Lower extremity deep venous thrombosis in cancer patients: correlation of presenting symptoms with venous sonographic findings.

We sought to determine how rates of sonographically detected deep venous thrombosis correlate with presenting symptoms in cancer patients. We performed venous sonography in 588 cancer patients with clinically suspected lower extremity deep venous thrombosis. Results were correlated with clinical findings. Deep venous thrombosis was diagnosed in 32% of patients with unilateral lower extremity symptoms and in 17% of patients with bilateral symptoms. Patients with unilateral symptoms of pain and swelling, swelling alone, or pain alone had significantly different rates of deep venous thrombosis (47%, 31%, and 16%, respectively). In patients with bilateral leg symptoms, deep venous thrombosis was significantly more likely when symptoms were not bilaterally symmetric.     

骨科术后下肢深静脉血栓的防治

目的探讨骨科术后下肢深静脉血栓的防治措施。方法回顾性分析15例下肢深静脉血栓,对患者采用卧床休息、抬高患肢,溶栓、抗凝等治疗。结果所有病例经治疗后症状缓解,复查超声提示血栓消失或缩小,无严重并发症。结论下肢深静脉血栓可继发肺栓塞导致死亡,医护人员在临床工作中要引起足够重视,对骨科技术有血栓形成高危因素的患者要早期预防,做到及时发现、积极治疗。     

不同高度下肢垫在下肢深静脉血栓形成患者中的应用效果观察*

目的：探讨不同高度下肢垫应用于下肢深静脉血栓形成（deep vein thrombosis, DVT）患者的疗效。方法：将60例下肢DVT患者按照下肢抬高的程度随机分为高垫组与低垫组,比较两组患者在住院期间患肢膝上及膝下水肿缓解程度、疼痛情况、舒适度及是否发生肺栓塞。结果：使用不同高度下肢垫的患者患肢水肿缓解程度、发生肺栓塞的概率差异无统计学意义,低垫组在治疗中期、出院时疼痛缓解情况及舒适度的生理维度均优于高垫组（P<0.05）。结论：使用高垫和低垫均可有效缓解下肢DVT患者患肢水肿、疼痛程度,使用低垫在减轻患者下肢疼痛、不舒适感中效果更佳。     

Treatment of Urinary Voiding Dysfunction Syndromes With Spinal Cord Stimulation

This case report presents the use of spinal cord stimulation (SCS) in a patient with urinary incontinence who had previously undergone trial and implantation of InterStim therapy (Medtronic Neurological, Minneapolis, MN). The patient also experienced bilateral lower extremity pain and low back pain related to post-laminectomy syndrome. Having failed all conservative treatment, the patient underwent SCS trial and subsequent implantation. In the postoperative period using SCS therapy, the patient had excellent relief of urinary incontinence symptoms, along with relief of low back pain and bilateral lower extremity pain and was able to discontinue use of InterStim therapy. For this patient, SCS was effective in controlling the urinary voiding dysfunction symptoms, bilateral lower extremity pain and back pain. The use of SCS to treat urinary incontinence problems deserves further study to explore its therapeutic potentials.     

Early ambulation after acute deep vein thrombosis: is it safe?

The number of thrombotic events in children, although significantly less than that in adults, is increasing as a result of therapeutic advances in primary illnesses that were previously fatal. When a patient, adult or pediatric, develops a deep vein thrombosis and anticoagulation therapy is initiated, many health professionals ask, "When should this patient have physical therapy and/or ambulate?" Fear of causing a pulmonary embolism with increased activity drives this question. Often, an order for bed rest is prescribed based more on tradition than on evidence-based medicine. A review of the literature has provided an evidence-based answer to the question, and although the studies are all of adult populations, the results have been extrapolated for use with comparable pediatric populations. The majority of studies agree that early ambulation does not increase an anticoagulated patient's risk for pulmonary embolism. Moreover, most studies report that early ambulation carries benefits such as decreased pain and swelling and fewer postthrombotic syndrome symptoms.     

