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.

Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis / Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis

Antecedentes: Hay escasa evidencia sobre el pronóstico de la tromboembolia venosa en pacientes sometidos a cirugía ortopédica y en pacientes que sufren un trauma no quirúrgico. Métodos: Utilizamos la base de datos RIETE (Registro Informatizado de pacientes con Enfermedad TromboEmbólica) para comparar el pronóstico del tromboembolismo venoso y el uso de tromboprofilaxis en pacientes sometidos a diferentes procedimientos ortopédicos y en pacientes con traumatismo que no requiere cirugía. Resultados: Desde marzo de 2001 a marzo de 2015, se inscribieron un total de 61.789 pacientes en RIETE. De estos, 943 (1.52%) desarrollaron tromboembolismo venoso después de artroplastia electiva, 445 (0.72%) después de fractura de cadera, 1.045 (1.69%) después de cirugía ortopédica no mayor y 2,136 (3.46%) después de trauma no quirúrgico. En general, 2.283 pacientes (50%) presentaron inicialmente embolia pulmonar. En los primeros 90 días de tratamiento, 30 pacientes (0.66%, IC 95% 0.45-0.93) murieron por embolia pulmonar. La tasa de embolia pulmonar fatal fue significativamente mayor después de cirugía de fractura de cadera (n = 9 [2.02%]) que después de la artroplastia electiva (n = 5 [0.53%]), cirugía ortopédica no mayor (n = 5 [0.48%]) o traumatismo no quirúrgico (n = 11 [0,48%]). La tromboprofilaxis se utilizó con mayor frecuencia para la fractura de cadera (93%) o la artroplastia electiva (94%) que para la cirugía ortopédica no mayor (71%) o traumatismo no quirúrgico (32%). La hemorragia mayor fue significativamente mayor después de la cirugía de fractura de cadera (4%) que después de artroplastia electiva (1,6%), cirugía ortopédica no mayor (1,5%) o traumatismo no quirúrgico (1,4%). Conclusiones: La tromboprofilaxis se utilizó con menos frecuencia en los procedimientos de menor riesgo a pesar del número absoluto de embolia pulmonar fatal después de cirugía ortopédica no mayor o traumatismo no quirúrgico, excedieron los observados después de procedimientos de alto riesgo

Background: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. Methods: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. Results: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). Conclusions: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures

Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis. / Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis.

BACKGROUND: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. METHODS: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. RESULTS: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). CONCLUSIONS: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures.

Los estudios prospectivos de pacientes consecutivos con enfermedad tromboembólica venosa no identifican a todos los pacientes en riesgo. Análisis multicéntrico ambispectivo del grupo Contaminatep / Prospective studies of consecutive patients with venous thromboembolic disease fail to identify all patients at risk. Multicenter, ambispective analysis of the Contaminatep Group

INTRODUCCIÓN: nuestro grupo ha comenzado un trabajo para estudiar la relación entre la incidencia de TEP y la contaminación ambiental. Para establecer una relación, es una condición metodológica fundamental contar con todos los casos incidentes en un periodo de tiempo. Por este motivo diseñamos este estudio, para valorar la eficacia de recogida de pacientes consecutivos con TEP. MATERIAL Y MÉTODOS: realizamos un estudio ambispectivo, multicéntrico, de un año de duración. En una primera fase se incluyeron prospectivamente todos los casos que ingresaron con diagnóstico de TEP y posteriormente, de forma retrospectiva, realizamos una revisión de los registros hospitalarios de cada uno de los centros participantes. Así, calculamos la eficacia dividiendo el número de casos incidentes en fase prospectiva por el número total de casos reclutados en ambas fases. RESULTADOS: desde febrero 2012 a febrero 2013 se reclutaron 839 pacientes (440 prospectivamente). El reclutamiento prospectivo presentó una eficacia de detección de TEP del 52,4%, mostrando variabilidad según el centro (29,3 - 100%). Cuando analizamos sólo a los pacientes con TEP agudo sintomático idiopático, la eficacia fue del 59,8 %, con variabilidad según centro (31,7 - 100%). La eficacia de reclutamiento de pacientes con TEP secundario o idiopático fue de 42,1% vs. 59,8%, respectivamente (p < 0,001). CONCLUSIONES: en los estudios prospectivos, el porcentaje de pacientes no diagnosticados no es desdeñable. Los resultados de este estudio nos deben hacer pensar en estrategias adicionales para reclutar pacientes consecutivos de forma correcta, principalmente en aquellos estudios donde la pérdida de pacientes supondría un sesgo a la hora de emitir conclusiones

