Anemia secundaria a infección por parvovirus B19 en adulto joven, previamente asintomático / Anemia associated with parvovirus B19 infection in a young adult without underlying disease

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[Low molecular weight heparin versus unfractionated heparin in the treatment of deep vein thrombosis]. / Heparinas de bajo peso molecular frente a heparinas no fraccionadas en el tratamiento de la trombosis venosa profunda.

BACKGROUND: Low-molecular-weight heparin (LMWH) are replacing unfractionated heparin (UH) in treatment of deep vein thrombosis (DVP), showing their security and effectiveness. METHODS: To demonstrate their security and effectiveness a randomized prospective study was realised. It compared UH with LMWH in DP treatment, clinically diagnosed and confirmed with eco-Doppler. The study included 32 patients (21 males and 11 females); 15 received UH in continuos i.v. infusion and 17 sodic dalteparine, with dicumarinic afterwards in every case. The patients were followed for one year. RESULTS: There were no differences between the two groups of treatment in clinical/radiological effectiveness either in short term nor one year follow up. There were no significative differences in side effects. CONCLUSION: LMWH are as effective and safe as UH for DVT treatment. They also have a more comfortable dosage for the patient, avoiding the i.v. infusion and the coagulation test, which allows treatment at home.

Heparinas de bajo peso molecular frente a heparinas no fraccionadas en el tratamiento de la trombosis venosa profunda / Low-molecular-weight heparin versus unfractiona ted heparin in the treatment of deep vein thrombosis

Antecedentes: Las heparinas de bajo peso molecular están sustituyendo de forma progresiva a las heparinas no fraccionadas en el tratamiento de la enfermedad tromboembólica, porque parecen haber demostrado ser seguras y eficaces.Métodos: Para analizar su eficacia y seguridad en nuestro medio, se realizó un estudio prospectivo aleatorizado en el que se comparaba la heparina sódica con una heparina de bajo peso molecular en el tratamiento de las trombosis venosas profundas, diagnosticadas clínicamente y confirmadas por eco-Doppler. Se incluyeron 32 pacientes (21 varones y 11 mujeres) de los cuales 15 recibieron heparina sódica en perfusión continua y 17 dalteparina sódica, seguida posteriormente de dicumarínicos en todos los casos. Se realizó un seguimiento de un año.Resultados: No hubo diferencias entre ambos grupos de tratamiento en eficacia clínica/radiológica a corto plazo ni en el año de seguimiento. Asimismo tampoco hubo diferencias significativas en cuanto a efectos secundarios.Conclusión: En nuestro medio, las heparinas de bajo peso molecular resultan tan eficaces y seguras como la heparina sódica para el tratamiento de la trombosis venosa profunda, presentando una posología más cómoda para el paciente, evitando el uso de bombas de infusión y la práctica de controles analíticos, y posibilitando el tratamiento domiciliario. (AU)

[The use of cefotaxime on patients admitted to the internal medicine service of a general hospital. An analysis from the viewpoint of health economics]. / Empleo de la cefotaxima en pacientes ingresados en el Servicio de Medicina Interna de un hospital general. Un análisis desde el punto de vista de la economía de la salud.

Cefotaxime is a widely employed antibiotic in hospital practice, leading to an important economical cost. We analyse the adequacy of the indications of cefotaxime in our Internal Medicine Unit along a two month period. The records of the 54 patients treated with cefotaxime along a two month period were retrospectively reviewed to establish the adequacy of the prescriptions by checking them with a list of indications based on widely used bibliographical sources. Cefotaxime prescription was considered inadequate because of its inefficiency in 15 out of the 54 patients studied (28%). They were all patients admitted because of bronchitic relapses of chronic obstructive lung disease ("COLD") without radiological evidence of pneumonic consolidation. We calculate that using a more efficient antibiotic alternative could lead to a decrease of a 3.6 to 7.53% in the total pharmaceutical expenses of our unit along the study period. We conclude that the unnecessary routine use of cefotaxime may lead to an avoidable important increase in sanitary costs.

[Brucellosis after treatment: the diagnosis of recurrences]. / La brucelosis después del tratamiento: diagnóstico de las recidivas.

