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Puigdellivol-Sanchez A.,University of Barcelona | Prats-Galino A.,University of Barcelona | Reina M.A.,University of San Pablo - CEU | Reina M.A.,Madrid Monteprincipe University Hospital | And 7 more authors.
Acta Anaesthesiologica Belgica | Year: 2011

Three-dimensional (3D) image-reconstruction of structures inside the spinal canal certainly produces relevant data of interest in regional anesthesia. Nowadays, all hospital MRI equipment is designed mainly for clinical diagnostic purposes. In order to overcome the limitations we have produced more accurate images of structures contained inside the spinal canal using different software, validating our quantitative results with those obtained with standard hospital MRI equipment. Neuroanatomical 3D reconstruction using Amira® software, including detailed manual edition was compared with semi-automatic 3D segmentation for CSF volume calculations by commonly available software linked to the MR equipment (MR hospital). Axial sections from seven patients were grouped in two aligned blocks (T1 Fast Field Eco 3D and T2 Balance Fast Field Eco 3D - resolution 0,65 x 0,65 x 0,65 mm, 130 mm length, 400 sections per case). T2 weighted was used for CSF volume estimations. The selected program allowed us to reconstruct 3D images of human vertebrae, dural sac, epidural fat, CSF and nerve roots. The CSF volume, including the amount contained inside nerve roots, was calculated. Different segmentation thresholds were used, but the CSF volume estimations showed high correlation between both teams (Pearson coefficient = 0.98, p = 0.003 for lower blocks ; Pearson 0.89, p = 0.042 for upper blocks). The mean estimated value of CSF volume in lower blocks (L 3-S1) was 15.8 ± 2.9 ml (Amira® software) and 13.1 ± 1.9 ml (software linked to the MR equipment) and in upper blocks (T11-L2) was 21 ± 4.47 ml and 18.9 ± 3.5 ml, respectively. A high variability was detected among cases, without correlation with either weight, height or body mass index. Aspects concerning the partial volume effect are also discussed. Quick semi-automatic hospital 3D reconstructions give results close to detailed neuroanatomical 3D reconstruction and could be used in the future for individual quantification of lumbosacral CSF volumes and other structures for anesthetic purposes. © Acta Anæsthesiologica Belgica, 2011.


De Andres J.,Hospital Universitario La Paz | De Andres J.,University of Valencia | De Andres J.,Hospital Universitario General Of Valencia | Perez-Cajaraville J.,Hospital Clinica Of Navarra | And 10 more authors.
Clinical Journal of Pain | Year: 2012

Objective: The aim of this study was to culturally adapt into Spanish and validate the painDETECT questionnaire, a brief self-administered instrument designed to screen the presence of a neuropathic pain component in usual clinical practice. Methods: The original English painDETECT questionnaire was culturally adapted into Spanish (Spain) by 2 independent translators under supervision of an expert panel. The LANNS, and a pain visual analog scale were administered along with the painDETECT questionnaire to a sample of 252 patients with neuropathic, nociceptive, or mixed pain for at least 3 months. Patients were classified by experienced specialists under normal conditions of clinical practice. A retest measure after 24 to 48 hours was also carried out. Reliability, construct validity, convergent validity, criterion, and discriminant validity were assessed. Results: An effective sample of 221 patients with chronic pain was recruited, 32% diagnosed of neuropathic origin, 32% of nociceptive, and remaining 36% presented mixed pain. The average age was 57.8 years (SD=14.2) and 59% were women. Cronbach alpha attained a value of 0.86, and the intraclass correlation coefficient with the retest was 0.93. The factor structure was coherent with the one informed for the original instrument. Pearson correlation with the LANSS scale was 0.88. Area under the receiver operating characteristic curve was 0.88 when comparing neuropathic and nociceptive groups. Using the suggested cutoff value for pain presence of 19 points or higher, the following discriminant values are obtained: sensitivity=75%, specificity=84%, Youden Index=0.595, positive predictive value=92%, and negative predictive value=60%. The absence cutoff value of 12 points or bellow raised the following values: sensitivity=93%, specificity=68%, Youden Index=0.61, positive predictive value=87%, and negative predictive value=80%. When mixed pain patients are included in the group with a neuropathic component, discriminant values are slightly reduced, as expected. Conclusions: The culturally adapted version of the painDETECT presents good psychometric properties and shows to be a valid patient-reported outcome for measuring the presence of a neuropathic component in patients with chronic pain. Copyright © 2012 by Lippincott Williams & Wilkins.


Navarro-Compan V.,Hospital Universitario La Paz | Navarro-Compan V.,Leiden University | de Miguel E.,Hospital Universitario La Paz | van der Heijde D.,Leiden University | And 6 more authors.
Arthritis Research and Therapy | Year: 2015

Introduction: Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA. Methods: Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR-) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain (IBP), their separate items and for other SpA features. Results: Pretest probabilityies of a positive result was 41 % for MRI-SI and 40 % for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment of the 'ASAS criteria' (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS-IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin-IBP criteria (LR + =5.5) increased the pre-test probability of MRI-sacroiliitis from 41 % to 79-80 %. Dactylitis (LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73 % and 81 %, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively). Conclusions: If patients with suspected axial SpA have either 1) IBP according to Calin/ASAS definition plus alternating buttock pain, or 2) IBP according to Calin definition plus awakening at night, or 3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantly. © 2015 Navarro-Compán et al.


