[pulmonary thromboembolism in hospitalized patients during the period 1994-2000: an autopsy study]. / Tromboembolismo pulmonar en pacientes hospitalizados entre 1994-2000: serie de autopsia.

BACKGROUND: Pulmonary thromboembolism (PTE) has been for a long time a significant cause of morbidity and mortality in hospitalized patients. The utility of Low-Molecular Weight Heparins (LMWH) in these patients in the last decade of the XX century has decreased the incidence of this disease. We try to know if the massive useful of LMWH as thromboprophylasis is diminishing its incidence in autopsies. MATERIAL AND METHODS: Retrospective study of all the autopsies in adults in the Hospital Clínico San Carlos (Madrid) in a period of 6 years (from January 1994 to December 1999). There were reviewed those necropsies which had pathological data of pulmonary thromboembolism and several items were studied: anatomopathological, epidemiological, clinical and therapeutical. RESULTS: 483 necropsies were performed in this period; 40 (8.3%) had PE. Most of them were older than 50 years (85%) and the most important risk factors associated were bedridden, chronic cardiovascular diseases and malignant neoplasias. Only Pre-mortem diagnosis was only suspected in 5 patients (12.5%) and 15 of them (37.5%) had a fatal pulmonary embolism despite receipt of thromboprophylasis with LMWH. CONCLUSIONS: PTE is still an important cause of mortality in hospitalized patients. The increased of life expect, survival of chronic cardiovascular and malignant disease made PTE a frequent possibility situation in hospitalized patients. Receipt of LMWH as thromboprophylaxis is not always effective to avoid PTE.

[Solitary hepatic mass as initial manifestation of non-hodgkin lymphoma]. / Masa hepática única como forma de presentación de un linfoma no Hodgkin.

A 55 years-old woman was admitted to the hospital because fifteen days of malaise, right upper quadrant pain and fever. Physical exam revealed hepato-splenomaly and radiologic evaluation (abdominal ultrasonography and CT) showed a solid hepatic mass with several retroperitoneal lymphadenopathies. Through an hepatic fine needle aspiration biopsy and a bone marrow biopsy, the diagnosis of a high grade non-Hodgkin lymphoma was made. The histopathological study of a retroperitoneal lymphadenopathy surgical biopsy got the definitive diagnosis. This form of liver involvement (big solid hepatic mass) by lymphoma is not usual and when it is found, it's necessary to make a differential diagnosis with primary hepatic tumors, hepatic metastases and primary lymphoma of the liver.

Tromboembolismo pulmonar en pacientes hospitalizados entre 1994-2000: serie de autopsia / Pulmonary thromboembolism in hospitalized patients during the period 1994-2000: an autopsy study

Introducción: El tromboembolismo pulmonar (TEP) ha sido durante muchos años una causa muy importante de morbi-mortalidad en los pacientes hospitalizados. El empleo de forma profiláctica de Heparinas de Bajo Peso Molecular (HBPM) en pacientes ingresados en la última década del siglo XX parece haber disminuido de forma significativa su incidencia clínica. Pretendemos ver si el empleo de HBPM como medida de tromboprofilaxis ha modificado el hallazgo de esta patología en autopsias. Material y métodos: Estudio retrospectivo de todas las autopsias realizadas en adultos en el Hospital Clínico San Carlos (Madrid) en un periodo de 6 años (Enero 1994-Diciembre 1999). Se incluyeron en el estudio todas aquellas que presentaron hallazgos anatomopatológicos (AP) de TEP y se rellenó un protocolo en el que se incluyeron datos AP, datos epidemiológicos, clínicos y terapéuticos. Resultados: En el periodo estudiado se realizaron 483 necropsias, de las cuales 40 (8,3%) tenían datos de TEP. La mayor parte de ellos tenían más de 50 años (85%) y entre los factores de riesgo destacaron el reposo-encamamiento, la enfermedad crónica médica y la presencia de tumores malignos (adenocarcinomas). Sólo se sospechó el diagnóstico pre-mortem en 5 (12,5 %) y 15 (37,5 %) desarrollaron la ETE a pesar de haber recibido tratamiento profiláctico con HBPM. Conclusiones: El TEP continúa siendo una causa muy importante de mortalidad de los pacientes ingresados en el hospital. El aumento de la esperanza de vida, de la supervivencia de enfermedades crónicas médicas y tumorales determina que hay que tener muy en cuenta esta patología. El empleo de una HBPM como profilaxis no excluye la posibilidad de esta entidad

Background: Pulmonary thromboembolism (PTE) has been for a long time a significant cause of morbidity and mortality in hospitalized patients. The utility of Low-Molecular Weight Heparins (LMWH) in these patients in the last decade of the XX century has decreased the incidence of this disease. We try to know if the massive useful of LMWH as thromboprophylasis is diminishing its incidence in autopsies. Material y methods: Retrospective study of all the autopsies in adults in the Hospital Clínico San Carlos (Madrid) in a period of 6 years (from January 1994 to December 1999). There were reviewed those necropsies which had pathological data of pulmonary thromboembolism and several items were studied: anatomopathological, epidemiological, clinical and therapeutical. Results: 483 necropsies were performed in this period; 40 (8.3%) had PE. Most of them were older than 50 years (85%) and the most important risk factors associated were bedridden, chronic cardiovascular diseases and malignant neoplasias. Only Pre-mortem diagnosis was only suspected in 5 patients (12.5%) and 15 of them (37.5%) had a fatal pulmonary embolism despite receipt of thromboprophylasis with LMWH. Conclusions: PTE is still an important cause of mortality in hospitalized patients. The increased of life expect, survival of chronic cardiovascular and malignant disease made PTE a frequent possibility situation in hospitalized patients. Receipt of LMWH as thromboprophylaxis is not always effective to avoid PTE

Neumonitis intersticial como única manifestación clínica en paciente con esclerosis sistémica sin esclerodermia / Interstitial pneumonitis as a clinical manifestation

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Dolor glúteo en mujer joven / Gluteal pain in a young female

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Déficit adquirido del factor VIII / Adquired factor VIII inhibitor

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Disfonía de tres años de evolución en mujer de 64 años / Three-year disphonia in a 64-year old woman

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Masa hepática única como forma de presentación de un linfoma no Hodgkin / Solitary hepatic mass as initial manifestation of a non-Hodgkin lymphoma

Una mujer de 55 años acudió por un cuadro constitucional de 15 días de evolución junto con dolor en hipocondrio derecho a lo que se añadió el día previo al ingreso fiebre. En la exploración física destacaba hepatoesplenomegalia y en las pruebas de imagen se constató la existencia de una masa hepática sólida y adenopatías retroperitoneales. La realización de una punción-aspiración con aguja fina de la masa hepática y una biopsia de médula ósea demostró la existencia de un linfoma no Hodgkin de alto grado que se confirmó posteriomente con el estudio histopatológico de una adenopatía resecada. Esta forma de afectación hepática (masa única de gran tamaño) en los linfomas es poco frecuente y puede plantear el diagnóstico diferencial con tumores primarios hepáticos, metastásicos o incluso con el linfoma hepático primario (AU)