Sonographic evolution of the superficial vein thrombosis of the lower extremity.

BACKGROUND: Superficial venous thrombosis (SVT) is a common clinical problem across various treatment settings. SVT shares risk factors with deep venous thrombosis (DVT) and carries a risk of thromboembolic complications, greater than previously expected. Little is known about the pathophysiology, resolution and recurrence of this disease. OBJECTIVES: The objective of the present study was to describe the natural course of SVT, and factors correlated with the progression or resolution of the thrombus. METHODS: We included 218 patients with a recent diagnosis of SVT that were consecutively referred to a thrombosis clinic from the Emergency Department (ED) between January 2016 and April of 2018. RESULTS: The resolution of the thrombus prior to discharge was correlated to gender (female 73.8% vs. male 57.5%, p = 0.015), presence of varicose veins (62.4% vs. 46.4, p = 0.026), absence of family or personal history of thrombosis (98% vs. 91.3%, p = 0.021). The factor most correlated to thrombus resolution prior to discharge was the result of the 2nd ultrasound (improvement 83.9% vs. 16.1%, p < 0.001) immediately after initiation of heparin treatment. In the multivariate analysis, a high thrombus burden in the early follow-up ultrasound was the most significant predictive variable with prior to discharge recanalization (B = 20.9, 95% CI 9.8-44.7; p < 0.001). CONCLUSION: The follow-up of SVT with duplex lower extremity ultrasound allows us to monitor the evolution and early identify residual thrombosis, as a marker of hypercoagulability and recurrence. This study offers new perspectives for future research, necessary to improve the management of this disease, to reduce long-term complications.

Reaffirmation of the importance of follow-up ultrasound studies in patients with high D-dimers and clinical suspicion of vein thrombosis.

BACKGROUND: Venous thromboembolism is a common disease seen in the emergency department and a cause of high morbidity and mortality, constituting a major health problem. OBJECTIVES: To assess the potential benefit of follow-up ultrasound of patients who attended the emergency department with suspected superficial venous thrombosis or deep venous thrombosis and were found to have an initial negative whole-leg (or arm) ultrasound study. METHODS: This retrospective study included patients aged 18 years or older who were consecutively referred to a thrombosis clinic from the emergency department, with abnormal D-dimer test and moderate to high pre-test probability of deep venous thrombosis (Well's score ≥ 1), but a negative whole-leg (or arm) ultrasound. Demographic characteristics, symptom duration, laboratory and ultrasound data were recorded. At one-week follow-up, an experienced physician repeated ultrasound, and recorded the findings. RESULTS: From January 2017 to April 2018, 54 patients were evaluated. The mean age was 66.8 years (SD 15.0) and 63% were women. The average D-dimer was 2159.9 (SD 3772.0) ng/mL. Ultrasound abnormalities were found in 12 patients (22.2%; 95% confidence interval of 12.5 to 36.0%), with 4 patients having proximal deep venous thrombosis, distal deep venous thrombosis in 2 patients and superficial venous thrombosis in 6 patients. We did not find any significant differences in demographic characteristics, venous thromboembolism risk factors or laboratory parameters between patients with negative and positive follow-up ultrasound. CONCLUSIONS: These preliminary findings suggest that a negative whole-leg (or arm) ultrasound in addition to an abnormal D-dimer in moderate to high deep venous thrombosis pretest probability patients, might be an insufficient diagnostic approach to exclude suspected deep venous thrombosis or superficial venous thrombosis. Confirmation of this higher than expected prevalence would support the need to repeat one-week ultrasound control in this population.

Kaposi sarcoma secondary to endogenous adrenocorticotropic hormone-dependent Cushing syndrome.

