Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic venous leg ulceration, which tends to recur, is difficult to treat and therefore needs special diagnostic and therapeutic care. We recently treated a 45-year-old patient with an obstruction of the left external iliac vein, caused by deep venous thrombosis. We would like to propose that, although rare, the existence of pelvic vein thrombosis and obstruction can cause venous leg ulcers. This case clearly pointed out that in patients with crural leg ulceration, showing no other signs of chronic venous insufficiency and where duplex ultrasound is normal, additional diagnostic evaluation should be performed. Because standard duplex ultrasound investigation can fail to demonstrate the obstruction, phlebography should be used in suspected cases as a secondary test to check both the superficial and the deep venous system for pathology, applying the endovascular therapeutic stent-placement technique.
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PMID:Chronic external iliac vein obstruction as a cause of leg ulceration. 1535 77

A 54-year-old man of Persian origin presented to our department with a 1-year history of ulcers on the right leg that had been unresponsive to numerous topical treatments, accompanied by lymphedema of the right leg. Medical history included hypergonadotropic hypogonadism, which had not been further investigated. He was treated for 20 years with testosterone IM once monthly, which he stopped a year before the current hospitalization for unclear reasons. The patient reported no congenital lymphedema. Physical examination revealed two deep skin ulcers (Figure 1) on the right leg measuring 10 cm in diameter with raised irregular inflammatory borders and a boggy, necrotic base discharging a purulent hemorrhagic exudate. Bilateral leg pitting edema and right lymphangitis with lymphadenitis were noted. He had low head hair implantment, sparse hair on the body and head, hyperpigmentation on both legs, onychodystrophia of the toenails (mainly the large toe and less prominent on the other toes), which was atrophic lichen-planus-like in appearance and needed no trimming (Figure 2), normal hand nails, oral thrush, and angular cheilitis. Other physical findings were gynecomastia, pectus excavatum, small and firm testicles, long extremities, asymmetrical goiter, systolic murmur 2/6 in left sternal border, and slow and inappropriate behavior. The patient's temperature on admission was 39 degrees C. Blood cultures were negative for bacterial growth. Results of laboratory investigations included hemoglobin (11.2 g/dL), hematocrit (26.8%), normal mean corpuscular volume and mean corpuscular hemoglobin volume, and red blood cell distribution width (16%). Blood smear showed spherocytes, slight hypochromia, anisocytosis, macrocytosis, and microcytosis. Blood chemistry values were taken for iron (4 micro g/dL [normal range 40-150 micro g/dL]), transferrin (193 mg/dL [normal range 220-400 mg/dL]), ferritin (1128 ng/mL [normal range 14-160 ng/mL]), transferrin saturation (1.5% [normal range 20%-55%]), serum folate (within normal limits), and vitamin B12 (within normal limits). Direct Coombs' test equaled positive 2 + IgG. All these values indicated anemia of chronic diseases combined with hemolytic anemia. Further blood work-up tested antinuclear antibody (positive <1:80 homogeneous pattern), rheumatoid factors (143 IU/mL [positive >8.5 IU/mL]), C-reactive protein (286 mg/L [normal range 0-5 mg/L]), anticardiolipin IgM antibody (9.0 monophosphoryl lipid U/mL [normal range 0-7.00 MPL U/mL]) and antithrombin III activity (135% [normal range 74%-114%]). Results of other blood tests were within normal limits or negative, including lupus anticoagulant, beta2 glycoprotein, anticardiolipin IgG Ab, anti-ss DNA Ab, C3, C4, anti-RO, anti-LA, anti-SC-70, anti-SM Ab, P-ANCA, C-ANCA, TSH, FT4, anti-T microsomal, antithyroglobulin, protein C activity, protein S free, cryoglobulins, serum immunoelectrophoresis, VDRL, hepatitis C antibodies, hepatitis B antigen, and human immunodeficiency virus. Endocrinological work-up examined luteinizing hormone (22.9 mIU/mL [normal range for adult men 0.8-6 mIU/mL]), follicle stimulating hormone (49.7 mIU/mL [normal range for adult men 1-11 mIU/mL]), testosterone (0.24 ng/mL [normal range for adult men 2.5-8.0 ng/mL]), bioavailable testosterone (0.02 ng/mL [normal range for adult men >0.6 ng/mL]), and percent bioavailable test (8.1% [normal value >20%]). These results indicate hypergonadotropic hypogonadism. Plasminogen activator inhibitor 1 was 6 U (normal value 5-20 U/mL). Karyotyping performed by G-banding technique revealed a 47 XXY karyotype, which is diagnostic of Klinefelter's syndrome. Doppler ultrasound of the leg ulcers disclosed partial thrombus in the distal right femoral vein. X-rays and bone scan displayed osteomyelitis along the right tibia. Histological examination of a 4-mm punch biopsy from the ulcer border revealed hyperkeratosis, acanthosis, hypergranulosis, and mixed inflammatory infiltrate containing eosinophils compatible with chronic ulcer. Multiple vessels were seen, compatible with a healing process. Direct immunofluorescence of the biopsy revealed granular IgM in the dermo-epidermal junction. Indirect immunofluorescence was negative. Thyroid function tests showed normal thyroid stimulating hormone and free throxine4. Multinodular goiter was seen on thyroid scan and ultrasound. Thyroid fine needle aspiration was compatible with multinodular goiter (normal follicular cells, free colloid, macrophages with pigment). IV treatment with amoxicillin-clavulanic acid 1 g t.i.d. was administered for 2 weeks, with a decrease in temperature and normalization of the leukocyte level. Oral antibiotic treatment with amoxicillin-clavulanic acid was continued for 10 more days, followed by 25 days of ciprofloxacin for the osteomyelitis. Local treatment included saline soakings followed by application of Promogran (Johnson & Johnson, New Brunswick, NJ) and Kaltostat (ConvaTec Ltd., a Bristol-Myers Squibb Company, New York, NY) with slight improvement. At the same time, the patient was treated with warfarin sodium due to deep vein thrombosis under international normalized ratio 2-3. The patient was treated with IM testosterone once monthly for 1 year, which resulted in a reduction in the diameter and depth of the leg ulcers (Figure 3). Blood tests were not performed for follow-up of the immune state.
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PMID:Klinefelter's syndrome presenting with leg ulcers. 1536 65

