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The method of sequential analysis was used to investigate the effect of injection of anaesthetic drugs into an intravenous infusion line on the incidence of thrombophlebitis in the 48 hours following surgery. Analysis of the results failed to show that anaesthetic drugs increased the incidence of thrombophlebitis (P = 0.05), and further showed that they were not a causative factor (P = 0.15).
Thrombophlebitis similar to that which is frequently observed following i.v. injection of irritative drugs in clinical treatment has been successfully reproduced in experimental animals by utilizing a newly devised technique. Thrombophlebitis at a high rate resulted within a few days by allowing the sample to remain in the sealed section of the V. retroauricularis in rabbits for 3 min after injection. The effects of several drug preparations on the thrombus as well as on the inflammation formed by means of this technique were examined, and the results were in good parallel with clinical cases reported in medical literature. Histopathologically, it was observed that each thrombus was formed by the irritative effect of drugs on the portion on the veneous wall damaged when needles had been inserted.
This report describes a 69-year-old Japanese woman with bilateral forearm thrombophlebitis that developed soon after transvenous permanent pacemaker insertion. Intravenous administration of urokinase and heparin rapidly resolved fever, painful forearm swelling and inflammatory findings. Digital subtraction venograms revealed a brachiocephalic vein thrombosis. A ten-month treatment with warfarin and ticlopidine resulted in the complete restoration of venous flow. Although thrombophlebitis associated with transvenous permanent pacemaker insertion has a relatively low incidence (0.3%), prompt diagnosis and treatment with anticoagulant and/or thrombolytic agents are important for the late clinical outcome in cases with deep venous thrombosis.
In a double-blind study, the efficacy and tolerability of nimesulide (100mg twice daily) were compared with those of diclofenac (50mg twice daily) when administered orally to 50 patients with acute superficial thrombophlebitis of the lower limbs. Pain relief and amelioration of inflammation were apparent in patients treated with either nimesulide or diclofenac; however, gastric intolerance was noted more frequently in those receiving diclofenac. The results of this study suggest that nimesulide should be considered as an alternative to diclofenac and other first-line NSAIDs in the treatment of acute superficial thrombophlebitis.
The authors report the clinical case of a young woman with thrombophlebitis of the right ovarian vein following delivery by caesarean section, initially presenting in the form of renal colic. In the light of a review of the literature, they recall the pathophysiological mechanisms of ovarian thrombophlebitis and the various features observed on imaging examinations. The most frequent clinical features are also described. The authors emphasize the potential, but rare severity of this disease, characterized by the risk of pulmonary embolism, and its treatment, which is usually medical.
A short survey of the relevant literature is followed by the description of the clinical course of a thrombophlebitis of the cavernous sinus. In this case, the initial focus was an infection of a canine which caused thrombophlebitis via the anterior facial vein. The healing must be attributed to the immediate application of broad spectrum antibiotics and removal of the primary focus.
A 34-year-old man developed fever, headache, nausea, double vision, exophthalmus, ptosis, disturbance of vision and oculomotor nerve palsy. Magnetic resonance imaging and cerebral angiography led to the clinical diagnoses of cavernous sinus thrombophlebitis and suspicion of bacterial aneurysm of the left internal carotid artery, respectively. Peptostreptococcus was detected in blood culture analysis. He died 15 days after admission. Systemic organs showed several septic changes. In particular, the bilateral cavernous sinuses were enlarged and showed severe neutrophilic leukocyte infiltration of the walls and organization, recanalization and abscesses in thrombi. In anterior to the middle cranial fossa, abscess-forming, necrotic, hemorrhagic meningitis, purulent sphenoid sinusitis, pyogenic osteomyelitis of the sphenoid bone, suppurative encephalitis, and inflammatory necrosis of the hypophysis were seen. Based on these findings, we diagnosed the patient with cavernous sinus thrombophlebitis caused by sphenoid sinusitis.
Septic thrombophlebitis of the portal vein is an unusual and serious complication of abdominal infection. We present a patient with thrombophlebitis of the portal vein of unknown origin, suffering from fever, abdominal pain, jaundice, abnormal liver test function and bacteremia related to Bacteroides fragilis. Ultrasonography, with doppler of the portal vein, was performed which showed thrombosis of the portal vein together with signs of portal hypertension. The patient underwent six weeks of antibiotic treatment. The evolution was favourable, the infection was overcome and the portal vein was de-obstructed as a consequence of which the signs of portal hypertension disappeared.
BACKGROUND: Superficial venous thrombophlebitis (SVT) of the long saphenous vein (LSV) has been shown to be associated with thrombus propagation into the common femoral vein in up to 44% of cases. Conservative management can thus result in deep vein thrombosis (DVT), deep vein insufficiency or fatal pulmonary embolism (PE). To examine the effects of emergency division of the sapheno-femoral junction (SFJ) on the deep venous system in SVT of the LSV we used pre- and postoperative venous duplex ultrasound. METHODS: Emergency division of the SFJ was performed in 17 patients presenting with acute superficial venous thrombophlebitis. All patients had duplex ultrasound, which demonstrated thrombus of the above knee long saphenous vein together with a normal deep venous system. A follow-up duplex ultrasound scan was arranged on discharge and at 2 months. RESULTS: No patient had propagation of thrombus into the deep venous system or a PE. One patient developed a non-occlusive clot in the popliteal vein at 2 months follow-up. All patients were discharged at 48 hours. CONCLUSIONS: Using duplex ultrasound it has been shown that emergency division of the SFJ is a safe and effective way of preventing serious complications caused by thrombus in above knee LSV SVT.
