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Baulies S.,Hospital Universitario Quiron Dexeus | Devesa M.,Hospital Universitario Quiron Dexeus | Garcia M.,Hospital Universitario Quiron Dexeus | Fargas F.,Hospital Universitario Quiron Dexeus | And 2 more authors.
Revista de Senologia y Patologia Mamaria | Year: 2017

The incidence of breast cancer (BC) has progressively increased, and approximately 15% of women will receive a diagnosis before the age of 45 years. This patient subgroup usually has more aggressive tumours and will be treated with systemic therapy (chemotherapy, hormone therapy, or both). In addition, the tendency to delay maternity implies that a many young patients with BC will not have fulfilled their reproductive wishes. The impact of cancer treatment on ovarian reserve depends on patient age, the type of regimen and the doses received. Senologists should be sensitive to their patients’ reproductive wishes and immediately refer them to Fertility Preservation Units. As shown by our results, referral does not imply a delay in treatment initiation. In our centre, 40 patients underwent ovarian tissue cryopreservation between 2010 and 2015. The mean number of days between BC diagnosis and the start of cancer treatment was 37.6 days. The mean time from stimulation (the start of stimulation until oocyte recovery) was 12 days (7-12). Therefore, we believe that young patients should be referred to a reproductive counselling unit, as recommended by EUSOMA. Fertility preservation requires liaison between the oncology and human reproduction teams. © 2017 SESPM


Belvis R.,Hospital Universitario Quiron Dexeus | Mas N.,Hospital Universitario Quiron Dexeus | Roig C.,Hospital Of La Santa Creu I Sant Pau
Revista de Neurologia | Year: 2015

Introduction. The International Headache Society (IHS) has published the third edition of the International Classification of Headache Disorders (ICHD-III beta), the most commonly used guide to diagnosing headaches in the world. Aims. To review the recent additions to the guide, to explain the new entities that appear in it and to compare the conditions that have had their criteria further clarified against the criteria in the previous edition. Development. We have recorded a large number of clarifications in the criteria in practically all the headaches and neuralgias in the classification, but the conditions that have undergone the most significant clarifications are chronic migraine, primary headache associated with sexual activity, short-lasting unilateral neuralgiform headache attacks, new daily persistent headache, medication-overuse headache, syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis. The most notable new entities that have been incorporated are external-compression headache, cold-stimulus headache, nummular headache, headache attributed to aeroplane travel and headache attributed to autonomic dysrefexia. Another point to be highlighted is the case of the new headaches (still not considered entities in their own right) included in the appendix, some of the most noteworthy being epicrania fugax, vestibular migraine and infantile colic. Conclusions. The IHS recommends no longer using the previous classification and changing over to the new classification (ICHD-III beta) in healthcare, teaching and research, in addition to making this new guide as widely known as possible. © 2015 Revista de Neurología.


Elkabets M.,Sloan Kettering Cancer Center | Pazarentzos E.,University of California at San Francisco | Juric D.,Massachusetts General Hospital | Sheng Q.,Novartis | And 23 more authors.
Cancer Cell | Year: 2015

Phosphoinositide-3-kinase (PI3K)-α inhibitors have shown clinical activity in squamous cell carcinomas (SCCs) of head and neck (H&N) bearing PIK3CA mutations or amplification. Studying models of therapeutic resistance, we have observed that SCC cells that become refractory to PI3Kα inhibition maintain PI3K-independent activation of the mammalian target of rapamycin (mTOR). This persistent mTOR activation is mediated by the tyrosine kinase receptor AXL. AXL is overexpressed in resistant tumors from both laboratory models and patients treated with the PI3Kα inhibitor BYL719. AXL dimerizes with and phosphorylates epidermal growth factor receptor (EGFR), resulting in activation of phospholipase Cγ (PLCγ)-protein kinase C (PKC), which, in turn, activates mTOR. Combined treatment with PI3Kα and either EGFR, AXL, or PKC inhibitors reverts this resistance. © 2015 Elsevier Inc.


