The efficacy of romiplostim in the treatment of severe thrombocytopenia associated to Evans syndrome refractory to rituximab.

We present a case of a man diagnosed with systemic lupus erythematosus, associated antiphospholipid syndrome and Evans syndrome, who developed a severe thrombocytopenia refractory to treatment with first-line drugs, cyclophosphamide and rituximab, and who responded to romiplostim with a normalization of the platelet recount, which later enabled a therapeutic splenectomy to be performed.

Aplicación del AEP en el área de Urgencias de un hospital / AEP utilization in the emergency department of a hospital

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Tamponade as the clinical onset of a cardiac angiosarcoma.

Primary tumors of the heart are usually benign, with the malignant forms being rare. In this article we report the case of an angiosarcoma with the only manifestation being a cardiac tamponade. When the patient being admitted to the hospital, an important differential diagnosis was pulmonary tumor. A mass in the right atrium was later detected in the echocardiogram. Further image studies, such as MRI, showed spectacular images of this mass suggestive of neoplasm. An intra-operatory biopsy diagnosed the mass as an angiosarcoma. Since there was no evidence of primary neoplasm in other studies carried out, the neoformation was diagnosed as a primary angiosarcoma. Surgery was carried out with a survival of only 13 months after the procedure. We also use this case to make a brief review of the primary tumors of the heart, especially angiosarcomas.

Inadecuación de los ingresos en un Servicio de Medicina Interna valorados en los protocolos A.E.P / Inappropiateness of the admissions in an Internal Medicine ward according the AEP Protocol

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[Appropriateness of admissions to an internal medicine department of a second level hospital]. / Adecuación de los ingresos en un servicio de Medicina Interna de un hospital de segundo nivel.

BACKGROUND: Study about the admissions appropriateness in the Internal Medicine ward of Hospital Juan Ramón Jiménez. MATERIAL AND METHODS: Retrospective review of the admissions in the first three months of 1997 not coming from any other ward. Two physicians not responsible of the admission evaluated separately the medical records by using the Appropriateness Evaluation Protocol. 201 patients were selected randomly from the 518 admissions which accomplished the criteria formerly exposed. RESULTS: 13.4% of the admissions did not fulfill any criteria of the Appropriateness Evaluation Protocol. The most frequent inadequate admission cause was for diagnostic purposes (66%). No significative difference was found in the percentage of inappropriate admissions with respect to age, gender, days of stay and number of previous admissions. CONCLUSIONS: The percentage of inappropriate admissions was slightly lower than that of similar studies carried out in similar conditions, probably because of the possibility of moving the patient to lower levels of care units according their needs.

Adecuación de los ingresos en un servicio de Medicina Interna de un hospital de segundo nivel / Appropriateness of the admission in an internal medicine ward of a secondary care hospital

Fundamento: Estudio de la adecuación de los ingresos en el Servicio de Medicina Interna del Hospital Juan Ramón Jiménez. Material y Métodos: Revisión retrospectiva de los ingresos durante el primer trimestre de 1997 no provenientes de otro servicio. Se estudiaron 201 pacientes, seleccionados aleatoriamente de entre los 518 ingresos que cumplían los requisitos expuestos aplicándoles la escala AEP (Appropiateness Evaluation Protocol). Resultados: El 13,4% de los ingresos realizados no cumplía ningún criterio de adecuación del Protocolo AEP. El motivo más frecuente de ingreso inadecuado fue completar estudio (66,7%). No se encontró diferencia significativa en el porcentaje de ingresos inapropiados con respecto a edad, género, tiempo de estancia, y multingreso-no multingreso. Conclusiones: El porcentaje de ingresos inadecuados fue ligeramente inferior al de otros estudios realizados a nivel similar, probablemente debido a la posibilidad de traslado de enfermos a unidades de menor nivel asistencial, de acuerdo con sus necesidades (AU)