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1.
J Int Med Res ; 50(1): 3000605211067688, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34986677

RESUMO

OBJECTIVE: To begin to understand how to prevent deep vein thrombosis (DVT) after an innovative operation termed intracorporeal laparoscopic reconstruction of detenial sigmoid neobladder, we explored the factors that influence DVT following surgery, with the aim of constructing a model for predicting DVT occurrence. METHODS: This retrospective study included 151 bladder cancer patients who underwent intracorporeal laparoscopic reconstruction of detenial sigmoid neobladder. Data describing general clinical characteristics and other common parameters were collected and analyzed. Thereafter, we generated model evaluation curves and finally cross-validated their extrapolations. RESULTS: Age and body mass index were risk factors for DVT, whereas postoperative use of hemostatic agents and postoperative passive muscle massage were significant protective factors. Model evaluation curves showed that the model had high accuracy and little bias. Cross-validation affirmed the accuracy of our model. CONCLUSION: The prediction model constructed herein was highly accurate and had little bias; thus, it can be used to predict the likelihood of developing DVT after surgery.


Assuntos
Laparoscopia , Neoplasias da Bexiga Urinária , Trombose Venosa , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
3.
Dis Colon Rectum ; 65(1): 11-13, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34636790

RESUMO

CASE SUMMARY: A 22-year-old woman with medically refractory ulcerative pancolitis underwent laparoscopic total proctocolectomy with IPAA and diverting ileostomy. She was discharged on postoperative day 4 feeling well. Because of the lack of risk factors for venous thromboembolism (including no family history or use of oral contraceptives), she was not discharged with prophylactic low-molecular-weight heparin, but she received low-molecular-weight heparin while in the hospital. The following day, she developed abdominal pain, nausea/vomiting, and decreased ostomy output. An abdominopelvic CT scan demonstrated a small amount of intraperitoneal free air felt to be postoperative in nature, small-bowel dilation consistent with ileus, and extensive portal and superior mesenteric vein thrombosis. She was started on low-molecular-weight heparin that resulted in rapid improvement. A subsequent repeat CT scan a few days later showed decreased clot burden.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Laparoscopia/métodos , Proctocolectomia Restauradora/efeitos adversos , Trombose Venosa/etiologia , Dor Abdominal/etiologia , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Ileostomia/efeitos adversos , Íleus/diagnóstico por imagem , Doenças Inflamatórias Intestinais/cirurgia , Veias Mesentéricas/patologia , Veia Porta/patologia , Cuidados Pós-Operatórios , Náusea e Vômito Pós-Operatórios/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Adulto Jovem
4.
J Med Case Rep ; 15(1): 623, 2021 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-34920760

RESUMO

BACKGROUND: Obesity is associated with an increased risk of morbidity and mortality, so weight reduction is important. Bariatric surgery is a well-tolerated approach for reducing body weight, with laparoscopic sleeve gastrectomy commonly performed. An uncommon and potentially fatal sequela of laparoscopic sleeve gastrectomy is portomesenteric vein thrombosis, which may result in severe bowel ischemia. CASE REPORT: A 32-year-old Middle Eastern obese man (body mass index 33) presented to the emergency department with severe, generalized abdominal pain 2 weeks after laparoscopic sleeve gastrectomy. Computed tomography of the abdomen and pelvis revealed extensive acute on chronic portosplenic and superior mesenteric vein thrombosis with associated small bowel ischemia. Laparoscopic exploration was converted to midline laparotomy and an extensive ischemic small bowel resection. CONCLUSION: Laparoscopic sleeve gastrectomy carries a risk of both morbidity and mortality. Venous thromboembolism is a well-known risk of bariatric surgery, but portomesenteric vein thrombosis is also a rare but sometimes serious complication. A high index of suspicion for portomesenteric vein thrombosis to prompt early detection is essential in patients who have undergone laparoscopic sleeve gastrectomy to minimize complications and optimize outcomes. Uncertainty still remains around the optimal dose and duration of anticoagulation after laparoscopic sleeve gastrectomy.


