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INFORMATION

The Cardiology Unit is form up by a professional team committed to diagnosis and treatment of patients’ cardiologic diseases, both as outpatient as hospitalized. It has the support and also assists all the cardiovascular area of the Hospital (ICU/Coronary unit, Imaging diagnosis, Haemodynamic, arrhythmology/electrophysiology, cardiac surgery, cardiology and paediatric surgery.
The cardiology unit is provided with the greatest innovative techniques as from the diagnosis point of view as therapeutically, with a continuous updating to constantly be benefited whenever of the latest technology in cardiology area.

WHAT DO WE TREAT?

Cardiology emergencies

Therapeutical and diagnosis catheterizations (coronary angioplasty-stent, percutaneous valvuloplasty)
Diagonosis and therapeutical electrophysiology (cardiac arrhythmia)

Coronary CT 64-multidetector

The Ruber International Hospital currently has two latest generation CT machines and the highest services available for clinical use. They are models from General Electric Medical Systems®, 16 slices Lightspeed Horizon and 64 slices Lightspeed VCT. This last is a device specially designed and conceived for the coronary arteries and for virtual colonoscopy.
What is adding Helical CT to CT or conventional scanner?
The helicoidal technology allows the data attainment in the area being studied continuously, therefore, is a volumetric acquisition. If also more than one detector is used, it can be obtained in each rotation of x-ray tube, at least, as images as detectors. This implies a considerably faster exploration, and it allows reconstructions of much more quality.
What do we designate 3D-CT?
The volumetric data acquisition allows, through a complicate computer process, to show the three-dimensional relations of the different organs. This is what we denominate 3D reconstruction or volume rendering. It is useful in trauma pathology and in vascular pathology, among others.

What kind of studies performs the CT?
This sort of CT or scanner allows performing the same kind of examinations done with conventional CT, much more detailed and in less time. Moreover, images acquisition is faster, the volumetric achievement and the three-dimensional reconstruction possibilities, the electrocardiographic synchronizing, the great advances in data treatment lately; all in all, it has let the development of several highly useful applications as for diagnosis, and for diseases follow up settled in early diagnosis or even in the detection of risk factors to suffer some of them.

Lung nodules screening
In recent years, a lung carcinoma early detection project has been developed internationally and called ELCAP (Early Lung Cancer Action Project)*, which preliminary findings were published in 1999. They discovered that, with a low radiation dosage CT, they could see the non-calcified lung nodules in a 23% of patients, against a 7% with chest radiography. Malignancies in chest in a 2-7% by CT and 27 cancers found were detected, 26 were resectable. They concluded that the low radiation CT can significantly improve the way to detect small lung cancers, in a really early stage and, though, potentially healed.
How does the Screening CT test work?
It is performed a complete “sweep” of both lungs with CT slices, adjusting the radiation dosage to a lowest level as possible to obtain diagnostic images. A deep breath is taken and it is a quick 20-second scan. There is no need to use contrast or any other previous preparation. Once the examination is conclude, the patient may return to his normal activity.
Afterwards, the radiologist will study the exploration and, if there is any injury, he could perform additionally, an automatic analyse of it. He would note the processes to follow depending on its characteristics and the suspicious degree of malignancy which is the causing the injury.

What results can generate the test?
If any lung nodule is detected, the result will be considered negative and if the patient obeys the risk criteria, he would be asked to repeat the test in a year term.
If nodules greater than 7 mm. in a preliminary study or with suspecting criteria of malignancy are objectified, the patient will be advised to contact, as soon as possible, to a specialist.
If there are one or more lung nodules, all of them lower than 7 mm. a follow-up program will be established, in the terms determined by the ELCAP protocol to detect eventual alterations to aware the possibility of a lung cancer.
In any of the mentioned cases, the evaluation, if possible, will be carried out by a reference doctor to unify criteria and to establish the best action for each patient.
Detection and quantification of coronary calcium.
Mainly in USA, the Coronary Artery Calcium Measurement (CAD) is being gradually implemented as a screening coronary pathology.
Everybody assumes that the coronary calcium presence provides evidence for atherosclerosis in the intima of this artery.

