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Hospital de Órbigo, Spain

Turpie A.G.G.,McMaster University | Kreutz R.,Charite - Medical University of Berlin | Llau J.,Hospital Clinico | Norrving B.,Lund University | Haas S.,TU Munich
Thrombosis and Haemostasis | Year: 2012

A number of novel oral anticoagulants that directly target factor Xa or thrombin have been developed in recent years. Rivaroxaban and apixa-ban (direct factor Xa inhibitors) and dabigatran etexilate (a direct throm-bin inhibitor) have shown considerable promise in large-scale, random -ised clinical studies for the management of thromboembolic disorders, and have been approved for clinical use in specific indications. Rivar-oxaban is licensed for the prevention of venous thromboembolism in patients undergoing elective hip or knee replacement surgery, the treatment of deep-vein thrombosis and prevention of recurrent venous thromboem-bolism, and for stroke prevention in patients with non-valvular atrial fibrillation. Based on the clinical trial data for rivaroxaban, feedback on its use in clinical practice and the authors' experience with the use of riva -roxaban, practical guidance for the use of rivaroxaban in special patient populations and specific clinical situations is provided. Although most recommendations are in line with the European summary of product characteristics for the approved indications, additional and, in several areas, different recommendations are given based on review of the literature and the authors' clinical experience. © Schattauer 2012.

Garcia-Roca R.,Hospital Clinic | Samame J.,Hospital Privado de Cordoba | Garcia-Criado M.A.,Hospital Clinico | Real M.I.,Hospital Clinic | And 2 more authors.
Transplantation | Year: 2012

Background. Pancreas graft thrombosis is the most common cause of technical graft failure, with an incidence of up to 20% is some series. In most instances, vascular thrombosis of the graft will require immediate removal to avoid further abdominal complications. We present a total of four cases of complete venous thrombosis with preservation of function that were managed conservatively, resulting in long-term graft function. Methods. Retrospective analysis of our case series over 10 years was carried out, obtaining patients with complete graft thrombosis by Doppler ultrasound. We included in the study only those patients who remained asymptomatic with preserved graft function. The clinical status of the patients, radiological findings, and therapeutic approach are evaluated. Patient and graft outcomes are analyzed. Results. Retrospective evaluation of 227 transplants, a total of four patients were found to have complete thrombosis of the graft, remaining asymptomatic and preserving function without complications. Graft thrombosis was found on routine Doppler ultrasound evaluation of the transplanted organs at a median time of 19 days (range, 11-28 days), angiographic confirmation was obtained in all cases. The clinical condition and the presence of collateral flow allowed for conservative treatment. Median hospital stay was 29 days (range, 16-38 days), with a median follow-up of 106 months (range, 24-110 months), all patients are alive with a functioning graft. Conclusions. In rare instances with complete thrombosis of the pancreas transplant in absence of clinical manifestations, the grafts can be closely monitored and treated with systemic anticoagulation, allowing long-term patient and graft survival. © 2012 by Lippincott Williams & Wilkins.

Zaouali M.A.,Institute Dinvestigacions Biomediques Of Barcelona Iibb | Boncompagni E.,Institute Dinvestigacions Biomediques Of Barcelona Iibb | Reiter R.J.,University of Texas at San Antonio | Bejaoui M.,Institute Dinvestigacions Biomediques Of Barcelona Iibb | And 6 more authors.
Journal of Pineal Research | Year: 2013

Ischemia/reperfusion injury (IRI) associated with liver transplantation plays an important role in the induction of graft injury. Prolonged cold storage remains a risk factor for liver graft outcome, especially when steatosis is present. Steatotic livers exhibit exacerbated endoplasmic reticulum (ER) stress that occurs in response to cold IRI. In addition, a defective liver autophagy correlates well with liver damage. Here, we evaluated the combined effect of melatonin and trimetazidine as additives to IGL-1 solution in the modulation of ER stress and autophagy in steatotic liver grafts through activation of AMPK. Steatotic livers were preserved for 24 hr (4°C) in UW or IGL-1 solutions with or without MEL + TMZ and subjected to 2-hr reperfusion (37°C). We assessed hepatic injury (ALT and AST) and function (bile production). We evaluated ER stress (GRP78, PERK, and CHOP) and autophagy (beclin-1, ATG7, LC3B, and P62). Steatotic livers preserved in IGL-1 + MEL + TMZ showed lower injury and better function as compared to those preserved in IGL-1 alone. IGL-1 + MEL + TMZ induced a significant decrease in GRP78, pPERK, and CHOP activation after reperfusion. This was consistent with a major activation of autophagic parameters (beclin-1, ATG7, and LC3B) and AMPK phosphorylation. The inhibition of AMPK induced an increase in ER stress and a significant reduction in autophagy. These data confirm the close relationship between AMPK activation and ER stress and autophagy after cold IRI. The addition of melatonin and TMZ to IGL-1 solution improved steatotic liver graft preservation through AMPK activation, which reduces ER stress and increases autophagy. © 2012 John Wiley & Sons A/S.

Moya A.,Autonomous University of Barcelona | Garcia-Civera R.,Hospital Clynico | Croci F.,Arrhythmologic Center | Brugada J.,Hospital Clinic | And 8 more authors.
European Heart Journal | Year: 2011

AimsAlthough patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach.Methods and resultsPatients with <1 syncope in the last 6 months, with QRS duration <120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR). Overall, 323 patients (left ventricular ejection fraction 56 ± 12) were studied. The aetiological diagnosis was established in 267 (82.7) patients (102 at initial evaluation, 113 upon EPS, and 52 upon ILR) with the following aetiologies: bradyarrhythmia (202), carotid sinus syndrome (20), ventricular tachycardia (18), neurally mediated (9), orthostatic hypotension (4), drug-induced (3), secondary to cardiopulmonary disease (2), supraventricular tachycardia (1), bradycardiatachycardia (1), and non-arrhythmic (7). A pacemaker was implanted in 220 (68.1), an implantable cardioverter defibrillator in 19 (5.8), and radiofrequency catheter ablation was performed in 3 patients. Twenty patients (6) had died at an average follow-up of 19.2 ± 8.2 months.ConclusionIn patients with syncope, BBB, and mean left ventricular ejection fraction of 56 ± 12, a systematic diagnostic approach achieves a high rate of aetiological diagnosis and allows to select specific treatment. © 2010 The Author.

Ruiz P.J.G.,Fundacion Jimenez Diaz | Catalan M.J.,Hospital Clinico | Carril J.M.F.,Hospital de Guadalajara
Neurologist | Year: 2011

Parkinson disease (PD) is characterized by a wide variety of motor and nonmotor symptoms. Although recently nonmotor symptoms have gained considerable relevance and interest, especially in advanced stages, motor symptoms define the main core of PD and are essential for clinical diagnosis. In this article, we review the characteristics, presentation, and evolution of motor symptoms in early PD. © 2011 by Lippincott Williams & Wilkins ISSN.

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