Changes in haemostasis and thrombosis associated with thyroid disease: Presentation of 2 cases

There is a relationship between thyroid diseases and primary and secondary changes in haemostasis. The most frequent association between them are hypocoagulability states with clinical hypothyroidism and vascular thrombophilia (hypercoagulability and/or hypofibrinolysis) with hyperparathyroidism. However, there are recent studies that have detected changes in haemostasis -primary and secondary- associated with thyroid diseases with normal hormone levels, suggesting other pathogenic mechanisms not yet known. The cases are presented of 2 patients with thyroid disease that required surgery: one multinodular goitre and one papillary carcinoma of the thyroid, both with normal hormone levels. They were shown to have haemostasis disorders during the preoperative work up. These showed a Factor VII deficiency and a Factor XI deficiency along with a thrombotic disease of unknown origin, respectively.

[Resuscitation damage control in the patient with severe trauma]

Severe trauma is the principle cause of death among young people in developed countries, with the main causes being due to road traffic accidents and accidents at work. The principle cause of death in severe trauma is the massive uncontrolled loss of blood. Most of the severe traumas with a massive haemorrhage develop coagulopathy, with some controversy over what is the best treatment for this. Patients with severe trauma are complex patients; they have a high mortality, they consume a significant amount of sources and can require rapid, intensive and multidisciplinary treatment encompassed within the concept of resuscitation damage control. In this article we attempt to present a current view of the pathophysiology of severe trauma and resuscitation damage control that may be applied to these types of patients.

[Urinary tract infections in a postoperative recovery unit]

OBJECTIVE

To analyze the frequency, etiology, risk factors, and mortality relating to urinary tract infection (UTI) in a postoperative recovery unit.

MATERIALS AND METHODS

A prospective study was carried out from 1998 through 2003 of all patients who stayed longer than 48 hours in a 12-bed critical care unit and who were followed to 48 hours following discharge from the unit. A descriptive statistics were compiled and univariate and multiple variable Cox regression analyses were performed for episodes of nosocomial UTI.

RESULTS

The incidence density for UTI associated with bladder catheterization was 8.4 cases per 1000 patient-days. The pathogens most frequently isolated in patients with bacteriuria were Candida albicans and Escherichia coli. The pathogen most frequently isolated in UTI in trauma patients was E. coli, whereas C. albicans was most often found in the postoperative patients. Multivariable analysis identified 3 risk factors: degree of severity on admission, duration of catheterization, and presence of diabetes mellitus. The mortality risk in patients with bladder catheterization and UTI was 2.20.

CONCLUSIONS

UTIs can have serious consequences and are responsible for excess mortality. The real importance of UTI is unknown and is probably underestimated despite the publication of many studies. We found that the UTI microbiology findings were markedly different for the trauma and postoperative cohorts in our department.