RESUMEN
OBJECTIVE: Post-thrombotic syndrome (PTS) is one of the main complications that occurs after venous thrombosis. There are few data on the proportion of patients that will develop upper extremity PTS (UE-PTS) after upper extremity venous thrombosis (UEVT). The main objective of the study was to assess the prevalence of PTS in a UEVT cohort and to identify predictive factors of UE-PTS. METHODS: This study included patients with a history of proximal or arm UEVT, diagnosed on duplex ultrasound examination, between January 1, 2015, and December 31, 2017, in a university hospital. After UEVT, each patient was evaluated by a prospective standardized recording of clinical manifestations and duplex ultrasound examination in case of upper limb symptoms. UE-PTS was defined as a modified Villalta score of 4 or higher. RESULTS: Ninety-two patients were included; 68 (73.9%) had deep vein thrombosis (DVT) and 24 (19.2%) arm superficial vein thrombosis. Thirteen patients had PTS (14.1%), 12 (17.6%) in the DVT group and 1 (4.2%) in the superficial vein thrombosis group. There was a history of DVT in 92.3% of the cases of PTS. PTS was more frequent in patients with strokes with limb movement reduction (P = .01). On multivariate Cox analysis, a history of stroke (hazard ratio, 5.4; 95% confidence interval, 1.46-20.22; P = .01) was predictive of UE-PTS. CONCLUSIONS: UE-PTS occurred in 14.1% of cases after UEVT. Stroke with a decrease in limb movement was a predictor of developing PTS. Diagnostic criteria should be established for UE-PTS and prospective studies are needed to improve the description and management of UE-PTS.
Asunto(s)
Síndrome Postrombótico/epidemiología , Síndrome Postrombótico/etiología , Trombosis Venosa Profunda de la Extremidad Superior/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Adulto JovenRESUMEN
We describe the case of a 20-year-old patient with salt-wasting congenital adrenal hyperplasia (CAH) related to 21-hydroxylase deficiency. Bilateral craggy testicular tumours were found, requiring histological evaluation. Prior to the surgical procedure, the patient was treated with dexamethasone (he presented cortisol deficiency) and was stimulated with ACTH. High levels of 11beta-OH steroids measured in the gonadal vein, compared with peripheral blood samples suggested the presence of adrenal rests. Incubation of the tumours (which could not be differentiated histologically, from Leydig tissue), with radioactive steroid precursors was carried out. The results revealed the testicular tumours were of adrenal tissue origin, associated with 21-hydroxylase deficiency. The patient's non-compliance to glucocorticoid treatment was the main cause of his hypogonadotropic hypogonadism.
Asunto(s)
Hiperplasia Suprarrenal Congénita/complicaciones , Tumor de Resto Suprarrenal/etiología , Esteroide 21-Hidroxilasa/metabolismo , Neoplasias Testiculares/etiología , Tumor de Resto Suprarrenal/diagnóstico , Tumor de Resto Suprarrenal/diagnóstico por imagen , Tumor de Resto Suprarrenal/tratamiento farmacológico , Tumor de Resto Suprarrenal/patología , Tumor de Resto Suprarrenal/cirugía , Hormona Adrenocorticotrópica/farmacología , Adulto , Sulfato de Deshidroepiandrosterona/sangre , Dexametasona/uso terapéutico , Diagnóstico Diferencial , Fludrocortisona/uso terapéutico , Hormona Folículo Estimulante/sangre , Estudios de Seguimiento , Glucocorticoides/uso terapéutico , Hormona Liberadora de Gonadotropina/metabolismo , Humanos , Hidrocortisona/deficiencia , Hipogonadismo/etiología , Inhibinas/sangre , Tumor de Células de Leydig/diagnóstico , Hormona Luteinizante/sangre , Masculino , Prolactina/sangre , Renina/sangre , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugía , Negativa del Paciente al Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: The etiology of age-related macular degeneration (ARMD) is poorly understood. Risk factors for cardiovascular disease have been thought to be associated with ARMD. Our purpose was to measure the concentration of atherogenic apolipoproteins (apo) and lipoparticles in serum from ARMD patients. METHODS: We analyzed lipids, lipoparticles and apolipoproteins concentrations in 84 unrelated patients with ARMD and compared the results with those of age- and sex-matched control subjects (n=62). Serum lipid concentrations were determined enzymatically; apolipoproteins levels by kinetic nephelometry and lipoparticles by electroimmunodiffusion. RESULTS: No difference in total cholesterol, triglycerides, phospholipids, high- and low-density lipoprotein-cholesterol (lHDL-C and LDL-C) concentrations were observed between ARMD patients and controls. Apo E and LpE non-B concentrations were found to be higher in serum from patients than in serum from controls. In contrast, Apo C-III and LpC-III non-B concentrations were lower in serum from patients than in serum from controls. CONCLUSIONS: The main differences observed between ARMD patients and controls are in Apo E, Apo C-III, LpC-III non-B and LpE non-B concentrations. These lipoparticles belong to the HDL family, which is considered to consist of anti-atherogenic lipoproteins. These results raise the possibility that cardiovascular risk factors are not associated with ARMD. Furthermore, we can hypothesize that ARMD development is linked to perturbations of HDL metabolism.