Alcázar de San Juan, Spain
Alcázar de San Juan, Spain

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Paduraru M.,General Hospital of Tomelloso | Moreno-Sanz C.,Hospital La Mancha Centro | Olalla Gallardo J.M.,Hospital La Mancha Centro
BMJ case reports | Year: 2016

Mucormycosis is most common in immunocompromised patients, but it can also occur in healthy hosts, most frequently as primary cutaneous mucormycosis (PCM) and predominantly as a result of skin trauma. We present an uncommon case of PCM in a healthy, young man with no previous history of local trauma. Despite rapid progression of the infection, the patient was successfully treated through surgical intervention and by administering liposomal amphotericin B and posaconazole. He made a full recovery without the need for skin grafting. 2016 BMJ Publishing Group Ltd.


Belinchon A.,Complejo Hospitalario Universitario Albacete | Perez- Garrigues H.,Hospital Universitario La Paz | Tenias J.M.,Hospital la Mancha Centro | Lopez A.,University of Castilla - La Mancha
Laryngoscope | Year: 2011

Objectives: To investigate the level of hearing loss and the configuration of the mean audiometric curve over the course of Menière's disease, correcting the data according to patient age. Study Design: A retrospective study of 3,963 hearing tests. Methods: Descriptive, longitudinal study of pure-tone audiometries of 237 patients at a tertiary hospital who had been diagnosed with definitive Menière's disease according to the American Academy of Otorhinolaryngology criteria. All audiometric results were age-corrected, and patients were followed for 1 to 31 years. In patients who had undergone surgery, only the data collected before the operation were assessed. Results: In patients with unilateral disease, the mean hearing loss was characteristically low frequency, even in very advanced stages of the disease. Hearing loss was accentuated at 5 and 15 years from onset. In bilateral cases, hearing loss was slightly more severe and the average loss produced a flatter audiometric curve than in unilateral cases. Conclusions: In Menière's disease, audiometry results corrected for patient age show an inherent upward-sloping configuration of the mean audiometric curve at all time points during the disease. The hearing pattern differs between unilateral and bilateral disease. The audiometric curve configuration may be an indicator of future bilateral disease. © 2011 The American Laryngological, Rhinological, and Otological Society, Inc., Rhinological, and Otological Society, Inc.


Belinchon A.,Complejo Hospitalario Universitario Albacete | Perez-Garrigues H.,Hospital Universitario La Paz | Tenias J.M.,Hospital la Mancha Centro
Audiology and Neurotology | Year: 2012

Objective: To investigate the sequence and correlation of symptoms of Ménière's disease (MD) depending on their order of manifestation. Methods: Descriptive, longitudinal study of the symptoms in 237 tertiary hospital patients who had been diagnosed with definite MD according to the criteria of the American Academy of Otolaryngology. Patients were followed for 1-31 years. Results: Disease began with the three classic symptoms in only 40% of the patients. We recorded the mean, median and maximum time needed to complete the symptoms as well as the time elapsed in some patients from disease onset in one ear to bilateral involvement. Conclusions: We reckon that this study may be of great help in ruling out a diagnosis of MD when the patient presents with only one or two symptoms of the triad. Furthermore, regarding the planning of treatment, the time interval between unilateral and bilateral involvement (5-7 years) is very important since bilateral involvement has great repercussions on treatment, especially surgical treatment. © 2011 S. Karger AG, Basel.


