Miguel Ángel Núñez Viejo
University of Cantabria
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Archivos De Bronconeumologia | 2009
Miguel Ángel Núñez Viejo; Ana Fernández Montes; Javier Velasco Montes; José Javier Gómez-Román; Carmen García Ibarbia; José Luis Hernández
We report the case of a 40-year-old woman diagnosed with interstitial lung disease due to long-term nitrofurantoin therapy. Despite severely distorted bronchiolar architecture and honeycombing confirmed by computed tomography of the thorax, transbronchial biopsy showed a pattern of acute/subacute interstitial pneumonitis and the symptoms and radiographic findings disappeared within 1 month after administration of prednisone. This case shows that nitrofurantoin-induced lung disease may run a benign course and respond favorably to corticosteroids, even when there is radiographic evidence of established lung fibrosis. Transbronchial biopsy might be useful for assessing the reversibility of pulmonary lesions associated with nitrofurantoin.
Archivos De Bronconeumologia | 2009
Miguel Ángel Núñez Viejo; Ana Fernández Montes; Javier Velasco Montes; José Javier Gómez-Román; Carmen García Ibarbia; José Luis Hernández
We report the case of a 40-year-old woman diagnosed with interstitial lung disease due to long-term nitrofurantoin therapy. Despite severely distorted bronchiolar architecture and honeycombing confirmed by computed tomography of the thorax, transbronchial biopsy showed a pattern of acute/subacute interstitial pneumonitis and the symptoms and radiographic findings disappeared within 1 month after administration of prednisone. This case shows that nitrofurantoin-induced lung disease may run a benign course and respond favorably to corticosteroids, even when there is radiographic evidence of established lung fibrosis. Transbronchial biopsy might be useful for assessing the reversibility of pulmonary lesions associated with nitrofurantoin.
Medicina Clinica | 2010
Miguel Ángel Núñez Viejo; Ana Fernández Montes; José Luis Hernández Hernández; Fernando Pons Romero; Emilio Fábrega García; Roberto Zarrabeitia
BACKGROUND AND OBJECTIVE Rendu-Oslers disease (RO) is a rare systemic vascular disorder due to a fibrovascular dysplasia in the endothelium of vessels. Recurrent epistaxis is the main clinical manifestation, but arteriovenous malformations (AVMs) can involve many organs, including the liver. Hepatic involvement can develop refractory heart failure due to large shunts between the hepatic veins and the hepatic artery. Embolization and hepatic artery ligation have also demonstrated to reduce cardiac output in RO, but these therapeutic options have significant morbidity and complications such as necrosis or liver failure. CASE REPORT We report the case of a 48 years old woman diagnosed in 1987 with RO and significant hepatic involvement, with multiple fistulas between veins and hepatic artery. In the following years she developed progressive heart failure that limited her quality of life. RESULTS She was admitted on more times with heart failure and her dyspnea worsened progressively up to NYHA IV. At this time, an echocardiograph control showed an output cardiac about 10.6l/min. On December 2004, although the medical treatment, the worsening of the patient went on, so we finally decided to conduct a liver transplant that resolved the symptoms and the hyperdynamic circulation. Despite the fact that liver transplant has become without doubt into the best treatment for these patients in the last years. CONCLUSIONS This is the first one done in Spain. There are different therapies available for these patients, but the indications for transplantation are greater each day, mainly due to the risks of the other options. Currently the stated guidelines are heart failure and portal hypertension refractory to medical treatment. So in these situations, liver transplantation should be proposed in the early stages of the disease and may be the only viable option.
Medicina Clinica | 2010
Miguel Ángel Núñez Viejo; Ana Fernández Montes; José Luis Hernández Hernández; Fernando Pons Romero; Emilio Fábrega García; Roberto Zarrabeitia
BACKGROUND AND OBJECTIVE Rendu-Oslers disease (RO) is a rare systemic vascular disorder due to a fibrovascular dysplasia in the endothelium of vessels. Recurrent epistaxis is the main clinical manifestation, but arteriovenous malformations (AVMs) can involve many organs, including the liver. Hepatic involvement can develop refractory heart failure due to large shunts between the hepatic veins and the hepatic artery. Embolization and hepatic artery ligation have also demonstrated to reduce cardiac output in RO, but these therapeutic options have significant morbidity and complications such as necrosis or liver failure. CASE REPORT We report the case of a 48 years old woman diagnosed in 1987 with RO and significant hepatic involvement, with multiple fistulas between veins and hepatic artery. In the following years she developed progressive heart failure that limited her quality of life. RESULTS She was admitted on more times with heart failure and her dyspnea worsened progressively up to NYHA IV. At this time, an echocardiograph control showed an output cardiac about 10.6l/min. On December 2004, although the medical treatment, the worsening of the patient went on, so we finally decided to conduct a liver transplant that resolved the symptoms and the hyperdynamic circulation. Despite the fact that liver transplant has become without doubt into the best treatment for these patients in the last years. CONCLUSIONS This is the first one done in Spain. There are different therapies available for these patients, but the indications for transplantation are greater each day, mainly due to the risks of the other options. Currently the stated guidelines are heart failure and portal hypertension refractory to medical treatment. So in these situations, liver transplantation should be proposed in the early stages of the disease and may be the only viable option.
