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PubMed2001

Treatment of superficial vein thrombophlebitis of the arm with Essaven gel--a placebo-controlled, randomized study.

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG), in comparison with placebo and with a group of controls in 23 patients with superficial vein thrombophlebitis (SVTPH) of the arms. SVTPH was consequent to infusional treatment with an intravenous catheter. The 4-week study evaluated the average skin temperature and an analogue symptomatic score. In patients treated with active EG, the decrease in score and in composite skin temperature was significantly larger than in the placebo and control groups. No intolerance was observed. The decrease in score and temperature in the placebo group was mainly due to skin manipulation and massage and to spontaneous resolution. In conclusion treatment with EG in arm SVTPH improves signs /symptoms and decreases skin temperature faster. This study confirms earlier observations on the effective, local use of EG in SVTPH.

Administration, Topical↗
PubMed1980

Triple therapy for acute deep thrombophlebitis.

Therapy for patients with extensive thrombophlebitis is ofter inadequate with available methods. The reluctance of most physicians in private practice to use streptokinase or urokinase is understandable when one considers the cost, hospitalization, length of stay and risks involved. This article discusses a unique and previously unreported mode of drug therapy in these patients, consisting of a combination of drugs designed to combine the antithrombotic and thrombusantipropagating effects of warfarin, the anti-inflammatory effect of trypsin-chymotrypsin enzymes, and the antiplatelet aggregating, antiadhesion, and possible enhanced fibrinolytic effects of aspirin with added buffered protection (Ascriptin A/D). This treatment program has been a safe, efficient, economical, and highly effective one for a very costly, common, and disabling disease. It therefore fulfills the ideal criteria for any form of therapy, provided one is knowledgable of its content, and adheres to its contraindications as well as to the basic application of the drugs involved. It is hoped that further investigations along these lines will continue until an ideal solution is reached. Although this is a preliminary report, this study will continue in its present form, and will be expanded to include a series of patients on the aspirin-enzyme combination without the use of warfarin.

Acute Disease↗
PubMed1980

Controversies and enigmas in thrombophlebitis and pulmonary embolism. Perspectives on alleged overdiagnosis.

Increased criticism concerning the alleged misdiagnosis and overdiagnosis of deep vein thrombophlebitis (DVT) in the lower extremities, and of pulmonary embolism is being leveled at clinicians when unequivocal documentation by venography, lung scanning, and pulmonary angiography is lacking. The excessive adoption of this attitude by audit and utilization committees could prove dangerous for patients with these conditions, particularly when rigid criteria intimidate the physician and override his clinical judgment and experience. The matter assumes added importance in view of the increasing magnitude of DVT and pulmonary embolism. The following pertinent issues will be discussed: 1. Failure to consider DVT and pulmonary embolism in the appropriate clinical settings, especially when they are still minor and atypical. 2. Deficiencies in the physical examination. 3. Failure to recognize the inherent limitations of existing diagnostic methods. 4. The perpetuation of diagnostic bias and dogma by teachers and the literature. 5. Confusion introduced by coexisting disorders. The combination of these insights, greater confidence in clinical skills, and newer noninvasive diagnostic methods promise to help resolve this heated controversy.

Adult↗
PubMed1994

Local transdermal glyceryl trinitrate has an antiinflammatory action on thrombophlebitis induced by sclerosis of leg varicose veins.

To test the antiinflammatory and analgesic effects of transdermal glyceryl trinitrate (GTN) the authors carried out a double-blind, randomized, controlled clinical study in 21 patients with mild to moderate leg varicose veins who underwent vein sclerotherapy in both legs. GTN or placebo ointment was applied in a blinded protocol along the surface of the sclerosed vein every eight hours until disappearance of inflammation signs. The varicose vein in one leg was treated with GTN and compared with placebo for the vein of the other leg used as control of thrombophlebitis (TP) signs. Fifteen minutes after first application inflammation signs were observed in all cases. The intensity of inflammation signs was assessed as 26% (10.4 +/- 4.1) in GTN-treated veins and as 61.5% (24.6 +/- 6.3) (P < 0.001) in the placebo-treated veins. One hour later only 63% of cases in the GTN group and all cases in the placebo group showed signs of TP (P < 0.001). The reduction in the intensity of signs at this time was 7.7 +/- 3.9 in the GTN group and 19.7 +/- 6.3 in the placebo group (P < 0.001). All veins in the GTN group were free of signs of TP in less than forty-eight hours. In the placebo group, 45% of veins required more than forty-eight hours for complete disappearance of signs of TP (P < 0.001). The authors conclude that GTN has an antiinflammatory effect in TP induced by sclerotherapy. This action may be related to the nitric oxide released from GTN, through a direct action on the vein and the surrounding inflamed tissue.

