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Highlights in this Round Up include evidence linking cooking oil fumes and lung cancer risk, the measurement of oestradiol whilst on HRT, and a description of May-Thumer syndrome.
May-Thumer syndrome – This is a condition in which patients develop iliofemoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. May-Thurner syndrome is an underdiagnosed cause of iliofemoral deep vein thrombosis, accounting for 2% to 5% of all deep vein thromboses. This condition is summarized on GPnotebook: May-Thurner syndrome
With respect to May-Thumer syndrome, which statement is false?
May-Thurner syndrome is characterized by venous insufficiency, obstruction, or thrombosis due to impaired venous return secondary to venous compression
May-Thumer syndrome is a rarely diagnosed condition in which patients develop iliofemoral deep venous thrombosis (DVT) due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine
May-Thurner syndrome is an underdiagnosed cause of iliofemoral deep vein thrombosis, accounting for 15% to 20% of all deep vein thromboses
HRT and oestradiol levels – Is there value in checking serum oestradiol if a patient is taking oral oestradiol? Is it possible to distinguish between endogenous and exogenous oestradiol through serum oestradiol testing? Recent guidance regarding oestradiol levels and HRT is summarized on GPnotebook.: HRT and oestradiol levels
With respect to HRT and oestradiol levels, which statement is false?
there is value in checking serum oestradiol if a patient is taking oral estradiol based HRT
in the perimenopause it is not possible to distinguish between endogenous and exogenous oestradiol through serum oestradiol testing
during the menopause transition there is an overall decline in oestradiol, but in the perimenopause oestradiol can fluctuate erratically and dramatically
DOACs in cancer patients – this section on GPnotebook has been updated.: DOACs in cancer patients
With respect to the use of DOACs in cancer patients, which statement is false?
there is evidence that DOACs reduce risk of venous thromboembolism (VTE) in comparison to injected low-molecular-weight-heparin (LMWH) in patients treated for cancer-associated thrombosis (CAT)
a recent meta-analysis showed that the risk of major bleeding associated with DOACs used in cancer associated thrombosis (CAT) was significantly higher than that associated with LMWH use
in a meta-analysis by Mousavi A et al, it was shown that there was no significant difference mortality risk compared to use of either DOACs or LMWH in patients with cancer associated thrombosis (CAT)
Lung cancer risk associated with cooking oil fumes – are ventilation hoods protective against risk of lung cancer development when cooking with oil? Is the number of dishes cooked daily a greater indicator of lung cancer risk than the number of cooking years?: Lung cancer and exposure to cooking oil fumes
With respect to lung cancer risk associated with exposure to cooking fumes, which statement is false?
a systematic review found that higher lifetime exposure to cooking oil fumes was associated with an increased risk for lung cancer in never-smoking women in high-income countries
evidence suggests a dose/response correlation between exposure to cooking fumes and the risk of developing lung cancer in never-smokers (LCINS)
evidence suggests that ventilation hoods have no protective effect against risk of developing lung cancer in never-smokers (LCINS)
Sister Joseph nodule – this was mentioned on a recent discharge letter. A sister Joseph nodule is a metastatic tumour deposit in the umbilicus, the anatomical region where the peritoneum is closest to the skin. Which primary cancers are most often associated with the development of this lesion?: Sister Joseph nodule
With respect to a Sister Joseph nodule, which statement is false?
the term "Sister Mary Joseph's nodule" was first introduced by Hamilton Bailey in 1949 in recognition of the superintendent nurse of St. Mary Hospital in Rochester, Minnesota, who predicted the presence of intra-abdominal malignancy by palpating a firm nodule in the umbilical region
tumours of the gastrointestinal tract and female internal genitalia are the more frequently reported primary lesions
Sister Mary Joseph's nodules usually present as a painless lump on the anterior abdominal wall
Ostium secondum atrial septal defect (ASD) – this section of GPnotebook has been updated.: Ostium secundum atrial septal defect
With respect to an ostium secundum atrial septal defect (ASD), which statement is false?
an ostium secundum defect represents the persistence of the ductus arteriosus
ostium secundum defects are more common than ostium primum defects
evidence suggests that percutaneous closure reduces the subsequent risk of stroke in appropriately selected patients, with a large relative benefit but small absolute benefit