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

Pathologic thrombosis, in the form of pulmonary embolism (PE) and deep venous thrombosis (DVT), causes significant morbidity and mortality in trauma patients and presents a diagnostic and therapeutic challenge because of associated conditions in these patients. This study examines the measurement of D-dimer crosslinked fibrin degradation products (D-dimer XDPs) as an indicator of hypercoagulability that places a trauma patient at risk of developing pathologic thrombosis. The time course of changes in D-dimer values after trauma normally involves an initial increase with a rapid decrease of D-dimer XDP levels to normal. Patients who then demonstrate a second rise in D-dimer values are at risk for pathologic thrombosis. Forty-one trauma patients were studied, in two groups, to evaluate the potential use of D-dimer XDP levels in evaluating the risk of pathologic thrombosis. A secondary increase in D-dimer XDP levels was found to occur in patients with PE, although sepsis and adult respiratory distress syndrome can also cause a late increase. However, D-dimer determinations appear to provide an easy, relatively inexpensive means of evaluating trauma patients for the risk of pathologic thrombosis.
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PMID:D-dimer levels correlate with pathologic thrombosis in trauma patients. 150 98

A retrospective review covering a 9-year period revealed 113 patients who underwent 157 major bowel procedures during 130 operations performed solely by gynecologic oncology surgeons. Forty-eight percent of the operations were done for tumor cytoreduction, and 33% were performed for a bowel obstruction. Other indications included colostomy closure, fistula repair, resection for multiple enterotomies, temporary diversions, repair of perforated bowel, treatment for severe proctosigmoiditis, management of ureteral stricture, treatment for vulvar necrosis, and resection of an incidental small bowel tumor. Of the 157 procedures, 44% were colostomies, 32% were bowel resections with reanastomosis, 9% were urinary conduits, 6% were intestinal bypass procedures, 5% were colostomy closures, and 4% were ileostomies. Postoperative complications occurred in 32% of the 130 operations. These included wound infection, death, sepsis, fistula formation, urinary tract infection, unexplained febrile morbidity, anastomotic leakage, stomal infarction, adult respiratory distress syndrome, bowel obstruction, deep venous thrombosis, and wound hematoma. Four of the eight deaths were due to tumor progression, three were from sepsis, and one was from adult respiratory distress syndrome. Of the 130 operations, 89 (68%) were associated with no complications. These data support the concept that gynecologic oncology surgeons are able to perform intestinal operations as therapy for gynecologic malignancies with acceptable complication rates. Since a thorough understanding of the natural history of the cancer, familiarity with alternative therapeutic options, and knowledge of the prognosis are important in making operative decisions, and since gynecologic oncologists are technically capable of performing operations on the small bowel and colon, referral of patients with a primary or recurrent gynecologic malignancy or with a subsequent intestinal complication after initial therapy should be directed to the gynecologic oncologist whenever possible.
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PMID:Intestinal surgery performed on gynecologic cancer patients. 198 13

A previously healthy 70-year-old woman was hospitalized for acute pain and edema of her right leg. Deep vein thrombosis was suspected, and she was put on anticoagulant therapy. Ten hours later, she developed a massive swelling of the leg with a well-demarcated violaceous discoloration of the skin and hemorrhagic bullae. She was in deep shock with signs of disseminated intravascular coagulation and adult respiratory distress syndrome. Gram stain of an aspirate from the bullae revealed short chains of Gram-positive cocci, and multiple blood cultures showed abundant growth of Streptococcus pyogenes. Despite intensive treatment, the patient died within hours. Autopsy findings showed extensive pyomyonecrosis of the leg muscles and changes secondary to septicemia. The misleading initial clinical picture and the rarity of this disease entity in temperate climates delayed the correct diagnosis and resulted in a fatal outcome.
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PMID:Fulminant streptococcal myositis. 264 2