Assuntos
Laparoscopia , Trombose Venosa , Adulto , Gastrectomia/efeitos adversos , Humanos , Obesidade/complicações , Obesidade/cirurgia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
5.
Cir Cir ; 89(S2): 84-89, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932543

RESUMO

BACKGROUND: Bariatric surgery is an effective way to lose weight and the laparoscopic gastric sleeve is one of the techniques currently used. Portosplenomesenteric venous thrombosis is a complication that occurs in patients undergoing this surgical technique. At the moment there are no protocols to reduce the risk of this thrombotic event, so we show our experience and propose an algorithm. CASE REPORT: A total of 620 patients were evaluated, six of whom presented between postoperative days 10 to 20 abdominal pain, nausea and dehydration. Therefore, a double contrast abdominal computed tomography scan was carried out, which demonstrated portomesenteric and portoesplenomesenteric thrombosis, in addition to two patients with signs of intestinal ischemia, which required reoperation. One of the patients died of pulmonary thromboembolism.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Trombose Venosa , Gastrectomia , Humanos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
6.
Ann Transplant ; 26: e909493, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34907151

RESUMO

BACKGROUND Portal vein thrombosis (PVT) after pediatric liver transplantation (LT) is a common but grave complication which could eventually result in life-threatening portal hypertension. A "Rex" shunt between the superior mesenteric vein and the Rex recess of the liver has been reported to be a treatment option for extrahepatic portal vein obstruction; however, its application to living donor liver transplantation (LDLT) is limited due to the availability of appropriate vein grafts. In this study, we retrospectively evaluated the effectiveness of Rex shunt as an option for the treatment of PVT after pediatric LDLT. CASE REPORT Three children underwent the Rex shunt for early (n=2) and late (n=1) PVT after LDLT using the greater saphenous vein (n=2) and the external iliac vein (n=1) from the parents who previously donated their livers. Two of the 3 children are free from symptoms with patent shunt grafts at 14 years after the procedures. One child died at 30 days after LDLT due to repeated episodes of PVT, which finally led to hepatic infarction. CONCLUSIONS The Rex shunt is feasible to treat PVT after LDLT. However, additional surgical insults to the living donor need further discussion.


Assuntos
Transplante de Fígado , Trombose Venosa , Criança , Humanos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Veia Porta/cirurgia , Estudos Retrospectivos , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
7.
BMC Nephrol ; 22(1): 420, 2021 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-34965863

RESUMO

BACKGROUND: As the COVID-19 pandemic spread worldwide, case reports and small series identified its association with an increasing number of medical conditions including a propensity for thrombotic complications. And since the nephrotic syndrome is also a thrombophilic state, its co-occurrence with the SARS-CoV-2 infection is likely to be associated with an even higher risk of thrombosis, particularly in the presence of known or unknown additional risk factors. Lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of COVID-19-associated hypercoagulable state with other venous or arterial sites being much less frequently involved. Although splanchnic vein thrombosis (SVT) has been reported to be 25 times less common than usual site venous thromboembolism (VTE) and rarely occurs in nephrotic patients, it can have catastrophic consequences. A small number of SVT cases have been reported in COVID-19 infected patients in spite of their number exceeding 180 million worldwide. CASE PRESENTATION: An unvaccinated young adult male with steroid-dependent nephrotic syndrome (SDNS) who was in a complete nephrotic remission relapsed following contracting SARS-CoV-2 infection and developed abdominal pain and diarrhea. Abdominal US revealed portal vein thrombosis. The patient was anticoagulated, yet the SVT rapidly propagated to involve the spleno-mesenteric, intrahepatic and the right hepatic veins. In spite of mechanical thrombectomy, thrombolytics and anticoagulation, he developed mesenteric ischemia which progressed to gangrene leading to bowel resection and a complicated hospital course. CONCLUSION: Our case highlights the potential for a catastrophic outcome when COVID-19 infection occurs in those with a concomitant hypercoagulable state and reminds us of the need for a careful assessment of abdominal symptoms in SARS-CoV-2 infected patients.


Assuntos
COVID-19/complicações , Isquemia Mesentérica/etiologia , Síndrome Nefrótica/complicações , Sistema Porta , Circulação Esplâncnica , Trombose Venosa/etiologia , Gangrena/etiologia , Humanos , Intestinos/patologia , Masculino , Isquemia Mesentérica/terapia , Síndrome Nefrótica/tratamento farmacológico , SARS-CoV-2 , Trombose Venosa/terapia , Adulto Jovem
8.
Scand J Immunol ; 94(5): e13097, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34940978

