ulmonary embolism (PE) is a major health problem associated with a significant morbidity and mortality particularly in older patients. The overall annual incidence is approximately more than 1 case per 1,000 person-years, 1 but this increases markedly with advancing age. [1][2][3][4] The incidence is distributed extremely unevenly over the ages: 1 case per 1,000,000 person-years for children aged less than 15 years, 72.4 cases per 100,000 person-years for adults aged 40-54 years and 2.8 cases per 1,000 personyears for those aged 85-89 years. 2,3,5 Autopsy series have shown that PE is responsible for, or at least accompanies, approximately 12% of inhospital deaths and this rate increases to 20% for the patients aged 70 years and over. 6,7 Kniffin et al reported a 1-year mortality for PE of 39% in patients older than 65 years, 3 and Sakuma et al reported that the relative risk of mortality from PE was 417.76 for the patients aged over 79 years. 8 The high incidence of PE requires physicians to maintain a high level of suspicion in order to make a prompt diagnosis and initiate appropriate treatment, which is even more important for elderly patients who have higher mortality rates. On the other hand, physicians have to deal with the challenge of diagnosing suspected PE in elderly because older patients with PE may present with atypical clinical features in the absence of the usual indices. However, the clinical presentation of PE in the elderly population has not been extensively investigated. In the present study, the Circulation Journal Vol.69, August 2005hospital records of patients with documented PE were analyzed according to age, and risk factors, presenting symptoms and signs, arterial blood gas (ABG) analysis, electrocardiographic (ECG) and echocardiographic (ECHO) findings and, pulmonary vascular obstruction scores (PVOs) as a marker of severity of the disease, were compared for a better definition of the disease characteristics in the older population. Methods Study Population and DesignThe study was carried out at Gazi University, a large teaching hospital in Ankara. Hospital records between 1998 to 2003 from the Chest Department's database were used to identify patients who had received a final diagnosis of PE, which was established according to the protocol previously published by Prospective Investigation of Pulmonary Embolism Diagnosis investigators. 9 Patients diagnosed with pneumonia were not included in the study.Patients who met the entry criteria were stratified into 2 groups as older (≥65 years old) or younger (<65 years old) patients. The risk factors for PE were defined as follows: 10,11 immobilization (at least 2 days' bed rest in the 2 weeks prior to admission), pregnancy (includes postpartum period within the 3 months prior to admission), estrogen or oral contraceptive use, stroke, obesity (body mass index >27 kg/m 2 ), trauma (within past 3 months), recent operation (within past 6 weeks), malignancy, recent history of long travel (>6 h within 1 week), chronic obstructive lung disease (COPD...

The aim of this study is to evaluate the plasma total homocysteine level in patients with venous thromboembolism (VTE) and to investigate the effect of different risk factors on plasma levels. Ninety-three-patients with VTE and 37-control participants diagnosed with other than VTE were included in the study. Plasma homocysteine levels and the factors affecting plasma homocysteine levels were evaluated. Plasma homocysteine level was higher among patients with VTE compared to the controls independent from vitamin B12 and folate levels. The prevalence of hyperhomocysteinemia in VTE was 63%. Plasma homocysteine level was higher in patients with PE than deep venous thrombosis (DVT; 23 ± 13.7 vs 16 ± 5.8 μmol/L, P = .018). With regression analysis hyperhomocysteinemia was found to be associated with a 4.8-fold increased risk of VTE. Hyperhomocysteinemia is a common and possibly modifiable risk factor that should be considered when screening patients with VTE. Secondary causes of hyperhomocysteinemia especially vitamin B12 deficiency should be monitored in patients with VTE to prevent recurrences.

Urinothorax is a rare complication of blunt renal trauma, ureteral instrumentation or ureteral surgery. A leakage from the urinary tract causes urinoma, a retroperitoneal collection of fluid, which can lead to urinothorax. We report a patient with solitary kidney who underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis. Four days after ESWL, she had right-sided pleural effusion which demonstrated as urinothorax. Urinoma occurring after ESWL, as in our case, is a situation that has not been reported before as a cause of urinothorax. Urinothorax should be taken into consideration in patients with pleural effusion who recently underwent ESWL.

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Foreign body aspiration has a wide range of outcomes, including immediate resolution, acute asphyxia, recurrent pulmonary disease and death. A 52-year-old man was misdiagnosed with asthma and pneumonia for 6 months. A thoracic computed tomography (CT) scan showed an endobronchial lesion in the right main bronchus. Fiberoptic bronchoscopy was performed and the teeth were detected in the right main bronchus, in addition to tracheal bronchus. Aspirated teeth were removed using a rigid bronchoscope under general anesthesia. The patient having a trauma should always be carefully and systematically examined for foreign bodies. A rapid diagnosis depends on high clinical suspicion, clinical signs and radiological findings and the clinician must be aware of all complications of foreign body aspiration.