Enrique M. Baldessari

Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric cross-sectional study

BackgroundVenous thromboembolic disease (VTE) is associated with high morbi-mortality. Adherence rate to the recommendations of antithrombotic prophylaxis guidelines (ATPG) is suboptimal. The aim of this study was to describe the adequacy of antithrombotic prophylaxis (ATP) in hospitalized patients as the initial stage of a program designed to improve physician adherence to –ATP recommendations in Argentina.MethodsThis study was a multicenter, cross-sectional study that included 28 Institutions throughout 5 provinces in Argentina.Results1315 patients were included, 729 (55.4%) were hospitalized for medical (clinical) reasons, and 586 (44.6%) for surgical reasons. Adequate ATP was provided to 66.9% of the patients and was more frequent in surgical (71%) compared to clinical (63.6%) subjects (p < 0.001). Inadequate ATP resulted from underuse in 76.6% of the patients. Among clinical, 203 (16%) had increased bleeding risk and mechanical ATP was used infrequently.ConclusionsThe adequacy of ATP was better in low VTE risk clinical and surgical patients and high VTE risk in orthopedic patients. There was worse adequacy in high risk patients (with active neoplasm) and in those with pharmacological ATP contraindications, in which the use of mechanical methods was scarce. The adequacy of ATP was greater at institutions with < 150 beds compared with larger institutions. This is the first multicentric study reporting ATP in Argentina. Understanding local characteristics of medical performance within our territory is the first step in order to develop measures for improving ATP in our environment.

Cardiogenic unilateral pulmonary edema: an unreported complication of a digestive endoscopic procedure.

Unilateral pulmonary edema is an uncommon clinical situation that may be difficult to distinguish from other conditions that cause lung infiltrates. Most cases occur in the right lung, and there are no reports about cardiogenic unilateral pulmonary edema as a complication of an endoscopic procedure of gastrointestinal tract. The authors describe a case of a 79-year-old woman with acute cardiac heart failure that developed soon after a diagnostic upper and lower digestive endoscopy. Continuous positive airway pressure, intravenous nitroglycerin, and furosemide treatment resulted in rapid improvement of symptoms and the progressive resolution of left-sided infiltrates on chest radiography. This case is of particular importance because of the rarity of cardiogenic unilateral edema in the left lung. This clinical finding was associated with the prolonged rest on the left side during the gastrointestinal endoscopic procedure.

Respiratory failure after treatment of pneumothorax

A 40-year-old man presented with an eight day history of left-side pleuritic chest pain and dyspnea. Chest examination revealed decreased air entry at the left lung. Chest X-ray examination revealed a large pneumothorax and a chest tube was successfully placed. Two hours after the procedure, auscultation revealed crackles over the left lung and oxygen saturation was 88% on room air. Chest radiography was repeated and showed a fully expanded left lung with alveolar-interstitial infiltrates.

Sweet's syndrome.

A 71-year-old man presented with a 3-day history of a progressive skin eruption, conjunctivitis and fever. Physical examination revealed tender purple-red papules, plaques and pustules distributed asymmetrically on the upper extremities (Fig. 1), face (Fig. 2), scalp and chest. Histological examination of a biopsy specimen showed oedema of the papillary dermis and a diffuse infiltrate of neutrophils throughout the upper dermis (Fig. 3). We ruled out malignancy, infections, autoimmune disease or new drug administration. A diagnosis of Sweet’s syndrome was established. Prednisone (1 mg/kg/day) was started and a rapid improvement in skin lesions was observed. Sweet’s syndrome (acute febrile neutrophilic dermatosis) is a neutrophilic dermatosis characterised by fever, neutrophilia, erythematous skin lesions and a diffuse dermal infiltrate of mature neutrophils. The pathogenesis Figure 3 The skin biopsy showed oedema of the papillary dermis and a diffuse infiltrate of neutrophils throughout the upper dermis (haematoxylin and eosin stain, ¥40). Figure 1 Multiple coalescent purple–red papules and plaques on the right elbow. Figure 2 Pustules and erythematous plaques with a pustular component on face. Images in Medicine