Loras C.,Hospital Universitari Mutua Of Terrassa |
Loras C.,CIBER ISCIII |
Perez-Roldan F.,Hospital General la Mancha Centro |
Gornals J.B.,Hospital Universitari Of Bellvitge Idibell |
And 11 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2012
Background: Balloon dilation (with or without steroid injection) is the endoscopic treatment of choice for short strictures in Crohn's disease (CD). The placement of a stent has only rarely been reported in this setting, and it may be a good alternative. Aim: To describe the efficacy of temporary placement of a self-expanding metallic stent (SEMS) in the endoscopic treatment of symptomatic strictures in CD. Methods: We included 17 CD patients treated with SEMS (4 partially covered SEMS and 21 fully covered SEMS) for symptomatic strictures refractory to medical and/or endoscopic treatment. Results: We placed 25 stents in 17 patients with stenosis (<8 cm), in the colon and in the ileocolonic anastomosis. In two cases, two stents were placed in the same endoscopic procedure. All except three cases had previously been unsuccessfully treated with endoscopic dilatation. The stents were maintained for an average of 28 days (1-112). The treatment was effective in 64.7% of the patients after a mean follow-up time of 60 weeks (5-266). In four cases, removal of the stents was technically difficult due to stent impaction (moderate adverse events-AEs) and one patient had a proximal stent migration requiring delayed surgery (severe AE). Conclusion: The placement of self-expanding metallic stent in Crohn's disease maintained over a period of 4 weeks is a safe, effective treatment for strictures refractory to medical treatment and/or balloon dilatation, and might be an alternative endoscopic treatment in these patients. © 2012 Blackwell Publishing Ltd.
Cembellin del Ama J.,Hospital Rio Carrion
Emergencias | Year: 2010
Objectives: To determine whether patient transfers from 2 secondary level hospitals (in Palencia and Zamora, Spain) to their respective tertiary care referral hospitals differ with respect to indications for transfer and medical conditions. Methods: Retrospective, observational study with consecutive patient inclusion comparing descriptive statistics for the 2 hospitals over a 3-year period. Hospital transfer orders and patient records were consulted to record patient characteristics, the reason for the transfer, and conditions to be treated. Data for the 2 provinces were then compared. Results: A total of 4467 transfers were analyzed (Palencia, 1861; Zamora, 2606); 58% were scheduled and 42% were emergencies. The mean (SD) age of patients was 60.9 (21.3) years and 67% were males. Scheduled cardiac catheterization accounted for 47.8% of the transfers. Of the emergency transfers, 26.5% were related to neurosurgery. We observed significant differences between the 2 provinces with respect to age, time of transfer, reason for transfer, department of destination, and patient return. Conclusions: Provinces with limited health care resources require interhospital ambulance services, due to the number and variety of transfers and the seriousness of patient conditions. However, there are significant differences between similar provinces, suggesting a need to regulate and standardize criteria for the use of such services.
Paiva B.,Hospital Universitario Of Salamanca |
Paiva B.,University of Salamanca |
Vidriales M.-B.,Hospital Universitario Of Salamanca |
Vidriales M.-B.,University of Salamanca |
And 21 more authors.
Blood | Year: 2011
The clinical value of multiparameter flow cytometry (MFC) immunophenotyping in primary or light chain amyloidosis (AL) remains unknown. We studied 44 consecutive bone marrow samples from newly diagnosed patients with amyloidosis; 35 patients with AL and 9 with other forms of amyloidosis. Monoclonal plasma cells (PCs) were identifiable by MFC immunophenotyping in 34 of 35 (97%) patients with AL, whereas it was absent from all but 1 of the 9 (11%) patients with other forms of amyloidosis. Quantification of bone marrow plasma cells (BMPCs) by MFC immunophenotyping was a significant prognostic factor for overall survival (OS) (≤ 1% vs > 1% BMPC cutoff; 2-year OS rates of 90% vs 44%, P = .02). Moreover, detecting persistent normal PCs at diagnosis identifies a subgroup of patients withAL with prolonged OS (> 5% vs ≤ 5% normal PC within all BMPC cutoff, 2-year rates of 88% vs 37%, P = .01). MFC immunophenotyping could be clinically useful for the demonstration of PC clonality in AL and for the prognostication of patients with AL. © 2011 by The American Society of Hematology.