INTRODUCTION: we are studying the relationship between the incidence of pulmonary embolism (PE) and air pollution, and all symptomatic PE were needed over a period of time to establish a relationship. For this reason we designed this study, to assess the efficacy of collection consecutive patients with PE. METHODS: ambispective, multicenter study, from February 2012 to February 2013. In the first phase, we included prospectively all cases admitted at the hospital with PE diagnosis, and in the second phase, we reviewed retrospectively, hospital records from each participating center. So, we calculate the efficacy by dividing the number of incident cases in prospective phase by the total number of cases recruited in both phases. RESULTS: during one year, 839 patients were recruited (440 prospectively). The prospective recruitment presented a PE efficacy detection of 52.4%, showing variability according to the center between 29.3 to 100%. When we analyzed only patients with idiopathic symptomatic PE, efficacy was 59.8%, with variability according to the center between 31.7 to 100%. The recruitment efficacy of patients with secondary or idiopathic PE was 42.1% vs. 59.8%, respectively (p < 0.001). CONCLUSIONS: A wide percentage of patients can pass up from prospectives studies. The results of this study try to make us think, that we need more strategies to get a good recruit of consecutive patients, especially in those studies where is essential collect all patients

Historia natural de la enfermedad tromboembólica venosa en el área mediterránea. Una revisión sistemática / Natural history of venous thromboembolism in patients from the Mediterranean region. A systematic review

Antecedentes: El pronóstico de las enfermedades cardiovasculares es mejor en los países mediterráneos que en otras partes del mundo. Se desconoce si estas diferencias también acontecen en la enfermedad tromboembólica venosa (ETV) Métodos: En las bases de datos Medline y EMBASE se revisaron los ensayos clínicos y estudios de cohortes de pacientes con ETV que habían recibido tratamiento anticoagulante durante 3 meses. Dos revisores extrajeron independientemente los datos de forma reglada. Se seleccionaron 24 estudios con un total de 7.225 pacientes incluidos (2.414 del área mediterránea y 4.811 de otras regiones). Resultados: Entre los pacientes del área mediterránea predominaban las mujeres, tenían mayor edad, y la ETV idiopática fue menos frecuente que en otras regiones del mundo. Comparados con otros países, los pacientes del área mediterránea presentaron más recidivas de trombosis venosa profunda (4,35% frente a 2,68%; odds ratio [OR]: 1,65; intervalo de confianza al 95% [IC95%]: 1,27-2,15), recidivas mortales de ETV (0,75% frente a 0,35%; OR: 2,11; IC95%: 1,09-4,12) y sangrado mortal (0,25% frente a 0,06%; OR: 3,99; IC95%: 1-16). En el área mediterránea el porcentaje de recidivas de ETV mortal fue del 12,8%, IC95%: 7,99-19,1 frente al 8,41%, IC95%: 5,15-12,9 en otras zonas del mundo. El porcentaje de hemorragias mortales fue del 11,3%, IC95%: 4,72-22,1 frente al 3,22%, IC95%: 0,83-8,53 en otras zonas geográficas. Conclusiones: Los pacientes con ETV del área mediterránea tienen una mayor mortalidad durante los 3 primeros meses de tratamiento imputable a una mayor incidencia de ETV recidivante y de hemorragias graves (AU)

