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Muros-Ortega M.,Fresenius Medical Care Services Murcia SL | Diaz-Carrasco M.S.,Virgen de la Arrixaca Hospital | Capel A.,Virgen de la Arrixaca Hospital | Calleja M.A.,Virgen de Las Nieves Hospital | Martinez F.,University of Granada
International Journal of Clinical Pharmacy | Year: 2013

Background Transarterial chemoembolization using microspheres is a new treatment option for patients with hepatocellular carcinoma. Objective To assess the effectiveness of this technique, in terms of tumor response and overall survival rates, and to assess the procedure's safety. Setting A General University Hospital in Spain. Methods Single-center retrospective observational study. The cohort included all patients treated between October 2006 and April 2010. Effectiveness was determined by the tumor response rate (using modified RECIST and EASL criteria) and overall survival. Safety was assessed according to the Common Terminology Criteria for Adverse Events. Main outcome measure Tumor response rate, overall survival and safety of transarterial chemoembolization in patients with hepatocelular carcinoma. Results 53 patients were treated (81.1 % men, median age 65). Baseline characteristics 98.1 % had cirrhosis, 75.5 % Child-Pugh Class A, 71.7 % Okuda I, and 94.3 % were ECOG 0. 43.4 % were waiting for a liver transplant and 56.6 % were given the treatment as a palliative measure. Eighty-one procedures were carried out, with a median of 1 per patient [1-5]. Four weeks after treatment, the objective response rate was 87.5 % and the complete response rate was 62.5 %. Median survival was 735 days (CI 95 %: 351.9-1118.1). The 1, 2 and 3-year overall survival rates were 65.4, 50.9 and 42.5 %, respectively. 71.7 % of patients experienced post-embolization syndrome, with grade 1 abdominal pain as the most frequent symptom (37.7 %). Conclusion This study provides new evidence of the safety and effectiveness of transarterial chemoembolization using doxorubicin-loaded microspheres for the treatment of hepatocellular carcinoma in patients who are not eligible for other treatments, or as a bridging treatment in patients on the liver transplant waiting list. © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013.

Larque E.,University of Murcia | Pagan A.,University of Murcia | Prieto M.T.,Virgen de la Arrixaca Hospital | Blanco J.E.,Virgen de la Arrixaca Hospital | And 7 more authors.
Annals of Nutrition and Metabolism | Year: 2014

The functionality of the placenta may affect neonatal adiposity and fetal levels of key nutrients such as long-chain polyunsaturated fatty acids. Fetal macrosomia and its complications may occur even in adequately controlled gestational diabetic (GDM) mothers, suggesting that maternal glycemia is not the only determinant of fetal glycemic status and wellbeing. We studied in vivo the placental transfer of fatty acids (FA) labeled with stable isotopes administered to 11 control and 9 GDM pregnant women (6 treated with insulin). Subjects received orally 13C-palmitic, 13C-oleic, and 13C-linoleic acids and 13C-docosahexaenoic acid (13C-DHA) 12 h before an elective caesarean section. FA were quantified by gas chromatography and 13C enrichments by gas chromatography-isotope ratio mass spectrometry. The 13C-FA concentration was higher in total lipids of maternal plasma in GDM patients versus controls, except for 13C-DHA. Moreover, 13C-DHA showed a lower placenta/maternal plasma ratio in GDM patients versus controls and a significantly lower cord/maternal plasma ratio. Other FA ratios studied were not different between GDM and controls. A disturbed 13C-DHA placental uptake occurred in GDM patients treated with diet or insulin, while the latter also had lower 13C-DHA levels in the venous cord. The tracer study pointed towards an impaired placental DHA uptake as a critical step, while the transfer of other 13C-FA was less affected. Patients with GDM treated with insulin could also have a greater fetal fat storage, which may have contributed to the reduced 13C-DHA in the venous cord observed. The DHA transfer to the fetus was reduced in GDM pregnancies compared to controls. This might have an influence on fetal neurodevelopment and long-term consequences for the child. © 2014 S. Karger AG, Basel.

Soria F.,Minimally Invasive Surgery Center | Lopez-Albors O.,University of Murcia | Morcillo E.,Minimally Invasive Surgery Center | Martin C.,Minimally Invasive Surgery Center | And 6 more authors.
Digestive Endoscopy | Year: 2013

Aim The aim of the present study was to assess the safety and efficacy of CO2 during double-balloon enteroscopy (DBE) in an experimental animal model study. In this study, insufflation with room air and with CO2 was compared. Methods Twenty healthy swines were used. The animals were randomly allocated to two groups. The room air-DBE group was insufflated with room air, whereas the CO2-DBE group was insufflated with CO2. Endoscopy duration was 90 min. The following parameters were measured during the study (basal, 30 min, 60 min, 90 min): invasive hemodynamic parameters, ventilatory parameters, arterial blood gases, exploration depth, as well as biochemical tests. Residual gas was evaluated at the end of DBE, at 180 min and 24 h after DBE. Results During the endoscopic exploration none of the animals showed hemodynamic, ventilatory or arterial blood gas alterations in the normal reference range for the swine species. The CO2 group showed statistically significant differences over the room air group with lower post-procedure residual gas and greater depth of the small bowel explored. Conclusion The use of CO2 for insufflation during DBE was safe and no complications associated with CO2 were observed. In addition, the use of CO2 offers benefits over the use of room air for insufflation during DBE. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

Diaz-Carrasco M.S.,Virgen de la Arrixaca Hospital | Olmos R.,Virgen de la Arrixaca Hospital | Blanquer M.,Virgen de la Arrixaca Hospital | Velasco J.,Virgen de la Arrixaca Hospital | And 2 more authors.
International Journal of Clinical Pharmacy | Year: 2013

Background Due to their favorable toxicity profile and lack of interactions, benzodiazepines have been proposed as prophylaxis of busulfan induced seizures. Although they are broadly used in pediatric patients, the experience in adults is limited. Objective To describe the effectivity for seizure prophylaxis of the fixed 1 mg every 8 h (q8h) i.v. clonazepam dosing in adult patients receiving high dose i.v busulfan, as part of the hematopoietic progenitors transplant conditioning regimen. Methods Retrospective, observational study, from January 2008 to June 2012. Patients over 15 years old that had received high dose busulfan and prophylaxis with 1 mg q8h i.v. clonazepam from 12 h before the first dose of busulfan to 24 h after the last one were selected. The primary endpoint was the occurrence of seizures until 72 h after finishing conditioning. Results Thirty-three patients, 13 female and 20 male, median age 48, were included. Autologous transplant was performed in 17 patients and allogeneic in 16. Busulfan dose was 3.2 mg/kg every 24 h with a variable duration of 2-4 days. No seizures were recorded. Conclusion The 1 mg q8h i.v. clonazepam fixed schedule is easily administered and is effective for the prevention of high dose busulfan induced seizures in adult patients. © 2013 Springer Science+Business Media Dordrecht.

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