Santa Cristina University Hospital

Santa Cristina d'Aro, Spain

Santa Cristina University Hospital

Santa Cristina d'Aro, Spain

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Zapardiel I.,Santa Cristina University Hospital | Zanagnolo V.,Italian National Cancer Institute
Acta Obstetricia et Gynecologica Scandinavica | Year: 2010

Radical parametrectomy is rarely performed for benign diseases given the considerable risk of complications, however, some benign conditions require wide excision of the pelvic tissue, including parametria. We report on two cases of robotic radical parametrectomy performed for benign diseases. An electronic search was also carried out in PubMed database online to review this subject. Robotic surgery for radical parametrectomy seems safe and feasible and may be the preferred approach in terms of both lower complication rates, and shorter hospital stay compared to laparotomy, with the same results in terms of improvement of symptoms of chronic pelvic pain, although further studies are needed to confirm this observation. © 2010 Informa UK Ltd.


Zapardiel I.,Santa Cristina University Hospital
Gynecologic and Obstetric Investigation | Year: 2011

Radical parametrectomy is indicated in cases of undiagnosed early-stage invasive cervical carcinoma discovered after simple hysterectomy performed for a presumed benign disease process. This radical surgical procedure is rarely performed for benign disease; however, there are some benign conditions such as endometriosis or ovarian remnant syndrome which may require wide excision, including parametria. Traditionally, radical parametrectomy has been performed via laparotomy; however, a minimally invasive approach via laparoscopy has been reported to be feasible and safe. Here we describe the robotic surgical approach to radical parametrectomy. © 2011 S. Karger AG, Basel.


PubMed | Institute Biomedicina Of Seville, Santa Cristina University Hospital, University of Malaga and University of Seville
Type: Journal Article | Journal: Journal of gastroenterology and hepatology | Year: 2016

A small but significant proportion of patients with normal body mass index show non-alcoholic fatty liver disease (NAFLD). Oxidized low-density lipoprotein (LDL) is a powerful immunogenic molecule, which causes oxidative stress and produces antibodies (oxLDL-ab). We aimed to analyze the role of oxLDL-ab on histological features in lean-NAFLD patients.Seventy-two biopsy-proven NAFLD patients were included. Lean patients showed body index mass of <30kg/m(2) . Liver biopsies were assessed by one pathologist blinded to clinical data. Histological features were non-alcoholic steatohepatitis (NASH), steatosis, hepatocellular ballooning, and liver fibrosis. Metabolic and hepatic profiles were analyzed, and lipid-lowering medication was recorded. OxLDL-ab levels were measured by ELISA. OxLDL-ab-based lipid indexes analyzed: oxLDL-ab/total cholesterol ratio; oxLDL-ab/LDL-c ratio; oxLDL-ab/high-density lipoprotein cholesterol (HDL-c) ratio; and oxLDL-ab/oxLDL ratio.Lean-NAFLD patients presented 26.5% (9/34) of NASH. OxLDL-ab/HDL-c ratio (r=0.570; n=34; P=0.001) correlated with NAS score and was the only variable associated with NASH in the multivariate analysis [odds ratio, OR, 1.10 (95% confidence interval, CI: 1.01-1.21); P=0.039]. Severe steatosis was present in 41.2% (14/34) of lean-NAFLD patients. OxLDL-ab/HDL-c ratio was higher in patients with grade-III steatosis (54.9 (37.3-124.6)) than those with grade II (37.1 (20.2-71.1)) and grade I (17.7 (13.1-22.8)) (P=0.018). Hepatocellular ballooning was present in 20.6% (7/34) of lean-NAFLD patients, and OxLDL-ab/HDL-c ratio (OR 1.03 [95% CI: 1.01-1.05]; P=0.050) was independently associated with histological features. OxLDL-ab/HDL-c ratio was higher in patients with advanced fibrosis (39.8 (22.9-121.6) vs 17.7 (13.9-30.9); P=0.025), increasing gradually with the fibrosis stage (P=0.042) and remained in the final multivariate model [OR 1.05 (95% CI: 1.00-1.11); P=0.05]. However, in obese-NAFLD patients, oxLDL/HDL-c ratio was not associated with histological features.Oxidized low-density lipoprotein antibodies/high-density lipoprotein cholesterol ratio could represent an interesting biomarker associated with NASH, hepatocellular ballooning, and liver fibrosis, in lean patients. OxLDL-ab/HDL-c could play an important role for distinguishing patients with and without NAFLD complications.


