ABSTRACT
Nonbacterial thrombotic endocarditis (NBTE) is a rare cause of peripheral embolism. NBTE is usually associated with malignant diseases and hypercoagulability states. Echocardiography is a very useful technique for the diagnosis. However valvular lesions in NBTE are similar to valvular vegetations observed from infectious endocarditis (IE), so it s necessary to establish a differential diagnosis. The treatment of thrombotic endocarditis is controversial, but the literature coincides in the use of intravenous heparin. We describe the case of a 42 years old woman with stroke in which transesophageal echocardiography (TEE) was useful in establishing the diagnosis of NBTE. The infectious origin was excluded with the realization of a exhaustive microbiologic study. In the search of causes for NBTE a lung adenocarcinoma was detected. In the present case the diagnosis of endocarditis preceded the neoplastic disease diagnosis.
Subject(s)
Endocarditis/etiology , Heart Diseases/etiology , Lung Neoplasms/diagnosis , Stroke/etiology , Thrombosis/etiology , Adult , Diagnosis, Differential , Endocarditis/diagnosis , Female , Heart Diseases/diagnosis , Humans , Lung Neoplasms/complications , Thrombosis/diagnosisABSTRACT
La endocarditis trombótica no bacteriana (ETNB) es una causa poco frecuente de embolismo sistémico cuya presencia suele asociarse a enfermedades malignas y estados de hipercoagulabilidad. La ecocardiografía constituye una técnica útil para el diagnóstico. Sin embargo las lesiones valvulares de la ETNB son ecográficamente indistinguibles de las vegetaciones observadas en la endocarditis infecciosa (EI), por lo cual es necesario establecer un diagnóstico diferencial con esta entidad. El tratamiento de la endocarditis trombótica es controvertido coincidiendo la literatura en el uso de heparina intravenosa. Presentamos el caso de una paciente de 42 años de edad con infartos isquémicos cerebrales múltiples, en la cual la realización una ecocardiografía transesofágica (ETE) ayudó a establecer el diagnóstico de ETNB. La etiología infecciosa fue descartada tras practicar un estudio microbiológico exhaustivo. En la búsqueda de patologías causantes o relacionadas con la ETNB se encontró la presencia de un adenocarcinoma pulmonar como enfermedad subyacente (AU)
Subject(s)
Adult , Humans , Female , Heart Diseases , Thrombosis , Endocarditis , Stroke , Diagnosis, Differential , Lung NeoplasmsABSTRACT
OBJECTIVES: To determine the number of smokers, their demographic characteristics, and the stages of change among patients visiting health care centers. PATIENTS AND METHODS: Descriptive cross-sectional study carried out at 7 primary health care centers in Health District 5 of the Autonomous Community of Valencia. RESULTS: An interview was given to 3633 people with a mean (SD) age of 55 (19) years, (range: 14-96 years). Women made up 61.7%, and 65% were seeking medical attention. Twenty-three per cent were current smokers (mean age 41.8 [15.2] years), 17.2% ex-smokers (60.6 [16.2] years), and 59.8% never smokers (58.4 [18.8] years). The stages of change were pre-contemplation for 32.1%, contemplation for 4.9%, chronic contemplation for 12.2%, preparation to quit for 6.8%, action for 2.3%, maintenance for 15.1%, and termination for 26.7%. According to current recommendations, it seems that between 23.6% and 44.7%, depending on category definitions, needed specific attention concerning tobacco dependence. CONCLUSIONS: Twenty-three per cent of the patients attended by the primary care physician were smokers. More than half did not want to quit smoking and 1 in 10 were prepared to do so. Between 23.6% and 44.7% of the people who came to the primary care center needed specific attention concerning tobacco dependence.
