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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 an investigation on deep venous thrombosis and pulmonary embolism, where neither dextran nor antithrombotic drug prophylaxis were employed, 30 patients undergoing total hip replacement were randomly allotted to one of two groups receiving either epidural or general anaesthesia. The epidural group (n = 15) was given 0.5% bupivacaine with epinephrine (5 micrograms/ml) and this was prolonged into the postoperative period for pain relief. The general anaesthesia group (n = 15) was operated on under artificial ventilation with nitrous oxide/oxygen via an endotracheal tube and intravenously administered fentanyl and pancuronium bromide. In this group of patients narcotic analgesics (ketobemidone) were given intramuscularly on demand for pain relief postoperatively. The frequency of deep venous thrombosis involving the femoral veins, as observed at phlebography, was significantly lower in patients receiving continuous epidural block (3 of 15; 20%), than in those receiving general anaesthesia and parenteral analgesics postoperatively (11 of 15; 73%). Further, the frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was lower in patients receiving continuous epidural block (2 of 15) than in the general anaesthesia group (7 of 15). Possible explanations for these findings are discussed, including a hyperkinetic lower limb blood flow and lower fibrinolysis inhibition activity in patients given epidural block. Lower blood transfusion requirements in patients given epidural block might also play a role, as well as a "stabilizing" effect of local anaesthetics on platelets, leukocytes and endothelial cells.
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PMID:Comparative influences of epidural and general anaesthesia on deep venous thrombosis and pulmonary embolism after total hip replacement. 732 41

Pain and swelling of the leg have been studied in 27 patients with deep vein thrombosis (DVT). Twenty-three of them were also examined for pulmonary embolism (PE) after one week of heparin treatment. Scoring systems were constructed to quantitate pain, size of DVT and PE. A ratio between swelling and pain (S/P ratio) was calculated for each patient. Actual size of the DVT, as estimated with venous phlebography, was correlated to swelling (rs = 0.51, p less than 0.01), S/P ratio (rs = 0.53, p less than 0.01) and PE (rs= 0.57, p less than 0.01). DVTs with not pain at all or just tenderness on palpation were more often associated with PE (p less than 0.05) and elevated blood pressure (p = 0.02) than DVTs with pain on walking. A free floating proximal end of DVT proved unreliable for predicting PE. It is concluded that the risk of developing PE depends not only on DVT size, but also on factors related to pain.
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PMID:The clinical picture of deep vein thrombosis correlated to the frequency of pulmonary embolism. 733 95

Pain in the legs is a common diagnostic problem. Diagnosis is made on an anatomical basis and by a process of exclusion. Deep vein thrombosis is still an exceedingly difficult condition to diagnose; however, investigation by ultrasound with the Doppler Flow Meter often provides a definite answer. There is a large group of patients, nearly always female and in their twenties and thirties, in whom chronic leg pain without demonstrable underlying cause poses a problem. These cases respond very favourably to Paroven 250 mg three or four times daily, as well as light support pantyhose.
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PMID:Painful legs: the GP's dilemma. 742 60

Ultrasonography was used to examine 42 patients who were complaining of popliteal and suprapatellar pain. When clinically indicated, patients also underwent phlebography, arthrography, and posterior synovectomy. In 17 patients, Baker's cysts were demonstrated by ultrasonogram. Of these 17 patients, four had confirmation of the cysts by arthrography. One patient had simultaneous deep venous thrombosis, proved by phlebography and arthrography. Five patients underwent posterior synovectomy, and the surgical specimens closely correlated with the dimensions predicted by ultrasonography. Internal echoes within the cysts correlated at surgery with either necrotic debris or organized hematoma. To our knowledge, this study is the first series where surgical correlations have been made with the ultrasonographic observations. Ultrasonography of the knee and surrounding area is a useful, painless, and relatively inexpensive method, with several advantages over arthrography.
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PMID:Ultrasonic evaluation of popliteal cysts. 743 41

Iliac vein thrombosis is an uncommon type of deep vein thrombosis (DVT) that occurs in young patients following surgical procedures for scoliosis. The symptomatology is diffuse and this type of DVT carries a risk for fatal pulmonary embolism as well as the development of a postphlebitic syndrome. Combined radionuclide phlebography and lung scanning were performed in 16 patients operated on for scoliosis with the Harrington procedure. In three patients with diffuse pain in the inguinal region, iliac vein thrombosis was easily visualized in the radionuclide phlebogram and confirmed by conventional phlebography in two cases. Six patients without lung symptoms had perfusion defects typical for pulmonary embolism. It is concluded that radionuclide phlebography can be recommended as a diagnostic procedure for iliac vein thrombosis in patients with diffuse symptoms in the inguinal region or the lower abdomen after scoliosis surgery. Advantages include the ease of performance, good patient acceptance and low radiation dose compared with conventional phlebography. Asymptomatic pulmonary embolism as diagnosed by the perfusion lung scan was an unexpected finding which raised clinical considerations that require further investigations.
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PMID:Combined radionuclide phlebography and lung scanning in patients operated on for scoliosis with the Harrington procedure. 743 9

Three hundred and eighty-three patients underwent superficial femoral vein ligation and distal venous thrombectomy in the treatment of deep venous thrombosis of the lower extremities. Two hundred and forty-eight patients were reviewed clinically. The results are quite satisfactory; no surgical mortality and no fatal pulmonary embolism. On long term follow-up the clinical symptoms such as pain, swelling, varicosities and ulceration are much less marked in the operated group when compared with the post-phlebitis syndrome which develops when the deep venous thrombosis is allowed to extend into the deep pelvic veins.
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PMID:[Superficial femoral vein ligation and distal venous thrombectomy as surgical therapy for recent thrombophlebitis of the lower extremities. A clinical study (author's transl)]. 746 27

