[Clinical usefulness of three quantitative D-dimers tests in outpatients with suspected deep vein thrombosis]. / Análisis de 3 métodos para determinar el dímero D en pacientes con sospecha de trombosis venosa profunda.

BACKGROUND AND OBJECTIVE: The diagnostic approach in outpatients with suspected deep vein thrombosis (DVT) of the lower limbs includes D-dimer measurement (DD). Elevated DD is not a diagnostic value for DVT. However, a normal value contributes to ruling out DVT. We do not know the best method to determine DD. Therefore, we have analyzed the clinical utility of three quantitative assays to determine DD in outpatients with suspected DVT. PATIENTS AND METHODS: Consecutive outpatients with suspected DVT of the lower limbs who were referred to the DVT medical consultation were enrolled in the study. We used a diagnostic algorithm that included determining the pretest clinical probability (PCP) (Wells scale), DD level using three different quantitative methods (ELISA mini-VIDAS(®), Acure-care DDMR and DD-Plus). The DVT diagnosis was confirmed by seriated compression ultrasonography of the lower limbs. We analyzed the concordance between the three analytic methods to quantify DD and the characteristics. RESULTS: A total of 306 patients (mean age 60 years, 62% women) with suspected DVT of the lower limbs were included. The compression ultrasonography confirmed the diagnosis of DVT in 23.8% of the patients. Anticoagulation treatment was not performed in patients in whom DVT was ruled out, and no thromboembolic event occurred during the 3 months of follow-up. The best concordance test results were between ELISA mini-VIDAS(®) and Acure-care DDMR assays. Both assays demonstrated elevated sensibility and a negative predictive value. ELISA mini-VIDAS(®) was the best analytic method for the subgroup of patients with low clinical probability. CONCLUSIONS: The ELISA mini-VIDAS(®) method to determine DD rules out DVT in patients with low clinical probability.

Cellular mechanisms involved in the pathogenesis of airway remodeling in chronic lung disease.

Background: Airway epithelial cells and lung fibroblasts play an important role in the development of chronic lung disease, but the exact mechanisms responsible have not been clarified. Our objective was to investigate the involvement of these cells in the inflammatory response associated to chronic lung disease. Methods: Human lung fibroblasts and airway epithelial cells were challenged with Interleukin-1ß and hypoxia, and with inhibitory (simvastatin) stimuli of the inflammatory response. Expression of markers of local inflammation ((IL-8, monocyte chemoattractant protein-1 (MCP-1), factor-κB1 (NF-κB1)), systemic inflammation ((C-reactive protein (CRP) and serum amyloid A (SAA)) and proteases matrix metalloproteinase (MMP) 9 and 12 were assessed by PCR and ELISA. Apoptosis/necrosis was analyzed by flow cytometry. Results: Our results showed that the lung fibroblasts had a higher expression of local and systemic inflammation and protease activity markers when they were treated with IL-1ß compared to airway epithelial cells. Under hypoxic conditions, we observed a decrease in systemic inflammation in lung fibroblasts, which was further attenuated by simvastatin. Conclusion: The lung fibroblasts seem to be the main initially stimulated cells that could potentially trigger the inflammatory response, and be responsible for the eventual onset of chronic lung disease. The involvement of IL-1ß stimulation in systemic inflammatory and proteinase imbalance biomarkers is higher in lung fibroblasts. Apoptosis is not a predominant mechanism in these cells.

Differential biomarker profiles between unprovoked venous thromboembolism and cancer.

BACKGROUND: The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis. OBJECTIVE: To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD. METHODS: A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA. RESULTS: TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis. CONCLUSIONS: Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases. Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations.

Estudio proteomico diferencial entre liquidos pleurales secundarios a cáncer de pulmón versus mesotelioma / Differential proteomic study between pleural fluid secondary to lung cancer versus mesothelioma

Objetivo: Encontrar perfiles proteicos en líquido pleural que diferencien derrames pleurales secundarios a cáncer de pulmón (CP) versus mesotelioma pleural maligno (MPM).Metodología: Recogimos líquidos pleurales de 60 pacientes de tres grupos diferentes: MPM (N = 20), CP (N = 20) y derrames pleurales benignos (N = 20). Realizamos un análisis con proteómica diferencial con ITRAQ 4 plex (Applied Biosystem). Realizamos la identificación y cuantificación relativa de las proteínas con el programa Proteome Discoverer 1.4 (Termofisher Scientific). Construimos diagramas de Venn con las proteínas sobre/infra-expresadas en cada grupo. Realizamos una validación interna/externa mediante ELISA (Myobiosorce) añadiendo 25 muestras de CP y 14 de MPM.Resultados: Encontramos sobreexpresión de Pi3K en los derrames pleurales neoplásicos (16,86 +/- 25,83 ng/ml en CP; 20,66 +/- 17,26 ng/ml en MPM vs 5,92 +/- 0,99 ng/ml en controles). Hubo sobreexpresión de SPRM en MPM (30.702 +/- 30.310,53 ng/ml en el grupo MPM vs 10.404 +/- 10.157,72 ng/ml en el grupo CP vs 8.498 + /- 3.437,18 ng/ml en controles). Existió sobreexpresión de RhoB en CP (4,46 +/- 1,65 mg/ml en CP vs 1,65 +/- 2,65 mg/ml en MPM vs 0,92 +/- 1,6 mg/ml en controles). También encontramos sobreexpresión de PDGFR-alfa en derrames pleurales benignos (74,12 +/- 22,57 ng/ml en controles vs 43,05 +/- 23,96 ng/ml en CP vs 36,12 +/- 21,51 ng/ml en MPM).Conclusión: Existe un perfil diferencial proteico entre los derrames secundarios a CP (sobreexpresión de RhoB) y a MPM (sobrexpresión de SPRM). La sobrexpresión de Pi3K indica asociación a derrames pleurales malignos y la de PDGFR-alfa a derrames benignos. (AU)

Objetivo: Find protein profiles in pleural fluid that differentiate pleural effusions secondary to lung cancer (LC) versus malignant pleural mesothelioma (MPM).Metodología: We collected pleural fluids from 60 patients from three different groups: MPM (N = 20), CP (N = 20), and benign pleural effusions (N = 20). We performed differential proteomics analysis with ITRAQ 4 plex (Applied Biosystem). We performed the identification and relative quantification of the proteins with the Proteome Discoverer 1.4 program (Termofisher Scientific). We built Venn diagrams with the over/under-expressed proteins in each group. We performed an internal/external validation using ELISA (Myobiosorce) adding 25 CP and 14 MPM samples.Resultados: We found Pi3K overexpression in neoplastic pleural effusions (16.86 +/- 25.83 ng/ml in PC; 20.66 +/- 17.26 ng/ml in MPM vs 5.92 +/- 0.99 ng/ml in controls). There was overexpression of SPRM in MPM (30,702 +/- 30,310.53 ng/ml in the MPM group vs 10,404 +/- 10,157.72 ng/ml in the CP group vs 8,498 +/- 3,437.18 ng/ml in controls). There was overexpression of RhoB in CP (4.46 +/- 1.65 mg/ml in CP vs 1.65 +/- 2.65 mg/ml in MPM vs 0.92 +/- 1.6 mg/ml in controls). We also found overexpression of PDGFR-alpha in benign pleural effusions (74.12 +/- 22.57 ng/ml in controls vs 43.05 +/- 23.96 ng/ml in PC vs 36.12 +/- 21.51 ng/ml in MPM ).Conclusión: There is a differential protein profile between effusions secondary to CP (RhoB overexpression) and MPM (SPRM overexpression). Pi3K overexpression indicates association with malignant pleural effusions and PDGFR-alpha overexpression with benign effusions. (AU)

[Evolution of pulmonary scintigraphy in the follow-up of pulmonary embolism. Effect of anticoagulant treatment and other associated factors]. / Evolución de la gammagrafía pulmonar en el seguimiento del embolismo pulmonar. Influencia del tratamiento anticoagulante y de otros factores asociados.

We performed a prospective study to determine the evolution of perfusion defects 6 months after pulmonary thromboembolism (PTE), to identify associated factors and to evaluate the incidence of subclinical recurrence. Seventy patients diagnosed of PTE were enrolled. Perfusion pulmonary scintiscans were performed 6 months after the acute PTE episode and the results were compared with initial defects. We looked for significant relations between several course profiles and factors such as age, sex, anticoagulation therapy and patient history. Defects revealed by the initial scintiscan remained the same 6 months later in 15 (21%), decreased in 35 (53%) and disappeared in 16 (23%) of the 70 patients. New defects were identified in 2 patients. A significant relation was found between a favorable outcome as shown by follow-up scintiscans and compliance with anticoagulation therapy (p = 0.0024). Other statistically significant relations were observed between favorable outcome and a history of surgical intervention during the acute episode (p = 0.004) and between unfavorable outcome and a history of venous thromboembolic disease (p = 0.004).

