Extreme Rhabdomyolysis, Acute Renal Failure, and Protracted Ileus in a Case of Legionella Pneumonia.

A 53-year-old man developed a Legionella pneumophila pneumonia complicated by rhabdomyolysis, acute kidney injury, and protracted ileus. Risk factors were smoking and chronic alcoholism, but the patient had no history of previous abdominal surgery. Hemodialysis was required for a period of 5 weeks with a full renal recovery. Pneumonia required respiratory support but for a limited period of 6 days. The protracted course of the ileus led to explorative laparotomy despite negative computed tomography findings. No cause of mechanical obstruction was found at surgery and common etiologies of intestinal obstruction were excluded. Parenteral nutrition was needed for a total of 4 weeks, before recovery of intestinal motility. This case illustrates the apparent discrepancy between the pulmonary symptoms and the extrapulmonary manifestations that could be seen as a consequence of an exaggerated immune response.

Dynamic self-assembly of DNA minor groove-binding ligand DB921 into nanotubes triggered by an alkali halide.

We describe a novel self-assembling supramolecular nanotube system formed by a heterocyclic cationic molecule which was originally designed for its potential as an antiparasitic and DNA sequence recognition agent. Our structural characterisation work indicates that the nanotubes form via a hierarchical assembly mechanism that can be triggered and tuned by well-defined concentrations of simple alkali halide salts in water. The nanotubes assembled in NaCl have inner and outer diameters of ca. 22 nm and 26 nm respectively, with lengths that reach into several microns. Our results suggest the tubes consist of DB921 molecules stacked along the direction of the nanotube long axis. The tubes are stabilised by face-to-face π-π stacking and ionic interactions between the charged amidinium groups of the ligand and the negative halide ions. The assembly process of the nanotubes was followed using small-angle X-ray and neutron scattering, transmission electron microscopy and ultraviolet/visible spectroscopy. Our data demonstrate that assembly occurs through the formation of intermediate ribbon-like structures that in turn form helices that tighten and compact to form the final stable filament. This assembly process was tested using different alkali-metal salts, showing a strong preference for chloride or bromide anions and with little dependency on the type of cation. Our data further demonstrates the existence of a critical anion concentration above which the rate of self-assembly is greatly enhanced.

Inactivation of Escherichia coli O157:H7 in Beef Roasts Cooked in Conventional or Convection Ovens or in a Slow Cooker under Selected Conditions.

Inactivation of Escherichia coli O157:H7 in beef roasts cooked under selected cooking conditions was evaluated. Eye of round roasts were each inoculated at five sites in the central plane with a five-strain cocktail of E. coli O157:H7 at ca. 6.3 log CFU per site and cooked to center temperatures of 56 to 71°C in a convection oven set at 120, 140, 180, or 200°C, in a conventional oven set at 120 or 210°C, and in a slow cooker set on high or low. Prime rib roasts were each inoculated at 10 sites throughout the roast with the same E. coli O157:H7 cocktail at ca. 6.6 log CFU per site and cooked in the conventional oven set at 140 or 180°C to center temperatures of 58 to 71°C. The number of sites yielding E. coli O157:H7 after cooking decreased with increasing roast center temperature for the eye of round roasts cooked in the convection oven or in the slow cooker at a given setting, but this trend was not apparent for roasts of either type cooked in the conventional oven. Reductions of E. coli O157 in both types of roasts were generally less at the center than at other locations, particularly locations closer to the surface of the meat. When eye of round roasts were cooked to the same center temperature in the convection oven, the reduction of E. coli O157:H7 increased with increasing oven temperature up to 180°C and decreased after that. The reduction of E. coli O157:H7 in replicate roasts cooked under conditions in which the organism was not eliminated during cooking mostly differed by >1 log CFU per site. However, E. coli O157:H7 was not recovered from any of the inoculation sites when eye of round roasts were cooked to 65, 60, 60, or 63°C in the convection oven set at 120, 140, 180, and 200°C, respectively; cooked to 63 or 71°C in the conventional oven set at 120 and 210°C, respectively; or cooked to 63°C in the slow cooker set at high or low. For prime rib roasts, E. coli O157:H7 was not recovered from any of the inoculation sites in roasts cooked to 71 or 58°C in the conventional oven set at 140 and 180°C, respectively.

Cognitive factors influencing treatment decision-making in patients with localised prostate cancer: development of a standardised questionnaire.

