RESUMEN
Venous thromboembolic disease is the leading preventable cause of hospital mortality. Up to 75 percent of these are in non - surgical patients. This is a large, heterogeneous group of patients; so to know the risk factors for deep venous thrombosis crucial to provide a correct prevention. This article reviewed the indications, contraindications and complications of thromboprophylaxis. Difficult cases in elderly, obese, chronic kidney disease, critical care and cirrhotic patients were reviewed. The purpose of this article is to support decision making on dvt prevention in hospitalized medical patients...
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Hospitalización , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/prevención & control , Factores de RiesgoRESUMEN
The aim of this study is to evaluate the use of thromboprophylaxis in surgical oncology patients in HCUCH in 2011. Method: Retrospective analysis of patients with cancer undergoing surgery in 2011. Was defined as adequate pharmacological thromboprophylaxis the correct dose, mechanical prophylaxis in case of drug contraindications and beginning on day 0 or 1. Results: 131 medical records were reviewed. Main neoplasms were colorectal (21.3 percent), prostate (12.9 percent), gallbladder (8.3 percent) and stomach (6.9 percent). Of the patients requiring pharmacologic thromboprophylaxis (n = 110) were rated as adequate 52 patients (47 percent), 47 inadequate (43 percent) and 11 absent (10 percent). The causes of inappropriate use of pharmacological thromboprophylaxis included 27 late onset (58 percent), 10 lower doses (21 percent), 3 late onset associated with lower dose (6 percent), 6 incomplete thromboprophylaxis (13 percent) and 1 dose increased (2 percent). Factors significantly associated with pharmacological thromboprophylaxis absent were: <40 years of age (p = 0.002), head and neck cancer (p < 0.001), and hospital stay <7 days (p < 0.001). Conclusions: The absence of pharmacological thromboprophylaxis is associated with lower absolute risk factors for VTE: Age less than 40 years old, head and neck cancer, hospital stay less than 7 days...
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Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , ChileRESUMEN
Cancer is a disease that impairs health of those who suffer it, affecting their quality of life. Chemotherapy produces deterioration on functional capacity as a result of the effects of therapy. Particularly affected are those patients who have to be admitted to receive treatment, by the very effects of hospitalization and prolonged rest. The deterioration of functional capacity (quality of life indicator) is explained by the alteration of physical capacity and ability to perform activities of daily living (ADLs) in an independent fashion, constituent elements of functional capacity. Given the prevalence of this disease, and the disability associated with both the disease and treatment, it is necessary to incorporate into daily practice interventions to reduce the impact on functionality, favoring the adequate reintegration of the person into his or her environment. The aim of this review is to describe the mechanisms that alter functional capacity, and the effects of physical training programs, complementary therapies and multidimensional interventions on symptomatology, well-being and quality of life of cancer patients in medical treatment. (AU)
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Grupo de Atención al Paciente/organización & administración , Calidad de Vida , Comunicación Interdisciplinaria , Servicio de Oncología en Hospital/organización & administración , Quimioterapia Adyuvante/efectos adversosRESUMEN
We report a 54-year-old male presenting with a history or recurrent nose bleeds and ecchymoses. The coagulation study showed a prolonged partial thromboplastin time, a factor VIII of 8% and a high inhibitor titer (193 Bethesda units). A diagnosis of acquired hemophilia A was reached. The patient was initially treated with cyclophosphamide for seven months without response. Therefore rituximab in doses of 375 mglm²/week for four weeks was started. After starting treatment, the patient had a hematoma in the psoas muscle with a concomitant factor VIII of less than 5%, that was treated with local measures. Thereafter, a progressive reduction in inhibitor titers was observed, until its disappearance at five months of treatment. Factor VIII levels normalized and the patient has not experienced abnormal bleeding episodes. The patient remains in remission after 67 months of follow up. Rituximab, a chimeric monoclonal antibody against the protein CD 20 is an effective treatment in acquired hemophilia A.
