J M Martínez-Peñuela

Complejo Hospitalario de Navarra, Iruña, Navarre, Spain

Are you J M Martínez-Peñuela?

Claim your profile

Publications (48)128.63 Total impact

  • Source
  • Source
    I Jaúregui, T Tuñón, J M Martínez-Peñuela
    [Show abstract] [Hide abstract]
    ABSTRACT: Lewy body disease (LBD) as a separate nosologic entity causing dementia in the elderly is being firmly established. To know its prevalence and characterization, we reviewed 549 consecutive autopsied brains in our Department. The age of death was 60 years or older in 391 subjects. Immunohistochemical staining with ubiquitin antibodies facilitated the identification of LB. Their specific density was measured (number per 100xfield) following a protocol in the predilection neocortical sites, entorhinal cortex, hippocampal gyrus, diencephalon and brainstem. We assessed the clinical features according to LB findings. Twelve brains (2.1%) had neocortical LB. Nine of them were diagnosed as diffuse Lewy body disease (DLBD). One more brain had nigral and neocortical LB leading to a pathological diagnosis of PD. In the remaining 2 cases, the finding of neocortical LB seems to be either incidental or asymptomatic or preclinical. Cognitive decline was mild to moderate in all subjects which had neocortical LB in 4 or more areas. However, the density of these LB does not correlate with the severity of dementia. Dementia was associated with minor parkinsonian symptoms and psychiatric features in the most of patients with DLBD. Thirty eight cases of the 391 (9.7%) older than 60 years in these series had been clinically diagnosed as senile dementia. Using accepted neuropathologic criteria, diagnoses were AD (63.1%), DLBD (21.05%) and vascular dementia (13.1%). These observation suggest that on consultant diagnosis of senile dementia, DLBD must be taken in account.
    Anales del sistema sanitario de Navarra 03/2014; 20(2):155-64. · 0.35 Impact Factor
  • F. Borda, J.M. Martínez-Peñuela, A. Borda, J. Urman, J. Jiménez, J.M. Zozaya
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. In colorectal cancer there is discussion about the possible relation between the mismatch repair protein expression (MMRPE) and tumour lymphocytic infiltration (TLI), as well as the possible prognostic effect of both factors. Methods. A review was made of 243 colorectal cancers, consecutively resected. We made an immunohystochemical study of the MMRPE of MLH1, MSH2 and MSH6. The TLI was evaluated through CD3 staining in the tumoural epithelium. We compared mortality and post-operative tumoural progression amongst the cases with and without MMRPE and with and without TLI. Additionally, we studied mortality and tumoural progression amongst MMRPE (+) cases, according to whether or not they presented TLI. Results. Thirteen point six percent of the tumours expressed MMRPE (+) and 25.5% TLI (+). The follow-up was: 73.8±34.6 months. The frequency of TLI (+) turned out to be similar between MMRPE (+) tumours: 27.3% and MMRPE (-): 25.2% (p = 0.80). The MMRPE (+) cases showed less mortality: 12.1% versus 23.3% (p = 0.15) and less tumoural progression: 21.2% versus 29% (p = 0.35). The ITL neoplasias (+) had a lower mortality: 9.7% versus 26% [p = 0.007; OR = 3.27(1.25-9.05)] and tumoural progression: 12.9% versus 33.1% [p = 0.002; OR = 3.35 (1.42-8.15)]. The 9 MMRPE (+) and ILT (+) tumours did not present mortality or tumoural progression, against a mortality: 16.7% and progression: 29.2% of the 24 MMRPE (+) and TLI (-) cases p = 0.19 and p = 0.07 respectively. Conclusions. No relation was found between MMRPE and TLI, with very similar rates of TLI (+) between cases with and without MMRPE. The TLI (+) showed a favourable prognostic effect higher than that of the MMRPE (+). The combination of TLI (+) and MMRPE (+) seems to have an accumulative protective effect, although its limited frequency reduces the significance of the finding.
