scispace - formally typeset
Search or ask a question

Showing papers by "Hospital General Universitario Gregorio Marañón published in 2001"


Journal ArticleDOI
TL;DR: It has been proven that physical and mental function are inversely correlated with the risk for hospitalization and mortality and the best treatment option should be assessed in each individual case, taking all possible factors into account.

491 citations


Journal ArticleDOI
TL;DR: OCD in the Spanish population was shown to be associated with worse quality of life than for any other patient group (including physical groups), except schizophrenics.

238 citations


Journal ArticleDOI
01 Jan 2001-Medicine
TL;DR: Although leishmaniasis could contribute to death in a significant number of HIV-infected patients, it was the main cause of death in only a few of them and should be considered as an AIDS-defining disease.

237 citations


Journal ArticleDOI
TL;DR: Age, SAPS II and length of ICU stay were significantly higher in patients Dying patients who had therapy withheld or withdrawn than in patients dying despite active treatment.
Abstract: Objective: To determine how frequently life support is withheld or withdrawn from adult critically ill patients, and how physicians and patients families agree on the decision regarding the limitation of life support. Design: Prospective multi-centre cohort study. Setting: Six adult medical-surgical Spanish intensive care units (ICUs). Patients and participants: Three thousand four hundred ninety-eight consecutive patients admitted to six ICUs were enrolled. Measurements and results: Data collected included age, sex, SAPS II score on admission and within 24 h of the decision to limit treatment, length of ICU stay, outcome at ICU discharge, cause and mode of death, time to death after the decision to withhold or withdraw life support, consultation and agreement with patient's family regarding withholding or withdrawal, and the modalities of therapies withdrawn or withheld. Two hundred twenty-six (6.6%) of 3,498 patients had therapy withheld or withdrawn and 221 of them died in the ICU. Age, SAPS II and length of ICU stay were significantly higher in patients dying patients who had therapy withheld or withdrawn than in patients dying despite active treatment. The proposal to withhold or withdraw life support was initiated by physicians in 210 (92.9%) of 226 patients and by the family in the remaining cases. The patient's family was not involved in the decision to withhold or withdraw life support therapy in 64 (28.3%) of 226 cases. Only 21 (9%) patients had expressed their wish to decline life-prolonging therapy prior to ICU admission. Conclusions: The withholding and withdrawing of treatment was frequent in critically ill patients and was initiated primarily by physicians.

228 citations


Journal ArticleDOI
TL;DR: A positive correlation between the two species in the prevalence of erythromycin resistance was found in site-by-site comparisons, suggesting some kind of link with antibiotic consumption, and ciprofloxacin resistance (MIC, ≥4 μg/ml) was significantly associated with macrolide resistance in both S. pneumoniae and S. pyogenes.
Abstract: A nationwide multicenter susceptibility surveillance study which included 1,684 Streptococcus pneumoniae and 2,039 S. pyogenes isolates was carried out over 1 year in order to assess the current resistance patterns for the two most important gram-positive microorganisms responsible for community-acquired infections in Spain. Susceptibility testing was done by a broth microdilution method according to National Committee for Clinical Laboratory Standards M100-S10 interpretative criteria. For S. pneumoniae, the prevalences of highly resistant strains were 5% for amoxicillin and amoxicillin-clavulanic acid; 7% for cefotaxime; 22% for penicillin; 31% for cefuroxime; 35% for erythromycin, clarithromycin, and azithromycin; and 42% for cefaclor. For S. pyogenes, the prevalence of erythromycin resistance was 20%. Efflux was encountered in 90% of S. pyogenes and 5% of S. pneumoniae isolates that exhibited erythromycin resistance. Erythromycin resistance was associated with clarithromycin and azithromycin in both species, regardless of phenotype. Despite the different nature of the mechanisms of resistance, a positive correlation (r = 0.612) between the two species in the prevalence of erythromycin resistance was found in site-by-site comparisons, suggesting some kind of link with antibiotic consumption. Regarding ciprofloxacin, the MIC was ≥4 μg/ml for 7% of S. pneumoniae and 3.5% of S. pyogenes isolates. Ciprofloxacin resistance (MIC, ≥4 μg/ml) was significantly (P < 0.05) associated with macrolide resistance in both S. pyogenes and S. pneumoniae and with penicillin nonsusceptibility in S. pneumoniae.

