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1.
Medicine (Baltimore) ; 100(4): e24008, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530197

RESUMEN

RATIONALE: Cerebrovascular accidents (CVAs) after percutaneous coronary intervention (PCI), although rare, are associated with high in-hospital morbidity and mortality rates. Cerebral venous thrombosis (CVT) is an uncommon cause of CVAs compared with arterial disease but is associated with favorable outcomes in most cases. We present a rare case of CVT following a simple PCI procedure with stent implantation, which has not been previously reported in the literature. PATIENT CONCERNS: A 78-year-old woman with hypertension, hyperlipidemia, and coronary artery disease received simple PCI with stent implantation. After PCI, she developed a throbbing headache with nausea and vomiting, with her blood pressure increasing to 190/100 mmHg. Drowsiness, disorientation, and neck stiffness were noted. Neurological complication due to the PCI procedure was highly suspected. DIAGNOSIS: Noncontrast brain computed tomography was performed along with emergency neurological consultation, and the patient was diagnosed as having acute CVT. INTERVENTIONS: The patient was treated with anti-intracranial pressure therapy and anticoagulation therapy through low-molecular-weight heparin and was subsequently treated with warfarin. OUTCOMES: After treatment, the patient's symptoms and signs gradually subsided, and her clinical condition improved. She was discharged with full recovery thereafter. LESSONS: A case of acute CVT, a rare, and atypical manifestation of venous thromboembolism and CVA, complicated simple PCI with stent implantation. During PCI, identifying patients with a high risk of a CVA is critical, and special care should be taken to prevent this devastating complication.


Asunto(s)
Trombosis Intracraneal/etiología , Intervención Coronaria Percutánea/efectos adversos , Accidente Cerebrovascular/etiología , Trombosis de la Vena/etiología , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Trombosis Intracraneal/terapia , Accidente Cerebrovascular/terapia , Trombosis de la Vena/terapia
2.
Int Heart J ; 62(1): 211-215, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33518660

RESUMEN

Anticoagulation is recommended for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT). In some cases, an inferior vena cava (IVC) filter is used to prevent PE. We report the case of a 70-year-old woman who developed non-massive PE and proximal DVT, which were treated using an IVC filter; two filters were placed owing to the fracture of the filters. Few previous reports have discussed IVC fractures and the difficulty in detecting such fractures on computed tomography before retrieval. Based on our experience, we suggest that a temporary IVC filter for DVT treatment should be considered carefully.


Asunto(s)
Filtros de Vena Cava/efectos adversos , Anciano , Femenino , Humanos , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia
4.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33452066

RESUMEN

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.


Asunto(s)
/complicaciones , Embolia Pulmonar/etiología , Trombosis de la Vena/etiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Antiparasitarios/uso terapéutico , Antivirales/uso terapéutico , /diagnóstico , /terapia , Angiografía por Tomografía Computarizada , Diabetes Mellitus Tipo 2/complicaciones , Doxiciclina/uso terapéutico , Vena Femoral , Productos de Degradación de Fibrina-Fibrinógeno , Glucocorticoides/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Ivermectina/uso terapéutico , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Vena Poplítea , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en Color , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia
5.
J Zoo Wildl Med ; 51(4): 1072-1076, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33480593

RESUMEN

An 18-yr-old female orangutan (Pongo pygmaeus pygmaeus) developed opisthotonus after sustaining conspecific bite wounds 3 wk earlier. The orangutan developed progressive tetraparesis and dysphagia, despite normal mentation, suggestive of tetanus. A tetanus vaccine had been administered at 2 yr of age, but none since. Brain magnetic resonance imaging, computed tomography, cerebral spinal fluid tap, and bloodwork were unremarkable. Viral, Baylisascaris, and tetanus toxin testing were negative. A femoral central venous catheter (CVC) was placed to provide medications, fluids, and parenteral nutrition. The orangutan received human tetanus immunoglobulin, tetanus toxoid, penicillin, methocarbamol, and analgesia. After 1 wk, the catheterized limb became edematous; a deep vein thrombosis (DVT) was diagnosed ultrasonographically. A cephalic CVC was placed, the limb casted, intravenous therapy reinitiated, and enoxaparin started. The orangutan became mobile days later, and progressively improved. Despite no compliance with enoxaparin, the DVT resolved without residual signs. This is the first reported case of presumptive tetanus and DVT in a great ape.


Asunto(s)
Enfermedades del Simio Antropoideo/patología , Pongo pygmaeus , Tétanos/veterinaria , Animales , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Anticoagulantes/uso terapéutico , Enfermedades del Simio Antropoideo/terapia , Mordeduras y Picaduras , Enoxaparina/uso terapéutico , Femenino , Tétanos/complicaciones , Tétanos/terapia , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Trombosis de la Vena/veterinaria
6.
Br J Radiol ; 94(1120): 20200939, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33411566

RESUMEN

In 2017, the long awaited results of the ATTRACT trial were published in the New England Journal of Medicine leaving the scientific community with disappointment as the study did not show the expected results. Producing not the expected outcome is not uncommon in science - furthermore, it is important to disapprove common beliefs. But has the ATTRACT trial really the power to change our practice? Are the results correct in terms of evidence based on the methods used?


Asunto(s)
Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Terapia Trombolítica/métodos , Trombosis de la Vena/terapia , Humanos , Resultado del Tratamiento
7.
Vasc Endovascular Surg ; 55(1): 69-72, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32862786

RESUMEN

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed.


Asunto(s)
Procedimientos Endovasculares/instrumentación , Atrios Cardíacos , Neoplasias/complicaciones , Stents , Síndrome de la Vena Cava Superior/terapia , Vena Cava Inferior , Vena Cava Superior , Trombosis de la Vena/terapia , Anciano , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias/diagnóstico por imagen , Neoplasias/patología , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/patología , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/patología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/patología
8.
Br J Radiol ; 94(1117): 20200415, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33245679

RESUMEN

OBJECTIVE: To evaluate the use of transarterial chemoembolisation (TACE) combined with microwave ablation (MWA) to treat patients with hepatocellular carcinoma (HCC) and type Ⅱ-Ⅲ portal vein tumour thrombosis (PVTT) intolerant to targeted drug (TG) therapy. METHODS: A total of 18 patients with HCC and type Ⅱ-Ⅲ PVTT intolerant to TG were enrolled between June 2015 and December 2019, who were treated with TACE + MWA (MWA group). 24 patients were treated with TACE + TG (TG group; control cohort). Time to progression and overall survival (OS) were analysed along with the incidence of adverse events. RESULTS: The median follow-up time was 19.0 months (9.0-32.0 months). The median OS was 17.0 months (8.3-29.3 months; MWA group) and 13.5 months (5.5-22.5 months; TG group) and was not significantly different. The 1- and 2 year OS was also comparable (MWA group: 66.7%, 44.4% vs Target group: 41.7%, 29.2%). Time to progression showed no distinct differences (MWA group: 11.5 months; TG group: 9.0 months) between the two groups. Moreover, the incidence of major Grade 3-4 adverse events in the MWA group (5.6%) was similar to those in the TG group (8.3%). CONCLUSION: TACE + MWA and TACE + TG were comparable in their safety and efficacy in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG. ADVANCES IN KNOWLEDGE: TACE + MWA can be used as a palliative treatment alternative for TACE + TG in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG.


Asunto(s)
Técnicas de Ablación/métodos , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Vena Porta/patología , Trombosis de la Vena/terapia , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/cirugía , Terapia Combinada/métodos , Femenino , Estudios de Seguimiento , Humanos , Hígado/cirugía , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Masculino , Microondas , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugía
12.
Ned Tijdschr Geneeskd ; 1642020 11 19.
Artículo en Holandés | MEDLINE | ID: mdl-33332036

RESUMEN

OBJECTIVE: Hospitalization for corona virus disease 2019 (COVID-19) may be followed by complications after discharge. We aimed to evaluate mortality, readmission rate, and readmission characteristics after hospitalization with COVID-19. DESIGN: A retrospective cohort study METHODS: Inclusion of all patients hospitalized for COVID-19 between March 1, 2020, and June 1, 2020 in Zuyderland Medical Centre, The Netherlands. Main outcome measures were mortality and readmission after hospitalization. Univariate and multivariate regression analysis were performed to identify risk factors for death and readmission. RESULTS: A total of 769 patients hospitalized with COVID-19 (mean age 70 ± 14 years; 39% female) were included in the study. In-hospital mortality was 22.4% , as such 596 patients were discharged alive and followed after discharge with a median of 80 days (IQR 66-91). Total mortality after discharge was 6.4% (n=38) and readmission rate was 11.7% (n=70). Main reasons for readmission were respiratory insufficiency (31%), arterial and venous thrombotic events (16%) or related to a chronic comorbidity (14%). Mortality rates were higher in older patients and patients who experienced delirium during hospital stay. Risk factors for readmission were male sex, discharge to a long-term care facility and COPD. CONCLUSION: 1 out of 6 COVID-19 positive patients died or was readmitted after discharge. This shows an ongoing vulnerability of COVID-19 patients. Physicians and policy makers should consider this high rate when making decisions on discharge, hospital-capacity planning, and patient monitoring after discharge.


Asunto(s)
Readmisión del Paciente/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Respiratoria , Trombosis de la Vena , Anciano , /fisiopatología , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Mortalidad , Países Bajos/epidemiología , Evaluación de Resultado en la Atención de Salud , Alta del Paciente , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/terapia , Factores de Riesgo , Trombosis de la Vena/etiología , Trombosis de la Vena/mortalidad , Trombosis de la Vena/terapia
14.
Anesth Analg ; 131(5): 1324-1333, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33079850

RESUMEN

Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19. However, therapeutic options are actually limited to unspecific supportive therapy. Whether viscoelastic testing can provide additional value in predicting clinical course, need for hospital resources and patient's outcome or in guiding anticoagulation in COVID-19-associated coagulopathy is still incompletely understood and currently under investigation (eg, in the rotational thromboelastometry analysis and standard coagulation tests in hospitalized patients with COVID-19 [ROHOCO] study). This article summarizes what we know already about COVID-19-associated coagulopathy and-perhaps even more importantly-characterizes important knowledge gaps.


Asunto(s)
Antiinflamatorios/uso terapéutico , Anticoagulantes/uso terapéutico , Betacoronavirus/patogenicidad , Coagulación Sanguínea/efectos de los fármacos , Infecciones por Coronavirus/terapia , Inflamación/terapia , Neumonía Viral/terapia , Embolia Pulmonar/terapia , Tromboembolia Venosa/terapia , Trombosis de la Vena/terapia , Antiinflamatorios/efectos adversos , Anticoagulantes/efectos adversos , Biomarcadores/sangre , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Medicina Basada en la Evidencia , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Mortalidad Hospitalaria , Interacciones Huésped-Patógeno , Humanos , Inflamación/sangre , Inflamación/mortalidad , Inflamación/virología , Mediadores de Inflamación/sangre , Pandemias , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Neumonía Viral/virología , Pronóstico , Embolia Pulmonar/sangre , Embolia Pulmonar/mortalidad , Embolia Pulmonar/virología , Factores de Riesgo , Tromboembolia Venosa/sangre , Tromboembolia Venosa/mortalidad , Tromboembolia Venosa/virología , Trombosis de la Vena/sangre , Trombosis de la Vena/mortalidad , Trombosis de la Vena/virología
15.
J. vasc. interv. radiol ; 31(10): 1529-1544, Oct. 2020.
Artículo en Inglés | BIGG - guías GRADE | ID: biblio-1128259

RESUMEN

To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease. A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations. The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations. Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.


Asunto(s)
Humanos , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/prevención & control , Trombosis de la Vena/terapia , Filtros de Vena Cava , Política Informada por la Evidencia
18.
J Vasc Interv Radiol ; 31(10): 1517-1528.e2, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32948386

RESUMEN

PURPOSE: To evaluate relationships between immediate venographic results and clinical outcomes of pharmacomechanical catheter-directed thrombolysis (PCDT). MATERIALS AND METHODS: Venograms from 317 patients with acute proximal deep vein thrombosis (DVT) who received PCDT in a multicenter randomized trial were reviewed. Quantitative thrombus resolution was assessed by independent readers using a modified Marder scale. The physician operators recorded their visual assessments of thrombus regression and venous flow. These immediate post-procedure results were correlated with patient outcomes at 1, 12, and 24 months. RESULTS: PCDT produced substantial thrombus removal (P < .001 for pre-PCDT vs. post-PCDT thrombus scores in all segments). At procedure end, spontaneous venous flow was present in 99% of iliofemoral venous segments and in 89% of femoral-popliteal venous segments. For the overall proximal DVT population, and for the femoral-popliteal DVT subgroup, post-PCDT thrombus volume did not correlate with 1-month or 24-month outcomes. For the iliofemoral DVT subgroup, over 1 and 24 months, symptom severity scores were higher (worse), and venous disease-specific quality of life (QOL) scores were lower (worse) in patients with greater post-PCDT thrombus volume, with the difference reaching statistical significance for the 24-month Villalta post-thrombotic syndrome (PTS) severity score (P = .0098). Post-PCDT thrombus volume did not correlate with 12-month valvular reflux. CONCLUSIONS: PCDT successfully removes thrombus in acute proximal DVT. However, the residual thrombus burden at procedure end does not correlate with the occurrence of PTS during the subsequent 24 months. In iliofemoral DVT, lower residual thrombus burden correlates with reduced PTS severity and possibly also with improved venous QOL and fewer early symptoms.


Asunto(s)
Vena Femoral , Fibrinolíticos/administración & dosificación , Vena Ilíaca , Vena Poplítea , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Trombosis de la Vena/terapia , Adolescente , Adulto , Anciano , Femenino , Vena Femoral/diagnóstico por imagen , Fibrinolíticos/efectos adversos , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Flebografía , Vena Poplítea/diagnóstico por imagen , Síndrome Postrombótico/etiología , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Estados Unidos , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Adulto Joven
19.
BMC Surg ; 20(1): 174, 2020 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-32738882

RESUMEN

BACKGROUND: Portal vein tumor thrombus (PVTT) is common in hepatocellular carcinoma (HCC). Recent studies indicate that more aggressive treatments, including surgical resection or locoregional treatment, may benefit selected HCC patients with PVTT. External radiation therapy and infusion chemotherapy were found to achieve good outcomes; however, the use of low-energy x-ray radiation system (INTRABEAM), intraoperative radiation therapy, and portal vein infusion chemotherapy for PVTT has not been reported. We present a case of HCC with PVTT. The patient underwent hemihepatectomy and thrombectomy along with intraoperative radiotherapy (IORT) using a portable INTRABEAM radiation system. Subsequently, to treat PVTT, portal vein infusion chemotherapy with FOLFOX (leucovorin [Folinic acid], fluorouracil, and oxaliplatin) regimen was administered. There were no obvious post-operative complications. After 20 months follow-up period, no obvious tumor recurrence had been observed, and PVTT gradually disappeared completely. CONCLUSIONS: IORT using the INTRABEAM radiation system combined with portal vein infusion chemotherapy is promising for select patients with PVTT.


Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Vena Porta , Trombosis de la Vena/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/terapia , Terapia Combinada , Fluorouracilo/uso terapéutico , Hepatectomía , Humanos , Cuidados Intraoperatorios , Leucovorina/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/terapia , Masculino , Compuestos Organoplatinos/uso terapéutico , Radioterapia Ayuvante , Estudios Retrospectivos , Trombectomía , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/radioterapia , Trombosis de la Vena/cirugía
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