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Moustakli E, Tsonis O. Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2094. [PMID: 38138197 PMCID: PMC10744413 DOI: 10.3390/medicina59122094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Transgender individuals often face elevated mental health challenges due to gender dysphoria, but gender-affirming treatments such as surgery and hormone therapy have been linked to significant improvements in mental well-being. The potential influence of time and circadian rhythms on these treatments is prevalent. The intricate interplay between hormones, clock genes, and fertility is profound, acknowledging the complexity of reproductive health in transgender individuals. Furthermore, risks associated with gender-affirming hormonal therapy and potential complications of puberty suppression emphasize the importance of ongoing surveillance for these patients and the need of fertility preservation and family-building options for transgender individuals. This narrative review delves into the intricate landscape of hormone therapy for transgender individuals, shedding light on its impact on bone, cardiovascular, and overall health. It explores how hormone therapy affects bone maintenance and cardiovascular risk factors, outlining the complex interplay of testosterone and estrogen. It also underscores the necessity for further research, especially regarding the long-term effects of transgender hormones. This project emphasizes the critical role of healthcare providers, particularly obstetricians and gynecologists, in providing affirming care, calling for comprehensive understanding and integration of transgender treatments. This review will contribute to a better understanding of the impact of hormone therapy on reproductive health and overall well-being in transgender individuals. It will provide valuable insights for healthcare providers, policymakers, and transgender individuals themselves, informing decision-making regarding hormone therapy and fertility preservation options. Additionally, by identifying research gaps, this review will guide future studies to address the evolving healthcare needs of transgender individuals. This project represents a critical step toward addressing the complex healthcare needs of this population. By synthesizing existing knowledge and highlighting areas for further investigation, this review aims to improve the quality of care and support provided to transgender individuals, ultimately enhancing their reproductive health and overall well-being.
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Affiliation(s)
- Efthalia Moustakli
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Orestis Tsonis
- Fertility Preservation Service, Assisted Conception Unit, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
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Abstract
Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Neil A Zakai
- Division of Hematology/Oncology, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Gutovitz S, Phelps K, Broussard I, Shah V, Hart L, Root P. A Tale of Two D-Dimers: Comparison of Two Assay Methods to Evaluate Deep Vein Thrombosis or Pulmonary Embolism. J Emerg Med 2022; 63:389-398. [PMID: 36096961 DOI: 10.1016/j.jemermed.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/14/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND D-dimer testing rules out deep vein thrombosis (DVT) and pulmonary embolism (PE) in low-risk emergency department (ED) patients. Most research has measured fibrin-equivalent units (FEUs), however, many laboratories measure D-dimer units (DDUs). OBJECTIVE Our aim was to determine whether either DDU measurements or FEU measurements can rule out DVT/PE using traditional or age-related cutoff values. METHODS We performed a de-identified multicenter retrospective evaluation of D-dimer in nonpregnant adult ED patients to evaluate for DVT/PE. DDUs were multiplied by 2 to determine equivalent FEUs prior to analysis. Sensitivity measurements for D-dimer were calculated for FEUs, DDUs, combined FEU/DDUs, and multiple age-adjusted values. RESULTS We identified 47,088 ED patients with a D-dimer laboratory value (27,307 FEUs/19,781 DDUs) and 1623 DVT/PEs. The median combined FEU/DDU D-dimer was 400 ng/mL FEUs (interquartile range [IQR] 300-900 ng/mL FEUs) for patients without a DVT/PE vs 2530 ng/mL FEU (IQR 1094-6000 ng/mL FEUs) with a DVT/PE (p < 0.001), overall sensitivity of 87.3% (95% confidence interval [CI] 87.0-87.6%) and negative predictive value of 99.3% (95% CI 99.2-99.4%). Individually, FEUs performed better than DDUs, with sensitivities of 88.0% (95% CI 85.8-89.9%) and 86.1% (95% CI 83.1-88.7%), respectively; however, this difference was not statistically significant. Combined age-adjusted performance had a sensitivity of 90.3% (95% CI 88.3-92.0%); however, a new DDU-only age-adjusted criteria had the highest sensitivity of 91.1% (95% CI 87.9-93.6%). CONCLUSIONS Our undifferentiated D-dimer measurements had a slightly lower sensitivity to rule out DVT/PE than reported previously. Our data support using either DDU or FEU measurements for all ages or when using various age-adjusted criteria to rule out DVT/PE.
