Treatment of deep vein thrombosis of the lower extremities. / Tratamiento de la trombosis venosa profunda de extremidades inferiores.

Deep vein thrombosis of the lower extremities is a common condition that should be treated appropriately given the possibility that it could lead to an ultimately fatal complication, as well as to a post-thrombotic syndrome that is in some cases disabling. The current treatment for this condition is differentiated into an acute phase, a long-term therapy and occasionally an extended therapy, which not only has defined objectives but also uses various drugs and even varying dosages for each drug. We describe the therapeutic anticoagulation options in each of these treatment phases and some of the treatments (thrombolysis, insertion of an inferior vena cava filter, surgery) that can play a role in certain conditions.

Diabetic muscle infarction: an underdiagnosed complication of long-standing diabetes.

OBJECTIVE: To systematically review all the reported cases of diabetic muscle infarction (DMI) and its pathogenesis, clinical features, prognostic implications, and management. RESEARCH DESIGN AND METHODS: We searched databases (MEDLINE and EMBASE) from their inception to August 2001 and reviewed bibliographies in reports retrieved. Data were extracted in a standardized form. RESULTS: A total of 47 references were retrieved; 115 patients and 166 episodes were included. DMI was more frequent in women (61.5%, mean age at presentation 42.6 years). Of the cases, 59% had type 1 diabetes; the mean duration of disease was 14.3 years, and multiple diabetic end-organ complications were noted. DMI affects the lower limbs with abrupt onset of pain and local swelling. Diagnosis is made by biopsy, but the characteristic features in magnetic resonance imaging are very typical. Treatment includes bed rest and administration of analgesics, but recurrence is common. CONCLUSIONS: DMI is a very uncommon complication of long-standing diabetes; presentation is well characterized and management is simple.

Varón con multiples imágenes quísticas en la TAC torácica en tratamiento con amiodarona / Pulmonary parenchymal infiltrates on CT of patient in treatment with amiodarone

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Metástasis esternal por hepatocarcinoma / Sternal metastases hepatocellular carcinoma

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[Aneurysm of the left subclavian artery: infrequent cause of upper pulmonary mass]. / Aneurisma de la arteria subclavia izquierda: causa infrecuente de masa pulmonar superior.

Subclavian artery aneurysm is an uncommon condition. Usually is arteriosclerotic in origin. Its clinical features are scarce and generally are due to compression of the neighbourhood structures or ischemic, embolic or, less frequently, rupture of it. Diagnosis is performed by an arteriography or a computed tomography scan. Treatment includes the surgical reaction or the embolization. We report the case of a patient with a left subclavian artery aneurysm and review the most important clinical features of this entity.

Mujer de 70 años con dolor e inflamación en pantorrilla derecha / Seventy-year old woman with pain and inflammation in the left calf

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Aneurisma de la arteria subclavia izquierda: causa infrecuente de masa pulmonar superior / Left subclavian artery aneurysm: uncommon cause of an upper lung mass

El aneurisma de la arteria subclavia es una entidad infrecuente. Su causa más frecuente es la arteriosclerosis. Sus manifestaciones clínicas suelen ser escasas y generalmente se deben a compresión de estructuras vecinas o a fenómenos isquémicos, embólicos o menos frecuentemente a ruptura del mismo. El diagnóstico se consigue mediante una arteriografía o tomografía computarizada. El tratamiento implica la resección quirúrgica o la embolización del mismo. Presentamos el caso de un paciente con un aneurisma de la arteria subclavia izquierda y revisamos los aspectos más importantes de esta patología. (AU)

[Clinical and analytic diagnostic evaluation of deep venous thrombosis of the lower limbs]. / Valoración diagnóstica clínica y analítica de la trombosis venosa profunda de miembros inferiores.

BACKGROUND: Diagnosis of deep-vein thrombosis (DVT) of lower limbs has changed in recent years. The objective of our study was to analyze the diagnostic accuracy of a combination of clinical and epidemiological data and the D-Dimer plasma levels in this entity. PATIENTS AND METHODS: Clinical (symptoms and signs) and epidemiological data, personal and family history, and D-dimer plasma levels or positivity were reviewed, on the admittance, in 108 patients to whom a phlebography was performed due to a suspected DVT. RESULTS: Phlebography was positive in 76 cases (70.37%). Logistic regression analysis determined a prediction model of the diagnostic of DVI including a combination of both D-dimer plasma levels or positivity and pain along the deep venous involved area. CONCLUSION: Combination of D-dimer testing and pain along the distribution of the deep venous area is useful as an initial diagnostic approach to the DVI of the lower limbs.