Síndrome de Klippel-Trenaunay en la gestación: a propósito de un caso y revisión de literatura reciente / Klippel-Trenaunay syndrome in pregnancy: A clinical case and review of recent literature

El síndrome de Klippel-Trenaunay es una entidad infrecuente que asocia riesgos, principalmente hemorrágicos y tromboembólicos. Dada la baja incidencia de este síndrome, existe escasa literatura relativa a su manejo obstétrico. Presentamos una revisión de la literatura reciente a propósito de un caso, con el objetivo de sintetizar el manejo obstétrico en pacientes con síndrome de Klippel-Trenaunay. Ante una gestante con esta patología deberá plantearse un manejo multidisciplinar que incluya obstetras, hematólogos y anestesistas, principalmente. Será de gran importancia la realización de estudios de imagen, sobre todo en el tercer trimestre, que ayuden a determinar la vía del parto. Dado el riesgo incrementado de eventos trombóticos, está indicado el uso de medidas profilácticas durante el embarazo y el puerperio en estas pacientes. La evidencia relativa al incremento de complicaciones hemorrágicas en estas pacientes no es tan concluyente; sin embargo, es una complicación que deberemos tener en cuenta para instaurar las medidas terapéuticas necesarias.(AU)

Klippel-Trenaunay syndrome is a rare entity with associated risks, mainly haemorrhagic and thromboembolic. Given the low incidence of this syndrome, there is little evidence on its obstetric management. We present a review of the recent literature about a case, with the aim of synthesizing the obstetric management of patients with Klippel-Trenaunay syndrome. In the case of a pregnant woman with this pathology, multidisciplinary management should be considered, which would mainly include obstetricians, haematologists, and anaesthesiologists. It is very important to perform imaging studies, especially in the third trimester, to help determine the delivery route. Given the increased risk of thrombotic events, the use of prophylactic measures during pregnancy and the puerperium is indicated. The evidence regarding the increase in bleeding complications in these patients is not so conclusive, however it is a complication that we must take into account to establish the necessary therapeutic measures.(AU)

A rare case of plastic bronchitis following bronchial thermoplasty

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Infiltrados pulmonares bilaterales en paciente con inmunodeficiencia común variable / No disponible

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Absceso pulmonar con eosinofilia y aumento de IgE / No disponible

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Eficacia diagnóstica de los complejos trombina-antitrombina III y dímero D ELISA rápido en el embolismo pulmonar: efecto de la anticoagulación con heparina / Diagnostic and capacity of the thrombin-antithrombin III and rapid D dimer ELISA in pulmonary embolism: effect of anticoagulation with heparina

Hemos evaluado la eficacia de los complejos trombina-antitrombina III por ELISA (TAT) y dímero D ELISA rápido (DD-VIDAS) en el diagnóstico del embolismo pulmonar (EP). También se analizó el efecto que sobre la eficacia diagnóstica de TAT y DD-VIDAS puede tener el inicio del tratamiento con heparina previo a la toma de la muestra. El estudio incluye a 52 pacientes consecutivos con sospecha clínica de EP. El diagnóstico de confirmación de EP o exclusión de EP se realizó según la impresión clínica y resultados de la gammagrafía pulmonar, estudio de miembros inferiores y arteriografía pulmonar. En todos los pacientes, antes de transcurridas 24 horas desde la sospecha de EP, se obtuvo una muestra de plasma para determinar TAT y DD-VIDAS. En cada caso se registró el inicio o no del tratamiento anticoagulante con heparina previo a la toma de la muestra. En 24 pacientes se confirmó EP (46%) y en 28 se excluyó (54%). Con un punto de corte de 500 ng/ml el DD-VIDAS mostró una sensibilidad del 96%, especificidad del 53%, valor predictivo positivo del 63% y valor predictivo negativo del 93%, observándose un solo falso negativo. Para los TAT con un nivel de corte de 4 ng/ml la sensibilidad fue del 79%, la especificidad del 50%, el valor predictivo positivo del 57% y el valor predictivo negativo del 73%, presentando 5 falsos negativos. La anticoagulación previa a la toma de la muestra estaba presente en 4 de los 5 falsos negativos observados para los TAT y en el único caso falso negativo para el DD-VIDAS. En conclusión, de las dos técnicas estudiadas, DD-VIDAS y TAT, el DD-VIDAS con un punto de corte de 500 ng/ml parece potencialmente útil para excluir EP en nuestro medio, aunque es necesario ampliar la serie para confirmar estos resultados. Los TAT mostraron escasa utilidad en el diagnóstico de exclusión de EP. El inicio de la anticoagulación con heparina previo a la toma de la muestra parece un factor decisivo que puede afectar a los resultados obtenidos con los TAT (AU)

