Cardiac Relapse of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation.

Secondary or metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. Any tumor can cause myocardial or pericardial metastasis, although isolated or combined tumor invasion of the pericardium is more common. Types of neoplasia with the highest rates of cardiac or pericardial involvement are melanoma, lung cancer, and breast and mediastinal carcinomas. Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Initial treatment involves chemotherapy followed by consolidation treatment to reduce the risk of relapse. In high-risk patients, the treatment of choice for consolidation is hematopoietic stem cell transplantation (HSCT). Relapse of AML is the most common cause of HSCT failure. Extramedullary relapse is rare. The organs most frequently affected, called "sanctuaries," are the testes, ovaries, and central nervous system. We present a case with extramedullary relapse in the form of a solid cardiac mass.

Dying of hematologic patients--treatment characteristics in a German University Hospital.

The treatment of hematologic patients in palliative situations remains a major challenge as there are special clinical needs, e.g., transfusions and the high risk for infectious complications with subsequent use of broad anti-infective treatment. Furthermore, most hematologic patients have a relatively long history of disease and are acquainted with "their" wards; that is why most are treated on these hematologic and not on specialized palliative wards. The standardized approach to the care of hematologic patients with curative treatment intention is probably not fully appropriate for palliative patients. In order to evaluate the current situation of treatment characteristics in a German university hospital, we retrospectively evaluated the medical documentation of all patients who died on a hematologic ward between 2005 and 2008. While we found a high number of chemotherapeutic, anti-infective, analgesic, and sedative treatments, of transfusions, of treatment on the intensive care units, and of invasive nature, non-somatic interventions were rather scarce. Symptom control, e.g., for bleeding events or pain, was frequently not adequately achieved. With regard to the palliative situation, a holistic approach with the maintenance of patients' autonomy and the preference for dying at home, the treatment of hematologic patients in a palliative situation has to be reconsidered.

Torsade de pointes por QT largo y silla turca vacía / Torsade de pointes with a long-QT interval and an empty sella turcica

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Síndrome coronario agudo y cocaína / Acute coronary syndrome and cocaine

Fundamento y objetivo: La cocaína está directamente relacionada con la aparición de síndrome coronario agudo (SCA). Analizamos las características diferenciales de los consumidores que presentan un SCA en nuestro medio. Material y métodos: Estudio retrospectivo de 914 pacientes con SCA que ingresaron de forma consecutiva en nuestro hospital. Resultados: Un total de 34 pacientes refirieron ser consumidores (3,7%, intervalo de confianza del 95% [IC del 95%], 2,7 5,2), con edad media (desviación estándar [DE]) de 40,1 (9,1) años, significativamente menor que en los no consumidores (63,6 [12,15] años; p<0,001). La prevalencia aumenta progresivamente en los grupos de menor edad. La mayoría son varones (82,4%), con mayor consumo de tabaco (el 88,2 frente al 34,2%; p<0,001) y de otras drogas ilegales (el 35,3 frente al 0,9%; p<0,001). Por el contrario, tienen con menos frecuencia hipertensión (el 26,5 frente al 60,5%; p<0,001) o diabetes (el 11,7 frente al 39,8%; p<0,001). Presentan enfermedad monovaso el 44,1% y coronariografía sin lesiones significativas el 20,6% de los casos. Conclusiones: El enfermo con SCA y consumidor de cocaína es generalmente un varón joven, que con frecuencia consume otras drogas y con una menor prevalencia de factores de riesgo clásico, datos a tener en cuenta a la hora de tomar medidas preventivas y terapéuticas (AU)

Background and objectives: Cocaine is directly related to the occurrence of acute coronary syndromes (ACS). We analyzed the differential characteristics of consumers who suffer an ACS in our environment. Material and methods: A retrospective study of 914 patients with ACS who entered consecutively to our hospital. Results: Thirty four patients were consumers (3.7%, CI95%: 2.7 5.2), with an average age of 40.1±9.1 years, significantly lower than non-consumers (63.6±12.15 years, P<.001). The prevalence increased progressively in younger groups. Most were men (82.4%), with higher consumption of tobacco (88.2% vs. 34.2%, P<.001) and other illegal drugs (35.3% vs 0.9%, P<.001). By contrast, they had less frequently hypertension (26.5 vs. 60.5%, P<.001) or diabetes (11.7 vs. 39.8%, P<.001). There was single vessel disease in 44.1%, and a coronary angiography without significant lesions in 20.6% cases. Conclusions: The typical patient with ACS who consumes cocaine is usually a young man, who often takes other drugs and with a lower prevalence of classic risk factors. These data have to be taken into account when considering preventive and therapeutic manoeuvres (AU)

[Acute coronary syndrome and cocaine]. / Síndrome coronario agudo y cocaína.

