Utilidad de los marcadores tumorales en el diagnóstico de neoplasia asociada a trombosis venosa profunda idiopática / Usefulness of the tumor markers in the diagnose of idiopathic deep venous thrombosis associated cancer

Objetivo: Valorar la utilidad para el diagnóstico de neoplasia de la determinación de un perfil amplio de marcadores tumorales (MT) junto a la evaluación inicial de los pacientes con trombosis venosa profunda (TVP) idiopática. Material y métodos: Estudio prospectivo de 48 pacientes con diagnóstico de TVP idiopática. Se determinó en suero a todos los pacientes: antígeno carcinoembronario, alfa-fetoprotetína, CA 19.9, CA 125, beta2-microglobulina, antígeno de células escamosas, enolasa neuronal específica, antígeno prostático específico en los varones y CA15.3 en las mujeres. Los pacientes fueron evaluados para neoplasia durante el ingreso y seguidos a los 6 y 12 meses. Resultados: La edad media fue de 65 años. En 23 pacientes (48 por ciento) se detectó al menos un marcador elevado. Se diagnosticaron 8 neoplasias (16 por ciento), 4 en el grupo con marcadores elevados y 4 en el grupo con marcadores normales. No apreciamos diferencias significativas en las incidencias de neoplasia entre ambos grupos. Sin embargo, de los 4 casos de neoplasias diagnosticadas en el grupo con marcadores elevados, solo 1 se consideró verdadero positivo puesto que en las otras el marcador elevado no resultó congruente con la neoplasia. Seis neoplasias se diagnosticaron durante el ingreso hospitalario y dos durante el seguimiento. Se obtuvo una sensibilidad del 12 por ciento, una especificidad del 52 por ciento, un valor predictivo positivo del 5 por ciento y un valor predictivo negativo del 75 por ciento. Conclusiones: La incidencia de neoplasia fue similar a la comunicada por otros autores. Encontramos poca sensibilidad y especificidad, y escaso valor predictivo positivo con numerosos falsos positivos. Sin embargo, el valor predictivo del resultado negativo fue del 75 por ciento, con lo que la mayoría de los pacientes con un perfil completo normal de MT y asintomáticos no tuvieron neoplasia al diagnóstico ni durante el tiempo de seguimiento (AU)

[Usefulness of the tumor markers in the diagnosis of idiopathic deep venous thrombosis associated cancer]. / Utilidad de los marcadores tumorales en el diagnóstico de neoplasia asociada a trombosis venosa profunda idiopática.

OBJECTIVE: To evaluate a wide detection of tumor markers practiced during admission for the diagnosis of cancer in patients with idiopathic deep venous thrombosis. MATERIAL AND METHODS: Prospective study including 48 patients with documented DVT who lacked a predisposing cause to DVT. It was determined in serum: carcinoembryonic antigen, alphafetoprotein, CA 19-9, CA 125, beta-2-microglobulin, SCC (squamous cell antigen), NSE (neuron-specific enolase), PSA (prostate-specific antigen) in the males and CA15-3 in the women. The patients were evaluated for cancer during admission and followed up at 6 and 12 months. RESULTS: The age was 65 years. A positive tumor marker at least was detected in 23 patients (48%). A cancer was diagnosed in 8 patients (16%), 4 in the group with elevated tumor markers and 4 in the group with normal tumor markers. We don't find significant differences in cancer incidence between both groups. However, of the 4 cases of cancer diagnosed in the group with elevated markers only 1 was considered true positive since in the others three cases the elevate tumor marker was not appropriated with the cancer diagnosed. Six tumors were diagnosed during admission and two during follow-up period. According to these results was obtained a sensitivity of 12%, a specificity of 52%, a positive predictive value of 5% and a negative predictive value of 75%. CONCLUSIONS: The cancer incidence is similar to previous series. We have found a poor sensitivity, specificity and positive predictive value. However, the negative predictive value was of 75% and the patients who were normals for results of all tumor markers and was asymptomatic during admission hadn't a subsequent cancer diagnosis.

[Cholesterol crystals embolization. A case report]. / Embolismo por cristales de colesterol. A propósito de un caso.

Cholesterol Crystals Embolization is not a very frequent entity that happens in people with atheromatous disease of spontaneous for or after the realization of vascular manipulation (angiographic, angioplasty procedures, cardiovascular surgery) or more rarely with the treatment with oral anticoagulants and after thrombolytic therapy. The clinical presentation is according to the arterial affected territory and so from diagnosed cases in autopsy reports to florid clinic forms exist. The more frequent are the cutaneous manifestations with apparition of livedo reticularis and purple toes that could go accompanied of necrosis of lower limbs, consecutive from the renal manifestations and the gastrointestinal tract one. The diagnosis is based on the biopsy of organ affected lesions to level of arterioles, that revealed characteristic cholesterol clefts, above all the cutaneous biopsy, muscular and in any case renal. As for the treatment is symptomatic with analgesics, antiplatelet agents, anti-inflammatory, etc ... but it doesn't after the presage and the evolution of the illness. A clear contraindication exists to the use of oral anticoagulants and heparin.

Upper extremity deep vein thrombosis in a young patient double heterozygous for factor V Leiden and prothrombin G20210A mutation.

We report on a 19-year-old girl with upper extremity deep vein thrombosis after catheter indwelling whose thrombophilic study disclosed the coexistence of factor V Leiden and the prothrombin G20210A mutation. The family study identified five other members who were also heterozygous for both mutations. This is the first case of upper extremity deep vein thrombosis with the co-inheritance of both genetic defects. It provides further evidence that thrombophilic defects mostly require additional triggering factors to induce a thrombotic event and suggests that in young patients with this venous thrombotic location, a thrombophilic search should be performed even when there are other acquired thrombotic risk factors.