Cartagena, Spain
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PubMed | Santa Lucia Hospital and University of Seville
Type: Journal Article | Journal: Oncology letters | Year: 2016

The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium-sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow-up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.03.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow-up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects.


PubMed | Ramon y Cajal Hospital, Santa Lucia Hospital, Hospital General Universitario Gregorio Maranon, Hospital Carlos Haya and 3 more.
Type: | Journal: European journal of internal medicine | Year: 2016

Venous and arterial thrombosis share a number of pathogenic mechanisms, but the burden of pulmonary embolism (PE) has not been consistently compared with that in other arterial diseases.We used the Spanish National Discharge Database to compare the frequency, clinical characteristics and mortality rate of all patients with PE, acute coronary syndrome (ACS) or ischemic stroke admitted from 2001 to 2010. Patients were classified as having primary diagnosis (the process leading to hospital admission) or secondary diagnosis (it appeared during hospital stay for other reasons)During the study period, 31,949,739 patients were discharged. Of these, 165,229 (0.52%) were diagnosed with PE, 562,837 (1.76%) with ACS and 495,427 (1.55%) with ischemic stroke. Overall, 31% of patients with PE, 8.4% with ACS and 13% with ischemic stroke had secondary diagnoses. The most common reasons for admission in patients with secondary PE were: cancer (21%), acute respiratory failure (11%), acute heart failure (6.4%) and stroke (5.5%). Mean hospital stay was: 14 13 days in PE patients, 9.7 9.7 in those with ACS and 13 14 days in those with stroke. In-hospital mortality rate was: 10.5%, 10.1% and 12.3% respectively in patients with primary diagnosis, and 36%, 34% and 29% in those with secondary diagnosis.Patients hospitalized with PE were 3-4 times less frequent than those with ACS or stroke, but had a higher mortality. One in every 3 patients with PE (but only one in every 10 with ACS or stroke) had secondary diagnosis, and these patients had the highest mortality.


Guijarro R.,University of Malaga | Trujillo-Santos J.,Santa Lucia Hospital | Bernal-Lopez M.R.,University of Malaga | Bernal-Lopez M.R.,CIBER ISCIII | And 8 more authors.
Journal of Thrombosis and Haemostasis | Year: 2015

Summary: Background: The existence of seasonal variability in patients with acute pulmonary embolism (PE) has been debated for years, with contradictory results. The aim of this study was to identify the trend and possible existence of a seasonal pattern in hospitalizations for PE in Spain. Methods: We analyzed the hospital discharge database of the Spanish National Health System from 2001 to 2010. Patients aged > 14 years diagnosed with PE were selected and a time series was constructed considering mean daily admissions for PE by month. The trend and seasonality factor of the series were determined using time-series analysis, and time-series modeling was used for analysis. Exponential smoothing models and the autoregressive integrated moving average test were used to generate a predictive model. Results: From 2001 to 2010, there were 162 032 diagnoses of PE (5.07 per 1000 hospitalizations). In 105 168 cases, PE was the reason for admission. The PE diagnosis rate ranged from 4.14 per 1000 in 2001 to 6.56 per 1000 in 2010; and hospital admissions due to PE ranged from 2.67 to 4.28 per 1000 hospital discharges. Time-series analysis showed a linear increase in the incidence and a significant seasonal pattern with 17% more admissions in February and 12% fewer in June-July with respect to the central tendency (difference from February to June, 29%). Conclusions: The incidence of hospitalizations for PE showed a linear increase and a seasonal pattern, with the highest number of admissions in winter and the lowest number in summer. © 2014 International Society on Thrombosis and Haemostasis.


Jimenez D.,University of Alcalá | De Miguel-Diez J.,Hospital Universitario Gregorio Maranon | Guijarro R.,University of Malaga | Trujillo-Santos J.,Santa Lucia Hospital | And 6 more authors.
Journal of the American College of Cardiology | Year: 2016

Background Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time. Objectives This study describes the trends in the management and outcomes of acute symptomatic PE. Methods We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis. Results Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend). Conclusions In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality. © 2016 American College of Cardiology Foundation.


