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Labarga P.,Hospital Carlos III | Barreiro P.,Hospital Carlos III | Da Silva A.,Hospital Xeral Cies CHUVI | Guardiola J.M.,Hospital Sant Pau | And 16 more authors.
Journal of Infectious Diseases | Year: 2012

Background. Ribavirin (RBV) exposure seems to be critical to maximize treatment response in human immunodeficiency virus (HIV)-positive patients with chronic hepatitis C virus (HCV) infection. Methods .HIV/HCV-coinfected individuals naive to interferon were prospectively randomized to receive peginterferon-α-2a (180 μg/d) plus either RBV standard dosing (1000 or 1200 mg/d if <75 or ≥75 kg, respectively) or RBV induction (2000 mg/d) along with subcutaneous erythropoietin (450 IU/kg/wk), both during the first 4 weeks, followed by standard RBV dosing until completion of therapy. Early stopping rules at weeks 12 and 24 were applied in patients with suboptimal virological response. Results .A total of 357 patients received ≥1 dose of the study medication. No differences in main baseline characteristics were found when comparing treatment arms. Sustained virological response (SVR) was attained by 160 (45) patients, with no significant differences between RBV induction and standard treatment arms (SVR in 72 of 169 patients [43] vs 88 of 188 [47], respectively). At week 4, undetectable HCV RNA (29 vs 25) and mean RBV trough concentration (2.48 vs 2.14 g/mL) were comparable in both arms, whereas mean hemoglobin decay was less pronounced in the RBV induction plus erythropoietin arm than in the RBV standard dosing arm (-1.7 vs-2.3 mg/dL; P <. 005). Treatment discontinuation occurred in 91 (25) patients owing to nonresponse and in 29 (8) owing to adverse events. HCV relapse occurred in 34 patients (10). Univariate and multivariate analyses identified HCV genotype 2 or 3 (odds ratio [OR], 10.3; 95 confidence interval [CI], 2.08-50.2; P =. 004), IL28B CC variants (OR, 2.92; 95 CI, 1.33-6.41; P =. 007), nonadvanced liver fibrosis (OR, 2.27; 95 CI, 1.06-5.01; P =. 03), and rapid virological response (OR, 40.3; 95 CI, 5.1-314.1; P <. 001) as predictors of SVR.Conclusions.A 4-week course of induction therapy with high RBV dosing along with erythropoietin does not improve SVR rates in HIV/HCV-coinfected patients. Preemptive erythropoietin might blunt the benefit of RBV overdosing by enhancing erythrocyte uptake of plasma RBV. © 2012 The Author.


Ortiz-Rey J.A.,Hospital Xeral Cies CHUVI | Anton-Badiola I.,Hospital Povisa | Perez-Pedrosa A.,Hospital Xeral Cies CHUVI | Peteiro-Cancelo A.,Hospital Povisa | Gonzalez-Carrero J.,Hospital Xeral Cies CHUVI
Applied Immunohistochemistry and Molecular Morphology | Year: 2012

Nephrogenic adenoma (NA) has been considered as a metaplastic process of the urothelium. It has been suggested that this lesion is of renal tubular cell origin or differentiation. Immunohistochemical studies of NA emphasize its staining with α-methylacyl-coenzyme A racemase (AMACR), and prostatic adenocarcinoma may be a possible differential diagnosis. This reactivity was recently discussed as an artifact due to endogenous biotin. Kidney-specific cadherin (Ksp-cad) is a marker of distal nephron. CD10 and KIT are also expressed in the kidney. We studied the immunohistochemical expression of AMACR, p63, Ksp-cad, CD10, and KIT in 9 cases of NA (forming a total of 12 lesions). Practically all of the lesions stained for AMACR with 2 different antibodies and 2 high-sensitivity (multimer or polymer based) biotin-free methods (83% and 100%). The staining was similar for both methods in 9 of these 12 lesions. All of the NAs were negative for p63 and KIT, except 1 case, with focal reactivity for KIT. CD10 was expressed very focally in 4 of the 12 lesions (33%). We observed weak staining for Ksp-cad in 6 lesions (50%) and 3 (25%) showed a moderate positivity in 15% to 50% of the cells. In conclusion, positivity of NA for AMACR is not an artifact, as we confirmed using 2 different methods. Besides, p63, a basal cell marker, is usually negative. Immunoreactivity for Ksp-cad seems to support the differentiation of NA to distal nephron cells, at least in some of the cases. Other markers expressed by the nephron, such as CD10 and KIT, are usually negative in NA. Copyright © 2012 by Lippincott Williams & Wilkins.