We have evaluated the efficacy of the thrombin-antithrombin III complexes by ELISA (TAT) and rapid D dimer (VIDASDD) in the diagnoses of pulmonary embolism (PD). The effect that the initiation of treatment with Heparin before the sample is obtained has on diagnostic efficacy of TAT and DD-VIDAS was also analyzed. The study includes 52 consecutive patients with clinical suspicion of PD. The confirmation diagnoses of PD or exclusion of PD was made according to a clinical impression and results on the pulmonary scintigraphy, study of the lower limbs and pulmonary arteriography. A sample of plasma was obtained in all of the patients within 24 hours from the suspicion of PD to determine TAT and VIDAS-DD. In every case, the initiation or not initiation of anticoagulant treatment with heparin prior to obtaining the sample was recorded. In 24 patients, PD (46%) was confirmed and it was excluded in 28 (54%). Using a cut off of 500 ng/ml, the VIDAS-DD showed a sensitivity of 96%, specificity of 53% and negative predictive value of 93%, only one false-negative being found. For the TAT with a cutoff of 4 ng/ml, sensitivity was 79%, specificity 50%, positive predictive value 57% and negative predictive value 73%, there being five false negatives. Anticoagulation prior to obtaining the sample was present in 4 of the 5 false negatives observed for TAT and in the only case of false-negative for VIDAS- DD. In conclusion, of the two techniques studied, VIDAS-DD and TAT, VIDAS-DD with a cutoff of 500 ng/ml seems to be potentially useful to exclude PD in our setting, although this series must be extended to confirm these results. The TAT showed little utility in the exclusion diagnosis of PD. Initiation of anticoagulation with heparin before the sample is obtained seems to be a decisive factor that may affect the results obtained with TAT (AU)

A bibliometric evaluation of European Union research of the respiratory system from 1987-1998.

This study analyses the evolution of the bibliometric indicators of productivity and repercussion of European Union (EU) research into the respiratory system during the period from 1987-1998, describing the geographical distribution. Using MedLine, a selection was made of those articles by EU authors published between 1987-1998 in 38 respiratory system journals (classification from the Institute for Scientific Information). The journals, country of origin, number of articles and the relation to socioeconomic data, productivity index, visibility index, expected impact factor (EIF) and relative impact factor (RIF) were all analysed. The number of EU publications in respiratory system journals experienced an exponential increase, going from 606 articles (14.3% of world production) in 1987, to 2,325 (33.2%) in 1998. During this same period, the EIF increased from 1,258 to 2,111. The greatest gross productivities were those of the UK, France, Italy and Germany, although when corrected for number of inhabitants, Sweden, the Netherlands, Belgium and Denmark headed the list. The countries with the greatest mean EIF were the Netherlands, the UK, Spain and Belgium. In conclusion, productivity and repercussions of European Union research of the respiratory system experienced an important increase during this period.

[Evolution of Spanish scientific production in international respiratory system journals from 1987 to 1998]. / Evolución de la producción científica española en revistas internacionales de sistema respiratorio de 1987 a 1998.

BACKGROUND: A relevant increase in the clinical relevance of respiratory system area has occurred in the last few years. The aims of this study were: to analyze the evolution of production and impact of Spanish scientific activity in the respiratory system area between 1987 to 1998; and to assess the participation of the different Spanish autonomic communities in this activity. METHODS: Papers published in 38 international journals of respiratory system during this period of time were selected by the MedLine system, delimiting Spanish production. Geographical and institutional distribution of the production, specialist of authors, main publication journals and type of publication were recorded. Production and impact bibliometric indicators were estimated. RESULTS: The number of Spanish documents from 1987 to 1998 multiplied by eight, reaching the 1.49% of the total published documents in 1998. However, the growth model of scientific production during this period was lineal. The increase in the scientific production was associated with a increase over time in the expected impact factor. In 1998, expected impact factor was 2. 206. Forty-two percent of the papers were signed by pneumologists. The highest contributor were hospitals. The most productive autonomous communities were Catalonia, Cantabria and Madrid. The communities with the highest expected impact factor were Balears and Catalonia. CONCLUSIONS: A relevant increase has occurred in the scientific production and impact of Spanish biomedical activity in respiratory system area.