Esteban F.,Hospital Clinico San Carlos | Cerdan F.J.,Hospital Clinico San Carlos | Garcia-Alonso M.,Hospital Clinico San Carlos | Sanz-Lopez R.,Hospital Clinico San Carlos | And 6 more authors.
Colorectal Disease | Year: 2014

Aim: The introduction of multimodal or fast track (FT) rehabilitation and laparoscopy in colorectal surgery has improved patient recovery and shortened hospital stay (HS). This study aimed to determine the influence of laparoscopic or open surgery on the postoperative recovery of colorectal cancer patients having a conventional care (CC) or FT protocol in the postoperative period. Method: A multicentre prospective study was controlled with a retrospective group. The prospective group included 300 patients having elective colorectal resection for cancer. The retrospective control group included 201 patients with the same characteristics who were treated before the introduction of the programme. The patients were divided into four groups including laparoscopy + FT, open surgery + FT, laparoscopy + CC, and open surgery + CC. The primary end-points were HS and morbidity. Secondary end-points included mortality and reoperation rates. Results: The overall median HS was 7 days. The median HS for laparoscopy + FT was 5 days, open + FT 6 days, laparoscopy + CC 9 days and open + CC 10 days (P < 0.001). In the regression model the laparoscopy + FT group had the greatest reduction in HS (P < 0.001). A significant reduction in HS was observed in the laparoscopy + FT group compared with laparoscopy + CC (P < 0.001). The overall patient morbidity was 30.6%. The logistic regression model adjusted for propensity score showed no statistically significant differences between the study groups regarding all other end-points. Conclusion: Colorectal cancer patients who underwent laparoscopic surgery within a multimodal rehabilitation protocol experienced the shortest HS and the lowest morbidity. © 2013 The Association of Coloproctology of Great Britain and Ireland.


Jimenez-Perez J.,Hospital Of Navarra | Casellas J.,Hospital General Universitario Of Alicante | Garcia-Cano J.,Hospital Virgen Of La Luz | Vandervoort J.,Onze Lieve Vrouw Ziekenhuis | And 7 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. Methods: This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. Results: A total of 182 patients were enrolled with obstructive tumor in the left colon (85%), rectum (11%), or splenic flexure (4%). Of these patients, 86% had localized colorectal cancer without metastasis. Procedural success was 98% (177/181). Clinical success was 94% (141/150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8% (13/167), including perforation in 3% (5/167), stent migration in 1.2% (2/167), bleeding in 0.6% (1/167), persistent colonic obstruction in 1.8% (3/167), and stent occlusion due to fecal impaction in 1.2% (2/167). One patient died from complications related to surgical management of a perforation. Conclusions: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients. © 2011 by the American College of Gastroenterology.


Clayton F.,University of Utah | Fang J.C.,University of Utah | Gleich G.J.,University of Utah | Lucendo A.J.,Hospital General Of Tomelloso | And 10 more authors.
Gastroenterology | Year: 2014

Background & Aims Eosinophilic esophagitis is usually triggered by foods, by unclear mechanisms. We evaluated the roles of IgE and IgG4 in the development of eosinophilic esophagitis. Methods We performed a prospective, randomized, double-blind, placebo-controlled trial of adults with eosinophilic esophagitis given an antibody against IgE (omalizumab, n = 16) or placebo (n = 14) every 2-4 weeks for 16 weeks, based on weight and serum level of IgE. Endoscopy was performed, esophageal biopsy specimens were collected, and symptoms were assessed at baseline and at 16 weeks. Maximum numbers of eosinophils/high-power field were determined. Homogenates of esophageal biopsy specimens from 11 subjects with eosinophilic esophagitis and 8 without (controls) were assessed for IgM, IgA, and IgG subclasses. In a retrospective analysis, we performed immunofluorescence analysis of IgG4 in fixed esophageal tissues from 2 patients with eosinophilic esophagitis who underwent esophagectomy and 47 consecutive autopsies (controls). We also performed immunofluorescence analysis of IgG4 in esophageal mucosal biopsy specimens from 24 subjects with eosinophilic esophagitis and 9 without (controls). Finally, sera were collected from 15 subjects with eosinophilic esophagitis and from 41 without (controls), and assayed for total and food-reactive IgG4. Results Omalizumab did not alter symptoms of eosinophilic esophagitis or eosinophil counts in biopsy samples compared with placebo. Homogenates of esophageal tissues from patients with eosinophilic esophagitis had a 45-fold increase in IgG4 compared with controls (P < 3 × 10-5), but no significant increases in other IgG subclasses, IgM, or IgA. Sparse stromal deposits resembling immune complexes were found in 2 of 5 eosinophilic esophagitis biopsy specimens based on ultrastructural analysis. Esophagectomy samples from 2 patients with eosinophilic esophagitis contained 180 and 300 IgG4 plasma cells/maximal high-power field, mainly in the deep lamina propria; these levels were greater than in tissues from controls. Fibrosis essentially was exclusive to the lamina propria. Granular extracellular IgG4 was detected in biopsy specimens from 21 of 24 patients with eosinophilic esophagitis, but in none of the specimens from 9 controls (P = 6 × 10-6). The total serum level of IgG4 increased only slightly in patients with eosinophilic esophagitis, compared with controls. Subjects with eosinophilic esophagitis had increased serum levels of IgG4 that reacted with milk, wheat, egg, and nuts - the 4 foods that most commonly trigger this condition (P < 3 × 10-5 for each food). Conclusions In a prospective trial, omalizumab did not reduce symptoms of eosinophilic esophagitis or tissue eosinophil counts compared with placebo. This finding, along with observed granular deposits of IgG4, abundant IgG4-containing plasma cells, and serum levels of IgG4 reactive to specific foods, indicate that, in adults, eosinophilic esophagitis is IgG4-associated, and not an IgE-induced allergy. ClinicalTrials.gov number: NCT 00123630. © 2014 by the AGA Institute.


