Rodriguez De La Flor M.,Hospital San Agustin |
Fernandez-Carreira J.M.,Hospital San Agustin
Journal of Orthopaedic Research | Year: 2013
The elevation of metal levels in serum and urine during post-operative follow-up is a frequent find following the implantation of certain models of metal-on-metal hip prostheses. Among 45 patients with the same resurfacing prostheses, chromium (Cr) and cobalt (Co) levels in serum and urine were determined at 3, 4, 5, and 6 years after surgery. In the same period, levels of Cr, Co and molibdene (Mo) in scalp hair were also measured. Mean Cr and Co levels in serum were 8.29 μg/L (SD 17.97) and 8.38 μg/L (SD 21.97), respectively, whereas in urine levels were 16.20 μg/L (SD SD 32.55) and 75.40 μg/L (SD 190.86), respectively. In hair, mean Cr level were 163.27 μg/g (SD 300.62), mean Co level 61.98 μg/g (SD 126.48), and Mo 31.36 μg/g (SD 37.86). A high concordance was observed between chromium-urine and chromium-serum and between cobalt-urine and cobalt-hair. A moderate concordance was present between cobalt-urine and cobalt-serum, and between cobalt-hair and cobalt-serum. Eleven patients required revision surgery, five of them due to metallosis and periarticular cyst. At 1 year after reintervention, analytics were performed again and the following decrease rates were found: 42.8% in Cr levels, 51.1% in Mo levels, and 90.3% in Co levels. © 2013 Orthopaedic Research Society.
Rivas-Crespo M.F.,Hospital Universitario Central Of Asturias |
Minones-Suarez L.,Hospital Universitario Central Of Asturias |
G-Gallarza S.S.,Hospital San Agustin
BMC Pediatrics | Year: 2012
Background: Most cases of neonatal central diabetes insipidus are caused by an injury, which often results in other handicaps in the patient. The infant's prognosis will be determined by his or her own early age and disability as well as by the physician's skill. However, the rarity of this condition prevents the acquisition of personal experience dealing with it.Case Presentation: A neonatal hemorrhagic stroke, caused by an aortic coarctation, caused right lower limb paresis, swallowing disability, and central diabetes insipidus in a term infant. The scant oral intake, as a consequence of his disability, caused progressive undernutrition which closed a vicious circle, delaying his development and his ability to overcome the swallowing handicap. On the other hand, nasal desmopressin absorption was blocked by several common colds, resulting in brain bleeding because of severe dehydration. This even greater brain damage hampered the improvement of swallowing, closing a second harmful circle. Moreover, a devastating central myelinolysis with quadriplegia, caused by an uncontrolled intravenous infusion, consummated a pernicious sequence, possibly unreported.Conclusions: The child's overall development advanced rapidly when his nutrition was improved by gastrostomy: This was a key effect of nutrition on his highly sensitive neurodevelopment. Besides, this case shows potential risks related to intranasal desmopressin treatment in young children. © 2012 Rivas-Crespo et al.; licensee BioMed Central Ltd.
Requena T.,University of Granada |
Espinosa-Sanchez J.M.,University of Granada |
Espinosa-Sanchez J.M.,Hospital San Agustin |
Lopez-Escamez J.A.,University of Granada |
Lopez-Escamez J.A.,Hospital Of Poniente
Current Opinion in Neurology | Year: 2014
PURPOSE OF REVIEW: Recent advances in next generation sequencing techniques (NGS) are increasing the number of novel genes associated with cerebellar and vestibular disorders. We have summarized clinical and molecular genetics findings in neuro-otolology during the last 2 years. RECENT FINDINGS: Whole-exome and targeted sequencing have defined the genetic basis of dizziness including new genes causing ataxia: GBA2, TGM6, ANO10 and SYT14. Novel mutations in KCNA1 and CACNA1A genes are associated with episodic ataxia type 1 and type 2, respectively. Moreover, new variants in genes such as COCH, MYO7A and POU4F3 are associated with nonsyndromic deafness and vestibular dysfunction. Several susceptibility loci have been linked to familial vestibular migraine, suggesting genetic heterogeneity, but no specific gene has been identified. Finally, loci for complex and heterogeneous diseases such as bilateral vestibular hypofunction or familial Ménière disease have not been identified yet, despite their strong familial aggregation. SUMMARY: Cerebellar and vestibular disorders leading to dizziness or episodic vertigo may show overlapping clinical features. A deep phenotyping including a complete familial history is a key step in performing a reliable molecular genetic diagnosis using NGS. Personalized molecular medicine will be essential to understand disease mechanisms as well as to improve their diagnosis and treatment. © 2014 Wolters Kluwer Health Lippincott Williams & Wilkins.