PubMed | University of Washington, Hospital Regional Universitario Of Malaga, Hospital Universitario Gregorio Maranon, CIBER ISCIII and 5 more.
Type: Journal Article | Journal: Journal of the American College of Cardiology | Year: 2016

Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time.This study describes the trends in the management and outcomes of acute symptomatic PE.We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis.Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p< 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p< 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p= 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p< 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p= 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p< 0.01 for trend).In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.


Acosta-Feria M.,Santa Lucia Hospital | Villar-Puchades R.,Santa Lucia Hospital | Haro-Luna J.J.,Santa Lucia Hospital | Ramos-Medina B.,Santa Lucia Hospital | Garcia-Solano E.,Santa Luciar Hospital
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology | Year: 2011

Background: Osteochondroma at the level of the coronoid process is unusual, causing a slowly progressive facial asymmetry and limitation of mouth opening. Histologically, it is a bone tumor covered by a thin capsule of cartilage. We present a literature review of cases published to date and present a new case in which osteochondroma originating in the coronoid process was associated with the formation of a cyst at the body of the zygoma, necessitating the reconstruction of the body of the zygoma. Study design: A 55-year-old woman had a bone tumor in the right malar region, producing a limitation in mouth opening. After preoperative computerized tomography, we decided to excise the lesion and pseudocyst with the use of a combined subciliary and coronal approach, reconstructing the body of the zygoma with a cortical chip of calvarian bone. Results: The patient regained normal mouth opening, without injury to the fronto-orbital branches of the facial nerve and no recurrence of the tumor to date. Conclusions: Osteochondroma is a slow-growing tumor that causes progressive facial asymmetry and limitation of mouth opening. The treatment of choice for symptomatic osteochondromas is surgical resection. © 2011 Mosby, Inc. All rights reserved.


PubMed | University of Rome La Sapienza, Santa Lucia Hospital, Arcispedale Santa Maria Nuova Hospital, CNR Institute of Genetics and Biophysics Adriano Buzzati Traverso and Aston University
Type: | Journal: Applied neuropsychology. Child | Year: 2016

Incontinentia Pigmenti (IP, OMIM#308300) is a rare X-linked genomic disorder (about 1,400 cases) that affects the neuroectodermal tissue and Central Nervous System (CNS). The objective of this study was to describe the cognitive-behavioural profile in children in order to plan a clinical intervention to improve their quality of life. A total of 14 girls (age range: from 1 year and 2 months to 12 years and 10 months) with IP and the IKBKG/NEMO gene deletion were submitted to a cognitive assessment including intelligence scales, language and visuo-spatial competence tests, learning ability tests, and a behavioural assessment. Five girls had severe to mild intellectual deficiencies and the remaining nine had a normal neurodevelopment. Four girls were of school age and two of these showed no intellectual disability, but had specific disabilities in calculation and arithmetic reasoning. This is the first description of the cognitive-behavioural profile in relation to developmental age. We stress the importance of an early assessment of learning abilities in individuals with IP without intellectual deficiencies to prevent the onset of any such deficit.


Den Exter P.L.,Leiden University | Gomez V.,Ramon y Cajal Hospital | Jimenez D.,Ramon y Cajal Hospital | Trujillo-Santos J.,Santa Lucia Hospital | And 3 more authors.
Chest | Year: 2013

