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THE FATE OF PULMONARY THROMBI AFTER PULMONARY EMBOLISM
S22
Oral Communications / European Journal of Internal Medicine 19S (2008), S1–S59
In 1997, in spite of treatment associating acetylsalicylate (100mg), LMWH (enoxaparine) at 0.4 ml ×2, prednisone at 10 mg/day, hydroxychloroquine at 400 mg/day, delivery is very premature (six and a half months), the child weighs only 1 kg 200g. In 1999, new delivery at 33 weeks and birth of a child weighing 2kg100. Tabagism is not completely stopped. In 2004, new pregnancy, same therapeutic attitude and stable lupus, new successful attempt to stop tabacco! The child will be born at 33 weeks, weighing 2 kgs. This is partially explained because of placenta praevia. Results: With pregnant woman, biological exam’s perturbations connected with tabagism, may be a means to speak firmly about tobacco. So it was in this case report. Discussion: Among vascular risk’s factors, tabagism is the one which prevalence has the most increased about woman, over the past three decades, becoming dominant factor about young woman. This case report permits to remind of dynaminc and precarious balance of coagulation during pregnancy. The presence of a greater risk’s factor like APS, requires a real participation from the patient. Conclusion: Lupus pregnancy is always difficult, all the more because associated with APS. Obtaining effective participation wich tabacco’s stop during pregnancy is an absolute necessity. That’s why the information must be clear, understood, and the contract accepted
were surgical complications (66.5%): Neurosurgery (32%), Gastrointestinal (21.5%), Cardiac (5%), Thoracic (5%) and Orthopaedic Surgery (3%). Main medical diagnoses (33.5%) were: cardio-vascular (11%), neurological (8%) and severe infections (8%). The mean length of ICU stay was 33 (1-105; SD: 23.4) days. Mean prealbumin and seroalbumin levels on hospital admission were 150 (5-495; SD: 104.5) mg/L and 26.3 (8-41; SD: 7.2) g/L, respectively. On admission to the MICI, pressure ulcers were present in 35% of patients, 74% had had a tracheotomy and 66.5% were receiving nasogastric tube feeding. During their stay in the MICI, tracheotomy was withdrawn in 41% of patients and the nasogastric tube was removed in 52%. Mean Barthel Index (BI) was 13 (0-80; SD: 17.2) on admission and 33 (0-100; SD: 30.4) on discharge. The mean length of stay in the MICI was 10.2 (1-58; SD: 8.8) days. On discharge, patients were transferred to Neurosurgery (26%), Gastrointestinal Surgery (17%), other Surgical Services (14%), Neurology (7%), Internal Medicine (7%), Infectious Diseases (5.5%), other Medical Services (6%) and nursing home (6.5%). Six patients (5.5%) were discharged to their own home and two patients (2%) were readmitted to ICU because of acute events. Mortality rate was 3.5%. Conclusions: An Intermediate Care Unit in the Internal Medicine Department is effective in the recovery of patients discharged after a prolonged stay in the ICU. The percentage of tracheotomy and nasogastric tube withdrawals, the improvement in the BI and the low mortality rate are clear indicators of this efficacy. Internists are better able to manage patients staying in these specific units
TH-54 PATIENTS OPINION ON THE QUALITY OF CARE OFFERED IN INTERNAL MEDICINE DEPARTMENT WARDS IN AN SPANISH TEACHING HOSPITAL P.H. Wikman, J.M. Peris, P. Safont, M. Gracia, E. Calabuig, M. Botas, C. Perez Molto, F. Muela, J Merino. Internal Medicine Department, San Juan University Hospital, Alicante, Spain Introduction: Modern clinical practice tries to be very high in quality and has placed the patient in the centre of all sanitary activities. That is why it is very important to know about his view on the care we offered him. Looking for detecting our insufficiencies and to establish an intervention program to correct them is the aim of this study. Material and Methods: Observational study on a random sample of patients cared in the wards of our Hospital (n=70) through the last two terms of 2007. For this purpose we have designed a form with 14 items using a likkert scale. The form has been offered to the patients recovered in our wards to be anonymously filled and deposed at nurses’ desk. The 30% of the forms were filled out by patients, 60% by their companions, (we ignore 10%). Mean age of those answering was 57, 2 years. 60% of them knew their doctors name and 55, 7% knew his medical speciality. Results are offered in percentage of answer for each item, being 1: very satisfactory, 2. satisfactory, 3. neutral, 4 unsatisfactory, 5. very unsatisfactory. a. The technical o professional approach by doctors has been: 68,6; 26,9; 4,5; 0;0, b. The humanistic approach: 71,6; 24;4,5;0;0; c. The information they offered about patient’s disease has been: 56,2; 37,5; 4,7; 1,6,0. d. Their information on complementary exams patients needed: 53; 39,; 3; 4.5;0.e. Information on treatment offered d: 57,1; 34,9; 6,3; 11,6; 0. f. Nurses care has been: 52,9; 35,3; 10,3; 0,0.; Humanistic approach by nurses and other sanitary professionals: 52,2; 40,3; 4,5; 2,98; Comments: This type of questionnaire offers us a better understanding of how patients think about the care we offer and allows us to initiate intervention programs to improve the quality of our care. In our case the result was quite satisfactory.
