Recommendations for the diagnosis and treatment of patients with thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA) characterized by the development of microangiopathic haemolytic anaemia, thrombocytopenia, and ischaemic organ dysfunction associated with ADAMTS13 levels lower than 10% in most cases. Recently there have been numerous advances in the field of PTT, new, rapid and accessible techniques capable of quantifying ADAMTS13 activity and inhibitors. The massive sequencing systems facilitate the identification of polymorphisms in the ADAMTS13 gene.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016.

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Minimal residual disease evaluation by flow cytometry is a complementary tool to cytogenetics for treatment decisions in acute myeloid leukaemia.

The clinical utility of minimal residual disease (MRD) analysis in acute myeloid leukaemia (AML) is not yet defined. We analysed the prognostic impact of MRD level at complete remision after induction therapy using multiparameter flow cytometry in 306 non-APL AML patients. First, we validated the prognostic value of MRD-thresholds we have previously proposed (≥ 0.

Sequential combination of mitomycin C plus bacillus Calmette-Guérin (BCG) is more effective but more toxic than BCG alone in patients with non-muscle-invasive bladder cancer in intermediate- and high-risk patients: final outcome of CUETO 93009, a randomized prospective trial.

Background: Intravesical bacillus Calmette-Guérin (BCG) is an effective therapy in non-muscle-invasive bladder cancer (NMIBC), but it has limitations in terms of recurrence and toxicity.

Objective: To determine whether the sequential combination of mitomycin C (MMC) and BCG is superior to BCG alone in increasing a disease-free interval (DFI).

Design, Setting, And Participants: We conducted a prospective randomized trial including 407 patients with intermediate- to high-risk NMIBC and allocated 211 to the MMC and BCG arm and 196 to the BCG-alone arm.

Management of the febrile neutropenic patient.

Fever of unknown origin in oncological patients is a frequent problem throughout the world. The microbiology of infections in these patients can vary widely. Gram-negative bacteria were more prevalent in early trials, but Gram-positive organisms have become increasingly common since the mid 1980s.

Atherosclerotic aortic rupture: documentation by transesophageal echocardiography.

We report a case of a 77-year-old woman who had a rupture of the descending thoracic aorta as a complication of an atherosclerotic aortic plaque. Transesophageal echocardiography enabled the diagnosis of aortic rupture and was very useful in the patient's surgical management.

Low molecular weight heparin (enoxaparin) versus oral anticoagulant therapy (acenocoumarol) in the long-term treatment of deep venous thrombosis in the elderly: a randomized trial.

This study aims to establish the relative effectiveness and safety of low molecular weight heparin in elderly patients with venous thrombosis in order to find an alternative to oral anticoagulant therapy with less bleeding complications in the long-term treatment of deep venous thrombosis (DVT). One hundred consecutive elderly patients (>75 years old) with venographically demonstrated proximal DVT were included in a randomized trial. All patients were treated for ten days with adjusted doses of intravenous heparin.

A new polymorphim (G->A) in the psizeta1 globin gene.

Background And Objectives: a-globin cluster polymorphisms are obtained with specific restriction enzymes (Xba I, Eco RI, Sac I, Apa I, Bgl II, etc) that can also have implications for genetic analysis. DESIGN AND AND METHODS: We studied three unrelated patients; one from Argentina, one from Spain and one from Australia but of Polish origin. Genomic DNA was digested with several different restriction enzymes and probes, amplified and sequenced with an ABI Prism 310 sequencer.

Migrant populations and the incidence of type 1 diabetes mellitus: an overview of the literature with a focus on the Spanish-heritage countries in Latin America.

Type 1 diabetes mellitus (DM) is a 'chronic' autoimmune disorder leading to the destruction of the pancreatic beta cell. The natural history of diabetes includes a long subclinical (prediabetes) period. The pathogenesis is multifactorial and characterized by the interaction of environmental factors, with predisposing genes, most of which are associated with the HLA DR DQ loci.

Penetrating atherosclerotic aortic ulcer: documentation by transesophageal echocardiography.

Objectives: This study sought to describe the ability of transesophageal echocardiography (TEE) to document the presence of penetrating atherosclerotic aortic ulcers and their complications.

Background: TEE has greatly enhanced our ability to assess patients with suspected aortic disease. However, the utility of this technique in the diagnosis of penetrating atherosclerotic aortic ulcers is still undefined.

Supravalvular aortic stenosis in aortic dissection.

