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We evaluate a case report of Yasmin induced pulmonary embolism in order to provide reference for safety use of oral contraceptives.
Introduction: Elevated serum troponin levels are a reliable indicator of right ventricular wall stress in patients with acute pulmonary artery embolism (PE). Raised troponin levels have been shown to predict adverse clinical outcome in these individuals. In this context it was our aim to determine the additional role of the heart-type fatty acid-binding protein (H-FABP) in patients with acute PE. Methods: 87 consecutive patients with confirmed PE were included in the present study. On arrival a qualitative H-FABP-test (positive cut-off 7ng/ml) and a detailed echocardiographic study were performed in all patients. These findings were related to both in hospital and 30 days mortality. Results: Of the included 87 patients, 17 had positive H-FABP-tests. Right ventricular function was severely deteriorated in 10 patients (59%) in the H-FABP-positive group but only in 2 patients (3%) of the H-FABP-negative group (p<0.005). 15/17 patients (88%) of the H-FABP-positive group needed inotropic support, of these, 14 (82%) died in hospital. Only one patient with a H-FABP-negative test (n= 70) needed vasoactive drugs, and none of these patients died (p<0.005). Conclusion: H-FABP showed a better correlation with in-hospital mortality and RV-function than troponin I. Our data show that H-FABP significantly correlates with in hospital and 30-day mortality in patients with PE. Furthermore, it is associated with impaired right ventricular function and showed better correlation with mortality in patients with PE as compared to Troponin I. Thus, it may be viewed as a novel and promising tool to optimise the management strategy in these patients.
Aim Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospital with orthopaedic surgery already an established risk factor. This study aims to establish the length of time that a patient is at risk of sustaining a VTE post orthopaedic surgery. Method A retrospective case series of all patients who underwent orthopaedic surgery between 2010 and 2014 whom re-presented with a VTE within one year of their initial operation. Demographic, operative and clinical information was obtained in order to identify potential risk factors. Results 53 patients were identified as having a VTE within one year of discharge. The majority (63.4%) underwent lower limb arthroplasty. 29% of the cohort had either a family or personal history of VTE, 79% had ischaemic heart disease (IHD), hypertension or both. The average body mass index (BMI) of the cohort was 31.4; above the UK national average. 56.6% of the cohort developed a pulmonary embolism (PE) and 49% developed a deep vein thrombosis (DVT). Co-occurring DVT and PE was diagnosed in 5.6% of patients. The average length of time for readmission for patients to re-present at hospital with a PE was 122 days (range 4-361) and 107 days (range 7 – 360) with a DVT. Conclusion This study confirms the existence of pre-established risk factors for developing VTE including obesity, personal and family history of DVT, cardiovascular disease and lower limb arthroplasty. These risk factors are recognised despite patients receiving post-operative thromboprophylaxis. The findings of this study extend the current research by suggesting that patients presenting with known risk factors of developing VTE may be at risk for longer than the current guidelines cover for the administration of thromboprophylaxis. We propose further studies are needed to identify any potential requirements for more extensive VTE prophylaxis in this population.
A 66 year old Chinese male with a medical history of hypertension, diabetes mellitus and hepatitis B carrier was diagnosed with hepatocellular carcinoma in 2009. He underwent treatment with selective internal radiation spheres and sorafenib, and multiple cycles of chemotherapeutic agents such as bevacizumab, erlotinib, OXAFI ( intravenous oxaliplatin and doxorubicin given on days 1, 8 and 15 in a 28-day cycle, a daily continuous infusion of fluorouracil and subcutaneous interferon alfa-2b 5 million units administered thrice weekly), thalidomide, capecitabine, and rapamycin over the course of four years. Along the course of treatment, he developed pulmonary embolism and was initially started on anti-coagulation. Two months later, he developed hemoptysis and the anti-coagulants were stopped. During his routine ophthalmology visit for diabetic eye evaluation, he complained of blurring of vision of his left eye for the past four to five weeks. He was found to have central retinal vein occlusion (CRVO) of the left eye, associated with macular edema. Visual acuity was 6/15 for the right eye and 6/60 for the left eye. Eyelids, conjunctiva, cornea, anterior chamber, pupils, lens and ocular motility were normal. Humphrey visual field testing showed a superior arcuate and basal defect. This is the first reported case of CRVO in hepatocellular carcinoma. The etiology of CRVO is multifactorial, withhepatic malignancy, previous major surgery, multiple cycles of chemotherapy and cessation of anticoagulant therapyas possible aetiological factors. His background medical problems of diabetes and hypertension are further contributors.