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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Current evidence indicates that prolonged air travel predisposes to venous thrombosis and pulmonary embolism. An effect is seen once travel duration exceeds 6 to 9 hours and becomes obvious in long-haul passengers traveling for 12 or more hours. A recent records linkage study found that increase in thrombosis rate among arriving passengers peaked during the first week and was no longer apparent after 2 weeks. Medium- to long-distance travelers have a 2- to 4-fold increase in relative thrombosis risk compared with nontravelers, but the averaged absolute risk is small (approximately one symptomatic event per 2 million arrivals, with a case-fatality rate of approximately 2%) and there is no evidence that thrombosis is more likely in economy class than in business- or first-class passengers. It remains uncertain whether and to what extent thrombosis risk is increased by short-distance air travel or prolonged travel by motorcar, train, or other means. Most travelers who develop venous thrombosis or pulmonary embolism also have one or more other predisposing risk factors that may include older age, obesity, recent injury or surgery, previous thrombosis, venous insufficiency, malignancy, hormonal therapies, or pregnancy. Limited (though theoretically plausible) evidence suggests that factor V Leiden and the prothrombin gene mutation predispose to thrombosis in otherwise healthy travelers. Given that very many passengers with such predispositions do not develop thrombosis, and a lack of prospective studies to link predisposition with disease, it is not now possible to allocate absolute thrombosis risk among intending passengers or to estimate benefit-to-risk ratios or benefit-to-cost ratios for prophylaxis. Randomized comparisons using ultrasound imaging indicate a measurable incidence of subclinical leg vein thrombosis after prolonged air travel, which appears to increase with travel duration and is reduced by graded pressure elastic support stockings. Whether this surrogate outcome measure translates into clinical benefit remains unknown, but support stockings are likely to be more effective and have less adverse effects than the use of aspirin.
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PMID:Travel, venous thromboembolism, and thrombophilia. 1570 80

Chronic venous disease is a common condition presenting to physicians in Western Europe and the United States. This article provides a comprehensive review of the published literature in the English language, from 1942 to the present, and focuses on the prevalence of chronic venous insufficiency and varicose veins, as well as the involved risk factors. Prevalence estimates vary widely by geographic location, with the highest reported rates in Western countries. Reports of prevalence of chronic venous insufficiency vary from < 1% to 40% in females and from < 1% to 17% in males. Prevalence estimates for varicose veins are higher, <1% to 73% in females and 2% to 56% in males. The reported ranges in prevalence estimations presumably reflect differences in the population distribution of risk factors, accuracy in application of diagnostic criteria, and the quality and availability of medical diagnostic and treatment resources. Established risk factors include older age, female gender, pregnancy, family history of venous disease, obesity, and occupations associated with orthostasis. Yet, there are several factors that are not well documented, such as diet, physical activity and exogenous hormone use, which may be important in the development of chronic venous disease and its clinical manifestations.
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PMID:The epidemiology of chronic venous insufficiency and varicose veins. 1572 61

Insufficient blood flow through end-resistance arteries leads to symptoms associated with peripheral vascular disease. This may be caused in part by poor macrocirculatory inflow or impaired microcirculatory function. Dysfunction of the microcirculation occurs in a similar fashion in multiple tissue beds long before the onset of atherosclerotic symptoms. Impaired microcirculatory vasodilatation has been shown to occur in certain disease states including peripheral vascular disease, diabetes mellitus, hypercholesterolemia, hypertension, chronic renal failure, abdominal aortic aneurysmal disease, and venous insufficiency, as well as in menopause, advanced age, and obesity. Microcirculatory structure and function can be evaluated with transcutaneous oxygen, pulp skin flow, iontophoresis, and capillaroscopy. We discuss the importance of the microcirculation, investigative methods for evaluating its function, and clinical applications and review the literature of the microcirculation in these different states.
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PMID:Evaluation of the microcirculation in vascular disease. 1617 12

Clinically, it has been observed that severely and morbidly obese individuals more often have venous leg symptoms related to venous stasis than normal-weight persons have. Obesity is associated with an increased intraabdominal pressure (IAP). The increased IAP in severely and morbidly obese patients would reasonably cause an elevated iliofemoral venous pressure (IFVP), which transmits via incompetent femoral veins, causing venous stasis in the lower limbs. The aim of this study was to determine whether the elevated IAP assessed by the urinary bladder pressure (UBP) corresponded with an increased directly measured IFVP. Fifteen women with morbid obesity were investigated with simultaneous UBP and direct iliofemoral vein pressures. Four normal-weight controls were investigated in the same manner. The obese patients had significantly higher UBP than the controls had, 19.1 and 8.5 cm H2O, respectively. They also had elevated IFVP compared with the controls, 19.7 and 7.5 cm H2O, respectively, and these IFVPs correlated well with the UBPs. The assumption that increased IAP in morbidly obese patients causes increased IFVP was consequently determined. To our knowledge, this has not previously been demonstrated in human individuals. How these elevated pressures contribute to the development of lower limb venous insufficiency is subject to further studies.
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PMID:Iliofemoral venous pressure correlates with intraabdominal pressure in morbidly obese patients. 1638 72

We present the case of a patient with severe obesity, type 2 diabetes mellitus, hypertension, and chronic venous insufficiency, as well as several vascular ulcers in the right extremity with complex clinical course. The importance of the treatment and follow-up of these vascular ulcers in primary care is essential to achieve healing or improvement. Because primary care centers can provide easy access and daily evaluation -if required-, the clinical course of vascular ulcers can be more favorable in this setting than in the hospital setting, where appointments are less frequent. In our case, the patient required several changes of treatment; at all times, the importance of controlling all the cardiovascular risk factors was explained to the patient. The involvement of the patient and his family in the disease, as well as follow-up in the primary care center, were essential to obtaining improvement.
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PMID:[Patients with vascular ulcers and cardiovascular risk factors. Case reports]. 1768 Nov 21

Asthma control is a key point in patient management. GINA's most recent report emphasises the need to investigate uncontrolled asthma, of which non-compliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes. The aim of this work is to evaluate the role of pulmonary thromboembolism (PTE) in cases of difficult- -to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes. In this group (n=254), 28 (11%) had severe persistent asthma and their mean age was 44 +/- SD18 years old. 86% were females. Of these, 57% (n=16) had uncontrolled disease: 35% (n=6) due to non-compliance with treatment; 29% (n=5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n=2) severe rhinosinusitis; 6% (n=1) hypereosinophilic syndrome; 6% (n=1) persistent allergen exposure and 6% (n=1) are still being investigated. Patients with TPE (mean age 56 +/- SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37 +/- SD14 years old). The mean time until the diagnosis of TPE was 18 +/- SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%). All these patients received anticoagulant therapy (80% are still medicated). It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group. This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.
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PMID:[Pulmonary embolism and difficult-to-treat asthma]. 1818 29

The prevalence of morbid obesity, along with related comorbidities, is dramatically increasing in the US, confounding wound care for persons at heightened risk for skin compromise. The purpose of this overview is to examine common concerns related to morbid obesity and interrelated lower extremity complications, including wound and skin infections, dermatologic conditions, lymphovenous obstruction syndromes, chronic venous insufficiency, and anatomical abnormalities such as massive localized lymphedema. Treatment may include surgery for massive lymphedema localizations, compression bandaging for chronic venous insufficiency as well as lymphedema, manual lymph drainage for lymphedema, and prompt and aggressive management of wound infection and bioburden. Case studies are presented to illustrate some lower extremity complications of morbid obesity and appropriate protocols of care. Although increasing evidence suggests that morbidly obese patients are predisposed to secondary lymphedema and that primary lymphedema can cause adult-onset obesity, the mechanisms by which these events occur remain unclear. However, unless the underlying problem of morbid obesity is addressed, the problems for which these patients seek care will continue to recur.
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PMID:A patient-centered approach to treatment of morbid obesity and lower extremity complications: an overview and case studies. 1825 Apr 84

The population of morbidly obese patients, along with the incidence of lymphedema and massive localized lymphedema associated with this condition, is increasing. A 5-year retrospective review of data (2000-2005) shows that the percentage of patients >350 lb in the authors' clinic population increased from approximately 7% to 11% and 75% of their morbidly obese patients (body mass index >40) had or have lymphedema. After a differential diagnosis between lipedema and lymphedema (primary or secondary) has been made, lymphedema management options include compression bandaging, manual lymphatic drainage, and localized surgeries. The treatment of morbidly obese lymphedema patients requires additional staff time and specialized equipment to move or position them and may be confounded by other conditions (eg, heart failure and venous insufficiency) that contribute to edema. Lymphedema treatments have been found to be useful, providing patients are able to follow treatment guidelines, especially with regard to weight control. In the authors' experience, massive localized lymphedema will recur unless the primary issue of obesity is addressed. Establishing clear criteria and patient participation guidelines before initiating a comprehensive localized lymphedema program will improve outcomes.
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PMID:Lymphedema in the morbidly obese patient: unique challenges in a unique population. 1825 Apr 86

Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.
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PMID:Telemedicine in wound care. 1880 29

Prostatic enlargement occurs over the course of a lifetime and is associated with many risk factors. Recent observations demonstrate that valvular damage, occurring in the internal spermatic veins results in increased hydrostatic pressures that lead to venous backflow. Two consequences of venous backflow are the prolonged exposure to hydrostatic pressure and high testosterone levels that effect the prostate directly. Furthermore, aging and obesity related states have long been associated with BPH and diminished testosterone concentrations, which by itself, predisposes and allows for the preferential deposition of abdominal/visceral fat. The increasing abdominal obesity leads to elevated intra-abdominal pressure, which over time, causes increased venous pressure. Chronically elevated intra-abdominal venous pressure eventually causes progressive failure of the one way valves in the internal spermatic veins and venous insufficiency that leads to prostate damage. All of these factors promote conditions that cause chronic progressive prostatic disease and eventually BPH.
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PMID:Benign prostatic hyperplasia: the hypogonadal-obesity-prostate connection. 1939 49


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