Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome.

Women with antiphospholipid syndrome (APS) may have diverse pregnancy outcomes. The objective of this study was to evaluate pregnancy outcome in women with APS according to their clinical phenotype, i.e. thrombotic and obstetric APS. Eighty-three pregnancies in 67 women with APS were included in the study, including 21 with recurrent miscarriage (Group 1), 21 with late fetal loss or early delivery due to placental dysfunction (Group 2) and 41 with thrombotic APS (Group 3). Group 3 had higher rates of preterm delivery (26.8% versus 4.7%, p = 0.05) than Group 1 and more small for gestational age (SGA) babies than Group 2 (39.5% versus 4.8%, p = 0.003). Group 2 had significantly longer gestations compared with their pretreatment pregnancies (38.4 [28.4-41.4] versus 24.0 [18-35] weeks, p < 0.0001) and 100% live birth rate after treatment with aspirin and low-molecular-weight heparin (LMWH). In conclusion, women with thrombotic APS (Group 3) have higher rates of pregnancy complications than those with obstetric APS (Groups 1 and 2). Treatment with aspirin and LMWH is associated with improved outcomes for women with previous late fetal loss or early delivery due to placental dysfunction (Group 2).

Phantom development for daily checks in electron intraoperative radiotherapy with a mobile linac.

PURPOSE: IORT with mobile linear accelerators is a well-established modality where the dose rate and, therefore, the dose per pulse are very high. The constancy of the dosimetric parameters of the accelerator has to be checked daily. The aim of this work is to develop a phantom with embedded detectors to improve both accuracy and efficiency in the daily test of an IORT linac at the surgery room. METHODS: The developed phantom is manufactured with transparent polymethyl methacrylate (PMMA), allocating 6 parallel-plate chambers: a central one to evaluate the on-axis beam output, another on-axis one placed at a fixed depth under the previous one to evaluate the energy constancy and four off-axis chambers to evaluate the flatness and symmetry. To analyse the readings a specific application has been developed. RESULTS: For all chambers and energies, the mean saturation and polarization corrections were smaller than 0.7%. The beam is monitored at different levels of the clinical beam. Output, energy constancy and flatness correlate very well with the correspondent values with the complete applicator. During the first six months of clinical use the beam dosimetric parameters showed excellent stability. CONCLUSIONS: A phantom has been developed with embedded parallel plate chambers attached to the upper applicator part of an IORT linac. The phantom allows a very efficient setup reducing the time to check the parameters. It provides complete dosimetric information (output, energy and flatness) with just one shot and using ionization chambers with minimum saturation effect, as this highly pulsed beam requires.

Immunoglobulin abnormalities are frequent in patients with lupus nephritis.

BACKGROUND: Hypogammaglobulinemia is a complication of B-cell targeting therapies (BCTT), used in vasculitis, rheumatoid arthritis and systemic lupus erythematosus (SLE). Since autoimmune diseases are associated with underlying and induced immune abnormalities, several societies recommend assessing immune function before and during rituximab treatment. In SLE, polyclonal hypergammaglobulinemia is the typical alteration of gammaglobulins, though hypogammaglobulinemia has also been reported. METHODS: This is a cross-sectional study describing immunoglobulin levels measured as part of routine care in patients with lupus nephritis, a group with multiple factors contributing to immunoglobulin abnormalities, including immune dysregulation, immunosuppression and nephrotic syndrome. RESULTS: Polyclonal hypergammaglobulinemia occurred in 15/83 (18.1%) patients. In contrast, low levels of immunoglobulins were found as follows: selective IgA deficiency 2/83 (2.4%), reduced IgG levels 7/83 (8.4%), reduced IgM 14/83 (16.9%). Only 1 patient required immunoglobulin replacement. CONCLUSIONS: Immunoglobulin abnormalities are frequently found in lupus nephritis, ranging from polyclonal hypergammaglobulinemia to hypogammglobulinemia. Consequently, immunoglobulin levels should be assessed prior to commencing BCTT.

[Hyperthrombophilia status in a patient without thrombotic events]. / Paciente en estado de hipertrombofilia sin eventos trombóticos.