Benavente L.,Hospital Universitario Central Asturias |
Moris G.,Hospital San Agustin
European Journal of Neurology | Year: 2011
Background and purpose: The study is aimed to report neurologic manifestations in a population of patients with inflammatory bowel disease in order to address its clinical characteristics.Methods: We conducted a retrospective study based on a computer-guided search, of patients with Crohn's disease or ulcerative colitis diagnosed at three hospitals in Spain spanning from 2000 through 2008. Patients were classified into different clinical groups based on the type of neurologic involvement. Only patients without iatrogenic complications, vitamin deficiencies, or known cerebrovascular risk factors were included.Results: We identified and reviewed the records of eighty-four inflammatory bowel disease patients with neurologic symptoms: thirteen patients with ulcerative colitis and twelve patients with Crohn's disease associated with neurologic complications were identified. Their ages ranged from 17 to 74 years. There was a slight predominance of women. Only four of them have another extra-intestinal manifestation. Most of the patients developed neurologic manifestations coincidental or after digestive symptoms appeared. Demyelinating disease was the most frequent manifestation observed (8 patients). Cerebrovascular, peripheral nerve, and epilepsy disorders were diagnosed in 6, 5, and 3 patients, respectively. One patient with myoclonus, one with amyotrophic lateral sclerosis, and one with sensorineural hearing loss were found.Conclusions: Although an incidence could not be obtained, this population of patients with inflammatory bowel disease have a low frequency of severe neurologic disorders. Neurologic diseases, such as cerebrovascular disease, demyelinating disease, and peripheral neuropathy, could be associated with Crohn's disease and ulcerative colitis. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.
Ibanez-Molina A.J.,University of Jaén |
Iglesias-Parro S.,University of Jaén |
Soriano M.F.,Hospital San Agustin |
Aznarte J.I.,Hospital San Agustin
Clinical Neurophysiology | Year: 2015
Objective: To demonstrate that the classical calculation of Lempel-Ziv complexity (LZC) has an important limitation when applied to EEGs with rapid rhythms, and to propose a multiscale approach that overcomes this limitation. Methods: We have evaluated, both with simulated and real EEGs, whether LZC calculation neglects functional characteristics of rapid EEG rhythms. In addition, we have proposed a procedure to obtain multiple binarization sequences that yield a spectrum of LZC, and we have explored whether complexity would be better captured using this computation. Results: In our simulated signals, classical LZC did not capture modulations of a rapid component when a slower component of more amplitude was included in the signal. In real EEGs from healthy participants with eyes closed and eyes open, classical LZC calculation failed to show any difference between these two conditions. However, a multiscale LZC showed that complexity was lower for eyes closed than for eyes open conditions. Conclusions: As hypothesized, our new approximation captures the complexity of series with fast components masked by slower rhythms. Significance: The method we introduce significantly improves LZC calculation, and it allows a better characterization of complexity of EEG signals. © 2014 International Federation of Clinical Neurophysiology.
