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

Emphasis is placed on the need to encourage original research in our training programs. This implies an obligation to help trainees inexperienced in research to bridge the gap between theory and practice. Four examples of patterns of research at a postgraduate institute are presented. All are in areas in some way relevant to carcinoma of the larynx: a) the effect of experimental hypothermia on transplanted tumors in rats; b) isotope detection of deep vein thrombosis following head and neck surgery; c) stomal calibre after laryngectomy related to airflow, esophageal voice and cineradiographic appearances; d) a case-controlled study of the etiologic role of asbestos in laryngeal cancer. These studies are still in progress but some preliminary observations can be reported.
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PMID:Research opportunities at the Institute of Laryngology and Otology, London. 120 91

The need for a portable extracorporeal support system that can be rapidly initiated for various types of cardiopulmonary failure is well known. The authors report on a system consisting of 3/8 inch tubing, a Sci-Med membrane oxygenator, Omnitherm heat exchanger, Biomedicus or Sarns centrifugal pump, portable battery, and oxygen tanks. The system is mounted on a cart for easy mobility and can be primed in 5-10 min. USCI, DLP, or Axiom cannulas can be inserted femorally. Over 30 months, 29 patients, aged 19-78 years, underwent extracorporeal membrane oxygenation (ECMO) support for cardiac arrest during catheterization (10 patients), shock secondary to acute myocardial infarction (MI) (10 patients), elective percutaneous transluminal coronary angioplasty (PTCA) support (four patients), postcardiotomy failure (four patients), and exposure hypothermia (one patient). Adequate support was achieved in all but one patient. Device flows ranged from 0.2 to 6.0 l/min. There were six survivors (elective PTCA support, three patients; cardiac arrest during catheterization, three patients). Complications included bleeding (15 patients), deep venous thrombosis (three patients), and pump failure (one patient). A portable ECMO system has been developed that allows rapid institution of circulatory support.
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PMID:Experience with an emergency resuscitation system. 259 11

Hypothermia and venous thrombosis can cause complications during perioperative and postoperative periods which can even be fatal to patients' conditions. Separative devices have currently been used to prevent those two problems. The device proposed here is to combine in a simple unobtrusive fashion the desirable effects of both temperature control and deep venous thrombosis prophylaxis in perioperative patients. A design chart of the new device is provided and design issues are addressed.
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PMID:Conceptual design of a combined device for normothermia and venous compression. 1096 44

Deep hypothermic cardiopulmonary bypass with or without circulatory arrest has been used to facilitate the surgical repair of complex cerebrovascular lesions. The advantages of deep hypothermia have been tempered by the occurrence of coagulopathy that is associated with substantial morbidity and mortality. This study analyzed retrospectively the records of 13 patients who underwent cerebrovascular neurosurgery using deep hypothermic cardiopulmonary bypass with or without circulatory arrest during the period 1993 through 1999. All patients received the serine protease inhibitor aprotinin in an effort to avoid the development of a coagulopathy, defined as hemorrhage requiring reoperation. No patients developed postoperative intracranial hemorrhage. There was also no evidence of renal dysfunction, deep venous thrombosis, myocardial infarction, or pulmonary embolism. In conclusion, this study suggests that aprotinin may be beneficial to avoid the coagulopathy that is more likely to occur if deep hypothermic cardiopulmonary bypass with or without circulatory arrest is used for craniotomy without adverse effects on renal function or apparent thrombotic complications.
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PMID:Aprotinin and deep hypothermic cardiopulmonary bypass with or without circulatory arrest for craniotomy. 1190 94

A 15-year-old female with short intestine syndrome due to chronic intestinal pseudo-obstruction associated with kidney failure underwent a multivisceral (stomach-duodenum-jejunum-ileum-pancreas-liver) and kidney transplant. She had required parenteral nutrition for the last 5 years, with numerous complications such as sepsis from the central catheter, deep venous thrombosis, severe liver dysfunction, pancytopenia due to bone marrow failure, and severe malnutrition. Surgery lasted 15 hours and was free of complications other than hypothermia, which worsened after revascularization of the grafts. Replacement of 6 units of blood products and crystalloids was required. Biochemical and hemodynamic variables were stable, apart from the development of hypernatremia, hyperglycemia, and lactic acidosis. The anesthetic approach included preoperative assessment of problems related to chronic parenteral nutrition (liver dysfunction, coagulopathy, and restricted venous access), the prevention of hypothermia, correction of electrolyte imbalance and the acid-base status, treatment of reperfusion syndrome, and the replacement of fluids and blood products to maintain circulatory homeostasis and assure sufficient splanchnic perfusion.
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PMID:[Anesthesia for a pediatric multivisceral transplant]. 1507 2