Natural history of venous thromboembolism

Venous thromboembolism (VTE) originates in systemic venous thrombosis and has different etiological mechanisms and natural history from arterial thrombosis. VTE typically originates as deep venous thrombosis in a lower extremity, where it may give rise to acute symptoms “upstream” from the obstructed vein, result in pulmonary embolism, and/or cause chronic venous obstruction. Pulmonary embolism may result in acute respiratory symptoms, cardiovascular collapse and, uncommonly, may also cause chronic disease.     

Thromboembolism during pregnancy. Risks, challenges, and recommendations

Pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. Diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. Physicians should maintain an appropriately high index of suspicion and request diagnostic imaging in a timely manner. Diagnosis of deep venous thrombosis with Doppler ultrasonography of the lower extremity poses no health risk to the fetus, but other radiographic studies pose a low radiation risk to the fetus. Because anticoagulant therapy poses a greater health risk to mother and fetus than does the radiation required for the diagnosis of pulmonary embolism, clinicians should aggressively pursue objective evidence of venous thromboembolism. Once the diagnosis is made, anticoagulation with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin should be used prepartum followed by warfarin therapy after delivery.     

Diagnostic role of ED ultrasound in deep venous thrombosis and pulmonary embolism.

Proximal deep venous thrombosis (DVT), which may lead to pulmonary embolism (PE), is one of the serious and underrecognized causes of lower extremity pain and swelling. The diagnosis of DVT requires a confirmatory objective test because clinical signs and symptoms are unreliable. Assessment of thigh vein compressibility with real-time ultrasound is an accurate test for DVT that may be performed rapidly at the bedside. Although unproven, we propose that wider use of this test in the emergency department by emergency physicians might increase the diagnosis of DVT, prevent PE, and reduce utilization of other more costly and invasive diagnostic tests. Evaluation of DVT by compression ultrasound may also be incorporated in the diagnostic workup of suspected PE. In the case of a nondiagnostic ventilation/perfusion scan, demonstration of proximal DVT by ultrasound represents a likely source of PE and an indication for anticoagulation, eliminating the need for pulmonary angiography. In the critically ill patient whose presentation is consistent with massive PE, one rapid approach to the diagnosis may be to combine transthoracic echocardiography with lower extremity ultrasound.     

人工髋关节置换后深静脉血栓形成影响因素的回顾分析

背景:目前尚缺少严格遵照<中国骨科大手术静脉血栓栓塞症预防指南>进行血栓预防的大宗人工髋关节置换后深静脉血栓栓塞症发生情况的报道.目的:调查人工髋关节置换患者在进行规范预防性抗凝治疗后下肢深静脉血栓的发生情况.方法:纳入2005-01/2010-07于北京协和医院骨科接受人工髋关节置换的患者,对置换后出现下肢深静脉血栓形成者进行回顾性分析,包括高危因素、预防措施、症状特点、治疗方案及转归.结果与结论:共纳入670例人工髋关节置换患者,其中16例发生下肢深静脉血栓,11例为人工股骨头置换患者,5例为单侧全髋关节置换患者.诊断分布为股骨颈骨折14例,股骨头无菌性坏死1例,血友病性关节炎1例.其合并症1~4个,包括高血压、糖尿病、类风湿性关节炎、慢性肾功能不全等.围手术期皆应用规范物理、药物疗法预防下肢深静脉血栓形成.14例表现为下肢肿胀、疼痛;2例以肺栓塞为首发症状.多数预后良好;1例死于与下肢深静脉血栓形成无关的肺部感染,1例抗凝治疗后并发脑出血导致植物生存状态.提示进行规范预防治疗可以降低下肢深静脉血栓形成发生率,但仍不能完全杜绝其发生.髋部骨折、长期卧床、高龄、代谢性内科疾病仍是下肢深静脉血栓形成的高危因素.     

