Hospital General Universitario Alicante

Alicante, Spain

Hospital General Universitario Alicante

Alicante, Spain
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Martinez Rubio M.,Hospital General Universitario Alicante | Moya Moya M.,Hospital General Universitario Alicante | Belmonte Martinez J.,Hospital General Universitario Alicante
Archivos de la Sociedad Espanola de Oftalmologia | Year: 2012

Objective: To determine the prevalence of diabetic retinopathy (DR) and evaluate our experience in DR screening in a study carried out between the Ophthalmology Department of the University General Hospital of Alicante and Department 19 Primary Care of Alicante by using a non-retinal mydriatic camera and telemedicine. Material and methods: A descriptive, cross-sectional study was conducted on 2,435 diabetic patients from 1 February 2006 to 1 February 2009. Three 45° retinographies of both eyes of each patient were obtained and sent to the Department of Ophthalmology via the hospital intranet. These were then evaluated by 2 ophthalmologists, experts in the retina, with each issuing an individualized report for each patient. Results: The prevalence of DR was 17.90%, with 80.73% of them having mild-moderate proliferative DR, 12.16% severe non-proliferative DR, 2.29% proliferative DR, and 4.82% with diabetic maculopathy associated with any level of retinopathy. The retinographies were considered low quality in 41 patients (1.69%). Conclusions: We highlight the benefits of the tele-ophthalmology in screening diabetic patients to enable early diagnosis and treatment, and improving the circuit of communication between primary and specialist care. © 2010 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved.

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.

Gomez-Hurtado I.,Hospital General Universitario Alicante | Such J.,Hospital General Universitario Alicante | Sanz Y.,CSIC - Institute of Agricultural Chemistry and Food Technology | Frances R.,Hospital General Universitario Alicante
World Journal of Gastroenterology | Year: 2014

Gut microbiota plays an important role in cirrhosis. The liver is constantly challenged with commensal bacteria and their products arriving through the portal vein in the so-called gut-liver axis. Bacterial translocation from the intestinal lumen through the intestinal wall and to mesenteric lymph nodes is facilitated by intestinal bacterial overgrowth, impairment in the permeability of the intestinal mucosal barrier, and deficiencies in local host immune defences. Deranged clearance of endogenous bacteria from portal and systemic circulation turns the gut into the major source of bacterialrelated complications. Liver function may therefore be affected by alterations in the composition of the intestinal microbiota and a role for commensal flora has been evidenced in the pathogenesis of several complications arising in end-stage liver disease such as hepatic encephalopathy, splanchnic arterial vasodilatation and spontaneous bacterial peritonitis. The use of antibiotics is the main therapeutic pipeline in the management of these bacteria-related complications. However, other strategies aimed at preserving intestinal homeostasis through the use of pre-, pro- or symbiotic formulations are being studied in the last years. In this review, the role of intestinal microbiota in the development of the most frequent complications arising in cirrhosis and the different clinical and experimental studies conducted to prevent or improve these complications by modifying the gut microbiota composition are summarized. © 2014 Baishideng Publishing Group Inc. All rights reserved.

Sanchez-Ortiga R.,Hospital General Universitario Alicante | Sanchez-Tejada L.,Hospital General Universitario Alicante | Moreno-Perez O.,Hospital General Universitario Alicante | Riesgo P.,Hospital Ribera | And 2 more authors.
Pituitary | Year: 2013

