SummaryParoxysmal demyelinating events produced sudden onset, transient, recurrent symptoms that were troublesome to our patient and puzzled the referring clinician who mistook them for transient ischaemic attacks or epilepsy. It was important to recognise the true nature of the underlying problem because the symptoms could then be readily treated; this is especially critical because the symptoms, in this case, represent a relapse of multiple sclerosis and, therefore, are significant for examination during the diagnosis. BACKGROUND
SUMMARY Serum from some patients with pernicious anaemia contains antibody activity to human intrinsic factor‐57CoB12 complex (IF‐57CoB12) which can be detected by co‐precipitation of IF‐57CoB12) with the globulin fraction precipitated with 45 per cent ethanol. The characteristics of this antigen‐antibody reaction include some dissociation of antigen from antibody during precipitation, and ready cross‐reaction of antibody with IF to which vitamin B12 is not bound. The IF‐B12 antigen also cross‐reacts with anti‐intrinsic‐factor antibody, as measured by the charcoal adsorption technique. This co‐precipitation technique may be to determine whether small quantities of B12‐binding material have the immunological characteristics of intrinsic factor. Although the anti‐IF antibody present in the blood of many patients with pernicious anaemia may be responsible for this anti‐IF‐B12 antibody activity, it is possible that a separate antibody system exists which is directed against IF‐B12.
15178 Background: The increased risk of thromboses is well documented in patients with malignancies, and those undergoing abdominal surgery. Furthermore, patients requiring hepatic resection for underlying malignant disease have been reported to be at increased risk for thrombotic complications. However, guidelines for thromboprophylaxis in this patient population are still under investigation. A cursory review performed at our institution determined the incidence of thrombotic events to be comparable to that reported in the literature. We, therefore, went further to study if there was a difference in the risk of thromboses between those undergoing resection for primary hepatic cancer, versus metastatic disease. Methods: We performed a retrospective chart review of patients undergoing surgical resection for hepatic malignancies. The primary end point was to determine whether there was a difference in the incidence of thrombotic events between primary and secondary malignancies. Results: A total of 99 patients at our institution underwent surgical resection for either primary or secondary hepatic malignancies in the past 5 years. There were 7 patients who developed thrombotic events within three months of their resection. Of these patients, all 7 underwent resection for secondary hepatic malignancies. Based on the nature of this study, and its lack of standardized thromboprophylaxis, statistical analysis was not performed. Conclusions: Patients undergoing surgical resection of hepatic malignancies appear to be at increased risk of thrombotic events, and may require more specific standardization of their thromboprophylaxis. Furthermore, based on our observation it appears those associated with metastatic disease may derive an even greater benefit from this. Future prospective studies will be required to evaluate this difference in thromboses, and to better define the guidelines for thromboprophylaxis. No significant financial relationships to disclose.
27ordered by his primary physician, showed extension of the clot, accompanied this time by the appearance of lung nodules [ Figure 1]. He was recommended discontinuation of warfarin and to be evaluated in hematology/oncology to rule out a neoplastic process.When seen at our institution, his only complaint was ongoing exertional shortness of breath, with no associated hemoptysis, chest pain, cough, night sweats or loss of consciousness. His review of systems was otherwise non-contributory. On account of the suspicion of a possible neoplastic process, a PET scan was obtained, which revealed increased radiotracer uptake over the area of the presumed pulmonary thrombus, as well as other areas of the right lung, including a lower lobe sub pleural nodule [ Figure 2].During his outpatient evaluation he developed two syncopal episodes, with associated exertional dyspnea and presented to our Emergency Department. His electrocardiogram showed ST elevations in leads V3-V5 along with a small elevation in the troponin I of 0.31 (normal is less than 0.20), indicative of AbstractSarcomas involving the lung are a rare occurrence, often a result of metastatic disease from primary malignancies involving the skin, liver, breast or heart. Primary pulmonary artery sarcomas are rarer still, with limited cases reported world-wide and consequently data regarding treatment modalities are sparse and largely experimental. These tumors are often mistaken for a pulmonary embolism and seemingly supported by radiological fi ndings. Patients will often present without symptom resolution despite therapeutic anticoagulation. The following case illustrates how a soft tissue sarcoma of the pulmonary artery can mimic a pulmonary embolism, thus, resulting in both a diagnostic and therapeutic dilemma. A positron emission tomography scan was an invaluable tool in this case, showing increased radiotracer uptake and placing neoplasm at the top of the differential diagnosis. This ultimately led to a biopsy that was vimentin positive, cytokeratin negative and CD117 negative, thus consistent with soft tissue sarcoma.
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