Arenas J.B.,Santa Cristina University Hospital | Perez-Medina T.,Autonomous University of Madrid
Donald School Journal of Ultrasound in Obstetrics and Gynecology | Year: 2012

We describe sonographic findings of pelvis inflammatory disease. The diagnosis of initial acute PID (acute salpingitis) begins with a challenge for the doctor, due to the little sensibility of the clinic's criteria. The accumulation of pus inside the fallopian tube gives a location for the tubaric abscess or pyosalpinx, whose characteristic signal is the presence of purulent material in considerable quantities and is visible by means of a sonograph inside the tubal light. We refer a series of characteristic sings that advise us.


Zapardiel I.,Santa Cristina University Hospital | Alvarez P.,Santa Cristina University Hospital | Perez-Medina T.,Santa Cristina University Hospital | Bajo-Arenas J.,Santa Cristina University Hospital
Journal of Medical Case Reports | Year: 2010

Introduction. A unicornuate uterus with a rudimentary horn is the most uncommon uterine anomaly of the female genital tract. It has an estimated frequency of one in 100,000 among the fertile female population. This anomaly results from the abnormal maturation of one Müllerian duct with the normal development of the contralateral one. Case presentation. We report here the case of a 14-year-old Caucasian girl who came to our hospital with intense dysmenorrhea. Imaging techniques revealed a unicornuate uterus with a rudimentary horn and a large hematosalpinx. We performed a laparoscopic removal of this uterine anomaly without any complication in the postoperative period. Conclusion. In our case report, we demonstrate that laparoscopy is the best approach for the treatment of IIb Müllerian abnormalities. Laparoscopy resulted in anatomical and reproductive results equivalent to those offered by a laparotomic approach, but with the additional advantages of minimally invasive surgery, such as better cosmetic results and postoperative period, which are essential for very young patients. © 2010Zapardiel et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2. 0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2010 Zapardiel et al; licensee BioMed Central Ltd.


Zapardiel I.,Santa Cristina University Hospital | Peiretti M.,Spanish Institute of Oceanography | Godoy-Tundidor S.,Kimmel Cancer Center
American Journal of Obstetrics and Gynecology | Year: 2010

The most common etiology of postpartum hemorrhage is uterine atony, although hematologic disorders may be present. A 36-year-old nulliparous woman underwent puerperal hysterectomy caused by uncontrolled postpartum hemorrhage. One day after discharge, she vomited in the emergency room a 24-cm long Ascaris lumbricoides. Infestation during gestation may cause hematologic disorders that could complicate pregnancy outcome. © 2010 Mosby, Inc. All rights reserved.


Zimmerman R.M.,Massachusetts General Hospital | Zimmerman R.M.,Santa Cristina University Hospital | Jupiter J.B.,Massachusetts General Hospital | Jupiter J.B.,Santa Cristina University Hospital | And 2 more authors.
Journal of Hand Surgery | Year: 2013

Purpose To retrospectively evaluate patients with 6-year minimum follow-up after submuscular transposition of the ulnar nerve for primary entrapment. Methods From 1992 to 2005, 142 patients were treated surgically for ulnar neuropathy at the elbow by 2 senior surgeons using a technique that preserved nerve vascularity. A total of 99 cases were eligible, and 82 elbows in 76 patients, average age 48 years, were followed for at least 6 years (average, 8.3 y). Thirty-two (42%) were male, and the dominant limb was involved in 49 (64%). The average duration of symptoms before surgery was 25 months. Clinical records were reviewed, and sensory (S0-2) and motor (M0-5) testing was performed. Dellon scores were determined, and visual analog scale and modified questionnaires from Novak et al and Kleinman and Bishop were completed. Preoperatively, 48 elbows were Dellon grade III, 33 were grade II, and one was grade I. Results There were clinically and statistically significant improvements in patient and surgeon-reported data regardless of the preoperative disease severity. Visual analog scale questionnaires, sensory scale, and motor strength all improved, with at least antigravity strength in all subjects. Dellon scores also improved, and 38 elbows had normalized to Dellon 0. Of the 33 preoperative elbows that were grade III, 15 improved to grade II, 13 to grade I, and 5 normalized. Of the 48 preoperative elbows that were grade II, 16 improved to grade I and 32 normalized. Preoperative Dellon III elbows had more residual symptoms than grade II elbows. A total of 73 elbows (89%) had a good or excellent outcome. There were no reoperations or infections. Conclusions Submuscular transposition is a safe and durable option for primary ulnar neuropathy at the elbow. Overall, good or excellent results were achieved in 89% of patients with a low complication rate. Type of study/level of evidence Therapeutic IV. © 2013 by the American Society for Surgery of the Hand. All rights reserved.


