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Le Touquet – Paris-Plage, France

Elikowski W.,Szpital Im. Jozefa Strusia W Poznaniu | Malek M.,Szpital Im. Jozefa Strusia W Poznaniu | Anocha M.,Szpital Im. Jozefa Strusia W Poznaniu | Anocha M.,Lords Transfiguration University Hospital | And 6 more authors.
Polski Merkuriusz Lekarski | Year: 2013

Stress-induced cardiomyopathy is characterized by transient regional left ventricular (LV) dysfunction that may involve, in different forms, midventricular, apical or basal segments. The authors describe a case of a 41-year-old woman with reversible, but global LV systolic dysfunction, complicated with apical thrombi. Clinical symptoms of dilated cardiomyopathy were preceded by persistent stressful workplace conditions. Ischemic, inflammatory, metabolic and endocrine causes of the disease were excluded. After 6 weeks, complete recovery of LV function in echocardiography and normal cardiac magnetic resonance imaging were observed, despite only modest doses of ramipril, carvedilol and diuretics. Six months later, as a result of another episode of emotional stress, she was hospitalized for typical takotsubo cardiomyopathy. Reversible global LV hypokinesis may be an atypical variant of stress-induced cardiomyopathy. Source


Although regular sports activities decrease the risk of venous thromboembolism (VTE), VTE cases have been observed among professional and amateur athletes practicing various disciplines. The authors describe a case of a 25-year-old-woman in whom calf pain, as popliteal vein thrombosis manifestation - preceding pulmonary embolism, occurred after she took up spinning, a popular form of indoor cycling. There was no history of leg injury. In hemostasis work up, factor V Leiden mutation and acquired low antithrombon activity related to oral contraceptives use, were found. Strenuous exercise in an untrained woman might augment prothrombotic hemostasis profile. Vigorous cycling in standing position in the last phase of spinning, seems to be most unfavorable for patients with high VTE risk. Source


Valade S.,Medical ICU | Valade S.,University Paris Diderot | Azoulay E.,Medical ICU | Azoulay E.,University Paris Diderot | And 16 more authors.
Medicine (United States) | Year: 2015

Reactive hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition related to a cytokine storm leading to multiorgan dysfunction. A better understanding of coagulation disorders, frequently reported in HLH patients, may improve outcomes. Critically ill HLH patients managed in a multidisciplinary national reference center were retrospectively included. Relationships between coagulation disorders, severe bleedings, and outcomes were assessed. One hundred and seventeen patients fulfilled the HLH 2004 criteria. The most common HLH etiology was hematologic conditions (73%), followed by infectious diseases (20%), systemic rheumatic diseases (5%), and undetermined HLH etiology (3%). All patients exerted thrombocytopenia. Coagulation disorders were diagnosed in 79 (68%) patients (61 had hypofibrinogenemia<1.5 g/L, 51 had prothrombin time [PT]<50%). The worst median value throughout ICU stay was 52% (38-65) for PT with a factor V level of 35% (27-43), 1.59 (1.30- 2.09) for the activated partial thromboplastin time (APTT) ratio, and 2.33 g/L (1.13-3.86) for the fibrinogen level. Disseminated intravascular coagulation (DIC) was found in 50% of patients. Coagulation disorders were more frequent in immunocompromised patients, those with histological/cytological feature of hemophagocytosis, those with the highest ferritin concentrations, and in patients with HLH not related to infection. These patients were more prone to receive mechanical ventilation, vasopressors, or renal replacement therapy. Twenty-six (22%) patients presented severe bleeding complications, including 5 patients dying from hemorrhagic shock. Strikingly, the only coagulation parameter significantly associated with severe bleeding was low fibrinogen with a cutoff value of 2 g/L (P=0.03). Overall, 33 (28%) patients died in the ICU and hospital mortality was 44%. Coagulation disorders were associated with higher mortality, especially fibrinogen<2 g/L (P=0.04) and PT value (P=0.03). The occurrence of bleeding complications was not associated with higher risk of hospital death. Risk factors associated with mortality by multivariate analysis were fibrinogen level<2 g/L (OR 2.42 [1.08-5.41]), SOFA score<6 (OR 3.04 [1.32-6.98]), and age<46 years (OR 2.26 [1.02-5.04]). Up to two-third of critically ill HLH patients present with coagulation disorders. Hypofibrinogenemia or DIC was found in half of the patients and low PT in 40%. These patients require more life support and have a higher mortality rate. Fibrinogen <2 g/L is associated with the occurrence of severe bleeding and mortality. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source


Elikowski W.,Oddzial Chorob Wewnetrznych | Grzybowski A.,Jozef Strus Hospital | MaLek M.,Jozef Strus Hospital | Swidurski W.,Jozef Strus Hospital | And 2 more authors.
Polski Merkuriusz Lekarski | Year: 2010

The etiology of central retinal artery occlusion (CRAO) is usually associated with atherosclerotic risk factors and the presence of intravascular (carotid artery, aortic arch) or intracardiac embolic material. At young age, CRAO may be a manifestation of inherited or acquired thrombophilia. The authors present a case of CRAO in a 21-year-old, previously healthy, non-smoking male, with neither metabolic nor hemostatic abnormalities and with normal echocardiography. However, he had a positive family history of premature coronary heart disease and a history of anabolic-androgenic steroids (AAS) use during amateur bodybuilding. We have not found an example of CRAO in the literature on various, systemic thromboembolic complications following AAS use. Source


Tsiamyrtzis P.,Athens University of Economics and Business | Sobas F.,Hemostasis Laboratory | Negrier C.,Hemostasis Laboratory
Blood Coagulation and Fibrinolysis | Year: 2015

The present study seeks to demonstrate the feasibility of avoiding the preliminary phase, which is mandatory in all conventional approaches for internal quality control (IQC) management. Apart from savings on the resources consumed by the preliminary phase, the alternative approach described here is able to detect any analytic problems during the startup and provide a foundation for subsequent conventional assessment. A new dynamically updated predictive control chart (PCC) is used. Being Bayesian in concept, it utilizes available prior information. The manufacturer's prior quality control target value, the manufacturer's maximum acceptable interassay coefficient of variation value and the interassay standard deviation value defined during method validation in each laboratory, allow online IQC management. An Excel template, downloadable from journal website, allows easy implementation of this alternative approach in any laboratory. In the practical case of prothrombin percentage measurement, PCC gave no false alarms with respect to the 1 ks rule (with same 5% false-alarm probability on a single control sample) during an overlap phase between two IQC batches. Moreover, PCCs were as effective as the 1 ks rule in detecting increases in both random and systematic error after the minimal preliminary phase required by medical biology guidelines. PCCs can improve efficiency in medical biology laboratories. © 2015 Wolters Kluwer Health, Inc. Source

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