Some pituitary adenomas (PA) demonstrate aggressive behavior with local invasion and recurrences. Angiogenesis is regarded as an essential step in the formation of solid tumors. The aim of this study is to find out whether angiogenic factors may have information about the aggressiveness of PA that could be useful in determining the frequency of follow-up and whether adjuvant therapy is necessary. In this retrospective descriptive study, we evaluated vascular endothelial growth factors (VEGF) and VEGF receptor (KDR) mRNA expression by RT-PCR analysis on 46 human PA samples. Clinical data, histological subtype and radiologic characteristics were studied to determine the associations between the variables and the pre-operative behavior of the tumor. In addition, we monitored 12 patients without adjuvant post-operative therapies over 46 months after surgery, determining progression of tumor remnants and its association with these markers. VEGF expression correlates with KDR expression (r = 0.40, p = 0.006). VEGF demonstrates different expression between histological subtypes (p = 0.036). The extension at magnetic resonance imaging showed that VEGF expression was related to suprasellar extension (p = 0.007), being expressed more on tumors with extrasellar growth than intrasellar ones (p = 0.008). Our results demonstrate a 27.5 times increased risk of extrasellar growth when VEGF expression exceeds 0.222 normalized copy number (NCN) (p = 0.002). Likewise, tumors with KDR greater than 0.750 NCN had less recurrence-free survival time (p = 0.032). Our results suggest that the expression of VEGF and its receptor could be a marker for poor outcome after partial tumor resection. These data should be considered in future studies evaluating angiogenic factors as therapeutic targets in patients with PA. © 2012 Springer Science+Business Media, LLC.

Sanchez-Tejada L.,Hospital General Universitario Alicante | Sanchez-Ortiga R.,Hospital General Universitario Alicante | Moreno-Perez O.,Hospital General Universitario Alicante | Montanana C.F.,Hospital Universitario La Paz | And 3 more authors.
Endocrinologia y Nutricion | Year: 2013

Introduction and objective: The ability to predict recurrence of pituitary adenoma (PA) after surgery may be helpful to determine follow-up frequency and the need for adjuvant treatment. The purpose of this study was to assess the prognostic capacity of pituitary tumor transforming gene (PTTG), insulin-like growth factor 1 receptor (IGF1R), and Ki-67. Materials and methods: In this retrospective study, the normalized copy number (NCN) of PTIG and IGF1R mRNA was measured using RT-PCR, and the Ki-67 index was measured by immunohistochemistry in 46 PA samples. Clinical data, histological subtype, and radiographic characteristics were collected to assess associations between variables and tumor behavior. Progression of tumor remnants and its association to markers was also studied in 14 patients with no adjuvant treatment after surgery followed up for 46 ± 36 months. Results: Extrasellar tumors had a lower PTTG expression as compared to sellar tumors (0.065 [1st-3rd quartile: 0.000-0.089] NCN vs. 0.135 [0.105-0.159] NCN, p= 0.04). IGF1R expression changed depending on histological subtype (p= 0.014), and was greater in tumor with remnant growth greater than 20% during follow-up (10.69 ± 3.84 NCN vs. 5.44 ± 3.55 NCN, p= 0.014). Conclusions: Our results suggest that the IGF1R is a more helpful molecular marker than PTTG in PA management. Ki-67 showed no association to tumor behavior. However, the potential of these markers should be established in future studies with standardized methods and on larger samples. © 2012 SEEN.

Lopez-Cuenca A.A.,Hospital Universitario Virgen Of La Arrixaca | Tello-Montoliu A.,Hospital General Universitario Alicante | Tello-Montoliu A.,Jacksonville University | Roldan V.,University of Murcia | And 3 more authors.
Angiology | Year: 2012

The aim of this study is to determine mean platelet volume (MPV) in a population with non-ST-elevation acute coronary syndrome (nSTEACS) and explore its relation with prognosis. Patients (n = 329) with a diagnosis of nSTEACS at admission were recruited, with a determination of MPV in the first 12 hours at admission. We also collected blood from 87 healthy controls. A composite end point of cardiovascular death and new ACS was assessed at 6-month follow-up. Patients with nSTEACS showed larger platelets (MPV: 11.0 [10.3-11.8] vs 9.2 [8.6-10.0] fL; P <.001.). In Cox regression analysis, MPV at admission was a significant predictor of cardiovascular adverse events in univariate analysis, hazard ratio (HR) 1.4 95% confidence interval (CI) 1.1-1.8; P =.018; but after adjustment with clinical variables, MPV lost its statistical significance. In conclusion, patients with nSTEACS present with larger platelets than healthy controls, however this parameter did not show an independent prognostic significance at 6-month follow-up. © The Author(s) 2012.

