Epistaxis y dabigatrán, nuevo anticoagulante oral no antagonista de la vitamina K / Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant

Objetivo: Dabigatrán es un nuevo anticoagulante no antivitamina K con efecto antitrombina. Se le atribuyen menos efectos secundarios hemorrágicos, pero no presenta antídoto que revierta su función ni tiempos de coagulación específicos que lo monitoricen. Materiales y métodos: Estudio longitudinal observacional prospectivo anotando las características epidemiológicas, clínicas y terapéuticas más relevantes entre los sujetos tratados con dabigatrán que manifestaron epistaxis. Se compararon resultados frente a un grupo de casos de epistaxis bajo terapia anticoagulante con acenocumarol y otro de epistaxis en controles no anticoagulados. Resultados: Desde su inclusión en el Sistema Nacional de Salud hace casi 3 años dabigatrán ha hecho acudir a urgencias de nuestro centro a 19 sujetos por epistaxis, frente a 59 por acenocumarol y 144 no anticoagulados, con ingresos hospitalarios del 26, 28 y 14%, respectivamente. En 3 de los 5 ingresados tratados con dabigatrán se detectó insuficiencia renal, previamente no documentada. Precisaron transfusión de hemoderivados el 80% de los tratados con dabigatrán, 58% con acenocumarol y 23% no anticogulados, y procedimientos invasivos el 80, 35 y 21%, respectivamente. Aunque el riesgo hemorrágico fue menor para dabigatrán, la estancia hospitalaria fue mayor frente a acenocumarol, y este frente a no anticoagulados. Conclusiones: Dabigatrán ofrece menos casos severos de epistaxis que acenocumarol, pero resultan más difíciles de controlar y revertir (AU)

Objective: Dabigatran is a new non-vitamin K antagonist (VKA) anticoagulant with anti-thrombin action, with supposedly fewer haemorrhagic complications. However, there are actually no established agents to reverse its effect, nor specific coagulation time tests for monitoring it. Materials and methods: An observational prospective study was developed, noting epidemiological, clinical and therapeutic features among subjects with epistaxis treated with dabigatran. Results were compared with a group of epistaxis cases of individuals under anticoagulant therapy with VKA (acenocoumarol) and a control group without anticoagulation. Results: Since its inclusion in our health system almost 3 years ago, 19 patients with epistaxis and concomitant use of dabigatran have been attended at the Emergency Unit in our hospital, as against 59 under VKA therapy and 144 without anticoagulation, with a mean admittance rate of 26%, 28% and 14%, respectively. In 3 out of 5 individuals admitted due to dabigatran treatment, previously unobserved renal failure was detected. Blood transfusion was needed in 80% of patients using dabigatran, 58% using VKA and 23% without anticoagulation. Invasive procedures to control nosebleed were required in 80%, 35% and 21%, respectively. Although haemorrhagic risk was lower in dabigatran cases, they showed the longest stay in the hospital when compared to the other groups (AU)

Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant.

OBJECTIVE: Dabigatran is a new non-vitamin K antagonist (VKA) anticoagulant with anti-thrombin action, with supposedly fewer haemorrhagic complications. However, there are actually no established agents to reverse its effect, nor specific coagulation time tests for monitoring it. MATERIALS AND METHODS: An observational prospective study was developed, noting epidemiological, clinical and therapeutic features among subjects with epistaxis treated with dabigatran. Results were compared with a group of epistaxis cases of individuals under anticoagulant therapy with VKA (acenocoumarol) and a control group without anticoagulation. RESULTS: Since its inclusion in our health system almost 3 years ago, 19 patients with epistaxis and concomitant use of dabigatran have been attended at the Emergency Unit in our hospital, as against 59 under VKA therapy and 144 without anticoagulation, with a mean admittance rate of 26%, 28% and 14%, respectively. In 3 out of 5 individuals admitted due to dabigatran treatment, previously unobserved renal failure was detected. Blood transfusion was needed in 80% of patients using dabigatran, 58% using VKA and 23% without anticoagulation. Invasive procedures to control nosebleed were required in 80%, 35% and 21%, respectively. Although haemorrhagic risk was lower in dabigatran cases, they showed the longest stay in the hospital when compared to the other groups. CONCLUSIONS: With dabigatran, there are fewer cases of severe epistaxis than with acenocoumarol, but controlling them is more difficult.

