Gaceta Medica de Bilbao最新文献

Pulmonary arteriovenous malformations are a rare clinical entity. Most are congenital and asymptomatic but some can cause dyspnea, hypoxemia, hemoptysis, and even more severe complications such as neurological and cardiovascular complications. Endovascular embolization with coils or detachable balloons has shown high therapeutic efficacy but is not exempt from possible complications due to distal migration of these devices. To avoid these adverse events, new devices have been designed with various mechanisms to prevent their migration. We report the case of a large solitary pulmonary arteriovenous malformation successfully treated with an Amplatzer^® device.

Vascular access for hemodialysis is of the utmost importance for all patients undergoing this dialysis technique, posing the need for all the specialists involved to coordinate in order to provide each patient with the best solution and possible alternatives (vascular surgery, angiologists, nephrology nurses). The present article evaluates the optimal type vascular access. The distinct approaches to the most common problems of vascular access in the predialysis and dialysis phases are analyzed, considering the three possibilities: arteriovenous fistula, prosthesis and venous catheter.

Streptococcus pyogenes, or group A Streptococcus, rarely causes bacterial meningitis in adults but has a high mortality rate if untreated. This bacterium has become more aggressive and shows greater invasive capacity, increasing the incidence and severity of infections. These observations have led to the hypothesis of a more virulent strain.

We report the case of a healthy 54-year-old woman with neck pain and rapid neurological and hemodynamic worsening despite appropriate antibiotic and corticosteroid treatment who died 5 hours after admission.

Background

To identify the resources that could improve the care of patients with advanced disease, the present study describes the sociodemographic characteristics of advanced cancer patients dying in a palliative care unit.

Method

We performed a retrospective study of oncology patients who died in a palliative care unit from January 2006 to December 2009. A descriptive analysis was conducted to compare the clinical and sociodemographic characteristics of advanced cancer patients, using measures of central tendency and frequencies.

Results

Of the total number of oncology patients, 443 died in the palliative care unit. The most frequent primary cancer site was the lung (20.5%), followed by the liver–pancreas (17.2%), and genitourinary apparatus (16.5%). The primary cancer diagnosis was significantly related to gender (χ² = 55.97, p < 0.00). The primary cancer diagnosis in younger patients was respiratory tumor. When gender was considered, men with a cancer diagnosis were significantly younger than women (Z = −2.19, p = 0.028). No significant differences in the length of admission were identified on comparing means according to the primary cancer diagnosis (χ² = 9.77, p = 0.36), gender (Z = −0.3, p = 0.76) or age groups (χ² = 5.29, p = 0.15).

Conclusions

Among patients with advanced cancer who died in the palliative care unit, significant demographic variables were gender and age.

Introduction

The CD40 ligand (CD40L) is a member of the tumor necrosis factor superfamily and plays an important role in the regulation of thymus-dependent humoral immunity and cell-mediated immune responses. This ligand is a 39 kDa, 261 amino acid (aa) glycoprotein that can form either homotrimers or undergo proteolytic cleavage to produce soluble forms of CD40 (i.e. 15-18 KDa). Elevated levels of soluble CD40L (sCD40L) have been observed in the sera of patients with systemic lupus erythematosus, chronic lymphocytic leukemia and unstable angina. Enhanced levels of both soluble and membrane-bound CD40L in angina patients suggest that CD40L plays a pathogenic role in the atherosclerotic process and in promoting acute coronary syndromes (ACS).

Material and methods

We analyzed serum sCD40L levels in 56 patients with ACS (aged 54.4 ± 13.4 years) from the internal medicine department of our hospital compared with levels in 22 healthy controls (aged 43 ± 8 years). To measure sCD40 we used the Quantikine CD40 ligand immunoassay, a solid-phase ELISA designed to measure human CD40 in serum using E. coli-expressed recombinant human CD40. For comparison purposes, troponin T data was measured in patients with ACS. These data were obtained by a chemiluminescent method using the Elecsys 2100 Roche Diagnostics analyzer.

Results

Mean values of CD40L were significantly higher in healthy controls (546.7 ± 64.7 pg/mL) than in ACS patients: 1,048 ± 157 pg/mL (p < 0.05). The comparison study between troponin T and CD40L generated the following regression equation: Troponin T = 1.48 * CD40L - 0.004.

Discussion

The proinflammatory and procoagulant protein CD40L represents a novel target in the treatment of atherosclerosis and ACS. Currently, risk evaluation in patients with ACS can be carried out by troponin analysis. Although troponins are only markers of myocardial necrosis, sCD40L is a marker of platelet activation and unstable plaques and can thus be used to identify disease activity before the development of cardiac cell necrosis.

Objectives

The incidence of trigeminal neuralgia is 4-5 cases/100,000 inhabitants per year. This disorder causes substantial morbidity in affected individuals. Identifying the factors associated with optimal detection and treatment of this disorder is essential. In this article, we describe our experience with trigeminal neuralgia in a 10-year period.

Methods

Our hospital database was searched and patients who were treated with radiofrequency thermo-coagulation from 1-1-2000 to 12-31-2009 were included in the analysis. Sixty-nine patients were identified, who underwent a total of 85 procedures.

Results

The mean age of patients was 66.83 years. We found that 7.25% of the patients had detectable alterations on magnetic resonance imaging. After treatment, 96.47% of patients reported immediate relief. In the long-term follow-up, 62.3% of patients were discharged and were symptom free.

Conclusions

In our study, gender, age and pain location were similar to those reported in the literature. In our series, there was no post-operative mortality. Postoperative complications were slightly lower than reported in the literature but this finding may be due to the retrospective nature of our study. Careful clinical investigation and imaging remain essential to trigeminal neuralgia diagnosis. Radiofrequency thermo-coagulation is a safe and effective treatment for patients with this disorder.