The diagnosis of pulmonary embolism based on clinical probability: D-dimer test and spiral CT]

Recently, an algorithm encompassing a dichotomized clinical score, D-dimer and helical CT has proved to be a valid tool in confirming or rejecting a clinical diagnosis of pulmonary embolism. The diagnosis can be rejected in the context of low clinical suspicion and a negative D-dimer test. In all other situations the diagnostic accuracy of helical CT for the diagnosis of pulmonary embolism compares favourably with pulmonary angiography, with regard to the occurrence of recurrent venous thromboembolism or fatal pulmonary embolism if anticoagulation is withheld in cases of negative findings. For final diagnosis of pulmonary embolism, pulmonary angiography is only necessary if CT-scan results are suboptimal or inconclusive. This new algorithm may increase the compliance in general practice of applying guideline recommendations in patients in whom thromboembolic disease is suspected. However the proposed clinical score must first be validated for use in general practice.     

Evaluation of the possible role of serum factors in the clearance of endotoxin from blood

Circulating endotoxins are eliminated from the blood by phagocytes, predominantly the Kupffer cells. Neither complement nor other plasma factors appear to play a significant role in the initial stage of the phagocytosis of endotoxin. This suggests that the early phase of this process consists of a direct interaction between endotoxin and specific endotoxin receptor or binding sites on the macrophage cell membrane.