Fernandez-Perez G.C.,POVISA Hospital |
Aguilar-Arjona J.A.,POVISA Hospital |
De La Fuente G.T.,POVISA Hospital |
Samartin M.,POVISA Hospital |
And 3 more authors.
American Journal of Roentgenology | Year: 2010
OBJECTIVE. The objective of this article is to show how MRI findings can be used to differentiate Takotsubo cardiomyopathy from acute coronary syndrome. CONCLUSION. Takotsubo cardiomyopathy is a disorder that mimics acute coronary syndrome. MRI can show not only edema in the ventricular wall, which is diffuse and without arterial territory distribution, but also motion abnormalities with typical akinesis in the apical and mid planes. Moreover, MRI can detect potential complications such as obstruction of the left ventricular outflow tract or thrombus in the left ventricular cavity. © American Roentgen Ray Society.
Fernandez-Sanroman J.,Povisa Hospital |
Lopez A.C.,Povisa Hospital |
Ferro M.F.,Povisa Hospital
Journal of Oral and Maxillofacial Surgery | Year: 2010
Purpose: We present our experience using modified Hyrax devices for treating transverse deficiencies of the maxilla in adult patients with periodontal pathology or insufficient tooth anchorage. The surgical technique, clinical indications, and results are discussed. Materials and Methods: Eight adult patients (6 females, 2 males) requiring maxillary expansion were studied prospectively between July 2002 and July 2007. All the patients had periodontal pathology or insufficient tooth anchorage preventing the use of conventional Hyrax devices. Patients underwent surgically assisted rapid maxillary expansion with the use of custom-made modified Hyrax devices (bone-borne or tooth-bone-borne devices). Patients received preoperatively (T1), at the end of distraction (T2), at removal of the expansion device (T3), and 12 months after surgery (T4) lateral and posterior anterior cephalograms and study models to measure the width of the anterior and posterior dental arches with a digital sliding calliper. Results: Mean age was 28.5 years (range, 18-45 years). A significant widening of the anterior (6.3 ± 1.6 mm) and posterior (7.1 ± 1.2 mm) dental arches was demonstrated. No significant differences were found when comparing T3 with T4 measures. No significant complications were found. Conclusion: The results indicated that maxillary expansion with custom-made devices in adults was an easy, affordable, predictable and stable technique without significant complications in patients who suffer periodontal pathology or patients without enough dental support. © 2010 American Association of Oral and Maxillofacial Surgeons.
Couceiro J.,POVISA Hospital |
Sanmartin M.,POVISA Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2014
The first dorsal metacarpal artery flap was initially described by Hilgenfeldt, it was designed as a racquet flap by Holevich and modified as an island flap by Foucher and Braun. The objective of the present is to compare the Holevich flap and the Foucher flap in terms of venous congestion and flap necrosis. From 2009 to 2013, ten first dorsal metacarpal artery flaps were performed at our hospital's hand unit. Five of the flaps were Holevich type flaps and five of the flaps were Foucher flaps. There were seven men and three women. The mean age was 47 years for the Foucher flap group (17-67 years), and 48 years for the Holevich flap group (36-61 years). Strength, static two tips discrimination, ranges of motion, satisfaction, cold intolerance, pain, flap congestion and flap necrosis were recorded for both groups. Similar values of strength, pain, range of motion and two tips discrimination were found on both groups. There was a higher incidence of flap congestion and necrosis on the Foucher flap group (two thumbs underwent partial flap necrosis and two underwent venous congestion in three patients). There was also a higher incidence of cold intolerance in the Foucher group (two patients exhibited moderate cold intolerance and one exhibited a severe cold intolerance). A proper statistical analysis was not possible due to the size of the case series. In this small case series the Holevich exhibited less flap necrosis, less venous congestion, and less incidence of cold intolerance than the Foucher flap.
