Thromb Haemostasis
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Multicenter Study Comparative Study
A positive compression ultrasonography of the lower limb veins is highly predictive of pulmonary embolism on computed tomography in suspected patients.
The presence of a clot-- even asymptomatic-- in the proximal lower limb veins of a patient with clinically suspected pulmonary embolism (PE) provides evidence for venous thromboembolism and indicates anticoagulant therapy in such patients. We aimed at assessing the diagnostic performance of compression ultrasonography as compared to multi-slice computed tomography (MSCT) for the diagnosis of PE. We analyzed data from a large outcome management study that included consecutive outpatients referred to the emergency ward with clinically suspected PE. ⋯ Positive and negative likelihood ratios were 42.2 (95% CI: 13.5 to 131.9) and 0.6 (95% CI: 0.5 to 0.7), respectively. We conclude from that large study of unselected patients that CUS has high specificity but low sensitivity, for the diagnosis of PE at MSCT in suspected patients. It allows ruling in the diagnosis of PE without further invasive and/or expensive testing in suspected patients.
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Case Reports
A novel fibrinogen Bbeta chain frameshift mutation in a patient with severe congenital hypofibrinogenaemia.
Congenital afibrinogenemia and severe hypofibrinogenemia are severe bleeding disorders characterized by either undetectable or very low levels of fibrinogen in patients' plasma and platelets. A majority of the reported cases are caused by mutations in the fibrinogen Aalpha chain. In this study, we identified a genetic defect in the fibrinogen Bbeta-chain (FGB) underlying severe hypofibrinogenemia. ⋯ This mutation contributes to Gly419-->Val, and the 419-434 codons are frame shifted, and a stop codon is formed at codon 435. The predicted truncated Bbeta-chain is 27 amino acids shorter than the normal Bbeta-chain and a central beta-strand in the globular betaC domain is absent, which may lead to destabilization of the entire beta-domain. To the best of our knowledge, this is the first report of such a mutation which is associated with severe hypofibrinogenemia.