Sonographic evolution of the superficial vein thrombosis of the lower extremity.

BACKGROUND: Superficial venous thrombosis (SVT) is a common clinical problem across various treatment settings. SVT shares risk factors with deep venous thrombosis (DVT) and carries a risk of thromboembolic complications, greater than previously expected. Little is known about the pathophysiology, resolution and recurrence of this disease. OBJECTIVES: The objective of the present study was to describe the natural course of SVT, and factors correlated with the progression or resolution of the thrombus. METHODS: We included 218 patients with a recent diagnosis of SVT that were consecutively referred to a thrombosis clinic from the Emergency Department (ED) between January 2016 and April of 2018. RESULTS: The resolution of the thrombus prior to discharge was correlated to gender (female 73.8% vs. male 57.5%, p = 0.015), presence of varicose veins (62.4% vs. 46.4, p = 0.026), absence of family or personal history of thrombosis (98% vs. 91.3%, p = 0.021). The factor most correlated to thrombus resolution prior to discharge was the result of the 2nd ultrasound (improvement 83.9% vs. 16.1%, p < 0.001) immediately after initiation of heparin treatment. In the multivariate analysis, a high thrombus burden in the early follow-up ultrasound was the most significant predictive variable with prior to discharge recanalization (B = 20.9, 95% CI 9.8-44.7; p < 0.001). CONCLUSION: The follow-up of SVT with duplex lower extremity ultrasound allows us to monitor the evolution and early identify residual thrombosis, as a marker of hypercoagulability and recurrence. This study offers new perspectives for future research, necessary to improve the management of this disease, to reduce long-term complications.

Reaffirmation of the importance of follow-up ultrasound studies in patients with high D-dimers and clinical suspicion of vein thrombosis.

BACKGROUND: Venous thromboembolism is a common disease seen in the emergency department and a cause of high morbidity and mortality, constituting a major health problem. OBJECTIVES: To assess the potential benefit of follow-up ultrasound of patients who attended the emergency department with suspected superficial venous thrombosis or deep venous thrombosis and were found to have an initial negative whole-leg (or arm) ultrasound study. METHODS: This retrospective study included patients aged 18 years or older who were consecutively referred to a thrombosis clinic from the emergency department, with abnormal D-dimer test and moderate to high pre-test probability of deep venous thrombosis (Well's score ≥ 1), but a negative whole-leg (or arm) ultrasound. Demographic characteristics, symptom duration, laboratory and ultrasound data were recorded. At one-week follow-up, an experienced physician repeated ultrasound, and recorded the findings. RESULTS: From January 2017 to April 2018, 54 patients were evaluated. The mean age was 66.8 years (SD 15.0) and 63% were women. The average D-dimer was 2159.9 (SD 3772.0) ng/mL. Ultrasound abnormalities were found in 12 patients (22.2%; 95% confidence interval of 12.5 to 36.0%), with 4 patients having proximal deep venous thrombosis, distal deep venous thrombosis in 2 patients and superficial venous thrombosis in 6 patients. We did not find any significant differences in demographic characteristics, venous thromboembolism risk factors or laboratory parameters between patients with negative and positive follow-up ultrasound. CONCLUSIONS: These preliminary findings suggest that a negative whole-leg (or arm) ultrasound in addition to an abnormal D-dimer in moderate to high deep venous thrombosis pretest probability patients, might be an insufficient diagnostic approach to exclude suspected deep venous thrombosis or superficial venous thrombosis. Confirmation of this higher than expected prevalence would support the need to repeat one-week ultrasound control in this population.

Advantages of non-cryopreserved autologous hematopoietic stem cell transplantation against a cryopreserved strategy.

