Martin M.C.,Hospital Universitario Of Torrejon |
Leon C.,University of Seville |
Cunat J.,Hospital Universitario La Paz |
Del Nogal F.,Hospital Severo Ochoa
Medicina Intensiva | Year: 2013
Objectives: To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities. Design: Prospective observational study. Setting: Spanish hospitals. Participants: Heads of the Services of ICM. Main outcome variables: Number of units and beds for critically ill patients and functional dependence. Results: The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5%. A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units. Conclusions: Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent. © 2013 Elsevier España, S.L. and SEMICYUC.
PubMed | Complutense University of Madrid, Rey Juan Carlos University, Hospital Universitario Of Torrejon, European University at Madrid and University of San Pablo - CEU
Type: Journal Article | Journal: Actas urologicas espanolas | Year: 2016
Recently, the European Randomized Study of Screening for Prostate Cancer achieved a reduction in prostate cancer mortality by measuring serum prostate-specific antigen (PSA) levels. These results were not reproduced in the Spanish arm of European Randomized Study of Screening for Prostate Cancer. PSA contamination (opportunistic measurements outside the study) could decrease the studys contrasting power if performed in the control arm. We have calculated the long-term rate of PSA contamination and its effect on performing prostate biopsy and detecting cancer.A total of 4,276 men were randomised (2,415 to the screening arm, 1,861 to the control arm) in the Spanish section of the European Randomized Study of Screening for Prostate Cancer. PSA measurements were not scheduled in the control arm. Sextant prostate biopsy was indicated if PSA levels were 3 ng/mL. All PSA readings performed outside the study were labelled as PSA contamination. We calculated the rates of PSA contamination, biopsy implementation and cancer detection.The median age and follow-up time were 57 and 15.1 years, respectively. A total of 2,511 men underwent at least one PSA reading outside the study. PSA contamination at 5, 10 and 15 years was 22.0%, 47.1% and 66.3% in the screening arm, respectively, and 20.8%, 43.2% and 58.6% in the control arm, respectively (P<.0001). The biopsy rate at 5, 10 and 15 years was 19.3%, 22.6% and 24.1% (screening), respectively, and 1.0%, 3.6% and 7.1% (control), respectively (P<.0001). The PC detection rate was 6.7% (screening) and 4.3% (control; P=.0006).Although the cumulative PSA contamination was pronounced in the 2 study arms, the rate of prostate biopsies was low in the control arm. We therefore believe that the effect of PSA contamination on the studys statistical power should be limited.
Casares Santiago M.,Hospital Universitario Of Torrejon |
Garcia-Tutor E.,Hospital Universitario Guadalajara |
Rodriguez Caravaca G.,Hospital Universitario Fundacion Alcorcon |
Del Cerro Gonzalez J.,Hospital Universitario Guadalajara |
And 2 more authors.
European Radiology | Year: 2014
Objectives: Preoperative planning of deep inferior epigastric perforator (DIEP) flaps has become increasingly important in radiology services as multidetector CT angiography (CTA) has been proven to be the technique of choice. We aim to optimise the process, checking the value of the "Navarra criteria," assessing radiological and surgical concordance. Methods: Preoperative CTA was obtained in 105 DIEP flaps involving 101 women (mean age 49.1 years). A main perforator pedicle and an alternative were chosen, applying a modification of the "Navarra criteria," assessing the correlation between the main perforator chosen by the radiologist and the one that was ultimately used to perform the flap using the Kappa index. Results: In 100 of the 105 DIEP flaps (95.2 %), the perforator pedicles chosen were ultimately used to raise the flap. Four of the perforator pedicles that were not used were dismissed due to avoidable errors in the radiological approach. Concordance was very high, with a Kappa index of 0.93 (95 % CI: 0.87-0.99). CT room time was less than 12 minutes, and reading time was 10 minutes. Conclusions: The application of the "Navarra criteria" in preoperative planning of DIEP flaps improves radiological and surgical concordance as well as the reading process. Key Points: • DIEP flap is one of the best techniques for breast reconstruction. • Preoperative planning is essential in DIEP flaps. • CTA is the best option for the preoperative planning of DIEP flaps. • "Navarra criteria" allow radiologists to choose the best perforator to form flaps. • Modified "Navarra criteria" improves radiological and surgical concordance. © 2014 European Society of Radiology.
