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1.
Angiol Sosud Khir ; 25(4): 181-187, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855216

RESUMO

BACKGROUND: Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS: Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS: After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION: Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.


Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Embolia Pulmonar/prevenção & controle , Trombectomia/métodos , Trombose Venosa/cirurgia , Implante de Prótese Vascular , Humanos , Embolia Pulmonar/etiologia , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/complicações
2.
Zhonghua Nei Ke Za Zhi ; 58(12): 894-898, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775452

RESUMO

Objective: Portal vein thrombosis (PVT) is a rare and severe clinical manifestation of antiphospholipid syndrome (APS), as well as a predictor of poor prognosis. This study was conducted to explore the clinical features and risk factors of PVT in APS patients. Methods: A total of 123 APS patients diagnosed from 2012 to 2019 were retrospectively enrolled. The diagnosis of PVT was made according to the 2009 American College of Liver Diseases (AASLD) criteria. Clinical and laboratory data were collected. A multivariate (MV) logistic regression model was constructed using a stepwise forward selection procedure among those candidate univariables with P values<0.10. Results: A total of 28 cases with PVT, and 95 control cases without PVT were finally enrolled.The 28 APS-PVT patients included 5 males and 23 females with age range from 17 to 63 years. Clinical manifestations included acute thrombosis in 8 patients, chronic thrombosis in 16, and 4 with portal vein spongiform. As to the involved vessels, single portal vein thrombosis was seen in 20 patients, portal combined with superior mesenteric vein (SMV) and splenic vein in one patient, portal plus SMV in 4 and only SMV in 3 patients. Other manifestations were portal hypertension (16/28), esophageal varices (13/28), spleen infarction (7/28) and gastrointestinal bleeding (4/28). Two antiphospholipid antibodies were positive in 13 cases. Triple positive antibodies were seen in 7 cases. Multivariate logistic regression analysis showed that disease duration less than 0.5 years (OR=72.74, 95%CI 7.50-705.45, P<0.001), hypoalbuminemia (OR=356.45, 95%CI 19.19-6 620.14, P<0.001), and elevated erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) (OR=14.41, 95%CI 1.49-139.20, P<0.001) were independent risk factors for PVT in APS. Conclusion: PVT is usually misdiagnosed due to insidious onset. Short disease duration, hypoalbuminemia and elevated ESR/CRP are risk factors for PVT in APS. Better understanding, early diagnosis and treatment will improve the clinical outcome.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/imunologia , Cirrose Hepática/imunologia , Veia Porta/patologia , Trombose/imunologia , Trombose Venosa/fisiopatologia , Adolescente , Adulto , Síndrome Antifosfolipídica/complicações , Feminino , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose/complicações , Trombose Venosa/complicações , Adulto Jovem
3.
J Radiol Case Rep ; 13(3): 19-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31565174

RESUMO

Spontaneous rupture of the inferior vena cava (IVC) is a rare entity. We report a case of a spontaneous IVC rupture associated with IVC filter thrombosis in a patient presenting with severe atraumatic back pain. Computed tomography (CT) identified a retroperitoneal hematoma and suggested IVC thrombosis. Magnetic resonance (MR) imaging confirmed the presence of IVC filter thrombosis and demonstrated a large defect in the infrarenal IVC, with the vessel lumen in free communication with the adjacent hematoma. The patient was managed conservatively and discharged in stable condition. MR imaging played an important role in characterizing the CT findings, which were unclear.


Assuntos
Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/terapia , Tratamento Conservador , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Ruptura Espontânea/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
4.
Transplant Proc ; 51(9): 3111-3115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611113

RESUMO

Extensive portosplenomesenteric thrombosis is regarded as a relative contraindication to liver transplantation because of the complexity of the surgical procedure. This report describes a case of living-donor liver transplantation (LDLT) for a patient with extensive portosplenomesenteric thrombosis, in whom portal flow was successfully restored by intraoperative transplenic portal vein and superior mesenteric vein stenting after surgical thrombectomy. The patient's liver function remained normal with a patent portal vein stent 6 months after LDLT, and Doppler ultrasonography demonstrated a normal wave form for portal flow. To the best of our knowledge, this is the world's first case of endovascular management of the portal vein via percutaneous transsplenic access during LDLT, demonstrating that transsplenic access can be an alternative approach without liver graft injury when the superior mesenteric vein branch and inferior mesenteric vein cannot be used as access routes.


