RESUMEN
Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR, providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials.
Asunto(s)
Minería de Datos/métodos , Registros Electrónicos de Salud , Medicina Basada en la Evidencia/métodos , Hematología/métodos , Oncología Médica/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Sistema de Registros , Recolección de Datos , Humanos , Registro Médico CoordinadoAsunto(s)
Síndrome Nefrótico/diagnóstico , Enfermedades del Recto/patología , Adulto , Antibacterianos/uso terapéutico , Humanos , Masculino , Síndrome Nefrótico/etiología , Síndrome Nefrótico/patología , Penicilina G/uso terapéutico , Proteinuria/tratamiento farmacológico , Proteinuria/etiología , Proteinuria/patología , Enfermedades del Recto/etiología , Factores de Riesgo , Sífilis/complicaciones , Sífilis/tratamiento farmacológico , Sífilis/patologíaRESUMEN
Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive variant of diffuse large B-cell lymphoma with frequent involvement of the central nervous system. Its atypical presentation often delays the diagnosis and due to its aggressive behaviour, the diagnosis is made post-mortem in half of the cases. We report a case of a 67-year-old male patient presenting with speech difficulties and balance disturbances in whom a magnetic resonance imaging (MRI) scan showed multiple lesions of the white matter, denoted as embolic infarctions. He was treated for a suspected endocarditis with antibiotics, but deteriorated neurologically with persistent fever. A consecutive FDG -PET /CT revealed an increased uptake in the adrenals, of which a biopsy showed IVLB CL. The patient was successfully treated with systemic R-CHOP with intrathecal methotrexate and achieved complete remission after six cycles of chemotherapy. The potential role of FDG-PET/CT is illustrated by this case leading to an exceptional diagnosis of IVLBCL.