TH-55 AN INTERMEDIATE CARE UNIT IN INTERNAL MEDICINE M. Bodro, I. Cabello, A. Riera-Mestre, A. Vidaller, A. Díaz-Prieto, R. Máñez, R. Pujol. Internal Medicine Department. Hospital Universitari de Bellvitge. Aim: To describe the clinical data of patients admitted to an Intermediate Care Unit in an Internal Medicine Department (MICI) in a tertiary care hospital and the impact of their stay here on their health status. Patients and methods: The MICI comprises four individual rooms in a 800-bed teaching hospital with 50 of these beds in the ICU. The MICI serves primarily to admit patients after a prolonged stay in the ICU and who require close monitoring and rehabilitation. Demographic and clinical data of consecutive patients admitted to MICI over a 12-month period were recorded. Results: 107 patients fulfilled this criterion; 71% were male. Mean age was 55.5 (18-83; SD: 16.3) years. Main diagnoses on admission to the ICU
Thursday, 8 May 2008, 14.30–15.45
Room D
Miscellaneous TH-56 THE FATE OF PULMONARY THROMBI AFTER PULMONARY EMBOLISM J.L. Alonso Martínez, F.J. Anniccherico Sánchez, M. Urbieta Echezarreta, J.L. Moya Andía, V. Fernández Ladrón. Department of Internal Medicine. Hospital of Navarra, Pamplona, Spain Background: Data of a few studies have addressed the topic of thrombi resolution after pulmonary embolism. Methods: Prospectively, we studied patients diagnosed of pulmonary embolism (PE) by means of thoracic computerized tomography (HCT) during 2006 and 2007. Subsequently a HCT was obtained in evolution in order to know the resolution or persistence of pulmonary thrombi while patients remain with anticoagulant therapy. We also searched for potential factors of persistence such as clinical antecedents of thromboembolic venous disease (TEVD), thrombophilia (Myeloproliferative syndrome, antiphospholipid syndrome, Leiden factor, Prothrombin 20210G-A, PC, PS, Antithrombin III, Factor VIII and homocisteine), the burden of initial pulmonary embolism (divided in central and peripheral pulmonary embolism), D-dimer values and proBNP values on initial diagnosis, delay in diagnosis (Measured by the number of days of clinical manifestations before diagnosis) and % of INR of prothtombin <2 in follow-up. Dyspnea was evaluated by de NYHA degree. Results: At present, we have data of 34 patients [mean age 64±17 years, male 20 (59%)]. The follow-up HCT was performed a mean of 166±64 days after initial episode. Thrombi in pulmonary arteries persisted in 9 (26%) patients: 1 in main pulmonary arteries, 6 in lobar arteries, 1 in segmentary arteries and 1 in subsegmentary arteries. Dyspnea index was I in 27 patients, II in 6 patients, and III in 1 patient. Neither age, gender, D-dimer, central or peripheral PE, dyspnea degree, diagnostic delay, presence of thrombophilia, proBNP or % of INR<2 were different between patients with resolved and persistent thrombi. The resolution of pulmonary thrombi was more frequent in patients without antecedents of TEVD (p<.05). Conclusions: A quarter of patients treated because of pulmonary embolism fail to clear thrombi of pulmonary arteries during anticoagulant therapy with clinical implications on the length of anticoagulation. Although the factors conducting to persistence are basically unknown, the first episode goes more often to resolution.
