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1.
Khirurgiia (Mosk) ; (10): 50-54, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626239

RESUMO

OBJECTIVE: To study the results of endovenous laser obliteration (EVLO) for acute thrombophlebitis of saphenous veins of the lower extremities. MATERIAL AND METHODS: There were 57 patients (39 (68%) men and 18 (32%) women), mean age of patients was 54±20 years (range 34-74) with acute ascending thrombophlebitis of varicose superficial veins of the lower extremities (type I and II). EVLO of great saphenous vein was performed in 48 cases, small saphenous vein - in 9 patients. All EVLO procedures were carried out in outpatient fashion without hospitalization to the hospital. RESULTS: Complete obliteration of the target vein confirmed by ultrasound was observed in all patients the next day after surgery. Smooth course in long-term period (up to 1 year) was also noted in all patients. Recanalization of previously obliterated venous segment was absent. CONCLUSION: EVLO a safe and reliable alternative to traditional surgical approach for acute ascending thrombophlebitis. This technique is followed by reduced incidence of recurrent thrombophlebitis, no injuries typical for conventional surgery, minimal postoperative hospital-stay and pain syndrome. The procedure is characterized by minimal trauma, favorable cosmetic result and does not require hospitalization to specialized hospitals. EVLO for thrombophlebitis of varicose veins results high economic benefits due to minimally invasive simultaneous treatment of varicose veins and thrombophlebitis with small incidence of recurrences and complications.


Assuntos
Extremidade Inferior/cirurgia , Veia Safena/cirurgia , Tromboflebite/cirurgia , Varizes/cirurgia , Doença Aguda , Adulto , Idoso , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboflebite/etiologia , Resultado do Tratamento , Varizes/complicações
3.
Int J Gynaecol Obstet ; 145(1): 122-123, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30648745

RESUMO

A patient had septic pelvic thrombophlebitis complicated by multiple septic emboli after intrauterine device insertion. Fusobacterium necrophorum, a well­known cause of Lemierre's syndrome, was identified.


Assuntos
Dispositivos Intrauterinos/efeitos adversos , Síndrome de Lemierre/microbiologia , Tromboflebite/etiologia , Feminino , Fusobacterium necrophorum/isolamento & purificação , Humanos , Síndrome de Lemierre/complicações , Tromboflebite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Cochrane Database Syst Rev ; 1: CD007798, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30671926

