[The 492nd case: recurrent thrombosis, thrombocytopenia]

A 43-year-old female patient was admitted with recurrent thrombosis for more than 2 years and thrombocytopenia for more than 1 year. Both arterial and venous thromboses developed especially at rare sites even during anticoagulation therapy such as cerebral venous sinus thrombosis. Antinuclear antibody, anti-ENA antibody and antiphospholipid antibody were all negative. Platelet count elevated to normal after high dose glucocorticoid and intravenous immunoglobulin (IVIG). Immune thrombocytopenia was suspected. When 4 grade thrombocytopenia recurred, intravenous heparin, rituximab 600 mg, IVIG and eltrombopag were administrated. After 3 weeks, thrombocytopenia did not improve, and new thrombosis developed instead. Screening of thrombophilia related genes revealed PROS1 gene heterozygous mutation and MTHFR TT genotype. Low amount of serum IgG κ monoclonal protein was detected. Heparin-induced thrombocytopenia was differentiated and excluded. Finally, serum negative antiphospholipid syndrome was considered the most likely diagnosis. Dexamethasone 20 mg/day × 4 days combined with sirolimus 2 mg/day was prescribed. The patient was discharged with low molecular weight heparin. At one month, her headache was greatly relieved. The platelet count raised to 20-30×10⁹/L, and no new thrombosis or bleeding was reported.

Low incidence of vascular uptake during ganglion impar sympathetic nerve blocks for coccydynia

Context:

Focal sympathetic nerve blocks of the ganglion impar are often effective treatments for coccydynia (coccyx pain) and other pelvic pain syndromes. These injections are generally performed under contrast-enhanced fluoroscopic guidance. Vascular uptake may potentially occur during the injection and vascular uptake rates have been reported for other spinal injections, but never for ganglion impar blocks.

Aims:

The purpose of the study was to determine vascular uptake rates during fluoroscopy-guided ganglion impar blocks.

Settings and Design:

An academic/University-based Coccyx Pain Center.

Methods and Materials:

A total of 78 consecutive trans-coccygeal ganglion impar blocks were analyzed for vascular uptake of contrast as determined by intermittent fluoroscopy.

Statistical Analysis Used:

Direct calculation of incidence.

Results:

Only one patient (1.3%) demonstrated a vascular uptake pattern, which was readily recognized and corrected by slightly adjusting the position of the needle tip and thereby subsequently obtaining the desired contrast pattern at the ganglion impar.

Conclusions:

Vascular uptake incidence is low during ganglion impar blocks. This information can be one of the multiple factors considered when a physician is deciding whether or not to use contrast in an individual patient.

Application of dot-immunogold-silver staining in the diagnosis of clonorchiasis

All 35 confirmed clonorchiasis cases showed a positive reaction in dot-immunogold-silver staining (Dot-IGSS) with a mean serum titre of 1:1656, while none of the sera from 35 normal individuals reacted. A seroepidemiological survey of middle-school students revealed a positive rate of 17.0% (142/836), and 76.1% (105/138) of the serologically positive students were egg positive in stool examination. The egg positive rates in those with antibody at levels of 1+ to 4+ were 57.1% (28/49), 75.7% (28/37), 94.7% (36/38) and 92.9% (13/14) respectively. It is believed that Dot-IGSS can be used for the clinical diagnosis and epidemiological survey of clonorchiasis.