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PubMed2003

[Otogenic cavernous sinus thrombophlebitis. A case report].

OBJECTIVES: Acquire knowledge concerning the diagnosis and treatment of otogenic cavernous sinus thrombophlebitis. PATIENT AND METHODS: We report a case of otogenic cavernous sinus thrombophlebitis (CST) in a 6-year-old boy. RESULTS: CST diagnosis was based on clinical signs (septic illness, ocular nerve palsy and chemosis), and neuro-imaging confirmed the diagnosis. Contrast-enhanced CT scan demonstrates different signs: (i) filling defect or heterogeneous enhancement of cavernous sinus, (ii) cavernous sinus enlargement with bulging of the lateral wall, (iii) intensive enhancement of lateral wall corresponding to enhancement of a collateral network replacing the thrombosed cavernous veins, (iiii) and sometimes indirect orbital signs (exophthalmus, densification of the retro-orbital fat, superior ophthalmic dilatation with partial or no enhancement in case of thrombosis extension). The bacteria most frequently found are Streptococci, Streptococcus pneumoniae, Staphylococcus aureus, Gram-negative rods and anaerobes combined. The therapeutic management of CST consists of intravenous administration of appropriate antibiotics combined radical mastoidectomy if medical therapy has failed. Anticoagulant therapy is controversial. CONCLUSION: Knowledge of early diagnosis of otogenic cavernous sinus is important because prior to the antibiotic era, CST was almost always fatal. Currently, therapeutic outcome is not always favorable due to high morbidity after aggressive treatment.

Cavernous Sinus Thrombosis↗
PubMed1989

[Surgical tactics in acute thrombophlebitis of the superficial veins of the lower extremities].

A 20-years experience of the clinic with substantiation of the surgeon's tactics for acute thrombophlebitis of superficial veins of lower extremities is presented. A conclusion is made that radical operations for acute thrombophlebitis of superficial veins of lower extremities without special preoperative preparation prevent further spread of the thrombotic process, development of thromboembolism of the pulmonary artery, make the duration of treatment at the hospital 2 times shorter and contributes to quicker recovery of working ability.

Acute Disease↗
PubMed1989

[Surgical tactics in acute superficial thrombophlebitis].

Results of the surgical treatment of 147 patients for acute thrombophlebitis of the dilated subcutaneous veins are described. Radical vagotomy was performed in most of the patients. The removal of thrombi from the umbilical veins with the help of the Fogarty probe and aspiration with a vacuum suction device was performed in 13 cases. A conclusion is made that the surgical treatment of acute thrombophlebitis of subcutaneous veins of lower extremities is an effective method of prophylactics of thromboses and pulmonary embolism.

Acute Disease↗
PubMed1985

Deep venous thrombosis, pulmonary embolism and acute surgery in thrombophlebitis of the long saphenous vein.

Twenty-eight consecutive cases of acute superficial thrombophlebitis of the long saphenous vein above the knee were reviewed concerning presence of asymptomatic deep venous thrombosis and pulmonary embolism and early clinical results after surgical treatment. Contrast phlebography of the ipsilateral leg revealed asymptomatic involvement of major deep veins of the thigh or calf in 4 of 21 examined patients. Perfusion lung scanning and chest radiography demonstrated typical segmental perfusion defects consistent with pulmonary embolism in two of ten examined patients. High ligation and stripping of the phlebitic veins gave prompt cure in 19 patients, though in two who were simultaneously treated with anticoagulants there was troublesome bleeding. Simple high ligation was performed in nine patients without complications, but four of them had protracted phlebitic pain. The results indicated that preoperative phlebography and lung scanning are helpful in detecting associated asymptomatic disorders and for planning therapy in patients with clinically isolated, superficial thrombophlebitis of the long saphenous vein. The treatment of choice is acute high ligation with removal of all phlebitic veins. If anticoagulation is indicated because of concomitant deep venous thrombosis or pulmonary embolism, the initial procedure should preferably be limited to high ligation.

Adult↗
PubMed1982

[Thrombophlebitis of the superior sagittal sinus in patient with systemic lupus erythematosus (author's transl)].

The case reported here is the first observation of thrombophlebitis of the superior sagittal and left transverse sinuses in a patient with systemic lupus erythematosus. Thrombophlebitis occurred thirty-six years after onset of SLE. The patient had neither nephrotic syndrome nor serum anti-coagulants. Various hypotheses concerning pathogenesis are suggested. The opportunity for heparin therapy is discussed.

Adolescent↗
PubMedDate not supplied

[Thrombophlebitis of the cavernous sinus secondary to polysinusitis. Report of a new case].

Cavernous sinus thrombophlebitis syndrome is uncommon nowadays. Despite the wide range of antimicrobial agents it carries a high mortality. The disease frequently arises from infection of face, mouth, nose and paranasal sinuses, reaching the cavernous sinus by venous spread. Involvement of adjacent anatomic structures accounts for most of the clinical findings. Meningeal involvement, bilateral orbital edema and ocular cranial nerves palsy are very helpful in the differential diagnosis. Streptococcus spp., Staphylococcus spp., Haemophilus influenzae and anaerobic organisms are considered to be the most frequent etiological agents. In the present paper we report a case of cavernous sinus thrombophlebitis following left side polysinusitis. The patient presented with the main clinical features of the syndrome along with Streptococcus equisimilis and Fusobacterium necrophorum bacteremia. Urgent surgery of infected sinuses and appropriate antibiotic therapy led to a favorable outcome. The patient made and excellent progress and was discharged completely recovered two weeks after admission.

Adult↗
PubMed1964

FIBRINOLYTIC THERAPY OF THROMBOPHLEBITIS. TWENTY-FIVE CASES STUDIED WITH SERIAL VENOGRAMS.

Twenty-five patients with deep thrombophlebitis, whose symptoms were of less than five days' duration, had serial venograms made before and after combined streptokinase-plasmin-anticoagulant therapy. Of 20 patients presenting with evidence of inflammation, 18 were asymptomatic within five days. Evidence provided by venograms suggests that thrombolysis of varying degree occurred in eight of 23 patients with comparable pre-treatment and post-treatment venograms. In only two patients was flow restored through a major venous channel. Thus, in most cases, no evidence was adduced that the administration of Thrombolysin(R) (derived from the euglobulin fraction of human plasma, activated with streptokinase and containing both preformed plasmin and plasminogen activator activity) added significantly to heparin therapy. With the dosage schedule of streptokinase-plasmin and anticoagulants employed, pulmonary embolism occurred in two cases and hemorrhagic phenomena in three patients, exclusive of oozing from the sites of injection. Side effects were minimal. Although thrombolysis did not occur in most cases studied, there is currently no adequate way to predict success or failure in the individual patient. One may hope for better results when the optimal choice of thrombolytic agent, dosage schedule, method of administration and anticoagulant programs are established.

Angiography↗
PubMed1976

Septic nonsuppurative thrombophlebitis.

Nonsuppurative peripheral thrombophlebitis is a frequently recognized source of sepsis. Eleven patients cared for on general medical and surgical services had Gram-negative bacillary sepsis on this basis. Ten had isolation of organisms of the Klebsiella-Enterobacter group from the involved peripheral vein. All failed to respond to organism-sensitive antibiotics until the involved vein was excised. After local vein excision, all patients were afebrile within 48 hours and recovered. In seven of the 11 patients, the septic phlebitis source was associated with a standard intravenous needle, and none had cutdown procedures. It is strongly emphasized that this condition is a source of life-threatening sepsis that can be treated by vein excision at the bedside. The treatment in our patients resulted in no morbidity. A high index of suspicion is necessary to diagnose this occult source of sepsis because of the minimal local physical signs.

Adult↗
PubMedDate not supplied

Sonography of postpartum ovarian vein thrombophlebitis.

PURPOSE: We report the gray-scale, color, and power Doppler findings in 3 cases of postpartum ovarian vein thrombophlebitis (PPOVT), an uncommon but potentially lethal disorder. METHODS: A retrospective review of medical records revealed 3 patients with PPOVT who had pelvic sonography performed during the disease course. RESULTS: The sonographic findings of PPOVT included a tubular, hypoechoic mass identified anterior to the psoas muscle in all cases. Perivenous phlegmon formation resulted in hydronephrosis and obstructive periureteritis in 1 case. Inferior vena cava involvement was detected in 2 cases. Decreases in the sizes of the thrombus and the phlegmon were seen on post-treatment studies. CONCLUSIONS: The long course of the thrombosed ovarian vein and the presence of inferior vena cava thrombus are sonographic signs helpful in distinguishing PPOVT from other inflammatory conditions. Sonography cannot be proposed as a primary tool in the diagnosis of PPOVT because it successfully diagnosed only 1 of our 3 cases. However, sonography may be useful in monitoring the response to anticoagulant therapy.

Adolescent↗
PubMed1995

Preventive effect of simultaneously infused lipid emulsion against thrombophlebitis during postoperative peripheral parenteral nutrition.

A prospective, randomized study was conducted to determine whether simultaneous infusion of lipid emulsion with an amino acid-dextrose-electrolyte solution would reduce the incidence of thrombophlebitis (TP) during postoperative peripheral parenteral nutrition (PPN). Thirty patients who had undergone gastric resection for adenocarcinoma were randomly divided into two groups according to whether they were infused with 10% lipid emulsion (group A) or 5% glucose solution (group B) simultaneously with the amino acid-glucose solutions. The total osmolarity of the infusion solutions in each group was 853 mOsm/l. The incidence of complications due to TP, namely, redness and/or edema beneath the cannula insertion site and/or pain, was investigated. There were no differences in the background characteristics of the patients in groups A and B, except regarding concurrent resection of other organs (P = 0.03). The incidence of edema in group A was significantly lower than in group B on postoperative days 2 and 4, although there was no difference in the incidence of redness and pain between the two groups. These findings suggest that the simultaneous infusion of lipid emulsion has a preventive effect against TP during postoperative PPN, and may be a practical means of providing PPN after gastrointestinal surgery.

Adenocarcinoma↗
PubMed1979

Experimental infusion thrombophlebitis. A comparison between glucose and frutcose and 5% and 10% glucose solution.

On the basis of clinical experience it has been claimed that glucose results in a higher incidence of infusion thrombophlebitis than fructose, and that glucose solutions in concentrations higher than 5% are extremely irritant to the venous endothelium. The validity of these two assertions has been investigated by an experimental method based on a quantitative histological study of rabbit-ear veins into which infusions were given under standardized conditions. In two series of experiments, it was shown (1) that fructose solutions caused significantly more inflammatory changes in the veins than did glucose solutions, and (2) that glucose in 10% solutions caused significantly more injury to the veins than 5% solutions, although the difference in the average inflammatory changes was only slight.

Animals↗
PubMed1978

Do fat emulsions protect against infusion thrombophlebitis? An experimental study.

The clinical experience that a fat emulsion (Intralipid) protects the vein against infusion thrombophlebitis caused by an amino acid solution (Aminosol) was controlled by an experimental method based on a quantitative histological analysis of the inflammatory changes observed in the veins of rabbit ears after infusions. In a controlled blind study, sequential analysis failed to reveal any difference in the histological changes which developed after infusion of Aminosol alone and Aminosol plus Intralipid. In a second series of experiments in which Intralipid was compared with 0.9% NaCl it was demonstrated that the fat emulsion alone gave rise to considerable inflammatory changes in the veins.

Animals↗
PubMed1976

Experimental infusion thrombophlebitis. Importance of the pH of glucose solutions.

An experimental method is presented, which compares the tendency of different infusions to cause thrombophlebitis. It is based ona quantitative histological analysis of the inflammatory changes in the veins of rabbit ears after infusions under standardized conditions. By means of this method the inflammatory changes in the veins have been shown to be significantly less pronounced when the pH of glucose solutions is altered from 3.0 to 3.6. This pH change has been prescribed in the 1971 corrections to Pharmacopoea Nordica 1963. By complete neutralization of 5% glucose a further reduction of the damage to the veins has been obtained. For this purpose phosphate buffer is recommended.

Animals↗
PubMed1984

On the efficacy of low dose prednisolone and heparin sodium in the prevention of infusion thrombophlebitis. A double-blind trial.

A prospective, double-blind investigation into the effectiveness of the addition to infusion fluids of an injectable containing 0.3 mg prednisolone and 10 units heparin per ml in a phosphate buffer pH = 7.5 versus the phosphate buffer alone is described. 196 Patients were allocated alternately to each group. On a total number of 593 cannulation days, 16 cases of thrombophlebitis were diagnosed. Statistical evaluation revealed a significant difference between the two groups (p less than 0.01) in favour of prednisolone + heparin sodium.

Catheterization↗
PubMed1993

Thrombophlebitis of the ovarian vein with free-floating thrombus in the inferior vena cava.

Two cases of thrombophlebitis of the right ovarian vein, one occurring after cesarean section and the other after natural childbirth, are reported. The clinical diagnosis was based on the symptoms of postpartum fever in association with right flank pain and confirmed by abdominal CT scans. In both cases the thrombosis extended into the inferior vena cava and was associated with a free-floating thrombus extending up to the renal veins. Thrombectomy of the inferior vena cava and ligation of the right ovarian vein were performed with good results in both cases, as shown by late follow-up CT scans. This and alternative therapeutic strategies are discussed.

Adult↗
PubMed2002

Superficial thrombophlebitis of the lower limbs in patients with varicose veins.

PURPOSE: This study reviews 51 consecutive patients with superficial thrombophlebitis (STP) among 710 patients treated for varicose veins in our department. Methods. An assessment was made of various factors involved. RESULTS: Of these 51 patients, 21 (41.1%) had systemic disorders, including 4 (7.8%) with malignant diseases. Six patients (11.8%) had deep vein thrombosis (DVT) and five (9.8%) had pulmonary embolism (PE). All of the patients with DVT and/or PE had a thrombus in either the greater saphenous vein or the lesser saphenous vein; however, none of the patients with STP and a thrombus in the distal saphenous branch had either DVT or PE. The levels of coagulofibrinolytic markers such as fibrin degradation product-D dimer, plasmin alpha plasmin inhibitor complex, and thrombin antithrombin III complex were elevated in patients with STP or DVT, compared with those with varicose veins only. The level of C-reactive protein (CRP) was also elevated in the patients with STP or DVT. These findings indicate that STP is not necessarily a localized disease, but may be a symptom of systemic disease. In addition to duplex scanning, the measurement of coagulofibrinolytic markers as well as CRP may be useful for detecting STP and/ or DVT prior to the treatment of varicose veins.

Adult↗