[Upper limb deep venous thrombosis. Risk factors, outcome, and posthrombotic syndrome]. / Trombosis venosa profunda de miembros superiores. Factores de riesgo, evolución y síndrome postrombótico.

OBJECTIVE: Our objective was that of describing a series of episodes of upper limb deep venous thrombosis, with special emphasis on the incidence of posthrombotic syndrome and its impact in the quality of life of the patients. METHODS: 33 episodes (29 patients) of upper limb deep venous thrombosis were studied, between January 1995 and January 2002; episodes until September 1999 (18 episodes) were considered retrospectively while those which took place starting in this date (15 episodes) were considered prospectively. In all, 24 patients were cared in hospital clinic. It was possible to obtain complete data in 16 cases, in which evolution toward posthrombotic syndrome, venous revascularization, and impact of the pathological process in the global quality of life of patients were studied. RESULTS: Average age of patients was 58.9 years. In 25 episodes (75.8%) some risk factor for venous thrombosis existed, the presence of a venous catheter being the most frequent. Subclavian axillary affectation was predominant (18 episodes, 55%) and in the left side (25 episodes, 76%). Twenty-eight episodes were diagnosed with echography (84.8%). Mean D-dimers concentration (N = 16) was 1,046 ng/ml (standard deviation [SD]: 826.9). One of the episodes (3%) was associated to lung thromboembolism. Treatment consisted on the administration of low molecular weight heparin during the acute phase in 70% of the cases. In 13 episodes (39%) additional treatment of thrombosis (endovascular in most) was carried out. In 29 episodes (88%) chronic treatment was administered with acenocoumarol, while in 4 episodes (12%) the administration of low molecular weight heparin was kept. No patient died during hospitalization. In 15 patients (52%) control of revascularizacion was performed. We detected complete revascularization in 6 patients (40%), revascularization with collateral circulation in 4 patients (27%), partial revascularization in other 4 patients (27%) and presence of permeability but with expansion and tortuosity of deep venous system in 1 case (6%). Posthrombotic syndrome was considered mild or nonexistent in 10 patients (62.5%) and moderate in 6 patients (37.5%). Quality of life of patients with moderate posthrombotic syndrome was significantly worse than that of patients with mild posthrombotic syndrome (73 vs 90, p < 0.035). CONCLUSIONS: Most of upper limb deep venous thrombosis are associated to the use of intravenous catheters. Echography is the primary diagnostic technique. At the time of the diagnosis, patients tend to show elevation in D-dimers levels. Evolution toward posthrombotic syndrome is frequent; this syndrome does not use to be serious but indeed influences the quality of life of patients.

Trombosis venosa profunda de miembros superiores. Factores de riesgo, evolución y síndrome postrombótico / Upper limb deep venous thrombosis

Objetivo. Nos propusimos describir una serie de episodios de trombosis venosa profunda de miembro superior, con especial énfasis en la incidencia posterior de síndrome postflebítico y surepercusión en la calidad de vida de los pacientes. Métodos. Se estudiaron 33 episodios (29 pacientes) de trombosis venosa profunda del miembro superior entre enero de 1995 y enero de 2002, incluidos retrospectivamente hasta septiembre de 1999 (18 episodios) y prospectivamente a partir de esta fecha (15 episodios). Se analizaron los factores de riesgo, la clínica, los procedimientos diagnósticos y el tratamiento administrado. Fueron controlados en la policlínica24 pacientes. Se dispuso de datos completos evaluables en16 casos, estudiándose la evolución a síndrome postflebítico, la repermeabilización venosa y la repercusión del proceso en la calidad de vida global de los pacientes. Resultados. La edad media fue de 58,9 años. En 25 episodios(75,8%) se apreció algún factor de riesgo para trombosisvenosa, siendo el más frecuente la presencia de un catéter venoso. Predominó la afectación axilosubclavia (18 episodios,55%) y del lado izquierdo (25 episodios, 76%). Veintiocho episodios (84,8%) se diagnosticaron con ecografía. La media de los niveles de D-dímeros (n=16) fue de 1.046 ng/ml.(DE: 862,9). En un episodio (3%) se asoció tromboembolismo pulmonar. El 70% de los casos se trató con heparina de bajo peso molecular en la fase aguda. En 13 episodios (39%) se practicó tratamiento adicional de la trombosis (endovascularla mayoría). En 29 episodios (88%) se administró tratamiento crónico con acenocumarol y en 4 (12%) se continuó con heparina de bajo peso molecular. No falleció ningún paciente durante el ingreso hospitalario. Se practicó control de repermeabilización en15 pacientes (52%). Detectamos repermeabilización completa en6 pacientes (40%), repermeabilización con circulación colateral en 4 (27%), repermeabilización parcial en otros 4 pacientes(27%) y eje permeable pero con dilatación y tortuosidad del sistema venoso profundo en un caso (6%). El síndrome postflebítico se clasificó como leve o ausente en 10 pacientes(62,5%) y moderado en 6 (37,5%). La calidad de vida de los pacientes con síndrome posflebítico moderado fue significativamente peor que la de los pacientes con síndrome postflebítico leve (73 frente a 90, p<0,035).Conclusiones. Las trombosis venosas profundas de miembros superiores más frecuentes se asocian al uso de catéteres intravenosos. La ecografía es la técnica diagnóstica predominante. Los D-dímeros se elevan al diagnóstico. La evolución a síndrome postflebítico es frecuente, pero éste no suele ser grave. aunque sí repercute en la calidad de vida de los pacientes

