- Email: [email protected]
PO-100 Factor V Leiden (FVL), prothrombin, MTHFR and PAI-1 polymorphisms and cancer risk in women; the Jerusalem Perinatal Study (JPS)
S176
4th Int. Conf. on Thrombosis and Hemostasis Issues in Cancer / Thrombosis Research 120 Suppl. 2 (2007) S145–S178
Patients and Methods: Among 56 consecutive ALL children who were studied for CVL-VT by ultrasound and spiral computed tomography (CT) at the end of induction, 49 were re-evaluated for CVL-VT outcome (resolution, persistence, recurrence, new VT, postthrombotic syndrome PTS) after CVL removal. Correlation between CVL-VT and survival was also analyzed (5 7 years from diagnosis). Results: CVL-VT at end of induction occurred in 73% (41/56) of patients (pts), most of them asymptomatic; CVL size/body surface ratio was the most predictive factor (Leukemia 2007; 21: 552). After removal, 3 pts presented a new VT and 10/41 had a persistent VT. The CVL size/body surface ratio was a significant risk factor for new or persistent CVL-VT; the left insertion site was significantly related to the persistence of CVL-VT. 4/10 pts (40%) with persistent VT developed a non-severe PTS. Among the 56 pts no significant correlation was found between CVL-VT and RFS and/or OS. Conclusion: Most (70%) of CVL-VT in ALL children recover spontaneously and do not affect survival, however pts should be followed up because of high risk of PTS. A careful choice of CVL lumen size and insertion site is recommended. PO-98 Venous thromboembolism (VTE) as first sign of occult malignancy is associated with increased risk of recurrent VTE S. Brækkan1 *, E.M. Johansen1 , E.B. Mathiesen2 , I. Njølstad3 , T. Wilsgaard3 , J. Størmer4 , J.-B. Hansen1 . 1 Center for Atherothrombotic Research in Tromsø; 2 Department of Neurology, Institute of Clinical Medicine, 3 Institute of Community Medicine, University of Tromsø; 4 Department of Radiology, University Hospital of Northern Norway, Norway Introduction: A first episode of VTE is often associated with overt malignancy and less frequently accompanied by occult malignancy. Cancer patients with VTE are more likely to develop recurrent thromboembolic complications than those without malignancy. However, little is known about the risk of recurrence and survival of VTE patients with occult malignancy. Aim: The objective of the present study was to investigate the risk of recurrent VTE and mortality in VTE patients without malignancy, with overt malignancy, and patients with subsequent diagnosis of malignancy during the following year. Materials and Methods: During 1994 2005 all first episodes of VTE were registered in the municipality of Tromsø (approximately 58,000 inhabitants). Recurrent VTE, mortality and subsequent diagnosis of malignancy were registered during one year follow-up. Results: There were 583 validated first VTE events in which 21.6% (126 pts) had overt malignancy. Subsequent diagnosis of malignancy appeared in 4.8% of the VTE patients (22 out of 457 pts) during the following year, in which 81.8% was diagnosed within 6 months. The 12-month cumulative incidence of recurrent VTE was 4.4% in patients without malignancy, 8.7% in patients with malignancy (p = 0.003) and 27.3% in patients with occult malignancy (p < 0.001 and p = 0.02, respectively). Cumulative survival was 88.0% in patients without malignancy, 37.3% in patients with malignancy (p < 0.001) and 45.5% in patients with occult malignancy (p < 0.001 and p = 0.39, respectively). Conclusion: VTE patients with occult malignancy had increased risk of recurrent VTE and similar risk of mortality compared to patients with overt malignancy. Our findings suggest that VTE as a first sign of malignancy is associated with malignant diseases of high procoagulant potential.