Pecci R.,Povisa Hospital |
De La Fuente Aguado J.,Povisa Hospital |
Sanjurjo Rivo A.B.,Povisa Hospital |
Sanchez Conde P.,Povisa Hospital |
Corbacho Abelaira M.D.,Povisa Hospital
International Angiology | Year: 2012
Aim. Cardiovascular disease (CV) is the second leading cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Peripheral arterial disease (PAD) is associated with cardiovascular disease, and its risk factors are common to other atherosclerotic diseases. The objective is to determine the prevalence of PAD in a population of patients with COPD using the ankle / brachial index (ABI) and to investigate the relationship between PAD and lung disease severity. Methods. In a prospective cross-sectional study, 246 patients with COPD were recruited. Patients were enrolled consecutively according to their admission to Povisa hospital from September 1, 2008, until March 1, 2010, and were assessed by clinical history, spirometry and ABI. The COPD severity was graded by GOLD criteria in spirometry. Results. Overall, 84 patients (36.8%) had abnormal ABI results and 59 (70.2%) were asymptomatic for PAD. COPD patients with PAD had a higher prevalence of moderate to severe COPD (61.9% vs. 41.7%, P=0.004), lower mean forced expiratory volume in 1 second (FEV1) values (46.7% ± 15 vs. 52.3±14%, P=0.001) and a higher prevalence of hypertension (69% vs. 54.3%, P=0.03) and previous cardiovascular disease (34.5% vs. 21.3%, P=0.03). Conclusion. There was a high prevalence of asymptomatic PAD in the COPD patients we examined. Abnormal ABI results were associated with a higher prevalence of cardiovascular risk factors and more severe lung disease. The diagnosis of peripheral arterial disease in COPD is important because this is an entity that limits the patient's physical activity and impairs their quality of life in addition to turn it into a high cardiovascular risk patient that requiring additional therapeutic measures.
PubMed | Diagnostico Medico Cantabria DMC, University of Cantabria, Clinica Mompia and POVISA Hospital
Type: Journal Article | Journal: Skeletal radiology | Year: 2016
Ischiofemoral impingement syndrome (IFI) is an underrecognized form of atypical, extra-articular hip impingement defined by hip pain related to narrowing of the space between the ischial tuberosity and the femur. The etiology of IFI is multifactorial and potential sources of ischiofemoral engagement include anatomic variants of the proximal femur or pelvis, functional disorders as hip instability, pelvic/spinal instability, or abductor/adductor imbalance, ischial tuberosity enthesopathies, trauma/overuse or extreme hip motion, iatrogenic conditions, tumors and other pathologies. Magnetic resonance imaging (MRI) is the diagnostic procedure of choice for assessing IFI and may substantially influence patient management. The injection test of the ischiofemoral space (IFS) has both a diagnostic and therapeutic function. Endoscopic decompression of the IFS appears useful in improving function and diminishing hip pain in patients with IFI but conservative treatment is always the first step in the treatment algorithm. Because of the ever-increasing use of advanced MRI techniques, the frequent response to conservative treatment, and the excellent outcomes of new endoscopic treatment, radiologists must be aware of factors that predispose or cause IFI. In addition, focused treatment in these conditions is often more important than in secondary impingement. In this article, we briefly describe the anatomy of the IFS, review the clinical examination and symptoms, assess the diagnostic imaging criteria and pathophysiological mechanisms, and develop an understandable classification of IFI, with particular focus on its etiology, predisposing factors, and associated musculoskeletal abnormalities. We also assess the role of the radiologist in the diagnosis, treatment, and preoperative evaluation of both primary and secondary IFI.
PubMed | Complexo Hospitalario Universitario Of runa, University of Santiago de Compostela, Povisa Hospital and University of Brasilia
Type: Review | Journal: International journal of oral and maxillofacial surgery | Year: 2016
The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of diagnostic delay, time interval, or waiting time to diagnosis, or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis.
PubMed | Povisa Hospital
Type: Journal Article | Journal: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery | Year: 2016
To study the complications of temporomandibular joint (TMJ) arthroscopic procedures using two-portal coblation technologies.The 397 consecutive patients (475 joints) who underwent arthroscopic surgery were prospectively analyzed.Complications were observed in 39 (8.21%) procedures. Complications recognized during or immediately after surgery were observed in 25 cases (5.26%). Vascular injury in the points of trocar insertion was observed in seven cases. Lesions of the fibrocartilage layer of the joint secondary to introduction of instruments were observed in 12 cases. Bleeding within the superior joint space was observed in 21 cases. Extravasation of irrigation fluid appeared in five patients, affecting the oropharyngeal space in one case. In 20 patients, more than one complication at the time of surgery occurred. Delay postoperative complications were noted in 14 patients. Blood clots in the external auditory canal were found in eight cases and lacerations in two cases. One patient experienced partial hearing loss, and two patients experienced vertigo. Temporary hypoesthesia of the auriculotemporal nerve was seen in two patients. Temporary damage to the V cranial nerve was observed in four patients. Temporary paralysis of the zygomatic branch of the facial nerve was seen in one patient.TMJ arthroscopy using coblation technologies is a safe surgical procedure when performed by experienced surgeons.