[Lung cancer mortality in Andalucia, 1975-2000]. / Mortalidad por cáncer de pulmón en Andalucia (1975-2000).

OBJECTIVE: To describe trends in lung cancer mortality in Andalucia, Spain, during the period from 1975 through 2000. SUBJECTS AND METHOD: Records of lung cancer deaths for the period from 1975 through 2000 were obtained from the Statistical Institute of Andalucia. The following indicators were calculated: crude rates, age-adjusted rates, truncated rates, and cumulative rates. RESULTS: Mortality rates for men dropped in all subject groups aged over 50 years during the period from 1994 through 2000. In women mortality rates were much lower, although we observed an increase in the 35-39 and 45-49 age groups, which is reflected in the 6.1% rise in the truncated rates (35-64 years) during the period from 1994 through 2000. In older women mortality rates fluctuated more within the different age groups, although on the whole the truncated rate for all those over 65 years old fell by 9.7% in the period between 1995 and 2000. CONCLUSION: Lung cancer mortality rates among men in Andalusia began to decrease after 1994. In contrast, mortality increased among young women, although their rates are still very low.

[Cerebral abscess as first manifestation of a familial pulmonary arteriovenous fistula]. / Absceso cerebral como primera manifestación de una fístula arteriovenosa pulmonar familiar.

Pulmonary arteriovenous fistula in a 63-year-old woman with no relevant medical history presented with neurological symptoms secondary to multiple polymicrobial abscesses. As a result of this finding, relatives were examined under suspicion of the presence of systemic angiomatosis (hemorrhagic hereditary telangiectasia or Rendu-Osler-Weber disease), which is asymptomatic in many victims. Follow-up and early diagnosis is crucial to preventing severe neurological complications by treatment of arteriovenous malformations and antibiotic prophylaxis during dental or other invasive procedures.

[The search for clinical markers of abnormal hypercoagulable states among factors that trigger venous thromboembolic disease]. / Búsqueda de marcadores clínicos de hipercoagulabilidad patológica según los factores desencadenantes de enfermedad tromboembólica venosa (ETV).

We proposed to search for markers of hypercoagulable states in function of age, sex or factors that trigger venous thromboembolic disease (VTD) in a group of patients so diagnosed. The following patient data were analyzed: age, sex and triggering factors of VTD categorized as associative-transient, permanent or unknown. In patients under age 55 years of age in whom the triggering factor of VTD was unknown, and in those who had a family and/or personal history of VTD, coagulability was assessed approximately three months after the episode of acute thrombosis and was repeated during follow-up. From April 1993 to July 1996 we saw 297 patients diagnosed of VTD and performed 187 coagulability tests (63%). Eighty-six were normal (46%) and 101 (54%) abnormal. No significant relations were found for age, sex or triggering factors and the results of follow-up coagulability testing. We conclude that factors known to trigger VTD are not the only ones relevant for indicating the need to order the assessment of coagulability, given that the presence of coagulopathy is not confined to patients with supposed clinical markers.

[Acute interstitial pneumonia (Hamman Rich syndrome)]. / Neumonía intersticial aguda (síndrome de Hamman Rich).

We report the case of a 65-year-old woman with no history of respiratory disease who suffered onset of dyspnea after an episode of pseudoinfluenza. Dyspnea progressed such that within 15 days it was triggered by minimal effort. The patient died 15 hours after admission to our hospital, with a clinical picture of adult respiratory distress. Autopsy allowed us to rule out several diseases and arrive at a diagnosis of acute interstitial pneumonia, consistent with clinical course, anatomical and pathological findings as described in the literature.

[Clinical assessment systems in the diagnosis of pulmonary thromboembolism]. / Sistemas de valoración clínica en el diagnóstico del tromboembolismo pulmonar (TEP).

