Jorge Mora

Dose-related Effect of Statins in Venous Thrombosis Risk Reduction

BACKGROUND Atherosclerosis and venous thromboembolism share similar pathophysiology based on common inflammatory mediators. The dose-related effect of statin therapy in venous thromboembolism remains controversial. This study investigated whether the use of antiplatelet therapy and statins decrease the occurrence of venous thromboembolism in patients with atherosclerosis. METHODS We conducted a retrospective cohort study reviewing 1795 consecutive patients with atherosclerosis admitted to a teaching hospital between 2005 and 2010. Patients who had been treated with anticoagulation therapy were excluded. Patients who either used statins for <2 months or never used them were allocated to the nonuser group. RESULTS The final analysis included 1100 patients. The overall incidence of venous thromboembolism was 9.7%. Among statin users, 6.3% (54/861) developed venous thromboembolism, compared with 22.2% (53/239) in the nonuser group (hazard ratio [HR] 0.24; P <.001). After controlling for confounding factors, statin use was still associated with a lower risk of developing venous thromboembolism (HR 0.29; P <.001). High-dose statin use (average 50.9 mg/day) (HR 0.25; P <.001) lowered the risk of venous thromboembolism compared with standard-dose statins (average 22.2 mg/day) (HR 0.38; P <.001). Dual antiplatelet therapy with aspirin and clopidogrel decreased occurrence of venous thromboembolism (HR 0.19; P <.001). Interestingly, combined statins and antiplatelet therapy further reduced the occurrence of venous thromboembolism (HR 0.16; P <.001). CONCLUSIONS The use of statins and antiplatelet therapy is associated with a significant reduction in the occurrence of venous thromboembolism with a dose-related response of statins.

Paneth cell carcinoma of the ampulla of Vater

We describe a Paneth cell carcinoma arising within the ampulla of Vater in a 64-year-old man. The phenotype of virtually all neoplastic cells was consistent with that of Paneth cells, based on routine morphology and their strong positive immunostaining for lysozyme. Additional widespread positive immunostaining for carcinoembryonic antigen and CA 19.9 supports a totipotential cell as the origin of such neoplastic cells. This case, therefore, represents a true Paneth cell carcinoma, as opposed to inclusion of occasional neoplastic Paneth cells into a poorly differentiated adenocarcinoma. This pattern of differentiation is rare, and predictions regarding its ultimate biological behavior and malignant potential must be guarded.

719A Rare Variant of Lemierre's Syndrome – Fusobacterium necrophorum Sepsis from Gynecological Origin

History: 19 year-old female presented with abdominal pain, nausea, vomiting and fever. Initially the patient denied any sexually transmitted diseases or recent pregnancy. Physical examination: Negative except severe pallor (+) Laboratory Values: Hemoglobin 2.9 g/dl, white blood cell count was normal 8000/microliter. Peripheral blood smear: no evidence of hemolysis, but severe microcytic anemia and thrombocytosis. Imaging: Abdominal and chest computerized tomography showed pelvic thrombophlebitis with extensive clot burden extending from common femoral vein to common iliac vessels with fluid in adenexa as well as segmental/sub-segmental pulmonary emboli. Other tests: Admission blood cultures grew Fusobacterium necrophorum on day 3. Hospital course: Detailed sexual history was taken again by a female medical resident and the patient revealed she had an abortion (not done by a medical professional). Diagnosis and Management: Keeping in mind . Lemierre’s syndrome is a rare, potentially severe disorder consisting of septic emboli from an internal jugular vein thrombus after oropharyngeal infection. There a few reports illustrating a variant of Lemierre’s syndrome with the female genital tract being the source. Case Report Background