It is estimated that up to one-third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D-dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3-month follow-up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9-99.6%), 29.3% (95% CI 19.2-42.0%), 52.9% (95% CI 42.5-63.0) and 94.4% (95% CI 74.2%-99.0), respectively. Sensitivity was 100% (95% CI 75.7-100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group. Am. J. Hematol. 82:41-44, 2007. V V C 2006 Wiley-Liss, Inc.
These findings document the progression of allergic asthma during a decade in a large sample of people who were influenced by similar environmental conditions and studied with the same diagnostic methods. This study represents the largest database of patients in which a common food is shown to be a risk factor for asthma.
The study was conducted to evaluate the prevalence of abnormal levels of several serum tumour markers in an institutionalized elderly population. Serum tumour markers assay of carcinoembryonic antigen (CEA), the carbohydrate antigens CA 19-9, CA 72-4 and CA 15-3 (Enzymun-test, Boehringer Mannheim GmbH Diagnostic), alpha-fetoprotein (AFP) and prostate specific antigen (PSA) (Abbot Diagnostic Division) were performed in 228 unselected, institutionalized elderly subjects, whose mean age (SD) was 82.4 (5. 79) range (66-99 years). Patients with acute or neoplastic diseases were excluded from the study. The serum markers were also measured in 52 healthy young adults (controls). Using the established threshold values, 92 subjects (40%) were found to have at least one elevated marker. PSA was elevated in 33%, CA 19-9 in 16%, CEA in 11. 5%, CA 15-3 in 11%, CA 72-4 in 8% and AFP in 3%. We found a significant difference in the serum levels between the two groups for CEA, CA 19-9. CA 15-3, and PSA (p < 0.0001). Healthy aged people appear to have an elevated prevalence of elevated levels of serum tumour markers. The results suggest that apart from PSA, elevated antigen levels in elderly subjects are related to the ageing process itself rather than to occult pathology.
References1 Motley RJ, Gould DJ, Douglas WS et al. Treatment of basal cell carcinoma by dermatologists in the United Kingdom. Br J Dermatol 1995; 132 : 437 -440. 2 Czarnecki D, Meehan C, Nash C. Prevention of post-excisional wound infections: A comparison of oral cephalexin with topical mupirocin and topical cetrimide-chlorhexidine cream. Int J Dermatol 1992; 31 : 359 -360. 3 Kirkup ME, de Berker DAR. Clinical measurement of dimensions of basal cell carcinoma: Effect of waiting for elective surgery.References 1 Altman J, Winkelmann RK. Diffuse normolipemic plane xanthoma. Arch Dermatol 1962; 85 : 633 -640. 2 Lynch PJ, Winkelmann RK. Generalized plane xanthoma and systemic disease. Arch Dermatol 1966; 93 : 639 -646. fig. 1 The patient presented with disseminated yellow patches on the face, neck, and anterior chest wall. The lesions were limited to photoexposed skin. fig. 2 The lesions were sharply demarcated from uninvolved skin. 512 Letters
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