Gene/Protein Disease Symptom Drug Enzyme Compound
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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 patients with deep venous thrombosis, there is a recent trend towards surgical thrombectomy to avoid late complications. However, up to 10% of these patients suffer from severe intraoperative pulmonary embolism, 30 to 40% of whom die on the operating table. Treatment options for massive pulmonary embolism include embolectomy (high mortality), transvenous thrombus fragmentation techniques, and thrombolytic therapy. However, while thrombolysis is recommended as the treatment of choice for PTE, it is usually considered contraindicated in surgical patients because of bleeding complications. We report on 5 cases of severe pulmonary thromboembolism with marked cardiogenic shock during venous thrombectomy. Three patients were treated successfully by intraoperative thrombolysis alone or in combination with mechanical fragmentation of the embolus using a catheter technique under fluoroscopy (one case). Diagnosis was established by a sudden decrease of mean arterial pressure (from 83 to 45 mmHg), a marked increase of mean pulmonary artery pressure (MPAP) (from 16 to 43 mmHg), hypoxaemia (SaO2 < 90%), an increased arterial-to-end-tidal CO2-difference (from 7 to 42 mmHg), and/or pulmonary angiography (2 cases). All patients had to be treated with high dosages of catecholamines (norepinephrine 0.5 microgram.kg-1.min-1 or epinephrine 0.1 microgram.kg-1.min-1, and dopamine 6-15 micrograms.kg-1.min-1). Three patients required CPR prior to or during thrombolytic therapy. Thrombolysis was started intraoperatively with rt-PA with dosages ranging from 20 to 90 mg, applied in single injections (5-75 mg) followed by infusions (5 or 10 mg.h-1) for up to 8 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intraoperative thrombolysis with rt-PA in massive pulmonary embolism during venous thrombectomy]. 781 77

Strain DVT, a halotolerant, Gram-negative, facultatively anaerobic bacterium, was isolated from a hypersaline pond located in Death Valley, California. The cells were non-spore-forming, motile, curved rods (1.0-1.8 x 0.5-0.6 microns) and occurred singly, in pairs or rarely in chains. Strain DVT was oxidase-, catalase-, Voges-Proskauer-, amylase-, gelatinase- and lipase-positive and indole-negative. Nitrate, sulfate and fumarate were not used as electron acceptors. Carbohydrates served as energy sources both aerobically and anaerobically. Strain DVT grew optimally at 37 degrees C (temperature range 20-50 degrees C) with 2.5% NaCl (NaCl range 0-12.5%) and pH 7.3 (pH range of 5.5-8.5) in a glucose/yeast extract medium with a doubling time of 20 min (aerobically) or 41 min (anaerobically). The end products of glucose fermentation were ethanol, isobutyrate, propionate, lactate, formate and CO2. Strain DVT was resistant to penicillin, D-cycloserine, streptomycin and tetracycline (200 micrograms ml-1). The G + C content was 50 mol%. 16S rRNA gene sequence analysis indicated that it was closely related to Salinivibrio costicola (97.7%) and this was confirmed by DNA-DNA hybridization (93% relatedness). However, phenotypic characteristics such as halotolerance, gas production, growth at 50 degrees C, antibiotic resistance, sugar-utilization spectrum and phylogenetic signatures are sufficiently different from Salinivibrio costicola to warrant designating strain DVT as a new subspecies of Salinivibrio costicola, Salinivibrio costicola subsp. vallismortis subsp. nov. (= DSM 8285T).
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PMID:Salinivibrio costicola subsp. vallismortis subsp. nov., a halotolerant facultative anaerobe from Death Valley, and emended description of Salinivibrio costicola. 1075 67

There are several reports on use of a temporary IVC filter (T-IVC-F) in patients with deep vein thrombosis. They conclude that the preoperative insertion of a T-IVC-F is useful to prevent intraoperative pulmonary thromboembolism (PTE). But there is no report on preoperative insertion of T-IVC-F not preventing PTE in perioperative period. We experienced a patient who had developed PTE perioperatively despite preoperative insertion of a T-IVC-F. There is a report that some thrombi are not trapped by T-IVC-F in vitro. This suggests that intraoperative PTE can occur. Then, even if T-IVC-F has been inserted preoperatively, it may cause minor thromboembolism, but not major. Therefore we have to observe the vital signs carefully on monitors, such as, pulmonary arterial pressure, end tidal CO2, and transesophageal echocardiograph.
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PMID:[A patient with pulmonary thromboembolism after cesarean section, inspite of having a temporary IVC filter inserted]. 1507 79

A 50-year-old woman underwent open reduction and internal fixation for bilateral lower extremity fracture under general anesthesia. During the surgery, arterial oxygen saturation and expired CO2 concentration dropped suddenly when the left limb was fixed. Immediately, we performed aspiration of the pulmonary thrombus and inserted a temporary infra-vena cava filter followed by heparinization. Ten days later, we carried out the surgery on the right limb uneventfully. The major cause of APTE is deep vein thrombosis (DVT), which is extremely common during perioperative period. Therefore, we must perform antithrombotic therapy for the patient at high risk for DVT.
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PMID:[Acute pulmonary thromboembolism during the surgery for bilateral lower extremity fracture]. 1550 Jan 11

Deep Vein Thrombosis (DVT) and pulmonary embolism are the dangerous and serious complications in patients undergoing surgery. It is known that prognosis is strictly linked to timely recognition of the pathogenetic-clinical phase of the thromboembolic disease and that prevention, therefore, plays the leading role in patients at risk. The most recent series show that, in absence of prophylaxis, the frequency of DVT, diagnosed by objective tests, is still significant in abdominal surgery. Modern diagnostic tools make possible to identify relatively silent clinical thrombosis, also with laboratory tests (i.e., D-dimer plasma levels). The Authors report a study on thromboembolic episodes in patients who underwent pneumoperitoneum with CO2 during laparoscopic abdominal surgery, compared to a control group submitted to open surgery. They underline the importance of a careful preoperative evaluation of the venous system, by Doppler study, in order to identify, patients at risk of DVT and establish a suitable anti-thrombotic prophylaxis.
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PMID:[Thromboembolic risk and prevention of deep venous thrombosis in open and laparoscopic surgery]. 1637 Nov 93

It has been estimated in Japan that Western-life style increases maternal mortality because of pulmonary thromboembolism (PTE). We report a 29-year-old primipara who suffered PTE due to deep venous thrombosis (DVT) in her 29th weeks' gestation. Except for slight tachypnea, she was relatively stable. Anticoagulation with heparin was started immediately. The retrievable inferior vena cava filter (IVC-F) was inserted. Four hours before surgery with discontinuation of heparin, the cesarean section was performed under general anesthesia. We used transesophageal echocardiography, a pulmonary artery catheter and end tidal CO2 monitoring for early detection and rapid management of recurrent PTE. She had no trouble during operation and her baby was born without serious symptoms. After recovery from anesthesia, she was admitted to the intensive care unit. Heparin was restarted after confirmation of hemostasis. On the 3rd postoperative day, we started thrombolytic therapy with urokinase which was tapered off during a week. Heparin was switched to warfarine gradually. On the 10th postoperative day, IVC-F could not be removed because of remaining DVT. She was discharged on daily warfarine. We experienced the perioperative management for cesarean section at 29 weeks' gestation following PTE due to DVT.
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PMID:[Perioperative management for cesarean section in a patient with pulmonary thromboembolism due to deep venous thrombosis]. 1751 98

Deep venous thrombosis (DVT) and the consequent pulmonary embolism (PE) are devastating complications in orthopedic surgery. We report a 45-year-old male patient who developed PE during an operation of proximal tibia fracture under general anesthesia. On mobilization of knee joint, end-tidal CO2 suddenly decreased from 28 to 18 mmHg. Sp(O2) decreased from 99 to 92%, but blood pressure was maintained. Postoperatively Sp(O2) was maintained 94-95% in room air, but sinus tachycardia over 120 beats x min(-1) continued. On postoperative day 1, the patient experienced dyspnea. In the chest CT scan, massive embolism was found in the bilateral main pulmonary arteries and both middle lobe as well as lower lobe arteries in the right lung. DVT was detected by enhanced CT scan of the lower extremity. This patient had many risk factors for PE such as obesity, smoking, immobilization and lack of thromboprophylaxis.
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PMID:[Massive pulmonary thromboembolism during an orthopedic surgery in an obese patient]. 2422 56

May-Thurner syndrome (MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein the right common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-bi-iliac stent graft placement with CO2 and IV contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly.
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PMID:May-Thurner syndrome: High output cardiac failure as a result of iatrogenic iliac fistula. 2578 5