RESUMO

COVID-19 is a global pandemic with a daily increasing number of affected individuals. Thrombosis is a severe complication of COVID-19 that leads to a worse clinical course with higher rates of mortality. Multiple lines of evidence suggest that hyperinflammation plays a crucial role in disease progression. This review compiles clinical data of COVID-19 patients who developed thrombotic complications to investigate the possible role of hyperinflammation in inducing hypercoagulation. A systematic literature search was performed using PubMed, Embase, Medline and Scopus to identify relevant clinical studies that investigated thrombotic manifestations and reported inflammatory and coagulation biomarkers in COVID-19 patients. Only 54 studies met our inclusion criteria, the majority of which demonstrated significantly elevated inflammatory markers. In the cohort studies with control, D-dimer was significantly higher in COVID-19 patients with thrombosis as compared to the control. Pulmonary embolism, deep vein thrombosis and strokes were frequently reported which could be attributed to the hyperinflammatory response associated with COVID-19 and/or to the direct viral activation of platelets and endothelial cells, two mechanisms that are discussed in this review. It is recommended that all admitted COVID-19 patients should be assessed for hypercoagulation. Furthermore, several studies have suggested that anticoagulation may be beneficial, especially in hospitalized non-ICU patients. Although vaccines against SARS-CoV-2 have been approved and distributed in several countries, research should continue in the field of prevention and treatment of COVID-19 and its severe complications including thrombosis due to the emergence of new variants against which the efficacy of the vaccines is not yet clear.


Assuntos
Artérias/patologia , Plaquetas/imunologia , COVID-19/imunologia , Endotélio Vascular/imunologia , Inflamação/imunologia , SARS-CoV-2/fisiologia , Trombose Venosa/imunologia , Animais , Anticoagulantes/uso terapêutico , Plaquetas/virologia , COVID-19/complicações , Endotélio Vascular/virologia , Humanos , Inflamação/complicações , Fenótipo , Trombose , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
9.
Methodist Debakey Cardiovasc J ; 17(3): 24-27, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824675

RESUMO

Arterialization of orbital veins is most often due to dural arteriovenous malformations of the cavernous sinus area. We report an unusual case of unilateral proptosis (exophthalmos) caused by arterialized retrograde venous flow in the external jugular vein and cavernous sinus in a patient with an upper extremity hemodialysis fistula and ipsilateral acute central venous thrombosis. The patient's symptoms improved after surgical closure of the hemodialysis fistula.


Assuntos
Exoftalmia , Trombose Venosa Profunda de Membros Superiores , Trombose Venosa , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Humanos , Diálise Renal , Extremidade Superior , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/terapia
10.
J Int Med Res ; 49(11): 3000605211058868, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34826376

RESUMO

Percutaneous nephrolithotomy (PCNL) remains an important method for treating upper urinary calculi. However, bleeding and peripheral vascular injury are serious complications of PCNL. Injury of the inferior vena cava accompanied by secondary thrombosis has rarely been reported clinically. We treated a patient who experienced bleeding during PCNL to establish a channel. A catheter was used to make a renal fistula, and the inferior vena cava was implanted. The wound was fixed and compressed by balloon injection, and secondary thrombosis and repeated infection occurred after the operation. A filter was then placed, the water balloon was released, and the fistula was removed. The anti-bacterial and anticoagulant filter was removed. This major complication was successfully managed. In our patient, during PCNL, the renal fistula entered the inferior vena cava by mistake. If this issue cannot be treated in time, it can easily lead to the formation of secondary thrombosis. A fistula can be extracted through an inferior vena cava filter, and anticoagulant treatment and other conservative treatment regimens can be used to treat patients in this situation. These treatments avoid the possibility of further damage from open surgery.


Assuntos
Nefrolitotomia Percutânea , Trombose , Trombose Venosa , Humanos , Nefrolitotomia Percutânea/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
11.
BMJ Case Rep ; 14(11)2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34785518

RESUMO

Renal arteriovenous malformation is a primarily congenital renal vascular abnormality. It is usually diagnosed incidentally on imaging, and the most common subtype is 'cirsoid', consisting of multiple, enlarged arterial feeders interconnecting with draining veins. We present a 74-year-old woman with an incidental finding of what was at first considered a hypervascularised kidney tumour but turned out to be a left intrarenal arteriovenous malformation associated with a left renal vein thrombosis. Selective endovascular embolisation was performed. The cause-consequence relationship between the arteriovenous malformation and the thrombosis is unique. To our knowledge, no such case has ever been reported.


