Enfermedad tromboembólica venosa: análisis de 239 casos / Thromboembolic diseases: analysis of 239 cases

Objetivo: Conocer el número de pacientes que ingresan o que desarrollan durante su ingreso en un hospital ETEV, analizar el manejo de esta enfermedad y sentar las bases para un estudio prospectivo de dicha enfermedad. Métodos: Se trata de un estudio descriptivo retrospectivo de pacientes diagnosticados de ETEV durante su ingreso en el Hospital Clínico San Carlos de Madrid en un período de 6 meses. Se recogen los datos relacionados con antecedentes epidemiológicos, diagnóstico, tratamiento y complicaciones de los pacientes con trombosis venosa profunda (TVP), tromboembolismo pulmonar (TEP) o ambas (TVP + TEP). Resultados: Del 1 de octubre de 2003 al 31 de marzo de 2004, 239 pacientes fueron diagnosticados de ETEV (64 TVP, 125 TEP y 51 TVP + TEP) al alta en nuestro hospital con una edad media de 73,2 años (desviación estándar 13,64). Como factores de riesgo con diferencias estadísticamente significativas detectamos la quimioterapia, el infarto agudo de miocardio y la obesidad. No se ha observado relación entre el tipo de tratamiento utilizado y la aparición de hemorragia. Los pacientes con episodios previos de ETEV presentaron hemorragias más frecuentemente que aquellos sin dichos antecedentes. La hipocinesia de ventrículo derecho en el ecocardiograma fue un factor de mal pronóstico para la muerte por ETEV así como la aparición de TVP + TEP. Conclusión: En más del 50% de los pacientes la ETEV era TEP y más del 60% eran mujeres. Es importante disponer de información sobre estos pacientes, ya que 2/3 ingresan en medicina interna. La quimioterapia, el IAM y la obesidad fueron factores que se asociaron a TVP, TEP y TVP + TEP de forma significativa, respectivamente. La hipocinesia de ventrículo derecho en el ecocardiograma fue un factor de mal pronóstico para la muerte por ETEV así como la coincidencia de TVP + TEP

Aim: To know the number of patients that are admitted in the hospital with TED or those who have developed it during their stay, analyzing how to manage this disease and make a basis for a prospective study of this disease. Methods: It is a descriptive and retrospective study of TED diagnosed patients during their stay at the Hospital Clínico San Carlos of Madrid for a 6 month period. Data related with epidemiologic records, diagnosis, treatment and complications of patients with Deep-Vein Thrombosis (DVT), Pulmonary Thromboembolism (PTE) or both (DVT+PTE) are collected. Results: From October 1st of 2003 to March 31st of 2004, 239 patients were diagnosed with TED (64 DVT, 125 PTE y 51 DVT + PTE) when they were discharged from our hospital, with an average age of 73.2 years (standar desviation 13.64). We classify as risky factors with significative statistical diferences chemotherapy, acute myocardium infarction and obesity. It has not been found any relation between the treatment used and the development of hemorrage. Patients with previous episodies of TED had more frequent hemorragies than those without such records. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis of the death for TED as well as the development of DVT + PTE. Conlusion: In more than a 50% of patients, TED was PTE and more than a 60% were women. It is important to obtain information about these patients because 2/3 of them are admitted to internal medicine. Chemotherapy, AIM and obesity were factors significatively associated to DVT, PTE and DVT + PTE. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis for TED as well as the development of DVT + PTE

Dolor abdominal de etiología muy infrecuente / Abdominal pain with very uncommon etiology

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[Thromboembolic disease: analysis of 239 cases]. / Enfermedad tromboembólica venosa: análisis de 239 casos.

AIM: To know the number of patients that are admitted in the hospital with TED or those who have developed it during their stay, analyzing how to manage this disease and make a basis for a prospective study of this disease. METHODS: It is a descriptive and retrospective study of TED diagnosed patients during their stay at the Hospital Clínico San Carlos of Madrid for a 6 month period. Data related with epidemiologic records, diagnosis, treatment and complications of patients with Deep-Vein Thrombosis (DVT), Pulmonary Thromboembolism (PTE) or both (DVT+PTE) are collected. RESULTS: From October 1st of 2003 to March 31st of 2004, 239 patients were diagnosed with TED (64 DVT, 125 PTE y 51 DVT + PTE) when they were discharged from our hospital, with an average age of 73.2 years (standard desviation 13.64). We classify as risky factors with significative statistical differences chemotherapy, acute myocardium infarction and obesity. It has not been found any relation between the treatment used and the development of hemorrhage. Patients with previous episodes of TED had more frequent hemorrhagies than those without such records. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis of the death for TED as well as the development of DVT + PTE. CONCLUSION: In more than a 50% of patients, TED was PTE and more than a 60% were women. It is important to obtain information about these patients because 2/3 of them are admitted to internal medicine. Chemotherapy, AIM and obesity were factors significatively associated to DVT, PTE and DVT + PTE. Hypokinesia in the right ventricle shown on the echocardiogram supposed a gloomy prognosis for TED as well as the development of DVT + PTE.