The LAC+USC Burn Center has admitted 3118 patients for treatment in the last 10 years. A majority of patients were young adults (1868), with the second largest group being small children (543). The ethnicity of the patients reflects the diverse nature of the population of Los Angeles County. Forty-eight percent of injuries were less than 5% TBSA and approximately 2% were greater than 60% TBSA. Eighty-two percent were accidental injuries. Sixty percent of admitted patients underwent skin grafting. Mortality was negligible in the group with burns over less than 10% of their body and very high (15/19), 79% in the most severely burned group. Further, there was a high correlation between age and mortality. Complications during treatment included: deep venous thrombosis 1% per year; pulmonary emboli in 5 patients; endotracheal tube dislodgment early or self-extubation about 1 month (11.3 per year); 4.5 patients per year who developed acute renal failure; abdominal compartment syndrome developed in 4.7 patients each year; heterotopic ossification was seen in 4 patients (0.4%); 4 patients (0.4%) developed stage II-IV pressure sores; hypothermia was present in 0.8% of patients.
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PMID:Burn care in Los Angeles, California: LAC+USC experience 1994-2004. 1564 15

A patient with cerebral deep sinus thrombosis, which was not diagnosed on the first examination, is reported. A 46-year-old woman presented with headache and vomiting. Neurological examination and a brain computed tomography (CT) scan showed no obvious abnormal findings. The patient suffered disturbed consciousness on the day after the examination, and was admitted to our emergency centre. A CT scan and magnetic resonance imaging revealed an ischaemic lesion in the left basal ganglia, suggesting deep sinus occlusion. Anticoagulant therapy was administered. One day after admission, a CT scan showed a haematoma and severe brain swelling in the same region. Cerebral angiography demonstrated a straight sinus occlusion. Intracranial pressure was not controlled with hypothermia, and the patient died 25 days after admission. Review of the initial CT scan revealed subtle, early findings of deep venous thrombosis that were missed on first examination.
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PMID:Subtle computed tomography abnormalities in cerebral deep sinus thrombosis. 1709 24

Pulmonary thromboendarterectomy (PTE) is a complicated surgical procedure that is an effective treatment in reducing pulmonary artery pressure and pulmonary vascular resistance for chronic thromboembolic pulmonary hypertension. Chronic thromboembolic pulmonary hypertension usually results from incomplete lysis of a large organized thrombus in the main pulmonary artery and secondary branches, leading to pulmonary hypertension, right ventricular failure, and subsequent death because of heart failure. Between March 1997 and April 2005, 30 PTE operations were performed in Fuwai Hospital, Beijing, China. They were 24 men and 6 women, with an average age of 45.7 +/- 11.4 years and average disease history of 48 +/- 12.6 months. Twelve of them were in New York Heart Association (NYHA) class 4, and 18 were in class 3. Seventeen cases were found with deep venous thrombosis (DVT), and inferior vena cava filters were implanted before surgery. The mean systolic pulmonary pressure was 91.4 +/- 22.4 mmHg, mean pressure of arterial oxygen (PaO2) was 56.2 +/- 8.6 mmHg, mean cardiac index (CI) was 1.64 +/- 0.47 L/min/m2, and mean saturation of arterial oxygen (SaO2) was 0.90 +/- 0.05. All operations were performed using the PTE procedure under deep hypothermia and intermittent circulation arrest. Perfusion management consisted of myocardial, cerebral protection, lung protection, and deep hypothermia with multiple periods of circulatory arrest and reperfusion at hypothermia, ultrafiltration, and cell-saving techniques. One patient died of infective shock post-operatively. Four cases experienced complications of the central nervous system. The mean cardiopulmonary bypass time was 191.1 +/- 34.4 minutes, the mean aortic clamping time was 95.1 +/- 27.8 minutes, and mean circulation arrest time was 47.7 +/- 12.9 minutes. Improvement of hemodynamic status occurred immediately after surgery. Mean pulmonary artery pressure decreased from 91.4 +/- 22.4 to 48.3 +/- 10.7 mmHg, and CI increased from 1.64 +/- 0.47 to 2.58 +/- 0.51 L/min/ m2. PaO2 increased from 56.2 +/- 8.6 to 88.9 +/- 6.0 mmHg and SaO2 increased from 0.90 +/- 0.05 to 0.97 +/- 0.01. Twenty-six cases were followed for 36.8 months: 22 in NYHA class 1, 3 in class 2, and 1 in class 3. PTE is an effective treatment for chronic thromboembolic pulmonary hypertension. The key to success is to adopt synthesized measures to protect the vital organ under deep hypothermic circulatory arrest (DHCA) from ischemia and reperfusion injury. Appropriate patient selection, perioperative management, improved techniques, and experience can optimize outcome.
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PMID:Perfusion techniques for pulmonary thromboendarterectomy under deep hypothermia circulatory arrest: a case series. 1731

