BackgroundDVT is the main cause of death in hospitalized patients and thromboprophylaxis is the only way to prevent these deaths. International recommendations suggested that active monitoring of DVT/PE prophylaxis can improve the efficacy in Hospitals.MethodsWe performed a cohort study in three consecutives periods to evaluate DVT prophylaxis in 388 adults hospitalized in a General Hospital.Results85% of the population had high risk factors for DVT. Thromboprophylaxis was in accordance with local and International guidelines (ACCP 2008) in 72.7% and 86% of the patients respectively. No significant difference could be founded between clinical and surgical patients. One every 10 patients received higher prophylaxis than suggested by guidelines and two out of ten received deficient or no prophylaxis. The worst 2 groups of patients were those with moderate/low risk of DVT and the group with a contraindication to pharmacologic prophylaxis. We observed a progressive improvement of the DVT prophylaxis in the 3 periods of evaluation.ConclusionsAlthough the rate of recommended thromboprophylaxis is higher than many other reports in the region we still have some areas where we need to improve. Regular audits like these are very helpful to find out what specific areas of the hospital needs some careful attention in order to have a better quality of assistance.

Summary This review discusses the applications of acupuncture (AP) and its eastern medical philosophy in equine health, and the main techniques used to stimulate acupoints in equine practice. These methods include dry needling, electroacupuncture (EA), moxibustion, laser therapy, haemopuncture, aquapuncture, pharmacopuncture, acupressure and gold implants.

Hutchinson and his historyThe prolific life of Jonathan Hutchinson is reviewed. The importance of triads, a set of signs and symptoms that lead to the suspicion of the presence of one or more clinical entities, that are a demonstration of associative thinking, is also discussed. Nowadays, when technology plays a very important role in medicine, we would like to underscore the value of history taking and physical examination as useful clinical tools.

Introducción. La miocardiopatía por estrés (MCS) o síndrome de takotsubo, se caracteriza por una disfunción sistólica aguda y transitoria que simula la presentación de un síndrome coronario agudo gatillada por un factor estresante psicológico o físico. Métodos. Se presenta una serie de casos de pacientes con MCS del Hospital Británico entre 2011 y 2016. Se describen las características de la población estudiada y factores epidemiológicos y clínicos asociados. Resultados. Se incluyeron 17 pacientes con una edad media de 62,5 años, de los cuales el 94% eran mujeres. Más del 70% presentaban uno o más factores de riesgo cardiovascular. La mayoría tenían valores elevados de los biomarcadores miocárdicos troponina T ultrasensible y creatinfosfokinasa. Se observó compromiso apical y medioventricular del ventrículo izquierdo con afectación moderada a severa de la fracción de eyección del ventrículo izquierdo e insuficiencia mitral variable. La evolución de la mayoría de los pacientes fue favorable. Discusión. La incidencia de este síndrome ha ido en aumento en la última década, debido al mayor conocimiento de la enfermedad y a los avances y disponibilidad de los medios de diagnóstico por imágenes. Los hallazgos de esta serie podrían contribuir a identificar rápidamente a los pacientes con miocardiopatía por estrés y optimizar su tratamiento y manejo clínico. Palabras clave: miocardiopatía de takotsubo; miocardiopatía por estrés; síndrome de corazón roto; síndrome de abombamiento apical, síndrome de aturdimiento apical transitorio del ventrículo izquierdo. Palabras clave: miocardiopatía de takotsubo, miocardiopatía por estrés, síndrome de corazón roto, síndrome de abombamiento apical, síndrome de aturdimiento apical transitorio del ventrículo izquierdo.

Ascites is rare in patients with multiple myeloma (MM). It may be due to diverse mechanisms, most frequently because of an increased permeability of the peritoneum or because of portal hypertension due to liver infiltration. Myelomatous ascites occurs more frequently in patients having Ig-G or Ig-A paraprotein and their prognosis is poor. It is submitted the case of a female patient aged 50 years with IgA-kappa MM, who evolved with cardiac failure (CF), plasma cells leukemia and ascites of mixed cause, because of peritoneal infiltrate of myelomatous cells, hepatic compromise and CF. A review of the different causes of ascites in patients with MM is performed. There are also summarized all myelomatous ascites cases published in the literature. Our report presents the first case of myelomatous ascites in a patient with plasma cells leukemia.

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e21519 Background: Chordoma is a rare primary bone tumor arising from primitive notochord remnants of axial skeleton. Adequate surgery still remains the mainstay of its therapeutic treatment. Methods: Our review has been focused on the clinical characteristics, type of treatment, and prognosis of 23 consecutive cases of chordomas observed from 2004 until today and followed by the same team of specialists (orthopedic surgeons and medical oncologists). Results: From June 2004 to December 2008, 23 pts with various stage of disease went to our observation. Male/female: 18/5. Median age at diagnosis: 60 yrs (range: 40 -74). Sites of origin: sacrum (10 pts), spine (12 pts), and skull base (1 pt). Ten pts (44%) had primary disease, 9 pts (39%) had recurrent disease, and 4 pts (17%) had developed metastatic lesions. Surgery was part of the treatment in 21 out of 23 pts. Surgical margins were rated as wide/marginal in 17 pts and intralesional in 4 pts. Adjuvant proton radiotherapy has been delivered to 2 pts. Conventional radiotherapy was performed in 4 pts. The rate of local relapse after primary surgical excision was 76%. The median time to recurrence was 14 months (range: 2–113).Sixteen pts with inoperable/unresectable or metastatic PDGFR β expressing disease were treated with imatinib mesylate (IM) in the context of a clinical trial and a subsequent expanded access program (Stacchiotti S., proc ASCO 2007. abstr. 10003). One pts received weekly cisplatin in combination with IM after progression during IM therapy. The 5-year survival rate of the entire series was 76 %. Two out of 17 pts (12%) surgically treated with adequate margins are still alive and without evidence of disease; two other pts died without evidence of disease. Conclusions: Despite the progress of current surgical techniques and some encouraging results with the use of targeted therapy, chordoma results, generally, in a long-lasting disabling and life-affecting disease. Nevertheless, specific experience of the multidisciplinar team is an important prerequisite to improve patients’ quality of life and, hopefully, outcome. No significant financial relationships to disclose.

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