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Mengual-Ballester M.,Hospital Universitario Morales Meseguer | Alcaraz-Mateos E.,Hospital Universitario Jose Maria Morales Meseguer
Cirugia y Cirujanos | Year: 2014

Background: Retrorectal or presacral space is occupied during embryological stem cell development and therefore may contain a heterogeneous group of tumors.Clinical case: We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst. Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor and magnetic resonance diagnosis of a presacral cystic compatible wtih germ cell tumor. The tumor was removed surgically through the abdomen and diagnosis of cystic teratoma was established.Conclusion: Retrorectal tumors are rare lesions whose presence must be ruled out in case of recurrent sinus. © 2014 Cir Cir.

Mora R.B.,Hospital Universitario Morales Meseguer
Southern Medical Journal | Year: 2010

Urinothorax or urothorax (UT) is a rare condition which often goes undiagnosed. In published cases of UT, the pleural fluid is usually transudative and is very rarely exudative. We present a case of UT after right nephroureterectomy for urothelial carcinoma, in which the pleural fluid presented characteristics of exudate. The diagnosis of UT was confirmed with the finding of a pleural/serum creatinine ratio above one and after demonstrating the presence of a postsurgical urinoma in the right renal fossa. UT should be included in the differential diagnosis of pleural effusion in patients with a recent urinary tract disorder, even when it is pleural exudate. © 2010 by The Southern Medical Association.

Teruel R.,University of Murcia | Perez-Sanchez C.,Hospital Universitario Reina Sofia | Corral J.,University of Murcia | Perez-Andreu V.,University of Murcia | And 7 more authors.
Journal of Thrombosis and Haemostasis | Year: 2011

Background:Tissue factor (TF) is the main initiator of the coagulation cascade and elements that may upregulate its expression might provoke thrombotic events. Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are autoimmune diseases characterized by a high TF expression in monocytes. Objectives:To examine the role of microRNAs (miRNAs) in TF expression and to evaluate their levels in SLE and APS patients. Methods:An in silico search was performed to find potential putative binding sites of miRNAs in TF mRNA. In vitro validation was performed transfecting cells expressing TF (THP-1 and MDA-MB-231) with oligonucleotide miRNA precursors and inhibitors. Additionally, reporter assays were performed to test for the binding of miR-20a to TF mRNA. Levels of miRNAs and TF were measured by quantitative (qRT-PCR) in patients with APS and SLE. Results:Overexpression of miRNA precursors, but not inhibitors, of two of the members of cluster miR-17∼92, for example miR-19b and miR-20a, in cells expressing TF decreased TF mRNA, protein levels, and procoagulant activity between 30% and 60%. Reporter assays showed that miR-20a binds to TF mRNA. Finally, we measured levels of miR-19b and miR-20a in monocytes from patients with APS and SLE and observed significantly lower miRNAs levels in comparison with healthy subjects inversely correlated with the levels of TF. Conclusions:Down-regulation of miR-19b and miR-20a observed in patients with SLE and APS could contribute to increased TF expression and thus provoke the hypercoagulable state characteristic of these patients. © 2011 International Society on Thrombosis and Haemostasis.

Vilchez J.A.,University of Birmingham | Vilchez J.A.,Hospital Universitario Virgen Of La Arrixaca | Gallego P.,University of Birmingham | Gallego P.,Hospital Universitario Morales Meseguer | Lip G.Y.H.,University of Birmingham
Therapeutic Advances in Drug Safety | Year: 2014

The recent development of new oral anticoagulants (NOACs) offers the possibility of efficacy, relative safety and convenience compared with warfarin. This could lead to greater patient compliance, with easier management and improved provision of thromboprophylaxis. Safety whilst using NOACs should be focused on bleeding cases, surgery or on the management of patients receiving anticoagulant therapy with concomitant impairment of renal function, especially since many NOACs are dependent on renal excretion. Thus, if the clearance creatinine indicates severe renal impairment, NOACS will be contraindicated or their dose needs to be changed. In patients who need surgery, there are published protocols of management, depending on the severity of the intervention and renal function. In the case of severe hemorrhage, requiring rapid reversal of the anticoagulant effect and in the absence of specific antidotes, alternatives such as one of the nonspecific haemostatic agents must be considered. Clinical evaluation in bleeding situations and a meticulous risk-benefit appraisal for NOACs is needed, and these procoagulant agents and patients must be monitored closely. This article provides an overview of the pharmacology and potential risks, as well as the efficacy and safety of NOACs. © The Author(s), 2013.

Alberca-de-las-Parras F.,Hospital Clinico Universitario Virgen Of La Arrixaca | Marin F.,Hospital Clinico Universitario Virgen Of La Arrixaca | Roldan-Schilling V.,Hospital Universitario Morales Meseguer | Carballo-Alvarez F.,Hospital Clinico Universitario Virgen Of La Arrixaca
Revista Espanola de Enfermedades Digestivas | Year: 2015

The use of antithrombotic drugs (anticoagulants and antiplatelets) has increased significantly with our understanding of cardiovascular risk. Encountering patients on these therapies who require an endoscopic procedure is therefore increasingly common. At decision making the endoscopist must rely on other specialists (basically cardiologists and hematologists) as risk not only lies among increased bleeding odds but also in the possibility of thrombosis following dose discontinuation or change. Understanding the pharmacology, indications, and risks of endoscopic procedures is therefore essential if sound decisions are to be made. The efforts of four scientific societies have been brought together to provide clinical answers on the use of antiplatelets and anticoagulants, as well as action algorithms and a practical protocol proposal for endoscopy units. © 2015 Arán Ediciones, S. L.

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