We proposed developing two symptom-based systems for assessing the presence of pulmonary thromboembolism (TEP) in our practice, using a standardized questionnaire and multivariate models. Data were collected from September 1993 through November 1994 (case reports, physical examination findings and complementary test results) of patients admitted to our ward with a suspicion of TEP. The calculated odds ratio for each of the variables recorded were used as weights to determine their relevance or not for the group at risk for TEP. The yield of the two systems developed (a weights system and a logistical model) were studied by plotting ROC curves. Eighty-two patients (40 women and 42 men, mean age 60.94 +/- 14.39 years) were admitted. The questionnaire had a sensitivity of 88% and a specificity of 75%, a positive predictive value of 94% and a negative predictive value of 60%. The logistical regression model had a sensitivity of 96.3% for a diagnosis of TEP with inclusion of the following variables: female sex, disease-related immobility, presence of deep venous thrombosis (DVT) in the lower extremities and the appearance of unexplained dyspnea. Neither system was clearly superior to the other for arriving at a clinical diagnosis of TEP.

[Venous compression ultrasonography of the lower limbs: a diagnostic tool in the hands of pneumologists]. / La ecografía venosa compresiva de miembros inferiores: una herramienta diagnóstica en manos de neumólogos.

Our objective was to study agreement between the compression ultrasound images taken in our respiratory medicine department and the duplex ultrasound images obtained by radiologists at our hospital for patients admitted to our ward with suspected diagnoses of venous thromboembolism.Seventy-eight consecutive patients admitted to our respiratory medicine ward suspected of venous thromboembolism were enrolled. Both types of images were available for all patients studied. Agreement was 90% with a Kappa coefficient of 0.81. Agreement between the two techniques was good. Therefore, compression ultrasonography is a technique that can be handled by respiratory medicine specialists for the diagnosis of venous thromboembolism.

[Pancoast syndrome caused by lung tuberculosis]. / Síndrome de Pancoast producido por tuberculosis pulmonar.

Pancoast's syndrome arises from neoplasms in 95% of cases but infection is a rare cause. We describe a patient with Pancoast's tumor secondary to tuberculosis. Pain caused by plexopathy and lack of diagnosis by noninvasive means led to the need for open biopsy.

[Role of dyspnea in quality of life of the patient with chronic obstructive pulmonary disease]. / Papel de la disnea en la calidad de vida del paciente con enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To analyze the correlation between quality of life and 1) lung function parameters at rest and during exercise, and 2) mean baseline dyspnea measured on two scales--Mahler's baseline dyspnea index (BDI/TDI) and the Medical Research Council (MRC) scale. We sought to observe the factor or factors having the greatest impact on the quality of life of such patients. MATERIAL AND METHODS: Fifty-five patients diagnosed of COPD in stable phase of disease participated. Al underwent lung function testing at rest and during exercise (shuttle walking test with increasing loads and an exercise cycle test). Quality of life was assessed on the validated Spanish translation of the Chronic Respiratory Disease Questionnaire, which refers specifically to COPD. Baseline dyspnea was measured using Mahler's BDI/TDI and the MRC scale. RESULTS: Mean patient age was 63 +/- 9.5 years and FEV1 was 40 +/- 16.9%. Overall quality of life and each sub-item correlated significantly with mean dyspnea on both scales (BDI/TDI and MRC). Effort was weakly correlated and function parameters at rest were unrelated. Multiple correlation analysis showed that baseline dyspnea (BDI/TDI) was the most important predictor of quality of life. CONCLUSIONS: Dyspnea, particularly when expressed as BDI/TDI but also as measured on the MRC scale, correlates more highly with quality of life than does any other parameter. This indicates that dyspnea has greater impact than other factor on quality of life and that BDI/TDI provides a good baseline assessment of dyspnea in COPD patients.

Calidad de vida relacionada con la salud en pacientes oncológicos con enfermedad tromboembólica venosa aguda sintomática. Diseño del estudio qca (quality of life in cancer). Estudio de casos y controles / Health-related quality of life in cancer patients with acute symptomatic venous thromboembolic disease. Design of the QCa (quality of life in cancer) study. Case-control study

