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Sample records for prevent thromboembolic complications

  1. Thromboembolic Complications Following Trauma

    Science.gov (United States)

    2009-12-01

    these physiologic derangements, it is estimated that hypercoagulable disorders, such as factor V Leiden and hyperhomocysteinemia, may be present in...risk factors of venous thrombosis. Hum Genet 2001;109:369-84. 3. Knudson MM, Ikossi DG. Venous thromboembolism after trauma. Curr Opin Crit Care...R E V I E W A R T I C L E Thromboembolic complications following trauma Daniel F. McLaughlin, Charles E. Wade, Howard R. Champion, Jose Salinas, and

  2. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Charles André

    2015-08-01

    Full Text Available Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF. Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  3. A prospective comparison of thromboembolic stockings, external sequential pneumatic compression stockings and heparin sodium/dihydroergotamine mesylate for the prevention of thromboembolic complications in urological surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hansberry, K.L.; Thompson, I.M. Jr.; Bauman, J.; Deppe, S.; Rodriguez, F.R. (Brooke Army Medical Center, Fort Sam Houston, TX (USA))

    1991-06-01

    Deep venous thrombosis and pulmonary emboli are reported to occur in up to 66% of the patients undergoing a major urological operation. Thromboembolic stockings, external sequential pneumatic compression stockings and anticoagulant agents, such as heparin sodium plus dihydroergotamine mesylate, have been suggested to decrease the risk of deep venous thrombosis and pulmonary emboli. A total of 74 evaluable patients undergoing a major urological operation was randomized to receive either thromboembolic stockings, external sequential pneumatic compression stockings, or heparin plus dihydroergotamine as prophylaxis against deep venous thrombosis and pulmonary emboli. {sup 111}Indium-labeled platelet scans, performed preoperatively and on days 1, 3 and 6 postoperatively, were used to diagnose deep venous thrombosis and pulmonary emboli. Mean patient age was 63 years and all but 1 operation was performed for neoplastic disease. Deep venous thrombosis was detected in 5 of 25 patients (20%) with thromboembolic stockings, 3 of 24 (12.5%) with external sequential pneumatic compression stockings and 2 of 25 (8%) with heparin plus dihydroergotamine. There was no difference in blood loss or complications among the groups. Although statistical significance among the treatment groups was not reached in this study, the trend to a decrease in deep venous thrombosis and pulmonary emboli with external sequential pneumatic compression stockings and heparin plus dihydroergotamine, and an absence of an increase in morbidity in these groups supports the use of these modalities to decrease the morbidity and mortality of deep venous thrombosis and pulmonary emboli.

  4. Thromboembolic and Bleeding Complications among Patients with ...

    African Journals Online (AJOL)

    Objective: This study was conducted to determine the incidence of thromboembolic and bleeding complications among patients with mechanical heart valves operated from 1990 to 2003 attending the Muhimbili National Hospital. Study design: This was a retrospective cohort study conducted at the cardiac, anticoagulation ...

  5. Prevention of thromboembolism during radiosynoviorthesis?

    International Nuclear Information System (INIS)

    Fischer, M.; Ritter, B.

    2006-01-01

    The question of pharmacological prevention of thromboembolic disease during radiosynoviorthesis with concomitant immobilization of the treated joint is discussed by means of a recent case report. The possible advantages must be balanced against the potential risks of hemorrhage and heparine-induced thrombocytopenia in every patient. The intraarticular radionuclide therapy might be ranked as ''low risk'', comparable to small or medium interventions with minor trauma according to surgical and perioperative classifications, provided that there are no individual risk factors. With respect to the possible side effects, a general thromboembolic prophylaxis is not recommended in these patients. After radiosynoviorthesis of the knee and an additional joint of the same limb which requires an immobilization spanning both joints, a ''medium risk'' of thromboembolic disease must be assumed. In these cases, as well as with two or more predisposing risk factors, a pharmacological prevention of thromboembolism is mandatory. Ready-to-use syringes containing low-molecular-weight heparine are available for this purpose. Although serious side effects from LMW heparine are rare, monitoring of the thrombocyte counts prior to and 1-2 times during heparine application are advisable. Pharmacological prophylaxis of thromboembolic disease is strictly contraindicated in patients with acute bleeding, cerebral aneurysms and known aortic dissections. In case of concomitant treatment with NSAIDs, antagonists of platelet aggregation or valproic acid, the indication for heparine treatment should be discussed very seriously. Both the verbal and written information of each patient must be complete and precise with respect to possible advantages and potential risks of pharmacological prevention of thromboembolic disease. (orig.)

  6. Pulmonary thromboembolism as a complication of lung transplantation

    DEFF Research Database (Denmark)

    Kristensen, Anna Warncke; Mortensen, Jann; Berg, Ronan M G

    2017-01-01

    Post-transplantation mortality after lung transplantation (LTX) is higher than for other solid organ transplantations. Thoracic surgery is associated with increased risk of thromboembolic complications, and as LTX recipients lack the collateral bronchial circulation, pulmonary thromboembolism (PTE...

  7. Chemoprophylaxis for Venous Thromboembolism Prevention: Concerns Regarding Efficacy and Ethics

    Directory of Open Access Journals (Sweden)

    Eric Swanson, MD

    2013-06-01

    Full Text Available Summary: Chemoprophylaxis has been recommended for plastic surgery patients judged to be at increased risk for venous thromboembolism. Several investigators have encountered this complication in patients despite anticoagulation therapy. An increased rate of complications related to postoperative bleeding has been reported. This article examines the efficacy and safety of this intervention, along with ethical considerations, in an attempt to determine whether any benefits of chemoprophylaxis justify the additional risks. The statistical methods and conclusion of the Venous Thromboembolism Prevention Study are challenged. Other preventative measures that do not cause negative side effects are discussed as safer alternatives.

  8. Kawasaki Disease: Complications, Treatment and Prevention

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Kawasaki Disease: Complications, Treatment and Prevention Updated:May 8, ... possibility of heart and coronary artery involvement makes Kawasaki disease unpredictable, but these problems usually are not ...

  9. Thromboembolic complications in childhood nephrotic syndrome: a clinical profile.

    Science.gov (United States)

    Suri, Deepti; Ahluwalia, Jasmina; Saxena, Akshay K; Sodhi, Kushaljit S; Singh, Paramjeet; Mittal, Bhagwant R; Das, Reena; Rawat, Amit; Singh, Surjit

    2014-10-01

    Thromboembolism is a rare life-threatening complication of childhood nephrotic syndrome. We present the clinical profile and outcome of 34 children with 35 events of thromboembolic complications with nephrotic syndrome. Cerebral venous thrombosis (CVT) was the commonest complication seen in 11 (31.4 %) children followed by pulmonary thromboembolism and deep venous thrombosis in 9 (25.7 %) and 6 (16.6 %) children, respectively. Arterial thrombosis resulting in central nervous system infarcts was observed in 7 (20 %) children and 2 children had thrombosis of the peripheral arteries. Episodes were equal in steroid-resistant nephrotic syndrome and steroid-dependent nephrotic syndrome groups. Most of the thromboembolic complications occurred with relapse but 11.4 % of children developed intracranial thrombosis during remission. The most sensitive symptom of CVT was persistent headache while unexplained respiratory distress and hypoxemia pointed towards pulmonary thromboembolism. Hypoalbuminemia was seen in 82.8 % of children, while concurrent infection was seen in 31.4 %. Coexistence of genetic prothrombotic condition was identified and merits evaluation. Early heparin therapy followed by oral anticoagulants resulted in complete recovery in 91.1 % of children. Death occurred in 3 (8.5 %) children and autopsy revealed pulmonary thromboembolism in 2 children. Venous and arterial thrombotic complications can occur in children with nephrotic syndrome. A high index of suspicion is required as the clinical features may be subtle. Neuroimaging and angiographic techniques help in confirming diagnosis. Early aggressive heparin therapy followed by oral anticoagulants is necessary for a favorable outcome.

  10. Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, non-inferiority SURPRISE phase 3b trial.

    Science.gov (United States)

    Beyer-Westendorf, Jan; Schellong, Sebastian M; Gerlach, Horst; Rabe, Eberhard; Weitz, Jeffrey I; Jersemann, Katja; Sahin, Kurtulus; Bauersachs, Rupert

    2017-03-01

    Superficial-vein thrombosis can lead to deep-vein thrombosis and pulmonary embolism. Rivaroxaban, an oral factor Xa inhibitor, might simplify treatment compared with fondaparinux because it does not require daily subcutaneous injection and is cheaper. We compared efficacy outcomes in patients with superficial-vein thrombosis and additional risk factors given either rivaroxaban or fondaparinux to assess whether rivaroxaban is non-inferior to fondaparinux in the prevention of thromboembolic complications. In this open-label, masked endpoint, randomised, non-inferiority phase 3b trial, we recruited patients aged 18 years or older with symptomatic superficial-vein thrombosis from 27 sites (academic, community hospitals, and specialist practices) in Germany. We randomly assigned patients (1:1) to receive 10 mg oral rivaroxaban or 2·5 mg subcutaneous fondaparinux once a day for 45 days. Patients were eligible if they had symptomatic thrombosis (at least 5 cm in a supragenual superficial-vein segment) and at least one additional risk factor (older than 65 years, male sex, previous venous thromboembolism, cancer, autoimmune disease, thrombosis of non-varicose veins). Main exclusion criteria were: symptoms for longer than 3 weeks, thrombus within 3 cm of the sapheno-femoral junction, indication for full-dose anticoagulation therapy, and substantial hepatic or renal impairment. Randomisation was done with a central block randomisation process. The primary efficacy outcome was a composite of symptomatic deep-vein thrombosis or pulmonary embolism, progression or recurrence of superficial vein-thrombosis, and all-cause mortality at 45 days in the per-protocol population (all randomly assigned patients without major protocol violations). We used a non-inferiority margin of 4·5% (absolute difference between rivaroxaban and fondaparinux). The main safety outcome was major bleeding. This study is registered with ClinicalTrials.gov, number NCT01499953. Between April 25, 2012, and

  11. ANALYSIS OF THE INFLUENCE OF THROMBOEMBOLIC COMPLICATIONS PREVENTION WITH ORAL ANTICOAGULANTS ON BUDGET IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-09-01

    cardiovascular events compared with warfarin. This allows recommending the inclusion of the drug in the federal and regional programs for the prevention of thromboembolic complications in this group of patients.

  12. [Thromboembolic complications of childhood nephrotic syndrome].

    Science.gov (United States)

    Gargah, Tahar; Abidi, Kamal; Nourchene, Khelil; Zarrouk, Chokri; Lakhoua, Mohamed R

    2012-02-01

    Vascular thrombosis in the childhood nephrotic syndrome is a rare event. It poses major diagnostic and therapeutic problems. The prognosis depends on early diagnosis and on precocious anticoagulation. The risk of extension of thrombosis and pulmonary embolism is real. To consider the major thrombotic events associated with childhood nephrotic syndrome and to establish an appropriate preventive approach based on objective clinical and laboratory parameters. This is a retrospective study of all cases of patients suffering from idiopathic nephrotic syndrome, during a period of 20 years, starting from January 1990 to December 2009. We selected six patients with vascular thrombosis. The diagnosis was confirmed by appropriate radiological investigation. Six cases of vascular thrombosis were identified among 260 cases of nephrotic syndrome collected during the period study. Patients are divided into five boys and one girl. The mean age was 13.3 years. The localisation of thrombosis is venous in all cases. One patient presented a massively fatal pulmonary embolism. Sinovenous thrombosis has been objectified in 3 patients who were all treated with a good therapeutic response. vascular thrombosis remains one of the most serious complications of nephrotic syndrome in children. Early diagnosis and precocious anticoagulation are essential for preventing the extension of thrombosis.

  13. Prevention and treatment ofvenous thromboembolism. Case report

    Directory of Open Access Journals (Sweden)

    Andrzej Kolbuszewski

    2015-06-01

    Full Text Available The problem of thromboembolic complications concerns nearly all orthopaedic and trauma patients. However, risk factors are different and prophylaxis slightly varies depending on the complication. The presence of thrombosis of complex and insidious clinical picture, which is presented in this case report, is alarming. The article reports a case of a 64-year-old male patient with risk factors of thromboembolism. The patient underwent high tibial osteotomy for varus deformity correction due to gonarthrosis. Venus thrombosis and pulmonary embolism developed in the postoperative period. Additionally, symptoms of infection appeared during the treatment in the form of inappropriate wound healing, which was an indication for surgical revision of the wound. The authors present the manner of safe perioperative management of a patient, which is consistent with the standards, taking into account the risk of recurrence of thromboembolism.

  14. Thromboembolism prevention in surgery of digestive cancer.

    Science.gov (United States)

    Malafaia, Osvaldo; Montagnini, Andre Luís; Luchese, Angélica; Accetta, Antonio Carlos; Zilberstein, Bruno; Malheiros, Carlos Alberto; Jacob, Carlos Eduardo; Quireze-Junior, Claudemiro; Bresciani, Cláudio José Caldas; Kruel, Cleber Dario Pinto; Cecconello, Ivan; Sad, Eduardo Fonseca; Ohana, Jorge Alberto Langbeck; Aguilar-Nascimento, José Eduardo de; Manso, José Eduardo Ferreira; Ribas-Filho, Jurandir Marcondes; Santo, Marco Aurélio; Andreollo, Nelson Adami; Torres, Orlando Jorge Martins; Herman, Paulo; Cuenca, Ronaldo Mafia; Sallum, Rubens Antônio Aissar; Bernardo, Wanderley Marques

    2012-01-01

    The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength. A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A

  15. Thrombo-embolic and bleeding complications in patients with ...

    African Journals Online (AJOL)

    Background and objectives. Long-term anticoagulation therapy is essential to prevent thrombo-embolic events in patients with mechanical valve replacements. In order to offer indigent patients mechanical heart valve replacement surgery, dedicated anticoagulation clinics are necessary for follow-up. This study assessed ...

  16. Thromboembolic Complications in Thermally Injured Patients,

    Science.gov (United States)

    1992-12-01

    utilisation systdmatique chez le brOld sauf chez les patients A bolism: A clinico -pathological study in injured and burned patients. thromoemblie.Br. J...fueron identificados como casos de tromboembolismo, complications in the surgical patient. Ann. Surg. 186:669, 1977 pulmonar significativo. En s6lo tres

  17. Left atrial appendage closure with Watchman device in prevention of thromboembolic complications in patients with atrial fibrillation: First experience in Serbia

    Directory of Open Access Journals (Sweden)

    Nedeljković Milan A.

    2017-01-01

    Full Text Available Introduction. Atrial fibrillation (AF is the major cause ofstroke, particularly in older patients over 75 years of age. EuropeanSociety of Cardiology guidelines recommend chronic anticoagulationtherapy in patients with atrial fibrillation ifCHA2DS2-VASc score is ≥ 1 (CHA2DS2-VASc score for estimatingthe risk of stroke in patients with non-rheumatic AFconsisting of the first letters of patients condition: C – congestiveheart failure; H – hypertension; A2 – age ≥ 75 years; D –diabetes mellitus; S2 – prior stroke, transitory ischaemic attack(TIA or thrombolism; V – vascular disease; A – age 65–74years; Sc – sex category. However, a significant number of patientshave a high bleeding risk, or are contraindicated forchronic oral anticoagulation, and present a group of patients inwhom alternative treatment options for thromboembolic preventionare required. Transcatheter percutaneous left atrial appendageclosure (LAAC devices have been recommended inpatients with contraindications for chronic anticoagulanttherapy. Case report. We present our first three patients withnonvalvular AF and contraindications for chronic anticoagulanttherapy who were successfully treated with implantation ofLAAC Watchman device in Catheterization Laboratory of theClinic for Cardiology, Clinical Center of Serbia in BelgradeConclusion. Our initial results with Watchman LAAC deviceare promising and encouraging, providing real alternative in patientswith non-valvular AF and contraindication for chronicanticoagulant therapy and high bleeding risk.

  18. Risk factors of arterial cardiovascular complications in patients with prior venous thromboembolism

    NARCIS (Netherlands)

    Roshani, S.; Lijfering, W. M.; Coppens, M.; Hamulyák, K.; Prins, M. H.; Büller, H. R.; Middeldorp, S.

    2011-01-01

    Background. The effect of cardiovascular risk factors (CVRs) and thrombophilic defects on the risk of arterial cardiovascular complications in patients with prior venous thromboembolism (VTE) is unclear. Objective. We investigated whether the risk of arterial cardiovascular complications is

  19. Risk factors of arterial cardiovascular complications in patients with prior venous thromboembolism

    NARCIS (Netherlands)

    Roshani, S.; Lijfering, W. M.; Coppens, M.; Hamulyak, K.; Prins, M. H.; Buller, H. R.; Middeldorp, S.

    Background. The effect of cardiovascular risk factors (CVRs) and thrombophilic defects on the risk of arterial cardiovascular complications in patients with prior venous thromboembolism (VTE) is unclear. Objective. We investigated whether the risk of arterial cardiovascular complications is

  20. Prevention and Treatment of Venous Thromboembolism in Patients with Cancer: Focus on Drug Therapy

    NARCIS (Netherlands)

    van Es, Nick; Bleker, Suzanne M.; Wilts, Ineke T.; Porreca, Ettore; Di Nisio, Marcello

    2016-01-01

    Venous thromboembolism (VTE) is a frequent complication in patients with cancer and is associated with significant morbidity and mortality. The use of anticoagulants for the prevention and treatment of VTE in this population is challenging given the high risk of both recurrent VTE and bleeding

  1. Prevention and Treatment of Venous Thromboembolism in Patients with Cancer : Focus on Drug Therapy

    NARCIS (Netherlands)

    van Es, Nick; Bleker, Suzanne M.; Wilts, Ineke T.; Porreca, Ettore; Di Nisio, Marcello

    Venous thromboembolism (VTE) is a frequent complication in patients with cancer and is associated with significant morbidity and mortality. The use of anticoagulants for the prevention and treatment of VTE in this population is challenging given the high risk of both recurrent VTE and bleeding

  2. Prevention and treatment of venous thromboembolism in the elderly patient

    Directory of Open Access Journals (Sweden)

    Enrico Tincani

    2007-07-01

    Full Text Available Enrico Tincani1, Mark A Crowther2, Fabrizio Turrini1, Domenico Prisco31Unità Operativa di Medicina Interna Cardiovascolare, Nuovo Ospedale Civile di Modena S.Agostino-Estense, Modena, Italy; 2McMaster University, St. Joseph’s Hospital and McMaster University, Hamilton, Canada; 3Dipartimento di Area Critica Medico Chirurgica, Universita’ di Firenze, Florence, ItalyAbstract: Venous thromboembolism (VTE is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both lowmolecular-weight heparins (LMWHs and unfractionated heparin (UFH, all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use.Keywords: venous thromboembolism, elderly patient, fondaparinux

  3. Prevention of thromboembolism during radiosynoviorthesis?; Thromboseprophylaxe bei der Radiosynoviorthese?

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, M. [Inst. fuer Nuklearmedizin, Klinikum Kassel (Germany); Ritter, B. [Klinik fuer Haematologie und Onkologie, Klinikum Kassel (Germany)

    2006-03-15

    The question of pharmacological prevention of thromboembolic disease during radiosynoviorthesis with concomitant immobilization of the treated joint is discussed by means of a recent case report. The possible advantages must be balanced against the potential risks of hemorrhage and heparine-induced thrombocytopenia in every patient. The intraarticular radionuclide therapy might be ranked as ''low risk'', comparable to small or medium interventions with minor trauma according to surgical and perioperative classifications, provided that there are no individual risk factors. With respect to the possible side effects, a general thromboembolic prophylaxis is not recommended in these patients. After radiosynoviorthesis of the knee and an additional joint of the same limb which requires an immobilization spanning both joints, a ''medium risk'' of thromboembolic disease must be assumed. In these cases, as well as with two or more predisposing risk factors, a pharmacological prevention of thromboembolism is mandatory. Ready-to-use syringes containing low-molecular-weight heparine are available for this purpose. Although serious side effects from LMW heparine are rare, monitoring of the thrombocyte counts prior to and 1-2 times during heparine application are advisable. Pharmacological prophylaxis of thromboembolic disease is strictly contraindicated in patients with acute bleeding, cerebral aneurysms and known aortic dissections. In case of concomitant treatment with NSAIDs, antagonists of platelet aggregation or valproic acid, the indication for heparine treatment should be discussed very seriously. Both the verbal and written information of each patient must be complete and precise with respect to possible advantages and potential risks of pharmacological prevention of thromboembolic disease. (orig.)

  4. Semuloparin for prevention of venous thromboembolism after major orthopedic surgery

    DEFF Research Database (Denmark)

    Lassen, M R; Fisher, W; Mouret, P

    2012-01-01

    BACKGROUND: Semuloparin is a novel ultra-low-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. OBJECTIVES: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic...

  5. Prevention of venous thromboembolism in patients undergoing bariatric surgery.

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented.

  6. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID:26316771

  7. Risk Stratification for Bleeding Complications in Patients With Venous Thromboembolism

    DEFF Research Database (Denmark)

    Brown, Joshua D; Goodin, Amie J; Lip, Gregory Y H

    2018-01-01

    thromboembolism (VTE). This study evaluates the HAS-BLED score in a large cohort of VTE patients. METHODS AND RESULTS: A retrospective cohort of adults ≥18 years with primary diagnosis of VTE between January 1, 2010 and November 31, 2013 were identified in an insurance claims database. Patients were tracked until...

  8. Venous Thromboembolic Complications to Hysterectomy for Benign Disease

    DEFF Research Database (Denmark)

    Kahr, Henriette Strøm; Thorlacius-Ussing, Ole; Christiansen, Ole Bjarne

    2017-01-01

    . MEASUREMENTS AND MAIN RESULTS: Eighty-nine thousand nine hundred thirty-one women met the inclusion criteria. Venous thromboembolism (VTE) as a diagnosis or cause of death was identified. The risk of postoperative VTE was examined with Cox proportional hazard models adjusting for age, surgical approach...

  9. [Treatment and prevention of venous thromboembolic disease: what's new?].

    Science.gov (United States)

    Rey, Marie-Antoinette; Bron, Cédric; Haesler, Erik; Mazzolai, Lucia

    2009-02-04

    Venous thromboembolic (VTE) disease is frequent and questions regarding its treatment or prevention are numerous. This review is aimed at summarizing and pointing out the novelties on VTE treatment and prevention recently published in the Chest journal earlier this year (8th edition of ACCP guidelines). Generally, the aim of guidelines and of this review as well, is to offer guidance to practictioners in making the most appropriate choice for treating or preventing VTE. They are not intended for strict application and doctors will always have to decide individually case by case taking into account patients preference and the risk-benefit balance.

  10. Thromboembolism in pregnancy: challenges and controversies in the prevention of pregnancy-associated venous thromboembolism and management of anticoagulation in women with mechanical prosthetic heart valves.

    Science.gov (United States)

    McLintock, Claire

    2014-05-01

    Thromboembolism in pregnancy is an important clinical issue. Despite identification of maternal and pregnancy-specific risk factors for development of pregnancy-associated venous thromboembolism, limited data are available to inform on optimal approaches for prevention. The relatively low overall prevalence of pregnancy-associated venous thromboembolism has prompted debate about the validity of recommendations, which are mainly based on expert opinion, and have resulted in an increased use of pharmacological thromboprophylaxis in pregnancy and postpartum. A pragmatic approach is required in the absence of more robust data. Anticoagulation management of pregnant women with mechanical prosthetic heart valves is particularly challenging. Continuation of therapeutic anticoagulation during pregnancy is essential to prevent valve thrombosis. Warfarin, the most effective anticoagulant, is associated with adverse fetal outcomes, including embryopathy and stillbirth. Fetal outcome is improved with therapeutic-dose low-molecular-weight heparin, but there may be more thromboembolic complications. More intensive anticoagulation, targeting higher trough anti-Xa levels, may reduce the risk of valve thrombosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. The impact of surgical complications as a main risk factor for venous thromboembolism: a multicenter study

    NARCIS (Netherlands)

    Celik, F.; Bounif, F.; Fliers, J. M.; Kersten, B. E.; van Dielen, F. M. H.; Cense, H. A.; Brandjes, D. P. M.; van Wagensveld, B. A.; Janssen, I. M. C.; van de Laar, A. W. J. M.; Gerdes, V. E. A.

    2014-01-01

    Studies suggest that postoperative complications are a risk factor for venous thromboembolism (VTE) after bariatric surgery. Knowledge of factors associated with a higher risk of VTE after bariatric surgery may be essential to select patients who may benefit from either prolonged or intensified

  12. Thromboembolic Complications after Zenith{sup ®} Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Urlings, T. A. J., E-mail: t-urlings@hotmail.com [Medical Center Westeinde, Department of Radiology (Netherlands); Vries, A. C. de, E-mail: a.de.vries@mchaaglanden.nl; Mol van Otterloo, J. C. A. de, E-mail: a.de.molvanotterloo@mchaaglanden.nl; Eefting, D., E-mail: d.eefting@mchaaglanden.nl [Medical Center Westeinde, Department of Vascular Surgery (Netherlands); Linden, E. van der, E-mail: e.van.der.linden@mchaaglanden.nl [Medical Center Westeinde, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith{sup ®} Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographic images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute.

  13. Thromboembolism as an important complication of inflammatory bowel disease.

    Science.gov (United States)

    Bollen, Lize; Vande Casteele, Niels; Ballet, Vera; van Assche, Gert; Ferrante, Marc; Vermeire, Séverine; Gils, Ann

    2016-01-01

    Patients with inflammatory bowel disease (IBD) have a higher risk of developing thromboembolic events (TE) compared with the healthy population. This study aimed to describe a cohort of IBD patients with a history of TE focusing on recurrence of TE, disease activity and IBD medication at the time of TE and surgery before TE. In a retrospective monocentric cohort study, we included IBD patients in whom an arterial and/or venous TE occurred. Eighty-four IBD patients with a history of TE (63% Crohn's disease, 44% men) and a mean age of 45±15 years were included; 25/84 patients (30%) were identified to have recurrent TE. Seventy out of 84 (83%) developed a venous TE, with a deep vein thrombosis as the major manifestation (28/70, 40%), followed by a pulmonary embolism (16/70, 23%). At the time of TE, 60/84 (71%) patients were diagnosed with active disease. In all, 23% patients were on 5-aminosalicylic acids, 36% on steroids, 18% on azathioprine, 5% on methotrexate, 12% on biologicals and 23% were not receiving specific IBD treatment. Moreover, within a 6-month period preceding the TE, 28/84 (33%) patients underwent surgery, of whom 17% received thromboprophylaxis at hospital discharge. We confirm the association between disease activity and the occurrence of TE. A substantial number of patients had additional risk factors such as recurrence of TE. In all, 36% received steroids at the time of TE and 33% underwent recent surgery, of whom only a minority received thromboprophylaxis at hospital discharge. Further efforts are required to increase thromboprophylaxis in at-risk patients.

  14. OPTIMAL PREVENTION OF HOSPITAL VENOUS THROMBOEMBOLISM WITH THE HELP OF MEDICAL INFORMATION SYSTEM

    Directory of Open Access Journals (Sweden)

    G. I. Nazarenko

    2014-01-01

    Full Text Available Deep vein thrombosis and pulmonary embolism are an important medical and social problem, contributing to the structure of morbidity and mortality in the developed countries. Despite the availability of clinical guidelines for the prevention of venous thromboembolic complications there is a gap between scientific knowledge and clinical practice. Clinical decision support systems (CDSS are confirmed to be effective tool for the implementation of clinical guidelines in daily practice. CDSS should be based on national and international clinical guidelines; their effectiveness depends upon successful integration with other health information systems and care flow processes.

  15. Venous thromboses and thromboembolism in acute stroke: risk factors, diagnosis, treatment, and prevention

    Directory of Open Access Journals (Sweden)

    Andrei Viktorovich Fonyakin

    2013-01-01

    Full Text Available Stroke patients among all patients with somatic diseases are at one of the highest risks for venous thromboembolism (VTE. The proven risk factors for venous thrombosis in stroke are prolonged immobilization, elderly age, obesity, diabetes mellitus, and inherited coagulopathies. If no drug prevention is done, the course of stroke is complicated by deep vein thrombosis (DVT in 75% of the immobilized patients and pulmonary thromboembolism develops in 20%. At present there are mechanical, pharmacological, and combined DVT prevention strategies that may considerably lower the rate of pulmonary embolism. In stroke patients, the use of low-molecular-weight heparins (LMWH reduces therisk of DVT, without increasing the risk of hemorrhagic complications. Novel oral anticoagulants used to treat venous thrombosis and VTE in stroke patients are an equivalent alternative to LMWH therapy. Treatment with novel oral anticoagulants to prevent recurrent VTE is effective and safe and may be continued up to 1–2 years.

  16. Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery

    DEFF Research Database (Denmark)

    Friis, Esbern; Hørby, John; Sørensen, Lars Tue

    2004-01-01

    Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through...... thrombosis, pulmonary embolism, wound hematoma, and sugillation were recorded, and 17 variables with a potential influence on complications were analyzed by logistic regression analysis. Heparin prophylaxis compared to prophylaxis with TED stockings was significantly and independently associated...

  17. VALUE OF THROMBOEMBOLIC PROPHYLAXIS IN PREVENTION OF THE THROMBOEMBOLISM IN ORTHOPEDIC SURGERY AND TRAUMATOLOGY

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    Gorana Rancic

    2006-07-01

    Full Text Available In the period between March 1, 2003 to June 1, 2003 at the Clinic of Orthopaedic Surgery and Traumatology, we treated 174 patients with injured or diseased extremities. An average age was 46,95 years (27-81. We treated 33 patients (18,9% nonoperatively and 141 patients (81,1% operatively. Preoperative and postoperative thromboembolic profilaxis (TEP with low molecular heparin was registered in 50 patients (28,9%. In the first 10 days, 12 (9,2% patients without TEP had signs of thromboembolism, 2 patients died in the first 10 days with the signs of thromboembolism.In the control group, in the period between March 1, 2005 to June 1, 2005 at the Clinic of Orthopaedic Surgery and Traumatology, we treated 162 patients with injured or diseased extremities. The average age was 47,2 years (17-82. We treated 29 patients nonoperatively (17,9% and 133 patients (82,1% operatively. All patients had preoperative and postoperative thromboembolic profilaxis (TEP with low molecular heparin. In the first 10 days, 5 (3% patients had signs of thromboembolism. None of the patients from control group died.Our results showed that TEP in orthopaedic surgery and traumatology is necessary.

  18. Neuromuscular electrical stimulation for the prevention of venous thromboembolism.

    Science.gov (United States)

    Ravikumar, Raveena; Williams, Katherine J; Babber, Adarsh; Moore, Hayley M; Lane, Tristan Ra; Shalhoub, Joseph; Davies, Alun H

    2017-01-01

    Objective Venous thromboembolism, encompassing deep vein thrombosis and pulmonary embolism, is a significant cause of morbidity and mortality, affecting one in 1000 adults per year. Neuromuscular electrical stimulation is the transcutaneous application of electrical impulses to elicit muscle contraction, preventing venous stasis. This review aims to investigate the evidence underlying the use of neuromuscular electrical stimulation in thromboprophylaxis. Methods The Medline and Embase databases were systematically searched, adhering to PRISMA guidelines, for articles relating to electrical stimulation and thromboprophylaxis. Articles were screened according to a priori inclusion and exclusion criteria. Results The search strategy identified 10 randomised controlled trials, which were used in three separate meta-analyses: five trials compared neuromuscular electrical stimulation to control, favouring neuromuscular electrical stimulation (odds ratio of deep vein thrombosis 0.29, 95% confidence interval 0.13-0.65; P = .003); three trials compared neuromuscular electrical stimulation to heparin, favouring heparin (odds ratio of deep vein thrombosis 2.00, 95% confidence interval 1.13-3.52; P = .02); three trials compared neuromuscular electrical stimulation as an adjunct to heparin versus heparin only, demonstrating no significant difference (odds ratio of deep vein thrombosis 0.33, 95% confidence interval 0.10-1.14; P = .08). Conclusion Neuromuscular electrical stimulation significantly reduces the risk of deep vein thrombosis compared to no prophylaxis. It is inferior to heparin in preventing deep vein thrombosis and there is no evidence for its use as an adjunct to heparin.

  19. Incidence and Management of Thrombotic and Thromboembolic Complications Following the Norwood Procedure: A Systematic Review.

    Science.gov (United States)

    Agarwal, Arnav; Firdouse, Mohammed; Brar, Nishaan; Yang, Andy; Lambiris, Panos; Chan, Anthony K; Mondal, Tapas K

    2017-11-01

    The stage 1 Norwood procedure and its variants represent the first step of palliation for hypoplastic left heart syndrome. Although appropriate postoperative thromboprophylaxis is integral, significant variance remains across institutional practices. The purpose of this systematic review is to estimate the incidence of thrombosis and thromboembolism following the Norwood or modified Blalock-Taussig shunt procedure and examine current thromboprophylaxis regimens. Ovid MEDLINE and Embase were searched from January 2000 to June 2016 for primary studies explicitly reporting incidence of thrombosis, thromboembolism (strokes and pulmonary embolisms), or shunt occlusion in neonates, infants, and children undergoing the Norwood procedure or any variant. All-cause mortality was a secondary outcome of interest. Of 887 identified articles, 15 cohort studies were deemed eligible, the majority including modified Blalock-Taussig shunt patients. Reported incidence of thrombosis ranged from 0% to 40%; thromboembolic events were rarely reported. Overall mortality ranged from 4.5% to 31.3% across studies. Although most studies involved the long-term acetylsalicylic acid use, thromboprophylaxis strategies varied across studies. Due to substantial variability in event rates, no correlation was identified with thrombotic complications. Clinical practice guidelines recommend that patients receive intraoperative unfractionated heparin therapy and either aspirin or no antithrombotic therapy postoperatively. Our findings suggest a substantial risk of thrombosis and thromboembolism and demonstrate substantial variation in thromboprophylaxis practices. Although postoperative thromboprophylaxis seems optimal, it remains controversial whether the long-term aspirin use is most effective. Our findings highlight the lack of a gold-standard thromboprophylaxis strategy and emphasize the need for more consistency.

  20. [Specification of the development risk of thromboembolic complications in abdominal surgery].

    Science.gov (United States)

    Shaposhnikov, S A; Sin'kov, S V; Zabolotskikh, I B

    2013-01-01

    The retrospective research included 1983 patients with different abdominal surgical pathology. Parameters of homeostasis were estimated in preoperative period and early postoperative period. Frequency of occurrence and relevance of different clinical risk factors of thrombosis were analyzed. The rate of development of thromboembolic complications was investigated in studied subgroup of patients. It was revealed, that high risk groups of thrombosis progress were the patients with malignant disease of the pancreas, the esophagus, the large and straight intestine as well as obstructive jaundice of malignant genesis. The most significant clinical factors were the presence of malignant process, accompanied by cardiac pathology, dehydration and high number (3 and more) on ASA scale.

  1. Successful management of acute thromboembolic disease complicated with heparin induced thrombocytopenia type II (HIT II: a case series

    Directory of Open Access Journals (Sweden)

    Trellopoulos George

    2008-07-01

    Full Text Available Abstract Heparin-induced thrombocytopenia type II (HIT II is a rare immune-mediated complication of heparin. The diagnosis of HIT is considered in patients exposed to heparin, presenting with thrombocytopenia and thrombosis. We present two cases with massive pulmonary embolism and HIT, successfully treated with the administration of fondaparinux, an alternative anticoagulant, combined with the insertion of an inferior vena cava filter for the prevention of new thromboembolic events. The two cases supplement the available data of the use of fondaparinux in patients with HIT and pulmonary embolism, before further large studies establish its efficacy and safety in this group of patients. Moreover, the management of these patients reveals the need for future evaluation of the combined therapy of alternative anticoagulant agents with the placement of vena cava filters.

  2. AVE5026, a new hemisynthetic ultra-low-molecular-weight heparin for the prevention of venous thromboembolism in patients after total knee replacement surgery

    DEFF Research Database (Denmark)

    Lassen, Michael Rud; Dahl, O E; Mismetti, P

    2009-01-01

    BACKGROUND: AVE5026 is a new hemisynthetic ultra-low-molecular-weight heparin, with a novel anti-thrombotic profile resulting from high anti-factor (F)Xa activity and residual anti-FIIa activity. AVE5026 is in clinical development for venous thromboembolism (VTE) prevention, a frequent complication...

  3. Update on pharmacologic approaches to prevent thromboembolism in atrial fibrillation: are thrombin and factor Xa inhibitors the ultimate answer?

    Science.gov (United States)

    Wolfram, Oliver; Hammwoehner, Matthias; Gramley, Felix; Goette, Andreas

    2011-05-01

    Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. Prevalence and incidence rates are rising with the advancing population age. A severe complication of untreated AF is thrombus formation in the left atrial appendage with consecutive peripheral thromboembolism. Thus, AF is a major contributor to thromboembolic events, especially in the elderly. Depending on the CHADS2 score for thromboembolic events that takes into account congestive heart failure, hypertension, age, diabetes mellitus and stroke as risk factors, oral anticoagulation therapy with vitamin K antagonists is currently the treatment of choice for the prevention of thromboembolism. However, due to drawbacks of current anticoagulation therapy new substances for oral therapy are currently evaluated in various clinical studies. This article provides an up to date overview of orally active compounds for the future treatment of AF. Emphasis lies on comparison of direct thrombin inhibitors with factor Xa inhibitors that are currently investigated in clinical phase III studies for the treatment of non-valvular AF. The direct thrombin inhibitor dabigatran will be compared with factor Xa inhibitors like rivaroxaban and apixaban. Other promising agents currently investigated in phase II trials such as direct factor Xa inhibitors DU-176b (edoxaban) and YM150, will also be discussed.

  4. Venous thromboembolism prevention in gynecologic cancer surgery: a systematic review.

    Science.gov (United States)

    Einstein, M Heather; Pritts, Elizabeth A; Hartenbach, Ellen M

    2007-06-01

    Advanced age, pelvic surgery, and the presence of malignancy place gynecologic oncology patients at high risk for venous thromboembolism (VTE). This study was designed to systematically analyze the world's literature on VTE in these patients and determine the optimal prophylaxis regimen. Computerized searches of Pubmed, Ovid, DARE, ACP Journal Club, Cochrane Database of Systematic Reviews, and Cochrane Controlled Trials Registry 1966-2005 were performed, as well as EMBASE 1980-2005. Major conferences and target references were hand-searched. Inclusion criteria were randomized controlled trials (RCTs) evaluating VTE prophylaxis with heparin, low-molecular-weight heparin (LMWH), and sequential compression devices (SCD). The search yielded 278 articles; 11 met inclusion criteria. Data were abstracted by one author and analyzed with the Mantel-Haenszel method. The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin (RR=0.58, 95% CI 0.35-0.95). There were no significant differences in EBL or transfusions between the two groups. In the 320 patients in the heparin vs. LMWH studies, there was no significant difference in DVT (RR 0.91, 95% CI 0.38-2.17), although power analysis demonstrated insufficient numbers to show a difference. No patient in either group required re-exploration for bleeding. All gynecologic cancer patients should receive VTE prophylaxis. Although heparin, LMWH, and SCD have been shown to be safe and effective, due to the paucity of data in the gynecologic oncology literature, no one prevention modality can be considered superior at this time. Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.

  5. Evaluation of an institutional project to improve venous thromboembolism prevention.

    Science.gov (United States)

    Minami, Christina A; Yang, Anthony D; Ju, Mila; Culver, Eckford; Seifert, Kathryn; Kreutzer, Lindsey; Halverson, Terri; O'Leary, Kevin J; Bilimoria, Karl Y

    2016-12-01

    Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. A retrospective observational study. NMH, an 885-bed academic medical center in Chicago, Illinois PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29-S37. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital

  6. Perioperative complications increase the risk of venous thromboembolism following bariatric surgery.

    Science.gov (United States)

    Helm, Melissa C; Simon, Kathleen; Higgins, Rana; Kindel, Tammy L; Gould, Jon C

    2017-12-01

    Morbidly obese patients are at increased risk of venous thromboembolism (VTE) following surgery. This study explores the impact of a perioperative complication on the risk of VTE after bariatric surgery. Patients who underwent bariatric surgery were identified from the American College of Surgeons National Surgical Quality Improvement Program dataset (2012-2014). The 17 most common perioperative complications were analyzed by multivariate regression analysis to determine the effect of complications on the risk of VTE. The postoperative incidence of VTE was 0.5% (n = 59,424 bariatric surgeries). The average time to diagnosis of VTE was 11.6 days. 80% of VTE events occurred after discharge. A major complication occurred prior to VTE in 22.6% of patients. The more complications experienced by an individual patient, the more likely they were to experience VTE. Unadjusted thirty-day mortality increased 13.89-fold following VTE (p bariatric surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Case series of thromboembolic complications in childhood nephrotic syndrome: Hacettepe experience.

    Science.gov (United States)

    Tavil, Betul; Kara, Fehime; Topaloglu, Rezan; Aytac, Selin; Unal, Sule; Kuskonmaz, Baris; Cetin, Mualla; Besbas, Nesrin; Gumruk, Fatma

    2015-06-01

    The aim of this study was to describe the incidence and contributory risk factors for thromboembolic complications in children with nephrotic syndrome (NS) and thrombosis. Among 188 children with the diagnosis of NS (80 girls; mean age: 12.6 ± 5.4 years) followed up in our hospital for the last 5 years, 17 (9.0 %) children (16 boys) identified as having thromboembolic complications. All 17 children with NS and thrombosis were screened for laboratory risk factors for thrombosis. The diagnosis was confirmed by cranial magnetic resonance imaging, doppler ultrasonography, and echocardiography. Among 17 children with thrombosis, 14 (82.3 %) were found to have focal segmental glomerulosclerosis (FSGS) as underlying pathology by renal biopsy. The mean age of the thrombotic children was 4.5 ± 3.2 years at the diagnosis of NS and that was 7.1 ± 4.9 years at the time of thrombosis. The mean time from NS diagnosis to the first thrombosis development was 2.6 ± 2.3 years. Thrombosis occurred during the first year of NS in 9/17 (52.9 %) children. Most of the children (88.2 %) had venous thrombosis. Among the screened risk factors, high factor VIII level (64.7 %) was the leading factor followed by decreased antithrombin III level (29.4 %). Furthermore, 4 children had central venous catheters and 2 had infection as clinical risk factors for thrombosis. In this case series, subtype of FSGS, active disease state of NS, central venous catheters, and some inherited and acquired thrombotic risk factors have been identified as contributory factors for the development of thrombosis in children with NS.

  8. Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy.

    Science.gov (United States)

    Kis, Zsuzsanna; Arany, Andrea; Gyori, Gabriella; Mihalcz, Attila; Kardos, Attila; Foldesi, Csaba; Kassai, Imre; Szili-Torok, Tamas

    2017-03-01

    Cardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients (pts). However, the transvenous left ventricular (LV) lead implantation remains ineffectual in a considerable number of pts. Transapical LV (TALV) lead implantation is an alternative minimally invasive, surgical, endocardial implantation technique. The aim of the present prospective study is to determine the long-term outcome, including the cerebral thromboembolic complications, of pts who underwent TALV lead placement. Twenty-six CRT candidates (19 men (78 %); mean age 61 ± 10 years) with a previously failed transvenous approach underwent TALV lead placement as a last resort therapy. The following data was collected: mortality rate, reoperation rate, and cerebrovascular event rate. Patients underwent a cerebral CT scan to determine any possible cerebrovascular event related to the presence of the TALV lead. Eleven out of 26 (47 %) patients survived after a median follow-up of 40 ± 24.5 months. Major acute ischemic stroke occurred in two cases, while in one case transient ischemic stroke was observed. Cerebral CT scan examination performed in asymptomatic patients revealed chronic ischemic lesions with minimal extension in two patients. Reoperation occurred in one case due to TALV lead fracture. This is the first study reporting the long-term outcome, mortality, and thromboembolic event rate exclusively after TALV lead implantation. Patients who underwent TALV lead implantation have a comparable long-term mortality rate to conventional CRT, although a major ischemic cerebrovascular event after TALV lead implantation is worrisome and has an impact on the outcome.

  9. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization.

    Science.gov (United States)

    Testroote, Mark; Stigter, Willem A H; Janssen, Loes; Janzing, Heinrich M J

    2014-04-25

    Immobilization of the lower leg is associated with venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is an anticoagulant treatment which might be used in adult patients with lower-leg immobilization to prevent deep venous thrombosis (DVT) and its complications. This is an update of the review first published in 2008. To assess the effectiveness of low molecular weight heparin for the prevention of venous thromboembolism in patients with lower-leg immobilization in an ambulant setting. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched June 2013) and CENTRAL (2013, Issue 5). Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that described thromboprophylaxis by means of LMWH compared with no prophylaxis or placebo in adult patients with lower-leg immobilization. Immobilization was by means of a plaster cast or brace. Two authors independently assessed trial quality and extracted data. The review authors contacted the trial authors for additional information if required. Statistical analysis was carried out using Review Manager (RevMan 5). We included six RCTs fulfilling the above criteria with a total of 1490 patients. We found an incidence of VTE ranging from 4.3% to 40% in patients who had a leg injury that had been immobilized in a plaster cast or a brace for at least one week and who received no prophylaxis, or placebo. This number was significantly lower in patients who received daily subcutaneous injections of LMWH during immobilization (event rates ranging from 0% to 37%; odds ratio (OR) 0.49; fixed 95% confidence interval (CI) 0.34 to 0.72; with minimal evidence of heterogeneity with an I(2) of 20%, P = 0. 29). Comparable results were seen in the following subcategories: operated patients, conservatively treated patients, patients with fractures, patients with soft-tissue injuries, patients with proximal thrombosis, patients with

  10. Venous thromboembolism prevention guidelines for medical inpatients: mind the (implementation) gap.

    Science.gov (United States)

    Maynard, Greg; Jenkins, Ian H; Merli, Geno J

    2013-10-01

    Hospital-associated nonsurgical venous thromboembolism (VTE) is an important problem addressed by new guidelines from the American College of Physicians (ACP) and American College of Chest Physicians (AT9). Narrative review and critique. Both guidelines discount asymptomatic VTE outcomes and caution against overprophylaxis, but have different methodologies and estimates of risk/benefit. Guideline complexity and lack of consensus on VTE risk assessment contribute to an implementation gap. Methods to estimate prophylaxis benefit have significant limitations because major trials included mostly screening-detected events. AT9 relies on a single Italian cohort study to conclude that those with a Padua score ≥4 have a very high VTE risk, whereas patients with a score AT9 includes the Padua model and Caprini point-based system for nonsurgical inpatients and surgical inpatients, respectively, but there is no evidence they are more effective than simpler risk-assessment models. New VTE prevention guidelines provide varied guidance on important issues including risk assessment. If Padua is used, a threshold of 3, as well as 4, should be considered. Simpler VTE risk-assessment models may be superior to complicated point-based models in environments without sophisticated clinical decision support. © 2013 Society of Hospital Medicine.

  11. [Thromboembolism prophylaxis in old age].

    Science.gov (United States)

    Röhrig, Gabriele; Kolb, Gerald

    2018-04-05

    Anticoagulation in geriatric patients is challenging regarding the risk of bleeding complications and thromboembolic problems. Age, comorbidities, such as renal insufficiency and polymedication have a vital impact on bleeding and thromboembolic risks; however, age is not an exclusion criterion for withholding anticoagulation. Age is the main risk factor for deep vein thrombosis and atrial fibrillation becomes more relevant with aging. Older patients with atrial fibrillation have a particularly high risk of having a stroke. Therefore, very old patients benefit particularly from oral anticoagulation because the risk of bleeding is outweighed by the clinical benefit of stroke prevention. Risk of bleeding and thromboembolic problems can be easily assessed by established diagnostic tools. This article reviews the epidemiology of thromboembolic problems in the aged as well as current diagnostic and therapeutic steps for primary and secondary prevention.

  12. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial.