Oral Communications / European Journal of Internal Medicine 19S (2008), S1–S59
In 1997, in spite of treatment associating acetylsalicylate (100mg), LMWH (enoxaparine) at 0.4 ml ×2, prednisone at 10 mg/day, hydroxychloroquine at 400 mg/day, delivery is very premature (six and a half months), the child weighs only 1 kg 200g. In 1999, new delivery at 33 weeks and birth of a child weighing 2kg100. Tabagism is not completely stopped. In 2004, new pregnancy, same therapeutic attitude and stable lupus, new successful attempt to stop tabacco! The child will be born at 33 weeks, weighing 2 kgs. This is partially explained because of placenta praevia. Results: With pregnant woman, biological exam’s perturbations connected with tabagism, may be a means to speak firmly about tobacco. So it was in this case report. Discussion: Among vascular risk’s factors, tabagism is the one which prevalence has the most increased about woman, over the past three decades, becoming dominant factor about young woman. This case report permits to remind of dynaminc and precarious balance of coagulation during pregnancy. The presence of a greater risk’s factor like APS, requires a real participation from the patient. Conclusion: Lupus pregnancy is always difficult, all the more because associated with APS. Obtaining effective participation wich tabacco’s stop during pregnancy is an absolute necessity. That’s why the information must be clear, understood, and the contract accepted
were surgical complications (66.5%): Neurosurgery (32%), Gastrointestinal (21.5%), Cardiac (5%), Thoracic (5%) and Orthopaedic Surgery (3%). Main medical diagnoses (33.5%) were: cardio-vascular (11%), neurological (8%) and severe infections (8%). The mean length of ICU stay was 33 (1-105; SD: 23.4) days. Mean prealbumin and seroalbumin levels on hospital admission were 150 (5-495; SD: 104.5) mg/L and 26.3 (8-41; SD: 7.2) g/L, respectively. On admission to the MICI, pressure ulcers were present in 35% of patients, 74% had had a tracheotomy and 66.5% were receiving nasogastric tube feeding. During their stay in the MICI, tracheotomy was withdrawn in 41% of patients and the nasogastric tube was removed in 52%. Mean Barthel Index (BI) was 13 (0-80; SD: 17.2) on admission and 33 (0-100; SD: 30.4) on discharge. The mean length of stay in the MICI was 10.2 (1-58; SD: 8.8) days. On discharge, patients were transferred to Neurosurgery (26%), Gastrointestinal Surgery (17%), other Surgical Services (14%), Neurology (7%), Internal Medicine (7%), Infectious Diseases (5.5%), other Medical Services (6%) and nursing home (6.5%). Six patients (5.5%) were discharged to their own home and two patients (2%) were readmitted to ICU because of acute events. Mortality rate was 3.5%. Conclusions: An Intermediate Care Unit in the Internal Medicine Department is effective in the recovery of patients discharged after a prolonged stay in the ICU. The percentage of tracheotomy and nasogastric tube withdrawals, the improvement in the BI and the low mortality rate are clear indicators of this efficacy. Internists are better able to manage patients staying in these specific units
TH-54 PATIENTS OPINION ON THE QUALITY OF CARE OFFERED IN INTERNAL MEDICINE DEPARTMENT WARDS IN AN SPANISH TEACHING HOSPITAL P.H. Wikman, J.M. Peris, P. Safont, M. Gracia, E. Calabuig, M. Botas, C. Perez Molto, F. Muela, J Merino. Internal Medicine Department, San Juan University Hospital, Alicante, Spain Introduction: Modern clinical practice tries to be very high in quality and has placed the patient in the centre of all sanitary activities. That is why it is very important to know about his view on the care we offered him. Looking for detecting our insufficiencies and to establish an intervention program to correct them is the aim of this study. Material and Methods: Observational study on a random sample of patients cared in the wards of our Hospital (n=70) through the last two terms of 2007. For this purpose we have designed a form with 14 items using a likkert scale. The form has been offered to the patients recovered in our wards to be anonymously filled and deposed at nurses’ desk. The 30% of the forms were filled out by patients, 60% by their companions, (we ignore 10%). Mean age of those answering was 57, 2 years. 60% of them knew their doctors name and 55, 7% knew his medical speciality. Results are offered in percentage of answer for each item, being 1: very satisfactory, 2. satisfactory, 3. neutral, 4 unsatisfactory, 5. very unsatisfactory. a. The technical o professional approach by doctors has been: 68,6; 26,9; 4,5; 0;0, b. The humanistic approach: 71,6; 24;4,5;0;0; c. The information they offered about patient’s disease has been: 56,2; 37,5; 4,7; 1,6,0. d. Their information on complementary exams patients needed: 53; 39,; 3; 4.5;0.e. Information on treatment offered d: 57,1; 34,9; 6,3; 11,6; 0. f. Nurses care has been: 52,9; 35,3; 10,3; 0,0.; Humanistic approach by nurses and other sanitary professionals: 52,2; 40,3; 4,5; 2,98; Comments: This type of questionnaire offers us a better understanding of how patients think about the care we offer and allows us to initiate intervention programs to improve the quality of our care. In our case the result was quite satisfactory.