225 citations


Journal ArticleDOI
TL;DR: HCC seems to occur at a younger age and after a shorter period of HCV infection in subjects coinfected with HIV, and in those with HCV-related cirrhosis the periodic monitoring of α-fetoprotein and abdominal ultrasonography should be recommended.

225 citations


Journal ArticleDOI
TL;DR: The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin.

191 citations


Journal Article
TL;DR: A general overview of the main areas of DTI clinical application, its main technical limitations, new directions still under investigation and some potential future developments of this emerging imaging technique are given.
Abstract: This paper try to give a general overview of the main areas of DTI clinical application, its main technical limitations, new directions still under investigation and some potential future developments of this emerging imaging technique. In this review article we pretend to discuss the main aspects of the new DTI method, its present "state of the art" and future perspectives of scientific and technical development.

184 citations



Journal ArticleDOI
TL;DR: In this article, the authors estimate the incidence of nosocomially acquired urinary tract infections (NAUTI) in Europe and provide information on the clinical characteristics, underlying conditions, etiology, management and outcome of patients.

152 citations


Journal ArticleDOI
TL;DR: The EWG concluded that the current level of evidence did not lend itself to the development of clinical guidelines and decided to publish the results of their work as a pragmatic report.
Abstract: Our objective in this study was to summarize the relevant knowledge on depression in palliative care and to provide a framework for clinical, scientific and educational efforts at improving its management. The Research Steering Committee (RSC) of the European Association of Palliative Care (EAPC) established an Expert Working Group (EWG) to address the issue of depression in palliative care. Each invited expert was allocated a specific topic and was asked to review the literature. These reviews were presented during the Sixth Congress of the EAPC in 1999 and then discussed in a closed meeting with members of the RSC. Based on these reviews, and the discussions that followed their presentation, a first draft of the paper was produced and circulated among the invited experts and members of the RSC who had been present at the meetings. After some debate the manuscript was revised, and a second draft was circulated, this time also to RSC members who had not attended the meetings. All persons consulted have agreed on this final version of the report. The EWG concluded that the current level of evidence did not lend itself to the development of clinical guidelines and decided to publish the results of their work as a pragmatic report. The report is divided into four sections, focusing on detection, training and nonpharmacological and pharmacological treatment of depression in palliative care. For each of these sections, general considerations are addressed on the basis of the literature review and of clinical experience and a short description of unresolved issues and recommendations is provided. Underdetection and undertreatment of depression is a serious problem in palliative care. Training of the nonpsychiatric staff should therefore have the highest priority. A proactive, flexible and comprehensive strategy embracing clinical, scientific, and educational aspects is advocated.

Journal ArticleDOI
TL;DR: Unlike propranolol, long-term losartan administration does not significantly reduce HVPG in patients with cirrhosis treated after a variceal bleeding episode, and it caused hypotension and reduced GFR in patientswith moderate liver failure.

Journal ArticleDOI
TL;DR: The lack of correlation between time to treatment and mortality in patients without cardiogenic shock suggests that the survival benefit of primary PTCA may be related principally to factors other than myocardial salvage.
Abstract: The mortality benefit of thrombolytic therapy for acute myocardial infarction (AMI) is strongly dependent on time to treatment. Recent observations suggest that time to treatment may be less important with primary percutaneous transluminal coronary angioplasty (PTCA). Patients with AMI of 6 hours [4.2%], p = 0.97). There were also no differences in other clinical outcomes by time to reperfusion, except that reinfarction and infarct artery reocclusion at 6 months were more frequent with later reperfusion. The lack of correlation between time to treatment and mortality in patients without cardiogenic shock suggests that the survival benefit of primary PTCA may be related principally to factors other than myocardial salvage. These data may also have implications regarding the triage of patients with AMI for primary PTCA.

Journal ArticleDOI
TL;DR: New methods based on the speed of bacterial growth to detectable levels of microorganisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections.
Abstract: The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these inconveniences and to assess the presence of tip colonization without withdrawal. One of these methods uses quantitative blood cultures with a jump (>5) in colony counts between blood obtained from the catheter lumen and simultaneously from a peripheral vein. It has a high sensitivity (>80%) and specificity (94%-100%) but is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization...

Journal ArticleDOI
TL;DR: Patients with systemic lupus erythematosus have a higher infection rate than the general population, and improvements in the control of the disease are discussed in this article.

