Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy.

Purpose: To compare multi-detector row computed tomography (CT) and ventilation-perfusion (V-P) scintigraphy in the diagnosis of acute pulmonary embolism (PE) in outpatients who were cared for in the emergency department.

Materials And Methods: Ninety-four nonconsecutive patients, in whom acute PE was suspected, underwent thin-collimation multi-detector row CT (collimation, 4 x 1 mm; pitch, 1.25; scanning time, 0.

ELISA D-dimer measurement for the clinical suspicion of pulmonary embolism in the emergency department: one-year observational study of the safety profile and physician's prescription.

Objectives: To validate the safety profile of a rapid ELISA D-dimer as the first diagnostic step in the clinical suspicion of pulmonary embolism (PE) in outpatients admitted to an emergency department (ED), and to retrospectively evaluate the appropriateness of the physician's prescription.

Design And Setting: An observational study of all patients admitted to the ED of an urban university teaching hospital with signs and symptoms justifying the prescription of a rapid ELISA D-dimer measurement (Vidas; Biomerieux; France) as the first line diagnostic test for PE. Acute PE was established or excluded according to an appropriate combination of the D-dimer concentration, the lung scintigraphy, the spiral computerized tomography (spiral CT), the venous ultrasonography, and the arteriography in case of uncertain results.

Hyperhomocysteinemia and venous thromboembolism: a risk factor more prevalent in the elderly and in idiopathic cases.

Fasting plasma homocysteine level and the related clinical findings were analysed in 240 consecutive patients with venous thromboembolism. Hyperhomocysteinemia, defined as a plasma level above 20 micromol/l (corresponding to the percentile 95th in the controls), was present in 11.2% of the patients.

Heparin-induced thrombocytopaenia complicated by arterial and venous thrombosis: report of 2 cases successfully treated by a danaparoid sodium.

Heparin-induced thrombocytopaenia is a dreaded, although infrequent, complication of heparin therapy. We report two cases of heparin-induced thrombocytopaenia (HIT) type II occurring in a patient treated with standard (unfractionated) heparin and in another patient given a low-weight molecular heparin. The clinical course of the first patient illustrates the potentially severe thrombotic complications of HIT.

The prothrombin gene G20210A variant in an unselected thromboembolic population. A Belgian prospective clinical study.

The presence of the 20210A allele of the prothrombin gene has recently been shown to be a risk factor of venous thromboembolism, probably mediated through increased prothrombin levels. The aim of the study was to determine the frequency of the prothrombin 20210A allele in 193 consecutive unselected patients with venous thromboembolism and 100 healthy controls and to analyze the clinical profile associated with this new inherited thrombophilic factor. In agreement with previous reports, we found a frequency of 7.

Prevalence of activated protein C resistance and analysis of clinical profile in thromboembolic patients. A Belgian prospective study.

Objectives: To assess the prevalence of activated protein C resistance (APC-R) among healthy subjects and thromboembolic patients and to determine the clinical characteristics associated with APC-R.

Design: A prospective study.

Setting: One academic medical centre.

Comparative study of antiphospholipid antibody detection in eleven Belgian laboratories.

Twenty-six plasma samples have been sent to 11 different Belgian laboratories in order to detect the presence of antiphospholipid antibodies, either by immunological methods and/or by coagulation tests. A good concordance between laboratories was observed for coagulation tests. Laboratories using detection tests and performing mixing procedures and neutralisation procedures displayed the highest sensitivity as compared with laboratories which did not perform one of these two latter procedures.

Large increase in plasmatic 11-dehydro-TxB2 levels due to oral contraceptives.

Coagulation factors, 11-dehydro-TxB2 (metabolite of TxA2) and 6-keto-PGF1 alpha (metabolite of PGI2) levels in 87 women who were treated for 9 months with oral contraceptives (OC) containing low doses of oestrogens and progestogens (Triquilar, Trinovum or Cilest) were investigated. In plasma, increases in F I, II, VII, VIII-c and 11-dehydro-TxB2 levels, but no modification of 6-keto-PGF1 alpha were observed. In urine, FPA concentration rose, but no change occurred in 11-dehydro-TxB2 and 6-keto-PGF1 alpha levels.

Hemostasis variables in type I diabetic patients without demonstrable vascular complications.

Objective: To determine hemostasis variables in type I diabetic patients without clinically demonstrable micro- and macroangiopathy and to relate them to glycemic control.

Research Design And Methods: Fifty patients and 50 comparable control subjects were enrolled in this study. The patients were subdivided in two groups, according to their level of HbA1c (group 1, n = 30, HbA1c < or = 8%; group 2, n = 20, HbA1c > 8%).

Triflusal versus acetylsalicylic acid: a double-blind study for the prophylaxis of deep vein thrombosis after hip surgery.

The authors report the results of a randomised double-blind study comparing the antithrombotic activity of a new anti-platelet drug (Triflusal) with that of acetylsalicylic acid (ASA). 99 patients who underwent hip surgery were included in the study (total hip replacement, osteosynthesis of a pertrochanter fracture or Moore's prosthesis for intracapsular fracture of the femoral neck). Of the 48 patients having received Triflusal, 7 (14.

Immunoassay by particle counting for coagulation testing: application to the determination of protein C.

Latex particles coated with F(ab)'2 fragments of anti-protein C IgG antibodies are agglutinated by protein C, and the quantity of particles agglutinated is proportional to the concentration of protein C. The reaction can be quantitated by optical particle counting. Based on this system, we designed an immunoassay for protein C.

Immunoassay by particle counting for coagulation testing: application to the determination of antithrombin III, von Willebrand factor antigen (vWF:Ag) and plasminogen.

Based on immunoassay by particle counting, three methods for antithrombin III, von Willebrand factor and plasminogen were developed on an automated IMPACT machine and on a semi-automated MULTIPACT system. Precision of the techniques, measured at low, medium and high level of the calibration curve showed coefficients of variation varying from 4.3 to 13.

Circulating lupus type anticoagulant and pulmonary hypertension associated with mixed connective tissue disease.

We report the case of a young woman, with mixed connective tissue disease (MCTD), associated with disabling pulmonary hypertension and presence of the "lupus anticoagulant". The "lupus anticoagulant", an antibody directed against phospholipid components, was linked in our patient to extensive thrombophlebitis and premature labor. Raynaud's phenomenon progressed towards finger necrosis in spite of optimal vasodilating treatment.