RESUMO

BACKGROUND: US Centers for Disease Control guidelines recommend replacement of peripheral intravenous catheters (PIVC) no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation or infection. Costs associated with routine replacement may be considerable. This is the third update of a review first published in 2010. OBJECTIVES: To assess the effects of removing peripheral intravenous catheters when clinically indicated compared with removing and re-siting the catheter routinely. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 18 April 2018. We also undertook reference checking, and contacted researchers and manufacturers to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials that compared routine removal of PIVC with removal only when clinically indicated, in hospitalised or community-dwelling patients receiving continuous or intermittent infusions. DATA COLLECTION AND ANALYSIS: Three review authors independently reviewed trials for inclusion, extracted data, and assessed risk of bias using Cochrane methods. We used GRADE to assess the overall evidence certainty. MAIN RESULTS: This update contains two new trials, taking the total to nine included studies with 7412 participants. Eight trials were conducted in acute hospitals and one in a community setting. We rated the overall certainty of evidence as moderate for most outcomes, due to serious risk of bias for unblinded outcome assessment or imprecision, or both. Because outcome assessment was unblinded in all of the trials, none met our criteria for high methodological quality.Primary outcomesSeven trials (7323 participants), assessed catheter-related bloodstream infection (CRBSI). There is no clear difference in the incidence of CRBSI between the clinically indicated (1/3590) and routine change (2/3733) groups (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.08 to 4.68), low-certainty evidence (downgraded twice for serious imprecision).All trials reported incidence of thrombophlebitis and we combined the results from seven of these in the analysis (7323 participants). We excluded two studies in the meta-analysis because they contributed to high heterogeneity. There is no clear difference in the incidence of thrombophlebitis whether catheters were changed according to clinical indication or routinely (RR 1.07, 95% CI 0.93 to 1.25; clinically indicated 317/3590; 3-day change 307/3733, moderate-certainty evidence, downgraded once for serious risk of bias). The result was unaffected by whether the infusion was continuous or intermittent. Six trials provided thrombophlebitis rates by number of device days (32,709 device days). There is no clear difference between groups (RR 0.90, 95% CI 0.76 to 1.08; clinically indicated 248/17,251; 3-day change 236/15,458; moderate-certainty evidence, downgraded once for serious risk of bias).One trial (3283 participants), assessed all-cause blood stream infection (BSI). We found no clear difference in the all-cause BSI rate between the two groups (RR 0.47, 95% CI 0.15 to 1.53; clinically indicated: 4/1593 (0.02%); routine change 9/1690 (0.05%); moderate-certainty evidence, downgraded one level for serious imprecision).Three trials (4244 participants), investigated costs; clinically indicated removal probably reduces device-related costs by approximately AUD 7.00 compared with routine removal (MD -6.96, 95% CI -9.05 to -4.86; moderate-certainty evidence, downgraded once for serious risk of bias).Secondary outcomesSix trials assessed infiltration (7123 participants). Routine replacement probably reduces infiltration of fluid into surrounding tissues compared with a clinically indicated change (RR 1.16 (95% CI 1.06 to 1.26; routine replacement 747/3638 (20.5%); clinically indicated 834/3485 (23.9%); moderate-certainty evidence, downgraded once for serious risk of bias).Meta-analysis of seven trials (7323 participants), found that rates of catheter failure due to blockage were probably lower in the routine-replacement group compared to the clinically indicated group (RR 1.14, 95% CI 1.01 to 1.29; routine-replacement 519/3733 (13.9%); clinically indicated 560/3590 (15.6%); moderate-certainty evidence, downgraded once for serious risk of bias).Four studies (4606 participants), reported local infection rates. It is uncertain if there are differences between groups (RR 4.96, 95% CI 0.24 to 102.98; clinically indicated 2/2260 (0.09%); routine replacement 0/2346 (0.0%); very low-certainty evidence, downgraded one level for serious risk of bias and two levels for very serious imprecision).One trial (3283 participants), found no clear difference in the incidence of mortality when clinically indicated removal was compared with routine removal (RR 1.06, 95% CI 0.27 to 4.23; low-certainty evidence, downgraded two levels for very serious imprecision).One small trial (198 participants) reported no clear difference in device-related pain between clinically indicated and routine removal groups (MD -0.60, 95% CI -1.44 to 0.24; low-certainty evidence, downgraded one level for serious risk of bias and one level for serious imprecision).The pre-planned outcomes 'number of catheter re-sites per patient', and 'satisfaction' were not reported by any studies included in this review. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence of no clear difference in rates of CRBSI, thrombophlebitis, all-cause BSI, mortality and pain between clinically indicated or routine replacement of PIVC. We are uncertain if local infection is reduced or increased when catheters are changed when clinically indicated. There is moderate-certainty evidence that infiltration and catheter blockage is probably lower when PIVC are changed routinely; and moderate-certainty evidence that clinically indicated removal probably reduces device-related costs. The addition of two new trials for this update found no further evidence to support changing catheters every 72 to 96 hours. Healthcare organisations may consider changing to a policy whereby catheters are changed only if there is a clinical indication to do so, for example, if there were signs of infection, blockage or infiltration. This would provide significant cost savings, spare patients the unnecessary pain of routine re-sites in the absence of clinical indications and would reduce time spent by busy clinicians on this intervention. To minimise PIVC-related complications, staff should inspect the insertion site at each shift change and remove the catheter if signs of inflammation, infiltration, occlusion, infection or blockage are present, or if the catheter is no longer needed for therapy.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/instrumentação , Remoção de Dispositivo/normas , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/economia , Cateteres de Demora/efeitos adversos , Fidelidade a Diretrizes , Humanos , Incidência , Flebite/epidemiologia , Flebite/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tromboflebite/epidemiologia , Tromboflebite/etiologia , Fatores de Tempo
5.
Eur Radiol ; 29(5): 2716-2723, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30560363