人工髋关节置换后深静脉血栓形成影响因素的回顾分析

背景：目前尚缺少严格遵照《中国骨科大手术静脉血栓栓塞症预防指南》进行血栓预防的大宗人工髋关节置换后深静脉血栓栓塞症发生情况的报道。目的：调查人工髋关节置换患者在进行规范预防性抗凝治疗后下肢深静脉血栓的发生情况。方法：纳入2005-01/2010-07于北京协和医院骨科接受人工髋关节置换的患者,对置换后出现下肢深静脉血栓形成者进行回顾性分析,包括高危因素、预防措施、症状特点、治疗方案及转归。结果与结论：共纳入670例人工髋关节置换患者,其中16例发生下肢深静脉血栓,11例为人工股骨头置换患者,5例为单侧全髋关节置换患者。诊断分布为股骨颈骨折14例,股骨头无菌性坏死1例,血友病性关节炎1例。其合并症1~4个,包括高血压、糖尿病、类风湿性关节炎、慢性肾功能不全等。围手术期皆应用规范物理、药物疗法预防下肢深静脉血栓形成。14例表现为下肢肿胀、疼痛;2例以肺栓塞为首发症状。多数预后良好;1例死于与下肢深静脉血栓形成无关的肺部感染,1例抗凝治疗后并发脑出血导致植物生存状态。提示进行规范预防治疗可以降低下肢深静脉血栓形成发生率,但仍不能完全杜绝其发生。髋部骨折、长期卧床、高龄、代谢性内科疾病仍是下肢深静脉血栓形成的高危因素。     

Acute lower extremity pain in an adult patient secondary to bilateral popliteal cysts

Lower leg and calf pain is a common presenting complaint in the Emergency Department and may involve a variety of etiologies, including musculoskeletal and vascular pathology such as deep venous thrombosis. Baker's cysts are a periodic finding in patients suspected of having deep venous thrombosis. As more emergency physicians perform their own lower extremity ultrasound examinations, they encounter Baker's cysts as the cause of unilateral leg pain or swelling. Bilateral Baker's cysts are very rare and may present a diagnostic challenge in the Emergency Department if bedside ultrasound is not available. We present a case of bilateral Baker's cysts in a young dancer who presented complaining of bilateral lower extremity pain and upper calf swelling. The bilateral cysts were diagnosed on bedside ultrasound by the treating emergency physician and a disposition quickly made.     

下肢深静脉血栓取栓术23例手术护理配合

目的:探讨下肢深静脉血栓形成取栓术的护理配合及临床效果。方法:2007年1月～2009年4月我院血管外科住院的下肢深静脉血栓形成患者23例,在硬膜外或局部麻醉下行股静脉切开取栓术治疗,对其进行术前访视护理干预、手术室环境准备、手术物品准备及术中洗手护士和巡回护士的配合。结果:23例下肢深静脉形成血栓取栓手术顺利完成,手术时间130～240min,平均165min,出血量150～300ml,平均220ml。术后随访17例患者,临床症状减轻,患肢肿胀消退,未发生肺动脉栓塞等并发症。结论:医师与护士的默契配合,严格执行无菌技术操作是手术成功的关键。     

下肢深静脉血栓形成导管溶栓治疗的围手术期护理

目的:总结导管溶栓治疗21例下肢深静脉血栓形成患者的围术期护理方法.方法:围手术期护理措施包括心理护理、基础护理及并发症观察.结果:手术均顺利进行,术后19例患者患肢肿胀、疼痛明显减轻或消失,2例出现出血倾向,调整用药3 d后消失.无1例出现肺栓塞.结论:完善术前准备,加强术中、术后观察和及时处理,可有效避免相关并发症,促进患者早日康复.     

