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Hospital de Órbigo, Spain

De Vries E.F.J.,University of Groningen | Roca M.,Hospital Universitario Of Bellvitge | Jamar F.,Catholic University of Louvain | Israel O.,Rambam Health Care Campus | Signore A.,University of Rome La Sapienza
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2010

We describe here a protocol for labelling autologous white blood cells with 99mTc-HMPAO based on previously published consensus papers and guidelines. This protocol includes quality control and safety procedures and is in accordance with current European Union regulations and International Atomic Energy Agency recommendations. © 2010 The Author(s). Source

Villabona C.,Hospital Universitario Of Bellvitge
Endocrinologia y Nutricion | Year: 2010

The non -peptide vasopressin antagonists (VPA), called vaptans, were developed in the 1990s to antagonize both the pressor and antidiuretic effects of vasopressin.There are three subtypes of VPA receptors: V1a, V1b and V2. V1a receptors are widely distributed in the body, mainly the blood vessels and myocardium. The V1b receptors are located mainly in the anterior pituitary gland and play a role in ACTH release. V2 receptors are located in the collecting tubular renal cells. Both V1a and V1b receptors act through the intracellular phosphoinositol signalling pathway, Ca++ being the second messenger. V2 receptors work through AMPc generation, which promotes aquaporin 2 (AQP2) trafficking and allows water to enter the cell.The vaptans act competitively at the AVP receptor. The most important are mozavaptan, lixivaptan, satavaptan and tolvaptan, all of which are selective V2 antagonists and are administered through the oral route. In contrast, conivaptan is a dual V1 and V2 antagonist administered through the endovenous route. The main characteristics of vaptans are their effect on free water elimination without affecting electrolyte excretion. There are several studies on the effects of these drugs in hypervolemic hyponatremia (heart failure, hepatic cirrhosis) as well as in normovolemic hyponatremia (inappropriate secretion of ADH [SIADH]).Current studies show that the vaptans are effective and well tolerated, although knowledge of these drugs remains limited. There are no studies of the use of vaptans in severe hyponatremia. Osmotic demyelination syndrome due to excessively rapid correction of hyponatremia has not been described. © 2010 Sociedad Española de Endocrinología y Nutrición. Source

Grau-Carmona T.,Hospital Universitario Doce Of Octubre | Bonet-Saris A.,Intensive Care Unit | Garcia-De-Lorenzo A.,Hospital Universitario La Paz | Sanchez-Alvarez C.,Hospital General Universitario Reina Sofia | And 5 more authors.
Critical Care Medicine | Year: 2015

Objective: n-3 polyunsaturated fatty acids (contained in fish oil) have been shown to beneficially influence infection rate and clinical outcomes in surgical patients probably due to their immunomodulatory action. In contrast, study results of fish oil administration in critically ill patients are controversial. The aim of this study was to investigate the effects of n-3 polyunsaturated fatty acids on the prevalence of nosocomial infections and clinical outcomes in medical and surgical critically ill patients. Design: Prospective, multicenter, randomized, comparative, double- blind study. Setting: Seventeen Spanish ICUs during 4 years. Subjects: A total of 159 medical and surgical intensive care patients with Acute Physiology and Chronic Health Evaluation II score more than or equal to 13, expected to require total parenteral nutrition for at least 5 days. Interventions: Patients received total parenteral nutrition prepared either with a lipid emulsion containing 10% fish oil or a fish oil-free lipid emulsion. The prevalence of nosocomial infections was detected during 28 days of ICU stay. Patients were followed 6 months after discharge from the ICU for length of hospital stay, hospital mortality, and 6-month mortality. Measurements and Main Results: The number of patients with nosocomial infections was significantly reduced in the fish oil-receiving group (21.0% vs 37.2%, p = 0.035) and the predicted time free of infection was prolonged (21 ± 2 vs 16 ± 2 d, p = 0.03). No significant differences were detected for ICU, hospital, and 6-month mortality. Conclusions: The results show that administration of n-3 polyunsaturated fatty acids reduces the risk of nosocomial infections and increases the predicted time free of infections in critically ill medical and surgical patients. The administration of n-3 polyunsaturated fatty acids was safe and well tolerated. Source

We present a systematic review of clinical trials to evaluate the efficacy of infusing local anesthetic through a catheter placed in the abdominal surgical wound. The Jadad (Oxford) scoring system was used to select trials. The variables considered in relation to each trial selected were as follows: type of intervention and incision; type, dose, and concentration of local anesthetic; site where the catheter was placed; rescue analgesia required; opioid use; and incidence of adverse events. Fifteen clinical trials with a mean Jadad score of 4.6 were selected. The 1139 patients enrolled in the trials were grouped according to catheter placement: subfascial (6 trials), subcutaneous (8 trials), and both (1 trial). Six additional unpublished trials registered at ClinicalTrials.gov were also located. Surgical wound analgesia is a safe technique whose effectiveness has been observed in cesarean sections and hysterectomies performed with Pfannenstiel incisions. Outcomes for other types of surgery are inconsistent. There is a lack of studies of the optimal site for catheter placement as well as of adequate anesthetic concentration and volume. Source

Santin Cerezales M.,Hospital Universitario Of Bellvitge | Elorza E.N.,Hospital Universitario Ramon y Cajal
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2011

The susceptibility to infection, the pathogenesis and the clinical manifestations of tuberculosis (TB) depend on the immunological status of the host. Immunological status is largely determined by age and comorbidities, but is also affected by other less well known factors. In Spain, most incidental cases of TB arise from the reactivation of remotely acquired latent infections and are favored by the aging of the population and the use of aggressive immunosuppressive therapies. The diagnosis and management of TB in these circumstances is often challenging. On the one hand, the atypical presentation with extrapulmonary involvement may delay diagnosis, and on the other, the toxicity and interactions of the antituberculous drugs frequently make treatment difficult. Immigration from resource-poor, high incidence TB countries, where the social and economic conditions are often suboptimal, adds a new challenge to the control of the disease in Spain. This chapter summarizes our current knowledge of epidemiological, clinical and treatment aspects of TB in particularly susceptible populations. © 2011 Elsevier España S.L. Source

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