As advancements are made in the prevention of automobile fatalities, an increase in the incidence of pelvic and lower extremity injuries has occurred. These remain the leading causes of impairment and loss of years of productive life. Pelvic trauma has a high initial mortality rate when severe. However, with early resuscitation and transport, more survivors arrive in our trauma centers harboring these injuries. Owing to early stabilization and mobilization of the traumatized patient, a decrease in complications in these patients has been noted. Both the trauma surgeon and the orthopedic trauma surgeon should work as a team and remain in continuous communication during the treatment of these patients. Open fractures are among the most difficult problems to manage; early and aggressive decisions can prevent a lifetime of complications and physical impairment. As previously stated, to obtain good outcomes, open fractures must be treated initially at the accident scene followed by timely transport to the trauma center for definitive care. It must be remembered that the golden time to prevent major complications is 6 hours. Intra-articular fractures of the lower extremity involve a major weight bearing joint. Post-traumatic arthritis and impairment develop in joints where joint congruity is not achieved. To preserve normal function, there should be articular congruity, stable fixation, axial alignment with the rest of the extremity, and restoration of full range of motion. Immediate stabilization of long bone fractures has many advantages in the multiply injured patient, such as improved long-term function, prevention of deep venous thrombosis and decubitus ulcer, decreased need for analgesia, and reduction in the incidence of adult respiratory distress syndrome and fat emboli. Patients with femoral shaft fractures should undergo immediate stabilization of the fracture within 24 hours of injury. We have presented a series of orthopedic injuries that have high mortality and high morbidity which, if not treated expediently, yield a high degree of impairment.
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PMID:The management of complex orthopedic injuries. 878 79

A prospective, controlled study of fixation for femoral shaft fractures was undertaken by the Documentation Centre of the Association for the Study of Internal Fixation (AO/ASIF) at 7 Swiss and 5 foreign clinics in Europe, South America and Asia. 283 fractures in 272 patients were evaluated. 17% of all patients suffered a polytrauma. Only two fractures (1%) were treated conservatively. Ten percent of all fractures were stabilised by external fixation, 35% were plated and 54% were treated by reamed intramedullary nailing. An ARDS and deep venous thrombosis occurred in 1% respectively. The local infection rate was 2%. Seven patients (2.5%) died perioperatively. 32 fractures (12%) were reoperated. At follow-up 86% of all fractures appeared consolidated on radiography. Full limb function was restored in 61% of all patients, slight impairment persisted in 32% and 6% of all patients remained severely handicapped. The average age of the female patients was significantly higher in Europe. Wide differences existed in the administration of prophylactic antibiotics and antithrombotic drugs. In some centers antithrombotic drugs were not part of the treatment scheme. Femoral shaft fractures were treated with high priority in Switzerland. Patients profited from short transport ways and from the routine use of high end material. Most operations in Switzerland were performed by registrars. Their assessment of stability of the fixation was high, as 90% of all patients were allowed to bear weight postoperatively. There is an international consensus on the need for surgical stabilisation of femoral shaft fractures. However divergent views on surgical management and perioperative care remain.
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PMID:[Fixation of femoral shaft fractures from a Swiss viewpoint. An international prospective controlled study by the Study Group for Osteosynthesis Problems]. 919 Feb 79

METHODS: Evaluated are surgical difficulties, management problems and weight loss in patients with distal gastric bypass as a revisionary procedure. Eighty patients were followed up to 3 years; four were lost to follow-up. Mean age was 43; mean prebariatric surgery weight 134 kg; height 1.65 meters; body mass index 40.1; ideal body weight 62.7 kg; excess weight 70.5 kg; per cent excess weight 214%. A 250 cm stomach-to-ileocecal valve segment of small bowel was used, and the biliopancreatic secretions were brought into the terminal ileum 100 6 in from the ileocecal valve. Mean pouch size was 63 cc; length of hospital stay 5 days; operative blood loss 616 cc; operative time 130 min. RESULTS: Intraoperative complications included three splenic injuries (without splenectomy). Early complications included one deep vein thrombosis, two marginal ulcers, one GI hemorrhage, one wound dehiscence, one pouch outlet obstruction and one pancreatitis. Late complications included: one death from protein malnutrition/ ARDS; 21 hypoproteinemia; six protein malnutrition, and of these, three had hyperalimentation; three cholecystitis; 27 anemia; 22 incisional hernia; two staple-line disruption (reoperated); 26 low serum iron; 11 prolonged (>6 months) diarrhea; three prolonged frequent vomiting; and two unrelated deaths (chronic myelogenous leukemia and amyotrophic lateral sclerosis). Mean excess weight loss was 83% at 12 months; 89% at 24 months; and 94% at 36 months. CONCLUSION: The distal gastric bypass is fraught with the operative and immediate post-operative complications experienced in any revisionary bariatric surgery. Distal gastric bypass is very effective in producing long-term weight loss. Nutritional problems are common but usually easily corrected. The most serious nutritional complication is protein malnutrition, which must be identified and corrected early. Success of this procedure is dependent upon patient compliance with proper nutrition and supplements, and regular office follow-up with monitoring of laboratory data. Patients who are noncompliant are at significant risk for complications.
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PMID:The Gastric Bypass for Failed Bariatric Surgical Procedures. 1072 55

