Tejerina E.,Hospital Universitario Of Getafe |
Tejerina E.,CIBER ISCIII |
Esteban A.,Hospital Universitario Of Getafe |
Esteban A.,CIBER ISCIII |
And 9 more authors.
Critical Care Medicine | Year: 2012
OBJECTIVES: To determine the proportion of clinical errors by comparing clinical and pathological diagnoses, and to evaluate changes of errors over time. DESIGN: We conducted a prospective study of all consecutive autopsies performed on patients who died in the intensive care unit of the Hospital Universitario de Getafe, Madrid, Spain, between January 1982 and December 2007. The diagnostic errors were classified in two categories: class I errors that were major misdiagnoses with direct impact on therapy, and class II diagnostic errors which comprised major unexpected findings that probably would not have changed therapy. MAIN RESULTS: Of 2,857 deaths during the study period, autopsies were performed in 866 patients (30.3%). Autopsy reports were available in 834 patients, of whom 63 (7.5%) had class I errors and 95 (11.4%) had type II errors. The most frequently missed diagnoses were pulmonary embolism, pneumonia, secondary peritonitis, invasive aspergillosis, endocarditis and myocardial infarction. The autopsy did not determine the cause of death in 22 patients (2.6%). Our rate of diagnostic discrepancy remained relatively constant over time, and the conditions leading to discrepancies have slightly changed, with pneumonia showing a decline in diagnostic accuracy in the last years. CONCLUSIONS: This study found significant discrepancies in 18.5% of patients who underwent autopsy, 7.5% of them were diagnoses with impact on therapy and outcome. This reinforces the importance of the postmortem examination in confirming diagnostic accuracy and improving the quality of care of critically ill patients. Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Gonzalez Martin-Moro J.,Hospital Del Henares |
Munoz Negrete F.,University of Alcalá |
Lozano Escobar I.,Hospital Del Henares |
Fernandez Miguel Y.,Hospital Del Henares
Archivos de la Sociedad Espanola de Oftalmologia | Year: 2013
Objective: Intraoperative-floppy iris syndrome (IFIS) has been recently described. It has been demonstrated that this new syndrome complicates cataract surgery. In this paper we have reviewed the syndrome, and offer practical information specially related to the origin and management of this syndrome and we offer practical information. Material and methods: A review of the related medical literature using PubMed and Cochrane databases. Combining the search terms tamsulosin, cataract, IFIS and intraoperative floppy iris syndrome, more than 200 articles were found. Eighty-two of them were obtained and analysed. In the remaining only the abstract could be studied. Results: The aetiological association between IFIS and tamsulosin (and to a lesser degree between IFIS and other alpha-antagonists) is well established. Other aetiological associations are doubtful. Most of the literature is centred on cataract surgery. However, a similar syndrome has been described during trabeculectomy. A possible association between these drugs and choroidal detachments has also been described. Undoubtedly tamsulosin treatment makes cataract surgery more difficult and increases the probability of intraoperative complications. Protocols to manage the syndrome have not yet been developed. Intracameral injection of alpha-adrenergic agonists seems to be useful. However there is no evidence of the usefulness of discontinuing the drug or using preoperative mydriatics. Conclusion: The aetiological and clinic features of the syndrome are well established. More studies are needed to provide scientific evidence on the most appropriate way to cope with this syndrome. © 2011 Sociedad Española de Oftalmologi ́a. Publicado por Elsevier España.
