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de la Torre M, Delgado M, Paradela M, González D, Fernández R, García J, Fieira E, Borro J. Influence of Body Mass Index in the Postoperative Evolution After Lung Transplantation. Transplant Proc 2010; 42:3026-8. [DOI: 10.1016/j.transproceed.2010.07.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pachón-Ibáñez ME, Ribes S, Domínguez MA, Fernández R, Tubau F, Ariza J, Gudiol F, Cabellos C. Efficacy of fosfomycin and its combination with linezolid, vancomycin and imipenem in an experimental peritonitis model caused by a Staphylococcus aureus strain with reduced susceptibility to vancomycin. Eur J Clin Microbiol Infect Dis 2010; 30:89-95. [PMID: 20844913 DOI: 10.1007/s10096-010-1058-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/28/2010] [Indexed: 11/30/2022]
Abstract
The objective of this study was to evaluate the in vitro and in vivo efficacies of therapies including fosfomycin against clinical Staphylococcus aureus isolates with reduced susceptibility to vancomycin (hGISA). Time-kill curves were performed over 24 h. Peritonitis in C57BL/6 mice was induced by intraperitoneal inoculation of 10(8) CFU/ml. Four hours later (0 h), therapy was started and the treatment groups were: control (not treated), fosfomycin (100 mg/kg/5 h), vancomycin (60 mg/kg/5 h), imipenem (30 mg/kg/5 h), fosfomycin plus linezolid, fosfomycin plus vancomycin and fosfomycin plus imipenem, receiving subcutaneous therapy over 25 h. Bacterial counts in peritoneal fluid, bacteraemia and mortality rates were determined. In vitro, fosfomycin showed a synergistic effect when combined with the other antimicrobials tested. In the animal model, fosfomycin combinations were effective and significantly reduced the bacteraemia rates achieved in the control, imipenem and vancomycin groups (p < 0.05). The best combination in vivo was fosfomycin plus imipenem. Also, fosfomycin plus linezolid was significantly better than vancomycin alone, reducing the bacterial concentration in the peritoneal fluid. In conclusion, in vitro and in vivo, fosfomycin in combination with linezolid, vancomycin or imipenem exerted a good activity. Fosfomycin plus imipenem was the most active combination, decreasing 3 log CFU/ml, and appears to be a promising combination for clinical practice.
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Gullón JA, Suárez I, Medina A, Rubinos G, Fernández R, González I. Role of emphysema and airway obstruction in prognosis of lung cancer. Lung Cancer 2010; 71:182-5. [PMID: 20554345 DOI: 10.1016/j.lungcan.2010.05.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 03/15/2010] [Accepted: 05/16/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE It has been reported that the presence of COPD and emphysema is associated with an increased risk of lung cancer, but the prognosis significance of these two conditions is not well known. The aim of our study was to analyze the influence of COPD and emphysema in the prognosis of non-small cell lung cancer (NSCLC). METHODS Three hundred and fifty-three patients with cytohistologic diagnosis of NSCLC were prospectively collected. The relationship between survival at two years and the following variables: age, sex, smoking habit, comorbid diseases (cardiovascular diseases, previous tumour and COPD), weight loss, presence of emphysema on CT scan, performance status (PS) and treatment, was analyzed. The Kaplan-Meier method and log-rank test were used for survival analysis. A multivariate Cox proportional hazard model, stratified by TNM stage, was used to evaluate prognostic factors. RESULTS Emphysema was present in 110 patients, associated with COPD in 78 (70.9%). In univariate analysis, survival decreased with age>70 years (p=0.01), presence of emphysema (p=0.02), weight loss (p=0.00001), PS≥2 (p=0.00001) and symptomatic treatment (p=0.0001). Multivariate analyses identified emphysema (HR=1.49 (95% CI 1.11-2.01)), PS≥2 (HR=2.12 (95% CI 1.31-3.38)) and treatment: surgery (HR=0.3 (95% CI 0.15-0.56)) and chemotherapy (HR=0.34 (95% CI 0.31-0.57)) as independent prognostic factors. CONCLUSION The presence of emphysema affects the prognostic outcome of patients with non-small cell lung cancer. Emphysema should therefore be considered for prognostic studies on comorbidity.
