Inferior vena cava ligation for pulmonary embolism. Review of 118 cases.
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Biomedical subjects
Publications and source records attributed to M Mozes.
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A 32-year-old man had a history of acquired Brown's syndrome associated with diplopia, proptosis, downward displacement of the globe, and lid edema. A CT scan of the orbit revealed an osteoma arising from the left frontal sinus and extending into the left orbit. After surgical extirpation the proptosis and diplopia disappeared and the globe returned to normal. To our knowledge, such a case has not been reported previously.
Interruption of the inferior vena cava is the definitive surgical measure for the control of pulmonary emboli. There is, however, some controversy as to whether the preferred treatment is complete or partial interruption. This report summarizes our experience with 49 patients who underwent partial ligation, using a technique developed in our Department, and 66 patients, who underwent complete ligation of the inferior vena cava. The incidence and severity of sequelae due to venous stasis in the legs were less in the group that underwent partial interruption.
A simple bedside diagnostic maneuver, consisting of a bimanual compression of the gastrocnemius muscle and its use in the assessment of lower limb ischemia, are described. The compression evokes a pain response in the ischemic muscles and, when positive, is strongly suggestive of vascular insufficiency and, when absent, suggests a nonvascular etiology. Thus, the test is useful for the differentiation of vascular from nonvascular leg pain and is recommended as a diagnostic screening maneuver. Further diagnosis requires appropriate clinical judgment and the use of confirmatory tests.
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