    Science.gov (United States)

    Westenbrink, B D; Alings, M; Connolly, S J; Eikelboom, J; Ezekowitz, M D; Oldgren, J; Yang, S; Pongue, J; Yusuf, S; Wallentin, L; van Gilst, W H

    2015-05-01

    Anemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). To investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. We retrospectively analyzed the RE-LY trial database, which randomized 18 113 patients with AF and a risk of stroke to receive dabigatran or warfarin for a median follow-up of 2 years. Cox regression analysis was used to determine whether anemia predicted cardiovascular events and bleeding complications in these patients. Anemia was present in 12% of the population at baseline, and the presence of anemia was associated with a higher risk of thromboembolic cardiovascular events, including the composite endpoint of all-cause mortality or myocardial infarction (adjusted hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.32-1.71) and the primary RE-LY outcome of stroke or systemic embolism (adjusted HR 1.41, 95% CI 1.12-1.78). Anemia was also associated with a higher risk of major bleeding complications (adjusted HR 2.14, 95% CI 1.87-2.46) and discontinuation of anticoagulants (adjusted HR 1.40, 95% CI 1.28-1.79). The association between anemia and outcome was similar irrespective of cardiovascular comorbidities, randomized treatment allocation, or prior use of warfarin. The incidence of events was lower in patients with transient anemia than in patients in whom anemia was sustained (adjusted HR 0.66, 95% CI 0.49-0.91). Anemia is associated with an increased risk of thromboembolic events, bleeding complications and mortality in anticoagulated patients with AF. These findings suggest that patients with anemia should be monitored closely during all types of anticoagulant treatment. © 2015 International Society on Thrombosis and Haemostasis.

  13. Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer.

    Science.gov (United States)

    Holwell, Anna; McKenzie, Jo-Lyn; Holmes, Miranda; Woods, Rodney; Nandurkar, Harshal; Tam, Constantine S; Bazargan, Ali

    2014-04-01

    Patients undergoing surgery for colorectal cancer are at high risk of post-operative venous thromboembolism (VTE). Thromboprophylaxis has been shown to have significant risk reduction, although there remains some controversy surrounding the optimal duration of pharmacological prophylaxis. Our institution does not routinely practise extended prophylaxis. The aim of this study was to retrospectively review the rate of post-operative thromboprophylaxis in colorectal cancer patients, and incidence of symptomatic VTE. We conducted a retrospective audit of 200 consecutive patients who underwent colorectal surgery for cancer. Data to 90 days post-operatively were collected from medical records and imaging and phone calls to patients and family practitioners. Of the patients, 98% received pharmacological prophylaxis, with a median duration of eight days. Eight (4%) symptomatic VTEs were diagnosed within the 90-day follow-up period: two deep vein thrombosis (DVTs), five pulmonary emboli (PE) and one patient with both PE and DVT. A higher proportion of patients developed DVT/PE if they received prophylaxis other than low molecular weight heparin and similarly there was a trend in increased risk of DVT in the presence of metastatic disease. However, using univariate analysis, these results were not statistically significant (P = 0.18 and 0.11, respectively). The use of thromboprophylaxis was high in our centre, and the incidence of VTE was low when patients received a median of 8 days pharmacological prophylaxis combined with mechanical prophylaxis. The VTE incidence of 4% is similar to previous studies using extended prophylaxis. Our study findings do not support changing local protocol to extended prophylaxis. © 2013 Royal Australasian College of Surgeons.

  14. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization.

    Science.gov (United States)

    Zee, Aniek Ag; van Lieshout, Kelly; van der Heide, Maaike; Janssen, Loes; Janzing, Heinrich Mj

    2017-08-06

    Immobilization of the lower limb is a risk factor for venous thromboembolism (VTE). Low molecular weight heparins (LMWHs) are anticoagulants, which might be used in adult patients with lower-limb immobilization to prevent deep venous thrombosis (DVT) and its complications. This is an update of the review first published in 2008. To assess the effectiveness of low molecular weight heparin for the prevention of venous thromboembolism in patients with lower-limb immobilization in an ambulatory setting. For this update, the Cochrane Vascular Information Specialist searched the Specialised Register, CENTRAL, and three trials registers (April 2017). Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that described thromboprophylaxis by means of LMWH compared with no prophylaxis or placebo in adult patients with lower-limb immobilization. Immobilization was by means of a plaster cast or brace. Two review authors independently selected trials, assessed risk of bias and extracted data. The review authors contacted the trial authors for additional information if required. Statistical analysis was carried out using Review Manager 5. We included eight RCTs that fulfilled our criteria, with a total of 3680 participants. The quality of evidence, according GRADE, varied by outcome and ranged from low to moderate. We found an incidence of DVT ranging from 4.3% to 40% in patients who had a leg injury that had been immobilized in a plaster cast or a brace for at least one week, and who received no prophylaxis, or placebo. This number was significantly lower in patients who received daily subcutaneous injections of LMWH during immobilization, with event rates ranging from 0% to 37% (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.33 to 0.61; with minimal evidence of heterogeneity: I² = 26%, P = 0.23; seven studies; 1676 participants, moderate-quality evidence). Comparable results were seen in the following groups of participants: patients with below

  15. Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps

    Directory of Open Access Journals (Sweden)

    Mohan Rangaswamy

    2013-01-01

    Full Text Available Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author′s own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.

  16. [Prevention of operational thromboembolic risk in plastic and aesthetic surgery. Analysis of cases, inquiries of practice and recommendations of professional practices].

    Science.gov (United States)

    Raulo, C; Samama, C M; Benhamou, D; Jeandel, T

    2012-08-01

    Thromboembolic accidents are a frightening complication of plastic and aesthetic surgery. The absence of recommendations for professional practices for the prevention of such accidents justified this work. The therapeutic practices of the surgeons were analysed and the results were then compared with those of the international literature. The analysis by a group of experts made it possible to establish recommendations for professional practices. This work consisted in collecting, retrospectively, the therapeutic practices and the complications of 440 surgeons, concerning four types of interventions (abdominoplasty, mammoplasty, abdominal lift and liposuction), from 2006 to 2008, i.e., approximately 110.000 interventions. The intervention with the greatest risk is abdominoplasty with 0.9% of thromboembolic accidents; the intervention with the least risk is mammoplasty with 0.1% of accidents. The risk with the abdominal lift and liposuction of more than three zones is similar and intermediate with 06% of accidents. A protocol of prevention of thromboembolic accidents in plastic surgery is proposed. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  17. Outcomes of inferior vena cava filter insertion in patients with lower extremity deep vein thrombosis for prevention of pulmonary thromboembolism: A single center retrospective analysis

    International Nuclear Information System (INIS)

    Park, Byung Jin; Kim, Jae Kyu; Yim, Nam Yeol; Kim, Hyoung Ook; Kang, Yang Jun

    2017-01-01

    To evaluate the mid- and long-term outcomes of inferior vena cava (IVC) filter insertion in patients with underlying deep vein thrombosis for prevention of pulmonary thromboembolism, based on a single center experience. A total of 166 IVC filter insertion procedures in 160 patients, between February 2004 and December 2014, were retrospectively reviewed. Severity of deep vein thrombosis, indwelling time of the IVC filter, retrieval rate, and complication rate depending on the type of IVC filter were analyzed based on the patients' radiologic findings and medical records. IVC filter insertion procedures were successfully performed in all patients. Among the 99 attempts at filter retrieval, 91 trials succeeded (91.9%, 91/99) and 8 trials failed. Indwelling time of the IVC filter showed a positive correlation with failure of filter retrieval (p = 0.01). There was no procedure-related complication after all IVC filter insertion procedures. Eight delayed complications (5.0%, 8/160 patients with IVC filter insertion) were observed [caval thrombosis below the IVC filter (n = 7) and IVC penetration (n = 1)]. Günther Tulip filter was associated with a significant incidence of complication (p = 0.036). IVC filter insertion in patients with lower extremity deep vein thrombosis for prevention of pulmonary thromboembolism can be regarded as a safe treatment modality with an acceptable complication rate

  18. Outcomes of inferior vena cava filter insertion in patients with lower extremity deep vein thrombosis for prevention of pulmonary thromboembolism: A single center retrospective analysis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Jin; Kim, Jae Kyu; Yim, Nam Yeol; Kim, Hyoung Ook [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Kang, Yang Jun [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2017-07-15

    To evaluate the mid- and long-term outcomes of inferior vena cava (IVC) filter insertion in patients with underlying deep vein thrombosis for prevention of pulmonary thromboembolism, based on a single center experience. A total of 166 IVC filter insertion procedures in 160 patients, between February 2004 and December 2014, were retrospectively reviewed. Severity of deep vein thrombosis, indwelling time of the IVC filter, retrieval rate, and complication rate depending on the type of IVC filter were analyzed based on the patients' radiologic findings and medical records. IVC filter insertion procedures were successfully performed in all patients. Among the 99 attempts at filter retrieval, 91 trials succeeded (91.9%, 91/99) and 8 trials failed. Indwelling time of the IVC filter showed a positive correlation with failure of filter retrieval (p = 0.01). There was no procedure-related complication after all IVC filter insertion procedures. Eight delayed complications (5.0%, 8/160 patients with IVC filter insertion) were observed [caval thrombosis below the IVC filter (n = 7) and IVC penetration (n = 1)]. Günther Tulip filter was associated with a significant incidence of complication (p = 0.036). IVC filter insertion in patients with lower extremity deep vein thrombosis for prevention of pulmonary thromboembolism can be regarded as a safe treatment modality with an acceptable complication rate.

  19. Cost-effectiveness of new oral anticoagulants in the treatment and secondary prevention of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-01-01

    Full Text Available Aim. To assess the cost-effectiveness of apixaban in the treatment and secondary prevention of venous thromboembolism (VTE compared with low molecular weight heparin (LMWH/warfarin and other new oral anticoagulants (NOACs. Material and methods. Cost-effectiveness analysis was performed using a Markov model, developed on the basis of the results of AMPLIFY AMPLIFY-Ext trials, and network meta-analyzes on the use of antithrombotic drugs in acute VTE and long-term administration after VTE. Markov cycle duration was 3 months. The duration of therapy in the simulation was 6 and 12 months. The time horizon of the study was 5 years. Life expectancy and costs were discounted by 3.5% per year. The costs on drugs were estimated based on the registered marginal cost price. Besides, the analysis was performed to the weighted average auctions prices for NOACs. The costs of monitoring and treatment of complications were calculated on the basis of the collective agreement of compulsory health insurance system (St. Petersburg, 2015. Results. Apixaban provided significant cost savings compared with other modes of anticoagulant therapy for hospital treatment. Apixaban provided cost savings compared with other NOACs with a minimal increase in life expectancy with regard to quality in long-term analysis. Apixaban provided an increase in life expectancy compared with the appointment of LMWH/warfarin, but required some increase in costs. At therapy duration of 6 months, the costs per one additional year of life with regard to quality and to one additional calendar year of life were 309.8-403.7 and 481.6-627.4 thousand rubles, respectively; at therapy duration of 12 months – 1254.4-1476.9 and 649.0-764.1 thousand rubles, respectively. Conclusion. Apixaban provided a reduction in the incidence of bleeding compared with other NOACs and LMWH/warfarin with comparable efficacy in treatment and secondary prevention of VTE. Apixaban therapy costs were lower than these

  20. Venous thromboembolism and pregnancy

    Directory of Open Access Journals (Sweden)

    Maristella D’Uva

    2010-03-01

    Full Text Available Maristella D’Uva1, Pierpaolo Di Micco2, Ida Strina1, Giuseppe De Placido1Department of Obstetrics and Gynecology and Human Reproduction, “Federico II” University of Naples, Naples, Italy; 2Internal Medicine Division, Buonconsiglio Fatebenefratelli Hospital of Naples, Naples, ItalyAbstract: In recent decades, the association between a hypercoagulable state and its causes and adverse pregnancy outcome, in particular recurrent pregnancy loss (RPL has been studied extensively. Although the first studies were focused only on the association between thrombophilia and RPL, subsequent studies underlined also a potential role of antithrombotic treatment to prevent vascular complication such as venous thromboembolism (VTE during pregnancy. Thromboprophylaxis should be considered also for pregnant subjects carriers of molecular thrombophilia or that previously experienced VTE, in order to prevent VTE during pregnancy, while antithrombotic treatment for VTE should be performed during all pregnant periods.Keywords: thrombophilia, venous thromboembolism, recurrent pregnancy loss, factor V Leiden

  1. Flowtron foot-pumps for prevention of venous thromboembolism in total hip and knee replacement.

    Science.gov (United States)

    Pitto, Rocco P; Koh, Chuan K

    2015-03-01

    Mechanical prophylaxis with foot-pumps provides an interesting alternative to chemical agents in the prevention of venous thomboembolism following major orthopaedic surgery procedures. The aim of this prospective study was to assess efficacy and safety of the Flowtron(®) foot-pumps system following total hip and knee replacement. The foot pumps were used as main tool for prevention of thromboembolic events, in most cases in association with a variety of chemicals. The primary endpoint of the study was to assess the incidence of deep vein thrombosis and pulmonary embolism after total hip and knee replacement. The secondary endpoints included postoperative bleeding, swelling, bruising and wound ooze. 424 consecutive patients were included in the study. Symptomatic deep vein thrombosis was detected in 7 patients (1.6%). All symptomatic deep vein thromboses were detected after discharge before the six week follow-up clinic. Five non-fatal pulmonary embolisms occurred (1.2%). Only one patient presented a major wound bleeding (0.2%). The mean difference of swelling of thigh pre-versus postoperatively was only 22.8 mm. In conclusion, thromboembolism prophylaxis after total hip and knee replacement using Flowtron(®) foot-pumps as main prevention tool of an individualised protocol appears effective and safe. This is the first clinical report related to this popular brand of foot pumps.

  2. Intravenous Therapy: Hazards, Complications and Their Prevention ...

    African Journals Online (AJOL)

    In this review article, the local and systemic complications of intravenous therapy are highlighted and their preventive measures are discussed. Intravenous therapy exposes the patient to numerous hazards and many of them are avoidable, if the health care provider understands the risks involved and acts appropriately and ...

  3. Analysis of incidence of thromboembolic complications in patients with chronic lymphoproliferative diseases

    Directory of Open Access Journals (Sweden)

    Nikolovski Srđan

    2015-01-01

    Full Text Available Introduction: An increased risk for thromboembolism in cancer patients has been observed in patients with solid tumours, whereas little data exist on malignant lymphoma. Aim: Determination of the incidence of TE in patients with non Hodgkin lymphoma (NHL, Hodgkin lymphoma (HL and chronic lymphocytic leukemia (CLL treated in our institution. Material and methods: We reviewed medical records of patients with NHL, HL and CLL diagnosed according to the WHO classification and treated at our institution between January 2006. and December 2014. Results: A total of 1054 patients, 48.4% had high-grade NHL, 20.0% low-grade NHL, 14.5% HL, 7.1% other forms of lymphoma and 10.0% CLL. In group of lymphoma patients, 72 (6.8 % had at least one TE. TE included deep vein thrombosis (38.9%, jugular vein thrombosis (12.5%, pulmonary embolism (11.1%, CNS thrombosis (6.9%, superficial vein thrombosis (2.8%, acute myocardial infarction (1.4% and other (26.4%. In 49 patients thrombosis occurred during treatment or up to three months after therapy completion, whereas in 23 patients thrombosis was diagnosed prior to therapy. Patients with aggressive NHL and CLL had significantly higher incidence of TE (8.63%, 8.57% compared to other types of lymphoma patients (p = 0.009. There is no statistical significance of impact of different types of lymphoproliferative diseases on increased risk for TE. Conclusion: This study confirmed findings of some earlier studies of increased risk of thromboembolic events (TE in patients with aggressive forms of chronic lymphoproliferative diseasses, but there is no significantly impact of gender or age on that risk.

  4. Complicações tromboembólicas no paciente cirúrgico e sua profilaxia Thromboembolic complications in surgical patients and its prophylaxis

    Directory of Open Access Journals (Sweden)

    Eric Rassam

    2009-03-01

    Full Text Available INTRODUÇÃO: Complicações tromboembólicas tornam-se mais frequentes à medida que a população envelhece, pois o idoso apresenta com maior frequência fatores de risco como a imobilidade, procedimentos cirúrgicos, insuficiência venosa crônica, insuficiência cardíaca congestiva, neoplasias e outras doenças. O tromboembolismo venoso, causa de óbito hospitalar evitável mais comum no pós-operatório, engloba duas complicações principais: trombose venosa profunda e tromboembolismo pulmonar. Os fatores ligados à etiologia e patogenia do trombo compõem a Tríade de Rudolf Virchow que inclui lesão vascular endotelial, hipercoagulabilidade e estase venosa. Este artigo de revisão tem como objetivo evidenciar a importância de se conhecer as complicações tromboembólicas no paciente cirúrgico a fim de evitá-las. MÉTODOS: Foram selecionados os artigos com informações mais atualizadas sobre o assunto no Medline/PubMed, os quais mostraram que a tromboprofilaxia constitui a estratégia mais eficaz para reduzir morbidade e mortalidade por tromboembolismo venoso em pacientes cirúrgicos. A incidência de trombose venosa profunda proximal sem profilaxia encontra-se em torno de 25% a 32% e, com profilaxia, de 10% a 18%. CONCLUSÃO: Conhecer riscos de trombose venosa profunda pode aumentar a atenção em relação aos problemas de tromboembolismo pulmonar em pacientes hospitalizados e formar as bases de estratégias de profilaxia.INTRODUCTION: Thromboembolic complications become more frequent in elderly, because they present risk factors more frequently, such as immobility, surgeries, chronic venous insufficiency, congestive heart failure, cancer and other diseases. The venous thromboembolism (VTE, the cause of preventable hospital death more common in post-operative, includes two main complications: deep vein thrombosis (DVT and pulmonary thromboembolism (PTE. The factors linked to the etiology and pathogenesis of thrombus up the Triad

  5. Complications of Blepharoplasty: Prevention and Management

    Directory of Open Access Journals (Sweden)

    James Oestreicher

    2012-01-01

    Full Text Available Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal tendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just as important as surgical technique.

  6. Complications of blepharoplasty: prevention and management.

    Science.gov (United States)

    Oestreicher, James; Mehta, Sonul

    2012-01-01

    Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal tendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just as important as surgical technique.

  7. Prevention of the Musculoskeletal Complications of Hemophilia

    Directory of Open Access Journals (Sweden)

    E. C. Rodriguez-Merchan

    2012-01-01

    Full Text Available Hemophilia is an inherited disorder of clotting factor deficiencies resulting in musculoskeletal bleeding, including hemarthroses, leading to musculoskeletal complications. The articular problems of hemophiliac patients begin in infancy. These include: recurrent hemarthroses, chronic synovitis, flexion deformities, hypertrophy of the growth epiphyses, damage to the articular cartilage, and hemophilic arthropathy. The most commonly affected joints are the ankle, the knee, and the elbow. Hematologic prophylactic treatment from ages 2 to 18 years could avoid the development of hemophilic arthropathy if the concentration of the patient's deficient factor is prevented from falling below 1% of normal. Hemarthroses can be prevented by the administration of clotting factor concentrates (prophylaxis. However, high costs and the need for venous access devices in younger children continue to complicate recommendations for universal prophylaxis. Prevention of joint arthropathy needs to focus on prevention of hemarthroses through prophylaxis, identifying early joint disease through the optimal use of cost-effective imaging modalities and the validation of serological markers of joint arthropathy. Screening for effects on bone health and optimal management of pain to improve quality of life are, likewise, important issues. Major hemarthrosis and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy.

  8. [Venous thromboembolism prevention in pregnancy and the postpartum period in Primary and Specialized Care].

    Science.gov (United States)

    Gallo-Vallejo, J L; Naveiro-Fuentes, M; Puertas-Prieto, A; Gallo-Vallejo, F J

    2017-09-01

    After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Thromboembolic complications following a first isolated episode of superficial vein thrombosis: a cross-sectional retrospective study.

    Science.gov (United States)

    Bell, Lauren N; Berg, Richard L; Schmelzer, John R; Liang, Hong; Mazza, Joseph J; Kanth, Rajan; Bray, Christopher L; Zaldivar, Calixto B; Yale, Steven H

    2017-01-01

    Superficial vein thrombosis (SVT) may be associated with complications such as venous thromboembolism (VTE) and recurrent SVT. The purpose of this study was to explore risk factors among patients with a first isolated episode of SVT (index SVT) involving upper and lower extremities and to estimate the prevalence of VTE complications within 1 year of index SVT. Retrospective chart review of electronic records at Marshfield Clinic in Wisconsin identified 381 subjects with a first isolated SVT diagnosis (male/female: 170/211; median age 59.4 years). Patients were stratified based on whether they did (n = 44; 11.5 %) or did not (n = 337; 88.5 %) experience VTE complications and whether they did (n = 25; 6.6 %) or did not (n = 356; 93.4 %) experience pulmonary embolism (PE) and/or deep vein thrombosis (DVT) within 1 year of index SVT. There were 49 complications among 44 patients; these included DVT (n = 18, 36.7 %), propagation of SVT (n = 18, 36.7 %), PE (n = 9, 18.4 %), new SVT at different location (n = 3, 6.1 %), and recurrent SVT (n = 1, 2.0 %). Univariate analysis of all VTE complications identified seven potential risk factors and similar analysis of PE/DVT complications identified eight potential risk factors, with six common risk factors identified in both analyses. Multivariate analysis identified indwelling venous catheter 30 days prior to SVT (p = 0.044), cancer history with treatment in the previous year (p = 0.001), and non-surgical trauma 7 days prior to SVT (p < 0.001) as independent risk factors for PE/DVT complications. Independent risk factors identified in the current study may convey greater risk for VTE complications, especially PE/DVT, following an initial isolated SVT episode.

  10. Apixaban: Effective and Safe in Preventing Thromboembolic Events in Patients with Atrial Fibrillation and Renal Failure.

    Science.gov (United States)

    Cortese, Francesca; Scicchitano, Pietro; Gesualdo, Michele; Ricci, Gabriella; Carbonara, Santa; Franchini, Carlo; Pia Schiavone, Brigida Immacolata; Corbo, Filomena; Ciccone, Marco Matteo

    2017-11-17

    Thromboembolic events, principally stroke, represent one of the leading causes of morbidity and mortality among subjects with atrial fibrillation. Chronic kidney disease determines a further increase of thromboembolic events, bleeding and mortality and complicates the pharmacological management of patients with atrial fibrillation, mainly due to the side effects of antiarrhythmic and anticoagulant drugs with renal excretion. Apixaban is a new oral anticoagulant characterized by good bioavailability and renal elimination accounting for only 25%, showing a safety profile and effectiveness in patients with renal impairment. In this manuscript, we reviewed literature data on the use of apixaban in the management of non-valvular atrial fibrillation in patients with renal failure, in order to clarify an often-debated topic in clinical practice. A PubMed search was performed on the terms atrial fibrillation, apixaban and renal failure with the aim of identifying relevant manuscripts, large randomized clinical trials, meta-analyses, and current guidelines. Literature data show that apixaban could represent an interesting alternative to warfarin and other selective antagonists of coagulation factors in patients with impaired renal function. About the risk of major bleeding, apixaban appears to be safer than warfarin in the presence of any degree of renal failure. Apixaban show to be an effective anticoagulant in patients with atrial fibrillation, even superior to warfarin in reducing the risk of stroke and systemic embolism regardless of the presence of renal insufficiency. Moreover, Food and Drug Administration allows the use of apixaban in patients with end stage renal disease on hemodialysis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. Individual Risk and Prevention of Complications:

    DEFF Research Database (Denmark)

    Serup, Jørgen

    2017-01-01

    Doctors who are consulted about health and tattoo risks have an important role in the prevention of an individual's tattoo complications. Tattooing is a tremendous exposure of the human body to needle operation, particles, and chemicals. The risk is related to a person's health condition, level...... of insight, decision-making, and to the operation of tattooing, tattoo inks and utensils, tattoo parlour, and the aftercare. Tattooing is painful minor surgery performed without anesthesia. It can be associated with syncope. It is major needle trauma with histamine release and wheal and flare...... in the operation field. The skin barrier is broken. Bacterial infections come early. Chronically intermittent and mild complaints affect 4/10 of all the tattooed, and 2/10 have sensitivity to sun. Chronic complications with allergy in red tattoos and nodules due to pigment agglomeration and foreign body formation...

  12. Evaluation of hospital nurses' perceived knowledge and practices of venous thromboembolism assessment and prevention.

    Science.gov (United States)

    Lee, Jung-Ah; Grochow, Donna; Drake, Diane; Johnson, Linda; Reed, Preston; van Servellen, Gwen

    2014-03-01

    Venous thromboembolism (VTE) is a preventable cause of hospital death. Bedside registered nurses (RNs) are a key group that can be the first to recognize risks of patients in acute care settings. The purpose of this study was to identify bedside hospital RNs' perceived knowledge of VTE, their assessment practices, their self-efficacy in conducting VTE prevention care, and their perceived barriers to performing VTE risk assessment. An anonymous web-based survey on VTE risk assessment and prevention was conducted with RNs who provided direct patient care at two hospitals. RNs who were not directly involved in bedside patient care such as managers and educators were excluded. A total of 221 RNs completed the survey. Most participants rated their overall knowledge of VTE risk assessment between "good" (44%) and "fair" (28%). VTE assessment frequencies performed by participants varied widely. Participants reported high confidence in their ability to educate patients and families about VTE symptoms, prevention, and treatments. Participants were least confident in their own ability to conduct a thorough VTE risk assessment. Greater self-reported VTE knowledge was associated with greater VTE assessment frequency and self-efficacy for VTE preventive care. The most common perceived barriers in performing VTE risk assessment were lack of knowledge (21%) and lack of time (21%). The findings demonstrate a substantial need for focused education about VTE prevention for hospital nurses and support for hospital systems to monitor VTE care. Despite the Joint Commission emphasis on VTE risk assessment in all hospitalized patients, there remains a gap between current, evidence-based recommendations for VTE prevention and reported nursing practices. Published by Mosby, Inc.

  13. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation : insights from the RE-LY trial

    NARCIS (Netherlands)

    Westenbrink, B. D.; Alings, M.; Connolly, S. J.; Eikelboom, J.; Ezekowitz, M. D.; Oldgren, J.; Yang, S.; Pongue, J.; Yusuf, S.; Wallentin, L.; van Gilst, W. H.

    BackgroundAnemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). ObjectivesTo investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. Patients and methodsWe retrospectively analyzed the RE-LY

  14. Direct oral anticoagulants in the prevention of venous thromboembolism: evidence from major clinical trials.

    Science.gov (United States)

    Prandoni, Paolo; Temraz, Sally; Taher, Ali

    2014-04-01

    Hospitalized medical and surgical patients encompass a group of patients in whom venous thromboembolism (VTE) poses a major concern on morbidity and mortality. Recently, direct oral anticoagulants for the prevention of VTE have been developed to overcome the drawbacks of the food/drug interactions and the need for frequent laboratory monitoring and dose adjustments associated with the use of vitamin K antagonists and the inconvenience of the subcutaneous administration of low-molecular-weight heparins and fondaparinux. The novel oral anticoagulants that have been tested in major clinical trials for VTE prevention in medical and surgical patients are the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, rivaroxaban, and edoxaban, which will be the focus of this review. While the new drugs proved to be highly effective and safe in the prevention of VTE following major orthopedic surgery, they failed to show a favorable benefit-to-risk profile in hospitalized medical patients receiving extended anticoagulation beyond the hospital stay. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism

    Directory of Open Access Journals (Sweden)

    Patrick P Kneeland

    2010-03-01

    Full Text Available Patrick P Kneeland, Margaret C FangThe University of California, San Francisco Division of Hospital Medicine, San Francisco, CA, USAAbstract: Warfarin therapy reduces morbidity and mortality related to thromboembolism. Yet adherence to long-term warfarin therapy remains challenging due to the risks of anticoagulantassociated complications and the burden of monitoring. The aim of this paper is to review determinants of adherence and persistence on long-term anticoagulant therapy for atrial fibrillation and venous thromboembolism. We evaluate what the current literature reveals about the impact of warfarin on quality of life, examine warfarin trial data for patterns of adherence, and summarize known risk factors for warfarin discontinuation. Studies suggest only modest adverse effects of warfarin on quality of life, but highlight the variability of individual lifestyle experiences of patients on warfarin. Interestingly, clinical trials comparing anticoagulant adherence to alternatives (such as aspirin show that discontinuation rates on warfarin are not consistently higher than in control arms. Observational studies link a number of risk factors to warfarin non-adherence including younger age, male sex, lower stroke risk, poor cognitive function, poverty, and higher educational attainment. In addition to differentiating the relative impact of warfarin-associated complications (such as bleeding versus the lifestyle burdens of warfarin monitoring on adherence, future investigation should focus on optimizing patient education and enhancing models of physician–patient shared-decision making around anticoagulation.Keywords: anticoagulation, warfarin, adherence, persistence, thromboembolism

  16. Prevention of venous thromboembolism with an oral factor Xa inhibitor, YM150, after total hip arthroplasty. A dose finding study (ONYX-2)

    NARCIS (Netherlands)

    Eriksson, B. I.; Turpie, A. G. G.; Lassen, M. R.; Prins, M. H.; Agnelli, G.; Kälebo, P.; Wetherill, G.; Wilpshaar, J. W.; Meems, L.; Paireddy, A.; Wall, M.; Hermus, G.; Willems, M.; Zachrisson, B.; Wallin, J.; Eriksson, H.; Sandgren, G.; Angerås, U.; Falk, A.; Bergqvist, D.; Gallus, A.; Tijssen, J. G. P.; Pessayre, D.; Grohs, J. G.; Nogler, M.; Wurnig, C.; Gavrankapetanovic, I.; Maric, V.; Pavic, V.; Deniger, J.; Kofránek, I.; Pink, M.; Pink, T.; Hölmich, P.; Mejdahl, S.; Mikkelsen, S.; Leppilahti, J.; Pesola, M.; Fink, B.; Göbel, F.; Graichen, H.; Halder, A. M.; Kienapfel, H.; Kurth, A.; Ferrousis, I.; Macheras, G.; D'Angelo, A.; Baudo, F.; Borghi, B.; Della Rocca, G.; Fanelli, G.; Grappiolo, G.; Grossi, P.; Piovella, F.; Silingardi, M.; Spotorno, L.; Baurovskis, A.; Keselis, J.; Peredistijs, A.; Kocius, M.; Smailys, A.; Buciuto, R.; Hedlund, T.; Talsnes, O.; Bednarek, A.; Blacha, J.; Kwiatkowski, K.; Niedzwiedzki, T.; Skowronski, J. C.; Wojciechowski, P.; Dryagin, V.; Ivanov, P.; Kopenkin, S.; Kuropatkin, G.; Lapshinov, E.; Levin, G.; Linnik, S.; Medvedev, A.; Nikolaev, V.; Safronov, A.; Sergeev, S.; Harhaji, V.; Kecojevic, V.; Mitkovic, M.; Nedeljkovic, R.; Ristic, B.; Stosic, P.; Todorovic, P.; Hlavác, M.; Oslanec, D.; Alonso Aguirre, M. A.; Casa Pantoja, V.; Cruz Pardos, A.; Díaz Almodovar, J. L.; Gomar Sancho, F.; Otero Fernández, R.; Valle Ortiz, M. J.; Vilanova Vázquez, J. L.; Ahnfelt, L.; Andersson, C.; Petersson, L.-G.; Ponzer, S.

    2010-01-01

    BACKGROUND: Anticoagulant prophylaxis substantially reduces the risk of venous thromboembolism (VTE) after major orthopedic surgery. The direct factor Xa inhibitor YM150 is currently under investigation for the prevention of VTE, stroke and ischemic vascular events in patients after orthopedic

  17. [Edoxaban for stroke prevention in atrial fibrillation and treatment of venous thromboembolism: an expert position paper].

    Science.gov (United States)

    Weiss, Thomas W; Rohla, Miklos; Dieplinger, Benjamin; Domanovits, Hans; Fries, Dietmar; Vosko, Milan R; Gary, Thomas; Ay, Cihan

    2018-04-01

    Edoxaban is the most recent available representative of the Non-Vitamin K antagonist oral anticoagulants (NOAC). The approval was based on the largest phase III trials of NOACs for stroke prevention in patients with non-valvular atrial fibrillation (AF, ENGAGE-AF), and for the treatment of venous thromboembolism (VTE, HOKUSAI-VTE). In both trials, edoxaban was associated with similar efficacy and a significant reduction in bleeding events with respect to the pre-defined primary safety endpoints, as compared to warfarin.Additionally, the once daily dosing of edoxaban, the clinically investigated strategy for dose-reduction based on clearly defined criteria and the favorable pharmacokinetic profile might further support the clinical applicability of the substance.In the light of recent data, this expert consensus document aims to summarize the latest clinical trial results while providing a concise overview of current guideline recommendations on the management of patients with non-valvular AF and VTE.

  18. Potential role of new anticoagulants for prevention and treatment of venous thromboembolism in cancer patients

    Directory of Open Access Journals (Sweden)

    Gómez-Outes A

    2013-05-01

    Full Text Available Antonio Gómez-Outes,1 M Luisa Suárez-Gea,1 Ramón Lecumberri,2 Ana Isabel Terleira-Fernández,3,4 Emilio Vargas-Castrillón,3,4 Eduardo Rocha51Division of Pharmacology and Clinical Evaluation, Medicines for Human Use, Spanish Agency for Medicines and Medical Devices, Madrid, 2Department of Hematology, University Clinic of Navarra, Pamplona, 3Department of Clinical Pharmacology, Hospital Clínico, Madrid, 4Department of Pharmacology, Universidad Complutense, Madrid, 5Department of Hematology, School of Medicine, University of Navarra, Pamplona, SpainAbstract: Venous thromboembolism (VTE, encompassing deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Low molecular weight heparins are the preferred option for anticoagulation in cancer patients according to current clinical practice guidelines. Fondaparinux may also have a place in prevention of VTE in hospitalized cancer patients with additional risk factors and for initial treatment of VTE. Although low molecular weight heparins and fondaparinux are effective and safe, they require daily subcutaneous administration, which may be problematic for many patients, particularly if long-term treatment is needed. Studying anticoagulant therapy in oncology patients is challenging because this patient group has an increased risk of VTE and bleeding during anticoagulant therapy compared with the population without cancer. Risk factors for increased VTE and bleeding risk in these patients include concomitant treatments (surgery, chemotherapy, placement of central venous catheters, radiotherapy, hormonal therapy, angiogenesis inhibitors, antiplatelet drugs, supportive therapies (ie, steroids, blood transfusion, white blood cell growth factors, and erythropoiesis-stimulating agents, and tumor-related factors (local vessel damage and invasion, abnormalities in platelet function, and number. New anticoagulants in development for prophylaxis

  19. Efficacy and safety of the new oral anticoagulants in the treatment of venous thromboembolic complications: meta-analysis

    Directory of Open Access Journals (Sweden)

    V. I. Petrov

    2016-01-01

    Full Text Available Aim. Analysis of the efficacy and safety of the new oral anticoagulants (NOACs in the management of venous thromboembolism (VTE.Material and methods. This meta-analysis of randomized controlled trials (RCTs was made in accordance with the instructions “Preferred reporting items for systematic reviews and meta-analyses (PRISMA”.Results. The meta-analysis included 5 RCTs. NOACs were as effective as vitamin K antagonists (VKAs in preventing recurrent symptomatic VTE (RR=0.93; 95% CI 0.77-1.12; p=0.44. The incidence of recurrent thrombosis (RR=0.82; 95% CI 0.63-1.08; p=0.16 and deep vein thrombosis ± fatal or nonfatal pulmonary embolism (RR=1.06; 95% CI 0.81-1.40; p=0.66 was comparable in the groups of comparison. Meta-analysis of the safety of the NOACs suggested significant reduction of risk of major bleeding as compared with standard therapy (RR=0.54; 95% CI 0.42-0.69; р<0.00001. The incidence of all types of bleeding was significantly lower with NOACs (RR=0.70; 95% CI 0.51-0.95; p=0.02. All-cause mortality rate was comparable between the groups (RR=0.93; 95% CI 0.76-1.13; p=0.46.Conclusions. NOACs are as effective as the standard therapy, at that they are much safer in VTE treatment.

  20. Antibiotics to prevent complications following tooth extractions.

    Science.gov (United States)

    Lodi, Giovanni; Figini, Lara; Sardella, Andrea; Carrassi, Antonio; Del Fabbro, Massimo; Furness, Susan

    2012-11-14

    The most frequent indications for tooth extractions are dental caries and periodontal infections, and these extractions are generally done by general dental practitioners. Antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. To determine the effect of antibiotic prophylaxis on the development of infectious complications following tooth extractions. The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 25 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1948 to 25 January 2012), EMBASE via OVID (1980 to 25 January 2012) and LILACS via BIREME (1982 to 25 January 2012). There were no restrictions regarding language or date of publication. We included randomised double-blind placebo-controlled trials of antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. For dichotomous outcomes we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. The quality of the body of evidence has been assessed using the GRADE tool. This review included 18 double-blind placebo-controlled trials with a total of 2456 participants. Five trials were assessed at unclear risk of bias, thirteen at high risk, and none at low risk of bias. Compared to placebo, antibiotics probably reduce the risk of infection in patients undergoing third molar extraction(s) by approximately 70% (RR 0.29 (95% CI 0.16 to 0.50) P antibiotics to prevent one infection following extraction of impacted wisdom teeth. There is evidence that antibiotics may reduce

  1. Complications of an implantable venous access port: Prevention and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok; Song, Myung Gyu [Dept. of Radiology, Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Cha, In Ho [Dept. Radiology, Chungang University Hospital, Chungang University College of Medicine, Seoul (Korea, Republic of)

    2016-11-15

    Placement of an implantable venous access port (IVAP) is a popular procedure for repeated and intermittent chemotherapy in patients with malignancy. In this article, we present various IVAP related complications. In addition, we review the technical tips to prevent and manage the complications. It is important that the operator should keep the mechanism of the complications in mind, perform a careful procedure for prevention, and manage the complication properly and immediately in case of its development for safety and satisfaction of the patients Complications of an implantable venous access port: Prevention and treatment.

  2. How to prevent complications in breast augmentation

    OpenAIRE

    Nava, Maurizio Bruno; Rancati, Alberto; Angrigiani, Claudio; Catanuto, Giuseppe; Rocco, Nicola

    2017-01-01

    No high-level evidences about the best technique or the best implant to use for obtaining the best outcomes in aesthetic breast augmentation, with low complications and re-interventions rates exist from available literature. In this paper we present the actual best evidence about the etiopathogenesis of main complications in aesthetic breast augmentation, identifying some basic rules to follow in order to reduce complication rates in our daily activity, minimizing re-interventions, obtaining ...

  3. Idiopathic pulmonary fibrosis complicated by acute thromboembolic disease: chest X-ray, HRCT and multi-detector row CT angiographic findings.

    Science.gov (United States)

    Camera, Luigi; Campanile, Francesco; Imbriaco, Massimo; Ippolito, Renato; Sirignano, Cesare; Santoro, Ciro; Galderisi, Maurizio; Salvatore, Marco

    2013-02-01

    Idiopathic pulmonary fibrosis (IPF) is a chronic diffuse interstitial disease characterized by a predominant reticular pattern of involvement of the lung parenchyma which can be well documented by High Resolution Computed Tomography (HRCT). While almost half of the patients with IPF may develop pulmonary arterial hypertension, the occurrence of superimposed acute thrombo-embolic disease is rare.We describe a case of an 87 yrs old female who was found to have IPF complicated by acute pulmonary thrombo-embolism during the clinical and radiological investigation of a rapidly worsening dyspnea. While chest x-ray findings were initially considered consistent with a congestive heart failure, a bed side echocardiography revealed findings suggestive of pulmonary arterial hypertension and right ventricular failure with enlargement of both right cavities and associated valvular regurgitations. An acute thrombo-embolic disease was initially ruled out by a perfusion lung scintigraphy and subsequently confirmed by contrast-enhanced multi-detector CT which showed an embolus at the emergency of the right inter-lobar artery with associated signs of chronic pulmonary hypertension. However, unenhanced scans performed with both conventional and high resolution techniques also depicted a reticular pattern of involvement of lung parenchyma considered suggestive of IPF despite a atypical upper lobe predominance. IPF was later confirmed by further clinical, serological and instrumental follow-up.

  4. Tuberculosis and Venous Thromboembolism: a case series.

    Science.gov (United States)

    Goncalves, Ivone M; Alves, Daniela Costa; Carvalho, Aurora; do Ceu Brito, Maria; Calvario, Fernando; Duarte, Raquel

    2009-12-16

    Tuberculosis remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism is a rare complication of this disease, it may be a potentially life-threatening event. We report two cases of severe pulmonary tuberculosis associated with venous thromboembolism. A 38 year-old caucasian male that had a thromboembolic event as an unsual presentation form of tuberculosis and a 51 year-old caucasian male that developed deep venous thrombosis later in the course of the disease. An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician's awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.

  5. Prevention and treatment of complications following percutaneous nephrolithotomy

    NARCIS (Netherlands)

    Skolarikos, Andreas; de la Rosette, Jean

    2008-01-01

    PURPOSE OF REVIEW: The aim of this article is to identify classification and grading systems of percutaneous nephrolithotomy-related complications and evidence for the prevention and treatment of these complications. RECENT FINDINGS: A total complication rate of up to 83% following percutaneous

  6. New oral antithrombotics: focus on dabigatran, an oral, reversible direct thrombin inhibitor for the prevention and treatment of venous and arterial thromboembolic disorders

    Directory of Open Access Journals (Sweden)

    Dahl OE

    2012-01-01

    Full Text Available Ola E Dahl1,21Department of Orthopaedics, Innlandet Hospital Trust, Elverum Central Hospital, Elverum, Norway; 2Thrombosis Research Institute, London, UKAbstract: Venous thromboembolism, presenting as deep vein thrombosis or pulmonary embolism, is a major challenge for health care systems. It is the third most common vascular disease after coronary heart disease and stroke, and many hospitalized patients have at least one risk factor. In particular, patients undergoing hip or knee replacement are at risk, with an incidence of asymptomatic deep vein thrombosis of 40%–60% without thromboprophylaxis. Venous thromboembolism is associated with significant mortality and morbidity, with patients being at risk of recurrence, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Arterial thromboembolism is even more frequent, and atrial fibrillation, the most common embolic source (cardiac arrhythmia, is associated with a five-fold increase in the risk of stroke. Strokes due to atrial fibrillation tend to be more severe and disabling and are more often fatal than strokes due to other causes. Currently, recommended management of both venous and arterial thromboembolism involves the use of anticoagulants such as coumarin and heparin derivatives. These agents are effective, although have characteristics that prevent them from providing optimal anticoagulation and convenience. Hence, new improved oral anticoagulants are being investigated. Dabigatran is a reversible, direct thrombin inhibitor, which is administered as dabigatran etexilate, the oral prodrug. Because it is the first new oral anticoagulant that has been licensed in many countries worldwide for thromboprophylaxis following orthopedic surgery and for stroke prevention in patients with atrial fibrillation, this compound will be the main focus of this review. Dabigatran has been investigated for the treatment of established venous thromboembolism and prevention of

  7. Transgastric migration of gossypiboma: A preventable complication

    Directory of Open Access Journals (Sweden)

    Mahesh Kumar Goenka

    2015-01-01

    Full Text Available Gossypiboma is term given for retained piece of cotton/sponge during surgery. The incidence of gossypiboma has described as 1 in 1000-3000 surgeries. Incidence is underestimated because of underreporting due to fear of medico-legal litigation and extreme criticism by media. Intraluminal migration is a rare complication of gossypiboma. Small intestine is most common intraluminal site followed by duodenum. Here, we report sixth case of transgastric migration of gossypiboma.

  8. Complications of Proximal Interphalangeal Joint Injuries: Prevention and Treatment.

    Science.gov (United States)

    Kamnerdnakta, Sirichai; Huetteman, Helen E; Chung, Kevin C

    2018-05-01

    Proximal interphalangeal joint injuries are one of the most common injuries of the hand. The severity of injury can vary from a minor sprain to a complex intra-articular fracture. Because of the complex anatomy of the joint, complications may occur even after an appropriate treatment. This article provides a comprehensive review on existing techniques to manage complications and imparts practical points to help prevent further complications after proximal interphalangeal joint injury. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. [Prevention of complications fixed restorations in prosthetic patients with hypertension].

    Science.gov (United States)

    2014-04-01

    The author on the basis of clinical and laboratory methods justified, that the use of locally cream "Solcoseryl-Denta" persons suffering from arterial hypertension, increase the speed of recovery of normal epithelial layer of the cells of the mucous membranes of the oral cavity, and, consequently, prevents the development of complications in prosthetics. On the basis of research identified the need in developing a method of prevention of inflammatory complications in prosthetic patients with arterial hypertension.

  10. Preventing microvascular complications in type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Vijay Viswanathan

    2015-01-01

    Full Text Available Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c 20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour.

  11. Prevention and treatment of complications for thyroid-arterial embolization

    International Nuclear Information System (INIS)

    Yang Jijin; Yuan Min; Tian Jianming; Chen Wei; Yang Chaoai; Hao Qiang; Zou Dajing; Wang Yongchun

    2003-01-01

    Objective: To investigate the complications of thyroid-arterial embolization and their prevention and treatment. Methods: 61 cases of thyroid disorders received the therapy of thyroid-arterial embolization were retrospectively studied. The complications of arterial embolization during or after the procedure were analyzed. How to prevent and deal with these complications were discussed. Results: Sensitivity to contrast media occurred in 1 case and surgical arterial injury in 2. After embolization thyroid storm occurred in 1 patient and all other complications including headache (23 cases), toothache (11 cases), neckache (13 cases), hoarseness (37 cases) were caused by non-target arterial embolization with the most serious one of cerebral infarction (1 case) and another eyelid ptosis (1 case). The cerebral infarct one was treated with some vasodilating drugs and anti-coagulant, all others were given anti-symptomatics or no special treatment. Conclusions: Proper treatment should be ready during thyroid arterial embolization and given in time with occurrence of complications

  12. Intermittent pneumatic compression in combination with low-molecular weight heparin in the prevention of venous thromboembolic events in esophageal cancer surgery

    NARCIS (Netherlands)

    Parry, Kevin; Sadeghi, Amir Hossein; van der Horst, Sylvia; Westerink, Jan; Ruurda, Jelle P.; van Hillegersberg, Richard

    2017-01-01

    Introduction: Aim of this study was to evaluate the use of Intermittent Pneumatic Compression (IPC) in the prevention of symptomatic venous thromboembolic events (VTE) in patients undergoing esophagectomy for cancer. Methods: From a prospective database, all patients operated between 2010 and 2014

  13. Do preoperative antibiotics prevent dental implant complications?

    Science.gov (United States)

    Balevi, Ben

    2008-01-01

    The Cochrane Oral Health Group's Trials Registry, the Cochrane Central Register of Controlled Trials, Medline and Embase were consulted to find relevant work. Searches were made by hand of numerous journals pertinent to oral implantology. There were no language restrictions. Randomised controlled clinical trials (RCT) with a followup of at least 3 months were chosen. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Two reviewers independently assessed the quality and extracted relevant data from included studies. The estimated effect of the intervention was expressed as a risk ratio together with its 95% confidence interval (CI). Numbers-needed-to-treat (NNT) were calculated from numbers of patients affected by implant failures. Meta-analysis was done only if there were studies with similar comparisons that reported the same outcome measure. Significance of any discrepancies between studies was assessed by means of the Cochran's test for heterogeneity and the I2 statistic. Only two RCT met the inclusion criteria. Meta-analysis of these two trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics (relative risk, 0.22; 95% CI, 0.06-0.86). The NNT to prevent one patient having an implant failure is 25 (95%CI, 13-100), based on a patient implant failure rate of 6% in people not receiving antibiotics. The following outcomes were not statistically significantly linked with implant failure: prosthesis failure, postoperative infection and adverse events (eg, gastrointestinal effects, hypersensitivity). There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduces failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. One dose of

  14. Incretin-Based Therapy for Prevention of Diabetic Vascular Complications

    Directory of Open Access Journals (Sweden)

    Akira Mima

    2016-01-01

    Full Text Available Diabetic vascular complications are the most common cause of mortality and morbidity worldwide, with numbers of affected individuals steadily increasing. Diabetic vascular complications can be divided into two categories: macrovascular and microvascular complications. Macrovascular complications include coronary artery disease and cerebrovascular disease, while microvascular complications include retinopathy and chronic kidney disease. These complications result from metabolic abnormalities, including hyperglycemia, elevated levels of free fatty acids, and insulin resistance. Multiple mechanisms have been proposed to mediate the adverse effects of these metabolic disorders on vascular tissues, including stimulation of protein kinase C signaling and activation of the polyol pathway by oxidative stress and inflammation. Additionally, the loss of tissue-specific insulin signaling induced by hyperglycemia and toxic metabolites can induce cellular dysfunction and both macro- and microvascular complications characteristic of diabetes. Despite these insights, few therapeutic methods are available for the management of diabetic complications. Recently, incretin-based therapeutic agents, such as glucagon-like peptide-1 and dipeptidyl peptidase-4 inhibitors, have been reported to elicit vasotropic actions, suggesting a potential for effecting an actual reduction in diabetic vascular complications. The present review will summarize the relationship between multiple adverse biological mechanisms in diabetes and putative incretin-based therapeutic interventions intended to prevent diabetic vascular complications.

