Penuelas O.,Hospital Universitario Infanta Cristina |
Penuelas O.,CIBER ISCIII |
Thille A.W.,University of Poitiers |
Esteban A.,CIBER ISCIII |
Esteban A.,Hospital Universitario Of Getafe
Current Opinion in Critical Care | Year: 2015
Purpose of Review: Weaning from mechanical ventilation implies two separate but closely related aspects of care, the discontinuation of mechanical ventilation and removal of artificial airway, which implies routine clinical dilemmas. Extubation delay and extubation failure are associated with poor clinical outcomes. We sought to summarize recent evidence on weaning. Recent Findings: Tolerance to an unassisted breathing does not require routine use of weaning predictors and can be addressed using weaning protocols or by implementing automatic weaning methods. Spontaneous breathing trial can be performed on low levels of pressure support, continuous positive airway pressure, or T-piece. Echocardiographic tools may help to prevent the failure of extubation. Noninvasive ventilation can prevent respiratory failure after extubation, when used in hypercapnic patients. Recently, sedation protocols and early mobilization in ventilated critically ill patients may decrease weaning period and duration of mechanical ventilation, and prevent extubation failure and complications such as ICU-acquired weakness. New techniques have been performed to identify patients with high risk for extubation failure. Summary: There is an interesting body of clinical research in the discontinuation of mechanical ventilation. Recent randomized controlled studies provide high-level evidence for the best approaches to weaning, especially in patients who fail the first spontaneous breathing trial or targeted populations. Copyright © 2015 Wolters Kluwer Health, Inc.
Alfonso F.,Hospital Universitario Of La Princesa |
Perez-Vizcayno M.J.,Hospital Universitario Clinico San Carlos |
Cardenas A.,Hospital Universitario Clinico San Carlos |
Garcia Del Blanco B.,Hospital Universitario Vall dHebron |
And 17 more authors.
Journal of the American College of Cardiology | Year: 2015
Background Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) remains a major challenge. Objectives This study evaluated the comparative efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients presenting with DES-ISR. Methods The study design of this multicenter randomized clinical trial assumed superiority of EES for the primary endpoint, in-segment minimal lumen diameter at the 6- to 9-month angiographic follow-up. Results A total of 309 patients with DES-ISR from 23 Spanish university hospitals were randomly allocated to DEB (n = 154) or EES (n = 155). At late angiography (median 247 days; 90% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p < 0.01) (absolute mean difference: 0.23 mm; 95% CI: 00.7 to 0.38), net lumen gain (1.28 ± 0.7 mm vs. 1.01 ± 0.7 mm; p < 0.01), and lower percent diameter stenosis (23 ± 22% vs. 30 ± 22%; p < 0.01) and binary restenosis rate (11% vs. 19%; p = 0.06), compared with patients in the DEB arm. Consistent results were observed in the in-lesion analysis. At the 1-year clinical follow-up (100% of patients), the main clinical outcome measure (composite of cardiac death, myocardial infarction, and target vessel revascularization) was significantly reduced in the EES arm (10% vs. 18%; p = 0.04; hazard ratio: 0.58; 95% CI: 0.35 to 0.98), mainly driven by a lower need for target vessel revascularization (8% vs. 16%; p = 0.035). Conclusions In patients with DES-ISR, EES provided superior long-term clinical and angiographic results compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent [RIBS IV]; NCT01239940) © 2015 American College of Cardiology Foundation.
Park J.-W.,Asklepios Klinik Harburg |
Bethencourt A.,Hospital Universitario Son Dureta |
Sievert H.,Cardiovascular Center Sankt Katharinen |
Santoro G.,Azienda Ospedaliera Universitaria Careggi |
And 7 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011
Background: In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from the left atrial appendage (LAA). Percutaneous closure of the LAA is a novel alternative for the treatment of patients with AF at a high risk of stroke, in whom long-term anticoagulation therapy is not possible or not desired. This study details the initial experience with the Amplatzer Cardiac Plug (ACP) in humans. Methods: Investigator-initiated retrospective preregistry data collection to evaluate procedural feasibility and safety up to 24 hr after implantation of the ACP, a nitinol device designed for percutaneous trans-septal implantation in LAA of patients with paroxysmal, permanent, or persistent AF. Results: In 137 of 143 patients, LAA occlusion was attempted, and successfully performed in 132 (96%). There were serious complications in 10 (7.0%) patients (three patients with ischemic stroke; two patients experienced device embolization, both percutaneously recaptured; and five patients with clinically significant pericardial effusions). Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia in two, and loss of the implant in the venous system in one patient. Conclusion: The implantation of the ACP device is a feasible method for percutaneous occlusion of the LAA. © 2011 Wiley-Liss, Inc.
