[Outpatient treatment of deep vein thrombosis: comparative study with historical inpatients]. / Tratamiento ambulatorio de la trombosis venosa profunda: comparación con tratamiento en hospitalización de pacientes de un registro histórico.

BACKGROUND: Outpatient treatment of deep venous thrombosis (DVT) has been proposed as a safe and cost-saving process, either as a mixed pattern: as an inpatient for 1 to 3 days followed by outpatient treatment; or rarely as completely outpatient. PATIENTS AND METHODS: We evaluated two cohorts of consecutive patients diagnosed with DVT. Patients who received entirely outpatient treatment in the years 2003 and 2004, compared with historical patients treated as inpatients during the year 2002. Our aim was to evaluate safety and the days of stay saved because of outpatient treatment of DVT. RESULTS: A total of 293 patients entered the study (Inpatients, 109; outpatients, 184). Demographic and clinical characteristics of patients were similar. Mean time of anticoagulant therapy and follow up were also both similar in the two groups. Major haemorrhage rate was 8% (CI 95% 4-15) in patients treated in hospital and 3% (CI 95%1-6.57) [Relative Risk (RR) 0.38] in patients treated as outpatients. Complications of venous thromboembolic disease occurred in 4% (CI 95% 1.18-9.68) of hospitalised patients and 5% (CI 95% 2.41-9.37) (RR 1.25) of patients treated as outpatients. The death rate was 11% (CI 95% 6-18.8) in hospitalised patients and 4% (CI 95% 1.68-7.99) (RR 0.36) in patients treated as outpatients. We observed a reduction of hospitalisation in relation to the index-year of 72.5% for the year 2003 (CI 95% -0.08 to -0.04) and 79% for the year 2004 (CI 95% -0.08 to -0.05) (p<0.001). Overall, 844 days of unnecessary hospitalisation were saved. CONCLUSIONS: Complete outpatient treatment of DVT shows outcomes at least as safe as inpatient treatment, adding additional reductions in costs for the Health System.

[Urinary infection by E. coli complicated with multiple abscesses]. / Infección urinaria por E. coli complicada con abscesos múltiples.

Vertebral osteomyelitis and septic arthritis are pathologies that principally affect people over fifty years old, but their incidence seems to be growing due to the increase of nosocomial bacteraemia associated with intravascular devices and the aging of hospitalised people. The majority of cases are produced by Staphylococcus aureus. We present the case and diagnostic process of a patient with vertebral osteomyelitis caused by another organism, Escherichia coli, with fatal evolution despite adequate treatment.

[Dabigatran as a therapeutic possibility in heparin-induced thrombocytopenia type II]. / Dabigatran como posibilidad terapéutica en el síndrome de trombocitopenia inducida por heparina tipo II.

The syndrome of heparin-induced thrombocytopenia (HIT), with an incidence of 0.2-0.5% in patients exposed to heparin for more than 4 days, is produced by an immune alteration with the formation of antibodies against the heparin platelet factor 4 complex. It presents a wide spectrum of clinical manifestations, the most frequent of which are thrombocytopenia, thrombotic arterial-venous phenomena, and cutaneous necrosis. Up to the present, lepiridin, recently suspended, and argatroban (direct thrombin inhibitors) have been the approved medicines normally used in treatment, administered in parenteral form. Dabigatran, a new anticoagulant medicine that is a direct and reversible thrombin inhibitor, could theoretically be a medicine employed in treating HIT. According to the bibliography consulted we are presenting the first case of HIT treated with dabigatran in the medical literature.

Dabigatran como posibilidad terapéutica en el síndrome de trombocitopenia inducida por heparina tipo II / Dabigatran as a therapeutic possibility in heparin-induced thrombocytopenia type II

El síndrome de trombocitopenia inducido por heparina (HIT) con una incidencia del 0,2-0,5 % en pacientes expuestos a heparina durante más de 4 días, es producido por una alteración inmune con formación de anticuerpos frente al complejo heparina-factor 4plaquetario, que presenta un amplio espectro de manifestaciones clínicas: siendo la trombocitopenia, los fenómenos trombóticos arteriales/venosos y la necrosis cutánea los más frecuentes. Hasta el momento actual, lepirudina, recientemente suspendida y argatroban (inhibidores directos de la trombina) son los fármacos aprobados y habitualmente usados en el tratamiento, suministrados de forma parenteral. El dabigatran, un nuevo fármaco anticoagulante, inhibidor directo y reversible de la trombina teóricamente podría ser un fármaco empleado en el tratamiento del HIT. Según la bibliografía consultada presentamos el primer caso de HIT tratada con dabigatran en la literatura médica(AU)

The syndrome of heparin-induced thrombocytopenia(HIT), with an incidence of 0.2-0.5% in patients exposed to heparin for more than 4 days, is produced by an immune alteration with the formation of antibodies against the heparin platelet factor 4 complex. It presents a wide spectrum of clinical manifestations, the most frequent of which are thrombocytopenia, thrombotic arterial-venous phenomena, and cutaneous necrosis. Up to the present, lepiridin, recently suspended, and argatroban (direct thrombin inhibitors) have been the approved medicines normally used in treatment, administered in parenteral form. Dabigatran, a new anticoagulant medicine that is a direct and reversible thrombin inhibitor, could theoretically be a medicine employed in treating HIT. According to the bibliography consulted we are presenting the first case of HIT treated with dabigatran in the medical literature(AU)

Infección urinaria por E. coli complicada con abscesos múltiples / Urinary infection by E. coli complicated with multiple abscesses

La osteomielitis vertebral y la artritis séptica poliarticular son patologías que afectan principalmente a personas a partir de los 50 años, aunque su incidencia parece ir en aumento debido al incremento de bacteriemias nosocomiales inoculadas por dispositivos intravasculares y otros instrumentos así como por el aumento de la edad de las personas hospitalizadas. En la mayoría de los casos están causadas por Staphylococcus aureus. Presentamos el caso y proceso diagnóstico de una paciente con esta patología causada por otro germen como, Escherichia coli, y la fatal evolución de ésta a pesar de recibir tratamiento adecuado

Vertebral osteomyelitis and septic arthritis are pathologies that principally affect people over fifty years old, but their incidence seems to be growing due to the increase of nosocomial bacteraemia associated with intravascular devices and the aging of hospitalised people. The majority of cases are produced by Staphylococcus aureus. We present the case and diagnostic process of a patient with vertebral osteomyelitis caused by another organism, Escherichia coli, with fatal evolution despite adequate treatment