[How to perform rhinoscopy?].
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Biomedical subjects
Publications and source records attributed to D Didon.
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OBJECTIVES: We analyzed the clinical and biological characteristics as well as the clinical course and outcome observed in 20 patients with antiphospholipid antibodies and clinical signs including thrombosis or repeated spontaneous abortion to better identify the recently described antiphospholipid syndrome. METHODS: We retrospectively studied all patients observed in our unit from 1981 to 1992 who fulfilled the following inclusion criteria: a) at least one episode of arterial or venous thrombosis and/or repeated spontaneous abortions, b) positive for antiphospholipid antibodies. RESULTS: Twenty patients were included, 3 with systemic lupus erythematosus (according to the American Rheumatism Association criteria). Arterial or venous thrombosis occurred in 9 and 16 respectively, including exceptional cases of cerebral phlebitis and thrombosis of dermal capillaries. High blood pressure was recorded in 8. Only 1 or 2 types of antiphospholipid antibodies were found in most patients. Anticardiolipin, a circulating anticoagulant and a false-positive Bordet-Wassermann reaction were found together in only 3 out of 16. In addition, the antibody level varied independently from the thrombotic events. There was no case with a clinical course from primary antiphospholipid syndrome to systemic erythromatosus lupus. The effect to treatment on occurrence of new thrombotic events was studied. Three patients suffered one or more haemorrhagic events during antivitamin K treatment. CONCLUSION: It is difficult to establish a differentiation between primary antiphospholipid syndrome, systemic lupus erythematosus and lupus-like syndromes, and precise methods of identifying antiphospholipid antibodies should be further developed.
D-dimers are specific fibrin degradation products which have been measured in plasma and used as a diagnostic test for deep vein thrombosis of the lower limbs. However, the results published so far have often been conflicting. We compared the results of D-dimer assays by the latex method (positivity threshold: 0.5 microgram/ml) in 3 groups of patients: 22 patients with clinically suspected thrombophlebitis confirmed by doppler ultrasound; 22 patients with clinically suspected thrombophlebitis not confirmed by doppler ultrasound; and 17 hospital patients with other diseases serving as controls. The sensitivity of a D-dimer concentration higher than 0.5 microgram/ml was 96 percent and its specificity 69 percent. In an internal medicine unit where the prevalence of thrombophlebitis was 50 percent, the positive predictive value of a D-dimer concentration higher than 0.5 microgram/ml was 81 percent, and its negative predictive value was 94 percent. Thus, because of its low specificity as compared with imaging methods the D-dimer assay test cannot be used to diagnose deep vein thrombosis, but as it has good sensitivity and is rapidly performed, safe and inexpensive it can be used as an emergency examination which, when negative, makes this diagnosis unlikely.
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