Abaigar M.,Cancer Research Center CSIC |
Ramos F.,Hospital de Leon |
Ramos F.,University of Leon |
Benito R.,Cancer Research Center CSIC |
And 15 more authors.
Annals of Hematology | Year: 2013
The prognostic impact of the aberrant hypermethylation in response to azacytidine (AZA) remains to be determined. Therefore, we have analyzed the influence of the methylation status prior to AZA treatment on the overall survival and clinical response of myeloid malignancies. DNA methylation status of 24 tumor suppressor genes was analyzed by methylation-specific multiplex ligation-dependent probe amplification in 63 patients with myelodysplastic syndromes and acute myeloid leukemia treated with azacytidine. Most patients (73 %) showed methylation of at least one gene, but only 12 % of patients displayed ≥3 methylated genes. The multivariate analysis demonstrated that the presence of a high number (≥2) of methylated genes (P = 0.022), a high WBC count (P = 0.033), or anemia (P = 0.029) were independent prognostic factors associated with shorter overall survival. The aberrant methylation status did not correlate with the response to AZA, although four of the five patients with ≥3 methylated genes did not respond. By contrast, favorable cytogenetics independently influenced the clinical response to AZA as 64.7 % of patients with good-risk cytogenetic abnormalities responded (P = 0.03). Aberrant methylation status influences the survival of patients treated with AZA, being shorter in those patients with a high number of methylated genes. © 2013 Springer-Verlag Berlin Heidelberg.
Sanchez P.L.,Hospital General Universitario Gregorio Maranon |
Gimeno F.,Hospital Clinico de Valladolid |
Ancillo P.,Hospital General de Segovia |
Sanz J.J.,Hospital Rio Hortega |
And 10 more authors.
Circulation: Cardiovascular Interventions | Year: 2010
A catheter-based approach after fibrinolysis is recommended if fibrinolysis is likely to be successful in patients with acute ST-elevation myocardial infarction. We designed a 2×2 randomized, open-label, multicenter trial to evaluate the efficacy and safety of the paclitaxel-eluting stent and tirofiban administered after fibrinolysis but before catheterization to optimize the results of this reperfusion strategy. Methods and Results-We randomly assigned 436 patients with acute ST-elevation myocardial infarction to (1) bare-metal stent without tirofiban, (2) bare-metal stent with tirofiban, (3) paclitaxel-eluting stent without tirofiban, and (4) paclitaxel-eluting stent with tirofiban. All patients were initially treated with tenecteplase and enoxaparin. Tirofiban was started 120 minutes after tenecteplase in those patients randomly assigned to tirofiban. Cardiac catheterization was performed within the first 3 to 12 hours after inclusion, and stenting (randomized paclitaxel or bare stent) was applied to the culprit artery. The primary objectives were the rate of in-segment binary restenosis of paclitaxel-eluting stent compared with that of bare-metal stent and the effect of tirofiban on epicardial and myocardial flow before and after mechanical revascularization. At 12 months, in-segment binary restenosis was similar between paclitaxel-eluting stent and bare-metal stent (10.1% versus 11.3%; relative risk, 1.06; 95% confidence interval, 0.74 to 1.52; P=0.89). However, late lumen loss (0.04±0.055 mm versus 0.27±0.057 mm, P=0.003) was reduced in the paclitaxel-eluting stent group. No evidence was found of any association between the use of tirofiban and any improvement in the epicardial and myocardial perfusion. Major bleeding was observed in 6.1% of patients receiving tirofiban and in 2.7% of patients not receiving it (relative risk, 2.22; 95% confidence interval, 0.86 to 5.73; P=0.14). Conclusions-This trial does not provide evidence to support the use of tirofiban after fibrinolysis to improve epicardial and myocardial perfusion. Compared with bare-metal stent, paclitaxel-eluting stent significantly reduced late loss but appeared not to reduce in-segment binary restenosis. © 2010 American Heart Association, Inc.