Puerta Of Hierro University Hospital

Majadahonda, Spain

Puerta Of Hierro University Hospital

Majadahonda, Spain

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Pereira A.,Gregorio Maranon University General Hospital | Perez-Medina T.,Puerta Of Hierro University Hospital | Rodriguez-Tapia A.,Autonomous University of Madrid | Mendizabal E.,Gregorio Maranon University General Hospital | Ortiz-Quintana L.,Gregorio Maranon University General Hospital
International Journal of Gynecological Cancer | Year: 2015

Objective: The objective of this study was to determine the survival of patients with nodepositive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system. Materials and Methods: We performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed. Results: The distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV(hazard ratios, 2.75and 3.16, respectively; P = 0.002).The hazard ratio for patientswith abdominal peritoneal metastaseswas 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001). Conclusions: The current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases. Copyright © 2014 by IGCS and ESGO.


Gayoso-Diz P.,Hospital Clinico Universitario | Gayoso-Diz P.,Institute Investigacion Sanitaria Of Santiago Idis | Rodriguez-Alvarez M.X.,Hospital Clinico Universitario | Rodriguez-Alvarez M.X.,Institute Investigacion Sanitaria Of Santiago Idis | And 6 more authors.
BMC Endocrine Disorders | Year: 2013

Background: Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. Methods: It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. Results: In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population.Conclusions: The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women. © 2013 Gayoso-Diz et al.; licensee BioMed Central Ltd.


Aguado D.,Complutense University of Madrid | Abreu M.,Hospital Universitario La Paz | Benito J.,North Carolina State University | Garcia-Fernandez J.,Puerta Of Hierro University Hospital | De Segura I.A.G.,Complutense University of Madrid
Anesthesiology | Year: 2013

Background: Opioid antagonists at ultra-low doses have been used with opioid agonists to prevent or limit opioid tolerance. The aim of this study was to evaluate whether an ultra-low dose of naloxone combined with remifentanil could block opioid-induced hyperalgesia and tolerance under sevoflurane anesthesia in rats. Methods: Male adult Wistar rats were allocated into one of four treatment groups (n = 7), receiving remifentanil (4 μg·kg· min) combined with naloxone (0.17 ng·kg·min), remifentanil alone, naloxone alone, or saline. Animals were evaluated for mechanical nociceptive thresholds (von Frey) and subsequently anesthetized with sevoflurane to determine the baseline minimum alveolar concentration (MAC). Next, treatments were administered, and the MAC was redetermined twice during the infusion. The experiment was performed three times on nonconsecutive days (0, 2, and 4). Hyperalgesia was considered to be a decrease in mechanical thresholds, whereas opioid tolerance was considered to be a decrease in sevoflurane MAC reduction by remifentanil. Results: Remifentanil produced a significant decrease in mechanical thresholds compared with baseline values at days 2 and 4 (mean ± SD, 30.7 ± 5.5, 22.1 ± 6.4, and 20.7 ± 3.7g at days 0, 2, and 4, respectively) and an increase in MAC baseline values (2.5 ± 0.3, 3.0 ± 0.3, and 3.1 ± 0.3 vol% at days 0, 2, and 4, respectively). Both effects were blocked by naloxone coadministration. However, both remifentanil-treated groups (with or without naloxone) developed opioid tolerance determined by their decrease in MAC reduction. Conclusions: An ultra-low dose of naloxone blocked remifentanil-induced hyperalgesia but did not change opioid tolerance under inhalant anesthesia. Moreover, the MAC increase associated with hyperalgesia was also blocked by naloxone. © 2013 the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology.


