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Manongi N, Byrns K, Fulman M, Jaffer A. Inferior mesenteric vein thrombosis in the setting of testosterone therapy. BMJ Case Rep 2022; 15:e251886. [PMID: 36517081 PMCID: PMC9756151 DOI: 10.1136/bcr-2022-251886] [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] [Indexed: 12/23/2022] Open
Abstract
Inferior mesenteric vein thrombosis (IMVT) is a rare and potentially lethal complication that can progress to mesenteric ischaemia if left untreated. We report a case of a man in his 70s with a history of polycythaemia vera (PV) with a known negative Janus kinase-2 mutation (JAK2V617) who was started on testosterone therapy 2 months before presenting with left lower quadrant abdominal and flank pain. Evaluation revealed thrombocytosis and IMVT on CT scan. A non-operative approach was deferred for anticoagulation therapy. Within 24 hours, the patient demonstrated significant clinical improvement, and he subsequently made a full recovery. The patient underwent 6 months of anticoagulation therapy with Apixaban. This case documents the first case of IMVT in the setting of PV and testosterone therapy in the literature.
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Affiliation(s)
- Ngoda Manongi
- Internal Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Kory Byrns
- Internal Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Malvina Fulman
- Internal Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Amir Jaffer
- Internal Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
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Glueck CJ, Goldenberg N, Wang P. Thromboembolism peaking 3 months after starting testosterone therapy: testosterone–thrombophilia interactions. J Investig Med 2017; 66:733-738. [DOI: 10.1136/jim-2017-000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
We assessed time of thrombotic events (venous thromboembolism (VTE)) after starting testosterone therapy (TT) in 21 men who sustained 23 VTE. The density of thrombotic events was greatest at 3 months after starting TT, with a rapid decline in events by 10 months. The 21 cases with VTE on TT differed from 110 patient controls with unprovoked VTE, not taking TT (VTE-no TT) for Factor V Leiden heterozygosity (FVL) (33 per cent vs 13 per cent, P=0.037), for high lipoprotein (a) (Lp(a)) (55 per cent vs 17 per cent, P=0.012), and for the lupus anticoagulant (33 per cent vs 4 per cent, P=0.003). These differences between cases and VTE-no TT controls were independent of age and gender. TT can interact with underlying thrombophilia–hypofibrinolysis promoting VTE. We suggest that TT should not be started in subjects with known thrombophilia. Coagulation screening, particularly for the FVL , Lp(a), and the lupus anticoagulant should be considered before starting TT, to identify men at high VTE risk who have an adverse risk/benefit ratio for TT.
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Afzal MJ, Tayyaba S, Ashraf MW, Hossain MK, Uddin MJ, Afzulpurkar N. Simulation, Fabrication and Analysis of Silver Based Ascending Sinusoidal Microchannel (ASMC) for Implant of Varicose Veins. MICROMACHINES 2017; 8:E278. [PMID: 30400469 PMCID: PMC6189736 DOI: 10.3390/mi8090278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 11/29/2022]
Abstract
Bioengineered veins can benefit humans needing bypass surgery, dialysis, and now, in the treatment of varicose veins. The implant of this vein in varicose veins has significant advantages over the conventional treatment methods. Deep vein thrombosis (DVT), vein patch repair, pulmonary embolus, and tissue-damaging problems can be solved with this implant. Here, the authors have proposed biomedical microdevices as an alternative for varicose veins. MATLAB and ANSYS Fluent have been used for simulations of blood flow for bioengineered veins. The silver based microchannel has been fabricated by using a micromachining process. The dimensions of the silver substrates are 51 mm, 25 mm, and 1.1 mm, in length, width, and depth respectively. The dimensions of microchannels grooved in the substrates are 0.9 mm in width and depth. The boundary conditions for pressure and velocity were considered, from 1.0 kPa to 1.50 kPa, and 0.02 m/s to 0.07 m/s, respectively. These are the actual values of pressure and velocity in varicose veins. The flow rate of 5.843 (0.1 nL/s) and velocity of 5.843 cm/s were determined at Reynolds number 164.88 in experimental testing. The graphs and results from simulations and experiments are in close agreement. These microchannels can be inserted into varicose veins as a replacement to maintain the excellent blood flow in human legs.
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Affiliation(s)
| | - Shahzadi Tayyaba
- Department of Computer Engineering, The University of Lahore, Lahore 54000, Pakistan.
| | | | - M Khalid Hossain
- Institute of Electronics, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, Dhaka 1349, Bangladesh.
| | - M Jalal Uddin
- Department of Applied Physics, Electronics and Communication Engineering; Islamic University, Khustia 7003, Bangladesh.
| | - Nitin Afzulpurkar
- Department of Mechanical Engineering Technology (MCET), Higher Colleges of Technology (HCT), Ras al-Khaimah POBox 4793, UAE.
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Jarman MI, Lee K, Kanevsky A, Min S, Schlam I, Mahida C, Huda A, Milgrom A, Goldenberg N, Glueck CJ, Wang P. Case report: primary osteonecrosis associated with thrombophilia-hypofibrinolysis and worsened by testosterone therapy. BMC HEMATOLOGY 2017; 17:5. [PMID: 28361003 PMCID: PMC5368894 DOI: 10.1186/s12878-017-0076-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
Background Familial and acquired thrombophilia are often etiologic for idiopathic hip and jaw osteonecrosis (ON), and testosterone therapy (TT) can interact with thrombophilia, worsening ON. Case presentation Case 1: A 62-year-old Caucasian male (previous deep venous thrombosis), on warfarin 1 year for atrial fibrillation (AF), had non-specific right hip-abdominal pain for 2 years. CT scan revealed bilateral femoral head ON without collapse. Coagulation studies revealed Factor V Leiden (FVL) heterozygosity, 4G/4G plasminogen activator inhibitor (PAI) homozygosity, high anti-cardiolipin (ACLA) IgM antibodies, and endothelial nitric oxide (NO) synthase (eNOS) T786C homozygosity (reduced conversion of L-arginine to NO, required for bone health). Apixaban 5 mg twice daily was substituted for warfarin; and L-arginine 9 g/day was started to increase NO. On Apixaban for 8 months, he became asymptomatic. Case 2: A 32-year-old hypogonadal Caucasian male had 10 years of unexplained tooth loss, progressing to primary jaw ON with cavitation 8 months after starting TT gel 50 mg/day. Coagulation studies revealed FVL heterozygosity, PAI 4G/4G homozygosity, and the lupus anticoagulant. TT was discontinued. Jaw pain was sharply reduced within 2 months. Conclusions Idiopathic ON, often caused by thrombophilia-hypofibrinolysis, is worsened by TT, and its progression may be slowed or stopped by discontinuation of TT and, thereafter, anticoagulation. Recognition of thrombophilia-hypofibrinolysis before joint collapse facilitates anticoagulation which may stop ON, preserving joints.
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Affiliation(s)
- Michael Ian Jarman
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Kevin Lee
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Ariel Kanevsky
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Sarah Min
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Ilana Schlam
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Chris Mahida
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Ali Huda
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Alexander Milgrom
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Naila Goldenberg
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Charles J Glueck
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
| | - Ping Wang
- Jewish Hospital, Internal Medicine Resident Graduate Medical Education Department, 4777 East Galbraith Road, Cincinnati, OH 45236 USA
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