RESUMEN
AIMS: Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol versus the long protocol. PATIENTS AND METHODS: A multicentre, prospective, randomized, double-blind, placebo-controlled trial was undertaken involving 229 patients undergoing primary cementless THA using a posterior approach, whose extended rivaroxaban thromboprophylaxis started on the day of surgery. There were 98 male and 131 female patients, with a mean age of 65.5 years (32 to 91). The primary outcome, perioperative RBL, was evaluated at 72 hours postoperatively. The efficacy of short- and long-TXA protocols in the reduction of perioperative RBL was compared with a placebo group. RESULTS: TXA significantly reduced perioperative blood loss compared with placebo (p < 0.001); the mean differences were 525.3 ml (short-TXA vs placebo) and 550.1 ml (long-TXA vs placebo). No venous or arterial thromboembolic complications were reported. The upper boundary of the 95% confidence interval, when comparing short and long protocols, was below the pre-specified margin of non-inferiority (p = 0.027). CONCLUSION: In patients undergoing primary cementless THA, using a posterior approach, who are treated with rivaroxaban for thromboembolic prophylaxis, short- and long-TXA IV protocols are significantly more effective than placebo in reducing perioperative RBL, without any thromboembolic complications. Non-inferiority of a short- versus a long-TXA protocol in reducing perioperative RBL was supported in a secondary analysis.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Pérdida de Sangre Quirúrgica/prevención & control , Fármacos Hematológicos/uso terapéutico , Artropatías/cirugía , Rivaroxabán/uso terapéutico , Ácido Tranexámico/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antifibrinolíticos/uso terapéutico , Cementos para Huesos , Cementación , Quimioprevención , Método Doble Ciego , Inhibidores del Factor Xa/uso terapéutico , Femenino , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: After stopping a 3 to 6 months course of oral anticoagulation for a first episode of idiopathic venous thromboembolism (VTE), the risk of recurrent VTE is high (10% per year). In this setting, international guidelines recommend at least 6 months treatment. However, this recommendation is not satisfactory for the following reasons: (1) no randomized trial has compared 6 months to extended duration (2 years) anticoagulation; and (2), even though the frequency of recurrent VTE is similar after pulmonary embolism (PE) and deep vein thrombosis (DVT), the fatality rate of recurrent VTE after PE is higher than that after DVT. METHODS: A French multicentre double blind randomized trial. The main objective is to demonstrate, after a first episode of symptomatic idiopathic PE treated for 6 months using a vitamin K antagonist, that extended anticoagulation for 18 months (INR between 2 and 3) is associated with an increased benefit / risk ratio (recurrent VTE and severe anticoagulant-related bleeding) compared to placebo. The double blind evaluation is ensured using by active warfarin and placebo, and blinded INR. The protocol was approved by the ethics board of the Brest Hospital on the 7th of March 2006. For an alpha risk of 5% and a beta risk of 20%, the estimated sample size is 374 patients. EXPECTED RESULTS: This study has the potential to: (1) demonstrate that the benefit / risk ratio of extended anticoagulation for 18 months is higher than that observed with placebo in patients with a first episode of idiopathic PE initially treated for 6 months, during and after the treatment period; and (2) to validate or invalidate the contribution of isotope lung scans, lower limb Doppler ultrasound and D-Dimer at 6 months of treatment as predictors of recurrent VTE (medico-economic analysis included).
Asunto(s)
Anticoagulantes/uso terapéutico , Embolia Pulmonar/tratamiento farmacológico , Tromboembolia Venosa/tratamiento farmacológico , Vitamina K/antagonistas & inhibidores , Warfarina/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Distribución de Chi-Cuadrado , Interpretación Estadística de Datos , Método Doble Ciego , Hemorragia/inducido químicamente , Humanos , Placebos , Guías de Práctica Clínica como Asunto , Pronóstico , Recurrencia , Medición de Riesgo , Factores de Tiempo , Warfarina/administración & dosificación , Warfarina/efectos adversosRESUMEN
Among the many factors likely to favour the occurrence of venous thromboembolism (VTE), exposure to certain drugs has to be taken into account. Although hormone treatments, oral contraception and hormone replacement therapy (HRT) for menopause have been studied, these are not the only drugs associated with an increased risk of VTE. The antipsychotics have also been incriminated in the occurrence of venous thromboembolism. The association of thalidomide and dexamethasone, used in the treatment of multiple myeloma, is responsible for a major increase in the risk of VTE. The physiopathological mechanisms accounting for the possible prothrombotic effect of most of these drugs is still not fully understood. Further observational and interventional clinical studies should provide a better understanding of VTE, potentially associated with drugs. However, certain drugs may be associated with a reduced risk of VTE. Although several studies indicate that aspirin and statins may favourably influence the risk of VTE, it is still not possible to draw up any practical recommendations.
