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Gabriel-Medina P, Ferrer-Costa R, Rodriguez-Frias F, Comas M, Vilallonga R, Ciudin A, Selva DM. Plasma SHBG Levels as an Early Predictor of Response to Bariatric Surgery. Obes Surg 2024; 34:760-768. [PMID: 38183592 PMCID: PMC10899416 DOI: 10.1007/s11695-023-06981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Obesity is a growing global health problem, and currently, bariatric surgery (BS) is the best solution in terms of sustained total weight loss (TWL). However, a significant number of patients present weight regain (WR) in time. There is a lack of biomarkers predicting the response to BS and WR during the follow-up. Plasma SHBG levels, which are low in obesity, increase 1 month after BS but there is no data of plasma SHBG levels at long term. We performed the present study aimed at exploring the SHBG role in predicting TWL and WR after BS. METHODS Prospective study including 62 patients with obesity undergoing BS. Anthropometric and biochemical variables, including SHBG were analyzed at baseline, 1, 6, 12, and 24 months; TWL ≥ 25% was considered as good BS response. RESULTS Weight loss nadir was achieved at 12 months post-BS where maximum SHBG increase was reached. Greater than or equal to 25% TWL patients presented significantly higher SHBG increases at the first and sixth months of follow-up with respect to baseline (100% and 150% respectively, p = 0.025), than < 25% TWL patients (40% and 50% respectively, p = 0.03). Also, these presented 6.6% WR after 24 months. The first month SHBG increase predicted BS response at 24 months (OR = 2.71; 95%CI = [1.11-6.60]; p = 0.028) and TWL in the 12th month (r = 0.330, p = 0.012) and the WR in the 24th (r = - 0.301, p = 0.028). CONCLUSIONS Our results showed for the first time that increase in plasma SHBG levels within the first month after BS is a good predictor of TWL and WR response after 2 years.
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Affiliation(s)
- P Gabriel-Medina
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
| | - R Ferrer-Costa
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
| | - F Rodriguez-Frias
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - M Comas
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - R Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Diabetes and Metabolism Research Unit, Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain.
| | - D M Selva
- Diabetes and Metabolism Research Unit, Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain.
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Ortiz-Zuñiga AM, Rojano Toimil A, Rahnama K, Lainez E, Raguer N, Simó-Servat O, Hernández C, Simó R, Ciudin A. Retinal sensitivity and gaze fixation evaluated by microperimetry in subjects with type 2 diabetes: two independent parameters that explore different neuronal circuits. J Endocrinol Invest 2023:10.1007/s40618-023-02046-y. [PMID: 36870015 PMCID: PMC10371889 DOI: 10.1007/s40618-023-02046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND AIMS Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperimetry are useful and complementary tools for identifying mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D). The hypothesis is that RS and GF examine different neural circuits: RS depends only on the visual pathway while GF reflects white matter complex connectivity networks. The aim of the study is to shed light to this issue by examining the relationship of these two parameters with visual evoked potentials (VEP), the current gold standard to examine the visual pathway. MATERIALS AND METHODS Consecutive T2D patients > 65 years were recruited from the outpatient clinic. Retinal microperimetry (MAIA 3rd generation) and visual evoked potentials (VEP) (Nicolet Viking ED). RS (dB), GF (BCEA63%, BCEA95%) (MAIA) and VEP (Latency P100ms, Amplitude75-100 uV) were analyzed. RESULTS Thirty three patients (45% women, 72.1 ± 4.6 years) were included. VEP parameters significantly correlated with RS but not with GF. CONCLUSIONS These results confirm that RS but not GF depends on the visual pathway, reinforcing the concept that they are complementary diagnostic tools. Used together can further increase the value of microperimetry as screening test for identifying T2D population with cognitive impairment.
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Affiliation(s)
- A M Ortiz-Zuñiga
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - A Rojano Toimil
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - K Rahnama
- Department of Clinical Neurophysiology, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - E Lainez
- Department of Clinical Neurophysiology, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - N Raguer
- Department of Clinical Neurophysiology, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - O Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain
| | - C Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain
| | - R Simó
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain.
| | - A Ciudin
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain.
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Vilarrasa N, Bretón I, Ballesteros-Pomar M, Lecube A, Goday A, Pellitero S, Sánchez R, Zugasti A, Ciudin A, de Hollanda A, Rubio MA. Recommendations for the diagnosis and treatment of hypoglycaemia after bariatric surgery. ENDOCRINOL DIAB NUTR 2022; 69:723-731. [PMID: 36424342 DOI: 10.1016/j.endien.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/12/2021] [Indexed: 06/16/2023]
Abstract
Postprandial hyperinsulinaemic hypoglycaemia is a common complication of bariatric surgery. Although in general its evolution is mild and self-limited, it can lead to neuroglycopaenia and compromise the patient's safety and quality of life. The aim of this document is to offer some recommendations to facilitate the clinical care of these complex patients, reviewing the aetiopathogenesis, its diagnosis and treatment that, sequentially, will include dietary and pharmacological measures and surgery in refractory cases. In the absence of high-quality studies, the diagnostic and therapeutic approach proposed is based on the consensus of experts of the Grupo de Obesidad de la Sociedad Española de Endocrinología y Nutrición [Obesity Group of the Spanish Society of Endocrinology and Nutrition], GOSEEN. Those undergoing bariatric surgery should be informed of the possibility of developing this complication.
