Ruiz F.R.,Hospital Costa Del Sol
Journal of the European Academy of Dermatology and Venereology | Year: 2012
Background Non-melanoma skin cancer (NMSC) is the most common tumour in white people. The progressive increase of these malignancies in such populations as those found in Europe represents an important public health concern which it is presumed will have a great impact on healthcare costs. However, the lack of comparable epidemiological information between countries hinders the development of a common health policy. Objectives The aim of this study was to describe the epidemiological, clinical and therapeutic aspects of NMSC in the public health area of the western part of the Costa del Sol, in southern Spain, and study the differences between the Spanish (S) population and that originally between the north and centre of Europe (N). Methods We undertook a retrospective analysis of all patients with histologically confirmed tumours in both populations during the period 1 January 2006 to 30 June 2009. Results In comparison with the Spanish, the patients from the north and centre of Europe were more likely to have phototype I/II (S: 56.9%; N: 85.8%), recreational photoexposure (S: 48.4%; N: 83.8%), multiple carcinomas (S: 16.8%; N: 28.2%) and more carcinomas per patient (S: 1.7 ± 1.3; N: 2.3 ± 2.3). The tumours were more often located on the trunk and limbs (S: 28.3%; N: 50.2%) with a predominance of the less aggressive histological types (S: 34.7%; N: 42.6%) and non-invasive treatments in patients from the north and centre of Europe (S: 25.6%; N: 35.3%) when compared with the Spanish population. Conclusion Persons from the north and centre of Europe living on the Costa del Sol present a different pattern of NMSC to the local Spanish population and usually require a less invasive therapeutic approach. These findings highlight the need to define prevention and treatment policies for NMSC according to the characteristics of each particular population. This would help reduce not only the frequency but also the associated morbimortality of this disease, particularly in high-risk populations. © 2011 he Authors.
Del Boz J.,Hospital Costa Del Sol |
Crespo V.,Complejo Hospitalario Carlos Haya |
De Troya M.,CIBER ISCIII
Pediatric Dermatology | Year: 2012
Tinea faciei (TF) is a common clinical form of tinea in children that is frequently misdiagnosed and treated with corticosteroids. No large case series of TF focusing on children have been published. The aim of this study was to analyze the main epidemiologic, clinical, and microbiologic features of TF in children over a period of 30 years and compare these features with those of other tineas. We undertook a retrospective study of 818 cases of tinea in children at a referral hospital in southern Spain, diagnosed between 1977 and 2006, concentrating for this study on TF. Of the 73 cases of TF diagnosed, 50.7% were in girls. Most children (46.6%) were 4 to 9 years old. At the time of diagnosis, 29.2% of the cases had been treated with topical steroids. The most frequently isolated dermatophyte was Trichophyton mentagrophytes, which was isolated significantly more frequently in TF than in the other tineas. Cases of TF in children were not extremely unusual, emphasizing that TF must be considered in children with inflammatory facial eruptions. This consideration and the more-frequent use of mycologic tests can help achieve the correct diagnosis, when present. © 2011 Wiley Periodicals, Inc.
Shah R.J.,Aurora University |
Shah J.N.,California Pacific Medical Center |
Waxman I.,University of Chicago |
Kowalski T.E.,Thomas Jefferson University |
And 5 more authors.
Clinical Gastroenterology and Hepatology | Year: 2015
Background and Aims: Plastic stents, placed via endoscopy to drain pancreatic fluid collections (PFCs), require repeat access. Covered metal stents are larger in diameter and can be inserted in a single step, but can migrate. We evaluated the safety and efficacy of a lumen-apposing, covered, self-expanding metal stent (LACSEMS) for PFC drainage. Methods: We performed a prospective study of the outcomes of stent placement in 33 patients (18 men; age, 53 ± 14 y; 28 with chronic pancreatitis) with symptomatic pancreatic pseudocysts and walled-off necrosis (>6 cm with >70% fluid content). Subjects were enrolled at 7 tertiary care centers (6 in the United States and 1 in Europe) from October 2011 through August 2013. Cystenterostomies were created based on endoscopist preference. Safety outcomes included infection, bleeding, perforation, tissue injury, and stent migration. Efficacy end points included LACSEMS placement, patency, and removal, as well as 50% or more reduction in PFCs. Results: The mean size of the patients' PFCs was 9 ± 3.3 cm. LACSEMSs were placed successfully via endoscopic ultrasound guidance in 30 patients (91%); the remaining 3 patients received 2 double-pigtail stents. One subject could not be evaluated because of a pseudoaneurysm. In the patients receiving LACSEMS, PFCs resolved in 27 of 29 (93%). Overall, PFCs resolved in 30 of 33 patients (91%). Endoscopic debridement through the LACSEMS was conducted in 11 subjects. Complications (15%) included abdominal pain (n= 3), spontaneous stent migration, back pain (n= 1), access-site infection, and stent dislodgement (n= 1). Conclusions: LACSEMS were placed successfully in 91% of subjects with PFCs. Overall, 93% had PFC resolution. Advantages of LACSEMSs over other stents include single-step deployment and the ability to perform endoscopic debridement with minimal stent migration. Clinicaltrials.gov: NCT01419769. © 2015 AGA Institute.
