Collado P.,Severo Ochoa University Hospital |
Naredo E.,Severo Ochoa University Hospital |
Calvo C.,Severo Ochoa University Hospital |
Gamir M.L.,Ramon y Cajal University Hospital |
And 6 more authors.
Rheumatology (United Kingdom) | Year: 2013
Objective. To propose a reduced joint power Doppler US (PDUS) assessment and provide preliminary evidence of its validity, feasibility, reliability and sensitivity to change compared with a comprehensive (i.e. 44 joints) PDUS assessment in evaluating synovitis in JIA. Methods. This multicentre study included 42 children with active JIA with ≥4 clinically involved joints requiring modified therapy. At each visit, clinical and PDUS assessments were performed blinded. Each joint was scored for greyscale (GS) synovitis and power Doppler signal according to a 4-point semiquantitative scale with calculation of US composite indices and US composite joint counts. A process of data reduction based on the frequency of US joint involvement was performed to obtain a reduced PDUS assessment. The relationship between the comprehensive and the reduced PDUS assessments was investigated by Spearman's coefficient at all visits, as well as the relationship between changes in the two PDUS assessments during follow-up. In addition, the metric properties of the comprehensive and the reduced PDUS assessments were tested. Results. The 10-joint PDUS assessment, including bilateral knee, ankle, wrist, elbow and the second MCP joints, detected 100% of children with GS synovitis and power Doppler signal. The two PDUS assessments were highly correlated at all visits. The reduced model had a higher responsiveness than the comprehensive model. Intraobserver and interobserver agreement was good for both US findings. Conclusion. The 10-joint PDUS assessment is valid and feasible for assessment of synovitis in JIA in clinical practice. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
PubMed | Infanta Sofia Hospital, Jerez Of La Frontera General Hospital, Hospital Complex of Vigo and Institute Investigacion Sanitaria Galicia Sur, Carlos Haya Hospital and 22 more.
Type: | Journal: Arthritis care & research | Year: 2016
To compare the prevalence of the main comorbidities in 2 large cohorts of patients with primary Sjgrens syndrome (SS) and systemic lupus erythematosus (SLE), with a focus on cardiovascular (CV) diseases.This was a cross-sectional multicenter study where the prevalence of more relevant comorbidities in 2 cohorts was compared. Patients under followup from SJOGRENSER (Spanish Rheumatology Society Registry of Primary SS) and RELESSER (Spanish Rheumatology Society Registry of SLE), and who fulfilled the 2002 American-European Consensus Group and 1997 American College of Rheumatology classification criteria, respectively, were included. A binomial logistic regression analysis was carried out to explore potential differences, making general adjustments for age, sex, and disease duration and specific adjustments for each variable, including CV risk factors and treatments, when appropriate.A total of 437 primary SS patients (95% female) and 2,926 SLE patients (89% female) were included. The mean age was 58.6 years (interquartile range [IQR] 50.0-69.9 years) for primary SS patients and 45.1 years (IQR 36.4-56.3 years) for SLE patients (P<0.001), and disease duration was 10.4 years (IQR 6.0-16.7 years) and 13.0 years (IQR 7.45-19.76 years), respectively (P<0.001). Smoking, dyslipidemia, and arterial hypertension were associated less frequently with primary SS (odds ratio [OR] 0.36 [95% confidence interval (95% CI) 0.28-0.48], 0.74 [95% CI 0.58-0.94], and 0.50 [95% CI 0.38-0.66], respectively) as were life-threatening CV events (i.e., stroke or myocardial infarction; OR 0.57 [95% CI 0.35-0.92]). Conversely, lymphoma was associated more frequently with primary SS (OR 4.41 [95% CI 1.35-14.43]). The prevalence of severe infection was lower in primary SS than in SLE (10.1% versus 16.9%; OR 0.54 [95% CI 0.39-0.76]; P<0.001).Primary SS patients have a consistently less serious CV comorbidity burden and a lower prevalence of severe infection than those with SLE. In contrast, their risk of lymphoma is greater.
