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Pozuelo de Alarcón, Spain

Vazquez-Sequeiros E.,Hospital Universitario Ramon y Cajal | Gonzalez-Panizo-Tamargo F.,Hospital Universitario Quiron Madrid | Boixeda-Miquel D.,Hospital Universitario Ramon y Cajal | Milicua J.M.,Hospital Universitario Ramon y Cajal
Revista Espanola de Enfermedades Digestivas | Year: 2011

Background: endoscopic ultrasonography (EUS) and magnetic resonance cholangiography (MRC) are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC). Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRC and EUS were compared, and so their impact in the management of these patients. Results: seventy six patients were evaluated (lithiasis in 30% of them). Sensitivity and diagnostic accuracy of EUS (100%, 92%) were significantly higher than MRC values (0%, 70%) (p < 0.05). EUS findings (suspicion of choledocholithiasis) favored a significant change in therapeutic attitude (therapeutic ERCP was performed) in 38% of the patients (in which MRC had ruled out the presence of choledocholithiasis, and so, ERCP had not been performed) (p < 0.05). Conclusions: EUS allows the diagnosis of lithiasis in approximately 1/3 of patients with intermediate suspicion of choledocholithiasis and normal MRC. EUS findings involve a significant change in the management of these patients; this supports the use of EUS in clinical practice. © 2011 ARÁN EDICIONES, S. L.

Fernandez-Mayoralas D.M.,Hospital Universitario Quiron Madrid | Martinez-Cervell C.,Servicio de Estadistica y Medicina Preventiva
Revista de Neurologia | Year: 2011

Introduction. Migraine is a common complaint in childhood. Atopy is the predisposition to the complaint of one or more of the following conditions: atopic dermatitis, rhinoconjunctivitis and asthma. Aim. To examine whether there is a relationship between atopy, taking into account each of its different variants, and migraine with or without aura. The practical application of knowing about this association includes improvement in the diagnosis of migraine, which is often difficult in children. Subjects and methods. We performed a retrospective case-control study of children (5-15 years old) with and without migraine; recruitment time: six months. Data evaluated included age, sex, questions from a questionnaire about atopy to measure prevalence, and medical diagnosis that appears in the patient's medical record and overall (intersection of the previous ones), among other things. A statistical analysis was performed. The odds ratio (OR) and the 95% confidence interval were both estimated. Confusion factors were studied. Results. Altogether 216 children were analysed. The prevalence of atopic dermatitis (OR = 7.1; p < 0.01), rhinoconjunctivitis (OR = 7.3; p < 0.01) and allergic asthma (OR = 4.69; p < 0.01), as well as their previous and overall medical diagnoses, is significantly higher and more severe in children with migraine. Dermatitis and rhinitis are more commonly diagnosed in the cases with aura. Conclusions. The prevalence and the percentage of prior and overall diagnoses of the three atopic diseases are significantly higher in children with migraine. © 2011 Revista de Neurología.

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.

Carod-Artal F.J.,Servicio de Neurologia | Irimia P.,University of Navarra | Ezpeleta D.,Hospital Universitario Quiron Madrid
Revista de Neurologia | Year: 2012

Introduction. Chronic migraine is the most frequent complication of migraine. It is defined by the presence of headache on 15 or more days a month, of which at least eight must meet the criteria of migraine without aura for a minimum of three months. In addition they must not be due to medication abuse or attributable to any other cause. Development. The prevalence of chronic migraine ranges between 1-3% of the population and its incidence has been estimated to be 2.5% per year. It produces from four to six times more disability, decreased productivity and disruption of quality of life than episodic migraine. The development of chronic migraine has been associated with both non-modifiable risk factors (being female, low socio-economic status and level of schooling) and modifiable risk factors (anxiety, depression, sleep apnoea/snoring, obesity, consumption of painkillers and caffeine). Patients with chronic migraine suffer from chronic pain, anxiety or depression two to three times more often than those with episodic migraine. Management requires identification and control of the risk factors that predispose patients to develop the condition, detoxification therapy in the event of abuse of analgesics, specific treatment for migraine attacks and preventive treatment. The effectiveness of the preventive drugs topiramate and Onabotulinumtoxin A in this complication of migraine has been proved in large-scale placebo-controlled clinical trials. Conclusions. Chronic migraine is a common condition that requires global management aimed at reducing the frequency of the attacks, lowering the associated disability and improving the patients' quality of life.

Maceira E.,Hospital Universitario Quiron Madrid | Monteagudo M.,Hospital Universitario Quiron Madrid
Foot and Ankle Clinics | Year: 2014

Functional hallux rigidus is a clinical condition in which the mobility of the first metatarsophalangeal joint is normal under non-weight-bearing conditions, but its dorsiflexion is blocked when first metatarsal is made to support weight. In mechanical terms, functional hallux rigidus implies a pattern of interfacial contact through rolling, whereas in a normal joint contact by gliding is established. Patients with functional hallux rigidus should only be operated on if the pain or disability makes it necessary. Gastrocnemius release is a beneficial procedure in most patients. © 2014 Elsevier Inc.

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