[Hyperhomocysteinemia complicated by myocardial infarction and portal vein thrombosis--case report]. / Hiperhomocysteinemia powiklana zawalem miesnia sercowego oraz zakrzepica zyly wrotnej--opis przypadku.

Hyperhomocysteinemia (HHcy) can be associated with deficiency of group B vitamins and folic acid. HHcy might also results from renal insufficiency, diabetes, hypothyreosis or malignant diseases. In same cases HHcy is connected with mutations of genes involved in its metabolism. HHcy causes the increased risk of arterial and vein thrombosis. In this paper we show case report of woman with HHcy, who developed several complications, probably because of HHcy. This patient in the age of 38 and 44 years developed twice myocardial infarction, whereas in the age of 48 she suffered from portal vein thrombosis. According to documentation, the level of cholesterol has never been elevated, however HHcy was observed. During diagnostic process, the primary and secondary causes of HHcy were assessed. Mutations of genes involved in Hcy metabolism were also assessed. We did not find any mutation in protein products of methylenotetrahydrofolate reductase (MTHFR) or cystationine beta-synthase (CBS). The patient was treated with the use of folic acid, vitamin B12 and B6 supplementation, and normalization of Hcy level was received. This case report underline, how important role in the case of HHcy play vitamin supplementation. The early treatment of HHcy might limit thromboembolic complication.

[Portal vein thrombosis in patients with thrombophilia--own observations]. / Zakrzepica ukladu zyly wrotnej u chorych z trombofilia-- obserwacje wlasne.

Portal vein thrombosis is one of the main prehepatic causes of portal hypertension. The most frequent causes of thrombosis in this localization, apart from hepatic cirrhosis, are the following: acute inflammatory diseases and abdominal cancers, traumas, proliferative diseases of the hematopoietic system. In recent years attention was given to disorders in hemostasis, such as thrombophilia, in the course of which thrombosis development is particularly common. The authors present 10 patients after an incident of portal vein thrombosis, in which primary hepatic pathology was excluded and tests directed at thrombophilia were performed. In seven patients abnormalities in the examined parameters were found, and what is more, in two cases they had a complex character and involved more than one parameter. In five patients hyperhomocysteinemia was found. Among them, in two patients there was also a decreased protein S activity and in one of them there was also APC-resistance. In the next two patients there were abnormalities in one of the examined parameters - APC-resistance. Hyperhomocysteinemia was found in all patients with idiopathic thrombosis, and in one of them there were concurrent changes in protein S activity and APC-resistance. In patients with the history of portal vein thrombosis diagnostics of thrombophilia should be performed.

[Negative D-dimers and exclusion of venous thromboembolism--own experience]. / Ujemny dimer D a wykluczenie zylnej choroby zakrzepowo-zatorowej--doswiadczenia wlasne.

The assessment of D-dimer concentration has become essential step during diagnostic algorithm of venous thromboembolism (VTE). This test characterizes high sensitivity but limited specificity. Negative D-dimer with high probability excludes VTE. The aim of this study was to assess the percentage of patients treated in Department of Internal Medicine, Endocrinology and Haemostatic Disorders, Medical University of Gdanisk, who in spite of clinical signs of VTE showed normal D-dimer level. Between 2000 and 2004 in our department 57 cases with recent deep vein thrombosis (DVT) were diagnosed, in 2 cases with co-existence of pulmonary embolism (PE). The D-dimer concentration was assessed in patients' plasma with the use of immunoturbidometry. Between 57 cases with VTE, 7 patients (12%) showed normal D-dimer level (<500 microg/ml). This group consisted of 4 men and 3 women, aged from 40 to 82 years (the mean age of 58 years). In all 7 cases DVT was diagnosed, in 2 patients with concomitent PE. The final diagnosis was confirmed by compression ultrasonography and pulmonary scintigraphy. Our analysis underlines the observation that occurrence of VTE and negative d-dimer concentration is possible and may probably be related to methodological limitations. However, the lack of increase of D-dimer could also be caused by fibrinolysis alteration.