The arterial inflow into the calf, venous emptying rate and venous capacity were studied by means of venous occlusion plethysmography on the non-operated leg in two groups of patients undergoing total hip replacement. One group of eight patients received epidural blockade intraoperatively, which was prolonged postoperatively for pain relief, while the other group of eight patients was given general anaesthesia with intermittent positive-pressure ventilation intraoperatively and parenteral analgesics for pain relief in the postoperative period. The calf blood flow and venous capacity were lower in patients receiving general anaesthesia when measured at the end of surgery and significantly lower in this group when measured 3 h postoperatively. The sustained reduction of flow in the deep veins of the lower limb might be a significant contributory factor in the initiation of deep venous thrombosis. In three of the eight patients in the general anaesthesia group, the venous emptying rate and venous capacity had decreased 3 h postoperatively to a very low level, indicating thrombus formation in immediate association with the surgery.
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PMID:Effect of epidural versus general anaesthesia on calf blood flow. 746 18

The history and physical examination were assessed in 215 patients with acute pulmonary embolism uncomplicated by preexisting cardiac or pulmonary disease. The patients had been included in the Urokinase Pulmonary Embolism Trial or the Urokinase-Streptokinase Embolism Trial. Presenting syndromes were (1) circulatory collapse with shock (10 percent) or syncope (9 percent); (2) pulmonary infarction with hemoptysis (25 percent) or pleuritic pain and no hemoptysis (41 percent); (3) uncomplicated embolism characterized by dyspnea (12 percent) or nonpleuritic pain usually with tachypnea (3 percent) or deep venous thrombosis with tachypnea (0.5 percent). The most frequent symptoms were dyspnea (84 percent), pleuritic pain (74 percent), apprehension (63 percent) and cough (50 percent). Hemoptysis occurred in only 28 percent. Dyspnea, hemoptysis or pleuritic pain occurred separately or in combination in 94 percent. All three occurred in only 22 percent. The most frequent signs were tachypnea (respiration ate 20/min or more) (85 percent), tachycardia (heart rate 100 beats/min or more) (58 percent), accentuated pulmonary component of the second heart sound (57 percent) and rales (56 percent). Signs of deep venous thrombosis were present in only 41 percent and a pleural friction rub was present in only 18 percent. Either dyspnea or tachypnea occurred in 96 percent. Dyspnea, tachypnea or deep venous thrombosis occurred in 99 percent. As a group, the identified clinical manifestations, although nonspecific, are strongly suggestive of acute pulmonary embolism. Conversely, acute pulmonary embolism was rarely identified in the absence of dyspnea, tachypnea or deep venous thrombosis.
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PMID:History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. 746 69

Parnaparin is a low molecular weight (LMW) heparin which, like other members of its class, apparently demonstrates a greater antithrombotic effect relative to its anticoagulant activity when compared with the unfractionated heparin (heparin) from which it is derived. Moreover, subcutaneous parnaparin has a greater bioavailability and longer half-life than heparin, permitting once-daily administration for the prophylaxis of deep venous thrombosis (DVT) or the treatment of established vascular disorders. Prophylaxis with a 7-day regimen of parnaparin 3200 or 6400 IUaXa/day has consistently been associated with a lower incidence of confirmed DVT compared with usual prophylactic regimens of heparin. This intertreatment difference reached statistical significance in a large multicentre study involving a total of 610 surgical patients (3.2% for parnaparin vs 6.3% for heparin). Thus far, however, comparisons of parnaparin with other LMW heparins for this indication are unavailable. Parnaparin has demonstrated equivalent efficacy to heparin in the treatment of established vascular disorders, including phlebopathies and related syndromes, as well as peripheral arterial occlusive disease. Parnaparin also showed some benefit as an adjunctive therapy in patients with angina pectoris. The risk of general bleeding appears to be similar with parnaparin or heparin, although parnaparin results in fewer haematomas at the site of injection, partly because of the less frequent administration regimen. Parnaparin has also been associated with a lower incidence of pain and/or burning sensation at the injection site compared with heparin. As with other LMW heparins, the possibility that parnaparin will be infrequently associated with thrombocytopenia cannot be excluded. Thus, parnaparin may be preferred over traditional heparin for the prophylaxis of thromboembolic events in surgical patients (particularly those at high risk for DVT), as well as the treatment of established vascular disorders with a thrombotic aetiology. Compared with heparin, parnaparin offers the advantages of a more convenient administration regimen coupled with improved local tolerability. However, the therapeutic advantages of parnaparin relative to other LMW heparins have yet to be established in large scale comparative trials.
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PMID:Parnaparin. A review of its pharmacology, and clinical application in the prevention and treatment of thromboembolic and other vascular disorders. 751 62

Magnetic resonance imaging (MRI) was used to investigate 38 patients suffering from leg oedema or pain of various etiology. Spin echo series with 10 mm transverse slices of both legs were obtained. Soft tissue changes were visualized best by T2-weighted sequences. Characteristic changes could be observed by MR images of patients with closed compartment syndrome (n = 2), chronic lymph oedema (n = 10) and post-reconstructive leg oedema following vascular surgery (n = 14). MRI can also show typical soft tissue changes in patients with deep vein thrombosis (n = 5) or post-thrombotic syndrome (n = 3). For most of these conditions, the diagnosis can usually be established using simpler methods. However, MRI is an excellent supplementary method for showing soft tissue changes, and is a promising way of investigating conditions that may give rise to leg oedema and pain.
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PMID:[Magnetic tomography in the examination of edema and pain in the leg]. 757 Apr 72


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