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At least 1,747 records · Page 97Linked to original sources
PubMed1995

[Vena iliaca externa thrombosis after open operation of the bladder and prostate].

Since 1986, we have performed total cystectomy or partial cystectomy with ureteroneocystostomy in 64 cases and prostatectomy in 182 cases. 5 cases developed vena iliaca external thrombosis (VIET) or thrombophlebitis postoperatively. Three of them recovered after treatment, and 2 died of pulmonary embolism 7 and 16 days after operations. VIET is a very serious complication. Once develops pulmonary embolism, the patient may die soon. We suggested that patients be encouraged to increase limbs activities, be given medicines of antilipemic and antiatherogenic preoperatively. And during the surgical operation, patients' blood pressure should be kept steady, and hypopietic shock should be avoided as long as possible. The vena iliaca external should never be constricted when a deep hook is used for exposure or gauze is used to stop bleeding. After operation, the patient should be encouraged to exercise on bed or around bed as early as possible, so as to increase venous flow. The veins of lower limbs should be avoided by using infusion. Styptic should not be applied abusively. Infusion of dextranum-40 and orally taking of persantinum may also be used to prevent this kind of complication.

Aged↗
PubMed1998

Efficacy and safety of the new antiandrogenic oral contraceptive Belara.

The aim of this open, noncontrolled phase III study was the assessment of the contraceptive efficacy and the evaluation of the safety of long-term use of Belara (30 micrograms ethinyl estradiol plus 2 mg chlormadinone acetate). Furthermore, cycle stability during administration of Belara and the influence of Belara on acne and seborrhea as clinical signs of androgenization were observed. Belara was taken by 1655 women for a total of 22,337 cycles. For the theoretical Pearl index, a value of 0.269 (95% CI [0.109, 0.600]) was calculated. In 1655 of 22,337 cycles (7.4%), no withdrawal bleeding was documented, whereas in 2565 of 22,308 cycles (11.5%), spottings and, in 786 of 22,308 cycles (3.5%), breakthrough bleeding occurred. After the intake of Belara for 12 cycles, acne on the face/neck improved in 64.1% of the women (209 of 326). In 53.4% of the women (175 of 326), acne disappeared completely. Seborrhea improved after 12 cycles in 89 of 131 women (67.9%), of whom 76 women (58.0%) were completely cured. Sixty-two serious adverse events (SAE) occurred in 59 of 1655 women. Accidents and injuries of the musculoskeletal system were the SAE with the highest incidence (0.66%). Two cases of deep venous thrombosis, one pulmonary embolism, and two cases of visual disturbances were observed. Only for the two cases of deep venous thrombosis could a relation to Belara be assumed. Of the adverse events commonly reported for oral contraceptives, headache was observed for the first time under study medication in 37.4%, nausea in 23.1%, breast tenderness in 21.7%, and vaginal discharge in 19.4% of the women. The frequency of adverse events decreased with longer duration of a drug consisting of intake of Belara. In conclusion, Belara can be described as an effective and safe oral contraceptive with marked antiandrogenic properties.

Acne Vulgaris↗
PubMed2003

[Diagnostic strategies of thrombo-embolic venous disease].

The advent of non invasive tests (D-dimer and lower limb venous compression ultrasonography) and minimally invasive tests (helical CT scan) and the rehabilitation of clinical assessment have allowed the development of safe, rational and cost-effective diagnostic strategies for deep venous thrombosis and pulmonary embolism. Several algorithms have been validated in studies in which patients classified as not having venous thromboembolism are left untreated and followed up during 3 months. The safety of such strategies is established by comparing the 3-month thromboembolic risk in such patients with that of patients left untreated based on a normal venogram, pulmonary angiogram or lung scintigram. Venography or pulmonary angiography remains necessary in selected cases such as patients with a high clinical probability of venous thromboembolism and an inconclusive non invasive workup, representing only approximately 5 to 10% of all patients. Finally, suspected massive pulmonary embolism is a distinct clinical situation in which echocardiography plays a major role.

Algorithms↗
PubMed2004

Factor V Leiden and the risk for venous thromboembolism in the adult Danish population.

