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

Between 1986 and 1992, 32 thoracolumbar fractures in 32 patients were treated nonoperatively with 4-6 weeks on a rotorest bed followed by bracing with a thoracolumbosacral orthosis for a total of 3-6 months. The fractures were classified as 20 burst, six fracture dislocations, five severe compression fractures, and one gunshot wound. There were 12 multilevel fractures. Nine patients had incomplete neurological injuries and three had complete neurological injuries. The average age was 36.8 years (range 17-63) and the average follow-up was 22.3 months (range 12-60). Fifty three percent (17/32) of these had multisystem injuries including visceral trauma and long extremity fractures. There were only two complications; a deep vein thrombosis and a heel ulcer. Neither of these complications extended the patients' hospital stay. All nine of those with incomplete neurological injuries improved at least one Frankel grade. Fifteen of 24 patients who were employed returned to their previous jobs, and only nine patients had persistent back pain requiring medication. Surgical treatment of thoracolumbar fractures is often favored over conservative treatment in the multitrauma and neurologically injured patient because of complications related to bedrest. However, by using a rotorest bed and aggressive physical therapy, conservative treatment may actually result in lower morbidity.
Paraplegia 1995 Feb
PMID:Non-operative treatment of thoracolumbar fractures. 775 71

Retrospective and prospective epidemiological studies in Bucharest indicated a high rate of spinal injuries (about 28.5 per million population per year) in Romania. Most patients were poor, male, manual workers. Half of them were aged less than 40. Falls, particularly from horse-drawn carts, and road traffic accidents were the most frequent causes of injury. In summer, diving accidents were a common cause of spinal injuries. Sixty per cent of the patients had cervical injuries. Pressure sores became less frequent as staff and relatives were trained to turn and position patients. Because gastroduodenal bleeding and deep vein thrombosis were rare, the systematic use of drugs to prevent these conditions was deemed to be unnecessary, given the financial constraints. A shortage of beds and facilities made it difficult to manage associated injuries in a neurosurgical clinic in Bucharest or to admit all patients for rehabilitation. Thirty-nine per cent of all patients admitted with spinal injuries had spinal surgery (61% of those with neurological impairment). Bone grafting was the most common procedure for cervical injuries; surgical stabilisation was not commonly performed due to the shortage of plates and screws. The mortality rate in the early days post injury decreased from 22% (1985-1991) to 10.1% (1992) as medical management improved and the relatives helped with care in the acute phase. A programme is needed in Romania to prevent the accidents that cause spinal injuries and to improve clinical management. As a result of this study, three films were made to aid the prevention of accidents and to train staff and relatives in the care of those with spinal cord injuries.
Paraplegia 1994 Nov
PMID:Epidemiology of spinal injuries in Romania. 788 13

Pulmonary embolism (PE) is a devastating complication in patients with traumatic spinal cord injury (SCI). Prophylactic measures such as venous compression hose or low-dose heparin are only partially protective in reducing the risk of venous thromboembolism and are contraindicated in some patients. Because of extended perturbations in fibrinolytic activity, catecholamine effects on platelet aggregation, increased activity of complement and acute phase reactants, abnormally high factor VIII concentrations, and persistent venous stasis with ongoing endothelial damage, the patient with an SCI remains at prolonged risk for venous thromboembolism. A retrospective 5-year review at the Medical Center Hospital of Vermont revealed seven patients with eight documented PEs (three fatal; 2.7%) in 111 SCI patients (6.3%). Six PEs (75%) occurred after discharge from the acute care facility. Median time to PE after injury was 78 days (range, 9-5993). Although comprising only 4% of all trauma admissions, SCI accounted for 31% of all PEs in the total trauma population (2525 patients). Beginning in July 1991, a new prophylaxis protocol was instituted, which included the percutaneous insertion of vena cava filters under local anesthesia in all SCI patients with paraplegia or quadriplegia. Fifteen patients have undergone the insertion of titanium filters. Impedance plethysmography was performed weekly to detect deep venous thrombosis. No complications were associated with vena cava filter insertion. No patients developed deep venous thrombosis during their acute hospitalization (median, 22 d), and no patients have developed PE after filter insertion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prophylactic vena cava filter insertion in patients with traumatic spinal cord injury: preliminary results. 796 30

