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

US is the imaging modality of choice in many situations encountered in the Emergency Department. It is particularly useful in evaluating renal colic, pain or vaginal bleeding in the pregnant patient, and pelvic pain in the nonpregnant woman; and in diagnosing gallbladder disease, appendicitis, proximal lower extremity DVT, and pericardial effusion. The information presented in each section, including sonographic findings and the role of US, should be helpful in choosing the most appropriate test in the evaluation process.
 ...
PMID:Ultrasonography in the emergency setting. 173 90

The diagnosis of DVT is a perplexing clinical challenge for the emergency physician. The algorithm depicted in Figure 9 from Hobson et al represents a logical strategy for the application of noninvasive studies. Positive studies in the proper setting that are reliably interpreted can dictate anticoagulant therapy, but equivocal or uninterpretable tests must be followed by invasive testing to exclude clot. Negative tests require close follow-up and serial evaluation to detect potentially silent early clot formation.
 ...
PMID:Imaging for deep venous thrombosis. 173 91

Ultrasonography has achieved the role of the contemporary diagnostic tool for the assessment of DVT. Routine use of venography to assess for lower extremity clot is very difficult to justify. Long-term follow-up of patients has provided sufficient documentation that ultrasonography can successfully supplant the venogram. Only with regard to calf vein thrombosis is there still uncertainty about the need to occasionally rely on venography. Radiologists must become cognizant of the capabilities of ultrasonography and facile in its interpretation. Performance of this test should be available in every institution. The nonradiological literature is replete with articles documenting the use of venous ultrasonography and encouraging its routine use for venous clot evaluation.
 ...
PMID:Ultrasound evaluation of deep venous thrombosis. 173 75

DVT is a fairly frequent event and often fails to be recognised. Its main complication, pulmonary embolism, is the third cause of death in Italy with more than 70,000 deaths per annum. In the presence of infra- and suprarenal floating thrombi, cases in which the application of neither intraluminal nor extraluminal filters is indicated, the treatment of choice is thrombectomy with direct surgical access to the cava. Personal experience of 11 patients operated in the past 16 months with excellent surgical success is analysed. The indications and surgical techniques adopted are described.
 ...
PMID:[Thrombectomy of the infra- and suprarenal cava to prevent pulmonary embolism in the presence of deep venous thrombosis. Personal experience with 11 surgically-treated cases]. 175 92

In the CT scan of a patient with knee tumor and deep vein thrombosis confirmed by phlebography, the casual observation of a thrombus image in the vein was made, characterized by wall contrastation in opposition to a lack of luminar contrastation. Then, CT scans of the lower limbs and the pelvic region were performed in 14 patients with suspected DVT, who were followed consecutively. Diagnosis of ruptured Baker cyst was made in one patient and DVT in 13 patients. DVT was demonstrated in both lower limbs of three patients. Diagnosis of DVT was confirmed in six of seven exams involving the legs. CT scan could detect thrombi in muscular veins and in deep femoral and internal iliac veins. In six patients with suspected pulmonary embolism, CT scan was also made of the thoracic region and showed pleuropulmonary involvement concomitant with lower limb DVT. The characteristic image of DVT in CT is that of a contrasted ring. Its brightness may be due to contrastation of the venous wall through its vasa vasorum, whereas the thrombus obstructs the luminar flow of the contrast medium. Reproducibility of the characteristic image of thrombus presence in the vein at different levels of the lower limbs and pelvic region gives CT the status of alternative diagnosis means for DVT. False negatives and false positives should be evaluated.
 ...
PMID:[Diagnosis of deep venous thrombosis of the lower limbs by computed tomography]. 177 81

The introduction of the stab-incision--phlebectomy (Muller's technique)--has opened a large field for ambulatory surgery. This is specially true when phlebectomy is combined with a saphena-femoral or saphena-popliteal ligature. In a series of 1825 operations including 1592 incompetent saphenous veins 1216 (67%) were performed under local anesthesia. Radical surgery of incompetent short saphenous veins as well as of minor forms of varicose long saphenous veins is feasible in local anesthesia. Regional or general anesthesia (609 operations) are still recommended for stripping procedures in advanced long saphenous varices. In most cases phlebectomy of varices (553) provides a better cosmetic result than sclerotherapy, the latter being the treatment of choice for small veins and telangiectasias. Ambulatory surgery and sclerotherapy are cost-effective and low-risk treatments. No deep vent thrombosis or pulmonary embolism was observed in this group, whereas 1 DVT and 2 PE occurred in the 609 operations performed under general anesthesia.
 ...
PMID:[Indications for and results of ambulatory varices therapy]. 178 Jul 98