Sanchez-Quintana D.,University of Extremadura |
Lopez-Minguez J.R.,Hospital Universitario Infanta Cristina |
Pizarro G.,European University at Madrid |
Murillo M.,University of Extremadura |
Cabrera J.A.,European University at Madrid
Current Cardiology Reviews | Year: 2012
The definition of atrial fibrillation (AF) as a functional electrical disorder does not reflect the significant underlying structural abnormalities. Atrial and Pulmonary Vein (PV) muscle sleeve microstructural remodeling is present, and establishes a vulnerable substrate for AF maintenance. In spite of an incomplete understanding of the anatomo-functional basis for AF, current evidence demonstrates that this arrhythmia usually requires a trigger for initiation and a vulnerable electrophysiological and/or anatomical substrate for maintenance. It is still unclear whether the trigger mechanisms include focal enhanced automaticity, triggered activity and/or micro re-entry from myocardial tissue. Initiation of AF can be favored by both parasympathetic and sympathetic stimulation, which also seem to play a role in maintaining AF. Finally, evolving clinical evidence demonstrates that inflammation is associated with new-onset and recurrent AF through a mechanism that possibly involves cellular degeneration, apoptosis, and subsequent atrial fibrosis. © 2012 Bentham Science Publishers.
Torres J.,Hospital Universitario Infanta Cristina |
Mingo C.,Hospital Universitario Infanta Cristina
Archivos Espanoles de Urologia | Year: 2015
OBJECTIVES: Many strategies have been proposed over the last years to ensure the Health Care System sustainability, mainly after the recent global economic crisis. One of the most attractive approaches is clinical management, which is a way of organizing health care units based on active participation of professionals who receive the transference of responsibilities to achieve the objectives with the mission of ensuring a proper patient centered care, taking into consideration the rational use of resources (Efficiency) For the start up of Health Care structures based on clinical management, it is necessary a previous management culture within the departments involved and the center's executive board. Furthermore, to achieve the objectives proposed various tools must be used, such as evidence based medicine, clinical practice variability analysis, process management, in addition of quality and safety strategies. The units involved have to propose a management plan that will result in a management contract with the center's executive board. This agreement will establish some activity, expense and quality objectives that will be quantifiable through various indicators. Risk transference to the unit must include certain budget allocation and incentive decision capacity. Clinical management must not be employed as a savings tool from the part of macro and meso management. There is not a health care structure based on clinical management that have a general character for all health care organizations, existing a great variability in the adoption of various organizational formulas, so that every center must perform its own analysis and decide the most adequate model. In our country there are many clinical management experiences, although there is a long way to go. dispo.
Errani C.,Instituto Ortopedico Rizzoli |
Ruggieri P.,Instituto Ortopedico Rizzoli |
Asenzio M.A.N.,Hospital Universitario Infanta Cristina |
Toscano A.,Instituto Ortopedico Rizzoli |
And 5 more authors.