Objective. Our objective was that of describing a series of episodes of upper limb deep venous thrombosis, with special emphasis on the incidence of posthrombotic syndrome and its impact in the quality of life of the patients. Methods. 33 episodes (29 patients) of upper limb deep venous thrombosis were studied, between January 1995 and January2002; episodes until September 1999 (18 episodes) were considered retrospectively while those which took place starting in this date (15 episodes) were considered prospectively. In all,24 patients were cared in hospital clinic. It was possible to obtain complete data in 16 cases, in which evolution toward posthrombotic syndrome, venous revascularization, and impact of the pathological process in the global quality of life of patients were studied. Results. Average age of patients was 58.9 years. In25 episodes (75.8%) some risk factor for venous thrombosis existed, the presence of a venous catheter being the most frequent. Subclavian axillary affectation was predominant(18 episodes, 55%) and in the left side (25 episodes, 76%).Twenty-eight episodes were diagnosed with echography (84.8%).Mean D-dimers concentration (N = 16) was 1,046 ng/ml(standard deviation [SD]: 826.9). One of the episodes (3%) was associated to lung thromboembolism. Treatment consisted on the administration of low molecular weight heparin during the acute phase in 70% of the cases. In 13 episodes (39%)additional treatment of thrombosis (endovascular in most)was carried out. In 29 episodes (88%) chronic treatment was administered with acenocoumarol, while in 4 episodes (12%)the administration of low molecular weight heparin was kept. No patient died during hospitalization. In 15 patients (52%)control of revascularización was performed. We detected complete revascularization in 6 patients (40%),revascularization with collateral circulation in 4 patients (27%),partial revascularization in other 4 patients (27%) and presence of permeability but with expansion and tortuosity of deep venous system in 1 case (6%). Posthrombotic syndrome was considered mild or nonexistent in 10 patients (62.5%) and moderate in 6 patients (37.5%). Quality of life of patients with moderate posthrombotic syndrome was significantly worse than that of patients with mild posthrombotic syndrome (73 vs 90,p<0,035).Conclusions. Most of upper limb deep venous thrombosis are associated to the use of intravenous catheters. Echography is the primary diagnostic technique. At the time of the diagnosis, patients tend to show elevation in D-dimers levels. Evolution toward posthrombotic syndrome is frequent; this syndrome does not use to be serious but indeed influences the quality of life of patients

[Non-Hodgkin lymphomas with systemic presentation in patients with HIV infection. Clinical and prognostic factors in a series evaluated before the introduction of the highly active antiretroviral therapy (HAART)]. / Linfomas no hodgkinianos de presentación sistémica e infección por VIH. Análisis clínico y de factores pronóstico en una serie tratada antes de la introducción del tratamiento antirretrovírico de gran actividad.

PATIENTS AND METHOD: We studied patients with acquired human immunodeficiency virus (HIV) infection that developed non-Hodgkin's lymphoma (NHL) from January 1985 to October 2001. RESULTS: 44 patients (36 men, 8 women; median age 34 years) were included. Burkitt's lymphoma was diagnosed in 34%, and diffuse large cell B lymphoma in 29.5%. A history of AIDS diagnosis was detected in 20 cases (45%). International prognostic index (IPI) was 0-1 in 19 patients (43%), 2 in 12 (27%) and higher than 3 in 13 (30%). Chemotherapy was used in 64% of the patients, radiation therapy in 2% and both in 11%. Criteria for partial response were reached in 13 patients (29%), for complete remission in 2 (4%) and for stabilization in 1 (2%). Nine (20%) patients are alive (5 without disease), 22 (50%) died because of NHL, 5 (11%) died because of treatment associated toxicity and 8 died because of other causes. Median survival were 3 months, with a 1-year survival estimate of 24% and a 2-year survival estimate of 14%. In the univariate analysis of prognostic factors, IPI = 0-1 in comparison with IPI = 2-5 (p = 0.000), physical status (PS) < or = 2 (p = 0.021) and absence of B symptoms (p = 0.012) were significant. In the multivariate analysis, IPI = 0-1 was also significant (p = 0.000). CONCLUSIONS: Patients with HIV and NHL has multiple factors of poor prognosis. The survival is limited and chemotherapy toxicity is high. Patients with low IPI are a subgroup with better prognosis.