CAD measurement can set the heart-attack risk criteria and performed in a serial way, the changes can be for evaluating the therapeutic actions.
TCMD met liability and reproducibility criteria required for a screening method.
Thanks to MDCT the study of big anatomies, for example, thorax, can be obtained in a breath pause (20 seconds) with an excellent spatial resolution. Alternatively, in less extensive areas, spatial resolution could be increased or reduce the time of acquisition. Though, heart isotropic images can be obtained with just one apnoea and electrocardiographic synchronization, taking images only during the diastole and avoiding the heart movement devices. This let detect and quantify the coronary calcium.

How does it work?
Any previous preparation is required. The patient is placed on the CT table and some electrodes are stuck on him, as the one used for electrocardiogram. A screening in unique deep breathing (less than 20 sec.) is made.
At the end, the normal activity can be resumed immediately.

Results evaluation.
The measuring can be performed through the Agatston system, quantifying the area, average density and the highest calcification for each segmentary injury applying a multiplying factor for each lesion which is the maximum density function. Another method is called volume 130, measuring the tissue with high density to 130 uH in the indicated regions.
The radiologist analyses the obtained images and indicates the territories of each coronary artery in the workstation. The program chooses those which densitometer value is over 130 uH and measures its volume. Finally, the corresponding volumes to each artery and total volume are summed.
This method does not allow predicting if a particular patient is going to suffer a coronary ischemia event by it does establish a risk level, based on this factor.
Coronary CT
The Coronary CT or 64 detectors multislice is being more successful as an alternative examination to catheterism for noncalcified plaques, the stenosis detection and measuring and the patients with coronary artery bypass follow-up.

The factors affecting to obtained quality images, and, therefore the sensibility of the tests, are the cardiac rhythm and frequency, the movement and the devices produced by larger calcifications.
How does it work?
First a coronary calcium study is made, as above described. This allows excluding from the test those patients with a high amount of calcium and whom the procedure is not going to become a diagnosis.
Next the forearm vein is cannulated and connected to a contrast injector.
During the contrast injection are obtained images from aortic root allowing to evaluate the best moment to perform the screening.

What is necessary?
β-blocking oral medication in a unique dosage and (before a lack of contradiction) if the patient has a cardiac rate over 75 beats per minute.
Intravenous contrast: 100-120 ml.
Patient’s tolerance to supine position (flat on one’s back).
Be able to hold breath for 10-15 sec.
Virtual colonoscopy
Virtual colonoscopy is a CT with a non-invasive image technique that enables revealing colorectal tumours and polyps as well as to measure its growth.
Likewise conventional colonoscopy, the virtual colonoscopy allows determine the entire colon surface to see cancers and polyps. In fact, the virtual colonoscopy achieves the 75 and 100% colon and rectum polyps and cancers detection of a diameter of 1 cm or more diameter.
A recent study, performed amid patients to be submitted to colon cancer screening, showed that the 60.2% preferred virtual colonoscopy, against a 25.7% who selected the classic one and a 14.1% without any favouritism.
The colorectal cancer is preventable or curable if it is early detected. It affects a big number of people and most of them die due to it. Virtual colonoscopy is effective for easy notice precancerous injuries, and it can be used as early detection method. Other virtual colonoscopy specifications include: The colon evaluation after an incomplete colonoscopy or in almost obstructive case of cancer, in elderly patients or seriously ill and in those who do not have tolerance to sedation.
How is it performed? Firstly, is necessary to prepare the colon one day before the testing date, similarly to the way classic colonoscopy is executed, as for the barium enema or for colon surgery. Seeking not to contain faecal residues that could be confused as mucous injuries.
Once in the CT table, the patient is placed with a thin tube in the rectum, through CO2 is inflated by a volume and pressure regulatory and to relax the entire colon.
It has been checked that CO2 is ahead in comfort to the patient at ambient air, and it is reabsorbed without the need to be evacuated.
After that, axial images are obtained in the entire abdomen. Then, the patient is put face down and axial images are obtained in this position.
Results evaluation
The interpretation is done in a workstation with a specific program showing simultaneously supine and prone sections in the same placement. It performs colon wall 3D re-creations allowing to be visualized from any angle and can restore the displayed mucous in a particular section or does a virtual “navigation” passing through the colon lumen.
With this we can identify raised injuries or even ulcers in colon mucous.
More info

