Sudden Death Due to Thrombosis Associated with Implantable Cardioverter-Defibrillator Electrodes.

Thrombosis associated with pacemaker leads is extremely rare, although the literature on this subject is scarce. A clinical case is reported, describing this condition and its clinical presentation, the complementary tests for establishing the diagnosis and the available therapeutic options. LEARNING POINTS: Thrombosis associated with pacemaker leads is extremely rare.The different causes that contribute to thrombosis all have Virchow's triad (blood stasis, endothelial injury/dysfunction and hypercoagulability) in common.Transthoracic and/or transoesophageal Doppler echocardiography is the gold standard for establishing the diagnosis, while the treatment options are anticoagulation, thrombolysis and surgical or endovascular embolectomy.

Constitutional Syndrome, Ascites and Duodenal Thickening Presenting as Groove Pancreatitis.

Groove pancreatitis (GP) is a very infrequent subtype of chronic pancreatitis affecting the pancreatic-duodenal junction. It usually manifests in middle-aged men with a history of chronic alcoholism, though it has also been described in women and in individuals who do not consume alcohol[1]. Even though the underlying etiology is unclear, chronic alcohol consumption is known to increase the viscosity of the pancreatic juice and exacerbate the inflammatory process[2]. We present a case of GP that posed diagnostic difficulties because it manifested as ascites and duodenal thickening, with pancreatic imaging findings initially normal. LEARNING POINTS: Groove pancreatitis typically manifests as upper hemiabdominal pain, postprandial vomiting and weight loss.It is important to establish a differential diagnosis with carcinoma of the head of the pancreas and duodenal neoplasms.Presentation of the disease in the form of ascites is exceptional but a possibility that must be taken into account.

Indicadores de calidad en el diagnóstico y tratamiento del cáncer para unidades de mama: encuesta nacional / Breast unit quality indicators in the diagnosis and treatment of cancer: A national survey

Objetivo. Establecer el estado actual de las unidades de patología mamaria (UPM) en la utilización de indicadores de calidad del manejo del cáncer de mama. Material y métodos. Se efectuó una búsqueda bibliográfica de indicadores del manejo del cáncer de mama. Con los resultados se confeccionó una encuesta electrónica de 27 preguntas que se envió a 167 UPM censadas en el Grupo de Estudios Senológicos. Se consideraron las respuestas de 33 de las UPM. Resultados. Solo 9 de las UPM que respondieron estaban acreditadas por la SESPM. Los indicadores más utilizados fueron: utilización de informes siguiendo guías estandarizadas en diagnóstico por la imagen, pacientes con cáncer orientadas para tratamiento por un comité multidisciplinar, determinación de factores pronósticos y predictivos en carcinoma infiltrante, y especificación en el informe de la distancia al margen más cercano de la lesión. Por grupos de indicadores los más utilizados fueron los del procedimiento general y anatomía patológica. Las UPM acreditadas utilizan los indicadores con mayor frecuencia que las no acreditadas. Solo 8 de los 20 indicadores eran utilizados por más del 70% de las UPM para el control de calidad de la unidad y no solo del servicio que los origina. Conclusión. El uso de indicadores para el control de calidad es una herramienta ampliamente utilizada en las UPM que han contestado la encuesta, si bien en muchas ocasiones el indicador solo se usa en el servicio que lo origina y no para la evaluación del funcionamiento de la unidad de forma integral (AU)

Objective. To determine the current state of breast pathology units (BPU) in the use of quality indicators in breast cancer management. Material and methods. After a literature research of breast cancer management indicators, a 27-question survey was designed and sent on-line to 167 BPU from the Group for Senology Studies. Completed surveys were considered from 33 BPU. Results. Only 9 of the BPU that responded were accredited by the SESPM. The most commonly used indicators were the following: use of standardised reporting guidelines in imaging diagnosis, patients with breast cancer treated by a multidisciplinary committee, determination of prognostic and predictive factors in invasive carcinoma, and specification of margin distance in the pathologic report. The most widely used indicators were those of the general process and pathology. Use of the indicators was more frequent in accredited than in non-accredited BPU. Only 8 of the 20 indicators were used by more than 70% of BPU for unit quality control and not only by the service creating them. Conclusions. The use of indicators for quality control is a widely used tool in the BPU responding to the survey. However, indicators are often only used in the service creating them and not for integral quality assessment of the BPU (AU)

Diagnosis of tuberculosis infection by tuberculin skin test and a whole-blood interferon-γ release assay in patients considered for anti-tumor necrosis factor-α therapy.

To assess the performance of QuantiFERON®-TB Gold in-Tube (QFT-GIT; Cellestis, Carnegie, Australia) and tuberculin skin test (TST) in patients with immune-mediated inflammatory diseases (IMID), before anti-tumor necrosis factor-α (TNF-α) therapy, and to compare the results with those from the healthy population. Three hundred fourteen subjects (214 with IMID and 100 controls) underwent simultaneous QFT-GIT and TST. QFT-GIT was positive in 21% of IMID patients and in 16% of controls (P = 0.29). Among IMID patients, 21% tested positive by QFT-GIT and 24%, by TST (P = 0.30). Positive QFT-GIT results were not affected by immunosuppressive therapy (odds ratio, 0.78; 95% confidence interval [CI], 0.36-1.68; P = 0.52). Agreement between both tests in those patients who tested positive by one of the tests was 50% (95% CI, 37.2-62.8). QFT-GIT is useful for identifying IMID patients requiring treatment of latent tuberculosis before anti-TNF therapy. However, given the poor agreement between TST and QFT-GIT, we advocate a strategy of simultaneous testing to optimize diagnostic sensitivity.