Standing posture at work does not increase the risk of varicose veins among health care providers in taiwan

Objective: This study compared the risk of varicose veins [VV] among physicians, nonphysician health care providers [HCP], and the general population

Subjects and Methods: The Taiwan National Health Insurance Research Database was used to identify 28,844 physicians and 26,099 nonphysi-cian HCP and an identical number of age- and sex-matched patients from the general population. Using logistic regression analyses, W risks between physicians and the general population, nonphysician HCP and the general population, and physicians and nonphysician HCP, and among physician specialists were compared by tracing their medical histories between 2007 and 2011

Results: Physicians and nonphysician HCP had cumulative W incidences of 0.12% [34/28,844] and 0.13% [33/26,099], respectively, during the 5-year period, compared to that of the general population within the same 5-year period. Physicians and nonphysician HCP didnot have a higher W risk than the general population after adjusting for deep vein thrombosis [DVT] history [adjusted odds ratio [AOR] 0.86; 95% confidence interval [Cl] 0.53-1.40, and AOR 1.43; 95% Cl 0.82-2.50, respectively]. Physicians did not a have higher VV risk than nonphysician HCP [AOR 0.80; 95% Cl 0.43-1.51] after adjusting for age, sex, and DVT history. Surgery had the highest incidence [0.22%] while pediatrics and emergency medicine had the lowest incidence [0%] of VV risk among physician specialists; however, the difference was not significant [all p values >0.05]

Conclusion: In this study, VV risk did not differ among physicians, non-physician HCP, and the general population

Pregnancy-induced acute intestinal infarction in a woman with chronic idiopathic mesenteric vein thrombosis under regular anticoagulation treatment

We present a case of acute intestinal infarction in a pregnant woman with chronic idiopathic mesenteric vein thrombosis [MVT] under regular anticoagulation treatment. The condition of the 26-year-old woman who was diagnosed with chronic idiopathic MVT after detailed investigation was stable after receiving regular anticoagulation with warfarin. One year later, she presented with a 7-day episode of intermittent epigastric pain. Acute intestinal infarction and concomitant 7-week pregnancy were diagnosed. To preserve her life, a dilation and curettage procedure and emergency laparotomy with bowel resection were performed. Ten days later, she was discharged, having made a good recovery. Although pregnancy was not the primary cause of chronic MVT, it did play a role in inducing the acute intestinal infarction. This case indicates that pregnant patients with known chronic idiopathic MVT should be counseled about the high risk of acute mesenteric thrombosis. This case also serves to remind physicians that there should always be a high level of suspicion of intestinal infarction in patients with an acute abdomen who are in a hypercoagulable state

Clinical characteristics of renal infarction in an Asian population

<p><b>INTRODUCTION</b>Renal infarction is a rare and easily missed disease. There is even less meaningful information on renal infarction in the Asian population. Thus, the aim of this study was to clarify the clinical characteristics of the disease in Asian patients.</p><p><b>CLINICAL PICTURE</b>Over a period of 10 years, 38 Chinese patients with renal infarction diagnosed by contract-enhanced CT or angiography were enrolled in this study. Their demographic data, clinical characteristics, laboratory and image results, risk factors or suspected causes, treatment and final outcomes were retrospectively reviewed. The results were also compared with the analogous Western data. The mean age of the sample population was 60.8 +/- 17.6 years, with patients aged over 50 years and males predominating. The most common symptoms/signs were abdominal (57.9%) and flank pain/tenderness (50%). Only 23.7% of patients had suffered previous thromboembolic events such as coronary or peripheral artery diseases, or cerebral infarction. Cardiogenic factors, such as atrial fibrillation, intra-cardiac thrombus, infective endocarditis and valvular heart disease, were the main causes of renal infarction (57.9%). The most common laboratory abnormalities were elevated serum LDH (92.1%) and proteinuria (76.3%). Only half of the cases involved haematuria at initial presentation.</p><p><b>TREATMENT AND OUTCOME</b>One-third of the sample suffered renal impairment after the renal infarction. Overall mortality rate during admission was 13.2% (n = 5). The cause of death was usually not the renal infarction itself but rather the underlying disease and its complications. There was no difference in outcome for anticoagulation treatment with or without thrombolytics. Compared to their Western counterparts, the proportion of males (71.1% versus 48.3%) and bilateral renal infarctions (31.6% versus 12.4%) were significantly higher, and the percentage of leukocytosis (50% versus 85%) significantly lower in our Asian patients.</p><p><b>CONCLUSION</b>Clinical presentation of renal infarction is usually non-specific and differs for Asian and Western populations. In our Asian patients, the most common clinical characteristics were abdominal pain/tenderness, flank pain/tenderness, elevated serum LDH and proteinuria. Early diagnosis and treatment are imperative because of the high rate of renal impairment and associated mortality. If this disease is suspected, contrast-enhanced CT is suggested to exclude or confirm renal infarction and anticoagulation alone is currently the favored treatment.</p>