BACKGROUND: Men diagnosed with localised prostate cancer have to make a well-informed treatment choice between (robot-assisted) radical prostatectomy, external beam radiotherapy and, in selected cases, brachytherapy and active surveillance. We developed and validated a questionnaire to determine the cognitive reasons motivating this choice. MATERIALS AND METHODS: The Prostate Cancer Decision-Making Questionnaire (PC-DMQ) was designed in-house and validated through the Delphi method. Finally, we tested the questionnaire in a cohort of 24 men, recently diagnosed with localised PC, before undergoing RARP (n = 16), EBRT (n = 6), brachytherapy (n = 1) or active surveillance (n = 1). RESULTS: The experts reached consensus after three rounds. In the patient cohort, 75% of men undergoing RARP chose this treatment because 'it provides the best chance of cure'. Reasons to choose EBRT were not as explicit: 33.3% chose this treatment because 'it provides the best chance of cure' and 33.3% because 'the maintenance of potency is important to them'. CONCLUSIONS: The PC-DMQ is a comprehensive and standardised tool that allows further research into cognitive factors that influence treatment decision-making in patients with localised PC.

Kinetics and anthelmintic efficacy of topical eprinomectin when given orally to goats.

Preliminary data suggest that topical eprinomectin in goat shows an individual variation in anthelmintic efficacy when used off-license at a dose rate of 0.5 or 1.0mg/kg BW. As a result, the use of oral administration of topical formulation of eprinomectin tends to develop in dairy goat farms in France. The plasma levels and milk excretion as well as the anthelmintic efficacy of eprinomectin were determined in goats following oral administration of a topical formulation of the drug at dose rates of 0.5 and 1mg/kg BW. The area under the concentration-time curve (AUC) values were 17.62 ± 9.68 ng day/ml and 6.56 ± 4.00 ng day/ml for plasma and milk respectively after the administration of 0.5mg/kg BW and 45.32 ± 13.90 ng day/ml and 13.88 ± 1.77 ng day/ml for plasma and milk, respectively after the administration of 1mg/kg BW. The milk-to-plasma ratio ranged from 0.33 to 0.36 and the amount of drug recovered in the milk was 0.4% of the total administered dose. The maximum concentrations of eprinomectin residues determined in milk after oral treatment were < 20 µg/kg (Maximum Residue Limit in goat milk). The anthelmintic efficacy of the oral administration of topical eprinomectin was 100% through Faecal Egg Count Reduction Test in natural infection and ≥ 99.8% through Controlled Test in experimental infection (Haemonchus contortus and Trichostrongylus colubriformis). Additional information is needed about the fate of the vehicles used for topical formulation when given by oral route concerning food safety.

Observations on the use of cidofovir for BK virus infection in renal transplantation.

BACKGROUND: In renal transplantation, BK virus infection can result in significant graft nephropathy and loss. While reduction in immunosuppression (IS) is considered standard therapy, adjunct agents may be warranted. Data are suggestive of a possible role of cidofovir for the management of BK. This study aims to describe the course of BK viremia (BKV) in a large cohort of renal transplant patients receiving adjunct cidofovir. METHODS: We evaluated kidney and kidney-pancreas recipients who received cidofovir combined with reduced IS for management of high-level BKV or BK virus nephropathy (BKVN). We examined the rate and timing of BKV clearance, and performed a multivariate analysis to identify risk factors associated with long-term (>6 months) viremia. RESULTS: In total, 75 patients received a median of 13 doses of cidofovir in conjunction with reduced IS; 32 patients (43%) had short-term BKV (≤6 months), and 43 (57%) had long-term BKV. Overall, 53 of 75 patients (71%) eventually cleared BKV at a median of 4.2 months (interquartile range 2.1-9.3 months). Independent factors associated with long-term BKV included older age (odds ratio [OR] 1.1, P = 0.02), delayed graft function (OR 31.4, P = 0.01), and higher peak BKV (OR 12.8, P = 0.02), while BKV reduction by at least 1 log(10) copies/mL at 1 month of treatment was associated with clearance within 6 months (OR 49.3, P < 0.01). Patients with earlier clearance maintained stable graft function and no graft losses, while long-term BKV was associated with a 15% decline in estimated glomerular filtration rate. CONCLUSIONS: Adjunct cidofovir resulted in preservation of renal function when viral clearance occurred within 6 months of initiation. This retrospective review defines factors predicting response to cidofovir in conjunction with reduced IS for BKVN or high-level BKV. Still, considering cost, frequency of administration, and treatment duration, a randomized trial is necessary to define the exact utility of cidofovir in the setting of BK virus infection.

