[Current and future diagnostic strategies in venous thromboembolic disease]. / Estrategias diagnósticas actuales y futuras de la enfermedad tromboembólica venosa.

Thromboembolic disease (TD), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common acute cardiovascular condition after ischemic cardiopathy and stroke. It is often difficult to diagnose, as it is well-known that half of PE episodes appear are recognized while the patient is still alive and which appear in 30-40% of symptomatic patients. Nonetheless, there are two well-differentiated phases in the diagnosis of TD: the suspicion, and the diagnosis. The first is very important, and is within the competence of any physician. The second can be ratified when carrying out specific tests. We have developed successive steps in the two phases of diagnosis, we critically review the distinct parts currently implicated in the strategic diagnosis of TD. Finally, we analyze the new diagnostic techniques to substitute, possibly, angiography in many cases, and perhaps to include ventilation/perfusion (V/Q) pulmonary gammagraphy, once become generally available.

Estrategias diagnósticas actuales y futuras de la enfermedad tromboembólica venosa / Thromboembolic disease: current and future strategies

La enfermedad tromboembólica venosa (ETEV), que incluye la trombosis venosa profunda (TVP) y el embolismo pulmonar (EP), es la afección cardiovascular aguda más frecuente después de la cardiopatía isquémica y el infarto cerebral. A menudo es difícil de diagnosticar, como lo prueba el hecho de que menos de la mitad de los episodios de EP son reconocidos mientras el enfermo todavía vive y a que únicamente puede demostrarse en el 30-40% de los pacientes sintomáticos. En cualquier caso, el diagnóstico de la ETEV pasa por dos fases bien diferenciadas: la de sospecha y la de confirmación. La primera es muy importante y está al alcance de cualquier médico. La segunda nos permite ratificarla mediante la realización de pruebas específicas. Desarrollamos los pasos sucesivos de las dos fases del diagnóstico. Para ello revisaremos de forma crítica los distintos apartados implicados actualmente en la estrategia diagnóstica de la ETEV. Finalmente, analizaremos las nuevas técnicas diagnósticas destinadas a substituir, posiblemente, a la angiografía en muchos casos y quizá incluso a la gammagrafía pulmonar de ventilación/perfusión (V/Q), en cuanto se dispongan de forma generalizada (AU)

[The correlation of the isotopic liver/spleen ratio with the tissue damage in chronic diffuse hepatopathies]. / Correlación del cociente hígado/bazo isotópico con el daño hístico en hepatopatías crónicas difusas.

The purpose of the study was to determine whether a correlation between the radioisotopic "spleen-to-liver" ratio and the hepatic damage (according to Knodell's Index) exists in patients with chronic liver disease, in order to ascertain whether hepatic biopsy should be performed under visual (laparoscopic) control or not (blind liver biopsy). Thirty patients with inflammatory chronic hepatic disease were studied (9 chronic persistent hepatitis, 14 active chronic hepatitis and 7 hepatic cirrhosis). An inverse correlation was found between Knodell's Index and the "spleen-to-liver" ratio with moderate statistical significance (r = -0.46). In conclusion, the isotopic "spleen-to-liver" ratio correlates moderately well with the degree of hepatic damage and consequently it can only be used as orientation about the preferable way for obtaining a liver biopsy (laparoscopically or not).

[The determination of tissue CEA in colorectal adenocarcinomas: an immunohistochemical study]. / Determinación del CEA tisular en adenocarcinomas colorrectales: un estudio inmunohistoquímico.

We carried out a CEA immunohistochemical study on 80 colorectal carcinomas, using the PAP methodology. Also we studied peritumoral "normal" mucosa on 69 cases. All tumoral (80/80) and the major part of normal colonic mucosa (68/69) cases stained positively. We present our experience with this immunohistochemical staining using a qualitative semi-quantitative evaluation, as an easy and reliable procedure. This permits to obtain, by immunostaining, a better homogeneous group of tumours (Apical, Mixed and Cytoplasmic, or Weak and Strong), necessary to further correlation with various tumoral parameters. On the basis of this evaluation, we found: A staining of weak intensity (65/68) of Apical type (55/68) in the vast majority of the normal, peritumoral mucosa. In tumors we found a prevalence of strong intensity (67/80), in relation to its major content of CEA. With respect to the type of immunostaining, although Apical staining (32/80) exists the Cytoplasmic (34/80) is predominant together with the Mixed type (14/80). This is expression of the alterations in secretion and distribution of the tissue CEA. We analyze the difficulties of such classification caused by the tumoral heterogeneity and we include other data whose significance is not always clear.

[Adverse effects of 2 forms of therapy with heparin in patients with non-surgical risk factors of venous thromboembolism]. / Reacciones adversas de dos formas de heparinoterapia en pacientes con factores de riesgo no quirúrgicos de thromboembolismo venoso.

Venous thromboembolism (VTE) is a frequent complication in hospitalized patients who have to stay in bed for long periods of time or with diseases favouring of low molecular weight (HLMW) developed during the past years have demonstrated that they are as effective as the non-fractionated heparins, but with the advantage of a better cutaneous absorption, greater bioavailability and plasmatic half-life, a more favourable antithrombotic/hemorrhagic ratio and a lower variability in the anticoagulant response to fixed doses. We have investigated the efficacy, efficiency and security of an HLMW (Enoxaparine) for the prevention of VTE, comparing it with an standard calcic heparin, subcutaneously administrated, in patients with non-surgical risk factors and more than 65 years of age. Based on our results, we cannot conclude that one therapy is better than the other, although the enoxaparine needs only one daily injection and it can be administrated in an out-patient basis for long periods of time, without the need of laboratory controls and the resulting cost savings.

[Brown bowel syndrome: diagnostic and therapeutic problems]. / Síndrome del intestino marrón: problemas diagnósticos y terapéuticos.

A new case of a brown bowel syndrome is presented in a 27 year-old man, clinically with severe esteatorrhea of many years of duration, with moderate pancreatic exocrine insufficiency and intestinal motility disorders suggesting a functional change secondary to a deposit of lipofucsin. We comment the pathogenic, diagnostic and therapeutic implications related to this circumstance.

[Surgical treatment of Zenker's diverticulum. Apropos of 14 cases]. / Tratamiento quirúrgico del divertículo de Zenker. A propósito de 14 casos.

We present our experience in the surgical treatment of 14 cases of Zenker's diverticulum, diagnosed from January, 1969 to December, 1988. In 11 cases we performed one stage diverticulectomy; in 4 cases, manometric findings required cricopharyngeal myotomy. In 3 cases surgical treatment was not indicated; 2 patients had liver cirrhosis and high surgical risk and the third patient declined the treatment. Current treatment is discussed.