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Affiliation(s)
- Nuria Vilarrasa
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge-IDIBELL, ĹHospitalet de Llobregat, Barcelona, Spain. CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain).
| | - Irene Bretón
- Servicio de Endocrinología y Nutrición, Hospital Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - María Ballesteros-Pomar
- Servicio de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
| | - Albert Lecube
- Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Lleida, Spain. Obesity, Diabetes and Metabolism Research Group (ODIM), IRBLLeida, Universitat de Lleida, CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain)
| | - Albert Goday
- Servicio de Endocrinología y Nutrició, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Spain. CIBERobn (Centros de Investigación Biomédica en Red-CIBER, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain)
| | - Silvia Pellitero
- Servicio de Endocrinología y Nutrición, Hospital Universitari Germans Trias i Pujol, IMPPC, Institut d Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain
| | - Raquel Sánchez
- Servicio de Cirugía General, Complejo Hospitalario Universitario de Vigo, Instituto de Investigación Galicia Sur, Vigo, Pontevedra, Spain
| | - Ana Zugasti
- Sección Nutrición y Dietética, Complejo Hospitalario de Navarra, Pamplona/Iruña, Spain
| | - Andrea Ciudin
- Servicio de Endocrinología y Nutrición, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain) Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Ana de Hollanda
- Servicio de Endocrinología y Nutrición, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain. CIBERobn (Centros de Investigación Biomédica en Red-CIBER, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid)
| | - Miguel Angel Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, IDISSC, Madrid, Spain
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Anastasiadou D, Vázquez-De Sebastián J, Spanlang B, Slater M, Quiroga J, Parramón Puig G, Ciudin A, Comas M, Lusilla-Palacios P. Can the integration of Motivational Interviewing skills in a virtual self-conversation be effective in promoting lifestyle changes among healthy adults and patients with obesity? A usability study. Eur Psychiatry 2022. [PMCID: PMC9567416 DOI: 10.1192/j.eurpsy.2022.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction The integration of Motivational Interviewing (MI) with behavioural and psychological interventions for the treatment of obesity has the potential to improve health-related outcomes of patients in the long-term. Objectives Our objective is to examine the usability of a VR embodiment tool for treating obesity. Methods Fourteen participants (6 healthy and 8 with morbid obesity) with a desire to make lifestyle changes were randomly assigned to the experimental group (EG) and the control group (CG). Participants from the EG engaged in a virtual self-conversation aiming at understanding their own motivation to make lifestyle changes. Using the body swapping technique, participants were embodied alternately in their own virtual representation and in their counsellor’s body. To better guide this virtual self-conversation, participants were previously trained on MI skills. Participants from the CG were embodied in their own virtual bodies and participated in a “scripted dialogue” with a virtual counsellor who gave them practical recommendations about how to achieve lifestyle changes. A mixed-methods design was used, involving a semi-structured interview examining users´ satisfaction with the virtual experience, as well as self-report questionnaires, including readiness to change habits, body ownership, and system usability. Results Participants showed high usability of the platform with higher scores among participants from the EG compared to the CG. Levels of body ownership were satisfactory, with no differences between groups. Conclusions Through the integration of MI in the VR context with the patient being properly trained to carry out his/her own motivational self-conversation, we will provide an important advance in the psychological treatments of obesity. Disclosure This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 951930
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Vilallonga R, García Ruiz de Gordejuela A, Fort JM, Gonzalez O, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Ciudin A, Pera-Ferreruela M, Petrola C, Armengol M. Laparoscopic Versus Robot-Assisted Roux-en-Y Gastric Bypass: A Center of Excellence for the EAC-BC Experience. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34612707 DOI: 10.1089/lap.2021.0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: After the first laparoscopic Roux-en-Y gastric bypass (RYGB) in 1994 by Wittgrove, the introduction of robot-assisted procedures was the next step in the surgical race to reduce invasiveness. This breakthrough allowed us to perform bariatric surgery with less surgical trauma in obese patients with metabolic disorders, producing an exponential increase in procedures performed. Methods: This is a retrospective cohort study of a prospective database for patients who underwent RYGB during a 7-year period through two different approaches, laparoscopic and robotic. The robotic cases were performed by two generations of the da Vinci platform (S and Xi), and three groups were identified and compared (L-RYGB, RYGB-S, and RYGB-Xi). Results: A total of 495 patients underwent RYGB, of which 224 by laparoscopy (45.2%) and 271 by robotic approach (54.7%): 134 RYGB-S and 137 RYGB-Xi. The majority of the patients (71.1%) were females, with a mean age of 46.2 years and a mean body mass index of 44 kg/m2. The mean intraoperative time and intraoperative complication rate were higher in the robotic groups, especially in the RYGB-S group. Postoperative complications were higher in the same group, with a rate of 11.9%, where the main leakage occurred on the upper part of the gastric pouch and not in the hand-sewed robotic anastomosis (7.5%). General mortality was 0.6%. We found no significant differences at 1-year percentage of total weight loss (%TWL); at 2 years, the RYGB-Xi group had the lowest %TWL (25.24 ± 14.54, P ≤ .001). Conclusions: The present study reflects our experience during the robotic bariatric introduction and performance since 2011. Features of the da Vinci S platform along our learning curve may explain a higher complication rate. The patients who have been operated by the RYGB-Xi system had lower complications than the laparoscopic group. The robotic approach did not differ with laparoscopy in terms of weight loss and chronic complications after 24 months of follow-up.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- ELSAN Clinic, Surgery Department, Clinique Saint Michel, Av. D'orient, Toulon, France
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Medicine, Federal University of Rondonia, Rondonia, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinolgy and Nutrition and Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Pera-Ferreruela
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Petrola
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Armengol