Ortiz-Rey J.A.,Hospital Xeral Cies CHUVI | Alberte-Lista L.M.,Hospital Xeral Cies CHUVI | Mateos-Martin A.,Hospital Xeral Cies CHUVI | Lopez-Garcia S.,Hospital Xeral Cies CHUVI
Archivos Espanoles de Urologia | Year: 2014

OBJECTIVE: To describe two cases of a rare type of renal tumor, mucinous tubular and spindle cell carcinoma (MTSC), with different pathologic features. METHODS: We present: 1) the case of a 36 year-old woman 24-week pregnant, in whom during an examination for a renal colic we discovered a 5.5 cm tumor in the lower pole of the left kidney. 2) A 71-year-old woman that consulted to her doctor due to loss of weight (5 kg) and anorexia. A 15 × 12 × 9.5 cm tumor was found in her left kidney. RESULTS: Radical nephrectomy was performed in both cases. Microscopic examination showed a myxoid matrix containing a proliferation of tubules and spindle cells, with low-grade atypia. Cells were immunoreactive for CK7, racemase, EMA and vimentin and negative for CD10. Case 1 had some foci of papillary morphology, and was pT1. Case 2 had some nests of clear cells and invaded the sinus fat focally. It was staged as pT3a. In April 2012, the patients are alive without evidence of recurrence or metastasis after 13.5 years (case 1) and 8 months (case 2) of follow up. CONCLUSIONS: MTSC is a rare type of renal carcinoma, which can appear with different clinical, gross and microscopic features. This tumor seems to share some morphological and immunohistochemical similarities with renal papillary carcinoma, and the differential diagnosis is difficult. The vast majority of cases reported had favourable evolution, like our case 1, although a remote possibility of metastasis exists, in cases with sarcomatoid differentiation, but even without it.


Castro O.,Hospital Xeral Cies CHUVI | Perez-Carro A.M.,Hospital Xeral Cies CHUVI | Ibarra I.,Hospital Xeral Cies CHUVI | Hamdan M.,Hospital Xeral Cies CHUVI | And 3 more authors.
Acta Otorrinolaringologica Espanola | Year: 2013

Introduction and objectives: Myringoplasty, one of the most frequent surgical techniques in otology, is the repair of tympanic membrane when the ear has only a perforation without any ossicular damage. The main objective of our work was to study the outcome of myringoplasty in patients less than 15 years of age. We also reviewed the existence of prognostic factors, such as Eustachian tube functionality, surgical technique and the hearing outcome after surgery. Method: We present a retrospective study (1994-2010) with a total of 81 children (under 15 years of age) who had undergone myringoplasty during that period of time. For these children, we analysed age, sex, technique, approach, type of graft, type of perforation, anaesthesia, hearing gain and perforation closure. We correlated these variables with the success of the surgery. Results: The percentage of closure was 84% (n = 68). The techniques used were underlay in 79.01% (n = 64), overlay in 11.11% (n = 9) and sandwich in 9.87% (n = 8). The percentage of patients with hearing improvement was 88.40% (n = 61). Conclusion: Myringoplasty is a surgical technique that offers good anatomical and functional results in children. We did not find prognostic factors in our study. We found postoperative improvement of hearing but it was not statistically significant. © 2012 Elsevier España, S.L.


PubMed | Hospital Xeral Cies CHUVI
Type: Journal Article | Journal: Applied immunohistochemistry & molecular morphology : AIMM | Year: 2012

Nephrogenic adenoma (NA) has been considered as a metaplastic process of the urothelium. It has been suggested that this lesion is of renal tubular cell origin or differentiation. Immunohistochemical studies of NA emphasize its staining with -methylacyl-coenzyme A racemase (AMACR), and prostatic adenocarcinoma may be a possible differential diagnosis. This reactivity was recently discussed as an artifact due to endogenous biotin. Kidney-specific cadherin (Ksp-cad) is a marker of distal nephron. CD10 and KIT are also expressed in the kidney. We studied the immunohistochemical expression of AMACR, p63, Ksp-cad, CD10, and KIT in 9 cases of NA (forming a total of 12 lesions). Practically all of the lesions stained for AMACR with 2 different antibodies and 2 high-sensitivity (multimer or polymer based) biotin-free methods (83% and 100%). The staining was similar for both methods in 9 of these 12 lesions. All of the NAs were negative for p63 and KIT, except 1 case, with focal reactivity for KIT. CD10 was expressed very focally in 4 of the 12 lesions (33%). We observed weak staining for Ksp-cad in 6 lesions (50%) and 3 (25%) showed a moderate positivity in 15% to 50% of the cells. In conclusion, positivity of NA for AMACR is not an artifact, as we confirmed using 2 different methods. Besides, p63, a basal cell marker, is usually negative. Immunoreactivity for Ksp-cad seems to support the differentiation of NA to distal nephron cells, at least in some of the cases. Other markers expressed by the nephron, such as CD10 and KIT, are usually negative in NA.


PubMed | Hospital Xeral Cies CHUVI
Type: Journal Article | Journal: Acta otorrinolaringologica espanola | Year: 2013

Myringoplasty, one of the most frequent surgical techniques in otology, is the repair of tympanic membrane when the ear has only a perforation without any ossicular damage. The main objective of our work was to study the outcome of myringoplasty in patients less than 15 years of age. We also reviewed the existence of prognostic factors, such as Eustachian tube functionality, surgical technique and the hearing outcome after surgery.We present a retrospective study (1994-2010) with a total of 81 children (under 15 years of age) who had undergone myringoplasty during that period of time. For these children, we analysed age, sex, technique, approach, type of graft, type of perforation, anaesthesia, hearing gain and perforation closure. We correlated these variables with the success of the surgery.The percentage of closure was 84% (n=68). The techniques used were underlay in 79.01% (n=64), overlay in 11.11% (n=9) and sandwich in 9.87% (n=8). The percentage of patients with hearing improvement was 88.40% (n=61).Myringoplasty is a surgical technique that offers good anatomical and functional results in children. We did not find prognostic factors in our study. We found postoperative improvement of hearing but it was not statistically significant.

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