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Patel V.R.,Florida Hospital Celebration Health | Patel V.R.,University of Central Florida | Schatloff O.,Florida Hospital Celebration Health | Chauhan S.,Florida Hospital Celebration Health | And 8 more authors.
European Urology | Year: 2012

Background: Macroscopic landmarks are lacking to identify the cavernosal nerves (CNs) during radical prostatectomy. The prostatic and capsular arteries run along the lateral border of the prostate and could help identify the location of the CNs during robot-assisted radical prostatectomy (RARP). Objective: Describe the visual cues that have helped us achieve consistent nerve sparing (NS) during RARP, placing special emphasis on the usefulness of the prostatic vasculature (PV). Design, setting, and participants: Retrospective video analysis of 133 consecutive patients who underwent RARP in a single institution between January and February 2011. Surgical procedure: NS was performed using a retrograde, antegrade, or combined approach. Measurements: A landmark artery (LA) was identified running on the lateral border of the prostate corresponding to either a prostatic or capsular artery. NS was classified as either medial or lateral to the LA. The area of residual nerve tissue on surgical specimens was measured to compare the amount of NS between the groups. Results and limitations: We could identify an LA in 73.3% (195 of 266) of the operated sides. The area of residual nerve tissue was significantly different whether the NS was performed medial (between the LA and the prostate) or lateral to the LA (between the LA and pelvic side wall): median (interquartile range) of 0 (0-3) mm 2 versus14 (9-25) mm 2; p < 0.001, respectively. Conclusions: The PV is an identifiable landmark during NS. Fine tailoring on the medial border of an LA can consistently result in a complete or almost complete NS, whereas performing the NS on its lateral border results in several degrees of incomplete NS. © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.


Hernandez Guitian J.,Central University of Venezuela | Hernandez Guitian J.,Hospital Universitario Of Caracas
Investigacion Clinica (Venezuela) | Year: 2015

Leptin was characterized for the first time 20 years ago as an anorexigenic peptide that acts on the hypothalamus and has since been described as having a key role in the functioning of a great number of tissues. The mouth is one of the areas of the body where this peptide influences processes, such as growth induction and differentiation of various dental and periodontal tissues, modulation of sweet tastes’ perception in the taste buds, swallowing regulation and immune response activation. Moreover, leptin also plays an important role in mediating the response to different oral aggressors, such as periodontopathic bacteria and alcohol, as well as its involvement in certain types of mouth cancer. This review aims to provide an overview of leptin’s known roles on the oral cavity to date, ranging from its function in a healthy mouth to its involvement in oral physiopathology. © 2015, Instituto de Investigaciones Clinicas. All rights reserved.


Simmons R.K.,Institute of Metabolic Science | Alberti K.G.M.M.,St Marys Hospital | Gale E.A.M.,University of Bristol | Colagiuri S.,University of Sydney | And 11 more authors.
Diabetologia | Year: 2010

This article presents the conclusions of a WHO Expert Consultation that evaluated the utility of the 'metabolic syndrome' concept in relation to four key areas: pathophysiology, epidemiology, clinical work and public health. The metabolic syndrome is a concept that focuses attention on complex multifactorial health problems. While it may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool. Further efforts to redefine it are inappropriate in the light of current knowledge and understanding, and there is limited utility in epidemiological studies in which different definitions of the metabolic syndrome are compared. Metabolic syndrome is a pre-morbid condition rather than a clinical diagnosis, and should thus exclude individuals with established diabetes or known cardiovascular disease (CVD). Future research should focus on: (1) further elucidation of common metabolic pathways underlying the development of diabetes and CVD, including those clustering within the metabolic syndrome; (2) early-life determinants of metabolic risk; (3) developing and evaluating context-specific strategies for identifying and reducing CVD and diabetes risk, based on available resources; and (4) developing and evaluating population-based prevention strategies. © 2009 World Health Organization, 2009. Published by Springer-Verlag GmbH Berlin, Heidelberg, 2009. All Rights Reserved.


