Clinico Universitario Lozano Blesa

Zaragoza, Spain

Clinico Universitario Lozano Blesa

Zaragoza, Spain

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R-Grau M.D.C.,Institute Investigacion Sanitaria Princesa IIS IP | Chaparro M.,Institute Investigacion Sanitaria Princesa IIS IP | Mesonero F.,Ramon y Cajal | Barreiro-de Acosta M.,Clinico de Santiago | And 15 more authors.
Digestive and Liver Disease | Year: 2016

Background: Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did not achieve remission with these drugs. Aims: To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability. Methods: Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy. Results: In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR = 0.3, 95% CI = 0.1-0.7, P = 0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively. Conclusions: Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease. © 2016 Editrice Gastroenterologica Italiana S.r.l.


Gastesi G.H.,Clinico Universitario Lozano Blesa
Archivos Argentinos de Pediatria | Year: 2015

Disorders of urea cycle account for up to 60% of severe neonatal hyperamoniemias. The base of this cycle disorders results in a deficit of its enzymes. Deficiency of the enzyme ornithine transcarbamylase is the most frequently detected. The prognosis depends on the degree of enzyme deficiency, age, early diagnosis and initiation of treatment. We report the case of a teenager who was treated with prednisone because of a peripheral facial palsy. He showed a progressive worsening and died a few days later. The high levels of ammonia made suspect a congenital disorder of urea cycle. The postmortem genetic study confirmed it. We studied the family and advised carriers. We reflect about the importance of the neonatal screening programs and their applicability for detection of inborn errors of metabolism. © 2015, Sociedad Argentina de Pediatria. All rights reserved.


PubMed | Institute Investigacion Sanitaria Princesa IIS IP, Clinico de Santiago, Infanta Sofia, Clinico Universitario Lozano Blesa and 11 more.
Type: Journal Article | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2016

Anti-TNF treatment is effective for Crohns disease (CD); however, some patients did not achieve remission with these drugs.To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability.Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy.In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR=0.3, 95% CI=0.1-0.7, P=0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively.Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease.


Martinez-Berganza M.T.E.,Clinico Universitario Lozano Blesa | Bergua B.S.,Clinico Universitario Lozano Blesa | Del Rio Perez C.,Clinico Universitario Lozano Blesa | Ballarin S.M.,Clinico Universitario Lozano Blesa
Neurologist | Year: 2011

Total congenital occlusion of the foramina of Monro in adults is extremely rare. Only 9 cases have been reported. Clinically, this manifest as a biventricular hydrocephalus and the most frequent presenting symptom is headache. The diagnosis can be confirmed by computed tomographic scan or magnetic resonance imaging. Regarding treatment, neuroendoscopy constitutes the procedure of choice. The prognosis is usually good. We describe a 35-year-old woman with a 2-month headache and sudden nausea, vomiting, and syncope. The patient was studied with computed tomograph, magnetic resonance imaging, and a ventricular infusion test, and subsequently treated with endoscopic foraminoplasty and a ventriculoperitoneal shunt. The protacted normal neurological history with late and rapid onset of symptoms speaks for a progressive restriction of the size of the foramina of Monro, which allows adaptation to the changes in cerebrospinal fluid dynamics. Regarding treatment, in almost every cases of bilateral occlusion of foramina of Monro reported to date, but in 1 case both: neuroendoscopy fenestration and the ventriculoperitoneal shunt were needed. Time is needed to allow cerebrospinal fluid dynamics and the ventricular system to normalize. Copyright © 2011 by Lippincott Williams & Wilkins.

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