Autologous stem cell transplantation (auto-HSCT) is an effective treatment strategy for hematological malignancies. The standard mode of handling hematopoietic progenitors for the autologous procedure (CRYO) consists on its collection and freezing with dimethyl sulfoxide (DMSO) and its subsequent thawing and re-infusion. This process is toxic and expensive. Non-cryopreserved (non-CRYO) is a less expensive mode of auto-HSCT. We designed a comparative study between both strategies performed in two different centers to analyze the short-term complications. In total 111 auto-HSCT were performed from January/2015 to October/2016 (42 non-CRYO and 74 CRYO). There were 74 males and 69 (62%) patients had the underlying diagnosis of multiple myeloma. No differences were seen on the characteristics of the apheresis products and their viability. Engraftment was significantly faster in the non-CRYO group (p = 0.001). Febrile neutropenia and severe mucositis were lower in the non-CRYO group (40% vs 92% p = 0.0001 and 11% vs 64%, p = 0.001, respectively). In addition, length of hospitalization was 5 days shorter in the non-CRYO group (p = 0.0001). Overall responses and transplantation outcomes were similar. Our data demonstrate a clear advantage of the non-CRYO over CRYO auto-HSCT with faster engraftment, lower incidence of febrile neutropenia and shorter hospital stay after the transplantation procedure. These data are especially relevant for centers with high transplant activity or with limited resources.

Magnesium, zinc, arsenic, selenium and platinum urinary excretion from cancer patients of Antofagasta region, Chile: multi-metal approach.

OBJECTIVES: To evaluate the short-term 24 h urinary excretion of platinum, arsenic, selenium, magnesium and zinc in patients with lung cancer and with cancer other than lungs treated with cisplatin or/and carboplatin from Antofagasta, Chile. DESIGN: Urine measurements of Pt and Se were made by inductively coupled plasma optical emission spectrometry, As by hydride-generation atomic absorption spectrometry and Mg and Zn by means of flame furnace atomic absorption spectrometry. SETTING: All samples were provided by the Oncological Centre of Antofagasta Regional Hospital (Region of Antofagasta, Chile). PARTICIPANTS: Ninety 24-h urine samples from cancer patients after the infusion of Pt-base drugs and 10 24-h urine samples from cancer patients not treated with metal-base drugs. MAIN OUTCOME MEASURES: Concentrations of Pt, Se, As, Zn and Mg coming from 24-h urine samples. RESULTS: Pt excreted was not significantly different between patients with lung and other cancers treated with cisplatin. The excretion of Mg, Zn and Se was greater than As. Then, Pt favours the excretion of essential elements. For lung and other types of cancers treated with drugs without Pt, excretion of Mg, Zn and Se was also greater than that of As, suggesting antagonism Mg-Zn-Se-anti-cancer drug relationship. CONCLUSIONS: The amounts of Mg, Zn and Se excreted were greater than for As either with or without Pt-containing drugs, suggesting antagonist Mg-Zn-Se-anti-cancer drug relationships. The excretion of As, Mg, Zn and Se is induced by Pt. Knowledge obtained can contribute to understanding the arsenic cancer mechanism and the As-Mg-Zn-Se-Pt inter-element association for lung cancer and other types of cancer.

Revascularization of the lower limb through arterial bypass with "in-situ" saphenous vein.

Thirty three femoropopliteal and infrapopliteal artery bypass grafts with in-situ saphenous vein as a conduit, operated and followed during 42 months are described. This method involved the use of microscissors and valvulotome (Leather) and of a modified valve cutter (Hall) to render the vein insufficient through the intraluminal incision of its valves, transversally to the cusps axis. Arteriovenous fistulae were detected intraoperatively visually and by angiography, and ligated. The operative indications were rest pain; ischemic ulcers and distal gangrene in 79% of cases, and invalidating claudication in the rest. The vein utilization rate was 97%. The cumulative patency rate for all grafts was 97% at 3 months, 82% at one year, 78% at two years and 75% at three and a half years. At 42 months, 4 of 18 femoropopliteal bypass grafts had occluded, with a cumulative patency rate of 78%. In the same period, 4 of 15 tibial or peroneal bypasses had occluded, with a patency rate of 72%. The data presented suggests that in Chile this technique should be preferentially adopted to revascularize the lower extremity, particularly in distal artery bypass grafts, due to the superior capacity of the in-situ saphenous vein to remain patent in low-flow states with poor outflow tracts.

Distribution and biotransformation of arsenic species in chicken cardiac and muscle tissues.