Sanchez-Ortiga R.,Massachusetts General Hospital | Sanchez-Ortiga R.,Hospital General Universitario Alicante | Klibanski A.,Massachusetts General Hospital | Klibanski A.,Harvard University | And 2 more authors.
Clinical Endocrinology | Year: 2012

Objective: Prader-Willi syndrome (PWS) is associated with GH deficiency, deleterious changes in body composition and function. As the effects of recombinant human GH (rhGH) in PWS adults have not been well established, we sought to conduct a meta-analysis of pertinent studies. Design: Meta-analysis of studies examining the effects of rhGH therapy in PWS adults. Patients: One hundred and thirty four PWS adults (75 men, 59 women). Measurements: Literature searches, including publications (PubMed, EMBASE and the Cochrane Register), and abstracts presented at meetings through July 2011 describing studies of rhGH therapy in PWS adults; 8/1194 articles, describing unique cohorts, were included. Two authors independently extracted data and examined study quality. Results: rhGH therapy for 12 months led to [weighted mean difference (95% CI)] decreased body fat [-2.91% (-3.90, -1.91)], visceral [-32.97 cm 2 (-55.67, -10.26)] and subcutaneous adiposity [-55.24 cm 2 (-89.05, -21.44)], and increased lean body mass (LBM) [2.41 Kg (1.32, 3.49)]. Similar changes in body fat [-2.89% (-4.69, -1.07)] and LBM [2.82 Kg (1.31, 4.33)] were found in longer studies. There were no changes in body mass index (BMI) or lipids. There was a small increase in fasting glucose [0.27 mmol/l (0.05, 0.49)] and trends towards higher fasting insulin [20.24 pmol/l (-0.55, 41.02)] and insulin resistance [HOMA: 0.60 (-0.04, 1.24)] after rhGH therapy for 12 months. Conclusions: In PWS adults, rhGH therapy led to decreased body adiposity and increased LBM without changes in BMI or lipids. There was a small increase in fasting glucose and trends towards higher insulin and insulin resistance. © 2012 Blackwell Publishing Ltd.

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

8044 Background: NSCLC patients (p) frequently older with significant comorbidities and not considered suitable for platinum-based chemotherapy (CT). Weekly single-agent PCT offers potential for lower toxicity, increased exposure to the drug with alternative cytotoxic/cytostatic mechanisms.Stages IIIB (pleural effusion)-IV, > 70 y, creatinine clearance < 60 ml/min, cardiovascular diseases, stage II chronic bronchitis, untreated p, measurable disease (RECIST). Treatment schedule: Paclitaxel 80 mg/m2 d1,8,15 every 28 d. End-points: Response Rate, Toxicity, TTP, Survival, biological correlates.74 p, 44 evaluable for response, 63 for toxicity. Median age: 73 y with 11% older than 80 y. PS 0/1/2: 10/52/38%.Squamous (49%), Adenocarcinoma (40%). Metastatic sites: lung (88%), lymph nodes (48%), liver (28%), pleura (21%) with 53% of p with > 1 site. Stage IV (distant metastases): 78%. Median creatinine clearance: 73 ml/min. Comorbidities: Chronic bronchitis 41%; Heart disease 22%, Diabetes 20%, Renal disease 18%, Vascular disease 11%. Comorbidity as single inclusion criteria 19%; age and comorbidity (both inclusion criteria): 29%. Median delivered CT cycles: 3 (1-9). Response rate (ITT analysis): CR 2%, PR 21%, SD 41%. Disease control rate at first evaluation (3 months): 64%. Median survival time (MST) 9 m with 1-year survival probability 31%; MST older 70 y 9m, younger 70 y 6 m (p= 0.08); MST PS 0-1: 11 m, PS 2-3: 6 m (p= 0.05) Toxicities: 3 p G3 anemia, 1 p G3 thrombocytopenia without bleeding, 1 p G3 neutropenia without fever; 1 p G3 arrithmia, 2 p G3 hypersensitivity, 2 p G3 neurotoxicity, 3 p G3 asthenia.Weekly PCT is feasible and safe in NSCLC p not-suitable for platinum-based CT due to age or comorbidities. 23% ORR with disease control rate of 64% at 12 w in this group of p with median age 73 y, 83% Stage IV, 38% PS 2 and 49% with significant comorbidities. MST 9 months with significant differences according PS and trend to worse survival for younger p with comorbidity. Mild toxicity profile without toxic deaths. Results of COX-2, Stathmin and PGP expression will be presented. [Table: see text].

