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Porcel J.M.,Institute Investigacion Biomedica Of Lleida | Mas E.,Institute Investigacion Biomedica Of Lleida | Rene J.M.,Hospital Universitario Arnau Of Vilanova | Bielsa S.,Institute Investigacion Biomedica Of Lleida
Medicina Clinica | Year: 2013

Background and objective To describe the clinical characteristics, the most effective treatment and survival of cirrhotic patients with hepatic hydrothorax (HH). Patients and method Descriptive and retrospective analysis of a cohort of consecutive patients with HH undergoing a diagnostic thoracentesis. The biochemical and radiological features of the pleural effusion, its control with different therapies and the factors affecting survival were evaluated, among other parameters. Results Seventy-seven patients with HH were included, of whom 14% did not have ascites. HH was right-sided in 77% of the cases, and occupied half or more of the hemithorax in 68%. Pleural fluids were transudative in 81% of the cases. Diuretic-resistant HH (27%) could be managed with liver transplantation, transjugular intrahepatic portosystemic shunt (TIPS) or indwelling pleural catheters. However, pleurodesis failed in most patients. Median survival was 9.1 months, and it was only favorably affected by liver transplantation. Conclusions HH has a limited survival, only influenced by liver transplantation. In diuretic-resistant cases, TIPS or pleural indwelling catheters should be considered as a management option. © 2013 Elsevier España, S.L. All rights reserved. Source

Lopez-Pueyo M.J.,Hospital Universitario Of Burgos | Olaechea-Astigarraga P.,Service of Intensive Care Medicine | Palomar-Martinez M.,Hospital Universitario Arnau Of Vilanova | Insausti-Ordenana J.,Service of Intensive Care Medicine | Alvarez-Lerma F.,Service of Intensive Care Medicine
Journal of Hospital Infection | Year: 2013

Background: Data validation is an essential aspect for the accuracy of a nosocomial infection surveillance registry. Aim: To report the results of the first quality control programme in the national surveillance programme of intensive care unit (ICU)-acquired infection in Spain (ENVIN-HELICS registry). Method: During 2008, of 13,824 records included in the database, 1500 (10.8%) registries from 20 ICUs were reviewed. These ICUs were selected at random and stratified according to the number of cases included in the registry. The proportion of infected patients, which was 9.6% [95% confidence interval (CI) 8.09-11.16], was maintained during the selection of cases for review. Two physicians were trained for the purpose of the study and undertook the review. Results: Overall sensitivity, specificity and positive and negative predictive values of the ENVIN-HELICS registry for the identification of patients with any device-related infection acquired during their ICU stay were 86.0% (95% CI 80.0-92.0), 98.7% (95% CI 82.19-93.6), 87.9% (95% CI 82.19-93.6) and 98.5% (95% CI 97.8-99.2), respectively, with a kappa index of 0.85 (95% CI 0.79-0.92). Secondary bloodstream infection had the lowest sensitivity (59.3%), and intubation-associated pneumonia had the highest sensitivity (86.3%). Conclusion: There was good correlation between data reported by the registrars and data validated by auditors, confirming the reliability of the ENVIN-HELICS registry. © 2013 The Healthcare Infection Society. Source

Boer K.,St John Hospital | Lang I.,National Institute of Oncology | Llombart-Cussac A.,Hospital Universitario Arnau Of Vilanova | Andreasson I.,Onkologkliniken | And 4 more authors.
Investigational New Drugs | Year: 2012

Purpose: The aim of this Phase II study was to assess the efficacy and safety of vandetanib in combination with docetaxel in patients with pretreated advanced breast cancer. Methods: The primary study objective was to compare the number of progression events in patients receiving once-daily oral vandetanib (100 mg) in combination with docetaxel (100 mg/m 2 iv every 21 days) versus placebo plus docetaxel. Sixty-four patients were randomized to receive study treatment (n=35, vandetanib; n=29, placebo). Results: A slightly greater number of patients had experienced a progression event by the data cut-off in the vandetanib group (24 [69%]) compared with the placebo group (18 [62%]); HR=1.19, two-sided 80% CI: 0.79-1.81; two-sided P=0.59), suggesting that the addition of vandetanib to docetaxel did not affect the risk of disease progression compared with placebo plus docetaxel. The safety and tolerability profile of the combination therapy reflected those of both drugs as monotherapy agents. Conclusions: In patients with advanced breast cancer, vandetanib plus docetaxel was generally well tolerated. Clinical benefit was not different to that observed with placebo plus docetaxel. However, due to the small patient number it was not possible to yield robust results, further research is required to identify predictive factors for patient selection. © Springer Science+Business Media, LLC 2010. Source

Blanco I.,Biomedical Research Office OIB FICYT | Lara B.,Hospital Universitario Arnau Of Vilanova | De Serres F.,National Health Research Institute
Orphanet Journal of Rare Diseases | Year: 2011

Up to now alpha 1-antitrypsin (AAT) augmentation therapy has been approved only for commercial use in selected adults with severe AAT deficiency-related pulmonary emphysema (i.e. PI*ZZ genotypes as well as combinations of Z, rare and null alleles expressing AAT serum concentrations <11 μmol/L). However, the compassionate use of augmentation therapy in recent years has proven outstanding efficacy in small cohorts of patients suffering from uncommon AAT deficiency-related diseases other than pulmonary emphysema, such as fibromyalgia, systemic vasculitis, relapsing panniculitis and bronchial asthma. Moreover, a series of preclinical studies provide evidence of the efficacy of AAT augmentation therapy in several infectious diseases, diabetes mellitus and organ transplant rejection. These facts have generated an expanding number of medical applications and patents with claims for other indications of AAT besides pulmonary emphysema. The aim of the present study is to compile and analyze both clinical and histological features of the aforementioned published case studies and reports where AAT augmentation therapy was used for conditions other than pulmonary emphysema. Particularly, our research refers to ten case reports and two clinical trials on AAT augmentation therapy in patients with both AAT deficiency and, at least, one of the following diseases: fibromyalgia, vasculitis, panniculitis and bronchial asthma. In all the cases, AAT was successfully applied whereas previous maximal conventional therapies had failed. In conclusion, laboratory studies in animals and humans as well as larger clinical trials should be, thus, performed in order to determine both the strong clinical efficacy and security of AAT in the treatment of conditions other than pulmonary emphysema. © 2011 Blanco et al; licensee BioMed Central Ltd. Source

Porcel J.M.,Hospital Universitario Arnau Of Vilanova
Revista Clinica Espanola | Year: 2016

Pleural ultrasonography is useful for identifying and characterising pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety. © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). Source

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