Alcalde, J. (Juan)
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- Experiencia del centro de simulación de la Facultad de medicina de la Universidad de Navarra(Facultad de Medicina y Ciencias de la salud de la Universidad de Alcalá, 2021) Uruñuela, N. (Nekane); Martin-Calvo, N. (Nerea); Fernández-González, S. (Secundino); Valencia, D. (David); Alcalde, J. (Juan); Pueyo-Villoslada, F.J. (Francisco Javier); Díez, J.C. (Juan Carlos); Diez-Goñi, N. (Nieves); Honorato-Cía, C. (Cristina); Orio, R. (Rubén)En los últimos años, las facultades de Medicina se han visto en la necesidad de ofrecer cambios en su forma de impartir la docencia; los alumnos, los pacientes y la normativa han cambiado. Estas circunstancias obligan a una renovación permanente con el objetivo de innovar y alcanzar la excelencia en la docencia universitaria. Fruto de esa renovación, la simulación ha adquirido un papel fundamental en la formación en el Grado de Medicina. La simulación ofrece un entorno seguro y controlado en el que reproducir, tantas veces como sea necesario, situaciones en las que el estudiante va construyendo su aprendizaje a partir de un trabajo explicativo, reflexivo, vivencial y colaborativo. Por otro lado, los avances tecnológicos hacen que las herramientas docentes en simulación sean altamente cambiantes, lo que obliga a una actualización permanente del equipo técnico y del equipo docente. En este monográfico acerca de la simulación en el Grado de Medicina se expondrá la experiencia del Centro de Simulación de la Facultad de Medicina (CSM) de la Universidad de Navarra, que se inauguró en 2011.
- Feasibility report of conservative surgery, perioperative high-dose-rate brachytherapy (PHDRB), and low-to-moderate dose external beam radiation therapy (EBRT) in pediatric sarcomas(Elsevier, 2004-12-15) Martinez-Monge, R. (Rafael); Garran, C. (Cristina); Sierrasesumaga, L. (Luis); San-Julian, M. (Mikel); Alcalde, J. (Juan); Cambeiro, M. (Mauricio)This study was undertaken to determine the feasibility of perioperative high-dose-rate brachytherapy (PHDRB) as an accelerated boost in patients with pediatric sarcomas. METHODS AND MATERIALS: Five pediatric patients (ages 7-16) with soft tissue sarcomas (STS) or soft tissue recurrences of previously treated osteosarcomas were treated with surgical resection and PHDRB (16-24 Gy) for R0-R1 resections. Patients with STS and osteosarcomas received 27 Gy and 45 Gy of EBRT postoperatively. RESULTS: After a median follow-up of 27 months (range, 12-50) all the patients remain locally controlled. Only 1 patient developed regrowth of pulmonary metastases and died of distant disease at 16 months. CONCLUSIONS: The use of PHDRB is safe in the short-term in this pediatric population. Only 1 patient suffered a partial wound dehiscence that may not be entirely related to PHDRB. Patients with recurrent osteosarcomas can be treated in a fashion similar to their adult soft tissue counterparts and avoid limb amputation. Younger patients with STS may achieve local control and prevent growth retardation with a combination of PHDRB and moderate doses of EBRT
- Surgical anatomy of the lingual nerve for palate surgery: where is located and how to avoid it(Springer, 2022) Fernández-González, S. (Secundino); Garaycochea, O. (Octavio); Moffa, A. (Antonio); O’Connor-Reina, C. (Carlos); Calvo-Imirizaldu, M. (Marta); Alcalde, J. (Juan); Terrasa, D. (David); Baptista, P.M. (Peter M.); Casale-Falcone, M. (Manuele); Plaza-Mayor, G. (Guillermo)Purpose To describe the anatomic relationship of the lingual nerve with the lateral oropharyngeal structures. Methods An anatomic dissection of the lateral oropharyngeal wall was conducted in eight sides from four fresh-frozen cadaveric heads. Small titanium clips were placed along the lingual nerve and the most anterior and medial border of the medial pterygoid muscle. Radiological reconstructions were employed for optimal visualization; the coronal view was preferred to resemble the surgical position. The distance between the lingual nerve and the medial pterygoid muscle at its upper and lower portion was measured radiologically. The trajectory angle of the lingual nerve with respect to the pterygomandibular raphe was obtained from the intersection between the vector generated between the clips connecting the upper and lower portion of the medial pterygoid muscle with the vector generated from the lingual nerve clips. Results The mean distance from the upper portion of the medial pterygoid muscle and superior lingual nerve clips was 10.16±2.18 mm (mean±standard deviation), and the lower area of the medial pterygoid muscle to the lingual nerve was separated 5.05±1.49 mm. The trajectory angle of the lingual nerve concerning to the vector that describes the upper portion of the most anterior and medial border of the medial pterygoid muscle with its lower part was 43.73º±11.29. Conclusions The lingual nerve runs lateral to the lateral oropharyngeal wall, from superiorly–inferiorly and laterally–medially, and it is closer to it at its lower third.