Kaposi sarcoma (KS) is an angioproliferative tumour that develops as a result of an infection by human herpesvirus 8, which is considered a necessary cause but not sufficient. Other factors - genetic, immunological and environmental - might play a role in the development of the disease. We report a case of KS secondary to endogenous Cushing syndrome (ECS) due to a pituitary adenoma, an association that has been reported only once. We also conducted a search through the Medline and PubMed databases for cases involving KS and ECS, finding only three additional cases that shared common clinical and prognostic features with ours. ECS might favour the development of KS due to immunosuppression. Dermatologists and other clinicians should be aware of this association, as it might be an underdiagnosed condition. It also has an important impact on the management of KS, and based on this review it relies on a good prognosis when ECS is well controlled.

Dolor abdominal y fiebre de dos meses de evolución / Abdominal pain and fever with two months of duration

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Tromboflebitis y neumonía en paciente VIH / Thrombophlebitis and pneumonia in HIV patient

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Antígeno CA-125 como marcador de tuberculosis peritoneal

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Isquemia de miembros inferiores en paciente con hepatitis por virus de la hepatitis C tratado con interferón alfa / Lower limb ischemia in a patient with HCV hepatitis treated with alpha-interferon

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¿Quién debe tomar la presión arterial en la consulta? / Who should measure blood pressure in the clinic?

La toma de la presión arterial es una de las actividades más habituales en la consulta médica y de ella dependen el diagnóstico y evaluación terapéutica de la hipertensión arterial. La lectura de la presión arterial por un médico induce una reacción de alerta, caracterizada por un incremento transitorio de la presión arterial y la frecuencia cardíaca. Dicha respuesta presora, conocida como "efecto de bata blanca", se produce también cuando una enfermera realiza la medición, pero su intensidad y duración es considerablemente inferior a la inducida por el médico. El efecto de bata blanca no se reduce por la repetición de visitas al mismo médico, al menos a corto plazo, aunque se ha sugerido (pero no demostrado) que un seguimiento más prolongado podría atenuarlo. La lectura de presión arterial por la enfermera se correlaciona más estrechamente con la presión ambulatoria diurna y varios marcadores de daño orgánico (masa del ventrículo izquierdo, microalbuminuria, etc.) que la efectuada por personal facultativo, por lo que representa mejor el perfil tensional del paciente fuera del centro sanitario, y potencialmente el daño en órganos diana. La lectura sistemática de la presión arterial por enfermeras podría evitar el diagnóstico de hipertensión de bata blanca en buen número de pacientes, en los que el inicio de un tratamiento farmacológico no estaría probablemente justificado. Los argumentos expuestos avalan la conveniencia de que sea el personal de enfermería (en lugar del médico) quien efectúe de modo rutinario la toma de presión en la consulta (AU)

Criterios terapéuticos ante la hiperuricemia / Therapeutic criteria in hyperuricemia

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Aterosclerosis e infección

La aterosclerosis es la principal causa de mortalidad en los países desarrollados y representa el 20 por ciento de la mortalidad global en el mundo. En los últimos años la investigación se ha centrado en aspectos etiopatogénicos encaminados a comprender mejor el fenómeno aterosclerótico y a encontrar posibles nuevas dianas terapéuticas. Paralelamente al desarrollo de la teoría de la inflamación se han encontrado diferentes asociaciones entre aterosclerosis y determinadas infecciones.En este trabajo se analizan las diferentes evidencias en favor y en contra de la asociación aterosclerosis e infección por medio de estudios seroepidemiológicos, patológicos, modelos animales y ensayos de intervención terapéutica (AU)

Un paciente con hiperuricemia

La hiperuricemia puede dar lugar o no a patología clínica, esencialmente articular y renal. En función de que La hiperuricemia es un trastorno metabólico que obliga a determinar su causa. La decisión de administrar un tratamiento hipouricemiante depende de la enfermedad de base y de su repercusión sistémica en cada individuo. El estudio de todo enfermo con una concentración sérica de uratos elevada debe ocuparse de los siguientes aspectos: a) diagnóstico fisiopatológico: sobreproducción y/o infraexcreción renal de ácido úrico; b) daño tisular; c) patologías asociadas, y d) tratamiento (AU)