Two criticisms are levelled against venous ultrasonography: its operator-dependent nature and the absence of any overall imaging document which can serve as a reference and be read by all. A very precise investigation technique is suggested to deal with the first criticism. This describes the investigation in detail, level by level from the inferior vena cava to the lower third of the leg and indicates the optimal position of patient and operator, in particular concerning the leg. A method of imaging presentation is proposed to deal with the second criticism. The site and extent of venous thromboses are shown on a precise anatomical diagram including muscle veins. This diagram reproduced by reduction on a four-fold card is given to the patient to be used during subsequent follow-up. It can be used as a reference document in case of suspected extension or recurrence. Ultrasonography has several advantages over phlebography: a better reliability rate, better sensitivity for lesions in muscles and where there are twin veins, possibilities of differential diagnosis of DVT and of the discovery of concomitant pathology. It should now always be performed as the investigation of primary intention.
 ...
PMID:[Venous ultrasonography of the lower limbs in the diagnosis of thrombosis. Examination methodology and presentation of results]. 179 64

Thromboembolism is a major cause of morbidity and mortality in patients with spinal cord injury. The prevalence of DVT approaches 100%, and 1 to 2% will die of PE. Following injury, there is hypercoagulability as reflected by an increase in von Willebrand factor activity and antigen, and increased platelet reactivity to collagen. Thrombosis usually occurs 1 to 3 weeks after injury, with a peak between days 7 and 9. Intermittent calf compression boots reduce the frequency of thrombosis to 40%, and the addition of aspirin, 300 mg twice daily, and dipyridamole, 75 mg thrice daily, decrease this further to 25%. In an attempt to provide more effective prophylaxis, a further trial was conducted using heparin. Twenty-nine patients were randomized to receive 5000 U subcutaneously every 12 hours and compared with an equal number of patients treated with doses of heparin adjusted to prolong the APTT to 1.5 times control values; the mean dose was 13,200 U every 12 hours. Thromboembolism occurred in 9 (31%) of those on the fixed dose (6 DVT and 3 PE) and only 2 (7%) on the adjusted dose (p less than 0.05); however, 7 (24%) of the patients receiving the higher doses of heparin had bleeding compared with none of those on the fixed dose (p less than 0.02). Most recently, we have compared the safety and effectiveness of a low molecular weight heparin (Logiparin, Novo) with standard heparin. The former was given once daily in a dose of 3500 anti-Xa units, and the latter was 5000 U every 8 hours, both given subcutaneously.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Prevention of thromboembolism after spinal cord injury. 180 5

Since PE is the result of DVT, predominantly of the lower extremities, prevention of DVT in patients who are at high risk is important. Regimens including Coumadin, heparin, and physical intervention have all been beneficial. In the presence of pulmonary symptoms, especially when risk factors for DVT are present, an imaging diagnostic work-up is indicated. Ventilation/perfusion scans and duplex scans of the lower extremities will be diagnostic in most cases. Pulmonary angiography should be performed when there is diagnostic uncertainty. Heparin followed by Coumadin is the mainstay of therapy. Fibrinolytic therapy is reserved for cases requiring medical thromboembolectomy. In patients for whom anticoagulation is contraindicated and in patients who have PE while on therapy, the inferior vena cava should be interrupted with a transvenously inserted filter.
 ...
PMID:Diagnosis and treatment of pulmonary embolism. 181 76

Anticoagulation is being used increasingly in the critical care areas. Thrombolytic therapy is now commonly used in emergency departments and coronary care units for treatment of AMI. Heparin therapy for unstable angina and for a 48 to 72 hour period following thrombolytic therapy for AMI is becoming commonplace. Beginning warfarin therapy concomitantly with heparin to decrease the total duration of heparin and the duration of hospital stay for DVT therapy is encouraged. The use of low-dose warfarin to prevent DVT in hip surgery, improve catheter patency, and prevent catheter-related subclavian thrombosis is increasing. Along with the increased use of anticoagulation must come a greater appreciation of the complications associated with the agents used, and of how to prevent or treat the hemorrhagic or thrombotic morbidity that may arise. Acute hemorrhage with thrombolytic agents must be recognized and the immediate implementation of conservative and aggressive measures begun. Heparin-induced thrombocytopenia with thrombosis is an often-unrecognized problem that may occur in 1% to 2% of heparin recipients and result in limb amputations. A delayed onset (6-10 days) requires frequent platelet counts for early diagnosis and treatment. The resurgence of warfarin use for prevention of cardiovascular and cerebrovascular disorders demands observation for skin necrosis from protein C and S inhibition. Early recognition of symptoms and syndromes associated with organ system hemorrhage in patients receiving chronic anticoagulation is imperative. The use of antagonists, such as protamine sulfate for heparin, vitamin K1 for warfarin, and antifibrinolytic drugs for thrombolytic agents, may be necessary in treating hemorrhagic events. However, their use may worsen the thromboembolic event initially treated.
 ...
PMID:Toxic effects of drugs used in the ICU. Anticoagulants and thrombolytics. Risks and benefits. 186 82


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>