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Romero P.,University Hospital Sant Joan | Romero P.,Rovira i Virgili University | Sagarra R.,Basic Care Unit of Reus Priorat | Ferrer J.,Sanitary Region | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2010

Aims: To evaluate the inclusion of family physicians in screening for diabetic retinopathy. Methods: We evaluated by non-mydriatic fundus camera 2779 diabetic patients. The family physicians made an initial evaluation of the fundus and pathological images were sent to a reference ophthalmologist. An audit was taken of all the patients at the end of the study. We analysed the concordance in: diabetic retinopathy, diabetic macular edema, and lesions in the macular area. Results: Diabetic retinopathy was observed in 226 patients (8.1%) and diabetic macular edema in 40 patients (1.4%). Other retinal pathologies were diagnosed in 291 (11.0%). The sensitivity of the study was 95.2% for diabetic retinopathy, 96.0% for macular lesions and 92.9% for diabetic macular edema. The specificity was above 98% in the three studied variables. Cohen's Kappa coefficient was 0.82 for diabetic retinopathy, 0.81 for diabetic macular edema and 0.96 for macular lesions. Conclusions: The inclusion of family physicians in the screening system seems to be effective in the diagnosis of diabetic retinopathy. © 2010 Elsevier Ireland Ltd.

Rubio-Casadevall J.,Institute Catala Doncologia Of Girona | Rubio-Casadevall J.,Biomedical Research Institute IdIBGi | Rubio-Casadevall J.,University of Girona | Borras J.L.,Rovira i Virgili University | And 17 more authors.
World Journal of Surgical Oncology | Year: 2015

Background: Gastrointestinal stromal tumors are sarcomas of the digestive tract characterized by mutations mainly located in the c-KIT or in the platelet-derived growth factor receptor (PDGFR)-alpha genes. Mutations in the BRAF gene have also been described. Our purpose is to define the distribution of c-KIT, PDGFR and BRAF mutations in a population-based cohort of gastrointestinal stromal tumors (GIST) patients and correlate them with anatomical site, risk classification and survival. In addition, as most of the GIST patients have a long survival, second cancers are frequently diagnosed in them. We performed a second primary cancer risk assessment. Methods: Our analysis was based on data from Tarragona and Girona Cancer Registries. We identified all GIST diagnosed from 1996 to 2006 and performed a mutational analysis of those in which paraffin-embedded tissue was obtained. Observed (OS) and relative survival (RS) were calculated according to risk classifications and mutational status. Multivariate analysis of variables for observed survival and was also done. Results: A total of 132 GIST cases were found and we analyzed mutations in 108 cases. We obtained 53.7% of mutations in exon 11 and 7.4% in exon 9 of c-KIT gene; 12% in exon 18 and 1.9% in exon 12 of PDGFR gene and 25% of cases were wild type GIST. Patients with mutations in exon 11 of the c-KIT gene had a 5-year OS and RS of 59.6% and 66.3%, respectively. Patients with mutations in exon 18 of the PDGFR gene had a 5-year OS and RS of 84.6% and 89.7%. In multivariate analysis, only age and risk group achieved statistical significance for observed survival. GIST patients had an increased risk of second cancer with a hazard ratio of 2.47. Conclusions: This population-based study shows a spectrum of mutations in the c-KIT and PDGFR genes in GIST patients similar to that previously published. The OS and RS of GIST with the exon 18 PDGFR gene mutation could indicate that this subgroup of patients may be less aggressive and have a good prognosis, although less sensitive to treatment at recurrence. In our study, GIST patients have an increased risk of developing a second neoplasm. © 2015 Rubió-Casadevall et al.; licensee BioMed Central.

Reyes-Torres J.,University Hospital Sant Joan | Blasco-Sune C.,University Hospital Sant Joan | Santos-Blanco E.,University Hospital Sant Joan | Montero-Jaime M.,University Hospital Sant Joan Dimatge | Romero-Aroca P.,University Hospital Sant Joan
Neuro-Ophthalmology | Year: 2012

A 46-year-old man was accidentally crushed in the chest by a heavy vehicle. He remained trapped for less than a minute. As a result of the entrapment he developed severe upper-body oedema and bilateral amaurosis. Funduscopic examination at the time he arrived in the emergency room was normal. A computed tomographic scan of the orbit performed 2 hours after trauma showed retro-orbital oedema of the soft tissues and bilateral exophthalmos. Magnetic resonance imaging of the brain performed 48 hours after the episode showed no abnormalities in the cortex or cerebral white matter and in particular no signs of ischaemia. Subsequently total bilateral optic atrophy developed. How the sudden and marked congestion of the orbits secondary to the soft tissue oedema led to optic nerve damage is unknown; possible factors are posterior ischaemia of the nerve secondary to venous congestion and compression and elongation of the optic nerve. © 2012 Informa Healthcare USA, Inc.

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