Differential biomarker profiles between unprovoked venous thromboembolism and cancer.

BACKGROUND: The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis. OBJECTIVE: To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD. METHODS: A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA. RESULTS: TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis. CONCLUSIONS: Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases. Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations.

Pancreatitis autoinmune: pseudotumor inflamatorio, afectación multifocal, hipertensión portal y evolución a largo plazo / No disponible

La pancreatitis autoinmune es una enfermedad recientementecaracterizada y que en la actualidad constituye un reto diagnósticoespecialmente su diferenciación con el cáncer de páncreas. Suevolución a largo plazo es poco conocida, presentándose un casoestudiado a lo largo de 14 años y mostrando su evolución clínica,bioquímica y morfológica.Paciente mujer de 54 años que debuta con un cuadro de ictericiaobstructiva y molestias abdominales inespecíficas y constataciónen la TAC de un aumento de la cabeza del páncreas, todoello sugestivo de neoplasia de páncreas. Fue intervenida evidenciándoseun aumento difuso de todo el páncreas descartándosemalignidad intraoperatoriamente, realizando únicamente colecistectomíay coledocoduodenostomía, quedando diagnosticada entoncescomo pancreatitis crónica. Durante los años posterioresfueron apareciendo diferentes procesos autoinmunes como asma,sialoadenitis y colangitis esclerosante secundaria, así como episodiosrecurrentes de ictericia e insuficiencia pancreática endocrinay exocrina. La aparición de estas complicaciones y la detección deniveles séricos elevados de IgG4 y de anticuerpos antianhidrasacarbónica II condujo a la reevaluación de la histología inicial concluyendofinalmente con el diagnóstico de pancreatitis autoinmuneal evidenciarse una infiltración linfocitaria y plasmacitariaIgG4+, así como fibrosis y flebitis obliterativa. En los últimos añosse ha añadido a las anteriores complicaciones una fibrosis retroperitonealcon hipertensión portal, varices esofágicas y esplenomegalia

Autoimmune pancreatitis is a recently characterized diseasethat still constitutes a diagnostic challenge, especially regarding differentialdiagnosis from neoplasia. Long-term outcome is poorlyknown. We herein report a case of a patient with autoimmunepancreatitis and 14 years of follow-up, and show its clinical, biochemical,and morphological characteristics.A 54-year-old female presented with obstructive jaundice andabdominal tenderness, as well as a mass at the pancreatic head ona CT scan, suggestive of pancreatic neoplasia. Surgery showed anincrease of the whole pancreas, malignancy was intraoperativelyruled out, and a cholecystectomy and choledochoduodenostomywere carried out. The diagnosis was chronic pancreatitis. Over thefollowing years different autoimmune complications developed, includingasthma, salivary gland swelling, and sclerosing cholangitis,as well as recurrent episodes of jaundice, and exocrine and endocrinepancreatic failure. The development of these complicationscombined with the demonstration of high serum levels ofIgG4 and carbonic anhydrase II led to a re-evaluation of the initialhistology of the pancreas, leading to a final diagnosis of autoimmunepancreatitis: IgG4+ lymphoplasmacytic infiltrates, fibrosis,and obliterative phlebitis. New complications developed during thelast few years: retroperitoneal fibrosis with portal hypertension,esophageal varices, and splenomegaly

[Autoimmune pancreatitis: inflammatory pseudotumor, multifocal fibrosclerosis, portal hypertension, and long-term outcome]. / Pancreatitis autoinmune: pseudotumor inflamatorio, afectación multifocal, hipertensión portal y evolución a largo plazo.

Autoimmune pancreatitis is a recently characterized disease that still constitutes a diagnostic challenge, especially regarding differential diagnosis from neoplasia. Long-term outcome is poorly known. We herein report a case of a patient with autoimmune pancreatitis and 14 years of follow-up, and show its clinical, biochemical, and morphological characteristics. A 54-year-old female presented with obstructive jaundice and abdominal tenderness, as well as a mass at the pancreatic head on a CT scan, suggestive of pancreatic neoplasia. Surgery showed an increase of the whole pancreas, malignancy was intraoperatively ruled out, and a cholecystectomy and choledochoduodenostomy were carried out. The diagnosis was chronic pancreatitis. Over the following years different autoimmune complications developed, including asthma, salivary gland swelling, and sclerosing cholangitis, as well as recurrent episodes of jaundice, and exocrine and endocrine pancreatic failure. The development of these complications combined with the demonstration of high serum levels of IgG4 and carbonic anhydrase II led to a re-evaluation of the initial histology of the pancreas, leading to a final diagnosis of autoimmune pancreatitis: IgG4+ lymphoplasmacytic infiltrates, fibrosis, and obliterative phlebitis. New complications developed during the last few years: retroperitoneal fibrosis with portal hypertension, esophageal varices, and splenomegaly.

[Evaluation of a computer predictive model to stratify risk and site of care in community acquired pneumonia]. / Utilidad de un modelo informatizado para estratificación de riesgo y decisión de lugar de tratamiento en la neumonía de la comunidad.

BACKGROUND: CAP is a common disorder with a great variability in clinical practice. The decision regarding the appropriate site of care is the most important for the level of treatment and costs. Recently a hospital in our region ( Hospital de Galdakao) developed a prediction rule based on the Pneumonia Severity Index (PSI) plus some additional criteria (hypoxemia <60, shock, previous correct treatment failure, social problems or inability to maintain oral intake, pleural effusion or unstable comorbidities) with an easy computer program to classify patients to be hospitalized or not. OBJECTIVE: Evaluate that computer program in the emergency department of our hospital. RESULTS: We included between December 02 and December 04,662 prospective patients with CAP admitted to our emergency department, 58 had a different final diagnosis. 285 (47%) were treated on outpatient basis. Readmission rate was 6%. There was no mortality in this group. 319 (53%) patients were hospitalized, 97 were PSI low risk patients (I-II), 61 of them were admitted to hospital because additional criteria. 45% of these "low risk patients" had significant complications. These results are similar to those obtained in Galdakao* CONCLUSIONS: The application of this computer risk stratifying program to assess admission to hospital in CAP is simple useful, secure and can be export to different settings. Additional criteria to PSI are necessary to detect low risk patients that complicate.

Pulmonary carcinosarcoma: a case study and review of the literature.

A case report of pulmonary carcinosarcoma and a review of the literature is presented. This is the only case where diagnosis has been obtained by thin needle percutaneous biopsy.