Background: Patients with cardiovascular diseases living in the Mediterranean area have a better outcome than those in other parts of the world, but it is not known whether these differences also occur with venous thromboembolism (VTE). Methods: We searched the Medline and EMBASE databases to identify clinical trials and cohort studies of patients with VTE who had been treated with anticoagulant therapy for 3 months. Two reviewers independently extracted the data in a standardized manner. A total of 24 studies that included 7,225 patients (2,414 from the Mediterranean region and 4,811 from other regions) were analyzed. Results: The patients from the Mediterranean area were predominately women and older, and the idiopathic VTE was less frequent than in other regions. Compared with patients from other regions, patients from the Mediterranean region had an increased rate of recurrent deep vein thrombosis (4.35% vs. 2.68%; odds ratio [OR], 1.65; 95% confidence interval [95% CI] 1.27-2.15), fatal recurrent VTE (0.75% vs. 0.35%; OR, 2.11; 95% CI 1.09-4.12) and fatal bleeding (0.25% vs. 0.06%; odds ratio: 3.99; 95% CI 1.00-16.0). The case-fatality rate (CFR) for recurrent VTE was 12.8% (95% CI 7.99-19.1) in the Mediterranean region and 8.41% (5.15-12.9) in other areas. The CFR for major bleeding was 11.3% (95% CI 4.72-22.1) and 3.22% (95% CI 0.83-8.53), respectively. Conclusions: Compared to other regions, patients with VTE from the Mediterranean region have greater mortality during the first 3 months of treatment due to a greater incidence of recurrent VTE and severe hemorrhaging (AU)

Natural history of venous thromboembolism in patients from the Mediterranean region. A systematic review.

BACKGROUND: Patients with cardiovascular diseases living in the Mediterranean area have a better outcome than those in other parts of the world, but it is not known whether these differences also occur with venous thromboembolism (VTE). METHODS: We searched the Medline and EMBASE databases to identify clinical trials and cohort studies of patients with VTE who had been treated with anticoagulant therapy for 3 months. Two reviewers independently extracted the data in a standardized manner. A total of 24 studies that included 7,225 patients (2,414 from the Mediterranean region and 4,811 from other regions) were analyzed. RESULTS: The patients from the Mediterranean area were predominately women and older, and the idiopathic VTE was less frequent than in other regions. Compared with patients from other regions, patients from the Mediterranean region had an increased rate of recurrent deep vein thrombosis (4.35% vs. 2.68%; odds ratio [OR], 1.65; 95% confidence interval [95% CI] 1.27-2.15), fatal recurrent VTE (0.75% vs. 0.35%; OR, 2.11; 95% CI 1.09-4.12) and fatal bleeding (0.25% vs. 0.06%; odds ratio: 3.99; 95% CI 1.00-16.0). The case-fatality rate (CFR) for recurrent VTE was 12.8% (95% CI 7.99-19.1) in the Mediterranean region and 8.41% (5.15-12.9) in other areas. The CFR for major bleeding was 11.3% (95% CI 4.72-22.1) and 3.22% (95% CI 0.83-8.53), respectively. CONCLUSIONS: Compared to other regions, patients with VTE from the Mediterranean region have greater mortality during the first 3 months of treatment due to a greater incidence of recurrent VTE and severe hemorrhaging.

[Risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge]. / Riesgo de enfermedad tromboembólica y estudio de utilización de tromboprofilaxis en pacientes médicos hospitalizados y al alta hospitalaria.

INTRODUCTION: The aim of this study is to establish the risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge, and their concordance with protocols used in our hospital. MATERIAL AND METHODS: We performed a cross-sectional with prospective follow-up until hospital discharge. It included all medical patients in Internal Medicine, Pneumology and Oncology Departments. The patient's thromboembolic risk and type of thromboembolism prophylaxis indication during hospitalization and after discharge were determined. RESULTS: A total of 116 patients (52 in Internal Medicine Department, 35 in Pneumology Department and 29 in Oncology Department), with a mean age of 67 +/- 17 years (35 females; 81 males) were included. During hospitalization, 62.9% of the patients had a high risk of thromboembolic events, 3.4% a moderate risk, 23.3% low risk, and 10.3% had no risk. After discharge, these proportions were 35.6%, 3.8%, 24% and 34.6%, respectively. A total of 49.1% of the patients had an adequate indication of venous thromboembolism prophylaxis during the hospitalization and after discharge.