Cardiac Nuclear Magnetic Resonance

Since January 2002, Ruber International Hospital has been working with the MR (Magnetic Resonance) with a magnet power of 3.0 Tesla, and it was the first unit set in Europe capable of taking images from brain and body.
The main advantage of a greater magnetic field is the capacity to work with a double sign, what allows executing the equivalent studies as with a magneto of 1. 5T in half the time, or to increase spatial resolution in the alike time, i.e., the image definition; therefore, it is possible to detect smaller injuries than in current devices. However, to work with double magnetic field is to get into a distinctive level of information, since in this magnetic field, the susceptibility of some particles is multiplied, achieving thus a new information, particularly in functional and biochemist area, different to what we can obtain with conventional devices.
In brain studies much smaller structures can be studied, as arteries, they can be visible from a size of 200-300 microns. It is also significant the differences with 3 Tesla in patients with epilepsy since really small injuries are detected, which are responsible for crisis, allowing a more effective treatment.
When conventional studies are executed, timing is reduced to a half, with a greater comfort to the patient. Moreover, the Ruber International Hospital is equipped with an image and sound system. It can be used as for MR research studies as for brain functional studies, as, for the patients’ comfort avoiding the claustrophobia sensation, since the patient can be watching a film while the MR study is being performed.
But the mail advantage of 3 Tesla field in Neuroimaging is highlighted in functional studies, in the spectroscopy and cardiologic studies.

Functional studies
In brain function studies, the capacity to detect brain activity is multiplied by a 2 or 3 factor. Therefore, brain functions impossible to discover with a 1.5 Tesla magnet can be estimated. It is possible to obtain not only brain activity maps (chart on the right side) during simple tasks like the movement or the vision, or complex ones like the language or attention, but it is also possible to study the brain recovery after injuries like traumas or strokes. Thus, a function map of the brain can be defined, changing from one patient to another and, consequently, to be able to guide the surgeon on the areas to be respected in a surgery, to avoid aftermath or brain damage that could restrict the patient’s life.
The brain activity map will allow us, in a coming future, to be able to dissociate from the Alzheimer’s illness from the rest of dementias.

Spectroscopy
In spectroscopy, biochemical brain information is obtained by means of the analysis of spectrum different peaks. The biggest sign of 3.0 Tesla MR lets to study brain areas, since the peaks are higher, but, at the same time, the field separates the different peaks on the spectrum, therefore, it is possible to distinguish better between the peaks placed closely. Hence, the biochemical analysis is much more precise.

Cardiologic studies
Cardiologic studies require a special recognition, for his foreseeable impact in the early detection of cardiovascular disease and prevention of myocardium infarction. Due to its own beat and the breath, the heart is an organ in nonstop movement, what hugely hinders the MR its study implementation. The electrocardiographic and respiratory synchronization, and the protocols usage specifically designed, have solved this problem, in such a way that the MR presently provides a wide range of diagnostic possibilities.
The Cardio Magnetic Resonance (Cardio MR), as in 1.5 machines as 3.0 Teslas is an available and bloodless, complementary to echocardiogram and of excellent utility in cardiac pathology, although mainly aimed to the ischemic cardiopathy estimation. In this sense, the MR offers several possibilities: Anatomical studies of high definition in any plane of space (for congenital pathology, arrhythmogenic dysplasia, mass study, etc.), movie mode sequences (for the contractibility study), blood flow measurement (for vascular dysfunction, shorcircuit,… ), etc.
There are two fundamental tools for diagnosis and evaluation of the ischemic illness: infusion studies and myocardial variability. Fast cuts are made to the heart in the first ones, together with an contrast injection via peripheral intravenous, revealing those areas of the myocardium, for having an injury in the coronary circulation on which they depend, they suffer ischemia or are in infarction risk. If necessary, also the test can be done under pharmacological stress testing.
If there has been an acute infarction, a study of myocardial viability can be performed. It is one of the most significant innovations in Cardiac MRI in latest years; it is based on the presence of late capture of injected contrast (arrow) in the unviable infarcted myocardium (it would not recover its contracting function unless the blood flow is restored by surgery or angioplasty). Note that due to high-definition images, it is possible to distinguish if the infarction involves partly or completely the myocardium thickness. This information is becoming vital in the treatment scheduling.
Both tools allow knowing indirectly the coronary circulation status as for the already diagnosed patient as for the general population who wants to checkup their health situation.
It is also possible by Cardio MR, the direct visualization of vessels or coronary catheterization. Although it is not yet used in the daily application area, it is likely that the successive technical innovations will allow in a coming future to evaluate the main coronary artery anatomy suitably defined to perform coronary stenosis screening.
Nowadays, the atheroma plaque is being investigated with Cardio-MR expecting to identify patients with coronary plaques that could be complex and cause an acute myocardium infarction. This will allow us to value the atheroma potentially dangerous plaques and to take appropriate preventive actions.

