Venous thromboembolic disease and pregnancy

Venous thrombo-embolic disease is the most common cause of maternal death during pregnancy. Haemodynamic, anatomical and biological changes support the notion that normal pregnancy in a prethrombotic state. But thrombotic events remain unusual episodes. A pre-thrombotic disease has to be investigated in such cases. Accurate diagnosis of deep vein thrombosis or pulmonary embolism is imperative, using non-invasive approaches. Heparin is the anticoagulant of choice to treat objective thrombosis. Thrombo-embolism prophylaxis using compression stockings and heparin has to be discussed in hypercoagulable disorders.     

Hydatid disease of liver and its complications (author''s transl)

This is a report on 121 cases of hydatid disease of liver. The alteration of the false cyst, explaining the most common complications of the disease, is discussed. Complications were present in 61 (50.41%) of our 121 patients: calcification in 13.22%, infection in 10.74%, perforation in bile ducts in 9.91%, thorax in 5.78% and abdominal cavity in 10.74% of our cases. Diagnostic importances of clinical findings, immunoelectrophoretic studies and radioisotopic liverscanning is emphasized. In 28 cases the complete excision of cysts were carried out, in 110 cases only removal of the hydatid membrane was performed. Other therapeutic methods are discussed. Of 108 treated patients 7 died postoperatively: they were all over 70 years old.     

Venous lesions in Beh?et''s disease

This study examined 117 patients with mild cervical atypia or atypical squamous cells of uncertain significance; it was found that 25% had histologically proven CIN lesions by colposcopically-directed punch biopsy or cone biopsy. 18% were found to have at least CIN 2 lesions and there was 1 case of invasive cancer. These data strongly support the recommendation of early colposcopic referral in patients with mild cervical atypia.     

Abdominal obesity and its metabolic complications: implications for the risk of ischaemic heart disease

Although the health hazards of obesity are well established, obese individuals are not all at equal risk of developing a disease, which reflects the heterogeneity of this condition. The regional distribution of body fat is now recognized as a very important component of the obesity-related health hazards. Epidemiological studies have shown that abdominal obesity, that is, a preponderance of fat in the abdominal area, is a better predictor of both cardiovascular disease and type 2 diabetes than obesity per se. It is now generally accepted that the fat located within the abdominal cavity, the visceral fat, is the best correlate of most of the highly atherogenic metabolic complications seen in individuals with abdominal obesity. These include, among others, insulin resistance and hyperinsulinaemia, hypertriglyceridaemia, reduced plasma high-density lipoprotein (HDL) cholesterol concentrations and an increased number of small, dense low-density lipoprotein (LDL) particles. This review summarizes the evidence that these metabolic complications may account to a large extent for the increased risk of cardiovascular disease associated with abdominal/visceral obesity. Abdominal obesity may be the most prevalent denominator of highly atherogenic dyslipidaemic and hyperinsulinaemic/insulin-resistant states in affluent, sedentary societies. Targeting individuals with this high-risk trait in primary prevention is therefore crucial if we are truly to have an impact on the incidence of cardiovascular disease.     

Urinary complications of Crohn's disease

A 22-year review of 328 patients with Crohn's disease revealed 70 patients with urinary tract symptoms. Cystitis was the most common problem, occurring in 44 patients. The urinary tract infections were recurrent in most patients, usually with 3 or 4 attacks per year. Despite the persistence of urinary infection, only 3 patients developed chronic pyelonephritis. Forty-nine patients had intravenous urography, and many were found to have slight dilatation of the upper urinary tract on one side. Seven patients had hydronephrosis, 3 with pyonephrosis. Five of 6 patients who developed calculi had a bowel resection. All of the recovered calculi were oxalate stones, but 3 were passed spontaneously and not analyzed. Eight patients, 7 of them males, had an ileovesical fistula. In 1, the colon was also affected. It was unusual for these patients to have severe urinary symptoms. One patient had a fistula from the rectum to the urethra. Although 32 of the 70 patients were female, most of the severe complications occurred in men. Aggressive investigation is not indicated, nor is radical surgery required.     

Psychosocial complications and management of sickle cell disease

Five adolescent girls with Turner syndrome (mean age 13.9 years, mean bone age 12.0 years) were treated with both recombinant human growth hormone (rhGH) and oxandrolone for 2 years with an average increment in height of 13.4 cm. The mean bone age advanced by only 1.2 years, providing an increase in the mean estimated mature height of 9.2 cm. We conclude that rhGH and oxandrolone benefit older teenagers with Turner syndrome because of an increased growth rate with slow progression of skeletal maturation.     

Venous disease: from pathophysiology to quality of life

Venous insufficiency is a multifactorial pathology that has an important impact on the quality of life of the patients. The primary factor of venous disease is an abnormal wall distensibility, which seems to be correlated with genetic factors. Facilitating factors include hormonal impregnation and prolonged hydrostatic load, particularly under conditions where the control of the sympathetic nervous system is reduced by an increase in local temperature. The resulting valvular incompetence, combined with the augmented hydrostatic load, leads to varicosis and venous stasis. The ensuing tissue hypoxia and local edema favor inflammation and infection, which ultimately favor the occurrence of ulcers. The available data on the impact of the disease suggest a relation between the physiopathological phenomena and some parameters of health-related quality of life.     

Hematologic complications of rheumatic disease therapies

Hematologic side effects of rheumatic disease therapies are generally mild and reversible; however, the clinician must be alert for potential profound and life-threatening toxicities. A knowledge of the toxicity patterns for the individual drugs is necessary to anticipate potential complications. Management of acute leukemias and lymphomas arising in patients with connective tissue disorders is particularly challenging. Further data are needed to define the best treatment options and thus enrollment in clinical trials is encouraged for these patients.     

Thromboembolic complications in inflammatory bowel disease

Thromboembolic complications during the course of inflammatory bowel disease are infrequent but are mainly found in young patients and are associated with a high morbimortality. The etiopathogenesis of these complications has been widely debated and the existence of coagulation alterations and fibrinolysis have been suggested. Nonetheless, the mechanism must be complex since not only do not all the patients with these alterations present this complication but neither do all the patients with thromboembolism have recognized coagulation disorders. The most common clinical presentation is deep vein thrombosis with pulmonary embolism with arterial thrombosis being rare. Five patients with Crohn's disease and two with ulcerative colitis who presented a total of new thromboembolic episodes, six arterial (1 in primitive iliac artery, 1 in common femoral artery, 1 in humeral-axillary artery, 2 in internal carotid and 1 in superior mesenteric artery) and three of venous localization (1 in brachyocephalic-subclavian trunk, 1 axillary and 1 iliac-femoral/pulmonary thromboembolism) are reported. An updated review of the etiopathogenesis, presentation, treatment and prophylaxis of the thromboembolic complications of inflammatory bowel disease is presented.     

Treatment of acute otitis media and its complications

Acute otitis media is extremely common in children under 6 years of age. This article reviews the pathogenesis and epidemiology of this problem. Treatments are outlined, including choice of antibiotics, decision-making for tympanocentesis, and approaches to recurrent otitis media. Complications such as mastoiditis, although rare, still occur and are discussed. Prevention of acute otitis media also is reviewed, including information on vaccines.