Assuntos
Procedimentos Endovasculares/métodos , Transplante de Fígado/métodos , Veia Porta/cirurgia , Veia Esplênica/cirurgia , Trombose Venosa/cirurgia , Humanos , Fígado/irrigação sanguínea , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Trombose Venosa/complicações
5.
Medicine (Baltimore) ; 98(37): e17172, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517871

RESUMO

The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Trombose Venosa/complicações , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/mortalidade , Feminino , Seguimentos , Humanos , Neoplasias Renais/genética , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia , Análise de Sobrevida , Trombectomia , Trombose Venosa/mortalidade , Adulto Jovem
6.
Cochrane Database Syst Rev ; 9: CD004177, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31531971

RESUMO

BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic complaints such as oedema and skin changes including; venous ectasia, varicose veins, redness, eczema, hyperpigmentation, and in severe cases fibrosis of the subcutaneous adipose in the affected limb. These chronic complaints are the effects of venous outflow restriction that can cause symptoms such as heaviness, itching, pain, cramps, and paraesthesia. Twenty to fifty percent of people with DVT develop post-thrombotic complications. Several non-pharmaceutical measures are used for prevention of PTS during the acute phase of DVT. These include elevation of the legs and compression therapy. There have been limited studies regarding the effectiveness of compression therapy for prevention or treatment of PTS. As a result, clinicians and guidelines differ in their assessment of compression therapy during treatment of DVT and in the treatment of PTS. This is an update of a review first published in 2003. OBJECTIVES: To assess the effectiveness of compression therapy for treatment of post-thrombotic syndrome, including elastic compression stockings and mechanical devices compared with no intervention, placebo and with each other. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries on 2 July 2018. SELECTION CRITERIA: We included trials that evaluated compression therapy for the treatment of PTS. The primary outcomes were severity of PTS and adverse effects. There were no restrictions on date or language. Two review authors (SA, DNK) independently assessed whether potentially relevant studies met the inclusion criteria. DATA COLLECTION AND ANALYSIS: One review author extracted and summarised data and one review author (DNK) verified them. We resolved disagreements by discussion. We assessed methodological study quality with the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. MAIN RESULTS: We identified four trials, with 116 participants, investigating the effectiveness of compression therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively.Two trials studied the effect of graduated elastic compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period.Two trials studied the effects of intermittent mechanical compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical compression devices.None of the studies evaluated patient satisfaction. AUTHORS' CONCLUSIONS: There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to compression device use owing to small studies of short duration. High-certainty evidence to support the use of compression therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.


Assuntos
Síndrome Pós-Trombótica/terapia , Meias de Compressão , Humanos , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/prevenção & controle , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose Venosa/complicações
7.
Cochrane Database Syst Rev ; 9: CD010546, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31550050

RESUMO

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including haemorrhage from oesophageal and gastrointestinal varices. Variceal haemorrhage commonly occurs in children with chronic liver disease or portal vein obstruction. Prevention is therefore important. Following numerous randomised clinical trials demonstrating efficacy of non-selective beta-blockers and endoscopic variceal ligation in decreasing the incidence of variceal haemorrhage, primary prophylaxis of variceal haemorrhage in adults has become the established standard of care. Hence, band ligation and beta-blockers have been proposed to be used as primary prophylaxis of oesophageal variceal bleeding in children. OBJECTIVES: To determine the benefits and harms of band ligation compared with any type of beta-blocker for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (February 2019), CENTRAL (December 2018), PubMed (December 2018), Embase Ovid (December 2018), LILACS (Bireme; January 2019), and Science Citation Index Expanded (Web of Science; December 2018). We scrutinised the reference lists of the retrieved publications and performed a manual search from the main paediatric gastroenterology and hepatology conferences (NASPGHAN and ESPGHAN) abstract books from 2009 to 2018. We searched ClinicalTrials.gov for ongoing clinical trials. There were no language or document type restrictions. SELECTION CRITERIA: We planned to include randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. We planned to also include quasi-randomised and other observational studies retrieved with the searches for randomised clinical trials for report of harm. DATA COLLECTION AND ANALYSIS: We planned to summarise data from randomised clinical trials using standard Cochrane methodologies. MAIN RESULTS: We found no randomised clinical trials assessing band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. AUTHORS' CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis are lacking. There is a need for well-designed, adequately powered randomised clinical trials to assess the benefits and harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. Those randomised clinical trials should include patient-relevant clinical outcomes such as mortality, failure to control bleeding, and adverse events.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/cirurgia , Ligadura/métodos , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Antifibrinolíticos/uso terapêutico , Doença Hepática Terminal/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Veia Porta , Prevenção Primária , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose Venosa/complicações
8.
Rev. bras. cir. plást ; 34(3): 310-314, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047144

RESUMO

Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.


Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.


Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Pacientes , Embolia Pulmonar , Cirurgia Plástica , Mama , Registros Médicos , Estudos Retrospectivos , Embolia e Trombose , Trombose Venosa , Pacientes/estatística & dados numéricos , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Cirurgia Plástica/estatística & dados numéricos , Mama/cirurgia , Registros Médicos/estatística & dados numéricos , Embolia e Trombose/cirurgia , Trombose Venosa/cirurgia , Trombose Venosa/complicações
9.
Biomed Res Int ; 2019: 2141859, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467872

RESUMO

Objectives: Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains a challenge in management. Transarterial chemoembolization (TACE) has been used for patients with PVTT but efficiency was limited with a median overall survival of 4 to 6.1 months. The aim of this study is to evaluate the efficiency of TACE combined with sorafenib in HBV background HCC with PVTT. Methods: A total of 498 patients were enrolled in the study including 69 patients who received TACE combined with sorafenib and 429 patients treated with TACE alone between January 1st, 2008, and April 30st, 2014. Using the 1:2 propensity score matching, 138 well-balanced patients were enrolled. Overall survival (OS) was compared between the two groups. The Kaplan-Meier method was used to evaluate the OS, and the differences between groups were analyzed with a log-rank test. Results: TACE combined with sorafenib improved the OS of the patients compared with TACE alone (13.0 vs 6.0 months, p<0.001). After propensity score matching, the median OS of combination therapy and TACE were 13.0 and 7.0 months, respectively (p=0.001). Subgroup analysis revealed that the patients younger than 60 years old, male patients, AFP more than 400ng/ml, tumor size more than 5cm, or type III/IV PVTT had OS benefits from TACE combined with sorafenib. Conclusions: Compared with TACE therapy alone, TACE combined with sorafenib could improve OS in HBV background HCC patients with PVTT. The patients who are younger, male, or with more tumor burden may benefit more from combination therapy.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Sorafenibe/administração & dosagem , Trombose Venosa/tratamento farmacológico , Adulto , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Quimioembolização Terapêutica , Terapia Combinada , Intervalo Livre de Doença , Feminino , Vírus da Hepatite B/patogenicidade , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Veia Porta/efeitos dos fármacos , Veia Porta/patologia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/patologia , Trombose Venosa/virologia
10.
Medicine (Baltimore) ; 98(30): e16522, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348266

RESUMO

INTRODUCTION: Paradoxical embolism (PDE) refers to direct passage of venous thrombi into the arterial circulation through an arteriovenous shunt. It is well-known that the pulmonary thromboembolism (PTE) can cause opening of the foramen ovale leading to paradoxical arterial embolism. Long term follow up of PDE patient over 10 years was not reported in the literature. PATIENT CONCERNS: A 57-year-old woman presented with initial symptoms of numbness/weakness and hypoxemia. Ultrasonography and pulmonary arteriography indicated pulmonary thromboembolism. DIAGNOSIS: Pulmonary embolism and paradoxical multiple arterial embolism or acute PTE concomitant with paradoxical multiple arterial embolism. INTERVENTIONS: Craniectomy and anticoagulation treatment was administered and the patient received low-dose warfarin therapy for 10 years. OUTCOMES: The patient is currently stable with no abnormalities seen in the deep veins of the bilateral lower limbs. The international normalized ratio (INR) was controlled within the range of 1.20 to 1.51. As this is a 10-year follow-up case report, the patient has responded well to the treatment and has been followed-up. The follow-up has been annual and the patient has been stable CONCLUSION:: Low intensity and persistent anticoagulation therapy can inhibit blood thrombophilia and reduce the risk of bleeding. It is noteworthy that such an approach used effectively in this patient. To best our knowledge, it is first report for long term follow up PDE patient successfully over 10 years.