    Anales del sistema sanitario de Navarra 12/2012; 35(3):377-384. · 0.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionColorectal cancer (CRC) can induce an anti-tumoral immune response mediated by T-lymphocytes, which express CD3.Objectives To analyze the prognostic value of tissue expression of intraepithelial CD3 (CD3I) both overall and in the early tumoral stages.Methods We revised 251 patients with resected CRC and favorable clinical course. CD3I expression was analyzed by immunohistochemistry. Multivariate analysis was used to analyze the variables independently associated with survival. We analyzed CD3I(+) expression in relation to survival and tumoral progression, both overall and in patients with pTNM(I-II) stage tumors. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CD3I expression were analyzed.ResultsA total of 25.9% of patients with CRC were CD3I(+). After a mean follow-up of 74 months, CD3I(+) expression showed a favorable prognostic value for survival in the multivariate analysis (p = 0.045). Survival curves and absence of tumoral progression were more favorable in CD3I(+) cases, both overall (p = 0.009 and p = 0.004, respectively), and in stages I-II (p = 0.029 and p = 0.015). The specificity and positive predictive value of CD3I(+) were as follows: Survival: overall: specificity =0.89; positive predictive value =0.91. Stage (I-II): specificity =0.94; positive predictive value =0.98. Absence of tumoral progression: overall: specificity = 0.89; positive predictive value =0.88. Stage (I-II): specificity =0.92; positive predictive value =0.96.ConclusionsCD3I expression has an favorable independent prognostic value, with statistically significantly higher percentages of survival and absence of tumoral progression. This more favorable outcome is maintained in the less advanced stages (I-II). CD3I expression shows high specificity and positive predictive value.
    Gastroenterología y Hepatología. 10/2012; 35(8):541–550.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) can induce an anti-tumoral immune response mediated by T-lymphocytes, which express CD3. To analyze the prognostic value of tissue expression of intraepithelial CD3 (CD3I) both overall and in the early tumoral stages. We revised 251 patients with resected CRC and favorable clinical course. CD3I expression was analyzed by immunohistochemistry. Multivariate analysis was used to analyze the variables independently associated with survival. We analyzed CD3I(+) expression in relation to survival and tumoral progression, both overall and in patients with pTNM(I-II) stage tumors. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CD3I expression were analyzed. A total of 25.9% of patients with CRC were CD3I(+). After a mean follow-up of 74 months, CD3I(+) expression showed a favorable prognostic value for survival in the multivariate analysis (p=0.045). Survival curves and absence of tumoral progression were more favorable in CD3I(+) cases, both overall (p=0.009 and p=0.004, respectively), and in stages I-II (p=0.029 and p=0.015). The specificity and positive predictive value of CD3I(+) were as follows: Survival: overall: specificity =0.89; positive predictive value =0.91. Stage (I-II): specificity =0.94; positive predictive value =0.98. Absence of tumoral progression: overall: specificity=0.89; positive predictive value =0.88. Stage (I-II): specificity =0.92; positive predictive value =0.96. CD3I expression has an favorable independent prognostic value, with statistically significantly higher percentages of survival and absence of tumoral progression. This more favorable outcome is maintained in the less advanced stages (I-II). CD3I expression shows high specificity and positive predictive value.
    Gastroenterología y Hepatología 08/2012; 35(8):541-50. · 0.57 Impact Factor
  • Pathology International 07/2012; 62(7):511-2. · 1.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: to identify possible risk factors for the development of metachronous lesions in colorectal cancer (CRC) which would allow to establish a post-surgical individual prognostic index. Patients and methods: three hundred eighty-two surgically treated CRC were reviewed. We compared the incidence of metachronous lesions in 40 variables concerning patient clinical data and initial neoplastic findings. An individual risk index for metachronicity was drawn up including those variables which presented significant differences in multivariate logistic regression, dividing patients into three groups. Results: variables with prognostic value for metachronicity were distal cancer location: OR= 2.30 (1.03-5.13), alcohol intake: OR = 2.20 (1.08-4.48), presence of synchronous adenomas: isolated: OR = 2.47 (1.03-4.48), multiple: OR = 4.26 (1.78-10.17), and presence of synchronous advanced adenoma: OR= 2.91 (1.52-12.60). Tumor MUC-5 expression proved to have a protective role: OR = 0.23 (0.08-0.66). An individual risk score was established considering these variables and patients could be classified into three groups, with a discrimination power for metachronicity of p< 0.0000001. Classification in high and low risk groups had a sensitivity = 75.32%, specificity = 84.21%, positive predictive value = 75.34%, negative predictive value = 92.31% and global diagnostic accuracy = 80.75%. Conclusions: the identification of risk factors for the development of metachronous lesions allow to calculate, at the time of surgical treatment, an individual prognostic index and to classify patients into three different risk groups. In high and low risk groups, both specificity and accuracy were acceptable for the prognosis of metachronous lesions, being remarkable the negative predictive power of our classification, which could become relevant when planning a different endoscopic follow up of these patients.