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Affiliation(s)
- Scott Gutovitz
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Kaitlyn Phelps
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Ian Broussard
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Vishal Shah
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Leslie Hart
- College of Charleston, Charleston, South Carolina
| | - Preston Root
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia
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Zaghloul MS, Abdul-Malak OM, Cherfan P, Go C, Saadeddin Z, Al-Khoury GE, Chaer RA, Avgerinos ED. Female Gender is a Predictor of Lower Iliac Vein Stenting Patency Rates. Ann Vasc Surg 2021; 78:247-256. [PMID: 34464730 DOI: 10.1016/j.avsg.2021.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/29/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Iliac venous stenting (IVS) for thrombotic and nonthrombotic venous disease is increasingly used as evidence of the safety, efficacy and durability of these interventions increases. Female gender has been implicated as a predictor of failure in arterial endovascular interventions. We hypothesize that female gender could be predictive of patency rates of iliac vein stenting. METHODS Consecutive patients who underwent IVS for thrombotic or nonthrombotic venous disease at our institution from 2007 until 2019 were identified and divided into groups based on gender. Operative notes, venograms, and the electronic health record were then queried to obtain operative details, co-morbid conditions, postoperative outcomes and stent patency. Study outcome was long term patency rate. The data was analyzed using chi-square, logistic regression, and Kaplan-Meier analysis as appropriate. RESULTS A total of 200 consecutive patients (231 limbs) were identified in our retrospective analysis, with a mean age of 48.8 ± 17.3, and BMI of 31.6 ± 8.6. Of those, 119 (59.5%) patients, (131 [56.8%] limbs) were female. Comparisons between the gender groups revealed no difference in age, BMI, or preoperative comorbidities. There was no difference in type of venous disease between male (85% thrombotic, 15% nonthrombotic) and female (84% thrombotic, 16% nonthrombotic), P= 0.830. The male cohort was more likely to present with leg ulceration (17% vs. 4.6%, P = 0.002), and the female cohort was more likely to present with leg edema (98.5% vs. 93.0%, P= 0.03). The male cohort had a higher rate of caval (48% vs. 33.6%, P= 0.027) and infrainguinal stent extension. (11% vs. 6.9%, P= 0.02). Females had a higher rate of left sided stenting (80.9% vs. 66/0%, P= 0.010). There was no difference in the median stent diameter used between the cohorts. Primary patency at 5 years was significantly higher for the male cohort (94.1% vs. 74.4%, P= 0.01) On adjusted multivariable cox regression female gender was a predictor of loss of primary patency within 5 years (HR, 4.04; P= 0.007). CONCLUSIONS In this single center retrospective analysis of IVS, male patients were found to have better primary stent patency compared to female.
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Affiliation(s)
- Mohamed S Zaghloul
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Othman M Abdul-Malak
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Patrick Cherfan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Zein Saadeddin
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Georges E Al-Khoury
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Jarman AF, Mumma BE, Singh KS, Nowadly CD, Maughan BC. Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non-pregnant adult patients. J Am Coll Emerg Physicians Open 2021; 2:e12378. [PMID: 33532761 PMCID: PMC7839235 DOI: 10.1002/emp2.12378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Acute pulmonary embolism (PE) affects over 600,000 Americans per year and is a common diagnostic consideration among emergency department patients. Although there are well-documented differences in the diagnosis, treatment, and outcomes of cardiovascular conditions, such as ischemic heart disease and stroke, the influence of sex and gender on PE remains poorly understood. The overall age-adjusted incidence of PE is similar in women and men, but women have higher relative rates of PE during early and mid-adulthood (ages 20-40 years); whereas, men have higher rates of PE after age 60 years. Women are tested for PE at far higher rates than men, yet women who undergo computed tomography pulmonary angiography are ultimately diagnosed with PE 35%-55% less often than men. Among those diagnosed with PE, women are more likely to have severe clinical features, such as hypotension and signs of right ventricular dysfunction. When controlled for PE severity, women are less likely to receive reperfusion therapies, such as thrombolysis. Finally, women have more bleeding complications for all types of anticoagulation. Further investigation of possible sex-specific diagnostic and treatment algorithms is necessary in order to more accurately detect and treat acute PE in non-pregnant adults.