BACKGROUND: Odds ratios for venous thromboembolism (deep venous thrombosis and pulmonary embolism) derived from case-control studies range from 3 to 16 for heterozygotes compared with noncarriers and up to 79 for homozygotes compared with noncarriers. OBJECTIVE: To estimate risks for venous thromboembolism in the adult Danish population according to factor V Leiden genotype. DESIGN: Cohort study with 23 years of follow-up. SETTING: Adult Danish population. PARTICIPANTS: 9253 randomly selected individuals. MEASUREMENTS: Hospitalization and death from venous thromboembolism, factor V Leiden genotype, and additional thromboembolic risk factors. RESULTS: Adjusted hazard ratios in heterozygotes and homozygotes compared with noncarriers were 2.7 (95% CI, 1.8 to 3.8) and 18 (CI, 4.1 to 41) for venous thromboembolism overall, 2.4 (CI, 1.3 to 3.8) and 22 (CI, 0 to 60) for deep venous thrombosis, and 3.0 (CI, 1.7 to 4.9) and 11 (CI, 0 to 33) for pulmonary embolism. The lowest absolute 10-year risks for venous thromboembolism in factor V Leiden heterozygotes and homozygotes--0.7% (CI, 0.5% to 1.0%) and 3% (CI, 1% to 8%)--were found in nonsmokers younger than 40 years of age with a body mass index below 25 kg/m2; the corresponding highest risks--10% (CI, 7% to 14%) and 51% (CI, 13% to 100%)--were found in smokers older than 60 years of age with a body mass index above 30 kg/m2. CONCLUSIONS: Hazard ratios for venous thromboembolism in factor V Leiden heterozygotes and homozygotes compared with noncarriers in the adult Danish population were approximately 3 and 18, respectively. The simultaneous presence of smoking, obesity, and old age resulted in absolute 10-year thromboembolic risks of 10% in heterozygotes and 51% in homozygotes.

Adult↗
PubMed1997

The Tempofilter: a multicenter study of a new temporary caval filter implantable for up to six weeks.

A multicenter study was conducted to evaluate a new temporary caval filter (Tempofilter) designed to be implanted for up to 6 weeks. A total of 66 patients with a mean age of 51.8 years were enrolled in the study. All had documented high risk of pulmonary embolism: severe deep venous thrombosis in 89.5% of cases and previous symptomatic pulmonary embolism in 65% of cases. Filter placement was performed in association with a surgical or obstetrical procedure in 68.5% of cases. The indication for filter placement was contraindication to or failure of anticoagulant therapy in 85% of the cases. The mean duration of implantation was 29.9 days. Pulmonary embolism was not observed during the implantation period. Partial thrombosis of the filter was observed in 15% of cases due to trapping of clots by the filter. Thrombosis did not hinder filter removal when attempted. Filter-related complications were minor. Filter migration occurred in only 7.5% of cases. Migration never led to complications and did not hinder filter removal. In all cases migration was due to specific, preventable causes. The results of this study show that the Tempofilter is not only safe and easy to use but also effective in preventing pulmonary embolism. A significantly longer maximum implantation time is a major advantage of the Tempofilter over conventional temporary filters. We believe that this filter can be used for temporary protection against the risk of pulmonary embolism particularly in young patients and in a surgical setting.

Adult↗
PubMed1996

Pulmonary embolism with duplicated inferior vena cava.

Congenital anomalies of the inferior vena cava (IVC) are common and usually of little clinical significance. We report the unusual cases of two patients with pulmonary embolism from thrombosis of part of a duplicated IVC. Both caval anomalies were easily identified with ultrasound, and the patients were successfully treated with anticoagulants. We encourage the reporting of similar cases since knowledge of the contribution of IVC duplication to thromboembolic disease is unknown.

Adult↗
PubMed2005

Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis.

OBJECTIVE: We placed temporary inferior vena cava filters to prevent pulmonary thromboembolism in patients with deep vein thrombosis (DVT) who were presumed to have an increased risk of pulmonary embolism in the perinatal period. These experiences of using temporary inferior vena cava filters in pregnant women are reported. METHODS: We reviewed 11 patients with DVT who underwent placement of a temporary inferior vena cava filter and delivered in our hospital between 1998 and 2004. All of the filters were placed at the suprarenal inferior vena cava before delivery. During filter placement, anticoagulant therapy was routinely performed, and we stopped the administration of anticoagulant agents intrapartum. RESULTS: No complications occurred at filter insertion or during placement. No symptomatic pulmonary thromboembolism occurred during or after delivery. All of the filters were successfully removed, one of which was exchanged for a permanent filter because the temporary filter captured a large thrombus. CONCLUSION: Intrapartum temporary inferior vena cava filters may reduce the incidence of pulmonary thromboembolism in pregnancy with DVT. Temporary inferior vena cava filters appear to be safe for pregnant women.

Adult↗
PubMed2004

Symptomatic venous thromboembolism in cancer patients treated with chemotherapy: an underestimated phenomenon.

BACKGROUND: The exact incidence of venous thromboembolism (VTE) in cancer patients is unknown, partly because of confounding factors. Prophylactic treatment is warranted in surgical patients with cancer because of a high incidence of VTE. We performed a retrospective study to evaluate if the same applies for cancer patients treated with chemotherapy. METHODS: The medical records of 206 consecutive patients with malignancy, treated with chemotherapy, were identified. The kind of malignancy and chemotherapeutic treatment were recorded, as was the date of treatment. The records were reviewed for other risk factors for VTE, and were searched for proved deep venous thrombosis or pulmonary embolism. RESULTS: Of those 206 patients, 15 (7.3%) had proved VTE during or within 3 months after chemotherapeutic treatment. The annual incidence was 10.9%. The incidence of VTE was specifically high in the 39 patients treated with a combination of fluorouracil and leucovorin calcium because of colorectal cancer (6 [15%] of the patients were affected). The occurrence of VTE in the latter group of patients was not influenced by factors such as surgery, central venous catheters, or tumor load. CONCLUSIONS: The annual incidence of VTE in patients treated with chemotherapy was high, specifically in patients with colorectal cancer treated with fluorouracil-leucovorin. If these observations are confirmed, trials to evaluate the use of prophylactic anticoagulant treatment should be conducted.

Adult↗
PubMed2001

Thromboprophylaxis in an academic medical center.

INTRODUCTION: Questions regarding which patients require prophylaxis for thromboembolism, what methods should be used and the appropriate duration of treatment remain unanswered. METHODS AND MATERIALS: A retrospective review from a single academic medical center was undertaken to evaluate prophylactic strategies. Multiple sources of data were used to identify patients who were prophylaxed and those who developed deep vein thrombosis or pulmonary embolism. These data were analyzed to determine factors associated with successful prophylaxis including age, type of prophylaxis and admitting services. RESULTS: A total of 22,030 patients were admitted of whom 7520 (36%) received prophylaxis and there were 523 thromboembolic events. Pneumatic compression devices and antiembolic stockings had the lowest incidence of failure, 2.2% and 3.2% respectively. There were significant differences in the rates of prophylaxis used by the five admitting services, being highest in surgery (40.8%) and lowest in gynecology (11.4%). However, these groups had the lowest incidence of venous thromboembolism (4.3%, 2.3%). Both of these groups used pneumatic compression as the method of choice (64.3% and 65.2%). CONCLUSIONS: Thromboembolism prophylaxis reduces the incidence of DVT and PE, however, our study demonstrates the variable effectiveness of each method in different types of patients. Our data suggest that patient risk of DVT should be individually assessed and an appropriate method of prophylaxis should be applied when warranted.

Academic Medical Centers↗
PubMed2002

Factor V Leiden in central venous catheter-associated thrombosis.

Subclavian vein thrombosis is a well-recognized complication following central venous catheter insertion and is associated with significant morbidity. The factor V Leiden mutation is an important risk factor for deep venous thrombosis and pulmonary embolism. Whether this mutation also predisposes patients fitted with a central venous catheter to subclavian vein thrombosis is not known. The occurrence of central venous catheter-associated thrombosis was investigated in 277 consecutive patients receiving an allogeneic bone marrow transplantation. All patients received a tunnelled double or triple catheter positioned in the subclavian vein. Catheter-associated thrombosis was diagnosed on the basis of clinical signs of thrombosis, i.e. swelling and/or redness of the limb or venous engorgement and was confirmed with a colour-flow Doppler ultrasound. Thirteen patients were heterozygous for the factor V Leiden mutation. Seven of these patients had a subclavian vein thrombosis (54%), while this occurred in only 9% of the factor V Leiden-negative patients, corresponding with a relative risk of 7.7 (95% CI 3.3-17.9). Factor V Leiden is attributable for 17.3% of all thrombosis in patients with central venous catheters. The majority of patients with the factor V Leiden mutation with a central venous catheter will develop thrombosis. Patients with a factor V Leiden mutation should receive adequate thrombosis prophylaxis upon catheter introduction and the catheter should be removed immediately after the treatment. Based on this very high risk, we advise testing for factor V Leiden in all bone marrow transplantation patients receiving a central venous catheter.

Bone Marrow Transplantation↗
PubMed2001

Cost comparison of tinzaparin versus enoxaparin as deep venous thrombosis prophylaxis in spinal cord injury: preliminary data.

Thromboembolic events are major causes of morbidity and mortality in patients with spinal cord injuries. Low molecular weight heparins are recommended as prophylaxis against such events. The purpose of the current study was to perform a cost analysis of tinzaparin versus enoxaparin using published efficacy and safety data as deep vein thrombosis and pulmonary embolism prophylaxis in this population. All published English language articles evaluating either tinzaparin or enoxaparin as pharmacoprophylaxis in spinal cord-injured patients were identified. Data from these studies were subjected to cost-effectiveness analyses followed by sensitivity analyses to determine which agent is the most cost-effective in these patients. Results demonstrated that tinzaparin 3500 U daily and enoxaparin 30 mg every 12 h are both cost-effective agents for thromboembolism prophylaxis in patients with spinal cord injuries.

Cost-Benefit Analysis↗
PubMed1985

Hereditary protein C deficiency.

Hereditary protein C deficiency, which is inherited as an autosomal-dominant trait, predisposes to venous thrombotic disease. Heterozygotes are at risk for superficial thrombophlebitis, deep venous thrombosis and/or pulmonary embolism, which may occur without apparent cause at a young age. Other manifestations are cerebral venous thrombosis and mesenteric vein thrombosis. In severe, often homozygous, protein C deficiency, a purpura fulminans syndrome may occur shortly after birth, resulting in death due to extensive thrombosis, if it is not adequately treated. The thrombotic manifestations in heterozygotes are effectively prevented by coumarin therapy. However, in the initial phase of oral anticoagulant therapy, the patients have an increased risk for the development of coumarin-induced haemorrhagic skin necrosis. The purpura fulminans syndrome can be treated with either replacement therapy or with coumarin therapy. Heparin appears to be ineffective in the prevention of both the purpura fulminans syndrome and the coumarin-induced skin necrosis.

Blood Coagulation Disorders↗
PubMed2000

Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale.

The incidence of venous thromboembolism has been studied during one year in a defined population of 342,000 inhabitants. The overall incidence (95% confidence interval) of venous thromboembolism was found to be 1.83 per thousand per year (1.69 to 1.98). The incidences of deep venous thrombosis and pulmonary embolism were 1.24 per thousand per year (1.12 to 1.36) and 0.60 per thousand per year (0.52 to 0.69), respectively. The incidence of venous thromboembolism rose markedly with increasing age for both sexes; over the age of 75, the annual incidence reached 1 per 100. Sixty three percent of the patients were at home when venous thromboembolism occurred. Of these, sixteen percent had been previously hospitalised within three months. These results raise concerns on identification of medical patients at high risk and effective prophylaxis.

Adolescent↗
PubMed1982

[Angiography imaging in pulmonary embolism (author's transl)].

The principal angiography images found in cases of recent pulmonary embolism include intravascular lacunae, dome-shaped obstructions, a "dead tree" appearance and an avascular region. The first two are specific, but are mainly observed during the few days following the embolism. Highest quality images are obtained by selective angiography of the pulmonary artery, but this technique, which involves transfer of the patient to a specialized unit and catheterization of the pulmonary artery, is not without risk and, more particularly, does not explore the veins of the lower limbs. However, in a series of 110 cases of recent pulmonary embolism, venous thrombosis, usually femoroiliocaval, was present in 102 patients. A new technique is therefore proposed, ascending venous angiopneumography, which has two advantages: --It can be performed in any radiological department as a catheter does not have to be inserted. --It explores both pulmonary and venous systems. Though pulmonary images are less specific (false positives occur more frequently), the simultaneous exploration of the veins allows logical determination of therapy based on the size and site of the embolus and possible associated extension of the venous thrombosis.

Angiography↗
PubMed1987

[Pulmonary and systemic embolism in a case of biatrial thrombosis. Role of two-dimensional echocardiography].

The authors describe the case of a 61-year-old woman affected with pulmonary embolism, in whom the presence of masses in both atria has been detected by two-dimensional echocardiography. The event of a systemic embolism and the dissolution of both masses after an anticoagulant therapy, has induced the authors to diagnose a biatrial thromboembolism propagating from the venous system and passage of thromboembolic material through a patent foramen ovale. These findings are, therefore, in differential diagnosis compared with other biatrial intracavitary masses.

Diagnosis, Differential↗
PubMed1980

Scintigraphy with 111In-labeled autologous platelets in venous thromboembolism.

Scintigraphy with 111in-labeled autologous platelets was performed in 20 patients with suspected venous thrombosis and/or pulmonary embolism. The platelets accumulated in venous thrombi in 6 or 7 patients (86%) with positive findings on impedance plethysmography or contrast venography; all 6 were receiving intravenous heparin. In 11 patients with pulmonary embolism diagnosed by ventilation--perfusion imaging or pulmonary angiography, platelet scintigraphy showed embolic uptake only in the one patient not on full-dose heparin. These findings suggest that scintigraphy with 111In-platelets is a promising noninvasive technique for detection of deep venous thrombosis. Heparin does not appear to block localization of labeled platelets in venous thrombi, but may inhibit their adherence to pulmonary emboli.

Adult↗
PubMed2004

Travel as a risk factor for venous thromboembolic disease.

There is increasing evidence that prolonged travel may be associated with the development of venous thromboembolic disease: ie deep venous thrombosis and pulmonary embolism. The data from case reports, retrospective reviews and case control studies have been confirmed by prospective studies. There have been several prospective studies of subjects embarking on airline flights of greater than 4 hours duration aimed at determining the incidence of DVT as detected by ultrasonography. In unprotected subjects, the incidence of thrombosis in the calf veins or muscular veins ranged between 0% and 10%. There is evidence that the incidence of travel-related pulmonary embolism appears to be related to the distance travelled and immobility during the flights. Whether the imputed causation is merely due to immobility and venous compression or to other factors associated with the aircraft cabin requires further clarification. The use of below-knee graduated compression stockings appears to be highly effective. A 100 AXa U/kg single dose of a low molecular weight heparin, given 2-4 hours before the flight, have been reported to be more effective than aspirin and placebo. However, the benefit/risk ratio of such a strategy remains to be assessed.

Humans↗
PubMed1981

Pulmonary embolism.

Acute pulmonary embolism is one of the most serious of the life-threatening illnesses, but it can be prevented or effectively treated. Unfortunately, there are no safe, rapid, or inexpensive tests for its detection, and so a high degree of alertness remains the clinician's best ally in the diagnosis of this disorder. Among the more useful diagnostic measures, a radioisotope ventilation-perfusion lung scan may be done in the search for a mismatch-an area normally ventilated where there is a perfusion defect. If two or more segmental mismatches are found, there is a high probability that pulmonary embolism is present. A normal perfusion scan virtually eliminates the possibility of pulmonary embolism, but an abnormal ventilation-perfusion scan is not synonymous with the diagnosis of pulmonary embolism and may lead to the overdiagnosis of this disorder. Subcutaneous administration of heparin has proved to be an effective measure in preventing deep venous thrombosis, but it must be started before any thrombosis occurs. Intravenous use of heparin and oral anticoagulation are the mainstays of the therapy of deep venous thrombosis and pulmonary embolism.

Doppler Effect↗