A case of upper left extremity deep vein thrombosis with right side middle lobe syndrome.

Upper extremity deep vein thrombosis is an extremely important clinical entity with potential for considerable morbidity and mortality. A 64-year-old woman was brought to the emergency department with complaints of left upper limb and neck swelling for 4 days. Ultrasonography of the neck showed thrombosis of the left internal jugular and other surrounding veins associated with local lymphadenopathy. Computed tomography (CT) of the neck also showed a hypodense 0.6 cm × 0.8 cm × 1.2 cm lesion in the right middle lobe bronchus, causing complete occlusion and collapse of the right middle lobe of the lung. Fine-needle aspiration cytology and a lymph node biopsy showed nongranulomatous lymphadenitis. The patient was started on fondaparinux 10 mg subcutaneously once daily. She was discharged on oral anticoagulants for 6 months. Repeat CT scan after 6 months showed dissolution of the lesion and reexpansion of the right lung.

A rare cause of lower GI bleeding.

The authors present a rare case of lower gastrointestinal (GI) bleed due to GI amyloidosis secondary to multiple myeloma. A 79-year-old lady who presented with bloody diarrhoea for 4 weeks. Flexible sigmoidoscopy showed slight oedematous mucosa extending up to the sigmoid colon. CT abdomen showed lytic lesions in the vertebral bodies. 24 h protein analysis and serum electrophoresis suggestive of multiple myeloma, which was confirmed with bone marrow biopsy, revealed plasma cell myeloma.

Colonoscopy in the octogenarian population: diagnostic and survival outcomes from a large series of patients.

OBJECTIVE: Our aim was to audit the diagnostic and survival outcomes of colonoscopy in octogenarians and to determine if it confers any survival benefit. METHODS: A review of a prospectively maintained database over a two year period between October 2005 and September 2007 was undertaken. Data on numerous outcome variables and survival were collected and analysed. Categorical variables were compared using the Chi-square test. Kaplan-Meier survival curves were constructed and log rank test were used to compare survival curves. RESULTS: There were 1905 patients, of which 289 (15%) were over the age of 80 years. Caecal intubation was significantly lower in octogenarians when compared with young patients (239/289, (82%) vs. 1411/1616 (88%), p = 0.025). The most common reason for failure to intubate the caecum was presence of stenosing pathology in distal bowel (octogenarians 46% (23 out of 50 failed intubations) vs. young 23% (49 out of 205 failed intubations), p = 0.002). A greater proportion of octogenarians had poor bowel preparation when compared with the young (20% vs. 13%, p = 0.001). Significantly more pathology was detected in octogenarians (72% vs. 59%, p = 0.001). Forty-four (15.2%) octogenarians were found to have malignancy. Of these, only 23 (52%) underwent subsequent surgery. Median survival of octogenarians who had surgery was not statistically better (31 (IQR 12-38) months vs. 16 (IQR 5-31) months, p = 0.10) than those who did not. CONCLUSION: Colonoscopy is safe in octogenarians and provides a high yield. Our results suggest that it does not appear to result in any survival benefit. However, to establish this, further research with larger cohorts and longer follow-up periods would be required.

Successful treatment of bleeding gastro-intestinal angiodysplasia in hereditary haemorrhagic telangiectasia with thalidomide.

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterised by epistaxis, cutaneous telangiectasia and visceral arterio-venous malformations (AVMs). It affects approximately one in 5000 people. Control of sustained and repeated haemorrhages from telangiectasias in the nose and gut in patients who may be transfusion dependent is clinically challenging. After repeated endoscopic coagulations, multiple lesions often recur at other sites of gastro-intestinal tract, where endoscopic therapy or surgical resection is not possible. Hormonal therapy has been employed for more than 50 years but has recently been shown to be ineffective. Thalidomide, with its antiangiogenic mechanism of action, seems to be promising drug as a treatment option where other modalities have been unsuccessful. In this article, the authors discuss a novel treatment of bleeding gastro-intestinal angiodysplasia.