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Affiliation(s)
- Angela F. Jarman
- Department of Emergency Medicine, Davis School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Bryn E. Mumma
- Department of Emergency Medicine, Davis School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Kajol S. Singh
- Department of Emergency Medicine, Davis School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Craig D. Nowadly
- Department of Emergency Medicine, Davis School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Brandon C. Maughan
- Department of Emergency MedicineOregon Health and Science UniversityPortlandOregonUSA
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Ibrahim MZ, Igashi JB, Lawal S, Usman B, Mubarak AZ, Suleiman HM. Doppler ultrasonographic evaluation of lower limbs deep-vein thrombosis in a teaching hospital, Northwestern Nigeria. Ann Afr Med 2020; 19:8-14. [PMID: 32174609 PMCID: PMC7189887 DOI: 10.4103/aam.aam_62_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Deep-venous thrombosis (DVT) of lower limbs is one of the most common causes of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. B-mode and color Doppler imaging are needed for the early diagnosis of DVT to prevent complications and sequalae of DVT. Objectives The objectives of this study are to evaluate the role of Doppler ultrasound in diagnosing DVT of lower limbs and to study the spectrum of findings in patients with DVT in Zaria. Methodology A retrospective study was carried out on patients who had Venous Doppler Scan in the Department of Radiology ABUTH, Zaria, Nigeria, for suspected DVT over a period of 4 years from February 2014 to January 2018. Scans were done using DC-3 and DC-6 Mindray Ultrasound machines (2009 and 2013 Models, respectively, Shantou, China) coupled with high-frequency (7.5-12 MHz) linear and low-frequency curvilinear (2-5 MHz) transducers. Analysis of cases of DVT was performed in terms of age, sex, clinical features, predisposing conditions, anatomic distribution, stage, and pattern of thrombus involvement in the veins. Data were analyzed using the SPSS version 20.0 and value of P < 0.005 was considered as statistically significant. Results A total of 252 patients' results were reviewed which consisted of 122 males (48.4%) and 130 females (51.6%). The patients' ages ranged from 11 to 80 years, averaging 45.5 ± 9.56 years. The most common indication for Doppler request was leg swellings. The most common risk factor for DVT was malignancy (36%), cardiac disorders (18%), and traumas (14%). Sixty-six (61%) cases showed left-sided and 26 (24%) right-sided, whereas 16 (15%) cases showed bilateral lower limb involvement. Predominant thrombus was above-knee region with 54% in the superficial femoral vein. Chronic stage was seen in 46 (42%) cases, subacute in 44 (41%) cases, and acute in 18 (17%) cases. Conclusion Middle-aged females, left-sided leg, and above-knee segment were predominantly affected with DVT; hence, this buttresses the need for Doppler ultrasound in the diagnosis of DVT in all patients.
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Affiliation(s)
- Muhammad Zaria Ibrahim
- Department of Radiology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Joseph Bako Igashi
- Department of Radiology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Suleiman Lawal
- Department of Radiology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Bello Usman
- Department of Radiology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Abdullahi Zubair Mubarak
- Department of Radiology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Hafsatu Maiwada Suleiman
- Department of Chemical Pathology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Weng MT, Park SH, Matsuoka K, Tung CC, Lee JY, Chang CH, Yang SK, Watanabe M, Wong JM, Wei SC. Incidence and Risk Factor Analysis of Thromboembolic Events in East Asian Patients With Inflammatory Bowel Disease, a Multinational Collaborative Study. Inflamm Bowel Dis 2018; 24:1791-1800. [PMID: 29726897 DOI: 10.1093/ibd/izy058] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism (VTE) events. However, the incidence and necessity of prophylaxis for VTE in Asian IBD patients is unknown. We examined the incidence of VTE in East Asian IBD patients and analyze the possible risk factors. METHODS We conducted a multinational retrospective study of 2562 hospitalized IBD patients from 2010 to 2015. Moreover, a nationwide cohort study from 2001 to 2013 from the Taiwan National Health Insurance Research Database (NHIRD) was conducted to analyze the incidence rate of VTE in IBD and non-IBD patients. RESULTS In the hospitalized cohort, 24 IBD patients [17 ulcerative colitis (UC) and 7 Crohn's disease (CD)] received a VTE diagnosis (0.9%). These patients had a higher proportion of extensive UC (P = 0.04), penetrating-type CD (P < 0.01), and bowel operation history (P = 0.01). VTE was associated with low hemoglobin (P < 0.01), low platelet (P < 0.01), and low albumin (P < 0.01) levels. For the nation-wide cohort study, 3178 IBD patients and 31,780 age- and sex-matched non-IBD patients were analyzed. The average incidence rate was 1.15 per 1000 person-years in the IBD cohort and 0.51 in the non-IBD cohort. The relative risk was 2.27 (95% CI, 1.99-2.60). CONCLUSIONS East Asian IBD patients carry a 2-fold increased risk of VTE than the general population. The incidence of VTE in the East Asian IBD patients is still lower than that in Western countries. Therefore, close monitoring rather than routine prophylaxis of VTE in East Asian IBD patients is recommended.
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Affiliation(s)
- Meng-Tzu Weng
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City Taiwan.,Department of Chemical Engineering & Materials Science, Yuan-Ze University, Taoyuan, Taiwan
| | - Sang Hyoung Park
- Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Katsuyoshi Matsuoka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chien-Chih Tung
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jae Yong Lee
- Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chin-Hao Chang
- Departments of Medical Research, National Taiwan University Hospital, Taipei City, Taiwan
| | - Suk-Kyun Yang
- Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jau-Min Wong
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shu-Chen Wei
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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Santosa F, Moysidis T, Moerchel C, Bufe A, Kröger K. Pulmonary embolism in young people. Hamostaseologie 2017; 34:88-92. [DOI: 10.5482/hamo-13-05-0028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/18/2013] [Indexed: 11/05/2022] Open
Abstract
Zusammenfassung
Ziele: Es gibt eine anhaltende Diskussion über die Auswirkungen der hormonalen Kon-trazeption auf die Inzidenz von venösen Thromboembolien (VTE) bei jungen Frauen. Spezifische Daten für die Größe des Problems und ihre Veränderungen in den letzten Jahren in Deutschland sind nicht verfügbar. Daher untersuchten wir die Häufigkeit von VTE bei hospitalisierten jungen Menschen und analysierten geschlechtsspezifische Unterschiede.