Sanchez Del Aguila M.J.,Hospital Costa del Sol |
Schenk M.,Center for Pain and Palliative Care |
Kern K.-U.,Institute of Pain Medicine Pain Practice |
Drost T.,Grunenthal GmbH |
Steigerwald I.,Grunenthal GmbH
Clinical Therapeutics | Year: 2015
Purpose: Chronic pain is often challenging to address appropriately. Although patients with severe chronic pain may respond to treatment with an opioid analgesic, opioids are often associated with adverse effects that may lead patients to disrupt or discontinue therapy. In addition, opioid analgesics alone may not be effective for all types of chronic pain, including neuropathic pain. Tapentadol prolonged release (PR), a centrally acting analgesic with 2 mechanisms of action (μ-opioid receptor agonism and noradrenaline reuptake inhibition), provides strong and reliable analgesia across a range of indications, including nociceptive, neuropathic, and mixed types of chronic pain, and is associated with an improved tolerability profile relative to classic opioid analgesics. The purpose of this article was to review the recent literature on different aspects related to the clinical use of tapentadol PR. Methods: A review was conducted of the current literature and relevant unpublished data on initiation and titration of tapentadol PR, switching from classic strong opioids, risk of withdrawal after discontinuation, long-term treatment, coadministration with other medications, and risk of abuse and diversion. Findings: Tapentadol PR may provide clinically meaningful benefits over classic opioid analgesics, including ease of initiating and titrating tapentadol PR treatment in opioid-naive and opioid-experienced patients, low risk of withdrawal after cessation of tapentadol PR therapy, a favorable pharmacokinetic profile (allowing for coadministration with other medications) of tapentadol PR, and low potential for tapentadol PR abuse. Implications: The broad analgesic efficacy of tapentadol PR may simplify chronic pain management by allowing for the treatment of different types of pain with a single analgesic. In addition, tapentadol is associated with a low risk of pharmacokinetic interactions, which permits its use in patients taking multiple medications. Furthermore, the favorable tolerability profile of tapentadol PR may result in improved patient compliance and allow for easy titration and rotation from previous strong opioids. © 2015 The Authors. Published by Elsevier HS Journals, Inc.
Alegria J.G.,Hospital Costa Del Sol
Revista Clinica Espanola | Year: 2013
This paper presents the activities and projects developed by the Spanish Society of Internal Medicine (SEMI) during the period 2010-2012. A review of the strategic objectives, initiatives to improve and increase the offer for members of the teaching activities at congresses, Working Groups meetings, summer schools for residents, and on-line training activities is made. The institutional and communication relations and information on the Revista Clínica Española are also reviewed. © 2013 Elsevier España, S.L. All right sreserved.
Del Boz J.,Hospital Costa Del Sol
Actas Dermo-Sifiliograficas | Year: 2015
Until quite recently, clinical guidelines and reviews on the treatment of hyperhidrosis advised against the use of systemic therapies based on their unacceptable adverse effects and a lack of evidence of usefulness. Numerous studies published over the past few years, however, have shown that, when used appropriately, these treatments are effective and in general have a favorable tolerability profile, making them an additional option for the treatment of hyperhidrosis, particularly for disease that is widespread, multifocal, or resistant to other treatments. In this review, the first of its kind, we examine the systemic therapies available for hyperhidrosis, including antihypertensives, psychoactive agents, and in particular oral anticholinergics, although none of these drugs are currently approved for this indication. © 2014 Elsevier España, S.L.U. and AEDV.
