Clinical risk factors to predict deep venous thrombosis post-endovenous laser ablation of saphenous veins.

OBJECTIVE: Endovenous laser ablation of saphenous veins is an alternative in treating symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported in up to 7.7% of patients undergoing such procedure. We sought to establish clinical risk factors that predict DVT post-endovenous laser ablation. METHOD: Patients who underwent endovenous laser ablation were prospectively followed. Clinical data and post-interventional duplex ultrasound were analysed. A P value <0.05 was accepted as representing a significant difference. RESULTS: From 2007 to 2008, 360 consecutive patients were followed. Nineteen DVTs were found on follow-up ultrasound. Eighteen cases involved either the saphenofemoral or saphenopopliteal junctions; only one case involved the deep venous system. Age >66 (P = 0.007), female gender (P = 0.048) and prior history of superficial thrombophlebitis (SVT) (P = 0.002) were associated with increased risk of DVT postprocedure. CONCLUSION: Age >66, female gender and history of SVT were significant predictors of DVT post-endovenous laser ablation of saphenous veins.

[Heavy metals in traditional Chinese medicine: ba-pao-neu-hwang-san].

Heavy metal intoxication of newborn infants fed with "Ba-Pao-Neu-Hwang-San" has been reported every year by many hospitals in Taiwan. About nine years ago, the National Laboratories of Foods and Drugs of the Department of Health, Executive Yuan, received one case report of a five month old female infant who died as a result of long term feeding with "Ba-Pao-Neu-Hwang-San". The drug was found to have contained lead 44,000 ppm. Although this unfortunate incident was propagated by most newspapers, the prescription of this ancient Chinese medicinal preparation is still widely accepted by ordinary people. Herbal medicine doctors prefer complex mineral drugs as did their ancestors thousands of years ago. In the last two years, we have collected 5 samples of "Ba-Pao-Neu-Hwang-San" from different manufacturers and measured the concentration of 16 heavy metals (including Cadmium, Mercury, Arsenic, Lead, Chromium, Manganese, Selenium, Germanium, Nickel, Calcium, Magnesium, Aluminum, Iron, Copper, Zinc, and Vanadium) in these drugs with Inductively-Coupled Plasma Atomic Emission Spectrometry and Graphite Furnace Atomic Absorption Spectrometry. The result of our survey revealed that the first sample (from Tainan) contained mercury 52,800 ppm, the fourth (from Ping-tung) contained mercury 34,500 ppm, and the fifth (from Sin-chu) contained mercury 65,700 ppm. The mercurial contents of these samples were apparently too high to be a safe drug.

[Survey of heavy metals in traditional Chinese medicinal preparations].

Traditional Chinese medicinal preparations are still widely used by natives in Taiwan. Some traditional Chinese medicine prepared with ancient formulas have been found to contain some heavy metals. There has been an occasional pediatric case admitted with heavy metal intoxication. In the last two years, we collected 11 ancient formula drug samples from the families of the patients. We detected the heavy metals with an inductively-coupled plasma atomic emission spectrometry and a graphite furnace atomic absorption spectrometry. The final result of our report reveals the problem of heavy metals in traditional Chinese medicinal preparations as being very serious.

[Child abuse: report of three cases].

Child abuse, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The first case is a 7-year-old boy suffering from abdominal distension and pain for 3 days. He was beaten by his mother as a result of inadequately learning his lessons. Sonogram and CT of the abdomen showed massive ascites and a pseudocyst of the pancreatic body about 3 x 3 cm in diameter. The second case is a 4-year-old girl who developed a semicomatose state after her father impulsively struck her with a chair. CT of the brain revealed subdural hematoma over the left fronto-temporal region and midline shift to the right. She expired 5 days later. The third case, a 2-year-old girl, suffered from headache, seizure, vomiting and general malaise. CT of the brain showed severe brain swelling over the right side and midline shift to the left. She expired 1 month later. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but our knowledge of these factors is limited. Parents who inflict abuse on children do not necessarily have psychopathic or sociopathic personalities or come from borderline socioeconomic groups, although most published cases fall into one of these categories. It is clearly the responsibility of all physicians serving children to be aware of, to recognize, and to properly manage any child who has been the victim of abuse.

Intracranial malignant rhabdoid tumor: report of one case.

A 4-year-old boy presented with anorexia, headache, and poor spirits was found to have tumors in posterior fossa and suprasellar region which enclosed by CT scan of brain. Bilateral suboccipital craniotomy was performed by neurosurgeon. The pathological report revealed the tumor was malignant rhabdoid tumor. The patient died two and one half months after diagnosis in spite of surgical resection and radiotherapy of the tumor.