Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls.

Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.

[Comparison of three clinical prediction rules among patients with suspected pulmonary embolism]. / Pulmoner emboli kuskusu olan hastalarda üç farkli klinik olasilik yönteminin karsilastirilmasi.

Certain clinical findings raise the suspicion of pulmonary embolism (PE) and may be useful in selecting patients for further diagnostic testing. Three prediction rules for PE have been described recently: Wells' rule (WR), Geneva rule (GR) and Miniati' rule (MR). The aim of present study is to compare the predictive accuracy of the three methods on the basis of our patients' results. Eighty-five patients admitted to our department with suspicion of PE were included into the study. Sixty-three patients were discharged with the diagnosis of PE, whereas in 22 patients, the initial PE diagnosis was ruled out. The three methods for assessing the clinical probability of PE classified similar proportions of patients into the low, intermediate and high clinical probability categories. The frequencies of PE in each method (WR, GR and MR) were 5%, 64% and 14% in the low category, 90%, 80% and 75% in the intermediate category and 100%, 100% and 94% in the high category (p = 0.001, 0.064, 0.001) respectively. When we compared the performances of WR and GR, including all possible total score values, the area under the ROC curve (AUC) was 0.99 for the WR (p= 0.001) and 0.74 for the GR (p= 0.001). When we used only the three probability categories (low, intermediate, high), AUC was 0.96 for the WR (p= 0.001), 0.64 for the GR (p= 0.04), and 0.7 for the MR (p= 0.005). In conclusion, the present study indicates that clinical assessment is a fundamental step in the diagnostic work-up of PE. The Wells' method performs better than other two methods.

A case of bronchogenic carcinoma presenting with acute abdomen.

Colonic metastasis of the bronchogenic carcinoma is quite rare. Here we document an extremely rare presentation of the lung cancer that presented with acute abdomen and was diagnosed as intestinal obstruction due to colon carcinoma initially. He underwent an urgent operation and the obliterating mass in the colon was resected and reported as "colon metastasis from epidermoid carcinoma probably of the lung". Afterwards bronchoscopy revealed an endobronchial lesion in the right lower lobe that was diagnosed as poorly differentiated squamous cell lung carcinoma. In this case, colon metastasis was diagnosed before the diagnosis of the primary disease.