Effects of selected cooking procedures on the survival of Escherichia coli O157:H7 in inoculated steaks cooked on a hot plate or gas barbecue grill.

Beef steaks (2 cm thick) were each inoculated at three sites in the central plane with Escherichia coli O157:H7 at 5.9 ± 0.3 log CFU per site. Temperatures at steak centers were monitored during cooking on a hot plate or the grill of a gas barbeque. Steaks were cooked in groups of five using the same procedures and cooking each steak to the same temperature, and surviving E. coli O157:H7 at each site was enumerated. When steaks cooked on the hot plate were turned over every 2 or 4 min during cooking to between 56 and 62°C, no E. coli O157:H7 was recovered from steaks cooked to ≥58 or 62°C, respectively. When steaks were cooked to ≤71°C and turned over once during cooking, E. coli O157:H7 was recovered from steaks in groups turned over after ≤8 min but not from steaks turned over after 10 or 12 min. E. coli O157:H7 was recovered in similar numbers from steaks that were not held or were held for 3 min after cooking when steaks were turned over once after 4 or 6 min during cooking. When steaks were cooked on the grill with the barbeque lid open and turned over every 2 or 4 min during cooking to 63 or 56°C, E. coli O157:H7 was recovered from only those steaks turned over at 4-min intervals and cooked to 56°C. E. coli O157:H7 was recovered from some steaks turned over once during cooking on the grill and held or not held after cooking to 63°C. E. coli O157:H7 was not recovered from steaks turned over after 4 min during cooking to 60°C on the grill with the barbeque lid closed or when the lid was closed after 6 min. Apparently, the microbiological safety of mechanically tenderized steaks can be assured by turning steaks over at intervals of about 2 min during cooking to ≥60°C in an open skillet or on a barbecue grill. When steaks are turned over only once during cooking to ≥60°C, microbiological safety may be assured by covering the skillet or grill with a lid during at least the final minutes of cooking.

Field study of dried blood spot specimens for HIV-1 drug resistance genotyping.

Dried blood spots (DBS) are an alternative specimen type for HIV drug resistance genotyping in resource-limited settings. Data relating to the impact of DBS storage and shipment conditions on genotyping efficiency under field conditions are limited. We compared the genotyping efficiencies and resistance profiles of DBS stored and shipped at different temperatures to those of plasma specimens collected in parallel from patients receiving antiretroviral therapy in Uganda. Plasma and four DBS cards from anti-coagulated venous blood and a fifth card from finger-prick blood were prepared from 103 HIV patients with a median viral load (VL) of 57,062 copies/ml (range, 1,081 to 2,964,191). DBS were stored at ambient temperature for 2 or 4 weeks or frozen at -80 °C and shipped from Uganda to the United States at ambient temperature or frozen on dry ice for genotyping using a broadly sensitive in-house method. Plasma (97.1%) and DBS (98.1%) stored and shipped frozen had similar genotyping efficiencies. DBS stored frozen (97.1%) or at ambient temperature for 2 weeks (93.2%) and shipped at ambient temperature also had similar genotyping efficiencies. Genotyping efficiency was reduced for DBS stored at ambient temperature for 4 weeks (89.3%, P = 0.03) or prepared from finger-prick blood and stored at ambient temperature for 2 weeks (77.7%, P < 0.001) compared to DBS prepared from venous blood and handled similarly. Resistance profiles were similar between plasma and DBS specimens. This report delineates the optimal DBS collection, storage, and shipping conditions and opens a new avenue for cost-saving ambient-temperature DBS specimen shipments for HIV drug resistance (HIVDR) surveillances in resource-limited settings.

Outcomes of living donor renal transplants with a negative cross-match and pretransplant donor-specific antibody.