Endovascular therapeutic hypothermia has been shown to preserve neurological function and improve outcomes; however, its use and potential complications have not been fully described in patients with traumatic head injuries. We believe that the use of endovascular cooling leads to deep venous thrombosis (DVT) in this high-risk population. We performed a retrospective review of 11 patients with severe head injuries admitted to our Level I trauma center surgical intensive care unit who underwent intravascular cooling. Duplex sonograms were obtained after 4 days at catheter removal or with clinical symptoms that were suspicious for DVT. Patients had a mean age of 23.2 (range, 16-42) years and an Injury Severity Score of 31.9 (range, 25-43). The overall incidence of DVT was 50 per cent. The DVT rate was 33 per cent if catheters were removed in 4 days or less and 75 per cent if removed after 4 days (risk ratio = 2.25; odds ratio = 6; P = ns). An elevated international normalized ratio upon admission was protective against DVT (no DVT = 1.26 vs DVT = 1.09; P = 0.02). Inferior vena cava filters were placed in most patients with DVT. The use of endovascular cooling catheters is associated with increased risk of DVT in patients with traumatic head injuries. Therefore, we discourage the use of endovascular cooling devices in this patient population.
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PMID:Increased risk of deep venous thrombosis with endovascular cooling in patients with traumatic head injury. 1752 Sep 99

Death due to hemorrhage from ruptured peripheral varicose veins is an uncommon event. A review of the files of Forensic Science SA (FSSA) in Adelaide, South Australia, was undertaken over a 10-year period from January 1996 to December 2005 for such cases. A total of 8 cases were found out of a total of 10,686, representing <0.01% of autopsy cases. The male to female ratio was 1:3, with an age range of 58-84 years (mean = 78 years). The victims were all located at their home addresses, where they had been alone at the time of their deaths. Scene investigations revealed considerable blood loss, with pooling around the victims' bodies, and also in other parts of the house, particularly the bathroom/toilet areas. Four ulcers were of an acute perforative type and 2 were of a chronic ulcerative type. In 2 cases, bleeding followed trauma. Toxicologic evaluation was performed in only 3 of the cases, revealing blood alcohol levels of 0.06% and 0.14% in 2 cases, respectively. A further victim had been prescribed anticoagulant drugs for an unrelated condition. Additional findings of significance were ischemic heart disease in 3 cases and deep venous thrombosis of the calf veins on the side of the fatal hemorrhage in another case (with no evidence of pulmonary thromboembolism). One victim had acute gastric erosions, suggesting that hypothermia following collapse played a role in the terminal event. Autopsy evaluation of such cases should include careful layer dissection of the area of hemorrhage to confirm the presence of the ruptured varix and to enable directed histologic sampling.
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PMID:The incidence and characteristic features of fatal hemorrhage due to ruptured varicose veins: a 10-year autopsy study. 1804 15


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