BACKGROUND: Given the frequency of relapse following treatment of brucellosis as well as the persistence of symptoms the authors attempted to discover a recommendable position for surveillance of patients once treatment has been completed. METHODS: A series of 105 patients treated for brucellosis was prospectively analyzed, 11 of whom had relapse. Post treatment symptoms, serology titers and the results of the cultures between the cured patients and those with relapse were compared. RESULTS: Hemocultures (sensitivity 0.73) and "specific" symptoms (prolonged fever, spondylitis, arthritis, orchitis and others) were the most useful data for diagnosis of relapse. The presence of vague symptoms following treatment was of slight value specially in the first months. Elevation of serology titers following treatment offered little aid in diagnosis (likelihood ratio 1.7). The persistence of high titers of serology several months following completion of treatment offered high likelihood ratios which may aid in therapeutic decision making. CONCLUSIONS: It is recommended that no tests be made on asymptomatic patients following treatment of brucellosis and to treat those patients with "specific" symptoms. Hemocultures are recommended for patients with vague symptoms and if several months have passed serology should be carried out from which the probability of relapse may be calculated.

[Diagnosis of brucellosis in an endemic area. Evaluation of routine diagnostic tests]. / El diagnóstico de la brucelosis en un área endémica. Valoración de las pruebas diagnósticas habituales.

BACKGROUND: The use of classic methods of diagnosis of brucellosis was analyzed, particularly serologic methods whose use in endemic areas and risk groups has been questioned in the literature. METHODS: Prospective analysis of these methods was performed in a group of 171 patients suspected as having brucellosis proceeding from an endemic area, with progressions of risk and frequent antecedents of brucellosis. The results obtained were compared in 119 patients in whom brucellosis was confirmed (80 with positive cultures and 39 with clinic-serologic diagnosis) and in 52 in whom the diagnosis was excluded. RESULTS: The hemocultures provided a sensitivity of 70% with a mean delay in growth of 13.6 days. The rise of Bengal test showed sensitivity of 95% and specificity of 75%. The most adequate cut-off point for seroagglutination was of 1/160 and for the Coombs test 1/320 with sensitivities of 93 and 92% and specificities of 97 and 100%, respectively. CONCLUSIONS: The routine serologic tests offer good results for the diagnosis of brucellosis in endemic areas upon use of adequate cut-off points and permitting therapeutic decisions to be taken prior to knowledge of the results of the cultures. The rose of Bengal test is valid for initial selection of this type of population.

Pancytopenia due to hemophagocytosis in patients with brucellosis: a report of four cases.

In 42 patients with brucellosis who had bone-marrow cultures performed, five had hemophagocytosis, four of whom demonstrated peripheral hemocytopenia. All five patients with hemophagocytosis had Brucella melitensis isolated from both blood and bone-marrow cultures. Infectious diseases such as brucellosis should be considered in patients whose clinical picture suggests malignant histiocytosis, especially in geographic areas where brucellar infections are common.

[Clinical endoscopic, and secretory responses in patients with duodenal ulcer treated one gram per day of cimetidine for a year (author's transl)]. / Respuesta clínica, endoscópica y secretoria en pacientes con enfermedad ulcerosa duodenal, tratados con cimetidina a la dosis de un gramo al día durante un ano.

In the case that long term treatment with cimetidine could lead to a reduction of the parietal cell mass, there would result important therapeutic consequences. To investigate this possibility, 26 patients with duodenal ulcer were prospectively studied while on treatment with 1 g daily of cimetidine for two six-month periods separated by a two-week interruption of the therapy. No significant changes in pentagastrin-stimulated gastric acid secretion were observed after seven to 14 days off cimetidine, following six and twelve months of treatment. Cimetidine therapy had a significant effect on ulcer pain and antacid consumption. There were reductions of 11% and 10% from the initial figures in the proportion of ulcer niches seen endoscopically, after six in twelve months of treatment respectively. Some patients without a visible duodenal niche on initial endoscopy showed one at subsequent examinations. The sudden interruption of cimetidine treatment after six months was followed by the development of a gastric ulcer, previously absent, in three patients, one of whom had an upper gastrointestinal haemorrhage. There were no extragastric complications in spite of the doses and the duration of treatment. The authors consider that maintaining patients on one gram per day of cimetidine for one year is useless.