Slevin M.,Manchester Metropolitan University |
Slevin M.,Hospital Of La Santa Creu I Sant Pau |
Slevin M.,University of East London |
Badimon L.,Hospital Of La Santa Creu I Sant Pau |
And 8 more authors.
Molecular BioSystems | Year: 2010
Activation of vasa vasorum (the microvessels supplying the major arteries) at specific sites in the adventitia initiates their proliferation or 'angiogenesis' concomitant with development of atherosclerotic plaques. Haemorrhagic, leaky blood vessels from unstable plaques proliferate abnormally, are of relatively large calibre but are immature neovessels poorly invested with smooth muscle cells and possess structural weaknesses which may contribute to instability of the plaque by facilitation of inflammatory cell infiltration and haemorrhagic complications. Weak neovascular beds in plaque intima as well as activated adventitial blood vessels are potential targets for molecular imaging and targeted drug therapy, however, the majority of tested, currently available imaging and therapeutic agents have been unsuccessful because of their limited capacity to reach and remain stably within the target tissue or cells in vivo. Nanoparticle technology together with magnetic resonance imaging has allowed the possibility of imaging of neovessels in coronary or carotid plaques, and infusion of nanoparticle suspensions using infusion catheters or implant-based drug delivery represents a novel and potentially much more efficient option for treatment. This review will describe the importance of angiogenesis in mediation of plaque growth and development of plaque instability and go on to investigate the possibility of future design of superparamagnetic/perfluorocarbon-derived nanoparticles for imaging of the vasculature in this disease or which could be directed to the adventitial vasa vasorum or indeed intimal microvessels and which can release active payloads directed against primary key external mitogens and intracellular signalling molecules in endothelial cells responsible for their activation with a view to inhibition of angiogenesis. © 2010 The Royal Society of Chemistry.
Fibla J.J.,Hospital Universitari del Sagrat Cor |
Molins L.,Hospital Clinic
Minerva Chirurgica | Year: 2016
Pectus excavatum (PE) is the most common congenital chest wall deformity. It consists of a concavity of the sternum, and the costal cartilages derived from an unbalanced growth of the costochondral regions of the anterior chest wall. The standard operative treatment for PE has been the Ravitch procedure. This technique requires a long incision in the anterior chest wall and bilateral resection of the affected costal cartilages, needing in most cases a posterior metal bar support. The belief that the treatment of PE is basically esthetic led Donald Nuss to develop in 1998 a minimally invasive surgical treatment based on the skeletal frame plasticity and reshape capacity applied to the thorax. Thereby he deviced a technique involving a retrosternal steel bar modifying the sternum's concavity and supporting the shape of the amended thorax, all performed through two small incisions at each side of the thorax with the help of a thoracoscope. The bar is maintained from 2 to 3 years, and removed after this period. This procedure obtains >90% of positive results with significant esthetic improvement and patient satisfaction. This minimally surgical approach for PE is to be discussed in this review. © 2016 Edizioni Minerva Medica.
PubMed | Hospital Universitari del Sagrat Cor, Hospital Universitario Miguel Servet Institute Investigacion Sanitaria Aragon and Hospital General Universitario Of Valladolid
Type: Journal Article | Journal: Annals of oncology : official journal of the European Society for Medical Oncology | Year: 2016
Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection.Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model.A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome.Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results.
Liria J.,Autonomous University of Barcelona |
Carrascal S.,Autonomous University of Barcelona |
Fernandez-Fairen M.,Institute Cirugia Ortopedica Y Traumatologia Of Barcelona |
Malgosa A.,Autonomous University of Barcelona |
And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2012
Background: Dislocation of both ends of the clavicle is a rare traumatic lesion and the mechanism of the lesion is usually related to major trauma. The first case was described in 1831. Case Description: We present the oldest referenced case of this alteration. The skeleton studied belonged to an old woman buried inside the Sant Pere de Madrona Church in Berga (Barcelona/Spain) and its dating indicated it corresponded to the end of the 17th century. There was a pseudarthrosis between the clavicle and coracoid ligament; when the bones were reconstructed by pseudarthrosis both ends of the clavicle appeared dislocated. Literature Review: Bipolar dislocation of both ends of the clavicle, or "floating-clavicle", is a rare injury. Since 1831 when this type of injury was first reported, approximately 40 cases have been published. No archaeological case has been published. Clinical Relevance: Despite experiencing bipolar dislocation of both ends of the clavicle, or floating-clavicle, it is possible to have acceptable function of the arm as suggested by the anthropologic parameters analyzed here. The head of the humerus of the affected shoulder shows no abnormalities and the contralateral glenoid cavity shows severe osteochondritis of the anteroinferior side. © 2011 The Association of Bone and Joint Surgeons®.
Arboix A.,Hospital Universitari Del Sagrat Cor |
Cartanya A.,Hospital Universitari Del Sagrat Cor |
Lowak M.,Hospital Universitari Del Sagrat Cor |
Garcia-Eroles L.,I-Systems |
And 3 more authors.
