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D Yeshurun

Publications and source records attributed to D Yeshurun.

168 records · Page 10Linked to original sources
PubMedDate not supplied

Thromboembolism. Clues for the presence of occult neoplasia.

It has been stated that it is inappropriate to conduct an extensive search for occult malignancy in patients with thromboembolism, unless there is some more specific indication. The present study defines those specific indices. By analyzing the clinical features of 11 consecutive patients with occult cancer presenting with thromboembolism (TE), criteria which differentiate TE in occult cancer from TE complicating other disorders were defined. These are the absence of an apparent cause for the TE at the time of the patient's admission, age more than 50 years, multiple sites of venous TE, associated venous and arterial TE, TE resistant to therapy with oral anticoagulants, and the presence of associated paraneoplastic syndromes. The incidence of these parameters in case reports from the literature was also analyzed. The six criteria that were prevalent in our series of patients with paraneoplastic TE, were observed to occur with similar incidence in different groups of historical cases. These criteria may be useful for stratification of patients with TE with regard to the probability of the presence of an occult cancer and the indications for further investigations.

Adult↗
PubMedDate not supplied

Incidence and diagnostic significance of paraneoplastic thromboembolism disorders. A survey from a community hospital.

The incidence of paraneoplastic thromboembolic disorders (PTD) at first presentation of cancer and its diagnostic significance as a cancer marker are unknown. Fourteen thousand two hundred and eighty-seven patients were admitted to the department of medicine during the period 1978-1987. Nine amongst those patients had thromboembolic disorders (TE) as the initial clinical disturbance. In another 2 patients TE was the first sign of recurrence in apparently cured cancer. PTD patients were elderly (median age 70 years), the clinical variants of PTD included solitary venous thrombosis in 3, migratory thrombophlebitis in 4, pulmonary TE in 1, arterial occlusion in 2, and associated arterial and venous occlusion in 1 case. PTD antedated the diagnosis of neoplasia by 3-180 days (median 21 days). Analysis of the impact of TE on the initiation of search for occult malignancy (PTD-cancer relevance) and on patient survival (PTD-cancer prognosis) demonstrated high PTD-cancer relevance scores in 9 among 11 cases, but favorable PTD-cancer prognosis scores in only 3 cases. This is consistent with the significance of TE for the earlier diagnosis of a, usually, disseminated cancer. The present study demonstrated a higher than usually stated association of TE with occult cancer (4.6%). It differs from recent studies by including not only venous thrombosis, but a variety of venous and arterial TE disorders as well. By studying the population from a community hospital, we believe that these data would reflect the situation in the general population at large. In this way our study differs from those of tertiary care hospitals in that our patients were not preselected.

Adult↗
PubMedDate not supplied

Treatment of severe, resistant familial combined hyperlipidemia with a bezafibrate-lovastatin combination.

Familial combined hyperlipidemia (FCHL) is a common lipid disorder characterized by high levels of cholesterol, triglycerides, or both. The basic metabolic abnormality is overproduction of apolipoprotein B-100. High atherogenicity has been attributed to all forms of FCHL. We evaluated combined bezafibrate-lovastatin therapy in 10 patients (9 men and 1 woman) with FCHL and markedly high cholesterol and triglyceride levels who were at high risk of coronary artery disease and who had not responded to diet and bezafibrate treatment alone. Eight patients had coronary artery disease, 6 had hypertension, and 3 had noninsulin-dependent diabetes mellitus. Lovastatin 20 mg/day was added to the bezafibrate 600 mg/day regimen for 6 weeks; the lovastatin dosage was then doubled to 40 mg/day for an additional 6 weeks. The addition of 20 mg of lovastatin resulted in decreases of 15%, 20%, and 13% in total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels, respectively. Increasing the dose of lovastatin to 40 mg resulted in further moderate decreases of 4%, 3%, and 8% in total cholesterol, LDL cholesterol, and triglycerides, respectively, compared with the 20 mg/day dosage. Although previous reports have emphasized the potential side effects of combination treatment with lovastatin and fibric acid derivatives, our patients tolerated the regimen well, with no significant subjective complaints or laboratory abnormalities. The bezafibrate-lovastatin combination is a possible therapeutic option for severe, resistant FCHL, but close medical supervision is needed because of potential side effects.

Adult↗