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

Lymphoscintigraphy has been very useful in determination of lymphatic abnormalities. However, the radioactive isotopes used have been investigational and difficult obtain. The purpose of this study was to examine patients with extremity edema by lymphoscintigraphy using a radioactive colloid readily available in our nuclear pharmacy, Technetium 99m sulfur minicolloid. Forty limbs in 20 patients were evaluated using Technetium 99m sulfur minicolloid lymphoscintigraphy. All patients had lower extremity edema initially attributed to a venous or lymphatic etiology. There were 12 patients with normal bilateral studies. Seven patients exhibited unilateral obstruction to lymphatic flow, and one had unilateral enhanced flow of lymph. Those with normal studies included five patients with nonspecific edema, four with varicosities, and one patient each with acute deep vein thrombosis, chylous ascites, and excision of the greater saphenous vein for arterial bypass grafting. Five patients with obstructed patterns had previous arterial bypass procedures, one had trauma to the extremity, and one had lymphedema tarda. The one enhanced lymphoscintigraphic pattern was seen in a patient with acute cellulitis. All patients had Doppler venous examinations and other studies included strain gauge phlethysmography, venograms, computed tomography, magnetic resonance imaging, and ultrasound. As with other scintigraphic imaging agents used to study lymphatic flow, Technetium 99m provides clinically useful information in evaluating the swollen extremity noninvasively.
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PMID:An easy method for diagnosis of lymphedema. 234 Feb 47

In Klippel-Trenaunay syndrome there are congenital vascular malformations, usually involving the limbs. It is characterized by extreme varicose veins, bone and soft tissue hypertrophy and pigmentary skin changes in the affected limbs. We report a 29-year-old pregnant woman with this syndrome. The combination of the physiologic changes which occur in the vascular system and in blood coagulation during pregnancy, and the malformations of this syndrome is very unusual. During the patient's pregnancy there was significant worsening of the typical complications. There was extreme dilatation of varicose veins in the left leg, from the ankle up to the posterior aspect of the buttock. The involved area was swollen and edematous, and there were signs of superficial thrombophlebitis. Because we were unable to rule out deep vein thrombosis in the affected limb, prophylactic anticoagulant treatment was given during the 3rd trimester and into the early puerperium. Only then did the complications begin to resolve, but return to the prepregnant state was incomplete.
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PMID:[Klippel-Trenaunay syndrome with complications during pregnancy]. 254 Oct 57

3 areas in which gynecological factors affect phlebology and especially the venous system of the lower extremities are discussed. The presence of small or moderate varices does not contraindicate use of oral contraceptives (OCs), but venous tonics or even anticoagulants should be administered under specific circumstances in women with a tendency toward thrombosis. OCs should be avoided in women with significant venous lesions. If OCs are imperative, the varices should be treated before OC administration is initiated. Women whose syndrome of venous stasis worsens during menstruation or OC use should be carefully examined for gynecological lesions. If no lesions are found and treated, the OCs should be replaced by a nonhormonal method of contraception or the cause of the venous insufficiency should be further explored. OCs should be temporarily suspended for women undergoing sclerotic treatment of their varicosities. Alternatively, limited interventions such as ambulatory phlebectomies under heparin therapy can be substituted, but in these cases stripping should be avoided because of the danger of deep venous thrombosis. The practitioner contemplating treatment of varicosities in women using OCs should bear in mind the possibility of a malpractice charge if phlebitis should develop. The appearance of varices of varicosities accompanied by a peripheral venous stasis syndrome can be 1 of the 1st signs of pregnancy. Such varices in pregnant women represent small exteriorizations of enormous venous dilatations in the pelvis. They are almost never hemorrhagic during delivery and regress rapidly in the postpartum. Their thrombosis, however, can be very grave when it does occur. Varices of pregnancy which do not regress within 3 months' postpartum will be permanent. Different interventions are necessary in the case of preexisting significant varicosities or complicated varicosities during pregnancy. The usual treatments combine support and heparin therapy. The presence of varices does not absolutely contraindicate gynecological interventions. But OCs are formally contraindicated in the case of women with histories of deep phlebitis with sequelae.
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PMID:[Phlebology and gynecology]. 262 67

