1/203. Clinical therapeutic conference: recurrent venous thrombotic and thromboembolic disease.Recurrent venous thrombotic and thromboembolic disease, once thought to be an uncommon entity, is increasingly being recognized. Etiologies of recurrent deep venous thrombosis usually include elements of Virchow's triad. Venous stasis (e.g., immobilization, congestive heart failure, acute myocardial infarction, obesity), hypercoagulability (e.g., malignancy, inflammatory bowel disease, hyperhomocysteinemia, protein c resistance, antithrombin iii, protein c or S deficiency) and endothelial trauma (e.g., surgical trauma, venous trauma, in-dwelling venous instrumentation) are risk factors. diagnosis is dependent on objective testing, including venography duplex Doppler (color) ultrasonography and impedance plethysmography. Treatment is usually started with heparin or low-molecular-weight heparin and advanced to warfarin (adjusted to international normalized ratio). Prophylaxis may continue using low-molecular-weight heparin, warfarin, venacaval interruption (Greenfield filter), or concomitant use of the platelet-active agent indobufen and graduated compression stockings.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
2/203. Thermolabile methyltetrahydrofolate reductase associated with unusual venous and arterial thromboses.We report a patient with unusual venous and arterial thromboses in association with the common thermolabile methyltetrahydrofolate (MTHFR) variant. The patient responded directly to folate supplementation. To our knowledge, this is the first report describing hyperhomocysteinemia in association with this type of thrombosis.- - - - - - - - - - ranking = 0.037550910833028keywords = bile, duct (Clic here for more details about this article) |
3/203. Primary liver carcinoma complicating membranous obstruction of the inferior vena cava.A rare autopsy case of primary liver carcinoma complicating a pre-existing, incomplete membranous obstruction of the inferior vena cava (MOVC) is reported. The patient, a 67-year-old Japanese male, was admitted to hospital following a 2 year illness of a left chest wall tumor and a 3 month illness with progressive abdominal pain. Computed tomography scans of the abdomen displayed space-occupying lesions in the third and seventh hepatic segments, respectively. One month later, the patient developed edema of the lower extremities and marked venous dilatation of the abdominal trunk. At that time, Doppler examination revealed the presence of intrahepatic large venovenous collaterals. The patient subsequently succumbed 82 days after hospitalization. At subsequent autopsy, the inferior vena cava was completely obstructed by tumor thrombus, which was formed caudally and cranially to a thin membrane and mimicked the valve, with calcification and elastic lamina, at the phrenic portion. Intrahepatic large collateral pathways were found between submembranous and supramembranous hepatic veins. Anomalous absence of the ostia of the middle hepatic vein was found. In addition, the portal venous trunk was occluded by tumor thrombus. histology of hepatic tumors revealed a combined hepatocellular and cholangiocellular carcinoma in the non-cirrhotic liver with severe acute centrilobular congestion. In MOVC patients such as the case presented, malignancy-induced thrombosis was deemed to be an important factor in prognosis.- - - - - - - - - - ranking = 0.61538746399479keywords = obstruction (Clic here for more details about this article) |
4/203. New considerations in the diagnosis and therapy of deep vein thrombosis.The cause of thrombosis is often unknown but is universally ascribed to part of Virchow's triad: stasis, hypercoagulability, and intimal injury. Venous thromboembolic disease is a common and costly medical problem, with iliofemoral deep vein thrombosis (IFDVT) being a less common but often underestimated presentation of this condition. Treatment options for deep vein thrombosis (DVT) have expanded in recent years and now include systemic anticoagulation, thrombolytic therapy, and surgery. Several studies have shown the efficacy of catheter-directed thrombolytic therapy in resolution of IFDVT. There is also growing evidence that early lysis is more likely to preserve valve function leading to a decrease in the incidence of postthrombotic syndrome, which is a known long-term complication of DVT and IFDVT. The following case report describes a patient, without malignancy, who had an atraumatic iliac and femoral DVT and illustrates the diagnostic considerations and therapy of a patient with iliofemoral DVT.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
5/203. Trousseau's syndrome with brachiocephalic vein thrombosis in a patient with uterine carcinosarcoma. A case report.The authors treated a patient with the previously unreported occurrence of brachiocephalic vein and superior vena cava thrombosis in association with a distantly located cancer. A 71-year-old woman presented with swelling over the right side of the neck and abdominal distension. physical examination revealed a huge mass, and computed tomography demonstrated thrombosis of the brachiocephalic vein and superior vena cava accompanied by jugular vein dilatation. No coagulation disorder was demonstrable. After anticoagulation and thrombolysis, hysterectomy was performed; microscopic examination of the specimen revealed uterine carcinosarcoma. Even though local tumor obstruction is a much more common cause of neck vein thrombosis, a distant occult cancer can present as this form of Trousseau's syndrome. In patients with otherwise unexplained neck vein thrombosis, examination not only of the head and neck but also of the abdomen and pelvis should be pursued.- - - - - - - - - - ranking = 0.12307749279896keywords = obstruction (Clic here for more details about this article) |