Incidence of hand-foot syndrome with capecitabine in combination with chemotherapy as first-line treatment in patients with advanced and/or metastatic gastric cancer suitable for treatment with a fluoropyrimidine-based regimen
Gomez-Martin C.,Fuenlabrada University Hospital |
Sanchez A.,Puerta Of Hierro University Hospital |
Irigoyen A.,Virgen Of Las Nieves Hospital |
Llorente B.,General Yague Hospital |
And 12 more authors.
Clinical and Translational Oncology | Year: 2012
Introduction Hand-foot syndrome (HFS) is a limiting toxicity of capecitabine, which is not life-threatening but could compromise capecitabine efficacy. Materials and methods This phase II, multicenter, noncontrolled study assessed the safety, particularly grade three HFS incidence, and efficacy of four capecitabinebased chemotherapy regimens [cisplatin/capecitabine (CX), epirubicin/cisplatin/capecitabine (ECX), epirubicin/ oxaliplatin/capecitabine (EOX) and docetaxel/cisplatin/ capecitabine (DCX)] as first-line treatment for advanced and/or metastatic gastric cancer. Results One hundred and eight patients were assigned to one of the four treatment groups, according to investigator's criteria, and grouped together for both safety and efficacy primary analyses. HFS was reported in 31 patients (19.6 %) and its first presentation occurred at a median of 72 days (range 19-209 days). Grade 3 HFS developed in 6.3, 5.2, 3.7 and 2.4 %, of patients receiving ECX, DCX, EOX or CX chemotherapy regimen, respectively. Capecitabine dose reduction/discontinuation due to HFS was required in 5.7 % of patients (9/158). The most common (>10 %) grade 3-4 treatment-related AEs were neutropenia (15.2 %), asthenia (12.0 %) and diarrhoea (11.4 %). Conclusions A moderate incidence of HFS was reported in patients treated with capecitabine, which generally presented late and required dose reduction in <1/3 of patients. The results suggest that capecitabine may be useful in combination with standard fluorouracil-based regimens in patients with advanced and/or metastatic gastric cancer with favourable safety profile. © 2012 Federación de Sociedades Españolas de Oncología (FESEO).
Martinez-Comendador J.,Hospital Of Leon |
Castano M.,Hospital Of Leon |
Mosquera I.,Juan Canalejo Hospital |
Plana J.G.,Hospital Of Leon |
And 3 more authors.
Journal of Cardiothoracic and Vascular Anesthesia | Year: 2011
Objective: Elevations of myocardial injury biomarkers after cardiac surgery without ablation of atrial fibrillation (AF) are related to perioperative myocardial ischemia and associated with an increased risk of mortality and cardiac events. However, there have not been any studies that examined the release of cardiac biomarkers after AF cryoablation procedures with concomitant cardiac surgery. The authors determined the levels of these biomarkers for 2 different procedures involving cryoablation and assessed their clinical implications. Design: A prospective cohort study with cardiac surgical patients. Setting: A tertiary care university hospital. Participants: One hundred fifty-two cardiac surgical patients. Interventions: Patients underwent 1 of 2 different cryoablation approaches: the modified Cox-Maze (CM) III procedure (n = 63) or the isolated left atrial (LA) maze procedure (n = 89). Plasma levels of cardiac biomarkers were measured at 1, 6, 12, and 24 hours after surgery. Twenty-four-hour Holter monitoring was performed at 1 month and 1 year after surgery. Measurements and Main Results: Both groups reached very high peak levels of CPK-MB (CM group, 368 ± 171.4 ng/mL and LA group, 203 ± 86.4 ng/mL) and troponin T (CM, 8 ± 4.5 ng/mL and LA, 3.4 ± 2.4 ng/mL). The CPK, CPK-MB, and troponin T levels were significantly higher in the modified CM group compared with the LA maze group. In the first 24 hours after surgery, the average CPK-MB and troponin T values were 78.2 ng/mL higher and 2.3 ng/mL higher, respectively, in the CM group compared with the LA group. In both groups, 79% of the patients remained free of AF at 12 months after surgery. Conclusions: Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF. © 2011 Elsevier Inc. All rights reserved.