Asunto(s)
Tromboembolia Venosa/inducido químicamente , Inhibidores de la Angiogénesis/efectos adversos , Aspirina/efectos adversos , Terapia de Reemplazo de Estrógeno/efectos adversos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Psicotrópicos/efectos adversos , Talidomida/efectos adversosRESUMEN
BACKGROUND: The vitamin K epoxide reductase complex subunit 1 (VKORC1) recycles endogenous vitamin K, a cofactor for vitamin K-dependent coagulation factor synthesis. Common polymorphisms in VKORC1, the gene coding for VKORC1, have been found to affect the dose response to vitamin K antagonists, and to confer an increased risk of vascular diseases in a Chinese population. The aim of this study was to evaluate the association between the VKORC1 1173C > T polymorphism and venous thromboembolism (VTE). METHODS: We report the results of a case-control study designed to evaluate interactions between acquired and inherited risk factors of VTE. We studied 439 cases hospitalized with a first venous thromboembolic event that was not related to a major acquired risk factor for VTE, and 439 matched controls. The VKORC1 1173C > T polymorphism was selected for genotyping as the tagging single-nucleotide polymorphism for previously identified VKORC1 haplotypes. RESULTS: The relationship between VTE and the VKORCI 1173C > T polymorphism was consistent with a recessive model. The frequency of the VKORCI TT genotype was lower in cases than in controls. The odds ratio (OR) (95% CI) was 0.62 (0.41-0.94) for the TT genotype as compared to CT/CC genotypes. Adjustment on cardiovascular diseases, body mass index, factor V (FV) and prothrombin gene mutations did not alter the results. CONCLUSIONS: In this case-control study, the frequency of the VKORCI TT genotype was lower in patients with VTE than in matched controls. The clinical consequence of these results remains to be determined, but gives new perspectives for exploration of the role of VKORCI polymorphism in the pathogenesis of VTE.
Asunto(s)
Oxigenasas de Función Mixta/genética , Polimorfismo Genético , Trombosis de la Vena/genética , Anciano , Estudios de Casos y Controles , Factor V/genética , Femenino , Frecuencia de los Genes , Humanos , Masculino , Persona de Mediana Edad , Mutación , Oportunidad Relativa , Polimorfismo de Nucleótido Simple , Protrombina/genética , Factores de Riesgo , Vitamina K Epóxido ReductasasRESUMEN
Cohort studies suggest that exposure to antipsychotic agents may be associated with an increased risk of venous thromboembolism (VTE). Few data concerning antidepressant drugs are available. Using a different methodological approach, the aim of this study was to estimate the association between neuroleptic and antidepressant drug use and the risk of VTE. We report the results of a case-control study designed to evaluate interactions between acquired and inherited risk factors of VTE. We included 677 cases hospitalized with deep vein thrombosis and or pulmonary embolism with no major acquired risk factor for VTE, and 677 controls matched for gender and age. Drug exposure was defined as current use of drugs at admission. Neuroleptic exposure was associated with an increased risk of VTE (OR = 2.1, 95% CI 1.4-3.2). Among neuroleptics, antipsychotic agent use was associated with a 3.5-fold increased risk of VTE (OR = 3.5, 95% CI 2.0-6.2). No association was found between antidepressant drug exposure and the risk of VTE (OR = 1.1, 95% CI 0.9-1.5). In this hospital-based case-control study, exposure to antipsychotic drugs was associated with an increased risk of VTE. These results, added to previous results, suggest that clinicians should consider antipsychotic drug exposure as a potential risk factor of VTE. More studies are needed in order to further elucidate this adverse effect, and to determine the possible predisposing factors and the biological mechanisms involved.