Further information soon

Neurology

Further information soon

Cardiology

Further information soon

Oncology

In the year 2003, the identification technique and sentinel lymph node biopsy are implemented in the Ruber International Hospital (RIH) both for breast tumours and for melanomas. Therefore, a multidisciplinary working group is created formed by pathologists, gynaecologists, and surgeons and nuclear. At present, and after having performed more than 200 cases, we have verified as the gynaecologists’ group as the general surgeons.
Approximately the 95% of these cases correspond to a breast tumour and the remaining 5% to melanomas.
The identification technique and the sentinel lymph node have prevented the realization of many axillar lymphadenectomies thus avoiding the morbidity of this technique.
This technique is based upon the fact of the lymph node lesion draining which also reveals us the affectation stage of the rest lymph nodes for being the first gathering the possible tumour spreading. If the analysis of the sentinel lymph node determines that there is not any affectation, we will infer that the remaining lymphatic chain is also undamaged.
The technique achievement comprises injecting a radioactive isotope around the injury and later performing a corresponding axilla sintygraphy where on the 99% of the cases, the sentinel lymph node is located. This is the axilla mark and in a second phase, and by a probe, it is located in the OT by surgeons and gynaecologists, eliminating and analysing it at the moment. If the analysis anatomical and pathological of the node shows no affection we can avoid an axillar lymphadenectomy performance.

Paediatrics

Further information soon

Radioimmunotherapy with Zevalin (Ibritumomab Tiuxetan)

Non-Hodgkin’s Lymphoma follicular (NHL) in advanced stage is a disease characterized by repeated relapses and decrements that are sequentially less frequents and shorter as a chemotherapy successive cycle response.
Zevalin is the first treatment of radioimmunotherapy approved for adult patients with follicular NHL of cells B CD20+ in relapses or refractory to treatment with Rituximab.
Zevalin belongs to a medicament group called monoclonal antibodies guided before body cells.
It is used jointly to a radioactive substance called Ytrio 90 (Y-90).
It makes the most of the monoclonal antibody Ibritumomab properties and from the radioactive isotope Ytrio-90.
A Zevalin cycle involves:
• Day 1: Intravenous infusion of Rituximab to deplete the peripheric B cells and optimize the radiopharmaceutical antibody spread.
• Day 8: Intravenous infusion of Rituximab followed by a 90Y-Zevalin dosage.
In Spain, the Ruber International Hospital is one of the centres with a highest experience in treatments with radioimmunotherapy with Zevalín since the year 2005.

MEDICAL TEAM

Dr. Ros Jellici, Jorge Team leader
Más información

DrJellici
  • Estudios de la carrera de Medicina en la Unidad Docente de la Ciudad Sanitaria  Valle Hebrón de la Universidad Autónoma de Barcelona.
  • Licenciatura en Medicina y Cirugía y examen de Grado de Licenciatura en Junio de 1983 con la calificación de SOBRESALIENTE.
  • Obtención de plaza para especialización en CARDIOLOGIA en la convocatoria de la Prueba Selectiva de Médicos Residentes (M.I.R.) 1985/86.
  • Especialización como Médico Interno Residente del Servicio de CARDIOLOGIA en el Hospital Universitario LA PAZ  de Madrid.
  • Médico Adjunto. Facultativo Especialista de Área de CARDIOLOGIA. Área Sanitaria 5. Hospital General La Paz, desde enero de 1991 hasta octubre de 1991.
  • Médico Adjunto. Facultativo Especialista de Área de CARDIOLOGIA. Área Sanitaria 3. Hospital Universitario Príncipe de Asturias, Alcalá de Henares; desde noviembre de 1991 hasta febrero de 1995.
  • Médico de la Unidad de Cardiología del HOSPITAL RUBER INTERNACIONAL desde agosto de 1990.
  • Jefe de la Unidad de Cardiología del HOSPITAL RUBER INTERNACIONAL desde noviembre de 2001.
  • Publicaciones y Comunicaciones a congresos: 43.