La asociación entre cáncer y enfermedad tromboembólica (ETV) se encuentra bien establecida. La ETV presenta una elevada morbimortalidad, objetivándose un incremento del riesgo de ETV hasta 4 veces mayor en aquellos pacientes con cáncer respecto a la población general. Sin embargo, existe poca evidencia científica sobre la CVRS (calidad de vida relacionada con la salud) en pacientes oncológicos con ETV, cuando es presumible que esta patología suponga un agravante sobre la percepción del estado de salud de los pacientes oncológicos. Nuestro objetivo es presentar el estudio "QCa Study", el cual pretende evaluar la CVRS de los pacientes oncológicos con ETV aguda sintomática en comparación con pacientes oncológicos sin ETV. "QCa study" es un estudio nacional de cohortes, prospectivo, de casos y controles en pacientes con cáncer activo. Definimos "caso" como aquel paciente oncológico con ETV aguda sintomática, y "control" aquel paciente oncológico sin ETV aguda sintomática. Los criterios de inclusión son: para los casos: presentar cáncer activo al momento de la inclusión. Tener más de 18 años, pacientes diagnosticados de trombosis venosa profunda (TVP) en miembros inferiores aguda sintomática o de embolia de pulmón (EP) confirmado de forma objetiva mediante pruebas de imagen y firma del consentimiento informado. Para los controles; presentar cáncer activo. Tener más de 18 años. Firma del consentimiento informado. Dado los escasos datos publicados respecto a la CVRS en pacientes con ETV, hemos diseñado el estudio Qca, para poder determinar el impacto que genera la ETV en la calidad de vida de los pacientes con cáncer

The association between cancer and venous thromboembolic disease (VTD) is well established. VTD presents a high rate of morbidity and mortality, with patients with cancer showing an increased risk of VTD that is up to 4 times greater than the general population. However, there is little scientific evidence on HRQoL (health-related quality of life) in cancer patients with VTD when this disease is likely to be an aggravating factor in perceived state of health among cancer patients. Our objective is to present the QCa study, which aims to evaluate the HRQoL of cancer patients with acute symptomatic VTD in comparison with cancer patients without VTD. The QCa study is a prospective, case-control national cohort study in patients with active cancer. We define "case" as a cancer patient with acute symptomatic VTD and "control" as a cancer patient without acute symptomatic VTD. Inclusion criteria for cases were: having active cancer at the time of inclusion, being over the age of 18, patients diagnosed with acute symptomatic deep vein thrombosis (DVT) in the lower extremities or pulmonary embolism (EP) that was objectively confirmed through imaging tests, and having signed the informed consent. For the controls: having active cancer, being over the age of 18, and having signed the informed consent. Given the scarce data published with regard to HRQoL in patients with VTD, we designed the QCa study to determine the impact VTD has on the quality of life of patients with cancer

Incidencia de enfermedad pulmonar obstructiva crónica en pacientes con el virus de la inmunodeficiencia humana. Análisis post-hoc del estudio viva / Incidence of chronic obstructive pulmonary disease in patients with human immunodeficiency virus. Post-hoc analysis of the viva study

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz

Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment

[Handbook for the preparation of evidence-based documents. Tools derived from scientific knowledge]. / Manual para la elaboración de documentos basados en la evidencia. Herramientas derivadas del conocimiento científico.

OBJECTIVES: This handbook is intended to be an accessible, easy-to-consult guide to help professionals produce or adapt Evidence-Based Documents. Such documents will help standardize both clinical practice and decision-making, the quality always being monitored in such a way that established references are complied with. MATERIALS AND METHODS: Evidence-Based Health Care Committee, a member of "Virgen del Rocío" University Hospital quality structure, proposed the preparation of a handbook to produce Evidence-Based Documents including: a description of products, characteristics, qualities, uses, methodology of production, and application scope of every one of them. RESULTS: The handbook consists of seven Evidence-Based tools, one chapter on critical analysis methodology of scientific literature, one chapter with internet resources, and some appendices with different assessment tools. CONCLUSIONS: This Handbook provides general practitioners with a great opportunity to improve quality and as a guideline to standardize clinical healthcare, and managers with a strategy to promote and encourage the development of documents in an effort to reduce clinical practice variability, as well as giving patients the opportunity of taking part in planning their own care.

Origen celular de micropartículas circulantes en pacientes con enfermedad tromboembólica venosa y cáncer / Celular origin of circulating microparticles in patients with venous thromboembolism and cancer

