Elastic compression stockings one year after DVT diagnosis: Who might discontinue?

BACKGROUND: Elastic compression stockings (ECS) are uncomfortable to wear but may prevent post-thrombotic syndrome (PTS). The ability to predict PTS may help clinical decision making regarding the optimal duration of ECS after deep vein thrombosis (DVT). AIMS: Predefined endpoint analysis of the Octavia study that randomized patients who compliantly used ECS up to one year after DVT to continue or discontinue ECS treatment. Primary aim was to identify predictors of PTS. METHODS: Patient characteristics were collected and ultrasonography was performed to assess reflux, residual thrombosis and persistent thrombus load 12 months after DVT. Multivariable analyses were performed to identify factors related to PTS. RESULTS: Thrombus score ≥ 3, BMI ≥ 26, duration of symptoms before DVT diagnosis ≥ 8 days and a Villalta score of 2-4 points were statistically significant predictors of PTS. The predictive value for PTS for the assessed variables was not different between the 2 treatment groups. In the stop ECS group, 3.2% (95%CI 0.08-18) of patients without any predictors for PTS were diagnosed with mild PTS during follow-up, and none with severe PTS, for a sensitivity of 98% (95% CI 89-100), a specificity of 14% (95% CI 10-20), a positive predictive value of 20% (95% CI 19-22), and a negative predictive value of 97% (95% CI 81-100). CONCLUSION: We identified 4 predictors of PTS occurring in the 2nd year after DVT. Our findings may be used to decide on whether to continue ECS treatment for an additional year, after one year of compliant ECS use, keeping in mind that patients with none of the predictors will have the lowest PTS incidence.

The Drosophila trithorax proteins contain a novel variant of the nuclear receptor type DNA binding domain and an ancient conserved motif found in other chromosomal proteins.

The products of the trithorax gene are required to stably maintain homeotic gene expression patterns established during embryo-genesis by the action of the transiently expressed segmentation genes. We have determined the intron/exon structure of the trx gene and the large alternatively spliced trx RNAs, which are capable of encoding only two protein isoforms. These very large trx proteins differ only in a long Ser- and Gly-rich N-terminal extension, encoded by exon II, which is present only in the larger trx isoform. We have identified a novel variant of the highly conserved nuclear receptor type of DNA binding domain. We have found that the previously identified Cys-rich central region contains multiple novel zinc finger motifs which are also present in the Polycomb-like protein and RBP2, a retinoblastoma binding protein. The trx proteins terminate with another novel conserved domain which we have identified in proteins from three kingdoms, including plants and fungi, indicating that has an ancient origin. Many of these proteins are chromosomally associated, suggesting that this domain may be involved in interactions between trx and other highly conserved components of chromatin involved in transcription regulation. The sequence alterations of trx mutations identify the highly conserved regions of trx as critical for the function of these large proteins. We show that zygotically expressed trx RNAs encoding the larger protein isoform are initially expressed in a spatially restricted pattern which overlaps the expression domains of the BX-C genes Ubx, abd-A and Abd-B. This pattern is transient and evolves into a broader expression domain encompassing the entire germ band during the extended germ band stage.

Management of nonstaphylococcal toxic epidermal necrolysis: follow-up study of 16 case histories.

In this study the clinical and laboratory data of 14 patients who experienced 16 attacks of nonstaphylococcal toxic epidermal necrolysis (TEN) are presented. All patients were treated in the Department of Dermatology of the University Hospital of Utrecht. Only 1 patient died. Attention is focused on a successful management consisting of reversed barrier nursing, painstakingly executed skin care, timely use of antibiotics and a therapy consisting of high dosages of corticosteroids. Thorough management in centers experienced in the treatment of TEN is essential for good treatment results. Further investigations concerning the use of corticosteroids in treating TEN are needed.

[Not meningitis but septic shock as the killer in acute meningococcal disease]. / Niet nekkramp, maar septische shock als schrikbeeld acute meningokokkenziekte.

The symptoms and clinical course of meningococcaemia in 14 cases are described; 10 patients died; in one of the four survivors amputations were inevitable for necrosis of hands and feet. The foremost symptoms at the first time that a doctor was contacted were fever, lethargy, petechiae and purpura. The fulminant course is shown by the high number of resuscitation at the time of admission or in the first hours after admission, and by the time between first symptoms and death. The mortality of meningococcaemia is mostly not due to meningitis. Most patients die of septic shock even before signs of meningitis can develop. The early signs of meningococcaemia are not those of meningitis, but those of sepsis. Meningism and headache are rare symptoms. The severest symptoms are fever and lethargy, in combination with petechiae and purpura. The fulminant course of the disease requires immediate admission. Treatment of infection and septic shock may be lifesaving.

Treatment of uncomplicated urogenital gonorrhoea in women with a single dose of enoxacin.

One hundred and twenty-three female patients suffering from uncomplicated urogenital gonorrhoea were treated in a double blind randomised trial with either 200 mg enoxacin (one capsule of 200 mg, one of placebo) or 400 mg enoxacin (two capsules of 200 mg). The cure rate in the 46 evaluable patients in the 400 mg group was 100%, and in the 40 evaluable patients in the 200 mg group 98.7%. Minor side effects such as nausea, headache and skin rash occurred in three of 109 evaluable patients (2.8%). The minimum inhibitory concentration of enoxacin for the Neisseria gonorrhoeae strains isolated varied between 0.03 and 0.12 mcg/ml. Enoxacin would seem to be a very effective drug in the treatment of uncomplicated urogenital gonorrhoea in female patients.

Treatment of uncomplicated gonococcal urethritis in men with two dosages of ciprofloxacin.

One hundred and sixty-four male patients suffering from urethral gonorrhoea were treated in an open randomised trial with either 250 mg (n = 85) or 500 mg (n = 79) ciprofloxacin administered in one tablet. Cure rates in both groups were 100%. Postgonococcal urethritis was observed in 31 of 85 (36%) patients in the first group, and in 21 of 79 patients (27%) in the second group. Side-effects were minor, occurring in four patients in the 250 mg group (4.7%) and in seven in the 500 mg group (8.9%). The side-effects consisted of nausea, diarrhoea and headache. Ciprofloxacin would appear to be a very effective drug in the treatment of urethral gonorrhoea in males.

Quinolones in the treatment of gonorrhoea and Chlamydia trachomatis infections.

123 Female patients suffering from uncomplicated urogenital gonorrhoea were treated with either 200 mg or 400 mg enoxacin. The cure rate in the 400 mg group was 100%; the cure rate in the 200 mg group was 95.7% 212 Male patients suffering from urethral gonorrhoea were treated with either 250 mg or 500 mg ciprofloxacin (one tablet). Cure rates in both groups were 100%. Post-gonococcal urethritis was observed in 31 out of 85 (36%) patients in the first, and 21 out of 79 (27%) in the second group. In a pilot study 42 male patients suffering from non-gonococcal urethritis were treated during one week with I g ciprofloxacin daily. In 22 patients Chlamydia trachomatis was isolated from the urethra: in 20 of these 22 cases Chlamydia trachomatis could not be cultured after treatment (cure rate 91%), but in 4 of these 20 cases (20%) and in 8 of the 20 Chlamydia trachomatis negative cases (40%) urine-sediment abnormalities were present after treatment.