Dr. Alegría Barrero, Eduardo
Más información

DrAlegria
  • Licenciado (2003) y Doctor Europeo (2009) en Medicina por la Universidad de Navarra.
  • Especialista en Cardiología en la Clínica Universitaria de Navarra (2009).
  • Acreditación en Hemodinámica y Cardiología Intervencionista (2010).
  • Interventional Fellow en el Hôpitaux Rangueil de Toulouse (2009).
  • Interventional and Research Fellow en el Royal Brompton Hospital de Londres, desarrollando proyectos de investigación clínica adscritos al Imperial College of London (2011-2012).
  • Máster de posgrado en Cardiología (2010), cuidados cardíacos agudos (2012) y rehabilitación cardíaca (2014).
  • Jefe de Servicio de Cardiología del Hospital Universitario de Torrejón.
  • Consultor clínico en la Unidad de Cardiología del Hospital Ruber Internacional (desde 2012).
  • Profesor asociado, tutor de alumnos y coordinador de la asignatura de Cardiología en la Universidad Francisco de Vitoria.

Áreas de investigación

  • Cardiopatía isquémica
  • hipertensión
  • intervencionismo estructural
  • trombosis
  • prevención cardiovascular

Autor de más de 80 publicaciones en revistas científicas nacionales e internacionales, más de 20 capítulos de libros y revisor de revistas científicas cardiológicas (Catheterization and Cardiovascular Interventions, Eurointervention, Circulation: Cardiovascular Interventions, European Heart Journal: Cardiovascular Imaging, Heart, American Journal of Cardiology).

Dra. Campallo Ramírez, María Jesús
Más información

DraCampallo
  • Estudios de la carrera de Medicina en la Unidad Docente del Hospital Provincial de Badajoz.
  • Licenciatura en Medicina y Cirugía y examen de Grado de Licenciatura en Junio de 1988 con la calificación de SOBRESALIENTE.
  • Título de Licenciada en Medicina y Cirugía expedido el 20 de Julio de 1988 con la calificación de SOBRESALIENTE.
  • Obtención de plaza para especialización en CARDIOLOGIA en la convocatoria de la Prueba Selectiva de Médicos Residentes (M.I.R.) 1989/90.
  • Especialización como Médico Interno Residente del Servicio de CARDIOLOGIA en el Hospital General LA PAZ de Madrid.
  • Obtención del Título de ESPECIALISTA EN CARDIOLOGIA el 31 de Diciembre de 1994.
  • Médico de la Unidad de Hospital Ruber Internacional desde 1995.

 

Dr. Pereira Boza, Julio
Más información

DrBoza
  • Licenciado en Medicina y Cirugía por la Facultad de Medicina de la Universidad de Navarra.
  • Médico especialista en Cardiología, vía MIR, en el Hospital Universitario La Paz de Madrid.
  • Completó el programa de Cursos de Doctorado en la Universidad Autónoma de Madrid.
  • Autor de diversas publicaciones y comunicaciones en congresos.
  • Desde 2001 trabaja en la Unidad de Cardiología del Hospital Ruber Internacional.

 

Dr. Ruiz García, Juan
Más información

foto-perfil-juan-ruiz-garcia

Datos Académicos

 – Licenciado en Medicina (Sobresaliente) Universidad Complutense de Madrid (2005).

– Research Fellowship. Cardiovascular Division, Mayo Clinic, Rochester MN, USA (2010).

– Título de Médico Especialista en Cardiología. H.G. U. Gregorio Marañón de Madrid (2011).

– Máster Universitario en Electrofisiología Cardíaca. Universidad CEU San Pablo (2011).

– Máster Universitario en Cardiología. Universidad Miguel Hernández (2012).

– Acreditación por la Sociedad Española de Cardiología para la Práctica de la Hemodinámica y

Cardiología Intervencionista (2013).

– Máster Universitario en Diagnóstico por la Imagen en Cardiología. Universidad Católica San

Antonio de Murcia (2014).