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Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Hemofilia A/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Rituximab , Resultado del TratamientoRESUMEN
We report a 54-year-old male presenting with a history or recurrent nose bleeds and ecchymoses. The coagulation study showed a prolongedpartial thromboplastin time, a factor VIII of 8 percent and a high inhibitor titer (193 Bethesda units). A diagnosis of acquired hemophilia A was reached. The patient was initially treated with cyclophosphamide for seven months without response. Therefore rituximab in doses of 375 mglm²Iweek for four weeks was started. After starting treatment, the patient had a hematoma in the psoas muscle with a concomitantfactor VIII ofless than 5 percent, thatwas treated with local measures. Thereafter, aprogressive reduction in inhibitor titers was observed, until its disappearance atfive months of treatment. Factor VIII levéis normalized and the patient has not experienced abnormal bleeding episodes. The patient remains in remission after 67 months offollow up. Rituximab, a chimeric monoclonal antibody against theprotein CD 20 is an effective treatment in acquired hemophilia A.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Hemofilia A/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Resultado del TratamientoRESUMEN
Background: Hospitalized patients with cancer have a high risk of venous thromboembolism (VTE). Aim: To study the frequency of VTE and its risk factors in hospitalized patients with cancer. Material and methods: Retrospective analysis of clinical records of patients with cancer, hospitalized at a university hospital between 2002 and 2004. Patients with the diagnosis of VTE at admission or using anticoagulants, were excluded from the analysis. Results: The medical records of 366 patients were reviewed. Fifty three percent had a digestive cáncer, 19 percent lung cáncer, 10 percent breast cancer and 18 percent had a tumor of other origin. In 77 percent, the tumor was in an advanced stage. The most common admission diagnoses were pneumonía, vomiting and dehydration, gastrointestinal bleeding and urinary infection. In 125 patients (34 percent) pharmacological thrombo-prophylaxis was not used and 242 (66 percent) received regular or low molecular weight heparin. VTE was detected in 11 patients (3 percent) and was significantly more common among patients not receiving thrombo prophylaxis compared to those receiving heparin (6.4 percent and 1.2 percent, respectively p =0.014). Factors associated to VTE were a history ofprevious VTE with an odds ratio (OR) of 12.9 (p <0.01), obesity with an OR of 13.3 (p <0.01), recent chemotherapy with an OR of 6.9 (p =0.01). The use of pharmacological thromboprophylaxis had an OR of 0.24 (p =0.05). Conclusions: Three percent of patients in this series had VTE during the hospitalization. Pharmacological thrombo-prophylaxis significantly reduced the risk of VTE.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Tromboembolia Venosa/etiología , Hospitalización , Neoplasias/sangre , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/prevención & controlRESUMEN
BACKGROUND: Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and beta2-microglobulin. AIM: To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS. MATERIAL AND METHODS: Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems. RESULTS: Information of 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11% were in stage I 12% in stage II and 73% in stage III According to ISS, 34% were in stage I 35% in stage II and 31% in stage III Median of survival of all patients was 32 months. Both staging systems had a prognostic value. However, median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages III and III, respectively, p =0.02). Patients in advanced stages II and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival. CONCLUSIONS: The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.
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Mieloma Múltiple/patología , Estadificación de Neoplasias/métodos , Adulto , Anciano , Anciano de 80 o más Años , Chile/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , PronósticoRESUMEN
Background: Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and betaZ-microglobulin. Aim: To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS. Material and methods: Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems. Results: Information of 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11 percent were in stage I 12 percent in stage II and 73 percent in stage III According to ISS, 34 percent were in stage I 35 percent in stage II and 31 percent in stage III Median of survival of all patients was 32 months. Both staging systems had a prognostic value. However, median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages III and III, respectively, p =0.02). Patients in advanced stages II and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival. Conclusions: The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/patología , Estadificación de Neoplasias/métodos , Chile/epidemiología , Métodos Epidemiológicos , Fallo Renal Crónico/complicaciones , Mieloma Múltiple/mortalidad , PronósticoRESUMEN
BACKGROUND: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). AIM: To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. MATERIAL AND METHOD: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. RESULTS: Data from 245 patients aged 38 to 95 years (129 women) was collected. Fifty two percent had an IgG myeloma, 25% had and IgA and 6.1% had light chains myeloma. According to Durie and Salmon staging system, 8,2% were in Stage 112.6% in Stage II, 60.5% in Stage III and in 18.8% the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30% had a serum creatinine over 2 mg/dL and 28% had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level <3.5 g/dL. There was a correlation between the number of bad prognosis factors present and the probability of early mortality. CONCLUSIONS: This group of Chilean patients with MM presented a short survival time, and 20% died within the first six months after diagnosis. More than a half of cases were diagnosed at an advanced stage (Durie and Salmon Stage III). Several factors were associated to early mortality, two of which (beta 2-microglobulin and serum albumin), are included in the new International Staging System for MM.
