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 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Warfarin-drug interactioions, which can result in life-threatening bleeding, are preventable. A 53-year-old man was admitted to hospital with exacerbation of chronic obstructive airways disease, cor pulmonale, pneumonia, deep vein thrombosis and acute pulmonary embolism. His pulmonary thromboemobolism was initially treated by low-molecular-weight-heparin and heparin. After a loading dose of 5 mg for 2 days, warfarin was given in a daily dose of 2 mg. On the fifth day of warfarin therapy, the last dose of Enoxaparin was given in the morning. He had a fall in the bathroom with blunt injury to the right flank. He complained of right thigh numbness and increasing pain and swelling over his right flank and abdomen. A tender mass was noted over the right flank. His Hb level dropped to 9.7 g/dl. His INR increased from 2.46 to 3.49-3.71 one day later. On further questioning, he admitted self applications of 20 g of Analgesic balm (50% methyl salicylate) over his right calf for 3 days. CT scan showed a large right retroperitoneal haematoma and right iliacus intramuscular haematoma. Warfarin was withheld. He was given fresh frozen plasma, packed cells and vitamin K(1). Inferior vena cava filter was inserted. The haematomas were resolving. He was subsequently discharged to convalescence hospital for continuation of anticoagulant therapy and close monitoring. Significant usage of topical methyl salicylate ointment can potentiate the anticoagulant effect of warfarin. The over-anticoagulation and the presence of platelet dysfunction increase the risk of severe bleeding, which can be provoked by trauma.
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PMID:Life-threatening retroperitoneal bleeding due to warfarin-drug interactions. 1928 75

Essential thrombocythemia is a hematological disorder characterized by clonal hemopoiesis in the bone marrow and increased number of circulating platelets. It is usually discovered accidentally at the time of routine blood examinations or can become clinically evident with either thrombotic or hemorrhagic complications. In the present article, we describe the case of a 66-year-old woman with pneumonia due to Pneumocystis carinii, who experienced deep vein thrombosis and pulmonary embolism during hospitalization with a subsequent heparin-induced thrombocytopenia. Bone marrow examination performed after clinical improvement revealed the patient to be affected by essential thrombocythemia.
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PMID:Unusual onset of venous thromboembolism and heparin-induced thrombocytopenia in a patient with essential thrombocythemia. 1992 84

Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has become a major pathogen causing significant infection in children in Saudi Arabia. It has emerged as a frequent cause of skin and soft tissue infections and can be associated with life-threatening complications such as necrotizing pneumonia and sepsis. Between January 2005 and March 2008, 5 (6%) previously healthy children with invasive CA-MRSA infections were identified from 80 children with community-onset MRSA infections. Three children had osteomyelitis, with one patient presenting a fulminant and extensive soft tissue and bone destruction complicated by deep vein thrombosis and pathological fracture. One child had deep-seated infection, and one infant had severe orbital cellulitis and bilateral orbital abscess complicated by subdural empyema. The median age was 4-years (range 3 months to 17 years). Only one patient had a risk factor. Two patients were initially treated with ineffective antimicrobial therapy (beta-lactam). One isolate showed inducible clindamycin resistance. The recovery was uneventful in all patients. This report should increase the awareness of clinicians regarding severe CA-MRSA infections and highlight the challenges encountered in the choice of therapy of serious infections caused by this organism.
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PMID:Severe community-acquired infection caused by methicillin-resistant Staphylococcus aureus in Saudi Arabian children. 2038 32

Oncology patients often experience urgent or emergent medical complications that are a direct or indirect result of the underlying malignant condition and are first identified or clarified on radiologic imaging studies. The aim of this review is to identify, discuss, and illustrate some of the major thoracic complications in patients with primary intrathoracic or extrathoracic neoplasms; particular focus is placed on issues in which radiologic imaging may have a significant impact on patient management, including superior vena cava (SVC) syndrome, post-obstructive pneumonia, diaphragmatic paralysis, pleural effusions, pericardial disease, tracheo-esophageal fistula, deep venous thrombosis, and pulmonary embolism.
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PMID:Thoracic complications and emergencies in oncologic patients. 1996 99

There are no data on the effects of the Joint Commission on the Accreditation of Healthcare Organizations intensive care unit (ICU) core measures for outcomes in the burn population. The impact of the ICU core measures on patients admitted to burn center was studied. The prospective outcomes measured were hospital length of stay, ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (BSI) rates, and mortality for all burn patients admitted to the ICU. Protocols for the ICU core measures of deep venous thrombosis prophylaxis, stress ulcer prophylaxis, and daily weaning parameters, were in place before the start of the study period in 2005. Head-of-bed up at 30 degrees and glucose control, although variably practiced, were formally instituted in 2005. Enforcement of daily weaning parameters and sedation holidays were also implemented after 2005. The time period before institution of the core measures was 2003 to 2004 (pregroup), which was compared with the study time period of 2006 to 2008 (postgroup). There were no differences in the mean burn size, percent of inhalation injuries, or age between the two time periods. The VAP rate fell from 42/1000 to 13/1000 ventilator days, P = .0001. The BSI rate also declined from 12/1000 to 4/1000 line days, P = .05. Hospital and ICU lengths of stay and ventilator days did not change significantly between the periods. Risk-adjusted mortality for ICU patients improved from 13 to 7% (P = 0.01, odds ratio = 0.5 [0.29-0.85]). Although not specifically designed for the burn population, implementation of the proposed Joint Commission on the Accreditation of Healthcare Organizations ICU core measures for burn patients was associated with improvements in VAP and BSI rates, as well as a lower mortality.
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PMID:Intensive care unit core measures improve infectious complications in burn patients. 2006 55

