BACKGROUND

The significance of isolated calf deep vein thrombosis (ICDVT) remains unclear with current guidelines not being based on strong level of evidence. Given the uncertainties, the therapeutic approaches vary among institutions; hence, it is prudent to look at existing experience of an institution where examination of calf veins is routinely done during venous duplex ultrasound of the lower extremities.

Using an analytical retrospective cohort design, this study investigated the clinical profile and outcomes of patients noted to have ICDVT on venous duplex scan at a single tertiary center from October 1, 2018 to June 30, 2023.

A total of 151 subjects were included in the study. Most of the cases had either stabilization (36.42%, 95% CI: 28.75%-44.64%) or complete resolution (35.76%, 95% CI: 28.14%-43.96%) of ICDVT. Recurrence occurred in 15.89% (95% CI: 10.46%-22.72%) while proximal DVT extension only occurred in 10.60% (95% CI: 6.18-16.64%) of the subjects. None of the factors studied, including therapeutic management, were significantly associated with proximal DVT extension, recurrence, pulmonary embolism and stabilization of ICDVT. When it comes to resolution of ICDVT, only therapeutic management was found to have significant association.

Previously cited medical risk factors do not play a role in the development of ICDVT complications. While anticoagulation contributes to resolution of ICDVT, it can safely be managed conservatively in cases of high bleeding risk.

Systemic Lupus erythematosus (SLE) is a multiorgan autoimmune disease that affects 20-150 per 100,000 women. It is a mutagenic disease which causes formation of autoantibodies immune complexes that leads to inflammation in different organs leading to organ damage. We present a case of a young female who was newly diagnosed to have SLE. She presented with an elevated ANA, low C3 and elevated Anti-DS DNA. She first manifested with epistaxis and subsequently experienced the various complications of SLE such as infection, thrombosis, bleeding, ascites, etc. The initial presentation of normochromic, normocytic anemia and thrombocytopenia together with further work-ups supported another concomitant autoimmune disease, namely Evan’s syndrome. Evan’s syndrome is a rare manifestation of SLE, and is observed in only 2.73% of the population. In addition, the patient manifested with sudden onset of right-sided body weakness with Cranial CT scan findings of areas of focal infarction in the frontal lobe with concomitant acute intracranial hemorrhages. The evidence of both thrombosis and hemorrhage provided conflicting management strategies for this patient. The use of hydroxychloroquine, which is the cornerstone of lupus therapy, provided beneficial antithrombotic effects. A multidisciplinary approach to management and prudent choice of medications were vital in the success of treatment on such a complicated case.

Objective Exploring CT observation of the occlusion site and recent prognosis characteristics of endovascular treatment in patients with acute vertebrobasilar artery occlusion.Methods A total of 140 patients with acute vertebrobasilar artery occlusion treated in our hospital from January 2019 to May 2022 were selected. According to the pathological mechanism， there were 98 cases of atherosclerosis （group A） and 42 cases of embolism （group B）. The clinical data， occlusion site， and prognosis of the two groups were compared using the t-test or χ2 test， and the differences in the clinical data of patients with different outcomes were analyzed. Receiver operating characteristic （ROC） curves were used to determine the value of the National Institutes of Health Stroke Scale （NIHSS） score and the Basilar Artery on Computed Tomography Angiography （BATMAN） score for predicting poor prognosis.Results There were no significant differences between group A and group B in sex， age， the body mass index， hypertension，diabetes，history of stroke， time from onset to admission，NIHSS score， and BATMAN score （P＞0.05）. The occlusion rates of the vertebral artery V4 segment and the middle basilar artery in group A were 41.84% and 33.67% respectively， which were significantly higher than those in group B （P＜0.05）. The proportion of upper basilar artery occlusion in group B was 59.52%， which was significantly higher than that in group A （P＜0.05）. The ischemic penumbra volume and infarct core volume in group A were （46.64±15.44） ml and （20.10±9.92）ml， respectively， which were significantly lower than those in group B（P＜0.05）. Patients with a poor prognosis had a significantly higher NIHSS score（24.41±2.09） points and a significantly lower BATMAN score （3.61±0.72） points than patients with a good prognosis（P＜0.05）. For NIHSS score and BATMAN score predicting a poor prognosis，the areas under the ROC curves were 0.893 and 0.902，the cut-off values were 22 and 5，the sensitivity values were 86.60% and 92.70%，and the sensitivity values were 86.20% and 77.60%，respectively.Conclusion Patients with acute vertebrobasilar artery occlusion caused by intracranial atherosclerosis and embolism differ significantly in the occlusion site， but with no significant difference in the prognosis of patients. The NIHSS score and BATMAN score have certain application value in predicting the prognosis of patients with acute vertebrobasilar artery occlusion.
Embolism ; Prognosis

Cerebral venous sinus thrombosis ( CVST) results from occlusion of cerebral venous sinuses, usually resulting in hemorrhagic infarction. It is a rare type of stroke affecting 3-5 per million people, often due to hypercoagulable states from clotting factor abnormalities or diseases like cancers, autoimmune and collagen vascular disease. Headache, visual changes, changes in sensorium, focal neurologic signs, seizures, and coma are some of the symptoms.

The role of exogenous estrogen in developing CVST among transgenders has not been reported frequently in literature. We report a 26-year-old transgender female who presented with throbbing headache after four years of exogenous high dose parenteral and oral estrogen. Magnetic resonance venography findings showed dural sinus thrombosis involving the left internal jugular vein, left sigmoid sinus, left transverse sinus, straight sinus, torcula and posterior aspect of the superior sagittal sinus. Patient was treated with topiramate, steroids and anticoagulants. Patient symptoms improved and was subsequently sent with home medications edoxaban. This case underscores the importance of monitoring the use of hormonal therapy in transgender individuals.

