2.Recurrent ischemic stroke as an initial manifestation of an concealed pancreatic adenocarcinoma: Trousseau's syndrome.
Semih GIRAY ; Feyzi Birol SARICA ; Zulfikar ARLIER ; Nebil BAL
Chinese Medical Journal 2011;124(4):637-640
In rare instances, stroke may precede a diagnosis of cancer and be the first clinical evidence of an underlying malignancy.Cerebral infarction mostly complicates lymphomas, carcinomas, and solid tumors. Malignancy-related thromboembolism can present as acute cerebral infarction, nonbacterial thrombotic endocarditis and migratory thrombophlebitis. It is generally attributed to a cancer-related hypercoagulable period, chronic disseminated intravascular coagulopathy (DIC), or tumor embolism. We reported a case of malignancy-related thromboembolism from an undiagnosed pancreatic adenocarcinoma in a 54-year-old man, who presented with recurrent ischemic stroke due to chronic DIC. He died of the underlying malignancy despite the appropriate institution of anticoagulation therapy.This case emphasizes that cerebral infarction may be the first manifestation of an undiagnosed cancer. If there is laboratory or clinical evidence associated with DIC, patients with a cerebral infarct of an unknown etiology should be investigated for a malignant process. The optimal method of anticoagulation in cancer patients with thromboembolic disease (TED) remains unclear.
Adenocarcinoma
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complications
;
diagnosis
;
physiopathology
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Humans
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Male
;
Middle Aged
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Pancreatic Neoplasms
;
complications
;
diagnosis
;
physiopathology
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Stroke
;
diagnosis
;
etiology
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Thrombosis
;
diagnosis
;
etiology
3.CHADS₂versus CHA₂DS₂-VASc scoring systems for predicting left atrial thrombus in patients with nonvalvular atrial fibrillation.
Jun GU ; Fengpeng JIA ; Panpan FENG
Journal of Southern Medical University 2014;34(11):1601-1605
OBJECTIVETo assess the correlation of CHADS₂and CHA₂DS₂-VASc scores for left atrial thrombus in patients with nonvalvular atrial fibrillation and the differences in the results between the two scoring systems.
METHODSA total of 397 patients with nonvalvular atrial fibrillation were enrolled in this study. The CHADS₂and CHA2DS2-VASc scoring systems were used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared. The correlation of CHADS₂ and CHA₂DS₂-VASc scores with left atrial thrombus was analyzed.
RESULTSThe average score of CHA₂DS₂-VASc was significantly higher than that of CHADS₂in these patients (1.37 ± 1.19 vs 0.63 ± 0.78, P<0.001). The proportion of high-risk group was significantly higher (P<0.001) while that of low-risk group significantly lower as stratified by CHA₂DS₂-VASc scores than by CHADS₂scores (P<0.001). Transesophageal echocardiography detected left atrial thrombus in 44 of the total patients. The prevalence of left atrial thrombus increased significantly with a higher risk stratification by CHADS₂or CHA₂DS₂-VASc scores (P<0.05). Univariate analysis showed that female gender, age ≥ 65 years, left atrium diameter ≥ 38 mm, left ventricular ejection fraction ≤ 40%, hypertension, diabetes, coronary heart disease, stroke history, CHADS₂≥ 2, and CHA₂DS₂-VASc ≥ 2 were all correlated with left atrial thrombus, but multivariate logistic analysis identified only CHA₂DS₂-VASc ≥ 2 as the independent risk factor for left atrial thrombus (OR=9.85, 95% CI: 2.178-44.542, P < 0.01).
CONCLUSIONThe average score of CHA₂DS₂-VASc is higher than that of CHADS₂and has better predictive ability for left atrial thrombus.
Atrial Fibrillation ; complications ; Echocardiography, Transesophageal ; Female ; Heart Atria ; pathology ; Humans ; Male ; Risk Factors ; Thrombosis ; complications ; diagnosis
4.Abducens Nerve Palsy Complicated by Inferior Petrosal Sinus Septic Thrombosis Due to Mastoiditis.
Jung Hyun JANG ; Jung Min PARK ; Jaehwan KWON ; Soo Jung LEE
Korean Journal of Ophthalmology 2012;26(1):65-68
We present a very rare case of a 29-month-old boy with acute onset right abducens nerve palsy complicated by inferior petrosal sinus septic thrombosis due to mastoiditis without petrous apicitis. Four months after mastoidectomy, the patient fully recovered from an esotropia of 30 prism diopters and an abduction limitation (-4) in his right eye.
Abducens Nerve Diseases/diagnosis/*etiology
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Child, Preschool
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Diagnosis, Differential
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Humans
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Male
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Mastoiditis/*complications/diagnosis/surgery
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Otitis Media/*complications/diagnosis
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Sinus Thrombosis, Intracranial/*complications/diagnosis
5.An Experience of Axillary-Subclavian Vein Thrombosis after Left Subclavian Vein Catheterization in Polycythemia Vera.
Young Moon JANG ; Baik Hwan CHO ; Jae Chun KIM ; Nam Poo KANG ; Young HWANG
Journal of the Korean Society for Vascular Surgery 1999;15(1):145-152
Deep venous thrombosis (DVT) of the upper extremity has been recently been recognized as being more common than previously reported (probably because of the increasingly frequent use of subclavian venous access). Since the initial descriptions of axillary-subclavian vein thrombosis more than 100 years ago, studies cites a 1.3% to 2.1% incidence of all DVT that occurs in the axillary or subclavian veins. Axillary-subclavian vein thrombosis is commonly associated with significant morbidity. The most serious aspect of morbidity and mortality is pulmonary embolization. Venography or digital subtraction studies are most reliable in allowing detection of thrombosis and Duplex imaging of vein is useful in following the course and assessing the effect of treatment. Early diagnosis and initiation of treatment before thrombus organization are important for successful outcome. Polycythemia vera are at an especially high risk for both thrombotic and hemorrhghic events and postoperative complications. We report a case of axillary-subclavian vein thrombosis after left subclavian vein catheterization in polycythemia vera.