Patienten und Methoden: Detaillierte Listen aller Lungenembolien (LE), kodiert als I26, und tiefer Venenthrombosen (TVT), kodiert als I80, bei Patienten im Alter von 10 bis 39 Jahre, die in den Jahren 2005 bis 2011 ins Krankenhaus eingeliefert worden waren, stellte das Statistische Bundesamt zur Verfügung.
Ergebnisse: Beginnend im Alter von 12–13 Jahren wurde für Frauen im Vergleich zu Männern eine höhere Anzahl von LE und TVT als Hauptdiagnose dokumentiert. Dieser geschlechtsspezifische Unterschied verschwindet im Alter von 32–33 Jahren. Dieser Unterschied in der Gesamtzahl der LE als Hauptdiagnose zwischen Männern und Frau-en innerhalb dieses Lebensabschnitts von 20 Jahre erhöhte sich von 318 in 2005 auf 606 im Jahr 2010 und sank auf 505 im Jahr 2011. Die Differenzierung in LE mit und ohne akutes cor pulmonale zeigte insbesondere eine spezifische Erhöhung der LE ohne akutes cor pulmonale bei jungen Frauen innerhalb dieser sieben Jahre. Ähnliche Änderungen konnten nicht für TVT als Hauptdiagnose gezeigt werden.
Schlussfolgerung: Die präsentierten Daten aus der deutschen DRG-Statistik zeigen einen dysproportional höheren Anstieg der Hospitalisierung junger Frauen mit Lungenembolie als Hauptdiagnose in den vergangenen Jahren. Die möglichen Ursachen der hormonalen Kon-trazeption für diesen Anstieg müssen weiter aufgeklärt werden.
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Gigante A, Di Mario F, Pierucci A, Amoroso A, Pignataro FS, Napoleone L, Basili S, Raparelli V. Kidney disease and venous thromboembolism: Does being woman make the difference? Eur J Intern Med 2017; 39:18-23. [PMID: 28258791 DOI: 10.1016/j.ejim.2017.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/20/2016] [Accepted: 02/16/2017] [Indexed: 01/05/2023]
Abstract
The risk of venous thromboembolism (VTE) is increased across the spectrum of chronic kidney disease (CKD), from mild to more advanced CKD, and typically characterizes nephrotic syndrome (NS). VTE risk in patients with kidney disease may be due to underlying hemostatic abnormalities, including activation of pro-thrombotic factors, inhibition of endogenous anticoagulation systems, enhanced platelet activation and aggregation, and decreased fibrinolytic activity. The mechanisms involved differ depending on the cause of the kidney impairment (i.e. presence of NS or CKD stage). Sex and gender differences, as well as, environmental factors or comorbidities may play a modulating role; however, specific sex and gender data on this topic are still rare. The aim of the present review is to discuss the VTE risk associated with impairment of kidney function, the potential mechanism accounting for it and the impact of sex differences in this clinical setting.
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Affiliation(s)
- A Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
| | - F Di Mario
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Pierucci
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Amoroso
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - F S Pignataro
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - L Napoleone
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basili
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; Research Center on Gender and Evaluation and Promotion of Quality in Medicine, (CEQUAM), Sapienza University of Rome, Rome, Italy
| | - V Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Disproportional increase of pulmonary embolism in young females in Germany: trends from 2005 to 2014. J Thromb Thrombolysis 2017; 43:417-422. [DOI: 10.1007/s11239-017-1486-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pai YW, Hsieh PF, Tung H, Wu CY, Ching CTS, Chang MH. Prognosis of cerebral lipiodol embolism caused by transarterial chemoembolization. Neurol Res 2016; 38:857-63. [PMID: 27357337 DOI: 10.1080/01616412.2016.1201928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Transarterial chemoembolization (TACE) plays an essential role in the management of unresectable hepatocellular cell carcinoma and other hepatic neoplasms. Cerebral lipiodol embolism (CLE) is a rare complication of TACE and its prognostic factors have not been well studied. The aim of this paper was to elucidate the prognostic factors of CLE based on clinical data obtained from our patients and cases published since 2004. METHODS We present two patients with CLE, analyze the clinical data, and review all CLE cases published since 2004. A poor outcome was defined as stupor, coma, quadriplegia, or death within 45 days. Patients who had other neurological conditions within 45 days were considered as having a good outcome. RESULTS The rate of poor outcome was 25.7% (9/35). Compared with the patients with good outcome, those with poor outcome were older (mean age 68.3 ± 7.3 vs. 58.3 ± 10.6 years, p = 0.03), more often female (76.9% vs. male 33.3%, p = 0.02), and more likely chemoembolized via both the right hepatic and right inferior phrenic arteries (44.4 vs. 8.7%, p = 0.02). DISCUSSION The prognosis of CLE was related to age, gender, and the arteries selected for injection.