Resano Barrio P.,Hospital Universitario Of Guadalajara |
Cabezon Gutierrez L.,Hospital Universitario Of Torrejon
Medicina Paliativa | Year: 2015
Cancer pain is a complex and highly important problem in daily clinical practice. Although cancer is usually painless in the early phases of its development, the prevalence of chronic pain is 30%-50% in cancer patients undergoing active treatment and 79%-90% in patients with advanced disease. The true prevalence of breakthrough cancer pain is unclear and varies widely across studies, ranging from 19% to 93%. Dyspnea is a highly frequent symptom that is common to many diseases, indicating its multisystemic origin. This symptom can occur in respiratory and non-respiratory diseases. Dyspnea is present in up to 78% of patients with lung cancer. We describe two clinical cases in which fentanyl pectin nasal spray was used in the management of both breakthrough cancer pain and dyspnea exacerbations, providing strong symptomatic relief in both patients. © 2015 Sociedad Española de Cuidados Paliativos. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.
PubMed | Complutense University of Madrid, Hospital Universitario Of Torrejon and Francisco de Vitoria University
Type: | Journal: Revista clinica espanola | Year: 2017
Cardiovascular diseases are still the most common cause of death, and heart failure is the most common reason for hospitalization of patients older than 65 years. However, Cardiology attributes low importance to end-of-life care. Cardiac patients perception of their diseases prognosis and the results of cardiopulmonary resuscitation differ greatly from reality. The do not resuscitate order allows patients to pre-emptively express their rejection for cardiopulmonary resuscitation, thereby avoiding its potentially negative consequences. However, these orders are still underused and misinterpreted in cardiac patients. Most of these patients usually have no opportunity to have the necessary conversations with their attending physician on their resuscitation preferences. In this review, we performed an analysis of the causes that could explain this situation.
Infantile hemangiomas treated by sequential application of pulsed dye laser and Nd:YAG laser radiation: A retrospective study [Hemangiomas infantiles tratados con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo]
Alcantara-Gonzalez J.,Hospital Universitario Ramon y Cajal |
Alcantara-Gonzalez J.,Hospital Universitario Of Torrejon |
Boixeda P.,Hospital Universitario Ramon y Cajal |
Truchuelo-Diez M.T.,Hospital Universitario Ramon y Cajal |
And 3 more authors.
Actas Dermo-Sifiliograficas | Year: 2013
Background and objectives: Infantile hemangiomas are the most common benign tumor in children. They have 3 phases of development: a proliferative phase, an involuting phase, and involution. Although active treatment is often not required, it is necessary in some cases. Of the possible treatments for hemangiomas, lasers have been shown to be effective in all phases of development. We report our experience with dual-wavelength sequential pulses from a pulsed dye laser and an Nd:YAG laser. Material and methods: This was a retrospective, descriptive study of patients with infantile hemangioma in different phases of development treated with pulsed dye laser pulses followed by Nd:YAG laser pulses. Four dermatologists assessed the effectiveness of treatment on a scale of 10 to 0. Adverse effects and incidents related to treatment were recorded. The median and interquartile range were calculated as descriptive statistics. Pretreatment and posttreatment comparisons were performed using the Wilcoxon test. Results: Twenty-two patients with hemangiomas in different phases of development were included. A statistically significant improvement was obtained both for the entire group and for different subgroups. Posttreatment events were reported in 4 patients, and included edema and ulceration, skin atrophy, and hyperpigmentation. Conclusions: We believe that treatment with dual-wavelength light from a pulsed dye laser and a Nd:YAG laser is a viable treatment option for infantile hemangiomas when first-line therapies are ineffective or contraindicated. © 2012 Elsevier Espña, S.L. and AEDV. All rights reserved.
Lledin Barbancho L.,Hospital Infantil La Paz |
Vecino Lopez R.,Hospital Universitario Of Torrejon
Pediatria Integral | Year: 2015
Symptomatology of gastrointestinal disease is a very common cause of pediatric consultation in the clinical practice. The majority of cases are not important processes and need no further diagnostic laboratory or imaging work-up. The main challenge for paediatricians is to detect those cases that need them. The approach to the evaluation of children with hepatobiliary disease may occasionally be a difficult task. Therefore, a thorough history and clinical examination is mandatory, focusing on key findings that may ultimately lead to diagnosis. An accurate interpretation of laboratory and radiological tests, as well as a rationale use of the latter has to be the rule in this context. Here we review in a clear, brief and practical presentation the most important diagnostic tests in liver disease, its advantages and limitations © 2015, Ediciones Ergon SA. All Righrts Reserved.
