We retrospectively reviewed the medical records of 154 consecutive patients with acute pulmonary embolism (PE) admitted to an Internal Medicine Service. At presentation, fever (temperature > 37 degrees C) without other identified causes was present in 28 patients (18.2%): 27 patients had low-grade fever (temperature 37-39 degrees C) and one patient had high-grade fever (temperature > 39 degrees C). Epidemiological and clinical characteristics, electrocardiographic and chest radiograph abnormalities and mortality rate were similar in patients with and without fever. Fever, including high-grade fever, is a possible presenting feature in patients with acute PE. Patients with acute PE and fever have similar characteristics compared with those without fever.

The possibility of an intermediate V/Q lung scan is higher in elderly patients and in patients with previous cardiopulmonary disease (especially with chronic obstructive pulmonary disease). Emphysema is the only chest radiograph abnormality associated with a greater possibility of an intermediate V/Q lung scan.

Background:There is controversy about an increased prevalence of antiphospholipid antibodies in diabetic patients. The possible implications are little known. Methods:We prospectively studied all consecutive outpatients with type 2 diabetes mellitus (DM) attended to in an Internal Medicine office. IgM and IgG anticardiolipin antibodies (ACA) were determined by standardized enzyme-linked immunoassay.Results: Fifty-six patients were included. Only one patient (1.8%) had a titer of IgM ACA higher than 15 MPL units and no patient had a titer of IgG ACA higher than 15 GPL units. Six patients (10.7%) had low IgM ACA titers (4-15 MPL units) and 18 patients (32.1%) had low IgG ACA titers (4-15 GPL units). There were no differences in the frequencies of a low IgM or IgG ACA titer or in the means of IgM and IgG ACA titers in patients with complicated and uncomplicated DM, with and without cardiovascular disease, with and without nephropathy, or with and without retinopathy. Conclusions:Moderate to high ACA titers must be exceptional in patients with type 2 DM. Low ACA titers may occur in patients with type 2 DM. These low titers do not seem to be associated with complicated DM, cardiovascular disease, nephropathy or retinopathy.

Aim:We study the electrocardiographic abnormalities at time of diagnosis of acute PE in our series of consecutive patients of the last years. We conclude that the electrocardiogram may have diagnostic and prognostic value in patients with acute PE.Methods: We retrospectively reviewed the records of 154 consecutive patients with acute PE.Diagnosis of PE was established by a high-probability ventilation/perfusion lung scan (121 patients), pulmonary angiography or spiral computed tomography (19 patients), or the combination of a suggestive clinical picture with a deep vein thrombosis (DVT) demonstrated by phlebography or echo-doppler (14 patients).Results: Electrocardiogram at time of diagnosis showed abnormalities consistent with acute PE in 107 patients (69.5%). These electrocardiographic abnormalities were: sinus tachycardia in 85 patients (55.2%), S1Q3T3 pattern in 41 patients (26.6%), right bundle branch block in 23 patients (14.9%), T-wave inversion in precordial leads in 22 patients (14.3%), supraventricular tachycardias in 11 patients (7.1%), ST segment depression in 4 patients (2.6%) and P pulmonale in 1 patient (0.6%). Supraventricular tachycardias were: presumed new-onset atrial fibrilation in 8 patients, atrial flutter in 2 patients and paroxysmal supraventricular tachycardia in 1 patient.Conclusion: We might conclude that sinus tachycardia and S1Q3T3 pattern are the principal determinants of severity between the electrocardiographic abnormalities at time of diagnosis in patients with acute PE.

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We describe a pregnant woman with ovarian hyperstimulation syndrome with bilateral pleural effusion and ascites. Ovarian hyperstimulation syndrome is an iatrogenic complication of ovarian stimulation, characterized by a massive crossing of a protein-rich fluid from the vascular compartment into the peritoneal, pleural, or to a lesser extent, pericardial cavities. Management is usually conservative, with fluid and electrolytes correction and thromboprophylaxis. Prevention is very difficult, but an age younger than 35 years, low body mass index, polycystic ovarian disease, a high number of follicles, a high plasma oestradiol concentration, pregnancy, hyperandrogenism, and hypothyroidism are predisposing factors.

Adverse outcomes during anticoagulant therapy are frequent in patients from a rural population with VTD. These adverse outcomes occur frequently during the first month of treatment and are associated with the patient's prior status and the presence of pulmonary thromboembolism.

We describe a patient with multiple pyogenic liver abscesses treated only with antibiotics with a favourable outcome. This conservative treatment may be an option in some patients with multiple pyogenic liver abscesses.