[Upper limb deep venous thrombosis. Risk factors, outcome, and posthrombotic syndrome]. / Trombosis venosa profunda de miembros superiores. Factores de riesgo, evolución y síndrome postrombótico.

OBJECTIVE: Our objective was that of describing a series of episodes of upper limb deep venous thrombosis, with special emphasis on the incidence of posthrombotic syndrome and its impact in the quality of life of the patients. METHODS: 33 episodes (29 patients) of upper limb deep venous thrombosis were studied, between January 1995 and January 2002; episodes until September 1999 (18 episodes) were considered retrospectively while those which took place starting in this date (15 episodes) were considered prospectively. In all, 24 patients were cared in hospital clinic. It was possible to obtain complete data in 16 cases, in which evolution toward posthrombotic syndrome, venous revascularization, and impact of the pathological process in the global quality of life of patients were studied. RESULTS: Average age of patients was 58.9 years. In 25 episodes (75.8%) some risk factor for venous thrombosis existed, the presence of a venous catheter being the most frequent. Subclavian axillary affectation was predominant (18 episodes, 55%) and in the left side (25 episodes, 76%). Twenty-eight episodes were diagnosed with echography (84.8%). Mean D-dimers concentration (N = 16) was 1,046 ng/ml (standard deviation [SD]: 826.9). One of the episodes (3%) was associated to lung thromboembolism. Treatment consisted on the administration of low molecular weight heparin during the acute phase in 70% of the cases. In 13 episodes (39%) additional treatment of thrombosis (endovascular in most) was carried out. In 29 episodes (88%) chronic treatment was administered with acenocoumarol, while in 4 episodes (12%) the administration of low molecular weight heparin was kept. No patient died during hospitalization. In 15 patients (52%) control of revascularizacion was performed. We detected complete revascularization in 6 patients (40%), revascularization with collateral circulation in 4 patients (27%), partial revascularization in other 4 patients (27%) and presence of permeability but with expansion and tortuosity of deep venous system in 1 case (6%). Posthrombotic syndrome was considered mild or nonexistent in 10 patients (62.5%) and moderate in 6 patients (37.5%). Quality of life of patients with moderate posthrombotic syndrome was significantly worse than that of patients with mild posthrombotic syndrome (73 vs 90, p < 0.035). CONCLUSIONS: Most of upper limb deep venous thrombosis are associated to the use of intravenous catheters. Echography is the primary diagnostic technique. At the time of the diagnosis, patients tend to show elevation in D-dimers levels. Evolution toward posthrombotic syndrome is frequent; this syndrome does not use to be serious but indeed influences the quality of life of patients.

Trombosis venosa profunda de miembros superiores. Factores de riesgo, evolución y síndrome postrombótico / Upper limb deep venous thrombosis

Objetivo. Nos propusimos describir una serie de episodios de trombosis venosa profunda de miembro superior, con especial énfasis en la incidencia posterior de síndrome postflebítico y surepercusión en la calidad de vida de los pacientes. Métodos. Se estudiaron 33 episodios (29 pacientes) de trombosis venosa profunda del miembro superior entre enero de 1995 y enero de 2002, incluidos retrospectivamente hasta septiembre de 1999 (18 episodios) y prospectivamente a partir de esta fecha (15 episodios). Se analizaron los factores de riesgo, la clínica, los procedimientos diagnósticos y el tratamiento administrado. Fueron controlados en la policlínica24 pacientes. Se dispuso de datos completos evaluables en16 casos, estudiándose la evolución a síndrome postflebítico, la repermeabilización venosa y la repercusión del proceso en la calidad de vida global de los pacientes. Resultados. La edad media fue de 58,9 años. En 25 episodios(75,8%) se apreció algún factor de riesgo para trombosisvenosa, siendo el más frecuente la presencia de un catéter venoso. Predominó la afectación axilosubclavia (18 episodios,55%) y del lado izquierdo (25 episodios, 76%). Veintiocho episodios (84,8%) se diagnosticaron con ecografía. La media de los niveles de D-dímeros (n=16) fue de 1.046 ng/ml.(DE: 862,9). En un episodio (3%) se asoció tromboembolismo pulmonar. El 70% de los casos se trató con heparina de bajo peso molecular en la fase aguda. En 13 episodios (39%) se practicó tratamiento adicional de la trombosis (endovascularla mayoría). En 29 episodios (88%) se administró tratamiento crónico con acenocumarol y en 4 (12%) se continuó con heparina de bajo peso molecular. No falleció ningún paciente durante el ingreso hospitalario. Se practicó control de repermeabilización en15 pacientes (52%). Detectamos repermeabilización completa en6 pacientes (40%), repermeabilización con circulación colateral en 4 (27%), repermeabilización parcial en otros 4 pacientes(27%) y eje permeable pero con dilatación y tortuosidad del sistema venoso profundo en un caso (6%). El síndrome postflebítico se clasificó como leve o ausente en 10 pacientes(62,5%) y moderado en 6 (37,5%). La calidad de vida de los pacientes con síndrome posflebítico moderado fue significativamente peor que la de los pacientes con síndrome postflebítico leve (73 frente a 90, p<0,035).Conclusiones. Las trombosis venosas profundas de miembros superiores más frecuentes se asocian al uso de catéteres intravenosos. La ecografía es la técnica diagnóstica predominante. Los D-dímeros se elevan al diagnóstico. La evolución a síndrome postflebítico es frecuente, pero éste no suele ser grave. aunque sí repercute en la calidad de vida de los pacientes