PubMed | Ourense University Hospital, University of Santiago de Compostela, Galicia Oncology Center, POVISA Hospital and 3 more.
Type: Review | Journal: Current oncology reports | Year: 2016
Once metastatic bladder cancer has progressed to first-line treatment, the number of therapeutic options is scarce. Among chemotherapeutic agents showing activity in phase II trials, including taxanes, vinflunine (VFL) is the only one shown to increase overall survival in a phase III trial. In addition to its efficacy, VFL is safe in special population groups. Despite this, the prognosis for these patients remains poor, and more effective therapies need to be developed. Agents acting on new therapeutic targets as well as biomarkers to aid matching patients to specific treatments are currently under evaluation. In this regard, immunotherapy is showing promising results. In this article, a critical review of current treatments and future prospects is made, and therapy recommendations are made based on existing scientific evidence.
PubMed | POVISA Hospital, Autonomous University of Madrid, Complejo Hospitalario Of Pontevedra, Complejo Hospitalario Universitario Of Vigo and University of Lincoln
Type: | Journal: International journal of cardiology | Year: 2016
The role of frailty as a prognostic factor in non-selected patients with symptomatic severe aortic stenosis (SAS) is still uncertain. This study aims to examine the association between the frailty syndrome and mortality among very old patients with symptomatic SAS, and to assess whether the association varies with the type of SAS treatment.Prospective study of 606 patients aged 75years with symptomatic SAS, recruited from February 2010 to January 2015, who were followed up through June 2015. At baseline, frailty was defined as having at least three of the following five criteria: muscle weakness, slow gait speed, low physical activity, exhaustion, and unintentional weight loss. Statistical analyses were performed with multivariate Cox regression. At baseline, 49.3% patients were frail. During a mean follow-up of 98weeks, 35.3% of patients died. The hazard ratio (95% confidence interval) of mortality among frail versus non-frail patients was 1.83 (1.33-2.51). The corresponding results were 1.58 (1.09-2.28) among patients under medical treatment, 3.06 (1.25-7.50) in those with transcatheter aortic valve replacement, and 1.97 (0.83-4.67) in those with surgical aortic valve replacement, p for interaction=0.21. When the frailty criteria were considered separately, mortality was also higher among patients with slow gait speed [1.52 (1.05-2.19)] or low physical activity [1.35 (1.00-1.85)].Frailty is associated with increased mortality among patients with symptomatic SAS, and this association does not vary with the type of SAS treatment. Future studies evaluating the benefits of different treatments in SAS patients should account for baseline frailty.
PubMed | University of Vigo and Povisa Hospital
Type: Journal Article | Journal: European radiology | Year: 2016
To determine whether the quantification of iodine with stress dual-energy computed tomography (DECT-S) allows for the discrimination between a normal and an ischemic or necrotic myocardium using magnetic resonance (MR) as a reference.This retrospective study was approved by the institutional review board, with waiver of informed consent. Thirty-six cardiac MR and DECT-S images from patients with suspected coronary artery disease were evaluated. Perfusion defects were visually determined, and myocardial iodine concentration was calculated by two observers using DECT colour-coded iodine maps. Iodine concentration differences were calculated using parametric tests. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the optimal iodine concentration threshold for discriminating pathologic myocardium.In total, 576 cardiac segments were evaluated. There were differences in mean iodine concentration (p<0.001) between normal (2.560.66mg/mL), ischemic (1.980.36mg/dL) and infarcted segments (1.350.57mg/mL). A myocardium iodine concentration of 2.1mg/mL represented the optimal threshold to discriminate between normal and pathologic myocardium (sensitivity 75%, specificity 73.6%, area under the curve 0.806). Excellent agreement was found in measured myocardium iodine concentration (intraclass correlation coefficient 0.814).Cardiac DECT-S with iodine quantification may be useful to differentiate healthy and ischemic or necrotic myocardium. DECT-S allows for determination of myocardial iodine concentration as a quantitative perfusion parameter. A high interobserver correlation exists in measuring myocardial iodine concentration with DECT-S. Myocardial iodine concentration may be useful in the assessment of patients with CAD.