Meisner S.,Bispebjerg Hospital | Gonzalez-Huix F.,Hospital Doctor Josep Trueta | Vandervoort J.G.,Onze Lieve Vrouw Ziekenhuis | Goldberg P.,Groote Schuur Hospital | And 7 more authors.
Gastrointestinal Endoscopy | Year: 2011

Background: The self-expandable metal stent (SEMS) can alleviate malignant colonic obstruction and avoid emergency decompressive surgery. Objective: To document performance, safety, and effectiveness of colorectal stents used per local standards of practice in patients with malignant large-bowel obstruction to avoid palliative stoma surgery in incurable patients (PAL) and facilitate bowel decompression as a bridge to surgery for curable patients (BTS). Design: Prospective clinical cohort study. Setting: Two global registries with 39 academic and community centers. Patients: This study involved 447 patients with malignant colonic obstruction who received stents (255 PAL, 182 BTS, 10 no indication specified). Intervention: Colorectal through-the-scope SEMS placement. Main Outcome Measurements: The primary endpoint was clinical success at 30 days, defined as the patient's ability to maintain bowel function without adverse events related to the procedure or stent. Secondary endpoints were procedural success, defined as successful stent placement in the correct position, symptoms of persistent or recurrent colonic obstruction, and complications. Results: The procedural success rate was 94.8% (439/463), and the clinical success rates were 90.5% (313/346) as assessed on a per protocol basis and 71.6% (313/437) as assessed on an intent-to-treat basis. Complications included 15 (3.9%) perforations, 3 resulting in death, 7 (1.8%) migrations, 7 (1.8%) cases of pain, and 2 (0.5%) cases of bleeding. Limitations: No control group. No primary endpoint analysis data for 25% of patients. Conclusion: This largest multicenter, prospective study of colonic SEMS placement demonstrates that colonic SEMSs are safe and highly effective for the short-term treatment of malignant colorectal obstruction, allowing most curable patients to have 1-step resection without stoma and providing most incurable patients minimally invasive palliation instead of surgery. The risk of complications, including perforation, was low. © 2011 American Society for Gastrointestinal Endoscopy.