PO-99 Outcomes in cancer patients with unsuspected pulmonary emboli found on staging CT scans C. O’Connell, L. Mark, W. Boswell, S. Boyle, S. Vasan, M. Ghalichi *, H.A. Liebman. University of Southern California Keck School of Medicine, Los Angeles, CA, USA Background: The significance of unsuspected pulmonary emboli (PE) found on routine cancer staging multi-detector row CT (MDCT) scans is unknown. Aim: To evaluate treatment, radiologic outcome, and survival data among cancer patients with unsuspected PE and to compare them to age-matched control subjects with the same cancer types and stages. Material and Methods: We performed a case-controlled retrospective study of cancer patients with unsuspected PE found on routine cancer staging MDCT scans between May, 2003 and December, 2004. Study design and patient characteristics have previously been published (J Clin Oncol 2006; 24: 4928). We recorded use of anticoagulation, IVC filters, appearance of PE on subsequent staging scans, time to death, and cause of death for cases and controls. Results: Of 53 patients with unsuspected PE, 46 had age and stage matched controls. Survival data were available for 45 patients. Thirty-nine patients were treated; 24 with warfarin, 14 with treatment-dose LMW heparin (LMWH) and 1 with prophylactic LMWH. 32 treated patients had follow-up MDCT, with either a decrease in size or resolution of PE in 31. No anticoagulation was administered to 7 patients. Follow-up MDCT in 4 untreated patients showed resolution of the initial PE. Three of the 7 untreated patients died within 5 weeks of PE diagnosis, 3 between 7 and 12 months and 1 alive at follow-up. Of 92 control subjects, 88 had available death data. There was a trend toward reduced survival in the unsuspected PE group as compared to the control group (median 39.7 weeks vs. 66.6 weeks, p = 0.08). Conclusion: Whether or not they are treated, most unsuspected PE resolve on subsequent staging CT scans; however, unsuspected PE may predict poorer overall survival in cancer patients. PO-100 Factor V Leiden (FVL), prothrombin, MTHFR and PAI-1 polymorphisms and cancer risk in women; the Jerusalem Perinatal Study (JPS) E. Tiram1 *, Y. Friedlander1 , L. Kadouri2 , O. Manor1 , R. Isacson3 , R. Yanetz1 , L. Deutsch1 , S. Harlap4 , O. Paltiel1 . 1 Hadassah-Hebrew University Braun School of Public Health; 2 Sharett Institute of Oncology, Hadassah University Hospital; 3 Department of Oncology, Shaare-Zedek Medical Center, Jerusalem, Israel, 4 Mailman School of Public Health, Columbia University, New York, NY, USA Introduction: Despite inconsistent reports of associations between MTHFR polymorphisms and stomach, breast and ovarian cancer as well as between PAI-1 genotype and breast or stomach cancer, an association between genetic thrombophilia and a tendency toward cancer development has not been established. To date no relation between FVL or prothrombin mutations and cancer have been described. Aim: To evaluate the association between genetic thrombophilia and cancer in a nested case-control study. Methods: The JPS cohort includes all West Jerusalem women who delivered from 1964 1976. From 2003 2006 we performed a nested case-control study within this cohort, which included 188 cancer cases (with breast, ovary, uterus, colorectal, lung and stomach) and 360 controls (without cancer) matched for age and ethnic origin. After obtaining signed informed consent, cases and controls were interviewed regarding medical history, thrombotic events, family history and lifestyle characteristics. A blood sample was taken and PCR tests performed for the determination of FVL1691, Prothrombin20210, MTHFR677 and PAI-1 (4G/5G) polymorphisms. Results: Comparing cases and controls, odds ratios (95% confidence intervals) of 0.89 (0.38 2.11), 2.0 (0.60 6.64), 1.01 (0.57 1.58) and
Abstracts / Thrombosis Research 120 Suppl. 2 (2007) S145–S178 0.96 (0.59 1.57) were found for FVL G1691A (AA+GA genotypes vs GG), Prothrombin G20210A (GA vs GG), MTHFR C677T (TT vs CC) and PAI-1 4G/5G (4G vs 5G), respectively. Furthermore no association was found for women bearing any combination of at least one of these mutations. Conclusion: We found no association between the known thrombophilic mutations and cancer in our study population. Our study does not support the hypothesis that women with a genetic tendency to thrombosis based on these genetic variants have an increased risk of cancer.