  15. [The efficacy of intermittent pneumatic compression in the prevention of venous thromboembolism in medical critically ill patients].

    Science.gov (United States)

    Zhang, Chuan; Zeng, Wei; Zhou, Hong; Zheng, Bi-xia; Cheng, Jin-chuan; Li, Xiao-yu; Jiang, Yuan-pu; Jiang, Li-dong; Li, Xiao-jin

    2011-09-01

    To evaluate the efficacy of intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE) in medical critically ill patients. A prospective, randomized, controlled study was conducted. One hundred and sixty-two medical critically ill patients were randomly assigned to IPC group and control group by random number table after admitted to intensive care unit (ICU) from June 2008 to June 2010. Patients under anticoagulation medicine therapy were excluded. Patients in the IPC group were treated with IPC to prevent VTE after ICU admission. No measures were taken to prevent VTE in the control group. The rate of VTE [deep vein thrombosis (DVT) and pulmonary embolism (PE)], duration of mechanical ventilation(MV), the length of stay in ICU, rate of non-sudden cardiac death and ICU mortality rate and related side-effects of IPC were compared during the subsequent 28 days between two groups. Compared with control group, IPC group was shown to have a significantly lower rate of DVT [3.80%(3/79) vs. 19.28%(16/83), P0.05). No related side-effects were found in the IPC group. IPC can prevent VTE, and lower the rate of non-sudden cardiac death, and it is safe in medical critically ill patients.

  16. Venous Thromboembolism Following Major Orthopedic Surgery

    Science.gov (United States)

    CIONAC FLORESCU, Simona; ANASTASE, Denisa-Madalina; MUNTEANU, Ana-Maria; STOICA, Ioan Cristian; ANTONESCU, Dinu

    2013-01-01

    ABSTRACT Venous thromboembolism (VTE) is an important complication of major orthopedic surgery (total hip arthroplasty-THA, total knee arthroplasty-TKA, hip fracture surgery-FHS) and is associated with significant morbidity and mortality. Despite this, not all patients receive an appropriate prophylaxis, often due to a disproportionate fear of bleeding complications. A challenge in the management of VTE prophylaxis is to balance the benefits of the treatment with the risk of bleeding. In this article, we review the latest guidelines recommendations regarding prevention of postoperative VTE in patients undergoing orthopedic surgery. PMID:24371484

  17. RIVAROXABAN IN THE PREVENTION OF THROMBOEMBOLIC COMPLICATIONS IN PATIENTS WITH ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    M. Yu. Gilyarov

    2012-01-01

    Full Text Available The possibilities of antithrombotic therapy in atrial fibrillation are highlighted. The alternative antithrombotic agents, including rivaroxaban presented along with the traditional drugs (acetyl-salicylic acid, warfarin. Efficacy and safety of rivaroxaban is considered on the basis of the results of the ROCKET-AF study.

  18. Cost-effectiveness analysis of rivaroxaban for treatment and secondary prevention of venous thromboembolism in the Netherlands.

    Science.gov (United States)

    Heisen, Marieke; Treur, Maarten J; Heemstra, Harald E; Giesen, Eric B W; Postma, Maarten J

    2017-08-01

    Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a novel oral anticoagulant associated with a significantly lower risk of major bleeds (hazard ratio = 0.54, 95% confidence interval = 0.37-0.79) compared to LMWH/VKA therapy, and does not require regular anticoagulation monitoring. To evaluate the health economic consequences of treating acute VTE patients with rivaroxaban compared to treatment with LMWH/VKA, viewed from the Dutch societal perspective. A life-time Markov model was populated with the findings of the EINSTEIN phase III clinical trial to analyze cost-effectiveness of rivaroxaban therapy in treatment and prevention of VTE from a Dutch societal perspective. Primary model outcomes were total and incremental quality-adjusted life years (QALYs), as well as life expectancy and costs. Over a patient's lifetime, rivaroxaban was shown to be dominant, with health gains of 0.047 QALYs and cost savings of €304 compared to LMWH/VKA therapy. Dominance was robustly present in all sensitivity analyses. Major drivers of the differences between the two treatment arms were related to anticoagulation monitoring (medical costs, travel costs, and loss of productivity) and the occurrence of major bleeds. Rivaroxaban treatment of patients with venous thromboembolism results in health gains and cost savings compared to LMWH/VKA therapy. This conclusion holds for the Dutch setting, both for the societal perspective, as well as the healthcare perspective.

  19. Complications of minimally invasive cosmetic procedures: Prevention and management

    Directory of Open Access Journals (Sweden)

    Lauren L Levy

    2012-01-01

    Full Text Available Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT, soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.

  20. Prevention of venous thromboembolic disease after total hip and knee arthroplasty.

    Science.gov (United States)

    Lieberman, Jay R; Hsu, Wellington K

    2005-09-01

    Patients undergoing total hip and knee arthroplasty are at increased risk for the development of venous thromboembolic disease, and there is general agreement that these patients require prophylaxis. The selection of a prophylactic agent involves a balance between efficacy and safety and often needs to be individualized for specific patients and institutions. Despite extensive research, the ideal agent for prophylaxis against deep venous thrombosis has not been identified. The results of randomized trials indicate that low-molecular-weight heparin, warfarin, and fondaparinux are the most effective prophylactic agents after total hip arthroplasty and that low-molecular-weight heparin, warfarin, fondaparinux, and pneumatic compression boots are the most effective agents after total knee arthroplasty. The duration of prophylaxis against deep venous thrombosis after total hip and knee arthroplasty remains controversial. Prophylaxis should be continued beyond hospital discharge. In the future, the determination of the duration of prophylaxis will be based on the risk stratification of individual patients. The practice of discharging patients from the hospital without prophylaxis, even when the decision is based on negative results of procedures that screen for the presence of deep venous thrombosis, is not cost-effective.

  1. [Advances in Pathogenesis and Related Clinical Research of Thromboembolism in Patients with Thalassemia after Splenectomy].

    Science.gov (United States)

    Sun, Na; Cheng, Peng; Deng, Dong-Hong

    2016-06-01

    Thalassemia is the most common human hereditary hemolytic anemia. Due to splenomegaly and hypersp-lenism, splenectomy can be used as a means of treatment for thalassemia. Various complications following splenectomy, however, especially thromboembolic complications are remarkable. This review summarizes the incidence, clinical manifestations and development time of thromboembolism. The pathogenesis of thromboembolism after splenectomy in thalassemia, such as abnormal platelet number and function, changes in red cell membrane, endothelial cell damage, dysfunction of other procoagulant and anticoagulant factors, and local factors associated with splenectomy are elaborated and the trategies to prevent and treat the thromboembolic events in thalassemia after splenectomy, including the attention to risk factors associated with splenectomy, a reassessment of splenectomy, regular blood transfusion to reduce the ratio of abnormal red blood cells, treatment with anticoagulant and antiplatelet drugs, application of hydroxyurea and stem cell transplantation are discussed.

  2. [Complications of cervicofacial radiotherapy. Prevention, diagnosis and multidisciplinary treatment].

    Science.gov (United States)

    Mano Azul, A; Rebelo, H

    1991-05-01

    This paper presents a review on the state of art about scientific knowledge on oral complications of head and neck radiotherapy, in an attempt to contribute for a better prevention, diagnosis and treatment. The authors also describe the protocols used on Instituto Português de Oncologia of Lisboa.

  3. Effects of different anticoagulant drugs on the prevention of complications in patients after arthroplasty: A network meta-analysis.

    Science.gov (United States)

    Gao, Ji-Hai; Chu, Xiu-Cheng; Wang, Lin-Liang; Ning, Bo; Zhao, Chuan-Xin

    2017-10-01

    After arthroplasty treatment, some complications commonly occur, such as early revision, infection/dislocation, and venous thromboembolism (VTE). This study aims to use a network meta-analysis to compare effects of 9 anticoagulant drugs (edoxaban, dabigatan, apixaban, rivaroxaban, warfarin, heparin, bemiparin, ximelagatran, and enoxaparin) in preventing postoperative complications in arthroplasty patients. After retrieving PubMed, Embase, and Cochrane Library database from the inception to November 2016, randomized controlled trials were enrolled. The integration of direct and indirect evidences was performed to calculate odd ratios and the surface under the cumulative ranking curves. Nineteen eligible randomized controlled trials were included. The network meta-analysis results showed that compared with warfarin, edoxaban, apixaban, and rivaroxaban had a lower incidence rate in asymptomatic deep venous thrombosis, which indicated that edoxaban, apixaban, and rivaroxaban had better effects on prevention. Similarly, in comparison to enoxaparin, edoxaban and rivaroxaban had better effect; rivaroxaban was better than ximelagatran in preventive effects. Compared with apixaban, edoxaban, dabigatan, rivaroxaban, and enoxaparin had a higher incidence rate in clinically relevant non-major bleeding, which showed that preventive effects were relatively poor. In addition, the results of the surface under the cumulative ranking curves showed that rivaroxaban and bemiparin worked best on symptomatic deep venous thrombosis and pulmonary embolism. In terms of bleeding, apixaban and warfarin had better preventive effects. Our findings suggested that rivaroxaban may work better in terms of symptomatic deep venous thrombosis and pulmonary embolism, whereas apixaban had better preventive effects in bleeding.

  4. Variability in initial response to standard clopidogrel therapy, delayed conversion to clopidogrel hyper-response, and associated thromboembolic and hemorrhagic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms.

    Science.gov (United States)

    Delgado Almandoz, Josser E; Kadkhodayan, Yasha; Crandall, Benjamin M; Scholz, Jill M; Fease, Jennifer L; Tubman, David E

    2014-12-01

    Variability in response to clopidogrel therapy is increasingly being recognized as an important factor in thromboembolic and hemorrhagic complications encountered after neurointerventional procedures. This study aims to determine the variability in response to clopidogrel therapy and associated complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms. We recorded baseline patient characteristics, co-administered medications, P2Y12 reaction units (PRU) values with VerifyNow, clopidogrel dosing, and thromboembolic and hemorrhagic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms at our institution during a 19 month period. 100 patients were included in the study, 76 women and 24 men, mean age 57.3 years. 15 patients exhibited an initial clopidogrel hypo-response (PRU >240) and 21 patients an initial clopidogrel hyper-response (PRU <60). 36 patients had a follow-up VerifyNow test performed without changes to the standard 75 mg daily clopidogrel dose, which demonstrated that 59% of patients who had initially been within the target 60-240 PRU range exhibited a delayed conversion to clopidogrel hyper-response. In our cohort, a clopidogrel hypo-response was associated with a significantly increased risk of thromboembolic complications in patients undergoing cerebral aneurysm treatment with stent assistance or the pipeline embolization device (60%, p=0.003), while a clopidogrel hyper-response was associated with a significantly increased risk of major hemorrhagic complications in all patients undergoing endovascular treatment of cerebral aneurysms (11%, p=0.016). We found wide and dynamic variability in response to clopidogrel therapy in patients undergoing endovascular treatment of unruptured cerebral aneurysms, which was significantly associated with thromboembolic and major hemorrhagic complications in our cohort. Published by the BMJ Publishing Group Limited. For permission to use (where

  5. The prevention of radiation-induced small bowel complications

    Energy Technology Data Exchange (ETDEWEB)

    Letschert, J.G.J. [Amsterdam Univ. (Netherlands). Academisch Ziekenhuis

    1995-07-01

    Moderate dose pelvic radiotherapy is associated with a 5% severe complication risk related to the small bowel. Strictures and/or fistulation can occur many years after treatment. These complications are difficult to treat, and surgical treatment (excision, bypass) bears a significant morbidity risk. The risk of chronic diarrhoea or malabsorption may increase to 40%, depending on the irradiated small bowel volume. Late small bowel complications are generally irreversible due to vascular aetiology. Prevention of these complications can be achieved by limiting the volume of small bowel treated. Consequence for radiotherapeutic techniques in treatment for rectal cancer are multiple beam set-up, customised blocking based on visualisation of the small bowel in the treatment position, and the use of a special open table-top device that results in a small bowel shift from the treatment field. (author).

  6. Contribution of novel anticoagulants fondaparinux and dabigatran to venous thromboembolism prevention

    Directory of Open Access Journals (Sweden)

    Antonijević Nebojša

    2015-01-01

    Full Text Available The data that episodes and sequels of venous thromboembolism (VTE are recorded in a significant percentage of patients receiving standard anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight heparin and vitamin K inhibitors as well as the fact that these drugs have significant limitations and that they may cause serious side-effects in some patients indicate the need for the introduction of new anticoagulant drugs. Fondaparinux, a selective inhibitor of Factor Xa, administered following major orthopedic surgeries having a high risk for the development of VTE, is more efficient than enoxaparin sodium used in European and North-American approved doses. The increased incidence of major bleeding (excluding fatal due to fondaparinux could be perhaps lowered by dosage reduction in patients with a mildly decreased creatinine clearance. Dabigatran, a peroral direct thrombin inhibitor, administered for VTE prophylaxis in elective hip and knee surgery, showed in to date studies the efficacy comparable (if dabigatran is given in both dosage regimes of 150 mg and 220 mg daily or superior (if dabigatran is given at a dose of 220 mg daily to enoxaparin administered in European-approved doses, while North American-approved doses of enoxaparin were superior than dabigatran in VTE reduction. No significant differences in bleeding rates were determined in any of the study groups. We consider that the introduction of new anticoagulants, including fondaparinux and dabigatran, will contribute to the establishment of a better safety profile and efficacy, and will also enable adequate therapy individualization for each patient depending on his/hers clinical characteristics. The introduction of novel peroral anticoagulants will, inter alia, significantly contribute to improvement in the quality of life, release the patient from numerous limitations in nutrition, interreaction, frequent laboratory monitoring, and also significantly improve therapeutic

  7. Aspirin and the prevention of venous thromboembolism following total joint arthroplasty: commonly asked questions.

    Science.gov (United States)

    Azboy, I; Barrack, R; Thomas, A M; Haddad, F S; Parvizi, J

    2017-11-01

    The number of arthroplasties being performed increases each year. Patients undergoing an arthroplasty are at risk of venous thromboembolism (VTE) and appropriate prophylaxis has been recommended. However, the optimal protocol and the best agent to minimise VTE under these circumstances are not known. Although many agents may be used, there is a difference in their efficacy and the risk of bleeding. Thus, the selection of a particular agent relies on the balance between the desire to minimise VTE and the attempt to reduce the risk of bleeding, with its undesirable, and occasionally fatal, consequences. Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis following arthroplasty. Many studies have shown its efficacy in minimising VTE under these circumstances. It is inexpensive and well-tolerated, and its use does not require routine blood tests. It is also a 'milder' agent and unlikely to result in haematoma formation, which may increase both the risk of infection and the need for further surgery. Aspirin is also unlikely to result in persistent wound drainage, which has been shown to be associated with the use of agents such as low-molecular-weight heparin (LMWH) and other more aggressive agents. The main objective of this review was to summarise the current evidence relating to the efficacy of aspirin as a VTE prophylaxis following arthroplasty, and to address some of the common questions about its use. There is convincing evidence that, taking all factors into account, aspirin is an effective, inexpensive, and safe form of VTE following arthroplasty in patients without a major risk factor for VTE, such as previous VTE. Cite this article: Bone Joint J 2017;99-B:1420-30. ©2017 Azboy et al.

  8. Venous and arterial thrombo-embolic complications of hormonal treatment in a male-to-female transgender patient.

    LENUS (Irish Health Repository)

    Mullins, G M

    2012-02-03

    We present a male-to-female (MTF) transgender patient admitted with a pulmonary embolism. The patient had been treated with high-dose oestrogens since the age of 16. Following a prolonged period of hypotension, our patient sustained cerebral border zone infarcts. There was evidence of bilateral carotid stenosis on Doppler ultrasound. We discuss the treatment and vascular complications of gender dysphoria.

  9. Reducing potentially preventable complications at the multi hospital level

    Directory of Open Access Journals (Sweden)

    Czyz Anne

    2011-07-01

    Full Text Available Abstract Background This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes. Findings This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems. The program is noteworthy because it included competing hospitals in the same community working together to reduce adverse patient outcomes and related costs. The study data identified statistically significant reductions in the frequency of high and low volume complications during the three year period at two of the hospitals. At both of these hospitals, aggregate complication rates also declined. At these hospitals, the differences between actual complication rates and severity adjusted complication rates were also reduced. At the third hospital, specific and aggregate complication rates remained the same or increased slightly. Differences between these rates and those of severity adjusted comparison population also remained the same or increased. Conclusions Results of the study suggested that, in one community health care system, the progress of reducing complications involved different experiences. At two hospitals with relatively higher rates at the beginning of the study, management by administrative and clinical staff outside quality assurance produced significant reductions in complication rates, while at a hospital with lower rates, management by quality assurance staff had little effect on reducing the rate of PPCs.

  10. Prevention and treatment of complications after transjugular intrahepatic portosystemic shunt

    Directory of Open Access Journals (Sweden)

    XUE Hui

    2016-02-01

    Full Text Available The application of transjugular intrahepatic portosystemic shunt (TIPS in the treatment of cirrhotic portal hypertension has been widely accepted both at home and abroad. This article focuses on the fatal complications of TIPS (including intraperitoneal bleeding and acute pulmonary embolism, shunt failure, and recurrent portosystemic hepatic encephalopathy, and elaborates on the reasons for such conditions and related preventive measures, in order to improve the accuracy and safety of intraoperative puncture, reduce common complications such as shunt failure and hepatic encephalopathy, and improve the clinical effect of TIPS in the treatment of cirrhotic portal hypertension.

  11. Bone graft complications: what can we do to prevent them?

    Science.gov (United States)

    Tandon, Rahul; Herford, Alan S.

    2014-03-01

    Introduction: Bone grafts are commonly used in oral and maxillofacial surgery, helping to restore missing bone structure and provide osseous support. In spite of their reported success, complications can and do arise. Examples include loosening and resorption of the graft, infection, and complete loss of the graft. These complications can potentially lead to larger defects, necessitating additional procedures to correct the problem. This not only causes great discomfort to the patient, but also drains considerable time and resources away from the clinician. Thus, improvements on identifying ways to identify and prevent these complications are constantly being sought. We have performed a literature review and identified several areas in the field of optics that could potentially help solve our problem. Optical Techniques: Raman spectroscopy has been shown to provide a transcutaneous measurement of bone mineral and matrix Raman bands. This could potentially provide surgeons with the ability to more accurately assess bone graft osseointegration. In-vivo near-infrared optical imaging could potentially provide accurate diagnosis of pathologic lesions such as osteosarcoma. Contrast-enhanced ultrasound could be used to detect vascular disturbances and other information related to the transplantation of osseous components. Conclusion: Bone graft complications can be one of the most devastating consequences of osseous surgery. As surgeons, we are constantly searching for ways to identify them earlier and prevent them. We hope that by presenting areas that could be used, we can gain a better insight to ways in which both fields can benefit.

  12. Embolis cutis medicamentosa, a rare preventable iatrogenic complication

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    Manjunath Kavya,

    2015-07-01

    Full Text Available Embolis cutis medicamentosa is an uncommon iatrogenic complication characterised by variable degree of skin and tissue necrosis, likely to follow intramuscular injection. Intense pain and purplish discoloration of overlying skin, with or without reticulate pattern subsequently followed by tissue necrosis and scarring is highly specific for this syndrome. It has also been reported following intravenous, intra-articular and subcutaneous injections. Herein we are reporting two cases of this rare preventable entity.

  13. [Rivaroxaban versus standard of care in venous thromboembolism prevention following hip or knee arthroplasty in daily clinical practice (Spanish data from the international study XAMOS)].

    Science.gov (United States)

    Granero, J; Díaz de Rada, P; Lozano, L M; Martínez, J; Herrera, A

    2016-01-01

    To analyse the effectiveness and safety of rivaroxaban vs. standard treatment (ST) in the prevention of venous thromboembolism after hip or knee replacement in daily clinical practice in Spain. A sub-analysis of the Spanish data in the XAMOS international observational study that included patients>18 years who received 10mg o.d. rivaroxaban or ST. up to 3 months after surgery. incidence of symptomatic/asymptomatic thromboembolic events, bleeding, mortality, and other adverse events; use of health resources and satisfaction after hospital discharge. Of the total 801 patients included, 410 received rivaroxaban and 391 ST (64.7% heparin, 24.0% fondaparinux, 11% dabigatran). The incidence of symptomatic thromboembolic events and major bleeding was similar in both groups (0.2% vs. 0.8% wit ST and 0.7% vs. 1.3% with ST [EMA criteria]/0.0% vs. 0.3% with ST [RECORD criteria]). The adverse events incidence associated with the drug was significantly higher rivaroxaban (overall: 4.4% vs. 0.8% with ST, P=.001; serious: 1.5% vs. 0.0% with ST, P=.03). The rivaroxaban used less health resources after discharge, and the majority considered the tolerability as «very good« and the treatment as «very comfortable». Rivaroxaban is at least as effective as ST in the prevention of venous thromboembolism prevention in daily clinical practice, with a similar incidence of haemorrhages. It provides greater satisfaction/comfort, and less health resources after discharge. These results should be interpreted taking into account the limitations inherent in observational studies. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Treatment and Prevention of Common Complications of Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sheikh Salahuddin Ahmed

    2014-01-01

    Full Text Available Chronic kidney disease (CKD is a worldwide public health problem with an increasing incidence and prevalence. Outcomes of CKD include not only complications of decreased kidney function and cardiovascular disease but also kidney failure causing increased morbidity and mortality. Unfortunately, CKD is often undetected and undertreated because of its insidious onset, variable progression, and length of time to overt kidney failure. Diabetes is now the leading cause of CKD requiring renal replacement therapy in many parts of the world, and its prevalence is increasing disproportionately in the developing countries. This review article outlines the current recommendations from various clinical guidelines and research studies for treatment, prevention and delaying the progression of both CKD and its common complications such as hypertension, anemia, renal osteodystrophy, electrolyte and acid-base imbalance, and hyperlipidemia. Recommendations for nutrition in CKD and measures adopted for early diabetic kidney disease to prevent further progression have also been reviewed. There is strong evidence that early detection and management of CKD can prevent or reduce disease progression, decrease complications and improve outcomes. Evidence supports that achieving optimal glucose control, blood pressure, reduction in albuminuria with a multifactorial intervention slows the progression of CKD. Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists are most effective because of their unique ability to decrease proteinuria, a factor important for the progression of CKD.

  15. Complications of thoracentesis: incidence, risk factors, and strategies for prevention.

    Science.gov (United States)

    Cantey, Eric P; Walter, James M; Corbridge, Thomas; Barsuk, Jeffrey H

    2016-07-01

    Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema. Recent data support the importance of operator expertise and the use of ultrasound in reducing the risk of iatrogenic pneumothorax. Although coagulopathy or thrombocytopenia and the use of anticoagulant or antiplatelet medications have traditionally been viewed as contraindications to thoracentesis, new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk. Re-expansion pulmonary edema, a rare complication of thoracentesis, is felt to result in part from the generation of excessively negative pleural pressure. When and how to monitor changes in pleural pressure during thoracentesis remains a focus of ongoing study. Major complications of thoracentesis are uncommon. Clinician awareness of risk factors for procedural complications and familiarity with strategies that improve outcomes are essential components for safely performing thoracentesis.

  16. Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study.

    Science.gov (United States)

    Duff, Jed; Omari, Abdullah; Middleton, Sandy; McInnes, Elizabeth; Walker, Kim

    2013-10-08

    Despite the availability of evidence-based guidelines on venous thromboembolism (VTE) prevention clinical audit and research reveals that hospitalised medical patients frequently receive suboptimal prophylaxis. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on the provision of VTE prophylaxis to hospitalised medical patients in a 270 bed acute care private hospital in metropolitan Australia. The study used an uncontrolled before-and-after design with accompanying process evaluation. The acceptability of the intervention to participants was measured with a post intervention survey; descriptive data on resource use was collected as a measure of utility; and clinical impact (prophylaxis rate) was assessed by pre and post intervention clinical audits. Doctors who admit >40 medical patients each year were targeted to receive the intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15 to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004). EOV is effective at improving doctors' provision of pharmacological VTE prophylaxis to hospitalised medical patients. It was also found to be an acceptable implementation strategy by the majority

  17. Secondary prevention of cardiogenic arterial thromboembolism in the cat: The double-blind, randomized, positive-controlled feline arterial thromboembolism; clopidogrel vs. aspirin trial (FAT CAT).

    Science.gov (United States)

    Hogan, Daniel F; Fox, Philip R; Jacob, Kristin; Keene, Bruce; Laste, Nancy J; Rosenthal, Steven; Sederquist, Kimberly; Weng, Hsin-Yi

    2015-12-01

    To determine if clopidogrel administration is associated with a reduced likelihood of recurrent cardiogenic arterial thromboembolism (CATE) in cats compared to aspirin administration. Secondary aims were to determine if clopidogrel administration had an effect on the composite endpoint of recurrent CATE and cardiac death and to identify adverse effects of chronic clopidogrel or aspirin therapy. Seventy-five cats that survived a CATE event. Multicenter, double-blind, randomized, positive-controlled study. Cats were assigned to clopidogrel (18.75 mg/cat PO q 24 h) or aspirin (81 mg/cat PO q 72 h). Kaplan-Meier survival curves were created for each endpoint and the log rank test performed to compare treatment groups with respect to time to event and the likelihood of the event occurring. The mean age of all cats was 8.0 ± 3.5 yr and 57/75 (76%) were male (p history of heart disease recorded prior to the CATE event. Clopidogrel administration was associated with significantly reduced likelihood of recurrent CATE compared to aspirin (p = 0.024) and had a longer median time to recurrence [443 (95% CI 185-990) days vs. 192 (95% CI 62-364) days, respectively]. Clopidogrel was also associated with a significantly reduced likelihood of the composite endpoint of recurrent CATE or cardiac death (p = 0.033) with a longer median time to event [346 (95% CI 146-495) days vs. 128 (95% CI 58-243) days]. Clopidogrel administration significantly reduces the likelihood of recurrent CATE compared with aspirin in cats; both drugs were well tolerated. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. PROGNOSIS, PREVENTION, AND TREATMENT OF DIABETIC CATARACT SURGERY POSTOPERATIVE COMPLICATIONS

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    M. A. Kovalevskaya

    2015-01-01

    Full Text Available Aim. To study immune and antioxidant status of diabetic cataract patients and to assess the efficacy of preoperative preparation for diabetic cataract surgery to prevent intra- and postoperative complications and the efficacy of cataract treatment in metabolic syndrome patients. Patients and methods. 136 cataract patients (272 eyes were examined (mean age 62±3.2 years. Among these patients, women predominated (n = 74. Control group included 25 healthy volunteers (10 men and 15 women aged 32‑56 (mean age 44.3±2.4 years without ocular diseases (50 eyes. Two patient groups were examined. Group 1 included 78 patients (mean age 54±1.5 younger than 60 (52.5 % with similar lens morphological changes and metabolic disorders who were diagnosed with complicated (diabetic cataract. Group 2 included 58 patients with age-related cataract. Tear, anterior chamber (AC humor, and blood tests were performed. Immune status, lipid peroxidation parameters in tear fluid and blood, active peroxiredoxin 6 (PRDX6 and / or its breakdown fragments in tear fluid and AC humor were studied. In group 1 (age-related cataracts, somatic disorders were diagnosed in 4.5 % of cases, in group 2 (complicated cataracts, somatic disorders were diagnosed in 100 % of cases. Expression of protective enzymes against oxidative stress in tear fluid was studied. Activity of tear antioxidant enzymes under oxidative stress conditions in therapy and after cataract surgery was evaluated. Results. Postoperatively, increase in PRDX6 level was revealed in age-related cataract patients. The absence of phaco complications confirms these findings. In complicated (diabetic cataracts, PRDX6 level was 6‑times less than in age-related cataracts. Conclusions. Prophylaxis of inflammatory complications in age-related cataract patients can be performed using the following schedule: 0.5 % levofloxacin 4 times daily, bromfenac once daily. 

  19. Patient factors influencing dermal filler complications: prevention, assessment, and treatment

    Directory of Open Access Journals (Sweden)

    De Boulle K

    2015-04-01

    Full Text Available Koenraad De Boulle,1 Izolda Heydenrych2 On behalf of the Consensus Group 1Aalst Dermatology Group, Aalst, Belgium; 2Cape Town Cosmetic Dermatology Centre, Century City, South Africa Abstract: While rare, complications do occur with the esthetic use of dermal fillers. Careful attention to patient factors and technique can do much to avoid these complications, and a well-informed practitioner can mitigate problems when they do occur. Since cosmetic surgery is usually an elective process, requested by the patient, clinical trials are complex to organize and run. For this reason, an international group of practicing physicians in the field of esthetics came together to share knowledge and to try and produce some informed guidance for their colleagues, considering the literature and also pooling their own extensive clinical experience. This manuscript aims to summarize the crucial aspects of patient selection, including absolute contraindications as well as situations that warrant caution, and also covers important considerations for the pre- and posttreatment periods as well as during the procedure itself. Guidance is given on both immediate and long-term management of adverse reactions. The majority of complications are related to accepting patients inappropriate for treatment or issues of sterility, placement, volume, and injection technique. It is clear that esthetic practitioners need an in-depth knowledge of all aspects of treatment with dermal fillers to achieve optimal outcomes for their patients. Keywords: dermal fillers, complications, prevention, assessment, treatment, patient factors

  20. Haemorrhagic Complications and Symptomatic Venous Thromboembolism in Interventional Tumour Ablations: The Impact of Peri-interventional Thrombosis Prophylaxis

    Energy Technology Data Exchange (ETDEWEB)

    Mohnike, Konrad, E-mail: konrad.mohnike@med.ovgu.de; Sauerland, Hanna; Seidensticker, Max [Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Klinik für Radiologie und Nuklearmedizin (Germany); Hass, Peter [Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Klinik für Strahlentherapie (Germany); Kropf, Siegfried [Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Institut für Biometrie (Germany); Seidensticker, Ricarda; Friebe, Björn; Fischbach, Frank; Fischbach, Katharina; Powerski, Maciej; Pech, Maciej; Grosser, O. S.; Kettner, Erika; Ricke, Jens [Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Klinik für Radiologie und Nuklearmedizin (Germany)

    2016-12-15

    AimThe aim of this study was to assess the rates of haemorrhagic and thrombotic complications in patients undergoing interventional tumour ablation with and without peri-interventional low-molecular-weight heparin (LMWH) thrombosis prophylaxis.MethodsPatients presented with primary and secondary neoplastic lesions in the liver, lung, kidney, lymph nodes and other locations. A total of 781 tumour ablations (radiofrequency ablation, n = 112; interstitial brachytherapy, n = 669) were performed in 446 patients over 22 months; 260 were conducted under peri-interventional thrombosis prophylaxis with LMWH (H-group;) and 521 without this (NH-group, in 143 of these, LMWH was given post-interventionally).ResultsSixty-three bleeding events occurred. There were significantly more bleedings in the H-group than in the NH-group (all interventions, 11.66 and 6.26 %, p = 0.0127; liver ablations, 12.73 and 7.1 %, p = 0.0416). The rate of bleeding events Grade ≥ III in all procedures was greater by a factor of >2.6 in the H-group than in the NH-group (4.64 and 1.73 %, p = 0.0243). In liver tumour ablations, the corresponding factor was about 3.3 (5.23 and 1.54 %, p = 0.028). In uni- and multivariate analyses including covariates, the only factor constantly and significantly associated with the rate of haemorrhage events was peri-interventional LMWH prophylaxis. Only one symptomatic lung embolism occurred in the entire cohort (NH-group). The 30- and 90-day mortalities were significantly greater in the H-group than in the NH-group.ConclusionsPeri-interventional LMWH thrombosis prophylaxis should be considered with caution. The rate of clinically relevant thrombotic events was extremely low.

  1. Randomized controlled trial of enoxaparin versus intermittent pneumatic compression for venous thromboembolism prevention in Japanese surgical patients with gynecologic malignancy.

    Science.gov (United States)

    Nagata, Chie; Tanabe, Hiroshi; Takakura, Satoshi; Narui, Chikage; Saito, Motoaki; Yanaihara, Nozomu; Okamoto, Aikou

    2015-09-01

    The aim of this study was to compare the efficacy and safety of enoxaparin and intermittent pneumatic compression (IPC) for venous thromboembolism (VTE) prevention in Japanese surgical patients with gynecologic malignancy. Patients ≥ 40 years old undergoing major surgery for gynecologic malignancy without preoperative VTE were included. Written informed consent was obtained. Enrolled patients received IPC immediately before surgery. After surgery, they were randomly assigned to either an enoxaparin group or an IPC-alone group. The enoxaparin group received enoxaparin injection (20 mg, subcutaneous, every 12 h) from postoperative day 2 to 8. IPC was discontinued after the first injection. In the IPC-alone group, IPC was continued until full ambulation. The primary end-point was incidence of VTE, including pulmonary embolism and deep vein thrombosis, regardless of symptoms. An interim analysis was to be conducted when the first 30 patients had completed the study protocol. A Data and Safety Monitoring Board was established for making recommendation on the continuation or termination of the study based on the interim results. At the time of the interim analysis, six cases of VTE were found: five in the IPC-alone group and one in the enoxaparin group (Fisher's exact test, P = 0.08). Three patients in the IPC-alone group developed pulmonary embolism, but none in the enoxaparin group did so (Fisher's exact test, P = 0.10). The study was terminated following the Data and Safety Monitoring Board's recommendation. Enoxaparin might have lowered the risk of VTE among surgical patients with gynecologic malignancy. Further studies are necessary to confirm this. © 2015 Japan Society of Obstetrics and Gynecology.

  2. Tromboprofilaxis en pacientes no quirúrgicos internados en un hospital general Venous thromboembolism prevention in non-surgical adult patients admitted in a general hospital

    Directory of Open Access Journals (Sweden)

    Marcelo J. Melero

    2012-10-01

    Full Text Available Los pacientes adultos internados por una enfermedad no quirúrgica tienen un riesgo alto de padecer una tromboembolia venosa y pueden desarrollar alguna forma de esta enfermedad cuando no reciben un tratamiento preventivo adecuado. Los objetivos de este estudio prospectivo, analítico, observacional y transversal, fueron: 1 determinar cuál es el porcentaje de pacientes adultos internados por una enfermedad aguda no quirúrgica en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, que tienen indicación de tromboprofilaxis, 2 establecer cuántos de ellos reciben un tratamiento preventivo para la tromboembolia venosa, y 3 comprobar cuántos estaban medicados con alguna forma de tromboprofilaxis sin tener causas que justificaran este tratamiento. Se estudiaron 93 pacientes durante un lapso de 72 horas consecutivas. Se encontró que el 90.3% de ellos necesitaba un tratamiento preventivo para la tromboembolia venosa y el 76.2% de estos enfermos recibían tromboprofilaxis farmacológica. Un 33.3% de los pacientes internados tenía indicado un tratamiento farmacológico preventivo sin tener una causa que justificara esta prescripción. El porcentaje encontrado de pacientes tratados con tromboprofilaxis es más alto que el comunicado en otros estudios observacionales.Adult patients hospitalized for a non-surgical condition, usually have a high risk of venous thromboembolism and may develop some form of this disease when they do not receive appropriate preventive treatment. The objectives of this prospective, analytical, observational and cross-sectional study were: 1 to determine what percentage of adult patients hospitalized for a non-surgical acute condition at the Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, had indication for preventive thromboprophylaxis, 2 to establish how many of them had been prescribed a preventive treatment of venous thromboembolism, 3 to establish how many of them had been

  3. [Venous thromboembolic disease: presentation of a case].

    Science.gov (United States)

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  4. Risk factors and prevention of vascular complications in polycythemia vera.

    Science.gov (United States)

    Barbui, T; Finazzi, G

    1997-01-01

    Risk factors for vascular complications in polycythemia vera (PV) include laboratory and clinical findings. Among laboratory values, the hematocrit has been clearly associated with thrombosis, particularly in the cerebral circulation. Platelet count is a possible but not yet clearly established predictor of vascular complications. Platelet function tests are of little help in prognostic evaluation because most attempts to correlate these abnormalities with clinical events have been disappointing. Clinical predictors of thrombosis include increasing age and a previous history of vascular events. Identifying risk factors for thrombosis is important to initiate therapy. Phlebotomy is associated with an increased incidence of thrombosis in the first 3 to 5 years, whereas chemotherapy may induce a higher risk of secondary malignancies after 7 to 10 years of follow-up. New cytoreductive drugs virtually devoid of mutagenic risk include interferon-alpha and anagrelide, but their role in reducing thrombotic complications remains to be demonstrated. Antithrombotic drugs, such as aspirin, are frequently used in PV, despite doubts regarding safety and efficacy. Two recent studies from the Gruppo Italiano Studio Policitemia Vera (GISP) assessed the rate of major thrombosis as well as the tolerability of low-dose aspirin in PV patients. These investigations created a favorable scenario for launching a European collaborative clinical trial (ECLAP study) aimed at testing the efficacy of low-dose aspirin in preventing thrombosis and prolonging survival in patients with PV.

  5. Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

    Science.gov (United States)

    Faustino, Ana; Paiva, Luís; Providência, Rui; Trigo, Joana; Botelho, Ana; Costa, Marco; Leitão-Marques, António

    2013-06-01

    In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism. To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed. Patients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography. The procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%). In our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. Management of tetanus complication

    Science.gov (United States)

    Somia, I. K. A.

    2018-03-01

    The mortality rate of tetanus is still high; it is because of various complications due to muscle spasms, autonomic dysfunction, as well as due to prolonged critical care. Management of tetanus with its complications is in intensive care facilities. Management goals include stopping toxin production, neutralization of unbound toxin, management of the airway, muscle spasm control, treatment of autonomic dysfunction and general supportive management. Currently, diazepam is still an effective medication to control of muscle spasm and rigidity. Therapy for autonomic dysfunction that supported by evidence is MgSO4. Also, general supportive management for long-term care remains necessary to prevent other complications such as thromboembolism, infection, malnutrition, and others.

  7. Antibiotics for preventing complications in children with measles.

    Science.gov (United States)

    Kabra, Sushil K; Lodha, Rakesh

    2013-08-14

    Measles is the leading killer among vaccine-preventable diseases; it is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually. To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality. We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013). Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles. Two review authors independently extracted data and assessed trial quality. Seven trials with 1263 children were included. The methodological quality of most studies was poor. Only two studies were randomized, double-blind trials. There was variation in antibiotics used, their doses, schedule and evaluation of outcome. Pooled study data showed that the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. Of the 654 children who received antibiotics, 27 (4.1%) developed pneumonia; while out of 609 children in the control group, 59 (9.6%) developed pneumonia (odds ratio (OR) 0.35; 95% confidence interval (0.12 to 1.01). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment. If the results of this trial are removed from the meta-analysis, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.26; 95% CI 0.12 to 0.60). The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or

  8. [Prevention of venous thromboembolic disease in the critical patient: an assessment of clinical practice in the Community of Madrid].

    Science.gov (United States)

    García-Olivares, P; Guerrero, J E; Tomey, M J; Hernangómez, A M; Stanescu, D O

    2014-01-01

    To analyze measures referred to venous thromboembolic prophylaxis in critically ill patients. An epidemiological, cross-sectional (prevalence cut), multicenter study was performed using an electronic survey. Comparison of results with quality indexes of the Spanish Society of Intensive Care Medicine, the American College of Chest Physician guidelines and international studies. Intensive Care Units (ICUs) in the Community of Madrid (Spain). All patients admitted to the ICU on the day of the survey. General aspects of venous thromboembolic prophylaxis and protocols used (risk stratification and ultrasound screening). A descriptive analysis was performed, continuous data being expressed as the mean or median, and categorical data as percentages. A total of 234 patients in 18 ICUs were included. Eighteen percent (42/234) received no prophylaxis, and 55% had no contraindication to pharmacological prophylaxis. Of the 192 patients receiving prophylaxis, 84% received pharmacological prophylaxis, 14% mechanical prophylaxis and 2% combined prophylaxis. Low molecular weight heparin was the only pharmacological prophylaxis used, with a majority use of enoxaparin (17 of 18 ICUs). In patients with mechanical prophylaxis (31/192), antiembolic stockings were the most commonly used option (58%). Pharmacological prophylaxis contraindications were reported in 20% of the patients (46/234), the most frequent cause being thrombocytopenia (28% of the cases). Fifty percent of the ICUs used no specific venous thromboembolic prophylaxis protocol. Pharmacological prophylaxis with low molecular weight heparin was the most frequently used venous thromboembolic prophylactic measure. In patients with contraindications to pharmacological prophylaxis, mechanical measures were little used. The use of combined prophylaxis was anecdotal. Many of our ICUs lack specific prophylaxis protocols. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  9. [Antibiotic treatment for prevention of infectious complications in joint replacement].

    Science.gov (United States)

    Jahoda, D; Nyc, O; Pokorný, D; Landor, I; Sosna, A

    2006-04-01

    used only in indicated cases when deep infection is suspected and no assessment of the causative agent is available. Otherwise this approach carries a high risk of infectious complications in aseptic revision arthroplasty. Long-term, unjustified administration of antibiotics leads to an increase in resistance to the antibiotic involved. Some studies show that a day's course is as effective as a seven-day one. A shorter antibiotic course decreases the costs, reduces side-effects and minimizes the development of resistance. An optimal duration of antibiotic treatment has not been defined yet, and is still a hot issue for discussion. Many authors recommend one pre-operative antibiotic dose and, according to the kind of antibiotic, agree to its 24-hour administration in order to lower the toxic effect of antibiotic and to prevent selection of resistant microorganisms. The choice of suitable antibiotics for prophylactic treatment should be based on the range of agents causing joint replacement infections and the pharmacological properties of the drug. This should have minimal toxicity, should be well tolerated by the patient and, from the epidemiological point of view, should have a low risk of inducing resistance because of frequent use. Naturally, it is not possible to include all antibiotics against all causative agents and therefore attention should be paid, in the first place, to Gram-positive bacteria, i. e., staphylococci and streptococci, which are the most common causes of infectious complications associated with joint replacement. Because of difficulties related to the right choice of antibiotic, it is recommended to keep a record of complications in each patient in order to provide feedback and to facilitate the establishment of reliable antibiotic-based prevention. The prevention of infection in orthopedics is a comprehensive issue. It cannot be expected that prophylactic antibiotic treatment will compensate for mistakes made in operative protocols, for

  10. Perioperative corticosteroids for preventing complications following facial plastic surgery.

    Science.gov (United States)

    da Silva, Edina M K; Hochman, Bernardo; Ferreira, Lydia M

    2014-06-02

    Early recovery is an important factor for people undergoing facial plastic surgery. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling) and ecchymosis (bruising), which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis. To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults. In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). There were no restrictions on the basis of date or language of publication. We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data. We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema) and bruising (ecchymosis). Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only possible for two studies, with a total of 60 participants, and showed that a single perioperative dose of 10 mg

  11. Perioperative corticosteroids for preventing complications following facial plastic surgery

    Directory of Open Access Journals (Sweden)

    Edina Mariko Koga da Silva

    Full Text Available BACKGROUND:Early recovery is an important factor for people undergoing facial plastic. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling and ecchymosis (bruising, which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis.OBJECTIVES:To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults.METHODS:Search strategy: In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations; Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS. There were no restrictions on the basis of date or language of publication. Selection criteria: We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. ata collection and analysis: Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data.MAIN RESULTS: We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema and bruising (ecchymosis. Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only

  12. Medical complications following splenectomy.

    Science.gov (United States)

    Buzelé, R; Barbier, L; Sauvanet, A; Fantin, B

    2016-08-01

    Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever. Thromboembolic complications can involve both the caval system (deep-vein thrombophlebitis, pulmonary embolism) and the portal system. Portal vein thrombosis occurs more commonly in patients with myeloproliferative disease and cirrhosis. No thromboembolic prophylaxis is recommended apart from perioperative low molecular weight heparin. However, some authors choose to prescribe a short course of anti-platelet medication if the post-splenectomy patient develops significant thrombocytosis. Thrombosis of the portal or caval venous system requires prolonged warfarin anticoagulation for 3 to 6 months. Finally, some studies have suggested an increase in the long-term incidence of cancer in splenectomized patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Travel habits and complications in patients treated with vitamin K antagonists: a cross sectional analysis.

    Science.gov (United States)

    Ringwald, Juergen; Lehmann, Marina; Niemeyer, Nicole; Seifert, Isabell; Daubmann, Anne; Wegscheider, Karl; Salzwedel, Annett; Luxembourg, Beate; Eckstein, Reinhold; Voeller, Heinz

    2014-01-01

    Travel-related conditions have impact on the quality of oral anticoagulation therapy (OAT) with vitamin K-antagonists. No predictors for travel activity and for travel-associated haemorrhage or thromboembolic complications of patients on OAT are known. A standardised questionnaire was sent to 2500 patients on long-term OAT in Austria, Switzerland and Germany. 997 questionnaires were received (responder rate 39.9%). Ordinal or logistic regression models with travel activity before and after onset of OAT or travel-associated haemorrhages and thromboembolic complications as outcome measures were applied. 43.4% changed travel habits since onset of OAT with 24.9% and 18.5% reporting decreased or increased travel activity, respectively. Long-distance worldwide before OAT or having suffered from thromboembolic complications was associated with reduced travel activity. Increased travel activity was associated with more intensive travel experience, increased duration of OAT, higher education, or performing patient self-management (PSM). Travel-associated haemorrhages or thromboembolic complications were reported by 6.5% and 0.9% of the patients, respectively. Former thromboembolic complications, former bleedings and PSM were significant predictors of travel-associated complications. OAT also increases travel intensity. Specific medical advice prior travelling to prevent complications should be given especially to patients with former bleedings or thromboembolic complications and to those performing PSM. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Is there still an avoidable fraction of post-operative thromboembolic complications with heparin prophylaxis? The results of a case-control surveillance. Collaborative Group on Heparin Prophylaxis in Surgery (S.E.P.E.C.).

    Science.gov (United States)

    Pangrazzi, J; Donati, M B; Romero, M; Scroccaro, G; Colombo, F; Terzian, E; Tognoni, G

    1993-04-01

    A case-control multicenter study was set up in 68 general and specialistic wards in Italian regional hospitals in order to assess whether underuse of heparin prophylaxis may account for at least a fraction of the thromboembolic events still occurring in surgical patients. 100 cases with clinically relevant thromboembolic or hemorrhagic events occurring during hospitalization for major surgery and 200 controls were identified. Controls were selected among patients not presenting any of the events under study during the same period of observation and were matched with cases for age, sex, and type of surgery. The results of the study suggest that heparin use in routine conditions of care closely reflects the "consensus" knowledge, patients at higher risk (specifically orthopedic surgical patients, those with varicose veins or with preoperative bed rest longer than 3 days) being treated more frequently with heparin. Absence of heparin prophylaxis does not appear to represent a specific risk factor for the occurrence of index events (OR 0.73, 95% CI = 0.42-1.26). Despite the higher rates of heparin exposure, the presence of varicose veins is associated with a statistically significant increase in the risk of postoperative complications (OR 2.23, 95% CI = 1.07-4.65). This study indicates that among known pre- and peri-operative risk factors only varicose veins may be unprotected by the current prophylaxis practice.