The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found.
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PMID:Lower extremity arterial and venous ulcers. 1592 1

This review discusses the epidemiology, pathogenesis, diagnosis and current therapeutic options for venous ulcer. Venous ulcer is a severe clinical manifestation of chronic venous insufficiency (CVI). It is responsible for about 70% of chronic ulcers of the lower limbs. The high prevalence of venous ulcer has a significant socioeconomic impact in terms of medical care, days off work and reduced quality of life. Long-term therapeutics are needed to heal venous ulcers and recurrence is quite common, ranging from 54 to 78%. Thrombophlebitis and trauma with long-term immobilization predisposing to deep venous thrombosis are important risk factors for CVI and venous ulcer. The most recent theories about pathogenesis of venous ulcer have associated it with microcirculatory abnormalities and generation of an inflammatory response. Management of venous leg ulcers is based on understanding the pathogenesis. In recent years novel therapeutic approaches for venous ulcers have offered valuable tools for the management of patients with this disorder.
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PMID:Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. 1594 30

Compressive stockings are considered the centerpiece of treatment in chronic venous disease (CVD). It is known that stockings fail in some patients for varied reasons: they are ineffective despite wear in some, but more commonly patients are unable or unwilling to use them as prescribed. Detailed statistics regarding stocking compliance have not been available except in a few selected series focused on leg ulcers. This study focuses on use, compliance, and efficacy of compression stockings among a large cohort of patients referred to a tertiary venous practice. A total of 3,144 new CVD patients were seen from 1998 to 2006. As a referral practice, patients had been under the care of primary-care physicians or specialists for variable times before. A detailed history of past and present compressive regimens was part of our initial evaluation of CVD patients. These data were entered into a time-stamped electronic medical record and later analyzed. Only 21% of patients reported using the stockings on a daily basis, 12% used them most days, and 4% used them less often. The remaining 63% did not use the stockings at all or abandoned them after a trial period in the past. The primary reasons given for nonusage were as follows: unable to specify a reason, 30%; not prescribed by the primary physician, 25%; did not help, 14%; binding/"cutting off" of circulation, 13%; "too hot" to wear, 8%; limb soreness, 2%; poor cosmetic appearance, 2%; unable to apply without help, 2%; contact dermatitis or itching, 2%; and other (cost, work situation, etc), 2%. Multiple factors were cited by 8%. Surprisingly, there was no difference in compliance between men and women (39% vs. 38%) or among different decile age groups. Compliance was relatively better at 50% in patients who gave a prior history of deep vein thrombosis (n = 675) compared to 35% in those without such a prior history (n = 2,437) (p < 0.0001). Compliance was poor in CEAP lower (0-2) as well as higher (3-6) clinical classes (p = nonsignificant). Overall compliance with stockings was low and statistically not different in several subsets with significant symptoms: compliance in pain, 39%; swelling, 37%; stasis dermatitis, 46%; and stasis ulceration, 37%. Compliance was relatively better with longer duration of symptoms: <1 year, 25%; 1-5 years, 34%; 6-10 years, 40%; >10 years, 44% (p < 0.003). Symptoms were still persistent in about a third (37%) of the patients despite apparent compliance with prescribed stockings. Compressive stockings are inapplicable in about a quarter of patients due to the condition of the limb or the general health of the patient. They are ineffective despite wear in about a third of patients seen. In the remainder, noncompliance with prescribed compressive stockings is an apparent major cause of treatment failure. Noncompliance is very high in patients with CVD regardless of age, sex, etiology of CVD, duration of symptoms, or disease severity. The reasons for noncompliance can be grouped into two interdependent major categories: (1) wear-comfort factors and (2) intangible sense of restriction imposed by the stockings.
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PMID:Use of compression stockings in chronic venous disease: patient compliance and efficacy. 1798 Jul 98

