[Venous thromboembolic disease in a rural area of Southern Extremadura (Spain)]. / Enfermedad tromboembólica venosa en un área ruraldel sur de Extremadura (España).

OBJECTIVE: To study the characteristics of the venous thromboembolic disease (VTD) in a rural area of Southern Extremadura (Spain). MATERIAL AND METHODS: Prospective observational study of all patients diagnosed by objective methods of VTD in the only hospital in our area from November 2002 to November 2004. RESULTS: Seventy-six patients were diagnosed of VTD: 35 (46.1%) with pulmonary thromboembolism and 41 (53.9%) with isolated deep vein thrombosis (DVT). The median age was 72.4 years (range 35-94 years), 51 (67.1%) were older than 70 years, and 43 (56.6%) were women. The annual incidence of VTD was 0.63 per 1,000 persons (0.74 per 1,000 persons in women and 0.54 per 1,000 persons in men). Thirty-seven patients (48.7%) had "idiopathic" VTD. After a median follow-up of 5.5 months with anticoagulant therapy, 13 patients (17.1%) had dead. Comorbidity and non "idiopathic" VTD were significantly more frequent in the dead patients. Three patients (3.9%) presented probable recurrence, and all of them died. There were 4 cases (5.3%) of non-fatal severe hemorrhage. Nine patients with isolated DVT did not require hospitalization, and there was no event in the follow-up. CONCLUSIONS: The incidence of VTD may be lower in our area than in other geographical areas. VTD affects more frequently to elderly and women, and almost half of cases are "idiopathic". The mortality is high, and it is related to the existence of comorbidity and non "idiopathic" VTD. The recurrences and the severe hemorrhages are not exceptional during the anticoagulant therapy. The ambulatory treatment of isolated DVT may be an option in selected patients.

[Symptomatic chronic hemichorea of a vascular lesion in the contralateral putamen]. / Hemicorea crónica sintomática de una lesión vascular en el putamen contralateral.

We present a case of chronic multifocal choreform dyskinesia with evident anatomical and temporal relationship with a contralateral putamen lesion of ischaemic origin after embolism originating in a partially thrombosed intracavernous caratid aneurysm. Isolated putamen lesions are associated with abnormal dystonic type involuntary movements, bilateral to Parkinsonisms, sometimes associating both these types of movements, and lesions involving the cauda giving rise to choreic movements. Given the rarity in the literature of this entity, chorea associated with unilateral ischaemic putamen lesion, and the absence of pathogenic mechanisms which might satisfactorily explain it, we propose a series of possibilities which could underlie this type of chorea. If putamen macroscopic lesions are really more associated with dystonic manifestations, it is possible that, in some cases they might selectively alter base ganglia circuits and bring on chronic choreas rather than dystonia.