Asunto(s)
Antidepresivos/efectos adversos , Antipsicóticos/efectos adversos , Tromboembolia Venosa/inducido químicamente , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
Clinical signs of pulmonary embolism are neither sensitive nor specific enough to rule in or out the diagnosis in suspected patients. As an example, a chest pain that is reproducible at palpation in suspected patients was recently shown not to be associated with a lower proportion of confirmed cases of pulmonary embolism. However, clinical evaluation of patients with suspected pulmonary embolism is important, because it allows the physician to assess the clinical probability of pulmonary embolism, a mandatory step in diagnostic strategies for this disease. In elderly patients, the diagnosis of pulmonary embolism is particularly challenging. Indeed, the diagnostic value of symptoms and clinical signs of pulmonary embolism is reduced, the evaluation of the clinical probability is more difficult, and performances of some diagnostic tests are diminished with increasing age. The diminution of the proportion of confirmed cases among suspected patients is a new challenge for physicians, and raises the question of what is a clinical suspicion of pulmonary embolism.
Asunto(s)
Embolia Pulmonar/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Embolia Pulmonar/clasificación , Embolia Pulmonar/epidemiología , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Moderate hyperhomocysteinemia and B vitamins deficiency are thought to be risk factors for venous thromboembolism (VTE). The causality and independence of those associations are still questioned. METHODS: We measured fasting serum total homocysteine, folates, and vitamin B12 levels as well as 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T genotypes in 467 patients hospitalized with a first well-documented deep vein thrombosis and/or pulmonary embolism not related to a major acquired risk factor and 467 controls matched for gender and age. RESULTS: Mild hyperhomocysteinemia, low serum folates, and vitamin B12 were associated with VTE independently of each other. In multivariate analysis, odds ratios (OR) (95% CI) for VTE associated with mild hyperhomocysteinemia (>15 micromol L(-1)), low serum folates (< or = 4.9 nmol L(-1)), and vitamin B12 (< or = 253 pmol L(-1)) were 1.48 (1.05-2.08), 3.14 (1.35-7.32) and 1.42 (1.03-1.98), respectively. An MTHFRC677T genotype was not significantly associated with VTE; OR (95% CI): 1.13 (0.70-1.81) CONCLUSIONS: The current data provides further knowledge in the complex relationship between hyperhomocysteinemia, low vitamin levels, and VTE.
Asunto(s)
Hiperhomocisteinemia/complicaciones , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnóstico , Vitamina B 12/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , Masculino , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Persona de Mediana Edad , Estudios Prospectivos , Embolia Pulmonar/complicaciones , Factores de Riesgo , Trombosis de la Vena/complicacionesRESUMEN
OBJECTIVE: To look for an association between venous thromboembolism (VTE) and antiphospholipid antibodies (aPL) in patients without Systemic Lupus Erythematosus (SLE) when implementing, beside conventional assays, new tests for aPL screening directed towards purified proteic targets. METHODS: We conducted a cross-sectional, hospital-based study of consecutive unselected outpatients. We compared VTE+ patients to VTE- among 398 consecutive unselected outpatients referred for clinical suspicion of VTE. To detect aPL, the following ELISAs were performed: 1) a conventional standardized ELISA 2) an improved APA assay, 3) an anti-Beta2GPI ELISA, 4) an anti-Annexin V ELISA, 5) an anti-Prothrombin ELISA. We sought an association between VTE and aPL through a quantitative (t-test) and a qualitative comparison (chi-square test, according to the cut-off values set as the 95th percentile of aPL distribution). First we conducted an analysis of all patients. Then we stratified them into 2 subgroups, with or without a wellknown risk factor for VTE (prolonged immobilization >72h, surgery or trauma within the past three months, current malignancy). RESULTS: 61% of patients were classified as VTE-positive. Before stratification, we did not find any significant association between the VTE status and aPL. However, after stratification, in the subgroup without risk factors for VTE, the frequency of positive values as regards the anti Prothrombin antibodies detection was significantly higher in VTE+ patients (p = 0,04). CONCLUSION: The presence of anti Prothrombin antibodies might be an independent risk factor of VTE. However systematic screening for aPL in non SLE patients referred for VTE suspicion at the time of the thrombo-embolic event has little clinical relevance.
