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INTRODUCTION: A retrospective study was performed in patients with a lumbar disc herniation treated with the Coflex interspinous U implant. MATERIAL AND METHODS: A total of 200 patients who underwent surgery for lumbar disc herniation were evaluated; 100 were assigned to the Coflex group and 100 underwent microsurgery only. A clinical assessment and serial X-rays were performed. All patients were followed-up for 5 years. RESULTS: Our study reveals that the use of the device was more effective (statistically significant) for delayed instability than the surgical technique by itself (p < 0.01). CONCLUSION: The use of this device delays vertebral collapse and therefore the instability of the operated segment.

Spaliviero M.,Sloan Kettering Cancer Center | Poon B.Y.,Sloan Kettering Cancer Center | Karlo C.A.,Sloan Kettering Cancer Center | Guglielmetti G.B.,Sloan Kettering Cancer Center | And 10 more authors.
European Urology | Year: 2016

Background Tumor characteristics affect surgical complexity and outcomes of partial nephrectomy (PN). Objective To develop an Arterial Based Complexity (ABC) scoring system to predict morbidity of PN. Design, setting, and participants Four readers independently scored contrast-enhanced computed tomography images of 179 patients who underwent PN. Intervention Renal cortical masses were categorized by the order of vessels needed to be transected/dissected during PN. Scores of 1, 2, 3S, or 3H were assigned to tumors requiring transection of interlobular and arcuate arteries, interlobar arteries, segmental arteries, or in close proximity of the renal hilum, respectively during PN. Outcome measurements and statistical analysis Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Linear regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss, and estimated glomerular filtration rates at 6 wk and 6 mo after surgery adjusted for baseline estimated glomerular filtration rate. Fisher's exact test was used to test for differences in risk of urinary fistula formation by reference category assignment. Results and limitations Pairwise comparisons of readers' score assignments were significantly correlated (all p < 0.0001); average kappa = 0.545 across all reader pairs. The average proportion of exact matches was 69%. Linear regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and ischemia time (p < 0.0001) and estimated blood loss (p = 0.049). Fisher's exact test showed a significant difference in risk of urinary fistula formation with higher reference category assignments (p = 0.028). Limitations include use of a single institutional cohort to evaluate our system. Conclusions The ABC scoring system for PN is intuitive, easy to use, and demonstrated good correlation with perioperative morbidity. Patient summary The ABC scoring system is a novel anatomy-reproducible tool developed to help patients and doctors understand the complexity of renal masses and predict the outcomes of kidney surgery. © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Langley P.C.,University of Minnesota | Ruiz-Iban M.A.,Arthroscopic Surgery Unit | Molina J.T.,University of Alcala | De Andres J.,Hospital General Universitario Of Valencia | Castellon J.R.G.-E.,Unit for the Study and Treatment of Pain
Journal of Medical Economics | Year: 2011