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 06/2012; 104(6):291-297. · 1.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: to identify possible risk factors for the development of metachronous lesions in colorectal cancer (CRC) which would allow to establish a post-surgical individual prognostic index. three hundred eighty-two surgically treated CRC were reviewed. We compared the incidence of metachronous lesions in 40 variables concerning patient clinical data and initial neoplastic findings. An individual risk index for metachronicity was drawn up including those variables which presented significant differences in multivariate logistic regression, dividing patients into three groups. variables with prognostic value for metachronicity were distal cancer location: OR = 2.30 (1.03-5.13), alcohol intake: OR = 2.20 (1.08-4.48), presence of synchronous adenomas: isolated: OR = 2.47 (1.03-4.48), multiple: OR = 4.26 (1.78-10.17), and presence of synchronous advanced adenoma: OR = 2.91 (1.52-12.60). Tumor MUC-5 expression proved to have a protective role: OR = 0.23 (0.08-0.66). An individual risk score was established considering these variables and patients could be classified into three groups, with a discrimination power for metachronicity of p < 0.0000001. Classification in high and low risk groups had a sensitivity = 75.32%, specificity = 84.21%, positive predictive value = 75.34%, negative predictive value = 92.31% and global diagnostic accuracy = 80.75%. the identification of risk factors for the development of metachronous lesions allow to calculate, at the time of surgical treatment, an individual prognostic index and to classify patients into three different risk groups. In high and low risk groups, both specificity and accuracy were acceptable for the prognosis of metachronous lesions, being remarkable the negative predictive power of our classification, which could become relevant when planning a different endoscopic follow up of these patients.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 06/2012; 104(6):291-7. · 1.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present a case of acute lymphoblastic leukaemia (ALL) in a 19-year female who presented with solitary mass in the right breast as an initial presentation of the disease. The patient received chemotherapy treatment with the PETHEMA LAL-high risk 2003 protocol, and later an HLA-identical bone marrow transplantation was performed. Two years after onset of the disease she had a recurrence, having multiple nodes in both breasts. She then had an HLA-identical bone marrow transplantation from was performed. Two years later, she showed recurrence of ALL in both breasts.To the best of our knowledge, only 33 cases have been reported in the literature, and in only 11 of them, including our, the infiltration of the breast was the initial presentation of the disease.A high level of suspicion is important in those cases of young women with bilateral and multiple masses, because unfortunately there is no reliable imaging pattern suggestive of leukemic infiltration of the breast. In addition to a histological study, a complete blood count should be performed at start up to speed up the diagnosis.
    Revista de Senología y Patología Mamaria. 01/2012; 25(3):125–129.
  • Source
    I. Rodríguez, T. Tuñón, José María Martínez-Peñuela, Mercado Maria del Rosario
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Leukemic cellswith multilobated nuclei are suggestive of HTLV-associated adult T-cell leukemia/lymphoma (ATLL), which is prevalent in southwestern Japan, where this virus is endemic. Case report: We report a case of diffuse large cells B lymphoma (DLBCL) of central nervous system (CNS) whose cells have multilobulated nuclei. Results: A 67-year-old woman had a tumor of CNS and one biopsy was performed. Microscopic examination showed infiltration of brain tissue by a population of large cells with multilobulated nuclei. Cells exhibited B-cell markers (CD20, CD79a) and also BCL2. We made a diagnosis of multilobulated DLBCL of CNS. Discussion: Peripheral T-cell lymphomas with large multilobulated nuclei were first described by Pinkus et al. in 1979. Since then, some series of multilobulated lymphomas with a Bcell phenotype have been reported. These tumors are more common in an extranodal location. In 1988, Van Baarlen et al. presented 30 cases in which this tumor was involved in a wide variety of tissues; one of these cases was a man with CNS involvement. So, to our knowledge, this is the second multilobulated B-lymphoma reported of CNS. It is important to recognize this entity because these lymphomas seem to have a better prognosis and a striking incidence of long-term remission.