Gonzalez-Pizarro P.,Akademiska Sjukhuset | Garcia-Fernandez J.,Puerta Of Hierro University Hospital | Canfran S.,Complutense University of Madrid | Gilsanz F.,Hospital Universitario La Paz
Respiratory Care | Year: 2016

Background: Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (<48 h old) with healthy lungs under general anesthesia. Methods: The primary outcome was peak inspiratory pressure (PIP) causing pneumothorax. Animals under anesthesia and bilateral chest tube catheterization were randomly allocated to 2 groups: one with PEEP and fixed inspiratory driving pressure of 15 cm H2O (PEEP group) and the second one with PEEP = 0 cm H2O and non-fixed inspiratory driving pressure (zero PEEP group). In both groups, the ventilation mode was pressure-controlled, and PIP was raised at 2-min intervals, with steps of 5 cm H2O until air leak was observed through the chest tubes. The PEEP group raised PIP through 5-cm H2O PEEP increments, and the zero PEEP group raised PIP through 5-cm H2O inspiratory driving pressure increments. RESULTS: Pneumothorax was observed with a PIP of 90.5 ± 15.7 cm H2O with no statistically significant differences between the PEEP group (92 ± 14.8 cm H2O) and the zero PEEP group (89 ± 18.2 cm H2O). The zero PEEP group had hypotension, with a PIP of 35 cm H2O; the PEEP group had hypotension, with a PIP of 60 cm H2O (P = .01). The zero PEEP group presented bradycardia, with PIP of 40 cm H2O; the PEEP group presented bradycardia, with PIP of 70 cm H2O (P = .002). Conclusions: Performing recruitment maneuvers in newborns without lung disease is a safe procedure in terms of pneumothorax. Pneumothorax does not seem to occur in the clinically relevant PIPs of <50 cm H2O. Hemodynamic impairment may occur with high driving pressures. More studies are needed to determine the exact hemodynamic impact of these procedures and pneumothorax PIP in poorly compliant lungs. © 2016 Daedalus Enterprises.


Cordero Y.,University of Murcia | Mottola M.F.,University of Western Ontario | Vargas J.,Puerta Of Hierro University Hospital | Blanco M.,Torrelodones University Hospital | Barakat R.,Technical University of Madrid
Medicine and Science in Sports and Exercise | Year: 2015

Purpose The objective of this study is to assess the effectiveness of a maternal exercise program (land/aquatic activities, both aerobic and muscular conditioning) in preventing gestational diabetes mellitus (GDM). Methods Three hundred and forty-two pregnant women from Spain (age, 33.24 ± 4.3 yr) without obstetric contraindications were recruited for a clinical randomized controlled trial. The intervention group (IG, n = 101) exercised for 60 and 50 min on land and in water, respectively, three times per week. The control group (n = 156) received usual standard care. Results The prevalence of GDM was reduced in the IG group (IG, 1%, n = 1, vs control group, 8.8%, n = 13 (χ2 1 = 6.84, P = 0.009)) with a significant risk estimate (odds ratio = 0.103; 95% confidence interval, 0.013-0.803). Conclusion The exercise program performed during pregnancy reduced the prevalence of GDM by preserving glucose tolerance. © 2014 by the American College of Sports Medicine.


Castro-Dufourny I.,Sureste University Hospital | Carrasco R.,Ramon y Cajal University Hospital | Prieto R.,Puerta Of Hierro University Hospital | Barrios L.,Computing Center | Pascual J.M.,La Princesa University Hospital
Pituitary | Year: 2015

