11/155. Noninvasive prevention of thrombosis of deep veins of the thigh using intermittent pneumatic compression.Intermitten venous compression promotes cyclic emptying and refilling of the veins and sinuses of the legs. It prevents stasis and formation of thrombi while the patient is on the operating table and during recovery. Once the patient is ambulatory, the system is discontinued. While the system is in use, thromboelastography, venous impedance plethysmography and venography, when indicated, are used to monitor the system. The intermittent pneumatic compression system is safe, simple and practical to use for almost all patients. There was no evidence of deep vein thrombosis or pulmonary embolism in 123 patients, as determined by an absence of clinical signs, a negative impedance plethysmogram and a negative venogram.- - - - - - - - - - ranking = 1keywords = pulmonary embolism, embolism (Clic here for more details about this article) |
12/155. heparin-associated thrombocytopenia in a patient treated with polysulphated chondroitin sulphate: evidence for immunological crossreactivity between heparin and polysulphated glycosaminoglycan.heparin-associated thrombocytopenia (HAT) type II, a severe side effect of heparin therapy, is thought to be induced by an immunological mechanism. By crossreactivity studies we have demonstrated that sera of patients with HAT type II activate platelets in vitro not only after the addition of heparin but also after addition of a chemically polysulphated chondroitin-like substance, Arteparon, used for treatment of degenerative joint disease. In addition here, we describe a patient who developed deep venous thrombosis and pulmonary embolism following administration of Arteparon and typical HAT type II with thrombocytopenia, 36 h after the first administration of heparin. This patient had never received heparin, but had repeatedly been treated with Arteparon for degenerative joint disease. We conclude that this patient had been presensitized by Arteparon, as indicated by his clinical course. in vitro studies again confirm crossreactivity between heparin and Arteparon.- - - - - - - - - - ranking = 1keywords = pulmonary embolism, embolism (Clic here for more details about this article) |
13/155. Experience with the Cardial inferior vena cava filter as prophylaxis against pulmonary embolism in pregnant women with extensive deep venous thrombosis.OBJECTIVE: To report the use of the Cardial inferior vena caval filter as prophylaxis against pulmonary embolism in pregnant women with extensive iliofemoral thrombosis. SETTING: Leicester Royal Infirmary. SUBJECTS: Four pregnant women with extensive iliofemoral thrombosis, deemed to be at high risk of pulmonary embolism, managed over a period of one year. TECHNIQUE: In addition to standard full anticoagulation with heparin, the Cardial inferior vena cava filter was introduced percutaneously under local anaesthesia through the unaffected contralateral femoral vein and positioned in the inferior cava below the renal veins. RESULTS: The procedure was uncomplicated and did not compromise feto-maternal condition. There was no evidence of pulmonary embolism after filter insertion. CONCLUSION: The use of inferior vena cava filters should be considered as an adjunct to intravenous anticoagulation in pregnant women with extensive deep vein thrombosis of the lower limbs.- - - - - - - - - - ranking = 7keywords = pulmonary embolism, embolism (Clic here for more details about this article) |
14/155. Heterotopic ossification and deep venous thrombosis: concurrence (?), bleeding complications, and caval interruption.Diagnosis and treatment of apparent deep venous thrombosis in a patient with spinal cord injury can be difficult. Heterotopic ossification in the paralyzed limbs of such patients can mimic deep venous thrombosis and can even produce false-positive findings on venograms. Anticoagulation, in turn, can be associated with soft tissue hemorrhage that may resemble thrombophlebitis and further confound interpretation of venograms. We have presented a case in which all these phenomena were present and in which a remaining risk of embolism was successfully managed through placement of a Greenfield filter.- - - - - - - - - - ranking = 0.047927840754817keywords = embolism (Clic here for more details about this article) |
15/155. pregnancy and protein c deficiency.This report examines a patient with recurrent attacks of thrombo-embolism due to a protein c deficiency. Alterations in the coagulation during pregnancy and the possible consequences of an altered coagulation during pregnancy will be discussed.- - - - - - - - - - ranking = 0.047927840754817keywords = embolism (Clic here for more details about this article) |
16/155. Fatal hemoperitoneum after fine-needle aspiration of a liver metastasis.Fine-needle aspiration (FNA) of the liver is a procedure considered virtually risk-free. We report here a patient with carcinoma of the pancreas, who suffered a fatal hemoperitoneum (HP) subsequent to FNA of the liver under the guidance of ultrasound. The patient had presented with migratory deep vein thrombosis (DVT), and recurrent cerebral embolism. The prothrombin time (PT) and partial thromboplastin time (PTT) had been normal, and FNA demonstrated adenocarcinoma cells. autopsy findings demonstrated carcinoma in the tail of the pancreas with liver and adrenal metastases, massive HP, and findings of chronic disseminated intravascular clotting (DIC). Since chronic DIC with enhanced fibrinolysis might have participated in the fatal bleeding, we recommend that FNA should be contraindicated in patients suspected of having malignancy with migratory DVT and recurrent arterial embolism, despite normal PT and PTT tests, unless the appropriate laboratory tests succeed in excluding DIC.- - - - - - - - - - ranking = 0.095855681509633keywords = embolism (Clic here for more details about this article) |
17/155. Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism.We describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiography with injection of agitated hydroxyethyl starch revealed a patent foramen ovale. Thrombophlebistis of the left saphenous vein with extension of thrombus into the femoral vein could be identified as the source of embolism. Paradoxical coronary embolism is an underrecognized cause of MI. Diagnosis is particularly difficult, when MI and PE coincide, because of the similarity in clinical signs and symptoms of both entities. A high level of clinical suspicion and echocardiography, especially if performed soon after presentation, can be the clue to early diagnosis of PDE.- - - - - - - - - - ranking = 5.3354948852837keywords = pulmonary embolism, embolism (Clic here for more details about this article) |
18/155. Laparoscopic procedures as a risk factor of deep venous thrombosis, superficial ascending thrombophlebitis and pulmonary embolism--case report and review of the literature.Since its introduction laparoscopic surgery has been used for many indications, e.g., cholecystolithiasis, hernia, appendicitis, fundoplication, benign large bowel disease and gynaecological disorders. It has been considered as safe and efficient procedure for most patients with only few contraindications, mostly heart-lung disease. When the initial enthusiasm has been replaced by a more critical observation, more complications of laparoscopy or laparoscopic surgery were not only discovered but also reported. In laparoscopic hernia repair there is a tendency for severe complications when compared to open surgery. There is a controversy on possible side-effects of laparoscopic surgery, e.g., thrombosis, and the increased necessity of prophylaxis for thromboembolic events. Recently a growing number of reports on thromboembolic complications in association with laparoscopic surgery were published. Thrombosis may be caused by detrimental effects of pneumoperitoneum on venous flow (increased abdominal pressure and negative Trendelenburg position) and activation of the haemostatic system. Further risk factors may contribute to the risk to develop venous thrombosis. It is well accepted that varicose veins are associated with an increased risk for the thrombosis. However, the association of varicose veins with complications of laparoscopic surgery is unclear. The possible impact of thrombotic complications makes an analysis of the association of varicose veins or a history of deep vein thrombosis on the development of thrombosis after laparoscopic surgery mandatory. Although this is the first report on ascending thrombophlebitis and thrombosis of the sapheno-femoral junction after laparoscopic surgery, the incidence of deep vein thrombosis or superficial thrombophlebitis after laparoscopic surgery or laparoscopy may be much higher according to the pathophysiological changes during and after these procedures. In many patients venous thrombosis may not be recognized or it appears when the patient is already discharged. CONCLUSION: laparoscopy and laparoscopic procedures may have an increased risk for the development of thrombosis due to increased abdominal pressure and negative Trendelenburg position. patients with varicose veins and a history of thromboembolism may aggravate laparoscopy associated risks for the development of thromboembolic complications. Superficial thrombophlebitis in the thigh is not a benign disease entity and may lead to deep vein thrombosis (DVT) and pulmonary embolism (PE). Urgent surgical treatment (high ligation) may be warranted together with low-molecular weight heparin (LMWH) and compressions therapy. patients with varicose veins and a history of venous thrombosis may not be suitable candidates for laparoscopic surgery. family practitioners may be confronted with this complication more often since patients are discharged earlier from hospital after laparoscopic interventions due to legislative regulations.- - - - - - - - - - ranking = 6.9136079749111keywords = thromboembolism, pulmonary embolism, embolism (Clic here for more details about this article) |
19/155. Acute pulmonary embolectomy with cardiopulmonary bypass support.Deep venous thrombosis and pulmonary thromboembolism remain major sources of patient morbidity and mortality. The authors present the case of a 55-year-old man with a massive pulmonary embolism and subsequent hemodynamic decompensation who was successfully treated by open pulmonary embolectomy supported with cardiopulmonary bypass. Indications for embolectomy and patient selection as well as technical considerations are discussed.- - - - - - - - - - ranking = 4.2362320038722keywords = thromboembolism, pulmonary thromboembolism, pulmonary embolism, embolism (Clic here for more details about this article) |
20/155. venous thromboembolism and travel: is there an association?This paper reviews the literature on the association between venous thromboembolism and travel. There are plausible physiological reasons why sitting still for long periods (particularly in the cramped conditions of most aircraft) might predispose to venous thromboembolism. This may have been the explanation for the apparent excess of deaths from pulmonary embolism seen during the first months of the london blitz. No published controlled studies of thromboembolism and travel were identified, but eight case reports were analysed. They covered 25 people aged from 19 to 84 years with deep vein thrombosis or pulmonary embolism following travel. The reports suggest that long journeys are a particular risk and that there are often no symptoms until many hours after leaving the plane (so conventional methods of assessing the hazards of air travel may underestimate the problem). It is concluded that the literature tends to support the hypothesis that venous thromboembolism is associated with travel, but that carefully controlled studies are needed to test this properly.- - - - - - - - - - ranking = 17.308863799289keywords = thromboembolism, pulmonary embolism, embolism (Clic here for more details about this article) |
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