INTRODUCTION: Management of renal transplant recipients with a negative complement-dependent cytotoxicity-antihuman globulin (CDC-AHG) cross-match and pretransplant donor-specific antibody (DSA) is controversial. We sought to compare outcomes of immunologically high-risk living donor (LD) renal transplant recipients with and without DSA. METHODS: We conducted a single-center, retrospective review of all high immune-risk LD renal transplant recipients with a negative CDC-AHG cross-match performed between January 2008 and December 2010. Pretransplant desensitization for DSA was not utilized. Immunosuppression consisted of thymoglobulin induction, followed by tacrolimus, myeophenolate mofetil, and prednisone. DSA was assessed pretransplant and at 1, 3, 6, 9, and 12 months, and every 6 months thereafter. RESULTS: Between January 2008 and December 2010, 44 LD renal transplants were performed in high immune-risk recipients with a negative CDC-AHG cross-match. Outcomes of 14 recipients with pretransplant DSA were compared with 30 recipients with no DSA. After a median follow-up of 26 months (range, 12-40), overall death-censored graft survival was 100%, with no acute rejection episodes in the DSA group and 1 antibody-mediated rejection in the non-DSA cohort. Mean serum creatinines of the DSA and non-DSA groups at 1 year post-transplant were 1.0 ± 0.4 and 1.2 ± 0.6 mg/dL (P = NS), respectively. Among the pretransplant DSA cohort, 5 of the 14 (36%) developed persistent post-transplant DSA at a median of 9 months (range, 3-24) versus 2 of 30 (7%; P = .025) at a median of 12 months post-transplant in the non-DSA cohort. All recipients in the pretransplant DSA group underwent renal biopsy for persistent post-transplant DSA. Three of 5 biopsies showed C4D deposition in peritubular capillaries without glomerulopathy or arteriopathy. CONCLUSIONS: Early post-transplant outcomes for LD recipients with a negative cross-match and pretransplant DSA were excellent. In recipients with good and stable renal function, the significance of persistent post-transplant DSA in combination with C4D deposition on biopsy is unclear at this time.

De novo donor specific antibodies and patient outcomes in renal transplantation.

Single antigen identification of HLA antibodies is used to detect donor specific antibodies (DSAs). However, the impact of DSA elements such as class, relative strength, duration, and longitudinal effect on graft function and survival, remains unclear. Routine DSAs (LabScreen, One Lambda, Inc., Canoga Park, CA) and metabolic studies were performed at 1, 3, 6, 9, and 12 months post-transplant, and every 6 months for renal transplant recipients from 7/2007-7/2010 (n = 389). Biopsies were evaluated by updated Banff 2005 guidelines after two consecutive positive DSAs. Based on these tests, 25% of recipients developed de novo DSA. Those with DSA had increased acute rejection episodes (AR), higher creatinine (Scr), and worse graft survival. Three subgroups of these patients were identified based on duration: persistent DSA (> 1), isolated DSA, or no DSA. Persistent DSA patients were more likely to be African American, and have higher mean fluorescence intensity (MFI) and AR rates. Persistent DSA patients, with or without AR, had elevated Scr. Recipients with DQ-only DSA had higher rates of antibody mediated rejection (AMR). From this, we conclude that routine posttransplant DSA monitoring identifies recipients at risk for graft damage or loss. Persistent de novo DSAs correlated with inferior graft outcomes and AMR. With or without AR, DSA persistence was associated with worse outcomes, possibly warranting intervention. De novo DQ-DSA may be a biomarker for chronic damage and/or AMR, while an isolated DSA determination appears clinically insignificant.

A finite element analysis of the vibrational behaviour of the intra-operatively manufactured prosthesis-femur system.

In total hip replacement (THR) a good initial stability of the prosthetic stem in the femur, which corresponds to a good overall initial contact, will help assure a good long-term result. During the insertion the implant stability increases and, as a consequence, the resonance frequencies increase, allowing the assessment of the implant fixation by vibration analysis. The influence of changing contact conditions on the resonance frequencies was however not yet quantitatively understood and therefore a finite element analysis (FEA) was set up. Modal analyses on the hip stem-femur system were performed in various contact situations. By modelling the contact changes by means of the contact tolerance options in the finite element software, contact could be varied over the entire hip stem surface or only in specific zones (proximal, central, distal) while keeping other system parameters constant. The results are in agreement with previous observations: contact increase causes positive resonance frequency shifts and the dynamic behaviour is most influenced by contact changes in the proximal zone. Although the finite element analysis did not establish a monotonous relationship between the vibrational mode number and the magnitude of the resonance frequency shift, in general the higher modes are more sensitive to the contact change.

