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

In a prospective study, peripheral pulses, claudication, peripheral oedema, and rest pain were evaluated in 314 sequentially presenting diabetic patients with foot ulcers. In the ulcerated limb pedal pulses were found to be present in 44% of the patients, peripheral oedema in 38%, and rest pain in 19%. Twelve per cent had claudication. Presence of pedal pulses was more common in patients whose ulcers underwent primary healing (56%) than in those who healed after amputation (23%) or died (25%, p less than 0.001). Eighty per cent of the patients with pedal pulses present underwent primary healing. However, 49% of patients with absence of pedal pulses also underwent primary healing and 12 patients developed gangrene despite presence of pedal pulses. Peripheral oedema was more common in patients who required amputation (58%) or died (55%) than in patients with primary healing (26%, p less than 0.001). A tentative predisposing factor was identified in 95% of the patients, the most common factors being neuropathy, congestive heart failure, and previous deep venous thrombosis. Rest pain was more common in patients who required amputation (48%) or died (23%) than in those with primary healing (7%; p less than 0.001). Only 50% of patients with gangrene had rest pain and of these patients, only one underwent primary healing. The presence of pedal pulses, oedema, and rest pain give valuable but imperfect information on the possible primary healing of foot ulcers in diabetic patients.
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PMID:The importance of peripheral pulses, peripheral oedema and local pain for the outcome of diabetic foot ulcers. 214 65

Upper extremity venous thrombosis is a clinical entity with numerous etiologic factors. Only 2% of all cases of deep venous thrombosis involve the upper extremity, and the incidence of pulmonary embolism related to thrombosis in this location is approximately 12%. Primary or "effort" thrombosis of the upper limb is related to the inherent anatomical structure of the thoracic outlet and axillary region. Secondary thrombosis may have such diverse origins as trauma, infection, congestive heart failure, central venous catheters, neoplasms, septic phlebitis, intravenous drug use, and hypercoagulable states. Patients present with peripheral edema and prominent superficial veins, and neurologic symptoms (pain and paresthesias) are usually present as well. Clinical diagnosis is confirmed by venography or sonography. Treatment regimens include conservative measures, thrombolysis with fibrinolytic agents, and surgical correction of indicated thoracic outlet and axillary structures. We present an unusual case in which upper extremity venous thrombosis in a young healthy female athlete was associated with the presence of cervical ribs. The patient was successfully treated with focal thrombolysis and surgical resection of her ipsilateral cervical rib.
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PMID:Upper extremity venous thrombosis. Case report and literature review. 218 88

Color duplex flow imaging (CDFI) permits pain- and risk-free direct imaging of the deep venous system of the lower extremities. To prospectively ascertain the accuracy and limitations of this technique, CDFI was performed in 75 lower limbs of 69 consecutive patients referred for venographic evaluation of clinically suspected lower extremity deep venous thrombosis (DVT). The CDFI study was obtained within 24 hours of the contrast venogram. Both studies were interpreted without knowledge of the patient's clinical findings or the results of the other test. Contrast venography was regarded as the standard for diagnosis of DVT. Accuracy was 99% for detection of DVT above the knee and 81% below the knee. Sonographic evaluation of the calf veins was technically adequate in 60% of limbs; accuracy was 98% in this group. In the 40% of limbs with technically limited CDFI studies of the calf, accuracy decreased to 57%. Although small nonocclusive thrombi occurred infrequently in this series of symptomatic patients, CDFI missed three of four such thrombi. It is concluded that CDFI, when not technically compromised, is sufficiently accurate to definitively diagnose symptomatic lower extremity DVT.
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PMID:Symptomatic lower extremity deep venous thrombosis: accuracy, limitations, and role of color duplex flow imaging in diagnosis. 218 93

Hip surgery is the most common major orthopedic procedure performed in the elderly. The indications are fracture and pain secondary to degenerative arthritis. Patients undergoing hip replacement for arthritis have excellent outcomes with decreased pain, increased mobility, and a low mortality. Age should not be a contraindication to hip replacement, with patient selection being made on the basis of symptomatology and overall health. In hip fracture, the prognosis is more guarded. Poor functional outcome results from complications of the fracture, such as avascular necrosis of the femoral head and fracture nonunion in femoral neck fractures and instability with delayed weight bearing in intertrochanteric fractures. In addition, patients sustaining hip fracture are more likely to have significant comorbidity and subsequent perioperative complications. Pressure ulcers, delirium, deep venous thrombosis, urinary retention and urinary tract infection, and cardiac events are the most frequent complications seen. These complications can be anticipated and prevented with careful preoperative assessment and post-operative prophylactic management. A team approach including the orthopedic surgeon, primary care physician, nursing staff, and physical therapists is essential for optimal outcome.
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PMID:Surgical management of the hip in the elderly patient. 219 20

The antithromboembolic efficacy of once a day low molecular weight heparin in fixed combination with dihydroergotamine (LMWH-DHE) was compared with conventional heparin-DHE in combination with Acenocoumarol (heparin-DHE/A) in 191 patients undergoing gynaecological surgery. LMWH-DHE proved equally effective in preventing thromboembolic complications, with a similar incidence of postoperative bleeding and side effects. Deep vein thrombosis occurred once in each group and one non-fatal pulmonary embolism occurred in the LMWH-DHE group. The main advantage of LMWH-DHE was significantly better patient acceptance of the single daily subcutaneous injection as compared with the two injections of conventional heparin-DHE (P = 0.02). On the other hand, LMWH-DHE was associated with significantly increased incidence of intraoperative bleeding (P less than 0.02). The bleeding did not, however, cause any clinical problems. Discontinuation of therapy due to bleeding or pain at the site of injection occurred three times in each group. We consider the use of LMWH-DHE to be an attractive, economic and safe method of thromboembolic prophylaxis.
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PMID:A prospective randomized trial of low molecular weight heparin-DHE and conventional heparin-DHE (with acenocoumarol) in patients undergoing gynaecological surgery. 254 52