This report is an example of a rare cause of thrombosis secondary to self-administration of parenteral and oral estrogen. Prompt diagnosis in this patient resulted in the prevention of a catastrophic event like a major stroke, highlighting the importance of vigilance in managing hormone therapy. Increasing awareness about transgender issues can improve health and reduce inequities in this population. Cerebral venous sinus thrombosis ( CVST) results from occlusion of cerebral venous sinuses, usually resulting in hemorrhagic infarction. It is a rare type of stroke affecting 3-5 per million people, often due to hypercoagulable states from clotting factor abnormalities or diseases like cancers, autoimmune and collagen vascular disease. Headache, visual changes, changes in sensorium, focal neurologic signs, seizures, and coma are some of the symptoms.

The role of exogenous estrogen in developing CVST among transgenders has not been reported frequently in literature. We report a 26-year-old transgender female who presented with headache after 4 years of exogenous high dose parenteral and oral estrogen. Magnetic resonance venography findings showed dural sinus thrombosis involving the left internal jugular vein, left sigmoid sinus, left transverse sinus, straight sinus, torcula and posterior aspect of the superior sagittal sinus. Patient was treated with topiramate, steroids and anticoagulants. Patient symptoms improved and was subsequently sent home on edoxaban. This case underscores the importance of monitoring hormonal therapy in transgender individuals.

This report is an example of a rare cause of thrombosis secondary to self-administration of parenteral and oral estrogen. Prompt diagnosis in this patient resulted in the prevention of a catastrophic event like a major stroke, highlighting the importance of vigilance in managing hormone therapy. Increasing awareness about transgender issues can improve health and reduce inequities in this population.

Humans ; Venous Thromboembolism/prevention & control* ; Anticoagulants/therapeutic use* ; Pulmonary Embolism ; Patients ; Hospitalization ; Risk Factors

Humans ; Hospital Mortality ; Pulmonary Embolism ; Comorbidity ; Registries ; Neoplasms/complications*

OBJECTIVES: To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy. METHODS: Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically. RESULTS: The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05). CONCLUSIONS CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.
Humans ; Autopsy ; Thrombosis ; Pulmonary Embolism/diagnostic imaging* ; Tomography, X-Ray Computed ; Angiography ; Cadaver

INTRODUCTION: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity. METHODS: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January 2020 and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded. RESULTS: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum. CONCLUSION Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement; and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
Humans ; Asian People ; COVID-19/complications* ; Inflammation/complications* ; SARS-CoV-2 ; Thrombosis

Humans ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; Myocarditis ; SARS-CoV-2 ; Thrombosis/etiology* ; Vaccination

OBJECTIVE: To retrospectively analyze clinical data of patients under 40 years old who underwent surgical treatment for renal tumors with tumor thrombus from January 2016 to December 2022 at Peking University Third Hospital, and to evaluate the surgical effect and investigate the relationship between clinicopathological characteristics and prognosis. METHODS: The clinical data of 17 young patients with renal tumor thrombus were retrospectively analyzed, and the clinicopathological features and prognosis were summarized. The patients were grouped according to the presence or absence of symptoms, 2017 American Joint Committee on Cancer (AJCC) clinical stage, and postoperative combined adjuvant therapy. Kaplan-Meier method was used to plot the survival curve, and Log-rank test was used to compare the differences in postoperative survival time and progression-free survival time between the different groups. The relationship between clinicopathological features and prognosis was analyzed. RESULTS: All the 17 patients received venous tumor thrombectomy, including 16 patients (94.1%) who underwent radical nephrectomy and 1 patient (5.9%) who underwent partial nephrectomy. Twelve patients (70.6%) had symptoms and 5 (29.4%) had no symptoms before operation. A total of 17 renal tumors were observed, with 2 patients (11.8%) identified as benign and 15 patients (88.2%) classified as malignant. Among the malignant tumors, 1 patient (6.7%) was diagnosed as clear cell carcinoma, while the remaining 14 patients (93.3%) were categorized as non-clear cell carcinoma. In terms of tumor stage, 8 patients (53.3%) were classified as stage Ⅲ according to the AJCC classification, while 7 patients (46.7%) were categorized as stage Ⅳ. Additionally, 6 patients (40%) received multiple adjuvant therapy, while 9 patients (60%) did not undergo such treatment. The follow-up period ranged from 2 to 78 months, with a median follow-up of 41 months. During this time, 3 patients (20%) died. The median survival time after surgery was 39.0 (2.3, 77.8) months, and the progression-free survival time was 16.4 (2.3, 77.8) months. There was no significant difference in postoperative survival time and progression-free survival time among young patients with renal tumor with tumor thrombus, based on the presence of symptoms before surgery (P=0.307, P=0.302), clinical stage of AJCC (P=0.340, P=0.492), and postoperative adjuvant therapy (P=0.459, P=0.253) group. CONCLUSION The pathological types of young patients with renal tumor with tumor thrombus are more complex and varied due to symptoms, and the proportion of non-clear cell carcinoma in malignant tumor with tumor thrombus is higher. Symptomatic and non-clear cell carcinoma may be potentially associated with poor prognosis. Surgical operation combined with adjuvant therapy is a relatively safe and effective treatment for young patients with renal tumor and tumor thrombus.
Humans ; Adult ; Carcinoma, Renal Cell/surgery* ; Retrospective Studies ; Vena Cava, Inferior/surgery* ; Kidney Neoplasms/surgery* ; Prognosis ; Thrombosis/surgery* ; Thrombectomy/methods* ; Nephrectomy/methods*