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Arias L, Fernández R, Fernández D, Jaramillo J, Gil M, López García-Asenjo J. C4D Immunostaining in Surveillance Endomyocardial Biopsies From Well-Functioning Heart Allografts. Transplant Proc 2010; 42:1793-6. [DOI: 10.1016/j.transproceed.2009.12.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022]
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Arenas R, Torres E, Amaya M, Rivera E, Espinal A, Polanco M, Fernández R, Isa-Isa R. Tinea capitis. Emergencia de Microsporum audouinii y Trichophyton tonsurans en la República Dominicana. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Otero A, Palacios F, Akinfiev T, Fernández R. A device for automatically measuring and supervising the critical care patient's urine output. SENSORS 2010; 10:934-51. [PMID: 22315578 PMCID: PMC3270879 DOI: 10.3390/s100100934] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 01/15/2010] [Accepted: 01/18/2010] [Indexed: 01/18/2023]
Abstract
Critical care units are equipped with commercial monitoring devices capable of sensing patients’ physiological parameters and supervising the achievement of the established therapeutic goals. This avoids human errors in this task and considerably decreases the workload of the healthcare staff. However, at present there still is a very relevant physiological parameter that is measured and supervised manually by the critical care units’ healthcare staff: urine output. This paper presents a patent-pending device capable of automatically recording and supervising the urine output of a critical care patient. A high precision scale is used to measure the weight of a commercial urine meter. On the scale’s pan there is a support frame made up of Bosch profiles that isolates the scale from force transmission from the patient’s bed, and guarantees that the urine flows properly through the urine meter input tube. The scale’s readings are sent to a PC via Bluetooth where an application supervises the achievement of the therapeutic goals. The device is currently undergoing tests at a research unit associated with the University Hospital of Getafe in Spain.
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Paradela M, González D, Parente I, Fernández R, De La Torre MM, Delgado M, García JA, Fieira E, Bonhome C, Maté JMB. Surgical risk factors associated with lung transplantation. Transplant Proc 2010; 41:2218-20. [PMID: 19715878 DOI: 10.1016/j.transproceed.2009.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite years of experience with lung transplantation, perioperative morbidity rates remain high. The objective of this study was to analyze our series of lung transplant recipients, seeking to identify possible intra- and postoperative risk factors associated with mortality. PATIENTS AND METHODS We performed a descriptive, retrospective study of 224 consecutive patients undergoing lung transplantation over a period of 112 months; we excluded retransplant procedures. We gathered details of the surgical procedure and postoperative period in the recovery unit. Univariate analysis using the chi-square test identified variables associated with the incidence of mortality. RESULTS From 1999 to 2008, we performed 224 lung transplants, including 66% in men and 34% in women. Their overall mean age was 49.9 +/- 13.5 years. The conditions that led to transplantation were pulmonary fibrosis (38.4%); chronic obstructive pulmonary disease emphysema (29%); cystic fibrosis (10.7%); bronchiectasis (8.9%); pulmonary hypertension (3.1%); and other diseases (9.9%). A total of 124 (55.4%) patients underwent single and 100 (44.6%) received sequential bilateral lung transplantations. Surgical risk factors were identified in 51.3% of the cases, the most frequent being hemorrhage (25.3%), followed by severe pulmonary hypertension (14.7%) and cardiopulmonary bypass (12.1%). Greater perioperative mortality was detected among patients with surgical risk factors, namely, significantly related to cardiopulmonary bypass, pulmonary hypertension, and air leak. A higher frequency of surgical risk factors was observed among patients with bilateral lung transplantations and longer procedures, but they were not associated with greater perioperative mortality. Reoperation was necessary in 16 patients (7.2%), mainly owing to bleeding, it was not significantly related to mortality risk. CONCLUSIONS The incidence of surgical risk factors in lung transplantation was high, especially in bilateral lung transplantations and prolonged procedures. Postoperative bleeding requiring reoperation was not frequent and not associated with increased preoperative mortality in our series.
