Tratamiento anticoagulante en la fibrilación auricular no valvular: hay margen de mejora / Anticoagulant treatment in nonvalvular atrial fibrillation there is room for improvement

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¿Qué aportan los nuevos anticoagulantes en la prevención del tromboembolismo venoso y arterial? / What do the new anticoagulants contribute to the prevention of venous and arterial thromboembolism?

A lo largo de las últimas décadas los únicos anticoagulantes orales disponibles han sido los antivitaminas K (AVK). Estos han demostrado su eficacia pero tienen múltiples inconvenientes, lo cual obliga a monitorizar periódicamente su acción anticoagulante para ajustar las dosis. Los nuevos anticoagulantes orales (NACOS) presentan ventajas farmacocinéticas y farmacodinámicas que permiten su administración por vía oral a dosis fijas sin necesidad de monitorización. En la prevención de la enfermedad tromboembólica venosa (ETV) tras cirugía ortopédica, los NACOS han demostrado una eficacia superior o similar a la enoxaparina y una seguridad similar. Mientras que, en el tratamiento y prevención de recurrencias de la ETV y en la prevención de ictus y embolias arteriales sistémicas en pacientes con fibrilación auricular no valvular, los NACOS han mostrado una eficacia similar o superior a los AVK y un perfil de seguridad superior con una reducción muy significativa en la tasa de hemorragias intracraneales

Over the last decades, the only available oral anticoagulants were antivitamin K(AVK). The efficacy of the AVKs has been demonstrated, although they entail many disadvantages which require periodic monitoring of their anticoagulation action to adjust the doses. The new oral anticoagulants (NOACs) have pharmacokinetic and pharmacodynamic advantages because they can be administered orally at fixed doses without requiring monitorization. In the prevention of venous thromboembolic disease (VTD) after orthopedic surgery, NOACs have been shown to have a superior or similar efficacy to enoxaparin and similar safety. However, in the treatment and prevention of recurrences of VTD and in the prevention of stroke and systemic arterial embolisms in patients with nonvalvular auricular fibrillation, the NOACs have shown similar or greater efficacy as AVK and a superior safety profile with a very significant reduction in the rate of intracranial hemorrhages

Apixaban versus enoxaparina para la tromboprofilaxis en pacientes médicos / No disponible

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Nódulos pulmonares múltiples en paciente con bronquitis crónica / Multiple pulmonary nodules in patient with chronic bronchitis

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[Primary cardiac lymphoma: cytological diagnosis and treatment with response to polychemotherapy and hematopoietic precursor autotransplant. Presentation of a case a review of the literature]. / Linfoma cardiaco primario: diagnóstico citológico y tratamiento con respuesta a poliquimioterapia y a autotrasplante de precursores hematopoyéticos. Presentación de un caso y revisión de la literatura.

The primary cardiac lymphoma (PCL) is an extremely infrequent tumor suffered by immunocompetent patients with a difficult diagnosis and slow progress leading to a serious prognosis and few therapeutically possibilities. It's a primary-cardiac non-Hodgkin's lymphoma (NHL) in a patient of 46-year-old, immunocompetent, who started with a congestive heart failure and atrial flutter. Some examinations were carried out such as a transesophageal echocardiography (TEE), a computed tomography (TC) and a magnetic resonance imaging (MRI) and an intracardiac tumor placed in the interauricular septum was detected. The diagnosis was based on a pleural fluid cytological examination. It was decided to follow a chemotherapy treatment and the autologous peripheral blood stem cells transplantation was carried out. The patient remains in full remission thirty-six months after diagnosis and twenty-nine months after the autotransplant. Our clinical experience indicated that an early and accurate diagnosis combined with the appropriate and aggressive antilymphoma therapy can thus help in obtaining a long survival in patients with PCL.

Linfoma cardiaco primario: diagnóstico citológico y tratamiento con respuesta a poliquimioterapia y a autotrasplante de precursores hematopoyéticos. Presentación de un caso y revisión de la literatura / Primary cardiac lymphoma: antemortem cytologic diagnosis and treatment with a response to polyche motherapy and the autologous peripheral blood stem cells transplantation. Presentation of one case report and review of the literature

El linfoma cardíaco primario (LCP) es un tumor extraordinariamente infrecuente en pacientes inmunocompetentes, de diagnóstico dificil y a menudo tardío, que comporta un pronóstico muy grave y escasas posibilidades terapeúticas.Presentamos un caso de linfoma no Hodgkin cardíaco primario en un paciente de 46 años, inmunocompetente, que debutó con insuficiencia cardíaca y flutter auricular. Se practicaron estudios con ecocardiografía transesofágica (TEE), tomografía computarizada (TC) y resonancia magnética (MR) que detectaron una tumoración intracardíaca localizada a nivel del septo interauricular. El diagnostico se fundamentó en el examen citológico del liquido pleural. Se instauró tratamiento quimioterápico y se sometió al paciente a un autotrasplante de precursores hematopoyéticos. El paciente permanece en remisión 36 meses después del diagnóstico y 29 meses del autotrasplante. Nuestra experiencia indica que un diagnóstico precoz y preciso conjuntamente con un tratamiento antilinfomatoso apropiado y agresivo puede ayudarnos a obtener una supervivencia prolongada en pacientes con LCP (AU)

The primary cardiac lymphoma (PCL) is an extremely infrequent tumor suffered by immunocompetents patients with a difficult diagnosis and slow progress leading to a serious prognosis and few therapeutically possibilities. It's a primary-cardiac non-Hodgkin's lymphoma (NHL) in a patient of 46-year-old, immunocompetent, who started with a congestive heart failure and atrial flutter. Some examinations were carried out such as a transesophageal echocardiography (TEE), a computed tomography (TC) and a magnetic resonance imaging (MRI) and an intracardiac tumor placed in the interauricular septum was detected. The diagnosis was based on a pleural fluid cytological examination. It was decided to follow a chemotherapy treatment and the autologous peripheral blood stem cells transplantation was carried out. The patient remains in full remission thirty-six months after diagnosis and twenty-nine months after the autotransplant. Our clinical experience indicated that an early and accurate diagnosis combined with the appropriate and aggressive antilymphoma therapy can thus help in obtaining a long survival in patients with PCL (AU)

[Factitious torpid skin ulcers. New concepts and classification of chronic factitious disorders]. / Ulceras cutáneas tórpidas facticias. Nuevos conceptos y clasificación de los trastornos facticios crónicos.

Chronic factitious disorders are diseases diagnosed after the discarding of organic causes. There are determined diagnostic data which may be suspicious: multiple hospitalization, submission to many invasive techniques and personal situations motivating simulation. The case of a 34 year old woman presenting a factitious disorder with dermal ulcers, subcutaneous abscesses and simulation of hematuria is described. An analysis of the concept and classification of this clinical picture is made. Following diagnostic suspicion, a search for objects or substances with which the patient was able to make the lesions was required to determine the appropriate therapy.