Purpose: Infundibulo-tuberal syndrome groups endocrine, metabolic and behavioral disturbances caused by lesions involving the upper neurohypophysis (median eminence) and adjacent basal hypothalamus (tuber cinereum). It was originally described by Henri Claude and Jean Lhermitte in 1917, in a patient with a craniopharyngioma. This study investigates the clinical, pathological and surgical evidence verifying the infundibulo-tuberal syndrome caused by craniopharyngiomas (CPs). Methods: A systematic retrospective review of craniopharyngiomas reported in French literature between 1705 and 1973 was conducted. A total of 128 well described reports providing a comprehensive clinical and pathological description of the tumors were selected. This series represents the historical French cohort of CPs reported in the pre-CT/MRI era. Results: Three major syndromes caused by CPs were categorized: pituitary syndrome (35 %), infundibulo-tuberal syndrome (52 %) and hypothalamic syndrome (49 %). CP topography was significantly related to the type of syndrome described (p < 0.001). Infundibulo-tuberal syndrome occurred in CPs which replaced or invaded the third ventricle floor. In contrast, the majority of sellar/suprasellar CPs growing below the third ventricle showed a pituitary syndrome (82 %). Cases with hypothalamic syndrome were characterized by anatomical integrity of the pituitary gland and stalk (p = 0.033) and occurred predominantly in adults older than 41 years old (p < 0.005). Among infundibulo-tuberal symptoms, abnormal somnolence was not related with the presence of hydrocephalus. All squamous-papillary CPs presented psychiatric disturbances (p < 0.001). Conclusion: This historical CP cohort evidences a clinical-topographical correlation between the patient’s type of syndrome and the anatomical structures involved by the tumor along the hypophysial-hypothalamic axis. © 2014, Springer Science+Business Media New York.


Prieto R.,Puerta Of Hierro University Hospital | Pascual J.M.,La Princesa University Hospital | Barrios L.,Computing Technical Center
World Neurosurgery | Year: 2015

OBJECTIVE: To evaluate the anatomic distortions of the optic chiasm caused by craniopharyngiomas (CPs) and their influence on preoperative and postoperative visual status. -METHODS: We conducted a retrospective investigation of 150 CPs including preoperative and postoperative magnetic resonance imaging (MRI) studies and the preoperative visual status and visual outcome after surgery. Morphologic distortions of the optic chiasm were analyzed on midsagittal MRI and correlated with preoperative vision, visual outcome, and features and topography of the CP. -RESULTS: Vision loss before operation was present in 68.7% of the patients. The type of chiasm distortion caused by the CP was the major predictive factor of preoperative visual impairment (P < 0.001). There were 6 patterns of chiasm distortion identified: Nondistorted or normal (11.3%), compressed downward (18%), compressed forward (23.3%), stretched forward (18%), stretched upward (16.7%), and stretched backward (4.7%). Reduced vision was present in >80% of compressed forward and stretched chiasms. Overall, the mechanical stretching deformation of the chiasm caused a more severe visual deficit than its compression. Postoperative chiasm morphology was the major predictive factor for visual outcome (P < 0.001). There were 6 different chiasm morphologies identified after surgery: Normal (52.7%), thinned (9.4%), thickened (16.7%), displaced forward (6%), displaced upward (4%), and displaced backward (2.7%). Thinned and displaced upward chiasms were associated with the highest rate of no visual improvement. A multivariate model including preoperative and postoperative chiasm distortions predicted the visual outcome in 91.3% of patients. -CONCLUSIONS: The type of chiasm distortion represents a valuable neuroradiologic finding to ascertain the preoperative and postoperative visual status.


Pascual J.M.,La Princesa University Hospital | Prieto R.,Puerta Of Hierro University Hospital
Neurosurgical Focus | Year: 2016

From the very beginning of his career, Harvey Williams Cushing (1869-1939) harbored a deep interest in a complex group of neoplasms that usually developed at the infundibulum. These were initially known as "interpeduncular" or "suprasellar" cysts. Cushing introduced the term "craniopharyngioma" for these lesions, which he believed represented one of the most baffling problems faced by neurosurgeons. The patient who most influenced Cushing's thinking was a 16-year-old seamstress named "Mary D.," whom he attended in December 1901, exactly the same month that Alfred Fröhlich published his seminal article describing an adiposogenital syndrome in a young boy with a pituitary cyst. Both Cushing's and Fröhlich's patients showed similar symptoms caused by the same type of tumor. Notably, Cushing and Fröhlich had met one another and became good friends in Liverpool the summer before these events took place. Their fortunate relationship led Cushing to realize that Fröhlich's syndrome represented a state of hypopituitarism and provided a useful method of diagnosing interpeduncular cysts. It is noteworthy that Cushing's very first neurosurgical procedure on a pituitary tumor was performed in the case of Mary D.'s "interpeduncular cyst," on February 21, 1902. Cushing failed to remove this lesion, which was later found during the patient's autopsy. This case was documented as Pituitary Case Number 3 in Cushing's masterpiece, The Pituitary Body and Its Disorders, published in 1912. This tumor was considered "a teratoma"; however, multiple sources of evidence suggest that this lesion actually corresponded to an adamantinomatous craniopharyngioma. Unfortunately, the pathological specimens of this lesion were misplaced, and this prompted Cushing's decision to retain all specimens and documents of the cases he would operate on throughout his career. Accordingly, Mary D.'s case crystallized the genesis of the Cushing Brain Tumor Registry, one of Cushing's major legacies to neurosurgery. In this paper the authors analyze the case of Mary D. and the great influence it had on Cushing's conceptions of the pituitary gland and its afflictions, and on the history of pituitary surgery.


