Hospital Universitari Joan

Tarragona, Spain

Hospital Universitari Joan

Tarragona, Spain
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De La Rubia J.,Hospital la Fe | De La Rubia J.,San Vicente Mártir Catholic University of Valencia | Contreras E.,Hospital Universitari Joan | Del Rio-Garma J.,Complejo Hospitalario Of Orense
Medicina Clinica | Year: 2011

Thrombotic thrombocytopenic purpura (TTP) is the most extensive and dangerous intravascular platelet clumping disorder. For more than a half-century after its initial recognition, mortality was near 100% and the etiology totally obscure. Then, in the late 1970s to early 1980s, empiric, but successful, therapy with plasma exchange was followed by sudden laboratory insight into pathophysiology. The most important finding was the identification of a novel metalloprotease, named ADAMTS13, which is involved in the regulation of the size of von Willebrand factor. Inherited or acquired deficiencies of ADAMTS13 impair von Willebrand factor cleavage, leading to the disseminated formation of platelet-rich thrombi in the microcirculation and to symptoms of end-organ ischemia. Treatment with plasma exchange, available for more than 20 years, has dramatically altered the course of disease in adults with TTP. Long term follow-up has revealed increasing frequencies of relapse that require new therapeutic alternatives for these patients. © 2009 Elsevier España, S.L. All rights reserved.

Richart C.,Rovira i Virgili University | Richart C.,Hospital Universitari Joan | Terra X.,Rovira i Virgili University | Auguet T.,Rovira i Virgili University | And 9 more authors.
Obesity | Year: 2013

Objective: We aimed to analyze the retinol binding protein-4 (RBP4) messenger RNA (mRNA) expression profiles in adipose tissues and liver of morbidly obese (MO) women with or without nonalcoholic fatty liver disease (NAFLD), and to study the relationships with other pro- and anti-inflammatory adipokines in vivo and in vitro. Design and Methods: We performed a cross-sectional analysis of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and liver samples from four lean and 45 MO women with or without NAFLD by enzyme-linked immunosorbent assay and real-time reverse transcription-PCR. We also studied RBP4 expression in HepG2 hepatocytes under various inflammatory stimuli. Results: Circulating RBP4 levels were higher in MO women, and specifically, in MO subjects with NAFLD compared with normal liver controls (lean and MO). RBP4 liver expression was higher in nonalcoholic steatohepatitis (NASH)-moderate/severe than in NASHmild. Overall RBP4 gene expression was higher in liver than in adipose tissues. Among them, the higher expression corresponded to SAT. VAT expression was lower in the MO cohort. In HepG2, RBP4 mRNA expression was reduced by tumor necrosis factor (TNF)-α and increased by adiponectin treatment. Conclusions: The results obtained in MO women with NAFLD, brings up the use of RBP4 and other adipokines as a panel of noninvasive molecular biomarkers when NAFLD is suspected. Further studies are needed with other obesity groups.

Alcoceba Borras E.,Hospital Universitari Of Tarragona Joan Xxiii | Gonzalez M.,Hospital Universitari Of Tarragona Joan Xxiii | Gaig P.,Hospital Universitari Of Tarragona Joan Xxiii | Figuerola E.,Hospital Universitari Joan | And 2 more authors.
Journal of Investigational Allergology and Clinical Immunology | Year: 2010

Edema of the uvula (EU) is a rare occurrence sometimes associated with angioedema, urticaria, and anaphylaxis. We analyze the causes, predisposing factors, and characteristics of EU in a group of 58 patients with a mean (SD) age of 48.2 (15.2) years over the course of a year. Of the 58 patients studied, 49 (84.5%) were male and 44 (75.9%) presented isolated EU. Thirty-two patients (55.1%) with no clear etiology were classed as idiopathic. Snoring and a high body mass index were more prevalent in these patients. A variety of probable causes were identified in 26 patients (44.9%). In this group, EU was usually accompanied by urticaria, angioedema, and anaphylaxis and there was also a greater prevalence of atopy. We found that EU was idiopathic in just over half of the patients studied and that the predisposing factors were being overweight and having a tendency to snore. Patients with EU should be tested for allergies to drugs, airborne allergens, and food. © 2010 Esmon Publicidad.

Mayayo E.,Rovira i Virgili University | Mayayo E.,Hospital Universitari Joan | Stchigel A.M.,Rovira i Virgili University | Cano J.F.,Rovira i Virgili University | And 2 more authors.
Revista Iberoamericana de Micologia | Year: 2013

Background: Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. Case report: A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. Conclusions: This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region. © 2012 Revista Iberoamericana de Micología.