Proper management of patients with venous disease requires recognition of the various syndromes and an accurate objective diagnosis. Unfortunately many physicians are unfamiliar with the different venous disorders and are unaware of the fallibility of the clinical diagnosis of these syndromes. This article reviews the six common venous conditions that collectively are more common than coronary or peripheral arterial disease. Acute and recurrent deep vein thrombosis, postthrombotic syndrome, superficial thrombophlebitis, varicose veins, and pulmonary embolism may all confront the physician regardless of his or her specialty. Clinical recognition and differentiation of these disorders along with appropriate use of objective, noninvasive isotopic and venographic studies should lead to accurate diagnosis and management of these venous syndromes. Such an approach will permit prompt and appropriate therapy for disabling and potentially life-threatening venous thromboembolism while avoiding unnecessary anticoagulation of patients with disorders mimicking venous disease.
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PMID:Clinical and noninvasive assessment of venous disease as related to pulmonary embolism. 269 7

The debate on discontinuation of the oral contraceptive (OC) pill prior to major surgery because of the risk of preoperation pregnancy and increase in postoperative mortality is reviewed in light of 6 studies published on this issue. OC use has been associated with the risk of thromboembolism and the postoperative onset of deep venous thrombosis (DVT) is equally well-known. A study by Vessey in 1970 found an almost 4 times higher risk for OC users to develop DVT after an operation, however, multiple biases could be ascribed to the study design. A U.S. questionnaire study following up released patients received only a 60% response rate, the subjects controls ratio was distorted, and the almost 3 times higher risk finding was highly suspect. 2 other studies showing a 19% and 10.5% DVT rate for OC users after surgery had even more significant omissions regarding age, weight, and pelvic disease. In a study by Gallus examining 221 women aged 18-49 after emergency surgery, only 1 control had DVT, however, controls tended to be older, heavier, and had twice as many varices. The Oxford/Family Planning Association contraceptive study indicated a 0.96% incidence of thromboembolism for OC users vs. 0.5% for nonusers, which is not statistically significant. Thus, the investigation of postoperative thromboembolism allegedly caused by OC use is wrought with difficulties owing to the multiplicity of risk factors, and before discontinuation is advised these variables have to be weighed and an alternative has to be offered.
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PMID:Oral contraception and post-operative thromboembolism: an epidemiological review. 269 7

Venous thromboembolism is a frequent major complication in patients with gynecologic cancer. Risk factors include being elderly and nonwhite, having an advanced stage of malignancy, a past history of deep venous thrombosis, previous venous disease as evidenced by lower extremity edema, venous stasis changes, or varicose veins. Patients who have had pelvic radiation therapy, or who are more than ten percent over their ideal body weight are also at increased risk. Thromboembolism in gyn cancer patients most often occurs in the perioperative period. Prevention is dependent upon the recognition of the patient at risk and institution of effective prophylactic methods, prior to surgery, and continuing until the patient is fully ambulatory. Low-dose heparin postoperatively is ineffective, but more intense regimens of heparin and intermittent leg compression in the operating room and postoperatively are effective.
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PMID:Thromboembolism in patients with Gyn tumors: risk factors, natural history, and prophylaxis. 270 2

To identify variables which might influence the results of varicose vein surgery, a ten-year retrospective study was carried out on 612 patients undergoing varicose vein surgery. Patient symptomatology, type of venous insufficiency and operator experience were examined and correlated with the results of surgery. The female-to-male ratio was 2:1. The mean age was 47 years for women, 45 years for men. A family history of varicose veins was recorded in 74% of patients. A history of previous deep venous thrombosis was reported in 5% of cases, but in the sub-group of patients with stasis ulceration, the incidence was 9%. Cosmetic appearance was the commonest presenting complaint (54%), while ulceration was relatively infrequent (14%). There was moderate-to-marked improvement in 86% of cases at one year. This was sustained in 79% at three years, in 75% at five years and in 74% at ten years. There was no correlation between the type of venous insufficiency or the presenting complaint, and the result of surgery. Operator experience had the most significant effect on the outcome of surgery (P less than 0.001). Our findings indicate that varicose vein surgery offers most patients a satisfactory result. The only significant variable was operator experience. We strongly recommend closer supervision of junior staff performing this type of surgery, particularly as a large proportion of these patients (25% in this study) are operated on by the more junior staff.
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PMID:Surgery in the treatment of varicose veins. 275 20