– Doctor en Medicina (Sobresaliente cum laude). Universidad Complutense de Madrid (2015).

– Título de Posgrado en Expertos en Fibrilación Auricular. Universidad de Santiago de

Compostela (2015).

– Máster de Posgrado en Prevención Cardiovascular y Rehabilitación Cardíaca. Universidad

Internacional Menéndez Pelayo (2016).

– Máster de Posgrado en Hemodinámica e Intervencionismo. Universidad Católica San Antonio

de Murcia (2017).

 

Datos Profesionales

 – Médico Interno Residente de Cardiología. H. G. U. Gregorio Marañón, Madrid (2006-2011).

– Médico Adjunto de Cardiología. Hospital Universitario Infanta Sofía, Madrid (2011-2013).

– Médico Becario. Sección de Hemodinámica y Cardiología Intervencionista. H. U. La Paz, Madrid (2011-2013).

– Médico Adjunto Cardiología Clínica e Intervencionista. H. U. Quirón, Madrid. (2013-2014).

– Médico Adjunto Cardiología Clínica e Intervencionista. H. U. de Torrejón, Madrid (2014-Actualidad).

 

Docencia Universitaria

 – Médico Colaborador de Docencia Práctica del Departamento de Medicina I, Universidad

Complutense de Madrid (2008-2011).

– Profesor Colaborador de Cardiología. Universidad Europea de Madrid (2013-2014).

– Tutor de la Facultad de Medicina. Universidad Francisco de Vitoria (2014-Actualidad).

– Profesor Asociado de Medicina. Universidad Francisco de Vitoria (2015-Actualidad).

– Director de Congreso Nacional de Cardiología para Estudiantes de Medicina UFV (2017).

 

Investigación

 – Autor de más de 35 publicaciones en revistas científicas nacionales e internacionales.

– Autor de más de 30 comunicaciones a congresos nacionales e internacionales.

– Áreas de interés e investigación:

  • Aterosclerosis y cardiopatía isquémica (angina de pecho, infarto).
  • Intervencionismo cardíaco percutáneo (cateterismo, angioplastia, stents, válvulas percutáneas).
  • Arritmias (palpitaciones, taquicardias, marcapasos, fibrilación auricular).
  • Hipertensión arterial, diabetes, hipercolesterolemia y prevención cardiovascular.
  • Insuficiencia cardíaca, bioética y cuidados al final de la vida.
SERVICES PORTFOLIO

Electrocardiography (ECG)

Pulsed and colour continuous echocardiogram-Doppler
It is an innocuous technique, non-aggressive, using ultrasounds for the heart study, both anatomical as functional. It allows the heart dynamic visualization with the purpose to study all kind of anomaly, thus it is useful in any cardiac pathology area (valve insufficiency, myocardiopathy, ischemic cardiopathy, congenital cardiopaties, rhythm disorders) Continuous, pulsed and colour, allowing a heart functional evaluation (valve function, contractile). There are optional techniques as the perthoracal, transesophageal, stressful (conventional or pharmacological) echocardiography. The standard technique (transthoracic) is the most used, and it does not require any special patient’s preparation, therefore it is not necessary for any previous fasting.

Cardiac stress test (cardiac diagnostic test)

With the cardiac stress test or endurance test, the heart response is studied before the physical overload to discard cardiovascular disease and also to value the cardiac rhythm response, arterial pressure, functional capacity, recovery capacity, etc…. The test is to walk along a moving belt with speed and increasing slope gradual and periodically. The electrocardiogram is being strictly monitored, and the arterial pressure is controlled. It is not necessary previous fasting. It requires the patient’s authorization by an informed consent.

ECG Holter (continuous monitoring)

It is the portable study of cardiac rhythm by ECG monitoring, usually during 24 hours. Electrodes connected to a small ECG recorder are stuck onto the patient’s skin, letting him to develop his normal activity. It is quite useful in any type of cardiac arrhythmias, as to value the response to their treatment. It is not required any special preparation.

T.A. Holter (mobile register)

It is the movable study, generally during 24 hours, of blood pressure by a pressure cuff connected to a small recorder letting the patient develop his normal activity. It is not required any particular preparation. It is useful to dismiss hypertension and to sort it and to value the response to antihypertensive treatment.