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[Osteoporosis and pre- and postpartal heparin therapy].

Multiple vertebral compression fractures occurred in the 33rd week of pregnancy in a breast-feeding mother receiving heparin (20,000-25,000 units/die over 5 months), for deep vein thrombosis. Osteoporosis under heparin therapy is a rare complication and this diagnosis was not made despite obvious clinical signs. It follows from this observation, that heparin therapy should be substituted by oral anticoagulant therapy and discontinued directly after delivery.

Adult↗

The natural history of deep-vein thrombosis.

Symptomatic deep vein thrombosis (DVT) carries a high risk for recurrent venous thromboembolism that persists for many years. This risk is dependent on readily identifiable risk factors, being low after a trauma or a surgical intervention, and higher in all the other patient categories. Severe post-thrombotic manifestations seem related with ipsilateral recurrence of DVT but are rare in patients with a first episode of venous thrombosis adequately treated with anticoagulant drugs and wearing compression elastic stockings. In the absence of malignancy, the prognosis with regard to survival is good.

Humans↗

Transcutaneous oxygen tension in patients with post-thrombotic leg ulcers: treatment with intermittent pneumatic compression.

Transcutaneous oxygen tension (TcPO2) and the effect of intermittent pneumatic compression on tissue oxygenation were studied in 10 patients with post-thrombotic leg ulcers. Oxygen tension was measured near the edge of the leg ulcer before and after 60 min of intermittent compression at 50 mmHg. The control group consisted of nine subjects with no evidence of peripheral vascular disease. The mean TcPO2 for the controls was 59.7 (SEM2.9) mmHg and for the study group 26.2 (SEM7.0) mmHg before treatment and 42.7 (SEM6.4) mmHg after treatment (p less than 0.005). Oxygen tension increased in nine patients in the study group. The change in TcPO2 correlated highly significantly (r = 0.912, p less than 0.002) with the reduction of oedema and the inverse change of skin temperature. The results suggest that intermittent pneumatic compression decreases interstitial fluid volume and venous stasis, both of which may lead to increased tissue oxygenation.

Aged↗

Effect of chronic wound exudates and MMP-2/-9 inhibitor on angiogenesis in vitro.

BACKGROUND: New evidence suggests that matrix metalloproteinases (MMPs) may facilitate angiogenesis as well as function to generate angiogenesis inhibitors. In this study, the angiogenic effect of wound exudates from patients with venous insufficiency ulcers was examined in an in vitro angiogenesis model with and without synthetic MMP-2/-9 inhibitor. METHODS: Wound exudates were obtained from 20 patients with venous insufficiency ulcers and 20 control patients with donor-site wounds after skin grafting for burns. In the angiogenesis model, suramin (20 microg/ml) was used in five wells without wound fluid as negative control, and vascular endothelial growth factor (1 microg/ml) was used in five other wells as positive control. Chronic wound fluids were analyzed without and with a synthetic MMP-2/-9 inhibitor with a concentration of 2 microM and 20 microM in the medium. The total length of tubules was calculated by map reader. Statistical analysis was performed using the Mann-Whitney test. The level of significance was considered to be p < 0.05. RESULTS: Chronic ulcer exudates inhibited angiogenesis significantly (490 +/- 130 microm) compared with acute wound fluids (1740 +/- 320 microm; p < 0.05). In wells with chronic wound exudates and high concentrations of MMP-2/-9 inhibitor, angiogenesis was stimulated significantly (870 +/- 220 microm, p < 0.05). CONCLUSIONS: In this model, reduced angiogenesis might be due to an antiangiogenic effect of MMP-2 and MMP-9. MMP-2/-9 inhibition results in a stimulation of angiogenesis and might be an approach for the treatment of patients with chronic wounds and reduced angiogenesis.

Aged↗

Ten years after...

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Administration, Oral↗

Deep venous thrombosis: gradient-recalled-echo MR imaging changes over time--experience in 10 patients.

PURPOSE: To determine the gradient-recalled-echo (GRE) magnetic resonance (MR) imaging changes caused by intraluminal thrombus of the lower extremities over time and to establish GRE MR imaging criteria to help distinguish acute from previous deep venous thrombosis. MATERIALS AND METHODS: Four women and six men, aged 38-76 years, underwent GRE MR imaging two to four time after the original diagnosis of deep venous thrombosis; eight also underwent confirmatory ultrasonography at that time. Follow-up was 3 months to 1 1/2 years. All patients were treated with anticoagulants. Evidence of thrombus, signal intensity characteristics, and MR imaging appearance were evaluated. RESULTS: Acute thrombosis was identified as an occlusion or prominent filling defect within the vessel. The luminal diameter of thrombosed veins was equal to or larger than that of a corresponding, unaffected vessel in each case. Acute thrombus signal intensity tended to be decreased initially and increase over time. Residual changes due to thrombosis included the web formation (n = 3), luminal narrowing (n = 4), and wall thickening and/or slow flow (n = 5). Vessels in three patients reverted to normal. CONCLUSION: GRE MR imaging demonstrated progressive changes of venous thrombus over time. These criteria may help distinguish acute deep venous thrombosis from the residual changes of previous thrombosis.

Adult↗

Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience.

PURPOSE: To assess the performance of three-dimensional (3D) magnetic resonance (MR) venography of the pelvis and lower extremities in patients without acute deep venous thrombosis by using a lower extremity vascular coil and pedal injection of paramagnetic contrast material. MATERIALS AND METHODS: Conventional and MR venography were performed in 35 legs in 25 patients referred for evaluation of varicosities (n = 8) and postthrombotic changes (n = 7) and assessment of the great saphenous veins prior to bypass surgery (n = 10). Injection of 120 mL of diluted (1:15) gadopentetate dimeglumine into a pedal vein was performed manually at a rate of 1 mL/sec, and 3D gradient-recalled echo data sets of the upper and lower veins were collected. Conventional and MR venographic images were analyzed separately in a blinded fashion. RESULTS: MR image quality was comparable to that of conventional venograms. Varicose changes of the great and small saphenous veins (sensitivity, 94% [44 of 47]; specificity, 96% [89 of 93]) were assessed as reliably as their status before bypass surgery (sensitivity, 98% [53 of 54]; specificity, 92% [47 of 51]). Postthrombotic changes were diagnosed with a sensitivity of 100% [13 of 13] and a specificity of 98% [88 of 90]. CONCLUSION: Direct 3D MR venography comprehensively displays the lower extremity venous system and permits assessment of postthrombotic and varicose changes and the bypass suitability of the saphenous vein.

Adult↗

Phlebography.

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Humans↗