Asunto(s)
Anticuerpos Antifosfolípidos/sangre , Proteínas/inmunología , Tromboembolia/inmunología , Trombosis de la Vena/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Anexina A5/inmunología , Autoanticuerpos/sangre , Estudios de Casos y Controles , Estudios Transversales , Femenino , Glicoproteínas/inmunología , Humanos , Masculino , Persona de Mediana Edad , Protrombina/inmunología , Factores de Riesgo , Tromboembolia/sangre , Tromboembolia/etiología , Trombosis de la Vena/sangre , Trombosis de la Vena/etiología , beta 2 Glicoproteína IRESUMEN
BACKGROUND: The 20210 A allele variation in the 3' -untranslated region of the prothrombin gene was recently identified as a risk factor as regards deep venous thrombosis. AIM: To assess the frequency of the variation in unselected patients with a proven venous thromboembolism (VTE). METHODS: The presence of the prothrombin variation was determined in all consecutive patients referred from July 1994 to August 1997 for a clinical suspicion of VTE, and in whom the diagnosis was confirmed. A control group consisted of bone marrow volunteer donors. RESULTS: Of the 366 patients included, 17 (4.6%) were carriers of the 20210 A allele (95% CI, 2.4% to 6.7%). The mutation was present in 1.0% of the 400 controls. Odds ratio for having VTE in the presence of the 20210 A allele was 4.8 (95% CI, 1.5 to 19.8). Forty-six (12.5%) patients had the mutation of the factor V gene and five (1.4%) patients shared both mutations. After excluding the carriers of the factor V mutation, odds ratio for having VTE in the presence of the 20210 A allele was 3.7 (95% CI, 1.1 to 13.6). Mean age at admission as well as mean age of the first VTE episode were both significantly higher in patients free from the two mutations studied, as compared to carriers of the 20210 A allele (p = 0.04 and 0.01, respectively). CONCLUSION: Our findings in a large series of patients (1) confirm the 20210 A allele prothrombin gene as a risk factor for VTE. (2) suggest that its association with the factor V Leiden is not uncommon.
Asunto(s)
Factor V/genética , Frecuencia de los Genes , Variación Genética , Protrombina/genética , Tromboembolia/genética , Adulto , Anciano , Alelos , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mutación , Factores de RiesgoRESUMEN
We assessed the accuracy of venous compression ultrasonography (CUS) for the detection of asymptomatic deep vein thrombosis in 122 consecutive patients, with a mean age of 69 years, who were hospitalised in an internal medicine unit. All included patients had CUS within 48 h of admission. Twelve out of 17 patients with a positive CUS underwent phlebography, as the others withdrew their consent, whereas the remaining 105 patients with a negative serial CUS testing were clinically followed-up at 3 months. We found that CUS had a sensitivity and a specificity of respectively 1 (95% CI, 0.73 to 1) and 1 (95% CI, 0.96 to 1) for the detection of asymptomatic deep vein thrombosis. Kappa-coefficients for intra-observer and inter-observer agreements were respectively 0.88 and 0.56. We concluded that venous compression ultrasonography, performed as described, fulfils requirements of a screening test that could be available for prophylactic clinical trials or epidemiological researches.
