Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

The potential benefits of low-molecular-weight heparins in cancer patients

Cancer patients are at increased risk of venous thromboembolism due to a range of factors directly related to their disease and its treatment. Given the high incidence of post-surgical venous thromboembolism in cancer patients and the poor outcomes associated with its development, thromboprophylaxis is warranted. A number of evidence-based guidelines delineate anticoagulation regimens for venous thromboembolism treatment, primary and secondary prophylaxis, and long-term anticoagulation in cancer patients. However, many give equal weight to several different drugs and do not make specific recommendations regarding duration of therapy. In terms of their efficacy and safety profiles, practicality of use, and cost-effectiveness the low-molecular-weight heparins are at least comparable to, and offer several advantages over, other available antithrombotics in cancer patients. In addition, data are emerging that the antithrombotics, and particularly low-molecular-weight heparins, may exert an antitumor effect which could contribute to improved survival in cancer patients when given for long-term prophylaxis. Such findings reinforce the importance of thromboprophylaxis with low-molecular-weight heparin in cancer patients

Feline cutaneous toxoplasmosis: a case report

A 9-year-old female, domestic short hair cat was presented with sudden onset of polyuria/polydipsia, and hundreds of cutaneous nodules. Prior to referral, the cat had had four skin nodules that were treated with steroids. The four skin nodules then multiplied to form more than 100 ulcerated and nonulcerated nodules located all over the trunk. Clinical evaluation revealed hypothermia and respiratory distress. Cytology from both skin nodules and bronchoalveolar lavage showed macrophages and small organisms whose shape and size were indicative of Toxoplasma spp., or similar organisms. Feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) serology results were negative. The cat was seropositive for Toxoplasma (IgG 1 : 640) and Neospora (1 : 80) infections. The cat died soon after referral. Necropsy revealed pyothorax, necrotic/purulent pneumonia, haemorrhagic spots on kidneys and mesentery. Histopathology from skin nodules showed diffuse, deep necrotic dermatitis/panniculitis, vasculitis and disseminated free and grouped protozoa. The parasites were found in lungs, spleen, kidneys and liver. Immunohistochemistry on skin tissue with anti-Toxoplasma gondii and Neospora caninum antibodies gave positive results with both. Electron microscopy showed single and grouped tachyzoites with morphological features of T. gondii, often within macrophages. Samples of cutaneous nodules and bronchoalveolar fluid were examined by a polymerase chain reaction (PCR) assay for detecting apicomplexa coccidia. PCR results were consistent only with T. gondii infection. Therefore, immunohistochemistry positivity for N. caninum was considered a cross-reaction and a diagnosis of cutaneous and visceral toxoplasmosis was made