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

Doppler velocimetry enables three haemodynamic parameters that are extremely useful for the study of venous diseases to be evaluated: blood flow direction, the morphology of the velocity wave and venous pressure. These three parameters are used in association depending on the particular requirements of the diagnostic problem. In the case of suspected deep venous thrombosis, study of the morphology of the velocity wave and clinostatism pressure give good diagnostic possibilities for the iliaco-femoral axis but poor for the leg trunks. In post-thrombotic syndrome, Doppler velocimetry is not so useful because the patient has to remain immobile during the examination while this specific pathology features insufficiency of the muscular pump during walking. In varicose disease, the investigation offers a very high diagnostic capability by evidencing the site and extent of valvular incontinence in the saphena and perforating vessels. The only limitation is the presence of numerous incontinent perforating vessels, but this is infrequent. In this pathology, Doppler v. has almost completely supplanted phlebography because it responds to the needs of modern medicine to replace invasive diagnostic investigations with non-invasive techniques that are equally effective. Finally, two other fields of application are very important for this investigation: the study of a patient with varices prior to saphenic stripping and prior to sclerotherapy. Definition of the origin and course of the reflux ways makes an optimal result possible, even allowing for the evolution of varicosity.
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PMID:[Venous Doppler velocimetry: ten years of development of a method]. 219 4

To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. 793 40

From 1989 to 1991, 480 patients undergoing general surgery under epidural anaesthesia were included in a multicentre, comparative, randomized, open-study designed to assess whether calcium nadroparin (Fraxiparine), one daily subcutaneous injection of 0.3 mL, i.e. 3,075 anti Xa IU per day, is more efficiency and better tolerated than a non-fragmented standard heparin (Calciparine), one subcutaneous injection of 0.2 mL t.i.d. 15,000 IU per day, for the prevention of postoperative deep vein thrombosis (DVT). The 480 patients, treated in 78 centres, were randomized in two groups (Fraxiparine, n = 241; Calciparine, n = 239). In both groups, treatment was started two hours after the end of the surgical procedure. Hernia repair and prostatic surgery accounted for 60% of operations. Thromboembolic events were detected by clinical examination performed at regular time intervals and by a systematic exam (doppler and rheoplethysmography or ultrasonogram) at the end of the treatment. Both agents demonstrated a similar efficiency. There was only one case of DVT, confirmed by phlebography in the Fraxiparine group. Tolerance was good in both groups. The proportion of patients requiring a transfusion was low (3% in each group). Hematuria was relatively frequent (33% in the Fraxiparine group and 28% in the Calciparine group), however these rates were related to prostatic and urinary incontinence surgery. This study, including a wide series of patients undergoing general surgery under epidural anaesthesia, demonstrates that efficiency and tolerance of one daily injection of Fraxiparine are similar to those of three daily injections of Calciparine. It it concluded that Fraxiparine improves of the patient's comfort and decreases the nursing work load.
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PMID:[Efficacy and tolerance of Fraxiparine in the prevention of deep vein thrombosis in general surgery performed with medullar conduction anesthesia]. 799 38

Chronic venous insufficiency of the lower limbs has varied expressions: purely functional disorders, varicose veins, varicosities, oedema and trophic cutaneous disorders. For a given individual, these aspects are not necessarily increasing stages of severity of the same disease. On the other hand, many associations are possible; they are determined by the mechanism and the degree of chronic venous insufficiency, as well as by the clinical situation in which they develop. Work-up is based on careful clinical examination. Doppler examination and echography are useful for varices if radical treatment is considered. Ultrasound examination is required in case of cutaneous ulcer in order not to mistake a varicose ulcer for a trophic disorder due to incontinence of deep venous trunks, most often of thrombotic origin. Varicose veins can become complicated. Varicose haemorrhage requires immediate treatment by compression. Superficial phlebitis needs doppler examination and echography because it can be associated to deep venous thrombosis. With regard to varices and chronic venous insufficiency, treatment varies according to the concerns of the patients. Elastic compression stockings are useful whatever the clinical expression of the disease. "Phlebotropic" drugs can be used whenever venous insufficiency is associated with functional symptoms. The use of radical treatment, whether sclerosing injections or surgery, depends on anatomic lesions, the degree of venous incontinence and the severity of symptoms, but also on the desires of the patients, fully informed as to the advantages and the limitations of each technique. Personalized treatment is thus possible.
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PMID:[Essential varicose veins and chronic venous insufficiency]. 805 10

The study objective was to review the existing literature regarding complications of anti-incontinence sling procedures. PubMed listings using keywords related to slings and associated complications with no date or language restrictions through May 2007 and the Manufacturer and User Facility Device Experience Database were searched for specific device- and procedure-related complications. Where no information was available, published abstracts were cited. Published reports of complications for all types of anti-incontinence sling procedures are analyzed and reported. Sling-related complications are multiple but can be summarized from studies on 13737 cumulative patients as involving: voiding dysfunction (8 studies, 881 patients, 16.3% average overall incidence [OI]); detrusor overactivity (20 studies, 1950 patients, 15.4% OI); urinary retention (14 studies, 943 patients, 14.2% OI); erosion/extrusion (19 studies, 2197 patients, 6.03% OI); impact on quality of life-dyspareunia (2 studies, 175 patients, 4.3% OI); infections-most often urinary tract infections but severe infections such as abscess are reported (19 studies, 1487 patients, 5.5% OI); hematoma-most often pelvic or vaginal (4 studies, 3691 patients, 2% OI); pain (6 studies, 597 patients, 7.3% OI); abdominal and pelvic organ injury-bladder, urethra, vagina, and intestines (10 studies, 1816 patients, 3.3% OI); systemic complications-deep vein thrombosis, sepsis (case reports); and death (case reports). Cure rates for all slings are as follows: subjective (16 studies, 1541 patients, 95% OI, range 63%-99%), objective (15 studies, 1203 patients, 82% OI, range 51%-97%), and failure (8 studies, 599 patients, 11.5% OI, range 4%-37%). It is likely that sling-related complications are under-reported in the published medical literature and in the Manufacturer and User Facility Device Experience Database. This review reports on the incidence of known complications for all types of slings. Some complications are common to all sling techniques; however, with development of minimally invasive slings, device-related complications are reported and compared.
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PMID:A comprehensive review of suburethral sling procedure complications. 1831 81