RESUMO

OBJECTIVE: To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line-associated bloodstream infections (CLABSIs). METHODS: Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models. RESULTS: Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149-0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI. CONCLUSIONS: Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI. KEY POINTS: • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Cateterismo Periférico/efeitos adversos , Tromboflebite/etiologia , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Feminino , Humanos , Incidência , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tromboflebite/epidemiologia
6.
Rev Gastroenterol Peru ; 38(3): 289-292, 2018 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30540734

RESUMO

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.


Assuntos
Estenose da Valva Aórtica/complicações , Carcinoma de Células em Anel de Sinete/complicações , Colelitíase/complicações , Pólipos do Colo/complicações , Divertículo/complicações , Hemorragia Gastrointestinal/etiologia , Hérnia Hiatal/complicações , Neoplasias Primárias Múltiplas/complicações , Neoplasias do Colo Sigmoide/complicações , Neoplasias Gástricas/complicações , Idoso , Anemia Ferropriva/etiologia , Angiodisplasia/etiologia , Morte Súbita , Evolução Fatal , Humanos , Masculino , Modelos Biológicos , Síndrome , Tromboflebite/etiologia
8.
Intern Med ; 57(18): 2607-2612, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-29780120

RESUMO

Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. Cases of MD can be roughly categorized into three different groups based on the site of the lesion as follows: original MD of the anterolateral thoracoabdominal wall, penile MD with dorsum and dorsolateral aspects of the penis, and axillary web syndrome with mid-upper arm after axillary surgery. The diagnosis of MD is rather straightforward and based on a physical examinations. However, some case occur "secondary" with another underlying disease, including malignancy, a hypercoagulative state, and vasculitis. Therefore, it is critical to identify MD precisely, evaluate any possible underlying disease, and avoid any unnecessary invasive tests or treatment. In this paper, we comprehensively review the clinical characteristics of MD.


Assuntos
Tromboflebite/diagnóstico , Braço , Humanos , Masculino , Doenças do Pênis/diagnóstico , Doenças do Pênis/epidemiologia , Doenças do Pênis/etiologia , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/etiologia , Doenças Raras/terapia , Tromboflebite/epidemiologia , Tromboflebite/etiologia , Tromboflebite/terapia
9.
Ann Vasc Surg ; 51: 239-245, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29518511

RESUMO

BACKGROUND: Phlegmasia cerulea dolens (PCD) is a severe complication of deep veions thrombosis, and there are several treatment methods. This study aimed to investigate the clinical efficacy of surgical thrombectomy and simultaneous iliac vein stent implantation for the treatment of PCD caused by iliac vein occlusion. PURPOSE: This study aimed to investigate the clinical efficacy of surgical thrombectomy and simultaneous iliac vein stent implantation for the treatment of phlegmasia cerulea dolens (PCD) caused by iliac vein occlusion. METHODS: From February 2014 to December 2016, 5 patients with secondary PCD complicated with iliac vein occlusion were treated in our center. Thrombectomy by venous incision was performed with simultaneous iliac vein balloon dilatation and stents implantation. Efficacy and stents patency were assessed. Iliac vein occlusions were confirmed in all 5 patients by angiography after the thrombectomy. Stents implantation were performed after balloon dilatation. Three stents were implanted in 1 case of iliac vein and inferior vena cava (IVC) occlusion, whereas 1 stent was implanted in each of the other 4 cases. RESULTS: Symptoms were significantly relieved after surgery, with no complications. Patients were followed up for 6-24 months, and minor swelling of the affected limb was found in 1 case, with no thrombosis recurrence in all cases and vascular stent patency. CONCLUSIONS: Thrombectomy by venous incision and simultaneous iliac vein stent implantation for the treatment of PCD caused by iliac vein occlusion can quickly relieve symptoms, is easily implemented, is associated with fewer complications, and has good midterm efficacy and a high patency rate, making this technique a good treatment method.


Assuntos
Angioplastia com Balão/instrumentação , Veia Ilíaca/cirurgia , Stents , Trombectomia , Tromboflebite/terapia , Trombose Venosa/terapia , Adulto , Angioplastia com Balão/efeitos adversos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Trombectomia/efeitos adversos , Tromboflebite/diagnóstico por imagem , Tromboflebite/etiologia , Tromboflebite/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
10.
Intern Med ; 57(2): 209-212, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29033437

RESUMO

A 46-year-old man visited the emergency department of our hospital with a 3-day history of anal pain, hemorrhaging, and a slight fever. He had previously been diagnosed with protein C deficiency and was prescribed dabigatran, a direct oral anticoagulant. Contrast-enhanced computed tomography showed severe rectal wall thickening with partial defect of enhancement. In addition, sigmoidoscopy revealed a dusky purplish swollen anorectal mucosa just above the dentate line. He was diagnosed with acute anorectal thrombophlebitis, and anticoagulant therapy with heparin was initiated. To our knowledge, this is the first case report of acute anorectal thrombophlebitis caused by protein C deficiency.


Assuntos
Deficiência de Proteína C/complicações , Doenças Retais/etiologia , Tromboflebite/etiologia , Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/tratamento farmacológico , Tromboflebite/tratamento farmacológico
11.
J Clin Nurs ; 27(1-2): e363-e367, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28699240

RESUMO

AIMS AND OBJECTIVES: To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards. BACKGROUND: Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital-acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people. DESIGN: Observational, point prevalence study. METHODS: Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail. RESULTS: Approximately one-quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one-third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one-third of these were receiving intravenous fluids. CONCLUSIONS: There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids. RELEVANCE TO CLINICAL PRACTICE: Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.


Assuntos
Cânula/estatística & dados numéricos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/enfermagem , Adulto , Antibacterianos/administração & dosagem , Cânula/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Infecção Hospitalar/etiologia , Estudos Transversais , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tromboflebite/etiologia , Fatores de Tempo
12.
Pan Afr Med J ; 31: 97, 2018.
Artigo em Francês | MEDLINE | ID: mdl-31011398

RESUMO

This case study presents an unusual pathogenic association among several cranioencephalic lesions characterized by the association of osteitis of the cranial vault, due to Aspergillus fumigatus, with underlying thrombophlebitis complicated by intracranial hypertension resulting from hydrocephalus. The study involved a 43-year old HIV (human immunodeficiency virus) negative man with multi-recurrent infection of the frontal scalp. The patient was successfully treated with cerebrospinal fluid diversion (CFD), Ketoconazole and low molecular weight heparin. This study describes the different pathophysiological and therapeutic features of this exceptional pathogenic association.


Assuntos
Aspergilose/complicações , Hidrocefalia/diagnóstico , Osteíte/complicações , Tromboflebite/diagnóstico , Adulto , Anticoagulantes/administração & dosagem , Antifúngicos/administração & dosagem , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Aspergillus fumigatus/isolamento & purificação , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Hidrocefalia/etiologia , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Cetoconazol/administração & dosagem , Masculino , Osteíte/microbiologia , Crânio/microbiologia , Seio Sagital Superior/patologia , Tromboflebite/tratamento farmacológico , Tromboflebite/etiologia
13.
J Med Case Rep ; 11(1): 309, 2017 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-29092714

RESUMO

BACKGROUND: Coronary sinus thrombosis is a rare phenomenon. When identified, it most often is a complication of infective endocarditis or procedural intervention. We present an unusual and unreported case of spontaneous coronary sinus thrombosis as embolic sequela of an intra-abdominal infectious process. CASE PRESENTATION: We report a case of a 61-year-old white woman with a history of end-stage renal disease on hemodialysis, paroxysmal atrial fibrillation not on long-term systemic anticoagulation, and history of recurrent diverticulitis that presented with acute onset abdominal pain and nausea. Computed tomography of her abdomen and pelvis with intravenous contrast was negative for acute intra-abdominal pathology, but incidentally identified an oval-shaped filling defect at the ostium of the coronary sinus suspicious for thrombus or mass which was confirmed on subsequent transesophageal echocardiogram. In light of her concomitant transaminitis but otherwise negative workup, the mass was believed to be thromboembolic in nature, originating within the hepatic venous system as a manifestation of recurrent diverticulitis with associated pylephlebitis and ultimately lodging into the coronary sinus. With the newly detected thrombus and history of paroxysmal atrial fibrillation, she was started on warfarin for therapeutic systemic anticoagulation that resolved her clot by 3-month follow up. CONCLUSIONS: Although coronary sinus thrombosis is rare, a high index of suspicion and close scrutiny of the venous system in patients with intra-abdominal infectious processes would prevent delay in management of this potentially serious complication. The discussion of this case highlights the anatomy of the cardiac venous system, the pathophysiology of thrombus formation, and the utility of transesophageal echocardiography in confirming a diagnosis and assessing treatment efficacy.


Assuntos
Trombose Coronária/diagnóstico por imagem , Ecocardiografia Transesofagiana , Veia Porta/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Dor Abdominal , Anticoagulantes/uso terapêutico , Trombose Coronária/tratamento farmacológico , Trombose Coronária/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Tromboflebite/tratamento farmacológico , Tromboflebite/etiologia , Resultado do Tratamento , Varfarina/uso terapêutico
14.
BMJ Case Rep ; 20172017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29092965

RESUMO

This is a rare case of thrombosis of the dorsal vein of the penis (Mondor's disease) occurred after an anterior-lateral retroperitoneal approach for a vertebral stabilisation in thoracolumbar vertebral fracture. Potential causes are traumatism, neoplasms, excessive sexual activity or abstinence. Although penile Mondor's disease is a clinical diagnosis, ultrasound imaging is the gold standard to confirm it. In the reported case, 1 week after neurosurgical retroperitoneal procedure of vertebral stabilisation, the patient complained of a painful cord-like mass midshaft of penis. The diagnosis was made by clinical evaluation and ultrasound images. After 2 weeks of therapy with enoxaparin sodium, the patient recovered. The authors report this case evaluating the possible correlation between the anterior-lateral retroperitoneal approach and the development of the rare Mondor's disease.


Assuntos
Fixação de Fratura/efeitos adversos , Vértebras Lombares , Doenças do Pênis/diagnóstico , Pênis/irrigação sanguínea , Fraturas da Coluna Vertebral/cirurgia , Tromboflebite/diagnóstico , Adulto , Diagnóstico Diferencial , Fixação de Fratura/métodos , Humanos , Masculino , Doenças do Pênis/etiologia , Tromboflebite/etiologia , Ultrassonografia Doppler em Cores
15.
Mil Med ; 182(5): e1823-e1825, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-29087934

RESUMO

Phlegmasia cerulea dolens (PCD) is a rare entity that refers to a painful, edematous, and cyanotic limb due to a massive deep vein thrombosis (DVT). Due to its rarity, the exact incidence is unknown; however, it is vital that the military health care provider recognize it as the condition can be limb and life threatening. Due to the recent increase in combat-related operations, DVT has had a steady increase in the past 10 years in the military population, and as such has become a condition of special interest and surveillance in the armed forces. PCD is part of a spectrum that consists of distal DVT, more proximal DVT, phlegmasia alba dolens (PAD), and finally PCD with venous gangrene. PAD is an early stage of PCD, in which although there is a massive DVT present, the collateral and superficial circulation are not yet involved; this in turn results in a painful, edematous, white leg. PCD is preceded by PAD in approximately 50% to 60% of the cases. PCD has an amputation rate of up to 50% and a mortality rate of up to 40%. The patient will present with a swollen, cyanotic, painful leg that may or may not show signs of venous gangrene. In PCD, the collateral circulation is not spared and this causes severe congestion and fluid sequestration in the limb leading to venous hypertension. This can lead to circulatory shock and arterial insufficiency as it progresses. We review a case report of a 66-year-old woman that presented to small community army hospital after a 26-hour bus drive with knee pain and leg swelling. The diagnosis of PCD was made after Doppler ultrasonography showed bilateral iliofemoral, common, femoral, and saphenous veins thrombosis. The patient's left lower extremity was discolored, tender, and swollen, although it had not progressed to venous gangrene or dermal necrosis. While the management of PCD is not standardized due to the rarity of the condition, several options are available. These options include anticoagulation, minimally invasive procedures such as catheter-directed thrombolysis, or more invasive procedures such as surgical thrombectomy. In the active duty military population, clot reduction techniques would be preferred to long-standing anticoagulation, as the morbidity is greater with anticoagulation alone as well as the probability of major hemorrhage. Besides pulmonary embolism, which is a complication in up to 30% of the patients with PCD, one must keep in mind the extent and duration of the thrombus when choosing a treatment method, as these factors are directly related to the morbidity associated with post-thrombotic syndrome. Functional impairment after a massive DVT or PCD is an important factor that must be kept in mind for troop readiness.


Assuntos
Tromboflebite/diagnóstico , Tromboflebite/etiologia , Trombose Venosa/complicações , Idoso , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hospitais Militares/organização & administração , Humanos , Joelho/irrigação sanguínea , Joelho/fisiopatologia , Tromboflebite/fisiopatologia , Ultrassonografia/métodos
16.
Schweiz Arch Tierheilkd ; 159(9): 477-485, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28952957

RESUMO

INTRODUCTION: Intravenous catheterization is a necessity for continuous administration of intravenous fluids and for intermittent intravenous access to avoid discomfort and potential complications of repeated needle insertions into the vein. Intravenous catheterization is commonly performed and well tolerated in horses, but catheter associated complications have been reported. The most commonly reported complication is thrombophlebitis, but others such as venous air embolism, exsanguination and catheter fragmentation may also occur. This article aims to review clinical signs, pathogenesis, diagnosis, therapy, risk factors and prevention of common catheter associated complications.


Assuntos
Cateterismo Periférico/veterinária , Embolia Aérea/veterinária , Doenças dos Cavalos/etiologia , Tromboflebite/veterinária , Dispositivos de Acesso Vascular/veterinária , Animais , Cateterismo Periférico/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Embolia Aérea/terapia , Exsanguinação/diagnóstico , Exsanguinação/etiologia , Exsanguinação/terapia , Exsanguinação/veterinária , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/terapia , Cavalos , Prognóstico , Fatores de Risco , Tromboflebite/diagnóstico , Tromboflebite/etiologia , Tromboflebite/terapia , Dispositivos de Acesso Vascular/efeitos adversos
17.
Ter Arkh ; 89(7): 76-84, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28766545

RESUMO

The paper describes 4 clinical cases of thrombotic events (pulmonary embolism, deep vein thrombophlebitis, acute myocardial infarction, ischemic stroke) that have occurred in patients with hemophilia. It discusses the possible causes of their development and methods for their prevention and treatment. Controlled natural hypocoagulation, in which the dose of an administered deficient factor decreases to such an extent that in order to maintain the safe level of hypocoagulation (plasma factor activity is 15-20%; activated partial thromboplastin time is 1.5-2 times normal values), is proposed as one of the treatment options.


Assuntos
Isquemia Encefálica , Fator VIII , Hemofilia A , Infarto do Miocárdio , Embolia Pulmonar , Acidente Vascular Cerebral , Tromboflebite , Adulto , Coagulação Sanguínea/fisiologia , Testes de Coagulação Sanguínea/métodos , Isquemia Encefálica/etiologia , Gerenciamento Clínico , Fator VIII/administração & dosagem , Fator VIII/análise , Hemofilia A/complicações , Hemofilia A/diagnóstico , Hemofilia A/fisiopatologia , Hemofilia A/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Tromboelastografia/métodos , Tromboflebite/diagnóstico , Tromboflebite/etiologia , Tromboflebite/fisiopatologia , Tromboflebite/terapia , Resultado do Tratamento
18.
J Craniofac Surg ; 28(3): 620-624, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28468135

RESUMO

Acute otitis media used to cause fatal results because of its intracranial complications before the introduction of potent and effective antibiotics. After the introduction of antibiotics, complications have started to be observed more frequently as a result of chronic otitis media and especially in children. Because clinical findings changed and became indistinct, the diagnosis of otitis and mastoiditis has been made occasionally with imaging findings only after complications occurred. Multidetector computed tomography and magnetic resonance imaging are efficient and sufficient methods in the rapid diagnosis and should be immediately referred methods.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Imagem por Ressonância Magnética , Mastoidite/complicações , Meningite/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Otite Média/complicações , Tromboflebite/diagnóstico por imagem , Doença Aguda , Adolescente , Adulto , Idoso , Abscesso Encefálico/etiologia , Criança , Doença Crônica , Feminino , Humanos , Masculino , Mastoidite/diagnóstico por imagem , Meningite/etiologia , Pessoa de Meia-Idade , Otite Média/diagnóstico por imagem , Estudos Retrospectivos , Tromboflebite/etiologia , Adulto Jovem
19.
Pediatr Infect Dis J ; 36(5): 457-461, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28403047

RESUMO

BACKGROUND: The occurrence of meningitis in children >5 years old may be associated with specific predisposing factors that can be anatomic, such as cerebrospinal fluid fistula or breach, or related to genetic susceptibility or N inborn or acquired immunologic defect. This study aimed to assess the anatomical and immunologic risk factors in children >5 years old with pneumococcal meningitis and prospectively enrolled in the French national meningitis network. METHODS: We analyzed all data for children who were 5-15 years old with a diagnosis of pneumococcal meningitis between 2001 and 2013. We describe the frequency and typology of the anatomic or immunologic risk factors, the clinical features and the pneumococcal serotypes. RESULTS: Among the 316 patients with pneumococcal meningitis, the mortality rate was 9.5% and 23.1% of cases presented complications (abscess, coma, hemodynamic failure, thrombophlebitis cerebral or deafness). In total, 108 children (34%) showed risk factors, the most frequent being anatomic: 70 cases (22.8%) were related to a cerebrospinal fluid breach or fistula and 55 (17.9%) to immunodeficiency, primary or acquired. Serotype data were available for 207 pneumococcal isolates (65.5%). The most frequent serotypes were as follows: 3, 18C, 19A and 19F between 2001 and 2009 and 19F, 3, 19A, 12F, 22F, 17F and 24F after 2009. CONCLUSIONS: We describe the largest cohort of children >5 years old with pneumococcal meningitis. One third of the children had risk factors justifying a complete immunologic and radiologic work-up.


Assuntos
Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/prevenção & controle , Meningite Pneumocócica/diagnóstico , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/patogenicidade , Vacinação , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/mortalidade , Abscesso/prevenção & controle , Adolescente , Criança , Pré-Escolar , Coma/diagnóstico , Coma/etiologia , Coma/mortalidade , Coma/prevenção & controle , Surdez/diagnóstico , Surdez/etiologia , Surdez/mortalidade , Surdez/prevenção & controle , Feminino , França , Humanos , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/mortalidade , Masculino , Meningite Pneumocócica/complicações , Meningite Pneumocócica/mortalidade , Meningite Pneumocócica/prevenção & controle , Estudos Prospectivos , Fatores de Risco , Sorogrupo , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Análise de Sobrevida , Tromboflebite/diagnóstico , Tromboflebite/etiologia , Tromboflebite/mortalidade , Tromboflebite/prevenção & controle
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