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Affiliation(s)
- Yen-Wei Pai
- a Neurological Institute , Taichung Veterans General Hospital , Taiwan , ROC
| | - Peiyuan F Hsieh
- a Neurological Institute , Taichung Veterans General Hospital , Taiwan , ROC.,b Department of Applied Chemistry , National Chi Nan University , Taiwan , ROC
| | - Hsin Tung
- a Neurological Institute , Taichung Veterans General Hospital , Taiwan , ROC
| | - Chun-Ying Wu
- c Department of Internal Medicine , Taichung Veterans General Hospital , Taiwan , ROC
| | - Congo T S Ching
- d Department of Electrical Engineering , National Chi Nan University , Taiwan , ROC
| | - Ming-Hong Chang
- a Neurological Institute , Taichung Veterans General Hospital , Taiwan , ROC
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Vigod SN, Lunsky Y, Cobigo V, Wilton AS, Somerton S, Seitz DP. Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs. BJPsych Open 2016; 2:188-194. [PMID: 27703773 PMCID: PMC4998937 DOI: 10.1192/bjpo.bp.116.002691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/15/2016] [Accepted: 03/23/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND While up to 45% of individuals with intellectual and developmental disabilities (IDD) have a comorbid psychiatric disorder, and antipsychotics are commonly prescribed, gender differences in the safety of antipsychotics have rarely been studied in this population. AIMS To compare men and women with IDD on medical outcomes after antipsychotic initiation. METHOD Our population-based study in Ontario, Canada, compared 1457 women and 1951 men with IDD newly initiating antipsychotic medication on risk for diabetes mellitus, hypertension, venous thromboembolism, myocardial infarction, stroke and death, with up to 4 years of follow-up. RESULTS Women were older and more medically complex at baseline. Women had higher risks for venous thromboembolism (HR 1.72, 95% CI 1.15-2.59) and death (HR 1.46, 95% CI 1.02-2.10) in crude analyses; but only thromboembolism risk was greater for women after covariate adjustment (aHR 1.58, 95% CI 1.05-2.38). CONCLUSIONS Gender should be considered in decision-making around antipsychotic medications for individuals with IDD. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Simone N Vigod
- , MD, MSc, Women,s Mental Health Program, Women,s College Hospital and Research Institute, Department of Psychiatry, University of Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Yona Lunsky
- , PhD, The Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Virginie Cobigo
- , PhD, The School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew S Wilton
- , MSc, The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sarah Somerton
- , MSW, Women,s Mental Health Program, Women,s College Hospital and Research Institute, Toronto, Ontario, Canada
| | - Dallas P Seitz
- , MD, Department of Psychiatry, Queen,s University, Kingston, Ontario, Canada; Baycrest Health Sciences, Toronto, Ontario, Canada
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Al-Thani H, El-Menyar A, Asim M, Kiliyanni AS. Clinical Presentation, Management, and Outcomes of Deep Vein Thrombosis Based on Doppler Ultrasonography Examination. Angiology 2015; 67:587-95. [PMID: 26345414 DOI: 10.1177/0003319715604265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We studied the frequency, clinical presentation, and outcomes of deep vein thrombosis (DVT). Serial Doppler ultrasonography was performed between 2008 and 2013 for 6420 patients with suspected DVT. Diagnosis was confirmed in 662 (10.3%) participants (mean age: 50 ± 17 years; 51% females). Obesity, diabetes mellitus, and malignancy were reported in 47%, 28%, and 16%, respectively. Abnormal protein C, protein S, factor V Leiden, or antithrombin III were found in 9%, 7%, 3.8%, and 4%, respectively. Left, right, and both legs were involved in 55%, 37%, and 8%, respectively. Common femoral, popliteal, and posterior tibial veins were affected in 48.5%, 72%, and 71%, respectively. Postthrombotic syndrome, pulmonary embolism, and death were reported in 50%, 12.2%, and 15% of cases, respectively. Kaplan-Meier survival curves and Cox regression analysis showed that gender had no impact on mortality during follow-up; however, age (>50 years) was associated with greater risk of death (hazard ratio: 6.54; 95% confidence interval: 3.2-13.3). These findings will improve our understanding of the various risk factors and help develop institutional guidelines for the management of patients with DVT.