关节置换后的深静脉血栓形成

背景：关节置换后形成深静脉血栓发病的概率为40%～60%,而深静脉血栓容易出现肺栓塞并发症而危及生命,死亡率高达20%～30%。目的：对骨科关节置换后下肢深静脉血栓形成的病因与治疗及并发症肺栓塞的治疗进展进行阐述。方法：以＂关节置换,静脉栓塞,肺栓塞,病因,预防,治疗＂为关键词应用计算机检索2000/2010万方数据库和中国期刊全文数据库。结果与结论：关节置换后下肢深部静脉血栓形成的病因及发病机制有着多方面的因素,深静脉血管壁损伤,血流缓慢和高凝状态是静脉血栓形成的3个因素。患者的全身状况差,合并其他疾病,关节置换手术创伤,手术麻醉方法,手术时间延长,肢体固定以及长期卧床都是下肢深静脉血栓形成的高危因素。下肢深静脉栓塞和肺栓塞是导致关节置换后患者高致残率和高死亡率的主要原因。临床医生应于术前对关节置换患者形成深静脉血栓的危险因素进行系统评估,并采取相应措施,最大限度降低其发生率。     

Wells、修正后的Geneva评分与肺栓塞严重程度指数对下肢深静脉血栓患者发生肺栓塞的预测价值

目的：探讨下肢深静脉血栓形成（DVT）患者发生肺栓塞（PE）的临床评分价值及相关影响因素。方法回顾性分析300例DVT患者的资料,根据是否发生 PE分为两组,对两组一般情况及 Wells、mGeneva评分及肺栓塞严重程度指数（PESI）进行比较;再以是否发生PE作为因变量,以血同型半胱氨酸（Hcy）是否增高、C反应蛋白是否升高、D-二聚体是否升高、性别、年龄、体质量、是否合并糖尿病、高血脂、高血压、是否有冠心病病史、脑梗死病史、吸烟史、饮酒史、Wells评分、mGeneva评分、PESI分值、左右侧肢体发病、DVT类型、是否并发下腔静脉（IVC）血栓、是否有静脉血栓病史及是否放置了 IVC滤器为自变量引入模型进行二分类多因素 logistic回归分析,探求 DVT患者发生PE的危险因素。结果300例DVT患者PE发生率25．3％（76／300）。两组在合并IVC血栓、Wells及mGeneva评分方面存在差异（P＜0．05）;Logistic回归分析显示,Wells 评分和合并 IVC血栓是发生 PE的危险因素,是否放置了IVC滤器是发生 PE 的保护性因素（OR 值＝2．262、534．752、0．046;95％的可信区间：1．102～4．646、54．010～5294．568、0．002～0．841）。结论在DVT患者中 Wells评分预测 PE的发生价值较大,合并 IVC血栓是 PE的危险因素,放置 IVC滤器是PE的保护性因素。     

Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain

Acute onset abdominal pain constitutes a significant proportion of emergency department visits, but only a small fraction of these cases are attributable to vascular pathologies (Bauersfeld, 1947 [1]). In this case, report, we present an incidental diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection (SISMAD). A 69-year-old man was admitted to the emergency department complaining of fever, loss of appetite, vague epigastric pain, dysuria, and a productive cough for several days. A lower extremity venous Doppler ultrasound was performed, and a deep venous thrombosis (DVT) was identified in the left main femoral vein and in the proximal segment of the superficial vein. The patient also had no blood flow in the distal part of left external iliac vein. A contrast-enhanced computerized tomography angiography of the thorax and abdomen was performed to detect pulmonary embolism and the etiology of the abdominal pain. No pulmonary embolism was found; however, multiple metastatic nodules were identified in both lungs, as well as infiltration on the posterobasal field of the right lung, metastases on the liver, focal dilatation, and an intimal flap on the middle-distal part of the superior mesenteric artery (SMA) at 2?cm, with a segment that was compatible with isolated dissection. There was a contrast passage on the distal part of SMA, and no sign of bowel ischemia.     

The diagnosis of lower extremity deep venous thrombosis.