European study on epidemiology and management of hepatitis C virus (HCV) infection in the haemodialysis population. Part 3: prevalence and incidence.

An analysis of the literature showed a high prevalence of HCV in the European dialysis population in the nineties. The prevalence was similar in most countries in northern Europe, but infection was more common in France, Italy, Spain, Portugal and Greece (1) and in Eastern European countries (2). The reported prevalence of anti-HCV-positive patients in the EDTA registry was 21% in 1992 and 18% in 1993 (3) ranging from 1% in Finland to 42% in Egypt (4). The incidence of HCV, in new patients starting renal replacement therapy, ranged from 3% to 7% (5,6) and reported seroconversion rates during dialysis treatment varied between 1% (7) and 16% (8) per year.

Epidemiological study of the prevalence of Babesia divergens in a veterinary practice in the mid-east of France.

To assess the epidemiology of Babesia divergens in a veterinary practice based in the mid-east of France ("Monts du Lyonnais"), blood was collected from 254 cattle belonging to 24 herds. To assess the dynamics of the carrier state, six carriers were identified, treated with flumethrin and sampled once every 3 weeks during 6 months. Two different DNA extraction methods were compared. Each sample was tested for the presence of parasites using a PCR-RFLP test based on the 18S rRNA gene. The sensitivity of the test was equivalent to a parasitaemia as low as 10(-5)% (in "Filter Paper" samples) and 10(-6)% in 1 ml blood (extracted using "Matrix"). With the latter method, the rate of detection diminishes in the low parasitaemia range but could probably be improved. This test proved to be very useful in the detection of B. divergens carriers. Serology using IFAT showed 7% of the cattle seropositive, which is suggestive of a disease situation with a low clinical risk level. Analysis of the PCR results suggests a 20% prevalence rate of carriers in the cattle population. The use of the mean parasitaemia is proposed to serve as a babesiosis clinical risk indicator. This approach could also be used in other babesia infections provided the lowest detectable parasitaemia level (threshold level) could be resolved for each parasite species.

Isolation, characterization, and identification of bacterial contaminants in semifinal gelatin extracts.

Bacterial contamination of gelatin is of great concern. Indeed, this animal colloid has many industrial applications, mainly in food and pharmaceutical products. In a previous study (E. De Clerck and P. De Vos, Syst. Appl. Microbiol. 25:611-618), contamination of a gelatin production process with a variety of gram-positive and gram-negative bacteria was demonstrated. In this study, bacterial contamination of semifinal gelatin extracts from several production plants was examined. Since these extracts are subjected to harsh conditions during production and a final ultrahigh-temperature treatment, the bacterial load at this stage is expected to be greatly reduced. In total, 1,129 isolates were obtained from a total of 73 gelatin batches originating from six different production plants. Each of these batches was suspected of having bacterial contamination based on quality control testing at the production plant from which it originated. For characterization and identification of the 1,129 bacterial isolates, repetitive-element PCR was used to obtain manageable groups. Representative strains were identified by means of 16S rRNA gene sequencing, species-specific gyrB PCR, and gyrA and rpoB sequencing and were tested for gelatinase activity. The majority of isolates belonged to members of Bacillus or related endospore-forming genera. Representative strains were identified as Bacillus cereus, Bacillus coagulans, Bacillus fumarioli, Bacillus amyloliquefaciens, Bacillus licheniformis, Bacillus pumilus, Bacillus sonorensis, Bacillus subtilis, Bacillus gelatini, Bacillus thermoamylovorans, Anoxybacillus contaminans, Anoxybacillus flavithermus, Brevibacillus agri, Brevibacillus borstelensis, and Geobacillus stearothermophilus. The majority of these species include strains exhibiting gelatinase activity. Moreover, some of these species have known pathogenic properties. These findings are of great concern with regard to the safety and quality of gelatin and its applications.

One-stage bilateral total hip replacement: a retrospective study of 70 patients.

In this study, we retrospectively reviewed 70 patients who had a one-stage bilateral total hip replacement in our institution, between 1992 and 1998. Different variables were considered such as gender, age, length of hospital stay, pre-operative diagnosis, duration of the operation and anesthesia, type of prosthesis, complications and amount of blood loss, pre- and postoperative range of motion, incidence of periarticular heterotopic ossifications and postoperative pain and walking distance. In our group of patients one-stage bilateral total hip replacement was found to have resulted in good objective results. Patients with a rheumatoid condition had the highest gain in postoperative hip mobility. In comparison with existing literature there were no more intra- or postoperative complications, making one-stage bilateral total hip replacement a safe procedure in well-selected cases.

