Pozuelo de Alarcón, Spain
Pozuelo de Alarcón, Spain

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Abejon D.,Hospital Universitario Quiron Madrid | Rueda P.,Medtronic | Del Saz J.,Hospital Universitario Quiron Madrid | Arango S.,Hospital Universitario Quiron Madrid | And 2 more authors.
Neuromodulation | Year: 2015

Introduction Neurostimulation is the process and technology derived from the application of electricity with different parameters to activate or inhibit nerve pathways. Pulse width (Pw) is the duration of each electrical impulse and, along with amplitude (I), determines the total energy charge of the stimulation. Objectives The aim of the study was to test Pw values to find the most adequate pulse widths in rechargeable systems to obtain the largest coverage of the painful area, the most comfortable paresthesia, and the greatest patient satisfaction. Material and Methods A study of the parameters was performed, varying Pw while maintaining a fixed frequency at 50 Hz. Data on perception threshold (Tp), discomfort threshold (Td), and therapeutic threshold (Tt) were recorded, applying 14 increasing Pw values ranging from 50 μsec to 1000 μsec. Lastly, the behavior of the therapeutic range (TR), the coverage of the painful area, the subjective patient perception of paresthesia, and the degree of patient satisfaction were assessed. Results The findings after analyzing the different thresholds were as follows: When varying the Pw, the differences obtained at each threshold (Tp, Tt, and Td) were statistically significant (p < 0.05). The differences among the resulting Tp values and among the resulting Tt values were statistically significant when varying Pw from 50 up to 600 μsec (p < 0.05). For Pw levels 600 μsec and up, no differences were observed in these thresholds. In the case of Td, significant differences existed as Pw increased from 50 to 700 μsec (p ≤ 0.05). The coverage increased in a statistically significant way (p < 0.05) from Pw values of 50 μsec to 300 μsec. Good or very good subjective perception was shown at about Pw 300 μsec. Conclusions The patient paresthesia coverage was introduced as an extra variable in the chronaxie-rheobase curve, allowing the adjustment of Pw values for optimal programming. The coverage of the patient against the current chronaxie-rheobase formula will be represented on three axes; an extra axis (z) will appear, multiplying each combination of Pw value and amplitude by the percentage of coverage corresponding to those values. Using this new comparison of chronaxie-rheobase curve vs. coverage, maximum Pw values will be obtained different from those obtained by classic methods. © 2014 International Neuromodulation Society.


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.


Munoz-Jareno N.,Hospital Infanta Leonor | Fernandez-Mayoralas D.M.,Hospital Universitario Quiron Madrid | Martinez-Cervell C.,Hospital Clinico San Carlos | Campos-Castello J.,Hospital Clinico San Carlos
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.


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.


Monteagudo M.,Hospital Universitario Quiron Madrid | Maceira E.,Hospital Universitario Quiron Madrid | Garcia-Virto V.,Complejo Hospitalario Of Segovia | Canosa R.,Hospital Universitario Quiron Madrid
International Orthopaedics | Year: 2013

Purpose: The purpose of this study was to compare results of partial proximal fasciotomy (PPF) with proximal medial gastrocnemius release (PMGR) in the treatment of chronic plantar fasciitis (CPF). Method: This retrospective study compares 30 patients with CPF that underwent PPF with 30 that underwent isolated PMGR. Both groups were matched in terms of previous treatments and time from onset of symptoms to surgery. Different standardised evaluation scales (VAS, Likert, AOFASh) were used to evaluate results. Results: Plantar fasciotomy had satisfactory results in just 60 % of patients, with an average ten weeks needed to resume work and sports. Patient satisfaction in the PMGR group reached 95 %, being back to work and sports at three weeks on average. Functional and pain scores were considerably better for PMGR and fewer complications registered. Conclusion: In our series, isolated PMGR is a simple and reliable procedure to treat patients with CPF. It provides far better results than conventional fasciotomy with less morbidity and better patient satisfaction, and thus has become our surgical procedure of choice in recalcitrant CPF. © 2013 Springer-Verlag Berlin Heidelberg.


