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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy-five patients with isolated calf vein thrombi were prospectively monitored with sequential duplex scans at 3- to 4-day intervals. Twenty-four patients (32%) propagated and 11 of these 24 (46%) into the popliteal or larger veins of the thigh. Sex, age, obesity, trauma, estrogen use, malignancy, varicose veins, smoking, surgery, and activity level were not predictive for proximal propagation. Proximal soleal vein thrombi had the highest incidence in both propagating and non-propagating groups. Thrombus extent and bilateral involvement were not predictive of propagation. Five percent (4 of 75 patients) had highly probable ventilation perfusion scans as their initial indication for duplex scanning. Deep vein thrombosis isolated to the calf is not a benign problem. If anticoagulant therapy is contraindicated, the progress of the thrombus can be followed by duplex scanning.
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PMID:Lower extremity calf thrombosis: to treat or not to treat? 194 69

Factors contributing to deep vein thrombosis (DVT) were studied in 51 patients (62 knees) who had a cementless total knee arthroplasty (TKA) and in 51 patients (69 knees) who had a cemented TKA. All patients were treated with a primary TKA using a porous-coated anatomic prosthesis with a porous-coated central tibial stem. Deep vein thrombosis was diagnosed by roentgenographic venography, and pulmonary embolism was diagnosed by perfusion lung scanning. Incidence of DVT was 32%, and there was no pulmonary embolism. The factors that do not seem to have much relevancy to DVT were advanced age, orthopedic disease, one- or two-staged bilateral TKA, venous anatomic variations, number of venous valves, coagulation assay data, hypertension, tourniquet time, choice of cementless or cemented TKA, severity or duration of operation, amount of blood loss, and amount of blood transfused. Conversely, more immediate relevant factors were obesity, postoperative prolonged immobilization, earlier venous disease, and hyperlipidemia.
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PMID:Factors leading to low incidence of deep vein thrombosis after cementless and cemented total knee arthroplasty. 195 58

The incidence of deep vein thrombosis in 244 patients who had total knee replacement has been studied. In 120 the prosthesis was cemented and in 124 it was cementless. In all cases the replacement was primary and a porous-coated prosthesis with a porous-coated central tibial stem was used. Deep vein thrombosis was diagnosed by venography, and pulmonary embolism by perfusion scanning. The incidence of deep vein thrombosis in the cementless knees (23.8%) and in the cemented (25%) was approximately the same. The only significant predisposing factors for deep vein thrombosis in both groups were obesity, prolonged postoperative immobilisation, previous venous disease and hyperlipidaemia.
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PMID:The incidence of deep vein thrombosis after cementless and cemented knee replacement. 221 55

At present 3 treatment alternatives for primary varicose veins are available: surgical stripping and ligation, injection/compression sclerotherapy, and a combination of the 2. At least 4 factors contribute to the decision of whether to treat the patient: pregnancy, obesity, oral contraceptive (OC) use, and age. Since varicose veins in pregnant women may later recede, only palliative treatment is recommended before delivery. Deep vein thrombosis may develop as a result of OC use during varicose vein treatment, leading some to advise OC discontinuation. Numerous clinical trials have endeavored to examine the relative effectiveness of treatment methods currently in use. The only randomized trial to evaluate all 3 treatment options over a 3-year period found that surgical stripping was significantly more effective than a combination of ligation and sclerotherapy, and that the combination was significantly more effective than sclerotherapy alone. Surgery appears to be the recommended treatment when the saphenous system is involved; surgery is also preferred for patients 35-64 years of age and for those presenting with signs of ankle edema and flare. Sclerotherapy seems to be more effective for dilated superficial veins and incompetent perforating veins in the lower leg. In addition, sclerotherapy is the most acceptable and least expensive method for the patient. The prevalence of primary varicose veins has been estimated at 20% in Europe and North America, with a female:male ratio of 5:1.
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PMID:Selecting a treatment for primary varicose veins. 389 Oct 60

Acute superficial thrombophlebitis of the lower extremities is one of the most common vascular diseases affecting the population. Although it is generally considered as a benign disease, it can be extended to the deep venous system and pulmonary embolism. We examined 50 patients (22 males and 28 females), mean age 52.5 years. These patients were surgically treated due to acute superficial thrombophlebitis of the lower limbs that affected great saphenous vein above the knee. The diagnosis was made by palpable subcutaneous cords in the course of great saphenous vein or its tributaries in association with tenderness, erythema and oedema. Of these 50 patients, 26 were examined by duplex ultrasonography before the operation. In 20 patients duplex scanning confirmed that the process was greater than we supposed after clinical examination (77%) and in 6 patients there were no differences (23%) (Figures 1 and 2). The operation included crossectomy, ligation and resection of the proximal part of the great saphenous vein. Intraoperative findings in 38 patients showed that the level of the phlebitic process was higher than the clinical level (76%). There was no difference in 12 patients (24%). Deep vein thrombosis and pulmonary embolism were noted in 14 patients (28%) (Tables 1 and 2). Both complications were found in two patients, and 12 had one of these complications. Generally, there were 12 patients with deep venous thrombosis and 4 patients with pulmonary embolism. Only in one patient deep venous thrombosis appeared postoperatively, while all other complications occurred before surgical intervention (Scheme 1 and Table 3). The most common risk factor was the presence of varicose veins (86%). Obesity, age over 60 years, cigarette smoking are listed in decreasing order of frequency. Patients under 60 years were more likely to have complications while older patients usually followed a benign clinical course (Tables 4 and 5). There was no intrahospital mortality. Average hospitalization was 5.7 days. It was 4 days in patients without complications. After thes urgent operation that practically removed the risk of potentially fatal consequences, the patients were dismissed from hospital. New hospitalization was recommended after two weeks when the second act of surgical treatment was performed. It included stripping of the great saphenous vein and extirpation of varicose veins in the area without acute inflammation. The findings of this study confirm the general opinion that acute superficial thrombophlebitis is a very common vascular disease with usually "benign" clinical course. In its ascending form that affects the great saphenous vein above the knee it can be associated with deep venous thrombosis and pulmonary embolism. The level of phlebitic process is usually much higher than can be palpated clinically. Duplex scanning was a highly reliable, precise, fast non-invasive diagnostic method that is necessary in examining, following and making decision for operative treatment of acute superficial thrombophlebitis. If suspected complications an urgent surgical intervention should be performed. It is short and efficient, contributing to the fast recovery of the patients and their return to normal activities.
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PMID:[Acute superficial thrombophlebitis--modern diagnosis and therapy]. 934 Jul 96