Supravalvular aortic stenosis is a rare complication of aortic dissection. We report on echocardiographic and magnetic resonance observations in 2 cases of aortic dissection with false lumen thrombosis of the ascending aorta and severe narrowing of the true lumen.

Prevalence and relevance of a septal diastolic notch during dobutamine stress echocardiography.

Background: Dobutamine stress echocardiography has become an accepted simple and inexpensive method of detecting coronary artery disease. In this pharmacological stress test, particular attention has been paid to transient systolic wall motion abnormalities. Our group has noted an abnormal diastolic ventricular septal motion, a 'diastolic notch', during dobutamine stress echocardiography that has not been previously described.

Primary mycotic aneurysm of the ascending aorta diagnosed by transesophageal echocardiography.

Primary mycotic aneurysms are rare, and they can be difficult to diagnose before rupture. Early diagnosis is the cornerstone to effective management. Preoperative diagnosis has traditionally involved angiography and computed tomography.

Natural history and serial morphology of aortic intramural hematoma: a novel variant of aortic dissection.

Background: Acute aortic dissection is a cardiovascular emergency that requires prompt diagnosis and treatment. Transesophageal echocardiography is the current standard diagnostic imaging modality in many medical centers. Aortic intramural hematoma is a variant of aortic dissection whose natural history and prognosis have not been well studied.

Atypical P. vivax and P. ovale morphology in two imported cases of malaria in Spain.

The finding of two imported cases of malaria in Spain is reported. Although their origin, their age and their clinical history were different, they both showed parasites of atypical morphology. One was diagnosed as P.

Retrograde atrial kick in acute aortic regurgitation. Study of mitral and pulmonary venous flow velocities by transthoracic and transesophageal echocardiography.

Background And Hypothesis: The purpose of this study was the comprehensive evaluation of the changes in pulmonary venous and mitral flow velocities of patients with acute and chronic severe aortic regurgitation. Transmitral flow velocities obtained with pulsed-wave Doppler echocardiography have been used to provide information on left ventricular (LV) filling and diastolic function. Pulmonary venous flow tracings are an important adjunct to LV inflow pattern in assessing LV diastolic function.

Increased serum levels of IgA antibodies to hsp70 protein in patients with diabetes mellitus: their relationship with vascular complications.

We measured class-specific antibodies to the mycobacterial hsp70 protein in 67 patients with diabetes mellitus (27 type 1 and 40 type 2) with or without vascular complications. Using ELISA, the levels of IgG and IgM antibodies in the sera of diabetic patients did not significantly differ either from those of healthy control subjects or between both types of diabetes, regardless of gender, disease duration, HbA1 level, or type of vascular complication. In patients with type 2 diabetes, the mean serum IgA levels were significantly higher than those in their matched controls [274(71) mg/dl vs 208(88) mg/dl; P < 0.

[Identification of intramural aortic hematoma by transesophageal echocardiography].

Background And Aim: The usefulness of transesophageal echocardiography in the diagnosis and assessment of patients with aortic dissection has been widely demonstrated. The aim of this study was to evaluate the role of this technique in the detection of intramural aortic hematoma and in the follow-up of these patients.

Methods: The records of 51 patients with aortic dissection by transesophageal echocardiography diagnosed between May 1990 and May 1994 were reviewed.

[Aortic intramural hematoma and penetrating aortic ulcer].

Two poor-defined acute aortic syndromes (intramural aortic hematoma and penetrating aortic ulcer) that must be distinguished from the classic dissection are reviewed in this article. Based on the literature and our own experience we describe the clinical characteristics, diagnostic aspects and treatment.

[Morphological and quantitative analysis of the mechanism of balloon angioplasty. An intravascular ultrasonic study].

Background And Objectives: Intracoronary ultrasound allows to study in vivo the morphology of the arterial wall, the presence and composition of atheroma and the associated lumen encroachment. The objective of our study was to assess the value of intravascular ultrasound to determine the dilatation mechanism after a conventional balloon angioplasty.

Patients And Methods: Sixteen patients were examined with intravascular ultrasound before and after they had undergone percutaneous transluminal coronary angioplasty.

[Effects of urethropexy on urination. A price to pay?].

Objectives: To evaluate the voiding repercussions of urethropexy.

Methods: We carried out a clinical and urodynamic study in 70 patients subjected to different techniques of urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch and simplified Ramirez) for stress urinary incontinence. We evaluated the voiding repercussions of urethropexy.