TH-55 AN INTERMEDIATE CARE UNIT IN INTERNAL MEDICINE M. Bodro, I. Cabello, A. Riera-Mestre, A. Vidaller, A. Díaz-Prieto, R. Máñez, R. Pujol. Internal Medicine Department. Hospital Universitari de Bellvitge. Aim: To describe the clinical data of patients admitted to an Intermediate Care Unit in an Internal Medicine Department (MICI) in a tertiary care hospital and the impact of their stay here on their health status. Patients and methods: The MICI comprises four individual rooms in a 800-bed teaching hospital with 50 of these beds in the ICU. The MICI serves primarily to admit patients after a prolonged stay in the ICU and who require close monitoring and rehabilitation. Demographic and clinical data of consecutive patients admitted to MICI over a 12-month period were recorded. Results: 107 patients fulfilled this criterion; 71% were male. Mean age was 55.5 (18-83; SD: 16.3) years. Main diagnoses on admission to the ICU
Thursday, 8 May 2008, 14.30–15.45
Room D
Miscellaneous TH-56 THE FATE OF PULMONARY THROMBI AFTER PULMONARY EMBOLISM J.L. Alonso Martínez, F.J. Anniccherico Sánchez, M. Urbieta Echezarreta, J.L. Moya Andía, V. Fernández Ladrón. Department of Internal Medicine. Hospital of Navarra, Pamplona, Spain Background: Data of a few studies have addressed the topic of thrombi resolution after pulmonary embolism. Methods: Prospectively, we studied patients diagnosed of pulmonary embolism (PE) by means of thoracic computerized tomography (HCT) during 2006 and 2007. Subsequently a HCT was obtained in evolution in order to know the resolution or persistence of pulmonary thrombi while patients remain with anticoagulant therapy. We also searched for potential factors of persistence such as clinical antecedents of thromboembolic venous disease (TEVD), thrombophilia (Myeloproliferative syndrome, antiphospholipid syndrome, Leiden factor, Prothrombin 20210G-A, PC, PS, Antithrombin III, Factor VIII and homocisteine), the burden of initial pulmonary embolism (divided in central and peripheral pulmonary embolism), D-dimer values and proBNP values on initial diagnosis, delay in diagnosis (Measured by the number of days of clinical manifestations before diagnosis) and % of INR of prothtombin <2 in follow-up. Dyspnea was evaluated by de NYHA degree. Results: At present, we have data of 34 patients [mean age 64±17 years, male 20 (59%)]. The follow-up HCT was performed a mean of 166±64 days after initial episode. Thrombi in pulmonary arteries persisted in 9 (26%) patients: 1 in main pulmonary arteries, 6 in lobar arteries, 1 in segmentary arteries and 1 in subsegmentary arteries. Dyspnea index was I in 27 patients, II in 6 patients, and III in 1 patient. Neither age, gender, D-dimer, central or peripheral PE, dyspnea degree, diagnostic delay, presence of thrombophilia, proBNP or % of INR<2 were different between patients with resolved and persistent thrombi. The resolution of pulmonary thrombi was more frequent in patients without antecedents of TEVD (p<.05). Conclusions: A quarter of patients treated because of pulmonary embolism fail to clear thrombi of pulmonary arteries during anticoagulant therapy with clinical implications on the length of anticoagulation. Although the factors conducting to persistence are basically unknown, the first episode goes more often to resolution.