San-Frutos L.,Puerta Of Hierro Majadahonda University Hospital | Engels V.,Infanta Leonor Hospital | Zapardiel I.,Santa Cristina University Hospital | Perez-Medina T.,Puerta Of Hierro Majadahonda University Hospital | And 3 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2011

Objective. To describe hemodynamic changes in normal pregnancy and postpartum by means of thoracic electrical bioimpedance (TEB). Methods. Eighteen healthy pregnant women were included in the study. Eight different hemodynamic variables were measured by thoracic electrical bioimpedance, from 12th week of gestation until 6th month of postpartum period. Data along pregnancy and postpartum were analyzed with SAS statistical software to compare the different values, so normality curves are reported. Results. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and peripheral vascular resistances (PVRs) seem to significantly decrease until 24th week of gestation, and then they seem to increase until delivery, recovering normal values gradually during postpartum period. End-diastolic volume (EDV), systolic volume (SV), cardiac output (CO), and ejection fraction (EF) seem to decrease until 48h after delivery; statistical significance was found. Conclusions. Thoracic electrical bioimpedance may be the most appropriate and accurate technique to measure normal hemodynamic changes during pregnancy and postpartum. © 2010 Informa UK, Ltd.


Zapardiel I.,Santa Cristina University Hospital | Delafuente-Valero J.,Santa Cristina University Hospital | Bajo-Arenas J.M.,Santa Cristina University Hospital
Gynecologic and Obstetric Investigation | Year: 2011

The incidence of renal angiomyolipoma (RA) is 0.3% in the general population, and even more infrequent during pregnancy. Pregnancy can increase the risk of rupture, although the causal mechanism is still not clearly defined. We completed a Medline literature search for articles on RA and pregnancy and its complications. We identified 16 articles (all case reports), but selected only 13 because of unavailable data in the 3 other articles. We report the case of a 30-year-old primiparous woman who presented at the emergency ward with a non-reassuring pattern at fetal monitoring; an urgent cesarean section was decided and carried out. After surgery, a wide retroperitoneal hematoma was observed caused by the rupture of an RA. Conservative management by means of arterial embolism was done and the patient was discharged on postoperative day 10. RAs seem to have a higher risk of rupture during pregnancy, but they should be managed conservatively when hemodynamically possible. Individualization of each case is necessary in order to achieve the best outcome for both the mother and fetus. © 2011 S. Karger AG, Basel.


PubMed | Santa Cristina University Hospital, Institute Investigacion Sanitaria Princesa and Hospital del Tajo
Type: Comparative Study | Journal: Liver international : official journal of the International Association for the Study of the Liver | Year: 2015

Relationship between gallstones and non-alcoholic fatty liver disease (NAFLD), and largely non-alcoholic steatohepatitis (NASH), is uncertain.To determine the prevalence, non-invasive fibrosis markers profile and risk factors for biopsy-proven NAFLD and NASH among patients with gallstones.Anthropometric and laboratory evaluation, an abdominal ultrasound and a liver biopsy were performed to 215 consecutive patients with gallstones referred for cholecystectomy.Prevalence of NASH was 10.2% whereas that of simple steatosis (SS) was 41.4%. In the cohort of NAFLD patients, negative predictive values for advanced fibrosis of FIB-4 and NAFLD fibrosis score were 96 and 95% respectively. Gallstone patients with NASH had a higher mean homeostatic model assessment (HOMA) score than those with SS (P = 0.015). Noteworthy, NASH was 2.5-fold more frequent in patients with gallstones who had metabolic syndrome than in those who did not (P < 0.001). Fatty liver on ultrasound was observed in 90.9% of gallstone patients with NASH compared with 61.8% of those with SS (P = 0.044). Using multivariate logistic regression, increased HOMA score (OR, 3.47; 95% CI, 1.41-8.52; P = 0.007) and fatty liver on ultrasound (OR, 23.27; 95% CI, 4.15-130.55; P < 0.001) were the only factors independently associated with NASH.Prevalence of NASH among patients with gallstones is lower than estimated previously, but NASH is frequent particularly in those patients with concurrent metabolic syndrome. The combination of an increased HOMA score with fatty liver on ultrasound has a good accuracy for predicting NASH in patients with gallstones.

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