The notion of a history of deep venous thrombosis in patients with varicose veins has often been at the origin of a contemplative attitude toward this pathology. What used to be an act of vigilance has now become plain negligence, if not a therapeutic error. Indeed, the difficulty in diagnosing an acute episode explains the many false positive results obtained; moreover, the variability of the evolution of true venous thrombosis should no longer cause one to adopt a monolithic attitude. In this indication, noninvasive investigating procedures allow distinguishing quite different situations occurring in these patients. In a substantial number of cases, no deep vein circulatory abnormality can be found. Treatment should address primary varicose veins. For those patients with deep venous thrombosis sequelae, such studies allow us to differentiate between occlusion/restriction states from devalvulation, and to detect the precise location of such sequelae, as well as their impact on circulatory function. When occlusion is found, varicose veins, which may be supplementary veins, are left untouched. When devalvulation occurs as an isolated phenomenon, superficial vein insufficiency is of primary importance. Treatment is the more complete that deep reflux will promote relapse through all existing leakage points. If, regardless of this treatment, deep reflux causes significant disturbances, surgical revalvulation should be recommended. More complex cases combining persisting occlusion with devalvulation call for a graded attitude. Noninvasive investigating procedures coupled with phlebography allow us to assess the part played by the various anomalies in causing the disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Management of patients with varicose veins presenting with a history of deep venous thrombosis]. 277 99

DSA was applied to the lower extremity phlebography on 21 cases (36 legs). The patient lay in the supine position and a tourniquet was placed around the ankle. Forty ml of contrast medium, diluted to 25% of the original concentration with normal saline, was injected into the dorsal vein of the foot. The anterior tibial vein, posterior tibial vein, peroneal vein and muscular vein of the calf were identified in 24 (63.2%), 36 (94.7%), 37 (97.4%) and 7 legs (18.4%), respectively. The poor opacification of the anterior tibial vein was attributed partly to the compression effect of the tourniquet. The abnormal findings were deep vein thrombosis (5 legs), reflux from the deep to the superficial vein (14 legs) and irregularity of the venous wall (16 legs). The superficial varicose veins were not demonstrated in DSA phlebography. The examination was comfortable because the patient position was supine and the dilute contrast medium caused no burning sensation. We believe that DSA phlebography is a safe and useful method for diagnosing the deep venous system disorders.
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PMID:[Digital subtraction angiography in lower extremity phlebography]. 279 45

Thromboembolic complications are one of the most common complications in patients undergoing major surgery or conservative treatment in cast. The incidence of thromboembolic complications is the highest in orthopedic and trauma surgery. Stasis in the deep veins of the lower extremity, intimal damage and disorders in blood coagulation are important factors in the pathogenesis of deep vein thrombosis. The most important predisposing risk factors are age, previous thrombosis, varices and the combination of oral contraceptives and smoking. 50% of thrombosis begins intraoperatively and 80-90% in the first 3-4 days after operation. The incidence of thromboembolic complications was significantly reduced after introduction of low-dose heparin and heparin with dihydroergotamine in the perioperative regimen. Recently various investigations demonstrated that low-molecular-weight heparin (LMWH) is equally as effective as a low-dose heparin regimen in preventing postoperative thromboembolic complications. Our own management of prophylaxis of thromboembolic complications is presented. In a prospective pilot study 100 trauma patients were evaluated. 84 patients received LMWH plus dihydroergotamine (DHE), 12 patients heparin alone because of contraindications for DHE and 4 patients received a low dose continuous intravenous heparin prophylaxis because of high risk. Two deep vein thrombosis occurred, one in a patient with high risk prophylaxis and one in a patient with a subcutaneously heparin prophylaxis. No thromboembolic complications occurred in patients with LMWH + DHE prophylaxis.
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PMID:[Prevention of thromboembolism in surgery]. 283 77


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