Objective. Our objective was that of describing a series of episodes of upper limb deep venous thrombosis, with special emphasis on the incidence of posthrombotic syndrome and its impact in the quality of life of the patients. Methods. 33 episodes (29 patients) of upper limb deep venous thrombosis were studied, between January 1995 and January2002; episodes until September 1999 (18 episodes) were considered retrospectively while those which took place starting in this date (15 episodes) were considered prospectively. In all,24 patients were cared in hospital clinic. It was possible to obtain complete data in 16 cases, in which evolution toward posthrombotic syndrome, venous revascularization, and impact of the pathological process in the global quality of life of patients were studied. Results. Average age of patients was 58.9 years. In25 episodes (75.8%) some risk factor for venous thrombosis existed, the presence of a venous catheter being the most frequent. Subclavian axillary affectation was predominant(18 episodes, 55%) and in the left side (25 episodes, 76%).Twenty-eight episodes were diagnosed with echography (84.8%).Mean D-dimers concentration (N = 16) was 1,046 ng/ml(standard deviation [SD]: 826.9). One of the episodes (3%) was associated to lung thromboembolism. Treatment consisted on the administration of low molecular weight heparin during the acute phase in 70% of the cases. In 13 episodes (39%)additional treatment of thrombosis (endovascular in most)was carried out. In 29 episodes (88%) chronic treatment was administered with acenocoumarol, while in 4 episodes (12%)the administration of low molecular weight heparin was kept. No patient died during hospitalization. In 15 patients (52%)control of revascularización was performed. We detected complete revascularization in 6 patients (40%),revascularization with collateral circulation in 4 patients (27%),partial revascularization in other 4 patients (27%) and presence of permeability but with expansion and tortuosity of deep venous system in 1 case (6%). Posthrombotic syndrome was considered mild or nonexistent in 10 patients (62.5%) and moderate in 6 patients (37.5%). Quality of life of patients with moderate posthrombotic syndrome was significantly worse than that of patients with mild posthrombotic syndrome (73 vs 90,p<0,035).Conclusions. Most of upper limb deep venous thrombosis are associated to the use of intravenous catheters. Echography is the primary diagnostic technique. At the time of the diagnosis, patients tend to show elevation in D-dimers levels. Evolution toward posthrombotic syndrome is frequent; this syndrome does not use to be serious but indeed influences the quality of life of patients

[Severe self-limiting hypersensitivity reaction after immunotherapy with intravesical BCG]. / Severa reacción de hipersensibilidad autolimitada tras inmunoterapia con BCG intravesical.

We present the case of a 67-years-old patient diagnosed of superficial vesical transitional carcinoma which, under immunotherapy with intravesical BCG, developed a severe hypersensitivity reaction with spontaneous resolution. We describe several adverse reactions after the administration of intravesical BCG, as well as its diagnostic and therapeutic problems, especially in the cases of hypersensitivity.