Necesidad de seguimiento endoscópico en la gastritis crónica atrófica con hiperplasia de células neuroendocrinas / Chronic atrophic gastritis and gastric hyperplasia of neuroendocrine cells: the need of screening

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Identificación de problemas de calidad en la información clínica a usuarios de un servicio de Urgencias hospitalario / Identification of quality problems in the clinical information to hospital emergency department patients

Objetivos. Valorar el nivel de asimilación de la información facilitada a los pacientes y familiares en el servicio de Urgencias y conocer el grado de satisfacción. Métodos. Se diseñó un estudio descriptivo transversal. La selección de los sujetos a estudio se realizó mediante un muestreo aleatorio simple, obteniéndose una muestra de 213 pacientes. En el momento del alta estos pacientes con sus acompañantes contestaron una encuesta escrita y anónima. Para valorar la comprensión de la información se contrastaron las respuestas del cuestionario con la historia clínica. Resultados. La presentación del médico, la información sobre el tiempo de estancia aproximado en Urgencias, la explicación de las pruebas complementarias a realizar y de los resultados de las mismas determinó significativamente la puntuación de satisfacción sobre la información ofrecida, que para los pacientes fue de 6,3 puntos sobre 10. El porcentaje de pacientes que tenía conocimiento puntual de las pruebas realizadas fue del 61,5 por ciento, del diagnóstico el 50,7 por ciento y del tratamiento administrado el 35,2 por ciento. La comprensión del diagnóstico y del tratamiento administrado fue diferente según la edad (p < 0,001), y la asimilación de la información sobre las recomendaciones al alta fue diferente según el nivel de estudios (p < 0,05).Conclusiones. La identificación del personal sanitario permitiría un mejor flujo bidireccional de la información. Dadas las características socioculturales de nuestro medio, la información debe ser clara y concisa. Para que la información se transmitiera a la mayoría de los usuarios del servicio de Urgencias sería útil la información previa sobre el funcionamiento del servicio en forma de folletos en la entrada y establecer protocolos para el consentimiento informado sobre diversas técnicas diagnósticas y de tratamiento propias de la Medicina de urgencias (AU)

Elaboración y puesta en marcha del programa de calidad del hospital / Elaboration and start up of the Hospital’s quality program

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House dust mites and Der p I in Tenerife (Canary Islands, Spain): the relative importance of other non Dermatophagoides spp mites.

BACKGROUND: House dust mites constitute the major etiologic factor causing sensitization and asthma its geographical distribution map is quite well known, although it is not yet complete. Home environments world-wide show mites that mainly belong to the Piroglyphidae family, the D. pteronyssinus specie being the predominant one. However others have also been considered of interest. OBJECTIVE: The aim of this work was to study the species and to determine the levels of Der p I, Der f I and group II of allergens of Dermatophagoides. Present in houses from Tenerife, Canary Islands (Spain). METHODS: Dust samples were collected in 130 houses. RESULTS: D. pteronyssinus was found in 121 (95.3%) homes, being the predominant species in 113 (89%). In 69 (55%) homes, Dermatophagoides spp. were found together with other species from other generus. Mean values for Der p I were 13.7 +/- 13.88 (mean +/- SD), for Der f 1 1.05 +/- 1.83 and for the Group I of allergens 7 +/- 6.77. CONCLUSION: Although D. pteronyssinus is the predominant species in our area, there are others that may be off importance and should be taken into consideration in the diagnostic, home disallergenization and later treatment of patients.

[Vasculitis caused by hypersensitivity: an analysis of 60 patients]. / Vasculitis por hipersensibilidad: análisis de 60 pacientes.

Sixty cases of hypersensitivity vasculitis are revised analyzing their possible etiology, clinical course, analytical and histological alterations, evolution, and treatment. Thirty of these cases corresponded to Schönlein Henoch purpura (SH). The results of this subgroup (SH) are compared to other hypersensitivity vasculitis (HV).

[Disseminated intravascular coagulation in systemic lupus erythematosus]. / Coagulación intravascular diseminada en el lupus eritematoso sistémico.

A patient with systemic lupus erythematosus (SLE) who developed disseminated intravascular coagulation during the beginning of SLE is presented. No other cause responsible for the producing of DIC was found. After treatment with corticoids, and cyclophosphamide the DIC was rapidly settled. This case supports the need for a complete blood test in patients with SLE who show coagulation alterations.