The incidence of the post-thrombotic syndrome (PTS) is increasing along with the incidence of deep vein thrombosis (DVT). The overall frequency of PTS ranges from 20 percent to 50 percent of DVT patients; severe PTS, which includes leg ulcers, occurs in a quarter of cases. Because of its severity and chronicity, PTS is associated with great morbidity and cost. Its diagnosis is primarily based on the presence of typical symptoms and signs, but objective evidence of venous valvular reflux can help to confirm the diagnosis. Because therapeutic options for PTS are extremely limited and results are often disappointing, prevention, recognition of clinical signs or complications, and early treatment remain the keys to reducing its morbidity. The prevention of DVT recurrence by anticoagulation and use of graduated compression stockings is likely to reduce the risk of PTS. There is no proven role for thrombolysis in preventing PTS.
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PMID:The post-thrombotic syndrome - a condition to prevent. 1862 14

Anti Phospholipid Syndrome (APS) is a relatively new conception of syndrome complex first noticed in 1983. It may be primary or secondary to other diseases like SLE, RA, Systemic sclerosis, behchet's syndrome, temporal arteritis, sjogren's syndrome psoriatic arthropathy etc. Clinical manifestations are consequences of vascular thrombosis and embolism like DVT, pulmonary embolism, stroke, TIA, complication of pregnancy with pregnancy loss. We report a 34 years married female housewife who presented with sudden onset of nausea, vomiting, vertigo, dysphagia, dysarthria and ataxia. She had a chronic leg ulcer. Neurological findings were consistent with lateral medullary syndrome due to stroke though she was normotensive, nondiabetic with normal lipid profile. She had history of two abortions in last three years. Investigations were done accordingly and she fulfilled the diagnostic criteria of APS. No secondary cause was detected after thorough clinical examination and laboratory investigations. She was treated symptomatically along with oral anticoagulation. She improved slowly but steadily.
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PMID:Anti phospholipid syndrome. 1918 54

Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic leg ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic leg ulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community leg ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the ulcer duration (P = 0.002), complexity of the ulcer aetiology (P = 0.035), presence of lipodermatosclerosis (P = 0.02), history of deep vein thrombosis (DVT) (P = 0.03) and thrombophlebitis (P = 0.03). Multivariate analysis showed that ulcer duration (P = 0.014), DVT (P = 0.008) and a lack of Pseudomonas on wound swab (P = 0.005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic leg ulceration. There appears to be little scope for interventions to improve healing from the factors identified.
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PMID:Clinical predictors of leg ulcer healing. 1978 16

Venous leg ulcers (VLUs) are a significant health problem that afflicts 1% of the population at some point during their lifetime. Intermittent pneumatic compression (IPC) is widely used to prevent deep venous thrombosis. However, IPC seems to have application to a broader base of circulatory diseases. The intermittent nature of pulsatile external compression produces beneficial physiologic changes, which include hematologic, hemodynamic, and endothelial effects, which should promote healing of VLUs. Clinical studies of the management of VLUs show that IPC increases overall healing and accelerates the rate of healing, leading to current guideline recommendations for care of patients with VLUs. Proper prescription of IPC to improve the management of patients with VLUs requires further definition. It seems that application of IPC in combination with sustained graduated compression improves outcome in patients with the most advanced venous disease.
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PMID:Intermittent pneumatic compression: physiologic and clinical basis to improve management of venous leg ulcers. 2105 Jul 1

Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort, pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n = 11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3), hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that physical functioning was the domain most affected among this group. This study has identified the need to raise awareness of this condition among clinicians working in the area of wound management.
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PMID:Prevalence of lymphoedema and quality of life among patients attending a hospital-based wound management and vascular clinic. 2191 Aug 29


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