Current state of non-hematologic cancer-associated thrombosis at a tertiary care hospital in India
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Cancer-associated thrombosis is a leading cause of morbidity and mortality in malignancy patients. Prophylactic anticoagulation is under-utilized and the cost of low-molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries.A retrospective analysis was performed of all cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in North India between 2011 and 2015. Patient demographics and disease-related parameters were collected and analyzed.A total of 771 patients attended the thrombosis clinic during study period, of which 64 cases were malignancy-associated. Of these, 56% of the patients were female and 20% were bedridden. The median age was 48.5 years, adenocarcinoma (48%) being the most common histological subtype. Gynecological malignancies (30%) were the most common malignancies, followed by genitourinary (11%) malignancies. Most of the cases occurred during first year of diagnosis (51%), and only 14% occurred after 3 years. Most of the patients were on combined treatment. Almost 40% of the patients developed thrombosis within 30 days of surgical treatment. Lower limb thrombosis was the most commonly seen type (56%), while abdominal and pulmonary thrombosis were both seen in 5%. Patients were managed with LMWH and vitamin K antagonists (84.3%) and only 6.25% with LMWH alone. Direct oral anticoagulants were not commonly used during the study period.At the hospital studied, most of the cases occurred early in the disease course. Postoperative prophylaxis could have contributed towards reducing thrombosis in the peri-operative period. Early suspicion and prompt treatment can improve quality of life in such patients.Patients with a known primary malignancy and one or more suspicious skeletal lesions are often assumed to have skeletal involvement by the known malignancy. We set out to determine how often one would be correct in making this assumption.All CT-guided bone biopsies performed at our institution between January 2006 and January 2009 in patients with a history of a single biopsy-proven malignancy were retrospectively reviewed. Pathology results were assigned to one of three outcomes: skeletal involvement by known malignancy, newly diagnosed malignancy, or no malignancy identified. Patients categorized as no malignancy identified required repeat biopsy or stability on follow-up imaging for confirmation.Of 104 patients with a known primary malignancy, 11 were excluded. Of the 93 included patients, there was skeletal involvement by the known malignancy in 82 (88%), a newly diagnosed malignancy in seven (8%), and no malignancy identified in four (4%).Biopsy of a suspicious skeletal lesion in a patient with a solitary known malignancy reveals a newly diagnosed malignancy or no evidence of malignancy in 12% of patients, emphasizing the importance of biopsy.
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Monitoring of anti-Xa activity (aXa) levels is not routinely required in patients receiving enoxaparine at prophylactic dosages, since aXa is supposed to stay below the manufacturer's recommended range in patients treated for venous thrombosis (0.5-1 IU/ml). In order to aXa in elderly subjects receiving prophylactic enoxaparin, 68 consecutive patients (mean age 82.5 +/- 10.7 years) hospitalized in a medical department receiving 4000 IU enoxaparin daily subcutaneously for the prevention of venous thromboembolic disease were studied. After the first injection of enoxaparin, the aXa of 57.4% patients was superior to 0.5 IU/ml while 69.4% had an aXa higher than 0.5 after 8.4 +/- 1.2 days. A negative relationship between aXa and body weight and a trend towards a positive correlation between aXa and age but not with creatinine clearance were noted. Our findings question the opportunity to monitor aXa in elderly patients receiving 4000 IU enoxaparin as antithrombotic prophylaxis.
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Enoxaparin sodium
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The urogenital tract is the most severe and common site of associated defects in anorectal malformations (ARM). Urogenital anomalies and their complications significantly increase the morbidity in these children after the ARM is corrected. The purpose of this study was to estimate the incidence of different types of urogenital anomalies with various types of anorectal malformations and to discuss the possible management and outcome. A retrospective study of patients with ARM and associated urogenital abnormalities admitted in the department of paediatric surgery of Sylhet MAG Osmani Medical College Hospital between 1998 and 2002 was undertaken. A total of 155 patients with Anorectal malformations were admitted of which 47 (30.32%) patients had associated anomalies involving other systems. Urogenital abnormalities were found in 25 (16.13%) patients. Patients of Anorectal malformations with urogenital abnormalities require careful assessment and well-timed intervention to minimize the morbidity.
Anorectal anomalies
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In 1865 Trousseau first described the association between venous thrombosis and malignancy. We now know that unprovoked deep vein thrombosis of the legs precedes the diagnosis of malignancy in more than 7% of the cases. In bilateral deep vein thrombosis the risk of occult malignancy exceeds 40%. We describe a patient with bilateral deep vein thrombosis as presenting symptom of pancreatic cancer.
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Portal vein thrombosis
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The paper reviews air travel and venous thrombosis. The risk of venous thrombosis increases with distance flown. The mechanisms that cause thrombosis are unknown, but may be related to hypobaric hypoxia, i.e. reduced air pressure inside the aeroplane, stasis of the lower limbs, often referred to as economy class syndrome (ECS), and dehydration.Symptomless deep venous thrombosis may occur in 10% of healthy long-haul airline travellers over 50 years of age, and up to 4.5% of passengers under 50 at high risk of thrombosis. Wearing of elastic compression stockings during the flight is associated with reduced risk of deep venous thrombosis.Passengers should be encouraged to use the muscle-vein pump regularly, ensure adequate hydration, and in some cases wear elastic compression stockings. A majority of passengers will not need any thromboprophylaxis. Aspirin may have a protective role, but its efficacy in preventing venous thrombosis is much smaller than that of low molecular weight heparins. A high prophylactic dose of a low molecular weight heparin should be considered in passengers at high risk of thrombosis.
Compression stockings
Air travel
Venous stasis
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Pelvic fracture
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Blunt trauma
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Objective To explore the value of MSCT features in predicting the malignancy degree of gastrointestinal stromal tumor(GIST).Methods CT Data of 44 patients with pathologically proved GIST were reviewed.The differences of CT features among different malignancy degrees of GIST were analyzed.Results Pathology confirmed very low malignancy GIST in 5 patients,low malignancy in 9,moderate malignancy in 7 and high malignancy in 23.The tumor size,location,growth pattern,enhancement pattern,contour,mesenteric fat infiltration,cystic-necrosis,tumor vascularization and direct organ invasion had statistical differences among different malignancy degrees(all P0.05).Conclusion Tumor size,location,growth pattern,enhancement pattern,border,mesenteric fat infiltration,cystic-necrosis,tumor vascularization and direct organ invasion might be predictive indexes for malignancy of GIST.
Stromal tumor
Infiltration (HVAC)
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