This study evaluated the bioaccumulation and biotransformation of arsenic species in chicken heart and meat tissues. The experimental study was carried out using two sets of samples. In the first one, 10-d-old chickens were exposed to sodium arsenate, using spiked drinking water. These chickens grew normally and were killed after 50 d of arsenic exposure. The second set were edible chickens used as blanks for a parallel study. The total arsenic and arsenic species content in the exposed samples were at least twice those in the normal edible chicken. It has been demonstrated that sodium arsenate is biotransformed to arsenite and an unknown species and its distribution varies among the different cardiac and meat tissues. One important aspect is the capability of the auricle to preconcentrate the most toxic species, arsenite, in the exposed chicken. A nonidentified arsenic species from the edible chicken was detected. Arsenobetaine was also detected in several tissues. This article shows that chicken can be used as a representative animal when considering inorganic arsenic exposure in humans.

Umbilical cord blood transplantation in hematologic diseases in patients over 15 years old: long-term experience at the Pontificia Universidad Católica de Chile.

Most patients who require a sibling stem cell transplantation do not have a matched donor. In our experience, only 1/3 patients have a matched unrelated donor (MUD); therefore, the majority of the patients will require umbilical cord blood (UCB). Patients treated for hematologic diseases with UCB transplants were included. UCB selection and conditioning regimens were performed according to the Minnesota group. Graft-versus-host disease (GVHD) prophylaxis, infection prevention, and patient care were performed according to institutional guidelines. We analyzed patients and graft demography, neutrophil and platelet recovery, chimerism kinetics, GVHD incidence, overall (OS), progression-free survival (PFS) and transplant-related mortality (TRM). We included 29 patients with a median age of 34.8 years (range 15-55). Eighteen were male and the median weight was 72.6 kg (range 54-100). Nineteen patients had acute leukemia. Myeloablative (MA) conditioning was used in 27 patients. Seventeen received double UCB (DUCB) grafts. Median total nucleated cell (10(7)/kg) was 4.2 (range 3.9-4.9) and 4.4 (range 2.8-6.3) for single UCB (SUCB) and DUCB transplants, respectively. Median time for neutrophil engraftment was 24.7 (range 14-43) and 25.8 days (range 14-52) after SUCB and DUCB transplants, respectively. Median time for platelet engraftment was 147 (range 30-516) and 81 days (range 37-200) after SUCB and DUCB transplants, respectively. All the patients receiving MA conditioning had >95% chimerism shortly after transplant. Cumulative incidence of grades II-IV and III-IV acute GVHD was 41% and 20%, respectively. Localized chronic GVHD was seen in 14% of the patients. Median follow-up was 16.7 months (range 1-63). Five-year OS and PFS were 38% and 39%, respectively. One-year TRM was 42%. UCB transplantation is associated with potential cure of hematologic malignancies and our results are similar to other series. Studies are needed to decrease mortality and improve immune reconstitution.

An approach to the arsenic status in cardiovascular tissues of patients with coronary heart disease.

Among non-cancer effects of arsenic, cardiovascular diseases have been well documented; however, few are known about the arsenic fate in cardiovascular tissues. We studied the analytic bioinorganic arsenic behaviour in cardiovascular tissues from an arsenic exposure coronary heart disease patient group from Antofagasta-Chile against a small unexposed arsenic coronary heart patient group. Total arsenic concentrations were measured in pieces of cardiovascular tissues of the arsenic-exposed and unexposed coronary heart patient groups by hydride generation atomic absorption spectrometry (HG-AAS); speciation analysis was made by high performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC-ICP-MS). Pieces of auricle (AU), mammary artery (MAM), saphenous vein (SAP) and fat residuals (FAT) were considered in this study. The arsenic concentrations in AU and MAM tissues were significantly different between both groups of patients. Also, it was demonstrated that the AU is an 'As(3+) target tissue.' Otherwise, linking of the total concentrations of arsenic with conditional variables and variables related to medical geology factors allowed us to infer that the latter are more important for the cardiovascular risk of arsenic exposure in the Antofagasta region. Knowledge of total arsenic and the prevalence of the trivalent ion (As(3+)) in the AU of patients could contribute to understanding the effect of arsenic on cardiovascular diseases.