BACKGROUND AND OBJECTIVES: Cocaine is directly related to the occurrence of acute coronary syndromes (ACS). We analyzed the differential characteristics of consumers who suffer an ACS in our environment. MATERIAL AND METHODS: A retrospective study of 914 patients with ACS who entered consecutively to our hospital. RESULTS: Thirty four patients were consumers (3.7%, CI95%: 2.7-5.2), with an average age of 40.1+/-9.1 years, significantly lower than non-consumers (63.6+/-12.15 years, P<.001). The prevalence increased progressively in younger groups. Most were men (82.4%), with higher consumption of tobacco (88.2% vs. 34.2%, P<.001) and other illegal drugs (35.3% vs 0.9%, P<.001). By contrast, they had less frequently hypertension (26.5 vs. 60.5%, P<.001) or diabetes (11.7 vs. 39.8%, P<.001). There was single vessel disease in 44.1%, and a coronary angiography without significant lesions in 20.6% cases. CONCLUSIONS: The typical patient with ACS who consumes cocaine is usually a young man, who often takes other drugs and with a lower prevalence of classic risk factors. These data have to be taken into account when considering preventive and therapeutic manoeuvres.

[Diagnostic usefulness of N-terminal brain natriuretic peptide in patients admitted to a cardiology service]. / Utilidad diagnóstica del fragmento N-terminal del propéptido natriurético cerebral en los pacientes ingresados en un servicio de cardiología.

BACKGROUND AND OBJECTIVE: The N-terminal brain natriuretic peptide (NT-proBNP) is a new tool for the diagnosis of patients with evidence of heart failure (HF). The diagnosis of HF is improbable in patients with a level of NT-proBNP<300 pg/ml. Our objective is to determine the validity of the cut-off points proposed by literature (inclusion/exclusion) regarding the age for NT-proBNP in patients admitted to our service. PATIENTS AND METHOD: We gathered consecutively the data of 76 patients admitted to our service with the diagnosis of HF (n=37) and with other diseases (n=39), taking a sample of plasma to determine NT-proBNP. We studied the sensitivity, specificity and predictive values of this test, as well as the relation between the levels of that marker and the clinical and echocardiographic variables. RESULTS: The ventricular diameter was larger and the ejection fraction was lower in patients with HF. Sensitivity for the diagnosis of exclusion reached a value of 97% and the negative predictive value was 94%. CONCLUSIONS: The cut-off point proposed for exclusion (300 pg/ml) shows high sensitivity and negative predictive value in the diagnosis of HF in patients admitted to our service.

Utilidad diagnóstica del fragmento N-terminal del propéptido natriurético cerebral en los pacientes ingresados en un servicio de cardiología / Diagnostic usefulness of N-terminal brain natriuretic peptide in patients admitted to a cardiology service

FUNDAMENTO Y OBJETIVO: El fragmento N-terminaldel propéptido natriurético cerebral o tipo B (NTproBNP)se utiliza para el diagnóstico de pacientescon sospecha de insuficiencia cardíaca (IC). Los valoresde NT-proBNP inferiores a 300 pg/ml indicanun diagnóstico improbable de IC. Nuestro objetivoha sido determinar la validez de los puntos de cortedel NT-proBNP según la edad, propuestos en la bibliografíamédica (inclusión/exclusión), en los pacientesingresados en nuestro servicio.PACIENTES Y MÉTODO: Hemos recogido de formaprospectiva los datos de 90 pacientes que ingresaronen nuestro servicio con diagnóstico de IC (n= 37) y de otras enfermedades (n = 39), y en quienesse determinó la concentración de NT-proBNP.Se estudiaron la sensibilidad, la especificidad y losvalores predictivos de este análisis, así como la relaciónde los valores de dicho marcador con las variablesclínicas y ecocardiográficas.RESULTADOS: En los pacientes con IC el diámetroventricular era mayor y la fracción de eyección,menor. La sensibilidad para el diagnóstico de exclusiónfue del 97% y el valor predictivo negativo,del 94%.CONCLUSIONES: El punto de corte de exclusión propuesto(300 pg/ml) posee una alta sensibilidad yvalor predictivo negativo para el diagnóstico de ICen los pacientes ingresados en nuestro servicio

BACKGROUND AND OBJECTIVE: The N-terminal brainnatriuretic peptide (NT-proBNP) is a new tool forthe diagnosis of patients with evidence of heart failure(HF). The diagnosis of HF is improbable in patientswith a level of NT-proBNP < 300 pg/ml. Ourobjective is to determine the validity of the cut-offpoints proposed by literature (inclusion/exclusion)regarding the age for NT-proBNP in patients admittedto our service.PATIENTS AND METHOD: We gathered consecutivelythe data of 76 patients admitted to our service withthe diagnosis of HF (n = 37) and with other diseases(n = 39), taking a sample of plasma to determineNT-proBNP. We studied the sensitivity, specificityand predictive values of this test, as well as the relationbetween the levels of that marker and the clinicaland echocardiographic variables.RESULTS: The ventricular diameter was larger andthe ejection fraction was lower in patients with HF.Sensitivity for the diagnosis of exclusion reached avalue of 97% and the negative predictive value was94%.CONCLUSIONS: The cut-off point proposed for exclusion(300 pg/ml) shows high sensitivity and negativepredictive value in the diagnosis of HF in patientsadmitted to our service