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vilallonga R, Fort JM, Rodríguez Luna MR, García Ruiz de Gordejuela A, Gonzalez O, Caubet E, Cirera de Tudela A, Palermo M, Ciudin A, Armengol M. The Panoramic View of Revisional Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34492201 DOI: 10.1089/lap.2021.0506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Obesity remains a major public chronic disease, and the multifactorial components of its relapse in many patients remain inevitable. Methods: This article provides a panoramic view of the most commonly performed revisional bariatric surgery (RBS). RBS is a complex procedure; thus, primary procedures should be well chosen and performed to avoid the increasing number of RBS cases. Results: Bariatric surgery is the only successful long-term treatment for obesity. However, a proportion of primary bariatric surgeries has failed during the follow-up period. In recent decades, the solution for these complications is by performing RBS. It is mandatory to understand obesity as a chronic disease to appropriately treat patients. Treatment strategies are needed to determine the indications for revision. RBS requires a meticulous evaluation to facilitate good long-term results. Conclusions: Treatment strategies will be a fundamental pillar to wisely determine the indications for revision and identify the factors influencing failure by prudently and rationally evaluating the revisional procedure that the patient will benefit from and acquiring a high level of surgical skills.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Andrea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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7
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Campos-Varela I, Villagrasa A, Simon-Talero M, Riveiro-Barciela M, Ventura-Cots M, Aguilera-Castro L, Alvarez-Lopez P, Nordahl EA, Anton A, Bañares J, Barber C, Barreira-Diaz A, Biagetti B, Camps-Relats L, Ciudin A, Cocera R, Dopazo C, Fernandez A, Jimenez C, Jimenez MM, Jofra M, Gil C, Gomez-Gavara C, Guanozzi D, Guevara JA, Lobo B, Malagelada C, Martinez-Camprecios J, Mayorga L, Miret E, Pando E, Pérez-Lopez A, Pigrau M, Prio A, Rivera-Esteban JM, Romero A, Tasayco S, Vidal-Gonzalez J, Vidal L, Minguez B, Augustin S, Genesca J. The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19. Therap Adv Gastroenterol 2021; 14:17562848211016567. [PMID: 34104210 PMCID: PMC8170328 DOI: 10.1177/17562848211016567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/12/2021] [Indexed: 02/04/2023] Open
Abstract
Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.
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Affiliation(s)
- Isabel Campos-Varela
- Liver Unit, Department of Internal Medicine,
Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, Barcelona,
08035, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Ares Villagrasa
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Macarena Simon-Talero
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Lara Aguilera-Castro
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Patricia Alvarez-Lopez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilie A Nordahl
- Department of Clinical Pharmacology, Vall
d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Adrian Anton
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Bañares
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Barber
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Ana Barreira-Diaz
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Betina Biagetti
- Department of Endocrinology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Camps-Relats
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Raul Cocera
- Department of Urology, Vall d’Hebron Barcelona
Hospital Campus, Barcelona, Spain
| | - Cristina Dopazo
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Andrea Fernandez
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cesar Jimenez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria M Jimenez
- Department of Hematology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Mariona Jofra
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Gil
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Gomez-Gavara
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Danila Guanozzi
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Jorge A Guevara
- Department of Endoscopy, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Lobo
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Carolina Malagelada
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Joan Martinez-Camprecios
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Mayorga
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Enric Miret
- Department of Urology, Vall d’Hebron Barcelona
Hospital Campus, Barcelona, Spain
| | - Elizabeth Pando
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Pérez-Lopez
- Department of Hematology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Marc Pigrau
- Department of Endoscopy, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Prio
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus M Rivera-Esteban
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Romero
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stephanie Tasayco
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Judit Vidal-Gonzalez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Vidal
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Minguez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Department of Internal Medicine,
Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, Barcelona,
08035, Spain
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
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8
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Vilallonga R, Cirera de Tudela A, Möller EG, Piñeiro LV, Segura MB, Ferreruela MP, Mata RM, Caubet E, Gonzalez O, Ruiz de Gordejuela AG, Ciudin A, Fort JM, Carrasco MA. Robotic Revisional Experience. Single Centre Prospective Cohort Study and Review of the Literature. Chirurgia (Bucur) 2021; 116:7-15. [PMID: 33638321 DOI: 10.21614/chirurgia.116.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Robotic bariatric surgery (RBS) has increased in recent years. Many doubts continue to exist regarding its utility in terms of postoperative complications, costs and technical aspects. RBS has increased its number and shows a more technical challenge associated with more post-operative complications compared to primary bariatric surgery. We herein present a single institution experience and review to describe its utility in revisional surgery.
Methods: A retrospective review of our experience and a review of the literature has been conducted to evaluate the impact of robotic revisional surgery in the bariatric field.
Results: A total of 17 patients (5 female and 12 male) were operated on. Most frequent surgery was conversion of sleeve gastrectomy to gastric bypass (n=9). No leaks were found nor severe complications. A systematic review showed similar results including a decreased number for complications when performing robotic revisional surgery.
Conclusions: Revisional robotic surgery shows better results compared to standard laparoscopic revisional bariatric surgery in terms of efficacy, safety and hospital stay. No differences were seen in rates of mortality, morbidity and reintervention between both approaches. We encourage surgeons to learn to perform the robotic technique as part of the process of democratization and standardization of bariatric surgery.