Riesgo de enfermedad tromboembólica y estudio de utilización de tromboprofilaxis en pacientes médicos hospitalizados y al alta hospitalaria / Risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge

Introducción. El objetivo de este estudio es conocer el riesgo de enfermedad tromboembólica venosa (ETV) en pacientes médicos durante su ingreso y al alta hospitalaria, y estudiar los hábitos de prescripción de tromboprofilaxis y su adecuación a los protocolos utilizados en nuestro medio. Material y método. Para ello se realizó un estudio transversal con seguimiento prospectivo hasta el alta hospitalaria. Se incluyeron pacientes médicos de los Servicios de Medicina Interna, Neumología y Oncología, en los que se determinó el grado de riesgo de ETV y el tipo de indicación de tromboprofilaxis durante el ingreso y al alta hospitalaria. Resultados. Se incluyeron 116 pacientes (52 en medicina interna, 35 en neumología y 29 en oncología), con una media de edad de 67 ± 17 años (35 mujeres; 81 hombres). En el ingreso el 62,9% tenían alto riesgo de ETV, el 3,4% moderado, el 23,3% bajo y el 10,3% no tenían riesgo. Al alta hospitalaria estos porcentajes fueron de 35,6; 3,8; 24 y 34,6%, respectivamente. La proporción de pacientes con prescripción adecuada a la indicación fue del 49,1%, tanto durante el ingreso como al alta hospitalaria (AU)

Introduction. The aim of this study is to establish the risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge, and their concordance with protocols used in our hospital. Material and methods. We performed a cross-sectional with prospective follow-up until hospital discharge. It included all medical patients in Internal Medicine, Pneumology and Oncology Departments. The patient's thromboembolic risk and type of thromboembolism prophylaxis indication during hospitalization and after discharge were determined. Results. A total of 116 patients (52 in Internal Medicine Department, 35 in Pneumology Department and 29 in Oncology Department), with a mean age of 67 ± 17 years (35 females; 81 males) were included. During hospitalization, 62.9% of the patients had a high risk of thromboembolic events, 3.4% a moderate risk, 23.3% low risk, and 10.3% had no risk. After discharge, these proportions were 35.6%, 3.8%, 24% and 34.6%, respectively. A total of 49.1% of the patients had an adequate indication of venous thromboembolism prophylaxis during the hospitalization and after discharge (AU)

Psicosis, alucinaciones visuales y deterioro de la función renal secundarias a la interacción gabapentina-morfina / Psychosis, visual hallucinations and worsening renal function due to a gabapentine-morphine interaction

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The influence of extreme body weight on clinical outcome of patients with venous thromboembolism: findings from a prospective registry (RIETE).

BACKGROUND: Data evaluating the safety of using weight-based dosing of low-molecular-weight heparin (LMWH) in either underweight or obese patients with venous thromboembolism (VTE) are limited. Thus, recommendations based on evidence from clinical trials might not be suitable for patients with extreme body weight. PATIENTS AND METHODS: Patients with objectively confirmed, symptomatic acute VTE are consecutively enrolled into the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry. For this analysis, data from patients in the following ranges of body weight were examined: <50, 50-100, and >100 kg. Patient characteristics, underlying conditions, treatment schedules and clinical outcomes during the first 15 days of treatment were compared. RESULTS: As of August 2004, 8845 patients with acute VTE were enrolled from 94 participating centers. Of these, 169 (1.9%) weighed <50 kg, 8382 (95%) weighed 50-100 kg and 294 (3.3%) weighed >100 kg. Patients weighing <50 kg were more commonly females, were taking non-steriodal antiinflammatory drugs (NSAIDs), and had severe underlying diseases more often than patients weighing 50-100 kg. Their incidence of overall bleeding complications was significantly higher than in patients weighing 50-100 kg (odds ratio 2.2; 95% CI: 1.2-4.0). Patients weighing >100 kg were younger, most commonly males, and had cancer less often than those weighing 50-100 kg. Incidences of recurrent VTE, fatal pulmonary embolism or major bleeding complications were similar in both groups. CONCLUSIONS: Patients with VTE weighing <50 kg have a significantly higher rate of bleeding complications. The clinical outcome of patients weighing over 100 kg was not significantly different from that in patients weighing 50-100 kg.