Clinical Neurology and Neurosurgery | Year: 2014
Results: Patients age increased significantly from a mean of 74.5 years in 19861992 to 81.2 years in20042009 (P < 0.001). Patients aged ≥85 years increased from 18.5% to 38.5% (P = 0.0001) as were patientswith hypertension, atrial fibrillation, and cardioembolic stroke. The in-hospital death decreased from17.6% to 11% (P = 0.02), median length of hospital from 14 to 9 days (P = 0.0001) and prolonged hospitalstay (>12 days) from 59.7% to 33.7% (P = 0.0001). Lacunar infarction was more frequent in men (21.5%vs. 16.2%, P = 0.0003) and cardioembolic infarction in women (26% vs. 15.6%, P = 0.0001). Acute strokein women continues to be a severe disease with high risk of death in the immediate post-stroke phase(13.5%) and low probability of early full neurological recovery (13.9% vs. 11.8%, P = 0.029).Objective: We assessed gender differences and women-specific secular trends in stroke.Methods: Data from 2318 women and 2274 men with first-ever stroke collected from the Sagrat CorHospital Stroke Registry of Barcelona between 1986 and 2009 were analyzed.Conclusion: Women differ from men in the distribution of risk factors and stroke subtype, stroke severity,and outcome. An increase in the patients age, hypertension, atrial fibrillation and cardioembolic infarc-tion, as well as a decrease mortality and length of hospitalization over a 24-year period was recorded. © 2014 Elsevier Ltd. All rights reserved.
Montiel R.,CINVESTAV |
Montiel R.,University of The Azores |
Solorzano E.,Autonomous University of Barcelona |
Diaz N.,Autonomous University of Barcelona |
And 7 more authors.
PLoS ONE | Year: 2012
Ancient DNA (aDNA) analysis can be a useful tool in bacterial disease diagnosis in human remains. However, while the recovery of Mycobacterium spp. has been widely successful, several authors report unsuccessful results regarding ancient treponemal DNA, casting doubts on the usefulness of this technique for the diagnosis of ancient syphilis. Here, we present results from an analysis of four newborn specimens recovered from the crypt of "La Ermita de la Soledad" (XVI-XVII centuries), located in the province of Huelva in the southwest of Spain. We extracted and analyzed aDNA in three independent laboratories, following specific procedures generally practiced in the aDNA field, including cloning of the amplified DNA fragments and sequencing of several clones. This is the most ancient case, reported to date, from which detection of DNA from T. pallidum subspecies pallidum has been successful in more than one individual, and we put forward a hypothesis to explain this result, taking into account the course of the disease in neonate individuals. © 2012 Montiel et al.
Sola-Ortigosa J.,Hospital Universitari Del Sagrat Cor |
Sanchez-Regana M.,Hospital Universitari Del Sagrat Cor |
Umbert-Millet P.,Hospital Universitari Del Sagrat Cor
Journal of Dermatological Treatment | Year: 2012
Background: Adalimumab is a fully human IgG1 monoclonal antibody that binds to tumor necrosis factor (TNF), a key proinflammatory cytokine involved in the pathogenesis of psoriasis. Objective: A single-center, retrospective study was conducted to assess the efficacy and safety of adalimumab in patients with moderate to severe psoriasis in daily practice. Methods: The medical records of 15 patients with moderate to severe psoriasis treated with adalimumab during a 1-year period were reviewed. Previous conventional systemic treatments or other biological agents were unsuccessful. All patients received subcutaneous injections of an initial dose of adalimumab (80 mg) at week 0 followed by adalimumab (40 mg) every other week. Results: A 75% improvement in the Psoriasis Area and Severity Index (PASI 75) score was achieved by 80% of patients at week 24 and by 73.3% of patients at week 48. Moreover, 13.3% of patients were almost completely cleared (PASI 90) at week 48. At 24 weeks, adalimumab therapy increased significantly a patient's quality of life as assessed by the Dermatology Life Quality Index (DLQI) (p 0.001). The Nail Psoriasis Severity Index (NAPSI) decreased from a mean (SD) of 18.9 (12.2) to 8.2 (4.7) (p 0.001) at week 24. Palmoplantar psoriasis decreased from a mean score of 1.1 (1.3) to 0.5 (0.9) (p 0.026) and scalp involvement from a mean of 2.5 (1.2) to 1.1 (1.0) (p 0.002) at week 24. Out of 11 patients with pruritus at the pre-treatment visit, this symptom had completely disappeared in nine of them after 24 weeks of treatment. Conclusions: Treatment with adalimumab proved to be effective for the management of chronic moderate to severe plaque-type psoriasis in patients whose disease had been refractory to systemic conventional therapies or other biologic agents. © 2012 Informa UK, Ltd.
