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Background: The relation between thrombosis and cancer is well documented, but the clinical evaluation appropriate for detecting underlying cancer in patients with deep venous thrombosis-remains unknown. Objectives: To 1) determine the appropriate initial evaluation for cancer in patients with idiopathic deep venous thrombosis and 2) estimate the incidence of subsequently diagnosed cancer in patients who were not found to have cancer when deep venous thrombosis was diagnosed. Design: Retrospective cohort study. Setting: Urban, tertiary care teaching hospital. Patients: 986 consecutive patients (637 women and 349 men; mean age [+ or -] SD, 53 [+ or -] 17 years) who had no risk factors for venous disease and had venous ultrasonography because idiopathic deep venous thrombosis was suspected. Measurements: Initial clinical evaluation was assessed by using chart review. The incidence of cancer at a median of 34 months after diagnosis of deep venous thrombosis was obtained through hospital chart review (38%), computerized record extraction (54%), mailed questionnaires (6%), telephone interviews (1%), or a death registry (1%). Results: Deep venous thrombosis was diagnosed in 142 patients (14%); 136 of the 142 were hospitalized. Cancer was diagnosed in 16 of these 136 patients (12%) during the index hospitalization. All 16 of these patients had one or more abnormalities on at least one of the four components of the clinical examination: history, physical examination, basic laboratory testing, or chest radiography. The probability of detecting cancer increased as the number of findings suggestive of cancer on the four components of the clinical evaluation increased. Cancer was diagnosed in none of the 56 patients with deep venous thrombosis who did not have findings on the clinical evaluation. The probability of cancer-free survival during follow-up (median, 34 months) was similar in patients with (3 of 122 [2.5%]) and without (23 of 844 [2.7%]) deep venous thrombosis and in the age-and sex-matched U.S. population. Conclusions: A clinical evaluation that includes a comprehensive medical history, physical examination, routine laboratory testing, and chest radiography seems to be appropriate for detecting cancer in these patients. Additional testing should be guided by any abnormalities detected by this clinical evaluation., It may be advisable to perform complete examinations on patients with deeply located blood clots in order to detect the presence of possible cancer. Researchers examined the medical records or responses to questionnaires from 986 middle-aged patients suspected of having deep blood clots. Of the 142 patients identified with deep blood clots, 12% were also found to have cancer within 34 months of the initial examination. All of the patients with at least one abnormal finding and none of the patients with no abnormal findings at the initial examination developed cancer during the study period.

* Objective: To assess the effect of estrogen replacement therapy on endothelium-dependent vasodilation in postmenopausal women. * Design: Double-blind, placebo-controlled, crossover trial. * Setting: University medical center. * Patients: 13 postmenopausal women aged 44 to 69 years (average age, 55 [+ or -] 7 years). * Intervention: Patients were randomly assigned to receive placebo, oral estradiol at a dose of 1 mg/d, and oral estradiol at a dose of 2 mg/d. Each treatment phase lasted 9 weeks. * Measurements: High-resolution ultrasonography was used to measure vascular reactivity in a peripheral conduit vessel, the brachial artery. Endothelium-dependent vasodilation was determined by measuring the change in brachial artery diameter during increases in flow induced by reactive hyperemia. Endothelium-independent vasodilation was measured after sublingual nitroglycerin was administered. * Results: Flow-mediated, endothelium-dependent vasodilation of the brachial artery was greater when patients received estradiol (13.5% and 11.6% for 1-mg and 2-mg doses, respectively) than when patients received placebo (6.8%; P < 0.05 for each dose compared with placebo). In contrast, estrogen administration had no effect on endothelium-independent vasodilation as assessed by sublingual nitroglycerin. * Conclusion: Short-term estrogen replacement therapy improves flow-mediated endothelium-dependent vasodilation in postmenopausal women. This improvement may be mediated by a direct effect of estrogen on vascular function or may be induced through modification of lipoprotein metabolism., Short-term treatment with estrogen replacements may improve dilation of the vessels of the heart in postmenopausal women, thus minimizing their risk of cardiovascular problems. A study of 13 postmenopausal women, aged 44 to 69, with high levels of cholesterol found that daily administration of estradiol (a form of estrogen) at a 1 milligram (mg) or 2 mg dose increased flow-mediated vasodilation in the brachial (arm) artery after nine weeks of treatment. High-resolution ultrasonography was used to measure changes in the diameter of the brachial artery. No major change in the total cholesterol level was noted with estrogen treatment. No specific dose of estrogen was recommended, although the study did conclude that estrogen replacement therapy improved the function of the blood vessels of the heart. Lower doses may be optimal because high doses of estrogen may increase the risk of endometrial cancer.