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

We performed radioisotope (RI)-venography in 31 patients suspected of deep vein thrombosis (DVT), and 18 patients of them (58.1%) had abnormal findings. Out of the 18 patients, 14 satisfied the diagnostic criteria for DVT, that were interruption in the venous flow with the presence of collateral circulation. Sensitivity, specificity and accuracy of RI-venography for DVT were 100%, 76%, 87%, respectively. In all of the patients with chief complaints of edema and pain in the unilateral extremity DVT was found by RI-venography. Lung scan revealed multiple pulmonary perfusion defects in 4 (33.3%) of 12 patients with DVT. Out of the 4 patients, 3 (75%) had silent pulmonary thromboembolism. 99mTc-MAA accumulation was seen in the left lobe of the liver in a patient with occlusion of the IVC and common iliac veins. We are convinced that patients with PTE and/or edema and pain in the unilateral lower extremity should undergo routine RI-venography. In conclusion, RI-venography using 99mTc-MAA was reassessed and we obtained the result that it is useful for screening and monitoring DVT and pulmonary thromboembolism.
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PMID:[Reassessment of radionuclide-venography for deep vein thrombosis in the lower extremities and pelvic cavity using 99mTc-MAA]. 160 41

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

With regard to increasing reservations as to homologous transfusions and the objective risks that they involve, since 1984 we have been using an autotransfusion technique in total hip arthroplasty constituting blood predeposit for hemodilution, and intra- and postoperative blood recovery. When this method was used postoperative complications were not very significant even when patients were high-risk (cardiopathic); furthermore, the use of homologous transfusions was required in 2.2% of the patients in 1994 as compared to 90% in 1985. The use of our orthopaedic protocol allows for rapid recovery of movement in the patient thus reducing time bed-ridden and related risks (DVT and/or PTE); the transfusion protocol allows for a return to normal of hemodynamic conditions a few days after surgery. Finally, the reduced incidence of complications caused by homologous transfusions (hepatitis, AIDS...) constitutes a financial saving for the government.
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PMID:Autotransfusion with intra- and postoperative blood recovery in prosthetic hip surgery. A study conducted on 1368 cementless prostheses. 949 42

The symptomatology of PTE is good for the suspicion of PTE only. Symptoms are mainly based on dyspnoea (respiratory rate) and pain in the chest. Clinical diagnostic procedures, on the other hand, are backed up by evaluation of specific risk factors (previous thrombosis, post-operative state, immobilisation) and search for deep venous thrombosis (DVT). Blood gas analysis is very sensitive to unravel (latent) respiratory failure, along with established routine measures (blood pressure, ECG, chest-film) and additional echocardiography. Most important in our experience is a perfusion scan at the earliest opportunity. Spiral-CT angiography is indicated in special cases only. We looked at 115 consecutive patients with suspected PTE and found close correlations between risk profiles of thrombosis, pathological BGA and high probability perfusion scans. DVT was detected in 50% only. Positive predictive values for high risk and pathological BGA were 86 and 92%, respectively. An algorithm for diagnostical/therapeutical strategies is presented. The early application of an heparin-bolus is stressed.
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PMID:[Clinical aspects and diagnosis of pulmonary thromboembolism]. 1037 30

The correct balance between risk factors for the patient and those related to the type of surgery performed is an essential requirement when proposing appropriate anti-thrombosis prophylaxis, which is not always without risks. The guidelines consist in the essential parameter with which the surgeon must be inspired. Nonetheless, their acceptance cannot be totally uninfluenced but must be submitted to a critical analysis, as it cannot constitute, in terms of so-called defensive medicine, a hypothetical refuge to avoid responsabilities nor can it be an acritical parameter in a legal situation. In recent years, cases in this field have increased so that it seems useful to suggest greater involvement by the coagulation specialist, at least in the most complex cases. Legal suits frequently involve a lack of prophylaxis, inadequate prophylaxis, lack of monitoring of coagulative parameters, insufficient duration of prophylaxis, lack of diagnostic testing to be used when DVT and PTE are suspected. Nonetheless, in order to avoid blame on the profession it is not enough to choose suitable and correct treatment; it is important to also keep iatrogenic injury from becoming the center of a legal action because of the lack of patient informed consent. The amount of data is directly proportional to the amount of risk. Furthermore, it is necessary to insist on the need to document data, as a preventive measure, so that the patient is also responsible for the risk taken. In court, the signing of forms cannot be valid proof that the patient was effectively and truly provided with all of the information required.
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PMID:The forensic medical aspects of thromboembolic risk in orthopaedic surgery. 1687 66

We aimed to investigate the relationship between the extent of venous thromboembolism (VTE) and nonspecific inflammatory markers such as neutrophil to lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP). We retrospectively enrolled 77 patients with VTE (distal deep vein thrombosis [DVT], n = 19; proximal DVT, n = 32; and pulmonary thromboembolism [PTE], n = 26) and 34 healthy controls. In the performed analysis of variance, the levels of white blood cell, NLR, and hs-CRP were clearly different among the groups (control, distal and proximal DVT, and PTE) (P < .001). Especially, a significant increase from the control group to the DVT and PTE was observed in the analysis made for NLR. In the performed receiver-operating characteristic curve analysis, area under curve (AUC) = 0.849 and P < .001 were detected for NLR > 1.84. For this value, the sensitivity and specificity were determined as 88.2% and 67.6%, respectively. The NLR is an inexpensive and a readily available marker that may be effective in determining the extent of VTE, and it is useful for risk stratification in patients with VTE.
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PMID:The role of the nonspecific inflammatory markers in determining the anatomic extent of venous thromboembolism. 2381 71

Introduction. Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms. Case Report. A fifty-six-year-old woman presented to the emergency service; the clinical workup revealed deep vein thrombosis in right leg and bilateral massive PTE. As the abdominal sections on the spiral CT revealed a giant pelvic mass of ovarian origin, she was referred to our hospital's gynecologic oncology department. She was scheduled for surgery under enoxaparin. She described numbness on one side of her face. Cranial imaging findings revealed acute ischemic cerebral lesions and transesophageal echocardiogram showed vegetation on the aortic cusp. Under anticoagulation treatment, she underwent hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. After tumor resection, her neurological symptoms dissolved with aggressive anticoagulant treatment. Pathology result was synchronous endometrial and ovarian adenocarcinoma. Discussion. NBTE is a rare condition often associated with advanced malignancies. Peripheral embolism and venous thrombosis are complications that have been associated with NBTE due to hypercoagulable state. These disorders could be resistant to routine anticoagulant treatment. In case of a thrombotic complication due to ovarian malignancy, surgical resection of the primary tumor may increase the effect of anticoagulant treatment.
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PMID:Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma Presenting with Nonbacterial Thrombotic Endocarditis and Pulmonary Thromboembolism: Adenocarcinoma with Thrombotic Events. 2657 8

Pancreatic cancer (PC) is known to be frequently associated with venous thromboembolism (VTE). Although treatment and prophylaxis strategies for VTE in PC patients were updated recently, these were mainly based on data from Western populations and were not verified in East Asian ethnic populations.We investigated the clinical characteristics of VTE in East Asian PC patients. We reviewed electronic medical records (EMR) of 1334 patients diagnosed with pancreatic adenocarcinoma from 2005 to 2010 at single tertiary hospital in Korea. All the patients with newly diagnosed VTE were classified by anatomical site and manifestation of symptoms. The primary outcomes of interest were 2-year cumulative incidence of VTE events. Cox proportional hazards models were used to analyze associations between risk factors and clinical outcomes.A total of 1115 patients were eligible for enrollment. The 2-year cumulative VTE incidence was 9.2%. Major risk factors associated with VTE event were advanced cancer stage, major surgery, and poor performance status. Risk factors associated with mortality after PC diagnosis included advanced cancer stage, poor performance score, leukocytosis, and lower albumin level. The overall VTE did not affected mortality. However in subgroup analysis, symptomatic VTE and deep vein thrombosis/pulmonary thromboembolism (DVT/PTE) showed worse prognosis than incidental or intra-abdominal VTE.The overall incidence of VTE events in Korean PC patients was lower than previous studies. Advanced cancer stage was the most important factor for VTE event and mortality. Unlike Western population group, VTE event did not affect overall prognosis after PC diagnosis. However, symptomatic VTE and DVT/PTE showed higher mortality after VTE event.
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PMID:Characteristics of Venous Thromboembolism in Pancreatic Adenocarcinoma in East Asian Ethnics: A Large Population-Based Observational Study. 2712 43

Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury.
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PMID:Management of Deep Vein Thrombosis (DVT) Prophylaxis in Trauma Patients. 2716 21