    Clinical neuropathology 01/2012; · 1.34 Impact Factor
  • Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 04/2011; 32(3):e26-7. · 1.44 Impact Factor
  • Gastroenterology 01/2011; 140(5). · 12.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To study the possibility of shift toward more proximal sites in colorectal cancer (CRC) after resection of tumors and synchronous lesions. We reviewed 382 resected CRC diagnosed and followed-up with complete colonoscopies. The localization of metachronous adenomas was compared with that of synchronous lesions overall and by sex, tumoral size and the number of synchronous lesions. The frequency of exclusively proximal localization in first-, second- and third-generation metachronous adenomas was compared with that of synchronous adenomas. A total of 54.5% of patients with CRC had synchronous adenomas. After a median follow-up of 48 months, with 2.74+/-1.47 colonoscopies/case, 42.4% developed metachronous adenomas, 16.8% second-generation adenomas and 7.3% third-generation lesions. Proximal shift was found in metachronous adenomas in both sexes, independently of tumoral size and the number of initial lesions. The frequency of exclusively proximal localization in adenomas was 21.2% in synchronous lesions, 39.5% in first-generation metachronous adenomas (p=0.0001; OR=2.46 [1.50-3.95]), 42.6% in second-generation metachronous adenomas (p=0.0008; OR=2.77 [1.44-5.31]) and 39.3% in third-generation metachronous lesions (p=0.0003; OR=2.41 [0.97-5.93]). We found a high incidence of synchronous and metachronous adenomas. Metachronous adenomas showed a proximal shift, independently of sex, tumoral size and the number of synchronous lesions. This tendency was maintained in successive generations of metachronous adenomas, thus demonstrating the need to perform complete colonoscopies throughout the postoperative follow-up period.
    Gastroenterología y Hepatología 04/2010; 33(6):419-24. · 0.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To study the possibility of shift toward more proximal sites in colorectal cancer (CRC) after resection of tumors and synchronous lesions.
    Gastroenterology 01/2010; 33(6):419-424. · 12.82 Impact Factor
  • Ana Martínez-Peñuela, María Rosario Mercado, Javier Aldave, José Maria Martínez-Peñuela
    [Show abstract] [Hide abstract]
    ABSTRACT: To report one case of primary adenocarcinoma of the seminal vesicles. We report the case of a 69-year-old man with obstructive voiding symptoms. Digital rectal examination reveals a marked enlargement of posterior area of the prostate and surrounding tissues. Transrectal needle biopsy shows a primary adenocarcinoma of the seminal vesicles. Primary adenocarcinoma of the seminal vesicles is an extremely uncommon neoplasm that is often difficult to diagnose as it has in specific morphology and can be confused with other primary adenocarcinomas from prostate, bladder or colon.
    Archivos españoles de urología 10/2009; 62(8):671-3.
  • A Borda, M Muñoz-Navas, J M Martínez-Peñuela, F J Jiménez, C Carretero, F Borda
    [Show abstract] [Hide abstract]
    ABSTRACT: To analyse the frequency and characteristics of metachronous neoplastic lesions, carcinomas and adenomas, following resection of colorectal cancer. We reviewed 382 patients subjected to RCC operations and followed up through complete colonoscopies in two hospitals in our province. We analysed the metachronous lesions registered, evaluating their localisation, time of diagnosis, histology, number and size. We studied the frequency of early adenomas (12 months), comparing their size with the rest of the lesions. The average follow-up was 48 months (12-112), with 2.74+/-1.47 colonoscopies/case. We diagnosed 7 metachronous cancers (1.8%), 4 of them in stage I. The average time until their diagnosis was 24 months (13-54). We registered metachronous adenomas in 162 cases (42.4%), without differences between the two hospitals: 42.1% vs. 43.8% (p=0.88). Six point three percent of the patients presented advanced adenomas. In 164 cases where the control was carried out after 12 months, the incidence of adenomas was 24%. In the majority of cases, the adenomas were sole (60.8%) and smaller than 5 mm (68.5%). In 55.5% of the cases with polyps, some had a proximal localisation. Diagnosis was made on the 1st exploration (56.2%), the 2nd (27.8%) or the 3rd (9%). Average time until diagnosis was 21 months (12-112) for simple adenoma and 35 (12-112) for advanced adenoma. Our follow up made it possible to apply a theoretically curative treatment in the majority of the metachronous carcinomas diagnosed. The high incidence of adenomas and the frequent proximal localisation make a follow up with complete colonoscopies necessary, which must be started one year after the operation and can become less strict following three consecutive explorations without polyps.
    Anales del sistema sanitario de Navarra 01/2009; 32(3):397-407. · 0.35 Impact Factor
  • Gastroenterology 01/2009; 136(5). · 12.82 Impact Factor
  • O. Nantes, J. M. Zozaya, F. J. Jiménez-Pérez, J. M. Martínez-Peñuela, F. Borda
    [Show abstract] [Hide abstract]
    ABSTRACT: Eosinophilic esophagitis (EE) is a disease characterised by the infiltration of esophageal mucosa by eosinophils, whose incidence in adults seems to have been increasing in recent years, in a way that is similar to what is occurring with other diseases of a probable immunoallergic aetiology. It predominates in young adults and is mainly expressed by dysphagia and esophageal food impactation. Treatment is based on eliminating the allergen that is potentially involved and the administration of corticoids. This article offers a retrospective review of EE cases diagnosed in the Hospital de Navarra between January 2002 and August 2008, with 25 patients found, which represents an incidence of 2.13 cases/105 inhabitants/year. Seventy-two percent of our patients showed dysphagia and 52% a history of food bolus impaction, with endoscopic alterations found in 23 of the 25 cases. Out of 24 patients studied, 76% showed an alimentary allergy or to neumoallergens, which supports the immunoallergic basis of the disease and the need for an allergy exam in all patients with EE. The majority of our patients (22 out of 24 evaluated) presented a good clinical response to treatment, which was based on avoiding exposure to the potentially involved allergen and/or the administration of corticoids (topical or systemic) and/or the administration of proton pump inhibitors.
