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PubMed | Hospital Universitario La Paz, Complejo Hospitalario Of Leon, Hospital Universitario Of La Princesa, Hospital Sur Alcorcon Clinica La Luz and 19 more.
Type: | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2016

High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical applications.


PubMed | Hospital Clinico Universitario Santiago, Hospital Quiron, Hospital Universitario Virgen Of Las Nieves, Hospital Universitario 12 Of Octubre and 10 more.
Type: | Journal: Epilepsy & behavior : E&B | Year: 2016

The choice of antiepileptic drug (AED) therapy in patients with brain tumor-related epilepsy (BTRE) is complicated, and there are a lack of robust clinical trial data to date.The NEOPLASM (Neuroncologic Patients treated with LAcoSaMide) study was a 6-month, multicenter, retrospective, observational study in patients with BTRE treated with lacosamide. Patients were started on lacosamide because of a lack of efficacy or adverse events (AEs) with prior AEDs or suitability versus other AEDs, according to clinical practice. The primary efficacy variable was the seizure-free rate at 6months. Safety variables included the proportion of patients with an AE and the proportion with an AE that led to discontinuation.Overall, 105 patients from 14 hospital centers were included in the analysis. Treatment with lacosamide for 6months resulted in a 30.8% seizure-free rate, and 66.3% of patients had a 50% seizure reduction (responders). In the subset of patients included because of a lack of efficacy with prior AEDs, seizure-free rates were 28.0%, and 66.7% of patients were responders. No statistically significant differences in efficacy were observed according to the mechanism of action or enzyme-inducing properties of concomitant AEDs. Adverse events were reported by 41.9% of patients at 6months, and 4.7% of them led to discontinuation. The most common AEs were somnolence/fatigue and dizziness. Notably, 57.1% of the patients who were switched to lacosamide because of AEs with their previous therapy did not report any AE at 6-month follow-up.In this open-label, observational study, lacosamide appeared to be effective and well tolerated in a large population of patients with BTRE. Lacosamide may therefore be a promising option for the treatment of patients with BTRE.


Lainez M.J.A.,Hospital Clinico Universitario Valencia | Lainez M.J.A.,University of Valencia | Marti A.S.,Hospital Clinico Universitario Valencia
Cephalalgia | Year: 2016

Objectives The cluster headache is the most excruciatingly painful primary headache. In some patients, neither preventive treatment nor acute treatment is effective or treatment is poorly tolerated. The sphenopalatine ganglion (SPG) has an important role in the pathophysiology of cluster headache and, for this reason, SPG stimulation has been used to treat cluster headache. Methods We have reviewed the published literature on the role of the SPG in cluster headache and the use of different treatments targeting the SPG. Results Multiple procedures have been used over the SPG to treat pain and trigemino-autonomic symptoms in patients with refractory cluster headache. After obtaining good results in a small number of patients, a miniaturized stimulator was developed. Stimulation of the SPG with this device proved to be efficacious in acute and preventive treatment in a clinical trial involving patients with chronic refractory cluster headache. Implantation of the device is minimally invasive and the most frequent side-effects are mild, such as paraesthesia and pain over the maxillary area. In patients who have used the SPG device for longer than one year, the therapeutic effect remains effective and the side-effects decrease. Conclusions The reported studies have demonstrated that SPG stimulation is a safe and effective treatment for chronic cluster headache. Long-term studies have shown that the effect remains over time and this treatment could be a good choice in patients with chronic refractory headache. We need more data about its potential use in other forms of headache, such as other trigemino-autonomic headaches or migraine. © International Headache Society.