Enfermedad inflamatoria intestinal: importancia del diagnóstico precoz / Inflammatory bowel disease: the importance of early diagnosis

La enfermedad inflamatoria intestinal (EII) en la edad pediátrica presenta ciertas peculiaridades clínicas y psicosociales que hacen que sea necesario realizar un diagnóstico y un tratamiento precoces. Es una enfermedad de curso crónico y recidivante que cuenta con manifestaciones gastrointestinales y extraintestinales. Incluye tres trastornos de etiología desconocida: la colitis ulcerosa, la enfermedad de Crohn y la EII no clasificada, que se definen según criterios clínicos, radiológicos, endoscópicos e histológicos. El seguimiento de estos pacientes requiere un abordaje multidisciplinar que incluya aspectos tanto médicos como psicosociales (AU)

Inflammatory bowel disease (IBD) in childhood has certain clinical and psychosocial characteristics that makes necessary an early diagnosis and treatment. It is a chronic and relapsing disease that has gastrointestinal and extraintestinal manifestations. It includes three disorders of unknown etiology: ulcerative colitis, Crohn's disease and unclassified IBD. They are defined by clinical, radiological, endoscopic and histological criteria. The follow up of these patients requires a multidisciplinary approach that addresses both medical and psychosocial aspects (AU)

Fitofotodermatitis por Ruta graveolens / Photosensitivity by Ruta graveolens

Introducción: las lesiones por fototoxicidad son poco frecuentes en edad pediátrica y son un motivo excepcional de consulta en Atención Primaria. Caso clínico: una paciente de 12 años nacida en España de madre nicaragüense acude a la consulta de Pediatría por aparición de lesiones marronáceas asintomáticas. Llamaba la atención la distribución lineal a lo largo de los miembros inferiores. Se solicitó una interconsulta a Dermatología, donde fue diagnosticada de reacción fototóxica. Posteriormente, la paciente refirió haberse derramado sobre las piernas una solución alcohólica con extracto de ruda. Conclusión: las lesiones cutáneas lineales adquiridas suelen tener una causa exógena. Es importante indagar las circunstancias que preceden la aparición de las lesiones para hacer un diagnóstico correcto (AU)

Introduction: Phytophotodermatitis is exceptional in pediatric population. Case: we report a case of a 12 year old female patient admitted in our clinic due to asymptomatic brown macular lesions. The lineal pattern trough the inferior limbs was remarkable and, after dermatological review, a phototoxic reaction was first considered. Afterwards the patient declared she had used a rue alcoholic solution. Conclusion: lineal acquired dermatological lesions commonly have an exogenous origin. It’s important to know the circumstances that underwent before they appear to make a right diagnosis (AU)

[Frequency of platelet specific alloantigens HPA-1a (P1A1) and HPA-4a (Pen(a)) expression in Chilean population]. / Frecuencia de expresion de los aloantigenos plaquetarios HPA-1a (P1A1) y HPA-4a (Pen(a)) en la poblacion Chilena.

The phenotype frequency of platelet-specific alloantigens has been reported to vary with the ethnic composition of the population under study and the only two HPA-4a negative individuals found in the United States were of Hispanic origin; therefore, the aim of this work was to define the frequency of expression of these systems in the Chilean population. Using an ELISA with captured antigen by monoclonal antibodies, 604 blood donors were typed for the platelet-specific antigen systems HPA-1 and HPA-4. Eight samples typed negative for HPA-1a (1.32%) and 596 typed positive (98.68%). The calculated gene frequencies were 0.88 for HPA-1a (gene frequency > 0.99). Since these antigens are involved in thrombocytopenic disorders such as neonatal alloimmune thrombocytopenia and post-transfusion purpura, their frequency in a population is of clinical relevance. The gene frequency found for HPA-1a is higher than in Europeans (0.85) and lower than in Mapuche Indians (0.99), which is to be expected from the ethnic origin of our population. The absence of HPA-4a negatives in this study does not support our original hypothesis of a higher polymorphism of this system among hispanics.