In 60 to 90% of patients with deep vein thrombosis, successful recanalization with prevention of postthrombotic syndrome and decreased risk of pulmonary embolism can be achieved through early diagnosis and aggressive treatment, thrombolysis or surgical correction. In our experience, if treatment is delayed more than four days after onset, the results are unfavorable; in the latter case, provided necrotizing inflammation is not present, we treat only with anticoagulation. The indication for surgery is considered established if thrombolytic treatment is contraindicated, in the presence of necrotizing inflammation, if thrombolysis is unsuccessful and for recurrent pulmonary embolism which is carried out mostly with a caval filter. Anticoagulation alone in most patients will not lead to successful results. Sixty percent of deep vein thromboses arise ascending from lower leg thromboses. Further points of predilection are the junctions of the popliteal vein, the veins in the inguinal region and the caval bifurcation. In principle, any calf pain should suggest the possibility of beginning lower leg thrombosis. With regard to the history, it is important to know if the event is the first of its kind or recurrent (Table 1). Additionally, deep vein thrombosis may be suspected in the presence of local trauma, in women on contraceptives, in patients with hemoblastoses, after surgery in the lower pelvic or leg region and, in particular in women, in the presence of pelvic venous impediment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnostic viewpoints in deep leg-/pelvic venous thrombosis]. 262 Aug 96

Compression ultrasound (US) has become widely used to diagnose acute deep venous thrombosis (DVT). To determine the appearance of veins with previous DVT, 60 legs (58 patients) in which DVT had been diagnosed 6-31 months earlier (mean, 15.1 months) were reexamined with compression US. At reevaluation there was no indication of acute DVT. Thirty-two extremities had an appearance consistent with clot at the time of this study; 28 demonstrated normal findings. Variables that correlated with findings at follow-up US included age, location of clot, number of previous clots, pain, and augmentation of flow at compression. These preliminary data indicate that compression US may not be reliable as a follow-up study in patients in whom postphlebotic syndrome develops after an acute episode of DVT.
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PMID:Recurrent deep venous thrombosis: limitations of US. 264 60

A new monoclonal antibody specific for the beta-chain of human fibrin (C22A) and labeled with 111In has been obtained and successfully used in rabbits and dogs for the in vivo detection of venous thrombosis. Studies in humans are currently ongoing. In order to assess the diagnostic value of 111In-antifibrin for the detection of venous thrombosis of the lower extremities, the authors investigated 25 consecutive patients. Ten patients had clinical and instrumental (contrast phlebography and duplex scanning) evidence of acute deep venous thrombosis (DVT), 3 had a long-standing DVT with relapsing episodes of swelling and pain, 5 had superficial venous thrombosis, and the remaining 7 had no signs of thrombosis at all. Twenty patients were being treated with heparin. All patients received 111In-antifibrin at the dose of 74 MBq IV and were scanned with a large field of view gamma camera coupled with a high-energy, parallel-hole collimator at 30 minutes and three, six, and twenty-four hours postinjection. Only the persistence of an abnormal uptake at twenty-four hours confirmed by two observers at visual inspection was considered as positive. A positive result was obtained in 9 of 10 DVT patients (90% sensitivity) and in all SVT patients. The single DVT patient with a negative 111In-antifibrin test had the longest interval between scintigraphy and onset of symptoms (fifty-five days). Thus, the age of thrombi represented a substantial limitation for the test. A false-positive result was obtained in a single SVT patient, in whom also a deep involvement, unconfirmed by phlebography, was suspected (91.6% specificity).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Immunoscintigraphic detection of venous thrombosis of the lower extremities by means of human antifibrin monoclonal antibodies labeled with 111In. 266 32

The case report describes a patient who presented with two simultaneously-occurring but distinct pain syndromes. Epidural morphine controlled the pain from the abdominoperineal resection, while the pain from a deep venous thrombosis was not masked. Such differential effects of epidural morphine on pain of varying origin supports physiological observations on the specificity of the site of action of spinal opioids.
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PMID:Clinical differences in spinal opioid efficacy. 275 43

Tennis leg, strain of the medial head of the gastrocnemius muscle, may follow a trivial trauma in athletic and nonathletic activities. Complete or partial tears of the musculotendinous unit may result in a hematoma. Clinical manifestations of gastrocnemius hematoma in a 64-year-old man with local swelling, pain and tenderness that was aggravated by passive dorsiflexion of the ankle joint, mimicked deep vein thrombosis. Failure to appreciate the precedent trivial trauma and the localized swelling and ecchymosis led to delayed diagnosis and inappropriate heparinization. The definite diagnosis was established by CT scan which revealed a local soft tissue mass within the gastrocnemius consistent with a hematoma. A compartment syndrome developed the day after heparinization and was adequately treated by discontinuation of heparin, aspiration and rest. Differentiation between tennis leg and deep vein thrombosis is of paramount importance, since the etiology, treatment and prognosis of these two clinical entities are quite different. Venography is recommended as specifically diagnostic for deep vein thrombosis while CT scan for gastrocnemius hematoma.
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PMID:Medial gastrocnemius hematoma mimicking deep vein thrombosis: report of a case. 279 64


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