Deep vein thrombosis (DVT) and pulmonary embolism remain important causes of morbidity and mortality. Without prophylaxis, at least 60% of patients undergoing orthopaedic or trauma surgery develop DVT, and the rate may still be as high as 20-45% even with the best prophylaxis available. The rate of thrombosis may be reduced by wider use of established prophylactic measures and targeting more intense prophylaxis to very-high-risk patients. Novel agents such as pentasaccharides and recombinant hirudins may provide more effective prophylaxis in very-high-risk settings, but their optimal use requires accurate assessment of thromboembolic risk. Risk levels are influenced both by the clinical setting and patient factors, such as obesity and malignancy. There is now growing interest in the influence of molecular risk factors, including acquired thrombophilias and congenital coagulation disorders. Activated protein C resistance and hyperhomocysteinaemia have been recently identified as potential risk factors. Further investigations are needed to clarify the individual contribution of different clinical and molecular factors to overall thromboembolic risk, and the effects of interactions between them. Screening for clotting disorders and other additional risk factors may assist identification of very-high-risk patients and allow appropriate targeting of intensive prophylactic therapy.
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PMID:Applying risk assessment models in orthopaedic surgery: effective risk stratification. 1049 32

Deep vein thrombosis is a frequent disease with an annual incidence reaching 5 per thousand among subjects over 75 years. Major acquired risk factors for venous thrombosis include surgery, neoplasm, reduced mobility or paresis, and a previous episode of deep vein thrombosis. Among women, hormonal status (pregnancy, oral contraceptive, hormone replacement therapy) is responsible for the majority of all venous thrombotic events. The impact of other factors is controversial: obesity, tobacco use and varicose veins. Venous thrombosis is a multifactorial disease and analysis of the interactions between acquired and inherited risk factors is an extremely interesting field of investigation.
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PMID:[Deep venous thrombosis: epidemiology, acquired risk factors]. 1247 41

Deep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (> 5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies.A transient direct-current electrical injury was induced in the common femoral vein of adult C57BI/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p < 0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121 +/- 0.018 mm3 vs. 0.052 +/- 0.008 mm3, respectively; p < 0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.
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PMID:A murine model of deep vein thrombosis: characterization and validation in transgenic mice. 1626 62

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1-2 RFs), 3.4 per cent in moderate (3-5 RFs), and 7.7 per cent in high (> or =6 RFs) VTE scores (P = 0.172). Incidence was statistically different (3% vs. 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1-4 RFs) and high-risk (> or =5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs. 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs. 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs. 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs. 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with > or =5 RFs vs. <5RFs, obesity (14.3 vs. 6.1%, P = 0.007), malignancy (5.6% vs. 0.6%, P = 0.006), coagulopathy (10.8% vs. 1.8%, P = 0.000), and previous VTE (3.2% vs. 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 +/- 1.75 RFs and a 9.61 +/- 4.93 VTE score, whereas, patients without DVT had 2.66 +/- 1.50 RFs and a 6.83 +/- 3.91 VTE score (P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P < or = 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of > or =15 and 25 had higher DVTs compared with the ones with lower injury severity score levels (P < or = 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.
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PMID:Venous thromboembolism in trauma patients. 1809 58

Deep vein thrombosis (DVT) is a common disorder frequently seen in both the inpatient and outpatient settings. DVT increases the risk of pulmonary embolism, a potentially fatal complication. These 2 conditions--DVT and pulmonary embolism--comprise venous thromboembolism (VTE), which is a major and often unrecognized cause of morbidity and mortality in hospitalized and ambulatory patients. Acquired risk factors include smoking, obesity, stasis (such as long-term travel), hypercoagulability, recent surgery, trauma, or hospitalizations. In addition, inherited or innate disorders that pose risk include increasing age and personal or family history of VTE.After a first episode of VTE, the risk for recurrent episodes of a DVT is elevated: 21.5% after a first event and 27.9% after a second. And, the risk of recurrence varies with time, with highest risk occurring during the first 6 to 12 months after the event. Death occurs in 6% of DVT cases within 1 month of diagnosis. Once a DVT occurs, the risk recurrence never resolves to zero; therefore, VTE should be considered a chronic illness rather than a short-term condition. As a key member of the healthcare team, the role a nurse practitioner is to identify patients at risk for VTE and institute appropriate preventative/treatment measures. By doing so, morbidity and mortality from this common disorder can be minimized.
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PMID:Venous thromboembolism: a chronic illness. 1985 62


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