[Suicidal attempt with colchicine]. / Intento autolítico con colchicina.

Colchicine is an alkaloid that has been successfully used for a long time in the treatment of acute gout episodes. It's efficacy lies in its inhibition of inflammation cell migration and in the action of specific cytokines, as well as of the production of lactic acid and deposition of uric acid in affected tissues. Colchicine toxicity is rare but may entail highly negative consequences for health unless a rapid gastric decontamination with stomach lavage and active carbon is carried out, and adequate support measures are taken as wellas appropriate hydration and electrolyte replacement. We present the case of a patient who was admitted to hospital after ingesting colchicine with suicidal intention. Colchicine inhibits cell division, which explains its distinct toxicity stages. The lack of proportion existing between ingested dose and clinical impact may result from concomitant treatment with other drugs or from peculiarities in its metabolism.

Interleukin-1 receptor antagonist gene polymorphism and mortality in patients with severe sepsis.

This study aims to determine the influence of the polymorphism within the intron 2 of the interleukin-1 receptor antagonist gene (IL-1RN*) on the outcome of severe sepsis, and to assess its functional significance by correlating this polymorphism with the total production of interleukin-1 receptor antagonist (IL-1Ra) protein determined in stimulated peripheral blood mononuclear cells (PBMC). A group of 78 patients with severe sepsis (51 survivors and 27 nonsurvivors) was compared with a healthy control group of 130 blood donors, and 56 patients with uncomplicated pneumonia. We found a significant association between IL-1RN* polymorphism and survival. Thus, after adjusting for age and APACHE II score, multiple logistic regression analysis showed that patients homozygotes for the allele *2 had a 6.47-fold increased risk of death (95% CI 1.01--41.47, P = 0.04). Besides, compared with patients homozygous or heterozygous for the allele *1, IL-1RN*2 homozygotes produced significantly lower levels of IL-1Ra from their PBMC. Our results suggest that insufficient production of this cytokine might contribute, among other factors, to the higher mortality rate found in severe sepsis patients with the IL-1RN*2 homozygous genotype.

Intracellular glutathione deficiency is associated with enhanced nuclear factor-kappaB activation in older non-insulin dependent diabetic patients.

Diabetes mellitus may be associated with intracellular glutathione (GSH) deficiency. Since in vivo studies have shown that plasma intracellular GSH plays a key role in regulating the activation of nuclear factor kappaB (NF-kappaB), we have investigated the relationship between intracellular thiols (GSH, homocysteine, cysteine and cysteinyglycine) and NF-kappaB activity in the peripheral blood mononuclear cells (PBMC) of 63 elderly non-insulin dependent diabetes mellitus (NIDDM) patients (28 microalbuminurics and 35 normoalbuminurics) and 30 healthy age- and sex-matched subjects. In addition, we have measured plasma concentrations of these thiol compounds, serum concentrations of interleukin-6 (IL-6) and vascular cell adhesion molecule-1 (sVCAM-1), that are partly dependent on the NF-kappaB activation, as well as the serum levels of thiobarbituric acid reacting substances (TBARS), as index of lipid peroxidation. Diabetic patients with microalbuminuria (MAB) and normoalbuminuria had NF-kappaB activity 2.1- and 1.5-fold greater, respectively, than the control group. As compared to normoalbuminuric patients, patients with MAB had significantly higher levels of glycemia, plasma homocysteine, and serum concentrations of TBARS, IL-6 and sVCAM-1 (in all cases, p < 0.01), and significantly lower GSH content in the PBMC (p < 0.05). The intracellular GSH in PBMC correlated with NF-kappaB activation (r = -0.82; p < 0.0001), serum TBARS (r = -0.60; p < 0.001), and with fasting glycemia (r = -0.56; p < 0.001) in patients with MAB, whereas a weaker association between GSH levels in PBMC and NF-kappaB activation (r = -0.504, p < 0.001) was seen in patients without MAB. These results suggest that the decrease of intracellular GSH content in elderly NIDDM patients with MAB is strongly associated with enhanced NF-kappaB activation, which could contribute to the development of increased glomerular capillary permeability and its rapid progression.

[Coeliac disease in the adult]. / Enfermedad celiaca del adulto.

Coeliac disease can by defined as a chronic disease characterized by a typical mucosal lesion of the small intestine and an impaired nutrient absorption which improves on withdrawal of gluten from the diet. The prevalence rate has increased over the last decades and just 1/3 of cases are diagnosed in childhood. There is a striking association with class II histocompatibility antigens, HLA-DR3 and HLA-DQ2. Cellular immune response mediated by intraepithelial and lamina propria lymphocytes is the primary event in the small intestine damage. Up to 50% of adult coeliac patients don't present intestinal symptoms being more frequent subclinic forms. The immunological markers of coeliac disease are antigliadin, antireticulin and antiendomysial antibodies, being the last one the most specific. Mortality of coeliac patient is increased mainly for malignancies, being the most frequent the intestinal T lymphoma.

[Spectrum of the renal pathology in HIV infection: description of 85 autopsies and clinico-pathologic correlation]. / El espectro de la patología renal en la infección por el VIH: descripción de 85 autopsias y correlación clínico-patológica.

A descriptive cross-sectional study was conducted on the prevalence and histologic characteristics of renal lesions found in the autopsies of 85 patients with HIV infection: also, a retrospective analysis of clinico-biological characteristics in 56 of these patients in order to establish the factors associated with the histological findings. A total of 85 autopsies were made from 1985 to 1993; 50 autopsies (58.8%) showed renal changes: 23 (27%) infections, 13 (15.2%) acute tubular necrosis (ATN), 6 (7%) tumors, 5 (5.8%) intersticial nephritis (IN), 5 (5.8%) nephrocalcinosis (NC), 10 (11.7%) others. In an additional study: group IIc (n = 37, study group with nephropathy) had a higher incidence in the hepatitis B surface marker (HBsAg) than in group Ic (n = 19, control group, without nephropathy) (0 vs 10, p < 0.05). The presence of disseminated mycobacteriosis in the autopsy was significantly higher in the group with nephropathy than in the group without nephropathy (11 vs 1, p < 0.05). No consistent data were observed between the clinical diagnosis of nephropathy and autopsic findings. In summary, a high incidence of nephropathy was found in the autopsies of HIV infected patients, although it was not previously suspected. Renal lesions in autopsies of HIV infected patients had a tubular-intersticial predominance over glomerular lesions. The use of potentially nephrotoxic drugs, the presence of HBsAG, and some opportunist infections apparently influenced on the development of renal lesions among these patients.

[Kawasaki's syndrome in the adult and bilateral sacroiliitis]. / Síndrome de Kawasaki del adulto y sacroileítis bilateral.

We present the case of a 23 year old patient with Kawasaki syndrome which resolved without sequelae after salicylate treatment. An peculiar finding was that of typical symptoms and signs of bilateral sacroiliitis demonstrated by symmetrically increased articular uptake of technetium 99 diphosphonate. This sacroiliitis disappeared completely after resolution of the syndrome. HLA-B27 ag was negative. Articular affection in Kawasaki syndrome comprises pain and/or swelling of large and small peripheral joints. Acute sacroiliitis is a finding not previously described. We believe this to have been an isolated episode and not the onset of a chronic seronegative spondylarthritis.