Ribas M.,Hospital Universitario Quiron Dexeus | Cardenas C.,Hospital Universitario Quiron Dexeus | Astarita E.,Hospital Universitario Quiron Dexeus | Moya E.,Hospital Universitario Quiron Dexeus | Bellotti V.,Hospital Universitario Quiron Dexeus
HIP International | Year: 2014

In the previous decade, metal-on-metal hip resurfacing has been considered an attractive option and theoretically advantageous over conventional total hip arthroplasty, especially in young active patients. Different authors have reported favourable mid-term clinical and functional results with acceptable survival rates. Proper indication and planning, as accurate technical execution have been advocated to be crucial elements for success. Concerns regarding serum metal ion levels and possible clinical implications have led in the last years to a decline in the use of metal-on-metal hip resurfacing and metal-on-metal bearings in general. The aim of this study is to present the results of our first 486 cases of hybrid hip resurfacing arthroplasties with a second generation cementing technique, and to describe our current restricted indication of this type of prosthesis, in the light of recent findings in the literature about the possible complications related to metallosis or improper patient selection. Global survivorship of our series was 97.9% at a mean follow-up of 7.2 years. In the second season of our experience the indication is restrictive. The candidate for a resurfacing hip replacement is a young and active male patient, with good bone quality, that has been made aware of the risks and benefits of this type of prosthesis. © 2014 Wichtig Publishing.


Martinez F.,Hospital Universitario Quiron Dexeus | Clua E.,Hospital Universitario Quiron Dexeus | Devesa M.,Hospital Universitario Quiron Dexeus | Rodriguez I.,Hospital Universitario Quiron Dexeus | And 6 more authors.
Fertility and Sterility | Year: 2014

Objective: To assess the clinical pregnancy rate per transfer in recipients of embryos from donor oocytes obtained after ovarian stimulation initiated on day 2 (D2) or day 15 (D15) of the menstrual cycle with a secondary end point of comparing the response to stimulation. Design: Prospective observational comparative study. Setting: Private in vitro fertilization (IVF) program. Patient(s): Oocyte donors (OD) and recipients. Intervention(s): Donors stimulated within 3 months, starting on day 2 or day 15 after bleeding, with recombinant follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH) antagonist, and GnRH agonist trigger, and oocytes vitri fied and later assigned to recipients, followed by routine IVF procedures one to two embryos transferred. Main Outcome Measure(s): Primary outcome pregnancy rate, and secondary outcome number of mature oocytes retrieved. Result(s): Nine D2 and nine D15 cycles were performed in nine donors. There were no differences between D2 and D15 in the number of mature oocytes obtained (14.0 ± 6.96 vs. 16.89 ± 7.52). To date, 20 recipients have received vitrified oocytes (8 recipients received D2 oocytes and 12 recipients received D15 oocytes). There were no differences between the groups of recipients in fertilization rate (77.3% vs. 76.5%) or number of embryos transferred (1.50 ± 0.53 vs. 1.67 ± 0.65). Twelve clinical pregnancies were obtained. No differences were noted in pregnancy rates (62.5% vs. 58.3%) or implantation rates (41.67% vs. 45%) between recipients of D2 oocytes and recipients of D15 oocytes. Conclusion(s): Donor oocytes obtained after ovarian stimulation initiated on day 15 of the cycle achieve good pregnancy rates. This information is useful for patients with cancer undergoing fertility preservation. Clinical Trial Registration Number: NCT 01645241. ©2014 by American Society for Reproductive Medicine.


Ezpeleta D.,Hospital Universitario Quiron Madrid | Belvis R.,Hospital Universitario Quiron Dexeus
Kranion | Year: 2013

Primary headache associated with sexual activity is the more well-known headache for the medical community. Regarding the rest of primary headaches, we have always thought that they negatively influence sexual activity and vice versa. However, several recent studies reveal that: 1. sexual desire and arousal seem normal in migraine patients; 2. the orgasm can abort a cluster or migraine attack (some patients usually perform this "therapeutic orgasm"); 3. sexual satisfaction and sexual dysfunctions are similar to those in non-headache people; 4. we do not have appropriate studies to demonstrate iatrogenic sexual dysfunction induced by migraine drugs at migraine-dose. We present an up-to-date review about the relationship between sexual activity and primary headaches.