Buti M.,CIBER ISCIII | Morillas R.M.,CIBER ISCIII | Prieto M.,Polytechnic University of Valencia | Prieto M.,CIBER ISCIII | And 9 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2012

BACKGROUND: Entecavir is an effective treatment for chronic hepatitis B. However, data from clinical practice are limited, especially in hepatitis B e antigen (HBeAg)-positive patients. METHODS: We retrospectively analysed data from 190 nucleos(t)ide-naive chronic hepatitis B patients treated with entecavir (0.5 mg/day) in 25 Spanish centres. Virological response (hepatitis B virus DNA <50 IU/ml by PCR), biochemical response (alanine aminotransferase ≤1×upper limit of normal) and serological response were assessed at weeks 12, 24, 36 and 48. RESULTS: The cohort was 73% male, 84% Caucasian, and 30% HBeAg-positive. Thirty-four per cent of the patients who underwent biopsy had advanced fibrosis/cirrhosis. At baseline, the median hepatitis B virus DNA was 5.94 (interquartile range=4.64-7.39) log10 IU/ml. At week 48, 83% of the patients (61% HBeAg-positive; 92% HBeAg-negative) achieved a virological response and 82% (78% HBeAg-positive; 83% HBeAg-negative) of those with elevated baseline alanine aminotransferase showed a biochemical response. Twenty-six per cent (14/54) of the HBeAg-positive patients lost HBeAg and 22% (12/54) achieved seroconversion to anti-HBe. A significant correlation was observed between virological response at week 12 and the rate of seroconversion to anti-HBe at week 48 (P=0.039). This correlation was also noted at weeks 24, 36 and 48 (P=0.003, 0.002 and 0.017, respectively). Three patients (2%) showed clearance of hepatitis B surface antigen. No resistance to entecavir was observed. Treatment with entecavir was generally well tolerated. No patients discontinued treatment due to adverse events. CONCLUSION: Entecavir monotherapy in clinical practice was well tolerated and resulted in a rapid and significant reduction in viral load. A virological response at week 12 correlated significantly with the rate of seroconversion to anti-HBe at week 48. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | University of Amsterdam, Hospital Universitario La Paz, Leiden University, Hospital Universitario General Of Valencia and 2 more.
Type: | Journal: Arthritis research & therapy | Year: 2015

Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA.Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR-) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain (IBP), their separate items and for other SpA features.Pretest probabilityies of a positive result was 41% for MRI-SI and 40% for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR+=2.6). Among the IBP-criteria, fulfillment of the ASAS criteria (LR+=2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS-IBP criteria (LR+=6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin-IBP criteria (LR+=5.5) increased the pre-test probability of MRI-sacroiliitis from 41% to 79-80%. Dactylitis (LR+=4.1) and inflammatory bowel disease (IBD) (LR+=6.4) increased this probability to 73% and 81%, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and uveitis were the most useful, but only marginally predictive (LR+= 1.3, 1,6 and 2.6, respectively).If patients with suspected axial SpA have either (1) IBP according to Calin/ASAS definition plus alternating buttock pain, or (2) IBP according to Calin definition plus awakening at night, or (3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantly.


Alfonso F.,Hospital Universitario Of La Princesa | Perez-Vizcayno M.J.,Hospital Universitario Clinico San Carlos | Cardenas A.,Hospital Universitario Clinico San Carlos | Garcia Del Blanco B.,Hospital Universitario Vall dHebron | And 17 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) remains a major challenge. Objectives This study evaluated the comparative efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients presenting with DES-ISR. Methods The study design of this multicenter randomized clinical trial assumed superiority of EES for the primary endpoint, in-segment minimal lumen diameter at the 6- to 9-month angiographic follow-up. Results A total of 309 patients with DES-ISR from 23 Spanish university hospitals were randomly allocated to DEB (n = 154) or EES (n = 155). At late angiography (median 247 days; 90% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p < 0.01) (absolute mean difference: 0.23 mm; 95% CI: 00.7 to 0.38), net lumen gain (1.28 ± 0.7 mm vs. 1.01 ± 0.7 mm; p < 0.01), and lower percent diameter stenosis (23 ± 22% vs. 30 ± 22%; p < 0.01) and binary restenosis rate (11% vs. 19%; p = 0.06), compared with patients in the DEB arm. Consistent results were observed in the in-lesion analysis. At the 1-year clinical follow-up (100% of patients), the main clinical outcome measure (composite of cardiac death, myocardial infarction, and target vessel revascularization) was significantly reduced in the EES arm (10% vs. 18%; p = 0.04; hazard ratio: 0.58; 95% CI: 0.35 to 0.98), mainly driven by a lower need for target vessel revascularization (8% vs. 16%; p = 0.035). Conclusions In patients with DES-ISR, EES provided superior long-term clinical and angiographic results compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent [RIBS IV]; NCT01239940) © 2015 American College of Cardiology Foundation.

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