Diagnostic and therapeutic strategies of white clot syndrome

Article Abstract:

White-clot syndrome is a form of thrombosis (an abnormal condition in which clotting elements accumulate and attach to a point on the interior wall of the vein) which is induced by heparin, an anticoagulant drug. The clot consists almost exclusively of fibrin and platelets, giving it its characteristic white color. This paradoxical condition occurs in patients who are being treated with heparin to prevent clotting and is often preceded by a low platelet count and increased resistance to heparin treatment. White clot syndrome may be the result of an immunologic response. A report is presented of the diagnostic and treatment regimen used for 12 patients with white clot syndrome. These patients represented 0.48 percent of 2,500 patients who received heparin during the study period of three years. Diagnosis was based on: decreased platelet count (under 100,000 per cubic millimeter of blood) during heparin administration, followed by normal levels once heparin was discontinued; positive heparin-induced platelet aggregation test; detection of white clots on pathology study; and complications resulting from clot formation. Thrombotic complications included: arterial occlusion in the legs; deep venous thrombosis (several patients also had pulmonary embolism, or clot in the lung); and combined venous and arterial thrombosis. Treatment included discontinuation of heparin, and intravenous dextran to increase blood volume. In addition, four patients underwent surgical removal of arterial clots, two patients had urokinase treatment, and six patients had insertion of Greenfield filters to prevent clot migration. Three patients died (25 percent), three (25 percent) had below-the-knee amputation, three had to have mid-foot or toe amputation. It is suggested that prior to administration of heparin, all patients have a platelet count determined; this should be repeated every two to three days. If the platelet count drops or thrombosis occurs, heparin should be immediately discontinued. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Complications and side effects, Blood platelets, Thrombocytopenia, Heparin

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Major salivary gland lymphoepithelial lesions and the acquired immunodeficiency syndrome

Article Abstract:

There has been a rapid increase in the incidence of benign lesions of the salivary glands involving lymphatic and epithelial tissue (cells lining the glands). In 1980, these lesions accounted for less than 3 percent of all benign tumors of the parotid (pair of major salivary glands); they now represent nearly 20 percent. Many of the recent cases have occurred in patients infected with the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). There is currently no agreed upon method of diagnosis or treatment. A review was undertaken of 60 patients with lymphoepithelial tumors; 38 patients had associated HIV infections. The HIV-positive group consisted of 32 males and 6 females and ranged in age from 20 to 68 years. The HIV-negative group consisted of 5 males and 17 females and ranged in age from 10 to 72 years. For most patients, the main initial symptom was a painless mass in the parotid gland. The average time that elapsed from when the patient first noted the mass to when he first sought medical care was 19 months; however, half of the patients sought treatment within eight months. HIV patients usually had lesions that were bilateral, multiple, cystic, and associated with lymphadenopathy (glandular abnormalities). Patients who were HIV-negative usually had solitary solid lesions. The HIV patients were treated with surgery, radiotherapy, zidovudine (AZT) and/or aspiration of the cyst. All methods of treatment were effective, except aspiration alone. Eighteen of the 32 HIV-positive patients developed AIDS during the course of the study. The authors present a suggested diagnostic and treatment algorithm. Most patients with lymphoepithelial lesions who are HIV-positive probably do not need to undergo surgery; treatment with AZT or radiotherapy is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, AIDS patients, HIV patients, Head and neck cancer, Mouth tumors

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