Asunto(s)
Trombosis de la Vena/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Flebografía/normas , Estudios Prospectivos , Sensibilidad y Especificidad , Ultrasonografía/métodos , Ultrasonografía/normas , Trombosis de la Vena/diagnósticoRESUMEN
BACKGROUND: Plasma D-Dimer analysis, using ELISA assays, has demonstrated in previous studies a high sensitivity, suggesting its utility in excluding deep venous thrombosis (DVT). AIM: To assess the performance of a new rapid plasma D-Dimer ELISA measurement in suspected DVT patients with recent clinical signs, not exceeding one week. METHODS: A prospective study of patients admitted for a suspected recent DVT. Contrast venography or compression ultrasonography were performed within 24 h of admission. A new membrane based ELISA technique, which uses an immunofiltration and two complementary monoclonal antibodies was tested. Results were expressed as positive or negative. A standard plasma D-Dimer ELISA measurement was also performed. D-Dimer performances were assessed at the end of the study. RESULTS: 265/448 patients had a proven DVT (72 distal, 193 proximal). The sensitivity of the instantaneous method in the diagnosis of overall DVT is 92 +/- 3.4% (95% CI), and specificity is 36.6 +/- 6.9%. Positive predictive value is 67.7 +/- 4.8% and negative predictive value is 76.1 +/- 8.9%. Sensitivity and negative predictive values reach 97.9 and 94.3% in the diagnosis of proximal DVT, but only 76.3 and 79.7% in the diagnosis of distal DVT. Similar results are observed with the standard ELISA method. CONCLUSION: This new rapid plasma D-Dimer measurement appears highly sensitive, and could substitute the older ELISA methods. Both methods provide lower sensitivity in the case of a distal DVT location.
Asunto(s)
Ensayo de Inmunoadsorción Enzimática , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Membranas Artificiales , Tromboflebitis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flebografía , Valor Predictivo de las Pruebas , Estudios Prospectivos , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Tromboflebitis/sangre , Tromboflebitis/diagnóstico por imagen , Factores de Tiempo , UltrasonografíaRESUMEN
Sera from patients with giant cell arteritis and/or polymyalgia rheumatica were tested for the presence of IgG, IgM and IgA antibody to endothelial cells (AEC), cardiolipin (ACL) and phosphatidylethanolamine (APE) using enzyme-linked immunosorbent assays. There were strong correlations between ACL and APE, but also between AEC and ACL IgM (p < 0.02) and between AEC and APE IgA (p < 0.003). Inhibition of AEC binding was achieved by absorption onto EC, but ACL and APE binding was also significantly reduced. In contrast, the binding of AEC antibody could not be inhibited by incubation with CL. Our data suggest that AEC constitute a heterogeneous population of autoantibodies.
Asunto(s)
Anticuerpos Antifosfolípidos/sangre , Autoanticuerpos/sangre , Endotelio Vascular/inmunología , Arteritis de Células Gigantes/inmunología , Polimialgia Reumática/inmunología , Anciano , Anciano de 80 o más Años , Células Cultivadas , Reacciones Cruzadas , Femenino , Arteritis de Células Gigantes/sangre , Humanos , Masculino , Persona de Mediana Edad , Fosfatidiletanolaminas/inmunología , Polimialgia Reumática/sangre , Cordón Umbilical/inmunologíaRESUMEN
BACKGROUND: Recent findings have demonstrated a high frequency of activated protein C resistance in patients suffering from deep venous thrombosis (DVT). This abnormality has been related to a mutation in the factor V gene (at nucleotide position 1,691, guanine to adenine [G-->A] substitution). AIM: To assess the frequency of the mutation in unselected inpatients with a proved DVT. To study the clinical characteristics of such patients. METHODS: All consecutive patients admitted to the hospital because of a clinical suspicion of DVT were eligible. Diagnosis of DVT with the help of venous ultrasound imaging or venography. Ventilation and perfusion lung scan was performed in all patients, and interpreted according to the Prospective Investigation of Pulmonary Embolism Diagnosis criteria; in patients with a low- or intermediate-probability lung scan, pulmonary angiography was requested. Polymerase chain reaction amplification was performed in patients with a proved DVT. A control group consisted of bone marrow volunteer donors. RESULTS: From July 1994 to November 1995, 165 patients were included. Thrombosis was considered as distal in 77 and proximal in 88; an associated pulmonary embolism (PE) was found in 75 patients. Of 165 patients, 24 (14.5%) showed the factor V gene mutation (95% confidence interval, 9.4 to 19.8); the mutation was present in 3.5% of 200 bone marrow volunteer donors; odds ratio for having DVT in the presence of the mutation was 4.1. No difference in the level of DVT, or the presence of an associated PE was observed according to the presence of the mutation. Patients with the mutation have a significantly more frequent history of DVT (p=0.04) and more previous reported episodes (1.1 vs 0.6; p=0.04). CONCLUSION: The factor V mutation is frequent in unselected DVT patients. No difference in the severity of the thrombosis episode was observed in these patients.