Assuntos
Embolia Paradoxal/etiologia , Forame Oval/irrigação sanguínea , Extremidade Inferior/irrigação sanguínea , Embolia Pulmonar/etiologia , Trombose Venosa/complicações , Anticoagulantes/uso terapêutico , Craniotomia/métodos , Embolia Paradoxal/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Resultado do Tratamento , Trombose Venosa/terapia
12.
Blood Coagul Fibrinolysis ; 30(5): 188-192, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157680

RESUMO

: Multiple studies have shown that in approximately half of individuals with pulmonary embolism (PE), the deep venous thrombosis (DVT) is not evident at the moment of PE diagnosis. The underlying factors and the origin of PE in these patients are not completely understood: missed DVT, embolization of DVT in its entirety, or de-novo PE being possible explanations. The aim of this study was to evaluate the differences in PE patient with or without co-existing DVT. Sixty-three consecutive PE patients were included. Whole leg bilateral Doppler compression ultrasound was performed to all patients. The PE location and extension, C-reactive protein, platelet count, hemostatic markers FV, FVIII, FXIIIa, Fibrinogen, von Willebrand factor antigen, thrombomodulin were assessed. Thorough clinical assessment including echocardiography and pulmonary function tests were performed upon arrival and seven months later. The mean age of the patients was 57 years (SD 17.3) and 33 (52%) were women. Thirty-one patients (49.2%) had co-existing DVT. The presence of DVT was associated with the proximal location of the PE (100%), whereas none of the patients (n = 10) with exclusively peripheral PE had co-existing DVT. The PE extension, the measured hemostatic and inflammatory markers or the patient characteristics did not statistically differ between patients with isolated PE and PE with co-existing DVT. In roughly half of the PE patients no DVT could be detected. The location of the PE was associated with the presence of co-existing DVT. There were no differences in the PE extension, hemostatic markers or in the patient characteristic between patients with isolated PE or PE with co-existing DVT.


Assuntos
Embolia Pulmonar/complicações , Trombose Venosa/complicações , Adulto , Idoso , Feminino , Hemostasia , Humanos , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Ultrassonografia Doppler , Trombose Venosa/sangue , Trombose Venosa/diagnóstico por imagem
13.
BMJ Case Rep ; 12(6)2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31160302

RESUMO

Although not frequent, thromboembolic events occurring in patient presenting tuberculosis may be observed. Frequency of such thromboembolic events seems correlated with the severity of tuberculosis. We herein report a case of venous thrombosis revealing an asymptomatic tuberculosis. A man aged 32 years was admitted for deep and superficial vein thrombosis of the left arm. Chest CT angiography ruled out pulmonary embolism and showed a mediastinal and pulmonary heterogeneous necrotic mass at the apical segment of the left lung. Histological study of a CT scan-guided pulmonary biopsy showed signs of caseating granuloma compatible with tuberculosis. Diagnosis of venous thrombosis due to pulmonary tuberculosis with lymph nodes involvement was made. Antituberculosis treatment was initiated and required an adjustment of anticoagulant therapy. Our observation highlights the possibility of causative effect between tuberculosis and venous thrombosis.


Assuntos
Veia Axilar , Veia Subclávia , Tuberculose Pulmonar/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Braço/irrigação sanguínea , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Masculino , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/patologia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
14.
Zhonghua Shao Shang Za Zhi ; 35(5): 395-397, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154741

RESUMO

On September 7th, 2017, one female patient, aged 48 years with deep partial-thickness flame burn on face, upper limbs, trunk, and lower limbs of 40% total body surface area was admitted to the First People's Hospital of Foshan City. After admission, active fluid replacement, anti-infection, nutritional support, and other treatments were performed. After debridement and skin grafting for 3 times and blood transfusion for 2 times, the patient recovered well. On the 20th day post admission, sudden heartbeat and respiratory arrest happened, and the patient died after ineffective rescue. Autopsy showed that thrombus formed in right internal jugular vein and deep veins of lower extremities, and vascular lumina of the bilateral pulmonary artery. The direct cause of death was acute pulmonary thromboembolism, but whether the embolus originated from deep vein of lower extremity or right internal jugular vein was not clear. This case suggests that clinician should not only pay attention to the prevention of deep venous thrombosis of lower extremities of burn patients, but also the possibility of internal jugular vein thrombosis, especially for patients with internal jugular vein access.


Assuntos
Queimaduras/complicações , Veias Jugulares/patologia , Transplante de Pele , Trombose Venosa/complicações , Transfusão de Sangue , Desbridamento , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Trombose , Trombose Venosa/mortalidade
15.
Cardiovasc Intervent Radiol ; 42(10): 1420-1428, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31187228

RESUMO

PURPOSE: To investigate the feasibility and safety of a helical iodine-125 (I-125) seed implant combined with transcatheter arterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT). METHODS: From December 2016 to February 2018, 26 cases of HCC with MPVTT patients were enrolled in this prospective study. Helical I-125 seed implants were placed into the portal vein through the percutaneous transhepatic route. Subsequently, TACE was performed. Follow-up with enhanced CT was performed every 6-8 weeks and TACE was repeated if the residual or recurrent tumor was found. Treatment response was measured with the modified response evaluation criteria in solid tumors. Complication rates and overall survival were also evaluated. RESULTS: Implantation and TACE were successful in all patients. There were no grade ≥ 3 complications observed in the patients. The objective response rates (ORR) and disease control rates (DCR) of MPVTT at 3 months after implantation were 42.3% and 84.6%, respectively, whereas ORR and DCR of the liver lesions were 34.6% and 46.2%, respectively. The median overall survival was 10.7 months (95% CI 6.2-15.2 months). CONCLUSION: Helical I-125 seed implants can be safely placed into the human main portal vein. Helical I-125 seed implants combined with TACE for HCC with MPVTT are safe and feasible.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Hepáticas/terapia , Veia Porta/patologia , Trombose Venosa/terapia , Carcinoma Hepatocelular/complicações , Terapia Combinada/métodos , Estudos de Viabilidade , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Critérios de Avaliação de Resposta em Tumores Sólidos , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/patologia
16.
Am J Case Rep ; 20: 886-895, 2019 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-31230060

RESUMO

BACKGROUND Systemic vasculitides constitute heterogenous conditions affecting many organs and systems through blood vessel inflammation. Although there are some classifications for vasculitis, several vasculitides are "unclassified" because they cannot be clearly assigned to one of the known entities. CASE REPORT We report an autopsy case of a 67-year-old Japanese man who presented with fever, ocular pain, erythema, chest pain, and headache. The disease caused episcleritis, thrombophlebitis, extensive deep vein thrombosis, multiple pulmonary nodules and masses, hypertrophic pachymeningitis, and hyper-intensity areas in brain parenchyma on magnetic resonance images. Histopathology of the pulmonary nodule confirmed vasculitis affecting medium-to-small veins and arteries without necrotizing vasculitis or granulomatous inflammation. We diagnosed the patient with unclassified vasculitis based on the clinicopathological characteristics. Steroids in combination with immunosuppressants were used, but the disease was refractory and relapsing. The disease activity was eventually controlled with rituximab, but the patient died of bronchopneumonia. On autopsy, lung and brain findings indicated healed vascular inflammation. CONCLUSIONS This is the first case report of unclassified vasculitis, which is characterized as medium-to-small-sized arteritis and phlebitis, causing episcleritis, thrombophlebitis, deep vein thrombosis, pulmonary vasculitis, and intracranial vasculitis. The clinical conditions share some similarities with granulomatosis with polyangiitis and Behçet's disease; however, they meet no classification criteria of any specific vasculitis. More cases need to be analyzed to confirm our findings.


Assuntos
Esclerite/diagnóstico , Tromboflebite/diagnóstico , Vasculite/diagnóstico , Trombose Venosa/diagnóstico , Idoso , Autopsia , Evolução Fatal , Humanos , Masculino , Esclerite/complicações , Esclerite/terapia , Tromboflebite/complicações , Tromboflebite/terapia , Vasculite/complicações , Vasculite/terapia , Trombose Venosa/complicações , Trombose Venosa/terapia
17.
PLoS One ; 14(5): e0216935, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141552

RESUMO

PURPOSE: Portal vein thrombosis (PVT) is generally recognized as a prognostic factor in HCC. Our purpose is to assess and compare the survival of patients with PVT and without PVT, after Y-90 Trans-Arterial Radio-Embolization (TARE) of unresectable HCC, unresponsive to other loco-regional treatments. MATERIALS AND METHODS: Between November 2005 and November 2012, Y-90 resin-based TARE was performed in an IRB-approved prospective protocol, on 89 patients with unresectable HCC. 33/89 patients had PVT, the remaining 56 were resistant-to-cTACE or underwent TARE as a downstaging therapy. All patients were studied with Multi-Detector Computed Tomography (MDCT), angiography, 99mTc-MAA-scintigraphy and liver biopsy. Gastro-duodenal artery was embolized in most cases. Proton-Pump Inhibitors were administered to prevent gastritis and ulcers. χ2 test with Yates correction and log rank test were used to compare the two proportions and Kaplan-Meier survival curves, respectively. RESULTS: The average activity administered was 1.7 ± 0.4 GBq. After the treatment, CTCAE grade 2 adverse events occurred in 46% (41/89) patients: in particular, fever and abdominal pain were found in 25 and 16 patients, respectively. No major side-effect was observed. According to mRECIST criteria, partial response or complete response was found in 70% of patient three months after the treatment, and in 90.5% nine months after the treatment. No significant difference was found in survival of patients with PVT compared to those without PVT (p-value = 0.672). A complete regression of PVT was observed in almost half patients (13/27, 48.1%). CONCLUSIONS: Portal vein invasion does not affect survival in advanced stage HCC-patients undergoing TARE using Y-90 resin-based microspheres. Y90 procedure is associated with regression of portal vein tumor thrombus.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Trombose Venosa/terapia , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/mortalidade , Estudos de Coortes , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Masculino , Microesferas , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estadiamento de Neoplasias , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Veia Porta/efeitos da radiação , Prognóstico , Cintilografia , Análise de Sobrevida , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
18.
J Coll Physicians Surg Pak ; 29(5): 448-452, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036116

RESUMO

OBJECTIVE: To observe the clinical effect of catheter-directed thrombolysis on deep venous thrombosis (DVT) of lower extremity after burn. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Invasive Technology Department, Binzhou City Center Hospital, China, from January 2015 to November 2017. METHODOLOGY: Eighty-two patients with lower extremity DVT after burn were selected as the study object. All patients received catheter-directed thrombolysis and the clinical efficacy was evaluated. The blood coagulation parameters including plasma prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrin original (FIB) and inflammatory response factors including interleukin (IL)-6, C-reactive protein (CRP) and D-dimer were compared before and after treatment. RESULTS: All interventional surgeries that the patients received were successful. The effective rate of catheter-directed thrombolysis was 98.78% (81 cases). After 6 days of treatment, compared with that before treatment, serum PT, APTT and TT were up-regulated (all p <0.001) and FIB was down-regulated (p <0.001). After 6 days of treatment, the levels of serum IL-6, CRP and D-dimer were lower than those before treatment (all p <0.001). No visceral hemorrhage occurred after 1 week of treatment. CONCLUSION: Catheter-directed thrombolysis of patients with lower extremity DVT after burn produces a good effect. It can improve the coagulation function and reduce the level of inflammatory response factors in patients with high safety.


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Fibrinolíticos/uso terapêutico , Extremidade Inferior/irrigação sanguínea , Terapia Trombolítica/métodos , Trombose Venosa/tratamento farmacológico , Trombose Venosa/terapia , Adulto , Idoso , Cateterismo Periférico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento , Trombose Venosa/complicações
19.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036738

RESUMO

Isolated cortical venous thrombosis (ICVT) occurring in the absence of dural venous thrombosis, constitutes about 2%-5% of all cerebral venous thrombosis. Its vague, non-specific presentation makes it a difficult and challenging diagnosis that needs an extensive workup especially in young patients. Outcome and prognosis depend mainly on early diagnosis and treatment. Here we discuss the clinical presentation, diagnosis and the treatment of a young woman diagnosed with ICVT with acute ischaemic venous stroke, in the setting of eclampsia and family history of coagulation disease.


Assuntos
Trombose Intracraniana/patologia , Acidente Vascular Cerebral/diagnóstico por imagem , Trombose Venosa/patologia , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Feminino , Morte Fetal , Humanos , Trombose Intracraniana/complicações , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Imagem por Ressonância Magnética/métodos , Flebografia/métodos , Gravidez , Doenças Raras , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
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