Comin Cabrera C.,Hospital Universitario Of Torrejon |
Sanchez Perales F.,Hospital Universitario Of Torrejon
Pediatria de Atencion Primaria | Year: 2015
Laryngomalacia is the most common congenital laryngeal abnormality underlying stridor in infants, and usually resolves spontaneously before two years of age. However, a small percentage of cases have no such favorable evolution, so it is important to identify severe cases with clinical consequences and perform a thorough differential diagnosis. Principal signs of concern are the presence of apnea or failure to thrive. We present two cases of interest in this field, one because of severe clinical consequences at early onset and the other because of late resolution with sleeping apnea episodes lived as threatening by the family. A careful clinical anamnesis, including perinatal details and surgical history, and a complete physical examination (stridor characteristics, peculiar facial features, skin lesions) are the key to an appropriate diagnosis approach. Awake flexible nasopharyngolaryngoscopy may achieve diagnosis of most supraglotic abnormalities, even though it may fail when detecting dynamic dysfunctions appearing only in certain circumstances (e.g. asleep patient in supine position). Fibrobronchoscopy under sedation, in patients breathing spontaneously, has been proven a safe and effective tool in the differential diagnosis of stridor in childhood. Moreover, it can be used as therapeutic approach in the same procedure, by means of different techniques under deep sedation or general anesthesia depending on their complexity. © 2015, Spanish Association of Primary Care Pediatrics. All rights reserved.
Cabezon Gutierrez L.,Hospital Universitario Of Torrejon |
Khosravi Shahi P.,Hospital Universitario Of Torrejon
Medicina Paliativa | Year: 2015
Despite adequate control of chronic cancer pain with major opioids, some patients experience transitory and intense exacerbations. These exacerbations, known as breakthrough pain, are characterized by rapid onset, short duration and strong intensity. Episodes of breakthrough pain require specific treatment with analgesics tailored to relieve this type of pain. Notable among these analgesics is a transmucosal nasal fentanyl formulation in a pectin-based gel (PecFent®), whose clinical development is summarized in this article. © 2015 Sociedad Española de Cuidados Paliativos. Published by Elsevier España, S.L.U. All rights reserved.
Eimil-Ortiz M.,Hospital Universitario Of Torrejon
Medicina Paliativa | Year: 2016
Objectives: To review medical literature regarding the implementation of Palliative care (PC) in acute stroke and to analyze its theoretical and practical framework: definition, criteria and screening tools developed for referral, patients ´profile and major needs and comparison between different palliative care patients. Methods: In order to achieve our goal, a systematic research was conducted using public data bases: PubMed, Tripdatabase, Embase. Terms employed: ". palliative care AND stroke", ". end of life AND stroke", ". advanced care directives AND stroke", ". neuro-critical AND acute stroke". We accepted all kind of articles published until september 1st 2015. Through a comprehensive reading of the articles, the following categories of papers were rejected: clinical cases, articles on basic sciences, other illness besides acute stroke, and those articles regarding chronic states. In order to achieve clarity in the exposition, bibliography was expanded if needed. 291 articles were evaluated. After reading abstracts and expanding bibliography with cross-references if needed, 29 articles formed the basis for this review. Conclusions: PC applied to acute stroke is similar to PC applied to other diseases. The needs of patients focus on symptomatic relief (dyspnea, respiratory secretions, pain, agitation), but they presented as differentiating factors a lower perception of imminent death by the family, doubts about the prognosis of patients, coexistence of potentially curativetreatment and high mortality, existence of communication problems and on nutrition and other ethical considerations. Tools for easy sreening usually include severity of stroke and age. The management of PC sometimes lies on specific teams but also on professionals who work in the stroke unit with special concern about this approach. An accepted approach implements the theoretical framework of the tradicional palliative care in potentially curable patients. © 2016 Sociedad Española de Cuidados Paliativos.