PO-101 Incidence, clinical-laboratory features, management and follow-up of acquired von Willebrand syndrome and other acquired defects of hemostasis in a cohort of 135 patients with chronic lymphoproliferative disorders M.T. Pugliano, M.T. Canciani, R. Garavaglia, R. Bader, P. Bucciarelli, A.B. Federici *. Angelo Bianchi Bonomi Hemophilia Thrombosis Center, Department of Internal Medicine, University of Milan, Milan, Italy Background: Acquired von Willebrand Syndrome (AVWS) is a rare bleeding disorder with laboratory findings similar to those for congenital von Willebrand disease. The actual prevalence of AVWS in the general population is unknown because large prospective studies are currently not available. Retrospective data showed that AVWS is especially frequent in lymphoproliferative disorders (LPD). Aims and Design of the study: To determine incidence, clinicallaboratory features and management of AVWS and other acquired hemostatic defects, we have sequentially observed for one year our cohort of patients with chronic LPD. Exclusion criteria were platelet counts <70,000/uL and any therapies, including non-steroid anti-inflammatory drugs. Patients with AVWS and other defects of hemostasis were then prospectively follow-up for an additional year for bleeding episodes, hospitalization, use of blood components and specific therapeutic approaches. Methods: A bleeding severity score (BSS) derived from a detailed history of 11 symptoms. Screening tests: bleeding time (BT), prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT) and, if prolonged, PT PTT TT 50:50 mixing tests. Additional specific tests: FVIII/VWF activities (AVWS/HA); platelet nucleotides (acquired storage pool defects, ASPD); silice clotting time (SCT), Russel viper venom time (RVVT), anticardiolipin antibodies (ACA) for lupus anticoagulant-antiphospholipid antibodies (LAC/APA). Results: Among 345, 135 patients satisfied the inclusion criteria, with percentual (%) diagnosis of MGUS (58), CLL (18), HD-NHL (14), MDS (4), MM (4) and amyloidosis (2). Results (median with ranges values of days, units, injections) are listed in the table. Features and diagnosis
Total cases BSS (>3) Abnormal screening tests Acquired defects AVWS Other defects
No. of cases
Hosp. stay
Therapeutic approaches
(%)
(days)
Unit PRBC
IV-IGG
Others
135 (100) 30/135 (23) 37/135 (27) 20/135 (15) 10/135 (7.5) 10/135 (7.5)
5 [0 33] 3 [0 25]
7 [0 27] 2 [0 6]
5 [0 23] 2 [0 3]
2 [0 8] 3 [0 6]
Patients with AVWS showed higher BSS than patients with other defects (8 [4 18] versus 3 [0 6]) and were exposed to more severe bleeds requiring hospitalization to correct severe anemia with PRBC. In one year, severe mucosal (n = 12) and non-mucosal (n = 8) bleeds in LPD were treated with DDAVP (n = 10), FFP/concentrates (n = 2), IVIg (n = 10), rFVIIa (n = 2). Conclusions: AVWS and the other acquired hemostatic defects shown here are not so rare (15%) and can be severe in LPD. An early correct diagnosis should improve morbidity and mortality of patients with bleeding complications in chronic LPD.
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PO-102 Incidental, asymptomatic, unsuspected pulmonary embolism in cancer patients: case reports M. Silingardi *, D. Arioli, A. Pizzini, I. Iori. Medicina I Centro Emostasi e Trombosi, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy Aims: To describe 2 cases of incidental pulmonary embolism in cancer patients. Patients: A 31 years old man was diagnosed second relapse of Acute Lymphoblastic Leukemia by videothoracoscopic-assisted biopsy on mediastinal lymphoadenopathy. He was then treated with L-Asparaginase, Vincristine, Adriblastine, Cyclophosphamide and Prednisone. In spite of a complicated clinical course (intestinal occlusion, acute pancreatitis and Graft versus Host disease) complete remission was achieved. A chest CT scan for restaging was performed. A near complete obstruction of the right pulmonary artery was reported while the patients was asymptomatic for signs/symptoms of venous thromboembolism (VTE). The actual platelet count was 75,000/ml and he wasn’t exposed to any heparin. Compression ultrasonography (CUS), echocardiography disclosed no sign of deep venous thrombosis (DVT) or right ventricular disfunction; thrombophilic workup was negative. The patient was treated with Enoxaparin for six months. A 81 years old women was diagnosed pelvic relapse of left lower limb melanoma surgically treated a year before. She underwent chemotherapy (platinum, vindesine). A chest CT scan for restaging showed pulmonary embolism (left main trunk) while she was completely asymptomatic. CUS disclosed DVT of the left common femoral vein. The patient is currently on treatment with Enoxaparin. Comment: Incidental pulmonary embolism is increasingly reported in cancer patients. Prognostic impact and correct treatment are not well defined. A prospective, multicenter, observational study on the incidence of VTE (symptomatic/asymptomatic) in the most frequent types of cancer has been licensed by FADOI (Italian Federation of Medical Hospitalist).