Corte Z.,Hospital San Agustin |
Garcia C.,Hospital San Agustin |
Venta R.,University of Oviedo
Annals of Clinical Biochemistry | Year: 2015
Background: Serum cardiac troponin T concentrations are important predictors of cardiovascular and all-cause mortality in end-stage renal disease. In patients with end-stage renal disease, assessment of serial results is essential to distinguish between a cardiovascular event and chronic elevation.We employed a high-sensitivity serum cardiac troponin T assay to evaluate the long-term biological variation in end-stage renal disease patients and in healthy individuals; these biological variation data were used to define the reference change value and the analytical goals.Methods: Serum samples were collected from 18 end-stage renal disease patients in steady-state conditions, one per month for 6 months, and from 11 healthy volunteers at weekly intervals over 5 weeks. Biological variation data were derived using analysis of variance.Results: Baseline serum cardiac troponin T concentrations in end-stage renal disease patients were above the 99th percentile of the healthy population and increased with duration of haemodialysis. For end-stage renal disease patients, within-subject (CVI) and between-subject (CVG) coefficients of variation were 14.7 and 77.8%, respectively, whereas these were 5.9 and 30.4%, respectively, for healthy individuals. The derived two-tailed and one-tailed reference change values were 44.1 and 37.1%, respectively, for end-stage renal disease patients, and 21.6 and 18.2% for healthy subjects.Conclusions: For appropriate clinical management of end-stage renal disease patients in the context of a cardiovascular event, regular monitoring of serum cardiac troponin T concentrations could be important in order to allow future comparison through reference change value. Biological variation data in end-stage renal disease patients were significantly higher than for healthy individuals; therefore, the use of proper reference change value data is recommended. Moreover, the observed CVI values provide demanding imprecision goals for current technology. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Garcia-Florez L.J.,Hospital San Agustin |
Gomez-Alvarez G.,University of Oviedo |
Frunza A.M.,University of Oviedo |
Barneo-Serra L.,University of Oviedo |
And 2 more authors.
Journal of Surgical Research | Year: 2015
Background Neoadjuvant therapy followed by radical surgery is the standard treatment in locally advanced rectal cancer. It is important to predict the response because the treatment has side effects and is costly. The aim of this study was to establish the relationship among clinical, pathologic, and molecular biomarkers and the response to neoadjuvant therapy. Method A total of 130 patients with locally advanced mid and low rectal cancer who underwent long-course radiotherapy with 5-FU based chemotherapy followed by radical surgical resection were included in the study. Clinical and pathologic data were collected. Paraffin-embedded sections obtained in diagnostic biopsies were assessed by immunohistochemical staining for molecular markers and classified using a semiquantitative method. Results were related with T-downstaging and tumor regression grade using Mandard scoring system on surgical specimens. Results Pathologic complete response was found in 19 patients (14.6%), while in another 18 (13.8%) only minor residual disease was seen in the rectal wall. T-downstaging was observed in 63 (48.5%). The average of lymph node retrieval in the surgical specimens was 9.4. Regarding predictive markers of response, there was significant correlation between the expression of B-cell lymphoma 2 (P = 0.005), β-catenin (P = 0.03), vascular endothelial growth factor (P = 0.048) and apoptotic protease activating factor 1 (P = 0.03), tumor differentiation grade (P < 0.001), and response in the univariate analysis. T-downstaging was associated with vascular endothelial growth factor expression (P = 0.03) and tumor differentiation grade (P < 0.001). Significant parameters found in the multivariate analysis were tumor differentiation grade and Bcl-2 expression. Conclusions Pathologic and molecular biomarkers in the diagnostic biopsies may help us predict tumor response to chemoradiation in rectal cancer patients. © 2015 Elsevier Inc.
Nuevo S.P.,Hospital San Agustin
BMJ case reports | Year: 2013
We describe a challenging case of sigmoid volvulus where a previously unrecognised anatomical condition, rather than the patient's age, was the main predisposing factor. A man in his thirties presented to the emergency department with a 3-day history of constipation and acute abdominal pain. Initial assessment and studies were inconclusive, but a CT scan revealed torsion of the large bowelSigmoid volvulus is a frequent cause of bowel obstruction that can be missed if appropriate imaging is not available. Clinical presentation and blood analysis can be similar to the findings in acute abdomen caused by other more common causes.
