Effort-induced venous thrombosis of the upper limbs

To report 3 patients who presented with effort-induced thrombosis of the upper limbs. The 1st patient presented with a 2-week history of fever, shortness of breath, and increasing swelling of the neck after strenuous manual work. The 2nd patient presented with a 2-day history of pain, swelling, and discolouration of the right upper limb following a session of intense weight lifting. The 3rd patient presented with a 2-day history of swelling, pain, and discolouration of the left upper limb due to repeated rotatory movements of the arm at work. In all 3 cases, the diagnosis of effort-induced thrombosis of subclavian and axillary veins was made. In the 1st case, the lesion was bilateral and complicated by superior vena cava obstruction. In the 2nd and in the 3rd case, right and left subclavian veins were thrombosed, respectively. After consulting the vascular team, anticoagulation therapy was initiated in all 3 cases. The patients described showed gradual recovery with eventual recanalization of the thrombosed veins on follow-up. These cases indicate the need to consider thrombosis of the subclavian vein as a part of the differential diagnosis in a patient with a history of strenuous manual work. Therapeutic options include immediate anticoagulation or thrombolysis, while vascular surgery should remain an option for cases with underlying anatomical anomalies

Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait

To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease [COPD]. Subjects and One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. Seventy-four of 104 [71%] hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 ' 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients [78%] had a baseline FEV1 <50% before hospitalization and 45 [64%] had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen [19%] died on admission. Risk factors identified included severity of disease [p < 0.05]; presence of comorbid disease [p < 0.01]; acidemia [p < 0.0001]; hypercapnia [p < 0.0001]; previous hospitalization [p < 0.01], and assisted ventilation [p < 0.001]. This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Pernicious anaemia associated with endocrinopathies and family clustering of various autoimmune disorders

The study is of a 62-year-old Jordanian lady who presented with pernicious anaemia, atrophic gastritis, vitiligo, premature greying of her hair and primary infertility. Members of the family were also affected by various autoimmune disorders

Serum alkaline phosphatase isoenzymes in an arab population with non-insulin-dependent diabetes mellitus

Total serum alkaline phosphatase and its liver, bone and intestinal isoenzymes were estimated in 62 Arab subjects with non-insulin-dependent diabetes mellitus and compared with the levels in 64 healthy controls. A significant elevation of total alkaline phosphatase was found in the diabetic patients [126 IU/1] compared to the controls [79 IU/1]. The level of the liver alkaline phosphatase isoenzyme fraction was also higher in the diabetic group [84 IU/1] than in the controls [64 IU/1]. In addition, the value for the bone isoenzyme fraction, which was the predominant fraction in 16 diabetics and 21 controls, was significantly higher in diabetics [122 IU/1] than in controls [31 IU/1]. However, the intestinal alkaline phosphatase band, which was present in 12 diabetics [54 IU/1] and 7 healthy controls [42 IU/1], was not significantly different. Both the diabetics and controls with this band had either blood group O or B. Total alkaline phosphatase and the bone isoenzyme were found to correlate positively with fasting blood glucose. Thus, although total alkaline phosphatase and its bone and liver isoenzyme fractions are elevated in diabetic subjects, the level of the intestinal fraction seems to be independent of the diabetic state