Pressure ulceration, deep venous thromboembolism, and hospital-acquired pneumonia are well-known complications of bed rest. This retrospective, single-center, observational cohort study evaluated the effectiveness of instituting bed rest protocol that included specific positioning, continuous heel off-loading, recumbent upper and lower body bed exercises, scheduled incentive spirometry, frequent position changes, and thromboprophylaxis (chemical, mechanical, or both), in reducing the incidence of pressure ulceration, deep venous thromboembolism, and hospital-acquired pneumonia in consecutive patients admitted for at least 7 days. A total of 29 patients (24 males, 5 females) were included in this study, with a mean age of 62.5 (median 63, range 17 to 84) years. The mean length of bed rest was 13.1 (median 10, range 7 to 31) days; and, the mean length of hospital stay was 21.1 (median 17, range 8 to 72) days. During hospitalization, 2 (6.9%) patients developed one or more of the complications measured, with 1 developing a posterior heel pressure ulcer that resolved with local care and another who developed deep venous thrombosis without pulmonary embolism, managed with therapeutic anticoagulation, and hospital-acquired pneumonia treated with antibiotic therapy. The results of this analysis were favorable in comparison with previously reported incidence rates for pressure ulcer, deep venous thrombosis, and hospital-acquired pulmonary complications in patients with similar risk factors, and suggested that a prescribed bed protocol reduces complications associated with bed rest.
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PMID:Effectiveness of instituting a specific bed protocol in reducing complications associated with bed rest. 2036 72

A 14-year-old patient presented with bilateral pneumonia and pleural effusions, septic arthritis of the hip, deep venous thrombosis, and pulmonary thromboembolism. Methicillin-sensitive Staphylococcus aureus (S. aureus) containing the Panton Valentine Leukocidin (PVL) genes was isolated. Contraindication to anticoagulation prompted inferior vena cava filter placement. He completed 4 weeks of treatment with flucloxacillin, with good clinical outcome. S. aureus containing PVL genes should be sought in cases of necrotizing pneumonia as it seems to increase the risk of severe multifocal infection and thrombotic complications. There are few reports of placement of filters during S. aureus sepsis and bacteraemia. This case highlights that when anticoagulation is not feasible, an inferior vena cava filter can be inserted safely, even in patients with active sepsis and high risk for seeding of the filter. Long-term follow-up confirmed a successful outcome with sterilization of the septic thrombosis with no further pulmonary embolism or additional sepsis episodes.
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PMID:Septic Pulmonary Embolism Case Report: Optimal Outcome after Insertion of an Inferior Vena Cava Filter in a Patient with Staphylococcus aureus Bacteraemia. 2062 14

Even though quality indicators are becoming more common in clinical medicine, there are very few of them in the area of stroke rehabilitation. This article proposes quality indicators for stroke rehabilitation based upon the Donabedian triad of structure, process, and outcomes. The quality indicators are in 3 categories: service delivery; system care coordination; and stroke prevention, health promotion, and medical management. Specific areas of focus include organized care, intensity of service, transitions of care, secondary stroke prevention, hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia, deep venous thrombosis prophylaxis, pneumonia and influenza vaccines, and patient and professional education. By highlighting both the presence and absence of evidence in various aspects of stroke rehabilitation, clinicians and researchers can focus on quality improvement in areas that already are known while providing opportunities for research into areas that evidence does not yet support.
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PMID:Stroke rehabilitation quality indicators: raising the bar in the inpatient rehabilitation facility. 2082 17

Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal.
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PMID:Postoperative pain management. 2083 19

The inclusion of the failure to rescue (FTR) measure as one of the Centers for Medicare and Medicaid Services Inpatient Prospective Payment System measures has raised questions about the characteristics of FTR cases and their outcomes. In this study, we validated 75% of the identified FTR complications using medical record review (n = 461). Nearly half (49.5%) of the complications originated in the community and were present on admission. Acute renal failure, gastrointestinal hemorrhage, and sepsis most often originated in the community. Cardiac arrest/shock, pneumonia, and pulmonary embolism and deep vein thrombosis most often developed in the hospitals. These findings have important implications for practice as clinical leadership focuses on the prevention and aggressive management of complications to prevent death, increased length of stay, and possible reductions in Medicare diagnosis related groups' reimbursements.
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PMID:Failure to rescue measure: validation of community- and hospital-acquired complications. 2085 92


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