  15. A Behcet’s Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism

    Directory of Open Access Journals (Sweden)

    Selvi Aşker

    2013-01-01

    Full Text Available Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet’s disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet’s disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2 × 1.6 cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet’s disease.

  16. Venous thromboembolism: The intricacies

    Directory of Open Access Journals (Sweden)

    Dutta T

    2009-01-01

    Full Text Available Venous thromboembolism (VTE has been a subject of great interest of late. Since Rudolph Virchow described the famous Virchow′s triad in 1856, there have been rapid strides in the understanding of the pathogenesis and factors responsible for it. Discovery of various thrombophilic factors, both primary and acquired, in the last 40 years has revolutionized prognostication and management of this potentially life-threatening condition due to its associated complication of pulmonary thromboembolism. Detailed genetic mapping and linkage analyses have been underlining the fact that VTE is a multifactorial disorder and a complex one. There are many gene-gene and gene-environment interactions that alter and magnify the clinical picture in this disorder. Point in case is pregnancy, where the risk of VTE is 100-150 times increased in the presence of Factor V Leiden, prothrombin mutation (Prothrombin 20210A and antithrombin deficiency. Risk of VTE associated with long-haul air flight has now been well recognized. Thrombotic events associated with antiphospholipid syndrome (APS are 70% venous and 30% arterial. Deep venous thrombosis and pulmonary embolism are the most common venous events, though unusual cases of catastrophes due to central vein thrombosis like renal vein thrombosis and Budd-Chiari syndrome (catastrophic APS may occur.

  17. Aetiology, complications, and preventive measures of liver cirrhosis ...

    African Journals Online (AJOL)

    Common complications included ascites (92%), hepatic encephalopathy (19%), portal hypertension (8%), hepatocellular carcinoma (5%), and spontaneous bacterial peritonitis (3%). In the majority of patients, management was based on diuretics (furosemide and spironolactone) and dietary sodium restriction. Few patients ...

  18. Prevention and treatment of complicated urinary tract infection

    Directory of Open Access Journals (Sweden)

    Shingo Yamamoto

    2016-12-01

    Full Text Available A complicated urinary tract infection (UTI has relapsing and refractory characteristics, and is sometimes life-threatening because of patient predisposing factors as well as the recent worldwide spread of multi-drug resistant bacteria. Patients with complicated UTI should be treated with effective antimicrobial therapy along with appropriate urological intervention to remove predisposing factors when the symptoms are associated. By contrast, routine use of antimicrobial prophylaxis for asymptomatic bacteriuria (ASB is not recommended, as that would contribute to an increase in even more resistant pathogens. Here, four classifications of complicated UTI, which are considered to be clinically important for general urologists, are reviewed, including UTI in patients with diabetes mellitus (DM and those with a neurogenic bladder, as well as catheter-associated UTI (CAUTI and obstructive pyelonephritis secondary to urolithiasis. Appropriate treatment approaches can only be chosen by proper understanding of the etiologies of complicated UTI, as well as correct diagnostic strategies and treatment options.

  19. The Multifactorial Nature of Thromboembolic and Bleeding ...

    African Journals Online (AJOL)

    Background: Thromboembolic and bleeding complications are the main causes of morbidity and mortality in patients with mechanical heart valves1. The risk factors for these complications in Tanzania have not been established. Methods: A retrospective cohort study was conducted among patients with mechanical heart ...

  20. Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review.

    Science.gov (United States)

    Asscheman, H; T'Sjoen, G; Lemaire, A; Mas, M; Meriggiola, M C; Mueller, A; Kuhn, A; Dhejne, C; Morel-Journel, N; Gooren, L J

    2014-09-01

    Administration of cross-sex hormones to male-to-female transsexual subjects, usually oestrogens + often anti-androgens, such as cyproterone acetate, carries a risk of venous thromboembolism (VTE). VTE usually occurs in the first year of oestrogen administration. Ethinyl oestradiol, due to its chemical structure, was in 2003 identified as a major factor in the occurrence of VTE. Most clinics do not prescribe ethinyl oestradiol any longer, but people who take hormones without medical supervision use often oral contraceptives containing ethinyl oestradiol, many times in overdose. Cessation of use of ethinyl oestradiol and peri-operative thrombosis prophylaxis for surgery have reduced prevalence rate of VTE. Other oral oestrogens should not be overdosed, and transdermal oestrogen is to be preferred. Thrombosis prophylaxis for surgery is mandatory. It seems advisable to stop hormone use at least 2 weeks before major surgery, to be resumed only after 3 weeks following full mobilisation. © 2013 Blackwell Verlag GmbH.

  1. Effectiveness and Safety of the Tempofilter II to Prevent the Occurrence of Pulmonary Thromboembolism in Patients with Lower Extremity Deep Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Byung Hyun; Jung, Min Young; Oh, Hyun Jun; Kim, Jae Kyu; Lee, Ho Kyun [Chonnam National University College of Medicine, Gwangju (Korea, Republic of); Jang, Nam Kyu [Chonnam National University Hospital, Hwasun (Korea, Republic of)

    2010-04-15

    To evaluate the efficacy and safety of the Tempofilter II for the prevention of a pulmonary thromboembolism (PTE) in patients with lower extremity deep vein thrombosis (DVT). Between January 2007 and December 2008, thirteen patients with lower extremity DVT whom were implanted with the Tempofilter II to prevent PTE were analyzed. A chest CT was compared before and after filter placement, to evaluate effectiveness of preventing PTE. Clinical symptoms of PTE were checked. Fluoroscopy and a plain radiograph were examined to evaluate filter status. The tempofilter II was successfully inserted in 13 patients. Nine patients underwent endovascular treatment after filter insertion. Trapping of thrombus was evaluated by following CT, venography, and filter retrieval. Trapped thrombus was detected in four patients by CT or retrieved filter. Two patients showed a decrease in thrombus in a follow-up chest CT. Not all patients showed symptoms of PTE. One filter was surgically removed due to the detachment of the anchoring device. The placement and retrieval of the Tempofilter II is feasible and effective for the prophylaxis of PTE in patients with lower extremity DVT; especially for patients that underwent subsequent endovascular treatment

  2. Type 2 diabetes mellitus : prevention of macrovascular complications

    NARCIS (Netherlands)

    Meeuwisse-Pasterkamp, Susanne H; van der Klauw, Melanie M.; Wolffenbuttel, Bruce HR

    2008-01-01

    Type 2 diabetes mellitus is a disease that affects a rapidly increasing number of patients. Most patients with Type 2 diabetes will develop vascular complications. This may be microvascular disease, such as nephropathy, retinopathy or polyneuropathy, and also macrovascular disease, such as coronary

  3. Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications.

    Science.gov (United States)

    Smith, Samuel

    2016-12-01

    Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.

  4. Prevention of cardiac complications in peripheral vascular surgery

    Energy Technology Data Exchange (ETDEWEB)

    Cutler, B.S.

    1986-04-01

    The prevalence of severe coronary artery disease in peripheral vascular patients exceeds 50 per cent. Complications of coronary artery disease are the most common causes of mortality following peripheral vascular operations. To reduce the incidence of cardiac complications, it is first necessary to identify patients at risk through screening tests. Screening methods in current use include risk factor analysis, exercise testing, routine coronary angiography, and dipyridamole thallium-201 scintigraphy. The risk factor approach has the advantage of being widely applicable since it makes use of historical, physical, and electrocardiographic findings that are already familiar to surgeons and anesthesiologists. It is also inexpensive. However, it may overlook the patient who has no symptoms of coronary artery disease, possibly as a result of the sedentary lifestyle imposed by complications of peripheral vascular disease. The electrocardiographically monitored stress test will identify the asymptomatic patient with occult coronary disease and is helpful in predicting operative risk. However, a meaningful test is dependent on the patient's ability to exercise--an activity that is frequently limited by claudication, amputation, or arthritis. Exercise testing also suffers from a lack of sensitivity and specificity when compared with coronary arteriography. Routine preoperative coronary angiography overcomes the exercise limitation of treadmill testing but is not widely applicable as a screening test for reasons of cost and inherent risk. Dipyridamole thallium-201 scanning, on the other hand, is safe and of relatively low cost and does not require exercise.

  5. Prevention of cardiac complications in peripheral vascular surgery

    International Nuclear Information System (INIS)

    Cutler, B.S.

    1986-01-01

    The prevalence of severe coronary artery disease in peripheral vascular patients exceeds 50 per cent. Complications of coronary artery disease are the most common causes of mortality following peripheral vascular operations. To reduce the incidence of cardiac complications, it is first necessary to identify patients at risk through screening tests. Screening methods in current use include risk factor analysis, exercise testing, routine coronary angiography, and dipyridamole thallium-201 scintigraphy. The risk factor approach has the advantage of being widely applicable since it makes use of historical, physical, and electrocardiographic findings that are already familiar to surgeons and anesthesiologists. It is also inexpensive. However, it may overlook the patient who has no symptoms of coronary artery disease, possibly as a result of the sedentary lifestyle imposed by complications of peripheral vascular disease. The electrocardiographically monitored stress test will identify the asymptomatic patient with occult coronary disease and is helpful in predicting operative risk. However, a meaningful test is dependent on the patient's ability to exercise--an activity that is frequently limited by claudication, amputation, or arthritis. Exercise testing also suffers from a lack of sensitivity and specificity when compared with coronary arteriography. Routine preoperative coronary angiography overcomes the exercise limitation of treadmill testing but is not widely applicable as a screening test for reasons of cost and inherent risk. Dipyridamole thallium-201 scanning, on the other hand, is safe and of relatively low cost and does not require exercise

  6. Two doses of rivaroxaban versus aspirin for prevention of recurrent venous thromboembolism. Rationale for and design of the EINSTEIN CHOICE study.

    Science.gov (United States)

    Weitz, Jeffrey I; Bauersachs, Rupert; Beyer-Westendorf, Jan; Bounameaux, Henri; Brighton, Timothy A; Cohen, Alexander T; Davidson, Bruce L; Holberg, Gerlind; Kakkar, Ajay; Lensing, Anthonie W A; Prins, Martin; Haskell, Lloyd; van Bellen, Bonno; Verhamme, Peter; Wells, Philip S; Prandoni, Paolo

    2015-08-31

    Patients with unprovoked venous thromboembolism (VTE) are at high risk for recurrence. Although rivaroxaban is effective for extended VTE treatment at a dose of 20 mg once daily, use of the 10 mg dose may further improve its benefit-to-risk ratio. Low-dose aspirin also reduces rates of recurrent VTE, but has not been compared with anticoagulant therapy. The EINSTEIN CHOICE study is a multicentre, randomised, double-blind, active-controlled, event-driven study comparing the efficacy and safety of two once daily doses of rivaroxaban (20 and 10 mg) with aspirin (100 mg daily) for the prevention of recurrent VTE in patients who completed 6-12 months of anticoagulant therapy for their index acute VTE event. All treatments will be given for 12 months. The primary efficacy objective is to determine whether both doses of rivaroxaban are superior to aspirin for the prevention of symptomatic recurrent VTE, while the principal safety outcome is the incidence of major bleeding. The trial is anticipated to enrol 2,850 patients from 230 sites in 31 countries over a period of 27 months. In conclusion, the EINSTEIN CHOICE study will provide new insights into the optimal antithrombotic strategy for extended VTE treatment by comparing two doses of rivaroxaban with aspirin (clinicaltrials.gov NCT02064439).

  7. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed...... is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together...... therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS...

  8. [Medical prevention and treatment of radiation-induced pulmonary complications].

    Science.gov (United States)

    Vallard, A; Rancoule, C; Le Floch, H; Guy, J-B; Espenel, S; Le Péchoux, C; Deutsch, É; Magné, N; Chargari, C

    2017-08-01

    Radiation-induced lung injuries mainly include the (acute or sub-acute) radiation pneumonitis, the lung fibrosis and the bronchiolitis obliterans organizing pneumonia (BOOP). The present review aims at describing the diagnostic process, the current physiopathological knowledge, and the available (non dosimetric) preventive and curative treatments. Radiation-induced lung injury is a diagnosis of exclusion, since clinical, radiological, or biological pathognomonic evidences do not exist. Investigations should necessarily include a thoracic high resolution CT-scan and lung function tests with a diffusing capacity of the lung for carbon monoxide. No treatment ever really showed efficacy to prevent acute radiation-induced lung injury, or to treat radiation-induced lung fibrosis. The most promising drugs in order to prevent radiation-induced lung injury are amifostine, angiotensin-converting-enzyme inhibitors and pentoxifylline. Inhibitors of collagen synthesis are currently tested at a pre-clinical stage to limit the radiation-induced lung fibrosis. Regarding available treatments of radiation-induced pneumonitis, corticoids can be considered the cornerstone. However, no standardized program or guidelines concerning the initial dose and the gradual tapering have been scientifically established. Alternative treatments can be prescribed, based on clinical cases reporting on the efficacy of immunosuppressive drugs. Such data highlight the major role of the lung dosimetric protection in order to efficiently prevent radiation-induced lung injury. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  9. The preoperative evaluation prevent the postoperative complications of thyroidectomy

    Directory of Open Access Journals (Sweden)

    Chien-Feng Huang

    2015-03-01

    Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

  10. Prevention of cardiovascular complications of diabetes mellitus by aspirin.

    Science.gov (United States)

    Nobles-James, Candi; James, Erskine A; Sowers, James R

    2004-01-01

    Eighteen million Americans have type 2 Diabetes Mellitus (DM) while another 40 million have impaired glucose tolerance. Atherosclerotic heart disease is the leading cause of death in patients with diabetes mellitus. In addition to the increased risk for CardioVascular Disease (CVD), patients with diabetes have a worse prognosis than nondiabetics when they suffer an ischemic event. Insulin resistance is increasingly recognized as a chronic, low-level, inflammatory state. Hyperinsulinemia has been proposed as the forerunner of hypertension, low high-density lipoprotein cholesterolemia, hypertriglyceridemia, abdominal obesity, and altered glucose tolerance, linking all these abnormalities to the development of coronary vascular disease. Atherosclerosis and insulin resistance share similar pathophysiological mechanisms, due to the actions of proinflammatory cytokines. The dynamic inflammatory milieu found in diabetes explains the susceptibility of diabetics to CVD and the potential mechanism by which aspirin may prevent CVD in diabetics. Aspirin decreases the risk for CVD in diabetic patients by a variety of established and novel mechanisms. Therapeutic strategies that lesson the CVD risk in diabetic patients, including the use of aspirin for primary and secondary prevention, are potentially very important. This review article addresses the antiatherosclerotic effects of aspirin, the potential anti-diabetic effects of aspirin, and the clinical trial evidence for CVD prevention by aspirin in diabetics. We also present recommendations for the use of aspirin in the diabetic population and the current guidelines put forth by the American Heart Association and by the American Diabetes Association.

  11. Thromboembolic chronicle pulmonary Hypertension

    International Nuclear Information System (INIS)

    Ovalle, Amador

    2003-01-01

    The thromboembolic chronicle pulmonary Hypertension, also well known as chronic lung thromboembolism not resolved; it is a form not very common of lung thromboembolism. Until very recently was considered a rare curiosity of autopsy, but as the methods of diagnoses have improved and our attitude has changed, the incidence of this nosological entity has experienced a notable increment, but the most excellent in this illness is maybe that it is a form of lung hypertension, potentially recoverable

  12. Preadmission interventions to prevent postoperative complications in older cardiac surgery patients: a systematic review.

    Science.gov (United States)

    Ettema, Roelof G A; Van Koeven, Heleen; Peelen, Linda M; Kalkman, Cor J; Schuurmans, Marieke J

    2014-02-01

    The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions. Here we provide a comprehensive overview of both single and multiple component preadmission interventions designed to prevent postoperative complications. We systematically reviewed the literature following the PRISMA statement guidelines. Of 1335 initial citations, 31 were subjected to critical appraisal. Finally, 23 studies were included, of which we derived a list of interventions that can be applied in the preadmission period to effectively reduce postoperative depression, infection, pulmonary complications, atrial fibrillation, prolonged intensive care unit stay and hospital stay in older elective cardiac surgery patients. No high quality studies were found describing effective interventions to prevent postoperative delirium. We did not find studies specifically targeting the prevention of pressure ulcers in this patient population. Multi-component approaches that include different single interventions have the strongest effect in preventing postoperative depression, pulmonary complications, prolonged intensive care unit stay and hospital stay. Postoperative infection can be best prevented by disinfection with chlorhexidine combined with immune-enhancing nutritional supplements. Atrial fibrillation might be prevented by ingestion of N-3 polyunsaturated fatty acids. High quality studies are urgently needed to evaluate preadmission preventive strategies to reduce postoperative delirium or pressure ulcers in older elective cardiac surgery patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Prevenção do tromboembolismo na cirurgia do câncer do aparelho digestivo Thromboembolism prevention in surgery of digestive cancer

    Directory of Open Access Journals (Sweden)

    Osvaldo Malafaia

    2012-12-01

    foram selecionados (1ª seleção 478 trabalhos avaliados pelo texto completo. A partir deles, para sustentar as recomendações, foram incluídos neste consenso 132 trabalhos. As 15 perguntas formuladas puderam ser respondidas com artigos com grau de evidência correspondentes à 31 A, 130 B, 1 C e 0 D. CONCLUSÃO: Esta revisão possibilitou elaborar orientação segura para a profilaxia do tromboembolismo nas operações sobre o câncer do aparelho digestivo, abordando os tópicos mais frequentes do quotidiano do trabalho dos cirurgiões gerais e do aparelho digestivo.BACKGROUND: The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. AIM: To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. METHODS: The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome, allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID. Evidence manual search was also conducted (BDTD and IBICT. The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for

  14. Colloidon baby – Rare case with preventable complications

    Directory of Open Access Journals (Sweden)

    Janardhan Bommakanti

    2015-01-01

    Full Text Available Colloidon baby is a rare congenital disorder characterized clinical-ly by parchment like taught membrane covering the whole body at the time of birth, which subsequently develops Non bullous ichthyosiform erythroderma or Lamellar ichthyiosis in most cases and in few cases other ichthyosiform disorders. The colloidon membrane spontaneously desquamates within 2 weeks or up to 3 months in few cases. Herein, we present 2 cases of colloidon babies born to consanguineously married couples of which the first baby was born at term by normal vaginal delivery and second baby born prematurely by caesarean section. Both 1st & 2nd baby were delivered in different private hospitals in villages of Nizamabad district, Telangana state and reported to tertiary level children’s hospital in Hyderabad city on 4nd and 6th day of life respectively with complaints of colloidon membrane and macera-tion of skin in diaper area, was admitted in Neonatal intensive care unit (NICU in humidified incubator, treated with emollients, intra-venous fluids and prophylactic antibiotics to avoid complications. Nursing care is of prime importance. This presentation was aimed at stressing not only the importance of early recognition by pedia-trician & timely referral to dermatologist and ophthalmologist for saving life of affected baby but also equal importance to proper nursing care.

  15. Proper Patient Positioning and Complication Prevention in Orthopaedic Surgery.

    Science.gov (United States)

    Bonnaig, Nicolas; Dailey, Steven; Archdeacon, Michael

    2014-07-02

    ➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding. Cushions on the operating-room table and armrest should be emphasized under osseous prominences.➤ Positioning the head in a non-neutral alignment or arm abduction of ≥90° may result in injury to the brachial plexus.➤ The hemilithotomy position increases intracompartmental pressure in the leg on the uninjured side. The risk of well-leg compartment syndrome can be minimized by avoiding this position if possible. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

  16. Correlation of venous thromboembolism prophylaxis and electronic medical record alerts with incidence among surgical patients.

    Science.gov (United States)

    Ramanathan, Rajesh; Lee, Nathaniel; Duane, Therese M; Gu, Zirui; Nguyen, Natalie; Potter, Teresa; Rensing, Edna; Sampson, Renata; Burrows, Mandy; Banas, Colin; Hartigan, Sarah; Grover, Amelia

    2016-11-01

    Venous thromboembolism events are potentially preventable adverse events. We investigated the effect of interruptions and delays in pharmacologic prophylaxis on venous thromboembolism incidence. Additionally, we evaluated the utility of electronic medical record alerts for venous thromboembolism prophylaxis. Venous thromboembolisms were identified in surgical patients retrospectively through Core Measure Venous ThromboEmbolism-6-6 and Patient Safety Indicator 12 between November 2013 and March 2015. Venous thromboembolism pharmacologic prophylaxis and prescriber response to electronic medical record alerts were recorded prospectively. Prophylaxis was categorized as continuous, delayed, interrupted, other, and none. Among 10,318 surgical admissions, there were 131 venous thromboembolisms; 23.7% of the venous thromboembolisms occurred with optimal continuous prophylaxis. Prophylaxis, length of stay, age, and transfer from another hospital were associated with increased venous thromboembolism incidence. Compared with continuous prophylaxis, interruptions were associated with 3 times greater odds of venous thromboembolism. Delays were associated with 2 times greater odds of venous thromboembolism. Electronic medical record alerts occurred in 45.7% of the encounters and were associated with a 2-fold increased venous thromboembolism incidence. Focus groups revealed procedures as the main contributor to interruptions, and workflow disruption as the main limitation of the electronic medical record alerts. Multidisciplinary strategies to decrease delays and interruptions in venous thromboembolism prophylaxis and optimization of electronic medical record tools for prophylaxis may help decrease rates of preventable venous thromboembolism. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Thromboembolism Induced by Umbilical Cord Mesenchymal Stem Cell Infusion: A Report of Two Cases and Literature Review.

    Science.gov (United States)

    Wu, Z; Zhang, S; Zhou, L; Cai, J; Tan, J; Gao, X; Zeng, Z; Li, D

    2017-09-01

    To investigate the thromboembolism induced by blood-mediated inflammatory reactions against infused cells during the clinical application of stem cells. Two patients with renal transplantation and chronic kidney disease, respectively, experienced thromboembolism after umbilical cord mesenchymal stem cell (UCMSC) infusion. The clinical manifestations and the laboratory test results were collected and analyzed. The patients received stem cell infusion through the peripheral veins and presented with a swollen and painful forearm postinfusion. Doppler ultrasound showed venous clots at the proximal end of the puncture site. Urokinase and warfarin were used for thrombolytic therapy. The swelling and pain were relieved and cured. Safety concerns are still a primary hurdle for stem cell therapy, and thromboembolism as a critical complication should be prevented appropriately. Copyright © 2017. Published by Elsevier Inc.

  18. Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial.

    Science.gov (United States)

    Lau, Brandyn D; Shaffer, Dauryne L; Hobson, Deborah B; Yenokyan, Gayane; Wang, Jiangxia; Sugar, Elizabeth A; Canner, Joseph K; Bongiovanni, David; Kraus, Peggy S; Popoola, Victor O; Shihab, Hasan M; Farrow, Norma E; Aboagye, Jonathan K; Pronovost, Peter J; Streiff, Michael B; Haut, Elliott R

    2017-01-01

    Venous thromboembolism (VTE) is a common cause of preventable harm in hospitalized patients. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. The purpose of this trial was to evaluate the effectiveness of nurse education on medication administration practice. This was a double-blinded, cluster randomized trial in 21 medical or surgical floors of 933 nurses at The Johns Hopkins Hospital, an academic medical center, from April 1, 2014 -March 31, 2015. Nurses were cluster-randomized by hospital floor to receive either a linear static education (Static) module with voiceover or an interactive learner-centric dynamic scenario-based education (Dynamic) module. The primary and secondary outcomes were non-administration of prescribed VTE prophylaxis medication and nurse-reported satisfaction with education modules, respectively. Overall, non-administration improved significantly following education (12.4% vs. 11.1%, conditional OR: 0.87, 95% CI: 0.80-0.95, p = 0.002) achieving our primary objective. The reduction in non-administration was greater for those randomized to the Dynamic arm (10.8% vs. 9.2%, conditional OR: 0.83, 95% CI: 0.72-0.95) versus the Static arm (14.5% vs. 13.5%, conditional OR: 0.92, 95% CI: 0.81-1.03), although the difference between arms was not statistically significant (p = 0.26). Satisfaction scores were significantly higher (p<0.05) for all survey items for nurses in the Dynamic arm. Education for nurses significantly improves medication administration practice. Dynamic learner-centered education is more effective at engaging nurses. These findings suggest that education should be tailored to the learner. ClinicalTrials.gov NCT02301793.

  19. Efficiency of various preventive methods of perinatal mother and child complications

    Directory of Open Access Journals (Sweden)

    Sadretdinova T.L.

    2012-03-01

    Full Text Available Purpose: to study efficiency of various methods of prevention of perinatal complications in mother and child. Material and methods. In three risk groups preventive treatment of intrauterine infected fetus (IUIF, gestosis, noncarrying of pregnancy and fetoplacental insufficiency has been carried out. In group I consisted of 71 pregnant women preventive treatment has included medication with application of antioxidants; stimulators of processes of carboxylation in cycle Krebs; endogenic synthesis prostaglandins, prostacyclin; drugs improving processes of microcirculation, stabilizing function of endothelium ofvessels, an exchange of homocysteine. In group II consisted of 67 pregnant women prevention of IUIF and complications has been carried out by means of physical exercises in combination with aqua aerobics. In group III consisted of 100 women prevention of IUIF has been standard. In the control group IV consisted of 70 women pregnancy has not been complicated. Parameters of oxidant and antioxidant systems, central hemodynamics, determined in this group have been determined as normal for comparison. Results. In relation to group III medicamen-tous treatment in group I, regular aqua aerobics in group II have allowed to lower frequency of IUIF, perinatal mother complications, perinatal diseases, death rates in newborns and morbidity in children of early age. Conclusion. For the prevention of IUIF, mother and child perinatal complications, morbidity in children of early age it has been proposed to use medication and regular aqua aerobics which provides nonmedicamentous pregnancy course

  20. [Measles and its secondary pulmonary complications: prevention is better than treatment].

    Science.gov (United States)

    Montella, S; Santamaria, F; Maglione, M; Ciofi degli Atti, M L

    2009-01-01

    Recent measles outbreaks observed in North America and in several European countries, including Italy, raised the attention about the risks linked to this infection and the need of implementing and maintaining adequate preventive strategies. Measles may cause several respiratory complications such as chronic obstructive lung disease, pneumonia, with subsequent development of chronic suppurative lung disease, giant cells pneumonia or progressive respiratory insufficiency. The current preventive strategies aim to improve vaccination coverage rates with 2 doses of measles-mumps and rubella vaccine, and to catch up individuals who have not been previously vaccinated. The present review analyses pulmonary complications of measles and measles preventive strategies. Elimination of measles is a feasible goal. Since measles complications are preventable by vaccination, improvement in vaccination coverage is highly desirable.

  1. Efficiency of various preventive methods of perinatal mother and child complications

    OpenAIRE

    Sadretdinova T.L.; Vasilenko L.V.; Zryachkin N.I.

    2012-01-01

    Purpose: to study efficiency of various methods of prevention of perinatal complications in mother and child. Material and methods. In three risk groups preventive treatment of intrauterine infected fetus (IUIF), gestosis, noncarrying of pregnancy and fetoplacental insufficiency has been carried out. In group I consisted of 71 pregnant women preventive treatment has included medication with application of antioxidants; stimulators of processes of carboxylation in cycle Krebs; endogenic synthe...

  2. FELINE AORTIC THROMBOEMBOLISM: CASE REPORT

    OpenAIRE

    Figueroa A., Lizbeth; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Paz M., Ricardo; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Díaz C., Diego; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Dávila F., Roberto; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.

    2014-01-01

    Se presenta el caso de un felino Siamés de 13 años con tromboembolismo aórtico. Esta es una complicación asociada a una cardiomiopatía hipertrófica (CMH), enfermedad cardiaca más común del gato y que se caracteriza por la hipertrofia concéntrica ventricular izquierda. A case of a 13 year old Siamese cat whit feline aortic thromboembolism is presented. This is a devastating complication associated to hypertrophic cardiomyopathy (HCM), one of the most common heart disease in cats characteriz...

  3. Does conventional practice prevent occular complications in prone position spinal surgery?

    Science.gov (United States)

    Haushofer, Lisa; Bhattacharyya, Mayukh; Isibor, Rochester N; Sakka, Samir A

    2009-01-01

    Postoperative visual loss following spinal surgery in the prone position may be the most limiting to the quality of a patient's life and the most likely to entail medico-legal consequences for medical and theatre personnel. We analyse the incidence of occular complications after 181 consecutive spinal surgery in the prone position in a typical district general hospital setting in the United Kingdom. No patient undergoing spinal surgery in the prone position lasting over 2 hours developed postoperative transient or permanent visual loss or any other occular complication (incidence 0%). Perioperative preventative measures were found to be sufficient to prevent any form of occular complications. We should inform and reassure patients of the reduced risk of occular complications in spinal surgery when sufficient perioperative precautionary measures are taken.

  4. Surgical videos for accident analysis, performance improvement, and complication prevention: time for a surgical black box?

    Science.gov (United States)

    Gambadauro, Pietro; Magos, Adam

    2012-03-01

    Conventional audit of surgical records through review of surgical results provides useful knowledge but hardly helps identify the technical reasons lying behind specific outcomes or complications. Surgical teams not only need to know that a complication might happen but also how and when it is most likely to happen. Functional awareness is therefore needed to prevent complications, know how to deal with them, and improve overall surgical performance. The authors wish to argue that the systematic recording and reviewing of surgical videos, a "surgical black box," might improve surgical care, help prevent complications, and allow accident analysis. A possible strategy to test this hypothesis is presented and discussed. Recording and reviewing surgical interventions, apart from helping us achieve functional awareness and increasing the safety profile of our performance, allows us also to effectively share our experience with colleagues. The authors believe that those potential implications make this hypothesis worth testing.

  5. Dalteparin or vitamin K antagonists to prevent recurrent venous thromboembolism in cancer patients: a patient-level economic analysis for France and Austria.

    Science.gov (United States)

    Dranitsaris, George; Shane, Lesley G; Galanaud, Jean-Philippe; Stemer, Gunar; Debourdeau, Philippe; Woodruff, Seth

    2017-07-01

    International guidelines recommend extended duration secondary prophylaxis in cancer patients who develop primary venous thromboembolism (VTE). Agent selection is guided in part by one large randomized trial (i.e., CLOT; Lee et al., N Engl J Med 349:146-53, 2003) which demonstrated that dalteparin reduced the relative risk of recurrence by 52% compared with oral vitamin K antagonists (VKA; HR = 0.48, 95% CI, 0.30 to 0.77). In a subgroup analysis from that same trial, patients with renal impairment also derived benefit with dalteparin (VTE rates = 3% vs. 17%; p = 0.011). To measure the economic value of secondary VTE prophylaxis with dalteparin, a patient-level pharmacoeconomic analysis was conducted from the Austrian and French healthcare system perspectives. Chapter 1 Healthcare resource use collected during the CLOT trial was extracted and converted into direct cost estimates. Incremental cost differences between the dalteparin and VKA groups were then combined with health state utilities to measure the cost per quality-adjusted life year (QALY) gained. The dalteparin group had significantly higher costs than the VKA group in both countries (Austria: dalteparin = €2687 vs. VKA = €2012; France: dalteparin = €2053 vs. VKA = €1352: p Austria and France, respectively. The analyses in patients with renal impairment suggested an even better economic profile, with the cost per QALY gained being less than €4000 in both countries. Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer.

  6. [Optic neuritis as a complication in preventive tetanus-diphtheria-poliomyelitis vaccination: a case report].

    Science.gov (United States)

    Burkhard, C; Choi, M; Wilhelm, H

    2001-01-01

    The preventive value of vaccinations is generally accepted. Public recommended vaccinations are administered frequently and therefore even rare complications may occur. We report on a 56-year-old patient who suffered from an acute unilateral optic neuritis, following ten days after vaccination against diphtheria, tetanus and poliomyelitis. A complete remission occurred within six weeks after intravenous megadose prednisolone. Neurological and ophthalmological complications following vaccinations are rare, and in most cases reversible.

  7. Rationale and design of XAMOS: noninterventional study of rivaroxaban for prophylaxis of venous thromboembolism after major hip and knee surgery

    Directory of Open Access Journals (Sweden)

    Turpie AG

    2012-06-01

    Full Text Available Alexander GG Turpie,1 André C Schmidt,2 Reinhold Kreutz,3 Michael R Lassen,4 Waheed Jama,1,2 Lorenzo Mantovani,5 Sylvia Haas61Department of Medicine, Hamilton Health Sciences, General Division, Ontario, Canada; 2Bayer Healthcare Pharmaceuticals, Global Development, Berlin, Germany; 3Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany; 4Department of Orthopaedics, Spine Clinic, Clinical Trial Unit, Hørsholm Hospital, University of Copenhagen, Hørsholm, Denmark; 5Faculty of Pharmacy, Federico II University of Naples, Naples, Italy; 6Institut für Experimentelle Onkologie und Therapieforschung, TU München, GermanyAbstract: Venous thromboembolism is a frequent and potentially life-threatening complication of orthopedic surgery. Rivaroxaban is an oral direct factor Xa inhibitor, which was shown to be effective for the prevention of venous thromboembolism after elective hip and knee arthroplasty in the RECORD study program. Rivaroxaban has the potential to overcome the limitations of the current standards of care in the prevention of venous thromboembolism. XAMOS (Xarelto® in the prophylaxis of post-surgical venous thromboembolism after elective major orthopedic surgery of hip or knee is an international, noninterventional, parallel-group study to gain insight into the safety (major bleeding, side effects and effectiveness (prevention of symptomatic thromboembolic events of rivaroxaban in daily clinical practice. XAMOS will follow 15,000 patients after major orthopedic surgery in approximately 200 centers worldwide, with about 7500 patients receiving rivaroxaban and about 7500 standard of care. XAMOS will supplement the clinical data obtained in the Phase III RECORD 1, 2, 3, and 4 trials in which rivaroxaban was shown to be superior for the primary efficacy endpoints, and with a safety profile similar to that of enoxaparin after hip or knee replacement surgery. XAMOS was

  8. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  9. Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study.

    Science.gov (United States)

    Najafzadeh, M; Kim, S C; Patterson, C; Schneeweiss, S; Katz, J N; Brick, G W; Ready, J E; Polinski, J M; Patorno, E

    2015-10-26

    The 9th edition of the American College of Chest Physicians' Antithrombotic Therapy and Prevention of Thrombosis guidelines emphasize the importance of considering the risk-benefit ratio of "patient-important" outcomes. However, little is known about patients' perception and understanding regarding the different outcomes of antithrombotic treatment after orthopedic surgery, and the factors that influence their decision to use these treatments. Using a series of semi-structured interviews, we explored patients' understanding and perception concerning the benefits and risks of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after joint replacement surgery. A series of semi-structured interviews were conducted with patients who had undergone knee or hip replacement surgery at a tertiary care hospital (Brigham and Women's Hospital, Boston, MA) in 2014. Discussions were recorded and transcribed. Two investigators independently coded and analyzed the data to identify important themes and concepts using the constant comparative method. Of 64 patients who were invited, 12 patients (19 %) completed the interviews. The majority of patients (92 %) were aware of the benefits of antithrombotic therapy for reducing the risk of blood clots, while less than half of them had a clear understanding of deep vein thrombosis and pulmonary embolism. While all patients were aware of risk of minor bleeding, only 6 patients (50 %) considered the risk of major bleeding as a possible side effect of antithrombotic treatment. Overall, patients perceived bleeding as a less important outcome than a thrombotic event. The lack of awareness about the risk of major bleeding, the assumption that a short-term exposure would not meaningfully affect bleeding risk, and the assumption that bleeding is a controllable event influenced their perception. Most patients (83 %) stated that their decision to use antithrombotic medications was mainly based on the trust in their

  10. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis.

    Science.gov (United States)

    Goldhill, David R; Imhoff, Michael; McLean, Barbara; Waldmann, Carl

    2007-01-01

    Immobility is associated with complications involving many body systems. To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

  11. Reasons of bleeding complications and prevention methods in endovascular stenting for intracranial artery stenosis

    International Nuclear Information System (INIS)

    Xu Bin; Shi Huaizhang; Xu Shancai; Ji Zhiyong; Wu Pei; Chu Ming

    2012-01-01

    Objective: To summarize the reasons of bleeding complications and the prevention methods in stenting for intracranial arterial stenosis. Methods: The clinical data of 366 patients underwent stent-assistant angioplasty of intracranial artery stenosis from July 2006 to December 2011 were analyzed retrospectively. Among them, 14 patients with bleeding complications were found. The initial 100 patients were categorized as early stage group and the rest as mature stage group. The reasons of bleeding and the methods for preventing this complication were summarized. Results: The overall incidence of bleeding complication was 3.8% (14/366). In the early stage group and mature stage group,the rates was 10%(10/100) and 1.5% (4/266). Six cases were related to the operational manipulation and 8 cases secondary to hyperperfusion injury. Death was found in 6 patients,severe disability in 3, mild paralysis in 2, and no neurological deficits in 3. Conclusions: The bleeding complications in stent-assisted angioplasty of intracranial artery stenosis have a high disability and mortality. The improvement of operative techniques and the more strict indications decrease the bleeding complications rate effectively. (authors)

  12. [Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement].

    Science.gov (United States)

    Agudo Villa, Teresa; Álvarez-Rodríguez, Esther; Caurel Sastre, Zaida; Martín Martínez, Alfonso; Merinero Palomares, Raúl; Alvarez Rodríguez, Virginia; Portero Sánchez, Isabel

    2015-06-01

    To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.

  13. [Current status of the prevention and treatment of stoma complications. A narrative review].

    Science.gov (United States)

    de Miguel Velasco, Mario; Jiménez Escovar, Fernando; Parajó Calvo, Alberto

    2014-03-01

    The aim of our study was to perform a review of the literature to assess the results of prevention and treatment of stoma complications. Medline, EMBASE medical database and the Cochrane Library were searched up to December 2012. Stomal complications are prevalent and associated with a worse quality of life and increased health-economic burdens. The most common complications are attributed to stoma construction. Attention to the finer technical points performed by experienced surgeons reduces morbidity. The use of mesh reduces the risk of parastomal hernia and recurrence rates in hernia repair. Preoperative stoma site marking and postoperative care by a stomatherapist are crucial for the patients' successful adaption, improving quality of life, promoting their independence and reducing the rates of complications. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  14. Obesity and the challenges of caesarean delivery: prevention and management of wound complications.

    Science.gov (United States)

    Ayres-de-Campos, Diogo

    2015-04-01

    Caesarean section in obese patients is associated with an increased risk of surgical wound complications, including haematoma, seroma, abscess and dehiscence. This review focusses on the available strategies to decrease wound complications in this population, and on the clinical management of these situations. Appropriate dose of prophylactic antibiotics, closure of the subcutaneous tissue, and avoidance of subcutaneous drains reduce the incidence of wound complications associated with caesarean section in obese patients. For treatment of superficial wound infection associated with dehiscence, there are data from general surgery patients to suggest that the use of vacuum-assisted devices leads to faster healing and that surgical reclosure is preferable to healing by secondary intention, when there are no signs of ongoing infection. There is a need for stronger evidence regarding the prevention and management of wound complications for caesarean section in obese women. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Stroke/thromboembolism and intracranial hemorrhage in a real-world atrial fibrillation population: the Complications of Atrial Fibrillation in the Bologna Area (CAFBO) study.

    Science.gov (United States)

    Palareti, Gualtiero; Salomone, Luisa; Cavazza, Mario; Guidi, Marcello; Muscari, Antonio; Boriani, Giuseppe; Di Micoli, Antonio; Guizzardi, Giordano; Procaccianti, Gaetano; Guidetti, Angelo; Binetti, Nicola; Malservisi, Simona; Masina, Marco; Viola, Antonella; Bua, Vincenzo; Ongari, Maurizio; Diaspri, Giampaolo; Lip, Gregory Y H

    2014-10-01

    Ischemic events (IEs) and intracranial hemorrhages (ICHs) are feared complications of atrial fibrillation (AF) and of antithrombotic treatment in patients with these conditions. Patients with AF admitted to the EDs of the Bologna, Italy, area with acute IE or ICH were prospectively recorded over 6 months. A total of 178 patients (60 male patients; median age: 85 years) presented with acute IE. Antithrombotic therapy was as follows: (1) vitamin K antagonists (VKAs) in 31 patients (17.4%), with international normalized ratio (INR) at admission of 3.0 in two patients; (2) aspirin (acetylsalicylic acid) (ASA) in 107 patients (60.1%); and (3) no treatment in 40 patients (22.5%), mainly because AF was not diagnosed. Twenty patients (eight male patients; median age: 82 years) presented with acute ICH: 13 (65%) received VKAs (INR, 2.0-3.0 in 11 patients and > 3.0 in two patients), while six (30%) received ASA. Most IEs (88%) and ICHs (95%) occurred in patients aged > 70 years. A modeling analysis of patients aged > 70 years was used to estimate annual incidence in subjects anticoagulated with VKAs in our Network of Anticoagulation Centers (NACs), or those expected to have AF but not included in NACs. The expected incidence of IE was 12.0%/y (95% CI, 10.7-13.3) in non-NACs and 0.57%/y (95% CI, 0.42-0.76) in NACs (absolute risk reduction [ARR], 11.4%/y; relative risk reduction [RRR], 95%; P < .0001). The incidence of ICH was 0.63%/y (95% CI, 0.34-1.04) and 0.30%/y (95% CI, 0.19-0.44), respectively (ARR, 0.33%/y; RRR, 52.4%/y; P = .04). IEs occurred mainly in elderly patients who received ASA or no treatment. One-half of patients with IEs receiving anticoagulant treatment had subtherapeutic INRs. Therapeutic approaches to elderly subjects with AF require an effective anticoagulant treatment strategy.

  16. Does salivary duct repositioning prevent complications after tumor resection or salivary gland surgery?

    Science.gov (United States)

    Sakakibara, Akiko; Minamikawa, Tsutomu; Hashikawa, Kazunobu; Sakakibara, Shunsuke; Hasegawa, Takumi; Akashi, Masaya; Furudoi, Shungo; Komori, Takahide

    2015-05-01

    Tissue that is resected for the treatment of oral tumors often includes salivary gland ducts. At their institution, the authors conserve and transfer as much of the salivary duct as possible during these procedures to avoid obstructive complications. Differentiating these obstructive complications from a metastatic node can be challenging and can confound subsequent oncologic management. This study compared and examined the effectiveness of salivary duct repositioning in decreasing the incidence of obstructive complications. Cases of oromandibular disease treated with salivary duct resection at Kobe University Graduate School of Medicine from 2008 to 2013 were retrospectively analyzed. Thirty-two cases (25 patients) of Wharton duct resection and 31 cases (31 patients) of Stensen duct resection were included. The incidence of complications after salivary duct repositioning, duct ligation, and retention of the sublingual gland around the Wharton duct was compared. Wharton ducts were repositioned in 30 cases and ligated in 2 cases. Complications, including oral swelling at the Wharton duct, were observed in 5 cases of repositioning and 2 cases of ligation. Stensen ducts were repositioned in 9 cases and ligated in 22 cases. The only complication reported was a single case of salivary fistula after ligation. Salivary duct repositioning is performed to prevent blockage of physiologic salivary discharge. Complications were more frequently associated with Wharton ducts than with Stensen ducts because of the unique physiologic and anatomic characteristics of the Wharton duct. Repositioning of the salivary duct is a suitable method for preventing complications associated with the Wharton duct. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    MJP

    Report from Centre for Disease Control and. Prevention (CDC) puts VTE related mortality in. ABSTRACT. Background: Venous thromboembolism (VTE) is a major public health challenge globally due to its high morbidity and mortality. The condition is often asymptomatic and under diagnosed due to lack of awareness on ...

  18. [Closed suction drainage to prevent postoperative complications after parotidectomy: a systematic review].

    Science.gov (United States)

    Sun, Jun; Li, Chun-jie; Li, Bo; Gao, Qing-hong; Men, Yi; Li, Long-jiang

    2014-06-01

    To evaluate the efficacy and safety of closed suction drainage for prevention of postoperative complications after parotidectomy. Pubmed, Cochrane Controlled Trials Register, Embase, Open Sigle, CBM, VIP and Wanfang database were searched electronically from the date of their establishment to May 10,2013. Hand-searching covering 19 relevant Chinese journals were also performed, and the literature of randomized controlled trials comparing closed suction drainage and open drainage for prevention of postoperative complications after parotidectomy were included. Risk of bias assessment, which was suggested by Cochrane handbook for systematic reviewers of intervention review, and data extraction of included studies were delivered by two reviewers in duplicate; and meta analysis was performed with Revman 5.2 software. Ten randomized controlled trials were included. All studies had unclear risk of bias. When compared with open drainage, closed suction drainage showed a significant advantage on reducing postoperative complications (salivary fistula/effusion, edema) after parotidectomy; it also improved clinical comprehensive effect and patients' quality of life (P<0.05). To a certain extent, closed suction drainage has better efficacy and safety than controls in preventing postoperative complications after parotidectomy. However, as the quality of some included studies is limited, more randomized controlled trials are needed to reinforce the conclusion.

  19. PREVENTION OF COMPLICATIONS CAUSED BY MYOCARDIAL ISCHEMIA-REPERFUSION IN NONCARDIAC SURGICAL PROCEDURES

    Directory of Open Access Journals (Sweden)

    I. A. Kozlov

    2016-01-01

    Full Text Available In the next 20 years, the aging population will be a major factor affecting the characteristics of perioperative anesthesia tactics. Domestic researchers have reported that the incidence of cardiac complications after general surgical procedures in patients with middle and old age is 9.1%, and mortality in these complications reached 45.5%. Analyzed current data on myocardial ischemia-reperfusion, the etiopathogenesis of perioperative cardiac complications, recurrence of their development and the possible consequences. It is concluded that prevention and timely treatment of complications resulting from ischemia-reperfusion of the myocardium, with noncardiac surgical interventions is an important tactical (prevention of perioperative myocardial infarction, arrhythmias, cardiac death and policy (prevention of cardiac remodeling and post-hospital disability of patients anaesthesiological tasks. Research carried out in the Nrgovsky Research Institute of General Reanimatology showed that in the real practice Detsky index, Lee index and echocardiographic left ventricular ejection fraction did not provide high accuracy prediction of cardiac events. More informative proved preoperative determination of blood N-terminal part of the pro-brain natriuretic peptide (NT-proBNP. In assessing the predictive ability of NT-proBNP area under the ROC-curve achieved 0.86. NT-proBNP value 358 pg/ml and above provided 77% sensitivity and 85% specificity. The comparative assessment and recommendations on the use to reduce the risk of cardiac complications of β-blockers, statins, calcium channel blockers, nitrates, clonidine, dexmedetomidine, levosimendan and phosphocreatine. Phosphocreatine, introduced in practice domestic cardiac surgery and transplantology more than 20 years ago, continues to be studied and used at the moment. Recently demonstrated that perioperative phosphocreatine usage appointment in older oncological patients with a high risk of cardiac

  20. Prevention of complications in glycogen storage disease type Ia with optimization of metabolic control.

    Science.gov (United States)

    Dambska, M; Labrador, E B; Kuo, C L; Weinstein, D A

    2017-08-01

    Prior to 1971, type Ia glycogen storage disease was marked by life-threatening hypoglycemia, lactic acidosis, severe failure to thrive, and developmental delay. With the introduction of continuous feeds in the 1970s and cornstarch in the 1980s, the prognosis improved, but complications almost universally developed. Changes in the management of type Ia glycogen storage disease have resulted in improved metabolic control, and this manuscript reviews the increasing evidence that complications can be delayed or prevented with optimal metabolic control as previously was seen in diabetes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Management and Prevention of Surgical and Nutritional Complications After Bariatric Surgery.