Puell M.C.,Complutense University of Madrid |
Barrio A.R.,Complutense University of Madrid |
Palomo-Alvarez C.,Complutense University of Madrid |
Gomez-Sanz F.J.,Hospital del Henares |
And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2012
PURPOSE. To determine photopic and mesopic distance highcontrast visual acuity (HC-VA) and low-contrast visual acuity (LC-VA) in eyes with early age-related macular degeneration (AMD). METHODS. Measurements were made in 22 subjects with early AMD and 28 healthy control subjects. Inclusion criteria included a photopic HC-VA of 20/25 or better. Distance VA was measured using HC (96%) and LC (10%) Bailey-Lovie logMAR letter charts under photopic (85 cd/m2) and mesopic (0.1-0.2 cd/m2) luminance conditions. RESULTS. Mean mesopic distance HC-VA and LC-VA were significantly worse (0.1 logMAR and 0.28 logMAR, respectively) in the early AMD group than in the control group. Under mesopic conditions, the mean difference between LC-VA and HC-VA was significantly greater in the early AMD (0.45 logMAR) than the control group (0.27 logMAR). Mean differences between mesopic versus photopic HC-VA and mesopic versus photopic LC-VA were significantly greater in the early AMD than the control group (0.13 and 0.32 logMAR of difference between the means, respectively). Sensitivity and specificity were significantly greater for mesopic LC-VA than for mesopic HC-VA (Receiver Operating Characteristics, area under the curve [AUC], 0.94 ± 0.030 and 0.76 ± 0.067, respectively). AUC values for photopic HC-VA and LC-VA were below 0.70. CONCLUSIONS. Visual acuity testing under low luminance conditions emerged as an optimal quantitative measure of retinal function in early AMD. © 2012 The Association for Research in Vision and Ophthalmology, Inc.
Criado J.M.,Hospital del Henares |
del Salto L.G.,Hospital del Henares |
Rivas P.F.,Hospital del Henares |
del Hoyo L.F.A.,Hospital del Henares |
And 5 more authors.
Radiographics | Year: 2012
Perianal fistulization is an inflammatory condition that affects the region around the anal canal, causing significant morbidity and often requiring repeated surgical treatments due to its high tendency to recur. To adopt the best surgical strategy and avoid recurrences, it is necessary to obtain precise radiologic information about the location of the fistulous track and the affected pelvic structures. Until recently, imaging techniques played a limited role in evaluation of perianal fistulas. However, magnetic resonance (MR) imaging now provides more precise information on the anatomy of the anal canal, the anal sphincter complex, and the relationships of the fistula to the pelvic floor structures and the plane of the levator ani muscle. MR imaging allows precise definition of the fistulous track and identification of secondary fistulas or abscesses. It provides accurate information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. Radiologists should be familiar with the anatomic and pathologic findings of perianal fistulas and classify them using the St James's University Hospital MR imaging-based grading system. © RSNA, 2012.
Abad P.,Hospital Del Henares |
Del Peso A.,Hospital Del Henares |
Arjona M.,Hospital Del Henares
Urology Annals | Year: 2013
Upper urinary tract transitional (UUTT) cell carcinoma is a relatively uncommon urologic tumor. The traditional treatment approach for them is radical nephroureterectomy. However, in recent years, less-invasive treatments, including different nephron-sparing procedures, have become increasingly popular. We report a case of laser ablation of UUTT cell carcinoma using new Olympus digital flexible ureteroscope (URF-V).
Barrientos N.,Hospital del Henares |
Garcia-Sanchez S.,Hospital del Henares |
Dominguez J.D.,Hospital del Henares
Dermatology Online Journal | Year: 2012
Lichenoid drug eruption is an uncommon, but previously reported, side effect of antitumor necrosis factor therapy. The majority of these adverse events relate to infliximab. We report a patient who developed a lichenoid eruption on the back of her hands during etanercept therapy. She improved with topical treatment and discontinuation of the drug was not necessary. The physiopathological link between anti-TNF treatment and lichenoid eruptions remains unclear. It is important to realize that a lichenoid reaction pattern may occur during anti-TNF agent treatment. © 2012 Dermatology Online Journal.
Garrido-Abad P.,Hospital del Henares |
Suarez-Fonseca C.,Hospital del Henares
Urology Annals | Year: 2015
Circumcision is an easy commonly performed surgical procedure in childhood. However, it is not free of a low number of complications, (1-5-5%). Here we report a case of a 3-year-old boy with glans superficial necrosis after circumcision, managed with topical (nitroglycerin, gentamicin), oral (pentoxifylline) and epidural (urgent caudal block with bupivacaine) treatment. A review of the literature and the different treatments reported by other authors was done. After 7 days of treatment, local signs of ischemia and severe pain disappeared, without adverse events related to treatment. Although the ischemia or necrosis of the glans after circumcision are rare, we may suspect them in case of presence of severe acute pain or dark color. We report the successful management of this complication.