PO-103 Epidemiological study: causes of deaths in Ptolemaida City M.P. Makris, L.P. Makri, S.I. Papamichos, P.E. Makris *. Aristotle University of Thessaloniki, Greece Introduction: We studied the causes of death in the general population of Ptolemaida (a city with 35,000 residents) during the years 1950 to 2005. Objective: In order to find out if environmental pollution, indeed, influence death rates, we decided to study causes of death in the city of Ptolemaida. The unique characteristic of Ptolemaida is that around the city, are located factories producing electricity, which use as raw material lignite. Lignite mines are located nearby the city and a cloud of coal dust overcasts the city. In addition several residents work as lignite miners. Materials and Method: We studied 6457 death certificates. We separated causes of death in four categories: (a) malignancies (Ca); (b) Thromboembolic events (TEs), such as acute myocardial infarction, ischaemic stroke, pulmonary embolism and coronary disease; (c) deaths from other causes; and (d) not diagnosed deaths. Furthermore we categorized deaths by age (age categories: 45 y, 45 65 y, >65 y) in order to exclude any hereditary predisposition to the above categories (a) and (b). Results: Our results are presented in the table. Conclusion: The comparison between causes of deaths in Ptolemaida and other cities (that we studied during previous years), reveals that Ptolemaida has the higher percentage of mortality caused by malignancies (up to 30% of total deaths for 2000 05) and a mortality of TEs corresponding to the one of the industrialized zone of Thessaloniki (the second biggest city of Greece). Electric factories
4th Int. Conf. on Thrombosis and Hemostasis Issues in Cancer / Thrombosis Research 120 Suppl. 2 (2007) S145–S178
Patients and Methods: Among 56 consecutive ALL children who were studied for CVL-VT by ultrasound and spiral computed tomography (CT) at the end of induction, 49 were re-evaluated for CVL-VT outcome (resolution, persistence, recurrence, new VT, postthrombotic syndrome PTS) after CVL removal. Correlation between CVL-VT and survival was also analyzed (5 7 years from diagnosis). Results: CVL-VT at end of induction occurred in 73% (41/56) of patients (pts), most of them asymptomatic; CVL size/body surface ratio was the most predictive factor (Leukemia 2007; 21: 552). After removal, 3 pts presented a new VT and 10/41 had a persistent VT. The CVL size/body surface ratio was a significant risk factor for new or persistent CVL-VT; the left insertion site was significantly related to the persistence of CVL-VT. 4/10 pts (40%) with persistent VT developed a non-severe PTS. Among the 56 pts no significant correlation was found between CVL-VT and RFS and/or OS. Conclusion: Most (70%) of CVL-VT in ALL children recover spontaneously and do not affect survival, however pts should be followed up because of high risk of PTS. A careful choice of CVL lumen size and insertion site is recommended. PO-98 Venous thromboembolism (VTE) as first sign of occult malignancy is associated with increased risk of recurrent VTE S. Brækkan1 *, E.M. Johansen1 , E.B. Mathiesen2 , I. Njølstad3 , T. Wilsgaard3 , J. Størmer4 , J.-B. Hansen1 . 1 Center for Atherothrombotic Research in Tromsø; 2 Department of Neurology, Institute of Clinical Medicine, 3 Institute of Community Medicine, University of Tromsø; 4 Department of Radiology, University Hospital of Northern Norway, Norway Introduction: A first episode of VTE is often associated with overt malignancy and less frequently accompanied by occult malignancy. Cancer patients with VTE are more likely to develop recurrent thromboembolic complications than those without malignancy. However, little is known about the risk of recurrence and survival of VTE patients with occult malignancy. Aim: The objective of the present study was to investigate the risk of recurrent VTE and mortality in VTE patients without malignancy, with overt malignancy, and patients with subsequent diagnosis of malignancy during the following year. Materials and Methods: During 1994 2005 all first episodes of VTE were registered in the municipality of Tromsø (approximately 58,000 inhabitants). Recurrent VTE, mortality and subsequent diagnosis of