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

Spinal cord injury increases the risk of many life-threatening medical problems, including respiratory failure, pulmonary embolism, and renal failure. Respiratory failure results from paralysis of muscles of inspiration (which impairs oxygen transport to alveoli) and of expiration (which impairs cough and predisposes to pneumonia and atelectasis). Respiratory failure in patients with spinal cord injury can be prevented by proper positioning of the patient, training of ventilatory muscles, pulmonary toilet, and aggressive use of antibiotics and bronchodilators. When respiratory failure occurs, it can be managed by administration of oxygen, intubation, and mechanical ventilation, and in instances of paralysis of the diaphragm, by diaphragmatic pacing. The risk of deep vein thrombosis and pulmonary embolism in acute spinal cord disease is increased by the immobilization of the patient and abnormalities in clotting factors. Thrombotic disease in spinal cord disease can be prevented by intermittent calf compression and heparinization. If pulmonary embolism develops, the patient should be started on a regimen of warfarin for at least 3 months. If anticoagulation is contraindicated, a Greenfield filter can be placed. However, concurrent use of quad cough places the patient at increased risk for complications from the Greenfield filter. Chronic pyelonephritis and systemic amyloidosis are the most common causes of renal failure in the patient with spinal cord disease. Renal failure can be prevented by maintaining a low postvoid residual volume, avoidance of indwelling catheters, use of medications that are not nephrotoxic, and rapid treatment of infection. Hemodialysis and peritoneal dialysis can extend the life of the patient with spinal cord disease in whom renal failure develops, and successful use of renal transplantation has recently been reported.
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PMID:Medical complications of spinal cord disease. 192 58

A 30-yr-old healthy male presented with recurrent pulmonary emboli without clinical or radiologic evidence of deep venous thrombosis. He was found to have an isolated hydatid cyst in the pelvis with invasion and thrombosis of the inferior vena cava to the level of the renal veins, which caused recurrent hydatid pulmonary emboli. The patient died because of postoperative intractable respiratory failure.
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PMID:Recurrent hydatid pulmonary emboli. 280 68

The incidence of deep venous thrombosis of the legs (DVT) was studied in 119 critically ill patients by 125I-labeled fibrinogen scanning; the efficacy of low-dose heparin prophylaxis was assessed in a randomized, double-blind study. DVT occurred in 29% of control patients and in 13% of patients receiving heparin 5000 U subcutaneously twice daily. DVT was found mainly in men and was associated with circulatory impairment, respiratory failure and recent vascular or cancer surgery. In a comparison study of medical patients, DVT occurred in 10% untreated and 2% treated. In conclusion, the critically ill are at high risk of venous thromboembolism and low-dose prophylaxis is warranted in those who have no hemostatic impairment.
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PMID:High risk of the critically ill for venous thromboembolism. 704 82

Largely on the basis of postmortem studies, pulmonary emboli have been implicated as an etiologic factor in the acute and chronic respiratory failure of chronic obstructive pulmonary disease (COPD). The diagnosis of pulmonary embolism clinically or by tests directed at the lungs (except pulmonary angiography) is likely to be inaccurate in the presence of COPD because of the underlying abnormalities. We reasoned that by directing tests at the lower extremities to determine the presence or absence of deep venous thrombosis (DVT), we might obtain an accurate reflection of the presence of pulmonary emboli (PE), since virtually all PE are believed to arise in those deep veins. Accordingly, in a group of 45 patients with decompensated COPD, we performed ascending contrast venography (12 patients), 125I-labeled fibrinogen scanning (6 patients), or both (27 patients). Only 2 patients had proximal DVT, which was probably present on admission (4.4%). Two other patients developed DVT (limited to the calf) while hospitalized, (overall incidence of 8.9%). Another patient developed superficial thrombophlebitis during the study but before venography. Noninvasive tests for DVT (Doppler ultrasound and impedance plethysmography) were performed in 40 subjects. A negative result had a high predictive value (94% for each), but contrary to findings in other settings, a positive test had a poor predictive value (Doppler = 33%, IPG = 25%).
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PMID:Venous thromboembolism in decompensated chronic obstructive pulmonary disease. A prospective study. 745 85