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

9519 Background: Pleural effusion is a frequent diagnostic problem in patients with malignancy and may have therapeutic and prognostic impact Methods: Measurement of DNA from pleural liquid (Pl) and peripheral blood (Pb) in patients (p) with pleural effusion (PE) and malignant neoplasm (study group A) and compare the obtained values in p with PE without malignancy (control group B). Group A of 44 samples in p with malignant neoplasm and PE; Group B 19 p with PE without malignancy. DNA were extracted and quantified in 2 simultaneous samples of Pl and Pb collected after 15 min centrifugation at 3000 rpm, aliquoted in 1 ml sterile vials and frozen until DNA extraction. DNA was extracted using DNA blood Qiagen kit. The amount of plasma and pleural DNA was determined by RT quantitative PCR amplification of the human RNase P, a single-copy gene encoding the RNA moiety for the RNase P enzyme. Mann-Whitney test compare the measured values of DNA from Pl and Pb. ROC curve performed to evaluate the diagnostic capacity and the AUC calculated with 95% c.i.Diagnosis of p included in the A group were: Lung Adenocarcinoma (13,6%), Lung Squamous Cell Carcinoma ( 13,6%), other Adenocarcinoma ( 34%), other Carcinoma (25%), Small-Cell Lung ( 9,1%), Mesothelioma ( 2,3%) and Sarcoma ( 2,3%). For the B group the main diagnosis were: CHF ( 73,6%), liver disease-cirrhosis ( 15,7%), hypoproteinemia (5,3%), pulmonary thromboembolism (5,3%). Median concentration of Pb and Pl DNA in ng/ml were respectively 33 (21-95) and 16,5 (4-83) in B group and 102 (55-206) and 97 (21-404) in A group. Median concentration of plasma DNA was three times greater in patients with neoplasia .Median concentration of DNA in pleural effusion was 6x greater in patients with malignancy . The areas under the ROC curve were 0,759 (95%CI=0,622-0,897) and 0,752 (95%CI=0,624-0,880). When the association between DNA measured values from serum and pleural effusion was calculated a positive correlation was found r=0,324 (p<0.05).Median pleural DNA values are greater in p with neoplasia than in pwithout malignancy. This technique could be useful in the diagnostic malignant process of p with pleural effusion. [Table: see text].

PubMed | Hospital General Universitario Alicante
Type: Journal Article | Journal: Annals of translational medicine | Year: 2016

Endobronchial lipomas are rare benign tumors whose symptoms are usually confused with recurrent infections or even asthma diagnosis, and mostly caused by endobronquial obstructive component which also conditions severity. We report a case of a 60-year-old man with a right-lower lobe upper-segment endobronchial myxoid tumor with uncertain diagnosis. We performed a single incision video-assisted anatomical segmentectomy and wedge bronchoplasty with handsewn closure to achieve complete resection and definitive diagnosis. During the postoperative air leak was not observed and there was no complication, with low pain scores and complete recovery. Final pathological exam showed endobronchial lipoma. Single-incision (SI) anatomical segmentectomies are lung-sparing resections for benign or low-grade malignancies with diagnostic and therapeutic value, and the need for a wedge bronchoplasty is not a necessary indication for conversion to multiport or open thoracotomy.

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