Trousseau's Syndrome in Cholangiocarcinoma: the Risk of Making the Diagnosis.

We report a case of Trousseau's syndrome with cholangiocarcinoma complicated by a fatal pulmonary embolism after liver biopsy. A 69 year-old man who presented with right upper quadrant pain was found to have portal vein thrombosis and nonspecific liver hypodensities after imaging by computerized tomography. Following four days of anticoagulation, heparin was held for percutaneous liver biopsy. After the biopsy, he developed acute hepatic failure, acute kidney injury, lactic acidemia, and expired. Autopsy revealed intrahepatic cholangiocarcinoma and a pulmonary embolism. Trousseau's syndrome with cholangiocarcinoma is rarely reported and has a poor prognosis. This case highlights a fundamental challenge in the diagnosis and early management of intrahepatic cholangiocarcinoma with hypercoagulability. Diagnostic biopsy creates an imperative to reduce post-operative bleeding risk, but this conflicts with the need to reduce thrombotic risk in a hypercoagulable state. Considering the risk of withholding anticoagulation in patients with proven or suspected cholangiocarcinoma complicated by portal vein thrombosis, physicians should consider biopsy procedures with lesser bleeding risks, such as transjugular liver biopsy or plugged percutaneous liver biopsy, to minimize interruption of anticoagulation. PMID: 26847482 [PubMed - as supplied by publisher]
Source: Clin Med Res - Category: Research Authors: Tags: Clin Med Res Source Type: research

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Abstract When the guidelines of the North American Spine Society concerning deep venous thrombosis (DVT) prophylaxis were followed, only 2 (0.63%) of 315 patients with minimally invasive transforaminal lumbar interbody fusions developed DVT complications over a 9-year period. Based on these findings, mechanical DVT prophylaxis appears to be adequate in patients undergoing elective spinal surgery, with no current support for pharmacologic prophylaxis. PMID: 32498960 [PubMed - in process]
Source: The Orthopedic Clinics of North America - Category: Orthopaedics Authors: Tags: Orthop Clin North Am Source Type: research
Conclusions: The data suggest that there is not a meaningful association between crouch gait and knee pain. Having patella alta was associated with pain. Further studies that use validated pain questionnaires are needed to understand the multifactorial etiology of knee pain within ambulatory individuals with CP. Level of Evidence: Level III—case-control study.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Cerebral Palsy Source Type: research
Conclusion: There are several risk factors for subsequent contralateral SCFE. On the basis of the available data, younger patients with a high PSA of the unaffected hip would most likely benefit from prophylactic fixation of the unaffected hip. Level of Evidence: Level II.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Hip Source Type: research
The objective of this study was to identify depression using the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) survey and to correlate with patient outcomes. Summary of Background Data. The impact of preexisting depressive symptoms on health-care related quality of life (HRQOL) outcomes following lumbar spine fusion is not well understood. Methods. Patients undergoing lumbar fusion between one to three levels at a single center, academic hospital were retrospectively identified. Patients under the age of 18 years and those undergoing surgery for infection, trauma, tumor, or revision, and less than 1-ye...
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research
Conclusion. Although intent-to-treat analysis failed to show significant differences in patients treated surgically, results of the as-treated analysis determined statically greater improvements in those patients with spondylolisthesis who were treated surgically as compared to those treated nonoperatively. Level of Evidence: 2
Source: Spine - Category: Orthopaedics Tags: LITERATURE REVIEW Source Type: research
Conclusion. Ten years after its inception, SPORT has made strides in standardization and optimization of treatment for spinal pathologies. SPORT has provided clinicians with insight about outcomes of surgical and nonoperative treatment of IDH. Results showed significantly greater improvements in patients treated surgically. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: LITERATURE REVIEW Source Type: research
Conclusion. Ten years after its inception, SPORT has made strides in standardization and optimization of treatment for spinal pathologies. SPORT has provided clinicians with insight about outcomes of surgical and nonoperative treatment of spinal stenosis. Results showed significantly greater improvement through 4 year follow up in those patients that received surgical treatment, however the difference between the surgical and nonsurgical groups diminished at 8 year follow up. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: LITERATURE REVIEW Source Type: research
Study Design. Retrospective, database review. Objective. The purpose of this study was to explore the association between preoperative opioid use and postoperative infection requiring operative wound washout in elective lumbar fusion patients. Summary of Background Data. Numerous peer-reviewed publications have conducted multivariate analyses of risk factors for surgical site infection. However, few have explored preoperative opioid use. Opioids have been widely prescribed preoperatively for pain management, but their effect on postsurgical infection is currently inconclusive. Methods. We retrospectively queried...
Source: Spine - Category: Orthopaedics Tags: SURGERY Source Type: research
In conclusion, there was some evidence that the interventions were effective in reducing employee-reported pain for highly exposed employees. PMID: 32501244 [PubMed - as supplied by publisher]
Source: Applied Ergonomics - Category: Occupational Health Authors: Tags: Appl Ergon Source Type: research
Publication date: Available online 30 May 2020Source: Multiple Sclerosis and Related DisordersAuthor(s): S Gasparini, M Russo, V Dattola, E Ferlazzo, U Aguglia
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research
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