Assuntos
Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Administração Oral , Área Sob a Curva , Azatioprina/uso terapêutico , Ciclosporina/administração & dosagem , Ciclosporina/sangue , Quimioterapia Combinada , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/sangue , Absorção Intestinal , Ácido Micofenólico/uso terapêutico , Transplante HomólogoRESUMO
QUESTIONS UNDER STUDY: Diagnostic strategies in venous thromboembolism (VTE) are subject to controversy and rapid change and are dependent on the availability of the specific tests. The aim was to critically analyse the diagnostic procedures in patients with VTE at an intermediate size, non-university hospital. METHODS: The diagnostic work up of 270 consecutive patients with suspected VTE disorders was analysed prospectively and the therapeutic decisions were monitored and compared with the actually implemented new standard evaluation which consists of a sequential application of the diagnostic tools (clinical probability, D-dimer compression ultrasound V/Q lung scan or CT). The patients were followed clinically for at least three months. RESULTS: 50% of the 55 patients with suspected deep vein thrombosis (DVT) and 35% of the 215 patients with suspected pulmonary embolism (PE) were found positive and were anticoagulated. The overall number of patients being anticoagulated was not significantly changed by the new procedure but approximately 30% of the additional examinations inclusive V/Q-scans, spiral CT and compression ultrasound or phlebography could be saved. Our study and the follow up after the therapeutic decision indicate that 92% of the patients can be clearly and safely allocated, while the remainders are managed according to an essentially clinical decision. CONCLUSIONS: The vast majority (>90%) of the patients can be clearly diagnosed as positive or negative with the strategy presently used. A minority still requires an "overall decision". Our modified approach results in considerable cost savings.
Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Embolia Pulmonar/diagnóstico , Tromboembolia/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Diagnóstico por Imagem/economia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/epidemiologia , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Taxa de Sobrevida , Suíça/epidemiologia , Tromboembolia/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Trombose Venosa/epidemiologia , Trombose Venosa/terapiaRESUMO
A 53 year old Italian with aethylic cirrhosis of the liver was hospitalized repeatedly over the last years because of recurrent ascites. During the last episode with fever, acute abdominal pain, exsudative ascites and elevated CRP spontaneous bacterial peritonitis was suspected and the patient was treated with antibiotics. Although the therapy was carried out correctly it had no effects on the symptoms. Finally the examination of ascites and matutinal sputum revealed mycobacterium tuberculosis and pulmonary and peritoneal tuberculosis was diagnosed. Tuberculostatic therapy was initiated with ethambutol, rifampicin and isoniacid adapted to impaired hepatic and renal function.