Cancer Treatment Reviews | Year: 2010
Giant cell tumor is still one of the most controversial and discussed bone tumors. Surgical treatment options include intralesional excision or segmental resection. Curettage has a higher recurrence rate but does preserve adjacent joint function. After curettage, the use of adjuvant therapies is still controversial. Three hundred forty-nine patients with giant cell tumors of the extremity, treated in a single institution, were analyzed in a retrospective study. Two hundred patients underwent curettage of the lesion and in 64 of these cases, three local adjuvants, such as phenol, alcohol and cement, were employed. The hypothesis is that an "aggressive curettage" with phenol, alcohol and cement provides better local control and functional results. The correlation between tumor in the proximal femur and higher recurrence rate has not been recorded before. The results of the present study suggest that an "aggressive curettage" reduces the recurrence rate in a disease whose aggressiveness is not easy to predict. Special attention must be given to giant cell tumors not only in the distal radius, but also in the proximal femur, where the treatment is more difficult and associated with a higher rate of local recurrence. Crown Copyright © 2009.
Mora J.R.,Institute Salud Carlos III |
Lujan M.,Hospital Universitario Infanta Cristina
Archivos Espanoles de Urologia | Year: 2015
Every organization with the intention to be oriented to processes management must know it is a system and what are the factors that characterize it. Health care institutions are open and mixed systems. It is in this system where the chain of value of the productive process occurs, generating a very complex integrated management system, as the productive system main recipients are people with health needs.
Lopez-Minguez J.R.,Hospital Universitario Infanta Cristina |
Nogales-Asensio J.M.,Hospital Universitario Infanta Cristina |
Gonzalez-Fernandez R.,Hospital Universitario Infanta Cristina
Cardiovascular Revascularization Medicine | Year: 2014
We present two cases of right coronary artery occlusion in which MGuard® stent implantation failed for different causes, leading to a retrieval procedure adapted to the situation. Complete retrieval was possible in both cases. These cases illustrate the need for careful selection of the lesions that are going to be treated with this type of stent, for which pre-dilatation is recommended in severe lesions located just after an acute vessel angle, the evaluation of proximal angulation and calcification, as well as strategies for complete retrieval in case of implantation failure. © 2014 Elsevier Inc.
Fernandez-Rodriguez S.,University of Extremadura |
Tormo-Molina R.,University of Extremadura |
Maya-Manzano J.M.,University of Extremadura |
Silva-Palacios I.,University of Extremadura |
Gonzalo-Garijo T.,Hospital Universitario Infanta Cristina
Fungal Ecology | Year: 2014
Volume assessments of the concentration of airborne fungi may provide different results depending on the methodology used. This work simultaneously analyses two methods for samples obtained outdoors and analysed in the context of meteorological conditions. The study was carried out in Badajoz (SW Spain) from Mar. 2009 to Jul. 2011. A Burkard fixed spore trap was used for the non-viable sampling, and three different methods were used for the viable sampling: a Burkard portable spore trap with two inlet port types and a Sampl'air AES trap. Daily average total concentrations of 285CFUm-3 and 1954sporesm-3 were recorded for the viable and non-viable methods, respectively. The spore/colony ratio showed important differences among the most relevant fungal types: Alternaria (2.6), Aspergillus-Penicillium (2.0) and Cladosporium (11.1). Although the two sampling types were essentially equivalent at showing temporal variations in outdoor airborne fungi, quantitative differences in the number of total colonies recorded depended on the culture media and conditions used. © 2013 Elsevier Ltd and The British Mycological Society.
Beltran L.M.,Hospital Universitario La Paz |
Garcia-Casasola G.,Hospital Universitario Infanta Cristina
Revista Clinica Espanola | Year: 2014
Ultrasonography in the hands of the internist can answer important clinical questions quickly at the point of patient care. This technique "enhance" the senses of the physicians and improves their ability to solve the problems of the patient. Point of care ultrasonography performed by clinicians has shown good accuracy in the diagnosis of diverse cardiac, abdominal and vascular pathologic conditions. It may also be useful for evaluation of thyroid, osteoarticular and soft tissue diseases. Furthermore, the use of ultrasound to guide invasive procedures (placement of venous catheters, thoracentesis, paracentesis) reduces the risk of complications. We present 5 cases to illustrate the usefulness of this technique in clinical practice: (i) peripartum cardiomyopathy; (ii) subclinical carotid artery atherosclerosis; (iii) asymptomatic abdominal aortic aneurysm; (iv) tendinitis of long head of biceps brachii and supraspinatus, and (v) spontaneous soleus muscle haematoma.