    Anales del sistema sanitario de Navarra 01/2009; 32(2). · 0.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Eosinophilic esophagitis (EE) is a disease characterised by the infiltration of esophageal mucous by eosinophils, whose incidence in adults seems to have been increasing in recent years, in a way that is similar to what is occurring with other diseases of a probable immunoallergic aetiology. It predominates in young adults and is mainly expressed by dysphagia and esophageal food impactation. Treatment is based on eliminating the allergen that is potentially involved and the administration of corticoids. This article offers a retrospective review of EE cases diagnosed in the Hospital de Navarra between January 2002 and August 2008, with 25 patients found, which represents an incidence of 2.13 cases/105 inhabitants/year. Seventy-two percent of our patients showed dysphagia and 52% a history of food bolus impaction, with endoscopic alterations found in 23 of the 25 cases. Out of 24 patients studied, 76% showed an alimentary allergy or neumoallergens, which supports the immunoallergic basis of the disease and the need for an allergy exam in all patients with EE. The majority of our patients (22 out of 24 evaluated) presented a good clinical response to treatment, which was based on avoiding exposure to the potentially involved allergen and/or the administration of corticoids (topical or systemic) and/or the administration of proton pump inhibitors.
    Anales del sistema sanitario de Navarra 01/2009; 32(2):227-34. · 0.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introducción Un elevado porcentaje de cánceres colo-rectales (CCR) desarrollan adenomas metacrónicos. Son escasos los trabajos que analizan el periodo de tiempo transcurrido entre la resección del tumor y el diagnóstico de las sucesivas generaciones de adenomas metacrónicos. Objetivos Estudiar la evolución del tiempo hasta el diagnóstico en las sucesivas generaciones de adenomas metacrónicos. Comparar la latencia diagnóstica de la primera lesión metacrónica entre los pacientes con y sin lesiones sincrónicas previas. Material y métodos Analizamos 382 CCR, seguidos mediante colonoscopias completas. Determinamos el tiempo transcurrido entre la resección del cáncer inicial y el diagnóstico de la 1a, 2a y 3a generación de adenomas metacrónicos. Comparamos las posibles diferencias en cuanto a tiempo hasta el diagnóstico del primer adenoma metacrónico entre los casos con y sin lesiones sincrónicas iniciales. Para el estudio estadístico empleamos el test de Mann Whitney, considerando significativos los valores de p<0,05. Resultados 208/382 pacientes (54,5%) presentaron adenomas sincrónicos y 162 (42,4%) desarrollaron adenomas metacrónicos. La media de colonoscopias de control ha sido de 2,74±1,75 por paciente. La mediana del tiempo (meses) de las sucesivas colonoscopias fue 1a=15; 2a=32; 3a=46; 4a=63; 5a=72; 6a=85; 7a=93 y 8a=100 meses. Las medianas del tiempo hasta el diagnóstico para la 1a generación de adenomas metacrónicos fueron de 21 meses, reduciéndose a 16 para la 2a generación y 14 meses para la 3a. En los pacientes con adenomas sincrónicos, la primera lesión metacrónica se diagnosticó significativamente antes: mediana=19 meses con respecto a los que no tenían lesiones sincrónicas: mediana=30 meses (p=0,011). Conclusiones 1. El intervalo hasta el diagnóstico de las lesiones metacrónicas se va reduciendo progresivamente en las sucesivas generaciones de adenomas. 2. El tiempo transcurrido hasta el diagnóstico del primer adenoma metacrónico es significativamente menor en los cánceres colo-rectales con adenomas sincrónicos iniciales. 3. Nuestros resultados aconsejan efectuar el primer control endoscópico de forma más precoz en los pacientes que hubieran presentado previamente adenomas sincrónicos.
    Gastroenterology 01/2009; 32(3):231-232. · 12.82 Impact Factor