Archivos De Bronconeumologia | 2010
Miguel Ángel Núñez Viejo; Ana Fernández Montes; David Iturbe Fernández
psoriasis cannot be ruled out as the cause of the lung disease; however, the patient had a history of treatment with methotrexate and cyclosporine and during hospital admission she was given many drugs which could have caused the lung affection, amongst which was acitretine, which has a well-documented link with interstitial damage. In the case of the patient we are reporting, she did not receive any medicine to justify the symptoms, and all the bacteriological studies performed were also negative. Likewise, the response to steroids alone was very good from both the point of view of the lungs and the skin, so we inferred that there was a clear association between the 2 entities, and this is the first reported case which links, beyond all doubt, organising pneumonia with psoriasis. To conclude, we must say that psoriasis patients can have lung manifestations and that organising pneumonia may be just another kind of lung affectation caused by this skin disease.
Archive | 2012
Ana Montes; Jesús García Gómez; Miguel Ángel Núñez Viejo; Miguel Alonso Bermejo; Susana Alonso Urrutia; Jesús García Mata
Ovarian cancer is the second most common gynecological malignancy following uterine corpus cancer and it is the fifth leading cause of cancer death in women. There are important differences in their incidence across the world. In Europe in 2008, estimated incidence was 66,734 cases with an estimated mortality of 41,929 women. In United States, ovarian cancer was diagnosed in 21,880 with 13,850 cancer deaths last year. Both incidence and mortality are declining in USA and Europe. Higher incidence rates are observed in North America and European countries exceeding 10 per 100.000 inhabitants. Lower rates are observed in South America (7,7 per 100.000) and Southern Asia (7,5 per 100.000). (Parkin et al, 2005) Such geographical variations are due to differences in oral contraceptive use practices, pregnancy history, breast-feeding and other hormonal factors. (Permuth –Wey & Sellers, 2009) The relative risk for developing ovarian cancer is 1.39% (lifetime risk). It affects 12.9 per 100,000 women per year. Incidence rate of ovarian cancer increases with aging, being more prevalent in the eighth decade of life. At diagnosis, mean age is 63 years, and 62% of patients have advanced disease. Inherited ovarian cancer presents at younger age. (www.Seer.gov,Ferlay et al 2010) Five year overall survival is 93.5% for localized disease, 73.4% for locoregional disease (regional lymph node involvement) and 27.6% for distant disease. Genetic studies on ovarian cancer indicate that most of the cases are sporadic while 5 to 10 percent are inherited, generally due to germline mutations. Three histological subgroups have been described: epithelial tumours, stromal tumours and germ-cell tumours. Ninety percent of cases are epithelial tumours arising from the ovarian surface epithelium or Mullerian derivatives. These tumours are typical in postmenopausal women. The World Health Organization classification defines six more histotypes: serous, mucinous, endometrioid, clear cell and squamous cell carcinomas. According to their architectural features like glandular or papillary components, carcinomas have been classified into three histological grades, well differentiated, moderately differentiated, poorly or undifferentiated. Malignant germ cell tumour affects younger women. (De Vita et al,2009) Despite the high incidence, ovarian cancer etiology is still poorly understood.
Medicina Clinica | 2010
Miguel Ángel Núñez Viejo; Ana Fernández Montes; Lourdes Gutiérrez Sanz; Francisco Ledesma Castaño
Figura 2. Varon de 75 anos que ingreso por cuadro de 2 meses de evolucion de dolor a la altura del hombro derecho y p erdida progresiva de fuerza y movilidad del brazo. En la reconstruccion osea tridimensional mediante TC multicorte (fig. 1) se apreciaba la destruccion completa de la cabeza humeral derecha. Una RMN medular (fig. 2) demostro la existencia de una cavidad siringomi elica que se extendia desde C1 hasta T7. La artropatia neurop atica de Charcot es un proceso destructivo articular de etiologia desconocida. Las causas m as frecuentes en los paises desarrollados son la diabetes y el alcohol, y el tobillo es la articulacion involucrada en la mayoria de los casos. La afectacion del hombro es rara y, cuando ocurre, con frecuencia se asocia a la siringomielia.
Archivos De Bronconeumologia | 2010
Miguel Ángel Núñez Viejo; Ana Fernández Montes; David Iturbe Fernández
psoriasis, que se hallaba en una fase de exacerbación, fue una neumonı́a organizada confirmada por anatomı́a patológica, que respondió de manera excelente al tratamiento con esteroides, al igual que el cuadro de psoriasis. Después de una exhaustiva búsqueda sólo hallamos la publicación de 2 casos de psoriasis con neumonı́a organizada. En uno se constató una infección aguda por citomegalovirus, por lo que se asumió como secundaria a este virus. En el otro caso es difı́cil precisar, aunque no se descarta, que la causa de esta enfermedad pulmonar fuera la psoriasis, ya que la paciente tenı́a el antecedente de haberse tratado con metotrexate y ciclosporina y que en el transcurso de la hospitalización se le administraron múltiples fármacos que pueden haber producido la afectación pulmonar, entre ellos acitretin, cuya vinculación con el compromiso intersticial se halla bien documentada. En el caso de la paciente que comunicamos, no recibió ningún fármaco que justificara el cuadro, como ası́ también fueron negativos todos los estudios bacteriológicos realizados. Asimismo, la respuesta a esteroides, sin ninguna otro fármaco, fue muy buena desde el punto de vista pulmonar como cutáneo, por lo que inferimos que existió una clara asociación entre las 2 entidades y que serı́a el primer caso comunicado que vincula, sin dudas, la neumonı́a organizada con la psoriasis. En conclusión, debemos decir que la psoriasis puede cursar con manifestaciones pulmonares y que la neumonı́a organizada puede ser una forma más de afectación pulmonar de esta enfermedad. Bibliografı́a
Galicia Clínica | 2010
Miguel Ángel Núñez Viejo; Ana María Arnáiz García; Ana Fernández Montes
Galicia Clínica | 2017
Miguel Ángel Núñez Viejo