Las micropartículas (MPs) son unas vesículas extracelulares consideradas potentes efectores celulares. Están presentes en individuos sanos y se encuentran elevadas en estados patológicos como enfermedades inflamatorias, neoplásicas y trombosis. La relación entre enfermedad tromboembólica venosa (ETV) y cáncer está bien establecida. Se piensa que las MPs serían una conexión patogénica entre ambas entidades. De confirmarse, podrían utilizarse como biomarcadores. Nuestro objetivo fue caracterizar las MPs en ambas patologías atendiendo a su origen celular (celular, endotelial, plaquetar, leucocitario y las que exhibían en su superficie mucina 1). También se estudiaron parámetros funcionales como el dímero D (DD) y la P-selectina soluble (sPS). Se consideraron 96 pacientes con ETV idiopática y 85 con neoplasias avanzadas de pulmón, gástrico o páncreas. A todos ellos se les realizó un seguimiento clínico de dos años en el que se excluyeron del estudio aquellos que fueron diagnosticados de cáncer en el grupo de ETV o que desarrollaron trombosis en el grupo de pacientes neoplásicos. Finalmente, se analizaron 82 pacientes con ETV y 68 con cáncer. En nuestros resultados encontramos que las MPs totales y las MPs de origen plaquetar diferenciaban ambos grupos de pacientes. Además, se determinaron cifras significativamente mayores de DD y sPS (p <0,001) en el grupo de ETV. Las diferencias encontradas entre ambos grupos, teniendo en cuenta el origen de las MPs, podrían estar causadas por las características protrombóticas del grupo neoplásico y por el secuestro de las mismas dentro de los coágulos activos en el grupo de ETV

Microparticles (MPs) are extracellular vesicles considered to be powerful cellular effectors. They are present in healthy individuals and are elevated in pathological conditions such as inflammatory and neoplastic diseases, and thrombosis. The relationship between venous thromboembolism (VTE) and cancer has been well established. MPs are thought to be a pathogenic connection between the two entities. If confirmed, they could be used as biomarkers. Our aim was to characterize the MPs in both diseases according to their cellular origin (cellular, endothelial, platelet, leukocyte and those that exhibited mucin 1 on their surface). Functional parameters such as D-dimer (DD) and soluble P-selectin (sPsel) were also studied. 96 patients with idiopathic VTE and 85 with advanced lung, stomach or pancreatic neoplasia were considered. All of them were followed clinically for two years and those who were diagnosed with cancer in the VTE group or those who developed thrombosis in the group of neoplastic patients were excluded from the study. Finally, 82 VTE patients and 68 cancer patients were analyzed. In our results, we found that total MPs and platelet-derived MPs differentiated both patient groups. Additionally, significantly greater numbers of DD and sPsel (p <0.001) were determined in the VTE group. The differences found between both groups, taking into account the origin of the MPs, could be caused by the prothrombotic characteristics of the neoplastic group and their sequestration within active clots in the VTE group

La ecografía en el diagnóstico de la enfermedad tromboembólica venosa / No disponible

La trombosis venosa profunda (TVP) y el tromboembolismo pulmonar (TEP) son manifestaciones clínicas distintas de una misma enfermedad, la enfermedad tromboembólica venosa (ETV). La ecografía de miembros inferiores es la técnica de imagen de elección para el diagnóstico de la TVP. Para el neumólogo, cuyo objetivo sería el diagnóstico de la TVP, no es necesario realizar una ecografía doppler, ya que se puede hacer el diagnóstico mediante ecografía compresiva bidimensional en escala de grises. El signo ecográfico más sensible (S) y específico (E) para el diagnóstico de TVP de miembros inferiores es la falta de compresibilidad de la vena (S 91% y E 99%). Además, nos puede dar un diagnóstico alternativo distinto a la TVP. Tanto la ecografía compresiva en dos puntos, realizada de forma seriada, como la ecografía compresiva completa única, son técnicas ecográficas que han demostrado ser seguras para descartar TVP, con una baja incidencia de ETV a los 3 meses de seguimiento. La ecografía torácica es útil clínicamente para el diagnóstico del TEP y puede ser una alternativa al angioTAC de tórax en grupos especiales de pacientes, como enfermos renales o embarazadas. El hallazgo ecográfico más característico es la existencia de una zona hipoecoica de base pleural y morfología triangular, localizada en la zona donde el paciente ha tenido dolor pleurítico. Además de hallazgos parenquimatosos, podemos encontrar hallazgos vasculares y pleurales. La sensibilidad de la ecografía para el diagnóstico de TEP es del 74% y la especificidad del 95%. Su principal limitación es que sólo permite detectar lesiones tromboembólicas que afecten a la periferia. La ecografía multiórgano (miembros inferiores, corazón y tórax) ha demostrado mejores resultados que la ecografía de cada órgano por separado en la sospecha de TEP y podría ser útil para seleccionar a aquellos pacientes a los que no habría que realizar angioTAC de tórax

No disponible