Trousseau's Syndrome in Cholangiocarcinoma: The Risk of Making the Diagnosis.

We report a case of Trousseau's syndrome with cholangiocarcinoma complicated by a fatal pulmonary embolism after liver biopsy. A 69-year-old man who presented with right upper quadrant pain was found to have portal vein thrombosis and nonspecific liver hypodensities after imaging by computerized tomography. Following four days of anticoagulation, heparin was held for percutaneous liver biopsy. After the biopsy, he developed acute hepatic failure, acute kidney injury, lactic acidemia, and expired. Autopsy revealed intrahepatic cholangiocarcinoma and a pulmonary embolism. Trousseau's syndrome with cholangiocarcinoma is rarely reported and has a poor prognosis. This case highlights a fundamental challenge in the diagnosis and early management of intrahepatic cholangiocarcinoma with hypercoagulability. Diagnostic biopsy creates an imperative to reduce post-operative bleeding risk, but this conflicts with the need to reduce thrombotic risk in a hypercoagulable state. Considering the risk of withholding anticoagulation in patients with proven or suspected cholangiocarcinoma complicated by portal vein thrombosis, physicians should consider biopsy procedures with lesser bleeding risks, such as transjugular liver biopsy or plugged percutaneous liver biopsy, to minimize interruption of anticoagulation.

Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain.

OBJECTIVE: To determine the relative incidence, prevalence, costs, and impact on disability of 8 common conditions treated by rehabilitation professionals. DATA SOURCES: Comprehensive bibliographic searches using MEDLINE, Google Scholar, and UpToDate, (June, 2013). DATA EXTRACTION: Two review authors independently screened the search results and performed data extraction. Eighty-two articles were identified that had relevant data on the following conditions: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain. DATA SYNTHESIS: Back pain and arthritis (osteoarthritis, rheumatoid arthritis) are the most common and costly conditions we analyzed, affecting more than 100 million individuals and costing greater than $200 billion per year. Traumatic brain injury, while less common than arthritis and back pain, carries enormous per capita direct and indirect costs, mostly because of the young age of those involved and the severe disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability, is likely second to both arthritis and back pain in its impact on functional limitations. CONCLUSIONS: Of the common rehabilitation diagnoses we studied, musculoskeletal conditions such as back pain and arthritis likely have the most impact on the health care system because of their high prevalence and impact on disability.

Controlling layer thickness and photostability of water-soluble cationic poly(p-phenylenevinylene) in multilayer thin films by surfactant complexation.

In this work we build on prior studies of the novel water-soluble cationic conjugated polymer known as "P2" (poly{2,5-bis[3-( N, N, N-triethylammonium bromide)-1-oxapropyl]-1,4-phenylenevinylene}) with a focus on its incorporation into thin films for such applications as photovoltaics or electroluminescent devices. Multilayer assemblies were constructed using P2, the anionic surfactant sodium dodecyl sulfate (SDS), and the polyanion poly(sodium 4-styrene-sulfonate) (PSS) using the technique of layer-by-layer electrostatic self-assembly (LBL-ESA). SDS was observed to affect the layer thicknesses and absorbance characteristics of the films. We show that the optical properties and photo-oxidative resistance can be improved by varying the SDS content in the assemblies. Specifically, the surfactant-complexed poly( p-phenylenevinylene) (PPV) shows an enhanced absorption at longer wavelengths as well as improved photostability. Therefore, our work may have broad implications on the development of stable PPV-based materials in general and their efficient integration into thin films technologies.

Tuning the optical properties of a water-soluble cationic poly(p-phenylenevinylene): surfactant complexation with a conjugated polyelectrolyte.

In this work, we investigate the emission and absorbance properties of the novel water-soluble cationic conjugated polymer poly{2,5-bis[3-(N,N,N-triethylammonium bromide)-1-oxapropyl]-1,4-phenylenevinylene}, denoted here as P2, in the presence of varying amounts of the anionic surfactant sodium dodecylsulfate (SDS). We show that the absolute photoluminescence quantum efficiency (PLQE), the absorption wavelength, and the emission wavelength of an aqueous solution of P2 can be adjusted according to the surfactant/polymer ratio in aqueous solution. In particular, we show that the addition of SDS to P2 increases the polyelectrolyte's PLQE to approximately 40%. An observed red shift in the emission spectra upon addition of the surfactant is attributed to the reduction in electrostatic repulsive interactions between side chains that minimize the benzene ring twisting along the backbone structure. At the surfactant's critical micelle concentration, the P2 chains wrap around the outer surface of the SDS micelles. This work has implications on the development of new stable poly(p-phenylenevinylene)-based photovoltaic and electroluminescent materials with tunable optical properties.