Pulmonary embolism after diagnostic curettage in patient with adenomyosis and hysteromyoma: A case report and brief review of literature.

RATIONALE: Pulmonary embolism (PE) is a common cause of cardiovascular death whose major acquired risk factors include postoperative states, pregnancy, malignancy, and age. We report a case of PE that occurred after diagnostic curettage for abnormal uterine bleeding, with a medical history of adenomyosis and hysteromyoma. PATIENT CONCERNS AND DIAGNOSES: A 31-year-old Han Chinese female was referred to our hospital with menstrual disorders, increased menstrual flow, and severe anemia. After admission, the patient was treated with a blood transfusion, iron supplementation, and erythropoietin, and diagnostic curettage was performed the following day. On the first postoperative day, the patient developed pulmonary embolism with dyspnea and fever diagnosed by CT pulmonary angiography and significantly elevated D-dimer. INTERVENTIONS AND OUTCOMES: Molecular weight heparin was administered for PE for 2 weeks, dyspnea was relieved significantly after 2 days of treatment and the uterine bleeding did not increase; and gonadotropin-releasing hormone agonists were administered for adenomyosis after 1 week of anticoagulant therapy to reduce bleeding. We followed up for 6 months, and the patient had no recurrence of thrombosis and uterine bleeding had improved. CONCLUSION: We speculate that the occurrence of pulmonary embolism was closely related to adenomyosis, hysteromyoma, and curettage in this patient. Treating the presence of both menstrual bleeding and thromboembolism is challenging, and careful management is necessary to avoid therapeutic contradictions.

Pulmonary Embolism After in vitro Fertilization and Cesarean Section: Two Case Reports and Brief Review of the Literature.

This paper reports two cases of postpartum pulmonary embolism in Taicang First People's Hospital affiliated to Soochow University. They share many similarities in age, fertilization way, birthing method, incidence of pulmonary embolism, treatment and prognosis. The main purpose is to inspire the current maternal PTE risk assessment, diagnosis and treatment, as well as to explore the existing limitations and problems.

Analysis of CRP, Antithrombin, Fibrinogen, and Hematological Changes in 433 Patients with PTE.

OBJECTIVE: To investigate the characteristics of coagulation indicators, such as C-reactive protein (CRP), antithrombin (AT), and fibrinogen (FB) in patients with pulmonary thromboembolism (PTE) and their relationship with PTE. METHODS: The clinical characteristics, CRP, AT, FB, plasma D-dimer (D-D) and platelet (PLT) counts, and blood coagulation indicators of 433 patients with PTE diagnosed by computed tomographic pulmonary angiography (CTPA) were comprehensively analyzed, and the relevant clinical significance was discussed. RESULTS: The total incidence of PTE was 1.60% (433/270,983 cases), and the age group with the highest incidence was over 60 years old. D-D increased in 412 (95.2%) patients. PLT was normal in 331 (76.4%) cases, but decreased in 53 (12.3%) cases and increased in 49 (11.3%) cases. CRP increased in 76.0% (288/379 cases) and was normal in 24.0% (91/379 cases). AT decreased in 109 (25.2%) cases and FB increased in 102 (23.6%) cases. There were no significant changes in other coagulation indexes. CRP was positively correlated with PLT and FB (r = 0.1026, t = 2.0118, P < 0.05, and r = 0.5360, t = 12.2963, P < 0.01, respectively). CRP was negatively correlated with AT (r = -0.2005, t = 4.0100, P < 0.01). CONCLUSION: The incidence of PTE was higher in hospitalized patients. Most patients with PTE have increased CRP and FB and decreased AT, and these levels may be related to the occurrence of PTE.

Expression of serum BMP6 and hepcidin in cancer-related anemia.

Objective: To study the function of human bone morphogenetic protein-6 (BMP6) and hepcidin in cancer-related anemia.Methods: The levels of Hemoglobin (Hb), serum C-reactive protein (CRP), BMP6, hepcidin and ferritin (SF) were measured in 115 patients with solid tumors, who were divided into elevated CRP group and normal CRP group, and further divided into anemia subgroup and non-anemia subgroup according to the CRP level.Results: The prevalence of anemia was 53.9% in all patients. In the elevated CRP group, the levels of CRP, hepcidin and SF of the anemia subgroup were higher than the non-anemia subgroup (P < 0.05); the BMP6 levels had no difference between the subgroups (P > 0.05). In the normal CRP group, the BMP6 level in the anemia subgroup was higher than the non-anemia subgroup (P < 0.01); the CRP, hepcidin and SF levels showed no difference between the subgroups (P > 0.05). Among the 115 patients, CRP and SF were both positively correlated with hepcidin (P < 0.05), and CRP and hepcidin were negatively correlated with Hb (P < 0.05), while SF had no correlation with Hb (P > 0.05); BMP6 was negatively correlated with Hb (P < 0.05) while had no correlation with CRP, hepcidin and SF (P < 0.05).Conclusions: The occurrence of anemia in patients with elevated CRP is associated with hepcidin over-expression, while in patients with normal CRP is associated with BMP6 over-expression. We speculate BMP6 and hepcidin likely play different roles in the occurrence of cancer-related anemia.

Characteristics and significance of changes of thrombomodulin and plasma protein C in patients with cancer before and after PICC.

OBJECTIVE: This study aimed to evaluate the changes and clinical significance of thrombomodulin (TM) and plasma protein C (PC) in patients with cancer before and after peripherally inserted central catheter placement (PICC). MATERIALS AND METHODS: The levels of plasma TM and PC in 35 patients with cancer before and after PICC were measured by enzyme-linked immunosorbent assay, and the significance of the differences was analyzed. RESULTS: TM was 3.57 ± 1.01 µg/L at 1 day after catheterization, which was significantly lower than the value of 4.41 ± 1.26 µg/L before catheterization; these values were 4.30 ± 1.81 and 4.73 ± 0.97 µg/L at 30 and 90 days after catheterization, respectively (F = 4.14,P < 0.05). PC was 3.32 ± 1.35 µg/L at 1 day after catheterization, which was significantly lower than the value of 5.32 ± 2.12 µg/L before catheterization; these values were 4.64 ± 2.44 and 5.83 ± 3.14 µg/L at 30 and 90 days after catheterization, respectively (F = 6.28,P < 0.01). There were no significant differences in platelet (PLT) counts, plasma D-D, and coagulation parameters among the four time points before and after catheterization. There was a positive correlation between TM and PC (r = 0.5420,P < 0.01) on day 1 after PICC line insertion. The levels of TM and PC were not related to PLT, plasma D-dimer, or various coagulation parameters. CONCLUSIONS: The levels of TM and PC in the patients 1 day after PICC were significantly decreased and showed a positive correlation, but were not related to PLT, plasma D-dimer, or coagulation function.