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9
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Vilallonga R, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Gonzalez O, Ruiz de Gordejuela A, Ciudin A, Armengol M, Fort JM. Reversal to Normal Anatomy (With Sleeve Gastrectomy) for Severe Hypoglycemia. Surg Innov 2020; 28:536-543. [PMID: 33381999 DOI: 10.1177/1553350620984647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background. Laparoscopic Roux-en-Y gastric bypass (GBP) is an essential bariatric surgical procedure which is globally performed because of the associated effective weight loss and resolution of metabolic comorbidities, such as diabetes and dyslipidemia. Although some complications may occur, hypoglycemia is a rare complication, which can lead to lethal consequences. We aimed to describe the technical aspects and surgical results after reversal to normal anatomy (RNA). Methods. We conducted a retrospective data analysis including 16 patients who underwent laparoscopic RNA from 2011 to 2018. All data were archived in a prospective database. Previous bariatric surgery and postoperative outcomes were analyzed. Results. Sixteen patients underwent RNA, most of them after GBP, and 15 patients required sleeve gastrectomy. Among them, 80% were women; 5 patients presented with postoperative complications, such as colitis with intra-abdominal collection (n = 1), gastric leak (n = 2) treated with an endoprosthesis, mesenteric venous thrombosis (n = 1), and intra-abdominal bleeding (n = 1). Mean length of hospital stay was 5.93 (3-30). All patients recovered from their initial condition although 3 patients presented with mild hypoglycemia during follow-up. Seven patients regained weight (43.75%), and another 4 developed gastroesophageal reflux disease (25%). Conclusions. These laparoscopic RNA results are acceptable, indicating a clinical improvement in the hypoglycemic syndrome in all patients.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain.,54809Research Institute against Digestive Cancer, Strasbourg, France
| | - Renato Roriz-Silva
- Department of Medicine, Federal University of Rondônia -Unir, Brazil.,Division of General Surgery, Hospital de Base of Porto Velho, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Amador Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Andrea Ciudin
- Endocrinolgy and Nutrition Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, 65462Vall Dd'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
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10
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Hernandez I, Palmas Candia F, Burgos Pelaez R, Ciudin A, Martínez P, Millán L, Corredor R, Segurola H. Evaluation of peripherally inserted central catheters (picc) for parenteral nutrition by intracavitary electrocardiogram verification method in our hospital setting. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Vilallonga R, Hidalgo M, Garcia Ruiz de Gordejuela A, Caubet E, Gonzalez O, Ciudin A, Rodríguez-Luna MR, Roriz-Silva R, Petrola C, Armengol M, Fort JM. Operative and Postoperative Complications of Laparoscopic Sleeve Gastrectomy in Super and Nonsuper Obese Patients: A Center of Excellence Experience Comparative Study. J Laparoendosc Adv Surg Tech A 2020; 30:501-507. [DOI: 10.1089/lap.2019.0721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
- ELSAN, Clinique St-Michel, Toulon, France
| | - Marta Hidalgo
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amador Garcia Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Andrea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Renato Roriz-Silva
- Department of Medicine, Federal University of Rondônia—UNIR, Porto Velho, Brazil
- Division of General Surgery, Hospital de Base of Porto Velho, Porto Velho, Brazil
| | - Carlos Petrola
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
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12
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Garcia-Rodriguez J, Fernandez-Gomez J, Cozar J, Miñana B, Gomez-Veiga F, Rodriguez-Antolin A, Pórtela P, Blanco E, González J, Baena V, Morales P, Villavicencio H, Palou J, Loizaga A, Ciudin A, Mihai D, Martínez Jabaloyas J, Castelló A, Díez N, Romero F, Subirá J, Chávez A, Capapé V, Mata M, Elizalde J, Lobato J, Jiménez J, Pérez Llorca L, Tenza J, Herranz F, Husillos A, López E, Ramírez D, Blaha I, Izquierdo E, Reina L, Passas J, Díez L, Hevia M, Castells M, Concepción Masip T, Plata A, Asuar Aydillo S, Alonso J, Mateos J, Carballido J, Martínez C, Areche J, Rodríguez R, Hevia V, Álvarez S, Requena M, Prieto R, Carazo J, Márquez J, Gómez E, García J, Amón J, Cepeda M, Álvarez L, Rodríguez V, de la Cruz B, Rivero A, Sánchez J, Mainez J, Medina R, Conde M, Castiñeiras J, González Baena A, Sánchez E, Campanario R, Saiz R, Romero E, Morote J, Raventós C, Celma A, Vázquez F, Gómez A, Buendía E, García N. Androgen deprivation therapy in patients with localized disease: Comparison with curative intent treatments and time to castration resistance. Results of the Spanish Prostate Cancer Registry. Actas Urol Esp 2020; 44:156-163. [PMID: 32113829 DOI: 10.1016/j.acuro.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/26/2019] [Accepted: 06/09/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND The effect of primary androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) has not been well documented. The objective of the present study was to analyze the outcome of tumors treated with ADT as primary therapy in the Spanish Prostate Cancer Registry (19.4% of the series). PATIENTS AND METHODS Patients were classified in three groups: 1) with low/intermediate risk clinically localized tumors; 2) with high risk and locally advanced (T3-4) tumors; 3) with metastatic tumors. Time to castration resistance and overall cancer-specific survival were analyzed. In non-metastatic tumors, survivals in patients treated with ADT were compared with data from patients who underwent local treatments from the Spanish Prostate Cancer Registry. RESULTS 703 cases were analyzed. There were significant differences in the time to castration resistance, which was lower in the group of metastatic tumors. During follow-up, there were 179 deaths (25.5%) of which 89 (12.6%) were due to PCa. After 3 years of ADT, only 14.6% of patients in group 1 had died (1% due to PCa), 20.5% in group 2 and 46.8% in group 3 (9.2% and 31.3% due to PCa, respectively). Cancer-specific survival was significantly worse in group 1 using ADT than radical prostatectomy or radiotherapy. In high-risk and locally advanced tumors, ADT also had a lower cancer-specific survival than local treatments. CONCLUSION A longer time until the castration resistance was observed in patients with well- and intermediate-risk localized tumors treated with ADT. Patients with metastatic tumors showed the shortest time to castration resistance.
