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

The most important side effects of oral contraceptives (OCs) and their incidence, together with advice and monitoring of the patient at risk, are pointed out. There is a mild increase in blood pressure in longterm contraceptive use caused by increased angiotensinogen production by the liver. It is significant only for women with a history of familial hypertension, diabetes mellitus, or pre-eclampsia. Smoking increases this risk. Urinary tract infections are 25-50% more frequent in pill users. Glucose tolerance is slightly decreased. Contraceptives' diabetogenic effect is higher in women with hereditary tendency for diabetes, latent diabetes, and/or obesity. They are contraindicated in latent diabetes. Findings are contradictory in their effects on cholesterol and triglyceride serum level, but the pill is contraindicated in lipid metabolism disorders. There is an increased incidence in cholecystitis and cholelithiasis in pill-users (70-80 additional cases/100,000 user years). Liver diseases, intrahepatic cholestasis, occur rarely and benign liver tumors have not conclusively been proved to be caused by the pill. A variety of laboratory findings have been related to contraceptive use and drug interactions occur with barbiturates, rifampicin, hydantoin, and phenylbutazone. Blood coagulation is increased, partially by increased production of various blood coagulation factors; but more importantly, by a decreased synthesis of antithrombin III, a natural protective mechanism against intravascular coagulation. This increases thrombosis risk. Risk doubles with simultaneous cigarette smoking. Various epidemiological studies indicate a 5-10 fold increase in thromboembolism and thrombophlebitis, deep vein thrombosis, and pulmonary embolism. There is a correlation between contraceptive use and cerebrovascular disorders and myocardial infarction. This risk increases with age and years of pill use. The pill is contraindicated with symptoms of thrombophlebitis and thromboembolism, sickle cell anemia, proposed surgery, and longterm immobilization. Overall risk factors are not too high. Recommendations for rational pill use related to age are given and further contraindications are mentioned.
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PMID:[Adverse effects of oral contraceptives]. 55 52

An inadequate efficiency of the fibrinolytic system was revealed in 50-60% of subjects suffering young age from venous thrombosis or myocardial infarction. In a group of 27 patients with the history of deep venous thrombosis of the idiopathic type the authors revealed a significant relationship between the elevated body weight and inadequate fibrinolysis manifested by a reduced fibrinolytic capacity and excess inhibitor of plasminogen activator and its inadequate decline after desmopressin infusion (DDAVP). In a group of 29 patients, who had suffered a myocardial infarction when young, the authors revealed a significant association between reduced fibrinolytic capacity and elevated body weight, hypertriglyceridaemia and increased immunoreactive insulin secretion after a glucose load. In half the investigated subjects it proved possible to improve the reduced fibrinolytic capacity by a low energy diet.
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PMID:[Disorders of fibrinolysis and thrombophilic states, risk factors and possibilities of dietary effects]. 205 93

The combined estrogen/progestogen oral contraceptive (OC) is the most common form of contraception that is used by sexually active women who are between the ages of 15-35 years. Serious side-effects are infrequent, and the failure rate is exceedingly low. The major side-effects of OC administration are seen in 4 distinct areas: subsequent fertility; the cardiovascular system; metabolic effects; and malignancy. Approximately 1% of women experience persistent amenorrhea after they cease to take OCs, but considerable doubt exists as to whether this is purely an effect of OC or is due to other factors such as weight change, excessive exercise, or psychological disturbances. The major cardiovascular problems are those of hormone-induced hypertension, deep vein thrombosis, coronary artery disease, and stroke. It is not possible to predict which patients will develop hypertension while taking OCs, and all patients should have their blood pressure checked within 6 months of starting OC use and then approximately once a year. There is little doubt that the increased risk of deep vein thrombosis that was observed in women using OCs in the 1960s was related to the high estrogen content of the early OCs. As the dose of estrogen has been reduced progressively, the incidence of deep vein thrombosis has decliined. It is now a rare occurrence in clinical practice. The association between coronary artery disease and cerebrovascular disease and OCs has been known for the last 5-6 years. It is evident that the risk is increased in women who smoke, especially when they are over age 35. The main predictor of the risk of coronary artery disease and stroke appears to be a reduction of high-density lipoprotein (HDL) cholesterol levels. In the combined OC preparations, the action of 1 steroid is variably balanced by the other, and the overall effect on HDL cholesterol levels is often minimal. The major metabolic side-effects concern the changes in gluclose tolerance and an apparently increased risk of gall bladder disease. Low-dose OCS have virtually no effect on glucose status and, providing that diabetic patients are supervised adequately and have no evidence of vascular disease, low-dose OC preparations can be used safely. The question of whether the steroidal components of OCs may have initiating or promoting effects in relation to the development of cancer continues to be debated. The major concern recently is in relation to breast and cervical malignancies.
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PMID:Beneficial and adverse side-effects of hormonal contraception. 394 15

The most common brain disease in middle and old age is dementia. Primary dementias comprise degenerative (dementia of Alzheimer type, DAT) and cerebrovascular (dementia of vascular type, DVT) types. These dementia types differ in morphological, clinical, and pathobiochemical terms. In DAT, large amounts of neuritic plaques and neurofibrillary tangles or paired helical filaments, are present throughout the whole brain cortex, but particularly numerous in temporal areas. Here and in hippocampus, the presynaptic cholinergic system seems to be predominantly affected. In DVT, multiple small infarcts are scattered over brain cortex and white matter obviously due to disturbances in cerebral microcirculation. Dementia is closely related to disturbances in brain blood flow and oxidative metabolism. In the beginning of DAT, cerebral blood flow and CMR-oxygen are found to be in normal ranges, but CMR-glucose is reduced. In DVT, cerebral blood flow and CMR-oxygen are also within the normal range, but CMR-glucose is found to be abnormally increased. When dementia symptoms are well developed in DAT, the same relationship between circulation and metabolism are found. Well-developed DVT symptoms seem to be associated with changes in blood flow and metabolism similar to variations after ischemic/anoxic lesions. In the beginning of both dementia types, a close correlation exists between cerebral blood flow and CMR-oxygen, but there is a dissociation from CMR-glucose. In the further course of both dementia types, cerebral blood flow and metabolism run into a final common path of a low functional level. No distinction between the dementia types is possible. In general, severity of dementia symptoms are correlated to the deviation of cerebral blood flow and metabolism from normal. There is much evidence that dementia, i.e. abnormal cerebral aging is different from normal cerebral aging. Dementia is not a form of accelerated cerebral aging.
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PMID:The abnormally aged brain. Its blood flow and oxidative metabolism. A review - part II. 676 4

Dextran is known to increase the plasminogen activation rate in vitro and to decrease the alpha2-antiplasmin activity. We decided to explore the effect of dextran on plasma tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) during surgical trauma. Thirty-one patients undergoing elective surgery were given 500 ml of 6% dextran 70. Another nine patients serving as controls were given 500 ml of a glucose-electrolyte solution. The activities of t-PA and PAI-1 during surgery were determined, as was the concentration of t-PA antigen. PAI-1 activity was decreased by 19% after infusion of 250 ml of dextran. After 500 ml, the activity was reduced by 22% (both P < 0.05). The activity of t-PA was increased by 43% and 29% (both P < 0.05) and the antigenic amount of t-PA was increased by 18% and 15% (both P < 0.05) after infusion of 250 ml and 500 ml of dextran, respectively. No changes in these variables were observed in the control patients. It is concluded that infusion of dextran promotes fibrinolysis by enhancing plasminogen activation in patients subjected to trauma. Since elevated levels of PAI-1 prior to surgery are known to predispose to deep vein thrombosis, which may form already during the operation, the effect of dextran on PAI-1 described here may explain its clot preventing properties.
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PMID:Effect of dextran on plasma tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) during surgery. 754 Jul 88

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

The authors report on the pharmacological employment of defibrotide in the treatment of a case of deep vein thrombosis (DVT) of the left iliac-femoral veins in a patient with a high-risk of hemorrhage (haematuria from kidney neoplasm, rupture of basilar artery aneurysm, urethral bleeding from catheter trauma). Alternatively to the traditional thrombolytic and anticoagulants, not indicated here for their haemorrhagic risk potential, defibrotide promptly resolved the DVT without any major effect on blood coagulation parameters. Initially, 1 gr of defibrotide in 250 ml of glucose-1-phosphate solution was administered twice-daily for the first two days when improvement had been observed. An additional 5 days of therapy was continued under the same regimen, then 400 mg intravenously every 2 hours for 14 days, and 400 mg intramuscularly every 24 hours until the 30th day. The patient was dismissed from the hospital on therapy with indobufen 200 mg orally, and elastic support stocking. After 6 months the patient is well. An echo color Doppler evaluation showed a normal venous blood flow through the femoral, iliac and caval veins, and venous blood reflux in the iliac-femoral and femoral saphenous veins due to valvular insufficiency. Caval filters, although recognized by many institutions as a preferred method of protection against pulmonary thromboembolism especially in patients with a contraindication to anticoagulation therapy or recurrent pulmonary embolism, was not used in this case, since the patient was critically ill. From this case report and the review of the literature it seems that defibrotide may represent a valid alternative therapy in the treatment of DVT, especially in high risk haemorrhagic patients.
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PMID:[Alternative therapy of deep venous thrombosis in patients at hemorrhagic risk]. 802 29

Preclinical management faces considerable diagnostic and therapeutic limitations. Patient history, physical examination, and few technical means (electrocardiogram [ECG], blood glucose measurement) must suffice to arrive at a suspected or definite diagnosis. Emergency treatment of most medical conditions inside the hospital differs from the preclinical setting. Critically ill patients must be transported to the hospital in emergency units with standardized equipment. Diagnosis of acute myocardial infarction relies on patient history, present symptoms, and a 12-lead ECG, and can be made with relative certainty. Therapeutic management focuses on reduction of myocardial oxygen consumption and optimizing oxygen availability. Monitoring for possible arrhythmias is essential. Few exceptional situations justify preclinical thrombolytic therapy. After a neurologic deficit has been diagnosed, the management of patients with stroke includes support of vital functions and admission to a hospital where computed tomography or magnetic resonance imaging is available. Pulmonary thromboembolism is frequently misdiagnosed even in the hospital. Preclinical physical examination, patient history, ECG, and pulse oximetry allow a positive diagnosis only in massive embolization. Anticoagulation with heparin is essential. If cardiopulmonary resuscitation is necessary, preclinical thrombolysis may be an option. Although deep vein thrombosis is difficult to recognize, classical symptoms of acute arterial occlusion are rarely missed. Treatment consists of general measures and anticoagulation.
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PMID:Preclinical management of thromboembolic disorders. 871 88

Defibrotide, a polydeoxyribonucleotide, has been found to modulate endothelial cell function, causing an increase in tissue plasminogen activator (t-PA) levels, a decrease in plasminogen activator inhibitor (PAI) levels, and an increase in prostaglandin I2 (PGI2) formation in humans. Defibrotide has no direct anticoagulant effect but has a synergistic action with heparin. A strong antithrombotic effect has been observed in animal models. Thus, defibrotide has a beneficial effect in cases of deep venous thrombosis (DVT), peripheral obliterative vascular disorder (POVD), stroke, vasculitis, and thromboembolism. Defibrotide also inhibits platelet function and activation. A significant decrease in platelet aggregate formation on the suture line in microarterial anastomosis in rats is one way defibrotide can inhibit platelet function and activation. In humans, a slight prolongation' of the lag period in collagen-induced aggregation has been observed. In addition, a slight decrease in the maximum amplitude of the secondary wave of ADP and adrenalin-induced aggregations was also found. Platelet adhesion is diminished, the platelet differential count on formvar membrane is altered, and platelet aggregate formation is significantly inhibited. With an increase in platelet cyclic AMP (cAMP) content and a decrease in malonyl dialdehyde (MDA) and thromboxane B2 (TXB2) formation, the levels of platelet secretion products such as PF-4 and beta-thromboglobulin (beta-TG) in plasma decreased progressively. It was also demonstrated that the 14C-glucose transport defect of the platelet membrane of atherosclerotic patients was partially corrected with defibrotide treatment.
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PMID:Effect of defibrotide on platelet function. 880 24

Near-infrared (NIR) spectroscopy is an inexpensive and noninvasive optical method to characterize biologic and physiologic systems. Measurements of oxygen saturation in various organs, cytochrome oxidase concentration, and glucose concentration in tissue are examples of NIR spectroscopy applications. This instrument also has potential for diagnostic imaging by comparing the optical properties of a given point in tissue with those of the surrounding areas, e.g., tumor localization, hematoma detection, or deep vein thrombosis detection. Currently, NIR spectroscopy is available in three modalities: time-resolved spectroscopy (TRS), continuous-wave spectroscopy (CWS), and a phase-modulation device. This paper describes a single-source phase-modulation device and a multiple-source (in- and anti-phased) device and their application to system identification. The phase and intensity information for homogeneous systems is correlated with system and instrumental parameters. Phase and intensity changes resulting from the presence of one and two absorbers are illustrated. The sensitivity of in- and anti-phased phase-modulation devices (phased arrays) is demonstrated. The use of amplitude-modulated phased array for heterogeneity detection is described.
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PMID:Feasibility study of a single- and multiple-source near-infrared phase-modulation device for characterizing biologic systems. 926 37


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