[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 role of clinical autopsy in monitoring the quality of the clinical diagnosis in an emergency department]. / El papel de la autopsia clínica en el control de calidad de los diagnósticos clínicos en una unidad de urgencias.

OBJECTIVE: A total of 61 autopsies performed in patients died in emergency department of a university hospital were retrospectively analysed and the findings were compared with clinical diagnoses. METHODS: Sensitivity and specificity of the clinical diagnoses and the correction of medical procedures were measured. The influence of age and sex of patients was analyzed using Fisher's exact test and chi-square-test. RESULTS: The most common causes of death were cardiovascular diseases (52.46%). Autopsy showed unexpected major findings in 44.26% of cases. Major discrepancies between the autopsy reports and the clinical diagnoses, were present in 26.22% of all cases. Absolute concordance between clinical and autopsy diagnoses was obtained in 44.26% of cases. The major sensitivity of clinical diagnosis was found in cerebrovascular disorders (100%), upper digestive hemorrhage (100%), and acute myocardial infarction (82.35%). The lowest sensitivity was found in malignant tumors (16.66%), hemorrhagic pancreatitis (0%) and bowel infarction (0%). The patient cares were correct in 68.85% of cases. No statistically significant differences were observed in relation to age and sex. CONCLUSIONS: We concluded that autopsy is a useful method for evaluate diagnostic procedures and quality of medical cares in emergency departments.

Etiologic role of unapparent exposure in cat allergy.

To determine the importance of unnoticed exposure to cat, we studied 20 patients with a history of respiratory allergy. All the patients had a positive prick test to cat dander extract, and none of them kept cats as pets. The prick test was carried out with a dander extract from cat at a concentration of 100 BU/ml. The specific IgE was determined by the commercially available Pharmacia CAP System. We carried out a conjunctival challenge test. The concentration of Fel d 1 was quantified in dust samples from the patients' homes by a commercially available method. The patients were reassessed in order to establish a relation between exposure and symptoms, and concealed allergen sources. Sixteen patients showed significant levels of Fel d 1 in their homes (mean of 3.35 micrograms/g of dust). The conjunctival challenge test was positive in 15 patients. These patients showed an exposure mean of 0.4 microgram/g of dust. The mean levels of specific serum IgE were higher in those patients with a positive challenge than in those with a negative challenge (P = 0.0145). In nine reassessed patients, a relation was established between natural exposure and the onset of the symptoms. A possible hidden allergen source was established in 11 patients.(ABSTRACT TRUNCATED AT 250 WORDS)