6/203. Homozygotes for prothrombin gene 20210 A allele in a thrombophilic family without clinical manifestations of venous thromboembolism.BACKGROUND AND OBJECTIVE: A new genetic risk factor for venous thromboembolism has recently been described which involves a G to A transition at position 20210 in the 3' untranslated region of the prothrombin gene. To date, only a few homozygotes for this mutation have been reported and in most of cases, they suffered from thrombotic disease. Here, we describe a pedigree including both heterozygous and homozygous subjects for prothrombin (PT) 20210 A. DESIGN AND methods: This family was recruited in 1996 as part of our gait (Genetic Analysis of Idiopathic thrombophilia) project. To qualify for the gait study, a pedigree was required to have at least 10 living individuals in three or more generations (i.e. extended pedigree). The pedigrees were selected through probands with idiopathic thrombophilia. A complete set of plasma and dna determinations related to hemostasis was performed on this family. RESULTS: The plasma studies yielded normal results in all of the individuals. The family members who had a history of thromboembolism were heterozygous carriers of the PT 20210 A variant. In addition, 4 relatives who were heterozygous, and two who were homozygous for this A allele, failed to show clinical manifestations. These two homozygotes were 51 and 19 years old. INTERPRETATION AND CONCLUSIONS: This case exemplifies the complexity of thrombotic disease since individuals homozygous for a mutant gene do not exhibit symptoms while heterozygous individuals often do exhibit the disease. This case suggests that the new genetic risk factor for thrombosis (i.e. PT 20210 A) may not be as strong as most of the previously described genetic risk factors.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
7/203. Cerebral sinovenous thrombosis in the idiopathic hypereosinophilic syndrome in childhood.The idiopathic hypereosinophilic syndrome (HES) is a leukoproliferative disorder marked by a sustained overproduction of eosinophils and a distinct predilection to damage specific organs, especially the cardiovascular system. It is primarily a disease of middle-aged people. Occasional cases have been encountered in children. We report a case of an 11-year-old boy affected by idiopathic HES with an unusual rapidly fatal course. In addition to eosinophilic cellulitis, cerebral straight and superior sagittal sinus vein thrombosis (CVT) was evident on cranial CT. In our review of the English literature we were unable to find an association between idiopathic HES and CVT.- - - - - - - - - - ranking = 0.0033380770329499keywords = duct (Clic here for more details about this article) |
8/203. Acute massive pulmonary embolism following high ligation combined with compression sclerotherapy for varicose veins report of a case.A case of acute pulmonary embolism following high ligation and compression sclerotherapy for varicose veins is reported. A 54-year-old women developed superficial varicosities and stasis pigmentation on her left leg 1 year prior to her first visit to hospital. No deep vein thrombosis was detected by ascending phlebography performed 3 months prior to operation. High ligation combined with compression sclerotherapy was performed for the varicose veins. One day after treatment, the patient complained of chest pain and discomfort, and then collapsed. perfusion scintigraphy revealed multiple embolisms in the bilateral lungs. The patient recovered after aggressive anticoagulant and thrombolytic therapy. Although pulmonary embolism is a rare complication of sclerotherapy, it is potentially one of the most serious.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
9/203. Bilateral lumbosacral plexopathy after mesenteric thrombosis.OBJECTIVE: A case of lumbosacral plexopathy (LSP) following operation for mesenteric thrombosis. DESIGN: Case report of a 64-year-old man who developed weakness and numbness of the distal legs after an operation for mesenteric thrombosis. SETTING: Department of Physical medicine and rehabilitation, University Hospital La Fe, Valencia, spain. SUBJECT: Single patient case report. MAIN OUTCOME MEASURE: Clinical and electromyography follow-up of the patient between October 1996 and August 1997. RESULTS: physical examination revealed marked lower extremity weakness, hypotonia, hyporreflexia and normal bowel and bladder function. electromyography demonstrated marked denervation of all major muscle groups, and sensory nerve conduction showed absence of responses in all peripheral nerves, in both legs. CONCLUSION: To our knowledge, bilateral LSP following an intervention of mesenteric thrombosis, has never been reported in the literature. diagnosis of LSP might be based on electromyography and nerve conduction studies that demonstrate electrodiagnostic criteria for LSP, including denervation in muscles innervated by at least two lumbosacral segmental levels and involving at least two different peripheral nerves, without paraspinal involvement.- - - - - - - - - - ranking = 0.0066761540658998keywords = duct (Clic here for more details about this article) |
10/203. tuberculosis presenting as deep vein thrombosis.We present two cases, women of 21 and 60 years old, who presented with deep vein thrombosis. Both cases had retroperitoneal para-aortic and iliac lymph node enlargement without any malignancy or other predisposing thrombophilic factors. Investigations revealed tubercular aetiology of the lymph nodes causing venae caval obstruction.- - - - - - - - - - ranking = 0.12307749279896keywords = obstruction (Clic here for more details about this article) |
| | Next -> |