A 33-year-old male patient with multiple sclerosis (MS) received an emergency laparotomy because of perforated appendicitis. He had been suffering from MS for 2 years and the symptoms of MS were paraplegia and urinary incontinence. Anesthesia was induced with propofol and remifentanil and maintained with nitrous oxide, sevoflurane and remifentanil. Rocuronium was used for tracheal intubation. Train of four ratio and bispectral index scale were also monitored for adequate muscle relaxation and anesthetic depth. The patient emerged from general anesthesia smoothly and was extubated without any complication. Postoperative exacerbation of MS symptoms did not appear. However, he was rehospitalized because deep vein thrombosis (DVT) occurred after discharge and he received heparinization immediately. Eventually, he was discharged after a full recovery from DVT. We report a safe anesthetic management of the patient with MS, with the use of sevoflurane and with no the aggravation of MS during postoperative period.
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PMID:Anesthetic management of the emergency laparotomy for a patient with multiple sclerosis -A case report-. 2117 1

Aggressive assessment and management of the secondary complications in the hours and days following spinal cord injury (SCI) leads to restoration of function in patients through intervention by a team of rehabilitation professionals. The recent certification of SCI physicians, newly validated assessments of impairment and function measures, and international databases agreed upon by SCI experts should lead to documentation of improved rehabilitation care. This chapter highlights recent advances in assessment and treatment based on evidence-based classification of literature reviews and expert opinion in the acute phase of SCI. A number of these reviews are the product of the Consortium for Spinal Cord Medicine, which offers clinical practice guidelines for healthcare professionals. Recognition of and early intervention for problems such as bradycardia, orthostatic hypotension, deep vein thrombosis/pulmonary embolism, and early ventilatory failure will be addressed although other chapters may discuss some issues in greater detail. Early assessment and intervention for neurogenic bladder and bowel function has proven effective in the prevention of renal failure and uncontrolled incontinence. Attention to overuse and disuse with training and advanced technology such as functional electrical stimulation have reduced pain and disability associated with upper extremity deterioration and improved physical fitness. Topics such as chronic pain, spasticity, sexual dysfunction, and pressure sores will be covered in more detail in additional chapters. However, the comprehensive and integrated rehabilitation by specialized SCI teams of physicians, nurses, therapists, social workers, and psychologists immediately following SCI has become the standard of care throughout the world.
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PMID:Advances in the rehabilitation management of acute spinal cord injury. 2309 13

The symptoms of overactive bladder (OAB) can be treated with oral medications using a variety of antimuscarinic medications and, more recently, mirabegron, a beta-3 agonist. However, the use of these medications may be limited for patients because of adverse drug reactions, contraindications, and those who are refractory to oral medications. Recently, intravesical injections of onabotulinumtoxinA (onaBoNTA) have been proven to be safe and effective as an alternative to oral OAB medications. Although this procedure is typically thought to be outside the realm of a consultant pharmacist, there are incidences in which a pharmacist can make a substantial impact on patient care. The patient, a 71-year old female, presents to her urologist for evaluation to assess appropriateness of intravesical onaBoNTA injections. She has failed multiple oral medications for the treatment of her OAB with urge incontinence. The procedure is further complicated by the patient's past medical history of atrial fibrillation (A fib), deep vein thrombosis (DVT), and pulmonary embolism (PE) that require anticoagulation with warfarin therapy. This case demonstrates the use of onaBoNTA for OAB in a patient concomitantly receiving warfarin for A fib, PE, and DVT. Specifically, it demonstrates discontinuation, bridge therapy, and reinitiation of warfarin on a patient undergoing intravesical injections of onaBoNTA for OAB, and a collaborative approach to care between a pharmacist and a urologist.
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PMID:Use of onabotulinumtoxinA for overactive bladder with concomitant warfarin. 2520 8

The purpose of this article is to present a case of cauda equina syndrome in a patient with incomplete motor and sensory deficits due to epidural venous plexus engorgement, owing to May-Thurner syndrome successfully treated with venous iliac stenting. A 40-year-old woman, with previous history of deep vein thrombosis and miscarriages, gradually developed right leg and back pain, with functional limitation, perineal hypoesthesia, and sphincter incontinence. Magnetic resonance imaging revealed epidural venous plexus engorgement and cauda equina roots involvement. Phlebography showed perimedullary venous enlargement and left common iliac vein stenosis, leading to the diagnosis of May-Thurner syndrome. Stenting of the left common iliac vein was performed resulting in pain improvement and disappearance of neurological symptoms. Thrombophilia study was positive to heterozygous factor V Leiden. Cauda equina syndrome as the first presentation of a May-Thurner syndrome is very rare. In this case, venous iliac stent placement was an effective and safe treatment.
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PMID:Cauda Equina Syndrome Caused by Epidural Venous Plexus Engorgement in a Patient with May-Thurner Syndrome. 3120 48