Nodular lesions of the liver in multiple myeloma

An 83-year-old woman was admitted because of asthenia, weight loss and abdominal pain. She had been diagnosed with MGUS IgGk twenty years earlier and the monoclonal protein levels had remained persistently stable. At admission, physical examination showed pallor, marked hepatomegaly (5 cm below th

Recurrence risk after first symptomatic distal versus proximal deep vein thrombosis according to baseline risk factors

Background   It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently independently associated with a lower risk of recurrence in all patients, or represents a marker of the the presence and severity of provoking factors for venous thromboembolism (VTE). Methods We investigated investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent recurrent VTE, including proximal DVT and PE. Results   A total of 205 (24.7%) patients presented with with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03-0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28-1.78]). Conclusions   The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer