Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.21.6 (thromboplastin)
 13,278 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a case of epidural hematoma in a liver cirrhosis patient with a depressed platelet count but normal prothrombin and activated thromboplastin times. A 60-year-old woman hospitalized with liver cirrhosis was referred to us for low back pain. She suffered the fracture of the body of the 12 th thoracic vertebra in a fall. Her platelet count was below normal ranges, but, other coagulation tests were within normal ranges. We inserted an 18-gauge epidural catheter at Th 12-L1 interspace. Twenty-one days later, paresis and hypesthesia in both legs, and a loss of sphincter function occurred. Magnetic resonance imaging revealed a posteriorly placed hematoma extending from Th 12 to L1. Considering the hemorrhagic tendency and hepatic insufficiency, we did not perform laminectomy. After 4 days, the patient's strength began to recover, and after 7 days paresis and hypesthesia improved. We should avoid performing epidural catheterization to improve chronic pain for a patient with liver cirrhosis if his or her platelet count is below 100,000.mm-3.
 ...
PMID:[Epidural hematoma associated with epidural catheterization in a cirrhotic patient]. 962 71

A 42-year-old man was admitted to our hospital because of lumbago and tachycardia-induced heart failure. Transthoracic echocardiography revealed impaired left ventricular function and a ball mass of thrombus in the left ventricle (LV). He was found to have systemic embolism in the spleen, kidneys, brain, and limbs. The patient was treated with limb thrombectomy followed by anticoagulation. Seven days after the direct factor Xa inhibitor, rivaroxaban, was initiated, transthoracic echocardiography was repeated, revealing disappearance of the LV thrombus without any clinical signs of cardiogenic embolism. His heart failure responded well and the LV wall motion had improved. This case suggests rivaroxaban has fibrinolytic effects on thrombi even in the LV.
...
PMID:Resolution of left ventricular thrombus secondary to tachycardia-induced heart failure with rivaroxaban. 2547 72

Objectives The Choosing Wisely Canada (CWC) Emergency Medicine group recommends avoidance of lumbosacral radiographs for patients with non-traumatic low back pain (LBP) in the absence of red flags. The objective of this study was to evaluate imaging practices of emergency physicians (EPs) in four Calgary emergency departments (EDs) and identify patient, physician, and environmental factors associated with over-ordering of radiographs for low-risk LBP patients. Methods Data was retrospectively collected from patients, ages 18-50 and Canadian Triage and Acuity Scale (CTAS) codes 2-5, who presented with non-traumatic LBP to Calgary EDs from April 1, 2014 to March 31, 2016. Patients considered high risk, specifically with partial thromboplastin time (PTT) > 40 seconds or international normalized ratio (INR) > 1.2 seconds, any consult, admission to hospital, and history of cancer, were excluded. The primary outcome was to establish the overall usage of lumbosacral radiographs. The secondary outcome was to identify factors that influenced lumbosacral spine imaging. Results Data from 2128 low-risk patients showed that 14.8% of the patients received lumbosacral radiographs. Variation among 132 physicians in X-ray ordering ranged from 0% to 90.9%. There were site-specific differences in ordering patterns [Rockyview General Hospital (RGH) = 21.6% > South Health Campus (SHC) = 15.6% > Peter Lougheed Centre (PLC) = 13.1% > Foothills Medical Centre (FMC) = 9.7%, p < 0.001]. Canadian College of Family Physicians-Emergency Medicine (CCFP-EM) licensed physicians ordered more X-rays compared to Fellow of the Royal College of Physicians of Canada (FRCPC) licensed physicians (16.6% vs. 11.1%, p < 0.001). Older physicians and physicians with more experience ordered more X-rays than their younger and less experienced colleagues. Conclusion Considerable variation exists in the ordering practices of Calgary EPs. Overall, EPs seem to be choosing wisely in terms of ordering plain radiographs for non-traumatic LBP.
 ...
PMID:Emergency Physicians Choose Wisely When Ordering Plain Radiographs for Low Back Pain Patients. 3034 85