Asunto(s)
Factor V/genética , Tromboflebitis/genética , Adulto , Anciano , Secuencia de Bases , ADN/sangre , Femenino , Francia/epidemiología , Frecuencia de los Genes , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Mutación Puntual , Reacción en Cadena de la Polimerasa/métodos , Prevalencia , Estudios Prospectivos , Tromboflebitis/sangre , Tromboflebitis/epidemiologíaRESUMEN
We report the case of an elderly woman with severe dysautonomic orthostatic hypotension in whom a deficit in dopamine B hydroxylase has been established. In the literature, such a deficit has been described in six young adults with long standing symptoms of postural hypotension. This enzyme catalyses the conversion of dopamine to noradrenaline. In our elderly patient, noradrenaline and adrenaline were undetectable in the plasma, but plasma dopamine was detectable. Treatment with the synthetic amino acid, DL-threo-dihydroxyphenylserine, which is converted to noradrenaline by dopa-decarboxylase, resulted in a significant increase in blood pressure. The mechanism of this acquired deficit is not elucidated.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/etiología , Dopamina beta-Hidroxilasa/deficiencia , Hipotensión Ortostática/etiología , Enfermedades Metabólicas/diagnóstico , Anciano , Anciano de 80 o más Años , Bioensayo , Presión Sanguínea/efectos de los fármacos , Dopamina/sangre , Dopamina beta-Hidroxilasa/fisiología , Droxidopa/administración & dosificación , Droxidopa/farmacología , Droxidopa/uso terapéutico , Epinefrina/sangre , Femenino , Humanos , Enfermedades Metabólicas/complicaciones , Enfermedades Metabólicas/tratamiento farmacológico , Norepinefrina/sangreRESUMEN
In previous studies, enzyme-linked immunosorbent assays (ELISA) for plasma D-dimer analysis have demonstrated high sensitivity, suggesting their potential usefulness in excluding deep venous thrombosis (DVT). We evaluated the usefulness of a new D-dimer test (Liatest D-dimer) for suspected DVT in a prospective study of patients admitted to the hospital because of recent (not exceeding 1 week before admission) clinical signs. Contrast venography or compression ultrasonography or both were performed within 24 hours of admission. A new quantitative determination of D-dimer concentration using a suspension of microlatex particles coated with specific antibodies was tested. A standard plasma D-dimer ELISA measurement was also performed. Of 464 patients, 276 had a proven DVT (distal, 74; proximal, 202). For a cutoff level of 400 ng/mL, sensitivity of the Liatest method in the diagnosis of overall DVT was 94.6% (95% confidence interval, 92.0%-97.0%), and the specificity was 35% (95% confidence interval, 28%-42%). The sensitivity and negative predictive value were 98.5% and 95.6%, respectively, in the diagnosis of proximal DVT, but only 83.8% and 84.6%, respectively, in the diagnosis of distal DVT. This new rapid Liatest D-dimer assay seems to be highly sensitive and could replace the ELISA method in excluding patients with proximal DVT. Both methods provide lower sensitivity for distal DVT.
Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno/análisis , Inmunoensayo/métodos , Tromboflebitis/diagnóstico , Autoanálisis , Ensayo de Inmunoadsorción Enzimática , Humanos , Látex , Microesferas , Flebografía , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
Ten early rheumatoid arthritis (RA) patients and 10 healthy volunteers were given 200 mg of ketoprofen daily for 8 days. Polymorphonuclear cell functional studies were performed just before and immediately after this treatment. In RA patients, increased chemotactic index and adherence returned to normal after this short-term treatment whilst reduced phagocytosis and bacterial function were not significantly modified by the drug. In healthy volunteers, no significant effect was shown. In addition, ketoprofen diminished the chemotactic activity induced by zymosan in RA patients and also in healthy volunteer plasma.