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Delgado M, Borro JM, De La Torre MM, Fernández R, González D, Paradela M, García JA, Fieira E, Rama P. Lung transplantation as the first choice in emphysema. Transplant Proc 2010; 41:2207-9. [PMID: 19715874 DOI: 10.1016/j.transproceed.2009.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The indication for single or double lung transplantation in patients diagnosed with pulmonary emphysema is a topic of current debate. Our aim was to analyze the differences in the incidence of perioperative complications, survival, and quality of life between single and double lung transplantations. MATERIALS AND METHODS From 1999 to 2008, 223 subjects underwent transplantation in our department, of whom 62 (28%) had a previous diagnosis of pulmonary emphysema. A retrospective study was performed to establish possible differences between group 1 (single lung) and group 2 (double lung) transplants analyzing overall survival using the Kaplan-Meier method and differences between groups using the log-rank test. Pearson chi-square test was used to compare the frequency of postoperative complications, bronchiolitis obliterans BOS acute rejection episodes, and infections. RESULTS We included 62 patients who underwent transplantation for emphysema. Cumulative 5-year survival rate, excluding preoperative mortality, was 54% overall, 59% for group 1, and 56% for group 2. No significant differences were observed between the groups (P = .47). The frequency of BOS was 34% in group 1 and 42% in group 2 (P = .52). At least 1 acute rejection episode occurred in 52% of group 1 patients and 51% of group 2 patients (P = .98). Bacterial infections were experienced by 50% of group 1 patients and 54% of group 2 patients (P = .72). Fungal infections affected 10% of group 1 patients and 15% of group 2 patients (P = .71). Intraoperative complications were recorded in 27.6% of group 1 patients versus 54% of group 2 patients, a difference that was statistically significant (P = .032). CONCLUSIONS The study results supported the decision of our group to consider single lung transplantation the treatment of choice in emphysema, which may be complemented with volume reduction surgery in the native lung or subsequent transplantation of the contralateral lung.
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de la Torre MM, Borro JM, Fernández R, González D, Delgado M, Paradela M, García JA, Lemos C. Results of "twinning procedure" in lung transplantation: experience in a single center. Transplant Proc 2010; 41:2213-5. [PMID: 19715876 DOI: 10.1016/j.transproceed.2009.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The major limiting factor for lung transplantation (LT), both worldwide and in Spain, is the number of suitable lung donors. This, together with the increased demand for LT, led us to propose the performance of 2 single lung transplantations simultaneously using the same donor (the "twinning procedure"). OBJECTIVE The objective of this study was to analyze the outcome of patients who underwent transplantation with this procedure, assessing differences between the first and the second transplant. PATIENTS AND METHODS From November 2001 to August 2008, 46 single lung transplantations (SLTs) were performed with 23 donors. RESULTS The mean ischemia time was 258 minutes (median, 265) for the first transplantation and 312 minutes (median, 320) for the second transplantation. Primary graft dysfunction occurred in 5 patients (24%) in the first group and 9 in the second group (39%; P = .27). The median intubation time was 8 hours for the first and 6.5 hours for the second group. The mean hospital stay was 39 and 31 days, respectively. Postoperative mortality was 2 (8.7%) and 3 (13%) patient, respectively (P = .99). There was no significant difference in the incidence of acute rejection episodes, infections, or chronic rejections. Five-year survival rates were 67.9% for the first and 61.5% for the second (Kaplan-Meier). CONCLUSIONS The performance of 2 SLTs using the same donor and in the same hospital was feasible with adequate planning, permitting better use of donors and reducing waiting list time and mortality. Our results showed no increased risk for recipients of the second transplant in the early postoperative and long-term periods.