Administration, Cutaneous↗
PubMed1999

An "enigmatic" cause of back pain following regional anaesthesia for caesarean section: septic pelvic thrombophlebitis.

A case of septic pelvic thrombophlebitis is reported. This presented as back pain and leg weakness 18 days after regional anaesthesia for caesarean section. The patient was referred to the Department of Anaesthesia. Obstetric review of the patient at the request of the anaesthetist led to a CT scan that demonstrated the diagnosis. This condition may lead to fatal "on-table" pulmonary embolus if the thrombosed vein is handled during an exploratory laparotomy. Treatment should be conservative with antibiotics and anticoagulation. This case illustrates the need for awareness amongst anaesthetists of possible surgical causes for morbidity that may initially appear anaesthetic-related.

Adult↗
PubMedDate not supplied

Low-molecular-weight heparin versus saphenofemoral disconnection for the treatment of above-knee greater saphenous thrombophlebitis: a prospective study.

The objective of this study was to assess the efficacy, safety, and cost of low-molecular-weight heparin compared to saphenofemoral disconnection for the treatment of internal saphenous proximal thrombophlebitis (SPT). Eighty-four consecutive patients diagnosed as presenting SPT alone (symptoms/echo-Doppler) were divided into 2 comparable groups treated with (1) saphenofemoral disconnection under local anesthesia with a short hospital stay (n = 45) or (2) prospective enoxaparin on an outpatient basis for 4 weeks (n = 39). Informed consent was obtained and inclusion, exclusion, and withdrawal criteria were established. Patients were followed up at 1, 3, and 6 months. Thirty patients per group completed the study requirements. In the disconnection group, 2 patients (6.7%) presented complications of the surgical wound, 1 (3.3%) had SPT recurrence (however, there was no deep venous thrombosis), and 2 (6.7%) had nonfatal pulmonary embolism confirmed by radionuclide scan. In the enoxaparin group, there were 2 cases (6.7%) of minor bleeding (epistaxis and rectal bleeding) and 3 (10%) recurrences of SPT. In the enoxaparin group there was no case of progression of the thrombosis to the deep venous system or pulmonary embolism. The study found no statistically significant differences between saphenofemoral disconnection and enoxaparin in the treatment of SPT, but the low-molecular-weight heparin group had socioeconomic advantages.

Adult↗
PubMed2004

Diagnosis of deep septic thrombophlebitis in cancer patients by fluorine-18 fluorodeoxyglucose positron emission tomography scanning: a preliminary report.

PURPOSE: To determine the role of the fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan in the diagnosis and management of deep septic thrombophlebitis (STP). PATIENTS AND METHODS: We conducted a prospective observational evaluation of FDG-PET in patients with cancer and suspected STP. Retrospective evaluation of patients with cancer and deep venous thrombosis (DVT) who underwent FDG-PET and extremity duplex scan (DS) was also performed. RESULTS: Strong venous uptake was observed in FDG-PET of nine STP episodes versus 0 of 27 DVT episodes (P <.001). FDG-PET identified central vein STP in five patients, whereas DS and venography were negative in five and two of these patients, respectively. FDG-PET diagnosis of STP resulted in therapeutic changes in all patients. In four patients, follow-up FDG-PET confirmed resolution. CONCLUSION: In cancer patients, FDG-PET identifies STP even in areas not optimally visualized by DS or venography, distinguishes STP from DVT, and leads to significant therapeutic changes.

Adult↗
PubMedDate not supplied

Thrombophlebitis after intravenous diazepam--can it be prevented?

Although pain and subsequent thrombophlebitis are complications in patients receiving intravenous (IV) diazepam, the mechanism and accompanying histology are unknown. To further elucidate the pathogenesis for this and determine whether it can be minimized, adult female rats received IV diazepam, diazepam vehicle, lidocaine, a combination of lidocaine and diazepam, or N saline solution, and underwent subsequent tissue light microscopy. Vascular tissue from animals receiving IV diazepam alone revealed marked inflammation with inflammatory edema and intramural polymorphonuclear-cell infiltration. Intravascular thrombosis and complete vein-wall destruction were also present in some animals as early as 48 hours after IV diazepam. Diazepam vehicle and diluted diazepam produced similar morphologic alterations. Lidocaine or saline IV resulted in no histologic alterations, while lidocaine added to diazepam did not reduce the inflammatory response. These results represent the first systematic morphologic evaluation of vein response to intravascular diazepam and suggest that it produces rapid and detrimental morphologic alterations. The dilution of diazepam or combination with lidocaine does not appear to alter these findings, and diazepam vehicle appears to assume a role in the production of the vascular injury.

Animals↗
PubMed1983

Cavernous sinus thrombophlebitis secondary to sphenoid sinusitis.

Cavernous sinus thrombosis is a serious life threatening condition which usually results from midfacial skin infections. Preantibiotic era mortality rates of 80% have improved markedly because of an early awareness of the condition and prompt initiation of parenteral antibiotics. Sphenoid sinusitis is an uncommon associated cause of cavernous sinus infection and is itself a rare and elusive clinical problem. A case of sphenoid sinusitis and concurrent cavernous sinus thrombophlebitis is presented to highlight the clinical diagnostic considerations with special emphasis on bilateral eye signs as indicators of the impending thrombophlebitic process.

Adolescent↗
PubMed1999

An adult case with an abnormal right ventricular structure causing intraventricular pressure gradient and a history of aphthous stomatitis and thrombophlebitis.

We report a 50-year-old man with a right ventricular structure causing an intraventricular pressure gradient. He had been diagnosed as vasculo-Behçet with a history of aphthous stomatitis and thrombophlebitis. He had also been suffering from atrial flutter and mild right-side heart failure. Echocardiography showed that there was an abnormal structure attached to the right ventricular free wall and protruding into the cavity, and that it caused the pressure gradient estimated to be approximately 19 mmHg. Chest X-ray computed tomography demonstrated that the structure was partially calcified. Magnetic resonance imaging depicted the structure separating the right ventricle into two chambers. Angiographic study revealed a markedly enlarged right atrium and a filling defect at the mid-portion of the right ventricle, which divided the right ventricular cavity into two parts. Hemodynamic study showed a slightly elevated right atrial pressure (mean 7 mmHg) and a peak-to-peak intraventricular pressure difference of 18 mmHg in the right ventricle. The diastolic pressure tracing of the right ventricular low pressure chamber showed a 'dip and plateau' pattern. Although the pathological features of the abnormal right ventricular structure in this case were not fully clarified, abnormal muscle bundle and/or endocardial fibrosis, which were reported to be associated with Behçet's disease, may have contributed to its generation.

Atrial Flutter↗
PubMed2000

The pivotal role of deep vein thrombophlebitis in the development of acute disseminated staphylococcal disease in children.

Deep vein thrombophlebitis (DVT) and septic pulmonary emboli (PE) are rare in children. The association of DVT and acute disseminated staphylococcal disease (DSD) during childhood has not been previously reported. We report 3 children who developed a triad of DVT, septic PE, and acute osteomyelitis with Staphylococcus aureus cultured from blood and bone. One child succumbed, while 2 survived following prolonged, morbid hospitalizations. The rapid clinical deterioration observed in these patients might be caused by the aggressiveness of staphylococcal infection combined with an ongoing showering of septic emboli from the ileo-femoral DVT. We suggest that infected DVT with septic PE had a pivotal role in the development of DSD in these children. The presence of this triad should prompt aggressive treatment with the appropriate antibiotics, anticoagulation, surgical drainage, and assisted ventilation when indicated.

Acute Disease↗
PubMed1993

Double-blind comparison of nimesulide and diclofenac in the treatment of superficial thrombophlebitis with telethermographic assessment.

A total of 60 patients with acute varicophlebitis or acute superficial thrombophlebitis of the lower limbs were recruited to this randomised double-blind comparative study, which evaluated the efficacy and tolerability of oral nimesulide (100mg twice daily) with those of diclofenac (50 mg/kg twice daily) over a period of < or = 20 days (average duration 13.6 days for nimesulide and 12.6 days for diclofenac). The analgesic effect of both drugs was rapid. Spontaneous pain disappeared within 3 to 5 days of commencing therapy, and pain on palpation within 7 days. Reduced inflammation was observed after approximately 15 days, and total resolution of redness and swelling was observed by day 20. Telethermographic assessment showed a reduction in local temperature, either in absolute terms or in the extent of inflammation. Indeed, 93% of patients showed complete recovery while 7% of patients showed a partial reduction in hyperthermia. For these latter patients, medical treatment was extended, although the subjective symptoms of the disease were no longer present. The comparison between nimesulide and the reference drug, diclofenac sodium, showed no significant difference for any of the considered parameters. Both drugs were well tolerated and no patient reported an adverse event.

