Plasma homocysteine level and 677C-->T mutation on the MTHFR gene in patients with venous thromboembolism.

BACKGROUND: The aim of this study was to evaluate the role of plasma total homocysteine level and 677C-->T mutation on the methylenetetrahydrofolate reductase (MTHFR) gene in the development of venous thromboembolism. METHODS: Thirty-six (18 male, 18 female and mean+SD; 48.3 +/- 15.5 years) patients with venous thromboembolism and 25 healthy adults (13 male, 12 female and mean +/- SD; 46.8 +/- 9.2 years) were included in the study. Fasting plasma total homocysteine level was determined by a high performance liquid chromatography. 677C-->T mutation on the MTHFR gene in peripheral blood was detected by Real Time-PCR method. RESULTS: The level of plasma total homocysteine (18.5 +/- 10.6 micromol/L) was significantly higher in patients with venous thromboembolism than in the control group (11.0 +/- 4.7 micromol/L) (p=0.015). 677C-->T mutation on the MTHFR gene heterozygosity was higher in the patient group than in the control group [13 (36.1%) and 2 (8%) respectively] but this difference was not significant (p=0.07). CONCLUSION: It is thought that a high plasma total homocysteine may cause venous thromboembolism (Tab. 2, Ref. 21). Full Text (Free, PDF) www.bmj.sk.

Ruptured hydatid cyst following minimal trauma and few signs on presentation.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in any organ, although the liver is the most commonly involved. Hydatid cysts can rupture either spontaneously or following trauma. Surgical treatment can be life-saving. This paper reports the atypical presentation of a young girl admitted to the emergency department. She presented with pain on her palms due to falling down a few steps. Because of the rebound tenderness on the right upper quadrant of her abdomen on physical examination, bedside ultrasonography was performed to identify the underlying cause, and promptly revealed a 62 x 72 mm lobular cyst on the right lobe of the liver with free fluid in the subcapsular area. Shortly afterwards, urticaria developed. Fluid resuscitation, methylprednisolone and diphenylhydramine were administered intravenously. Afterwards she was taken to the operation room for unroofing, drainage and capitonage. In conclusion, primary care and emergency physicians should perform a complete physical examination on all admitted patients with vague symptoms and a high index of suspicion for a ruptured hydatid cyst, even following trivial trauma, especially in endemic regions.

Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room.

BACKGROUND/AIMS: The aim of this study was to examine a plausible correlation between venous and arterial blood gas values in acidotic patients with chronic uremia or diabetic ketoacidosis (DKA). METHODS: A total of 152 arterial and 152 venous blood samples from uremic patients (n = 100), DKA patients (n = 21) and healthy controls (n = 31) were analyzed for measurements of blood gas and acid-base status. RESULTS: The means of arterial and venous pH, and arterial and venous HCO(-)(3) values for the uremic patients were 7. 17 +/- 0.14, 7.13 +/- 0.14, 10.13 +/- 4.26 and 11.86 +/- 4.23 mmol/l, respectively. The respective mean differences between arterial and venous pH values and arterial and venous HCO(-)(3) values were 0.04 +/- 0.02 and -1.72 +/- 0.42 mmol/l, respectively, for these patients. The means of the laboratory findings of DKA patients were arterial pH, 7.15 +/- 0.15; venous pH, 7.10 +/- 0.15; arterial HCO(-)(3), 8. 57 +/- 5.71 mmol/l and venous HCO(-)(3), 10.46 +/- 5.73 mmol/l. The respective mean differences between arterial and venous pH and arterial and venous HCO(-)(3) for this group were calculated to be 0. 05 +/- 0.01 and -1.88 +/- 0.41 mmol/l. In the healthy controls, the means of arterial and venous pH, and arterial and venous HCO(-)(3) values were 7.39 +/- 0.02, 7.34 +/- 0.02, 24.91 +/- 0.82 and 26.57 +/- 0.83 mmol/l, respectively. For the healthy controls the mean differences between the respective values in arterial and venous pH, and arterial and venous HCO(-)(3) were 0.05 +/- 0.01 and -1.66 +/- 0. 58 mmol/l. Although in healthy controls the correlation between arterial and venous pH values (r(2): 0.595) and arterial and venous HCO(-)(3) values (r(2): 0.552) were moderate, these correlations were significantly increased in both the acidotic patient group (r(2): 0.979 and 0.990) and the DKA group (r(2): 0.989 and 0.995) CONCLUSION: A venous blood sample can be used to evaluate the acid-base status in uremic and DKA patients.