Journal ArticleDOI
15 Dec 2001-Blood
TL;DR: Data support a novel mechanism of tetraspanin-mediated regulation of TC transcellular migration independent of TC motility and growth during metastasis and a role for these molecules in the formation of TC-EC mosaic monolayers during tumor angiogenesis.

Journal ArticleDOI
TL;DR: Antimicrobial prophylaxis, treatment of early and relapsing urinary tract infections, and management of asymptomatic bacteriuria in renal transplant patients and the incidence of lymphocele after renal transplantation are discussed.
Abstract: The most frequent infectious complication after renal transplantation is urinary tract infection. This article deals with antimicrobial prophylaxis, treatment of early and relapsing urinary tract infections, and management of asymptomatic bacteriuria in renal transplant patients. The incidence of lymphocele after renal transplantation varies, and its treatment is still controversial. Management options are discussed.

Journal ArticleDOI
TL;DR: Patients who underwent multivessel coronary intervention had a higher risk of adverse clinical outcomes through 6 months compared with matched controls in whom coronary intervention was limited to the infarct-related artery.
Abstract: The feasibility and safety of simultaneous multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction was analyzed in a retrospective, case-controlled study. Patients who underwent multivessel coronary intervention had a higher risk of adverse clinical outcomes through 6 months compared with matched controls in whom coronary intervention was limited to the infarct-related artery.

Journal ArticleDOI
TL;DR: Studies on the cellular and molecular pathology of intra-abdominal abscesses, peritoneal sclerosis, and other less frequent clinical entities (eg, tertiary peritonitis) are needed, and biological therapy may contribute to improved clinical management of such diseases.
Abstract: The peritoneal cavity contains resident and migratory cell populations, which play crucial roles in the local defensive response against bacterial invasion Although mononuclear phagocytes predominate in the peritoneal cavity of healthy subjects, recent attention has been focused on mesothelial and dendritic cells Kinetic analysis of inflammatory mediators has derived from experimental models of peritonitis, but advances in the understanding of the roles of molecules such as lipocortins, PAF, leukotriene B4, PPAR gamma agonists, and chemokines has also been made Little is known about the peritoneal response to physical trauma in the context of the abdominal compartment syndrome Studies on the cellular and molecular pathology of intra-abdominal abscesses, peritoneal sclerosis, and other less frequent clinical entities (eg, tertiary peritonitis) are needed Biological therapy may contribute to improved clinical management of such diseases

Journal ArticleDOI
TL;DR: There is a high prevalence of HTN in renal patients, which depends on the type of nephropathy and the degree of renal failure, and BP control in kidney patients is quite poor and should be improved to reduce progression of the renal disease.
Abstract: Background. Hypertension (HTN) is very frequent in patients with renal disease and its prevalence increases as renal failure progresses. Methods. We studied the prevalence of HTN in 1921 patients with different nephropathies. Patients on dialysis and renal transplant patients were not included in the study. HTN was defined as SBP > 140 and/ or DBP > 90 mmHg, or requiring antihypertensive therapy. Results. The prevalence of HTN in the total group of patients with renal diseases was 60.5%, but this prevalence varied widely depending upon the type of underlying nephropathy. The prevalence of HTN was practically universal in patients with renal vascular disease (93%) and in patients with established diabetic nephropathy (87%), and 74% of the patients with polycystic kidney disease, 63% of the patients with chronic pyelonephritis and 54% of the patients diagnosed with glomerulonephritis were hypertensive. The prevalence of HTN in patients with renal insufficiency (80%) is significantly higher than that in patients without renal insufficiency (43% P < 0.001). In a multiple logistic regression analysis, the independent risk factors defining HTN in renal patients were: renal failure, age, the presence of diabetes, hypertriglyceridaemia and proteinuria. Antihypertensive treatment consisted of diet alone in 4% of the patients, one drug in 45%, two drugs in 36%, three medications in 13% and more than three drugs in 2.5%. The angiotensin-converting enzyme (ACE) inhibitors were the most frequently prescribed drug (39% of the patients treated in monotherapy) followed by calcium channel blockers (27%), diuretics (18%) and β-blockers (9%). The most common combined therapy was a diuretic plus an ACE inhibitor. The percentage of patients with BP controlled according to current recommendations for renal patients (BP < 130/85) was very low; SBP in only 49% and DBP in 24%. Control of both was only achieved in 10% of the patients. Conclusions. There is a high prevalence of HTN in renal patients, which depends on the type of nephropathy and the degree of renal failure. Other independent risk factors for HTN in patients with renal disease are: advanced age, the presence of diabetes, hypertriglyceridaemia and the severity of proteinuria. BP control in renal patients is quite poor and should be improved to reduce progression of the renal disease.

