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Biomedical subjects

M L Thomas

Publications and source records attributed to M L Thomas.

At least 307 records · Page 17Linked to original sources

Post-thrombotic inferior vena caval obstruction. A review of 24 patients.

An analysis of the clinical features of 24 patients with post-thrombotic obstruction of the inferior vena cava demonstrated by phlebography showed that the possible precipitating cause was usually trivial and the onset was often associated with bed rest. The classical physical signs of bilateral leg swelling and dilated superficial abdominal wall collateral veins were often absent. In this series bilateral leg swelling was present in 42% and dilated collateral veins were present in half of the patients.A history of recurrent varicose veins and venous ulcers was common and must be taken as an indication for cavography. The presence or absence of proteinuria is no guide to the level of the caval obstruction. The value of inferior vena cavography in making an accurate diagnosis is emphasized.

Adolescent↗

Kidney function after renal arterial embolism.

Seven patients with atrial fibrillation had acute unilateral renal pain associated with suppression of function in the affected kidney. This was ascribed to renal embolism. Arteriography performed in four patients showed abnormalities in the renal arterial tree in three, though thrombus in a main artery was present in only one.Considerable function returned spontaneously to the affected kidney in six patients as judged by intravenous pyelography or renography. In two patients the sole functioning kidney was affected, leading to acute oliguric renal failure, but renal function recovered in each case. The routine use of anticoagulants in persistent atrial fibrillation is justified by such cases.

Acute Kidney Injury↗

Prevention of recurrent pulmonary embolism.

Fifty patients have been studied by bilateral phlebography following their first, or sometimes recurrent, pulmonary embolus. Nineteen were found to have fresh loose peripheral thrombus, and in eight of them the thrombus looked big enough to cause a major pulmonary artery obstruction and death. These 19 patients were treated by vein ligation in addition to anticoagulants.The incidence of recurrent embolism in the trial group is significantly lower than that found in a retrospective study of 50 patients treated with anticoagulants only. It is suggested that anticoagulants will not prevent all recurrent pulmonary emboli, and that phlebography, and if necessary surgery, should be part of the routine investigation and treatment of all patients after their first pulmonary embolus.

Adolescent↗

Streptokinase and deep vein thrombosis.

Five patients with deep vein thrombosis were given streptokinase. Five others with similar phlebograms were given anticoagulants, and the results assessed by examining changes in the iliac, femoral, and calf segments of the phlebograms when repeated 7-10 days later. Those of the anticoagulant group were unchanged. Four of the five given streptokinase had a reduction in the size and extent of their thrombosis. Fresh thrombus surrounded by flowing blood was lysed. Thrombus completely blocking a vein was not lysed.The indications for the use of streptokinase in deep vein thrombosis are reviewed.

Adolescent↗