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Affiliation(s)
- Hassan Al-Thani
- Vascular Surgery, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, HGH, HMC, Doha, Qatar Clinical Medicine, Weill Cornell Medical College, Doha, Qatar Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, HGH, HMC, Doha, Qatar
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Chung WS, Lin CL, Kao CH. Carbon monoxide poisoning and risk of deep vein thrombosis and pulmonary embolism: a nationwide retrospective cohort study. J Epidemiol Community Health 2015; 69:557-62. [PMID: 25614638 DOI: 10.1136/jech-2014-205047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/31/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Few studies have investigated the relationship between carbon monoxide (CO) poisoning and risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we conducted a nationwide longitudinal cohort study in Taiwan to determine whether patients with CO poisoning are associated with increased risk of developing DVT and PE. METHODS This study investigated the incidence and risk factors for DVT and PE in 8316 patients newly diagnosed with CO poisoning from the Taiwan National Health Insurance Research Database between 2000 and 2011. The comparison cohort contained 33 264 controls without CO poisoning from the general population. Follow-up was initiated on the date of initial diagnosis of CO poisoning and continued until the date of a DVT or PE event, censoring or December 31, 2011. Cox proportional hazard regression models were used to analyse the risk of DVT and PE according to sex, age and comorbidities. RESULTS The incidences of DVT and PE were higher in the patients with CO poisoning than in the controls (5.67 vs 1.47/10 000 person-years and 1.97 vs 1.02/10 000 person-years, respectively). After adjusting for age, sex and comorbidities, the patients with CO poisoning were associated with a 3.85-fold higher risk of DVT compared with the comparison cohort, and non-significantly associated with risk of PE. CO poisoning patients with a coexisting comorbidity or acute respiratory failure were associated with significantly and substantially increased risk of DVT. CONCLUSION Risk of DVT is significantly higher in patients with CO poisoning than in the general population.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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15
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Walen S, Leijstra MA, Uil SM, Boomsma MF, van den Berg JWK. Diagnostic yield of CT thorax angiography in patients suspected of pulmonary embolism: independent predictors and protocol adherence. Insights Imaging 2014; 5:231-6. [PMID: 24696191 PMCID: PMC3999363 DOI: 10.1007/s13244-014-0325-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 11/09/2022] Open
Abstract
Objectives To determine the diagnostic yield of computed tomography scanning of the pulmonary arteries (CTPA) in our centre and factors associated with it. Differences between specialties as well as adherence to protocol were investigated. Methods All patients receiving a first CTPA for pulmonary embolism (PE) in 2010 were included. Data about relevant clinical information and the requesting specialty were retrospectively obtained. Differences in diagnostic yield were tested using a chi-squared test. Independent predictors were identified with multivariate logistic regression. Results PE on CTPA was found in 224 of the 974 patients (23 %). Between specialties, diagnostic yield varied from 19.5 to 23.9 % (p = 0.20). Independent predictors of diagnostic yield were: age, sex, D-dimer, cough, dyspnea, cardiac history, chronic obstructive pulmonary disease (COPD), atelectasis/consolidation, intrapulmonary mass and/or interstitial pulmonary disease on CT. Wells scores were poorly documented (n = 127, 13.0 %). Poor adherence to protocol was also shown by a high amount of unnecessary D-dimer values with a high Wells-score (35 of 58; 58.6 %). Conclusions The diagnostic yield of CTPA in this study was relatively high in comparison with other studies (6.7–31 %). Better adherence to protocol might improve the diagnostic yield further. A prospective study could confirm the independent predictors found in this study. Teaching Points • Pulmonary embolism is potentially life-threatening and requires quick and reliable diagnosis. • Computed tomography of the pulmonary arteries (CTPA) provides this reliable diagnosis. • Several independent predictors of diagnostic yield of CTPA for pulmonary embolism were identified. • Diagnostic yield of CTPA did not differ between requesting specialties in our Hospital. • Better protocol adherence could improve the diagnostic yield of CTPA for pulmonary embolism.
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Affiliation(s)
- Stefan Walen
- Department of Pulmonology, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands,
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Johnson MA, Haukoos JS, Larabee TM, Daugherty S, Chan PS, McNally B, Sasson C. Females of childbearing age have a survival benefit after out-of-hospital cardiac arrest. Resuscitation 2013; 84:639-44. [PMID: 22986061 PMCID: PMC3810408 DOI: 10.1016/j.resuscitation.2012.09.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/31/2012] [Accepted: 09/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is controversy regarding the association between age and being female and survival to hospital discharge after out-of-hospital cardiac arrest (OHCA). We hypothesized that younger females (aged 12-49 years) would be independently associated with increased survival after OHCA when compared to other age and sex groups. METHODS We conducted a secondary analysis of prospectively collected data from 29 United States cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were ≥12 years of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009. Hierarchical multivariable logistic regression analyses were used to estimate the associations between age and sex groups and survival to hospital discharge. RESULTS Females were less likely to have a cardiac arrest in public, was witnessed, or was treatable with defibrillation. Females in the 12-49 year old age group had a similar proportion of survival to hospital discharge when compared to age-matched males (females 11.6% vs. males 11.2%), while males ≥50 years old were more likely to survive when compared to age matched females (females 6.9% vs. males 9.6%). Age stratified regression models demonstrated that 12-49 year old females had the largest association with survival to hospital discharge (OR 1.55, 95% CI 1.20-2.00), while females in the ≥50 year old age group had a smaller increased odds of survival to hospital discharge (OR 1.18, 95% CI 1.03-1.35), which only lasted until the age of 55 years (OR 1.12, 95% CI 0.97-1.29). CONCLUSIONS Younger aged females were associated with increased odds of survival despite being found with poorer prognostic arrest characteristics.