Journal ArticleDOI
TL;DR: The isolates were frequently non-toxigenic and the extra-intestinal infections occurred without concomitant diarrhea or prior anti-microbial therapy, and out of the 17 patients, eight died and nine survived.

Journal ArticleDOI
TL;DR: The in vitro activity of the oxazolidinone linezolid was compared with the activities of vancomycin and teicoplanin against 450 Gram-positive clinical isolates, including a variety of multiply resistant strains.
Abstract: The in vitro activity of the oxazolidinone linezolid was compared with the activities of vancomycin and teicoplanin against 450 Gram-positive clinical isolates, including a variety of multiply resistant strains. Linezolid inhibited all microorganisms tested at < or = 4 mg/L, including methicillin- and teicoplanin-resistant staphylococci, glycopeptide-resistant enterococci, penicillin- and multiply resistant pneumococci and viridans streptococci, and erythromycin-resistant beta-haemolytic streptococci. The MIC(90) of linezolid for all isolates was 2 mg/L.

Journal ArticleDOI
TL;DR: The association between HA‐1 mismatch and risk of mild acute GvHD was confirmed, but HA‐ 1 mismatch was not associated with an increased incidence of chronic Gv HD and did not affect relapse or overall survival.
Abstract: Disparity for the minor histocompatibility antigen HA-1 between patient and donor has been associated with an increased risk of acute graft-versus-host disease (GvHD) after allogeneic human leucocyte antigen (HLA)-identical sibling donor stem cell transplantation (SCT). However, no data concerning the impact of such disparity on chronic GvHD, relapse or overall survival are available. A retrospective multicentre study was performed on 215 HLA-A2-positive patients who received an HLA-identical sibling SCT, in order to determine the differences in acute and chronic GvHD incidence on the basis of the presence or absence of the HA-1 antigen mismatch. Disease-free survival and overall survival were also analysed. We detected 34 patient–donor pairs mismatched for HA-1 antigen (15·8%). Grades II–IV acute GvHD occurred in 51·6% of the HA-1-mismatched pairs compared with 37·1% of the non-mismatched. The multivariate logistic regression model showed statistical significance (P: 0·035, OR: 2·96, 95% CI: 1·07–8·14). No differences were observed between the two groups for grades III–IV acute GvHD, chronic GvHD, disease-free survival or overall survival. These results confirmed the association between HA-1 mismatch and risk of mild acute GvHD, but HA-1 mismatch was not associated with an increased incidence of chronic GvHD and did not affect relapse or overall survival.

Book ChapterDOI
14 Oct 2001
TL;DR: A cardiac motion estimation technique that uses non-rigid registration to compute the dense cardiac displacement field from 2D ultrasound sequences using a semi-local deformation model which provides controlled smoothness is proposed.
Abstract: In this article we propose a cardiac motion estimation technique that uses non-rigid registration to compute the dense cardiac displacement field from 2D ultrasound sequences. Our method employs a semi-local deformation model which provides controlled smoothness. We apply a multiresolution optimization strategy for better speed and robustness. To further improve the accuracy, the sequence is registered in both forward and backward directions. We calculate additional parameters from the displacement field, such as total displacement and strain.We create an artificial ultrasound sequence ofon e heart cycle using a motion model and use it to validate the accuracy oft he algorithm. Finally, we present results on real data from normal and pathological subjects that show the clinical applicability of our method.

Journal ArticleDOI
TL;DR: ABSTRACT A β-lactamase prevalence of 23% was found among 1,730Haemophilus influenzae isolates, and susceptibility was nearly 100% for cefotaxime, cefixime, azithromycin, and cefuroxime.
Abstract: A β-lactamase prevalence of 23% was found among 1,730 Haemophilus influenzae isolates. Ampicillin susceptibility was 70%, and 12% of β-lactamase-negative strains presented diminished susceptibility to ampicillin (BLNAR phenotype). Susceptibility of 90% was found for cefaclor and clarithromycin, whereas it was nearly 100% for cefotaxime, cefixime, azithromycin, and cefuroxime. Ciprofloxacin-resistant (0.1%) and β-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) phenotypes (0.1%) are anecdotal so far.

