Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Apr 2020
ReviewHow to diagnose mast cell activation syndrome: practical considerations.
Mast cells (MCs) are an important component of the immune system. Their physiological function is involved in multiple areas of human physiology, thus symptoms of their increased activation vary greatly from severe allergic reactions, such as anaphylaxis, to chronic symptoms, such as depression or osteoporosis. Studies on mastocytosis revealed a subgroup of patients presenting symptoms of increased MC degranulation, defined as mast cell activation syndrome (MCAS). ⋯ The syndrome is diagnosed on the basis of 3 criteria: 1) the presence of typical symptoms; 2) elevation of serum tryptase levels; and 3) response to anti-mediator treatment. The diagnosis of MCAS is important especially in patients with anaphylaxis or osteoporosis who require the use of an epinephrine emergency kit and insect venom immunotherapy. In this review, genetic mechanisms and typical symptoms of MCAS as well as its diagnostic criteria and implications were discussed, with a special emphasis on practical guidance with the aim to improve patient care.
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Pol. Arch. Med. Wewn. · Apr 2020
How to manage patients with symptomatic subsegmental pulmonary embolism?
Advances in modalities for the diagnosis of pulmonary embolism (PE) have led to a rise in the incidence of this disease. Some studies report a decrease in the case‑fatality rate of PE with no changes in the mortality rate, suggesting potential overdiagnosis. A growing number of diagnoses of less severe, smaller PE (ie, perfusion defects affecting pulmonary arteries of smaller caliber) of unknown clinical significance may potentially explain this phenomenon. ⋯ Only low-quality evidence suggested that subsegmental PE may be safely managed without initiating anticoagulation. Based on an individualized risk-benefit ratio, current clinical practice guidelines suggest that a selected group of patients with subsegmental PE, deemed to be at low risk of recurrence and without concomitant deep vein thrombosis detected by serial bilateral leg ultrasound, might benefit from clinical surveillance instead of anticoagulation. This approach is currently assessed in an ongoing prospective cohort study.