Risk for recurrence of symptomatic upper-extremity deep vein thrombosis in patients without cancer: Analysis of three RIETE cohorts.

BACKGROUND: The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. METHODS: We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. RESULTS: As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6). CONCLUSIONS: Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.

Manejo de la ascitis quilosa y revisión de la literatura / Management of chylous ascites and review of literature

Introducción: La ascitis quilosa es la acumulación de líquido linfático en la cavidad peritoneal. Se trata de una patología poco frecuente cuya causa puede ser traumática oatraumática, siendo la obstrucción por neoplasias abdominales la etiología más frecuente en adultos. No existe evidenciacientífica acerca de una terapia que resulte totalmente eficazen el tratamiento de esta patología. Objetivos: El objetivo fundamental de esta revisión esprofundizar, integrar, resumir y actualizar la información publicada sobre este tema, así como proporcionar informaciónútil y contrastada a otros compañeros para su aplicación en lapráctica clínica. Material y Métodos: Se realiza una revisión de la bibliografía empleando la base de datos PubMed, Medline y Sciencedirect con los descriptores “chylous ascitis” AND “diet”. Los filtros empleados fueron: humanos, últimos 5 años y lenguasespañola e inglesa. Se revisaron los artículos y se seleccionaron 12 trabajos. Resultados: Se describen las diferentes alternativas terapéuticas tanto dietéticas como el tratamiento intervencionista.Discusión: La ascitis quilosa supone un problema médicocomplejo por el potencial deterioro nutricional e inmunológico que genera. Revisada la literatura, existe poca evidenciacientífica sobre el tratamiento de elección en los pacientescon ascitis quilosa, aunque parece existir consenso de que ladieta es el tratamiento más simple y, habitualmente, el primero en implementarse. Debido a esta complejidad, es imprescindible la valoración del paciente por un equipo multidisciplinar y la actitud terapéutica elegida dependerá de lacausa de la ascitis, la situación clínica y la experiencia de losprofesionales sanitarios. Conclusiones: La terapia nutricional de la ascitis quilosase basa en una dieta baja en grasas suplementada con triglicéridos de cadena media y es el tratamiento de elección porsu alto porcentaje de eficacia.(AU)

Introduction: Chylous ascites is the accumulation oflymphatic fluid in the peritoneal cavity. It is a rare pathologyand it can be traumatic or no traumatic. The most commoncause of chylous ascites in adults is obstruction by abdominalneoplasms. There is insufficient evidence about an effectivetreatment. Objectives: The main objective of this review is to deepen, integrate, summarize and update the information published about this topic. Also, we want to provide to other healthprofessionals, a useful and verified information to applicate inclinical practice. Material and Methods: A literature review was made: PubMed, Medline and Science direct search using as descriptors “chylous ascites” AND “diet”. The following filters areused: human, last 5 years and Spanish/English languages.Articles were reviewed and 12 papers were selected. Results: We describe the dietary alternatives and the interventional treatment. Discussion: Chylous ascites is an important medical problem, because of the deterioration of immune system and nutritional parameters. Literature review was made and there isno scientific evidence about the treatment of choice in patients with chylous ascites. Diet is the simplest treatment andthe first to be implemented. A multidisciplinary team is important in the treatment of these patients. To choose the besttherapeutic attitude, we must know the cause, the clinical situation and the experience of health care workers. Conclusions: A lowfat diet supplemented with mediumchain triglycerides is the most efficacy treatment for chylousascites. There is no evidence about an effective treatment forthis pathology and most publications are clinical cases.Prospective, randomized studies are needed to get more evidence on the management of chylous ascites.(AU)

Hipocortisolismo hipofisario por sobrecarga férrica en un paciente conAnemia de Blackfan-Diamond / Pituitary hypocortisolism due to iron overload in a patient with Blackfan-Diamond anemia

Iron overload in the context of a Blackfan-Diamond anemia is a extremely uncommon cause of central adrenal insufficiency. We report apatient with Blackfan-Diamond anemia diagnosis during his childhood.Ten years later, as a consequence of iron overload caused by repeatedtransfusions, he developed central hypocortisolism. Blackfan-Diamondanemia is a hereditary syndrome characterized by erythroid aplasia,predisposition to hematologic and solid organ malignancies and congenital abnormalities.Endocrine complications of Blackfan-Diamond anemia are reported inthe literature and highly variable. Hypocortisolism is considered as anuncommon complication (0.7-4 %). Therefore, in a patient with repeated transfusions, we must considerer in a possible ACTH deficiency inthe context of hemochromatosis due to iron overload. (AU)

Las causas de insuficiencia adrenal de origen central son múltiples,siendo la sobrecarga férrica en el seno de una anemia de Blackfan-Diamond extremadamente infrecuente. Se presenta el caso de un pacientede 15 años diagnosticado de anemia de Blackfan-Diamond en la infancia que desarrolla hipocortisolismo de origen central como consecuencia de la sobrecarga férrica por transfusiones de repetición comotratamiento de soporte de la anemia. La anemia de Blackfan-Diamondes un síndrome hereditario caracterizado por una aplasia eritroide queconlleva un recuento reducido de glóbulos rojos, anomalías congénitasy predisposición a neoplasias hematológicas y de órganos sólidos. Laprevalencia de las complicaciones endocrinas reportadas en la literatura secundarias a esta patología es muy variable siendo el hipocortisolismo muy poco frecuente (0,7-4 %).Por ello, ante un paciente contransfusiones de repetición, debemos tener en cuenta el posible déficitde ACTH en en el contexto de una hemocromatosis por sobrecarga férrica. (AU)

Polineuropatía sensitiva desmielinizante asociada a anticuerpos anti-Yo y cáncer papilar de tiroides / Sensitive demyelinating neuropathy associated with anti-Yo antibodies and papillary thyroid cancer

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Factors influencing erythrocyte sedimentation rate in adults: New evidence for an old test.

The erythrocyte sedimentation rate (ESR) is a routine test for inflammation. Few studies have investigated the potential influence of lifestyle factors and common metabolic abnormalities on the ESR. This study investigates the influence of demographic factors, alcohol consumption, smoking, physical activity, obesity, and metabolic syndrome on the ESR in adults.This cross-sectional study covered 1472 individuals (44.5% males; age range, 18-91 years) randomly selected from the population of a Spanish municipality. The ESR was measured using a standardized method. We assessed habitual alcohol consumption in standard drinking units, along with tobacco smoking, regular physical exercise (by questionnaire), body mass index, and variables defining metabolic syndrome. Multivariate analyses were performed, including mean corpuscular volume and hemoglobin concentration in the models.The ESR was higher in females than in males, and increased steadily with age. Median ESR of females was 2-fold higher than that of males, and median ESR of individuals aged >65 years was 2-fold higher than that of individuals in the youngest category (ages 18-35 years). Body mass index, presence of metabolic syndrome, and smoking were independently and positively associated with higher ESR values. Light alcohol drinkers and individuals with high regular physical activity displayed lower ESR values than did alcohol abstainers and individuals with low physical activity, respectively.ESR varies greatly with age and sex, and corresponding reference values are proposed. Lifestyle factors (physical activity, smoking, and alcohol consumption) and common metabolic abnormalities (obesity and related metabolic syndrome) may also influence ESR values.