Some case reports have been published in the literature about thrombosis associated with several risk factors, especially in hypercoagulability state. Nevertheless, we have not found any description of a case like this of hyperthrombophilia status without thrombotic events. We present a 75 year old woman who was assessed for thrombophilia state on occasion of a deep venous thrombosis which affected to her daughter. Many thrombosis risk factors were detected (13 altogether), both inherited and acquired, arterial and venous, that surprisingly, have not led to any thrombosis event. Its description led us to highlight the risk factors of this patient and to open questions about the present knowledge on etiology and etiopathogenesis of thrombotic phenomena.

Paciente en estado de hipertrombofilia sin eventos trombóticos / Hyperthrombophilia status in a patient without thrombotic events

Se han publicado diferentes casos clínicos de pacientes afectos de trombosis con asociación de factores de riesgo, especialmente estados de hipercoagulabilidad. Sin embargo, no hemos encontrado en la literatura un caso como el que presentamos: una mujer de 75 años, evaluada paratrombofilia a raíz de un episodio de trombosis venosa profunda que afectóa su hija, a la que se le ha detectado una acumulación factores de riesgo (13 en total), tanto congénitos como adquiridos, arteriales como venosos que, sorprendentemente, no ha abocado a evento trombótico alguno. Su exposición nos permite incidir sobre los factores de riesgo de la paciente y abrir interrogantes sobre el conocimiento actual de la etiología y etiopatogenia de los fenómenos trombóticos

Some case reports have been published in the literature about thrombosis associated with several risk factors, specially in hypercoagulability state. Nevertheless, we have not found any description of a case like this of hyperthrombophilia status without thrombotic events. We present a 75 years old woman who was assessed for thrombophilia state on occasion of a deep venous thrombosis which affected to her daughter. Many thrombosis risk factors were detected (13 altogether), both inherited and acquired, arterial and venous, that surprisingly, have not led to any thrombosis event. Its description led us to highlight the risk factors of this patient and to open questions about the present knowledge on etiology and etiopathogenesis of thrombotic phenomena

Asociación de angiomas cavernosos con venosos / Association of cavernous and venous angiomas

Introducción. Los angiomas cavernosos y venosos deforma aislada son malformaciones vasculocerebrales frecuentes.Su asociación se identifica cada vez más debido ala mayor utilización de la resonancia magnética (RM) en losestudios cerebrales. Objetivo. Analizar las características de la asociaciónentre angioma cavernoso y venoso y la relación con su localizacióny tamaño, el sexo del paciente y el uso de contrasteintravenoso para el diagnóstico por RM. Métodos. Retrospectivamente se han revisado los estudiosde RM cerebral de 37 pacientes con angiomas cavernosos.Las relaciones estadísticas se establecieron con tablas decontingencia y el estadístico de la χ2 de Pearson y la t deStudent para muestras independientes. Resultados. Se identificaron 52 angiomas cavernososen 37 pacientes. No se han encontrado diferencias estadísticamentesignificativas que relacionen el tamaño del angiomacavernoso, su localización y el sexo del paciente con laexistencia de un angioma venoso asociado. Sólo la administraciónde contraste ha mostrado una relación estadísticamentesignificativa para su diagnóstico. Conclusiones. La asociación de angioma cavernoso y venosoes frecuente (30 %). Es necesario administrar contrastepara detectar los angiomas venosos. Esta asociación tiene implicacionespronósticas por el riesgo de sangrado y quirúrgicas,ya que la resección de la anomalía venosa no se aconsejapor la posibilidad de desencadenar infartos venosos

Introduction. Isolated cavernous and venous angiomasare common vascular cerebral malformations. Due to theroutine use of magnetic resonance imaging (MRI) in cerebral studies, their association has been identified more frequently. Objective. To analyze the characteristics of the association between both lesions (cavernous and venous angiomas), and the relationships with localization, size, patient gender and the use of intravenous contrast material in the diagnosis with MR.Methods. A retrospective analysis of the cerebral MRIstudies of 37 patients with cavernous angiomas was made.Statistical relationships were established with contingency tables and statistical methods of Pearson χ2 and of Student’s test for independent samples. Results. A total of 52 cavernous angiomas were identified in 37 patients. No significant statistical differenceswere found that related the cavernous angioma size, localization or patient gender with the existence ofan associated venous angioma. Only the administrationof contrast material has shown a statistically significantrelationship for the diagnosis. Conclusions. The association of cavernous and venous angioma is frequent (30 %). Contrast material must be administeredto detect venous angiomas. This association hasprognostic implications, due to bleeding risk and surgerysince resection of the venous anomaly is not recommendeddue to the possible venous infarction