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Arenas R, Torres E, Amaya M, Rivera E, Espinal A, Polanco M, Fernández R, Isa-Isa R. Emergence of Microsporum audouinii and Trichophyton tonsurans as Causative Organisms of Tinea Capitis in the Dominican Republic. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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86
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Herrero-Velázquez S, Guerrero-Peral AL, Fuertes JJ, Rojo-Martínez E, Peñas-Martínez ML, Cortijo E, Fernández R. [Neuralgia of the intermediate nerve and facial palsy with or without herpes]. Rev Neurol 2009; 49:670-671. [PMID: 20013721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Guerrero-Peral AL, Rojo-Martínez E, Gutiérrez-Gómez JM, Fuertes JJ, Peñas-Martínez ML, Herrero-Velázquez S, Cortijo E, Fernández R. [Paralysis of upward gaze and eyelid retraction as isolated symptoms of posterior commissure infarction]. Rev Neurol 2009; 49:496-497. [PMID: 19859892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Alvarez L, Macias R, Pavón N, López G, Rodríguez-Oroz MC, Rodríguez R, Alvarez M, Pedroso I, Teijeiro J, Fernández R, Casabona E, Salazar S, Maragoto C, Carballo M, García I, Guridi J, Juncos JL, DeLong MR, Obeso JA. Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months. J Neurol Neurosurg Psychiatry 2009; 80:979-85. [PMID: 19204026 DOI: 10.1136/jnnp.2008.154948] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stereotactic thermocoagulative lesions of the subthalamic nucleus (STN) have been shown to induce significant motor improvement in patients with Parkinson's disease (PD). PATIENTS AND METHODS 89 patients with PD were treated with unilateral subthalamotomy. 68 patients were available for evaluations after 12 months, 36 at 24 months and 25 at 36 months. RESULTS The Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved significantly contralaterally to the lesion in the "off" and "on" states throughout the follow-up, except for the "on" state at the last evaluation. Axial features and signs ipsilateral to the lesion progressed steadily throughout the study. Levodopa daily doses were significantly reduced by 45%, 36% and 28% at 12, 24 and 36 months post-surgery. 14 patients (15%) developed postoperative hemichorea-ballism which required pallidotomy in eight. These 14 patients had significantly higher dyskinesia scores (levodopa induced) preoperatively than the entire cohort. CONCLUSION Unilateral subthalamotomy was associated with significant and sustained motor benefit contralateral to the lesion. Further work is needed to ascertain what factors led to severe, persistent chorea-ballism in a subset of patients. Subthalamotomy may be considered an option in circumstances when deep brain stimulation is not viable.
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González D, Paradela M, Parente I, De la Torre M, Fernández R, Delgado M, García J, Fieira E, Pato O, Borro J. Reoperation in the Postoperative Period of Lung Transplantation. Transplant Proc 2009; 41:2221-2. [DOI: 10.1016/j.transproceed.2009.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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90
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Fernández R, Mondragon I, Galante M, Oyanguren P. Influence of chromophore concentration and network structure on the photo-orientation properties of crosslinked epoxy-based azopolymers. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/polb.21704] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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91
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Pastor JC, Fernández I, Barragán S, Coco R, Sanabria MR, Rodríguez-de-la-Rúa E, Rojas J, Sánchez D, Fernández R. [Training and clinical activity of Spanish retinologists: a preliminary approach. Retina 2 project. Descriptive analysis]. ACTA ACUST UNITED AC 2009; 84:75-83. [PMID: 19253177 DOI: 10.4321/s0365-66912009000200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To create a database of Spanish ophthalmologists mainly dedicated to retinal pathology care, describing their training period characteristics and their daily activity (clinical and surgical). METHODS A postal questionnaire was sent to 504 possible retinologists identified through the information supplied by the Spanish Ophthalmological Society and the Spanish Vitreous-Retina Society, with a minimum of 3 retinologists per Autonomous Region. RESULTS 267 (52.9% of the sample population) responses were collected and processed. Most of the respondents had started their residency after 1980 (82.4%). Ninety-four percent had received specific training in retinal pathology, mostly during the residency period (82.1%) and from more experienced colleagues (62.9%). Official fellowships were held in a minority of cases (around 12%). Twelve percent of retinologists performed retinal surgery only, 14.6% performed anterior segment surgery, and 60.7% performed both types of surgery. CONCLUSIONS Despite not having taken into consideration non-response bias, this study provides the first reported data on the professional profile of Spanish retinologists.