Lluch P.,Hospital Clinico Universitario Valencia | Segarra G.,University of Valencia | Medina P.,University of Valencia
World Journal of Gastroenterology | Year: 2015

Cirrhosis is associated with marked abnormalities in the circulatory function that involve a reduction in systemic vascular resistance. An important cause of this vasodilatation is the increased production or activity of nitric oxide (NO) in the splanchnic circulation. During portal hypertension and cirrhosis an increased endothelial NO synthase (eNOS) activity is demonstrated in splanchnic vessels. In contrast, the activity of eNOS in the cirrhotic liver is decreased, which suggests a different regulation of eNOS in the liver and in the splanchnic vessels. Asymmetric dimethylarginine (ADMA) is an endogenous NO inhibitor and higher plasma levels of ADMA are related to increased cardiovascular risk in both the general population and among patients with cirrhosis. It has been demonstrated that the liver is a key player in the metabolism of ADMA. This observation was further supported by investigations in human patients, showing a close correlation between ADMA plasma levels and the degree of hepatic dysfunction. ADMA is degraded to citrulline and dimethylamine by dimethylarginine dimethylaminohydrolases (DDAHs). DDAHs are expressed as type 1 and 2 isoforms and are widely distributed in various organs and tissues, including the liver. In this review, we discuss experimental and clinical data that document the effects of dimethylarginines on vascular function in cirrhosis. Our increasing understanding of the routes of synthesis and metabolism of methylarginines is beginning to provide insights into novel mechanisms of liver disease and allowing us to identify potential therapeutic opportunities. © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.


PubMed | University of Valencia and Hospital Clinico Universitario Valencia
Type: | Journal: Cephalalgia : an international journal of headache | Year: 2016

The cluster headache is the most excruciatingly painful primary headache. In some patients, neither preventive treatment nor acute treatment is effective or treatment is poorly tolerated. The sphenopalatine ganglion (SPG) has an important role in the pathophysiology of cluster headache and, for this reason, SPG stimulation has been used to treat cluster headache.We have reviewed the published literature on the role of the SPG in cluster headache and the use of different treatments targeting the SPG.Multiple procedures have been used over the SPG to treat pain and trigemino-autonomic symptoms in patients with refractory cluster headache. After obtaining good results in a small number of patients, a miniaturized stimulator was developed. Stimulation of the SPG with this device proved to be efficacious in acute and preventive treatment in a clinical trial involving patients with chronic refractory cluster headache. Implantation of the device is minimally invasive and the most frequent side-effects are mild, such as paraesthesia and pain over the maxillary area. In patients who have used the SPG device for longer than one year, the therapeutic effect remains effective and the side-effects decrease.The reported studies have demonstrated that SPG stimulation is a safe and effective treatment for chronic cluster headache. Long-term studies have shown that the effect remains over time and this treatment could be a good choice in patients with chronic refractory headache. We need more data about its potential use in other forms of headache, such as other trigemino-autonomic headaches or migraine.


Rodriguez-Borja E.,Hospital Clinico Universitario Valencia | Villalba-Martinez C.,Hospital Clinico Universitario Valencia | Carratala-Calvo A.,Hospital Clinico Universitario Valencia
Journal of Clinical Pathology | Year: 2014

Background: Traditionally, laboratories' turnaround times (TAT) have been calculated by only considering analytical or intralaboratory steps. The measure of the postanalytical impact in TAT has barely been studied and, more specifi cally, the running time from when finalised results are available to when clinicians make their first enquiry with an electronic medical record. Methods: During May-June of 2013, two 'Times' were collected from our laboratory information system for all the priority requests coming from our day hospitals: 'Validation time ' (TV), as the request report time with full veri fied results and 'Enquiry time' (TQ), as the time when the first consult was made via electronic medical record. We classi fied requests in groups depending on time results, and TQ-TV ( percentiles) were calculated for each group. Results: 654 (69%) requests were consulted by clinicians before 15 : 00 on the same day with available results. 191 (20%) were consulted after 15 : 00 and had complete results as well (p50 (TQ -TV): 5 days) while 61 (7%) were never consulted (up to 31/12/2013). 39 (4%) requests were fi nally consulted before 15 : 00 h with no available results, but the average time difference between validation and enquiry was 31 min. Conclusions: The results obtained lead us to reconsider the TAT established with our day hospitals in order to know if priority has to be reviewed or if there are failures in follow-up results. 'Enquiry time' appears to be a powerful tool in detecting these issues and shows that TATs are no longer just a 'laboratory problem'.