Assuntos
Malformações Arteriovenosas , Neoplasias Renais , Doenças Urológicas , Trombose Venosa , Idoso , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
12.
J Med Case Rep ; 15(1): 569, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34823573

RESUMO

BACKGROUND: Nephrotic-range proteinuria is a common reason for nephrological consultation in clinical practice. The differential diagnosis is wide, and generally focuses on different forms of glomerulonephritis, but other causes should not be overlooked, as illustrated in this article. CASE PRESENTATIONS: We report two female patients with nephrotic-range proteinuria. In the first case, a 46 year old Caucasian patient who suffered from extreme obesity (Body mass index (BMI) 77 kg/m2), acute kidney injury and nephrotic-range proteinuria were discovered during an emergency consultation for acute abdominal pain. The second patient (aged 52, also Caucasian) developed stage 4 chronic kidney disease and nephrotic proteinuria (protein/creatinine ratio 1821 g/mol) after accidental rupture of the inferior vena cava during a gastric bypass operation. On split-urine collection, both had a much higher degree of proteinuria during the day than during the night, compatible with orthostatic proteinuria. At further work-up, inferior vena cava thrombosis was diagnosed in both patients, whereas renal veins were patent. DISCUSSION: After simple anticoagulation in the first case, and anticoagulation plus endovascular recanalization in the second, there was almost complete resolution of the orthostatic proteinuria and a strong improvement of the estimated glomerular filtration rate in both patients. These cases highlight that nephrotic-range proteinuria can be linked to inferior vena cava thrombosis, and that a split-urine collection may also be very useful in the diagnostic work-up of proteinuria in adults.


Assuntos
Injúria Renal Aguda , Trombose Venosa , Feminino , Humanos , Pessoa de Meia-Idade , Proteinúria/etiologia , Veias Renais/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/etiologia
13.
J Invasive Cardiol ; 33(11): E910-E915, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34735354

RESUMO

BACKGROUND: Deep vein thrombosis (DVT) is often seen in patients with acute pulmonary embolism (PE). Risk stratification of PE patients is useful in predicting mortality risk and hospital course. However, rates or predictors of DVT or proximal DVT (popliteal, femoral, common femoral, or iliac thrombosis) have not been studied in the highest-risk patients who receive catheter-directed therapy (CDT) for their PE. A single-center retrospective analysis of patients referred for CDT for confirmed PE was conducted to evaluate rates and predictors of DVT or proximal DVT and the impact on short-term outcomes. In 137 consecutive patients undergoing CDT for PE with available lower-extremity ultrasound, the rates of DVT and proximal DVT in PE patients receiving CDT were 76.6% and 65.0%, respectively. Rates of DVT (P=.68) and proximal DVT (P=.72) did not differ between high-risk or non-high risk PE patients. The only significant factor associated with presence of concomitant DVT was previous DVT (P=.045). The presence of a concomitant DVT or proximal DVT was not associated with an increase in all-cause mortality or hospitalization at 30 days or 1 year compared with an absence of concomitant DVT or proximal DVT. The results of this study suggest that patients with PE clinically requiring CDT have high rates of concomitant DVT and proximal DVT, prior DVT predicts concomitant DVT, and the presence of DVT is not associated with additional risk in this already high-risk population of patients.


Assuntos
Embolia Pulmonar , Trombose Venosa , Cateteres , Humanos , Extremidade Inferior , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
14.
Ceska Gynekol ; 86(5): 339-342, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34736333

RESUMO

OBJECTIVE: Case report of a patient with cerebral venous thrombosis after caesarean section. CASE REPORT: We present a case of a 22-year-old patient after an acute caesarean section, which was complicated by cerebral venous thrombosis. The etiology of the thrombosis was multifactorial. Dia-gnosis was determined using imaging methods once the neurological symptoms were expressed. Follow-up care for the patient included comprehensive care in the intensive care unit, including a temporary decompresive craniectomy. CONCLUSION: Cerebral venous thrombosis is a rare disease with a varied clinical manifestation whose development is affected by a number of acquired and congenital factors. The incidence is increased in women in the puerperium, but we can also see it in gynecological practice in young contraception users. Contextual knowledge is essential in early dia-gnosis as well as using a correct treatment strategy with a multidisciplinary approach and interdisciplinary collaboration.