Asunto(s)
Artritis Reumatoide/inmunología , Cetoprofeno/farmacología , Neutrófilos/efectos de los fármacos , Fenilpropionatos/farmacología , Adulto , Artritis Reumatoide/sangre , Artritis Reumatoide/tratamiento farmacológico , Actividad Bactericida de la Sangre/efectos de los fármacos , Adhesión Celular/efectos de los fármacos , Quimiotaxis de Leucocito/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neutrófilos/inmunología , Fagocitosis/efectos de los fármacosRESUMEN
Activated protein C (APC) resistance is related to a single point mutation in the factor V gene (FV:Q506) and appears to be the most common inherited risk factor for venous thromboembolism. A reliable screening test is therefore useful. We aimed to evaluate a new APC resistance test, on the basis of the procoagulant activity present in one snake venom of a crotalidae family: STA Staclot APC-R. We studied 36 consecutive patients with an acute deep venous thrombosis (DVT) confirmed by compression ultrasonography and carrying the FV:Q506 allele, assessed by DNA analysis, 103 of their family members and 35 consecutive patients with a proven DVT but who did not carry the FV:Q506 allele. Blood samples were collected within 24 h of admission for the DVT cases and on the day of medical registration for the family members. Tests were performed blind. The STA Staclot APC-R test, using a cut-off value of 0.80, had an overall sensitivity of 100% (95% CI, 95-100) and a specificity of 98.8% (95% CI, 92.0-99.6). An acute thrombosis process did not influence the performance of the test. We conclude that this test is easy and rapid to perform in every day practice and fulfills the criteria for a screening test.
Asunto(s)
Pruebas de Coagulación Sanguínea/métodos , Venenos de Crotálidos , Resistencia a Medicamentos/fisiología , Proteína C/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Alelos , Activación Enzimática/fisiología , Factor V/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mutación Puntual/fisiología , Estudios Prospectivos , Proteína C/farmacología , Sensibilidad y Especificidad , Tromboflebitis/genéticaRESUMEN
This study focused on the frequency of pathological acid gastroesophageal reflux (AGER) on 50 children considered to be at risk for sudden infant death syndrome: that is to say, 30 near misses and 20 subsequent siblings. Four parameters were studied in a 24-h pH metry: (1) The percentage of time spent at pH less than 4. (2) The length of the longest reflux. (3) The number of refluxes greater than 5 min/h. (4) Esophageal clearance. In comparison to a control group of 46 normal children, we noted a rate of 20% of AGER on the near misses and 31% on children whose siblings had died from sudden infant death syndrome. The pH level of these two groups was significantly more often less than 4, compared to the normal children. The role of AGER in sudden infant death syndrome will, therefore, be discussed.
Asunto(s)
Reflujo Gastroesofágico/complicaciones , Muerte Súbita del Lactante/etiología , Humanos , Concentración de Iones de Hidrógeno , Lactante , Monitoreo Fisiológico , Estudios Prospectivos , Factores de RiesgoRESUMEN
The value and role of clinical findings in the diagnosis of pulmonary embolism were analysed in the three steps of clinical reasoning: firstly, they lead the physician to suspect the diagnosis; however, no sign or association of clinical signs allow confirmation or infirmation of the diagnosis; they are simply a guide to diagnosis; secondly, they contribute to the exclusion of a number of differential diagnoses, with the help of simple complementary investigations such as blood gases, electrocardiograms and chest X-ray; finally, when grouped together and expressed in terms of probability, clinical data are essential for the interpretation of pulmonary scintigraphy and for assessing the indications of further investigations.
Asunto(s)
Embolia Pulmonar/diagnóstico , Análisis de los Gases de la Sangre , Dolor en el Pecho/etiología , Estudios de Cohortes , Diagnóstico Diferencial , Disnea/etiología , Electrocardiografía , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Probabilidad , Embolia Pulmonar/sangre , Embolia Pulmonar/complicaciones , Radiografía Torácica , Factores de Riesgo , Taquicardia/etiologíaRESUMEN
The authors report the association of a clinically florid form of lupus with malignant hypertension and renal failure. The renal histology revealed lesions of nephroangiosclerosis, with virtually no signs of lupus proliferative glomerulonephritis. With a follow-up period of 42 months, the renal function has returned to normal, although steroid treatment has been interrupted for 33 months. However, intensive antihypertensive treatment is still required. This unusual case is discussed in the light of previous reports in the literature of the association of disseminated lupus erythematosus and malignant hypertension, which is nevertheless a rare entity.