Journal ArticleDOI
TL;DR: The currently available Center for Disease Control recommendations are reviewed and the own experiences in the field are reported, and the indications and problems of fungal environmental and patient surveillance are discussed.

Journal ArticleDOI
TL;DR: The combination of direct-cell culture assay, culture for toxigenic C. difficile and "second-look" cell culture assay enhances the potential for diagnosis of CDAD and enables us to be more efficient with patient care resources.

Journal ArticleDOI
TL;DR: It is suggested that cognitive dysfunction in OCD fluctuates with changes in the clinical associated with treatment, probably in relationship to central serotoninergic transmission.
Abstract: Neuropsychological findings in obsessive-compulsive disorder (OCD) have been explained in terms of reduced cognitive shifting ability as a result of low levels of frontal inhibitory activity. This deficit could be reflected in an abnormal P300 component of the event-related potential. The improvement in cognitive processing due to pharmacological treatment would modify the P300 component, bringing it close to that of normal controls. Nineteen patients suffering from OCD and 19 normal controls were recorded. We used a computerized version of the auditory 'odd-ball paradigm' to obtain the P300 component at the Pz electrode. Patients were tested twice, drug-free and under treatment with clomipramine in 250-300 mg doses. We observed the P300 component to have lower amplitude and longer latency in drug-free OCD patients when compared with controls. P300 amplitude in OCD increased after treatment, although this was supported only by a statistical trend. There was no modification in P300 latency after treatment. It is possible that inhibitory activity improves with treatment and allows patients to answer with more confidence, which results in an increase in P300 amplitude. This study suggests that cognitive dysfunction in OCD fluctuates with changes in the clinical associated with treatment, probably in relationship to central serotoninergic transmission.

Journal ArticleDOI
TL;DR: The method shows that intracardiac instantaneous pressure gradients can be analysed noninvasively using color Doppler M-mode echocardiography combined with image postprocessing methods.
Abstract: Doppler assessment of intracardiac pressure gradients using the simplified Bernoulli equation is inaccurate in the absence of a restricted orifice. The purpose of this study is to develop a new general method to map instantaneous pressure gradients inside the heart using Doppler echocardiography. Color Doppler M-mode recordings are digitally postprocessed with a software algorithm that decodes flow velocity and fits a bivariate spatio-temporal tensor-product smoothing spline. Temporal and spatial accelerations are then calculated by analytical derivation of the fitted velocity data, allowing solution of both inertial and convective terms of Euler's equation. A database of 39 transmitral inflow and transaortic outflow color Doppler M-mode recordings from 20 patients with a number of cardiac conditions was analysed, along with matched pulsed-wave spectral recordings. A close agreement was observed between the spectral and postprocessed color Doppler velocity values (error = 0.8 +/- 11.7 cm/s), validating the data decoding and fitting process. Spatio-temporal pressure-gradient maps were obtained from all studies, allowing visualisation of instantaneous pressure gradients from the atrium to the apex during left ventricular filling, and from the apex to the outflow tract during ejection. Instantaneous pressure differences between localised intracardiac sample points closely matched previously published catheterization findings, both in magnitude and waveform shape. Our method shows that intracardiac instantaneous pressure gradients can be analysed noninvasively using color Doppler M-mode echocardiography combined with image postprocessing methods.

Journal ArticleDOI
TL;DR: In histologically positive neck disease, the survival rates were better with postoperative radiotherapy only in cases of extracapsular spread, and there were no differences between comprehensive and anterolateral elective neck dissections.
Abstract: We present the results of a retrospective study of 903 patients treated with conservation surgery for carcinoma of the supraglottic larynx so we can evaluate our management of supraglottic cancer with different types of surgery. In 301 patients, an extended supraglottic laryngectomy was performed. The recent selective use of transoral laser resection appears to be a rational approach. The 5-year uncorrected survival was 84%, 81%, 76%, and 55% for stages I, II, III, and IV, respectively. The most common site for local-regional failure was the cervical lymphatics. The percentage of occult disease in the NO neck was 21% and epilaryngeal supraglottic location, locally advanced and GIII tumors have a higher frequency of lymph node involvement. There were no differences between comprehensive and anterolateral elective neck dissections. A bilateral elective neck dissection is recommended. In histologically positive neck disease, the survival rates were better with postoperative radiotherapy only in cases of extracapsular spread.