malignancy were registered during one year follow-up. Results: There were 583 validated first VTE events in which 21.6% (126 pts) had overt malignancy. Subsequent diagnosis of malignancy appeared in 4.8% of the VTE patients (22 out of 457 pts) during the following year, in which 81.8% was diagnosed within 6 months. The 12-month cumulative incidence of recurrent VTE was 4.4% in patients without malignancy, 8.7% in patients with malignancy (p = 0.003) and 27.3% in patients with occult malignancy (p < 0.001 and p = 0.02, respectively). Cumulative survival was 88.0% in patients without malignancy, 37.3% in patients with malignancy (p < 0.001) and 45.5% in patients with occult malignancy (p < 0.001 and p = 0.39, respectively). Conclusion: VTE patients with occult malignancy had increased risk of recurrent VTE and similar risk of mortality compared to patients with overt malignancy. Our findings suggest that VTE as a first sign of malignancy is associated with malignant diseases of high procoagulant potential.
PO-99 Outcomes in cancer patients with unsuspected pulmonary emboli found on staging CT scans C. O’Connell, L. Mark, W. Boswell, S. Boyle, S. Vasan, M. Ghalichi *, H.A. Liebman. University of Southern California Keck School of Medicine, Los Angeles, CA, USA Background: The significance of unsuspected pulmonary emboli (PE) found on routine cancer staging multi-detector row CT (MDCT) scans is unknown. Aim: To evaluate treatment, radiologic outcome, and survival data among cancer patients with unsuspected PE and to compare them to age-matched control subjects with the same cancer types and stages. Material and Methods: We performed a case-controlled retrospective study of cancer patients with unsuspected PE found on routine cancer staging MDCT scans between May, 2003 and December, 2004. Study design and patient characteristics have previously been published (J Clin Oncol 2006; 24: 4928). We recorded use of anticoagulation, IVC filters, appearance of PE on subsequent staging scans, time to death, and cause of death for cases and controls. Results: Of 53 patients with unsuspected PE, 46 had age and stage matched controls. Survival data were available for 45 patients. Thirty-nine patients were treated; 24 with warfarin, 14 with treatment-dose LMW heparin (LMWH) and 1 with prophylactic LMWH. 32 treated patients had follow-up MDCT, with either a decrease in size or resolution of PE in 31. No anticoagulation was administered to 7 patients. Follow-up MDCT in 4 untreated patients showed resolution of the initial PE. Three of the 7 untreated patients died within 5 weeks of PE diagnosis, 3 between 7 and 12 months and 1 alive at follow-up. Of 92 control subjects, 88 had available death data. There was a trend toward reduced survival in the unsuspected PE group as compared to the control group (median 39.7 weeks vs. 66.6 weeks, p = 0.08). Conclusion: Whether or not they are treated, most unsuspected PE resolve on subsequent staging CT scans; however, unsuspected PE may predict poorer overall survival in cancer patients. PO-100 Factor V Leiden (FVL), prothrombin, MTHFR and PAI-1 polymorphisms and cancer risk in women; the Jerusalem Perinatal Study (JPS) E. Tiram1 *, Y. Friedlander1 , L. Kadouri2 , O. Manor1 , R. Isacson3 , R. Yanetz1 , L. Deutsch1 , S. Harlap4 , O. Paltiel1 . 1 Hadassah-Hebrew University Braun School of Public Health; 2 Sharett Institute of Oncology, Hadassah University Hospital; 3 Department of Oncology, Shaare-Zedek Medical Center, Jerusalem, Israel, 4 Mailman School of Public Health, Columbia University, New York, NY, USA Introduction: Despite inconsistent reports of associations between MTHFR polymorphisms and stomach, breast and ovarian cancer as well as between PAI-1 genotype and breast or stomach cancer, an association between genetic thrombophilia and a tendency toward cancer development has not been established. To date no relation between FVL or prothrombin mutations and cancer have been described. Aim: To evaluate the association between genetic thrombophilia and cancer in a nested case-control study. Methods: The JPS cohort includes all West Jerusalem women who delivered from 1964 1976. From 2003 2006 we performed a nested case-control study within this cohort, which included 188 cancer cases (with breast, ovary, uterus, colorectal, lung and stomach) and 360 controls (without cancer) matched for age and ethnic origin. After obtaining signed informed consent, cases and controls were interviewed regarding medical history, thrombotic events, family history and lifestyle characteristics. A blood sample was taken and PCR tests performed for the determination of FVL1691, Prothrombin20210, MTHFR677 and PAI-1 (4G/5G) polymorphisms. Results: Comparing cases and controls, odds ratios (95% confidence intervals) of 0.89 (0.38 2.11), 2.0 (0.60 6.64), 1.01 (0.57 1.58) and