Garrido Abad P.,Hospital Del Henares |
Coloma Del Peso A.,Hospital Del Henares |
Sinues Ojas B.,Hospital Del Henares |
Fernandez Arjona M.,Hospital Del Henares
Archivos Espanoles de Urologia | Year: 2013
OBJECTIVES: To report the preliminary results of one of the first series of patients treated with a new simple surgical technique for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and to evaluate its safety and feasibility. METHODS: We have performed a novel surgical treatment of BPH, the UroLift® System (Neotract, Inc). It opens the urethra directly by retracting the obstructing prostatic lobes without applying incisions, surgical resection or thermal injury to the prostate. RESULTS: The procedure was carried out in 20 patients with a mean age of 74.3 (43-90) years, with mean prostate volume of 42.6 mL (19-109) using the same operative protocol in all case subjects. Mean operative time was 19.1 min (range: 12-45). International Prostate Symptom Score (IPSS) at 4 weeks reduced from 26.7 to 16.7 and peak urinary flow rate (Qmax) increased from 8.6 mL/s to 13.2 mL/s. No major complications were encountered, neither sexual dysfunction. Mean follow-up: 12.3 (2-22) months. CONCLUSIONS: The UroLift® System procedure appears to be safe and efficient at short term. This technique minimizes the bleeding of the urethra and, therefore, makes bladder catheter not always necessary, and can preserve sexual function with low morbidity. Further studies are warranted to determine long-term outcome.
Clemente Pollan J.,Hospital del Henares
Pediatria Integral | Year: 2010
The presence of the microorganism is required, but not sufficient, for the development o an infectious disease. Environmental and host factors also have a role. The mammalian immune system consists of two different arms-innate and adaptive immunity-, and cooperative interactions of these two arms are required for elimination of infective pathogens with efficiency. The innate immune system possesses different cell types with multiple recognition molecules (PRRs) in different cellular compartments (e.g. plasma membrane, cytoplasm, endosome, lysosome) and soluble mediators, including complement and the mannose binding lectin (MBL). Mutations of PRRs or their signaling molecules may predispose the host to recurrent infections and are linked to immunodeficiencies and autoimmune diseases in humans. There is now accumulating evidence that the genetic control of common infectious diseases is a continuous spectrum from simple Mendelian susceptibility (mutation) to complex polygenic predisposition (polymorphisms). Implications of polymorphisms in host defence are generally difficult to asses. Several examples of genetic predisposition or genetic resistance to infectious diseases have been deciphered at the molecular level. Host immunocompetence could be defined as the capacity to deal with a microbial infection without the development of symptoms, a single life-threatening infection is sufficient to define an immunodeficiency. Immunity ensures the survival of the species, rather than that of every individual. In contrast to what might be assumed, human immunocompetence is the rule rather than the exception.
Gordo-Vidal F.,Hospital del Henares |
Calvo-Herranz E.,Hospital del Henares |
Abella-Alvarez A.,Hospital del Henares |
Salinas-Gabina I.,Hospital del Henares
Medicina Intensiva | Year: 2010
Mechanical ventilation may cause and aggravate lung damage and contribute to the appearance of multiorgan failure. One of the mechanisms that has been described is alveolar hyperoxia. In experimental models, it has lead to the production of free oxygen radicals that exceed the cell defense capacity, giving rise to inflammation, cell damage and gene overexpression with necrosis and apoptosis phenomenon. However, these findings in humans are not as conclusive, although a functional alteration due to the exposure to high FiO2, and greater lung de-recruitment in patients with lung injury has been clearly demonstrated. Moreover, both the FiO2 used as well as the PaO2 achieved in the first 24 h of admission are associated with mortality. Clinical trials are needed that assess the threshold of the safe oxygen level for FiO2 and oxygen saturation. © 2009 Elsevier España, S.L. y SEMICYUC.