Del Boz-Gonzalez J.,Hospital Costa del Sol
Actas Dermo-Sifiliograficas | Year: 2012
Considerable information is available on the changing incidence, etiology, clinical forms and management of tinea capitis in Spain. While the condition became epidemic during the 19th century, when it was predominantly caused by anthropophilic dermatophytes, the incidence fell with the advent of treatment with griseofulvin, after which zoophilic dermatophytes became the main etiologic agents. Although the true incidence of tinea capitis in Spain today is unknown, the condition continues to be a public health problem. Ongoing changes are evident in the greater diversity of pathogenic species identified and a renewed increase in anthropophilic dermatophytes, especially associated with immigration. Consequently, unless action is taken to correctly diagnose, treat, and prevent this infection, its prevalence may once again reach epidemic proportions in the near future. © 2011 Elsevier España, S.L. and AEDV. All rights reserved.
Jimenez-Puente A.,Hospital Costa del Sol
BMC health services research | Year: 2012
Obstetric epidural analgesia (EA) is widely applied, but studies have reported that its use may be less extensive among immigrant women or those from minority ethnic groups. Our aim was to examine whether this was the case in our geographic area, which contains an important immigrant population, and if so, to describe the different components of this phenomenon. Cross-sectional observational study. Setting: general acute care hospital, located in Marbella, southern Spain. Analysis of computer records of deliveries performed from 2004 to 2010. Comparison of characteristics of deliveries according to the mothers' geographic origins and of vaginal deliveries noting whether EA was received, using univariate and bivariate statistical analysis and multiple logistic regression (MLR). A total of 21,034 deliveries were recorded, and 37.4% of these corresponded to immigrant women. EA was provided to 61.1% of the Spanish women and to 51.5% of the immigrants, with important variations according to geographic origin: over 52% of women from other European countries and South America received EA, compared with around 45% of the African women and 37% of the Asian women. These differences persisted in the MLR model after adjusting for the mother's age, type of labor initiation, the weight of the neonate and for single or multiple gestation. With the Spanish patients as the reference category, all the other countries of origin presented lower probabilities of EA use. This was particularly apparent for the patients from Asia (OR 0.38; 95%CI 0.31-0.46), Morocco (OR 0.49; 95%CI 0.43-0.54) and other Africa (OR 0.55; 95%CI 0.37-0.81). We observed a different use of EA in vaginal deliveries, according to the geographic origin of the women. The explanation for this involves a complex set of factors, depending both on the patient and on the healthcare staff.
Arenas J.,Hospital Costa del Sol
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral | Year: 2012
The need to create a stoma is frequent in the daily clinical practice. Usually ileostomies work well within the first 24 hours. However, many times they are associated with important morbidity up to 76%. Although the complications derived from this technique may be surgical, metabolic complications, which are preceded by large losses through the stoma, are the ones going undetected. It is not rare to see patients carrying an ileostomy that come repeatedly to the hospital with severe metabolic impairments and in whom the underlying cause remains untreated. The case reported herein is just one of a series published in this journal making us aware of the need for a multidisciplinary approach of the ileostomies and the prevention of major complications derived from their poor functioning.
Perez-Ruiz E.,Hospital Costa del Sol
Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine | Year: 2012
The efficacy of epidermal growth factor-targeting therapies has been found to be limited in tumors with the wild-type K-RAS gene, suggesting a predictive value of K-RAS gene analysis in tumoral response. However, the prognostic value of K-RAS is controversial. This study included patients diagnosed with metastatic colorectal cancer. The presence of K-RAS mutations was analyzed, and the tumors positive for a K-RAS mutation were further analyzed to identify the mutation type. Similarly, the following clinical and pathological variables were also collected. The study was composed of 53.3 % of patients with wild-type K-RAS and 46.7 % of patients with mutated K-RAS (mutated codon 12 was the most frequent). With a mean follow-up of 15 months (range, 1-45), the median survival of patients with wild-type K-RAS was 31.6 months. The median survival was 24.8 months for patients with K-RAS mutated in codon 12 and 17.8 months for patients with mutated codon 13 (p = 0.37). In a univariate analysis, K-RAS was associated with stage IV at diagnosis (p < 0.005). When K-RAS was mutated, a lower overall survival was observed in cases of G → A transition compared with G → T transversion (19.5 vs. 24.2 months, respectively; p = 0.47). When the amino acid change resulted in an acidic substitution, survival was lower, but it increased when the substitution resulted in a polar or nonpolar amino acid (19.5 vs. 23.2 vs. 24.4 months, p = 0.79). The type of K-RAS mutation or amino acid changes may have prognostic implications in metastatic colon cancer patients. Further research is needed in patients treated in prospective controlled trials.