Upper body venous thrombosis associated with ovarian stimulation: case report and review of the literature

Thromboembolic events are a serious complication of assisted conception treatment. Thrombosis may be either arterial or venous but the latter is far more common. This phenomenon is more frequent in the lower limb, but several cases of upper extremity thrombosis have been described in the literature. Although the aetiology of these thromboembolic disorders is not fully understood, the mechanism is thought to be due to a hypercoagulable state associated with haemostasis and thrombophilia. Predisposing factors seem to be hyperoestrogenism, ovarian hyperstimulation syndrome, a hereditary hypercoagulable state and multifoetal pregnancy. We report a case of superior sagittal sinus thrombosis that developed in a patient following successful assisted conception in the absence of evident risk factors. In the current literature, the site of thrombosis, possible predisposing factors, oestrogen levels, number of foetuses, maternal and foetal outcomes, and management of thrombosis were analysed.

Serum phosphate concentration with relation to the hematocrit value in uremic patients on chronic hemodialysis

The acute effects of hemodialysis on the serum inorganic phosphorus levels (sPi) with relation to the predialysis plasma volume (PV) and the hematocrit (Ht) values were studied in a group of chronic uremic patients on regular hemodialysis. The results obtained confirmed the close direct correlation between predialysis sPi and fall in sPi induced by hemodialysis. Furthermore, the present fall in sPi induced by hemodialysis was found to be directly correlated to the PV values, and inversely to the HT values. An equation was derived from these data to predict in the individual patients the postdialysis sPi levels, utilizing both the predialysis sPi and the Ht values; this equation showed a better predictive capability than similar expression based on the use of the predialysis sPi value alone.

Plasma exchange in the treatment of lupus nephritis

Seven women with severe Systemic Lupus Erythematosus Nephritis were treated with Plasma Exchange, without any additional therapy with cytotoxic agents. All patients had failed to respond to high doses of corticosteroids and, in 3 cases, to 6-methylprednisolone pulses. In 4 patients the indication for plasma exchange treatment was a rapid deterioration of renal function, and in the others a need to better control symptoms without using toxic corticosteroid dosages. The total number of plasma exchange sessions ranged from 14 to 57 depending on the patient. After PE treatment, serum creatinine values significantly decreased in all 4 patients with rapidly developing, nephritis while in the others it remained unchanged. No major side effects were recorded and no relapse of renal disease occurred whenever Plasma Exchange treatment was gradually tapered or discontinued. These data suggest that prolonged Plasma Exchange treatment without the concomitant administration of cytotoxic agents may be effective in the treatment of steroid resistant severe lupus nephritis.