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In 1898 the first manual was published on a new medical discipline that had not yet taken a definite form and still did not have an established name: radiology. Its author was the young German physician Hermann Moritz Gocht. The aim of this paper is to outline briefly the contents of the book, placing it in its historical context and in the career of its author. © 2013 ACTEDI. Published by Elsevier España, S.L. All rights reserved.

Mesejo A.,Hospital Clinico Universitario Of Valencia
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral | Year: 2011

As a response to metabolic stress, obese critically-ill patients have the same risk of nutritional deficiency as the non-obese and can develop protein-energy malnutrition with accelerated loss of muscle mass. The primary aim of nutritional support in these patients should be to minimize loss of lean mass and accurately evaluate energy expenditure. However, routinely used formulae can overestimate calorie requirements if the patient's actual weight is used. Consequently, the use of adjusted or ideal weight is recommended with these formulae, although indirect calorimetry is the method of choice. Controversy surrounds the question of whether a strict nutritional support criterion, adjusted to the patient's requirements, should be applied or whether a certain degree of hyponutrition should be allowed. Current evidence suggested that hypocaloric nutrition can improve results, partly due to a lower rate of infectious complications and better control of hyperglycemia. Therefore, hypocaloric and hyperproteic nutrition, whether enteral or parenteral, should be standard practice in the nutritional support of critically-ill obese patients when not contraindicated. Widely accepted recommendations consist of no more than 60-70% of requirements or administration of 11-14 kcal/kg current body weight/day or 22-25 kcal/kg ideal weight/day, with 2-2.5 g/kg ideal weight/day of proteins. In a broad sense, hypocaloric-hyperprotein regimens can be considered specific to obese critically-ill patients, although the complications related to comorbidities in these patients may require other therapeutic possibilities to be considered, with specific nutrients for hyperglycemia, acute respiratory distress syndrome (ARDS) and sepsis. However, there are no prospective randomized trials with this type of nutrition in this specific population subgroup and the available data are drawn from the general population of critically-ill patients. Consequently, caution should be exercised when interpreting these data.

Bosch A.,Fundacion Investigacion del Hospital Clinico Universitario | Eroles P.,Fundacion Investigacion del Hospital Clinico Universitario | Zaragoza R.,University of Valencia | Vina J.R.,Fundacion Investigacion del Hospital Clinico Universitario | And 3 more authors.
Cancer Treatment Reviews | Year: 2010

Breast cancer is a heterogeneous disease with different morphologies, molecular profiles, clinical behaviour and response to therapy. The triple negative is a particular type of breast cancer defined by absence of oestrogen and progesterone receptor expression as well as absence of ERBB2 amplification. It is characterized by its biological aggressiveness, worse prognosis and lack of a therapeutic target in contrast with hormonal receptor positive and ERBB2+ breast cancers. Given these characteristics, triple-negative breast cancer is a challenge in today's clinical practice.A new breast cancer classification emerged recently in the scientific scene based in gene expression profiles. The new subgroups (luminal, ERBB2, normal breast and basal-like) have distinct gene expression patterns and phenotypical characteristics. Triple-negative breast cancer shares phenotypical features with basal-like breast cancer, which is in turn the most aggressive and with worse outcome. Since microarray gene-expression assays are only used in the research setting, clinicians use the triple-negative definition as a surrogate of basal-like breast cancer.The aim of this review, that focuses on triple-negative breast cancer, is to summarize the most relevant knowledge on this particular type of cancer in terms of molecular features, pathogenesis, clinical characteristics, current treatments and the new therapeutic options that include the use of platinum compounds, EGFR antagonists, antiangiogenics and PARP inhibitors. Advances in research are promising and new types of active drugs will become a reality in the near future, making possible a better outcome for this subgroup of breast cancer patients. © 2009 Elsevier Ltd.

Lluch A.,Hospital Clinico Universitario Of Valencia | Alvarez I.,Hospital Universitario Of Donostia | Munoz M.,Hospital Clinic | Segui M.T.,Corporacio Sanitaria Parc Tauli | And 2 more authors.
Critical Reviews in Oncology/Hematology | Year: 2014

In spite of recent advances in the treatment of metastatic breast cancer, this disease remains essentially incurable. Anthracyclines and taxanes have been widely demonstrated to be the most active cytotoxic drugs for the treatment of breast cancer. Paclitaxel and docetaxel are both hydrophobic drugs that need to be administered with detergent-like substances as solvents. In contrast, nanoparticle albumin-bound (nab) paclitaxel uses the natural characteristics of albumin to reversibly bind paclitaxel, transport it across endothelial cells and concentrate the active ingredient within the tumor. Several trials have demonstrated that nab-paclitaxel results in superior efficacy, with more complete responses, prolonged time to recurrence and survival, than paclitaxel and docetaxel in MBC. As second-line treatment, the novel formulation has almost doubled overall response rate, increased time to progression and overall survival in comparison with paclitaxel. Due to these results, to date nab-paclitaxel stands out as a promising treatment of metastatic breast cancer. © 2013.

Fernandez Julian E.,Hospital Clinico Universitario Of Valencia
Acta Otorrinolaringologica Espanola | Year: 2010

The surgical treatment of sleep-related breathing disorders in children depends on the cause of the upper airway obstruction, which can be located in the nasal fossae, pharynx (the most frequent adenotonsillar hyperplasia), or larynx (laryngomalacia, cysts...), or can be multilevel, as in syndromic diseases. Adenotonsillectomy is the most frequently performed and effective (70-80%) procedure. The aim of this technique is to normalize nocturnal respiratory parameters and daytime symptoms, as well as to revert, or at least to halt, cardiovascular complications, neurocognitive disturbances, growth delay and enuresis, which can develop if treatment is not provided or is delayed. However, despite its effectiveness, adenotonsillectomy more frequently leads to complications in children with sleep apnea-hypopnea syndrome (SAHS) than in those undergoing this procedure for other reasons. Moreover, 20-30% of children with SAHS who undergo adenotonsillectomy will show residual SAHS, and this percentage can increase to 70% in patients with severe SAHS, Down syndrome, craniofacial anomalies, neuromuscular disturbances, and morbid obesity.Consequently, both clinical and polysomnographic follow-up are recommended after adenotonsillectomy, especially in the latter risk group. Finally, other obstructive disorders of the upper airway must also be treated, although less frequently due to their lower incidence. These disorders include choanal atresia or stenosis, laryngomalacia, and hypoplasia of the midface or mandible. Tracheotomy will sometimes be required. © 2010 Elsevier España S.L.

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