Arranz L.-I.,University of Barcelona | Rafecas M.,University of Barcelona | Alegre C.,Hospital Universitario Quiron Dexeus
Current Rheumatology Reports | Year: 2014

Many people throughout the world have both chronic pain and obesity. Overweight and obese people are more prone to a proinflammatory state manifesting as metabolic syndrome but also to a higher prevalence of chronic pain comorbidities. Obesity and a high body mass index (BMI) are associated with impaired functional capacity and reduced quality of life (QoL) in patients with chronic pain conditions. Systemic inflammation is not only involved in metabolic syndrome but it also initiates and perpetuates chronic pain. Changes in lifestyle, behavior, physical activity, and diet have demonstrated benefits in functional capacity and QoL; therefore, patient assessment should tackle high BMI and metabolic syndrome as part of the treatment of chronic pain. A healthier lifestyle would lead to a lower inflammatory state and consequently to an improvement in function and QoL in overweight or obese patients who have chronic pain conditions. © 2013 Springer Science+Business Media New York.


PubMed | Hospital Universitario Quiron Dexeus
Type: Journal Article | Journal: Fertility and sterility | Year: 2016

To evaluate in our setting whether there is currently a level of P on the hCG day (P-hCG) predictive of no pregnancy.Observational study of prospectively collected data of the P-hCG levels of stimulated IVF cycles.In vitro fertilization unit.All cycles of IVF/intracytoplasmic sperm injection with fresh embryo transfer performed between January 2009 and March 2014.None.Pregnancy rate.Clinical pregnancy rate per ET was 38.7% and live birth rate was 29.1%. The P-hCG concentration was positively correlated to E2 on the hCG day, and the number of oocytes was negatively correlated to age. Progesterone on hCG day was higher among agonist- compared with antagonist-treated patients (mean SD: 1.13 0.69 ng/mL vs. 0.97 0.50 ng/mL) and among recombinant FSH compared with recombinant FSH + hMG stimulation (mean SD: 1.11 0.58 ng/mL vs. 0.94 0.50 ng/mL). Pregnancy rate was positively associated with the number of oocytes. There was no correlation between P-hCG value and pregnancy rate, overall or according to the type of treatment.In our setting there is no P-hCG value differentiating a good from a poor cycle success rate.NCT02323347.


PubMed | Hospital Of Sabadell, Hospital Universitario Of Basurto, University of Barcelona, Hospital Universitario Quiron Dexeus and 10 more.
Type: Journal Article | Journal: BJOG : an international journal of obstetrics and gynaecology | Year: 2016

To evaluate whether maintenance treatment with vaginal progesterone after an arrested preterm labour reduces the incidence of preterm delivery.Multicentre, randomised, double-blind, placebo-controlled trial.Twelve tertiary care centres in Spain.A total of 265 women with singleton pregnancy, preterm labour successfully arrested with tocolytic treatment, and cervical length of <25mm.Randomisation was stratified by gestational age (from 24.0 to <31.0weeks of gestation and from 31.0 to <34.0weeks of gestation) and centre. Patients were randomly assigned, in a 1:1 ratio, to either daily vaginal capsules of 200mg progesterone or placebo until delivery or 36.6weeks of gestation, whichever occurred first.Primary outcome was delivery before 34.0 and 37.0weeks of gestation. Secondary outcomes were discharge-to-delivery time, readmissions because of preterm labour, emergency service use, and neonatal morbidity and mortality.From June 2008 through June 2012, 1419 women were screened: 472 met the inclusion criteria and 265 were randomised. The final analysis included 258 women: 126 in the progesterone group and 132 in the placebo group. There were no significant differences between the progesterone and placebo groups in terms of delivery at <34weeks of gestation [9/126 (7.1%) versus 10/132 (7.6%), P=0.91] or <37weeks of gestation [36/126 (28.6%) versus 29/132 (22.0%), P=0.22]. There were no differences observed between groups when considering the two strata of gestational age at inclusion.A maintenance treatment of 200mg of daily vaginal progesterone capsules in women discharged home after an episode of arrested preterm labour did not significantly reduce the rate of preterm delivery.Maintenance progesterone in 258 women after arrested PTL showed no benefit.


PubMed | Hospital Universitario Quiron Dexeus and Hospital Universitari Of Bellvitge
Type: Journal Article | Journal: Acta otorrinolaringologica espanola | Year: 2016

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty.

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