Caliz R.,University of Granada |
Del Amo J.,Progenika Biopharma SA |
Balsa A.,Hospital Universitario La Paz |
Blanco F.,Juan Canalejo Hospital |
And 12 more authors.
Scandinavian Journal of Rheumatology | Year: 2012
Objective: Methotrexate (MTX) is the first-choice drug for the treatment of rheumatoid arthritis (RA) patients. However, 30% of RA patients discontinue therapy within 1 year, usually because of adverse effects. Previous studies have reported conflicting results on the association of polymorphisms in the MTHFR gene with the toxicity of MTX in RA. The aim of this study was to assess the involvement of the C677T and A1298C polymorphisms in the MTHFR gene in the toxicity of MTX in a Spanish RA population. Methods: The study included retrospectively 468 Spanish RA patients treated with MTX. Single nucleotide polymorphism (SNP) genotyping was performed using the oligonucleotide microarray technique. Allele and genotype association analyses with regard to MTX toxicity and a haplotype association test were also performed. Results: Eighty-four out of the 468 patients (18%) had to discontinue therapy due to adverse effects or MTX toxicity. The C677T polymorphism (rs1801133) was associated with increased MTX toxicity [odds ratio (OR) 1.42, 95% confidence interval (CI) 1.011.98, p = 0.0428], and the strongest association was shown in the recessive model (OR 1.95, 95% CI 1.083.53, p = 0.0246). The A1298C polymorphism (rs1801131) was not associated with increased MTX toxicity (OR 0.94, 95% CI 0.651.38, p = 0.761). A borderline significant risk haplotype was found: 677T-1298A (OR 1.40, 95% CI 1.001.96, p = 0.0518). Conclusion: These results demonstrate that the C677T polymorphism in the MTHFR gene is associated with MTX toxicity in a Spanish RA population. © 2011 Taylor & Francis on license from Scandinavian Rheumatology Research Foundation.
Fernandez A.L.,University of Santiago de Compostela |
El-Diasty M.M.,Juan Canalejo Hospital |
Martinez A.,University of Santiago de Compostela |
Alvarez J.,University of Santiago de Compostela |
Garcia-Bengochea J.B.,University of Santiago de Compostela
Annals of Thoracic Surgery | Year: 2011
Mechanical occlusion of the right coronary artery during aortic valve surgery is an infrequent but serious complication. Early recognition and expeditious management are important to reduce mortality. We developed a safe, quick, and easy technique to assess right coronary artery flow after aortic valve surgery. Direct intraoperative right coronary artery flow was measured by placing a transit-time flowmeter probe around the right coronary artery. We were able to promptly detect severe right coronary artery insufficiency in patients with acute unexpected right ventricular failure after aortic valve replacement. © 2011 The Society of Thoracic Surgeons.
Garcia-Campelo R.,University of La Coruña |
Quindos M.,University of La Coruña |
Dopico Vazquez D.,University of La Coruña |
Reboredo Lopez M.,University of La Coruña |
And 6 more authors.
Anti-Cancer Drugs | Year: 2010
A 75-year-old-man, with a 2-month history of abdominal pain, underwent a standard diagnostic workup that included a CT scan that showed a large right renal mass and subcentimeter nodes in the right and left lung lobes. In December 2003, the patient underwent right nephrectomy with adrenalectomy and a diagnosis of renal cell carcinoma (pT3N0M0 stage) was made. No further treatment was proposed and patient was followed up regularly. In October 2006, the annual gastrointestinal endoscopy showed asymptomatic multilobulated and polypoid masses in the gastric fundus and gastric body that corresponded to metastasis of the renal carcinoma that had been resected three years ago. Surgical treatment was refused and oral treatment with sunitinib (50 mg/day consecutively for 4 weeks followed by 2 weeks off) was initiated. Patient completed one cycle and development of acute toxicity (grade 3 asthenia, anorexia and mucositis) led to treatment interruption. After recovering from acute toxicity, the patient was proposed to reinitiate treatment with dose reduction, but he refused any medical treatment. At the follow-up visit, three months later, the gastrointestinal endoscopy showed four unspecific 2 mm nodules without malignant evidence. The whole-body CT did not reveal any other abnormality except for the known lung nodes. PET scan six months after treatment confirmed complete gastric response. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Paradela S.,Juan Canalejo Hospital |
Fonseca E.,Juan Canalejo Hospital |
Pita-Fernandez S.,Juan Canalejo Hospital |
Kantrow S.M.,Vanderbilt University |
And 3 more authors.