Recent articles in the literature on adults have recommended prophylaxis for pulmonary embolism (PE) in selected trauma patients; however, to date no information is available regarding pediatric patients. We decided to investigate whether the incidence of PE in pediatric trauma patients is as high as that reported in adults, and identify those children who might be at high risk and benefit from prophylactic treatment. Utilizing the data from the National Pediatric Trauma Registry (NPTR), records were reviewed of all pediatric trauma patients (age < 19 years) admitted to the participating institutions between December 1987 and February 1993. Patients with documented PE were identified as well as those having associated risk factors as identified in adult trauma patients (deep venous thrombosis, extremity injury, spinal cord injury, and head injury). A total of 28,692 pediatric trauma patients were reviewed from the NPTR. The mean age was 9 years and the mean Injury Severity Score for the group was 11. Two thousand one children (7%) had serious head injuries (Glasgow Coma Scale score < 8), over 5700 (20%) had an isolated extremity injury, 290 had an identified spinal cord injury (108 with associated paralysis), and deep venous thrombosis was identified in 6 patients. Pulmonary embolism occurred in only two of the children in this series. Both patients with PE had spinal cord injuries with associated paraplegia, significant pulmonary injury, and high ISSs (25 and 27). The overall incidence of PE in the group was 0.000069%, and for those children with paralysis from spinal cord injury 1.85%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonary embolism in pediatric trauma patients. 799 3

In this study to determine the incidence of deep vein thrombosis (DVT) in spinal cord injury (SCI) patients, we evaluated 30 instances of bilateral ascending venography obtained in 31 patients. Every patient was on prophylactic low dose heparin anticoagulant therapy. The incidence of DVT was found to be 53.3%. Adverse effects due to venography were seen in 10% of patients. No major complications including postvenographic phlebitis and allergic reactions were observed.
Paraplegia 1993 Sep
PMID:Deep vein thrombosis in spinal cord injured patients. 824 3

Three patients are presented with traumatic spinal cord injury (SCI) complicated by acute heterotopic ossification (HO), and concurrent deep vein thrombosis 15 months, 18 months and 22 years after SCI, accompanied by persistent hypercoagulation. The diagnosis of HO preceded deep vein thrombosis in all three patients. All were treated with etidronate disodium and therapeutic heparin followed by oral anticoagulation. As these patients were not acutely injured, the questions arose as to what predisposed them to deep vein thrombosis and when was the appropriate time to discontinue anticoagulation. Over a course of 3 years following deep vein thrombosis, these patients were monitored for evidence of hypercoagulation by D-dimer assay, plasma fibrinogen estimation, and rate of whole blood clotting by Sonoclot coagulation analyzer. The activity of acute HO was assessed by three-phase bone scan. A steady state of hypercoagulation, reflected by an increase in all three parameters, ran parallel to the extent of acute HO for the entire observation period. Moreover, hypercoagulation was persistently greater during increased acute HO activity even when the warfarin-induced prothrombin time ratio was 1.2-1.5. In addition, as acute heterotopic ossification activity decreased, the test values returned to near normal during warfarin therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Paraplegia 1993 Oct
PMID:Persistent hypercoagulation associated with heterotopic ossification in patients with spinal cord injury long after injury has occurred. 825 28

