Sudden Death Due to Thrombosis Associated with Implantable Cardioverter-Defibrillator Electrodes.

Thrombosis associated with pacemaker leads is extremely rare, although the literature on this subject is scarce. A clinical case is reported, describing this condition and its clinical presentation, the complementary tests for establishing the diagnosis and the available therapeutic options. LEARNING POINTS: Thrombosis associated with pacemaker leads is extremely rare.The different causes that contribute to thrombosis all have Virchow's triad (blood stasis, endothelial injury/dysfunction and hypercoagulability) in common.Transthoracic and/or transoesophageal Doppler echocardiography is the gold standard for establishing the diagnosis, while the treatment options are anticoagulation, thrombolysis and surgical or endovascular embolectomy.

Ablación intraductal por radiofrecuencia en neoplasias biliopancreáticas inoperables con ictericia: experiencia en un hospital comarcal / Intraductal ablation by radiofrequency for inoperable biliopancreatic neoplasms with jaundice: experience at a regional hospital

En la actualidad, el tratamiento de elección en las neoplasias biliopancreáticas inoperables y/o irresecables complicadas con ictericia es la colocación de prótesis metálicas biliares, siendo la complicación más frecuente la obstrucción por crecimiento tumoral. La aplicación de ablación por radiofrecuencia (ARF) es una técnica novedosa mínimamente invasiva que tiene como objetivo la termoablación del tejido tumoral que condiciona la estenosis biliar. La experiencia con ARF es exigua, con escasos estudios retrospectivos de casos clínicos y con un número limitado de pacientes, por lo que los hay pocos datos sobre la dificultad técnica, seguridad y seguimiento a corto-medio plazo. Presentamos tres casos (un colangiocarcinoma y dos adenocarcinomas de cabeza pancreática) con ictericia por estenosis biliar en los que se aplica ARF con sonda ELRA durante la colangiopancreatografía retrógrada endoscópica (CPRE), realizando seguimiento durante diez meses donde se evalúa la dificultad del tratamiento, la eficacia y las complicaciones inmediatas y a medio plazo

The current treatment of choice for inoperable and/or unresectable biliopancreatic neoplasms complicated by jaundice is the placement of metal biliary stents. The most common complication is obstruction due to tumor growth. The application of radiofrequency ablation (RFA) is a new minimally invasive technique for the thermal ablation of the tumor tissue that causes biliary stenosis. Experience with RFA is scarce and there are few retrospective studies of clinical cases with a limited number of patients. Thus, there is little information on technical difficulty, safety and short-medium term monitoring. We present three cases, one cholangiocarcinoma and two pancreatic adenocarcinomas, with jaundice due to biliary stenosis. RFA was used with an ELRA catheter during endoscopic retrograde cholangiopancreatography (ERCP). The patients were monitored for ten months in order to assess the difficulty of treatment, efficacy and immediate and medium-term complications

Intraductal ablation by radiofrequency for inoperable biliopancreatic neoplasms with jaundice: experience at a regional hospital.

The current treatment of choice for inoperable and/or unresectable biliopancreatic neoplasms complicated by jaundice is the placement of metal biliary stents. The most common complication is obstruction due to tumor growth. The application of radiofrequency ablation (RFA) is a new minimally invasive technique for the thermal ablation of the tumor tissue that causes biliary stenosis. Experience with RFA is scarce and there are few retrospective studies of clinical cases with a limited number of patients. Thus, there is little information on technical difficulty, safety and short-medium term monitoring. We present three cases, one cholangiocarcinoma and two pancreatic adenocarcinomas, with jaundice due to biliary stenosis. RFA was used with an ELRA catheter during endoscopic retrograde cholangiopancreatography (ERCP). The patients were monitored for ten months in order to assess the difficulty of treatment, efficacy and immediate and medium-term complications.

Levofloxacin versus ceftriaxone plus clarithromycin in the treatment of adults with community-acquired pneumonia requiring hospitalization.

Consecutive adult patients admitted to the hospital with community-acquired pneumonia from January 2000 to September 2003 were included in this prospective observational cohort study. A total of 459 patients, 259 treated with levofloxacin in single drug therapy at a dose of 500 mg once a day and 209 with the combination of ceftriaxone plus clarithromycin at a dose of 2 g once a day and 500 mg every 12 h, respectively, were included. The hospital admission decision was made using a clinical guideline based on the Pneumonia Severity Index (PSI). Fifteen (6%) patients died in the group treated with levofloxacin in single drug therapy and 25 (12%) in the group treated with ceftriaxone plus clarithromycin (P = 0.024). The mortality differences between both treatment groups, adjusted by the PSI score, show an OR of 0.39 (95% CI 0.17-0.87). There were no statistically significant differences between the duration of treatments or hospital stay. These data suggest that levofloxacin as single drug therapy is more effective than the combination of ceftriaxone plus clarithromycin in the treatment of moderate to severe pneumonia that requires hospitalization.