Garcia E.,Hospital Clinico San Carlos | Martin P.,Hospital Clinico San Carlos | Hernandez R.,Hospital Clinico San Carlos | Rodriguez V.,Hospital Universitario Of Caracas | And 4 more authors.
Catheterization and Cardiovascular Interventions | Year: 2014

Objectives Balloon valvuloplasty (BV) before transcatheter aortic implantation has been thought to be mandatory before the valve is implanted. We have explored the feasibility and safety of direct implantation of balloon expandable Edwards SAPIEN XT valve without prior balloon dilatation. Background Some complications after transcatheter aortic valve replacement (TAVR) have been associated with unwanted effects of BV, mainly the contribution to stroke and severe aortic regurgitation (AR) before the valve is implanted. Direct implantation with a self-expanding aortic valve has been recently reported. Methods From November 2011 to April 2012, ten patients were selected that met the following criteria in the transesophageal echocardiography (TEE): moderate calcification, homogeneous distribution of calcium, symmetrical opening of the valve, and some degree of aortic insufficiency. Results All patients had symptomatic aortic stenosis of a native valve and high surgical risk; six patients had the valve mildly calcified, in four patients the degree of calcification was moderate the native valve was crossed and the prosthetic aortic valve was properly positioned in all cases and implanted in the correct position. No patient underwent post-dilatation and trivial AR was present in four patients there were no adverse events (death, need for pacemaker, myocardial infarction, or stroke). At 30 days post-procedure, all patients were alive and had significant clinical improvement. Conclusions Direct implantation of Edwards SAPIEN XT without prior BV in selected cases is feasible and safe the number of patients in whom this technique would be applicable, and their impact on reducing complications has to be determined. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.


Gutierrez-Gonzalez L.A.,Hospital Universitario Of Caracas
Clinical Rheumatology | Year: 2015

Rheumatological conditions can sometimes present as emergencies. These can occur due to the disease process or infection; contrary to what many people think, rheumatologic emergencies like a pain, rheumatic crisis, or attack gout do not compromise the patient's life. This article mentioned only true emergencies: catastrophic antiphospholipid syndrome (cAPS), kidney-lung syndrome, central nervous system (CNS) vasculitis, anti-Ro syndrome (neonatal lupus), and macrophage activation syndrome (MAS). The management of above emergencies includes critical care, immunosuppression when indicated, and use of a diagnostic flowchart as well as fast laboratory profile for making decisions. Anticoagulants have to be used in the management of antiphospholipid syndrome. A good understanding of these conditions is of paramount importance for proper management. © 2015, International League of Associations for Rheumatology (ILAR).


Bellorin-Font E.,Hospital Universitario Of Caracas
Nefrología : publicación oficial de la Sociedad Española Nefrologia | Year: 2013

The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chronic kidney disease mineral and bone disorders (CKD-BMD) in adults, of the Latin American Society of Nephrology and Hypertension (SLANH) comprise a set of recommendations developed to support the doctor in the management of these abnormalities in adult patients with stages 3-5 kidney disease. This excludes changes associated with renal transplantation. The topics covered in the guidelines are divided into four chapters: 1) Evaluation of biochemical changes, 2) Evaluation of bone changes, 3) Evaluation of vascular calcifications, and 4) Treatment of CKD-MBD. The guidelines are based on the recommendations proposed and published by the Kidney Disease: Improving Global Outcomes (KDIGO) for the prevention, diagnosis, evaluation and treatment of CKD-MBD (KDIGO Clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease Mineral and Bone Disorder [CKD-MBD]), adapted to the conditions of patients, institutions and resources available in Latin America, with the support of KDIGO. In some cases, the guidelines correspond to management recommendations directly defined by the working group for their implementation in our region, based on the evidence available in the literature. Each chapter contains guidelines and their rationale, supported by numerous updated references. Unfortunately, there are few controlled studies with statistically sufficient weight in Latin America to support specific recommendations for the region, and as such, most of the references used correspond to studies carried out in other regions. This highlights the need to plan research studies designed to establish the current status of mineral and bone metabolism disorders in Latin America as well as defining the best treatment options for our population.