- Reconstrucción de defectos faríngeos(Elsevier España, 2009) Sanhueza, I. (Ignacio); Raquel; Gimeno-Vilar, C. (Carlos); Montes-Jovellar, L. (Lourdes); Alcalde, J. (Juan)Reconstruction of pharyngeal defects continues to present a clinical challenge for the head and neck surgeon. We have different reconstructive options to preserve speech, airway, and swallowing functions. Reconstructive surgery implies a balance between oncologic cure, patient morbidity, and quality of life. Classical reconstructive techniques include pedicled cervical cutaneous or myocutaneous flaps and distal myocutaneous flaps such as from the pectoralis major. Current microvascular technique
- Tomografía de emisión de positrones con F-18-FDG: una nueva técnica en la evaluación de pacientes con neoplasias de cabeza y cuello(Gobierno de Navarra. Departamento de Salud, 1999) Peñuelas-Sanchez, I. (Ivan); Quesada, J. (J.); Richter, J.A. (José Ángel); Azinovic, I. (Ignacio); Garcia-Velloso, M. J. (María José); Alcalde, J. (Juan); Marti, J.M. (J.M.)INTRODUCTION: Positron emission tomography using fluoro-deoxyglucose (PET-FDG) imaging has been shown to be effective in detecting and staging malignancies based on tumor glucose metabolism. The aim of the study was to evaluate the use of PET-FDG for the detection of metastatic lesions as well as early recurrence in patients with head and neck tumors. MATERIAL AND METHODS: Eleven patients were examined with PET-FDG to study the reliability of PET in assessing regional nodal status and in identifying distant metastasis (group I) and 37 patients who had previously received curative treatment and who presented differential diagnostic problems were imaged to differentiate between scar and residual or recurrent cancer (group II). PET-FDG studies were compared to results of computed tomography (CT) in 35 patients, magnetic resonance imaging (MRI) in 4 patients and both techniques in 6 patients. RESULTS: All PET-FDG studies were positive in group I, while CT failed to detect metastatic lesions in three patients. In group II PET-FDG accurately detected recurrent disease in 22/25 patients, while CT/MRI were negative in 4 cases and equivocal in 6 cases. However, there was a false positive PET study with equivocal CT in a patient with local infection. CONCLUSION: PET-FDG was highly effective in detecting metastatic cervical lymph nodes in head and neck tumours. It was most helpful in differentiating residual or recurrent tumour from scar sequelae and it enhanced the diagnostic accuracy when CT and MRI were equivocal due to anatomical distortions.
- TAK1 mRNA Expression in the Tumor Tissue of Locally Advanced Head and Neck Cancer Patients(Libertas Academica, 2008) Martinez-Monge, R. (Rafael); Alcalde, J. (Juan); Garcia-Foncillas, J. (Jesús); Honorato-Cía, B. (Beatriz); Zabalegui, N. (Natalia)Resistance to radio and chemotherapy is one of the major drawbacks in the progression of head and neck squamous cell cancer (HNSCC) patients, evidencing the importance of finding optimum molecular prognosis markers to develop personalized treatment schedules. TGF-β effector TAK1 activity has been related to a greater aggressiveness in several types of cancer (Kondo et al. 1998; Edlund et al. 2003; Kaur et al. 2005) and, although there has been described no significant implication of TAK1 in HNSCC development, we have further examined the role of its mRNA expression as a marker of prognosis in HNSCC. Fifty-nine advanced HNSCC patients were recruited for the study. The tumor expression of TAK1 mRNA was analyzed with RT-PCR using Taqman technology and its relationship with the clinical outcome of the patients studied. TAK1 mRNA expression was lower in patients that relapsed than in those that did not, but the difference was only significant between the patients that showed response to treatment (p < 0.001). ROC curve analyses pointed a 0.5 expression ratio TAK1/B2M value as an optimum cut-off point for relapse and response. Our data suggest the TAK1 mRNA analysis by Taqman RT-PCR can predict the risk of relapse in HNSCC patients.
- Stylohyoid Complex (Eagle) Syndrome Starting in a 9-Year-Old Boy(Thieme Gruppe, 2017) Dominguez, P. (Pablo); Irimia, P. (Pablo); Narbona, J. (Juan); Gárriz-Luis, M. (Maite); Alcalde, J. (Juan)Background There are only four previous pediatric reports of the glossopharyngeal neuralgic form of the stylohyoid complex syndrome. Stylohyoid complex has merely been described as cases of glossopharyngeal neuralgia in children. Case Report A 12-year-old boy came to our hospital because of recurrent episodes of severe cranial pain (9/10) lasting for 5 to 15 minutes. Pain affected the right tonsillar fossa, ear, and mastoid region. Since the start at the age of 9 years, the frequency of painful episodes has progressively increased: when admitted to our clinics 3 years later, the child was having up to five episodes daily in spite of analgesic, antiepileptic, and antidepressant drugs; he had abandoned school and leisure. Between episodes, neurological examination detected only discomfort to pressure on the right tonsillar fossa. Three-dimensional computed tomography images of the skull base showed an elongated right styloid process and bilateral calcification of the stylohyoid ligament. After surgical excision of the right styloid process and of part of the stylohyoid ligament, the glossopharyngeal painful episodes ceased. The patient remains asymptomatic seven years later. Conclusion In spite of its rarity in childhood, this debilitating but treatable syndrome should be kept in mind for the differential diagnosis of recurrent cranial pain in the pediatric population.
