RESUMEN
The object of the present investigation was to identify those who, among high-risk patients, would "break through" low-dose heparin prophylaxis and develop thromboembolism after major abdominal surgery. Twenty-nine variables (clinical characteristics, pre- and postoperative coagulation and fibrinolytic factors) from 19 patients with and 26 patients without thromboembolism were analyzed by means of a multivariate supervised pattern recognition technique (SIMCA). We found no statistically significant difference between patients with and without thromboembolism. Thus, in the studied group of high-risk patients it was not possible to identify a predictive index for selection of individual patients liable to develop postoperative thromboembolism despite low-dose heparin prophylaxis in major abdominal surgery.
Asunto(s)
Abdomen/cirugía , Heparina/administración & dosificación , Tromboembolia/etiología , Adulto , Factores de Edad , Anciano , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Recuento de Plaquetas , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Riesgo , Serotonina/sangre , Tromboembolia/sangre , Tromboembolia/prevención & control , Reacción a la Transfusión , Equilibrio Hidroelectrolítico , beta-Tromboglobulina/metabolismoRESUMEN
We evaluated a diagnostic strategy by studying 481 patients suspected of having had an acute myocardial infarction; the prevalence of infarction by independent criteria was 0.43. This strategy is based on the sequential application of: (a) clinical criteria; (b) total creatine kinase determinations in two serum samples drawn within 10 to 20 h of the onset of acute symptoms; and (c) creatine kinase B-subunit (S-CK B) determinations after immunoinhibition with antibodies to creatine kinase M-subunit in the reaction medium in all samples found to have increased total creatine kinase activity. Discrimination limits of 150 U/L total creatine kinase for women and 200 U/L for men gave a diagnostic sensitivity of 0.99. Activities less than these limits in samples identified 68% of the 274 non-infarct cases (posterior probability of a negative result of 0.99) within 20 h. Subsequent determination of S-CK B in 292 patients who were positive by the discrimination limits for total creatine kinase verified myocardial infarction in 99% of 207 cases for which S-CK B exceeded the discrimination limit of 12 U/L. The strategy excluded 98% of all non-infarct cases at a posterior probability of 0.99.
Asunto(s)
Pruebas Enzimáticas Clínicas , Creatina Quinasa/sangre , Infarto del Miocardio/diagnóstico , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Humanos , Isoenzimas , L-Lactato Deshidrogenasa/sangre , Masculino , Factores Sexuales , Factores de TiempoRESUMEN
After the successful struggle against malaria, smallpox and tuberculosis, Chagas' disease must be considered the commonest and most serious scourge of the American continent. Experts assess the number of persons suffering from Chagas' disease at about 7 millions with about 35 millions at risk. The acute infection with Trypanosoma cruzi in the blood stream is found chiefly in children in the first few years of life but rarely in adults. Mortality in the acute phase is about 10%. The disease tends to run a chronic course. After an asymptomatic phase (usually 10--12 years), chronic Chagas' myocarditis dominates the chronic form. A great therapeutic advance has been achieved with the nitrofurfurylidene preparation Lampit. For the first time it has become possible to eliminate trypanosomes found in both blood and tissues. Success is particularly to be expected in the treatment of the acute infection.