Surgical cases of massive pulmonary embolism remain rare in Japan. To discuss the surgical problems, clinical courses of 4 patients who underwent pulmonary embolectomy under cardiopulmonary bypass at our hospital for the last six years were reviewed. There were 2 men and 2 women; ranging from 41 to 72 years (mean age, 63 years), 1 of whom had deep venous thrombosis of the lower extremity as a predisposing factor. The initial disease recurred in 2 patients. Shock occurred in 3 patients preoperatively, 2 of whom had sudden syncope. Cardiac arrest occurred before and during pulmonary arteriography (PAG) in 1 patient. The systolic pulmonary arterial pressure rose to between 60 and 80 mmHg in all patients except for 1 of whom it was not measured. The diagnosis was established in 3 patients by PAG and clinically in the remaining recurrent patient. Thrombolysis was not effective in all patients, then pulmonary embolectomy was performed between four hours and five days after the onset of the disease. One patient with preoperative cardiac arrest died of low output syndrome and severe respiratory failure, but 3 survived with clinical improvement. Development of the prompt and noninvasive diagnostic procedure, rapid cardiopulmonary support in severe cases and an early decision to operate are required to improve the operative results. Partial resection of the lung was obliged due to massive endobronchial hemorrhage after embolectomy in 1 recurred patient. Compression of the lungs and embolectomy using a balloon catheter should be performed carefully to prevent injuring pulmonary arteries. Implantation of an inferior vena cava filter may be beneficial for the selected patient to prevent recurrence of the disease.
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PMID:[Pulmonary embolectomy for massive pulmonary embolism]. 771 82

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute spinal cord injury. Our preliminary studies indicated that low molecular weight heparin (LMWH) was significantly more effective than standard heparin in preventing these complications. We have now extended these studies by screening an additional 122 patients and treating 60 who met predefined criteria with LMWH in a dose of 3,500 anti-Xa U given subcutaneously once daily for 8 weeks. All patients were examined daily at bedside and had regularly scheduled venous ultrasonography; those with abnormalities had confirmatory venography and lung scans. Postmortem examinations were conducted in those who died. Forty completed the trial without incident, 6 had DVT (4 proximal and 2 distal), 1 had a fatal PE, 1 had postoperative bleeding requiring discontinuation of the LMWH, 10 were transferred or discharged, and 2 died of respiratory failure. The percentage of patients free of thrombosis or bleeding after 8 weeks of treatment was 85.9 +/- 5.0% standard error of mean (SEM). Thirty-three patients entered a follow-up observation period of 4 weeks without thromboprophylaxis; 2 weeks into this period 1 had a proximal DVT and 1 had a fatal PE; the course of the remainder was uneventful. We conclude that LMWH compares favorably with standard heparin in preventing venous thromboembolism, and is associated with significantly less bleeding. Eight weeks of prophylaxis seems adequate for most patients.
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PMID:Prevention of thromboembolism in spinal cord injury: role of low molecular weight heparin. 812 81

Severe pulmonary hypertension due to tumor cell microemboli or lymphangitic carcinomatosis is a rare complication of malignant disease. In most of the reported cases, a clinical picture of subacute cor pulmonale developed. A 57-year-old man with deep vein thrombosis in his left calf developed acute progressive dyspnea with hypoxemia, cyanosis and the clinical picture of acute cor pulmonale, while he was on full heparinization. Respiratory failure with the need for mechanical ventilatory support developed within 2 days. Chest radiography revealed the development of acute cardiac enlargement, dilated pulmonary artery and diffuse opacities in the fields of both lungs. Open lung biopsy disclosed massive tumor cell microemboli and lymphangitic carcinomatosis. No parenchymal metastases were found. This case is extremely rare because of the rapid development of the patient's respiratory signs and symptoms of acute cor pulmonale due to pulmonary tumor cell microemboli and lymphangitic carcinomatosis. It is also most atypical because of the rare pulmonary radiographic presentation.
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PMID:Acute cor pulmonale due to tumor cell microemboli. 931 Oct 58