Catheterization*
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Catheters*
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Early Diagnosis
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Incidence
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Mortality
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Phlebography
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Polycythemia Vera*
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Polycythemia*
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Postoperative Complications
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Subclavian Vein*
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Thrombosis*
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Upper Extremity
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Veins*
;
Venous Thrombosis
6.Deficiencies in proteins C and S in a patient with idiopathic portal hypertension accompanied by portal vein thrombosis.
Sena HWANG ; Do Young KIM ; Minju KIM ; Young Eun CHON ; Hyun Jung LEE ; Young Nyun PARK ; Jun Yong PARK ; Sang Hoon AHN ; Kwang Hyub HAN ; Chae Yoon CHON
The Korean Journal of Hepatology 2010;16(2):176-181
Portal vein thrombosis (PVT) is an uncommon cause of presinusoidal portal hypertension. Among various hepatoportal disorders, noncirrhotic portal hypertension conditions such as idiopathic portal hypertension (IPH) are considered to have a close relation with PVT. PVT is known to have several predisposing conditions, including infection, malignancies, and coagulation disorders. There is growing interest and recognition that deficiencies in proteins C and S are associated with a hypercoagulable state. These deficiencies are regarded as key factors of systemic hypercoagulability and recurrent venous thromboembolism. We report the case of a 19-year-old male diagnosed as IPH with PVT and combined deficiencies in proteins C and S.
Humans
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Hypertension, Portal/complications/*diagnosis/pathology
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Male
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*Portal Vein
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Protein C Deficiency/*complications
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Protein S Deficiency/*complications
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Tomography, X-Ray Computed
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Venous Thrombosis/complications/*diagnosis/pathology
;
Young Adult
8.A Case of Portal Vein Thrombosis Associated with Acute Pancreatitis and Cholangitis.
Dae Young CHEUNG ; Jae Kwang KIM ; Don Hyoun JO ; Hyun Jong OH ; Tae Ho KIM ; So Yeon LEE ; Soo Heon PARK ; Joon Yeol HAN ; Kyu Won CHUNG ; Hee Sik SUN
The Korean Journal of Gastroenterology 2005;46(1):60-65
Portal vein thrombosis is a rare complication accompanied with acute pancreatitis or cholangitis/cholecystitis. The main pathogenesis of portal vein thrombosis in pancreatitis or cholangitis/cholecystitis are suggested to be venous compression by pseudocyst and an imbalance between the blood coagulation and fibrinolysis. In this case report, we experienced a 63 year old male who developed portal vein thrombosis later in the course of the treatment of acute gallstone pancreatitis with cholangitis/cholecystitis without any symptom or sign. The diagnosis of portal vein thrombosis was given on follow up CT scan and serum protein S activity was decreased to 27% in laboratory study. Immediate anticoagulation therapy with heparin and thrombolytic therapy with urokinase and balloon dilatation were performed. Despite the aggressive treatment, complete reperfusion could not be obtained. With oral warfarin anticoagulation, the patient showed no disease progression and was discharged. We report a case of portal vein thrombosis as a complication of acute pancreatitis and cholangitis/cholecystitis with a review of literatures.
Acute Disease
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Cholangitis/*complications/diagnosis
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Cholecystitis/complications
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Humans
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Male
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Middle Aged
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Pancreatitis/*complications/diagnosis
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*Portal Vein
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Tomography, X-Ray Computed
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Venous Thrombosis/diagnosis/*etiology
9.Analysis of acute cerebral arterial thrombosis with multiple organ dysfunction syndrome.
Long-Yuan JIANG ; Zheng-Fei YANG ; Lian-Hong YANG
Journal of Southern Medical University 2007;27(8):1215-1217
OBJECTIVETo investigate the incidence, case fatality and risk factors of acute cerebral arterial thrombosis complicated by multiple organ dysfunction syndrome (MODS).
METHODSA retrospective study was conducted in 830 patients with acute cerebral arterial thrombosis, among whom 89 also developed MODS.
RESULTSThe incidence of MODS in these patients was 10.7% with case fatality of 58.4%. The presence of concurrent infection and increased number of organ involved both resulted in higher case fatality. The preceding health status, number of failing organs and score of neurologic impairment were the main fetal factors according to logistic regression analysis.
CONCLUSIONMODS usually occurs in two weeks after the onset of acute cerebral arterial thrombosis. Prevention of MODS involves rigorous treatment of the compromised organs and comprehensive systemic therapy in addition to the management of the primary diseases.
Cerebral Arterial Diseases ; complications ; diagnosis ; epidemiology ; mortality ; Female ; Humans ; Intracranial Thrombosis ; complications ; diagnosis ; epidemiology ; mortality ; Male ; Middle Aged ; Multiple Organ Failure ; complications ; diagnosis ; epidemiology ; mortality ; Prognosis ; Risk Factors
10.Acute myocardial infarction and sub-acute stent thrombosis associated with occult essential thrombocythemia.
Zafer ISILAK ; Mehmet TEZCAN ; Murat ATALAY ; Ejder KARDESOGLU
Chinese Medical Journal 2014;127(19):3512-3513
Aged
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Female
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Humans
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Myocardial Infarction
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diagnosis
;
etiology
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Stents
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adverse effects
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Thrombocythemia, Essential
;
complications
;
diagnosis
;
Thrombosis
;
diagnosis
;
etiology