Objectives: The aims of this paper are to report on the prevalence, correlates and treatment of pain in the adult Spanish population. The analysis also explores the association between the experience of pain and health-related quality of life (HRQoL), employment and productivity, and healthcare resource utilization. Methods: Data are from the internet-based, 2010 National Health and Wellness Survey (NHWS) Spain. The sample was weighted by age and sex to correspond to the 2010 adult Spanish population. All respondents to the NHWS reported on socio-demographic and economic characteristics, medication adherence and major health conditions. They also reported on their HRQoL (the SF-12), their employment status and workplace productivity experience (WPAI instrument) and their healthcare resource utilization. Persons reporting experiencing pain gave details on conditions causing pain, prescription and over the counter (OTC) medication utilization, duration of utilization and satisfaction with medications. A supplementary analysis evaluated the population prevalence of pain for the five most populous Spanish autonomous communities (regions). Results: An estimated 6.10 million (17.25%) of the adult population of Spain reported experiencing pain in the last month. Of these11.69% experienced severe pain, 64.17% moderate pain and 24.14% mild pain. Daily pain was experienced by 6.95% of the population The major conditions causing pain are back pain (60.53%) followed by joint pain (40.21%). Sleep difficulties (42.24%) and anxiety (40.62%) were most commonly cited as comorbidities. Prescription medication utilization was most important in the severe and moderate pain categories, with 71.62% reporting they were satisfied with their prescription pain medications. Adherence to pain medications was high with an overall Morisky score of 0.99 (range 0-4). Pain had a major negative effect on labor force participation for those reporting moderate and severe pain with a participation rate of only 42.62% for those with severe pain. Pain was associated with substantial health-related quality of life deficits as measured by the physical and mental score components of the SF-12. In the case of SF-6D utilities, the utility score for the pain population was markedly below that for the no-pain population (0.65 vs. 0.75; p<0.05).The experience of pain also negatively impacted rates of absenteeism and presenteeism, as well as being associated with greater healthcare resource utilization. Finally, for the five most populous autonomous communities of Spain estimated pain prevalence ranged from 14.80% for Madrid to 18.79% for Comunidad Valenciana. The are a number of limitations which should be noted. First, this is an internet-based sample study and the respondent population may not be representative of the Spanish adult population. Second, respondents are asked to report their experience of pain with no independent clinical conformation. Finally, while a number of obvious acute pain categories are exclude, there is no attempt to arbitrarily define a chronic pain population or to identify pain categories such as neuropathic pain. Conclusions: The experience of pain represents a substantial burden on both individuals and the Spanish economy. The experience of pain is associated with a substantial reduction in both the PCS component of the SF-12 and SF-6D absolute utilities - most notably in respect of severe pain. The experience of pain is also associated, not only with reduced labor force participation and increased absenteeism and presenteeism, but with substantially higher patterns of healthcare resource utilization. © 2011 Informa UK Ltd.

Gomez-Reino J.J.,Hospital Clinico Universitario | Gomez-Reino J.J.,University of Santiago de Compostela | Rodriguez-Lozano C.,Hospital Universitario Of Gran Canaria Dr Negrin | Campos-Fernandez C.,Hospital General Universitario Of Valencia | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objective: To investigate in rheumatoid arthritis (RA) the rate and reason of discontinuation of tumour necrosis factor (TNF) antagonists over the past decade. Methods: RA patients in BIOBADASER 2.0 were stratified according to the start date of their first TNF antagonist into 2000-3, 2004-6 and 2007-9 interval years. Cumulative incidence function of discontinuation for inefficacy or toxicity was estimated with the alternative reason as competing risk. Competing risks regression models were used to measure the association of study groups with covariates and reasons for discontinuation. Association is expressed as subhazard ratios (SHR). Results: 2907 RA patients were included in the study. Competing risk regression for inefficacy shows larger SHR for patients starting treatment in 2004-6 (SHR 2.57; 95% CI 1.55 to 4.25) and 2007-9 (SHR 3.4; 95% CI 2.08 to 5.55) than for those starting in 2000-3, after adjusting for TNF antagonists, clinical activity and concomitant treatment. Competing risk regression analysis for adverse events revealed no differences across the three time intervals. Conclusions: In RA, the discontinuation rate of TNF antagonists in the first year of treatment is higher more recently than a decade ago, inefficacy being the main reason for the increased rate. The rate of discontinuation for adverse events has remained stable.

Bernat-Garcia J.,Hospital Universitario Doctor Peset | Morales Suarez-Varela M.,University of Valencia | Vilata-Corell J.J.,Hospital General Universitario Of Valencia | Marquina-Vila A.,Hospital Universitario Doctor Peset
Actas Dermo-Sifiliograficas | Year: 2014

Background The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-β) have been most frequently associated with the development of skin cancer. Objectives To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. Methods Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. Results HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-β was the most common type isolated. Conclusion We found a wide range of HPV types (mostly HPV-β) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer. © 2013 Elsevier España, S.L. y AEDV. Todos los derechos reservados.

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