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Biomedical subjects

M Labiós Gómez

Publications and source records attributed to M Labiós Gómez.

11 recordsLinked to original sources

[New criteria for the diagnostic and treatment of the deep vein thrombosis of the lower limbs].

The diagnosis of the deep vein thrombosis (DVT) based exclusively on its symptomatology and on the examination clinic is of few usefulness due to its small sensibility and especificity. However, its adequate combination with the presence of risk factors for the thrombosis, and the existence or not of an alternative diagnosis, it can be employed it to classify to the patients according to the forecast model clinic of DVT of Wells in two categories: high or probability decrease of suffering it. Their utilization in urgencies together with the determination of the D dimer (DD) will indicate us the need or not of accomplishing an echo -- Doppler, currently the complementary election test. The phlebography is maintained as "the gold test", though is reservation for certain cases. Unless exceptions, the heparins of under molecular weight have displaced the heparins not fractioned in the treatment of the disease, due to the series of inconvenients that present: complications hemorrhagics, thrombocytopenia, need of hospitalization and of biological control. It is possible, that in a future most or less next new antithrombotics, as the fondaparinux or the ximelagatran change substantially the treatment of the DVT. The indication of the thrombolysis is little accepted, due to the fact that the relationship risk -- benefit is not satisfactory. Though they are not exempt of complications, exist clean-looking situations in those which is indicated the placement of a filter in the inferior vein cava. An exception, they would be the thrombosis massive veins with gangrene risk phlegmasia cerulea dolens, in patient with under risk hemorrhagic. Finally, in the cases that developed ischemia venous, that generally appear in the occlusions most proximals -- iliac and inferior vein cava --, an effective option to re-establish the venous permeability would be the thrombectomy venous.

Anticoagulants↗

[New advances in the knowledge on post-thrombotic syndrome].

The real incidence of the post-thrombotic syndrome (PTS) is not known precisely, though of the most part of the variable studies, seems be deduced that it can be established a year after the deep venous thrombosis (DVT) acute of the inferior members in 17% to the 50% of the patients. Inseparably united to the venous hypertension that continues to the development of the incompetence valvular, is accompanied of a series of inflammatory reactions that include the increase in the permeability endothelial, the union of the circulating leukocytes at endothelium, the infiltration by monocytes, lymphocytes and mastocytes of the connective tissue, and the development of infiltrated tissular fibrotics and different molecular markers. To the contrary that in the DVT, we know very little about the factors that increase the risk of suffering a PTS, since the only one identified up until now it is the recurrent DVT. Currently we have different scales standardized for their your clinical diagnosis, though the Echo-Doppler is, currently, the technique not invasive of election to detect, locate and evaluate the venous disability valvular and the venous obstruction chronicle. The modern technical of image: computed tomography (CT), magnetic resonance (MR) and isotopics have a promising future, even though are found in validation phase. The phlebothropics drugs are the therapeutic election strategy for the patients with PTS in those which is not indicated the surgery or in those which this is a assisting of the medical treatment. Finally, the deep venous surgery must be reserved for all those patients that suffer from venous insufficiency serious chronicle, with meaningful venous reflux and ambulatory venous hypertension.

Endothelium, Vascular↗

[Assessment of the role of doppler color ultrasonography and magnetic resonance angio-resonance in the diagnosis of Takayasu's arteritis].

Takayasu arteritis (TA) is a chronic inflammatory process of unknown etiology which affects the aorta and its main branches causing occlusion, stenosis or dilation of the vessels concerned. A case of TA in a young woman is presented, who underwent colour doppler duplex ultrasound image study and whose diagnosis was confirmed by magnetic nuclear angioresonance (MNAR). The role of these two explorations in the detection and follow-up of this condition is discussed. Due to the fact that the expression and age at presentation may vary according to the different geographical areas affected, we would especially underline the new diagnostic criteria for this entity and based on the angiography findings obtained.

Adult↗

[Aortoenteric fistula secondary to aortobifemoral prosthesis infection].

