[Outpatient treatment of deep vein thrombosis: comparative study with historical inpatients]. / Tratamiento ambulatorio de la trombosis venosa profunda: comparación con tratamiento en hospitalización de pacientes de un registro histórico.

BACKGROUND: Outpatient treatment of deep venous thrombosis (DVT) has been proposed as a safe and cost-saving process, either as a mixed pattern: as an inpatient for 1 to 3 days followed by outpatient treatment; or rarely as completely outpatient. PATIENTS AND METHODS: We evaluated two cohorts of consecutive patients diagnosed with DVT. Patients who received entirely outpatient treatment in the years 2003 and 2004, compared with historical patients treated as inpatients during the year 2002. Our aim was to evaluate safety and the days of stay saved because of outpatient treatment of DVT. RESULTS: A total of 293 patients entered the study (Inpatients, 109; outpatients, 184). Demographic and clinical characteristics of patients were similar. Mean time of anticoagulant therapy and follow up were also both similar in the two groups. Major haemorrhage rate was 8% (CI 95% 4-15) in patients treated in hospital and 3% (CI 95%1-6.57) [Relative Risk (RR) 0.38] in patients treated as outpatients. Complications of venous thromboembolic disease occurred in 4% (CI 95% 1.18-9.68) of hospitalised patients and 5% (CI 95% 2.41-9.37) (RR 1.25) of patients treated as outpatients. The death rate was 11% (CI 95% 6-18.8) in hospitalised patients and 4% (CI 95% 1.68-7.99) (RR 0.36) in patients treated as outpatients. We observed a reduction of hospitalisation in relation to the index-year of 72.5% for the year 2003 (CI 95% -0.08 to -0.04) and 79% for the year 2004 (CI 95% -0.08 to -0.05) (p<0.001). Overall, 844 days of unnecessary hospitalisation were saved. CONCLUSIONS: Complete outpatient treatment of DVT shows outcomes at least as safe as inpatient treatment, adding additional reductions in costs for the Health System.

Chemotherapy and concurrent hyperfractionated radiotherapy for patients with limited small-cell lung cancer: long term results from a single institution and a review of the literature

- Objetivos: Nuestro principal objetivo fue estimar la supervivencia libre de enfermedad (SLE) y la supervivencia global (SG) a largo plazo, en pacientes con enfermedad limitada de cáncer de pulmón de células pequeñas (EL-CPCP), tratados con quimioterapia y radioterapia torácica (RTT) hiperfraccionada concurrente. También se evaluó la toxicidad y la respuesta al tratamiento.- Material y métodos: 23 pacientes EL-CPCP, confirmados histológica o citológicamente, fueron tratados con quimioterapia y RTT hiperfraccionada concurrente. La quimioterapia consistió en 4 ciclos de 20 mg/m2/d de cisplatino (P) y 80 mg/m2/d de etopósido (E). Los ciclos se repitieron cada 21 días. La dosis total de RTT fue de 45 Gy. Los pacientes que obtuvieron una respuesta clínica completa (RC) o una respuesta parcial (RP) recibieron irradiación craneal profiláctica (ICP). El protocolo fue completado en 21 pacientes (91 por ciento). La SLE y la SG fueron calculadas por el método de KaplanMeier.- Resultados: Con una mediana de seguimiento para el grupo entero de pacientes, la SG a los 2, 4 y 6 años fue de 52.2 por ciento, 29.4 por ciento y 23.5 por ciento, respectivamente. La SLE a los 2, 4 y 6 años fue de 52.2 por ciento, 33.8 por ciento y 21.1 por ciento, respectivamente. Respuestas objetivas se observaron en 21 pacientes (91 por ciento): 17 pacientes (74 por ciento) alcanzaron RC y 4 pacientes (17 por ciento) alcanzaron RP. La principal toxicidad fue hematológica.- Conclusiones: Los resultados de este estudio, apoyan la eficacia de la RTT administrada dos veces al día concurrente con EP, en pacientes con EL-CPCP aunque muchos de estos pacientes probablemente sean enfermedad diseminada al inicio del diagnóstico o tratamiento. La toxicidad resultó ser aceptable y menor sobre otros regímenes (AU)

[Clinical and evolutive study of plasma cell leukemia. Apropos of 9 cases]. / Estudio clínico y evolutivo de la leucemia de células plasmáticas. A propósito de nueve casos.

Nine patients were diagnosed with plasma cell leukemia (PCL) from 1982-1995 at our hospital. Seven patients had primary PCL and the other two patients a secondary from. In this study the clinical and analytical features are reported, as well as the therapy and response obtained in these patients. Also, the karyotype findings in bone marrow of four of these patients are reported. At diagnosis, the most common symptom was bone pain which was associated with osteolytic lesions or diffuse bone demineralization. Analytical features were similar to those reported in other series of patients with PCL. Different therapeutical regimens were used, and VAD was the most commonly employed. Two patients underwent consolidation therapy with autologous transplantation of hemopoietic stem cells. The mean survival time was 5.5 months. Although PCL prognosis associated with chemotherapy is still poor, myeloablative therapy with hemopoietic support can increase the survival length in these patients.

[The rifampicin test in the diagnosis of Gilbert syndrome]. / La prueba de la rifampicina en el diagnóstico del síndrome de Gilbert.

OBJECTIVE: To show the effectiveness and feasibility of the Rifampicin test in diagnosing Gilbert's syndrome. DESIGN: A prospective, descriptive study. SITE. General Medical Service of the Navarra Hospital. PATIENTS: 17 patients with bilirubin levels on two or more occasions and 6 healthy patients without these data. Both in- and out-patients. MAIN MEASUREMENTS AND RESULTS: The Rifampicin test. Bilirubin levels were determined when fasting and one, two, three and four hours after taking 900 mg of Rifampicin (Rimactan). After the test, those patients who had Gilbert's disease presented bilirubin levels significantly higher than the healthy patients, who remained within normal levels. CONCLUSIONS: In the group studied, the Rifampicin test demonstrated its effectiveness in the diagnosis of suspected Gilbert's disease. It would therefore be possible to use this test in the Primary Care field.