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Delgado M, Fernández R, Paradela M, De La Torre M, González D, García J, Borro J. Development of Neoplasms During Lung Transplantation Follow-up. Transplant Proc 2008; 40:3094-6. [DOI: 10.1016/j.transproceed.2008.08.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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93
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Teijeiro J, Macı´as R, López G, Alvarez L, Maragoto C, Garcı´a I, Fernández R, Morales J. 64. PC based deep brain recording system for stereotactic and functional neurosurgery. Clin Neurophysiol 2008. [DOI: 10.1016/j.clinph.2008.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fernández R, Bertrand A, Casares A, García R, González A, Tamés RS. Cadmium accumulation and its effect on the in vitro growth of woody fleabane and mycorrhized white birch. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2008; 152:522-9. [PMID: 17719154 DOI: 10.1016/j.envpol.2007.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 07/10/2007] [Accepted: 07/13/2007] [Indexed: 05/16/2023]
Abstract
The effect of Cd on woody fleabane (Dittrichia viscosa (L.) Greuter) and white birch (Betula celtiberica Rothm. & Vasc.) was examined. Woody fleabane and white birch were grown in vitro in Murashige, T., Skoog, F., [1962. A revised medium for rapid growth and bioassays with tobacco tissue cultures. Physiol. Plant. 15, 473-479] (MS) plus Cd (10 mg Cd kg(-1)) and except for root length in white birch, plant development was inhibited when Cd was added. Cd accumulation in above-ground tissues showed differences among clones, reaching 1300 and 463 mg Cd kg(-1) dry wt. in selected clones of woody fleabane and white birch, respectively. Tolerance of Paxillus filamentosus (Scop) Fr. to Cd was also examined before mycorrhization. Plants of mycorrhized white birch grown in the presence of Cd had a better development and accumulated more Cd in their shoots than the non-mycorrhized ones. The use of selected clones of woody fleabane and the mycorrhization of white birch enhance extraction efficiency from contaminated soils in phytoremediation programs.
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Díaz-Marsá M, Galian M, Montes A, Fernández R, Arza R, López-Ibor J, Carrasco J. [Long-acting injectable risperidone in treatment resistant borderline personality disorder. A small series report]. ACTAS ESPANOLAS DE PSIQUIATRIA 2008; 36:70-74. [PMID: 18365787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is usually treated with a combination of antipsychotic and anticonvulsant drugs although only limited efficacy is obtained in many patients. A major problem in the treatment of BPD is the lack of compliance derived form the pathological impulsivity of BPD patients. METHODS Twelve severe BPD patients refractory to previous treatment with drug combinations for three months were treated with intramuscular long-acting risperidone for a six-month period. Clinical changes were rated with the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale, anxiety and aggression scales. Functional improvement was evaluated with the Global Assessment of Functioning (GAF). RESULTS Six-month treatment with IM risperidone was associated with significant improvement of CGI (t: 5.7 - 4.0; p<0.01) and of GAF (t: -4.5; gl: 10; p<0.01). Clinical improvement was robust after the first month of treatment. No relevant extrapiramidal side effects were reported with the exception of mild psychomotor slowing which requires dose adjustments in four patients. CONCLUSIONS Treatment with i.m. long acting risperidone during six months was associated with significant clinical and functional improvement and excellent tolerability in a group of BPD patients refractory to previous treatment. The results indicate that the effect of IM risperidone in BPD should be further investigated in large placebo-controlled trials.
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del Valle V, Bermejo Alvarez MA, Rubio Marauri P, Fernández R. [Pneumothorax secondary to axillary sentinel lymph node biopsy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:185-186. [PMID: 18401995 DOI: 10.1016/s0034-9356(08)70539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Peces R, Fernández R, Peces C, González E, Olivas E, Renjel F, Jiménez M, Costero O, Montero A, Selgas R. [Effectiveness of pre-emptive hemodialysis with high-flux membranes for the treatment of life-threatening alcohol poisoning]. Nefrologia 2008; 28:413-418. [PMID: 18662149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Alcohol intoxication (methanol, ethanol and ethylene glycol) may result in metabolic acidosis with increased anion gap, increased serum osmolal gap, and neurologic abnormalities ranging from drunkenness to coma, and death. The mortality and morbidity rates remain very high despite intensive care therapy. The toxicity of methanol and ethylene glycol is clearly correlated to the degree of metabolic acidosis. The established treatment of severe methanol and ethylene glycol intoxication is ethanol administration and hemodialysis (HD). By inhibiting the main metabolic pathway of methanol and ethylene glycol (alcohol dehydrogenase), ethanol prevents the formation of major toxic metabolites (formic acid, glycolic acid and oxalic acid). Conventional HD can reduce serum methanol, ethanol and ethylene glycol and its metabolites rapidly, but high-flux membranes should be capable of removing more toxic per hour of HD. In this report, we describe 14 cases of life-threatening alcohol intoxication (11 methanol, 1 ethanol, and 2 ethylene glycol) who were treated successfully with supportive care, ethanol infusion (methanol and ethylene glycol), and early HD with a high-flux dialyser. The median pH was 7.04 +/- 0.06 (range 6.60-7.33), median bicarbonate 9.9 +/- 1.9 mmol/l (range 1.4-25), and median base deficit 18.4 +/- 2.6 mmol/l (range 2-33). The median anion gap was 29.1 +/- 2.3 mmol/l (range 16-45) and the median osmolal gap was 119 +/- 47 mOsm/l (range 16-402). On admission there was an excellent linear correlation between the serum toxic alcohol concentrations and the osmolal gaps (R2 = 0.98, p = 0.0006). In all cases early HD corrected metabolic acidosis and osmolal abnormalities. The mortality was 7 % (1 from 14). We conclude that pre-emptive HD should be performed in severe intoxications to remove both the parent compound and its metabolites. The HD prescription should include a large surface area dialyser with high-flux membrane, a blood flow rate in excess of 250 ml/min, a modified bicarbonate bath enriched with phosphorus and potassium, and a long time session. The phosphorus and potassium-enriched bicarbonate-based dialysis solution used in patients with normal phosphorus and potassium serum levels avoided HD-induced hypophosphatemia and hypopotassemia. HD as implemented in these cases is a safe and very effective approach to the management of alcohol poisoning.