We present the case of a 76 year-old man, intervened of an obstruction bilateral iliac by means of placement of a prosthesis aortobifemoral that presented pain in the grave left iliac and fever in needles of 39 degrees C to the five years of the intervention. In the physical exploration it highlighted a painful abdomen in the grave left iliac with signs of peritoneal irritation. In the laboratory tests a leukocytosis was detected with neutrophilia and negative culture. The computed thomography (CT) show the presence of gas bubbles around the prosthesis, as well as a liquid collection with areas necrotics in their interior that affected to the psoas and iliac muscles. In the same exploration the aspirative puncture with drainage of the absces demonstrated in the cultivations carried out in aerobic means the presence of Enterococcus faecalis and Enterobacter cloacae. When presenting a high gastrointestinal hemorrhage abruptly, he was practiced and gastroduodenal endoscope in which a aortoduodenal fistula was evidenced with having bled active. When a bypass extra-anatomic, the sick person will practice it died when presenting a shock abrupt hipovolemic that he didn't respond to the pertinent treatment. We analyze the approaches current diagnoses of infection of the vascular prosthesis and their more serious complication, the aortoenteric fistula (AEF) that either appears in the 0.3-5.9% of the patients who undergo prosthetic reconstruction of the abdominal aorta, for occlusive or aneurismal disease. We highlight the importance of carrying out a precocious diagnosis of the infection of the portion retroperitoneal of the vascular graft that, often, it is manifested with subtle and not specific clinical signs, with the techniques at the moment available as: the CT, fine needle aspiration guided by her, and to diminish the rates of mortality, from the current of 43%, until the most optimistic estimated in 19%.

Aged↗

[Current and future diagnostic strategies in venous thromboembolic disease].

Thromboembolic disease (TD), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common acute cardiovascular condition after ischemic cardiopathy and stroke. It is often difficult to diagnose, as it is well-known that half of PE episodes appear are recognized while the patient is still alive and which appear in 30-40% of symptomatic patients. Nonetheless, there are two well-differentiated phases in the diagnosis of TD: the suspicion, and the diagnosis. The first is very important, and is within the competence of any physician. The second can be ratified when carrying out specific tests. We have developed successive steps in the two phases of diagnosis, we critically review the distinct parts currently implicated in the strategic diagnosis of TD. Finally, we analyze the new diagnostic techniques to substitute, possibly, angiography in many cases, and perhaps to include ventilation/perfusion (V/Q) pulmonary gammagraphy, once become generally available.

Adult↗

[Sjogren's syndrome: a new diagnostic approximation].

At presentation the history of a 51 years old woman with xerostomia and dry keratoconjunctivitis sicca (KCS) with a development of ten months. Investigations revealed the presence in serum of antibodies against cytoplasmic antigens SS-A (Ac anti-Ro/SS-A), antinuclear antibodies (ANAS), and rheumatoid factor (RF). The test with Rose of Bengal was positive, and in the salivary gammagraphy made with pertecnate-99 m Tc it was observed a decreased of the captation and excretion of the designer for the salivary glands. The histopathology and immunohistochemical study of the minor salivary glands showed the presence of a focal lymphocytic sialadenitis (fls) and a predominance of lymphocytes CD4+. It was diagnosed a primary Sjögren a Syndrome (SSP) and the patient was treated with salivary substitutes and artificial tears. We analyse the current diagnostic criteria of the group of studies of the European Community for the SS. We emphasize the importance of the histologics and immunohistochemical study that with the rest of the complementary test will let us to distinguish not only the different forms of presentation of the illness, but also those of all the patients with pathologies which are very prevalent in our environment nowadays, such as the infections by virus C of the hepatitis (VCH) and the human immunodeficiency (VIH).

Autoantibodies↗

[Primary polycythaemia vera in the elderly].

We present an 86-years-old woman's case with paralysis in her left hand of abrupt apparition, accompanied by arterial hypertension and dizziness. The investigation revealed erythrocytosis, leukocytosis, thrombocytosis, with normal arterial O2 saturation (O2 SAT), increased of his red cell volume and blood viscosity. The polycythaemia vera (PV) was diagnose and the paralysis disappeared, when 24 hours before a phlebotomy was practiced, and the function was recovered by the hand. We analysed the presents diagnostics criteria of the disease defined by Polycythaemia Vera Study Group (PVSG). The different treatments for PV are discussed; in addition to venesection, conventional treatment include chemotherapy with hydroxyurea and pipobroman, as well as the erythropheresis, -interferon and aspirin. All of the treatments are associated with complications; thrombotic in the case of phlebotomy; malignancies and gastrointestinal bleeding in the case of myelosuppressive treatments and aspirin. We think the optimal treatment for PV is a judicious combination of the available alternatives, depending on the phase of the disease, and the age of the patient.

Aged↗

[Changes in blood viscosity and erythrocyte deformability in patients with dyslipidemia treated with binifibrate].

31 patients afflicted with primary hyperlipidemia who did not improve after 30 days on a diet were treated with 1800 mg/day of binifibrate. We measured the total cholesterol level and triglyceridemia, as well as blood viscosity and red cell deformability at day 0, 30, 60, 90 of treatment. We found a statistically significant decrease in cholesterol and triglyceride levels as well as blood viscosity, and an increment of red cell deformability which improved the circulatory dynamisms augmentin the tissular perfusion in these patients.

Aged↗