Capmany R.P.,Hospital Universitari del Sagrat Cor |
Ibanez M.O.,Hospital Universitari del Sagrat Cor |
Pesquer X.J.,Hospital Universitari del Sagrat Cor
Current Cardiology Reviews | Year: 2010
In many stroke patients it is not possible to establish the etiology of stroke. However, in the last two decades, the use of transesophageal echocardiography in patients with stroke of uncertain etiology reveals atherosclerotic plaques in the aortic arch, which often protrude into the lumen and have mobile components in a high percentage of cases. Several autopsy series and retrospective studies of cases and controls have shown an association between aortic arch atheroma and arterial embolism, which was later confirmed by prospectively designed studies. The association with ischemic stroke was particularly strong when atheromas were located proximal to the ostium of the left subclavian artery, when the plaque was ≥ 4 mm thick and particularly when mobile components are present. In these cases, aspirin might not prevent adequately new arterial ischemic events especially stroke. Here we review the evidence of aortic arch atheroma as an independent risk factor for stroke and arterial embolism, including clinical and pathological data on atherosclerosis of the thoracic aorta as an embolic source. In addition, the impact of complex plaques (≥ 4 mm thick, or with mobile components) on increasing the risk of stroke is also reviewed. In non-randomized retrospective studies anticoagulation was superior to antiplatelet therapy in patients with stroke and aortic arch plaques with mobile components. In a retrospective case-control study, statins significantly reduced the relative risk of new vascular events. However, given the limited data available and its retrospective nature, randomized prospective studies are needed to establish the optimal secondary prevention therapeutic regimens in these high risk patients. © 2010 Bentham Science Publishers Ltd.
PubMed | Hospital Universitari del Sagrat Cor
Type: Journal Article | Journal: Minerva chirurgica | Year: 2016
Pectus excavatum (PE) is the most common congenital chest wall deformity. It consists of a concavity of the sternum, and the costal cartilages derived from an unbalanced growth of the costochondral regions of the anterior chest wall. The standard operative treatment for PE has been the Ravitch procedure. This technique requires a long incision in the anterior chest wall and bilateral resection of the affected costal cartilages, needing in most cases a posterior metal bar support. The belief that the treatment of PE is basically esthetic led Donald Nuss to develop in 1998 a minimally invasive surgical treatment based on the skeletal frame plasticity and reshape capacity applied to the thorax. Thereby he deviced a technique involving a retrosternal steel bar modifying the sternums concavity and supporting the shape of the amended thorax, all performed through two small incisions at each side of the thorax with the help of a thoracoscope. The bar is maintained from 2 to 3 years, and removed after this period. This procedure obtains >90% of positive results with significant esthetic improvement and patient satisfaction. This minimally surgical approach for PE is to be discussed in this review.
PubMed | Hospital Universitari del Sagrat Cor
Type: Journal Article | Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2015
Paravertebral block (PVB) with infusion of local anaesthetic (LA) through a paravertebral catheter is an effective alternative to epidural analgesia in the management of post-thoracotomy pain. PVB can be done in two ways: either through administration of a bolus dose of the LA or continuous infusion via an infusion pump; currently, there is no consensus on which route is best. Our objective was to compare the efficacy of the PVB for post-thoracotomy pain control using bolus doses versus a continuous infusion pump.We performed a prospective randomized study of 80 patients submitted to thoracotomy. Patients were divided into two independent groups (anterior thoracotomy--ANT--and posterolateral thoracotomy-POST). At the conclusion of the surgery, a catheter was inserted under direct vision in the thoracic paravertebral space at the level of the incision. In each group, patients were randomized to receive levobupivacaine 0.5% every 6 h (Bolus group) or levobupivacaine 0.25% in continuous infusion at 5 ml/h through an elastomeric pump (Continuous infusion group). Patients in both groups received the same dosage of LA: 300 mg/day. Metamizole (every 6 h) was administered as an adjunct. Subcutaneous meperidine was employed as a rescue medication. Pain scores were measured using the visual analogue scale (VAS) at 1, 6, 24, 48 and 72 h after surgery.Thirteen (16.2%) patients required meperidine for rescue (8 in continuous infusion and 5 in the bolus group). Mean VAS scores were the following: all the cases (n = 80): 5.0 1.6, ANT (n = 36): 4.4 1.8, POST (n = 44): 5.4 1.6, Bolus (n = 40): 4.7 1.7, Continuous infusion (n = 40): 5.2 1.8, ANT with bolus (n = 18): 4.1 1.7, ANT with continuous infusion (n = 18): 4.7 1.8, POST with bolus (n = 22): 5.2 1.5, POST with continuous infusion (n = 22): 5.6 1.6.Post-thoracotomy pain control using a combination of PVB and a non-steroidal anti-inflammatory drug is a safe and effective approach. Patients submitted to ANT experienced less pain than those with POST 4.4 vs 5.4 (P = 0.02). Since no statistical differences were observed, it was not possible to confirm differences between the LA administered in a bolus versus continuous infusion.