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13
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Comas Martínez M, Sánchez M, Romero D, Fidilio E, Ortiz A, Burgos R, Ciudin A. PT06.5: The Loss of Fat-Free Mass: An Early Event in Patients with Morbid Obesity Undergoing Bariatric Surgery. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Sánchez D, Castilla-Marti M, Rodríguez-Gómez O, Valero S, Piferrer A, Martínez G, Martínez J, Serra J, Moreno-Grau S, Hernández-Olasagarre B, De Rojas I, Hernández I, Abdelnour C, Rosende-Roca M, Vargas L, Mauleón A, Santos-Santos MA, Alegret M, Ortega G, Espinosa A, Pérez-Cordón A, Sanabria Á, Ciudin A, Simó R, Hernández C, Villoslada P, Ruiz A, Tàrraga L, Boada M. Usefulness of peripapillary nerve fiber layer thickness assessed by optical coherence tomography as a biomarker for Alzheimer's disease. Sci Rep 2018; 8:16345. [PMID: 30397251 PMCID: PMC6218495 DOI: 10.1038/s41598-018-34577-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/17/2018] [Indexed: 12/14/2022] Open
Abstract
The use of optical coherence tomography (OCT) has been suggested as a potential biomarker for Alzheimer’s Disease based on previously reported thinning of the retinal nerve fiber layer (RNFL) in Alzheimer’s disease’s (AD) and Mild Cognitive Impairment (MCI). However, other studies have not shown such results. 930 individuals (414 cognitively healthy individuals, 192 probable amnestic MCI and 324 probable AD) attending a memory clinic were consecutively included and underwent spectral domain OCT (Maestro, Topcon) examinations to assess differences in peripapillary RNFL thickness, using a design of high ecological validity. Adjustment by age, education, sex and OCT image quality was performed. We found a non-significant decrease in mean RNFL thickness as follows: control group: 100,20 ± 14,60 µm, MCI group: 98,54 ± 14,43 µm and AD group: 96,61 ± 15,27 µm. The multivariate adjusted analysis revealed no significant differences in mean overall (p = 0.352), temporal (p = 0,119), nasal (p = 0,151), superior (p = 0,435) or inferior (p = 0,825) quadrants between AD, MCI and control groups. These results do not support the usefulness of peripapillary RNFL analysis as a marker of cognitive impairment or in discriminating between cognitive groups. The analysis of other OCT measurements in other retinal areas and layers as biomarkers for AD should be tested further.
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Affiliation(s)
- Domingo Sánchez
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain.
| | - Miguel Castilla-Marti
- Clínica Oftalmológica Dr. Castilla, Barcelona, Spain.,Valles Ophthalmology Research, Hospital General de Catalunya, Sant Cugat del Vallès, Spain
| | - Octavio Rodríguez-Gómez
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Sergi Valero
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain.,Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Gabriel Martínez
- Faculty of Medicine and Dentistry. Faculty of Medicine and Dentistry, Universidad de Antofagasta, Antofagasta, Chile.,Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Joan Martínez
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Judit Serra
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Sonia Moreno-Grau
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Begoña Hernández-Olasagarre
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Itziar De Rojas
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Isabel Hernández
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Carla Abdelnour
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Maitée Rosende-Roca
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Liliana Vargas
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Ana Mauleón
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Miguel A Santos-Santos
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Montserrat Alegret
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Gemma Ortega
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Ana Espinosa
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Alba Pérez-Cordón
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Ángela Sanabria
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Andrea Ciudin
- Diabetes and Metabolism Research Unit and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólica Asociada (CIBERDEM), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólica Asociada (CIBERDEM), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólica Asociada (CIBERDEM), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Pablo Villoslada
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Agustín Ruiz
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lluís Tàrraga
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Mercè Boada
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
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15
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Gil-Barrionuevo E, Balibrea JM, Caubet E, Gonzalez O, Vilallonga R, Fort JM, Ciudin A, Armengol M. Adrenergic cardiomyopathy and cardiogenic shock as initial presentation of pheochromocytoma. A case report and review of the literature. Int J Surg Case Rep 2018; 49:145-148. [PMID: 30007262 PMCID: PMC6068086 DOI: 10.1016/j.ijscr.2018.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/23/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pheochromocytomas are infrequent tumors arised from the chromaphine cells of the adrenal sympathetic system. The excess of circulating catecholamines may lead to different cardiovascular disorders from silent alterations of the myocardial conduction to different forms of cardiomyopathy. The onset as cardiogenic shock is exceptional. PRESENTATION OF CASE A 35-year-old male, with a known history of acute myopericarditis of unknown origin which debuted as acute pulmonary edema, was admitted with dyspnea in the context of a new heart failure episode with pulmonary edema. An initial ECG showed segmentary repolarization changes, reversed in subsequent ECGs. The echocardiogram showed severe left ventricular dysfunction and lateral and apical hypokinesia. Subsequent echocardiograms showed partial recovery of alterations and preserved systolic function. A cardiac MRI showed a subepicardial minimum catchment focus and myocardial edema suggestive of adrenergic myocarditis. A solid nodular lesion was found in the left adrenal gland, suggesting a pheochromocytoma. Laparoscopic left adrenalectomy confirmed a 30 mm adrenal tumor without signs of locoregional invasion. The patient had normal catecholamine excretion and heart function a few weeks after surgery. Histopathology confirmed the diagnosis of pheochromocytoma. DISCUSSION AND CONCLUSIONS Adrenergic cardiomyopathy is a rare entity with a variable clinical presentation. The onset as cardiogenic shock is exceptional. The differential diagnosis of a patient with cardiogenic shock of unknown origin should consider the presence of an underlying pheocromocytoma as well as other states of adrenergic hyperstimulation. The reversibility of the myocardial affection in pheocromocytoma-associated myocardiopathy is common after the tumor resection.