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.


Carod-Artal F.J.,Hospital Virgen Of La Luz | 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.


Espada M.,Hospital Universitario Quiron Madrid | Garcia-Flores J.R.,Hospital Universitario Quiron Madrid | Jimenez M.,Hospital Universitario Quiron Madrid | Alvarez-Moreno E.,Hospital Universitario Quiron Madrid | And 5 more authors.
European Radiology | Year: 2013

Objectives: To analyse the diagnostic accuracy and to establish a predictive score based on diffusion-weighted magnetic resonance imaging (DWMRI) compared to exploratory laparotomy (EL) for predicting suboptimal cytoreductive surgery for different intra-abdominal sites of implants in patients with ovarian cancer. Methods: Thirty-four patients with advanced ovarian carcinoma were studied. Preoperative DWMRI of the abdomen and pelvis was performed. DWMRI findings were compared with EL. Ten anatomical sites were selected for inclusion in the score. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for suboptimal cytoreduction were calculated for both DWMRI and EL. Receiver operating characteristic (ROC) curve analysis was used to assess the ability to predict suboptimal cytoreduction. Results: Using predictive score, ROC curves were generated with an area under the curve of 0.938 for DWMRI and 0.947 for EL (P < 0.0001). For DWMRI, a score ≥6 had the highest overall accuracy at 91.1 % and identified patients with unnecessary EL with a sensitivity of 75 %. For EL, a score ≥4 had the highest overall accuracy at 88.2 % and was able to identify patients with unnecessary EL with a sensitivity of 87.5 %. Conclusions: DWMRI is an emerging technique that may be useful to predict suboptimal cytoreduction in ovarian cancer. Key Points: • DWMRI is increasingly used in ovarian cancer. • DWMRI is an accurate technique for depicting intra-abdominal sites of implants • DWMRI is useful for predicting optimal cytoreductive surgical outcome. • We report a high predictive value similar to exploratory laparotomy. © 2013 European Society of Radiology.


Echave-Sustaeta J.M.,Hospital Universitario Quiron Madrid | Comeche Casanova L.,Hospital Universitario Quiron Madrid | Cosio B.G.,Hospital Universitario Son Espases | Soler-Cataluna J.J.,Hospital Arnau Of Vilanova | And 2 more authors.
International journal of chronic obstructive pulmonary disease | Year: 2014

BACKGROUND AND OBJECTIVE: Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients.PATIENTS AND METHODS: In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated.RESULTS: Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage.CONCLUSION: COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity.


Alonso R.C.,Hospital Universitario Quiron Madrid | de la Pena M.J.,Hospital Universitario Quiron Madrid | Caicoya A.G.,Hospital Universitario Quiron Madrid | Rodriguez M.R.,Hospital Universitario Quiron Madrid | And 2 more authors.
Radiographics | Year: 2012

Cerebrospinal fluid (CSF) fistulas are characterized by the egress of CSF from the intracranial cavity through an osteodural disruption between the subarachnoid space and a pneumatized structure within the skull base. Depending on the cause, CSF fistulas are classified as acquired or congenital, and acquired fistulas are further classified as traumatic, nontraumatic, or spontaneous. Spontaneous CSF fistulas are considered to result from a multifactorial process and have been postulated to represent a variant of idiopathic intracranial hypertension. However, an anatomic predisposition involving thinning of the cranial base, such as pneumatization of the sinus walls, must also be present. This process creates areas of structural weakness that act as potential pathways for CSF leaks, which most commonly occur in the ethmoid roof, sphenoid sinus, and temporal bone. Because CSF leaks may be overlooked, a result of their asymptomatic or subtle, intermittent course, a high level of suspicion is crucial in making an early diagnosis. However, CSF fistulas may be well seen at computed tomography (CT), which depicts bone defects, and magnetic resonance cisternography, which reveals the contents of herniated tissue. Knowledge of the location and size of the bone defect and herniated contents is crucial for the selection of surgical approach and grafting material. © RSNA, 2013.

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