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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient with methicillin-resistant Staphylococcus aureus bacteremia received vancomycin (MIC = 0.8 microgram/ml, MBC = 15 micrograms/ml) and heparin simultaneously through the same intravenous line to treat a septic deep venous thrombosis. Bacteremia persisted for 7 days. Bacteremia terminated when the simultaneous infusion of heparin and vancomycin through the same line was stopped. This suggested that an interaction between vancomycin and heparin may have occurred, which resulted in a reduction in vancomycin activity. To test for such an interaction, mixtures of heparin and vancomycin in various concentrations were made and tested for antimicrobial activity against the organisms in the patient. A precipitate formed at the concentrations achieved in the intravenous lines, and when the vancomycin concentrations were measured by bioassay, a 50 to 60% reduction in activity was noted. In contrast, when these solutions were prepared and mixed at microgram concentrations, a precipitate was no longer observed, and antimicrobial activity was not reduced. Heparin appeared to interact unfavorably with vancomycin at the concentrations in the intravenous lines when these drugs were administered simultaneously to patients. This may be the cause of poor therapeutic responses to vancomycin in some patients, especially those infected with tolerant organisms.
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PMID:Persistent staphylococcal bacteremia in an intravenous drug abuser. 371 29

Group B streptococcus (Streptococcus agalactiae) is a common etiology of bacteremia among adults. Pyomyoma is a rare infectious complication of uterine leiomyomas. We report the case of a diabetic postmenopausal woman with a giant pyomyoma simulating an ovarian cancer. It was associated with S. agalactiae endocarditis and deep venous thrombosis of the right external iliac and femoral veins. Treated initially with intravenous penicillin, amikacin, and anticoagulation, the patient later had abdominal hysterectomy with an uneventful recovery. We also review the cases of pyomyoma reported since 1945. Of 14 cases described (including ours), mortality was 21%. Endocarditis was never reported in association with pyomyoma. The presence of bacteremia and a leiomyoma should raise suspicion for this disease.
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PMID:Streptococcus agalactiae endocarditis and giant pyomyoma simulating ovarian cancer. 1137 3

Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.
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PMID:Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports. 1188 28

We describe here the first case of Salmonella paratyphi A bacteremia associated with deep vein thrombosis in a 10-year-old patient. In spite of aggressive antibiotic therapy and supportive care, the patient died of progressive respiratory distress and septic shock. Awareness of unusual clinical presentation of Salmonella infection in important. A review of the previously reported cases of Salmonella associated venous thrombosis worldwide is also presented.
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PMID:Venous thrombosis associated with Salmonella: report of a case and review of literature. 1451 51

Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%). A mean of eight operations were required for limb salvage. Six free-tissue transfers, 2 fillet flaps, 14 local flaps, and multiple skin grafts were performed. Five patients underwent tibial burring for granulation tissue stimulation, and the subatmospheric pressure device was used in eight patients. Seven limb amputations (18%) were required in four patients, and 76% of patients were ambulatory on follow-up. The mean hospital stay was 76 days with high rates of cellulitis, deep vein thrombosis, and bacteremia. Patients treated with flap closure had a significant decrease in the number of operations required for limb salvage. Fourth-degree lower-extremity burns require multistage reconstructive procedures using multiple levels of the reconstructive ladder but limb salvage is possible in a majority of cases.
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PMID:Fourth-degree burns to the lower extremity with exposed tendon and bone: a ten-year experience. 1656 35

Patients with sepsis frequently have activated coagulation pathways triggered by tissue factor, reduced levels of anticoagulation factors, reduced fibrinolysis, activated endothelial surfaces, and activated platelets. These processes result in disseminated intravascular coagulation and microthrombus formation and contribute to multi-organ system failure. S aureus surface proteins and exotoxins can contribute to thrombus formation through effects on the coagulation pathway and on anticoagulation factors. In addition, S aureus can activate endothelial surfaces and platelets. Some exotoxins such as the Panton-Valentine leukocidin can cause leukocyte lysis and additional injury to endothelial surfaces. These events can cause microthrombosis and deep venous thrombosis. Several case series have described an association between acute hematogenous osteomyelitis secondary to S aureus and the development of deep venous thrombosis in extremities. In addition, a recent clinical case review of staphylococcal community-acquired pneumonia demonstrated that patients who died secondary to these infections frequently had deep venous thrombosis. These observations support the idea that S aureus can contribute to thrombus formation. We recently cared for a patient who developed splanchnic vein thrombosis during an episode of staphylococcal cellulitis associated with bacteremia and multi-organ system failure. The pathogenesis of splenic vein thrombosis differs from the pathogenesis of deep venous thrombosis in the extremities in some, but not all, respects. Clearly the presence of circulating staphylococci and associated proteins could contribute to the formation of thrombi in the splanchnic circulation. Patients with hypervirulent staphylococcal infections require evaluation for deep venous thrombosis in extremities and in unusual sites. The development of these clots has a potentially significant impact on management and outcome. This review considers the pathogenesis of deep vein thrombosis in patients with sepsis, the potential contributions of Staphylococcus aureus in this process, and clot formation in unusual locations which greatly increases the complexity of patient care.
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PMID:The role of hypervirulent Staphylococcus aureus infections in the development of deep vein thrombosis. 2277 Dec 17

We report incidental FDG PET/CT findings of deep venous thrombosis and pulmonary embolism in a patient with bacteremia. In this patient, diagnosis of thromboembolism was not considered until FDG PET/CT imaging was performed, and the findings prompted immediate anticoagulant therapy. The role of FDG PET/CT in venous thromboembolism is not yet well established, but the potential benefit must be kept in mind when interpreting FDG PET/CT images regardless of the underlying disease.
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PMID:Deep venous thrombosis and pulmonary embolism detected by FDG PET/CT in a patient with bacteremia. 2342

Statins have dramatically improved the treatment of hyperlipidemia and cardiovascular disease through its inhibition of hydroxymethylglutaryl-coenzyme A reductase. Although its main effect has long been known, much is yet to be understood about the wide and varied pleiotropic properties of statins. Some studies have demonstrated that statins contain antiplatelet, antithrombotic, antiinflammatory, cardioprotective, and neuroprotective properties independent of their ability to lower plasma low-density lipoprotein cholesterol. More recently, statins have been used in novel ways in the treatment of Alzheimer disease, sepsis, pneumonia, and bacteremia. In 2000, it was first suggested that statins could decrease the incidence of venous thromboembolisms (VTEs). A recent publication showed that not only do statins lower the incidence of deep vein thrombosis and pulmonary embolism, but they do so in a dose-dependent manner. Although there is certainly strong evidence demonstrating that statins do indeed lower VTEs, the mechanism is not understood. Possible hypotheses include their antiinflammatory and antithrombotic properties. With only one randomized clinical trial available, further studies must be conducted before routinely recommending statins for prophylaxis of VTEs.
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PMID:Statins and venous thromboembolic disease prophylaxis. 2370 92

Deep vein thrombosis (DVT) is a rare disease in pediatric patients. We report a pediatric patient who developed DVT in association with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia complicated with septic arthritis, osteomyelitis, and myositis extensively. It is crucial to consider musculoskeletal infection associated with DVT in any child who presents with severe swollen limbs and limitations of motion. Prompt antibiotic and anticoagulant treatments should be initiated to reduce the risk of fatal complications.
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PMID:Musculoskeletal Sepsis Associated with Deep Vein Thrombosis in a Child. 2427 76

Central venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.
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PMID:How I treat central venous access device-related upper extremity deep vein thrombosis. 2837 61


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