Assuntos
Trombose Intracraniana , Trombose Venosa , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Período Pós-Parto , Gravidez , Trombose Venosa/etiologia , Adulto Jovem
15.
BMC Surg ; 21(1): 366, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641842

RESUMO

BACKGROUND: Portal vein thrombosis (PVT) is a common complication following splenectomy. It affects between 5 and 55% of patients undergoing surgery with no clearly defined pre-operative risk factors. The aim of this study was to determine the pre-operative risk factors of PVT. PATIENTS AND METHOD: Single centre, retrospective study of data compiled for every consecutive patient who underwent splenectomy at Toulouse University Hospital between January 2009 and January 2019. Patients with pre- and post-surgical CT scans have been included. RESULTS: 149 out of 261 patients were enrolled in the study (59% were males, mean age 52 years). The indications for splenectomy were splenic trauma (30.9%), malignant haemopathy (26.8%) and immune thrombocytopenia (8.0%). Twenty-nine cases of PVT (19.5%) were diagnosed based on a post-operative CT scan performed on post-operative day (POD) 5. Univariate analysis identifies three main risk factors associated with post-operative PVT: estimated splenic weight exceeding 500 g with an OR of 8.72 95% CI (3.3-22.9), splenic vein diameter over 10 mm with an OR of 4.92 95% CI (2.1-11.8) and lymphoma with an OR of 7.39 (2.7-20.1). The role of splenic vein diameter with an OR of 3.03 95% CI (1.1-8.6), and splenic weight with an OR of 5.22 (1.8-15.2), as independent risk factors is confirmed by multivariate analysis. A screening test based on a POD 5 CT scan with one or two of these items present could indicate sensitivity of 86.2% and specificity of 86.7%. CONCLUSION: This study suggests that pre-operative CT scan findings could predict post-operative PVT. A CT scan should be performed on POD 5 if a risk factor has been identified prior to surgery.


Assuntos
Veia Esplênica , Trombose Venosa , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Esplenectomia/efeitos adversos , Veia Esplênica/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
16.
Mymensingh Med J ; 30(4): 1009-1015, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605471

RESUMO

This prospective study was conducted to find the rate of deep and risk factors associated with vein thrombosis following major abdominal surgery in Sylhet MAG Osmani Medical College Hospital from 1st November 2017 to 30th April 2018. Total 103 patients aged above 20 years both male and female who got admitted in Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet for their disease requiring routine and emergency major abdominal operation during the study period and fulfilling the inclusion and exclusion criteria were selected in this study. Informed written consent was obtained from the patients after full explanation of the purpose of the study. After full investigations and proper preparation of each patient for operative procedure major abdominal surgery were done. Peroperative findings were noted and post-operative period were followed up routinely. Duplex scanning was done on 3rd POD in all cases. The age of the patients ranged from 25 to 74 years with the mean age of 49.5±13.8 years. There were 60(58.3%) male and 43(41.7%) female. Deep vein thrombosis (DVT) developed in 5(4.9%) of cases and not developed in 98(95.1%) cases. All the five cases were confirmed by color duplex scan. DVT was detected in 2(3.3%) of the 60 males and 3(7.0%) of the 43 females undergoing major general surgical procedures. Among 63 patients in whom the duration of surgery was up to 2 hours, none developed DVT, while among the 40 patients in whom the duration of surgery lasted more than 2 hours, 5(12.5%) developed DVT. Among 23 patients in whom the surgery for malignancy was done, 4(17.4%) developed DVT, while among the 80 patients in whom surgery for non-malignancy, 1(1.2%) developed DVT. The Incidence of DVT in patients undergoing major abdominal surgery is 4.9%. Patients undergoing major abdominal surgery for malignancy and duration of operation greater than 2 hours have higher risk of developing DVT. But there is no significant increase in risk of development of DVT relation to age and sex; and also in patients on oral contraceptives, diabetes mellitus, obesity and smoking. Clinical findings alone cannot be relied upon for the diagnosis of DVT. The study has to be continued with larger sample size to get statistically significant results.