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Mieloma Múltiple/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Anemia/complicaciones , Chile/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , Hipercalcemia/complicaciones , Masculino , Persona de Mediana Edad , Mieloma Múltiple/inmunología , Mieloma Múltiple/patología , Estadificación de Neoplasias , Pronóstico , Insuficiencia Renal/complicaciones , Albúmina Sérica/análisis , Factores Sexuales , Trombocitopenia/complicaciones , Factores de Tiempo , Microglobulina beta-2/sangreRESUMEN
Background: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). Aim To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. Material and Method: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. Results: Data from 245patients aged 38 to 95years (129 women) was collected. Fifty two percent had an IgG myeloma, 25 percent had and IgA and 6.1 percent had light chains myeloma. According to Durie and Salmon staging system, 8,2 percent were in Stage 112.6 percent in Stage II, 60.5 percent in Stage III and in 18.8 percent the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30 percent had a serum creatinine over 2 mg/dL and 28 percent had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level <3.5 g/dL. There was a correlation between the number of bad prognosis factors present and the probability of early mortality. Conclusions: This group of Chilean patients with MM presented a short survival time, and 20 percent died within the first six months after diagnosis. More than a half of cases were diagnosed at an advanced stage (Durie and Salmon Stage III). Several factors were associated to early mortality, two of which (beta 2-microglobulin and serum albumin), are included in the new International Staging System for MM.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , Insuficiencia Renal , Anemia/complicaciones , Chile/epidemiología , Métodos Epidemiológicos , Hipercalcemia/complicaciones , Mieloma Múltiple/inmunología , Mieloma Múltiple/patología , Estadificación de Neoplasias , Pronóstico , Albúmina Sérica/análisis , Factores Sexuales , Trombocitopenia/complicaciones , Factores de Tiempo , /sangreRESUMEN
The new development in transfusion medicine has allowed that blood component would be available safely for patients. However, like other medical therapies, we should establish clearly the indications based on the best benefit/risk relationship. In the following paragraphs the indications for red cells, platelets, fresh frozen plasma and cryoprecipitate will be shown. Finally, the risks and adverse events to blood transfusion will be reviewed.
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Humanos , Transfusión Sanguínea , Transfusión Sanguínea/métodos , Transfusión Sanguínea/normas , Transfusión de Eritrocitos , Plasma , Transfusión de PlaquetasRESUMEN
We report a 78 year old male with prostatism, that was subjected to a prostate biopsy. The pathological study showed a microvascular lymphocytic infiltration. Four months later, the patients presentd with reduced alertness, cough, dyspnea, fever and elevation of lactic dehydrogenase and erythrocyte sedimentation rate. Chest and abdominal CAT scans, bone marrow aspirate, protein electrophoresis and prostate specific antigen were normal. A re-evaluation of prostate biopsy showed an intravascular lymphoid infiltration, positive for CD45 and CD20, compatible with the diagnosis of intravascular lymphoma. Chemotherapy was started, but it was not tolerated by the patient and the response was partial. Therefore, treatment with monoclonal antibodies anti CD20 (Rituximab) was started. The tumor had a complete and prolonged (24 months) remission after the treatment.