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Affiliation(s)
- Esther Gil-Barrionuevo
- General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - José Maria Balibrea
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ramón Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Ciudin
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Medical Endocrinology Department, Vall d' Hebron University Hospital, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Giribes M, Cárdenas G, Fidilio E, Guerrero M, Velasquez M, Ortiz A, Romero D, Mesa J, Ciudin A, Segurola H, Burgos R. OR39: Changes in Resting Energy Expenditure in Patients with Extreme Obesity After Bariatric Surgery. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Castellano-Tejedor C, Moreno J, Ciudin A, Parramón G, Lusilla-Palacios P. PREventive Care Infrastructure based On Ubiquitous Sensing (PRECIOUS): A Study Protocol. JMIR Res Protoc 2017; 6:e105. [PMID: 28566263 PMCID: PMC5471342 DOI: 10.2196/resprot.6973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background mHealth has experienced a huge growth during the last decade. It has been presented as a new and promising pathway to increase self-management of health and chronic conditions in several populations. One of the most prolific areas of mHealth has been healthy lifestyles promotion. However, few mobile apps have succeeded in engaging people and ensuring sustained use. Objective This paper describes the pilot test protocol of the PReventive Care Infrastructure based on Ubiquitous Sensing (PRECIOUS) project, aimed at validating the PRECIOUS system with end users. This system includes, within a motivational framework, the Bodyguard2 sensor (accelerometer with heart rate monitoring) and the PRECIOUS app. Methods This is a pilot experimental study targeting morbidly obese prediabetic patients who will be randomized to three conditions: (1) Group 1 - Control group (Treatment as usual with the endocrinologist and the nurse + Bodyguard2), (2) Group 2 - PRECIOUS system (Bodyguard2 + PRECIOUS app), and (3) Group 3 - PRECIOUS system (Bodyguard2 + PRECIOUS app + Motivational Interviewing). The duration of the study will be 3 months with scheduled follow-up appointments within the scope of the project at Weeks 3, 5, 8, and 12. During the study, several measures related to healthy lifestyles, weight management, and health-related quality of life will be collected to explore the effectiveness of PRECIOUS to foster behavior change, as well as user acceptance, usability, and satisfaction with the solution. Results Because of the encouraging results shown in similar scientific work analyzing health apps acceptance in clinical settings, we expect patients to widely accept and express satisfaction with PRECIOUS. We also expect to find acceptable usability of the preventive health solution. The recruitment of the pilot study has concluded with the inclusion of 31 morbidly obese prediabetic patients. Results are expected to be available in mid-2017. Conclusions Adopting and maintaining healthy habits may be challenging in people with chronic conditions who usually need regular support to ensure mid/long-term adherence to recommendations and behavior change. Thus, mHealth could become a powerful and efficient tool since it allows continuous communication with users and immediate feedback. The PRECIOUS system is an innovative preventive health care solution aimed at enhancing inner motivation from users to change their lifestyles and adopt healthier habits. PRECIOUS includes ubiquitous sensors and a scientifically grounded app to address three main components of health: physical activity, diet, and stress levels. Trial Registration Clinicaltrials.gov NCT02818790; https://clinicaltrials.gov/ct2/show/NCT02818790 (Archived by WebCite at http://www.webcitation.org/6qfzdfMoU)
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Affiliation(s)
- Carmina Castellano-Tejedor
- University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Department of Psychiatry, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Moreno
- University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Department of Psychiatry, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Department of Endocrinology, Diabetes and Associated Metabolic Disorders (Ciberdem), Instituto de Salud Carlos III, Autonomous University of Barcelona, Barcelona, Spain
| | - Gemma Parramón
- University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Department of Psychiatry, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Lusilla-Palacios
- University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Department of Psychiatry, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
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Lecube A, Romero O, Sampol G, Mestre O, Ciudin A, Sánchez E, Hernández C, Caixàs A, Vigil L, Simó R. Sleep biosignature of Type 2 diabetes: a case-control study. Diabet Med 2017; 34:79-85. [PMID: 27278263 DOI: 10.1111/dme.13161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 01/30/2023]
Abstract
AIM To determine whether or not the sleep disturbances associated with Type 2 diabetes affect the structure of sleep. METHODS We designed a case-control study in 76 patients with Type 2 diabetes and 76 control subjects without Type 2 diabetes, matched by age, gender, BMI and waist and neck circumferences. A subgroup of 32 patients with Type 2 diabetes was also matched with 64 control subjects without Type 2 diabetes according to apnoea-hypopnoea index score. Examination included an overnight full polysomnography. RESULTS No differences in the percentage of time spent in either rapid eye movement or non-rapid eye movement sleep were observed between groups; however, patients with Type 2 diabetes had more microarousal events during sleep than control subjects [41.4 (total range 4.0-104.4) vs 20.7 (total range 1.3-94.5) events/h; P < 0.001]. These differences were mainly observed during the non-rapid eye movement sleep [7.4 (total range 0-107.2) vs 0.2 (total range 0-65.2) events/h; P < 0.001]. In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤90%, were significantly greater during the rapid eye movement sleep in patients with Type 2 diabetes [20.3 (total range 0-99.2) vs. 10.5 (total range 0-94.0)%; P = 0.047]. This pattern was maintained in the subgroup of patients matched by apnoea-hypopnaea index. Finally, stepwise regression analyses showed that apnoea-hypopnoea index, the presence of Type 2 diabetes and fasting plasma glucose value were independently associated with the number of microarousals (R2 =0.667). CONCLUSIONS Type 2 diabetes is associated with an altered sleep structure, with different effects according to rapid eye movement (increase in nocturnal hypoxia) or non-rapid eye movement (increase in sleep fragmentation) sleep.
