Hospital Universitario Doctor Peset

Aguilar de Codés, Spain

Hospital Universitario Doctor Peset

Aguilar de Codés, Spain
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Villegas F.C.B.,Hospital Universitario Doctor Peset | Roca F.J.F.,Hospital Universitario Doctor Peset
Medicina Cutanea Ibero-Latino-Americana | Year: 2016

Alopecia areata (AA) is a multifactorial autoinmune process that manifests as localized loss of hair, usually at scalp, without visible inflammation, like well delimited circular areas. Several forms of unusual presentation have been described such as sudden graying, sisaifo and androgenetic alopecia, among others. In addition, there are the paradoxical regrowth such as Castling phenomenon, Renbök phenomenon, perinevoid alopecia and targetoid or concentric pattern. We report a healthy 8-year-old patient who comes for asintomatic symmetric alopecic patchs in a triangular and targetoid pattern in scalp, specifically localizated in fronto-parietal-temporo-occipital left area. The histology was compatible with areata alopecia. Treatment was initiated with clobetasol propionate foam 0.05% (500 μg) at night in every other week regimen with good response.

Martinez-Perez A.,University Paris Est Creteil | Martinez-Perez A.,Hospital Universitario Doctor Peset | Carra M.C.,University Paris Diderot | Brunetti F.,University Paris Est Creteil | De'Angelis N.,University Paris Est Creteil
JAMA Surgery | Year: 2017

IMPORTANCE Rectal resection with mesorectal excision is the mainstay treatment for rectal cancer. OBJECTIVE To review and analyze the evidence concerning the pathologic outcomes of laparoscopic (LRR) vs open (ORR) rectal resection for rectal cancer. DATA SOURCES The Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), EMBASE, Scopus databases, and were searched for randomized clinical trials (RCTs) comparing LRR vs ORR. STUDY SELECTION Only RCTs published in English from January 1, 1995, to June 30, 2016, that compared LRR with ORR for histologically proven rectal cancer in adult patients and reported pathologic outcomes (eg, positive circumferential resection margin, and complete mesorectal excision) were eligible for inclusion. Of 369 records screened, 14 RCTs were selected for the qualitative and quantitative analyses. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed the study selection and quality assessment. Random-effects models were used to summarize the risk ratio (RR) and mean differences. MAIN OUTCOMES AND MEASURES The rate of positive circumferential resection margin (CRM), defined as 1mmor less from the closest tumor to the cut edge of the tissue, and the quality ofmesorectal excision (complete, nearly complete, or incomplete). RESULTS Themeta-analysis included 14 unique RCTs with 4034 unique patients. Of 2989 patients undergoing rectal resection, a positive CRM was found in 135 (7.9%) of 1697 patients undergoing LRR and 79 (6.1%) of 1292 patients undergoing ORR (RR, 1.17; 95%CI, 0.89-1.53; P = .26; I2 = 0%) in 9 studies. A noncomplete (nearly complete and incomplete) mesorectal excision was reported in 179 (13.2%) of 1354 patients undergoing LRR and 104 (10.4%) of 998 patients undergoing ORR (RR, 1.31; 95%CI, 1.05-1.64; P = .02; I2 = 0%) in 5 studies. The distal resection margin involvement (RR, 1.12; 95%CI, 0.34-3.67; P = .86), the mean number of lymph nodes retrieved (mean difference, 0.05; 95%CI, -0.77 to 0.86; P = .91), the mean distance to the distal margin (mean difference, 0.01 cm; 95%CI, -0.12 to 0.15 cm; P = .87), and the mean distance to radial margins (mean difference, -0.67 mm; 95%CI, -2.16 to 0.83 mm; P = .38) were not significantly different between LRR and ORR. The risk for bias was assessed as low in 10 studies, high in 3, and unknown in 1. The overall quality of the evidence emerging from the literature was rated as high. CONCLUSIONS AND RELEVANCE Based on the available evidence, the risk for achieving a noncomplete mesorectal excision is significantly higher in patients undergoing LRR compared with ORR. These findings question the oncologic safety of laparoscopy for the treatment of rectal cancer. However, long-term results of the ongoing RCTs are awaited to assess whether these pathologic results have an effect on disease-free and overall patient survival. © 2017 American Medical Association.