In tropical thrombophlebitis the leg veins are most often involved, but in some patients thrombosis of the visceral veins may be fatal. As its cause is unknown, attention is called to outbreaks of relapsing fever in the Transvaal which effects labourers on citrus and maize farms and which often develops into thrombophlebitis. Appropriate tests for relapsing fever should be done in patients who develop this complication. Passengers on long overnight journeys by air are liable to deep vein thrombosis and should exercise to avoid it.
Post-partum cerebral thrombophlebitis is a rare accident (1/3000 to 1/10000 births). Symptoms vary and may be misleading. We report three cases of cerebral thrombophlebitis occurring during the pospartum period where diagnosis was based on clinical signs and imaging data (computed tomography and cerebral angiography). Heparin therapy led to good outcome in all three cases. Heparin therapy has been controversial for these patients but recent work has shown improvement in this severe conditions with very poor prognosis.
Superficial thrombophlebitis is a frequently occurring disease which, because of risk factors, affects women to a greater extent than men. The presence of deep venous thrombosis should be excluded by imaging procedures. Heparin or low-molecular weight heparins are indicated for treatment, if deep venous thrombosis is present or threatening. In the acute stage non-steroidal antiinflammatory drugs can be taken orally in order to alleviate pain and inflammation. In the case of concomitant chronic venous insufficiency, edema protective drugs (e. g. preparations containing horse chestnut extract and flavonoids) can support the therapy. For the treatment of inflammatory conditions in relatively short superficial vein segments without involvement of the deep venous system, a limitation to topical treatment is possible. In addition to compression therapy, the application of creams or gels containing heparin or heparinoids are the usual treatment approach. The use of topical products containing mucopolysaccharide polysulfate (MPS) has been proven to be beneficial. The problem of providing evidence of the efficacy of topical products in the therapy for superficial thrombophlebitis under the current strict demands of our regulatory authorities and of developing new products under these conditions is discussed.
In 1955, the first reported case of Mondor's disease (superficial thrombophlebitis) of the penis was published. Since then, there have been scattered reports of penile Mondor's disease in the literature. Most studies suggest sexual trauma or neoplasm as the most frequent etiologic factor. The authors report a case of a sickle cell episode presenting with superficial thrombophlebitis of the penis. The patient was treated with an antiinflammatory agent and reassured that this is a self-limiting process. Resolution of symptoms occurred within 6 weeks.
Six cases of ovarian vein thrombophlebitis are reported including one resulting in operative death, a case diagnosed by phlebography, a postabortal case, and a case followed by habitual abortion. An historic review of this disease is presented. It is suggested that the ovarian vein may be the most commonly involved vein in puerperal pelvic thrombophlebitis.
Two studies were conducted to evaluate the factors associated with the development of thrombophlebitis in cattle following intravenous catheterization of the jugular vein. In study 1, 20 healthy animals were catheterized with 2 different types of catheter (polytetrafluoroethylene (PTE) versus polyvinylchloride (PVC)) for a period of 120 hours. In study 2, 50 dairy cows referred for treatment to the Large Animal Veterinary Teaching Hospital at the University of Montreal were catheterized with a commercial PTE catheter, using a standardized technique, for a period varying from 3 to 6 days, and inherent risk factors were evaluated. A clinical and echographical evaluation of the 2 groups in study 1 demonstrated a higher frequency of thrombosis in the PTE group than in the PVC group. In study 2, the primary factors associated with the development of thrombophlebitis in sick cows were the experience of the manipulator and the severity of the disease.
Fungi are increasingly recognized as microorganisms causing superficial suppurative thrombophlebitis being managed by aggressive surgical therapy and antifungal agents. We report a case of Fusarium proliferatum superficial suppurative thrombophlebitis in an immunocompetent patient with no evidence of systemic infection and who responded to venotomy alone.
The data on examination and surgical treatment of 35 patients, suffering severe forms of varicose disease in stage of trophic disorders occurrence and with an acute thrombophlebitis are adduced. The concept of an active surgical help, including thromboembolic complications prophylaxis, depending on thrombophlebitis localization, correction of the venous hemodynamics disorders and the staged closure of trophic ulcer is substantiated. Introduction of the proposed tactics had permitted to achieve satisfactory outcomes, including the trophic ulcer healing and the trophic disorders regression in all the patients operated on.
Venous stasis, injury or alteration of the intima and alterations in the coagulability of the blood are the three most common etiologic factors in thrombophlebitis. Usually at least two of these factors must be present before the clinical manifestations of the disease develop.A plan of treatment based on correcting these three factors has been used in over 250 cases of thrombophlebitis, and it is believed that a significant decrease was brought about in the acute and long term disability and in the occurrence of complications. The program consists of absolute bed rest in a hospital for about a week, elevation of the foot of the bed, administration of anticoagulants and adenosine-5-monophosphate for at least six weeks, progressive ambulation after the fourth day of treatment, with avoidance of prolonged standing and sitting, and adequate elastic support. Treatment must be continued until the patient has returned to full, normal activity and all signs of phlebitis have disappeared.