Adolescent↗
PubMed1997

Acute myeloid leukemia accompanied by multiple thrombophlebitis.

A 66-year-old woman suffering from fever and thrombophlebitis was referred to our hospital. A peripheral blood examination revealed hyperleukocytosis with 96% blast cells and thrombocytopenia. The patient was diagnosed as having acute myeloid leukemia (AML) accompanied by disseminated intravascular coagulation (DIC). A marked decrease in protein C (PC) antigen and activity were observed. In this case, PC levels were lower than those observed in AML with DIC. Induction therapy for leukemia and treatment of DIC were started on the first day of hospitalization. The patient achieved complete remission, with PC antigen and activity levels normalized.

Aged↗
PubMed1997

Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT, and sonography.

OBJECTIVE: Our objective was to compare prospectively the abilities of MR imaging, CT, and sonography to reveal puerperal septic thrombophlebitis in the pelvis. SUBJECTS AND METHODS: Seventy-six women with puerperal fever for 5 days refractory to antimicrobial therapy underwent MR imaging, CT, and sonography. We obtained unenhanced axial CT images followed by enhanced images after the administration of an oral contrast agent for which we followed a specific protocol. Axial T1- and T2-weighted spin-echo MR images with phase reconstruction and sagittal T1-weighted MR images were obtained. Real-time sonography was performed using Doppler color flow mapping and spectral waveform analysis. RESULTS: Of the 76 women, 64 completed studies with all three techniques. Ovarian vein thrombosis was diagnosed in 12 women. True-positive results were indicated when at least two of the three studies showed the presence of a clot; true-negative results were indicated when at least two of the three studies showed a lack of thrombosis. MR imaging and CT revealed both ovarian veins in all cases (64/64). Sonography revealed 33 (52%) of 64 right ovarian veins and 15 (23%) of 64 left ovarian veins. MR imaging (sensitivity, 92%; specificity, 100%) and CT (sensitivity, 100%; specificity 99%) were comparable in all but two cases. In one such case, MR imaging showed patency, CT revealed findings interpreted as thrombosis, and sonography showed flow in the partially occluded vein. In the second such case, bilateral thrombosis was seen on CT, but interpretations based on sonography and MR imaging were left-sided thrombosis only. Sonography correctly revealed six of the 12 cases of ovarian vein thrombosis. CONCLUSION: CT and MR imaging proved to be the studies of choice in the evaluation of ovarian vein thrombosis.

Adult↗
PubMed2000

Varicella zoster meningitis preceeded by thrombophlebitis in a patient with Hodgkin's disease.

Varicella zoster (V-Z) infections are common among patients with hematological malignancies, particularly Hodgkin's disease (HD). The common denominator in both HD and V-Z infections is immunosuppression. Most of V-Z infections occur in patients with HD during the remission period, who have mixed cellularity sub-type, with stage III disease and who have received combined chemo-radiation therapy. Involvement of the central nervous system usually manifests as post-herpetic neuralgia or encephalitis. Angiitis has also been found in association with V-Z infections. The authors describe a case of HD who developed V-Z meningitis preceeded by superficial thrombophlebitis of upper extremities during the period of active chemotherapy.

Adult↗
PubMedDate not supplied

[Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management of three cases].

BACKGROUND: Pylephlebitis is thrombophlebitis of the portal vein and/or of its branches; it is acute and generally arises as a complication of inflammatory intra-abdominal processes or of surgical interventions in patients with blood discrasies. As its clinical picture is fairly non-specific, radiological findings, while not pathognomonic, are of great use in early diagnosis and improved vital prognosis of these patients. The aims of this study are to review the pathophysiology of this entity and its clinical and radiological presentation, which allow for early clinical suspicion. CLINICAL CASES: Three cases of pylephlebitis are presented, two of them post-surgical, in which the only common clinical data for suspicion were the febricula and leucocytosis. Diagnosis was obtained from the finding of helicoidal computer tomography with IV contrast - Somaton Siemens - and abdominal echography - Ellegra Siemens - carried out on the three. The result of these tests was decisive for an early diagnosis, efficient treatment and satisfactory evolution in the three cases. DISCUSSION: We wish to emphasize the importance of clinical suspicion and early radiology for an early diagnosis of this entity, which make it possible to establish an efficient treatment.

Adult↗