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Di Cosimo S.,University of Barcelona | Di Cosimo S.,Hospital Universitario Vall dHebron
Targeted Oncology | Year: 2011

Trastuzumab is regarded as the foundation of care for HER2-positive breast cancer as it has revolutionized the treatment of this disease across all settings. Although generally well tolerated, patients may develop symptomatic or asymptomatic cardiotoxicity, forcing a discontinuation of treatment, therefore preventing patients from benefiting from maximal disease control. Evolving research supports that trastuzumab-induced cardiotoxicity may be prevented or at least minimized by a number of prophylactic measures, such as identification of patients at risk and close monitoring. Optimized chemotherapy regimens, scheduling and formulations also contribute to minimizing cardiac adverse events. Equally important, if cardiotoxicity develops, medical interventions are now available that facilitate the reintroduction of trastuzumab once normal cardiac function has been restored. Awareness of this still-evolving information may lead to optimal use of trastuzumab, especially in combination regimens, maximizing antitumor benefit, while minimizing risk. © Springer-Verlag 2011.


Vallejo Llamas J.C.,Hospital Universitario Central Of Asturias | Ruiz-Camps I.,Hospital Universitario Vall dHebron
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2012

Invasive fungal infection (IFI), caused by both yeasts and moulds, is a persistent problem, with high morbidity and mortality rates among patients on chemotherapy for haematology diseases, and hematopoietic stem cell transplant recipients. Management of IFI in these types of patients has become highly complex with the advent of new antifungals and diagnostic tests, resulting in different therapeutic strategies (prophylactic, empirical, pre-emptive, and targeted). A proper assessment of the risk for IFI of each individual patient appears to be critical in order to use the best prophylactic and therapeutic approach, and to increase the survival rates. Among the available antifungals, the most frequently used are fluconazole, mould-active azoles (itraconazole, posaconazole, voriconazole), candins (anidulafungin, caspofungin, micafungin), and amphotericin B (particularly its lipids formulations). Specific recommendations for use and the criteria for selection of antifungal agents are discussed in this paper. © 2012 Elsevier España, S.L. All rights reserved.


Medeiros M.D.,Institute Microcirugia Ocular | Navarro R.,Institute Microcirugia Ocular | Garcia-Arumi J.,Institute Microcirugia Ocular | Garcia-Arumi J.,Hospital Universitario Vall dHebron | And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2013

PURPOSE. To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant, over 6 months in patients with recalcitrant CME due to Irvine-Gass syndrome. METHODS. Retrospective review of the medical records of nine patients with refractory macular edema (ME) due to Irvine-Gass syndrome, who underwent a single intravitreal injection of dexamethasone implant, Ozurdex, between November 2010 and January 2012, at the Instituto de Microcirurgia Ocular, Barcelona, Spain. All patients underwent a complete ophthalmic evaluation, including best-corrected visual acuity (BCVA) using standardized ETDRS charts, tonometry, fluorescein angiography, and spectral-domain optical coherence tomography with foveal thickness (FT) measurement. RESULTS. The mean duration of CME before treatment with Ozurdex was 9.1 months (range, 6-13 months). At baseline, the mean FT was 542.22 ± 134.78 μm. Mean (SD) values of FT did decrease to 350.88 ± 98.71 μm (P = 0.001) at month 1 and 319.22 ± 60.96 μm (P = 0.002) at month 3. Data on the 6-month follow-up showed a mild increase 398.33 ± 127.89 lm (P = 0.031). The mean (SD) change from baseline FT was 191.33 μm (a decrease value of 35%) at month 1, and 223.00 μm (decrease value of 41%) and 143.89 μm (decrease value of 26%) at month 3 and month 6, respectively. The baseline BCVA data were 0.62 ± 0.15 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.47 ± 0.21 logMAR (P = 0.008) and 0.37 ± 0.24 logMAR (P = 0.001) after month 1 and month 3, respectively. At the last visit (6-month follow-up), the mean BCVA was 0.37 6 ±.26 logMAR (P = 0.002). CONCLUSIONS. In this study, both mean FT and mean BCVA had improved from baseline by 1 month after treatment with a dexamethasone implant, and the improvement remained statistically significant throughout the 6-month study. © 2013 The Association for Research in Vision and Ophthalmology, Inc.


Brignole M.,Arrhythmologic Center | Moya A.,Hospital Universitario Vall dHebron | Andresen D.,Vivantes Klinikum Am Urban | Blanc J.J.,Brest University Hospital Center | And 6 more authors.
Circulation | Year: 2012

Background-The efficacy of cardiac pacing for prevention of syncopal recurrences in patients with neurally mediated syncope is controversial. We wanted to determine whether pacing therapy reduces syncopal recurrences in patients with severe asystolic neurally mediated syncope. Methods and Results-Double-blind, randomized placebo-controlled study conducted in 29 centers in the Third International Study on Syncope of Uncertain Etiology (ISSUE-3) trial. Patients were 40 years, had experienced 3 syncopal episodes in the previous 2 years. Initially, 511 patients, received an implantable loop recorder; 89 of these had documentation of syncope with 3 s asystole or 6 s asystole without syncope within 12±10 months and met criteria for pacemaker implantation; 77 of 89 patients were randomly assigned to dual-chamber pacing with rate drop response or to sensing only. The data were analyzed on intention-to-treat principle. There was syncope recurrence during follow-up in 27 patients, 19 of whom had been assigned to pacemaker OFF and 8 to pacemaker ON. The 2-year estimated syncope recurrence rate was 57% (95% CI, 40-74) with pacemaker OFF and 25% (95% CI, 13-45) with pacemaker ON (log rank: P=0.039 at the threshold of statistical significance of 0.04). The risk of recurrence was reduced by 57% (95% CI, 4-81). Five patients had procedural complications: lead dislodgment in 4 requiring correction and subclavian vein thrombosis in 1 patient. Conclusions-Dual-chamber permanent pacing is effective in reducing recurrence of syncope in patients 40 years with severe asystolic neurally mediated syncope. The observed 32% absolute and 57% relative reduction in syncope recurrence support this invasive treatment for the relatively benign neurally mediated syncope. Clinical Trial Registration-URL: http://www. clinicaltrials.gov. Unique identifier: NCT00359203. © 2012 American Heart Association, Inc.


The European Cubicin® Outcome Registry and Experience (EU-CORE) is a retrospective, non-interventional, multicenter database of daptomycin use in several European countries. This database provides information on the routine use of this antibiotic to treat various infections caused by Gram-positive microorganisms. This article describes the demography, clinical characteristics, and outcomes of patients treated in Spanish hospitals participating in the EUCORE database, as well as the types of infection and causal pathogens involved. Overall, most indications and dosing regimens of daptomycin were within the health authorities' approved criteria, although the antibiotic was sometimes used for other clinical situations and at doses higher than those currently established. Daptomycin was mainly used as rescue therapy, and the efficacy and safety of the drug were very high. The experience gained with the EUCORE database suggests that daptomycin may be suitable for application in potentially severe infections caused by several species of Gram-positive microorganisms. © 2010 Elsevier España, S.L. All rights reserved.

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