First report of a medullar cord compression secondary to osseous plasmacytoma successfully treated with bortezomib and dexamethasone.

Medullar cord compression secondary to osseous plasmacytomas affecting the vertebrae is an oncological emergency. A 75-year-old woman with recurrent osseous plasmacytomas and thoracic spinal cord compression, previously treated with radiotherapy, was successfully treated with bortezomib and dexamethasone. Three years later, when the plasmacytoma and spinal cord compression relapsed, she was retreated with the same therapeutic scheme, achieving a new complete clinical remission. This is the first reported case of an excellent response to the combination of bortezomib and dexamethasone for spinal cord compression due to osseous plasmacytoma.

Artoplastia de cadera y rodilla:¿precisan de un mayor tiempo de profilaxis antitrombótica los pacientes con insuficiencia cardíaca congestiva (ICC) o hipertensión arterial (HTA) ? / Is opportune the prolongation of thromboprophylaxis in patients undergoing hip and knee arthroplasty with diagnosis of arterial hypertension or congestive heart failure?

Introducción: Evaluamos el posible estímulo de la HTA y de la ICC sobre varios marcadores hipercoagulativos determinados antes de la cirugía de cadera o rodilla, con el fin de identificar a pacientes con un mayor riesgo de enfermedad tromboembólica venosa (ETV), en los que podría ser necesaria una profilaxis más larga Pacientes y métodos: En 79 pacientes ingresados para artroplastia de cadera y rodilla, obtuvimos los siguientes marcadores previamente a la intervención: dimero-D (D-D), complejo trombina-antitrombina (TAT) y el fragmento 1 + 2 de la protrombina (Fl + 2). Veinticinco casos con HTA fueron detectados en el grupo de estudio y cinco enfermos mostraron signos de ICC. Se emplearon los tests estadísticos t de Student y U de Mann-Whitney. Resultados: Los niveles preoperatorios de los marcadores en el grupo con HTA o ICC no mostraron diferencias significativas (p > 0,05) respecto al grupo sin dichos diagnósticos. Conclusiones: Las dos patologías cardiovasculares no modiricaron sustancialmente los valores preoperatorios de los marcadores hipercoagulativos en esta cirugía. Por tanto, ninguna de ambas entidades permitió discriminar a los sujetos beneficiarios de profilaxis más largas (AU)

Comparación de dos heparinas de bajo peso molecular (HBMP) mediante marcadores hipercoagulativos en cirugía sustitutiva de cadera y rodilla / Comparative study of two low-molecular-weight heparins (LMWH) by hypercoagulability markers determination on hip and knee substitutive surgery

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Relación entre los valores plasmáticos preoperatorios de marcadores hipercoagulativos y de reactantes de fase aguda en pacientes con artritis reumatoide candidatos a artroplastia de cadera o rodilla

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Concentración plasmática de factor VIII como principal indicador de riesgo para la enfermedad tromboembólica venosa y el ictus isquémico / Plasmatic concentration of factor VIII as a relevant risk indicator for the venous thromboembolic disease and the ischemic stroke

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Hypercoagulability state in hip and knee surgery: influence of ABO antigenic system and allogenic transfusion.

It is well know that people with blood group O have a lower risk for venous thromboembolic disease (VTED) than does the general population. Moreover blood transfusion has been identified as a risk factor for VTED in patients with major trauma. The aim of this work is to investigate the behaviour of several markers of hypercoagulability before and after substitutive surgery of hip and knee in order to evaluate the relationship between the plasmatic levels of these markers, the ABO antigenic system and the allogenic blood transfusion. The plasmatic levels of D dimer (D-D), thrombin-antithrombin complex (TAT), and fragment 1 + 2 of prothrombin (F1 + 2) have been determined by the ELISA method in 79 patients subject to substitutive surgery of hip or knee one day before and one day after surgery. The 41 patients with blood groups different from O had presurgical levels of F1 + 2 higher than those of group O (p = 0.004), while no differences could be found for D-D and TAT. The 28 patients who received allogenic blood presented higher levels of D-D one day after surgery than non-transfused patients (p = 0.043); the practice of transfusion did not modify significantly the levels of TAT and F1 + 2 after surgery. In accordance with these results we suggest that blood group and transfusion are risk factors for hypercoagulability, and therefore we advise for a restrictive policy of transfusion practice. New therapies such as aprotinin should be assayed in order to minimize blood loss.

[Hypercoagulability status previous to total hip and knee arthroplasty: the contribution of rheumatoid arthritis]. / Estado hipercoagulativo previo a la artroplastia total de cadera y rodilla: contribución de la artritis reumatoide.

PURPOSE: Starting from a status hypercoagulability previous to substitutive hip and knee surgery, the aim of this work was to investigate the influence of different osteoarthropatic pictures for which arthroplasty is indicated in the activation of the clotting cascade, rheumatoid arthritis (RA) being one of such pictures. PATIENTS AND METHODS: Of 79 patients suitable for prosthetic surgery of hip (53) and knee (26), the preoperative values of several markers, namely, D dimers (D-D), thrombin-antithrombin (TAT) complex, and F1 + 2 prothrombin fragment (F1 + F2) were assessed by enzymoimmunoasay. The mean age of the patients was 65.5 years, and their sex distribution was 50 women and 29 men. The indications for arthroplasty were as follows: osteoarthrosis (62), aseptic necrosis (11), RA (9), articular gout (2), previous fracture (2), more than one diagnosis overlapped in some cases. The results attained were compared with a control group comprised of 33 subjects (16 women and 17 men) with mean age similar to the patient's group (68.06 years). RESULTS: The D-D values in the patients suitable for hip arthroplasty and the TAT values in patients suitable for both types of surgery were significantly higher than those found in the control group (p = 0.012 and 0.01, respectively). The preoperative TAT levels of the RA patients were significantly higher (p = 0.025) than those found in the patients with the other surgical indications. CONCLUSIONS: Previously to the performance of arthroplasty, the patients show hypercoagulative marker values higher than those of age-matched controls. The significant rising of TAT found in RA patients is concordant with the literature, and this fact makes it advisable to include RA among the pathologic situations associated with hypercoagulability, as this is a common indication for substitutive hip and knee surgery with high risk of venous thromboembolic disease.

[Comparative study of 2 antithrombotic regimens in 75 patients with coronary endoprostheses]. / Estudio comparativo de dos pautas antitrombóticas en 75 pacientes portadores de endoprótesis coronaria.

PURPOSE: To compare systemic anticoagulation with antiaggregation in patients with coronary stent, with regard to subacute occlusion, mean hospital staying and haemorrhagic complications. PATIENTS AND METHODS: Seventy-five patients with coronary stent were treated with one of two different antithrombotic protocols. A group comprised of 34 patients (group A) received sodium heparin and acenocoumarin, plus acetylsalicylic acid (325 mg) and dipyridamole (225 mg). The remaining 41 patients (group B) were given antiplatelet agents, namely ticlopidine (125-250 mg) and aspirin (125 mg). RESULTS: One case of group A (2.9%) showed thrombosis due to stent occlusion. No thrombotic complications were seen in the patients with antiplatelet drugs. Haemorrhagic complications were present in 11 group A patients (32.3%), and blood transfusion was necessary in 3 of them. Hemorrhage was present in 9 cases of group B (21.8%), and none of them needed blood transfusion. The mean number of days to achieve INR > 2 was 3.06 (1-11) in group and 2.02 (1-5) in group B. CONCLUSIONS: Antiplatelet regimes appear as a good choice in coronary stent, in spite of the fact that the primary indication seems that of group A.