[Neonatal autoimmune purpura: laboratory study of 5 cases]. / Purpura aloinmune neonatal: estudio de laboratorio en cinco casos.

Maternal alloimmunization against fetal platelets can cause fetal and neonatal thrombocytopenia. We report our experience in the study of five cases with severe neonatal-thrombocytopenia. Using an ELISA with antigen capture and other serologic tests on platelets, we investigated the sera of the five mothers. Sera from four mothers contained a platelet-specific alloantibody, anti-HPA-1a (PlA1) whereas the platelets typed as HPA-1b/b. In one case despite extensive serological investigation and clinically unequivocal diagnosis of AINT, no antibodies were demonstrated. The use of monoclonal antibodies for antigen immobilization, showed to be a reliable and sensitive test for the detection and identification of platelet antibodies in AINT. These techniques could also be used in the follow-up of patients at risk (e.g. pregnant HPA-1b/b women) and in the screening of blood donors lacking of certain antigens, whose platelets are collected to be transfused in patients with platelet-specific antibodies.

[A toxic syndrome and subcutaneous nodules as the only clinical manifestation of systemic sarcoidosis]. / Síndrome tóxico y nódulos subcutáneos como única manifestación clínica de sarcoidosis sistémica.

Sarcoidosis is a systemic disease with frequent cutaneous manifestations. Among these exists a predominance of the so-called unspecific lesions because of their histopathological features. Within the specific lesions, that is those which showed non-caseous granulomas, subcutaneous nodules are underlined, which have been associated with chronic sarcoidosis with a frequency of 1.4%-6%. These lesions appear during the evolution of the disease but rarely constitute an initial manifestation of it. The patient whose case is discussed had a debut with toxic syndrome and subcutaneous nodules. Histopathological study of these nodules showed the existence of non caseous granulomas formed by histiocytes, epithelioid cells, Langhans and foreign body giant cells. Lobulet hepatic granulomas were showed together with mediastinal pulmonary captation of gallium. We conclude that sarcoidosis must be considered when performing the differential diagnosis of the disease which debut with subcutaneous nodules.

Plasma lipoprotein alterations in patients with chronic hepatocellular liver disease resulting from alcohol abuse: effects of alcohol intake cessation.

Cholesterol and triglyceride in plasma and lipoprotein fractions and serum apoprotein concentrations were measured in 51 chronic alcoholic subjects; 23 had minimal or mild hepatic changes (steatosis and/or fibrosis) and 28 had cirrhosis. Of the latter, 16 had stopped alcohol consumption at least 3 months before the study, while the other 12 and all the mildly affected patients had continued drinking. None of the patients presented with cholestasis or alcoholic hepatitis. The control group was composed of 15 healthy, non-drinking volunteers selected from the hospital staff with an age- and sex-distribution similar to that of the alcoholic group. Patients with minimal hepatic changes had plasma total cholesterol concentrations within the ranges of the normal population but with increased high density lipoprotein and decreased low density lipoprotein fractions. Total plasma triglyceride values were not significantly elevated but the distributions in the low density lipoprotein and high density lipoprotein fractions were significantly increased in patients compared to controls. This alteration was accompanied by a consistent increase in serum apolipoprotein C-III concentration. Conversely, in patients with cirrhosis, serum concentrations of apolipoproteins A-I and B were significantly lower and were reflected in the cholesterol concentrations in the lipoprotein fractions. Comparisons between abstainers and non-abstainers within the group with cirrhosis indicated that cessation of alcohol intake was not sufficient to rectify lipoprotein dysfunction following damage from cirrhosis.