Cancer | Year: 2010
BACKGROUND: Cutaneous melanoma in childhood is rare; therefore, its prognostic factors and biologic behavior and the effectiveness of adjuvant diagnostic techniques in this group remain mostly unknown. METHODS: The authors conducted a retrospective, observational study on the prognostic significance of clinical and pathologic findings from 137 cutaneous and mucosal melanomas in patients aged <18 years that were reviewed by the pathology department of a large cancer center during the period from 1992 to 2006. RESULTS: Univariate analysis indicated that there was a significantly greater risk of metastases for patients who had previous nonmelanocytic malignancies, nodular histologic type, fusiform or spitzoid cytology, high Breslow thickness, vertical growth phase, high dermal mitotic activity, ulceration, and vascular invasion. Adjacent nevus and radial growth phase were associated with a better prognosis. Twelve patients (10.3%) died during follow-up. Decreased overall survival was related significantly to age >10 years, previous nonmelanocytic malignancy, high Breslow thickness, high Clark level, and the presence of metastases at diagnosis. All patients who died were aged ≥11 years, and 8 of those patients had metastases at diagnosis. In multivariate analysis, higher Breslow thickness predicted an increased risk of metastases, whereas age >10 years and the presence of metastases at diagnosis were associated with decreased survival. CONCLUSIONS: Similar to adults, the detection of metastases at diagnosis in children with melanoma was 1 of the main factors that influenced overall survival. Melanomas that were detected in children aged <11 years appeared to have a less aggressive behavior than those detected in adults. © 2010 American Cancer Society.
Fernandez A.L.,University of Santiago de Compostela |
Vega M.,University of Santiago de Compostela |
El-Diasty M.M.,Juan Canalejo Hospital |
Suarez J.M.,University of Santiago de Compostela
Interactive Cardiovascular and Thoracic Surgery | Year: 2012
Myxomatous tumours can arise from different cardiac structures. They have a special predilection for the left atrium and are an exceedingly uncommon finding in cardiac valves. We report the case of a 28-year old man who presented with a stroke and was found to have a mass arising from his aortic valve. The patient underwent a successful surgical excision of the aortic valve with the implantation of a mechanical prosthesis. The histopathological examination of the aortic valve confirmed the diagnosis of myxoma. Some aspects related to the diagnosis and management of this entity are discussed in this article. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PubMed | Juan Canalejo Hospital
Type: Journal Article | Journal: European journal of physical and rehabilitation medicine | Year: 2010
The stroke and aphasia quality of life scale-39 is an interviewer administered questionnaire that has been developed and validated in the United Kingdom to be applied to patients with chronic aphasia as a consequence of a stroke. The objective of this article was to translate the Stroke and Aphasia Quality of Life-39 Scale (SAQOL-39) into Spanish language, and evaluate its acceptability and reliability.The cross-cultural adaptation of the SAQOL-39 into Spanish was carried out by following the translation and back-translation method. Twenty three patients with long-term aphasia due to stroke were tested. The patients were interviewed twice in a period from 2 to 12 days. The acceptability of the Spanish SAQOL-39 was evaluated by examining the floor/ceiling effects and the missing data. The reliability was assessed by Cronbachs alpha (internal consistence) and intraclass correlation coefficients (test-retest reliability) for the overall scale and its subdomains.There were no difficulties to translate the original version into Spanish. There was good acceptability demonstrated by minimal missing data and floor/ceiling effects. Test-retest reliability for the overall score, and the subscales scores was 0.949 (0.854-0.944). Internal consistency analysis by Cronbachs a was 0.950 (0.851-0.900).This small scale study provided preliminary evidence for the acceptability and reliability of the Spanish version of the SAQOL-39. Further testing in larger samples is needed to evaluate the validity of the scale, its sensitivity to change and to confirm its reliability.