Study on relationships among deep vein thrombosis, homocysteine and related B group vitamins

Hyperhomocysteinemia has been considered as a potential risk factor for deep venous thrombosis [DVT] but it is still controversy. We aimed to evaluate the prevalence of hyperhomocysteinemia in patients with DVT. Our second objective was to document the prevalence of folate, Vitamin B6, and Vitamin B12 level in this patient population. Sixty patients with DVT aged from 23 to 84 years, were assessed regarding demographic characteristics, serum levels of homocysteine, folate, vitamin B12, and vitamin B6. The diagnosis of DVT was based upon Wells scoring system and serum D-dimer level and confirmed by deep venous Doppler ultrasonography of the lower limbs. Mean serum homocysteine levels were found significantly higher in patients over the age of 40 years [10.81 +/- 4.26 micromol/L vs 9.13 +/- 3.23 micromol/L]. Of all the patients, 9 patients had homocysteine level above the 15 micromol/L, 26 had folic acid level below 3 ng/ml, one had vitamin B12 level below 150 pmol/L, and two had vitamin B6 level below 30 nmol/L. In the hyperhomocysteinemic group, five patients had low folic acid level, one had low vitamin B12 level, and two had low vitamin B6 level. Hyperhomocysteinemia, in women older than 40 years, may be a risk factor for DVT. Folic acid deficiency may also influence serum homocysteine concentrations. Folate therapy may be offered to the patients with DVT. However further studies are required to clarify the underlying molecular mechanisms

Diagnostic value of the biochemical tests in patients with purulent pericarditis

Purulent pericarditis is a collection of purulent effusion in the pericardial space. It has become a rare entity with the increased availability and use of antibiotics. In contrast to pleural empyema, there are few data regarding the biochemical parameters of purulent pericardial effusion to aid diagnosis. Therefore, in this study, we have evaluated the diagnostic utility of biochemical tests in patients with purulent pericarditis. Between September 2004 and September 2012, we treated fifteen children with purulent pericarditis and tamponade. There were 8 boys and 7 girls, ranging in age from 8 months to 14 years, with a mean age of 5.3 +/- 3.2 years. Echocardiographic diagnosis of cardiac tamponade was made in all patients. All patients underwent immediate surgical drainage due to cardiac tamponade. The diagnosis of purulent pericarditis was supported by biochemical tests. Anterior mini-thoracotomy or subxiphoid approach was performed for surgical drainage. The most common clinical findings were tamponade, hepatomegaly, tachycardia, fever refractory antibiotic therapy, dyspnea, tachypnea, cough, and increased jugular venous pressure. Central venous pressure decreased and arterial tension increased immediately after the evacuation of purulent effusion during operation in all patients. The pericardial effusion had high lactic dehydrogenase, and low glucose concentration, confirming purulent pericarditis. Also, pH [mean +/- SD] was 7.01 +/- 0.06. The culture of pericardial effusions and blood samples were negative. Biochemical tests are useful guideline when assessing the pericardial effusions. However, these tests should be interpreted with the clinical and operative findings

Echinococcal tension pneumothorax in a pregnant woman

Pulmonary hydatid cyst in pregnancy is a very rare pathology and its diagnosis and treatment is stilt a complex of problem. We report a rare case of ruptured giant pulmonary hydatid cyst presenting with tension pneumothorax during pregnancy. According to our knowledge this is the first report of such a case. A 21 -year old pregnant woman was admitted to our hospital with complaints of left-sided chest pain, cyanosis and dyspnea. Chest radiograph showed tension pneumothorax, mediastinal shift, and tracheal displacement. Echocardiography revealed perforated hydatid cyst adjacent to pericardium. She was taken to the operating room immediately. During operation, a giant perforated hydatid cyst [12x10cm] was found, outside the pericardium displacing and compressing the left lower lobe. Histopathological examination confirmed the diagnosis. Approximately 5 months later she had a spontaneous vaginal delivery. Both the patient and her baby were healthy. Perforated pulmonary hydatid cyst should be kept in mind in the differential diagnosis of tension pneumothorax in a pregnant woman and surgical intervention should be performed promptly