Villanueva V.,Polytechnic University of Valencia | Lopez-Gomariz E.,Hospital Lluis Alcanyis Xativa | Lopez-Trigo J.,Consorcio Hospital General Universitario Valencia | Palau J.,Polytechnic University of Valencia | And 4 more authors.
Epilepsy and Behavior | Year: 2012

There has been little long-term success with polytherapy for patients with refractory partial-onset epilepsy. The rational combination of antiepileptic drugs based on their mechanism of action may help improve treatment efficacy and tolerability. Lacosamide, a novel sodium channel blocker (SCB), was investigated in 158 patients with partial-onset epilepsy in the prospective, multicenter, observational, RELACOVA cohort study conducted in Spain. After 12. months' treatment with lacosamide, 47% of patients were responders (≥ 50% reduction in seizure frequency) and 24% were seizure free. Lacosamide was well tolerated; dizziness was the most frequent adverse event. Efficacy was better (responder rate, 65% vs 38%; seizure free rate, 35% vs 17%) and there was a lower adverse event rate (33% vs 58%) in patients receiving non-SCBs (n = 49) versus those receiving SCBs (n = 104) as concomitant therapy at baseline. Further investigation of lacosamide combination therapy is warranted. © 2012 Elsevier Inc.


PubMed | Hospital Clinico Universitario Valencia
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

4059 Background: In metastatic colorectal cancers initially treated with FOLFOX, irinotecan is commonly used as second line. We investigated in an unselected population which irinotecan-based regimen had the best antitumoral activity.As the choice of the second line therapy was given to the investigators, without any inclusion criterion, various second line regimens were prospectively registered in the phase III OPTIMOX1 study (front-line FOLFOX4 or 7). Simultaneous use of EGFR inhibitors was excluded. Patients characteristics (Age, performance status (PS), LDH, ALP and CEA levels before the first line of chemotherapy), first line regimen (FOLFOX4 or 7, oxaliplatin reintroduction, PFS achieved in first line) and type of irinotecan-based regimen were tested for an association with second-line progression-free survival (PFS) and tumor control.Among the 620 patients enrolled in the OPTIMOX1 study, 343 received an irinotecan-based second-line chemotherapy: FOLFIRI-3 (n=101, irinotecan 100mg/mIn unselected patients pretreated with oxaliplatin, the PFS of irinotecan-based chemotherapy regimens might be shorter than described in second-line trials. In this unselected second-line setting, FOLFIRI3 regimen showed higher efficacy than other irinotecan-based chemotherapy regimens. [Table: see text].


PubMed | Hospital Clinico Universitario Of Valencia and Hospital Clinico Universitario Valencia
Type: Journal Article | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2016

Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression.A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patient-clinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative.This case is of interest for four rarely concurring reasons. Its a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic.


PubMed | Hospital Clinico Universitario Valencia
Type: Journal Article | Journal: Biochemia medica | Year: 2016

Failure to follow-up laboratory test results has been described as one of the major processes contributing to unsafe patient care. Currently, most of the laboratories do not know with certainty not only their rate of missed (or unreviewed) requests but the economical cost and impact that this issue implies. The aim of our study was to measure that rate and calculate the resulting costs.In January 2015, we checked in our Laboratory Information Management System (LIMS) for every emergency request from 1(st) July 2011 to 30(th) June 2014, if they had been reviewed by any allowed user or not. 319,064 requests were ordered during that period of time. Results were expressed as ordered requests, missed requests and its percentage. Additionally, total cost of missed requests was calculated in euros (). Non-productive days were theorised (as the days producing requests that were not reviewed) based on these results.7924 requests (2.5%) were never reviewed by clinicians. This represented a total cost of 203,039 and 27 non-productive days in three years. Significant differences between inpatients, outpatients and emergency department as well as different emergencies units were found after application of statistical analysis.In terms of resources, never reviewed or missed requests appear to be a not negligible problem for the clinical laboratory management. Electronic result delivery, with electronic endorsement to indicate follow-up of requests along with better systems of electronic requesting should be investigated as a way of improving patient outcomes and save unnecessary expenses.

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