Background: Physicians need a specific risk-stratification tool to facilitate safe and cost-effective approaches to the management of patients with cancer and acute pulmonary embolism (PE). The objective of this study was to develop a simple risk score for predicting 30-day mortality in patients with PE and cancer by using measures readily obtained at the time of PE diagnosis. Methods: Investigators randomly allocated 1,556 consecutive patients with cancer and acute PE from the international multicenter Registro Informatizado de la Enfermedad TromboEmbólica to derivation (67%) and internal validation (33%) samples. The external validation cohort for this study consisted of 261 patients with cancer and acute PE. Investigators compared 30-day all-cause mortality and nonfatal adverse medical outcomes across the derivation and two validation samples. Results: In the derivation sample, multivariable analyses produced the risk score, which contained six variables: age > 80 years, heart rate ≥ 110/min, systolic BP < 100 mm Hg, body weight < 60 kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% of patients (113 of 508) classified as low risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6%-8.2%) compared with 29.9% (95% CI, 25.4%-34.4%) in the high-risk group. In the external validation cohort, the 18% of patients (47 of 261) classified as low risk by the prognostic model had a 30-day mortality of 0%, compared with 19.6% (95% CI, 14.3%-25.0%) in the high-risk group. Conclusions: The developed clinical prediction rule accurately identifies low-risk patients with cancer and acute PE. © 2013 American College of Chest Physicians.


Trujillo-Santos J.,Santa Lucia Hospital | den Exter P.L.,Leiden University | Gomez V.,Ramon y Cajal Hospital | del Castillo H.,Ramon y Cajal Hospital | And 6 more authors.
Journal of Thrombosis and Haemostasis | Year: 2013

Background: The ability of computed tomography (CT)-assessed right ventricular dysfunction (RVD) to identify normotensive patients with acute pulmonary embolism (PE) at high risk of mortality or adverse outcome lacks clarity. Methods and Results: We performed a systematic review and a meta-analysis of studies in normotensive patients with acute PE to assess the prognostic value of CT-assessed RVD for death and a predefined composite outcome of PE-related complications. We conducted unrestricted searches of MEDLINE and EMBASE from 1980 to March 2013, and used the terms 'computed tomography', 'pulmonary embolism', and 'prognos*'. We used a random-effects model to pool study results, funnel-plot inspection to evaluate for publication bias, and I2 testing to assess for heterogeneity. The analysis included data from 10 studies (2288 patients). Overall, 99 of 1268 patients with RVD assessed by CT died (7.8%; 95% confidence interval [CI] 6.3-9.3) as compared with 52 of 1020 without RVD (5.1%; 95% CI 3.7-6.4). CT-assessed RVD had significant associations with mortality (odds ratio [OR] 1.8; 95% CI 1.3-2.6), with death resulting from PE (OR 7.4; 95% CI 1.4-39.5), and with PE-related complications (OR 2.4; 95% CI 1.2-4.7). Pooled likelihood ratios (LRs) were not extreme (negative LR 0.71; 95% CI 0.57-0.89; and positive LR 1.27; 95% CI 1.12-1.43). Conclusions: Although RVD assessed by CT showed an association with an increased risk of mortality in patients with hemodynamically stable PE, it resulted in only small increases in the ability to classify risk. © 2013 International Society on Thrombosis and Haemostasis.


PubMed | Santa Lucia Hospital
Type: | Journal: Clinica chimica acta; international journal of clinical chemistry | Year: 2016

Presepsin is a promising biomarker for the diagnosis and prognosis of sepsis. However, results reported about its value to diagnose sepsis in an emergency department (ED) are controversial, probably due to differences in the design of the studies. We have evaluated the diagnostic accuracy of presepsin for infection and sepsis, compared with procalcitonin (PCT) and C-reactive protein (CRP), in patients presenting to the emergency department (ED) with suspected infection.223 patients with suspected infection were enrolled for the study. Blood samples were collected on admission for measurement of biomarkers. Definitive diagnosis was obtained afterwards by analysis of digital medical records. Receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic accuracy.Infection was confirmed in 200 patients, including 130 with non-complicated infection and 70 with sepsis. Median CRP, PCT and presepsin levels were significantly higher in patients with infection and sepsis. PCT was the biomarker with the highest performance for infection (ROC AUC: 0.910); for sepsis, PCT (ROC AUC: 0.815) and presepsin (ROC AUC: 0.775) shown a similar performance.Although presepsin is a valuable biomarker for diagnosis of infection and sepsis, its diagnostic accuracy in our study does not improve that of PCT. Its introduction in clinical practice is not justified.

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