Un caso de leishmaniasis laríngea / Laryngeal leishmaniasis. A case report

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Linfadenitis cervical debida a granuloma de silicona tras implantes mamarios / Neck lymphadenitis due to silicone granuloma after mammary implants

Introducción: La reacción a cuerpo extraño producida por la silicona donde se infiltra o en los territorios donde migra se conoce como siliconoma. Su empleo en las técnicas de aumento de pecho puede generar esta reacción en niveles cervicales si la cápsula del implante se rompe. Métodos: Se han revisado los casos que consultaron por adenopatías cervicales de tamaño elevado en pacientes previamente sometidos a cirugía plástica de mama con geles cohesivos de silicona. Resultados: En 10 años han sido constatados 12 casos con adenopatías cervicales infiltradas por silicona, confirmados mediante punción-aspiración con aguja fina. Suponen el 3,5% de todos los pacientes atendidos para estudio de adenopatías cervicales. Fueron retiradas aquellas detectadas por exploración física y TC en 5 casos, bien por presentar características patológicas o por historial previo de malignidad. En 2 casos intervenidos los ganglios reaparecieron, mientras que en 2 de los 7 pacientes donde se decidió no actuar, el volumen de las adenopatías también aumentó. Tras retirar los implantes, solo se observaron fugas en 7 casos. Conclusiones: La silicona empleada en geles cohesivos para implantes mamarios es susceptible de generar como efecto secundario el aumento del volumen de los ganglios linfáticos del cuello debido a reacciones sistémicas frente a la misma cuando migra. Las alternativas quirúrgicas de las adenopatías afectadas no suelen ofrecer buenos resultados a largo plazo (AU)

Introduction: A foreign body reaction due to silicone where it is infiltrated or at the places to which it can migrate is known as siliconoma. The use of silicone in breast augmentation procedures can provoke this reaction at the neck level in cases of leakage from mammary implants. Methods: We reviewed the cases of patients with increased size neck lymph nodes who had previously undergone plastic surgery of the breast with highly cohesive silicone gel implants. Results: In a 10-year period, we identified 12 cases with silicone-infiltrated neck lymphadenopathies, histologically confirmed by fine needle aspiration. They represented 3.5% of patients attended for neck lymph node study. We removed those detected by physical examination and CT in 5 cases, due to pathological characteristics of the node or a previous malignant history. In 2 of these nodes recurred, and node size also increased in 2 of the other 7 non-operated cases. After implant removal, silicone leakage was observed in only 7 cases. Conclusions: Cohesive gel silicone used for mammary implants can generate increased neck lymphadenopathies as a secondary effect due to systemic reactions against the silicone when it migrates in cases of implant failure. Surgical options for involved nodes usually do not offer good long-term results (AU)

Neck lymphadenitis due to silicone granuloma after mammary implants.

INTRODUCTION: A foreign body reaction due to silicone where it is infiltrated or at the places to which it can migrate is known as siliconoma. The use of silicone in breast augmentation procedures can provoke this reaction at the neck level in cases of leakage from mammary implants. METHODS: We reviewed the cases of patients with increased size neck lymph nodes who had previously undergone plastic surgery of the breast with highly cohesive silicone gel implants. RESULTS: In a 10-year period, we identified 12 cases with silicone-infiltrated neck lymphadenopathies, histologically confirmed by fine needle aspiration. They represented 3.5% of patients attended for neck lymph node study. We removed those detected by physical examination and CT in 5 cases, due to pathological characteristics of the node or a previous malignant history. In 2 of these nodes recurred, and node size also increased in 2 of the other 7 non-operated cases. After implant removal, silicone leakage was observed in only 7 cases. CONCLUSIONS: Cohesive gel silicone used for mammary implants can generate increased neck lymphadenopathies as a secondary effect due to systemic reactions against the silicone when it migrates in cases of implant failure. Surgical options for involved nodes usually do not offer good long-term results.