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Biomedical subjects

M V Huisman

Publications and source records attributed to M V Huisman.

62 records · Page 4Linked to original sources
PubMed1986

Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. The Amsterdam General Practitioner Study.

Diagnosis of deep venous thrombosis by clinical signs and symptoms is unreliable, but contrast venography is relatively expensive and invasive. We therefore evaluated the use of impedance plethysmography as a noninvasive alternative in 426 consecutive outpatients with clinically suspected acute deep venous thrombosis. Four sequential impedance plethysmograms were obtained on days 1, 2, 5, and 10 of the study. In 289 patients (68 percent), the results of all four studies were normal, and these patients were not treated with anticoagulants. One of these patients may have had a minor pulmonary embolus during the 10-day study period. During a six-month follow-up of all patients, none of the 289 patients whose plethysmograms were normal died of venous thromboembolism or presented with suspected pulmonary embolism. In 137 patients (32 percent), the impedance plethysmograms were abnormal; 117 (85 percent) had the abnormal results on their first test, and 20 (15 percent) had them on subsequent tests. All patients with abnormal plethysmograms also underwent contrast venography, which confirmed the diagnosis of deep venous thrombosis in 92 percent. We conclude that the diagnostic accuracy of repeated impedance plethysmography compares favorably with that of venography and that the technique is a safe and effective noninvasive approach to the diagnosis and care of outpatients with clinically suspected acute deep venous thrombosis.

Adult↗
PubMed1985

A comparison of impedance plethysmography and strain gauge plethysmography in the diagnosis of deep venous thrombosis in symptomatic outpatients.

Strain gauge plethysmography and impedance plethysmography are non-invasive diagnostic techniques for deep venous thrombosis. In 145 consecutive out-patients presented with suspected acute deep venous thrombosis we compared these two techniques. Venography was performed if one or both tests were positive. Both tests were repeatedly normal in 91 (63%) patients, while in 38 (26%) patients both tests were abnormal and venography confirmed the presence of venous thrombosis. In six other patients the impedance plethysmography test result and venography were positive while the result of the strain gauge plethysmography test was normal. This difference was statistically significant (p less than 0.001). Four of these six patients had acute proximal thrombosis of the deep leg veins. The impedance plethysmography was falsely positive in four patients while strain gauge plethysmography was falsely abnormal in one patient. We conclude that in the diagnostic management of patients with suspected deep venous thrombosis, impedance plethysmography is superior to strain gauge plethysmography.

Diagnostic Errors↗
PubMedDate not supplied

Frequency of major hemorrhage in patients treated with unfractionated intravenous heparin for deep venous thrombosis or pulmonary embolism: a study in routine clinical practice.

BACKGROUND: The rate of major hemorrhage during the initial treatment with unfractionated heparin (UFH) in patients with deep venous thrombosis (DVT) and pulmonary embolism (PE) in routine clinical practice is understudied. In recent clinical trials an overall average of 3.8% was reported. However, the incidence of this complication in routine patient care might be higher owing to less strict patient selection and lack of standardization in the administration of heparin. We have determined major bleeding rates during heparin treatment for DVT or PE in routine practice and compared these rates with data from clinical trials. METHODS: Data on the occurrence of major hemorrhage were retrieved according to strict criteria from the records of patients who had received continuous intravenous UFH therapy to treat objectively documented DVT or PE in 3 hospitals. RESULTS: After exclusion of 29 patients because of lack of objective diagnosis of DVT or PE and 25 patients because of initial treatment with low-molecular-weight heparin, 424 consecutive patients were available for detailed analysis. Among them, 17 patients (4.0%; 95% confidence interval, 2.1%-5.9%) experienced major hemorrhage during UFH treatment, which in most patients occurred at the end of planned heparin therapy; one of the hemorrhages was fatal. Six patients (1.4%; 95% confidence interval, 0.3%-2.5%) developed clinically suspected recurrent venous thromboembolism (fatal in 1 case) during UFH treatment or within 7 days' cessation. CONCLUSIONS: Administration of continuous intravenous UFH in patients with DVT or PE in routine clinical practice leads to a major bleeding rate of 4.0%. This rate is comparable to the rate of major bleeding in patients who received UFH in clinical trials. Our findings are relevant to the discussion of major bleeding rates in patients with DVT and PE treated in daily clinical practice with subcutaneous low-molecular-weight heparin and newer antithrombotic drugs.

Adult↗
PubMedDate not supplied

The role of helical CT in the diagnosis of pulmonary embolism.

Diagnosing pulmonary embolism is problematic since clinical signs and symptoms of PE are aspecific. Diagnostic algorithms have been developed to rationalize the use of imaging tests in patients with a clinical suspicion of PE. An algorithm based on helical CT has gained widespread interest due to the availability of helical CT. However, these algorithms have often been implemented without appropriate assessment in clinical practice. If one is to implement helical CT as a first line diagnostic test for patients with clinically suspected pulmonary embolism it is important to note that a) CT is sensitive to larger emboli b) single slice technology may miss smaller subsegmental pulmonary emboli and c) outcome studies using a combination of normal single slice helical CT and normal compression ultrasonography rules out safely pulmonary embolism. In view of recent developments in multi row detector CT technology, large, well-designed studies are needed to determine the exact role of multi row helical CT in diagnosing PE.

Humans↗