Figueras M.J.,Rovira i Virgili University | Levican A.,Rovira i Virgili University | Levican A.,Andrés Bello University | Pujol I.,Rovira i Virgili University | And 5 more authors.
New Microbes and New Infections | Year: 2014

Although rarely, Arcobacter spp. have been associated with diarrhoea and bacteraemia. We report a persistent case in a healthy 26-year-old Spanish male of bloody diarrhoea, which was attributed to Campylobacter but in fact was caused by Arcobacter cryaerophilus, as determined by sequencing of the rpoB gene. The isolate was re-identified by matrix-assisted laser desorption ionization time of flight (MALDI-TOF) and genotyped for five putative virulence genes and for seven genes included in the Arcobacter multilocus sequence typing database. The low score obtained by MALDI-TOF indicates the need to complement the database with more isolates. Only the ciaB gene, which encodes for an invasin, was detected. Despite the isolate belonging to a new sequence type, three of the alleles (glnA, pgm and tkt) had been found previously in isolates from faeces of patients with diarrhoea. This study, together with the reviewed literature, indicates that Arcobacter can produce bacteraemia and that the isolation from patients with diarrhoea range from 0.11% to 1.25%. This study also demonstrates that Arcobacter species are confused with Campylobacter spp., as previously suggested. This is one of the factors that leads to underestimation of their incidence together with the use of inappropriate detection and identification methods.

Mateo M.G.,University of Barcelona | Gutierrez M.D.M.,University of Barcelona | Vidal F.,Hospital Universitari Joan | Domingo P.,University of Barcelona
Expert Opinion on Drug Safety | Year: 2012

Introduction: The lamivudine (3TC) + stavudine (d4T) combination is still widely used as part of first-line therapy for HIV-1-infected patients in low-resource countries. This review is intended to assess the benefits and risks in terms of safety of d4T + 3TC-based combination antiretroviral therapy (ART) for the treatment of HIV-1 infection. Areas covered: The most relevant papers related to the safety of d4T + 3TC-based ART were selected and summarized. Expert opinion: In industrialized countries, the 3TC + d4T combination is not recommended for initial therapy because of long-term metabolic toxicities associated with d4T. In developing countries, it may have a role in the treatment of HIV-infected patients if there is no other chance for starting antiretroviral therapy. © 2012 Informa UK, Ltd.

Romani J.,Autonomous University of Barcelona | Romani J.,Hospital Parc Tauli | Caixas A.,Autonomous University of Barcelona | Ceperuelo-Mallafre V.,Hospital Clinico Virgen Of La Victoria | And 5 more authors.
Archives of Dermatological Research | Year: 2013

Psoriasis has been related to metabolic syndrome (MS). Adipocytokines produced by white adipose tissue may be involved in the pathogenesis of psoriasis and its association with MS. Our objectives were to characterize the profile of a number of different inflammatory and atherogenic markers, vitamins, adipokines and cytokines and their potential involvement in MS in patients with moderate-to-severe psoriasis without joint involvement compared to anthropometrically matched controls, and to evaluate correlation with severity of the skin disease and changes after narrow-band UVB (NB-UVB) phototherapy. We designed a prospective cross-sectional study. Baseline waist circumference, body fat composition, lipid, carbohydrate and calcium metabolism profile, inflammation markers, homocysteine and vitamins D, B6, B12 and folic acid, leptin, resistin, omentin, lipocalin-2, adipocyte fatty acid-binding protein, retinol-binding protein-4 (RBP-4), interleukin-6, soluble tumour necrosis factor receptor 1 (sTNFR1) and interleukin-17 of 50 psoriasis patients and 50 gender, age and body mass index-matched controls were recorded, then evaluated after NB-UVB in the patients. The patients had higher baseline serum concentrations of leptin, RBP-4, lipocalin-2 and sTNFR1. Baseline psoriasis area and severity index correlated with serum concentrations of RBP-4 and lipocalin-2 only. Principal components analysis disclosed a component including vitamins B12, B6, folic acid, calcidiol and HDL-cholesterol that was only present in healthy controls and opposed to a cluster of variables which promote MS. This component was absent in the patients. Our results point to lipocalin-2 and RBP-4 as relevant mediators of the trend towards MS in psoriatic patients. © 2012 Springer-Verlag Berlin Heidelberg.

