies is essential to understanding the development of these diseases. We undertook this study to demonstrate the utility of mass spectrometry (MS)-based molecular imaging for studying the spatial distribution of different components in human articular cartilage sections. Methods We compared the distribution of peptides and proteins in human control and osteoarthritic (OA) cartilage. Human control and OA cartilage slices were cut and deposited on conductive slides. After tryptic digestion, we performed matrix-assisted laser desorption ionization-imaging MS (MALDI-IMS) experiments in a MALDI-quadrupole time-of-flight mass spectrometer. Protein identification was undertaken with a combination of multivariate statistical methods and Mascot protein database queries. Hematoxylin and eosin staining and immunohistochemistry were performed to validate the results. Results We created maps of peptide distributions at 150-μm raster size from control and OA human cartilage. Proteins such as biglycan, prolargin, decorin, and aggrecan core protein were identified and localized. Specific protein markers for cartilage oligomeric matrix protein and fibronectin were found exclusively in OA cartilage samples. Their distribution displayed a stronger intensity in the deep area than in the superficial area. New tentative OA markers were found in the deep area of the OA cartilage. Conclusion MALDI-IMS identifies and localizes disease-specific peptides and proteins in cartilage. All the OA-related peptides and proteins detected display a stronger intensity in the deep cartilage. MS-based molecular imaging is demonstrated to be an innovative method for studying OA pathology. © 2013 by the American College of Rheumatology. Source

Ramos-Barbon D.,Servicio de Neumologia | Parra-Arrondo A.,Complexo Hospitalario Universitario runa
Archivos de Bronconeumologia | Year: 2011

Asthma is characterized by inflammation and remodeling of the airways, giving rise to airway obstruction and symptoms of wheezing, chest tightness, cough and dyspnea. Most of these observations arise from the study of samples obtained from the central airways by distinct methods. However, it is currently accepted that this inflammatory process occurs not only in the central airway but also in the small airway and even in the pulmonary parenchyma of all asthmatic patients, even those with mild asthma. CD4+ lymphocytes, activated eosinophils and IL-5 mRNA expression are present in a greater quantity in the small airways. Also present is remodeling, with an increase in submucosal thickness, the muscular layer and adventitia. This inflammatory process causes a disconnection between the pulmonary parenchyma and the airway, giving rise to obstruction of the small airway, which is currently considered to be predominant in asthmatic patients. Likewise, studies of experimental asthma in animals support the substantial role of the distal airway. Recognition that asthma affects the entire airway could be clinically important and lead to the distal lung being considered as a target in any effective therapeutic strategy. However, longitudinal studies are required to evaluate the impact of distal airway inflammation and its treatment in asthma. © 2011 Sociedad Española de Neumología y Cirugía Torácica. Source

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