Cutillas-Marco E.,Hospital Of La Vega Lorenzo Guirao | Fuertes-Prosper A.,Hospital Universitario Doctor Peset | Grant W.B.,Nutrition and Health Research Center | Morales-Suarez-Varela M.,University of Valencia | Morales-Suarez-Varela M.,CIBER ISCIII
Photodermatology Photoimmunology and Photomedicine | Year: 2012

The main source of vitamin D is synthesis in the skin during exposure to ultraviolet radiation. The existence of photoaggravated diseases and the increasing incidence of skin cancer have prompted recommendations to avoid the sun. Here, we study the status of vitamin D in a healthy population and its relation to their habits of sun exposure. To do so, we designed a cross-sectional study that included 177 healthy people. We analyzed parameters about demographic data, sun exposure, and protection habits and estimated vitamin D dietary intake. We performed blood tests to measure serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, and intact parathyroid hormone. Mean levels (±standard deviation) of 25(OH)D were 24.0 (±8.5) ng/ml. Seventy-six percent of the population did not reach recommended levels of vitamin D (30ng/ml), including 4.5% who were vitamin D deficient (<10ng/ml). Levels were higher in young people (P=0.04) and those with more sun exposure (P=0.04). Smoking was associated with an increased risk of hypovitaminosis D (odds ratio, 1.8; 95% confidence interval, 1.00-3.35). On the basis of our findings, we should consider the risk of hypovitaminosis when we recommend sun avoidance, especially in some risk groups, because the sun is the most important source of this vitamin. © 2012 John Wiley & Sons A/S.

Bernat Garcia J.,Hospital Universitario Doctor Peset | Morales Suarez-Varela M.,University of Valencia | Vilata J.J.,Hospital General Universitario | Marquina A.,Hospital Universitario Doctor Peset | And 2 more authors.
Acta Dermato-Venereologica | Year: 2013

Non-melanoma skin cancer (NMSC) is the most frequent malignancy in organ transplant recipients. The aetiology of NMSC after transplant is multifactorial. The aim of this study was to determine the clinical and environmental factors involved in the development of NMSC in a Spanish kidney transplant population from the Mediterranean region. A total of 289 patients who had received a kidney transplant during the period January 1996 to December 2010 were included in the study. Both prospective and retrospective data were used. All patients underwent a structured interview and a complete examination of the skin. After a median follow-up of 72 months (range 12-180 months), 73 of the 289 patients (25.2%) developed 162 tumours. The ratio of basal cell carcinoma to squamous cell carcinoma was 2.21:1. The cumulative incidence of NMSC increased with the duration of immunosuppression, from 20.78% at 5 years, to 37.35% at 10 years to 53.08% at 15 years after transplantation. Age at the time of transplant, phototype and occupational sun exposure were associated with a higher risk of NMSC. NMSC is a significant clinical problem in kidney transplant recipients. This has implications for the development of prevention and surveillance strategies. Clinical and environmental factors may be used to identify those patients who are at risk for NMSC. © 2013 The Authors.

Bernat-Garcia J.,Hospital Universitario Doctor Peset | Morales Suarez-Varela M.,University of Valencia | Vilata-Corell J.J.,Hospital General Universitario Of Valencia | Marquina-Vila A.,Hospital Universitario Doctor Peset
Actas Dermo-Sifiliograficas | Year: 2014

Background The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-β) have been most frequently associated with the development of skin cancer. Objectives To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. Methods Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. Results HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-β was the most common type isolated. Conclusion We found a wide range of HPV types (mostly HPV-β) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer. © 2013 Elsevier España, S.L. y AEDV. Todos los derechos reservados.

Silvestre F.J.,University of Valencia | Silvestre F.J.,Hospital Universitario Doctor Peset | Silvestre-Rangil J.,University of Valencia | Lopez-Jornet P.,University of Murcia
Revista de Neurologia | Year: 2015

Burning mouth syndrome (BMS) is mainly found in middle aged or elderly women and is characterized by intense burning or itching sensation of the tongue or other regions of the oral mucosa. It can be accompanied by xerostomia and dysgeusia. The syndrome generally manifests spontaneously, and the discomfort is typically of a continuous nature but increases in intensity during the evening and at night. Although BMS classically has been attributed to a range of factors, in recent years evidence has been obtained relating it peripheral (sensory C and/or trigeminal nerve fibers) or central neuropathic disturbances (involving the nigrostriatal dopaminergic system). The differential diagnosis requires the exclusion of oral mucosal lesions or blood test alterations that can produce burning mouth sensation. Patient management is based on the avoidance of causes of oral irritation and the provision of psychological support. Drug treatment for burning sensation in primary BMS of peripheral origin can consist of topical clonazepam, while central type BMS appears to improve with the use of antidepressants such as duloxetine, antiseizure drugs such as gabapentin, or amisulpride. © 2015 Revista de Neurología.