The goal of the present study was to use intravenous etidronate in the acute phase of heterotopic ossification (HO) in an attempt to achieve a high initial drug concentration at the site of the active ectopic ossification. The study included 27 consecutive patients with an acute onset of HO after spinal cord injury (SCI). The three-phase bone scan was used to confirm clinical diagnosis of HO. Disodium etidronate (Didronel) 300 mg was administered intravenously daily for 3 to 5 days. In 20 patients there was a rapid (1-2 days) decrease of soft tissue swelling (p < 0.01) with no side effects associated with the intravenous administration. In seven patients there was minimal or no improvement of edema after intravenous etidronate. In these patients deep vein thrombosis was found in the affected limbs. The effect of high dose etidronate on HO was determined in the group of 13 patients with positive clinical and scintigraphic finding of an acute HO, but negative radiographic studies. After intravenous administration of etidronate for 3 days (300 mg/day) the drug was continued orally with 20 mg/kg/day for 6 months. A placebo was not used in this study. In eight patients there was no radiographic evidence of HO after therapy while two patients had minimal ossifications. In three patients therapy was interrupted and all developed HO in 1-2 months.
Paraplegia 1993 Oct
PMID:Intravenous disodium etidronate therapy in spinal cord injury patients with heterotopic ossification. 825 29

Heterotopic ossification (HO) is a potentially disabling complication of spinal injuries and other chronic disorders. It is of unknown aetiology and currently there is no easy or convenient diagnostic method that will allow very early confirmation of the inflammatory changes that precede osteoid and, later, true bone formation. Clinical experience, however, indicates that early treatment with radiotherapy, antiinflammatory agents or diphosphonates is needed to control the progression. This study was undertaken to assess the role of ultrasound (US) in the very early diagnosis of HO in patients with spinal injuries. US was found to be very sensitive in detecting focal soft tissue abnormalities around joints and in the muscles of these patients. If combined with a Doppler study to exclude deep venous thrombosis (DVT), and infection or tumour could be excluded clinically, US was extremely accurate in predicting the presence or absence of early HO changes within hours of the clinical manifestation. In 2 patients it successfully predicted HO in the opposite leg before clinical signs were evident. This study also provided supportive evidence of the theory of microtrauma in the aetiology of HO. As ultrasound is portable, safe, cheap, reproducible and accurate, it is the method of choice in the early diagnosis of HO. It allows early treatment to prevent the formation of osteoid and subsequent bone formation.
Paraplegia 1993 Aug
PMID:Ultrasound in the early diagnosis of heterotopic ossification in patients with spinal injuries. 841 33

The medical records of 209 patients with acute traumatic spinal cord injury (SCI) admitted to the SCI rehabilitation unit from 7/1/88 through 12/31/92 were reviewed. Whereas the incidence of heterotopic ossification (HO) and deep venous thrombosis (DVT) in this population were 16.7% and 14.3%, respectively, 36.6% of the individuals with DVT had HO. 31.4% of those with HO developed DVT at some time during their acute or rehabilitation hospitalization. The overall incidence of coexistent DVT and HO was 5.3%. The correlation between the occurrence of HO and DVT in this SCI population reached statistical significance (chi 2 = 9.97; p < 0.005). The results of this study suggest that there exists an association between the occurrence of DVT and HO following traumatic SCI. We hypothesize that venous compression from expanding heterotopic bone can result in lower limb DVT following traumatic SCI.
Paraplegia 1993 Aug
PMID:The association between deep venous thrombosis and heterotopic ossification in patients with acute traumatic spinal cord injury. 801 47

A variety of stimuli including neurological insult may provoke primitive mesenchymal cells to differentiate into bone forming cells. Such a sequel following spinal cord injury can delay rehabilitation, enhance the spasticity and reduce the range of movement in the affected joint. It is characterised by an initial inflammatory phase followed by heterotopic bone formation. The early inflammatory lesion clinically mimics deep vein thrombosis, a developing pressure sore, infection, and tumour. An early diagnosis at a time of clinical uncertainty, before the plain radiographic features develop, has distinct advantages and therapeutic implications. The unique pathological evolution and maturation of the lesion is clearly demonstrated by sequential sonographic (ultrasonic) assessment with depiction of the 'zone phenomena' seen on histology. Sonographic scans in 7 spinal injury patients proved diagnostic, before there was radiographic evidence of bone formation, and confidently excluded HBF in a further 18 patients without any false negative results.
Paraplegia 1993 Jan
PMID:Sonographic diagnosis of heterotopic bone formation in spinal injury patients. 844 47


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