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Sanchez-Quintana A.,Hospital Universitario Nuestra Senora Of La Candelaria
BMJ case reports | Year: 2013

We describe a case of progressive multifocal leucoencephalopathy (PML) in a 39-year-old patient diagnosed with chronic lymphocytic leukaemia (CLL) who underwent two allogenic matched-sibling stem cell transplantations. PML was confirmed just after the first transplantation with cerebral MRI and by PCR in the cerebrospinal fluid. After immunosuppression withdrawal and cidofovir treatment, he achieved a reversal of clinical symptoms, John Cunningham (JC) virus positivity and MRI lesions regression. He remained asymptomatic for 5 years with no signs of infection activity, even though he received three new chemotherapy regimens due to a CLL relapse. However, after the second stem cell transplantation, new neurological symptoms began and a reactivation of the JC virus infection was detected. This time, treatment with mefloquine was started, but he experienced a progressive neurological deterioration and died 1 month after the symptoms began. Source


Perez-Etchepare E.,Hospital Universitario Nuestra Senora Of La Candelaria
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2012

Pericardial tamponade is a rare medical emergency in children. We describe a 16 years old patient, who presented with pneumonia localized in upper left lobe complicated with lung abscess and ipsilateral pleural effusion, associated with pericardial effusion. The initial treatment was: broad-spectrum antibiotics, left thoracic drenage and pericardiocentesis After 24 hours postoperative, developed circulatory collapse with significant increase in pericardial effusion. The preoperative studies were thoracic CT-scann and echocardiography, showing an increase of pericardial effusion with no major changes in lung pathology. We performed a pericardial window by right thoracoscopic. After this, quickly improved clinically and the echocardiography 24 hours postoperatively was normal. The thoracoscopic approach in cases of pericardial tamponade is an useful alternative, benefiting the patient of minimally invasive approaches. Source


Perez-Etchepare E.,Hospital Universitario Nuestra Senora Of La Candelaria
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2013

Costal osteochondromas are benign, uncommon and usually asymptomatic tumors, but may be associated with severe intrathoracic complications such as pneumothorax, hemothorax, nerve or vascular injury and fractures. We report a 12 year old patient, who presented a right spontaneous pneumothorax, which did not improve with standard treatment. Thoracic CT showed a costal exostosis of 2.5 cm in length. Excision was performed by videothoracoscopy (VATS), with good postoperative course. We consider the thoracoscopic approach as the most appropriate initial way in this type of tumors. Source


Alcazar Navarrete B.,Neumologia | Casanova C.,Hospital Universitario Nuestra Senora Of La Candelaria | Miravitlles M.,Hospital Universitari Vall dHebron | de Lucas P.,Hospital General Universitario Gregorio Maranon | And 2 more authors.
Archivos de Bronconeumologia | Year: 2015

Introduction: Indications for inhaled corticosteroids (IC) in combination with long-acting bronchodilators (LABD) are well defined in clinical practice guidelines. However, there are some doubts about their efficacy and safety. The aim of this document is to establish an expert consensus to clarify these issues. Method: A coordinator group was formed, which systematically reviewed the scientific evidence with the aim of identifying areas of uncertainty about the efficacy of ICs, the adverse effects associated with their use and criteria for withdrawal. Their proposals were submitted to a panel of experts and the Delphi technique was used to test the level of consensus. Results: Twenty-five experts participated in the panel, and consensus was reached on the use of IC in the mixed chronic obstructive pulmonary disease (COPD)-asthma phenotype and in frequent exacerbators, and on not using IC in association with LABD for improving lung function in COPD. There was no general consensus on restricting the use of IC to prevent adverse effects. The panel did agree that IC withdrawal is feasible but should be undertaken gradually, and patients who have discontinued must be evaluated in the short term. Conclusions: Consensus was reached regarding the indication of IC in mixed COPD-asthma and frequent exacerbator phenotypes. The potential for adverse effects must be taken into consideration, but there is no consensus on whether limiting use is justified. The withdrawal of ICs was uniformly agreed to be feasible. © 2014 SEPAR. Source


Alvarez-Acosta L.,Hospital Universitario Nuestra Senora Of La Candelaria
BMJ case reports | Year: 2013

A 14-year-old asymptomatic girl without relevant medical history was referred to our department for heart murmur evaluation. The echocardiogram showed cardiac chambers with normal size and function. Noteworthy was the presence of an apparently fibrous tissue joining the ventricular surfaces of the aortic non-coronary and right coronary leaflets with the anterior mitral leaflet. Both valves were slightly thickened and there was a mild anterior mitral valve 'billowing' causing an eccentric mild-to-moderate regurgitant jet. During systole, tethering of this tissue caused the incomplete opening of both mentioned aortic leaflets, causing a turbulent flow with no significant gradient across the valve. During diastole, moderate eccentric aortic regurgitation jet was noted, probably related to incomplete coaptation at the insertion point of this anomalous tissue. We speculate that this finding may represent the remnant of some tissue during heart development that abnormally persisted in this young lady. Source

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