RESUMEN
INTRODUCTION: Lung cancer surgery is a well-known risk factor for venous thromboembolism. Thus, standard care involves the use of pharmacological and mechanical prophylaxis until discharge from the hospital. Pulmonary artery stump thrombosis (PAST) is a rare condition which can develop months to years after lung cancer surgery. This report describes a patient diagnosed with PAST and the decisions that were made regarding his treatment. CASE REPORT: A 67-year-old male was diagnosed with lung cancer due to shortness of breath, dry cough, hemoptysis, and typical chest computed tomography (CT) findings. He underwent right lower lobectomy and mediastinal lymphadenectomy by video-assisted thoracoscopic surgery. The procedure was complicated by the development of a right pleural empyema. After pleural drainage and an antibiotic regimen, he was discharged from the hospital with further improvement. A follow-up CT pulmonary angiography performed three months after lobectomy revealed thrombosis in the right lower lobar pulmonary artery stump. The patient had no symptoms. The attending physician decided to use anticoagulants. Consequently, the patient received low molecular-weight heparin subcutaneously for one month and a non-vitamin-K antagonist oral anticoagulant (NOAC) for the following 5 months. A CT scan performed after 3 months of anticoagulation showed complete resolution of stump thrombosis. Subsequent examinations showed no recurrence of either lung cancer or artery stump thrombosis and no anticoagulant-related bleeding. DISCUSSION: Pulmonary artery stump thrombosis can develop after lung cancer surgery. This complication is uncommon and the prognosis is favorable in most treated cases. However, thrombosis may progress, and pulmonary embolism or chronic thromboembolic pulmonary hypertension may develop. Decisions about instituting anticoagulation therapy and its duration are made on an individual basis after considering both the benefits and the potential risks.
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Neumonectomía/efectos adversos , Venas Pulmonares/patología , Venas Pulmonares/cirugía , Trombosis de la Vena/rehabilitación , Humanos , Neoplasias Pulmonares/cirugía , Factores de Riesgo , Trombosis de la Vena/etiologíaAsunto(s)
Trombofilia/complicaciones , Trombofilia/diagnóstico , Insuficiencia Venosa/complicaciones , Anciano , Alprazolam/farmacología , Alprazolam/uso terapéutico , Aminas/farmacología , Aminas/uso terapéutico , Amputación Quirúrgica/efectos adversos , Amputación Quirúrgica/rehabilitación , Atorvastatina/farmacología , Atorvastatina/uso terapéutico , Ácidos Ciclohexanocarboxílicos/farmacología , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Femenino , Gabapentina , Humanos , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Ticlopidina/farmacología , Ticlopidina/uso terapéutico , Insuficiencia Venosa/rehabilitación , Trombosis de la Vena/complicaciones , Trombosis de la Vena/etiología , Trombosis de la Vena/rehabilitación , Ácido gamma-Aminobutírico/farmacología , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
AIMS: Patients with an acute Achilles tendon rupture (ATR) take a long time to heal, have a high incidence of deep vein thrombosis (DVT) and widely variable functional outcomes. This variation in outcome may be explained by a lack of knowledge of adverse factors, and a subsequent shortage of appropriate interventions. PATIENTS AND METHODS: A total of 111 patients (95 men, 16 women; mean age 40.3, standard deviation 8.4) with an acute total ATR were prospectively assessed. At one year post-operatively a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining three validated, independent, outcome measures: Achilles tendon Total Rupture Score, heel-rise height test, and limb symmetry heel-rise height. Predictors of ACOS included treatment; gender; age; smoking; body mass index; time to surgery; physical activity level pre- and post-injury; symptoms; quality of life and incidence of DVT. RESULTS: There were three independent variables that correlated significantly with the dichotomised outcome score (ACOS), while there was no correlation with other factors. An age of less than 40 years old was the strongest independent predictor of a good outcome one year after ATR (odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08 to 0.51), followed by female gender (OR) 4.18, 95% CI 1.01 to 17.24). Notably, patients who did not have a DVT while immobilised post-operatively had a better outcome (OR 0.31, 95% CI 0.12 to 0.80). CONCLUSION: Over the age of 40 years, male gender and having a DVT while immobilised are independent negative predictors of outcome in patients with an acute ATR. Cite this article: Bone Joint J 2016;98-B:1635-41.
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Tendón Calcáneo/lesiones , Complicaciones Posoperatorias/rehabilitación , Traumatismos de los Tendones/rehabilitación , Trombosis de la Vena/rehabilitación , Tendón Calcáneo/cirugía , Enfermedad Aguda , Adulto , Factores de Edad , Articulación del Tobillo/fisiopatología , Moldes Quirúrgicos , Femenino , Humanos , Aparatos de Compresión Neumática Intermitente , Masculino , Persona de Mediana Edad , Aparatos Ortopédicos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Pronóstico , Estudios Prospectivos , Recuperación de la Función , Factores de Riesgo , Factores Sexuales , Traumatismos de los Tendones/cirugía , Resultado del Tratamiento , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & controlRESUMEN
BACKGROUND: Thrombocytosis can follow surgery and has occasionally been observed after major orthopaedic surgery. The aim of the present study was to ascertain the platelet count (PLTC) change in patients admitted to a rehabilitation unit after major joint surgery and whether deep venous thrombosis (DVT) and poor outcomes occurred in those who had thrombocytosis. METHOD: PLTC, red blood cells (RBC), haemoglobin (Hb), fibrinogen, and D-dimers were assessed in patients on admission and at discharge after major joint surgery. Functional outcomes were ascertained using the Barthel Scale (BS), the Functional Independence Measure (FIM) and gait evaluation. Thrombocytosis was considered to have occurred when PLTC was greater than or equal to 500 × 100(9)/L. All subjects with thrombocytosis had ultrasonography to assess DVT occurrence. The patients were divided into "young" and "old" groups according to an age cut-off of 75 years to investigate potential age-related differences. RESULTS: Two hundred and seventy-five patients were identified and 142 (36 M and 106 F, mean age 77.2 ± 10.7) were enrolled. Seventy-six (53.5%) underwent total hip arthroplasty (THA), 40 (51.1%) underwent hip internal fixation and 26 (18.3%) subjects underwent total knee arthroplasty (TKA). The young and old groups included 60 and 82 patients, respectively. Fifty-nine (42.4%) patients had PLTC above 400 × 100(9)/L. Of these, 28 (20.1%) had thrombocytosis with PLTC above 500 × 100(9)/L, and 15 of them (10.7%) had very high values above 600 × 100(9)/L. Increased levels of fibrinogen and D-dimers were also detected. No subject with thrombocytosis had DVT. Outcome was not affected by PLTC. At discharge, significant improvement in all functional assessments was observed in young compared to old people; gait: 2.9 ± 0.2 vs. 2.2 ± 0.8; BS: 97 ± 6.9 vs. 70.5 ± 25.6; and FIM: 116.4 ± 10.9 vs. 83.6 ± 31.2 (p < 0.004), respectively. BS and FIM mean scores were positively correlated with Hb level. CONCLUSION: Elevated PLTC and thrombocytosis were not uncommon in patients after major joint surgery, but no subject developed DVT. Platelet count change did not affect the outcome. Higher age and lower haemoglobin level correlated with poorer functional recovery.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Recuperación de la Función , Centros de Rehabilitación/tendencias , Trombocitosis/diagnóstico , Trombosis de la Vena/diagnóstico , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/tendencias , Artroplastia de Reemplazo de Rodilla/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas/tendencias , Factores de Riesgo , Trombocitosis/etiología , Trombocitosis/rehabilitación , Resultado del Tratamiento , Trombosis de la Vena/etiología , Trombosis de la Vena/rehabilitaciónRESUMEN
Aggressive assessment and management of the secondary complications in the hours and days following spinal cord injury (SCI) leads to restoration of function in patients through intervention by a team of rehabilitation professionals. The recent certification of SCI physicians, newly validated assessments of impairment and function measures, and international databases agreed upon by SCI experts should lead to documentation of improved rehabilitation care. This chapter highlights recent advances in assessment and treatment based on evidence-based classification of literature reviews and expert opinion in the acute phase of SCI. A number of these reviews are the product of the Consortium for Spinal Cord Medicine, which offers clinical practice guidelines for healthcare professionals. Recognition of and early intervention for problems such as bradycardia, orthostatic hypotension, deep vein thrombosis/pulmonary embolism, and early ventilatory failure will be addressed although other chapters may discuss some issues in greater detail. Early assessment and intervention for neurogenic bladder and bowel function has proven effective in the prevention of renal failure and uncontrolled incontinence. Attention to overuse and disuse with training and advanced technology such as functional electrical stimulation have reduced pain and disability associated with upper extremity deterioration and improved physical fitness. Topics such as chronic pain, spasticity, sexual dysfunction, and pressure sores will be covered in more detail in additional chapters. However, the comprehensive and integrated rehabilitation by specialized SCI teams of physicians, nurses, therapists, social workers, and psychologists immediately following SCI has become the standard of care throughout the world.
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Traumatismos de la Médula Espinal/rehabilitación , Enfermedad Aguda/rehabilitación , Enfermedades del Sistema Nervioso Autónomo/etiología , Enfermedades del Sistema Nervioso Autónomo/rehabilitación , Humanos , Espasticidad Muscular , Embolia Pulmonar/etiología , Embolia Pulmonar/rehabilitación , Traumatismos de la Médula Espinal/complicaciones , Trombosis de la Vena/etiología , Trombosis de la Vena/rehabilitaciónRESUMEN
Developmental venous anomalies (DVA) are generally considered the most common vascular anomalies. They are usually asymptomatic and display a benign clinical course. We report two cases of thrombosed developmental venous anomalies. Both patients developed venous infarcts with haemorrhagic transformation from the thrombosed DVA, and 1 patient needed decompressive craniectomy.
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Infarto Encefálico , Venas Cerebrales , Trombosis de la Vena , Adulto , Infarto Encefálico/complicaciones , Infarto Encefálico/etiología , Infarto Encefálico/cirugía , Venas Cerebrales/anomalías , Venas Cerebrales/cirugía , Craniectomía Descompresiva/métodos , Humanos , Masculino , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Trombosis de la Vena/complicaciones , Trombosis de la Vena/rehabilitación , Trombosis de la Vena/cirugíaRESUMEN
PRIMARY OBJECTIVE: The purpose of this review is to survey the types of intermittent pneumatic compression systems that are currently used, and their medical applications. MAIN OUTCOMES AND RESULTS: Intermittent compression devices have taken many forms since their initial development, but medical justifications for particular properties of cuff design, compression timing and pressure are often weak. Intermittent compression is well established, and effective in the prevention of deep vein thrombosis (DVT) and reduction of lymphoedema. Other therapeutic applications, such as in chronic arterial and venous disease, are not yet as well accepted, but may become more popular as published evidence increases. CONCLUSIONS: The full potential of intermittent pneumatic compression has probably not yet been realized, and requires better quality research. System design must follow physiological evidence, and while complexity in that design may allow greater therapeutic flexibility, it may incur greater financial cost, difficulty in use, and in the prevention of DVT in particular may be unnecessary.
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Aparatos de Compresión Neumática Intermitente/tendencias , Linfedema/rehabilitación , Trombosis de la Vena/rehabilitación , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Evaluación de la Tecnología BiomédicaRESUMEN
A specially developed card including 147 parameters was used in examination of 118 elderly phlebological patients. Pathology of the veins occurs in the elderly 5.4 times more often than in subjects younger than 60. A six-step system was developed for treatment of such patients: primary step, day hospital, specialized vascular and surgical unit, rehabilitation center, health resort treatment, dispensary examinations. Laboratory investigation of thrombophilic conditions, ultrasonic angioscanning and using minimally invasive methods of operative treatment should be introduced in the laboratory practice for the improvement of quality of life and prevention of complications.
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Tromboflebitis/rehabilitación , Insuficiencia Venosa/rehabilitación , Trombosis de la Vena/rehabilitación , Anciano , Angiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tromboflebitis/diagnóstico por imagen , Tromboflebitis/terapia , Ultrasonografía Doppler , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/terapia , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapiaRESUMEN
OBJECTIVES: The results of treatment for subclavian vein effort thrombosis were assessed in a series of competitive athletes. METHODS: A retrospective review was conducted of high-performance athletes who underwent multidisciplinary management for venous thoracic outlet syndrome in a specialized referral center. The overall time required to return to athletic activity was assessed with respect to the timing and methods of diagnosis, initial treatment, operative management, and postoperative care. RESULTS: Between January 1997 and January 2007, 32 competitive athletes (29 male and 3 female) were treated for venous thoracic outlet syndrome, of which 31% were in high school, 47% were in college, and 22% were professional. The median age was 20.3 years (range, 16-26 years). Venous duplex ultrasound examination in 21 patients had a diagnostic sensitivity of 71%, and the mean interval between symptoms and definitive venographic diagnosis was 20.2 +/- 5.6 days (range, 1-120 days). Catheter-directed subclavian vein thrombolysis was performed in 26 (81%), with balloon angioplasty in 12 and stent placement in one. Paraclavicular thoracic outlet decompression was performed with circumferential external venolysis alone (56%) or direct axillary-subclavian vein reconstruction (44%), using saphenous vein panel graft bypass (n = 8), reversed saphenous vein graft bypass (n = 3), and saphenous vein patch angioplasty (n = 3). In 19 patients (59%), simultaneous creation of a temporary (12 weeks) adjunctive radiocephalic arteriovenous fistula was done. The mean hospital stay was 5.2 +/- 0.4 days (range, 2-11 days). Seven patients required secondary procedures. Anticoagulation was maintained for 12 weeks. All 32 patients resumed unrestricted use of the upper extremity, with a median interval of 3.5 months between operation and the return to participation in competitive athletics (range, 2-10 months). The overall duration of management from symptoms to full athletic activity was significantly correlated with the time interval from venographic diagnosis to operation (r = 0.820, P < .001) and was longer in patients with persistent symptoms (P < .05) or rethrombosis before referral (P < .01). CONCLUSIONS: Successful outcomes were achieved for the management of effort thrombosis in a series of 32 competitive athletes using a multidisciplinary approach based on (1) early diagnostic venography, thrombolysis, and tertiary referral; (2) paraclavicular thoracic outlet decompression with external venolysis and frequent use of subclavian vein reconstruction; and (3) temporary postoperative anticoagulation, with or without an adjunctive arteriovenous fistula. Optimal outcomes for venous thoracic outlet syndrome depend on early recognition by treating physicians and prompt referral for comprehensive surgical management.
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Deportes , Vena Subclavia , Síndrome del Desfiladero Torácico/cirugía , Trombosis de la Vena/cirugía , Adolescente , Adulto , Anticoagulantes/uso terapéutico , Femenino , Humanos , Tiempo de Internación , Masculino , Grupo de Atención al Paciente , Flebografía , Vena Subclavia/cirugía , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/rehabilitación , Síndrome del Desfiladero Torácico/terapia , Terapia Trombolítica , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/rehabilitación , Trombosis de la Vena/terapiaRESUMEN
The number of thrombotic events in children, although significantly less than that in adults, is increasing as a result of therapeutic advances in primary illnesses that were previously fatal. When a patient, adult or pediatric, develops a deep vein thrombosis and anticoagulation therapy is initiated, many health professionals ask, "When should this patient have physical therapy and/or ambulate?" Fear of causing a pulmonary embolism with increased activity drives this question. Often, an order for bed rest is prescribed based more on tradition than on evidence-based medicine. A review of the literature has provided an evidence-based answer to the question, and although the studies are all of adult populations, the results have been extrapolated for use with comparable pediatric populations. The majority of studies agree that early ambulation does not increase an anticoagulated patient's risk for pulmonary embolism. Moreover, most studies report that early ambulation carries benefits such as decreased pain and swelling and fewer postthrombotic syndrome symptoms.
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Ambulación Precoz , Administración de la Seguridad , Trombosis de la Vena/rehabilitación , Adolescente , Niño , Anticonceptivos Hormonales Orales/efectos adversos , Femenino , Humanos , Lactante , Masculino , Factores de Riesgo , Trombofilia/congénito , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & controlRESUMEN
OBJECTIVE: To assess the validity of VEINES-QOL/Sym, a patient-reported questionnaire to evaluate quality of life and symptoms in patients with deep venous thrombosis (DVT). STUDY DESIGN AND SETTING: Psychometric study within the Venous Thrombosis Outcomes (VETO) Study, a prospective cohort study of long-term outcomes after DVT. A total of 359 English- and French-speaking patients with acute, objectively diagnosed DVT were recruited at seven hospitals in Quebec, Canada. The VEINES-QOL/Sym questionnaire, a 26-item patient-reported measure that generates separate summary scores for symptoms (VEINES-Sym) and quality of life (VEINES-QOL) was evaluated for acceptability, reliability, validity, and responsiveness in VETO Study subjects. RESULTS: Standard psychometric tests confirmed the acceptability (missing data, item endorsement frequencies, floor and ceiling effects), reliability (internal consistency, item-total and inter-item correlations, test-retest), validity (content, construct, convergent, discriminant, known groups), and responsiveness to clinical change of the VEINES-QOL/Sym in patients with DVT. CONCLUSION: The VEINES-QOL/Sym is a practical and scientifically sound patient-reported measure of outcomes that was developed using gold-standard methods. VEINES-QOL/Sym is valid and reliable for use as a measure of quality of life and symptoms in patients with acute DVT and provides a rigorous tool to allow more comprehensive evaluation of outcomes in clinical trials and epidemiological studies of patients with DVT.
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Indicadores de Salud , Calidad de Vida , Trombosis de la Vena/rehabilitación , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Escolaridad , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Resultado del TratamientoAsunto(s)
Ambulación Precoz , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/prevención & control , Tromboflebitis/rehabilitación , Trombosis de la Vena/rehabilitación , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Vendajes , Reposo en Cama , Estudios de Casos y Controles , Estudios de Cohortes , Terapia por Ejercicio , Fibrinolíticos/administración & dosificación , Fibrinolíticos/uso terapéutico , Heparina/administración & dosificación , Heparina/uso terapéutico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Inmovilización , Estudios Prospectivos , Embolia Pulmonar/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Seguridad , Tromboembolia/prevención & control , Tromboflebitis/complicaciones , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/prevención & control , Factores de Tiempo , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , CaminataRESUMEN
STUDY DESIGN: Retrospective review of patient data. OBJECTIVES: (i) To determine the incidence and time of deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in spinal cord injury (SCI), (ii) to determine the incidence and time of heterotopic ossification (HO) and (iii) to assess a possible aetiologic relationship in the pathogenesis of DVT and HO. SETTING: Swiss Paraplegic Centre, Nottwil. METHODS: We analyzed the incidence of DVT and HO in 1209 SCI patients (275 first rehabilitations) at the Swiss Paraplegic Centre Nottwil from 1998 to 2000. Clinical files and laboratory data were scrutinised for particularities preceding DVT and HO. RESULTS: The incidence of DVT was 6.55% for first rehabilitation compared to only 1.59% in all patients hospitalised. DVT was complicated by pulmonary embolism (PE) in 1.45% and 0.47% respectively. Incidence of HO was 8% for first rehabilitation and 1.82% for all patients hospitalised. In first rehabilitation patients the peak for DVT occurred around day 30 contrary to HO with a peak around day 120. In single patients HO was identified by MRI as a rapidly progressing process. Laboratory profiles were inflammatory in both HO and DVT. Increased physical activity preceding HO was observed in four patients. In two patients acute HO was complicated by ipsilateral DVT. CONCLUSION: Prophylaxis with LMWH and elastic stockings significantly reduces the frequency of DVT during first rehabilitation in SCI. DVT and HO are both associated with laboratory parameters of non-infectious inflammation. The later onset of HO coinciding with ongoing mobilisation, argues for a different pathogenetic mechanism. Acute HO of the hip region appears to favour ipsilateral DVT by well known thrombogenic mechanisms.
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Osificación Heterotópica/epidemiología , Centros de Rehabilitación/estadística & datos numéricos , Traumatismos de la Médula Espinal/epidemiología , Trombosis de la Vena/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/etiología , Osificación Heterotópica/rehabilitación , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Suiza/epidemiología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/rehabilitaciónRESUMEN
BACKGROUND: The postthrombotic syndrome (PTS) occurs frequently after deep venous thrombosis (DVT) and is believed to worsen with upright posture and physical activity. However, the effects of exercise in patients with previous DVT have not been studied. STUDY OBJECTIVES: To determine whether previous DVT and PTS limit the ability to exercise, and whether exercise increases the severity of venous symptoms and signs. DESIGN AND SETTING: A repeated-measures cohort study that was conducted at a university-affiliated teaching hospital, 1999-2000. PARTICIPANTS: Subjects with a first episode of unilateral DVT at least 1 year earlier were recruited from the Thrombosis Clinic (total, 41 subjects; with PTS, 19 subjects). INTERVENTION: Treadmill exercise session. MEASUREMENTS AND RESULTS: Venous symptoms, calf muscle fatigability, flexibility, and leg volume before and after treadmill exercise were measured and compared. Exercise did not worsen venous symptoms, despite a higher gain in affected leg volume in subjects with PTS vs subjects without PTS (mean difference: affected leg, 53 mL; unaffected leg, -15 mL; p = 0.018). Calf flexibility significantly improved after exercise in subjects with PTS (gastrocnemius: affected-unaffected, PTS vs no PTS + 4.5 degrees, p = 0.0029; soleus: affected-unaffected, PTS vs no PTS + 5.7 degrees, p = 0.0011). CONCLUSIONS: Exercise did not acutely exacerbate symptoms and, in subjects with PTS, resulted in improved flexibility in the affected leg. Our findings suggest that treadmill or similar exercise is unlikely to make symptoms of PTS worse, and may improve flexibility. Further study is indicated to determine whether a regular exercise-training program might have a role in the management of patients with PTS, since, to date, the treatment options for this condition are limited.
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Ejercicio Físico , Síndrome Posflebítico/rehabilitación , Trombosis de la Vena/rehabilitación , Adulto , Anciano , Estudios de Cohortes , Ejercicio Físico/fisiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome Posflebítico/diagnóstico , Síndrome Posflebítico/fisiopatología , Pronóstico , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/fisiopatologíaRESUMEN
Potential complications of reduced mobility in both acute and chronically ill patients continue to challenge nurses on a daily basis. Deep vein thrombosis (DVT) is one of the most serious of these complications. Graduated compression stockings, also known as antiembolism stockings, are among the most commonly available and accepted methods of external compression for the prophylaxis of DVT. Currently, there are 2 lengths of graduated compression stockings in common use, thigh-length and below-knee. Although thigh-length stockings are widely perceived to be more effective in prophylaxis, difficulties associated with therapeutic application and maintenance are often encountered in different clinical settings. Below-knee stockings are easier to apply and maintain and appear to be tolerated better by patients. The aim of this article is to examine existing support for both lengths of stockings in terms of their effectiveness in DVT prophylaxis and to discuss the implications for practice.
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Vendajes , Trombosis de la Vena/prevención & control , Vendajes/efectos adversos , Vendajes/economía , Edema/etiología , Diseño de Equipo , Humanos , Isquemia/etiología , Pierna/irrigación sanguínea , Ensayos Clínicos Controlados Aleatorios como Asunto , Trombosis de la Vena/fisiopatología , Trombosis de la Vena/rehabilitaciónRESUMEN
Resumo: Objetios: Comparar a retinografia fluorescente coma microscopia óptica e com a microscopia eletrônica de transmissäo como método diagnóstico de obstruçäo/desobstruçäo venular retiana em coelhos, pelo método da fototrombose. Avaliar, pela microscopia eletrônica, a composiçäo do trombo venoso e eventuais alteraçöes na parede venular após a fototrombose. Local: Hospital Säo Geraldo da Faculdade de Medicina da Universidade Federal de Minas Gerais. Metodologia: Após a obstruçäo , 12 olhos foram submetidos a retinografia fluorescente para evidenciar a obstruçäo. Todos esses olhos foram enucleados e examinados pela microscopia óptica (4 olhos) e à microscopia eletrônica de transmissäo (8 olhos), para evidenciar histologicamente a obstruçäo e estudar suas caracteristicas microscópicas. Quatro olhos foram submetidos à retinografia fluorescente, microscopia óptica e microscopia eletrônica de transmissäo, trinta dias após a fototrombose. Resultaos: Houve complea concordância entre os resultados dos olhos submetidos à retinografia fluorescente e os do exame histológico em evidenciar a obstruçäo venular. Conclusöes: A microscopia óptica e a microscopia eletrônica de transmissäo evidenciaram o trombo venoso e os seus constituintes. A retinografia fluorescente mostrou-se semelhante ao exame anato-patológico - realizado mediante a microscopia óptica e a microscopia eletrônica de transmissäo - em evidenciar a obstruçäo/patência venular, demonstrando,assim, ser um métoo confiável para o estudo da obstruçäo venular dentro do modelo utilizado