The symptomatology of PTE is good for the suspicion of PTE only. Symptoms are mainly based on dyspnoea (respiratory rate) and pain in the chest. Clinical diagnostic procedures, on the other hand, are backed up by evaluation of specific risk factors (previous thrombosis, post-operative state, immobilisation) and search for deep venous thrombosis (DVT). Blood gas analysis is very sensitive to unravel (latent) respiratory failure, along with established routine measures (blood pressure, ECG, chest-film) and additional echocardiography. Most important in our experience is a perfusion scan at the earliest opportunity. Spiral-CT angiography is indicated in special cases only. We looked at 115 consecutive patients with suspected PTE and found close correlations between risk profiles of thrombosis, pathological BGA and high probability perfusion scans. DVT was detected in 50% only. Positive predictive values for high risk and pathological BGA were 86 and 92%, respectively. An algorithm for diagnostical/therapeutical strategies is presented. The early application of an heparin-bolus is stressed.
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PMID:[Clinical aspects and diagnosis of pulmonary thromboembolism]. 1037 30

Indications for concomitant renal revascularization during aortic surgery are not well established. Higher mortality and poorer results are often cited. To examine this, all combined aortic and renal revascularization procedures from August 1992 until May 1998 were reviewed. Of 2003 major arterial reconstructions performed on the Vascular Teaching Service, 45 patients (2%) underwent renal revascularization. Of these 31 patients (69%) had combined aortic and renal procedures. Aortic pathology in these 31 patients (54% male, 94% white, median age 64 years) included arterial occlusive disease (n = 21; 47%), abdominal aortic aneurysm (n = 6; 13%), and thoracoabdominal aortic aneurysm (n = 4; 9%). In all 31 cases the patient presented because of the aortic pathology. Indications for concomitant renal revascularization included renovascular hypertension (n = 21; 68%) and preservation of renal function (n = 10; 32%). Renal revascularization procedures included transaortic endarterectomy (n = 23; 74%), renal bypass (n = 7; 23%), and both bypass and endarterectomy (n = 1; 3%). Seven (22%) complications and two (6%) deaths (both patients operated on for renal salvage) occurred perioperatively. Complications included wound infection (n = 2; 6%), postoperative bleeding (n = 1; 3%), respiratory failure (n = 1; 3%), deep venous thrombosis (n = 1; 3%), cerebrovascular accident (n = 1; 3%), and pseudomembranous enterocolitis (n = 1; 3%). All patients either were cured of their hypertension (n = 5; 24%) or were improved (n = 16; 76%) at 3 months. No patient to date operated on for renal salvage progressed to chronic hemodialysis, but mortality was higher after renal revascularization for renal salvage versus hypertension (20% vs. 0; P = 0.034). There was no significant difference in mortality between the combined aortic/renal procedures versus aortic procedures alone. Despite adding complexity, renal revascularization in patients undergoing aortic surgery appears relatively safe and effective. These data favor an aggressive approach toward renal revascularization in selected patients needing aortic surgery.
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PMID:Concomitant renal revascularization with aortic surgery: are the risks of combined procedures justified? 1096 38

Both undetected and clinically evident venous thrombosis and venous thromboembolism (VTE) can seriously impact the prognosis of acutely and/or critically ill patients. Pulmonary embolism (PE) is harder to diagnose in the acutely and/or critically ill, many of whom also have developed respiratory failure for other reasons. Deep vein thrombosis (DVT) of the upper and lower extremities can subsequently complicate insertion of central venous catheters, leading to PE, sepsis and septic shock. Recovery from the original critical illness (e.g. weaning from mechanical ventilation) can be adversely affected by these complications. There are recent data suggesting that, for prophylaxis, low-molecular-weight heparin (LMWH) is more effective than unfractionated heparin (UFH) in critically ill trauma patients, and that high-dose LMWH is more effective than placebo or low-dose LMWH in seriously ill medical patients. In both populations, LMWH appeared safe. While LMWH appears superior to UFH in acute stroke patients to prevent venographically-proven lower-extremity DVT, whether it provides a superior long-term outcome after acute stroke is uncertain. One study found that a high dosage of the LMWH dalteparin was more effective than placebo in preventing left ventricular thrombi after acute myocardial infarction, but there was a significant safety cost. Current questions surrounding prophylaxis of VTE and the use of LMWH in acutely and/or critically ill patients include whether monitoring levels and dosage adjustment in some of these patients would improve outcome, and whether the diagnosis of VTE can be improved so that treatment can be instituted when prophylaxis has failed.
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PMID:Risk assessment and prophylaxis of venous thromboembolism in acutely and/or critically ill patients. 1125 46


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