A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity.

BACKGROUND: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. METHODS: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. RESULTS: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. CONCLUSIONS: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

Update on distal deep venous thrombosis. Reports of a multicenter study.

AIM: No study of strong methodology could be found to resolve the controversy of optimal treatment of distal deep venous thrombosis (DDVT). Some inconclusive evidence exists on two approaches to care: anticoagulants and compression therapy or compression therapy and Duplex scanning monitoring. Different studies report propagation to popliteal vein in 8% of patients without anticoagulant treatment, while a complete thrombus resolution within 4 weeks occurred in 20% of patients. We report data of a study conducted in patients affected by DDVT and treated with nadroparin administered once daily in association with compression therapy. METHODS: One hundred and ten patients with DDVT of the gastrocnemius or tibial veins, assessed by Duplex scanning, were enrolled in 8 clinical centres of the Lazio Region. At baseline, patient demographics, medical history (including risk factors for DDVT), circumferences of both calves and ankles, and a VAS-pain scale were recorded. At 7 and 28 days from baseline, patients were re-assessed by Duplex scanning, calves and ankles circumferences and VAS-pain were measured, and the patients were asked about possible side effects. RESULTS: At the end of the study period, no propagation to the popliteal vein was observed, and no side effects were reported. Overall, the calf circumference in the affected leg significantly decreased from baseline (38.1 cm) to week 1 (37.1 cm), and to week 4 (35.7 cm). Also the VAS-pain scores significantly decreased during the study - the observed means were 58.4, 30.7, and 12.7 at the three visits, respectively. The percentage of partial recanalization of tibial DVT at 7 days was lower than gastrocnemius DVT (31.6% vs. 59.8%) whereas the percentage of total recanalization at 28 days was comparable (52.6% vs. 59.8%). Complete recanalization occurred in 56.4% of all patients. CONCLUSION: Our study suggests that anticoagulant treatment, associated with compression therapy, is safe and causes clinical improvement (as assessed by calf measurements) and pain relief. Overall complete resolution (56.4%) is significantly higher than in untreated patients (20%). Such results, together with the already reported higher satisfaction of patients for the once-daily administration regimen, should be considered as a viable option for the treatment of DDVT.

[Sensitization to ethylene oxide: a possible cause of reactions in hemodialysis patients]. / Sensibilizzazione verso l'ossido di etilene: una possibile causa di reazioni nei pazienti in emodialisi.

147 hemodialyzed patient were studied for the presence of allergic reactions related to the dialytic treatment. Total IgE and specific IgE to common inhalants, ethylene oxide and phthalic anhydride were determined in all patients. The same determinations were also performed in two control groups. Specific IgE to ethylene oxide were detected in 7 sera. Among these 6 had a high total IgE level and 2 had a positive Phadiatop. Only 3 among the 7 positive patients had adverse reactions related to the hemodialysis (one suffered from itching, one from urticaria and the third from angioedema and hypotension). The resolution of the symptoms was obtained utilizing a gamma-rays sterilized filter. Therefore ethylene oxide sensitization may be a cause of some problems during hemodialysis. We couldn't find a relationship between atopic status and sensitization to ethylene oxide in as much in only 2 out of 7 patients sensitized to ethylene oxide, specific IgE to common inhalants were detected.

[Effect of histamine on the positive reactions produced during skin tests]. / Influenza dell'istamina sulle positivitá riscontrate durante l'esecuzione dei test cutanei.

The effect of histamine control on the reaction produced by adjacent allergens or diluent control during skin test was evaluated in 742 patients sensitized to one or more inhalant allergens. In 4 cases (0.7%) both the diluent control and all the tested allergens were positive thus indicating an altered cutaneous reactivity. The allergens placed near the histamine control were positive in 183 cases (24.7%). Among these 144 (19.4%) were strong positive results according to the history. In 39 cases (5.2%) the positive result didn't correlate with the history. Of note in 35 cases (4.7%) the reaction was classified as weak positive (+) according to Berg and Johansson (1974). Although our findings confirm only partially those from Terho and Coworkers, we agree with the Authors on the opportunity of positioning the histamine control at a suitable distance from other allergens during skin test.

Ticlopidine-pentoxifylline combination in the treatment of atherosclerosis and the prevention of cerebrovascular accidents.

This randomized, double-blind study on 79 patients reported the efficacy of ticlopidine-pentoxifylline combination in the treatment of atherosclerosis and the prevention of cerebrovascular accidents. Comparisons were made with aspirin-dipyridamole-buflomedil and buflomedil-placebo combinations as controls. Global symptoms, sensorimotor disorders and vertigo were improved in all treatment groups, although improvement tended to be more pronounced with ticlopidine-pentoxifylline. None of the groups showed any change in stenosis or vessel wall rigidity although ticlopidine-pentoxifylline reduced flow irregularity. This combination therapy also normalized the direction of flow in the ophthalmic artery in 46.2% of patients with retrograde flow prior to treatment, compared with 30.0% following aspirin-dipyridamole-buflomedil and 28.6% following buflomedil-placebo administration. Significantly fewer cerebrovascular accidents occurred after treatment with ticlopidine-pentoxifylline. In conclusion, ticlopidine-pentoxifylline showed good therapeutic efficacy against atherosclerosis and a preventative effect against new cerebrovascular accidents. This therapy was well tolerated.

Optical design considerations for contact lens bifocals.

Primary concerns for designing conventional bifocal contact lens optics involve placement of sufficient representation of distance and near optical powers before the pupil and minimizing the presence of secondary images. Geometrical models and lens measurements are used to establish guidelines for predicting bifocal contact lens performance. Proportional optical zone representation, image jump, and power distribution are presented for the most commonly employed bifocal zone configurations. Adequate zone representation and effective lens power are shown to be quite sensitive to variation in pupil size and position. Strategies for optimizing lens performance in view of these effects are discussed.

[Sensitization against Parietaria pollen in a group of 1143 patients in the Brescian area]. / Sensibilizzazione verso il polline di Parietaria in una casistica di 1143 pazienti dell'area Bresciana.

1143 patients were selected among atopic outpatients followed up at our Institution (Clinical Immunology-University of Brescia) on the basis of documented sensitization to one or more inhalant allergens. All patients had been investigated by skin prick tests employing a large panel of allergens. Specific sensitization had been confirmed by clinical history and when necessary by RAST. The patients were investigated retrospectively for the prevalence of sensitization to Paretaria. 880 patients were sensitized to one or more pollens and among these 427 (48.5) to Parietaria. Among pollen monosensitized patients (with no concomitant allergy to other inhalants), 222 were sensitized to Graminacee and 125 to Parietaria. In these groups there was no difference in prevalence of asthma. Our study thereby shows that the prevalence of sensitization to Parietaria in Brescia is higher than described in other cities in North Italy. Our findings are supported by pollen concentration in atmosphere as determined by Burkard pollen trap.