Various nonpharmacologic strategies for reducing anxiety in children and improving cooperation during induction of anesthesia have been investigated. Parental presence during anesthetic induction has been the alternative studied most often, especially in English-speaking populations. Mixed results have been reported, however. The aim of this study was to evaluate the quality of anesthetic induction and the development of postoperative agitation in Spanish children undergoing ear, nose, or throat surgery with or without parental presence in the operating room. Children in American Society of Anesthesiologists class 1 or 2 who were scheduled for ear, nose or throat surgery under inhalation anesthesia were randomized to 2 groups for presence or absence of a parent in the operating room. The induction experience was classified as easy, carried out with moderate resistance, or traumatic. The postoperative period was assessed as easy or traumatic. Forty children were randomized. Time to onset of anesthesia was similar in the 2 groups. Induction was easy for 65% of the children with parental presence and for 25% of the children without a parent present (P < .05). Induction was traumatic for 25% in the parental presence group and for 35% in the parental absence group (P < .05). The incidence of moderate resistance during induction was similar in the 2 groups; the quality of the postoperative experience was also similar. Parental presence during induction of inhalation anesthesia improves the induction experience of nonpremeditated Spanish children, increasing the incidence of easy induction and decreasing the presence of traumatic induction. The quality of the postoperative experience is similar.

Cordellat I.M.,Hospital Universitario Doctor Peset
Reumatologia Clinica | Year: 2012

Primary hyperparathyroidism (PHPT) is characterized by the autonomous production of parathyroid hormone (PTH), in which there is hypercalcemia or normal-high serum calcium levels in the presence of elevated or inappropriately normal serum PTH concentrations. Exceptionally in symptomatic patients, a diagnostic can be established on the basis of clinical data. PHPT must always be evaluated in patients with clinical histories of nephrolithiasis, nephrocalcinosis, osseous pain, subperiosteal resorption, and pathologic fractures, as well as in those with osteoporosis-osteopenia, a personal history of neck irradiation, or a family history of multiple endocrine neoplasia syndrome (types 1 or 2). Diagnosis of PHPT is biochemical. Asymptomatic hypercalcemia without guiding signs or symptoms is the most frequent manifestation of the disease. For differential diagnosis, PTH must be measured, as well as phosphate, chloride, 25-hydroxyvitamin D, 1,25 dyhidroxyvitamin D and calcium-to-creatinine clearance.The diagnosis and differential diagnosis of primary hyperparathyroidism will be discussed here. © 2011 Elsevier España, S.L..

Flors Blasco L.,Hospital Universitario Doctor Peset | Domingo M.L.,Hospital Universitario Doctor Peset | Leiva-Salinas C.,Hospital Universitario Doctor Peset | Mazon M.,Hospital Universitario Doctor Peset | And 2 more authors.
American Journal of Roentgenology | Year: 2010

OBJECTIVE. The purpose of this article is to describe the high-resolution CT (HRCT) features of uncommon occupational lung diseases. CONCLUSION. HRCT plays an increasing role in the evaluation of occupational lung diseases. We present several cases of unusual occupational lung diseases and their HRCT findings. The diseases studied were siderosis, talcosis, berylliosis, calcicosis, hypersensitivity pneumonitis (due to wheat flour and isocyanates), and Ardystil syndrome. The characteristic HRCT findings together with clinical features and related occupational history improve the diagnostic accuracy of these diseases. © American Roentgen Ray Society.

Objectives: To describe the monthly costs of drugs per standardized patient in the Doctor Peset health department in Valencia, Spain and to correlate them with the computerization of prescription in primary care clinics using time series analysis. Other objectives were to identify internal causes that could explain the variations observed, and to evaluate the drug costs associated with these variations. Material and methods: Observational and retrospective study to analyse the variables: a) monthly costs of drugs by standardized patient and b) number of defined daily doses (DDD) per 1000 inhabitants and per day of drugs used to prevent cardiovascular risk prescribed by the Primary Care doctors of the Doctor Peset health department in Valencia, between January 2001 and August 2009. Time series were adjusted using ARIMA models. The impact of computerization was assessed using an intervention analysis on time series. Results: ARIMA models for the monthly costs of drugs by standardized patient shows that this indicator was increased by 4.9% in August 2007. The modelling of daily DDD per 1000 inhabitants showed an increase of 8.5% on the same date. Both increases occurred together with the introduction of the computerized prescription in Primary Care clinics. The pharmacoeconomic study estimated that drug costs associated with the trend changes increased by 11,365,409 euros within the period September 2007 to August 2009. Conclusions: The computerization of prescription in Primary Care clinics can be correlated with an increase in the monthly costs of drugs per standardized patient and with the number of daily DDD per 1000 inhabitants of drugs to reduce the cardiovascular risk by 4.5% and 8.5%, respectively. © 2009 SECA. Published by Elsevier España, S.L. All rights reserved.

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