Java-based graphical user interface for the MRUI quantitation package.

This article describes the Java-based version of the magnetic resonance user interface (MRUI) quantitation package. This package allows MR spectroscopists to easily perform time-domain analysis of in vivo MR spectroscopy data. We show that the Java programming language is very well suited for developing highly interactive graphical software applications such as the MRUI software. We have also established that MR quantitation algorithms, programmed in other languages, can easily be embedded into the Java-based MRUI by using the Java native interface (JNI). This new graphical user interface (GUI) has been conceived for the processing of large data sets and uses prior knowledge data-bases to make interactive quantitation algorithms more userfriendly.

Malignant plasma cell lines express a functional CD28 molecule.

The function of CD28 molecules that are present on malignant plasma cells of human myeloma cell lines (HMCL) was studied. First, myeloma cells expressed a similar density of CD28 antigen to that of normal T cells. The myeloma CD28 molecules were able to bind B7-Ig molecules as well as L cells transfected with a B7-1 cDNA, and anti-CD28 mAb inhibited the binding. Myeloma cells did not express B7-1 antigens but a low density of B7-2 antigens. The myeloma B7-2 molecules of two HMCL were able to bind CTLA-4 protein. No autocrine CD28:B7-2 activation could be evidenced as we found no spontaneous binding of the p85 subunit of PI-3 kinase to CD28 molecules. In addition, a blocking anti-CD28 mAb did not affect the IL-6-dependent or autonomous proliferation of the HMCL. The activation of myeloma CD28 molecules with or without TPA stimulation did not affect the proliferation, survival, differentiation, expression of activation antigens and cytokine receptors or cytokine production of myeloma cells. However, the triggering of myeloma CD28 molecules by B7-1 transfectant cells resulted in binding of the p85 subunit of PI-3 kinase to CD28 molecules as previously shown for T cell CD28 molecules. This expression of a large density of CD28 molecules able to bind B7 molecules might contribute to a downregulation of the immune control of myeloma cells.

Studies on multispecific resistance of gastrointestinal nematodes to benzimidazoles on dairy-goat farms.

Multispecific resistance to benzimidazoles was studied in three selected farms. These farms had bred dairy goats for more than 15 years. The helminths were introduced with the goats at the establishment of the farms which afterwards remained isolated. Nematode resistance could then be related to their own management practices. Faecal egg count tests and egg hatch assays were performed to assess intensity of resistance. The generic (infective larvae in faecal cultures) and specific richness (adult worms) were assessed. The resistant species were Trichostrongylus colubriformis, Teladorsagia circumcincta, Haemonchus contortus and Oesophagostomum venulosum. Faecal egg count reduction tests and egg-hatch assays did not match exactly. Faecal larval counts after treatments gave a distorted picture of multispecific resistance: Haemonchus and Oesophagostomum were very largely over represented. The number of species found in the three farms was relatively low compared with other reports in goat farms of the area. This reduction of diversity might also be due in part to characteristics of breeding management and history (use of permanent pasture and introduction of goats at the establishment of farm).

Nursing research priorities for the care of the naval hospital patient: a Delphi survey.

The purpose of this study was to identify priorities for nursing research in a naval hospital using the Delphi technique. A general objective was to provide empirically based information to guide the development of a nursing research program at a regional medical treatment facility. Via a three-round Delphi survey, priority research questions were identified for the nursing department of a naval regional medical treatment facility. A serendipitous result was the identification of nursing research priorities within a deployed naval fleet hospital.

Sneddon's syndrome: generalized livedo reticularis and cerebrovascular disease. Importance of hemostatic screening.

We report two cases of Sneddon's syndrome. Both cases had widespread livedo reticularis with repeated cerebrovascular accidents without persistent neurological deficit. In one case, hemostatic examination revealed an imbalance of plasminogen activator-inhibitor values, possibly related to the thrombogenic propensity of the syndrome. Treatment with acetylsalicylic acid led to normalization of hemostatic parameters and resulted in a symptom-free period of more than 10 months. The importance of hemostatic screening in patients with Sneddon's syndrome is discussed.