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Affiliation(s)
- M Austin Johnson
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
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Kuwashiro T, Toyoda K, Oyama N, Kawase K, Okazaki S, Nagano K, Koga M, Matsuo H, Naritomi H, Minematsu K. High Plasma D-Dimer is a Marker of Deep Vein Thrombosis in Acute Stroke. J Stroke Cerebrovasc Dis 2012; 21:205-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/16/2010] [Accepted: 06/27/2010] [Indexed: 11/25/2022] Open
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18
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Pulmonary embolism in young males and females in Germany: data from the federal statistical office. Blood Coagul Fibrinolysis 2010; 21:511-5. [DOI: 10.1097/mbc.0b013e328339cc49] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Robert-Ebadi H, Le Gal G, Carrier M, Couturaud F, Perrier A, Bounameaux H, Righini M. Differences in clinical presentation of pulmonary embolism in women and men. J Thromb Haemost 2010; 8:693-8. [PMID: 20096004 DOI: 10.1111/j.1538-7836.2010.03774.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The risk of recurrence of pulmonary embolism (PE) is higher in men than in women. Differences in clinical presentation of deep vein thrombosis (DVT) have been reported between the two genders but comparative data on PE are lacking. OBJECTIVES To compare clinical characteristics between women and men with suspected and confirmed PE and their impact on clinical probability prediction scores and on diagnostic work-up of PE, and to assess whether differences at presentation could account for the increased recurrence rate in men. METHODS Combined data from three prospective cohort studies including a total of 3414 outpatients with suspected PE were analyzed retrospectively. Clinical characteristics, pretest probability of PE, diagnostic yield of non-invasive tests and VTE recurrence rate were compared between genders. RESULTS The overall prevalence of PE was similar among women and men (22.3% vs. 23.1%; P = 0.55). The clinical probability prediction scores (Geneva score and Wells score) performed equally well in both genders. A non-invasive diagnostic work-up was possible more often in men than in women. The proportion of PE-associated proximal DVT was higher in men than in women (43% vs. 33%; P = 0.009). VTE recurrence rate was also higher in men than women with PE (5.0% vs. 2.3%; P = 0.045). CONCLUSION In spite of some differences in the clinical presentation of PE between women and men, clinical probability prediction scores perform equally in both genders. A higher prevalence of PE-associated proximal DVT in men could possibly indicate greater severity of PE episodes and partly account for the higher VTE recurrence rate in men.
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Affiliation(s)
- H Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
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Andreou ER, Koru-Sengul T, Linkins L, Bates SM, Ginsberg JS, Kearon C. Differences in clinical presentation of deep vein thrombosis in men and women. J Thromb Haemost 2008; 6:1713-9. [PMID: 18665920 DOI: 10.1111/j.1538-7836.2008.03110.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As assessment of clinical pretest probability is the first step in the diagnostic evaluation of deep vein thrombosis (DVT), it is important to know if the clinical features of DVT are the same in men and women. OBJECTIVES To compare the prevalence and clinical characteristics of DVT, and the accuracy of clinical pretest probability assessment, between men and women with suspected DVT. METHODS A retrospective analysis of individual patient data from three prospective studies by our group that evaluated diagnostic tests for a suspected first episode of DVT. Clinical characteristics, clinical pretest probability for DVT, and prevalence and extent of DVT was assessed in a total of 1838 outpatients. RESULTS The overall prevalence of DVT was higher in men than in women (14.4% vs. 9.4%) (P = 0.001). The prevalence of DVT was higher in men than in women who were categorized as having a clinical pretest probability that was low (6.9% vs. 3.5%; P = 0.025) or moderate (16.9% vs. 8.7%; P = 0.04), but similar in patients in the high category (40.2% vs. 44.0%; P = 0.6). In patients diagnosed with DVT, swelling of the entire leg occurred more often (41.5% vs. 15.7%; P < 0.001), and thrombosis was more extensive (involvement of both popliteal and common femoral veins in 47.9% vs. 21.6%), in women than in men. CONCLUSIONS In outpatients with suspected DVT, the overall prevalence of thrombosis and the prevalence of thrombosis in those with a low or a moderate clinical pretest probability were higher in men than in women.