Garcia A.I.R.,Hospital San Agustin
Revista Espanola de Salud Publica | Year: 2012
Background: Calcium supplements and vitamin D are involved in current debates of health, as cardiovascular safety of calcium, and correction of vitamin levels. The aim is to review the possibilities of making better use of supplements marketed in Spain, depending on their availability, information and related epidemiology. Methods: Analysis of comercial offer and available information about pharmacological aspects of Spanish medicinal supplements in data-sheets (39), guides and reports current institutional and professional, with additional search of this information and epidemiological data related Spanish in Cochrane Database of Systematic Reviews ®, Pub-Med ® (tool "Clinical Queries"), Dialnet database and hand search of Spanish journals directly related. Results: There is no uniformity in terms of indication, expression of content, dosages, precautions and safety in data sheets or technical reports. The literature search found more recent publications volume for vitamin D than calcium, No evidence was found to establish appropriate dosing regimens indisputable or universal, or cholecalciferol bioavailability tests with aqueous vehiculización. In Spain nutritional situation is found generally suitable for the calcium but a status mostly unsuitable for vitamin D with several references for insufficiency and vitamin deficiency in adults. Corrective treatments primarily affect calcium supplements. Conclusions: There is an ample supply of calcium and vitamin D in Spain, whose drug design should rethink because don't respond to the needs identified or correction possibilities currently recommended. It should also improve and update their information, with particular interest in health status related to hypovitaminosis D.
Hernandez-Vaquero D.,University of Oviedo |
Fernandez-Carreira J.M.,Hospital San Agustin
BMC Musculoskeletal Disorders | Year: 2012
Background: Controversy exists regarding the relationship between radiographic findings and clinical status in knee osteoarthritis. Although the surgical indication for total knee arthroplasty (TKA) should be based on pain, clinical status, and the deterioration of quality of life, the radiographic study is the most commonly used criterion for preoperative evaluation. The objective of this study is to find out the relationship between the Ahlbäck classification and clinical status in patients undergoing TKA. Methods. 1329 protocols were collected from preoperative studies in four multicentric working groups (the Interax, Duracon, Scorpio, and Triathlon Spanish groups) in 30 Spanish hospitals. Mean age was 70.4 years (SD: 6.8; range: 35 to 98); 76.3% of patients were women. Patients entered the study whenever the surgeon found that medical treatment was insufficient to control pain and functional limitation. Data were collected using electronic Case Report Forms, and included Ahlbäck grading scores, Hospital for Special Surgery Knee Score (HSS), SF-12, and other clinical and epidemiologic variables. Results: According to the Ahlbäck grading system, patients were divided as follows: 243 grade I (18.3%), 358 grade II (26.9%), 416 grade III (31.3%), 241 grade IV (18.1%), and 71 grade V (5.3%). As for HSS, the following scores were obtained: <60 points in 925 patients (69.6%), 60 to 69 points in 286 patients (21.5%), 70 to 84 points in 112 patients (8.4%) and 85 to 100 points in 6 patients (0.5%). Scores showed a statistically significant difference depending on Ahlbäck grade, with a clear tendency towards decrease in HSS scores as the Ahlbäck grade increases (p<0.001). However, the HSS score difference between Ahlbäck grades I and V was of 9.56 points only. Comparing the status of the patients at the start (1994) and at the end (2010) of the data collection process, we observed that patients who underwent surgery in the last years were older and showed a lower Ahlbäck grade. Conclusions: We found a relationship between Ahlbäck grading and the preoperative clinical score. The range of variability of the HSS score between the different Ahlbäck grades is small. © 2012 Hernández-Vaquero and Fernández-Carreira; licensee BioMed Central Ltd.