- Lacrimal Diversion Devices (Sinopsys Lacrimal Stent): Sharing our Experience with Patients with Chronic Rhinosinusitis without Polyposis(Georg Thieme Verlag KG, 2019) Álvarez-de-Linera-Alperi, M. (Marta); Garaycochea, O. (Octavio); Alcalde, J. (Juan); Baptista, P.M. (Peter M.); Prieto-Matos, C. (Carlos)Introduction: Chronic rhinosinusitis (CRS) is a highly prevalent pathology in our society. Due to the prevalence of this condition and to the persisting symptoms despite an appropriate medical treatment, surgical techniques are often required. Lately, minimal invasive techniques have been described, such as lacrimal diversion devices (LDDs). This technique offers a fast and convenient choice for delivery of sinus irrigation and topical medication. Objective: We aimed to describe our experience with LDDs and evaluate the safety and effectiveness of the procedure in patients with moderate to severe CRS without nasal polyposis (CRSsNP) and persistent symptomatology despite medical therapy. Methods: A total of 7 patients underwent bilateral lacrimal stents placement in the operating room. A retrospective observational study was conducted. The Sino-Nasal Outcome Test-20 (SNOT-20) survey was performed and the score obtained was compared before and 1 month after the procedure. Results: The LDDs were used for an average of 80 days. During the follow-up, only three patients had a mild complication with the device (granuloma in the punctum, obstruction, and early extrusion). The mean baseline SNOT-20 score dropped significantly (p ¼ 0.015) from 25.85 to 11.57 (mean: - 14.29) 1 month after the procedure. Conclusion: According to our experience and results, the use of LDD is a novel, feasible, and less invasive technique to treat refractory CRS. It reduces the risk of mucosal stripping, provides short-term outcomes, and the surgical procedure does not require advanced training in endoscopic sinus surgery. Moreover, it can be performed in-office under local anesthesia or sedation.
- Spindle cell carcinoma: Two instances mistaken for vocal polyps(Elsevier, 2023) Ferran, S. (Sol); Fernández-González, S. (Secundino); Garaycochea, O. (Octavio); Garcia-Tobar, L. (Laura); Alcalde, J. (Juan)Spindle cell carcinoma is a variant of squamous carcinoma, with behavior that is apparently more aggressive than that of squamous carcinoma and that can produce distant lymphatic metastasis. It was first described by Virchow in 1864 [1], but the origin of the tumor is still not clear. The tumor is biphasic, with an epidermal component and a sarcomatous component involving spindle cells; transition zones between these components can be found [2–5]. In part due to this peculiar and complex nature, the tumor has accumulated various names since it was first described: sarcomatoid tumor, carci- nosarcoma, pleomorphic carcinoma, collision tumor, etc. [2,5,6].
- Tracking dynamic evolution of low‐ and intermediate‐risk differentiated thyroid cancer: Identification of individuals at risk of recurrence(John Wiley & Sons, 2024) Alegre, E. (Estibaliz); Lozano, M.D. (María Dolores); Volpi, F. (Federico); Colombo, C. (Carla); Argueta, A. (Allan); Larrache, J. (Javier); Alcalde, J. (Juan); Galofre, J.C. (Juan Carlos)Objective: The generally good prognosis of low- and intermediate-risk differentiated thyroid cancer (DTC) underscored the need to identify those few patients who relapse. Design: Records of 299 low- or intermediate-risk DTC patients (mean follow-up 8.2 ± 6.2 years) were retrospectively reviewed. The sample was classified following the American Thyroid Association (ATA) dynamic risk stratification (DRS) system. Patients and measurement: After classifying patients according to DRS at the first visit following initial therapy (FU1), structural recurrence occurred in 2/181 (1.1%), 5/81 (6.2%) and 13/26 (50.0%) with excellent, indeterminate and biochemical incomplete response to treatment, respectively. All relapses but one happened within 5 years from FU1. Univariate analysis comparing excellent, indeterminate and biochemical incomplete with structural incomplete responses at the end of the follow-up, identified tumour size (p < .001), T status (<0.001), positive lymph nodes (N) (p < .01), multifocality (p < .004), need of additional radioactive iodine (RAI) (p < .0001) and first DRS status (p < .0003) as risk factors of recurrence. In the multivariate analysis, only RAI remained statistically significant (p < .02). Comparison between excellent and indeterminate with biochemical and structural incomplete responses, identified tumour size (p < .0004), T (p < .01), N (p < .0001), bilaterality (p < .03), first DRS status (p < .0001) and RAI (p < .001) as recurrence risk factors. T (p < .01) and first DRS (p < .0006) were confirmed in the multivariate analysis. Conclusions: Patients with DTC classified as low- or intermediate-risk of recurrence with excellent response to treatment at FU1 rarely develop structural disease and this occurs almost exclusively in the first 5 years. Initial DRS status is an accurate tool for determining the risk of recurrence.