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Affiliation(s)
- E Roseann Andreou
- McMaster University, Henderson Research Centre, Hamilton, ON, Canada
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CT angiography in suspected pulmonary embolism: impact of patient characteristics and different venous lines on vessel enhancement and image quality. AJR Am J Roentgenol 2008; 190:W351-9. [PMID: 18492877 DOI: 10.2214/ajr.07.3402] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to compare image quality, patient characteristics, and different catheters in pulmonary CT angiography (CTA) performed with bolus tracking and z-axis automated tube current modulation (ATCM) in patients with suspected pulmonary embolism. SUBJECTS AND METHODS One hundred twenty-six patients were referred to undergo pulmonary CTA with bolus tracking and ATCM. Besides patient characteristics, the type, position, size, and side of venous catheters were documented. Pulmonary vessel enhancement and image noise were quantified; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective vessel contrast was assessed by two radiologists in consensus. RESULTS Patient age showed a moderate but significant positive correlation to vessel enhancement (r = 0.244, p = 0.006), CNR (r = 0.178, p = 0.046), and subjective image quality (r = 0.344, p < 0.001). Patient weight revealed a significant negative correlation to vessel enhancement (r = -0.496, p < 0.001), SNR (r = -0.446, p < 0.001), CNR (r = -0.425, p < 0.001), and subjective image quality (r = -0.422, p < 0.001). In univariate analysis, SNR and CNR were significantly higher in patients who received contrast medium through peripheral catheters (30 +/- 13 and 27 +/- 13, respectively) than in those in whom central catheters were used (22 +/- 8 and 19 +/- 7, p = 0.041 and p = 0.029, respectively). Neither patient sex nor catheter size, position, or side had any significant impact on image quality. CONCLUSION Patient age and weight showed significant impact on vascular attenuation and image quality in pulmonary CTA with bolus tracking and ATCM, whereas patient sex and different peripheral catheters did not significantly influence image parameters.
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Computed tomography pulmonary angiography in the diagnosis of acute pulmonary embolism in the emergency department. Adv Ther 2007; 24:1173-80. [PMID: 18165199 DOI: 10.1007/bf02877763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study was undertaken to evaluate the use of computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) who were followed in the emergency department (ED). The files and computer records of 850 patients older than 16 years of age who were seen in the Hacettepe University Hospital ED between April 10, 2001, and December 1, 2005, and who required CTPA for PE prediagnosis and/or another diagnosis, were studied retrospectively. PE was identified by CTPA in 9.4% of 416 women and in 5.8% of 434 men. A significant difference (P<.05) was noted in the women and men in whom PE was detected. The mean age of the patients was 58.13+/-17.88 y (range, 16-100 y). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for clinical susceptibility to PE among patients who underwent CTPA were assessed at 95.3%, 48.2%, 13%, and 99.2%, respectively. CTPA was done for different reasons: aortic aneurysm dissection (n=1), cough distinctive diagnosis (n=1), dyspnea distinctive diagnosis (n=6), chest pain distinctive diagnosis (n=3), PE prediagnosis (n=51), and other reasons (n=2). Also, sensitivity, specificity, PPV, and NPV were found to be 95.4%, 16.2%, 14.4%, and 96%, respectively, for D-dimer. CTPA, which is accessible on a 24-h basis in the ED, is a valuable tool for the diagnosis of PE.
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Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V. Image Quality and Radiation Exposure at Pulmonary CT Angiography with 100- or 120-kVp Protocol: Prospective Randomized Study. Radiology 2007; 245:577-83. [PMID: 17940308 DOI: 10.1148/radiol.2452061919] [Citation(s) in RCA: 232] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph M Heyer
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Ruhr-University of Bochum, Buerkle-de-la-Camp Platz 1, D-44789, Bochum, Germany.
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Gonçalves Marcos IAC. [Pregnancy and lungs]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2007; 13:213-37. [PMID: 17492234 DOI: 10.1016/s0873-2159(15)30345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Respiratory pathology can be relatively frequent during pregnancy. One third of pregnant woman may experience worsening of their asthma condition. Pulmonary tromboembolism is 5 times more frequent in pregnancy. Bacterial, viral and fungal pneumonias are badly tolerated during pregnancy, provoking mother-foetal morbidity, respiratory insufficiency, low born-weight or prematurity. Non-treated tuberculosis may increase maternal mortality and preterm birth by 4 and 9 times respectively. Pregnancy is counter-indicated in women with cystic fibrosis and severe pulmonary function. Despite therapeutic progresses already made, pulmonary hypertension is associated to over 30% of mother-foetal morbidity and mortality. Approximately 1 in 1,000-1,500 pregnancies is affected by mother cancer. High rates of lung cancer morbility in women bring new and important challenges to therapy.
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Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1974 to 2005. Chin Med J (Engl) 2006. [DOI: 10.1097/00029330-200606020-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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