The diagnosis of lower extremity deep venous thrombosis (DVT) is critical to emergency physicians because of the risk of pulmonary embolism. This article reviews the diagnostic modalities available for patients with suspected lower extremity DVT. The use of compression ultrasonography and the recent advances in the D-dimer assays are emphasized. A clinical algorithm that utilizes a non invasive approach to this potentially life threatening disease is presented.     

Chronic CT features in PE patients with co-existing DVT

ObjectiveClinical features may be different in patients with PE without co-existing DVT compared to those with PE with co-existing DVT. This prospective study aims to investigate the different clinical features between patients with isolated pulmonary embolism (PE) and those with PE associated with deep venous thrombosis.MethodThis is a prospective study conducted in 107 consecutive patients diagnosed with acute PE in the emergency department or other departments of Kırıkkale University Hospital. The diagnosis of PE was confirmed by computed tomography pulmonary angiography (CTPA), which was ordered on the basis of symptoms and findings. Bilateral lower extremity compression ultrasound with standard 7.5 MHz linear array probe was applied to all patients. According to compression ultrasound results, the patients were divided into two classes as with and without deep venous thrombosis. Embolism in the main or lobar pulmonary arteries were classified as central, and those found only in segmental or subsegmental arteries were classified as peripheral. Laboratory parameters and Oxygen saturation were assessed on admission.Results67 of 107 (62.6%) patients with PE were isolated pulmonary embolism, and 40 (37.4%) were PE + DVT. Patients with PE with co-existing DVT have wider pulmonary artery, higher d-dimer and pro BNP level, and lower saturation than those with isolated pulmonary embolism. Central pulmonary embolism is more common in patients with deep vein thrombus than those without it. (87.5% (35/40) vs 32.8% (22/67),p = 0.001). 38.6% of central pulmonary embolism occur without deep vein thrombosis of the lower extremities.Patients with PE with co-existing DVT have 42.5% mosaic perfusion pattern,70% chronic infarct appearance such as linear band, pleural nodüle, %15.0 thickened, small arteries and, %12.5 shrunken complete artery occlusion, suggesting the chronic background.ConclusionPE patients with co-existing DVT are clinically more serious than those who do not have a DVT. An acute picture may be present in the chronic background in a significant proportion of patients with PE with co-existing DVT. In the presence of deep vein thrombosis, pulmonary embolism is usually central, but more than one-third of central pulmonary emboli occur without lower extremity deep vein thrombosis.     

下腔静脉滤器植入后中西医结合介入治疗急性下肢深静脉血栓的临床应用

目的 探讨下腔静脉滤器植入后中西医结合介入治疗急性下肢深静脉血栓形成的应用价值.方法 收集有明确临床症状、体征,并经彩色多普勒超声或造影证实的下肢深静脉血栓形成患者56例,随机分为治疗组(28例)和对照组(28例),所有急性下肢深静脉血栓患者均在植入下腔静脉滤器后抗凝治疗,治疗组经插管溶栓或经患肢足背静脉溶栓治疗并联合应用中药内服外敷,对照组经插管溶栓或经患肢足背静脉溶栓治疗.结果 按血管通畅度评价,治疗组血管通畅度高于对照组.随访结果显示治疗组治疗的疗效优于对照组治疗(P＜0.01).溶栓治疗过程中未出现肺动脉栓塞症状及出血现象.结论 中西医结合介入治疗方法对急性下肢深静脉血栓形成有良效,结合中医辨证论治综合治疗,可以增强疗效.     

Bilateral adrenal hemorrhage: an unusual complication after bilateral total knee arthroplasty

Total knee arthroplasty is a commonly performed surgical procedure usually associated with excellent improvement in mobility and function and with lessening of pain. Most cases are performed without complication. Complications, when they do occur, are most often associated with deep venous thrombosis and possible pulmonary embolism, infection, prosthetic failure or loosening, or neurovascular complications. This article presents a case report of an unusual, but serious, complication, bilateral adrenal hemorrhage, occurring in the postoperative, rehabilitative phase after what seemed to be successful bilateral knee arthroplasties in an 83-yr-old woman.