ObjectiveTo determine the cause of a markedly raised D-dimer among patients in whom a diagnosis of pulmonary embolism (PE) has been excluded by CT pulmonary angiogram (CTPA) with particular reference to new cases of cancer and aortic dissection.MethodsOne thousand consecutive patients, suspected of PE, who had undergone CTPA and for whom a D-dimer had been requested, were seen between 2012 and 2016. Retrospectively we examined the case records of all those in the top quintile of the D-dimer distribution whose CTPA was negative for PE. D-dimer in the top quintile ranged from 7.5 to 260 times upper limit normal.ResultsEighty-five patients fulfilled our inclusion criteria. The likely causes of their very high D-dimer were infection (n=35, 41.2%), cardiovascular disease (n=12, 14.1% including two patients with previously undiagnosed aortic dissection), surgery or trauma (n=12, 14.1%), new or active cancer (n=9, 10.6% comprising six new cancers and three patients with cancers diagnosed previously that were considered to be active) and miscellaneous causes (n=17, 20.0%). Thirty-five patients (43.5%) died over a 2-year follow-up. Kaplan-Meier survival analysis showed poorer outcomes for patients with new or active cancer, when compared with those with no known cancer (p<0.001).ConclusionsWe have shown that a small proportion of patients suspected of PE whose D-dimers are markedly elevated have diagnoses we would not want to miss including previously unsuspected cancer and aortic dissection. Further studies will be required to define the optimal workup of patients with extremely high D-dimer who do not have venous thromboembolism
Aim The incidence of cutaneous squamous cell carcinoma (cSCC) in Asians remains low but shows a steady rising trend. There is a lack of reporting of the long‐term outcome in this population. This study aims to evaluate the 5‐year overall survival and its associated prognostic factors among patients with head and neck cSCC. Patients and Methods Patients with head and neck cSCC were identified in a regional hospital over 20 years. The 5‐year overall survival was estimated with the Kaplan–Meier curve and its prognostic risk factors were analysed using Cox proportional hazard regression. Results A total of 73 patients were identified. The median age was 84. The 5‐year overall survival rate was 40.3%. A higher grade of differentiation (hazard ratio 3.732, 95% confidence interval 1.161–11.991, P = .027) was a significant prognostic factor on both univariate and multivariate analyses. Conclusion In this Asian cSCC survival series specific to the head and neck region, which mostly included octogenarians, the 5‐year overall‐survival was low and a poor grade of differentiation was associated with a worse survival. Further studies on the Asian population is warranted.
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