Serra-Bonett N.,Hospital Universitario Of Caracas | Rodriguez M.A.,Hospital Universitario Of Caracas
Rheumatology International | Year: 2011

Autoimmune diseases result from an interplay between susceptibility genes and environmental factors. These interacting etiopathogenetic components converge in a critical step preceding disease, the loss of tolerance to self. In this review, we examine the evidences linking tobacco smoking with the initiation and perpetuation of inflammation affecting both the synovial membrane and the endothelial lining in patients with rheumatoid arthritis. This disease is a compelling argument for the decisive role of environment in the triggering of a human autoimmune disease in genetically prone individuals. © 2010 Springer-Verlag.


Gutierrez-Gonzalez L.A.,Hospital Universitario Of Caracas
Current Rheumatology Reports | Year: 2016

The use of biologics has been associated with the paradoxical development of biologics-induced autoimmune diseases. The purpose of this review was to describe the key immunopathogenic mechanisms involved in the development of these conditions, and to discuss the clinical and laboratory characteristics usually described in the medical literature, reviewing case reports as well as records on national biologic therapies (BIOGEAS, RABBIT, BSRBR-RA, BIOBADAVEN). More than 200 cases have so far been reported, all of them diagnosed on the basis of the histopathology or meeting the ACR/Chapel Hill criteria. Over 75 % of the cases were females with a mean age of 48 ± 5 years. More than 50 % had rheumatoid arthritis. Most of the biologics-associated vasculitis developed in 90 ± 31 days. Complete resolution in almost 75 % of the cases was observed upon treatment discontinuation; however, steroid therapy was indicated for all patients and one death was recorded. The use of cyclophosphamide, rituximab or plasma exchange was reserved for the most severe cases. © 2016, Springer Science+Business Media New York.


Pujadas-Arias Z.,Hospital Universitario Of Caracas
Informe Medico | Year: 2012

This is a clinical case of a 23 years old female patient who presented paroxysmal episodes of increased volume in the lumbar region. She started current disease nine months after injection, for esthetical reasons, of 250 mL of polymethylmethacrylate, as a filler substance, in gluteal region. Symptoms began with inflammation in the lumbar region, accompanied by pain, fever and chills that recurred seven times, every four months. Soft tissue ultrasound images were obtained, showing several anechoic, oval dispersed foreign images in the lumbosacral area. Unfortunately, no current effective treatment is available for this iatrogenic disorder. Iatrogenic allogenosis, is a new disease that could be considered a public health problem because of the number of annual cases reported. The adverse reactions to soft tissue filling substances may occur in some patients some hours after or up to 25 years post-administration.


Mangupli R.,Hospital Universitario Of Caracas | Camperos P.,Hospital Universitario Of Caracas | Webb S.M.,Autonomous University of Barcelona
Pituitary | Year: 2014

Objectives: AcroQoL is a questionnaire developed to assess quality of life in patients with acromegaly, covering physical and psychological dimensions. This study was designed to determine AcroQoL score changes and concentrations of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), before and after treatment with octreotide-LAR (oct-LAR) in acromegaly.Methods: Retrospective observational study of 28 acromegalic patients with a mean age of 45 years (range 28–64), evaluated over a 4-year period, before and during treatment with oct-LAR in clinical practice conditions.Results: Baseline AcroQoL score (53 ± 15) improved after oct-LAR treatment (70 ± 15) globally for the 28 patients (p < 0.001). Three patients in whom AcroQoL score did not improve over time had severe headaches, which did not disappear. In patients who normalized, both GH (<2.5 μg/L) and IGF-1, AcroQoL score increased on average by 22 points (p = 0.003); when GH and IGF-1 improved, but did not normalize, AcroQol score increased on average by 16 points (p = 0.008). In 6 patients with discordant results, AcroQol score tended to improve if IGF-1 normalized (n = 4, p = 0.066), but not if IGF-1 remained high.Conclusion: Oct-LAR therapy in acromegaly improved quality of life scores in parallel to biochemical markers, except in patients with severe headaches. The AcroQoL questionnaire is an additional tool to establish therapeutic effectivity. © 2013, Springer Science+Business Media New York.

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