Landeyro J.,Hospital Universitari Joan | Diaz M.L.,Hospital Universitari Joan | Raventos A.,Hospital Universitari Joan | Vadillo J.,Servei Of Cirurgia General Hospital Universitari Joan Xxiii | Martinez M.S.,Hospital Universitari Joan
Diagnostic Cytopathology | Year: 2012

Myofibroblastoma of the breast is a rare, benign mesenchymal tumor derived from the stroma and tends to occur mainly in middle-aged to elderly men. There are a few cases reported in the literature describing its cytological features. We report the cytological and histological findings of a breast myofibroblastoma in a 68-year-old man. He presented with a palpable nodule of 2-months duration in his left breast. The cytological smears obtained by fine needle aspiration showed less cohesive cellularity in a fascicular arrangement consisting of spindle cells with elongated cytoplasm, occasional nuclear grooves, and intranuclear cytoplasmic inclusions associated to fragments of stromal collagen. The cytological diagnosis was a mesenchymal proliferation suggesting the possibility of myofibroblastoma which was confirmed on histopathological examination. The breast myofibroblastoma has distinctive cytological features that in conjunction with the clinical and radiological data allow a specific diagnosis. Copyright © 2011 Wiley Periodicals, Inc.

Romani J.,Hospital Parc Tauli | Caixas A.,Hospital Of Sabadell | Escote X.,Hospital Universitari Joan | Carrascosa J.M.,Autonomous University of Barcelona | And 4 more authors.
Clinical and Experimental Dermatology | Year: 2013

Lipopolysaccharide-binding protein (LBP) is a reliable indicator of serum lipopolysaccharide (LPS) concentration. Raised levels of circulating LPS can trigger an increase in chronic pro-inflammatory cytokines, which may mediate the development of insulin resistance and obesity. Psoriasis is a chronic inflammatory skin disease that has been associated with metabolic syndrome. We aimed to study the expression of LBP in patients with psoriasis treated with narrowband ultraviolet B phototherapy, and controls matched by age, gender and body mass index (BMI). We did not find any differences in serum LBP concentration between patients and controls, and serum LBP did not correlate with the Psoriasis Area and Severity Index. However, patients with psoriasis and metabolic syndrome had higher serum concentration of LBP than controls. Furthermore, correlation with BMI and apolipoprotein B was present in controls, but not in patients with psoriasis. Serum LBP level did not change significantly after treatment with phototherapy. © The Author(s). CED © 2012 British Association of Dermatologists.

Escosa Bae M.,Hospital Universitari Joan | Wessling H.,Hospital Universitari Joan | Salca H.C.,Hospital Universitari Joan | De Las Heras Echeverria P.,Hospital Universitari Joan
Acta Neurochirurgica | Year: 2011

Background: Recurrence rates after chronic subdural hematoma (CSDH) evacuation with any of actual techniques [twist-drill craniostomy (TDC), burr-hole craniostomy, craniotomy] range from 5% to 30%. Use of drain has improved recurrence rates when used with burr-hole craniostomy. Now, we analyze predictors of recurrence of TDC with drain. Method: Three hundred twelve consecutive patients with CSDH have been studied in a retrospective study. Operative technique in all patients consisted in TDC with drain. Data recorded included any associated comorbidity. Radiologic measures of the CSDH before and after the procedure were studied. Clinical evaluation included Modified Rankin Scale, Glasgow Coma Scale (GCS), and neurological deficits. Two groups were compared: recurrence group and nonrecurrence group. Follow-up was for at least 1 year. Results: Twelve percent experienced recurrence. Preoperative CSDH width, preoperative midline shift, postoperative midline width, postoperative CSDH width, and residual CSDH 1 month later were significantly associated with CSDH recurrence. The logistic regression model for the multivariate analysis revealed that postoperative midline shift and postoperative neurological deficit were significantly associated with CSDH recurrence. The duration of treatment with dexamethasone was found not to be related with recurrence. Mortality before hospital discharge was 1%. Hospital stay was 2.5 days. Conclusions: TDC with drain has similar results in recurrence rates, morbidity, mortality, and outcome as other techniques as burr-hole craniostomy with drain. Preoperative and postoperative hematoma width and midline shift are independent predictors of recurrence. Brain re-expansion and time of drain maintenance are important factors related with recurrence of CSDH. Future CSDH reservoirs must avoid negative pressure and sudden pressure changes inside the whole closed drain system. © 2010 Springer-Verlag.

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