Painful swollen leg – think beyond deep vein thrombosis or Baker's cyst

<p>Abstract</p> <p>Background</p> <p>The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation.</p> <p>Case presentation</p> <p>This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a baker's cyst, but later diagnosed as a pleomorphic sarcoma, a malignant giant cell tumor of the muscle and a myxoid liposarcoma. A brief review of such similar reports and the relevant literature is presented.</p> <p>Conclusion</p> <p>A painful swollen leg is a common clinical scenario and though rare, tumors must be thought of without any delay, in a duplex negative, low risk deep vein thrombosis situation.</p

Multicenter evaluation of a new quantitative highly sensitive D-dimer assay, the Hemosil D-dimer HS 500, in patients with clinically suspected venous thromboembolism.

D-dimer testing is widely used in conjunction with clinical pretest probability (PTP) for venous thromboembolism (VTE) exclusion. We report on a multicenter evaluation of a new, automated, latex enhanced turbidimetric immunoassay [HemosIL D-Dimer HS 500, Instrumentation Laboratory (IL)].747 consecutive outpatients with suspected proximal deep vein thrombosis (DVT, n=401) or pulmonary embolism (PE, n=346) were evaluated at four university hospitals in a management study with a 3 month follow-up. Samples were tested at each center using the new D-dimer assay on an automated coagulation analyzer [ACL TOP (IL)], with clinical cut-off for VTE at 500 ng/mL (FEU).The sensitivity and negative predictive value (NPV) were 100\% for all PTP subgroups (no false negative results); for both sensitivity and NPV the lower limit of the 95\% CI in patients with moderate/low PTP was higher than 95\%. The overall specificity was 45.1\% (95\%CI: 41.1-49.3\%). Higher specificity value was recorded in the low PTP subgroup [49.2\% (95\%CI: 41.7-56.7)]. No significant differences were found between patients suspected of having DVT or PE; sensitivity and NPV were 100\%. The reproducibility of the assay was good, being the total CVs\% less than 10\% for D-dimer concentration near the clinical cut-off.The new, highly sensitive D-dimer assay proved to be accurate when used for VTE diagnostic work-up in outpatients. Based on 100\% sensitivity and NPV and lower limit of the 95\% CI higher than 95\%, the assay can be used as a stand-alone test in patients with non high PTP

Identifying obstacles and opportunities for inclusion in the school curriculum for children adopted from overseas: developmental and social constructionist perspectives

In Australia, teachers are expected to teach a diverse range of students, including children adopted from overseas who have experienced attachment disruption and complex trauma early in life. International research identifies the potential vulnerability of this minority group at school. However, teachers’ backgrounds, knowledge and experience, as well as curriculum policies and school practices, may influence how teachers respond to the diverse needs of these children. Drawing on examples from a qualitative study which used focus group interviews and a multi-case study of 10 adoptive families, this article applies developmental and social constructionist perspectives to analyse the potential impact some common curriculum units may have on these children’s experiences of school. This paper reports on the way in which various units in the Australian Curriculum may provide obstacles and opportunities for inclusion, with particular examples provided from the English and History Curriculum. Findings show there is a need for greater awareness, understanding and sensitivity in teaching approach, as well as flexibility in teachers’ professional agency and discretion in the selection of resources when responding to the educational needs of intercountry adoptees