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Affiliation(s)
- A Lecube
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Universitat de Lleida, Lleida, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Romero
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Department of Neurophysiology, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Sampol
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Department of Pneumology, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Mestre
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Ciudin
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Sánchez
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Universitat de Lleida, Lleida, Spain
| | - C Hernández
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Caixàs
- Department of Endocrinology and Nutrition, Corporació Sanitària Parc Taulí, Parc Taulí, Spain
| | - L Vigil
- Sleep Unit, Department of Pneumology, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - R Simó
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vilarrasa N, Rubio MA, Miñambres I, Flores L, Caixàs A, Ciudin A, Bueno M, García-Luna PP, Ballesteros-Pomar MD, Ruiz-Adana M, Lecube A. Long-Term Outcomes in Patients with Morbid Obesity and Type 1 Diabetes Undergoing Bariatric Surgery. Obes Surg 2016; 27:856-863. [DOI: 10.1007/s11695-016-2390-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Salvador R, Luque MP, Ciudin A, Paño B, Buñesch L, Sebastia C, Nicolau C. Utilidad de la tomografía computarizada de doble energía con un programa específico para la identificación de litiasis renales de ácido úrico. Radiología 2016; 58:120-8. [PMID: 26460216 DOI: 10.1016/j.rx.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/09/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022]
Affiliation(s)
- R Salvador
- Sección de Radiología Genitourinaria, Radiología, Hospital Clínic de Barcelona, Barcelona, España.
| | - M P Luque
- Urología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Ciudin
- Urología, Hospital Clínic de Barcelona, Barcelona, España
| | - B Paño
- Sección de Radiología Genitourinaria, Radiología, Hospital Clínic de Barcelona, Barcelona, España
| | - L Buñesch
- Sección de Radiología Genitourinaria, Radiología, Hospital Clínic de Barcelona, Barcelona, España
| | - C Sebastia
- Sección de Radiología Genitourinaria, Radiología, Hospital Clínic de Barcelona, Barcelona, España
| | - C Nicolau
- Sección de Radiología Genitourinaria, Radiología, Hospital Clínic de Barcelona, Barcelona, España
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Salvador R, Luque M, Ciudin A, Paño B, Buñesch L, Sebastia C, Nicolau C. Usefulness of dual-energy computed tomography with and without dedicated software in identifying uric acid kidney stones. Radiología (English Edition) 2016. [DOI: 10.1016/j.rxeng.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vilarrasa N, Goday A, Rubio MA, Caixàs A, Pellitero S, Ciudin A, Calañas A, Botella JI, Bretón I, Morales MJ, Díaz-Fernández MJ, García-Luna PP, Lecube A. Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry. Obes Facts 2016; 9:41-51. [PMID: 26901345 PMCID: PMC5644871 DOI: 10.1159/000442764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/24/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. METHODS Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. RESULTS Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. CONCLUSIONS There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.
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Affiliation(s)
- Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Lx00B4;Hospitalet de Llobregat, Barcelona, Spain
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Constantin V, Carap AC, Zaharia L, Bobic S, Ciudin A, Brătilă E, Vlădăreanu V, Socea B. High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous pneumothorax: can we omit X-rays for tube management? Eur Surg 2015. [DOI: 10.1007/s10353-015-0333-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Vilallonga R, Fort JM, Caubet E, Gonzalez O, Balibrea JM, Ciudin A, Armengol M. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures. J Obes 2015; 2015:586419. [PMID: 26491560 PMCID: PMC4605372 DOI: 10.1155/2015/586419] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- *Ramon Vilallonga:
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - José Maria Balibrea
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Andrea Ciudin
- Endocrinology Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Gómez-Veiga F, Martínez-Breijo S, Solsona-Narbón E, Hernández C, Ciudin A, Ribal M, Dickinson L, Moore C, Ahmed H, Rodríguez Antolín A, Breda A, Gaya J, Portela-Pereira P, Emberton M. Focal therapy for prostate cancer. Alternative treatment. Actas Urol Esp 2014; 38:465-75. [PMID: 24612733 DOI: 10.1016/j.acuro.2013.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 02/04/2023]
Abstract
CONTEXT The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. EVIDENCE ACQUISITION Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumour selection, characteristics and indications cited in MEDLINE search were reviewed. SUMMARY OF EVIDENCE Focal therapy standardized criteria must be: low risk tumors, PSA<10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3+4 or PSA>15. CONCLUSIONS Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.
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Ciudin A, Musquera M, Huguet J, Peri L, Alvarez-Vijande J, Ribal M, Alcaraz A. Transposition of Iliac Vessels in Implantation of Right Living Donor Kidneys. Transplant Proc 2012. [DOI: 10.1016/j.transproceed.2012.07.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Biagetti B, Ciudin A, Portela M, Dalama B, Mesa J. [Interns' viewpoints and knowledge about management of hyperglycemia in the hospital setting]. Endocrinol Nutr 2012; 59:423-8. [PMID: 22795620 DOI: 10.1016/j.endonu.2012.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE In many hospitals, adequate glycemic control is not achieved despite implementation of new insulin therapy protocols. Our aim was to assess resident physician' attitudes toward inpatient hyperglycemia, barriers to achieve optimum control, and impact on them of an insulin training program MATERIAL AND METHODS A questionnaire was used to assess understanding and standard management of hyperglycemia before and six months after implementation of an inpatient insulin treatment program. RESULTS Twenty-five interns completed the questionnaire. Glycemic control was considered "very important" in all admission situations, but was only considered "very important" in conventional hospitalization by 36% of interns. Most of these felt "comfortable" using sliding scales, but not with the basal/bolus regimen, which was the least commonly used. Perception of number of well-controlled patients and comfort and use of basal/bolus therapy increased at six months, but use of "sliding scales" remained high. The greatest difficulty reported for adequate management of hyperglycemia was the lack of knowledge. CONCLUSIONS Most residents are aware of the importance of adequate glycemic control, but cannot achieve it because of inadequate knowledge. The insulin training program led to an improved perception and applicability of basal-bolus insulin regimens. However, despite all efforts, use of sliding scales remains high. Training programs should emphasize management of hyperglycemia.
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Affiliation(s)
- Betina Biagetti
- Servicio de Endocrinología, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Ciudin A, Huguet J, García-Larrosa A, Musquera M, Alvarez-Vijande JR, José Ribal M, Alcaraz A. [Delayed bleeding after partial nephrectomy. Management with selective embolization]. Actas Urol Esp 2011; 35:615-9. [PMID: 21764183 DOI: 10.1016/j.acuro.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/22/2011] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Bleeding after partial nephrectomy can be immediate or delayed and may have severe consequences. The incidence of this complication is low. The most frequent cause of delayed bleeding is arterial pseudoaneurysm. Superselective embolization is a feasible therapeutic option that has shown good results. OBJECTIVE To evaluate treatment and outcomes of delayed bleeding in our series of patients with partial nephrectomy. MATERIAL AND METHODS We performed a retrospective study of our database of partial nephrectomies. Patients who developed delayed bleeding (after discharge) were identified. Clinical histories were reviewed and data on presentation, diagnosis, treatment and outcomes were analyzed. RESULTS Among our series of patients undergoing partial nephrectomy, three developed delayed bleeding (1.3%). Symptom onset occurred 17 to 25 days after surgery and consisted of hematuria or lumbar pain. Diagnosis was provided through ultrasound, abdominal computed tomography and renal angiography. In all three patients, a complicated pseudoaneurysm was diagnosed and all patients underwent renal artery catheterization with selective renal artery embolization. In all patients, immediate control of bleeding was achieved. Outcome after a follow-up of 61 to 92 months was favorable. CONCLUSIONS Selective vascular embolization is the treatment of choice of renal pseudoaneurysm after partial nephrectomy in hemodynamically stable patients.
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Affiliation(s)
- A Ciudin
- Servicio de Urología, Instituto Clínico de Nefrología y Urología, Hospital Clínic, Barcelona, España.
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Hernández C, Francisco G, Ciudin A, Chacón P, Montoro B, Llaverias G, Blanco-Vaca F, Simó R. Effect of atorvastatin on lipoprotein (a) and interleukin-10: A randomized placebo-controlled trial. Diabetes & Metabolism 2011; 37:124-30. [DOI: 10.1016/j.diabet.2010.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/19/2010] [Accepted: 08/21/2010] [Indexed: 10/18/2022]
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Vilallonga R, Ciudin A, Fort JM, Baena JA, Gonzalez O, Armengol M, Mesa J, Ruiz Marcellán MC. Isolated langerhans cell histiocytosis of the thyroid in an adult female: one-year followup. Int J Endocrinol 2011; 2011:898302. [PMID: 21461403 PMCID: PMC3065032 DOI: 10.1155/2011/898302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 12/09/2010] [Accepted: 01/13/2011] [Indexed: 11/17/2022] Open
Abstract
Thyroid gland involvement as the unique presentation of Langerhans cell histiocytosis is a rare phenomenon that can result in misdiagnosis. We report a case of Langerhans cell histiocytosis (LCH) presenting as a thyroid mass. It is a 52-year-old woman who presented an enlarged, diffusely firm, nontender, nonmobile, and not particularly nodular thyroid gland with mild compressive symptoms. Ultrasound and fine-needle aspiration showed a unique right node with benign signs. Patient was referred to our Ambulatory Surgery Department, where a hemithyroidectomy was performed. Histologic evaluation of the right thyroid gland revealed an involvement by LCH, confirmed by immunohistochemical analysis showing Langerhans cells that were positive for CD1a. LCH was a completely incidental occult finding apparent only after surgical resection and examination of the gland. Patient was evaluated, and no evidence of systemic affectation was found. LCH can rarely involve the thyroid gland in adults. Few cases have been reported in the literature. Most patients had evidence of LCH involving other anatomic sites.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
- *Ramon Vilallonga:
| | - Andrea Ciudin
- Endocrinology Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Juan Antonio Baena
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Manuel Armengol
- General Surgery Department, University Hospital Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Mesa
- Endocrinology Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
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Márquez MP, García-Cruz E, Bartolomé MP, Ciudin A, Pérez JH, Caparrós MR, Asensio AA. Low testosterone levels are associated with poor prognosis risk factors on needle prostate cancer biopsies. Journal of Men's Health 2009. [DOI: 10.1016/j.jomh.2009.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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García-Cruz E, Ciudin A, Bartolomé MP, Márquez MP, Pérez JH, Asensio AA. Second to fourth digit relationship (D2: D4), serum testosterone and testosterone deficiency syndrome. Journal of Men's Health 2009. [DOI: 10.1016/j.jomh.2009.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Constantin V, Ciudin A, Popa F. [Viral small bowel intussusception: a rare cause of intestinal obstruction]. Chirurgia (Bucur) 2007; 102:79-82. [PMID: 17410735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Representing a rare cause of bowel obstruction, the ileal intussusception is commonly met in the pediatric surgery. Even if in children's cases the symptoms can mimick a multitude of abdominal syndromes, usually in adult cases the symptoms fit the pattern of the intestinal obstruction. This paper presents 2 clinical cases of small bowel intussusception in adult, the particularity of cases being that the pathogenesis couldn't be established first hand; the pathology exam revealed only minor inflammatory responses,including modest reactive lymph nodes in the vicinity of lesions, without further alterations. The etiology of bowel intussusception was finally attributed to viral infection with gastroenteritis, based on clinical and pathological criteria.
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Affiliation(s)
- V Constantin
- Clinica de Chirurgie, Spitalul de Urgenţa Sf. Pantelimon, Bucureşti
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