Mordillo-Mateos L.,Hospital Nacional Of Paraplejicos | Turpin-Fenoll L.,Hospital la Mancha Centro | Millan-Pascual J.,Hospital la Mancha Centro | Nunez-Perez N.,Hospital Nacional Of Paraplejicos | And 6 more authors.
Brain Stimulation | Year: 2012

Background: Transcranial direct current stimulation (tDCS) is a noninvasive technique that has been investigated as a therapeutic tool for different neurologic disorders. Neuronal excitability can be modified by application of DC in a polarity-specific manner: anodal tDCS increases excitability, while cathodal tDCS decreases excitability. Previous research has shown that simultaneous bilateral tDCS of the human motor cortex facilitates motor performance in the anodal stimulated hemisphere much more than when the same hemisphere is stimulated using unilateral anodal motor cortex tDCS. Objective: The main purpose of this study was to determine whether simultaneous bilateral tDCS is able to increase cortical excitability in one hemisphere whereas decreasing cortical excitability in the contralateral hemisphere. To test our hypothesis, cortical excitability before and after bilateral motor cortex tDCS was evaluated. Moreover, the effects of bilateral tDCS were compared with those of unilateral motor cortex tDCS. Methods: We evaluated cortical excitability in healthy volunteers before and after unilateral or bilateral tDCS using transcranial magnetic stimulation. Results: We demonstrated that simultaneous application of anodal tDCS over the motor cortex and cathodal tDCS over the contralateral motor cortex induces an increase in cortical excitability on the anodal-stimulated side and a decrease in the cathodal stimulated side. We also used the electrode montage (motor cortex-contralateral orbit) method to compare the bilateral tDCS montage with unilateral tDCS montage. The simultaneous bilateral tDCS induced similar effects to the unilateral montage on the cathode-stimulated side. On the anodal tDCS side, the simultaneous bilateral tDCS seems to be a slightly less robust electrode arrangement compared with the placement of electrodes in the motor cortex-contralateral orbit montage. We also found that intersubject variability of the excitability changes that were induced by the anodal motor cortex tDCS using the bilateral montage was lower than that with the unilateral montage. Conclusions: This is the first study in which cortical excitability before and after bilateral motor cortex tDCS was extensively evaluated, and the effects of bilateral tDCS were compared with unilateral motor cortex tDCS. Simultaneous bilateral tDCS seems to be a useful tool to obtain increases in cortical excitability of one hemisphere whereas causing decreases of cortical excitability in the contralateral hemisphere (e.g.,to treat stroke). © 2012 Elsevier Inc. All rights reserved.


Objective: The objective of this study is to review the available bibliography about environmental factors, life habits and drugs that could produce the existence of infertility. Method: We conducted a systematic bibliographic search of the main databases. We also included those articles published in the last ten years. Results: Regarding the life habits, we highlight the influence of diet, exercise and toxic habits. Most of the existing bibliography about drugs that might negatively affect fertility makes reference to the oncologic treatment. Alquilant agents are the chemotherapeutic agents that most intensely produce azoospermia and ovarian failure. Regarding immunosuppressants, the most studied drugs are sirolimus, everolimus and tacrolimus. Hyperprolactinemia is an undesired side effect of using neuroleptics, both typical and atypical. Other relevant drugs are antiepileptics, antidepressants (mainly selective serotonin reuptake inhibitors), hormones and anti-inflammatory drugs (like sulfasalazine used in rheumatoid arthritis). Conclusions: There are numerous factors related to sterility. However, we do not exactly know the frequency in which these factors intervene. Most of the time, the medical practice focuses on the treatment of infertility, being also of great importance the educational work in the areas of health education and social consciousness-raising about its prevention. Regarding the drugs associated with sterility, we should substitute them for other ones in cases of couples that already have fertility problems or in cases of patients infertile age with the desire to procreate. This study is a review of drugs' association with fertility, and not of their teratogenic potential.


Sanchez-Fernandez S.A.,Hospital La Mancha Centro | Carrasco Fernandez J.A.,Hospital La Mancha Centro | Rojas Vargas L.M.,Hospital La Mancha Centro
Reumatologia Clinica | Year: 2013

We report one case of dermatomyositis and one of polymyositis refractory to several conventional inmunosupressive therapies, which present a response after treatment with rituximab, enabling steroid dose reduction and a prolonged remission. © 2012 Elsevier España, S.L.

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