BICAP tumor probe en el tratamiento paliativo de la estenosis esofágicas malignas / BICAP tumor probe in the treatment of malignant sophageal stenosis

Background: BICAP tumor probe is a device that consists in an energy source and olives that deliver bipolar electricity. It can be used for the fulguration of esophageal tumors after endoscopic dilatation. Aim: To report the experience in the treatment of malignant esophageal stenoses using the BICAP tumor probe. Patients and methods: Patients with advanced esophageal tumors in aphagia, that were not candidates for palliative surgery were included in this study. After endoscopic dilatation, the tumor was fulgurated with the BICAP tumor probe. Results: Twenty one patients (nine male, aged 43 to 91 years old) were treated with the device. A mean of 1.3 sessions with BICAP were necessary to obtain tumor permeabilization, which was obtained in all patients. One patient died of pneumonia 15 days after the procedure. All other patients were ingesting liquid or semisolid diets after two months of follow up. Mean survival after the procedure was 3.8 months. Conclusions: Electrical fulguration of esophageal tumors is a valid therapeutic alternative in aphagic patients

Distrofia muscular de Duchenne: efecto de la administración de vitamina E sobre la luminiscencia urinaria / Effects of vitamin E supplementation on urinary luminescence in patients with Duchenne muscular dystrophy

Background: Urinary luminescence is increased in patients with Duchenne muscular dystrophy, probably due to the higher oxidative stress present in this disease. Aim: To assess the effects of vitamin E supplementation on urinary luminescence in children with Duchenne muscular dystrophy. Patients and methods: Eighteen children with muscular dystrophy aged 12.2 years old and nine control children aged 10 years old, received 400 IU/day of vitamin E during one month. Prior to supplementation and twice a week thereafter, spot urine samples were obtained to measure urinary luminescence in a scintillation counter. Results: There was a wide variability in urinary luminescence within and between children. Mean values decreased after vitamin E supplementation in six of nine controls and in 12 of 18 children with muscular dystrophy. Conclusions: Vitamin E supplementation significantly decreases urinary luminescence in healthy children and in patients with Duchenne muscular dystrophy. Therefore, it could be useful or the treatment of this disease

Gastroplastía endoscópica antirreflujo: análisis experimental de su efecto en la presión del esfínter esofágico inferior / Antireflux endoscopic gastroplasty: experimental analysis of it effect in the inferior esophageal sphincter

El objetivo de este trabajo es evaluar en forma experimental el efecto de la cirugía endoscópica antirreflujo en la presión del esfínter esofágico inferior en perros. Se utilizó 5 perros mestizos que fueron mantenidos en ayunas por 12 horas previo procedimiento. Luego fueron pesados y anestesiados con una dosis inicial de 25 mg/kg de pentotal i.v. y bolos de 10 mg/kg según necesidad. Se introdujo una sonda perfundida de tres canales, conectada a un transductor de presión y un polígrafo Beckmann R411, determinándose la presión y ubicación del esfínter esofágico inferior (EEI). A continuación se realizó una endoscopía y se instaló un sobretubo esofágico. Se instaló el mecanismo de sutura endoscópica en un endoscopio Olympus CF-1TS2, se colocaron 2 puntos 1 cm bajo la línea Z a la derecha de la curvatura menor y luego fueron anudados para formar un pliegue. El procedimiento se repitió pero colocando los puntos a la izquierda de la curvatura. A continuación se midió nuevamente la presión del EEI con la misma técnica. Los animales fueron mantenidos con libre acceso al alimento y agua por 7 días. Después de este período fueron nuevamente anestesiados y se midió nuevamente la presión del EEI. Los resultados confirman que la gastroplastía endoscópica es capaz de aumentar en forma significativa la presión del EEI en perros

Valores hematológicos, serológicos y peso de órganos en la rata Sprague-Dawley adulta / Hematological and serological values and organo weight in Sprague-Dawley adult rats

Sprague-Dawley rats are frequently used in experiments and their normal hematological, serological and anatomical parameters are not easily available. The aim of this study was to measure these parameters in adult Sprague-Dawley rats. 24 rats (12 males) whose weight ranged between 200 and 300 g raised at the Instituto de salud Pública in controlled environment conditions and fed with pellets were studied. After a 24 h fast animals were anesthetized with Droperidol and Ketamine and after obtaining a cardiac blood for glucose, calcium, amylase, total proteins, cholesterol, AST, ALT, bilirrubin, alkaline phosphatases, electrolytes and complete blood count were determined. Heart, lung, pancreas, kidney and testicle mean weight was also calculated. Male and female rats had significant differences in packed red cell volume, white blood cell count and hemoglobin