Abstracts / Thrombosis Research 120 Suppl. 2 (2007) S145–S178 0.96 (0.59 1.57) were found for FVL G1691A (AA+GA genotypes vs GG), Prothrombin G20210A (GA vs GG), MTHFR C677T (TT vs CC) and PAI-1 4G/5G (4G vs 5G), respectively. Furthermore no association was found for women bearing any combination of at least one of these mutations. Conclusion: We found no association between the known thrombophilic mutations and cancer in our study population. Our study does not support the hypothesis that women with a genetic tendency to thrombosis based on these genetic variants have an increased risk of cancer.
PO-101 Incidence, clinical-laboratory features, management and follow-up of acquired von Willebrand syndrome and other acquired defects of hemostasis in a cohort of 135 patients with chronic lymphoproliferative disorders M.T. Pugliano, M.T. Canciani, R. Garavaglia, R. Bader, P. Bucciarelli, A.B. Federici *. Angelo Bianchi Bonomi Hemophilia Thrombosis Center, Department of Internal Medicine, University of Milan, Milan, Italy Background: Acquired von Willebrand Syndrome (AVWS) is a rare bleeding disorder with laboratory findings similar to those for congenital von Willebrand disease. The actual prevalence of AVWS in the general population is unknown because large prospective studies are currently not available. Retrospective data showed that AVWS is especially frequent in lymphoproliferative disorders (LPD). Aims and Design of the study: To determine incidence, clinicallaboratory features and management of AVWS and other acquired hemostatic defects, we have sequentially observed for one year our cohort of patients with chronic LPD. Exclusion criteria were platelet counts <70,000/uL and any therapies, including non-steroid anti-inflammatory drugs. Patients with AVWS and other defects of hemostasis were then prospectively follow-up for an additional year for bleeding episodes, hospitalization, use of blood components and specific therapeutic approaches. Methods: A bleeding severity score (BSS) derived from a detailed history of 11 symptoms. Screening tests: bleeding time (BT), prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT) and, if prolonged, PT PTT TT 50:50 mixing tests. Additional specific tests: FVIII/VWF activities (AVWS/HA); platelet nucleotides (acquired storage pool defects, ASPD); silice clotting time (SCT), Russel viper venom time (RVVT), anticardiolipin antibodies (ACA) for lupus anticoagulant-antiphospholipid antibodies (LAC/APA). Results: Among 345, 135 patients satisfied the inclusion criteria, with percentual (%) diagnosis of MGUS (58), CLL (18), HD-NHL (14), MDS (4), MM (4) and amyloidosis (2). Results (median with ranges values of days, units, injections) are listed in the table. Features and diagnosis
Total cases BSS (>3) Abnormal screening tests Acquired defects AVWS Other defects
No. of cases
Hosp. stay
Therapeutic approaches
(%)
(days)
Unit PRBC
IV-IGG
Others
135 (100) 30/135 (23) 37/135 (27) 20/135 (15) 10/135 (7.5) 10/135 (7.5)
5 [0 33] 3 [0 25]
7 [0 27] 2 [0 6]
5 [0 23] 2 [0 3]
2 [0 8] 3 [0 6]
Patients with AVWS showed higher BSS than patients with other defects (8 [4 18] versus 3 [0 6]) and were exposed to more severe bleeds requiring hospitalization to correct severe anemia with PRBC. In one year, severe mucosal (n = 12) and non-mucosal (n = 8) bleeds in LPD were treated with DDAVP (n = 10), FFP/concentrates (n = 2), IVIg (n = 10), rFVIIa (n = 2). Conclusions: AVWS and the other acquired hemostatic defects shown here are not so rare (15%) and can be severe in LPD. An early correct diagnosis should improve morbidity and mortality of patients with bleeding complications in chronic LPD.