Assuntos
Trombose Venosa , Adulto , Idoso , Bangladesh , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
18.
Clin Appl Thromb Hemost ; 27: 10760296211039288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34595937

RESUMO

Coronavirus disease 2019 (COVID-19) is a systemic disease that can be life-threatening involving immune and inflammatory responses, and that can result in potentially lethal complications, including venous thrombo-embolism (VTE). Forming an integrative approach to thrombo-prophylaxis and coagulation treatment for COVID-19 patients ensues. We aim at reviewing the literature for anticoagulation in the setting of COVID-19 infection to provide a summary on anticoagulation for this patient population. COVID-19 infection is associated with a state of continuous inflammation, which results in macrophage activation syndrome and an increased rate of thrombosis. Risk assessment models to predict the risk of thrombosis in critically ill patients have not yet been validated. Currently published guidelines suggest the use of prophylactic intensity over intermediate intensity or therapeutic intensity anticoagulant for patients with critical illness or acute illness related to COVID-19 infection. Critically ill COVID-19 patients who are diagnosed with acute VTE are considered to have a provoking factor, and, therefore, treatment duration should be at least 3 months. Patients with proximal deep venous thrombosis or pulmonary embolism should receive parenteral over oral anticoagulants with low-molecular-weight heparin or fondaparinux preferred over unfractionated heparin. In patients with impending hemodynamic compromise due to PE, and who are not at increased risk for bleeding, reperfusion may be necessary. Internists should remain updated on new emerging evidence regarding anticoagulation for COVID-19 patients. Awaiting these findings, we invite internists to perform individualized decisions that are unique for every patient and to base them on clinical judgment for risk assessment.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , SARS-CoV-2 , Trombofilia/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Consenso , Estado Terminal , Gerenciamento Clínico , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fondaparinux/efeitos adversos , Fondaparinux/uso terapêutico , Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pacientes Internados , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações Hematológicas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/sangue , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Risco , Trombofilia/etiologia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
19.
J Med Case Rep ; 15(1): 529, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663446

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an effective cardiopulmonary support therapy, which can provide temporary cardiopulmonary support for critically ill patients whose condition cannot be reversed by conventional therapy. However, there are many complications in the use of ECMO, such as bleeding, thrombosis, and so on. Among them, inferior vena cava (IVC) thrombosis which can cause pulmonary embolism is a rare complication, which may be life-threatening. CASE PRESENTATION: A 75-year-old female patient (Han Chinese ethnicity) with acute heart failure due to acute myocardial infarction in our department was retrospectively analyzed. After regular treatment was unsuccessful, she was treated with venoarterial ECMO (VA-ECMO). After her condition improved, she was withdrawn from ECMO and experienced a complication of IVC thrombosis. Enoxaparin was given immediately for 1 mg/kg every 12 hours hypodermic injection. The thrombus disappeared after anticoagulant therapy. She was discharged on the 60th day. Her level of consciousness returned to normal without residual central nervous system-related complications. CONCLUSIONS: IVC thrombosis is one of the possible serious complications in the process of ECMO therapy. Prevention of thrombosis and optimization of the anticoagulant regimen are the main preventive measures. Anticoagulant therapy is still the main treatment of IVC thrombosis in the process of ECMO therapy. Other interventional strategies need to accumulate clinical experience.


Assuntos
Oxigenação por Membrana Extracorpórea , Trombose , Trombose Venosa , Idoso , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Humanos , Estudos Retrospectivos , Trombose/etiologia , Trombose/terapia , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/terapia
20.
Georgian Med News ; (318): 24-28, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34628373

RESUMO

Objective - to evaluate the effectiveness of surgical treatment of varicothrombophlebitis complicated by transfascial thrombosis. The results of examination and treatment of 45 patients with varicothrombophlebitis of the great saphenous vein complicated by transfascial thrombosis. The indications for surgical prophylaxis of pulmonary embolism in transfascial thrombosis in the basin of the great saphenous vein have been substantiated. In the postoperative period, all patients with transfascial thrombosis, regardless of the radical nature of the surgical intervention, were offered to prescribe treatment as in deep vein thrombosis. The introduction of active surgical tactics in transfascial thrombosis allows for effective prevention of pulmonary embolism. In varicothrombophlebitis complicated by transfascial thrombosis, thrombectomy with further prevention of recurrence of the disease and pulmonary embolism should be considered the main standard of treatment. For perforating vein thrombosis, subfascial thrombectomy followed by perforating ligation should be performed. All patients with transfascial thrombosis, regardless of the volume of surgery, should be treated as for deep vein thrombosis.


Assuntos
Embolia Pulmonar , Trombose Venosa , Humanos , Ligadura , Embolia Pulmonar/cirurgia , Veia Safena/cirurgia , Trombectomia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
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