The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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PMID:Unusual manifestations of the antiphospholipid syndrome. 1279 62

Authors report the case of a pregnant woman with antiphospholipid syndrome associated with HELLP syndrome. Pregnancy was terminated because of severe preeclampsia. However the patient's condition worsened. New symptoms of antiphospholipid syndrome developed (deep vein thrombosis, ischaemic optic lesion) and ARDS, therefore respiratory therapy was introduced. Plasmaphereses were performed concomitantly with high-dose intravenous immunoglobulin, glucocorticoid, cyclophosphamide and anticoagulant therapy. She responded to the therapy well, and eventually recovered completely. There are only a few case reports about pregnancies complicated with the association of antiphospholipid syndrome and HELLP syndrome. To authors' best knowledge, this is the first Hungarian report about this rare and curious association and it's successful treatment.
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PMID:[Primary antiphospholipid syndrome associated with HELLP syndrome in pregnancy]. 1290 49

One hundred ninety eight adult patients who had sustained long bone fractures were treated by external fixation from admission to bone healing and consolidation. Of these, 135 had sustained high-energy injuries, 39 of them had suffered multi-system injuries. Superficial pin track infection was the most common complication, occurring predominantly in pins located in the femur, upper tibia and upper humerus. There were no cases of deep infection or osteomyelitis. One patient with a femoral shaft fracture developed a DVT although he was on preventive low molecular weight heparin, i.e. sc Clexane 40 mg daily. There were no cases of PE or ARDS. External fixation systems are a minimal invasive surgical modality, which allow three-dimensional fracture fixation after closed or minimal open reduction. They require a good command of surgical anatomy, but provide an optimal preservation of the fracture's soft tissue envelope, the critical biological factor for new bone formation and fracture healing. Recent publications have suggested that in the critically ill patient, minimally invasive fracture fixation surgery may prevent the perpetuation of a reactive, life threatening inflammatory reaction (the "second hit") which may induce the development of multiple organ dysfunction (MODS).
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PMID:Complications encountered while using thin-wire-hybrid-external fixation modular frames for fracture fixation. A retrospective clinical analysis and possible support for "Damage Control Orthopaedic Surgery". 1582 16

Bilateral femur fractures have been associated with frequent morbidity and mortality. Associated injuries and massive hemorrhage contributed to mortality rates that were as high as 27% in previous reports. The goals of this study were to determine the frequency of associated complications, including mortality, and to identify which patient and injury features are associated with increased morbidity and mortality. The authors proposed that some patients with bilateral femur fractures may undergo early definitive fixation with an acceptable rate of complications. Patients who had bilateral femur fractures during the same injury event were retrospectively reviewed. Demographic characteristics, associated injuries, and the type and timing of treatment were determined. Complications were identified. The authors identified 50 men and 22 women, with a mean age of 41.5 years, who had high-energy bilateral femur fractures. These patients accounted for 5.5% of all femur fractures treated at the authors' institution over a period of 11 years. Two patients died before fixation. In addition, 13 other patients (19%) had 21 complications, including pneumonia in 6 (8.6%) and deep venous thrombosis in 7 (10%). No patient had adult respiratory distress syndrome, but 2 died of multiple organ failure. All patients with pulmonary complications had an underlying chest injury (P=.004). The overall mortality rate was 6.9%, and mortality was associated with higher mean age and higher Injury Severity Score (ISS). Of the 60 patients who had definitive fixation within 24 hours of injury, 53 (88%) had no complications. Complication rates were similar to those reported in the literature, with a mortality rate of 6.9%, including 3 patients who died after femoral fixation. Mortality was associated with advanced age and higher ISS. Chest injuries were associated with pulmonary complications. Most patients had early definitive fixation without complications, but it is not possible to predict which patients may be safely treated on an early basis.
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PMID:Morbidity and Mortality of Bilateral Femur Fractures. 2618 20


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