Sarcoma pleomorfico maligno indiferenciado en auricula izquierda. Reporte de caso

The incidence of malignant primary cardiac tumors is very low and they present a poor prognosis due to local recurrence, with very poor survival. This type of tumors presents nonspecific symptoms and its presentation usually occurs in advanced stages of the disease. Surgical resection is the initial treatment, adyuvant chemoterapy and radiation therapy are often palliative options since the prognosis despite these therapies is one year or less. We present the case of a patient with undifferentiated malignant pleomorphic sarcoma with aggressive presentation and early recurrence despite surgical resectionLa incidencia de tumores cardíacos primarios malignos es muy baja, presentan mal pronóstico debido a la recidiva local, siendo la supervivencia muy escasa. Este tipo de tumores presentan síntomas inespecíficos y su presentación suele ocurrir en etapas avanzadas de la enfermedad. La resección quirúrgica es el tratamiento inicial; la quimioterapia adyuvante y radioterapia son a menudo opciones paliativas ya que el pronóstico a pesar de estas terapias es de un año o menos. Presentamos el caso de una paciente con sarcoma pleomórfico maligno indiferenciado con presentación agresiva y recidiva precoz a pesar de resección quirúrgica.

Demographic characteristics and comorbidities of patients with Rheumatoid Arthritis Central Military Hospital between August 2013 and December 2013

Realizamos la descripción de las diferentes variables sociodemograficas y comorbilidades en pacientes con Artritis Reumatoide que asistieron a la consulta externa de Reumatología del Hospital Militar Central se encontro que la mayoría de pacientes son mujeres, con una edad promedio de 61 años y con un nivel socioeconómico medio o bajo, sin embargo al comparar con los estudios reportados en colombia esta cohorte tiene menor analfabetismo y un mayor grado de educación superior El tiempo de evolución de la enfermedad es prolongado y la edad promedio de nuestros pacientes es avanzada, lo que podria condicionar un incremento en la morbilidad y mortalidadhospital militarWe carry the description of the different sociodemographic variables and comorbidities in patients with rheumatoid arthritis who attended the outpatient Rheumatology Central Military Hospital was found that most patients are women, with an average age of 61 years and a middle socioeconomic or low, however when compared to the studies reported in this cohort Colombia has higher literacy and a greater degree of higher education The time evolution of the disease is prolonged and the average age of our patients is advanced, which could determine an increase in morbidity and mortalit

A Survey of Empirical Results on Program Slicing

International audienceBACKGROUND:Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS:This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS:Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION:Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding