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

Traumatic spinal cord lesions in children are infrequent (2 to 5 per cent of all cases admitted to specialised paraplegic centres depending on whether the upper age limit is set at 10 or 15 years). Traffic accidents are responsible for at least 50 per cent of the lesions; playground accidents and various sports add another 35 per cent. A large proportion of the accidents have been found to be related to the child's normal desire for adventure and exploration. The segment most frequently involved in our own series of 18 cases was the cervical and upper thoracic spine. Histopathological studies have shown that splitting of the cartilaginous end-plate in the growth zone of the vertebrae is a common finding. Radiological signs of spinal trauma are less evident than in adults; they may be totally missing. Precise neurological assessment must rely on repeated examination and close clinical observation, especially in the comatous child with a head injury. Spinal cord involvement must be suspected and the child treated as a paraplegic until definite proof of a normal neurological status is available. Due to a highly labile water electrolyte balance in the early post-traumatic stage and considerable fluctuations in plasma volume and temperature regulation, permanent monitoring of the cardiovascular function, body temperature and diuresis is mandatory. In children below the age of 10, deep vein thrombosis and embolism are exceptional (sepsis creates a high-risk situation requiring anticoagulation). In the initial treatment of spinal injury only conservative measures should be considered; there are no indications for laminectomy, nor for spinal fusion. In the tetraplegic child below the age of 6, skull-traction should be avoided and immobilisation of the cervical segment achieved by bilateral padded head-rests.
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PMID:Spinal cord injury in children and adolescents: diagnostic pitfalls and therapeutic considerations in the acute stage [proceedings]. 89 57

1. The purpose of fluid administration is not only the restoration of blood volume but also the normalization of impaired nutritive flow. 2. Plasma oncotic (colloid osmotic) pressure is the only force which can draw water into the circulation. In shock the infusion of colloid solutions is able to normalize nutritive flow and peripheral resistance almost at once. 3. Five per cent solutions of pasteurized plasma protein or albumin and 6 per cent dextran 70 yield a volume expansion corresponding to the amount infused. 4. The decrease in hematocrit produced by the infusion of these three colloidal solutions is accompanied by a decrease in whole blood viscosity resulting in a rise in cardiac output as well as in nutritional tissue flow. 5. Hemodilution improves oxygen supply as long as the hematocrit does not fall below 30 per cent, although normovolemia is the critical requirement. 6. Transmission of viral hepatitis is still the greatest danger of blood transfusion. 7. The use of large amounts of Ringer's lactate is not advised, as this solution does not reduce the total number of units of blood which need to be given. Pulmonary edema may become a problem. 8. Dextrans are best suited to initial volume replacement in shock. They increase plasma volume, improve blood flow, have antithrombotic properties, and are easily available and relatively cheap. Anaphylactoid reactions are rare. 9. Every third patient undergoing general surgery and every other patient having hip surgery develops a deep venous thrombosis. Widespread prophylaxis to prevent thromboembolic complications is mandatory. 10. The antithrombotic properties of dextran are due to a reduction in platelet adhesiveness, a change in fibrin clot structure, and the increased lysability of thrombi and the improvement of blood flow. 11. In a personal controlled, prospective, randomezed trial comparing subcutaneous heparin and intravenous dextran 40, 35.8 per cent of the controls (n=95), 13.2 per cent of the 83 patients in the heparin group, and 20.5 per cent in the dextran group (n=83) developed deep venous thrombosis. The difference between dextran and heparin is not significant; however, both treatment groups show a statistically significant effect compared to the controls.
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PMID:Dextran and the prevention of postoperative thromboembolic complications. 116 22

A case of pulmonary embolism associated with diabetes insipidus is reported in an 18-year-old male. The patient, who had been treated with DDAVP for diabetes insipidus and hydrocortisone for hypocorticism for two years after first operation for the removal of craniopharyngioma, was admitted with recurrence of that tumor. Diabetes insipidus immediately after second operation was controlled with intermittent drip infusion of a small amount of aqueous pitressin under monitorings of body weight hourly using a patient weighing system to keep the weight changes within +/- one kilogram. Serum and urine electrolytes levels, osmolarity, and free water clearance were also monitored every three hours to maintain water-electrolytes balances appropriately. Postoperative course had been uneventful except that CSF rhinorrhea occurred 7 days after operation. The patient was, then, kept in bed with horizontal plane to avoid further leakage of CSF. Two days later, he developed chest pain suddenly with tachypnea, tachycardia, and general cyanosis. The arterial-BGA showed PaO2 of 53.5mmHg and PaCO2 of 35.3mmHg in room air. The definite diagnosis of pulmonary embolism was made by technetium microaggregate lung perfusion scans and by pulmonary angiograms. The patient was treated with heparin, 15000IU/day, and urokinase, 720000IU/day. The symptoms due to pulmonary embolism had improved gradually within a couple of weeks. Recent articles have shown an unexpected high incidence of deep vein thrombosis and pulmonary embolism in neurosurgical patients associated with the elevation of blood coagulability. Brain tumors, especially suprasellar mass with hypothalamic dysfunction have been suggested to cause thromboembolic disorders frequently. The clinical course was described and factors causing pulmonary embolism on this patient was discussed.
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PMID:[A case of pulmonary embolism with diabetes insipidus developed after removal of craniopharyngioma]. 233 47

From 1975 to 1986, 2435 patients were admitted to the Northwestern University-Midwest Regional Spinal Cord Injury Unit. Of these, 220 patients (9.0%) had documented neck fractures from diving accidents, representing the largest series of acute diving injuries yet analyzed. The average age of these patients was 21 years, and males predominated. Two hundred twelve patients (96.4%) were admitted within 48 hours of injury. Associated injuries were rare: none had intracranial mass lesions or systemic injuries, and only nine were near-drowning victims who required endotracheal intubation. The most common levels of injury were C-5 (140 fractures) and C-6 (85 fractures), with 70 patients having fractures at more than one level. Neurological injury was sustained in 154 (70.0%) patients, while 66 (30.0%) patients were neurologically intact. One hundred forty-seven (66.8%) patients underwent posterior cervical fusion, and anterior fusion was performed in 36 (16.4%), allowing for early ambulation and an average hospital stay of 17 days. Hospitalization was relatively uncomplicated, with urinary tract infection in 121 (55.0%), pneumonia in nine (4.1%), and deep vein thrombosis in 24 (10.9%). Long-term follow up averaged 5 years and was obtained in 160 (72.7%) patients. Sixteen (10.0%) improved neurologically, five (3.1%) deteriorated, and 139 (86.9%) were unchanged. Notably, this large study shows that diving accidents occur in a young, healthy population who sustain essentially no other associated intracranial or systemic injuries and have few serious hospital complications. Such patients may be mobilized early in their care after either internal or external stabilization. Subsequent long-term neurological improvement can be expected to occur in about 10% of patients. The importance of water safety and injury prevention is stressed.
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PMID:Diving injuries of the cervical spine. 238 21

A series of 43 hips (41 patients) in which a cemented revision arthroplasty was performed for a symptomatic, nonseptic, loose (42) or broken (1) femoral component was reviewed clinically and radiographically. The operation was done using femoral components of contemporary design, a trochanteric osteotomy, a cement gun, and a PMMA femoral plug. The femoral compactor and water pic were used once they became available (36%). The average follow-up period was 74 months (range, 60-111 months). The primary diagnoses included osteoarthritis (52%), CDH (32%), posttraumatic arthritis (6%), AVN (6%), and SCFE (4%). The average age of the patients at the time of the operation that failed was 52.2 years and at revision was 57.4 years. Only one revised cemented femoral component (2% of hips) required rerevision surgery for septic loosening. The average postoperative Harris hip score was 87 points. Four hips (9%) were classified radiographically as definitely loose, one (2%) as probably loose, and one (2%) as possibly loose, but all of these patients had a good or excellent clinical rating. Complications included deep venous thrombosis in 16 patients, trochanteric nonunion in 3 hips, femoral shaft perforations in eight hips, and postoperative dislocations in 6 hips. These techniques appear to represent an improvement over prior techniques.
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PMID:Revision of nonseptic, loose, cemented femoral components using modern cementing techniques. 318 78

In spite of good correlations between cardiac output measurements by impedance and established invasive procedures (dye- and thermo-dilution) reported by numerous authors it is doubtful uptil now whether calculations of stroke volume according to the formula of Kubicek et al. (1974) can provide absolutely reliable results. The origin of the dz/dt curve and influencing factors of impedance wave have to be cleared up prior to the total acception of impedance cardiography as a reliable method for determining non-invasive stroke volume. This is true in spite of the agreement of all authors we know, that the reproducibility of the impedance cardiography values is as good as in dye or thermo-dilution measurements. However, for patient monitoring it is sometimes more important to assess the relative changes in stroke volume than to measure its absolute value. For long-term non-invasive monitoring of myocardial contractility in critically ill patients or after pharmacological interventions impedance cardiography may be recommended. Besides systolic time intervals, such as pre-ejection time and ventricular ejection time, three more reliable parameters can be derived from the first derivate of impedance wave. Impedance plethysmography has been shown as a reliable method to diagnose deep vein thrombosis and good correlations between impedance and strain-gauge plethysmography and phlebographic findings are reported. In addition fluid volume changes in the leg, venous capacity, venous outflow and arterial inflow may be determined by impedance plethysmography in a simple way. There is no doubt that alterations in the fluid content of biological tissue may measured by impedance technique. However, correlations between changes in the transthoracic impedance and fluid content of the thorax can be quantified only in a single subject which serves as its own control. Overall standardization is not possible. The reason for interindividual differences in the thoracic impedance at a given reduction of body water are due to anatomical differences, intrapulmonary air volume and pressure, location of the electrodes, electrical conductivity of the tissue and, above all, due to the position of the body. Therefore if transthoracic impedance is determined sequentially measurements must be performed with special attention to the position of the body to get reproducible results. Rapid infusion of colloids or blood transfusion may decrease transthoracic impedance due to intravascular volume expansion even at a net fluid lost during forced furosemide-induced diuresis or extracorporal hemodialysis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Application of impedance cardiography in critical care medicine. 632 26

Subcutaneous heparin injections are frequently prescribed for the prevention of deep vein thrombosis. One of the most commonly encountered adverse physiological responses to this intervention is the formation of a haematoma at the injection site. This creates a challenge for the nurse attempting to minimize haematoma formation and/or patient discomfort during the treatment regime. The purpose of this study was to determine if the application of ice to subcutaneous heparin injection sites decreases the incidence and size of haematoma formation and/or minimizes patient discomfort. The study used a quasi-experimental design with the subjects as their own control. A convenience sample of 70 subjects was each given two injections of subcutaneous heparin, 12 hours apart. Ice was applied pre- and post-injection to one of the sites. Immediately following each injection, the subjects were asked to rate the level of perceived discomfort at the time of the injection using a visual analogue scale. Forty-eight hours post-injection, the nurse inspected the injection sites for the presence of haematoma. Results showed that when ice was applied there was no significant difference in the incidence or size of haematoma; however, the subject's perception of pain was significantly less.
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PMID:Heparin and haematoma: does ice make a difference? 774 95

The involvement of the lymphatic drainage in patients with postthrombotic syndrome can be verified by (quantitative) isotopic lymphography (99m Tc labelled microcolloids) and by indirect lymphography (water-soluble contrast medium Iotrolan). Both methods point to an augmented praefascial lymph-transport. In the region of lipodermatosclerotic skin changes dermal backflow can be explained by a local damage of peripheral skin-lymphatics ("localized lymphoedema"). No working lymphatics can be found in the border of ulcers. As could be demonstrated by intramuscular injection of the radioactive tracer subfascial lymphtransport is decreased not only in the postthrombotic stage but already in the acute phase of a deep vein thrombosis. The alterations of the lymph-drainage in a postthrombotic syndrome may have some pathophysiological importance for the development of the tissue changes and may also explain some clinical signs.
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PMID:[Involvement of the lymphatic system in post-thrombotic syndrome]. 785 87

There are many common and significant medical complications of head injury. These include (1) cardiovascular problems such as hyperdynamic state, myocardial injury, and dysrhythmias; (2) respiratory changes such as neurogenic pulmonary edema, hypoxia, abnormal ventilatory patterns, pulmonary infections, and pulmonary emboli secondary to deep vein thrombosis; (3) consumption coagulopathy; (4) water and electrolyte derangements--hypo- and hypernatremia; (5) hypothalamic/pituitary dysfunction--syndrome of inappropriate secretion of antidiuretic hormone and diabetes insipidus; (6) increased general metabolism with loss of immunocompetence, respiratory compromise, and complications of decreased activity; (7) gastrointestinal difficulties, particularly stress gastritis; and (8) infectious problems including those related to contamination from open wounds and foreign bodies such as monitors.
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PMID:Medical complications of head injury. 841 23

A hydrazinonicotinamide-functionalized cyclic glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist [cyclo(D-Val-NMeArg-Gly-Asp-Mamb(5-(6-(6-hydrazinonicotin amido)hexanamide))) (HYNICtide)] was labeled with 99mTc using tricine and a water soluble phosphine [trisodium triphenylphosphine-3,3',3"-trisulfonate (TPPTS); disodium triphenylphosphine-3,3'-disulfonate (TPPDS); or sodium triphenylphosphine-3-monosulfonate (TPPMS)] as coligands. Three complexes, [99mTc(HYNICtide)(L)(tricine)] (1, L = TPPTS; 2, L = TPPDS; 3, L = TPPMS), were evaluated in the canine arteriovenous shunt (AV shunt) model and canine deep vein thrombosis imaging (DVT) model. All three agents were adequately incorporated into the arterial and venous portions of the growing thrombus (7.8-9.9 and 0.2-3.7% ID/g, respectively) in the canine AV shunt model. In the canine DVT model all three complexes had thrombus uptake that far exceeded the negative control, [99mTc]albumin. The findings indicate similar incorporation into a venous thrombus (% ID/g = 2.86 +/- 0.4, 3.4 +/- 0.9, and 3.38 +/- 1.1 for complexes 1, 2, and 3, respectively) and similar blood clearance with a t1/2 of approximately 90 min. Gamma camera scintigraphy allowed visualization of deep vein thrombosis in as little as 15 min with the thrombus/muscle ratios being 3.8 +/- 0.8, 2.8 +/- 0.4, and 3.0 +/- 0.8 for complexes 1, 2, and 3, respectively. The visualization of the thrombus improved over time, and the thrombus/muscle ratios were 9.7 +/- 1.9, 13.8 +/- 3.6, and 9.4 +/- 2 for complexes 1, 2, and 3, respectively, at 120 min postinjection. The administration of complexes 1-3 did not alter platelet function, hemodynamics, or the coagulation cascade. Furthermore, complexes 1-3 did not significantly differ in their uptake into the growing thrombus, blood clearance, and target to background ratios. Therefore, all three complexes have the capability to detect rapidly growing venous and arterial thrombi.
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PMID:Biological evaluation of thrombus imaging agents utilizing water soluble phosphines and tricine as coligands when used to label a hydrazinonicotinamide-modified cyclic glycoprotein IIb/IIIa receptor antagonist with 99mTc. 909 55


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