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Vallés J, Pobo A, García-Esquirol O, Mariscal D, Real J, Fernández R. Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs late onset. Intensive Care Med 2007; 33:1363-8. [PMID: 17558495 DOI: 10.1007/s00134-007-0721-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 04/06/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the impact of ventilator-associated pneumonia (VAP) on ICU mortality, and whether it is related to time of onset of pneumonia. DESIGN Prospective cohort study. SETTING 16-bed medical-surgical ICU at a university-affiliated hospital. PATIENTS AND MEASUREMENTS From 2002 to 2003, we recorded patients receiving mechanical ventilation for > 72 h. Patients developing an infection other than VAP were excluded. Patients definitively diagnosed with VAP (n=40) were cases and patients free of any infection acquired during ICU stay (n=61) were controls. The VAP-attributed mortality was defined as the difference between observed mortality and predicted mortality (SAPS II) on admission. RESULTS Mechanical ventilation was longer in VAP patients (25 +/- 20 vs 11 +/- 9 days; p < 0.001), as was ICU stay (33 +/- 23 vs 14 +/- 12 days; p < 0.001). In the non-VAP group, no difference was found between observed and predicted mortality (27.9 vs 27.4%; p > 0.2). In the VAP group, observed mortality was 45% and predicted mortality 26.5% (p < 0.001), with attributable mortality 18.5%, and relative risk (RR) 1.7 (95% CI 1.12-23.17). No difference was observed between observed and predicted mortality in early-onset VAP (27.3 vs 25.8%; p > 0.20); in late-onset VAP, observed mortality was higher (51.7 vs 26.7%; p < 0.01) with attributable mortality of 25% and an RR 1.9 (95% CI 1.26-2.63). Empiric antibiotic treatment was appropriate in 77.5% of episodes. No differences in mortality were related to treatment appropriateness. CONCLUSIONS In mechanically ventilated patients, VAP is associated with excess mortality, mostly restricted to late-onset VAP and despite appropriate antibiotic treatment.
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Fernández R, Verea MM, Martínez W, Yebra-Pimentel MT, Fonseca E. [Bilateral pseudo-Kaposi sarcoma in upper limbs]. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98:268-70. [PMID: 17506959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Acroangiodermatitis or pseudo-Kaposi sarcoma is an angioproliferative, self-limited entity that includes a group of diseases, congenital or acquired, with cutaneous lesions similar to Kaposi sarcoma (KS). This term can lead to confusion because it comprises several entities that are completely different, nonetheless, it has an important clinical value as it guides the diagnosis and management of these patients. We report the case of a 67-year-old patient with lesions of acroangiodermatitis in both forearms secondary to arteriovenous shunts from hemodialysis. Doppler ultrasound showed a former arteriovenous fistula in addition to the one already known. Immunohistochemical study showed CD34+ staining in endotelial cells and absence of HHV-8 expression.
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Fernández R, Verea M, Martínez W, Yebra-Pimentel M, Fonseca E. Pseudosarcoma de Kaposi bilateral en miembros superiores. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70061-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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