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Doñinos de Salamanca, Spain

Herrero-Herrero J.-I.,Universitary Hospital of Salamanca | Garcia-Aparicio J.,Universitary Hospital of Salamanca
Journal of Medical Toxicology

Amoxicillin-clavulanate is the most common drug involved in drug-induced liver injury and the single most frequently prescribed product leading to hospitalization for drug-induced liver disease in Spain. The liver damage most frequently associated with amoxicillin-clavulanate is cholestasic type. The latency period between first intake and onset of symptoms is 3-4 weeks on average. A 76-year-old man developed fever, pruritus, and jaundice 3 weeks after having completed treatment with amoxicillin-clavulanate. Liver function tests showed cholestasic hepatitis (up to 50.75 mg/dL of total serum bilirubin level). The ultrasound-guided liver biopsy revealed severe canalicular cholestasis and portal and lobular eosinophilic infiltrates. Prednisone and ursodeoxycholic acid therapy were then prescribed. The patient became symptom-free with normal liver function tests. Amoxicillin-clavulanate can cause hepatocellular, cholestasic, or mixed liver injury. The presence of eosinophilic infiltrates in the liver biopsy and the clinical signs of hypersensitivity in some of the cholestasic cases suggest a pathophysiological immunoallergic mechanism. For this reason, corticosteroid treatment should be considered for patients with severe cholestasic liver injury. © 2010 American College of Medical Toxicology. Source

Juanes J.A.,University of Salamanca | Alonso P.,Universitary Hospital of Salamanca | Hernandez F.,Universitary Hospital of Salamanca | Ruisoto P.,University of Salamanca | And 2 more authors.
ACM International Conference Proceeding Series

Background. Performing peripheral nerve block is a key element in the curriculum of medical students, in particular, anesthesiologists. Regions considered optimal for performing peripheral nerve blocking have been well documented. However, students and professors show difficulties in both learning and teaching the way to identify and perform regional anesthesia in those regions from ultrasound images. Purpose. This study aims to develop a virtual environment for the simulation of ultrasound exploration of the neck nerves and both the upper and lower limbs for regional anesthesia teaching and learning. Method. Cross-sectional images were obtained from Magnetic Resonance Imaging for puncture regions involved in ultrasound-guided nerve block. Results. A three-dimensional digital viewer was developed which allowed the identification of key structures involved in peripheral nerve block in neck, upper and lower limbs. Additionally, a complete list of neuromuscular systems of the arms and legs, involving nerves and muscles, are also displayed for their study. Conclusions. Implications for learning and teaching the ultrasound exploration for regional anesthesia procedures and acquisition of anatomical knowledge are discussed. Copyright 2013 ACM. Source

Blasco J.N.,Universitary Hospital of Salamanca | Hernandez P.A.,Universitary Hospital of Salamanca | Juanes J.A.,University of Salamanca | Sanchez J.A.S.,Universitary Hospital of Salamanca | And 5 more authors.
ACM International Conference Proceeding Series

Taking self-learning or e-learning as a model and by the application of new technologies, we introduce the software application of an echograph simulator, a very useful tool to nurture knowledge and training of the health professionals, integrating the images taken during echograph exploration with the anatomical knowledge, key for the the infiltration of the botulinum toxin in the treatment context or when addressing spasticity. The application of this echograph simulator allows us to virtually explore muscular groups both of the upper and lower limb, as well as point out the best spots where the correct and precise infiltration of the toxin in the spastic muscle can be done, identifying the structures seen in the echograph. Illustrations of sectioned anatomy taken from nuclear magnetic resonance (RMN) images of the common regions for echo-guided infiltration are included, where the different anatomic structures that comprise them are highlighted. The main objective is to introduce a training tool for the doctor, in order to get a better knowledge grade and better practical skills in the infiltration of the botulinum toxin when dealing with spasticity. Copyright 2013 ACM. Source

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