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Hospital de Órbigo, Spain

Perin F.,Hospital Universitario Virgen Of Las Nieves | Rodriguez Vazquez Del Rey M.M.,Hospital Universitario Virgen Of Las Nieves | Deiros Bronte L.,Hospital Universitario La Paz | Ferrer Menduina Q.,Hospital Universitario Vall dHebron | And 6 more authors.
Anales de Pediatria | Year: 2014

Objective The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers. Methods Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography. Results A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months. Conclusions Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial. © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved. Source

Perin F.,Hospital Universitario Virgen Of Las Nieves | Rodriguez Vazquez M.M.,Hospital Universitario Virgen Of Las Nieves | Ferrer Menduina Q.,Hospital Universitario Of La Vall Dhebron | Deiros Bronte L.,Hospital Universitario La Paz | And 6 more authors.
Acta Pediatrica Espanola | Year: 2015

Introduction and objective: Optimal treatment for fetal tachycardia is still controversial. The aim of this study is to review the actual management and outcome of fetal tachycardia in 9 Spanish centers. Method: Retrospective multicentric study: analysis of all fetuses with tachycardia diagnosed at 9 Spanish centers between January 2008 and September 2010. Results:37 cases were registered, 30% of which were hydropic. We had 26 no hydropic cases, of which 4 atrial flutter-all of them successfully cardioverted intrautero or after delivery- and 22 with supraventricular tachycardia (SVT), of which 17 short ventriculo-auricular (VA) interval and 5 long VA interval. Digoxin was the drug of choice in most cases. Prenatal control of the tachycardia was achieved in 93% of treated SVT with short VA interval and 50% of long VA, being digoxine effective in short VA but not long VA interval (p= 0.019). 1 fetus with supraventricular tachycardia with ventricular dysfunction died. 11 cases were hydropic, all of them diagnosed as SVT. Management strategies were highly diverse in this group. 5 patients died: 1 after delivery, 2 intrautero very shortly after starting treatment, and 2 intrautero in spite of being successfully cardioverted to sinus rhythm (1 with Sotalol, 1 with flecainide). Conclusions: Hydropic fetuses have shown a high mortality rate in our population, which calls for further studies and unification of criteria. Here we propose a common protocol aimed at improving the outcome of fetal tachycardia. © 2015 Ediciones Mayo, S.A. All rights reserved. Source

Longo-Munoz F.,Hospital Universitario Ramon y Cajal | Argiles G.,Autonomous University of Barcelona | Tabernero J.,Autonomous University of Barcelona | Cervantes A.,University of Valencia | And 7 more authors.
Clinical and Translational Oncology | Year: 2016

Purpose: TAS-102 is a combination of the thymidine-based nucleoside analog trifluridine and the thymidine phosphorylase inhibitor tipiracil. Efficacy and safety of TAS-102 in patients with metastatic colorectal cancer (mCRC) refractory or intolerant to standard therapies were evaluated in the phase 3 RECOURSE trial. Results of RECOURSE demonstrated significant improvement in overall survival (OS) and progression-free survival (PFS) with TAS-102 versus placebo [hazard ratio (HR) = 0.68 and 0.48 for OS and PFS, respectively; both P < 0.001]. The current analysis evaluates efficacy and safety of TAS-102 in the RECOURSE Spanish subgroup. Methods: Primary and key secondary endpoints were evaluated in a post hoc analysis of the RECOURSE Spanish subgroup, using univariate and multivariate analyses. Safety and tolerability were reported with descriptive statistics. Results: The RECOURSE Spanish subgroup included 112 patients (mean age 61 years, 62 % male). Median OS was 6.8 months in the TAS-102 group (n = 80) versus 4.6 months in the placebo group (n = 32) [HR = 0.47; 95 % confidence interval (CI): 0.28–0.78; P = 0.0032). Median PFS was 2.0 months in the TAS-102 group and 1.7 months in the placebo group (HR = 0.47; 95 % CI: 0.30–0.74; P = 0.001). Eighty (100 %) TAS-102 versus 31 (96.9 %) placebo patients had adverse events (AEs). The most common drug-related ≥Grade 3 AE was neutropenia (40 % TAS-102 versus 0 % placebo). There was 1 (1.3 %) case of febrile neutropenia in the TAS-102 group versus none in the placebo group. Conclusions: In the RECOURSE Spanish subgroup, TAS-102 was associated with significantly improved OS and PFS versus placebo, consistent with the overall RECOURSE population. No new safety signals were identified. ClinicalTrials.gov study number: NCT01607957 © 2016 Federación de Sociedades Españolas de Oncología (FESEO) Source

Call Manosa S.,Hospital Universitario Of Sabadell | Pujol Garcia A.,UFISS | Chacon Jordan E.,Hospital Universitario Of Sabadell | Marti Hereu L.,Hospital Universitario Of Sabadell | And 6 more authors.
Enfermeria Intensiva | Year: 2016

An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO).A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk.The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters. . .).A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning.Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model.This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. © 2016. Source

Perica Pijaume J.C.,Hospital Universitario Of Sabadell | Pisa Gatell A.,Hospital Universitario Of Sabadell | Dotor Navarro E.,Hospital Universitario Of Sabadell | Llort Pursals G.,Hospital Universitario Of Sabadell | Saigi Grau E.I.,Hospital Universitario Of Sabadell
Revisiones en Cancer | Year: 2013

Gastric cancer has experienced a reduction in incidence and mortality rates at the expense of the locations in body and antrum, with an increased incidence in the gastroesophageal junction. The main pathogenetic factors for gastric carcinogenesis are environmental factors, genetic and specific comorbidities that confer increased risk. The main ones are gastric Helicobacter pylori infection, aging, food with high salt content or smoked or canned foods, chronic atrophic gastritis, family history of stomach cancer, among others. It is known that various molecular alterations are important in gastric carcinogenesis. We have studied different ways, such as EGFR and the MAPK pathway, Human epidermal growth factor receptor type 2, E-cadherin and Wnt/catenin, Hedgehog, COX-2/PGE2, nuclear factor kappa B (NFkappaB), and growth Transformig factor beta (TGFbeta)/bone morphogenic proteins (BMPs). An estimated 10 % of gastric neoplasms is a familial aggregation, and that 1-3 % of gastric neoplasms are the result of hereditary predisposition syndromes. Depending on the histology can be classified into: Intestinal Gastric Cancer Family (CGIF), familial diffuse gastric cancer (CGDF) or hereditary diffuse gastric cancer (HDGC). Copyright © 2013 Aran Ediciones, s. L. Source

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