Pascual J.M.,La Princesa University Hospital | Prieto R.,Puerta Of Hierro University Hospital | Mazzarello P.,University of Pavia
Journal of neurosurgery | Year: 2015

Sir Victor Horsley (1857-1916) is considered to be the pioneer of pituitary surgery. He is known to have performed the first surgical operation on the pituitary gland in 1889, and in 1906 he stated that he had operated on 10 patients with pituitary tumors. He did not publish the details of these procedures nor did he provide evidence of the pathology of the pituitary lesions operated on. Four of the patients underwent surgery at the National Hospital for Neurology and Neurosurgery (Queen Square, London), and the records of those cases were recently retrieved and analyzed by members of the hospital staff. The remaining cases corresponded to private operations whose records were presumably kept in Horsley's personal notebooks, most of which have been lost. In this paper, the authors have investigated the only scientific monograph providing a complete account of the pituitary surgeries that Horsley performed in his private practice, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), written in 1911 by Giovanni Verga, Italian assistant professor of anatomy at the University of Pavia. They have traced the life and work of this little-known physician who contributed to the preservation of Horsley's legacy in pituitary surgery. Within Verga's pituitary treatise, a full transcription of Horsley's notes is provided for 10 pituitary cases, including the patients' clinical symptoms, surgical techniques employed, intraoperative findings, and the outcome of surgery. The descriptions of the topographical and macroscopic features of two of the lesions correspond unmistakably to the features of craniopharyngiomas, one of the squamous-papillary type and one of the adamantinomatous type. The former lesion was found on necropsy after the patient's sudden death following a temporal osteoplastic craniectomy. Surgical removal of the lesion in the latter case, with the assumed nature of an adamantinomatous craniopharyngioma, was successful. According to the evidence provided in Giovanni Verga's monograph, it can be claimed that Sir Victor Horsley was not only the pioneer of pituitary gland surgery but also the pioneer of craniopharyngioma surgery.


Gutierrez-Gonzalez R.,Puerta Of Hierro University Hospital
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2012

Chondromyxoid fibroma (CMF) is a benign tumour of the bone that typically occurs in long bone metaphysis. Spinal involvement is uncommon, but more frequent in the cervical and thoracic segments. Lumbar involvement is extremely rare. We report the ninth case of lumbar CMF and the first one involving the articular process of the vertebra. A review of the literature is also intended making special emphasis on the differential diagnosis with other benign spinal tumours of the bone. A 21-year-old Caucasian male suffering from low back pain that increased with sports and interrupted sleep was diagnosed with a tumoural lesion in the right inferior articular process of L5. Complete surgical excision of the tumour was accomplished. Histological diagnosis confirmed a CMF. The patient remains asymptomatic at 1-year follow-up. Despite the low incidence of CMF in the lumbar spine, differential diagnosis must include this subtype of lesion among other benign tumours of the bone and cartilage. Histological diagnosis is essential in order to provide the patient with an accurate management of the pathology. Recurrence rate is to be considered even in the case of complete surgical excision. Radiotherapy administration is controversial due to suspicion of malignant transformation of the tumour.

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