S177
PO-102 Incidental, asymptomatic, unsuspected pulmonary embolism in cancer patients: case reports M. Silingardi *, D. Arioli, A. Pizzini, I. Iori. Medicina I Centro Emostasi e Trombosi, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy Aims: To describe 2 cases of incidental pulmonary embolism in cancer patients. Patients: A 31 years old man was diagnosed second relapse of Acute Lymphoblastic Leukemia by videothoracoscopic-assisted biopsy on mediastinal lymphoadenopathy. He was then treated with L-Asparaginase, Vincristine, Adriblastine, Cyclophosphamide and Prednisone. In spite of a complicated clinical course (intestinal occlusion, acute pancreatitis and Graft versus Host disease) complete remission was achieved. A chest CT scan for restaging was performed. A near complete obstruction of the right pulmonary artery was reported while the patients was asymptomatic for signs/symptoms of venous thromboembolism (VTE). The actual platelet count was 75,000/ml and he wasn’t exposed to any heparin. Compression ultrasonography (CUS), echocardiography disclosed no sign of deep venous thrombosis (DVT) or right ventricular disfunction; thrombophilic workup was negative. The patient was treated with Enoxaparin for six months. A 81 years old women was diagnosed pelvic relapse of left lower limb melanoma surgically treated a year before. She underwent chemotherapy (platinum, vindesine). A chest CT scan for restaging showed pulmonary embolism (left main trunk) while she was completely asymptomatic. CUS disclosed DVT of the left common femoral vein. The patient is currently on treatment with Enoxaparin. Comment: Incidental pulmonary embolism is increasingly reported in cancer patients. Prognostic impact and correct treatment are not well defined. A prospective, multicenter, observational study on the incidence of VTE (symptomatic/asymptomatic) in the most frequent types of cancer has been licensed by FADOI (Italian Federation of Medical Hospitalist).
PO-103 Epidemiological study: causes of deaths in Ptolemaida City M.P. Makris, L.P. Makri, S.I. Papamichos, P.E. Makris *. Aristotle University of Thessaloniki, Greece Introduction: We studied the causes of death in the general population of Ptolemaida (a city with 35,000 residents) during the years 1950 to 2005. Objective: In order to find out if environmental pollution, indeed, influence death rates, we decided to study causes of death in the city of Ptolemaida. The unique characteristic of Ptolemaida is that around the city, are located factories producing electricity, which use as raw material lignite. Lignite mines are located nearby the city and a cloud of coal dust overcasts the city. In addition several residents work as lignite miners. Materials and Method: We studied 6457 death certificates. We separated causes of death in four categories: (a) malignancies (Ca); (b) Thromboembolic events (TEs), such as acute myocardial infarction, ischaemic stroke, pulmonary embolism and coronary disease; (c) deaths from other causes; and (d) not diagnosed deaths. Furthermore we categorized deaths by age (age categories: 45 y, 45 65 y, >65 y) in order to exclude any hereditary predisposition to the above categories (a) and (b). Results: Our results are presented in the table. Conclusion: The comparison between causes of deaths in Ptolemaida and other cities (that we studied during previous years), reveals that Ptolemaida has the higher percentage of mortality caused by malignancies (up to 30% of total deaths for 2000 05) and a mortality of TEs corresponding to the one of the industrialized zone of Thessaloniki (the second biggest city of Greece). Electric factories