    Science.gov (United States)

    Marcotte, Eric; Chand, Bipan

    2016-08-01

    Bariatric surgery is well-recognized for its effects on health, beyond weight-loss. It underwent a revolution recently with the growing performance of laparoscopic procedures, leading to enhanced recovery and a reduction in procedural risk. However, surgical complications, although rare, do develop. It is important to recognize the complications, and ideally prevent them from happening. This article reviews the risks of the four most commonly performed bariatric procedures, with an emphasis on technique and management in the intraoperative and postoperative period. The nutritional aspect of bariatric surgery is of the utmost importance, because catastrophic consequences have been linked to malnutrition and vitamin deficiencies. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Complications of lung cancer radiation therapy and the preventive role of positron-emission tomography

    Directory of Open Access Journals (Sweden)

    O. Yu. Stoliarova

    2018-02-01

    were used. Results. The side effects of radiation therapy were identified in 23 % of LC cases (22 % men and 32 % women. Among the main complications of LC it has been found (in descending order: myelodepression, pulmonary hypertension, acute radiation pneumonitis, hemoptysis, acute vascular insufficiency, radiation esophagitis, acute coronary syndrome, pulmonary fibrosis, acute cerebrovascular accident, pulmonary edema, thromboembolism of the pulmonary artery branches. The integral nature of the radiotherapy complications is associated with radiotherapy for primary tumor and palliative for distant metastases, has sexual dimorphism (radiation pneumofibrosis, esophagitis, acute vascular insufficiency, pulmonary edema and is determined by the irradiation power (development of myelodepression, radiation esophagitis. The use of a metabolic image in PET/CT allowed us to specify the area of irradiation by including a peritumorous zone in the target. It has significantly increased the carcinocidal effect of radiation in all patients and ensured a higher survival rate of patients, avoiding cases of acute radiation pneumonitis, esophagitis and pulmonary fibrosis. Conclusions. The integral nature of the radiochemotherapy complications in LC is observed practically in every fourth patient with LC, it is associated with radical RT for the primary tumor and palliative for distant metastases, has gender specific features and is determined by the irradiation rate. PET/CT provides an increase in the radiation exposure effectiveness with a decrease in its effects on healthy lung tissue, and as the result the incidence of RT side effects is reduced. cancer of lungs; radiation therapy; positron-emission tomography

  3. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  4. [Prevention and treatment for complications in the application of new technology for stomach cancers].

    Science.gov (United States)

    Su, Xiangqian; Zhou, Chuanyong; Yang, Hong

    2017-02-25

    With the rapid advancement of minimally invasive new technology, laparoscopic surgery and robotic surgery are now regarded as the main direction in surgical treatment for stomach cancers. Recent evidence has confirmed the safety and feasibility of laparoscopic surgery for early gastric cancer and advanced gastric cancer. However, gastrointestinal surgeons should pay more attention to complications after laparoscopic gastrectomy because of rich blood supply, complex tissue layers and lymph node metastasis. Common complications related to laparoscopic surgery are associated with laparoscopic instruments and operating, intra-abdominal bleeding, anastomotic leakage, anastomotic bleeding, pancreatic leakage, duodenal stump leakage, lymphatic leakage and so on. This article mainly focuses on the causes, prevention and treatment of the complications after laparoscopic gastrectomy.

  5. [The key points of prevention for special surgical complications after radical operation of gastric cancer].

    Science.gov (United States)

    Xu, Hao; Wang, Weizhi; Li, Panyuan; Zhang, Diancai; Yang, Li; Xu, Zekuan

    2017-02-25

    Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation

  6. [Venous thromboembolism in patients with acute tuberculosis].

    Science.gov (United States)

    Ben Amar, J; Dahri, B; Aouina, H; Bouacha, H

    2015-12-01

    Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Infectious Thromboembolism related to prolonged reduced motility in ill acute patients

    Directory of Open Access Journals (Sweden)

    F. Dodi

    2011-01-01

    Full Text Available Update in new clinic complications related to infectious diseases reveals emergent, at present, the thromboembolic risk. Clinicians must examine carefully thromboembolism related to prolonged reduced motility during acute invalidating infectious diseases because it represents major risk during clinical conditions involving enzimatic procoagulant activity, fibronectine production, procoagulant autoimmunitary damage. Recent experimental data show that pathogenesis of thromboembolic lesions involves clinical risk factors, vascular anatomic features and bacterial genetic properties.

  8. Maternal complication prevention: evidence from a case-control study in southwest Nigeria

    Directory of Open Access Journals (Sweden)

    Kayode O. Osungbade

    2014-01-01

    Full Text Available Background: The importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes.Aim: This study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention.Setting: The study was carried out in a postnatal ward in a secondary health facility.Methods: This was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases was done, and one booked pregnant woman (control was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05.Results: Booked women had a lower median length of labour (10 hours compared to unbooked women (13 hours. More women in the booked control group (139; 35.1% than in the unbooked case group (96; 23.6% reported at least one type of morbidity during the index pregnancy (p = 0.0004. Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery.Conclusion: Strengthening antenatal and secondary healthcare services as short- and mediumterm measures might be cost-effective as a preventive strategy in complications of pregnancy,whilst socio-economic dimensions of health are accorded priority in the long term.

  9. Guidelines for preventing common medical complications of catatonia: case report and literature review.

    Science.gov (United States)

    Clinebell, Kimberly; Azzam, Pierre N; Gopalan, Priya; Haskett, Roger

    2014-06-01

    Comprehensive hospital-based care for individuals with catatonia relies on preventive approaches to reduce medical morbidity and mortality. Without syndrome-specific guidelines, psychiatrists must draw from measures used for general medical and surgical inpatients. We employ a prototypical case to highlight medical complications of catatonia and review preventive guidelines for implementation in the inpatient setting. Searches of the PubMed and Ovid databases were conducted from September-November 2013 using keywords relevant to 4 medical complications of catatonia: deep vein thrombosis/pulmonary embolism, pressure ulcers, muscle contractures, and nutritional deficiencies. A complementary general web-browser search was performed to help ensure that unpublished guidelines were considered. A search for deep vein thrombosis/pulmonary embolism guidelines yielded 478 articles that were appraised for relevance, and 6 were chosen for review; the pressure ulcer guideline search yielded 5,665 articles, and 5 were chosen; the muscle contractures guideline search yielded 1,481 articles, and 3 were chosen; and the nutritional deficiencies guideline search yielded 16,937 articles, and 4 were chosen. Guidelines were reviewed for content and summarized in a manner relevant to the audience. No quantitative analyses were conducted. Guidelines for deep vein thrombosis/pulmonary embolism prophylaxis support use of anticoagulant therapies for patients with catatonia who are at lower risk for acute bleeding. Pressure ulcer prevention hinges on frequent skin evaluation, use of support surfaces, and repositioning. Muscle contracture data are less clear and must be extrapolated from studies of patients with neurologic injuries. Early initiation of enteral nutrition should be considered in patients with prolonged immobility. As medical complications are common with catatonia, implementation of preventive measures is imperative. © Copyright 2014 Physicians Postgraduate Press, Inc.

  10. Cinnamic Acid and Its Derivatives: Mechanisms for Prevention and Management of Diabetes and Its Complications

    Directory of Open Access Journals (Sweden)

    Sirichai Adisakwattana

    2017-02-01

    Full Text Available With recent insight into the development of dietary supplements and functional foods, search of effective phytochemical compounds and their mechanisms involved in prevention and management of diabetes and its complications are now being assessed. Cinnamic acid and its derivatives occur naturally in high levels of plant-based foods. Among various biological activities, cinnamic acid and its derivatives are associated with a beneficial influence on diabetes and its complications. The aim of the review is to summarize the potential mechanisms of these compounds for prevention and management of diabetes and its complications. Based on several in vitro studies and animal models, cinnamic acid and its derivatives act on different mechanism of actions, including stimulation of insulin secretion, improvement of pancreatic β-cell functionality, inhibition of hepatic gluconeogenesis, enhanced glucose uptake, increased insulin signaling pathway, delay of carbohydrate digestion and glucose absorption, and inhibition of protein glycation and insulin fibrillation. However, due to the limited intestinal absorption being a result of low bioavailability of cinnamic acid and its derivatives, current improvement efforts with entrapping into solid and liquid particles are highlighted. Further human clinical studies are needed to clarify the effects of cinnamic acid and its derivatives in diabetic patients.

  11. Implementation of physiotherapeutic shares in the prevention of diabetes complications in a Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Ana Paula Coelho Figueira Freire

    Full Text Available Introduction In the Family Health Strategy (FHS, the treatment of Diabetes Mellitus (DM includes education and lifestyle change strategies. Physiotherapists have a key role in this health setting. Objectives To implement actions of evaluation and guidelines for patients with type 2 DM who attend a Family Health Strategy (FHS, regarding diabetic foot and the practice of regular physical exercise in the control and prevention of the complications of Diabetes Mellitus. Methods 17 individuals from an FHS were evaluated, with the following procedures: clinical and anthropometric parameters, inspection, a questionnaire on diabetic neuropathy, tests of vibratory and tactile sensitivity, muscle function, range of motion, functional analysis, questions about exercise practice and guidance regarding controlling blood glucose and foot care. Results Deformities, dry skin, calluses, dehydration, ulceration, cracking and brittle nails were found. Peripheral neuropathy was not observed; tactile sensitivity was altered in the heel region and the vibratory sense was absent in 5% of individuals. A decrease in functionality of ankle movements was verified. Of the participants, 76% were sedentary, 24% knew about the benefits of practicing regular exercise, 25% had undergone a medical evaluation prior to performing physical exercise and, of these, 25% were supervised by a qualified professional. Discussion The implementation of physiotherapy actions in diabetics from an FHS was important for highlighting the presence of risk factors for diabetic complications. Conclusions Individuals attending the FHS need more information and programs for the prevention of diabetic complications.

  12. Mobile tele-medicine systems in the multidisciplinary approach of diabetes management : the remote prevention of diabetes complications.

    Science.gov (United States)

    Mammas, Constantinos S; Geropoulos, Spyros; Markou, Georgia; Saatsakis, George; Lemonidou, Chryssa; Tentolouris, Nikolaos

    2014-01-01

    Evaluation of feasibility and reliability of Mobile-Telemedicine Systems (M-TS) in the remote prevention of diabetes related complications. A feasibility-reliability evaluation based on a simulating experimentation by ten specialists (N=10) who examined a diabetic patient on the electronic space of a mobile experimental telemedicine system (MU-Exp.-TS). I. Remote prevention of diabetic foot and other diabetes related complications is feasible (acceptability: 89-100%). II. Remote ulcer classification and diabetic foot amputation risk estimation: Accuracy=89%. The proposed MU-TS based multidisciplinary approach and prevention of diabetes related complications is feasible while that of diabetic foot is both feasible and reliable.

  13. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.

    Science.gov (United States)

    Allemann, Pierre; Probst, Herve; Demartines, Nicolas; Schäfer, Markus

    2011-01-01

    Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

  14. [Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery].

    Science.gov (United States)

    Wu, Haifu; Zhong, Ming; Zhou, Di; Shi, Chenye; Jiao, Heng; Wu, Wei; Chang, Xinxia; Cang, Jing; Bian, Hua

    2017-04-25

    Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical

  15. Immediate implant placement: surgical techniques for prevention and management of complications.

    Science.gov (United States)

    Al-Sabbagh, Mohanad; Kutkut, Ahmad

    2015-01-01

    Loss of soft and hard tissue is common after tooth extraction. Substantial resorption of alveolar bone compromises esthetics and may result in prosthetic and surgical limitations. Immediate implant placement at the time of tooth extraction is used to maintain alveolar ridge dimensions. Clinical studies support the successful outcome of immediate placement of dental implants in fresh extraction sockets; comparative clinical studies have found that implant survival rates after immediate placement are similar to those after delayed placement. This article addresses surgical techniques for immediate implant placement and the prevention and the management of complications associated with this procedure. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Managing Complications in Abdominoplasty: A Literature Review

    Directory of Open Access Journals (Sweden)

    Pedro Vidal

    2017-09-01

    Full Text Available Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results.

  17. Preadmission interventions to prevent postoperative complications in older cardiac surgery patients : A systematic review

    NARCIS (Netherlands)

    Ettema, Roelof G A; Van Koeven, Heleen; Peelen, Linda M.; Kalkman, Cor J.; Schuurmans, Marieke J.

    Objective(s): The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional

  18. Individual Risk and Prevention of Complications: Doctors' Advice to Persons Wishing a New Tattoo.

    Science.gov (United States)

    Serup, Jørgen

    2017-01-01

    Doctors who are consulted about health and tattoo risks have an important role in the prevention of an individual's tattoo complications. Tattooing is a tremendous exposure of the human body to needle operation, particles, and chemicals. The risk is related to a person's health condition, level of insight, decision-making, and to the operation of tattooing, tattoo inks and utensils, tattoo parlour, and the aftercare. Tattooing is painful minor surgery performed without anesthesia. It can be associated with syncope. It is major needle trauma with histamine release and wheal and flare in the operation field. The skin barrier is broken. Bacterial infections come early. Chronically intermittent and mild complaints affect 4/10 of all the tattooed, and 2/10 have sensitivity to sun. Chronic complications with allergy in red tattoos and nodules due to pigment agglomeration and foreign body formation in black tattoos are less common but certainly at the level of cumbersome skin disease. Reactions to black tattoos are strongly associated with sarcoidosis. There are many other distinct entities of tattoo complications. A campaign called 'Tattoo - know your risk' is presented with detailed fact sheets about tattoos, tattoo problems, how to reduce risk, and a checklist for the tattoo customer before decision-making. The sheets with keynote information are useful aids for doctors giving advice to persons curious about acquiring a tattoo. © 2017 S. Karger AG, Basel.

  19. Taking a look to promoting health and complications' prevention: differences by context

    Directory of Open Access Journals (Sweden)

    Rosa Maria de Albuquerque Freire

    Full Text Available ABSTRACT Objectives: to acknowledge and compare the health promotion and complications' prevention practices performed by nurses working in hospital and primary health care contexts. Methods: descriptive, exploratory and crosscutting study, performed with 474 nurses selected by convenience sampling. It was used a form that encompassed two categories of descriptive statements about quality in the professional exercise of nurses. This study had ethical committee approval. Results: the nurses' population was mainly women (87,3% with an average age of 35,5 years. There was more practices of the hospital's nurses related to the identification of potential problems of the patient (p=0.001 and supervision of the activities that put in place the nursing interventions and the activities that they delegate (p=0.003. Conclusion: the nurses perform health promotion and complications' prevention activities, however not in a systematic fashion and professional practices differ by context. This study is relevant as it may promote the critical consciousness of the nurses about the need of stressing quality practices.

  20. Acupuncture for Preventing Complications after Radical Hysterectomy: A Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Wei-min Yi

    2014-01-01

    Full Text Available We aimed to investigate the preventive effects of acupuncture for complications after radical hysterectomy. A single-center randomized controlled single-blinded trial was performed in a western-style hospital in China. One hundred and twenty patients after radical hysterectomy were randomly allocated to two groups and started acupuncture from sixth postoperative day for five consecutive days. Sanyinjiao (SP6, Shuidao (ST28, and Epangxian III (MS4 were selected with electrical stimulation and Zusanli (ST36 without electrical stimulation for thirty minutes in treatment group. Binao (LI14 was selected as sham acupuncture point without any stimulation in control group. The main outcome measures were bladder function and prevalence of postoperative complications. Compared with control group, treatment group reported significantly improved bladder function in terms of maximal cystometric capacity, first voiding desire, maximal flow rate, residual urine, and bladder compliance, and decreased bladder sensory loss, incontinence, and urinary retention on fifteenth and thirtieth postoperative days. Treatment group showed significant advantage in reduction of urinary tract infection on thirtieth postoperative day. But no significant difference between groups was observed for lymphocyst formation. By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy.

  1. Nurses' perceptions of standardised assessment and prevention of complications in an ICU.

    Science.gov (United States)

    Soh, Kim Lam; Davidson, Patricia M; Leslie, Gavin; DiGiacomo, Michelle; Soh, Kim Geok

    2013-03-01

    To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. A qualitative focus group study. Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. These findings provide valuable information for implementing clinical practice improvement interventions. © 2012 Blackwell Publishing Ltd.

  2. Complications of post-operative beta irradiation for prevention of recurrence of pterygium

    International Nuclear Information System (INIS)

    Hussain, R.; Nisa, L.; Jehan, A.H.

    2007-01-01

    Full text: Beta irradiation by Strontium (Sr-90) has been in use for about 20 years in Bangladesh. A retrospective analysis was performed to evaluate its efficacy and the risk and incidence of both short-term and long-term complications. Materials and Methods: A retrospective analysis was done of 417 patients receiving post-operative beta irradiation from January 2001 to January 2006. There were 303 males and 114 females. Ages ranged from 18 to 65 years, with a mean of 38 years. Each patient received 2500cGy to the postoperative sclera surface in five fractions by hand-held Sr-90 surface applicator from Amersham International. The patients were followed up after one week, one month, six months and a year after beta irradiation. Results: Out of the total 417 patients, all had follow-ups at one week. But then gradually some patients were missed and did not turn up according to the schedule. At one month, 401 attended, at 6 months, 325 and at one year, 288 patients attended for follow-up. 18 cases had recurrence within one year and a second dose of beta radiation was given. Short-term complications included conjunctivitis, photophobia, watering of eyes etc. As for long term complications, two patients developed cataract and one patient developed ophthalmomalacia. Discussion: The short-term complications were self-limiting and had no serious effects. The two cases developing cataracts were over 50 years old, so it could not be clearly understood whether the normal aging process or the radiation contributed more in the development of the cataract. Ophthalmomalacia developed in one patient, who had simultaneous Graves' disease. The rest of the patients were fine with significant improvements in visual acuity. Conclusion: Sr-90 beta irradiation is effective and a safe treatment option to prevent recurrence of pterygium. (author)

  3. Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

    Science.gov (United States)

    Alexander, Dayna S; Alfonso, Moya L; Cao, Chunhua; Wright, Alesha R

    2017-07-01

    Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children's positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers' support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers' support for prevention initiatives. Methods A convenience sample of maternal caregivers (N = 129, ages 22-65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers' support for prevention strategies. Results Caregivers' perceptions of childhood obesity risk factors were moderate (M = 3.4; SD = 0.64), as were their perceptions of obesity-related health complications (M = 3.3; SD = 0.75); however, they perceived a high level of support for prevention strategies (M = 4.2; SD = 0.74). In the regression model, only health complications were significantly associated with caregiver support (β = 0.348; p Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.

  4. Complications of image-guided radiofrequency ablation of renal cell carcinoma: causes, imaging features and prevention methods

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan; Kim, Chan Kyo [Sungkyunkwan University School of Medicine, The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2009-09-15

    Radiofrequency (RF) ablation is an alternative treatment for renal cell carcinoma (RCC) in patients unable to undergo surgery. Although RF ablation has a low complication rate because of its minimally invasive nature, unintended heat may be conducted by several critical organs during ablation procedures, leading to a variety of complications. Major complications that usually require treatment include bowel injury, ureteral injury, massive bleeding and residual or recurrent tumour. Minor complications that may require only observation include pain, haematoma, haematuria, neuromuscular injury, pneumothorax, infarction and inflammatory tract mass. The most common cause of complications is the tumour's proximity to neighbouring organs. In addition, careless electrode manipulation and the patient's comorbidities may also lead to complications. To avoid many of these complications, the distance between the tumour and neighbouring organs should be widened using methods such as changing the patient's position, using the RF electrode as a lever and hydrodissection. Furthermore, carefully manipulating the RF electrode and assessing the patient's general condition help to prevent complications. In this review, we discuss the complications resulting from RF ablation of RCC with an emphasis on causes, imaging features and prevention methods. (orig.)

  5. APPLICATION OF CALCIUM ANTAGONISTS IN PREVENTION OF CARDIOVASCULAR COMPLICATIONS DURING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    S. V. Nedogoda

    2006-01-01

    Full Text Available Results of randomized clinical trials on the usage of calcium antagonists (CA in order to prevent perioperative complications during aortocoronary bypass procedure and operations on heart valves are analyzed. CA reduced the risk of perioperative myocardial infarctions and episodes of reversible myocardial ischemia. After angioplasty of coronary arteries CA (particularly amlodipine show positive effects on restenosis incidence and reduce about 3 times a number of repeated angioplasty and aortocoronary bypass operations. The use of CA was accompanied by more often need in heart electro stimulation without any subclass differences. It is also registered that nimodipine can strengthen intraoperative blood loss. It is concluded, that CA have significant evident base that allows recommending them to patients undertaken by cardiological surgery.

  6. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use

    NARCIS (Netherlands)

    Martinelli, Ida; Lensing, Anthonie W. A.; Middeldorp, Saskia; Levi, Marcel; Beyer-Westendorf, Jan; van Bellen, Bonno; Bounameaux, Henri; Brighton, Timothy A.; Cohen, Alexander T.; Trajanovic, Mila; Gebel, Martin; Lam, Phuong; Wells, Philip S.; Prins, Martin H.

    2016-01-01

    Women receiving vitamin K antagonists (VKAs) require adequate contraception because of the potential for fetal complications. It is unknown whether the use of hormonal therapy, especially those containing estrogens, is associated with recurrent venous thromboembolism (VTE) during anticoagulation.

  7. Use of a heparinoid in patients with hemorrhagic stroke and thromboembolic disease

    NARCIS (Netherlands)

    ten Cate, H.; Henny, C. P.; Büller, H. R.; ten Cate, J. W.; Magnani, H. N.

    1984-01-01

    A new heparinoid, Org 10172, was given to five patients with hemorrhagic stroke with thromboembolic complications. Treatment did not cause progression of cerebral bleeding, and thrombotic processes were inhibited. No side effects were encountered

  8. Prevention and management of the complications during embolizing intracranial aneurysm with GDC

    International Nuclear Information System (INIS)

    Zhong Ming; Tan Xianxi; Wang Junlu; Hu Wenhao; Fan Lianghao

    2002-01-01

    Objective: To sum up the experience of embolization of intracranial aneurysm with Guglielmi detachable coil (GDC) and to discuss how to prevent and manage the complications during the endovascular treatment. Methods: 108 patients with intracranial aneurysm were embolized with GDC. 24 accident out of 20 patients during embolization were reviewed. Results: Among the 24 accidents, there were 10 aneurysm rupture, 5 over- embolization 5 coils end protruding to parent artery, and 4 thrombosis. Once the aneurysm ruptures, neutralizing heparin and continuing embolization was administered. Among 10 cases of aneurysm ruptures, 4 were death, 1 was severe deformity, 1 was mild deformity. Thrombolysis, heparinisation and raising blood pressure were used to control over-embolization, coil protrusion, and thrombosis. Among 5 cases of over-embolization, 1 died, 4 recovered. Among 5 cases of coils end protruding, 1 was severe deformity, 1 was mild deformity. Among 4 cases of embolization, 1 died, 1 was led sensory aphasics. The accidents resulted in 5 deaths (4.6%), 4 permanent neurological deficits (3.7%). Conclusion: The correct management of the complications during the treatment, the better understanding of the aneurysm and its parent artery angio-anatomy and the improved skill of embolizing technique are helpful to reduce the accidents and increase the cure rate

  9. Naringin prevents HIV-1 protease inhibitors-induced metabolic complications in vivo.

    Directory of Open Access Journals (Sweden)

    Sanelisiwe Nzuza

    Full Text Available Insulin resistance, glucose intolerance and overt diabetes are known metabolic complications associated with chronic use of HIV-Protease Inhibitors. Naringin is a grapefruit-derived flavonoid with anti-diabetic, anti-dyslipidemia, anti-inflammatory and anti-oxidant activities.The study investigated the protective effects of naringin on glucose intolerance and impaired insulin secretion and signaling in vivo.Male Wistar rats were divided into six groups (n = 6 and were daily orally treated with distilled water {3.0 ml/kg body weight (BW}, atazanavir (133 mg/kg BW, saquinavir (333 mg/kg BW with or without naringin (50 mg/kg BW, respectively for 56 days. Body weights and water consumption were recorded daily. Glucose tolerance tests were carried out on day 55 of the treatment and thereafter, the rats were sacrificed by halothane overdose.Atazanavir (ATV- or saquinavir (SQV-treated rats exhibited significant weight loss, polydipsia, elevated Fasting blood glucose (FBG, reduced Fasting Plasma Insulin (FPI and expression of phosphorylated, Insulin Receptor Substrate-1 (IRS-1 and Akt proteins, hepatic and pancreatic glucokinase levels, and also increasing pancreatic caspase-3 and -9 as well as UCP2 protein expressions compared to controls, respectively. These effects were completely reversed by naringin treatment.Naringin prevents PI-induced glucose intolerance and impairment of insulin signaling and as nutritional supplement it could therefore alleviate metabolic complications associated with antiretroviral therapy.

  10. Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review.

    Science.gov (United States)

    Sangro, Bruno; Martínez-Urbistondo, Diego; Bester, Lourens; Bilbao, Jose I; Coldwell, Douglas M; Flamen, Patrick; Kennedy, Andrew; Ricke, Jens; Sharma, Ricky A

    2017-09-01

    Selective internal radiation therapy (or radioembolization) by intra-arterial injection of radioactive yttrium-90-loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer. The high-dose beta-radiation penetrates an average of only 2.5 mm from the source, thus limiting its effects to the site of delivery. However, the off-target diversion of yttrium-90 microspheres to tissues other than the tumor may lead to complications. The most prominent of these complications include radiation gastritis and gastrointestinal ulcers, cholecystitis, radiation pneumonitis, and radioembolization-induced liver disease, which may occur despite careful pretreatment planning. Thus, selective internal radiation therapy demands an expert multidisciplinary team approach in order to provide comprehensive care for patients. This review provides recommendations to multidisciplinary teams on the optimal medical processes in order to ensure the safe delivery of selective internal radiation therapy. Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis, and management of potential radiation injury to the liver and to other organs. (Hepatology 2017;66:969-982). © 2017 by the American Association for the Study of Liver Diseases.

  11. Pre-operative therapeutic eyelid hygiene in the prevention of complications following excimer laser vision correction

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov

    2012-01-01

    Full Text Available Purpose: to assess the effectiveness of pre-operative therapeutic eyelid hygiene in the prevention and treatment of dry eye and meibomian glands dysfunction following excimer laser vision surgery.Methods: In enrolled 144 patients (288 eyes, ocular surface and meibomian glands functions were evaluated before and following refractive surgery (LASIK and REIK. In pre- and post-operative period, standard ophthalmological studies were performed, including best-corrected visual acuity determination, biomicroscopy, Schirmer’s test and Norn’s test (tear break-up time. In pre-operative pe- riod, ocular surface microbial profile was assessed. Subjective symptoms of impaired tear production were revealed via questioning. In study group (70 patients, 140 eyes, therapeutic eyelid hygiene using Blefarogel 1 or Blefarogel 2 (Ltd. Heltec-Medica, Moscow, Russia was prescribed one week before surgery. In control group, no therapeutic eyelid hygiene was prescribed. All patients were received antibacterial treatment including Vigamox (Alcon, Fort Worth, tX. In both groups, Natural tears and Systane Ultra (Alcon were used as tear replacement therapy.Results: Complex treatment, including therapeutic eyelid hygiene in study group, significantly improved tear film and ocular sur- face health as well as meibomian glands functions. Inflammatory complications rate was estimated as 5.7% in study group and 10.6% in control group.Conclusion: therapeutic eyelid hygiene is highly effective in the prophylaxis and treatment of post-operative complications duу to ocular surface pathology and meibomian glands dysfunction. the procedure is safe and can be recommended as a part of complex preventive treatment before excimer laser vision correction.

  12. Pre-operative therapeutic eyelid hygiene in the prevention of complications following excimer laser vision correction

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov

    2014-07-01

    Full Text Available Purpose: to assess the effectiveness of pre-operative therapeutic eyelid hygiene in the prevention and treatment of dry eye and meibomian glands dysfunction following excimer laser vision surgery.Methods: In enrolled 144 patients (288 eyes, ocular surface and meibomian glands functions were evaluated before and following refractive surgery (LASIK and REIK. In pre- and post-operative period, standard ophthalmological studies were performed, including best-corrected visual acuity determination, biomicroscopy, Schirmer’s test and Norn’s test (tear break-up time. In pre-operative pe- riod, ocular surface microbial profile was assessed. Subjective symptoms of impaired tear production were revealed via questioning. In study group (70 patients, 140 eyes, therapeutic eyelid hygiene using Blefarogel 1 or Blefarogel 2 (Ltd. Heltec-Medica, Moscow, Russia was prescribed one week before surgery. In control group, no therapeutic eyelid hygiene was prescribed. All patients were received antibacterial treatment including Vigamox (Alcon, Fort Worth, tX. In both groups, Natural tears and Systane Ultra (Alcon were used as tear replacement therapy.Results: Complex treatment, including therapeutic eyelid hygiene in study group, significantly improved tear film and ocular sur- face health as well as meibomian glands functions. Inflammatory complications rate was estimated as 5.7% in study group and 10.6% in control group.Conclusion: therapeutic eyelid hygiene is highly effective in the prophylaxis and treatment of post-operative complications duу to ocular surface pathology and meibomian glands dysfunction. the procedure is safe and can be recommended as a part of complex preventive treatment before excimer laser vision correction.

  13. [The nurse in the surgical area: prevention of complications and implemention of intervention in patient care].

    Science.gov (United States)

    Falcó-Pegueroles, Anna; Rodríguez-Garcia, Catalina; Estrada-Masllorens, Joan Maria

    2011-12-01

    The contribution made by the surgical nurse is essential to ensure the security of the patient who is subjected to surgery as well as accompany this specialized professional work to ensure that the patient is in the best physical and mental condition to deal with procedures of these characteristics. Nurse care in the surgical area is frequently described from a biomedical approach as it focuses on the type of surgery or the surgical technique, a perspective that might be inadequate and obsolete in identifying the areas of professional intervention and in clarifying the objectives of the nursing staff in the surgical area. In this paper nursing interventions such as emotional support, enhanced security and the prevention of infection are described as well as the identification of potential complications more prevalent in the different stages of surgical procedure, such as bleeding, hypoxia or hypothermia, among others, all these different points are developed, from a rationalistic nursing approach with emphasis on a humanistic vision of patient care. The specificity of the surgical area demands a prepared and competent professional nurse in the emotional support of the patient and his or her family, as well as the demons- tration of knowledge and skills in technical management and instruments associated with each type of surgery. It also requires competence in the diagnosis of potential com- plications and the development of activities designed to the prevention, early detection and treatment of potential health problems.

  14. The application of evidence-based nursing in preventing complications occurred after interventional treatment of primary liver cancer

    International Nuclear Information System (INIS)

    Xu Cuirong

    2010-01-01

    Objective: To investigate the clinical effect of evidence-based nursing in preventing complications occurred after interventional treatment of primary liver cancer. Methods: Fifty-four patients of primary liver cancer who had received hepatic arterial chemo embolization were enrolled in this study. Using evidence-based thinking, the author analyzed the causes of complications occurred after the interventional treatment, formulated scientific nursing countermeasures and adopted foreseeable nursing care. Results: Through timely observation and targeted care, the incidence of complications after interventional treatment was effectively reduced, moreover, the patient's rehabilitation was improved. Conclusion: For the prevention of complications occurred after interventional treatment in patients with primary liver cancer, the evidencebased nursing plays an important role. It can provide scientific guidance to nursing practice, improve the quality and efficiency of nursing and enhance the ability of nurses in solving clinical problems. (J Intervent Radiol, 2010, 19 : 824-826) (authors)

  15. Legal issues related to postoperative pulmonary thromboembolism in Korea

    Science.gov (United States)

    Park, Bo Young; Kim, Min Ji; Kang, So Ra

    2016-01-01

    Purpose Currently, development of pulmonary thromboembolism (PTE) after surgery is frequently being followed by legal action in Korea, as consequences may be fatal. In the current study, we assessed possible countermeasures that medical teams can take when faced with conflicting opinions on responsibility for PTE. Methods A retrospective analysis of claims handled by the Supreme Court and subordinate courts, from 1999 to 2015, was performed. We analyzed the type of procedure, associated complications, and critical legal points from the recorded judgments along with any liability limitations on surgeons. Results After reviewing cases between 1999 and 2015, a total of 18 cases were analyzed. There were no cases in which the surgeon was held accountable between 1999 and 2002. From 2003, there were instances of the surgeon being held accountable, with a peak of cases in 2013. Legal standards applied in judicial decision-making related to appropriate use of preventive measures, operation characteristics, doctor's reaction towards symptom occurrence, obligation of postoperative medical care, and duty of explanation. Conclusion The courts in Korea have changed their position from one of denying doctors' liability to one of enforcing responsibility for PTE. Surgeons are therefore being held responsible with greater frequency, depending on the details of the case. Lessons can be learnt from precedents that can be incorporated into medical education and training programs with the aim of reducing both major PTE complication rates and litigation costs. PMID:27904854

  16. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review.

    Science.gov (United States)

    Pasquina, Patrick; Tramèr, Martin R; Granier, Jean-Max; Walder, Bernhard

    2006-12-01

    To examine the efficacy of respiratory physiotherapy for prevention of pulmonary complications after abdominal surgery. We searched in databases and bibliographies for articles in all languages through November 2005. Randomized trials were included if they investigated prophylactic respiratory physiotherapy and pulmonary outcomes, and if the follow-up was at least 2 days. Efficacy data were expressed as risk differences (RDs) and number needed to treat (NNT), with 95% confidence intervals (CIs). Thirty-five trials tested respiratory physiotherapy treatments. Of 13 trials with a "no intervention" control group, 9 studies (n = 883) did not report on significant differences, and 4 studies (n = 528) did: in 1 study, the incidence of pneumonia was decreased from 37.3 to 13.7% with deep breathing, directed cough, and postural drainage (RD, 23.6%; 95% CI, 7 to 40%; NNT, 4.3; 95% CI, 2.5 to 14); in 1 study, the incidence of atelectasis was decreased from 39 to 15% with deep breathing and directed cough (RD, 24%; 95% CI, 5 to 43%; NNT, 4.2; 95% CI, 2.4 to 18); in 1 study, the incidence of atelectasis was decreased from 77 to 59% with deep breathing, directed cough, and postural drainage (RD, 18%; 95% CI, 5 to 31%; NNT, 5.6; 95% CI, 3.3 to 19); in 1 study, the incidence of unspecified pulmonary complications was decreased from 47.7% to 21.4 to 22.2% with intermittent positive pressure breathing, or incentive spirometry, or deep breathing with directed cough (RD, 25.5 to 26.3%; NNT, 3.8 to 3.9). Twenty-two trials (n = 2,734) compared physiotherapy treatments without no intervention control subjects; no conclusions could be drawn. There are only a few trials that support the usefulness of prophylactic respiratory physiotherapy. The routine use of respiratory physiotherapy after abdominal surgery does not seem to be justified.

  17. Preventing the aortic complications of Marfan syndrome: a case-example of translational genomic medicine

    Science.gov (United States)

    Li-Wan-Po, Alain; Loeys, Bart; Farndon, Peter; Latham, David; Bradley, Caroline

    2011-01-01

    The translational path from pharmacological insight to effective therapy can be a long one. We aim to describe the management of Marfan syndrome as a case-example of how pharmacological and genomic insights can contribute to improved therapy. We undertook a literature search for studies of Marfan syndrome, to identify milestones in description, understanding and therapy of the syndrome. From the studies retrieved we then weaved an evidence-based description of progress. Marfan syndrome shows considerable heterogeneity in clinical presentation. It relies on defined clinical criteria with confirmation based on FBN1 mutation testing. Surgical advances have prolonged life in Marfan syndrome. First-line prophylaxis of complications with β-adrenoceptor blockers became established on the basis that reduction of aortic pressure and heart rate would help. Over-activity of proteinases, first suggested in 1980, has since been confirmed by evidence of over-expression of matrix metalloproteinases (MMP), notably MMP-2 and MMP-9. The search for MMP inhibitors led to the evaluation of doxycycline, and both animal studies and small trials, provided early evidence that this widely used antimicrobial agent was useful. Identification of the importance of TGF-β led to evaluation of angiotensin II type I receptor (AT1R) blockers with highly promising results. Combination prophylactic therapy would appear rational. Pharmacological and genomic research has provided good evidence that therapy with losartan and doxycycline would prevent the aortic complications of Marfan syndrome. If on-going well designed trials confirm their efficacy, the outlook for Marfan syndrome patients would be improved considerably. PMID:21276043

  18. Impact of diverticular inflammation and complication assessment classification on the burden of medical therapies in preventing diverticular disease complications in Italy.

    Science.gov (United States)

    Tursi, Antonio; Elisei, Walter; Picchio, Marcello; Nasi, Gabriella; Mastromatteo, Angela Maria; Di Mario, Francesco; Di Rosa, Enrico; Brandimarte, Maria Alessandra; Brandimarte, Giovanni

    2017-08-01

    Several treatments are currently advised to manage diverticular disease (DD) patients, but their impact on the burden of the disease is unknown. Our aim was to assess the economic analysis of using the recent Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the burden of medical therapies prescribed in preventing DD complications occurrence in Italy. We assessed retrospectively the cost/year of treatments in estimated DICA 1, DICA 2 and DICA 3 population. Analysis of diverticulosis prevalence was estimated according to data population provided by Italian Institute of Statistics (ISTAT). Cost of treatments calculated according to data on drugs' consumption collected during the DICA study. We estimated that >8 million of Italian people >60 years may have diverticulosis, and that about 75% of diverticular population are on DICA 1, about 30% on DICA 2, and about 13% on DICA 3. We estimated that >387 million of euros could be spent in DICA 1 population, >203 million of euros in DICA 2 population, and >88 million of euros in DICA 3 population. Since medical treatments did not show any significant advantage when treating DICA 1 and DICA 3 people in terms of prevention of acute diverticulitis occurrence/recurrence and surgery occurrence, we can estimated that >475 million of euros could be spent in Italy without any significant benefit in preventing DD complications occurrence. DICA endoscopic classification may have a significant impact on the burden of DD in Italy, because it helps to select DD people who effectively need treatments in terms of prevention of acute diverticulitis occurrence/recurrence and surgery occurrence.

  19. Prevention and nursing care of the complications occurred in interventional therapy for arteriosclerosis obliterans of lower extremity

    International Nuclear Information System (INIS)

    Xu Yang; Qi Yuchun; Wang Hua; Han Yajun; Fu Wenli; Fan Rui; Lv Xiaoying

    2009-01-01

    Objective: To discuss the prevention and nursing care of the perioperative complications occurred in interventional therapy for arteriosclerosis obliterans of lower extremity. Methods: During the period of July 2006 to June 2009, interventional treatment for the arteriosclerosis obliterans of lower extremity was performed in 380 cases. The clinical data and complications were reviewed and analyzed, and the prevention and nursing care of the complications were summarized. Results: Complications occurred in 41 cases. During the surgery, vascular rupture or arterial dissection occurred in 5 cases, hypoglycemia reaction in 3 cases and elevation of blood pressure in 2 cases. The complications,which occurred after the treatment,included acute arterial thrombosis (n=3), deep vein thrombosis (n=2), bleeding of different tissues or organs (n=17), acute myocardial infarction (n=2), pseudoaneurysm (n=2), excessive lower limb perfusion syndrome (n=4) and compression sores (n=1). Conclusion: Detailed information of medical history, careful observation of clinical condition, intensive care of patient, adequate preparation of medical materials, seriously handing over the duty to the next shift and taking one's turn on duty, etc. are all the effective measures to prevent and to reduce the occurrence of complications. (authors)

  20. Prevention of hypoxic fetal complications in pregnant women with congenital heart disease and anemia

    Directory of Open Access Journals (Sweden)

    Iu. Davydova

    2016-06-01

    Full Text Available The aim of the study is — to develop a strategy of prevention of hypoxic fetal abnormalities in pregnant women with congenital heart disease, heart failure and iron deficiency anemia. Materials and methods. The study included 86 pregnant women with CHD and NYHA II–III. 68 women in the third trimester of pregnancy is diagnosed anemia (group I, 18 pregnant women with CHD, NYHA II–III without anemia (II group, the control group consisted of 24 pregnant women without cardiac disease, with physiological pregnancy. All pregnant with information registration consent studied the concentration of ferritin, hemoglobin level, morphological study of the placenta. All pregnant women were assigned to iron supplements, oral iron (III hydroxide polymaltose complex (Maltofer when hemoglobin levels above 95 g/l and the expected delivery date more than 40 days of starting treatment. When the hemoglobin level below 95 g/l of intravenously administered iron (III hydroxide sucrose complex (Venofer followed by transfer to oral iron (III. Results. In groups of pregnant I and II did not have perinatal losses, births in gestation less than 28 weeks, with a score Apgar at birth of less than 4 points. Pregnant women with cyanotic heart defects and the need for early delivery in less than 37 weeks are not included in the study. Also, there is a correlation between the degree of severity of anemia in women with CHD with HF and prematurity, and the presence of IUGR child birth asphyxia able to varying degrees (respectively, r=0.8, r=0.75 and r=0.85. Conclusions. Formation of fetoplacental unit in women with CHD on a background of heart failure occurs with complications associated with the presence of tissue hypoxia, as well as the possible impact on the process of oxidative stress. The development of iron deficiency anemia in this group is an additional risk factor for placental dysfunction, which is confirmed by morphometric and morphological studies of placentas

  1. Are systemic antibiotics necessary in the prevention of wound healing complications after intra-alveolar dental extraction?

    Science.gov (United States)

    Gbotolorun, O M; Dipo-Fagbemi, I M; Olojede, A O; Ebigwei, S; Adetoye, J O

    2016-12-01

    This double-blind, randomized controlled study was done to assess the necessity of systemic antibiotics in the prevention of wound healing complications after intra-alveolar dental extraction. A consecutive recruitment method was used to allocate participants to two treatment groups. Subjects in group A (antibiotics group, n=75) received amoxicillin and metronidazole for 5 days postoperatively, while those in group B (placebo group, n=75) were given identical-looking placebo drugs in place of the antibiotics. Postoperative socket healing complications, pain, and compliance with postoperative instructions were assessed postoperatively. Healing was uneventful in 129 patients (86%). Twenty-one patients (14%) developed wound healing complications. Dry socket was the most common complication in the antibiotics group (six subjects), while acutely inflamed sockets was the most common in the placebo group (five subjects). Non-adherence to postoperative instructions and postoperative pain were found to be significantly associated with the development of wound healing complications. The prescription of antibiotics after routine intra-alveolar dental extraction in healthy patients may not play any significant role in preventing wound healing complications. However, non-compliance with postoperative instructions might be associated with increased wound healing complications. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Potential of Dietary Non-Provitamin A Carotenoids in the Prevention and Treatment of Diabetic Microvascular Complications12

    Science.gov (United States)

    Murillo, Ana Gabriela

    2016-01-01

    Diabetes is a chronic metabolic disease that affects a substantial part of the population around the world. Whether type I or type II, this disease has serious macro- and microvascular complications that constitute the primary cause of death in diabetic patients. Microvascular complications include diabetic retinopathy, nephropathy, and neuropathy. Although these complications are clinically and etiologically diverse, they share a common factor: glucose-induced damage. In the progression of diabetic complications, oxidative stress, inflammation, and the formation of glycation end products play an important role. Previous studies have shown that a healthy diet is vital in preventing these complications; in particular, the intake of antioxidants has been studied for their potential effect in ameliorating hyperglycemic injuries. Carotenoids are lipid-soluble pigments synthesized by plants, bacteria, and some kinds of algae that are responsible for the yellow, red, and orange colors in food. These compounds are part of the antioxidant machinery in plants and have also shown their efficacy in quenching free radicals, scavenging reactive oxygen species, modulating gene expression, and reducing inflammation in vitro and in vivo, showing that they can potentially be used as part of a preventive strategy for metabolic disorders, including diabetes and its related complications. This review highlights the potential protective effects of 4 non-provitamin A carotenoids—lutein, zeaxanthin, lycopene, and astaxanthin—in the development and progression of diabetic microvascular complications. PMID:26773012

  3. Real-life practices for preventing venous thromboembolism in multiple myeloma patients: a cohort study from the French health insurance database.

    Science.gov (United States)

    Palmaro, Aurore; Rougé-Bugat, Marie-Eve; Gauthier, Martin; Despas, Fabien; Moulis, Guillaume; Lapeyre-Mestre, Maryse

    2017-05-01

    The risk of venous thromboembolic event (VTE) in multiple myeloma is particularly increased. Current guidelines recommend systematic VTE prophylaxis with vitamin K antagonists (VKA) or low weight molecular heparin (LWMH) or unfractionated heparin (UFH) in high-risk patients, based on treatment received [e.g. use of IMiDs (thalidomide, lenalidomide and pomalidomide), alkylating agents or erythropoietin] and individual risk factors (e.g. history of VTE). The aim of this study was to describe strategy of VTE prophylaxis and prescribing of other antithrombotic agents during the first 6 months of multiple myeloma therapy, with stratification on IMiD-based regimens and drug and disease-related risk factors. A retrospective cohort study of French beneficiaries from the health insurance database (SNIIRAM, Système National d'Information Inter-Régime de l'Assurance Maladie) was designed in the Midi-Pyrénées area (South West France). Patients starting a treatment for multiple myeloma in the period 2011-2014 were identified through hospital and chronic disease diagnoses. Among the 236 incident multiple myeloma patients, 56% male (n = 133), 67% >65 years (n = 159) and 47% (n = 110) patients received an IMiD-based regimen. In these patients, 63% (n = 69) were identified as high-risk patients with indication for low molecular weight heparin or equivalent, and 37% (n = 41) were identified as low-risk with aspirin recommended. Among the high-risk IMiDs patients, 43% (30/69) currently received a VTE prophylaxis after starting their first regimen: 70% LWMH (21/30), 40% VKA (12/30), 10% UFH (3/30) and 13% (4/30) other drugs (rivaroxaban and fondaparinux); 33% of the patients (23/69) received an antiplatelet drug only, and 23% (16/69) did not receive any antithrombotic drug. These results revealed lack of implementation of VTE prophylaxis in one out of high-risk multiple myeloma patients with IMiD. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley

  4. Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.

    Science.gov (United States)

    Ruscic, Katarina J; Grabitz, Stephanie D; Rudolph, Maíra I; Eikermann, Matthias

    2017-06-01

    Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.

  5. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery - a systematic review.

    Science.gov (United States)

    Thybo Karanfil, Emil Osman; Møller, Ann Merete

    2018-03-01

    Post-operative pulmonary complications are a common cause of morbidity and mortality in patients undergoing heart surgery. The aim of this systematic review was to determine if preoperative inspiratory muscle training could prevent the development of pneumonia and atelectasis in patients undergoing coronary artery bypass grafting (CABG) or heart valve surgery. Systematic searches were performed in MEDLINE, Embase and the Cochrane Library. The included studies compared the development of pneumonia and atelectasis in CABG patients or heart valve surgery patients who were prescribed either preoperative inspiratory muscle training or usual care. The quality of the studies was assessed using the Cochrane Risk of Bias Tool. The search yielded 2,479 records. The inclusion criteria were fulfilled by five studies. All the studies were randomised controlled trials. We found that the development of both pneumonia and atelectasis was significantly reduced among patients who received inspiratory muscle training preoperatively compared with patients treated with usual care. Preoperative inspiratory muscle training may reduce the risk of developing pneumonia and atelectasis. However, more trials are needed to support and strengthen the evidence found in this systematic review before routine implementation of this kind of training preoperatively. Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

  6. Hyperbaric index in the primary prevention of hypertensive complications in high-risk pregnancy.

    Science.gov (United States)

    Otero González, Alfonso; Uribe Moya, Silvia; Arenas Moncaleano, Ivan Gilberto; Borrajo Prol, María Paz; García García, María Jesús; López Sánchez, Luis

    2015-01-01

    Preeclampsia (PE) is a major cause of fetal morbidity and mortality. In the Western World, PE affects 2-7% of pregnancies and is responsible for 50,000 deaths annually. Early detection is a priority as it can change the clinical course, but there are no biomarkers or instrumental methods with high sensitivity and specificity. Only the hyperbaric index has a sensitivity and specificity of 99% for early identification of pregnant women at risk of developing PE, but its use is not widespread. To assess the usefulness of the hyperbaric index in the primary prevention of hypertensive pregnancy complications in a public healthcare area. This is a retrospective study of pregnancies that occurred in our area during the period 2007-2012 (N=11,784). The diagnosis was established by the hyperbaric index and pregnant women at risk were treated with ASA at night. In pregnant patients referred to the nephrology clinic (38.2%), diagnosed as high-risk for PE, and treated with 100mg ASA/night (from week 17), the incidence of PE episodes was reduced by 96.94. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Optimal management of venous thromboembolism in adolescent and young adult oncology patients

    Directory of Open Access Journals (Sweden)

    McKillop S

    2016-09-01

    Full Text Available Sarah McKillop,1 Cynthia Wu,2 Aisha Bruce,1 Joseph Brandwein2 1Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Medicine, Department of Pediatrics, 2Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada Abstract: Venous thromboembolism (VTE is a serious complication experienced by adolescents and young adults (AYAs diagnosed with cancer. Data exist in the adult literature to guide the management of cancer-associated thrombosis. Unfortunately, little is known regarding the epidemiology of cancer-associated thrombosis in AYAs. As a result, evidence on the treatment and prevention of thrombosis in this vulnerable population is lacking, posing a great challenge to physicians caring for AYAs with cancer. It is clear that the basic principles of VTE likely apply to AYAs and that low-molecular-weight heparin is the drug of choice for the treatment of VTE regardless of age. We review the available data on the epidemiology, diagnostic methods, and management of AYAs with cancer and VTE. Recognizing the lack of accepted guidelines for the prevention or management of VTE in this population, we offer expert opinion recommendations to serve as guidance to improve management of thrombosis in AYA cancer patients. Keywords: adolescents, young adults, thrombosis, cancer, venous thromboembolism, anticoagulation

  8. Direct oral anticoagulants and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Massimo Franchini

    2016-09-01

    Full Text Available Venous thromboembolism (VTE, consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban and thrombin inhibitors (e.g. dabigatran etexilate. This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.

  9. The prevention of oral complications in bone-marrow transplantations by means of oral hygiene and dental intervention

    NARCIS (Netherlands)

    Raber-Durlacher, J. E.; Abraham-Inpijn, L.; van Leeuwen, E. F.; Lustig, K. H.; van Winkelhoff, A. J.

    1989-01-01

    Oral complications cause morbidity and mortality in patients, undergoing allogeneic or autologous bone-marrow transplantation. The clinical features and the pathogenesis of the oral sequelae of bone marrow ablative therapy and graft-versus-host disease are discussed. In addition, a preventive oral

  10. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults.

    Science.gov (United States)

    Madrid, Eva; Urrútia, Gerard; Roqué i Figuls, Marta; Pardo-Hernandez, Hector; Campos, Juan Manuel; Paniagua, Pilar; Maestre, Luz; Alonso-Coello, Pablo

    2016-04-21

    Inadvertent perioperative hypothermia is a phenomenon that can occur as a result of the suppression of the central mechanisms of temperature regulation due to anaesthesia, and of prolonged exposure of large surfaces of skin to cold temperatures in operating rooms. Inadvertent perioperative hypothermia has been associated with clinical complications such as surgical site infection and wound-healing delay, increased bleeding or cardiovascular events. One of the most frequently used techniques to prevent inadvertent perioperative hypothermia is active body surface warming systems (ABSW), which generate heat mechanically (heating of air, water or gels) that is transferred to the patient via skin contact. To assess the effectiveness of pre- or intraoperative active body surface warming systems (ABSW), or both, to prevent perioperative complications from unintended hypothermia during surgery in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 9, 2015); MEDLINE (PubMed) (1964 to October 2015), EMBASE (Ovid) (1980 to October 2015), and CINAHL (Ovid) (1982 to October 2015). We included randomized controlled trials (RCTs) that compared an ABSW system aimed at maintaining normothermia perioperatively against a control or against any other ABSW system. Eligible studies also had to include relevant clinical outcomes other than measuring temperature alone. Several authors, by pairs, screened references and determined eligibility, extracted data, and assessed risks of bias. We resolved disagreements by discussion and consensus, with the collaboration of a third author. We included 67 trials with 5438 participants that comprised 79 comparisons. Forty-five RCTs compared ABSW versus control, whereas 18 compared two different types of ABSW, and 10 compared two different techniques to administer the same type of ABSW. Forced-air warming (FAW) was by far the most studied intervention.Trials varied widely regarding whether the interventions were

  11. Probiotic Therapy in Preventing Gastrointestinal Complications in Patients Undergoing Chemotherapy and Pelvic Radiation Therapy

    Science.gov (United States)

    2016-07-01

    Cognitive/Functional Effects; Constipation, Impaction, and Bowel Obstruction; Diarrhea; Fatigue; Gastrointestinal Complications; Psychosocial Effects of Cancer and Its Treatment; Unspecified Adult Solid Tumor, Protocol Specific

  12. Study of qinolones usage in prevention and therapy of septic complications of radiation damage

    International Nuclear Information System (INIS)

    Petyrek, P.; Spelda, S.

    1994-01-01

    A standard model of experimental sepsis was elaborated at rats in dependence on a gamma irradiation dose and a time interval between irradiation and application infectious agents E. coli O 83:K 24:H 31. For a development of experimental sepsis was proved that it is not decisive in these laboratory animals when infectious agents is i.v. or i.p. applicated. Such amount of organisms (1-20.10 7-8 ) was applicated in particular not to develop sepsis in non-irradiated laboratory animals. Laboratory animals were irradiated with sublethal doses and approximately. LD 50-30 doses of gamma radiation. The laboratory animals were treated only in experiments and qinolone drug ofloxacin was used in the treatment of experimental sepsis. Ofloxacin perorally administrated in the dose of 40 mg/kg in an hour after application of infectious agents and its administration for 5 days in the 24-h intervals confirmed in fact 100% therapeutic effectiveness in irradiated experimental animals. In non-treated experimental groups, animals died in 24-28 hours interval after application of infectious agents and sepsis was a cause of death. In treated experimental groups, animal survived by day 30 after irradiation with sublethal doses or died during the period typical for a bone marrow syndrome of acute radiation injury after irradiation with lethal doses of gamma radiation. Acquired experimental outcomes may suggest that fluorochinolone chemotherapeuticals in the respect of their essential pharmacokinetic properties will be used for a prevention of infectious complications in acute radiation injury. (author)

  13. Venous Thromboembolism in Adolescents

    Directory of Open Access Journals (Sweden)

    Aneta Samková

    2012-01-01

    Full Text Available The incidence of venous thromboembolism (VTE during childhood is low with two peaks – neonatal and adolescent age. This retrospective study is focused on clinical characteristics of VTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed – 16 girls (88.9%, 2 boys (11.1%. In 9 patients (50% thrombosis of the lower limb deep veins was diagnosed, six patients (33.3% suffered from symptomatic pulmonary embolism (PE and 3 patients (16.7% from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%. The most frequent acquired risk factor was oral contraception (OC in 12 out of 16 girls (75%. All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6% patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50% in patients with distal lower limb thrombosis, but very high (100% in patients with PE.

  14. Thromboembolic disease in vasculitis

    Science.gov (United States)

    Tomasson, Gunnar; Monach, Paul A.; Merkel, Peter A.

    2011-01-01

    Purpose of review To give an overview of recent clinical findings of thromboembolic disease in vasculitis and provide insight into possible explanations of the association between thrombosis and inflammation. Recent findings A high incidence of venous thrombotic events has recently been described in four distinct cohorts of patients with antineutrophil cytoplasmic antibodies-associated vasculitis (AAV), especially during periods of active disease. No factors other than the vasculitis itself have been identified that explain this high occurrence of thrombosis. Several studies have shown an increased rate of thrombosis in Behçet’s disease, with a different clinical presentation than that observed in AAV. Recent laboratory findings provide exciting insights into a bidirectional feedback loop between coagulation and inflammation that may be applicable to vasculitis. Summary Thrombosis is an important clinical manifestation of some types of vasculitis. Better understanding of the association of thrombosis with inflammation in vasculitis might lead to development of clinically useful biomarkers and new approaches to therapy. Additionally, study of the specific factors involved in thrombosis in systemic vasculitis could help explain the role of inflammation in more common settings of venous thrombotic events. PMID:19077717

  15. Pulmonary thromboembolism in children

    Energy Technology Data Exchange (ETDEWEB)

    Babyn, Paul S.; Gahunia, Harpal K. [Hospital for Sick Children, Department of Pediatric Diagnostic Imaging, Toronto, ON (Canada); Massicotte, Patricia [Stollery Children' s Hospital and University of Alberta, Departments of Pediatric Hematology and Cardiology, Edmonton, AB (Canada)

    2005-03-01

    Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients. (orig.)

  16. Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes.

    Science.gov (United States)

    O'Brien, Sarah H; Koch, Terah; Vesely, Sara K; Schwarz, Eleanor Bimla

    2017-02-01

    To investigate safety of hormonal contraception with regard to thromboembolic events in women with type 1 or 2 diabetes. We used data from 2002-2011 in Clinformatics Data Mart to identify women in the U.S., 14-44 years of age, with an ICD-9-CM code for diabetes and a prescription for a diabetic medication or device. We examined contraceptive claims and compared time to thromboembolism (venous thrombosis, stroke, or myocardial infarction) among women with diabetes dispensed hormonal contraception using a modification of Cox regression to control for age, smoking, obesity, hypertension, hyperlipidemia, diabetic complications, and history of cancer; we excluded data for 3 months after women gave birth. We identified 146,080 women with diabetes who experienced 3,012 thromboembolic events. Only 28% of reproductive-aged women with diabetes had any claims for hormonal contraception, with the majority receiving estrogen-containing oral contraceptives. Rates of thromboembolism were highest among women who used the contraceptive patch (16 per 1,000 woman-years) and lowest among women who used intrauterine (3.4 per 1,000 woman-years) and subdermal (0 per 163 woman-years) contraceptives. Compared with use of intrauterine contraception, progestin-only injectable contraception was associated with increased risk of thromboembolism (12.5 per 1,000 woman-years; adjusted hazard ratio 4.69 [95% CI 2.51-8.77]). The absolute risk of thromboembolism among women with type 1 or 2 diabetes using hormonal contraception is low. Highly effective, intrauterine and subdermal contraceptives are excellent options for women with diabetes who hope to avoid the teratogenic effects of hyperglycemia by carefully planning their pregnancies. © 2017 by the American Diabetes Association.

  17. [Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis].

    Science.gov (United States)

    Rojas-Tomba, F; Gormaz-Talavera, I; Menéndez-Quintanilla, I E; Moriel-Durán, J; García de Quevedo-Puerta, D; Villanueva-Pareja, F

    2016-01-01

    To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication. A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24-48 hours after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography. A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 minutes, patients older than 70 years of age, hypertension, and degenerative scoliosis. There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 minutes, when 4 or more levels are involved. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  18. Update on chronic thromboembolic pulmonary hypertension.

    Science.gov (United States)

    Robbins, Ivan M; Pugh, Meredith E; Hemnes, Anna R

    2017-01-01

    Chronic, unresolved thromboemboli are an important cause of pulmonary hypertension (PH) with specific treatment strategies differing from other types of PH. Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 PH by the World Health Organization. It is a rare, but underdiagnosed, complication of acute pulmonary embolism that does not resolve and results in occlusion of large pulmonary arteries with a fibro-thrombotic material. The etiology of CTEPH remains uncertain, and it is unknown why certain patients with acute pulmonary embolism develop this disorder. The evaluation for CTEPH is an important part of the evaluation for PH in general, and it is crucial not to overlook this diagnosis, as it is the only form of PH that is potentially curable. Patients diagnosed with CTEPH should be referred to an expert center for consideration of pulmonary endarterectomy, and surgical removal of the chronic thromboembolic material. Not all patients with CTEPH are surgical candidates, however, and there are emerging treatments-medical therapy and balloon pulmonary angioplasty-that have shown benefit in this patient population. Without treatment, CTEPH can lead to progressive pulmonary vascular obstruction, right heart failure, and death. Thus, it is important for clinicians to recognize this subtype of PH. In this review, we provide an overview of current understanding of the pathogenesis of CTEPH and highlight recommendations and recent advances in the evaluation and treatment of CTEPH. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Complications of Transvaginal Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: Tips for Prevention, Recognition, and Management.

    Science.gov (United States)

    MacDonald, Susan; Terlecki, Ryan; Costantini, Elisabetta; Badlani, Gopal

    2016-08-01

    Mesh-related complications following transvaginal management of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) have received significant attention in the last decade. We sought to identify patient, product, and technical factors associated with an increased risk of complications after mesh-based transvaginal repair of anterior POP and SUI. In this review we clarify the different pattern of complications after POP and SUI repairs. Our aim is to provide a practical evidence-based guide for physicians to prevent and, if necessary, manage product-associated complications in a stepwise manner. We conducted a comprehensive PubMed search of all English-language articles published from 2010 to June 2016, using these search terms: mesh, pelvic organ prolapse, and stress urinary incontinence. Expert opinion is also provided. Mesh-related complications are much lower after repair of SUI compared with POP, despite its more frequent use. Vaginal exposure is the most common mesh-specific complication. Patients may present with vaginal discharge, dyspareunia, pain, recurrent urinary tract infection, and/or hematuria. Conversely, patients may be asymptomatic. Small asymptomatic mesh exposures (urinary tract must be fully excised. Following excision, pain may persist in up to 50% of patients. Vaginal extrusion, persistent pain, and urethral and/or bladder erosion are the three most common product-specific complications following mesh-based repair for SUI or POP. Conservative therapies may be attempted, but most patients ultimately require partial or complete mesh excision. We reviewed the recent literature on mesh-related complications after repair of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Vaginal exposure, persistent pain, and erosion into the urinary tract are the most common. These often require surgical management, best suited to a urologist with training and experience in this area. Evidence supports mesh use for correction of

  20. The prevention and management of complications during and immediately after percutaneous balloon mitral valvuloplasty

    International Nuclear Information System (INIS)

    Jiang Shiliang; Huang Lianjun; Xu Zhongying; Zhao Shihua; Zheng Hong; Ling Jian; Xie Ruolan; Dai Ruping

    2002-01-01

    Objective: To approach the cause and treatment of complication during and immediately after percutaneous balloon mitral valvuloplasty. Methods: One thousand three hundred and eleven patients with mitral stenosis were treated by percutaneous transseptal balloon mitral valvuloplasty. Among them, 42 patients with complications were retrospectively analyzed. Results: The overall complications rate was 3.2% (42/1311) including atrial fibrillation 0.8% (10/1311), acute pericardial tamponade 0.31% (4/1311), severe mitral insufficiency 0.46% (6/1311), femoral arterial venous fistula 0.69% (9/1311), acute pulmonary edema and iatrogenic atrial septal defect 0.23% (3/1311), respectively. Coronary air embolism, arterial thrombosis and transient cerebrovascular accident was 0.15% (2/1311) for every other one. Balloon rupture was 0.08%(1/1311). Conclusions: The complications of percutaneous balloon mitral valvuloplasty rarely occur. It is a safe and efficient nonsurgical method for treating rheumatic mitral stenosis

  1. Prevention of infectious complications in surgical patients: potential role of probiotics

    NARCIS (Netherlands)

    Besselink, Marc G. H.; Timmerman, Harro M.; van Minnen, L. Paul; Akkermans, Louis M. A.; Gooszen, Hein G.

    2005-01-01

    Infectious complications in surgical patients often originate from the intestinal microflora. In the critically ill patient, small bowel motility is disturbed, leading to bacterial overgrowth and subsequent bacterial translocation due to dysfunction of the gut mucosal barrier. The optimal

  2. Prevention of pregnancy complications in iran following implementing a national educational program.

    Directory of Open Access Journals (Sweden)

    Maryam Moghani Lankarani

    2014-09-01

    Full Text Available To determine the impact of a national intervention program on some pregnancy complications in Iran.This multicenter study was conducted in governmental sector in 14 provinces in Iran between 2003 and 2005. Intervention included education of all maternal health care providers including gynecologists, general physicians, and midwifes in the governmental sector. Time interval between the pre- (of 3,978 and 3,958 pregnancies and post- (3,958 pregnancies measurements were 18 months. Self reported data on pregnancy complications were registered. Interviews were conducted by trained personnel. Participants were interviewed when admitted for delivery or at the time attending for vaccination of their 2 month infants.The following pregnancy complications were reduced significantly as compared to before intervention: 1 bleeding or spotting, 2 urinary tract complications, 3 blurred vision and severe headache, 4 premature labor pain, 5 anemia, 6 severe vomiting, 7 inappropriate weight gain, 8 endometritis, 9 urinary incontinence, 10 breast abscess or mastitis, 11 wound infection, and 12 bleeding was significantly reduced after intervention, compared to before intervention. Premature rupture of membrane showed a significant increase. These complications did not show a significant change: 1 hypertension, 2 fever and chills, 3 convulsion, shock, and loss of consciousness, and 4 obstetric fistula.National programs may be proved to be largely effective by decreasing some of the pregnancy complications in developing countries.

  3. Taking a look to promoting health and complications' prevention: differences by context.

    Science.gov (United States)

    Freire, Rosa Maria de Albuquerque; Landeiro, Maria José Lumini; Martins, Maria Manuela Ferreira Pereira da Silva; Martins, Teresa; Peres, Heloísa Helena Ciqueto

    2016-08-08

    to acknowledge and compare the health promotion and complications' prevention practices performed by nurses working in hospital and primary health care contexts. descriptive, exploratory and crosscutting study, performed with 474 nurses selected by convenience sampling. It was used a form that encompassed two categories of descriptive statements about quality in the professional exercise of nurses. This study had ethical committee approval. the nurses' population was mainly women (87,3%) with an average age of 35,5 years. There was more practices of the hospital's nurses related to the identification of potential problems of the patient (p=0.001) and supervision of the activities that put in place the nursing interventions and the activities that they delegate (p=0.003). the nurses perform health promotion and complications' prevention activities, however not in a systematic fashion and professional practices differ by context. This study is relevant as it may promote the critical consciousness of the nurses about the need of stressing quality practices. conhecer e comparar as práticas de promoção da saúde e prevenção de complicações de enfermeiros que exercem em contexto hospitalar e em cuidados de atenção básica à saúde. estudo descritivo, exploratório e transversal desenvolvido com 474 enfermeiros, selecionados por meio de amostragem por conveniência. Foi utilizado questionário que integrou duas categorias de enunciados descritivos de qualidade do exercício profissional dos enfermeiros. O estudo foi aprovado em comitê de ética. a maioria dos enfermeiros era do sexo feminino (87,3%), com idade média de 35,5 anos. Houve mais práticas dos enfermeiros dos cuidados básicos à saúde relativamente a promoção de estilos de vida saudável (hospital relativamente a identificação dos problemas potenciais do paciente (p=0.001) e supervisão das atividades que concretizam as intervenções de enfermagem e as atividades que delegam (p=0.003). os

  4. [Prevention of complications in the air transport of the critically ill pediatric patient between hospitals].

    Science.gov (United States)

    Carreras-Gonzalez, E; Brió-Sanagustin, S

    2014-10-01

    To analyze the rate of complications recorded during patient transport after applying a stabilization protocol in the sending hospital, defined by a paediatric critical patients air transport unit. We retrospectively analyzed the transfers made by the air unit of our hospital over a 5 years period. Patients with respiratory failure, hemodynamic compromise, or neurological involvement were identified. The stabilization protocol prior to transport is described. Operations performed during stabilization period, as well as during the transfer are quantified. Complications during transport are recorded and classified into major and minor ones. A total of 388 patients were transferred, of which 207 had respiratory failure, 124 neurological disorders, and 102 with hemodynamic instability. During the stabilization period, 295 patients required oxygen and 161 mechanical ventilation. A total of 14 pleural drains, 397 peripheral lines and 97 central lines were placed. Vasoactive drugs were administered on 92 occasions and anticonvulsants in 41. We have performed 24 cardiopulmonary resuscitation, and 2 patients died before the move, and one required surgery. Twenty major complications have been recorded during transfer (6 neurological, 13 hemodynamic, and 1 respiratory), and 69 minor complications (14 neurological, 29 hemodynamic and 26 respiratory). One patient died. Compliance with defined stabilization standards led to a high rate of interventions during the preparation phase. On the other hand, a small number of complications occurred during transport: only 5.1% of the patients showed any serious complication. This low rate of complications is attributable to a correct stabilization carried out prior to transfer, and based on the standards adopted by the team. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  5. Complications of nephrotic syndrome

    Directory of Open Access Journals (Sweden)

    Se Jin Park

    2011-08-01

    Full Text Available Nephrotic syndrome (NS is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox, thromboembolism (e.g., venous thromboembolism and pulmonary embolism, hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension, cardiovascular problems (e.g., hyperlipidemia, acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception. The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

  6. Efficacy and Safety of Direct Oral Anticoagulants Compared to Warfarin in Prevention of Thromboembolic Events Among Elderly Patients with Atrial Fibrillation.

    Science.gov (United States)

    Kailas, Shilpa D; Thambuluru, Sirisha Reddy

    2016-10-18

    Direct oral anticoagulants (DOACs), previously also known as novel oral anticoagulants (NOACs), have increased the therapeutic options for stroke prevention in atrial fibrillation (AF). Previous studies comparing their relative efficacy and safety do not address age-related differences, such as comorbidities and physical and social boundaries. This review aimed to summarize and compare the clinical and safety outcomes of DOACs and warfarin for stroke prevention in AF in the elderly population (≥ 65 years). We searched PubMed for randomized controlled trials and meta-analyses that compared DOACs and warfarin in elderly patients with AF. Stroke and systemic embolism (SSE) and major bleeding (MB) were primary outcomes. Secondary outcomes included ischemic stroke, all-cause mortality, intracranial bleeding, and gastrointestinal bleeding. Of 66 studies identified, one randomized control trial (RCT) and one meta-analysis were included. DOACs were at least as effective at reducing the risk of SSE as warfarin. DOACs demonstrated a minimal benefit for ischemic stroke (dabigatran, 110 mg, relative risk (RR) 1.08; edoxaban, 60 mg, RR 1.00; and apixaban, 5 mg, RR 0.99). DOACs associated with decreased risk of MB relative to warfarin include dabigatran, 110 mg; apixaban, 5 mg; and edoxaban, 60 mg (RR 0.80, 0.70, and 0.80, respectively), while dabigatran, 150 mg, and rivaroxaban, 20 mg, increased risk (RR 0.79 - 0.83, respectively). Dabigatran, 110 mg and 150 mg doses, and edoxaban increased the risk of gastrointestinal bleeding (RR 1.04, 1.12, and 1.23, respectively). Lower rates of SSE and intracranial bleeding were seen with DOACs compared to warfarin. Dabigatran, 150 mg, and rivaroxaban, 20 mg, were associated with higher MB in older elderly compared to warfarin. DOACs may be attractive alternatives to warfarin, but further studies are needed to make clinical recommendations.

  7. Dose-Dependent Effect of Statin Pretreatment on Preventing the Periprocedural Complications of Carotid Artery Stenting.

    Science.gov (United States)

    Hong, Jeong-Ho; Sohn, Sung-Il; Kwak, Jaehyuk; Yoo, Joonsang; Chang, Hyuk Won; Kwon, O-Ki; Jung, Cheolkyu; Chung, Inyoung; Bae, Hee-Joon; Lee, Ji Sung; Han, Moon-Ku

    2017-07-01

    We investigated whether statin pretreatment can dose dependently reduce periprocedural complications in patients undergoing carotid artery stenting because of symptomatic carotid artery stenosis. We enrolled a consecutive series of 397 symptomatic carotid artery stenosis (≥50% stenosis on conventional angiography) treated with carotid artery stenting at 2 tertiary university hospitals over a decade. Definition of periprocedural complications included any stroke, myocardial infarction, and death within 1 month after or during the procedure. Statin pretreatment was divided into 3 categories according to the atorvastatin equivalent dose: none (n=158; 39.8%), standard dose (statin use were 12.0%, 4.5%, and 1.2%. After adjustment, a change in the atorvastatin dose category was associated with reduction in the odds of periprocedural complications for each change in dose category (standard-dose statin: odds ratio, 0.24; 95% confidence interval, 0.07-0.81; high-dose statin: odds ratio, 0.11; 95% confidence interval, 0.01-0.96; P for trend=0.01). Administration of antiplatelet drugs was also an independent factor in periprocedural complications (OR, 0.18; 95% CI, 0.05-0.69). This study shows that statin pretreatment may reduce the incidence of periprocedural complications dose dependently in patients with symptomatic carotid artery stenting. © 2017 American Heart Association, Inc.

  8. What Is the Safety and Efficacy of Chemical Venous Thromboembolism Prophylaxis Following Vestibular Schwannoma Surgery?

    Science.gov (United States)

    Casazza, Geoffrey C; Bowers, Christian A; MacDonald, Joel D; Couldwell, William T; Shelton, Clough; Gurgel, Richard K

    2018-02-01

    The benefit of routine chemical prophylaxis use for venous thromboembolism (VTE) prevention in skull base surgery is controversial. Chemical prophylaxis can prevent undue morbidity and mortality, however there are risks for hemorrhagic complications. Retrospective case-control. A retrospective chart review of patients who underwent surgery for vestibular schwannoma from 2011 to 2016 was performed. Patients were divided by receipt of chemical VTE prophylaxis. Number of VTEs and hemorrhagic complications (intracranial hemorrhage, abdominal hematoma, and postauricular hematoma) were recorded. One hundred twenty-six patients were identified, 55 received chemical prophylaxis, and 71 did not. All the patients received mechanical prophylaxis. Two patients developed a deep vein thrombosis (DVT) and one patient developed a pulmonary embolism (PE). All patients who developed a DVT or PE received chemical prophylaxis. There was no difference in DVT (p = 0.1886) or PE (p = 0.4365) between those who received chemical prophylaxis and those who did not. Five patients developed a hemorrhagic complication, two intracranial hemorrhage, three abdominal hematoma, and zero postauricular hematoma. All five patients with a complication received chemical prophylaxis (p = 0.00142). The relative risk of a hemorrhagic complication was 14.14 (95% CI = 0.7987-250.4307; p = 0.0778). There was a significant difference between the number of hemorrhagic complications but not between numbers of DVT or PE. Mechanical and chemical prophylaxis may lower the risk of VTE but in our series, hemorrhagic complications were observed. These measures should be used selectively in conjunction with early ambulation.

  9. Venous thromboembolism: have we made headway?

    Science.gov (United States)

    Fitzgerald, Jan

    2010-01-01

    Venous thromboembolism (VTE) is a primary cause of preventable hospital death. The need for effective VTE prophylaxis has been recognized by the Surgical Care Improvement Program (SCIP) and the Joint Commission, which is offering VTE prevention as a core measure set, starting October 1, 2009. The adoption of SCIP VTE measures and mandate to publicly report these rates offers the opportunity to improve the use of prophylaxis in surgical patients and reduce VTE-related morbidity, mortality, and costs. Essential to this reduction is a team approach to implementing real-time interventions. Crucial to the success of the team is early identification of each patient's VTE risk and a mechanism to provide key information to ensure that the physician prescribes appropriate prophylaxis. In addition, it may be the nurse who is responsible for ensuring that a patient receives the appropriate prophylaxis, as well as being the first clinician to observe the clinical signs of a VTE event.

  10. Stomal construction: Technical tricks for difficult situations, prevention and treatment of post-operative complications.

    Science.gov (United States)

    Sabbagh, C; Rebibo, L; Hariz, H; Regimbeau, J M

    2018-02-21

    The creation of a digestive stoma, whether it is a lateral stoma or a terminal stoma, is an essential gesture in colorectal surgery, but that may result in post-operative complications in 35% of patients. Surgeons are aware of the situations at the origin of complications, although there is little factual data in the literature to discriminate them. They are related to patient-specific factors (obesity, cirrhosis, portal hypertension) or to the underlying pathology (colon obstruction) or the conditions under which the intervention is performed (emergency). The aim of this review is to describe these different situations and the data from the literature that may allow reduction of the risk of an unsatisfactory or even complicated stoma. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Preventing Complications of Pediatric Tracheostomy Through Standardized Wound Care and Parent Education.

    Science.gov (United States)

    Gaudreau, Philip A; Greenlick, Hannah; Dong, Tiffany; Levy, Michelle; Hackett, Alyssa; Preciado, Diego; Zalzal, George; Reilly, Brian K

    2016-10-01

    Pediatric tracheostomy is commonly performed for upper airway obstruction and prolonged mechanical ventilation. Children undergoing tracheostomy typically have multiple chronic medical problems that place them at high risk for readmission and additional complications. To determine whether the institution of a postoperative protocol for parent education and wound care with a nurse trained in tracheostomy care decreases the rate of readmission and other complications. A case series and medical record review was conducted of children 18 years and younger who underwent tracheostomy at a tertiary pediatric medical center between January 1, 2009, and December 31, 2014. A postoperative tracheostomy care and education protocol. Overall 30-day readmission rate, 30-day tracheostomy-related readmission rate, tracheostomy wound complications, and additional factors that may have affected readmission rates and wound complications (age at the time of tracheostomy, discharge location, indication for tracheostomy). A total of 191 children (118 boys and 73 girls) were included; of these, 112 participated in the education protocol and 79 children did not. Following institution of the education protocol, there was no decrease in the overall readmission rate (26.8% before the protocol vs 26.6% after the protocol; difference, 0.2%; 95% CI, -12.5% to 13.0%) or in the tracheostomy-related readmission rate (10.1% before the protocol vs 7.1% after the protocol; difference, 3.0%; 95% CI, -5.0% to 11.0%). Overall, 68.6% of readmissions were associated with medical comorbidities (95% CI, 55.9% to 81.3%). There was a significant decrease in tracheostomy-related wound complications after institution of the protocol (31.6% to 17.9%; difference, 13.7%; 95% CI, 1.6% to 26.0%). Multiple logistic regression analysis showed that children who were discharged home were significantly more likely to be readmitted for a tracheostomy-related complication than were patients discharged to an advanced care

  12. The Possible Role of Flavonoids in the Prevention of Diabetic Complications

    Directory of Open Access Journals (Sweden)

    Roberto Testa

    2016-05-01

    Full Text Available Type 2 diabetes mellitus is a disease that affects many metabolic pathways. It is associated with insulin resistance, impaired insulin signaling, β-cell dysfunction, abnormal glucose levels, altered lipid metabolism, sub-clinical inflammation and increased oxidative stress. These and other unknown mechanisms lead to micro- and macro-complications, such as neuropathy, retinopathy, nephropathy and cardiovascular disease. Based on several in vitro animal models and some human studies, flavonoids appear to play a role in many of the metabolic processes involved in type 2 diabetes mellitus. In this review, we seek to highlight the most recent papers focusing on the relationship between flavonoids and main diabetic complications.

  13. [Double-blind randomized comparative study of enoxaparin and standard heparin in the prevention of thromboembolic disease during insertion of total hip replacement].

    Science.gov (United States)

    Planes, A; Vochelle, N; Mazas, F; Mansat, C; Zucman, G; Landais, A; Weill, D; Pascariello, J C; Butel, J

    1988-01-01

    237 patients with a non-traumatic disease of the hip requiring total hip replacement entered a multicentre trial. Treatments were allocated at random in a double-blind manner: 113 patients received 5000 IU of standard heparin t.d.s.; 124 patients received enoxaparin 40 mg once a day. Treatment lasted from 10 to 15 days until bilateral ascending phlebography of the lower limbs (BAPLL) was performed. Its effectiveness was assessed by the results of BAPLL, by evaluation of the risk of bleeding on examination of the surgical wound, by the units of blood required for perfusion and by daily blood count and differential. BAPLL was performed in 228 patients: 15 phlebographies (12.5 p. 100) were positive in the 120 assessed patients of the enoxaparin group, while 27 (25 p. 100) were positive in the 108 assessed patients of the standard heparin group (p = 0.014). Proximal deep vein thrombosis was significantly (p = 0.03) less frequent in the enoxaparin group (7.5 p. 100) than in the standard heparin group (18.5 p. 100). Pulmonary embolism was observed in a patient on standard heparin. The units of blood required for perfusion were significantly (p = 0.03) smaller in the enoxaparin group (3.37 +/- 1.81 U) than in the standard heparin group (3.84 +/- 1.70 U). Thus, one single subcutaneous injection of enoxaparin 40 mg daily was significantly more effective and safer than standard heparin 5000 IU t.d.s. in the prevention of deep vein thrombosis after total hip replacement.

  14. Pulmonary thrombo-embolic disease

    African Journals Online (AJOL)

    plasminogen abnormalities, have been found to have an increased incidence of venous thrombo-embolic episodes. Pregnancy, a hypercoagulable state with ... Diagnostic tests. 1. e ECG shows sinus tachycardia, features of pulmonary hypertension and right ventricular strain such as P-pulmonale,. S1Q3T3 pattern, right ...

  15. Familial Clustering of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Oestergaard, Louise Bruun; Gundlund, Anna

    2016-01-01

    BACKGROUND: Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration. OBJECTIVES: To examine the relative ...

  16. Clinical overview of venous thromboembolism

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) is the result of a venous blood clot formation which may manifest itself as deep vein thrombosis. (DVT) or pulmonary embolism (PE).1,2 DVT and PE are part of the same syndrome. However, important distinguishing factors in terms of epidemiology, diagnosis and treatment exist between.

  17. Comparison of the Non-VKA Oral Anticoagulants Apixaban, Dabigatran, and Rivaroxaban in the Extended Treatment and Prevention of Venous Thromboembolism: Systematic Review and Network Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    A T Cohen

    Full Text Available Historically, warfarin or aspirin have been the recommended therapeutic options for the extended treatment (>3 months of VTE. Data from Phase III randomised controlled trials (RCTs are now available for non-VKA oral anticoagulants (NOACs in this indication. The current systematic review and network meta-analysis (NMA were conducted to compare the efficacy and safety of anticoagulants for the extended treatment of VTE.Electronic databases (accessed July 2014 and updated April 2016 were systematically searched to identify RCTs evaluating apixaban, aspirin, dabigatran, edoxaban, rivaroxaban, and warfarin for the extended treatment of VTE. Eligible studies included adults with an objectively confirmed deep vein thrombosis, pulmonary embolism or both. A fixed-effect Bayesian NMA was conducted, and results were presented as relative risks (RRs. Sensitivity analyses examining (i the dataset employed according to the time frame for outcome assessment (ii the model used for the NMA were conducted.Eleven Phase III RCTs (examining apixaban, aspirin, dabigatran, rivaroxaban, warfarin and placebo were included. The risk of the composite efficacy outcome (VTE and VTE-related death was statistically significantly lower with the NOACs and warfarin INR 2.0-3.0 compared with aspirin, with no significant differences between the NOACs. Treatment with apixaban (RR 0.23, 95% CrI 0.10, 0.55 or dabigatran (RR 0.55, 95% Crl 0.43, 0.71 was associated with a statistically significantly reduced risk of 'major or clinically relevant non-major bleed' compared with warfarin INR 2.0-3.0. Apixaban also showed a significantly reduced risk compared with dabigatran (RR 0.42, 95% Crl 0.18, 0.97 and rivaroxaban (RR 0.23, 95% Crl 0.09, 0.59. Sensitivity analyses indicate that results were dependent on the dataset, but not on the type of NMA model employed.Results from the NMA indicate that NOACs are an effective treatment for prevention of VTE or VTE-related death in the extended

  18. Complication assessment and prevention strategies using midfoot fusion bolt for medial column stabilization in Charcot's osteoarthropathy

    DEFF Research Database (Denmark)

    Mehlhorn, Alexander T; Walther, Markus; Iblher, Niklas

    2016-01-01

    . There was a significant association between preoperative increased Hba1c value, presence of preoperative ulcer and wound infection. Healing of arthrodesis was demonstrated in 57% and a permanent weight-bearing foot without recurrent ulcer was achieved in 79%. The early and late postoperative complications could....... Since bolt dislocation takes place frequently, it was aimed to predict an appropriate time point for bolt removal under the condition that osseous healing has occurred. Fourteen consecutive patients with neuroosteoarthropathy of the foot and arch collapse were treated with open reduction...... and stabilization using midfoot fusion bolt and lateral lag screws. Age, gender, presence of preoperative osteomyelitis or ulcer, number of complications and operative revisions, Hba1c value, consolidation of arthrodesis, presence of a load-bearing foot and period to bolt dislocation was assessed. The mean follow...

  19. [Prevention and treatment with cefoperazone of postoperative suppurative complications in heart surgery].

    Science.gov (United States)

    Nemchenko, V I

    1992-08-01

    Clinical trials of cefoperazone (cefobid, Pfizer, USA) were carried out in 49 patients with cardiovascular diseases who had undergone surgical operations. The pathogens of infectious complications were investigated bacteriologically. Good results of the treatment were observed in 43 patients. Allergic reaction developed in 1 patient. Cefoperazone was shown advantageous in treatment of pulmonary complications in the operated patients. It was found possible to use cefoperazone in combination with aminoglycosides. Cefoperazone was found to be one of the drugs of choice in the treatment of aerobic and anaerobic bacteriemia, as well as sepsis after surgical operations on the heart and great vessels. The results on the use of cefoperazone for short-term "perioperative" prophylaxis in cardiosurgery (in accordance with the WHO instructions) are also presented.

  20. Water lily in a subcutaneous plane - preventing complications of unplanned excision.

    Science.gov (United States)

    Madura, Chandraiah; Shenoy, Chaithra; Girish, Malavalli Lakshminarasimhaiha; Chandrashekar, Byalakere Shivanna

    2017-07-01

    Human cysticercosis is caused by the larval form of Taenia solium (T. solium) and is a condition more commonly seen in tropical countries. The infestation can present with varied symptoms depending upon the site of infection, e.g. intramuscular, subcutaneous, intracerebral, or elsewhere. Diagnosing cysticercosis, although fairly easy, becomes challenging in unusual cases. Unplanned excisions can lead to catastrophic complications. © 2017 The International Society of Dermatology.

  1. Recurrence factors and prevention of complications of pediatric differentiated thyroid cancer

    Directory of Open Access Journals (Sweden)

    Changyuan Wang

    2017-01-01

    Conclusion: Pediatric differentiated thyroid cancer has a high metastatic rate to lymph nodes and distant organs, but the total prognosis is good. Application of total resection cannot necessarily reduce the relapse rate of pediatric differentiated thyroid cancer, but it may increase the postoperative hypocalcemia and hoarseness. The authors propose strictly adhering to various operation indicators, and carrying out various operations with a full understanding of the local lesion and lymph nodes in order to reduce relapse and postoperative complications.

  2. [Prevention of immediate and delayed complications of the resection of stomach].

    Science.gov (United States)

    Ohonovskyĭ, V K; Podilćhak, M D; Vynnychenko, B I

    1994-01-01

    Complex of arrangements directed for prophylaxis of the purulent-inflammatory complications occurrence after stomach resection performance: the longitudinal sewing in of the duodenal stump, its decompression, wound sanatation with the help of chlorhexydine bigluconate, intravenous intraoperative injection of antibiotics, catgut application repudiation etc. While performing Bilroth-II procedure the antireflux transversal gastrojejunal anastomosis was provided, the choice of stomach resection method was optimized. The measures provided have promoted the essential improvement of immediate and late follow-up results of treatment.

  3. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin

    DEFF Research Database (Denmark)

    Andersen, Anita Sylvest; Berthelsen, Jørgen G.; Bergholt, Thomas

    2010-01-01

    OBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH) for prophylaxis and treatment of thromboembolic complications in pregnancy. DESIGN: Cohort study with a chronologic register-based control group. SETTING: Department of Obstetrics and Gynecology, Hiller...... were in good health at discharge. CONCLUSIONS: Individually dosed LMWH is well tolerated and safe for prophylaxis and treatment of thromboembolic complications during pregnancy, delivery and the postpartum periodOBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH......) for prophylaxis and treatment of thromboembolic complications in pregnancy. DESIGN: Cohort study with a chronologic register-based control group. SETTING: Department of Obstetrics and Gynecology, Hillerød Hospital, Denmark. POPULATION: All 166 women treated with LMWH in pregnancy between 1 January 2001 and 31...

  4. Complications of treatments of carcinoma on intact uterine cervix: results and prevention

    International Nuclear Information System (INIS)

    Barillot, I.; Maingon, P.; Truc, G.; Horiot, J.C.

    2000-01-01

    The prospective record of acute and late toxicity after treatment of cervix carcinomas is a part of the description of treatment outcome as well as local control and survival. Due to the large number of scales and glossaries used, the comparison of the results from one study to another is often difficult. The French-Italian syllabus seems to be the most reliable scale, providing implementation of quality of life assessment. The main predictive factor of complications, which is not related to the treatment type, is the previous history of abdominal or pelvic surgery. The incidence and severity of complications occurring after surgery are related to the surgical procedure and to the amount of peri-uterine tissues removed. The increase in dose and volume of external irradiation and brachytherapy and the increase in dose rate of the low-dose rate brachytherapy are responsible for the radiotherapeutic morbidity. The significant decrease of severe complication rates during the last 15 years was obtained by the implementation of individual adjustments in treatment planning. The treatment strategies of early bulky and advanced carcinomas are changing. Concurrent radiotherapy and chemotherapy is becoming a standard, but its late toxicity needs to be documented by a longer follow-up. The optimisation of radiation therapy should remain a reference to evaluate the outcome and morbidity of the new combined strategies: the addition of chemotherapy will never compensate for less than optimal radiotherapy/brachytherapy planning. (authors)

  5. Early versus delayed post-operative bathing or showering to prevent wound complications.

    Science.gov (United States)

    Toon, Clare D; Sinha, Sidhartha; Davidson, Brian R; Gurusamy, Kurinchi Selvan

    2015-07-23

    their wounds, irrespective of the location of the wound and whether or not the wound was dressed. We excluded trials if they included patients with contaminated, dirty or infected wounds and those that included open wounds. We also excluded quasi-randomised trials, cohort studies and case-control studies. We extracted data on the characteristics of the patients included in the trials, risk of bias in the trials and outcomes from each trial. For binary outcomes, we calculated the risk ratio (RR) with 95% confidence interval (CI). For continuous variables we planned to calculate the mean difference (MD), or standardised mean difference (SMD) with 95% CI. For count data outcomes, we planned to calculate the rate ratio (RaR) with 95% CI. We used RevMan 5 software for performing these calculations. Only one trial was identified for inclusion in this review. This trial was at a high risk of bias. This trial included 857 patients undergoing minor skin excision surgery in the primary care setting. The wounds were sutured after the excision. Patients were randomised to early post-operative bathing (dressing to be removed after 12 hours and normal bathing resumed) (n = 415) or delayed post-operative bathing (dressing to be retained for at least 48 hours before removal and resumption of normal bathing) (n = 442). The only outcome of interest reported in this trial was surgical site infection (SSI). There was no statistically significant difference in the proportion of patients who developed SSIs between the two groups (857 patients; RR 0.96; 95% CI 0.62 to 1.48). The proportions of patients who developed SSIs were 8.5% in the early bathing group and 8.8% in the delayed bathing group. There is currently no conclusive evidence available from randomised trials regarding the benefits or harms of early versus delayed post-operative showering or bathing for the prevention of wound complications, as the confidence intervals around the point estimate are wide, and, therefore, a clinically

  6. A STUDY TO COMPARE THE EFFICACY OF SUBCUTANEOUS SUTURE REAPPROXIMATAION VERSUS SUBCUTANEOUS DRAIN FOR THE PREVENTION OF WOUND COMPLICATION IN WOMEN UNDERGOING CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Anjali H.

    2015-10-01

    Full Text Available Obesity has been linked as a risk factor for wound complication and is becoming a more common occurrence. We reviewed the risk factors, preventive strategies and recommended management of wound complication in women undergoing caesarean section. The limited available data support the use of prophylactic antibiotic before caesarean delivery, closure of subcutaneo us space >2cm and maintaining normothermic intra - operatively to help reduce the incidence of postoperative wound complication. There is a need for randomized controlled trials which evaluate the prevention and management of wound complications in obese wom en undergoing caesarean delivery

  7. Prevention of congenital cytomegalovirus complications by maternal and neonatal treatments: a systematic review.

    Science.gov (United States)

    Hamilton, Stuart T; van Zuylen, Wendy; Shand, Antonia; Scott, Gillian M; Naing, Zin; Hall, Beverley; Craig, Maria E; Rawlinson, William D

    2014-11-01

    Human cytomegalovirus is the leading non-genetic cause of congenital malformation in developed countries. Congenital CMV may result in fetal and neonatal death or development of serious clinical sequelae. In this review, we identified evidence-based interventions for prevention of congenital CMV at the primary level (prevention of maternal infection), secondary level (risk reduction of fetal infection and disease) and tertiary level (risk reduction of infected neonates being affected by CMV). A systematic review of existing literature revealed 24 eligible studies that met the inclusion criteria. Prevention of maternal infection using hygiene and behavioural interventions reduced maternal seroconversion rates during pregnancy. However, evidence suggested maternal adherence to education on preventative behaviours was a limiting factor. Treatment of maternal CMV infection with hyperimmune globulin (HIG) showed some evidence for efficacy in prevention of fetal infection and fetal/neonatal morbidity with a reasonable safety profile. However, more robust clinical evidence is required before HIG therapy can be routinely recommended. Limited evidence also existed for the safety and efficacy of established CMV antivirals (valaciclovir, ganciclovir and valganciclovir) to treat neonatal consequences of CMV infection, but toxicity and lack of randomised clinical trial data remain major issues. In the absence of a licensed CMV vaccine or robust clinical evidence for anti-CMV therapeutics, patient education and behavioural interventions that emphasise adherence remain the best preventative strategies for congenital CMV. There is a strong need for further data on the use of HIG and other antivirals in pregnancy, as well as the development of less toxic, novel, antiviral agents. Copyright © 2014 John Wiley & Sons, Ltd.

  8. Tattoos: Evaluation of knowledge about health complications and their prevention among students of Tricity universities.

    Science.gov (United States)

    Rogowska, Patrycja; Szczerkowska-Dobosz, Aneta; Kaczorowska, Róża; Słomka, Justyna; Nowicki, Roman

    2018-02-01

    Tattooing is a very popular form of body modification among young people. However, this kind of procedure entails the risk of various health complications. The objective of the study was to evaluate the students' knowledge about contraindications, complications, and health risks that skin tattooing may cause. Additionally, the purpose of the study was to assess how the profile of education (medical vs nonmedical) impacts on the knowledge of the respondents. We surveyed a group of 1199 people, of which 326 (27%) had tattoos. The base of the study is an anonymously filled, author's online survey consisting of 25 questions. Eighty six percent of the students from the Medical University of Gdańsk indicated the risk of HCV virus infection during tattooing, while only 34% of students from other Tricity universities were aware of this danger. Sixty seven percent of people with tattoos felt that having them does not affect any diagnostic and therapeutic procedures. Most of respondents mentioned the tattoo artist (79%) and the Internet (73%) as a source of information before having a tattoo, while only 5% and 8% respondents asked a doctor or read medical literature about it. Fourty nine percent of respondents reported that before the procedure, tattooist failed to ask them about their health condition and medications. Knowledge of students about safety, contraindications, and complications associated with the performance of tattooing is insufficient. As a result, a need for a better education on the topic for both people who are getting tattoos and tattooists appears evident. © 2017 Wiley Periodicals, Inc.

  9. Prevention and management of oral surgery complications in general dental practice.

    Science.gov (United States)

    Oliver, R

    2014-03-01

    In recent decades advances in dentistry have enabled more patients to keep their teeth for longer. However, when the time does come to extract these teeth it can be far from straightforward. This article, and the associated session at the 2014 British Dental Conference & Exhibition, describes the assessment of teeth for extraction and highlights potential problem areas and how to deal with them. Tips and techniques for dealing with failed or stubborn extractions are also discussed, as well as how to manage some of the more common complications of dental extractions.

  10. Closed suction drainage using Lichtenstein technique in preventing wound complications following inguinal hernioplasty: brief report

    Directory of Open Access Journals (Sweden)

    Hamid Reza Hemmati

    2015-03-01

    Results: No adverse event including hematoma, seroma or wound infection occurred in either group with or without closed suction drainage in the first 10 days after surgery. Only one patient carried wound infection during days 10 to 15 following operation who was in the group with closed drainage (P=1.00. Conclusion: In this study, Seroma and hematoma was not observed in patients with and without closed suction drainage. To avoid drains' complications, indiscriminate use of antibiotics, prolonged hospital stay, we do not recommend the use of drains in this type of surgery.

  11. The prevention and treatment of biliary complications occurred after CT-guided percutaneous radiofrequency ablation for hepatic neoplasms

    International Nuclear Information System (INIS)

    Li Jianjun; Zheng Jiasheng; Cui Xiongwei; Cui Shichang; Sun Bin

    2011-01-01

    Objective: To discuss the prevention and treatment of biliary complications occurred after CT-guided percutaneous radiofrequency ablation (RFA) for hepatic neoplasms. Methods: A total of 1136 patients, including 920 males and 216 females, with hepatic neoplasms were enrolled in this study. The hepatic tumors consisted of primary hepatocellular carcinoma (n=1037), hepatic metastasis (n=83) and hepatic cavernous hemangioma (n=16). The diameters of the tumors ranged from 0.5 to 16 cm. A total of 1944 RFA procedures were carried out in all patients. Results: Thirty-five patients developed biliary complication (35/1944, 1.80%). Twelve patients developed asymptomatic bile duct dilatation and no special treatment was given. Obstructive jaundice occurred in two patients and percutaneous transhepatic cholangiocholecystic drainage (PTCD) together with subsequent inner stent implantation had to be carried out. Eighteen patients developed biloma, and liver abscess formation secondary to biloma infection occurred in seven of them. Percutaneous transhepatic biloma drainage (PTBD) was adopted in all these patients. One patient suffered from obstructive jaundice complicated by biloma, and both PTCD and PTBD combined with inner stent implantation were simultaneously performed. One patient had the biloma secondary to obstructive jaundice, and PTCD followed by PTBD was conducted in turn. One patient developed obstructive jaundice secondary to biloma, and PTBD followed by PTCD was employed in turn. Conclusion: Obstructive jaundice and biloma are severe biliary complications occurred after CT-guided percutaneous radiofrequency ablation for hepatic tumors, and PTCD and/or PTBD should be carried out without delay to treat these complications. The clinical symptoms can be relieved, or even completely disappear, after treatment. (authors)

  12. Current approaches to prevention of venous thromboembolism ...

    African Journals Online (AJOL)

    The purpose of this paper is to review the current approaches being used to reduce post hip and knee replacement incidences of VTE as recommended by various external guidelines for benchmarking purposes in the Kenyan context. Data Sources: This article relies on published scientific data from various online ...

  13. current approaches to prevention of venous thromboembolism

    African Journals Online (AJOL)

    considering prophylactic treatment options which should be adjusted according to the individual patient needs. .... country's priorities with regard to future policy on the use of various thromboprophylactic methods can best .... Warfarin is a coumarin derivative that interferes with the production of clotting factors. There is a.

  14. RESULTS OF TENEKTEPLASE USE IN MASSIVE PULMONARY THROMBOEMBOLISM. CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    R. Rajan

    2011-01-01

    Full Text Available Pulmonary thromboembolism (PTE — a life-threatening condition that can lead to death at any age. PTE — is not an independent disease, but it is a complication of venous thromboembolism. Conflicting opinions about the possibility of using tissue plasminogen activator (tenekteplase expressed in the literature. Clinical case of the tenekteplase use in 42 years old woman with acute massive PTE and its results are described. PTE in the case was observed simultaneously with diabetic ketoacidosis. Full resolution of this thrombus according to computer pulmonary angiography was observed in patient hospitalized within 24 hours after symptom onset. This is one of the first cases of effective application of the tenekteplase in patients with massive PTE and diabetic ketoacidosis.

  15. Reducing tobacco smoking and smoke exposure to prevent preterm birth and its complications.

    Science.gov (United States)

    Wagijo, Mary-Ann; Sheikh, Aziz; Duijts, Liesbeth; Been, Jasper V

    2017-03-01

    Tobacco smoking and smoke exposure during pregnancy are associated with a range of adverse health outcomes, including preterm birth. Also, children born preterm have a higher risk of complications including bronchopulmonary dysplasia and asthma when their mothers smoked during pregnancy. Smoking cessation in early pregnancy can help reduce the adverse impact on offspring health. Counselling interventions are effective in promoting smoking cessation and reducing the incidence of preterm birth. Peer support and incentive-based approaches are likely to be of additional benefit, whereas the effectiveness of pharmacological interventions, including nicotine replacement therapy, has not definitely been established. Smoke-free legislation can help reduce smoke exposure as well as maternal smoking rates at a population level, and is associated with a reduction in preterm birth. Helping future mothers to stop smoking and protect their children from second hand smoke exposure must be a key priority for health care workers and policy makers alike. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Tele-diabetology to Screen for Diabetes and Associated Complications in Rural India: The Chunampet Rural Diabetes Prevention Project Model.

    Science.gov (United States)

    Mohan, Viswanathan; Prathiba, Vijayaraghavan; Pradeepa, Rajendra

    2014-03-01

    Diabetes, with its acute and long-term complications, has become a major health hazard in developing countries. An estimated 62.4 million people in India have diabetes. With increasing urbanization and industrialization, we can expect huge numbers of people with diabetes in India in the future. Moreover, all diabetes efforts in India are currently focused in urban areas while 70% of India's population actually lives in rural areas. The current statistics demonstrates that urgent interventions are mandatory to curb the epidemic of diabetes and its complications at the grassroots level. This gap in providing diabetes care can be nullified by the use of tele-diabetology. This holds great potential to overcome barriers and improve quality and access to diabetes care to remote, underserved areas of developing counties. The Chunampet Rural Diabetes Prevention Project (CRDPP) has been developed and tested as a successful model for screening and delivering diabetes care to rural areas in developing countries. Using a tele-diabetology mobile van loaded with appropriate equipment, trained technicians, and satellite technology helped us to screen for diabetes and its complications and deliver diabetes care to remote villages in southern India. The Chunampet model can be applied in reaching out to remote areas where specialized diabetes care facilities may not be available. © 2014 Diabetes Technology Society.

  17. Postoperative temporal hollowing: Is there a surgical approach that prevents this complication? A systematic review and anatomic illustration.

    Science.gov (United States)

    Vaca, Elbert E; Purnell, Chad A; Gosain, Arun K; Alghoul, Mohammed S

    2017-03-01

    Temporal hollowing is a common complication following surgical dissection in the temporal region. Our objectives were to: (1) review and clarify the temporal soft tissue relationships - supplemented by cadaveric dissection - to better understand surgical approach variations and elucidate potential etiologies of postoperative hollowing; (2) identify if there is any evidence to support a surgical approach that prevents hollowing through a systematic review. Cadaveric dissection was performed on six hemi-heads. A systematic review of the literature was undertaken to identify surgical approaches with a decreased risk of postoperative hollowing. A total of 1212 articles were reviewed; 19 of these met final inclusion criteria. Level I and II evidence supports against the use of a dissection plane beneath the superficial layer of the deep temporal fascia or through the intermediate temporal fat pad. Level II evidence supports preservation of the temporalis muscle origin - no evidence is available to support other temporalis resuspension techniques. For intracranial exposure, refraining from temporal fat pad dissection (Level I Evidence) and use of decreased access approaches such as the minipterional craniotomy (Level I Evidence) appear to minimize temporal soft tissue atrophy. This study highlights the significance of preservation of the temporal soft tissue components to prevent hollowing. Preserving the temporalis origin and avoiding dissection between the leaflets of the deep temporal fascia or through the intermediate temporal fat pad appear to minimize this complication. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Xie H

    2016-12-01

    Full Text Available Hai Xie,1 Yan-na Chang2 1Department of Emergency, The First Hospital of Lanzhou University, 2Department of Anesthesiology, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, People’s Republic of China Objective: To evaluate systematically the clinical efficacy of omega-3 polyunsaturated fatty acids (PUFAs in the prevention of postoperative complications in colorectal cancer (CRC patients.Materials and methods: Published articles were identified by using search terms in online databases – PubMed, Embase, and the Cochrane Library – up to March 2016. Only randomized controlled trials investigating the efficacy of omega-3 PUFAs in CRC were selected and analyzed through a meta-analysis. Subgroup, sensitivity, and inverted funnel-plot analyses were also conducted. Results: Eleven articles with 694 CRC patients were finally included. Compared with control, omega-3 PUFA-enriched enteral or parenteral nutrition during the perioperative period reduced infectious complications (risk ratio [RR] 0.63, 95% confidence interval [CI] 0.47–0.86; P=0.004, tumor necrosis factor alpha (standard mean difference [SMD] -0.37, 95% CI -0.66 to -0.07; P=0.01, interleukin-6 (SMD -0.36, 95% CI -0.66 to -0.07; P=0.02, and hospital stay (MD -2.09, 95% CI -3.71 to -0.48; P=0.01. No significant difference was found in total complications, surgical site infection, or CD4+:CD8+ cell ratio. Conclusion: Short-term omega-3 PUFA administration was associated with reduced postoperative infectious complications, inflammatory cytokines, and hospital stay after CRC surgery. Due to heterogeneity and relatively small sample size, the optimal timing and route of administration deserve further study. Keywords: omega-3, fatty acids, fish oil, colorectal surgery, meta-analysis 

  19. Managing cancer-related venous thromboembolic disease: low-molecular-weight heparins and beyond.

    Science.gov (United States)

    O'Connell, Casey L; Liebman, Howard A

    2008-12-01

    Venous thromboembolism is a major contributor to the morbidity and mortality of patients with cancer. For patients undergoing cancer surgery, several trials support the safety and efficacy of unfractionated heparin and of low-molecular-weight heparin for the prevention of venous thromboembolism, while data regarding the efficacy and safety of these agents in the setting of medical hospitalization is less definitive and must be extracted from trials including noncancer patients with different thrombotic risk factors. Randomized clinical studies confirm that patients with cancer who develop venous thromboembolism have superior outcomes when treated with long-term low-molecular-weight heparin as compared with warfarin. Novel anticoagulants that are orally bioavailable and function by directly inhibiting factor Xa or thrombin are entering the market. To date, data regarding the efficacy and safety of these novel anticoagulants as venous thromboembolism prophylaxis and treatment in cancer patients are not available and must be extracted from larger trials with heterogeneous patient populations.

  20. Prevention of Renal Complications Induced by Non- Steroidal Anti-Inflammatory Drugs.

    Science.gov (United States)

    Ković, Sonja Vuč; Vujović, Katarina Savić; Srebro, Dragana; Medić, Branislava; Ilic-Mostic, Tatjana

    2016-01-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the treatment of pain, inflamation and fever. They are usually well tolerated in healthy persons, but in patients with risk factors (advanced age, renal impairment, heart failure, liver disease, concurrent medications with antihypertensive drugs), NSAIDs can induce serious renal adverse effects. They include sodium and water retention with edema, worsening of heart failure, hypertension, hyponatremia, hyperkalemia, acute kidney injury, chronic kidney disease, renal papillary necrosis and acute interstitial nephritis. The majority of these adverse effects are due to the inhibition of prostaglandins synthesis and they are dose and duration-dependent. Acute forms of kidney injuries are transient and often reversible upon drug withdrawal. Chronic use of NSAIDs in some patients may result in chronic kidney disease. It is recommended that patients at risk should have preventative strategies in place, including the use of the "lowest effective dose" of NSAID for the "shortest possible time" and monitoring renal function, fluid retention and electrolyte abnormalities. Patients who are taking antihypertensive medications should be monitored for high blood pressure and the doses of antihypertensive medications should be adjusted if needed. In general, the combination of NSAIDs and angiotensin inhibitors should be avoided. Some other preventive measures are dietary salt restriction, use of topical NSAIDs/non-pharmacological therapies and use of calcium channel blockers for treating hypertension.

  1. The Consideration of Socioeconomic Determinants in Prevention of Traditional Male Circumcision Deaths and Complications.

    Science.gov (United States)

    Douglas, Mbuyiselo; Hongoro, Charles

    2018-05-01

    The responsiveness to socioeconomic determinants is perceived as highly crucial in preventing the high mortality and morbidity rates of traditional male circumcision initiates in the Eastern Cape, a province in South Africa. The study sought to describe social determinants and explore economic determinants related to traditional circumcision of boys from 12 to 18 years of age in Libode rural communities in Eastern Cape Province. From the results of a descriptive cross-sectional survey ( n = 1,036), 956 (92.2%) boys preferred traditional male circumcision because of associated social determinants which included the variables for the attainment of social manhood values and benefits; 403 (38.9%) wanted to attain community respect; 347 (33.5%) wanted the accepted traditional male circumcision for hygienic purposes. The findings from the exploratory focus group discussions were revolving around variables associated with poverty, unemployment, and illegal actions to gain money. The three negative economic determinants were yielded as themes: (a) commercialization and profitmaking, (b) poverty and unemployment, (c) taking health risk for cheaper practices, and the last theme was the (d) actions suggested to prevent the problem. The study concluded with discussion and recommendations based on a developed strategic circumcision health promotion program which is considerate of socioeconomic determinants.

  2. Primary and secondary prevention of acute complications of radiotherapy of head and neck cancers

    International Nuclear Information System (INIS)

    Lambrexhe, M.; Frederick, B.; Burie, D.; Cavuto, C.; Rob, L.; Rasquin, I.; Coiffier, N.; Untereiner, M.

    2009-01-01

    Purpose: the standard treatment of head and neck cancers associates a 70 Gy irradiation and weekly concomitant chemotherapy by 5-fluoro-uracils and cisplatin or targeted therapy by Erbitux. A retrospective study realised at the Francois Baclesse center in 2004-2005 for 84 patients suffering of ear-nose-throat cancers whom treatment was a concomitant chemoradiotherapy, showed the noxious effects of the treatment on the patients nutritional situation: weight loss for 90% of patients; temporary interruption or definitive stop of radiotherapy for 28% of patients. based on this observation, a preventive approach of the nutritional risk was implemented. The objective was to reduce the malnutrition risk linked to radiotherapy associated to chemotherapy or to the targeted therapy. (N.C.)

  3. Vegetarian Diets in the Prevention and Management of Diabetes and Its Complications

    Science.gov (United States)

    2017-01-01

    IN BRIEF Epidemiological studies have found a lower prevalence of type 2 diabetes among vegetarians compared to nonvegetarians. This reduced risk is likely a function of improved weight status, higher intake of dietary fiber, and the absence of animal protein and heme iron in the diet. Interventional studies have shown that vegetarian diets, especially a vegan diet, are effective tools in glycemic control and that these diets control plasma glucose to a greater level than do control diets, including diets traditionally recommended for patients with diabetes (e.g., diets based on carbohydrate counting). Vegetarian diets are associated with improvement in secondary outcomes such as weight reduction, serum lipid profile, and blood pressure. Studies indicate that vegetarian diets can be universally used in type 2 diabetes prevention and as tools to improve blood glucose management. PMID:28588373

  4. Sudden blindness as a complication of percutaneous trigeminal procedures: mechanism analysis and prevention.

    Science.gov (United States)

    Agazzi, Siviero; Chang, Stanley; Drucker, Mitchell D; Youssef, A Samy; Van Loveren, Harry R

    2009-04-01

    The authors describe the case of a 76-year-old man in whom reversible sudden blindness developed after a percutaneous balloon compression rhizotomy for trigeminal neuralgia. His eye became tense and swollen with intraocular pressures of 66 mm Hg. Acetazolamide was administered, and visual acuity (20/50) returned within several months. Despite correct needle placement, the intraocular pressure rose acutely because of transient occlusion of the orbital venous drainage through the cavernous sinus; this was reversed with aggressive medical treatment. In cadaveric studies (dried skull and formalin-fixed head), the authors studied the mechanism of optic nerve penetration. Their findings showed that excessive cranial angulation of the needle with penetration of the inferior orbital fissure can directly traumatize the optic nerve in the orbital apex. Direct trauma to the optic nerve can therefore be prevented by early and repeated confirmation of the needle trajectory with lateral fluoroscopy before penetration of the foramen ovale.

  5. Ferric citrate hydrate, a new phosphate binder, prevents the complications of secondary hyperparathyroidism and vascular calcification.

    Science.gov (United States)

    Iida, Akio; Kemmochi, Yusuke; Kakimoto, Kochi; Tanimoto, Minako; Mimura, Takayuki; Shinozaki, Yuichi; Uemura, Atsuhiro; Matsuo, Akira; Matsushita, Mutsuyoshi; Miyamoto, Ken-ichi

    2013-01-01

    Ferric citrate hydrate (JTT-751) is being developed as a treatment for hyperphosphatemia in chronic kidney disease patients, and shows serum phosphorus-reducing effects on hyperphosphatemia in hemodialysis patients. We examined whether JTT-751 could reduce phosphorus absorption in normal rats and prevent the progression of ectopic calcification, secondary hyperparathyroidism and bone abnormalities in chronic renal failure (CRF) rats. Normal rats were fed a diet containing 0.3, 1 or 3% JTT-751 for 7 days. The effects of JTT-751 on phosphorus absorption were evaluated with fecal and urinary phosphorus excretion. Next, a CRF model simulating hyperphosphatemia was induced by feeding rats a 0.75% adenine diet. After 21 days of starting the adenine diet feeding, 1 or 3% JTT-751 was administered for 35 days by dietary admixture. The serum phosphorus levels and mineral parameters were measured. Calcification in the aorta was examined biochemically and histopathologically. Hyperparathyroidism and bone abnormalities were evaluated by histopathological analysis of the parathyroid and femur, respectively. In normal rats, JTT-751 increased fecal phosphorus excretion and reduced phosphorus absorption and urinary phosphorus excretion. In CRF rats, JTT-751 reduced serum phosphorus levels, the calcium-phosphorus product and calcium content in the aorta. Serum intact parathyroid hormone levels and the incidence and severity of parathyroid hyperplasia were also decreased. JTT-751 reduced femoral bone fibrosis, porosity and osteoid formation. JTT-751 could bind with phosphate in the gastrointestinal tract, increase fecal phosphorus excretion and reduce phosphorus absorption. JTT-751 could prevent the progression of ectopic calcification, secondary hyperparathyroidism and bone abnormalities in rats. Copyright © 2013 S. Karger AG, Basel.

  6. 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications.

    Science.gov (United States)

    Lawn, Joy E; Mwansa-Kambafwile, Judith; Horta, Bernardo L; Barros, Fernando C; Cousens, Simon

    2010-04-01

    'Kangaroo mother care' (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC's mortality benefit, and did not report neonatal-specific data. The objectives of this study were to review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth. We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken. We identified 15 studies reporting mortality and/or morbidity outcomes including nine randomized controlled trials (RCTs) and six observational studies all from low- or middle-income settings. Except one, all were hospital-based and included only babies of birth-weight community-based trial had missing birthweight data, as well as other limitations and was excluded. Neonatal-specific data were supplied by two authors. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29-0.82] compared with standard care. A meta-analysis of three observational studies also suggested significant mortality benefit (RR 0.68, 95% CI 0.58-0.79). Five RCTs suggested significant reductions in serious morbidity for babies <2000 g (RR 0.34, 95% CI 0.17-0.65). This is the first published meta-analysis showing that KMC substantially reduces neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries.

  7. ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications

    Science.gov (United States)

    Lawn, Joy E; Mwansa-Kambafwile, Judith; Horta, Bernardo L; Barros, Fernando C; Cousens, Simon

    2010-01-01

    Background ‘Kangaroo mother care’ (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC’s mortality benefit, and did not report neonatal-specific data. Objectives The objectives of this study were to review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth. Methods We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken. Results We identified 15 studies reporting mortality and/or morbidity outcomes including nine randomized controlled trials (RCTs) and six observational studies all from low- or middle-income settings. Except one, all were hospital-based and included only babies of birth-weight community-based trial had missing birthweight data, as well as other limitations and was excluded. Neonatal-specific data were supplied by two authors. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29–0.82] compared with standard care. A meta-analysis of three observational studies also suggested significant mortality benefit (RR 0.68, 95% CI 0.58–0.79). Five RCTs suggested significant reductions in serious morbidity for babies <2000 g (RR 0.34, 95% CI 0.17–0.65). Conclusion This is the first published meta-analysis showing that KMC substantially reduces neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries. PMID:20348117

  8. Individualized Risk Model for Venous Thromboembolism After Total Joint Arthroplasty.

    Science.gov (United States)

    Parvizi, Javad; Huang, Ronald; Rezapoor, Maryam; Bagheri, Behrad; Maltenfort, Mitchell G

    2016-09-01

    Venous thromboembolism (VTE) after total joint arthroplasty (TJA) is a potentially fatal complication. Currently, a standard protocol for postoperative VTE prophylaxis is used that makes little distinction between patients at varying risks of VTE. We sought to develop a simple scoring system identifying patients at higher risk for VTE in whom more potent anticoagulation may need to be administered. Utilizing the National Inpatient Sample data, 1,721,806 patients undergoing TJA were identified, among whom 15,775 (0.9%) developed VTE after index arthroplasty. Among the cohort, all known potential risk factors for VTE were assessed. An initial logistic regression model using potential predictors for VTE was performed. Predictors with little contribution or poor predictive power were pruned from the data, and the model was refit. After pruning of variables that had little to no contribution to VTE risk, using the logistic regression, all independent predictors of VTE after TJA were identified in the data. Relative weights for each factor were determined. Hypercoagulability, metastatic cancer, stroke, sepsis, and chronic obstructive pulmonary disease had some of the highest points. Patients with any of these conditions had risk for postoperative VTE that exceeded the 3% rate. Based on the model, an iOS (iPhone operating system) application was developed (VTEstimator) that could be used to assign patients into low or high risk for VTE after TJA. We believe individualization of VTE prophylaxis after TJA can improve the efficacy of preventing VTE while minimizing untoward risks associated with the administration of anticoagulation. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Role of hydroxycarbamide in prevention of complications in patients with sickle cell disease

    Directory of Open Access Journals (Sweden)

    NM Wiles

    2009-09-01

    Full Text Available NM Wiles, J HowardDepartment of Haematology, St Thomas’ Hospital, Westminster, Bridge Road, London, SE1 7EH, UKAbstract: Sickle cell disease (SCD is a genetically inherited condition caused by a point mutation in the beta globin gene. This results in the production of the abnormal hemoglobin, sickle hemoglobin (HbS. Hydroxycarbamide, is an antimetabolite/cytotoxic which works by inhibiting ribonucleotide reductase, blocking the synthesis of DNA and arresting cells in the S phase. In sickle cell anemia, it promotes fetal hemoglobin (HbF synthesis, improves red cell hydration, decreases neutrophil and platelet count, modifies red cell endothelial cell interactions and acts as a nitric oxide donor. Trials have shown the clinical benefit of hydroxycarbamide in a subpopulation of adult patients with SCD, with a 44% reduction in the median annual rate of painful crises, a decrease in the incidence of acute chest syndrome and an estimated 40% reduction in overall mortality over a 9-year observational period. Its use in pediatrics has also been well established; trials have shown it is well tolerated and does not impair growth or development. In addition it decreases the number and duration of hospital attendences. A number of emerging uses of hydroxycarbamide currently are being investigated, such as stroke prevention.Keywords: sickle cell anemia, hydroxycarbamide, hydroxyurea, maximum tolerated dose, vaso-occlusive crisis

  10. The effectiveness of the implementation of new technologies in the prevention of purulent complications of repeated surgеries for complications of fractures of the proximal femur of patients

    Directory of Open Access Journals (Sweden)

    An. V. Kalashnikov

    2016-06-01

    Full Text Available Despite the latest achievements of modern traumatology, remains quite high percentage of unsatisfactory results of treatment of fractures of the proximal femur (fPf. According to the literature repeated surgery increases the risk of postoperative purulent complications in several times. The authors of the article developed the innovations introduced in practice based on the use of thrombocytopoiesis fibrin gel, which has a high antibacterial activity due to preservation of leukocytes (local antibiotic effect, together with bone shavings during the performing of the operations when performing reactioneze and TEP after performing osteosynthesis, and also at persons of senile and elderly, for prevention of postoperative purulent complications in fPf. A comprehensive clinical study of 120 patients with fPf complications (false joints, aseptic necrosis of the femoral head, axial deformation after osteomyelitis who underwent re-operative intervention was provided. Patients were divided into two groups, first (control group consisted of 60 patients with consequences fPf who underwent total endoprosthesis (TEP of the hip joint (30 patients and locked intramedullary nailing (LIN (30 patients by conventional methods. The second (experimental group consisted of 60 patients with consequences fPf who underwent TEP of the hip joint (30 patients and LIN (30 patients with use developed by authors of innovations. Effectiveness of prevention of septic complications in both groups of observation was evaluated. The observation period was 1 year. There was statistically significant (p≤0.01 decrease in the number of early (4 times and late (3 times postoperative complications in patients of the experimental group in comparison with patients of control group. The new technologies use allows to increase in 8.4% the efficiency of preventive maintenance of purulent complications of surgical treatment of patients with complications after performing osteosynthesis in the

  11. Thrombo-embolism and antithrombotic therapy for heart failure in sinus rhythm. A joint consensus document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis.

    Science.gov (United States)

    Lip, Gregory Y H; Ponikowski, Piotr; Andreotti, Felicita; Anker, Stefan D; Filippatos, Gerasimos; Homma, Shunichi; Morais, Joao; Pullicino, Patrick; Rasmussen, Lars H; Marin, Francisco; Lane, Deirdre A

    2012-07-01

    Chronic heart failure (HF) with either reduced or preserved ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to HF can be related to thrombosis. Epidemiological and pathophysiological data also link HF to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thrombo-embolism, and/or venous thrombo-embolism. This consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence and summarizes 'best practice', and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation, oral anticoagulation is recommended, and the CHA(2)DS(2)-VASc and HAS-BLED scores should be used to determine the likely risk-benefit ratio (thrombo-embolism prevention vs. risk of bleeding) of oral anticoagulation. In HF patients with reduced left ventricular ejection fraction who are in sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Despite the potential for a reduction in ischaemic stroke, there is currently no compelling reason to use warfarin routinely for these patients. Risk factors associated with increased risk of thrombo-embolic events should be identified and decisions regarding use of anticoagulation individualized. Patient values and preferences are important determinants when balancing the risk of thrombo-embolism against bleeding risk. New oral anticoagulants that offer a different risk-benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.

  12. Thromboembolism and antithrombotic therapy for heart failure in sinus rhythm: an executive summary of a joint consensus document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis.

    Science.gov (United States)

    Lip, Gregory Y H; Piotrponikowski, Piotr; Andreotti, Felicita; Anker, Stefan D; Filippatos, Gerasimos; Homma, Shunichi; Morais, Joao; Pullicino, Patrick; Rasmussen, Lars H; Marín, Francisco; Lane, Deirdre A

    2012-12-01

    Chronic heart failure (HF) with either reduced or preserved left ventricular (LV) ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to heart failure can be related to thrombosis. Epidemiological and pathophysiological data also link HF to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thromboembolism and/or venous thromboembolism. This executive summary of a joint consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence, summarises 'best practice', and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation, oral anticoagulation is clearly recommended, and the CHA2DS2-VASc and HAS-BLED scores should be used to determine the likely risk-benefit ratio (thromboembolism prevention versus risk of bleeding) of oral anticoagulation. In HF patients with reduced LV ejection fraction who are in sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Whilst there is the potential for a reduction in ischaemic stroke, there is currently no compelling reason to routinely use warfarin for these patients. Risk factors associated with increased risk of thromboembolic events should be identified and decisions regarding use of anticoagulation individualised. Patient values and preferences are important determinants when balancing the risk of thromboembolism against bleeding risk. Novel oral anticoagulants that offer a different risk-benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.

  13. Prevention & treatment of obstetrical complications in APS: Is hydroxychloroquine the Holy Grail we are looking for?

    Science.gov (United States)

    Meroni, Pier Luigi

    2016-12-01

    Pregnancy morbidity is part of the clinical spectrum of the anti-phospholipid syndrome (APS), with an important social and economical cost. Antiplatelet and anticoagulant agents are effective in preventing the clinical manifestations in the majority of the patients. However, a consistent proportion of the pregnant women present recurrences in spite of the standard therapy. Observational studies and anecdotal reports raised the issue of additional therapeutic strategies in these refractory cases. Among these, anti-malarials (AMs) and in particular hydroxychloroquine (HCQ) are becoming more and more popular in APS as well as in other systemic autoimmune rheumatic conditions. AMs display a pleiotropic activity spanning from immunomodulation effect to anti-inflammatory and anti-thrombotic activities, all of which potentially useful in APS. The well-known safety of HCQ in pregnancy encouraged its use in pregnant women with autoimmune rheumatic disorders including APS and observational reports suggested a protective effect on obstetrical recurrences. Since thrombosis does not seem to be the main pathogenic mechanism in obstetric APS, effectiveness of the treatment with HCQ should be related to other pharmacological effects rather than to the anti-platelet or anti-thrombotic activity of the molecule. Experimental models showed that HCQ may restore some defective biological functions induced by anti-phospholipid antibodies (aPL) on trophoblasts and a recent study reported a protective effect on in vivo aPL-mediated placental and foetal neurodevelopmental abnormalities. Although the rational behind the use of HCQ in obstetric APS is sound, the evidence from the real life is not conclusive and a critical appraisal through clinical trials is mandatory. Copyright © 2016. Published by Elsevier Ltd.

  14. Community-based InterVentions to prevent serIous Complications (CIVIC) following spinal cord injury in Bangladesh

    DEFF Research Database (Denmark)

    Hossain, Mohammad S; Harvey, Lisa A; Rahman, Md Akhlasur

    2016-01-01

    model of community-based care designed to prevent and manage complications in people with SCI in Bangladesh. METHODS AND ANALYSIS: A pragmatic randomised controlled trial will be undertaken. 410 wheelchair-dependent people with recent SCI will be randomised to Intervention and Control groups shortly...... with health professionals. The primary outcome is all-cause mortality at 2 years. Recruitment started on 12 July 2015 and the trial is expected to take 5 years to complete. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Ethics Committee at the site in Bangladesh and from...... the University of Sydney, Australia. The study will be conducted in compliance with all stipulations of its protocol, the conditions of ethics committee approval, the NHMRC National Statement on Ethical Conduct in Human Research (2007), the Note for Guidance on Good Clinical Practice (CPMP/ICH-135...

  15. Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin

    DEFF Research Database (Denmark)

    Sjåvik, Kristin; Bartek, Jiri; Solheim, Ole

    2015-01-01

    OBJECT: Venous thromboembolism (VTE) is a serious complication after intracranial meningioma surgery. To what extent systemic prophylaxis with pharmacotherapy is beneficial with respect to VTE risk, or associated with increased risk of bleeding and postoperative hemorrhage, remains debated. The c...

  16. Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report

    Directory of Open Access Journals (Sweden)

    Singh Gurpreet

    2011-10-01

    Full Text Available Abstract Background Although complications related to suprapubic cystostomies are well documented, there is scarcity of literature on safety issues involved in long-term care of suprapubic cystostomy in spinal cord injury patients. Case Presentation A 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1 Suprapubic catheter came out requiring reoperation. (2 The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3 Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4 Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5 Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscle Conclusion Suprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.

  17. The use of TachoSil for the prevention of postoperative complications after groin dissection in cases of gynecologic malignancy.

    Science.gov (United States)

    Buda, Alessandro; Fruscio, Robert; Pirovano, Cecilia; Signorelli, Mauro; Betti, Marta; Milani, Rodolfo

    2012-06-01

    To evaluate the effect of TachoSil in preventing postoperative complications after groin dissection performed for primary or recurrent gynecologic malignancy. In a case-control analysis, the incidence of postoperative complications-including lymphocyst formation, wound breakdown and/or infection, and chronic lymphedema-was examined among 8 patients who received TachoSil and 16 controls (standard technique) treated for vulvar cancer or recurrent ovarian/breast cancer at San Gerardo Hospital, Monza, Italy, from 2008 to 2011. Thirty-eight inguinal dissections were performed in the 24 patients. Bilateral groin dissection was performed in 14 patients (n=4 in the study group; n=10 in the control group). Patients in the study group had a lower mean daily drainage volume than those in the control group (133 mL [range, 50-356 mL] vs 320 mL [range, 67-472 mL]; Pgynecologic malignancy. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Devices and dressings to secure peripheral venous catheters to prevent complications.

    Science.gov (United States)

    Marsh, Nicole; Webster, Joan; Mihala, Gabor; Rickard, Claire M

    2015-06-12

    A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. To assess the effects of PVC dressings and securement devices on the incidence of PVC failure. We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard

  19. Abnormal vaginal bleeding in women with venous thromboembolism treated with apixaban or warfarin

    NARCIS (Netherlands)

    Brekelmans, Marjolein P. A.; Scheres, Luuk J. J.; Bleker, Suzanne M.; Hutten, Barbara A.; Timmermans, Anne; Büller, Harry R.; Middeldorp, Saskia

    2017-01-01

    Abnormal vaginal bleeding can complicate direct oral anticoagulant (DOAC) treatment. We aimed to investigate the characteristics of abnormal vaginal bleeding in patients with venous thromboembolism (VTE) receiving apixaban or enoxaparin/warfarin. Data were derived from the AMPLIFY trial. We compared

  20. The effectiveness of the implementation of new technologies in the prevention of purulent complications of repeated surgеries for complications of fractures of the proximal femur of patients

    Directory of Open Access Journals (Sweden)

    An. V. Kalashnikov

    2016-06-01

    Full Text Available Despite the latest achievements of modern traumatology, remains quite high percentage of unsatisfactory results of treatment of fractures of the proximal femur (fPf. According to the literature repeated surgery increases the risk of postoperative purulent complications in several times. The authors of the article developed the innovations introduced in practice based on the use of thrombocytopoiesis fibrin gel, which has a high antibacterial activity due to preservation of leukocytes (local antibiotic effect, together with bone shavings during the performing of the operations when performing reactioneze and TEP after performing osteosynthesis, and also at persons of senile and elderly, for prevention of postoperative purulent complications in fPf. A comprehensive clinical study of 120 patients with fPf complications (false joints, aseptic necrosis of the femoral head, axial deformation after osteomyelitis who underwent re-operative intervention was provided. Patients were divided into two groups, first (control group consisted of 60 patients with consequences fPf who underwent total endoprosthesis (TEP of the hip joint (30 patients and locked intramedullary nailing (LIN (30 patients by conventional methods. The second (experimental group consisted of 60 patients with consequences fPf who underwent TEP of the hip joint (30 patients and LIN (30 patients with use developed by authors of innovations. Effectiveness of prevention of septic complications in both groups of observation was evaluated. The observation period was 1 year. There was statistically significant (p≤0.01 decrease in the number of early (4 times and late (3 times postoperative complications in patients of the experimental group in comparison with patients of control group. The new technologies use allows to increase in 8.4% the efficiency of preventive maintenance of purulent complications of surgical treatment of patients with complications after performing osteosynthesis in the

  1. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.

    Science.gov (United States)

    Esposito, Marco; Worthington, Helen V; Loli, Vassiliki; Coulthard, Paul; Grusovin, Maria Gabriella

    2010-07-07

    trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity was to be investigated including both clinical and methodological factors. Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg 4 times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significant higher number of patients experiencing implant failures in the group not receiving antibiotics: RR = 0.40 (95% CI 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17 to 100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group. There is some evidence suggesting that 2 g of amoxicillin given orally 1 hour preoperatively significantly reduce failures of dental implants placed in ordinary conditions. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether postoperative antibiotics are beneficial, and which is the most effective antibiotic.

  2. Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications

    Directory of Open Access Journals (Sweden)

    Foglia E

    2017-06-01

    Full Text Available Emanuela Foglia,1 Lucrezia Ferrario,1 Elisabetta Garagiola,1 Giuseppe Signoriello,2 Gianluca Pellino,3 Davide Croce,1,4 Silvestro Canonico3 1Centre for Health Economics, Social and Health Care Management - LIUC University, Castellanza, Italy; 2Department of Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 3School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; 4School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South \tAfrica Purpose: Surgical-site complications (SSCs affect patients’ clinical pathway, prolonging their hospitalization and incrementing their management costs. The present study aimed to assess the economic and organizational implications of a portable device for negative-pressure wound therapy (NPWT implementation, compared with the administration of pharmacological therapies alone for preventing surgical complications in patients undergoing general, cardiac, obstetrical–gynecological, or orthopedic surgical procedures.Patients and methods: A total of 8,566 hospital procedures, related to the year 2015 from one hospital, were evaluated considering infection risk index, occurrence rates of SSCs, drug therapies, and surgical, diagnostic, and specialist procedures and hematological exams. Activity-based costing and budget impact analyses were implemented for the economic assessment.Results: Patients developing an SSC absorbed i 64.27% more economic resources considering the length of stay (€ 8,269±2,096 versus € 5,034±2,901, p<0.05 and ii 42.43% more economic resources related to hematological and diagnostic procedures (€ 639±117 versus € 449±72, p<0.05. If the innovative device had been used over the 12-month time period, it would have decreased the risk of developing SSCs; the hospital would have realized an average reduction in health care expenditure equal to −0.69% (−€ 483

  3. Venous Thromboembolism Disease Prophylaxis in Foot and Ankle Surgery.

    Science.gov (United States)

    Chien, Bonnie Y; Dixon, Tonya; Guss, Daniel; DiGiovanni, Christopher

    2018-04-01

    There are limited data to guide the use of venous thromboembolism disease (VTED) prophylaxis after foot and ankle surgery. Although there is general consensus that the overall risk is lower than after hip or knee replacement, subpopulations of patients may be at relatively heightened risk. Furthermore, existing data are often conflicting regarding the efficacy of prophylaxis, with little acknowledgment of the tradeoffs between VTED prophylaxis and potential complications associated with the use of such medications. This article provides an overview of currently available evidence to guide decision making regarding VTED prophylaxis in patients who undergo foot and ankle surgery. Published by Elsevier Inc.

  4. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.

    Science.gov (United States)

    Esposito, Marco; Grusovin, Maria Gabriella; Worthington, Helen V

    2013-07-31

    events (gastrointestinal, hypersensitivity, etc). Screening of eligible studies, assessment of the risk of bias of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity, including both clinical and methodological factors, was to be investigated. Six RCTs with 1162 participants were included: three trials compared 2 g of preoperative amoxicillin versus placebo (927 participants), one compared 3 g of preoperative amoxicillin versus placebo (55 participants), one compared 1 g of preoperative amoxicillin plus 500 mg four times a day for two days versus no antibiotics (80 participants), and one compared four groups: (1) 2 g of preoperative amoxicillin; (2) 2 g of preoperative amoxicillin plus 1 g twice a day for seven days; (3) 1 g of postoperative amoxicillin twice a day for seven days, and (4) no antibiotics (100 participants). The overall body of evidence was considered to be of moderate quality. The meta-analyses of the six trials showed a statistically significant higher number of participants experiencing implant failures in the group not receiving antibiotics (RR 0.33; 95% CI 0.16 to 0.67, P value 0.002, heterogeneity: Tau(2) 0.00; Chi(2) 2.87, df = 5 (P value 0.57); I(2) 0%). The number needed to treat for one additional beneficial outcome (NNTB) to prevent one person having an implant failure is 25 (95% CI 14 to 100), based on an implant failure rate of 6% in participants not receiving antibiotics. There was borderline statistical significance for prosthesis failures (RR 0.44; 95% CI 0.19 to 1.00), with no statistically significant differences for infections (RR 0.69; 95% CI 0.36 to 1.35), or adverse events (RR 1; 95% CI 0.06 to 15.85) (only two minor adverse events were recorded, one in the placebo group). No conclusive information can be derived from the only trial that

  5. Clinical evaluation of piroxicam-FDDF and azithromycin in the prevention of complications associated with impacted lower third molar extraction.

    Science.gov (United States)

    Graziani, F; Corsi, L; Fornai, M; Antonioli, L; Tonelli, M; Cei, S; Colucci, R; Blandizzi, C; Gabriele, M; Del Tacca, M

    2005-12-01

    Combined treatments with non-steroidal anti-inflammatory drugs and antibiotics may offer significant benefits in the prevention of pain and infections associated with oral surgery. In this study, piroxicam and azithromycin were administered to patients undergoing dental extraction to examine the efficacy of piroxicam in the prevention of post-operative pain and inflammatory complications, either in the absence or in the presence of a concomitant antibiotic treatment. Thirty patients were randomly assigned to three groups and treated for 3 days, before impacted lower third molar removal, as follows: (1) sublingual piroxicam-FDDF (fast dissolving dosage formulation) 20 mg/day; (2) oral azithromycin 500 mg/day; (3) piroxicam-FDDF 20 mg/day plus azithromycin 500 mg/day. Oral acetaminophen (500 mg tablets) was allowed as rescue analgesic medication. Pain intensity was evaluated on a 100-mm visual-analogue scale after dental extraction (day 1), and at days 2, 3, 7 after surgery. Edema and trismus were estimated at days 2 and 7. At days 1 and 2, pain intensity was significantly lower in patients treated with piroxicam-FDDF, either alone (p antibiotic may reduce the influence of piroxicam on post-operative inflammation, without affecting its beneficial effect on surgical pain.

  6. Venous Thromboembolism Incidence After Craniofacial Surgery.

    Science.gov (United States)

    Omesiete, Wilson I; Walker, James A; Yu, Jack C

    2018-05-01

    Current protocols for venous thromboembolism (VTE) prophylaxis after craniofacial surgery (CFS) vary widely with substantial disagreements in both indications and managements. An evidence-based approach to this issue requires the following: the incidence of postoperative VTE, comorbidities associated with coagulopathy, risk reduction after VTE prophylaxis, and complications attributable to prophylaxis. This study addresses the first two. Retrospective cross-sectional study. Discharge data from 64,170 patients undergoing CFS between 2008 and 2013 extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were analyzed. The outcome measures extracted were: deep venous thrombosis, pulmonary embolism, demographic data, common comorbidities, length of stay, total cost, and discharge outcome. Diagnoses of deep venous thrombosis or pulmonary embolism, collectively classified as VTE, were observed in 355 (0.55%) of 64,170 patients discharged after CFS. Other surgeries exhibited a VTE rate of 1.17%. Men exhibited nearly double the incidence of VTE relative to women (0.69% compared with 0.37% respectively, P use did not exhibit any significant association (odds ratio, 0.94; P = 0.679). Afflicted patients experienced 4.60 times longer hospital stays averaging 23.8 days (95% confidence interval, 21.4-26.2; P use of VTE chemoprophylaxis is appropriate.

  7. Abnormal uterine bleeding in women receiving direct oral anticoagulants for the treatment of venous thromboembolism.

    Science.gov (United States)

    Godin, Richard; Marcoux, Violaine; Tagalakis, Vicky

    2017-08-01

    Abnormal uterine bleeding (AUB) is a common complication of anticoagulant therapy in premenopausal women affected with acute venous thromboembolism. AUB impacts quality of life, and can lead to premature cessation of anticoagulation. There is increasing data to suggest that the direct oral anticoagulants when used for the treatment of venous thromboembolism differ in their menstrual bleeding profile. This article aims to review the existing literature regarding the association between AUB and the direct oral anticoagulants and make practical recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Challenges to preventing infectious complications, decreasing re-hospitalizations, and reducing cost burden in long-term survivors after allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Fuji, Shigeo; Kapp, Markus; Einsele, Hermann

    2012-01-01

    Even though the overall outcome after allogeneic transplant has improved significantly in the last decades, late infectious diseases are still the most important causes of late morbidity and mortality. Here, impaired immune reconstitution and therapy of chronic graft-versus-host disease (GVHD) represent the major risk factors. In this review, we give a comprehensive overview of late infectious complications and summarize possible diagnostic and therapeutic interventions to prevent these complications. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe

    DEFF Research Database (Denmark)

    Lip, Gregory Y.H.; Dagres, Nikolaos; Proclemer, Alessandro

    2013-01-01

    was 10.6 per year and most (73%) centres performed ≤10 procedures per year. We found that LAAO was being performed for stroke prevention in AF, for the most common indication being 'the patient has absolute contraindication to long term oral anticoagulants'. Among survey respondents, LAAO procedures...... are most often performed by interventional cardiologists. Experience varied widely, and this was reflected in the wide range of thromboembolic and procedural (tamponade, bleeding) complications reported by the respondents to this EP wire survey....

  10. Dual antiplatelet therapy versus oral anticoagulation plus dual antiplatelet therapy in patients with atrial fibrillation and low-to-moderate thromboembolic risk undergoing coronary stenting: design of the MUSICA-2 randomized trial.

    Science.gov (United States)

    Sambola, Antonia; Montoro, J Bruno; Del Blanco, Bruno García; Llavero, Nadia; Barrabés, José A; Alfonso, Fernando; Bueno, Héctor; Cequier, Angel; Serra, Antonio; Zueco, Javier; Sabaté, Manel; Rodríguez-Leor, Oriol; García-Dorado, David

    2013-10-01

    Oral anticoagulation (OAC) is the recommended therapy for patients with atrial fibrillation (AF) because it reduces the risk of stroke and other thromboembolic events. Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention and stenting (PCI-S). In patients with AF requiring PCI-S, the association of DAPT and OAC carries an increased risk of bleeding, whereas OAC therapy or DAPT alone may not protect against the risk of developing new ischemic or thromboembolic events. The MUSICA-2 study will test the hypothesis that DAPT compared with triple therapy (TT) in patients with nonvalvular AF at low-to-moderate risk of stroke (CHADS2 score ≤2) after PCI-S reduces the risk of bleeding and is not inferior to TT for preventing thromboembolic complications. The MUSICA-2 is a multicenter, open-label randomized trial that will compare TT with DAPT in patients with AF and CHADS2 score ≤2 undergoing PCI-S. The primary end point is the incidence of stroke or any systemic embolism or major adverse cardiac events: death, myocardial infarction, stent thrombosis, or target vessel revascularization at 1 year of PCI-S. The secondary end point is the combination of any cardiovascular event with major or minor bleeding at 1 year of PCI-S. The calculated sample size is 304 patients. The MUSICA-2 will attempt to determine the most effective and safe treatment in patients with nonvalvular AF and CHADS2 score ≤2 after PCI-S. Restricting TT for AF patients at high risk for stroke may reduce the incidence of bleeding without increasing the risk of thromboembolic complications. © 2013.

  11. Review of the cost of venous thromboembolism

    Science.gov (United States)

    Fernandez, Maria M; Hogue, Susan; Preblick, Ronald; Kwong, Winghan Jacqueline

    2015-01-01

    Background Venous thromboembolism (VTE) is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion Costs for VTE treatment are considerable and increasing faster than general inflation for medical care services, with hospitalization costs being the primary cost driver. Readmissions for VTE are generally more costly than the initial VTE admission. Further studies evaluating the economic impact of new

  12. [Pulmonary thromboembolism in Occupational Medicine].

    Science.gov (United States)

    Reinoso-Barbero, Luis; Díaz-Garrido, Ramón; Fernández-Fernández, Miguel; Capapé-Aguilar, Ana; Romero-Paredes, Carmen; Aguado-Benedí, María-José

    2015-01-01

    Occupational physicians should be familiar with the risk factors and clinical presentation of pulmonary thromboembolism (PTE). PTE belongs to the group ofis a cardiovascular diseases, which are the main cause (40%) of death in Spanish workplaces; at present, they may be considered a work-related injury because of the doctrinal evolution in the legal interpretation of the presumption of iuris tantum. We present the case of a hypertensive and obese adult male who suffered a PTE at his workplace. The availability of a portable pulse oximeter (room air SpO2, 92%) was critical in guiding the decision to refer him urgently to the hospital, where the diagnosis was confirmed. We can conclude that, independently of whether this event is later deemed to be work-related (in this case it was not), occupational physicians must know how to correctly manage and refer affected workers. Copyright belongs to the Societat Catalana de Salut Laboral.

  13. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence?

    Science.gov (United States)

    Salehi, Nooshin; Choi, Eric D; Garrison, Roger C

    2017-01-16

    BACKGROUND Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1-5% of all Guillain-Barre cases in Western countries. Patients with Miller Fisher Syndrome usually have good recovery without residual deficits. Venous thromboembolism is a common complication of Guillain-Barre Syndrome and has also been reported in Miller Fisher Syndrome, but it has generally been reported in the presence of at least one prothrombotic risk factor such as immobility. A direct correlation between venous thromboembolism and Miller Fisher Syndrome or Guillain-Barre Syndrome has not been previously described. CASE REPORT We report the case of a 32-year-old Hispanic male who presented with acute, severe thromboembolic disease and concurrently demonstrated characteristic clinical features of Miller Fisher Syndrome including ophthalmoplegia, ataxia, and areflexia. Past medical and family history were negative for thromboembolic disease, and subsequent hypercoagulability workup was unremarkable. During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema.

  14. Resveratrol Prevents Cardiovascular Complications in the SHR/STZ Rat by Reductions in Oxidative Stress and Inflammation

    Directory of Open Access Journals (Sweden)

    Rebecca K. Vella

    2015-01-01

    Full Text Available The cardioprotective effects of resveratrol are well established in animal models of metabolic disease but are yet to be investigated in a combined model of hypertension and diabetes. This study investigated the ability of resveratrol’s antioxidant and anti-inflammatory effects to prevent cardiovascular complications in the spontaneously hypertensive streptozotocin-induced diabetic rat. Diabetes was induced in eight-week-old male spontaneously hypertensive rats via a single intravenous injection of streptozotocin. Following this, resveratrol was administered orally for an eight-week period until the animals were sixteen weeks of age. Upon completion of the treatment regime assessments of oxidative stress, lipid peroxidation, inflammation, and cardiovascular function were made. Resveratrol administration to hypertensive-diabetic animals did not impact upon blood glucose or haemodynamics but significantly reduced oxidative stress, lipid peroxidation, and inflammatory cytokines. Reductions in systemic levels of oxidative stress and inflammation conferred improvements in vascular reactivity and left ventricular pump function and electrophysiology. This study demonstrates that resveratrol administration to hypertensive diabetic animals can elicit cardioprotective properties via antioxidant and anti-inflammatory effects. The observed preservation of cardiovascular function was independent of changes in blood glucose concentration and haemodynamics, suggesting that oxidative stress and inflammation are key components within the pathological cascade associated with hypertension and diabetes.

  15. [HIV infection in the child after materno-fetal transmission: early treatment with azidothymidine and prevention of secondary infectious complications].

    Science.gov (United States)

    Michel, G; Vallée, D; Thuret, I; Chambost, H; Tamalet, C; de Boisse, P; Leclaire, M; Farnarier, C; Kaplanski, S; Perrimond, H

    1992-01-01

    Twenty-four perinatally HIV infected children received early treatment as soon as the diagnosis of viral contamination was established. In 13 cases (group 1), this diagnosis was based on a viremia and/or antigenemia during the first 6 months of life. In 11 cases (group 2), children were more than 15 months-old and had a positive HIV antibody test. Therapy included azidothymidine (AZT, 400 mg/m2/d) and the prevention of secondary infectious complications with intravenous immunoglobulin and cotrimoxazole. With a median follow-up of 26 months, we reported no case of severe secondary infection and no case of encephalopathy. Hematological side effects of AZT were rarely observed. Only one patient developed anemia. In all other cases, the only hematological abnormality was macrocytosis of red blood cells. Before treatment, the mean value of T4 cells age-adjusted count was 96, 86 and 91%, respectively, for groups 1, 2 and the entire study group. At the time of analysis, these values were 64, 62 and 63% respectively. This decrease was statistically significant for group 1 and for the entire study group, but did not reach statistical significance for group 2. These data show that AZT is probably insufficient as a long-term therapy for HIV infected children. Other therapeutic approaches need to be developed in the future, notably the combination of anti-retroviral drugs.

  16. Reconstruction of iliac crest with rib to prevent donor site complications: A prospective study of 26 cases

    Directory of Open Access Journals (Sweden)

    Dave B

    2007-01-01

    Full Text Available Background: The tricortical bone graft from the iliac crest are used to reconstruct the post corpectomy spinal defects. The donor iliac area defect is large and may give rise to pain at donor site, instability of pelvis, fracture of ilium, donor site muscle herniation or abdominal content herniation. Rib removed during thoracotomy was used by us to reconstruct the iliac crest defect. Materials and Methods: Twenty-six patients who underwent thoracotomy for dorsal spine corpectomy or curettage for various spinal pathologies from June 2002 to May 2004 were included in the study. After adequate decompression the spine was reconstructed by tricortical bone graft from iliac crest and reconstruction of the iliac crest was done with the rib removed for exposure during thoracotomy. Results: The mean follow up was 15 months. All patients had good graft incorporation which was evaluated on the basis of local tenderness and radiographs. One patient had graft displacement. Conclusion: The reconstruction of iliac crest by rib is a simple and effective procedure to prevent donor site complications.

  17. The pathophysiology of chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Gérald Simonneau

    2017-03-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is a rare, progressive pulmonary vascular disease that is usually a consequence of prior acute pulmonary embolism. CTEPH usually begins with persistent obstruction of large and/or middle-sized pulmonary arteries by organised thrombi. Failure of thrombi to resolve may be related to abnormal fibrinolysis or underlying haematological or autoimmune disorders. It is now known that small-vessel abnormalities also contribute to haemodynamic compromise, functional impairment and disease progression in CTEPH. Small-vessel disease can occur in obstructed areas, possibly triggered by unresolved thrombotic material, and downstream from occlusions, possibly because of excessive collateral blood supply from high-pressure bronchial and systemic arteries. The molecular processes underlying small-vessel disease are not completely understood and further research is needed in this area. The degree of small-vessel disease has a substantial impact on the severity of CTEPH and postsurgical outcomes. Interventional and medical treatment of CTEPH should aim to restore normal flow distribution within the pulmonary vasculature, unload the right ventricle and prevent or treat small-vessel disease. It requires early, reliable identification of patients with CTEPH and use of optimal treatment modalities in expert centres.

  18. CT evaluation of chronic thromboembolic pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Willemink, M.J. [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands); Es, H.W. van, E-mail: h.es@antoniusziekenhuis.nl [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands); Koobs, L. [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands); Morshuis, W.J. [Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein (Netherlands); Snijder, R.J. [Department of Pulmonary Disease, St Antonius Hospital, Nieuwegein (Netherlands); Heesewijk, J.P.M. van [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands)

    2012-03-15

    The educational objectives of this article are to provide an overview of the computed tomography (CT) findings in chronic thromboembolic pulmonary hypertension. This article reviews the key imaging findings at CT in patients with chronic thromboembolic pulmonary hypertension. After reading this article, the reader should have an improved awareness of the condition, its imaging features, and the CT imaging features associated with surgically accessible disease.

  19. CT evaluation of chronic thromboembolic pulmonary hypertension

    International Nuclear Information System (INIS)

    Willemink, M.J.; Es, H.W. van; Koobs, L.; Morshuis, W.J.; Snijder, R.J.; Heesewijk, J.P.M. van

    2012-01-01

    The educational objectives of this article are to provide an overview of the computed tomography (CT) findings in chronic thromboembolic pulmonary hypertension. This article reviews the key imaging findings at CT in patients with chronic thromboembolic pulmonary hypertension. After reading this article, the reader should have an improved awareness of the condition, its imaging features, and the CT imaging features associated with surgically accessible disease.

  20. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial.

    Science.gov (United States)

    Boden, Ianthe; Skinner, Elizabeth H; Browning, Laura; Reeve, Julie; Anderson, Lesley; Hill, Cat; Robertson, Iain K; Story, David; Denehy, Linda

    2018-01-24

    To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial. Preoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided. The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months. The incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute risk reduction of 15% (95% confidence interval 7% to 22%) and a number needed to treat of 7

  1. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial

    Science.gov (United States)

    Skinner, Elizabeth H; Browning, Laura; Reeve, Julie; Anderson, Lesley; Hill, Cat; Robertson, Iain K; Story, David; Denehy, Linda

    2018-01-01

    Abstract Objective To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. Design Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. Setting Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. Participants 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial. Interventions Preoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided. Main outcome measures The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months. Results The incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute

  2. The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialty.

    Science.gov (United States)

    Amaral, Cristina; Guimarães Pereira, Luís; Moreto, Ana; Sá, Ana Carolina; Azevedo, Ana

    2017-09-01

    Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Duration of Diabetes Mellitus and Risk of Thromboembolism and Bleeding in Atrial Fibrillation: Nationwide Cohort Study.

    Science.gov (United States)

    Overvad, Thure Filskov; Skjøth, Flemming; Lip, Gregory Y H; Lane, Deirdre A; Albertsen, Ida Ehlers; Rasmussen, Lars Hvilsted; Larsen, Torben Bjerregaard

    2015-08-01

    Guidelines advocate anticoagulant treatment to all patients with atrial fibrillation and concomitant diabetes mellitus. The potential refinement to thromboembolic risk stratification that may spring from subdividing diabetes mellitus is unexplored. The purpose was to investigate duration of diabetes mellitus as a predictor of thromboembolism and anticoagulant-related bleeding in patients with atrial fibrillation. Using nationwide Danish registries, we identified all patients discharged from hospital with an incident diagnosis of atrial fibrillation from 2000 to 2011. Hazard ratios with 95% confidence intervals for thromboembolism and bleeding according to years of diabetes mellitus duration in categories (0-4, 5-9, 10-14, and ≥15) and as a continuous variable using cubic splines were calculated by Cox regression. The study population comprised 137 222 patients with atrial fibrillation, of which 12.4% had diabetes mellitus. Compared with patients without diabetes mellitus and after adjustment for anticoagulant treatment and CHA2DS2-VASc components (congestive heart failure, hypertension, age, previous stroke, vascular disease, and sex), the risk of thromboembolism was lowest in the 0 to 4 years duration category (hazard ratio, 1.11; 95% confidence interval, 1.03-1.20), and highest in the longest duration category of ≥15 years (hazard ratio, 1.48; 95% confidence interval, 1.29-1.70). When analyzed as a continuous variable, duration of diabetes mellitus was associated with risk of thromboembolism in a dose-response-dependent manner, but not with a higher risk of bleeding during anticoagulant treatment. In patients with atrial fibrillation, longer duration of diabetes mellitus was associated with a higher risk of thromboembolism, but not with a higher risk of anticoagulant-related bleeding. Considering the critical balance between preventing thromboembolism and avoiding bleeding, longer duration of diabetes mellitus may favor initiation of anticoagulant therapy.

  4. Thromboembolic events in Fabry disease and the impact of factor V Leiden.

    Science.gov (United States)

    Lenders, Malte; Karabul, Nesrin; Duning, Thomas; Schmitz, Boris; Schelleckes, Michael; Mesters, Rolf; Hense, Hans-Werner; Beck, Michael; Brand, Stefan-Martin; Brand, Eva

    2015-03-10

    Although several reports suggest an increased thromboembolic event rate, especially regarding strokes and TIAs at early age in patients with Fabry disease (FD), the risk for patients with FD to experience these events, the clinical relevance of additional risk factors including the concurrence of factor V Leiden (FVL), and the benefit of enzyme replacement therapy (ERT) regarding these events remain unclear. Three hundred four consecutively recruited patients with FD were evaluated for their lifetime occurrence of thromboembolic events such as stroke, TIA, deep vein thrombosis, and pulmonary embolism. The thromboembolic risk was determined in patients with FD and concurrent FVL, and the impact of ERT was assessed. The 304 patients with FD had a median age of 41 years and 53 (17.4%) had experienced at least one thromboembolic event during their lifetime. Among 226 patients with FD screened for FVL, 16 gene carriers were identified (7.1%). The occurrence of thromboembolic events in patients with FD and concurrent FVL was significantly increased compared to those without FVL (hazard ratio = 5.45, 95% confidence interval 2.29-12.99; p risk of thromboembolic events compared to those without ERT (hazard ratio = 0.362, 95% confidence interval 0.132-0.992; p = 0.0422). This observational study confirms that patients with FD have a high risk of clinically relevant thromboembolic events, which could be aggravated by a concurrence of FVL. ERT might be of benefit in preventing vascular events in patients with FD. The latter observation needs confirmation, however, by randomized and controlled clinical trials. © 2015 American Academy of Neurology.

  5. Evaluation of add-on devices for the prevention of phlebitis and other complications associated with the use of peripheral catheters in hospitalised adults: a randomised controlled study.

    Science.gov (United States)

    Martínez, J A; Piazuelo, M; Almela, M; Blecua, P; Gallardo, R; Rodríguez, S; Escalante, Z; Robau, M; Trilla, A

    2009-10-01

    The aim of this study was to assess the role of add-on devices for the prevention of phlebitis and other complications associated with the use of peripheral catheters. Patients admitted to an infectious diseases ward and requiring the insertion of a peripheral catheter for at least 24h were randomly allocated to be managed with or without add-on devices. Incidence of phlebitis and all complications were the primary outcomes. Extravasation, inadvertent withdrawal, obstruction and rupture were considered to be mechanical complications, and analysis was performed using survival methods. Of 683 evaluated catheters, 351 were allocated to the add-on device arm and 332 to the control arm. Despite randomisation, patients in the add-on device group were older (P=0.048), less likely to have human immunodeficiency virus (P=0.02) and more likely to have received antibiotics (P=0.05). After adjustment for these variables, the hazard ratio for phlebitis remained non-significant (hazard ratio: 0.95; 95% confidence interval: 0.7-1.3), but the risk of mechanical complications became lower in the add-on device arm (0.68; 0.5-0.94). This translated into a trend towards a lower risk of any complication (0.83; 0.67-1.01). The beneficial effect on mechanical or all complications was noticeable after six days of catheterisation. Add-on devices do not reduce the incidence of phlebitis but may prevent mechanical complications. However, the impact of add-on devices on the incidence of all complications is at most small and only apparent after the sixth day of catheter use.

  6. Surgical thromboendarterectomy for chronic thromboembolic pulmonary hypertension using circulatory arrest with selective antegrade cerebral perfusion

    NARCIS (Netherlands)

    Zeebregts, CJAM; Dossche, KM; Morshuis, WJ; Knaepen, PJ; Schepens, MAAM

    The use of circulatory arrest with selective antegrade cerebral perfusion is described in a 59-year-old man who underwent thrombendarterectomy for chronic thromboembolic pulmonary hypertension. The postoperative course was uneventful. The described surgical technique may prevent the patient from

  7. Statin treatment and risk of recurrent venous thromboembolism: a nationwide cohort study

    NARCIS (Netherlands)

    Nguyen, Cu Dinh; Andersson, Charlotte; Jensen, Thomas Bo; Gjesing, Anne; Schjerning Olsen, Anne-Marie; Malta Hansen, Carolina; Büller, Harry; Torp-Pedersen, Christian; Gislason, Gunnar H.

    2013-01-01

    Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin therapy and

  8. Thromboembolic and bleeding risks in patients undergoing atrial fibrillation ablation: oral anticoagulation perspectives.

    Science.gov (United States)

    Briceño, David F; Madan, Nidhi; Romero, Jorge; Londoño, Alejandra; Villablanca, Pedro A; Natale, Andrea; Di Biase, Luigi

    2017-07-01

    Atrial fibrillation (AF) is a cause of significant morbidity and mortality. Catheter ablation for AF (CAAF) has emerged as an effective treatment option of rhythm control for patients with symptomatic AF. However, the risk of thromboembolism and bleeding in the periprocedural period represent a worrisome complication of this therapy. The reported incidence of thromboembolic and bleeding events associated with CAAF varies from 0.9% to 5% depending on the CAAF strategy and the anticoagulation regimen used in the periprocedural period. Areas covered: The different anticoagulation regimens used prior to, during, and after CAAF to minimize the risk of thromboembolic and bleeding events are reviewed. The use of uninterrupted oral anticoagulation and appropriate heparin dosing to achieve safe activated clotting time levels are also detailed. A comprehensive approach with assessment of individual risk for thromboembolic and bleeding complications, and understanding the pharmacokinetics of the anticoagulant agents available is also reviewed. Expert opinion: The key advances done in the periprocedural anticoagulation field include the use of uninterrupted anticoagulation strategies in patients undergoing AF ablation and efforts to simplify the selection of patients who need LAA thrombus screening prior to ablation.

  9. Venous thromboembolism during air travel: does the existing evidence raise legal implications?

    Science.gov (United States)

    Mavroforou, A; Michalodimitrakis, E; Koutsias, S; Mavrophoros, D; Giannoukas, A D

    2009-08-01

    Venous thromboembolism associated with prolonged sitting during air travel has been reported in the medical literature. The aim of this article was to review whether the existing evidence can raise ethical concerns and grounds for legal implications. Review of the pertinent literature. Long duration air travel is linked with venous thromboembolism in susceptible individuals. However, the jurisdictions in countries that have adopted the Warsaw Convention 1929 and its amendment at Hague in 1955 have invariably based their approach on whether venous thromboembolism developed after air travel is an ''accident'' under the provision of article 17. Not only this has failed to be proven under various jurisdictions but also inaction, including not warning of the risk and not giving advice on the precautions that would minimise that risk have not been considered sufficient to rank venous thromboembolism as an ''accident''. While there is scientific evidence to support that long-haul flights may predispose to the development of venous thromboembolism in susceptible individuals, there is a clear trend in various jurisdictions that the airline carrier does not incur liability under the Warsaw convention. Nevertheless, the existing scientific evidence raises ethical concerns on the need for information and advice on prevention to those passengers at risk from the airline companies.

  10. Prevention of complications after pulpi-tis treatment in pediatrics at the stage of root system formation and its resorption

    Directory of Open Access Journals (Sweden)

    Makhonova E.M.

    2011-03-01

    Full Text Available Most frequently pulpitis develops as a complication of caries. In pediatric practice both acute and chronic forms of pulpitis are observed. However, primary chronic process is more often among milk teeth. The devital amputation is the most popular method of pulpitis treatment in pediatrics. Its professional and accurate implementation is the first step to avoid any possible future complications

  11. Practical aspects of treatment with target specific anticoagulants: initiation, payment and current market, transitions, and venous thromboembolism treatment.

    Science.gov (United States)

    Mahan, Charles E

    2015-04-01

    Target specific anticoagulants (TSOACs) have recently been introduced to the US market for multiple indications including venous thromboembolism (VTE) prevention in total hip and knee replacement surgeries, VTE treatment and reduction in the risk of stroke in patients with non-valvular atrial fibrillation (NVAF). Currently, three TSOACs are available including rivaroxaban, apixaban, and dabigatran with edoxaban currently under Food and Drug Administration review for VTE treatment and stroke prevention in NVAF. The introduction of these agents has created a paradigm shift in anticoagulation by considerably simplifying treatment and anticoagulant initiation for patients by giving clinicians the opportunity to use a rapid onset, rapid offset, oral agent. The availability of these rapid onset TSOACs is allowing for outpatient treatment of low risk pulmonary embolism and deep vein thrombosis which can greatly reduce healthcare costs by avoiding inpatient hospitalizations and treatment for the disease. Additionally with this practice, the complications of an inpatient hospitalization may also be avoided such as nosocomial infections. Single-agent approaches with TSOACs represent a paradigm shift in the treatment of VTE versus the complicated overlap of a parenteral agent with warfarin. Transitions between anticoagulants, including TSOACs, are a high-risk period for the patient, and clinicians must carefully consider patient characteristics such as renal function as well as the agents that are being transitioned. TSOAC use appears to be growing slowly with improved payment coverage throughout the US.

  12. Review of the cost of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Fernandez MM

    2015-08-01

    Full Text Available Maria M Fernandez,1 Susan Hogue,1 Ronald Preblick,2 Winghan Jacqueline Kwong2 1RTI-Health Solutions, Market Access and Outcomes Strategy, Research Triangle Park, NC, 2Daiichi Sankyo, Inc., Health Economics & Outcomes Research, Parsippany, NJ, USA Background: Venous thromboembolism (VTE is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods: Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results: Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion: Costs for VTE treatment are

  13. Effect of ginkgo capsules combined with secondary preventive drugs on the endothelial injury and plaque properties of patients with hypertension complicated by carotid atherosclerosis

    Directory of Open Access Journals (Sweden)

    Wei Li

    2017-10-01

    Full Text Available Objective: To study the effect of ginkgo capsules combined with secondary preventive drugs on the endothelial injury and plaque properties of patients with hypertension complicated by carotid atherosclerosis. Methods: A total of 178 patients with hypertension complicated by carotid atherosclerosis who were treated in Chengyue Community Health Service Center of Xisaishan District Huangshi City Hubei Province between February 2015 and January 2017 were collected and randomly divided into two groups. Control group were treated with conventional secondary preventive drugs, and observation group were treated with ginkgo capsules combined with secondary preventive drugs. The differences in serum endothelial injury indexes and lipid metabolism indexes as well as carotid artery ultrasound parameters were compared between the two groups before and after treatment. Results: Before treatment, endothelial injury indexes and lipid metabolism indexes as well as carotid artery ultrasound parameters were not significantly different between two groups. After treatment, serum ET, AngⅡ, TC, LDL-C and LpA contents as well as carotid artery ultrasound parameters DS and AS levels of observation group were lower than those of control group while serum NO and HDL-C contents as well as carotid artery ultrasound parameter MLD level were higher than those of control group. Conclusion: Ginkgo capsule combined with secondary preventive drugs can effectively reduce the endothelial injury and stabilize the plaques in patients with hypertension complicated by carotid atherosclerosis.

  14. Pregnancy-associated venous thromboembolism: Part I- Deep vein thrombus diagnosis and treatment

    International Nuclear Information System (INIS)

    Al-Gahtani, Farjah H.

    2009-01-01

    Venous thromboembolic (VTE) complications are leading causes of mortality in the developed world. Over the past 20 years, there has been an increase of deep venous thrombosis (DVT) in the pregnant women, and this increase may be explained by the risk factors including older age, cesarean section, history of VTE and presence of thrombophilia. To reduce the incidence of VTE in pregnancy and improve the outcomes, a wider understanding of the risk factors and a better identification of women at a risk of the thrombosis, with objective diagnosis and provide the optimal effective and safe treatment. Deep venous thrombosis and pulmonary embolism, considered manifestations of the same disease, are often preventable and usually treatable. Nevertheless, VTE remains a substantial problem despite the dramatic decline in pregnancy-related mortality in industrialized countries over the past century. While diagnosis and management of VTE in pregnancy are challenging, and many diagnosis tests are less accurate in pregnant than non-pregnant patients and the available options are suboptimal. This is a review in 2 parts, in part I, we address the following questions. In pregnant women, who developed DVT; how to diagnose and the treatment once the diagnosis is confirmed. For each of these problems, the relevant background is briefly summarized, approaches recommended and the suggested practical and relatively safe diagnostic management approaches. Part II, we address pregnant women with pulmonary embolism, how to diagnose and treat. (author)

  15. [Maternal death by venous thromboembolic disease].

    Science.gov (United States)

    Rossignol, M; Morau, E; Dreyfus, M

    2017-12-01

    Pregnancy and postpartum are very high-risk periods for venous thromboembolism events (TEE), which seems to extend far beyond the classical 6-8 weeks after childbirth. Pulmonary embolism (PE) is one of the 3 main causes of direct maternal death in western countries. Between 2010 an 2012 in France, 24 deaths were related to PE giving a maternal mortality ratio of 1/100,000, which is not different from the former report (2007-2009). PE is responsible of 9% of maternal deaths, in equal position with postpartum hemorrhage and amniotic fluid embolism. Four deaths (16%) occurred after pregnancy interruption (1 abortion, 3 medical interruptions), 7 (30%) during ongoing pregnancy (before 22 weeks of pregnancy) and 13 (54%) in the postpartum period (9 to 60 days after childbirth). Among these deaths, 9 occurred in extra hospital setting (at home or in the street). Fifty percent of these deaths seem to be avoidable, as it was in the former report. Main avoidability criteria were: diagnostic delay; mobilization before effective anticoagulation of proximal deep venous thrombosis; insufficient preventive treatment with low molecular weight heparin [duration and/or dose (obesity)]; unjustified induction of labor. Analyzing those deaths allow to remind that in case of high suspicion of TEE, effective anticoagulation should be started without delay, and that angio-TDM is not contraindicated in pregnant women. Low molecular weight heparin regiment should be adapted to real weight. Monitoring of anti-Xa activity, if not routinely recommended, is probably useful in case of obesity or renal insufficiency. Anticipating birth by induction of labor, in the absence of abnormal fetal heart rhythm, should not delay effective anticoagulation of near-term TEE. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. MRI in venous thromboembolic disease

    International Nuclear Information System (INIS)

    Sostman, H.D.; Debatin, J.F.; Spritzer, C.E.; Coleman, R.E.; Grist, T.M.; MacFall, J.R.

    1993-01-01

    We evaluated the ability of magnetic resonance (MR) imaging to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). MR venography was performed on 217 patients suspected of having DVT. Cine-MR imaging of the pulmonary arteries was performed in 14 other patients who were thought to have PE based on other imaging studies. In a third group of 5 patients, MR pulmonary angiograms were performed in the sagittal and coronal planes with a multislice fast gradient recalled echo technique. All but one of the 217 MR venograms were technically adequate. In 72 patients with correlative imaging studies (venography and ultrasound) MR venography was 99% sensitive and 95% specific. On the basis of follow-up (mean 8.3 months), no false-negative MR venograms were detected in an additional 64 patients. In 11 other patients MR revealed a diagnosis other than DVT. Cine-MR showed PE in all 14 patients evaluated. MR pulmonary arteriography demonstrated filling defects consistent with acute PE in 2 of 3 patients with acute PE; in the third patient only a questionable filling defect was seen. Coarctations or webs were found in the pulmonary arteries of both patients with chronic PE. These preliminary data suggest that MR imaging may be able to evaluate both the peripheral venous and the pulmonary arterial component of venous thromboembolic disease. Further technical refinement and more extensive clinical experience will be required to establish the role of this method in diagnosing pulmonary embolism, but MR venography is now used routinely in our hospital for the diagnosis of deep venous thrombosis. (orig.)

  17. Pregnancy-related venous thromboembolism and risk of occult cancer

    DEFF Research Database (Denmark)

    Hansen, Anette Tarp; Veres, Katalin; Horváth-Puhó, Erzsébet

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected. An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected. An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  18. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin

    DEFF Research Database (Denmark)

    Andersen, Anita Sylvest; Berthelsen, Jørgen G.; Bergholt, Thomas

    2010-01-01

    OBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH) for prophylaxis and treatment of thromboembolic complications in pregnancy. DESIGN: Cohort study with a chronologic register-based control group. SETTING: Department of Obstetrics and Gynecology, Hiller...... side effects of treatment and no osteoporotic fractures or episodes of heparin-induced thrombocytopenia. The 166 pregnancies resulted in 159 live infants. There was a significantly higher risk of preterm delivery (13% vs. 6%) and intrauterine growth restriction (4.4% vs. 3.5%). Delivery by cesarean...... were in good health at discharge. CONCLUSIONS: Individually dosed LMWH is well tolerated and safe for prophylaxis and treatment of thromboembolic complications during pregnancy, delivery and the postpartum periodOBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH...

  19. [Incidence of thromboembolic events after major operations in patients with haemophilia].

    Science.gov (United States)

    Krekeler, S; Alesci, S; Miesbach, W

    2012-01-01

    Thromboembolic complications may occur in patients with major operations even after routine thromboprophylaxis with low-molecular-weight-heparin. In this retrospective, single center survey the post-operative course of patients with haemophilia was investigated. Overall, the postoperative course in 85 patients with haemophilia A and B (median age: 43 years, 18-73 years) and 139 surgical procedures was analyzed. The surgical procedures mainly consist of major orthopedic surgery (58 total knee replacement, 15 hip replacement, 17 other major orthopedic surgery, 15 minor orthopedic procedures). Additional surgical procedures were abdominal-surgical (18), urological (8), neurosurgical (5). During the post-operative observation period a small number of wound healing complications occurred (4%). None of the patients developed symptomatic deep vein thrombosis or lung embolism. There seems to a decreased risk of postoperative thromboembolism in patients with haemophilia.

  20. Acute Pericarditis Following Acute Pulmonary Thromboembolism.

    Science.gov (United States)

    Nakata, Akio; Aburadani, Isao; Kontani, Koichirou; Hirota, Satoshi

    2017-12-12

    We describe the case of a 45-year-old Japanese man who developed acute pericarditis following an acute pulmonary thromboembolism. He had developed shortness of breath 7 days prior to hospitalization and was admitted with severe dyspnea. Echocardiography and laboratory results were compatible with acute pulmonary thromboembolism, which was confirmed by contrast-enhanced chest computed tomography. On the third hospital day, he experienced chest pain exacerbated by inspiration. On the fourth hospital day, his body temperature increased to 39°C and echocardiography revealed circumferential pericardial effusion. A diagnosis of acute pericarditis was made and the patient was treated with colchicine and aspirin. On the fifth hospital day, his symptoms largely subsided. Auscultation revealed pericardial friction rub. Electrocardiography demonstrated diffuse ST-segment elevations. Twenty-four days later, computed tomography revealed the disappearance of both the pericardial effusion and pulmonary arterial emboli. This case was thought to be one of acute pericarditis following acute pulmonary thromboembolism.

  1. Austrian Lipid Consensus on the management of metabolic lipid disorders to prevent vascular complications: A joint position statement issued by eight medical societies. 2016 update.

    Science.gov (United States)

    Toplak, Hermann; Ludvik, Bernhard; Lechleitner, Monika; Dieplinger, Hans; Föger, Bernhard; Paulweber, Bernhard; Weber, Thomas; Watschinger, Bruno; Horn, Sabine; Wascher, Thomas C; Drexel, Heinz; Brodmann, Marianne; Pilger, Ernst; Rosenkranz, Alexander; Pohanka, Erich; Oberbauer, Rainer; Traindl, Otto; Roithinger, Franz Xaver; Metzler, Bernhard; Haring, Hans-Peter; Kiechl, Stefan

    2016-04-01

    In 2010, eight Austrian medical societies proposed a joint position statement on the management of metabolic lipid disorders for the prevention of vascular complications. An updated and extended version of these recommendations according to the current literature is presented, referring to the primary and secondary prevention of vascular complications in adults, taking into consideration the guidelines of other societies. The "Austrian Lipid Consensus - 2016 update" provides guidance for individualized risk stratification and respective therapeutic targets, and discusses the evidence for reducing vascular endpoints with available lipid-lowering therapies. Furthermore, specific management in key patient groups is outlined, including subjects presenting with coronary, cerebrovascular, and/or peripheral atherosclerosis; diabetes mellitus and/or metabolic syndrome; nephropathy; and familial hypercholesterolemia.

  2. Diagnosing chronic thromboembolic pulmonary hypertension: current perspectives

    Directory of Open Access Journals (Sweden)

    Hadinnapola C

    2014-09-01

    Full Text Available Charaka Hadinnapola, Deepa Gopalan, David P Jenkins Papworth Hospital National Health Service Foundation Trust, Papworth Everard, Cambridge, United Kingdom Abstract: Chronic thromboembolic pulmonary hypertension is a rare and relatively poorly understood disease. It remains underdiagnosed and is often not recognized in primary and secondary care, as its symptoms are nonspecific and there are few clinical signs until late in the disease process. However, pulmonary endarterectomy (PEA offers a potential cure for patients with this type of pulmonary hypertension; therefore, it is important that they are identified and diagnosed in a timely manner. PEA is associated with a 2.2%–5% risk of significant morbidity and mortality, even in experienced PEA centers. Therefore, once chronic thromboembolic pulmonary hypertension is diagnosed, further assessment of operability and patient selection is crucial. Assessment of operability involves determining the distribution and burden of chronic thromboembolic disease, assessing pulmonary hemodynamics, and assessing the functional impairment of the patient. Ventilation perfusion scintigraphy is of value in screening for the presence of chronic thromboembolic disease. However, computer tomography pulmonary angiography and magnetic resonance pulmonary angiography are now increasingly used to image the vascular occlusions directly. This allows assessment of the surgically accessible disease burden. Some centers still advocate conventional selective pulmonary angiography for the latter. Right-heart catheterization remains the gold standard for assessing pulmonary hemodynamics. Higher pulmonary vascular resistances are associated with poorer outcomes as well as increased risks at the time of surgery. This is in part because of the presence of more distal chronic thromboembolic material and distal pulmonary artery remodeling. However, in experienced centers, these patients are being operated on safely and with good

  3. Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

    Directory of Open Access Journals (Sweden)

    Menozzi Mila

    2012-10-01

    Full Text Available Abstract Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting. Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used. Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.

  4. Antibiotic prophylaxis for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) related complications in surgical patients.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Koti, Rahul; Wilson, Peter; Davidson, Brian R

    2013-08-19

    Risk of methicillin-resistant Staphylococcus aureus (MRSA) infection after surgery is generally low, but affects up to 33% of patients after certain types of surgery. Postoperative MRSA infection can occur as surgical site infections (SSIs), chest infections, or bloodstream infections (bacteraemia). The incidence of MRSA SSIs varies from 1% to 33% depending upon the type of surgery performed and the carrier status of the individuals concerned. The optimal prophylactic antibiotic regimen for the prevention of MRSA after surgery is not known. To compare the benefits and harms of all methods of antibiotic prophylaxis in the prevention of postoperative MRSA infection and related complications in people undergoing surgery. In March 2013 we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); NHS Economic Evaluation Database (The Cochrane Library); Health Technology Assessment (HTA) Database (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We included only randomised controlled trials (RCTs) that compared one antibiotic regimen used as prophylaxis for SSIs (and other postoperative infections) with another antibiotic regimen or with no antibiotic, and that reported the methicillin resistance status of the cultured organisms. We did not limit our search for RCTs by language, publication status, publication year, or sample size. Two review authors independently identified the trials for inclusion in the review, and extracted data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing binary outcomes between the groups and planned to calculated the mean difference (MD) with 95% CI for comparing continuous outcomes. We planned to perform meta-analysis using both a fixed-effect model and a random-effects model

  5. A Randomized Trial to Assess the Contribution of a Novel Thorax Support Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.

    Science.gov (United States)

    Caimmi, Philippe P; Sabbatini, Maurizio; Kapetanakis, Emmanouil I; Cantone, Silvia; Ferraz, Marcus V; Cannas, Mario; Tesler, Ugo F

    2017-06-01

    Mechanical complications of median sternotomy may cause significant morbidity and mortality in cardiac surgical patients. This study was aimed at assessing the role of Posthorax support vest (Epple, Inc., Vienna, Austria) in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical sternal dehiscence after cardiac surgery by mean of median sternotomy. A prospective, randomized, study was performed and 310 patients with predisposing factors for sternal dehiscence after sternotomy for cardiac surgery were included. The patients were divided into two groups: patients who received the Posthorax support vest after surgery, and patients who did not. Primary variables assessed included the incidence of mechanical sternal complications, the quality of sternal healing, the rate of re-operation, the duration of hospitalization, rate and duration of hospital, re-admission for sternal complications. Secondary variables assessed were the post-operative pain, the number of requests for supplemental analgesia and the quality of life measured by means of the EQ-5D format. Patients using vest demonstrated a lower incidence of mechanical sternal complications, a better anatomical sternum healing, lower hospital stay, no re-operations for sternal dehiscence before discharge and lower re-admissions for mechanical sternal complication. In addition, patients using a vest reported a better quality of life with better freedom from limitations in mobility, self-care, and pain. Our findings demonstrate that the use of the Posthorax vest reduces post-sternotomy mechanical complications and improves the healing of the sternotomy, the clinical course, and the post-operative quality of life.

  6. Venous thromboembolism risk and prophylaxis in the Portuguese hospital care setting: The ARTE study.

    Science.gov (United States)

    Ferreira, Daniel; de Sousa, Joaquim Abreu; Felicíssimo, Paulo; França, Ana

    2017-11-01

    Venous thromboembolism (VTE) is a relatively common complication during hospital stay and determination of VTE risk is critical to choosing the best prophylactic strategy for each patient. In the present study we studied the risk profile for VTE in hospitalized patients in a group of hospitals in Portugal. Based on an open cohort of 4248 patients hospitalized in surgical, internal medicine, orthopedic or oncology departments, we determined thromboembolic risk at admission by applying a new score, modified from the Caprini and Khorana scores. Thrombotic, embolic and bleeding events and death were assessed during hospital stay and at three and six months after discharge. The median duration of hospital stay was five days and thromboembolic prophylaxis was implemented in 67.2% (n=2747) of the patients. A low molecular weight heparin was used as prophylaxis in the majority of cases (88.3%). Most patients were classified as high (68%) or intermediate risk (27%). The overall incidence of thromboembolic events was 1.5%. Major bleeding events were recorded in 3.89% of patients and all-cause mortality was 3.4%. In this study, we propose a modified VTE risk score that effectively risk-stratifies a mixed inpatient population during hospital stay. The use of this score may result in improvement of thromboprophylaxis practices in hospitals. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Extended anticoagulation in venous thromboembolism disease. In favour.

    Science.gov (United States)

    Fernández Capitan, M C

    Venous thromboembolism disease can be considered a chronic disease because, after the first episode, there is a life-long risk of recurrence. Recurrence is a severe complication. Anticoagulation is effective while it is maintained, but when it is discontinued, the risk of new thrombotic events persists indefinitely. Clinical practice guidelines offer specific recommendations on the treatment duration for patients with provoked or recurrent disease but are not specific for those with a first unprovoked episode. The decision should be made after a careful individual assessment of the risk-benefit of anticoagulation. This article reviews the evidence in favour of extending the anticoagulation and the current therapeutic options. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  8. MANAGEMENT OF THROMBOLYTIC TREATMENT IN PATIENTS WTH MASSIVE PULMONARY THROMBOEMBOLISM

    Directory of Open Access Journals (Sweden)

    Turan Aktas

    2013-09-01

    In total, whose age change between 27 and 90, who got mPTE diagnosis and received thrombolytic treatment were included in the study. Male vs. female rate was 2/3. Mortality developed in 2 patients, who were included in the study. Intracranial hemorrhage which is one of the major complications occurred in only one patient . Recurrence thromboembolism was not followed in none of the patients after the thrombolytic treatment. In mPTE, early diagnosis and rapid treatment are life saving. With the help of the diagnostic methods developing and becoming widespread lately, diagnosis of the mPTE can be made more rapidly and the treatment can be started without losing time. Moreover, it can be said that thrombolytic treatment is definitely a life saving treatment way in mPTE when it is made with close follow-up. [J Contemp Med 2013; 3(3.000: 166-172

  9. Incisional negative pressure therapy to prevent wound complications following cesarean section in morbidly obese women: a pilot study.

    Science.gov (United States)

    Mark, Katrina S; Alger, Lindsay; Terplan, Mishka

    2014-08-01

    We sought to evaluate the efficacy of incisional negative pressure therapy in decreasing postoperative wound complications when placed prophylactically over clean, closed incisions following cesarean section in obese patients. This was a retrospective cohort study comparing rates of wound complications following cesarean sections in morbidly obese women prior to and following the institution of standard use of prophylactic incisional negative pressure therapy. All women with a body mass index greater than 45 kg/m(2) undergoing cesarean section in a 2-year period in a single institution were included. The exposure was incisional negative pressure therapy, which began in September 2009, versus standard wound dressing used in the previous year. The main outcome was wound complication identified by ICD-9 codes. Demographic and wound outcomes were compared with χ(2) and t tests. Stata version 11.0 was used for all analysis. A total of 63 women met the inclusion criteria, 21 of whom received negative pressure wound therapy. The historical comparison and exposure groups were similar in all characteristics studied with the exceptions of length of surgery (64 vs 76 minutes, P = .03), length of labor (78 vs 261 minutes, P = .02), scheduled versus nonscheduled (77% vs 52%, P = .04), and mean age (29.5 vs 26.1 years, P = .04), respectively. There were 5 wound complications in the control group (10.4%) and none (0%) in the study group (P = .15). This pilot study suggests a decrease in wound complications in morbidly obese women receiving incisional negative pressure therapy following cesarean section. © The Author(s) 2013.

  10. Venous Thromboembolic Events After Cerebral Vein Thrombosis

    NARCIS (Netherlands)

    Miranda, Bruno; Ferro, José M.; Canhão, Patrícia; Stam, Jan; Bousser, Marie-Germaine; Barinagarrementeria, Fernando; Scoditti, Umberto

    2010-01-01

    Background and Purpose-After cerebral vein and dural sinus thrombosis (CVT), there is an increased risk of further venous thromboembolic events (VTEs). Time to a second cerebral or systemic venous thrombotic event and risk factors for recurrence have not been investigated in large prospective

  11. Venous Thromboembolism in Patients With Thrombocytopenia

    DEFF Research Database (Denmark)

    Bælum, Jens Kristian; Ellingsen Moe, Espen; Nybo, Mads

    2017-01-01

    BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. O...

  12. Clinical overview of venous thromboembolism | Schellack | South ...

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) encompasses two vascular conditions that are of significant importance, namely deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is also the most common cause of PE. Medical and surgical patients, and individuals who are at increased risk of developing VTE through a ...

  13. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    However, the high level of thromboprophylaxis practice appears doubtful because only a few of these physicians carry out VTE risk assessment for their patients as well as follow clinical guidelines on VTE thromboprophylaxis. Key words: Venous thromboembolism, deep vein thrombosis, pulmonary embolism, risk factor, ...

  14. Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension

    NARCIS (Netherlands)

    Schölzel, B.E.

    2015-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a raised mean pulmonary artery pressure (of at least 25 mmHg at rest) caused by persistent obstruction of pulmonary arteries after pulmonary embolism that has not resolved despite at least 3 months of therapeutic anticoagulation.

  15. Venous thromboembolism: Risk profile and management of ...

    African Journals Online (AJOL)

    Objectives. This study aims to describe the venous thromboembolism (VTE) risk profile of women undergoing elective gynaecological surgery in a tertiary hospital and to audit the VTE prophylaxis prescribed. Methods. One hundred and nine women who underwent elective gynaecological surgery at Kalafong Provincial ...

  16. Acute Thrombo-embolic Renal Infarction

    Directory of Open Access Journals (Sweden)

    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  17. VENOUS THROMBOEMBOLISM PROPHYLAXIS – THE OTHER ...

    African Journals Online (AJOL)

    Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any guidelines, most of the information available has been provided mainly by the pharmaceutical industry which is an interested party. There have been publications in local journals that lean more on ...

  18. Knowledge, attitude and practice of venous thromboembolism ...

    African Journals Online (AJOL)

    USER

    We aimed to assess the knowledge, attitude and practice of prophylaxis in venous thromboembolism among medical doctors in Usmanu Danfodiyo University Teaching Hospital,. Sokoto, North-West Nigeria. Methodology: The knowledge, attitude and practice of VTE prophylaxis among medical doctors was assessed using ...

  19. Venous Thromboembolism: A Comparison of Chronic Spinal Cord Injury and General Surgery Patients in a Metropolitan Veterans Affairs Hospital.

    Science.gov (United States)

    Moore, Ryan M; Rimler, Jonathan; Smith, Brian R; Wirth, Garrett A; Paydar, Keyianoosh Z

    2016-11-01

    Venous thromboembolic events result in significant morbidity, mortality, and costly therapeutic interventions. As medical resource allocation strategies are becoming more pervasive, appropriate risk stratification and prophylactic regimens are essential. Previous studies have shown a decreased incidence of perioperative venous thromboembolism in the chronic spinal cord injury population. The question remains of whether chronic spinal cord injury is protective against venous thromboembolism. A retrospective review of all cases involving chronic spinal cord injury patients who underwent plastic and reconstructive surgery operations (n = 424) and general surgery patients (n = 777) with a primary outcome of deep venous thrombosis or pulmonary embolism within 90 days of surgery was performed. The incidence of postoperative deep venous thrombosis in the control and spinal cord injury groups was 1.7 percent and 0.2 percent, respectively (p = 0.027). However, such significance was not observed with regard to postoperative pulmonary embolism incidence (p = 0.070). Collectively, the incidence of postoperative venous thromboembolism-specifically, deep venous thrombosis or pulmonary embolism-was significantly greater in the general surgery population (p = 0.014). A nearly 10-fold increased risk of venous thromboembolism was seen among the control group (1.9 percent versus 0.2 percent) despite administration of optimal prophylaxis. This study demonstrates a profoundly low incidence of venous thromboembolism among chronic spinal cord injury patients compared with general surgery patients. Future efforts to elucidate how chronic spinal cord injury confers a protective mechanism may potentially influence the evolution of venous thromboembolism prevention guidelines, and spark the development of alternative prophylactic agents or customized application of prevention efforts.

  20. Use of optimized ultrasound axis along with marked introducer needle to prevent mechanical complications of internal jugular vein catheterization

    Directory of Open Access Journals (Sweden)

    Tanmoy Ghatak

    2013-01-01

    Full Text Available Internal jugular vein (IJV catheterization is a routine technique in the intensive care unit. Ultrasound (US guided central venous catheter (CVC insertion is now the recommended standard. However, mechanical complications still occur due to non-visualization of the introducer needle tip during US guidance. This may result in arterial or posterior venous wall puncture or pneumothorax. We describe a new technique of (IJV catheterization using US, initially the depth of the IJV from the skin is measured in short-axis and then using real time US long-axis view guidance a marked introducer needle is advanced towards the IJV to the defined depth measured earlier in the short axis and the IJV is identified, assessed and cannulated for the CVC insertion. Our technique is simple and may reduce mechanical complications of US guided CVC insertion.

  1. Tele-diabetology to Screen for Diabetes and Associated Complications in Rural India: The Chunampet Rural Diabetes Prevention Project Model

    OpenAIRE

    Mohan, Viswanathan; Prathiba, Vijayaraghavan; Pradeepa, Rajendra

    2014-01-01

    Diabetes, with its acute and long-term complications, has become a major health hazard in developing countries. An estimated 62.4 million people in India have diabetes. With increasing urbanization and industrialization, we can expect huge numbers of people with diabetes in India in the future. Moreover, all diabetes efforts in India are currently focused in urban areas while 70% of India’s population actually lives in rural areas. The current statistics demonstrates that urgent interventions...

  2. Quantified approach to the analysis and prevention of urinary complications in radiotherapeutic treatment of cancer of the cervix

    International Nuclear Information System (INIS)

    Pourquier, H.; Delard, R.; Achille, E.

    1987-01-01

    This paper is the report of a dosimetric study of 79 urinary complications after radical radiation treatment (1975-1979) of 624 cervical uterine tumors. Treatment consisted of external irradiation (25 MeV linear accelerator) and intracavitary irradiation (Fletcher-Suit-Delclos applicator). Dosimetric-computerized studies were expressed as the maximum bladder dose on the trigone, as proposed by the I.C.R.U. Bladder doses were actually studied as a function of intracavitary irradiation and intracavitary + external irradiation. The results show a significant difference in patients with and without complications based on the dose reaching the bladder. The relative contribution of external therapy and intracavitary irradiation and their value can serve as one of the primary indicators for predicting complications. These values should be determined before placement of intracavitary sources. We found that the dose to the critical organs cannot be defined as a single number. These results argue in favor of adapting individual patient therapy based on rectal and bladder dosimetry and may be adjustable to all treatment modalities

  3. Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device.

    Science.gov (United States)

    Stulak, John M; Lee, Dustin; Haft, Jonathon W; Romano, Matthew A; Cowger, Jennifer A; Park, Soon J; Aaronson, Keith D; Pagani, Francis D

    2014-01-01

    Modern left ventricular assist devices (LVAD) require anti-coagulation (AC) with warfarin and anti-platelet therapy to prevent thromboembolic complications in patients. Gastrointestinal bleeding (GI) is a significant adverse event in these patients and treatment typically requires reduction or elimination of AC or anti-platelet therapy. It is not known whether alterations in AC to treat GI bleeding influence subsequent risk of thromboembolic (TE) events during LVAD support. Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous-flow LVAD at the University of Michigan Health System and the Mayo Clinic. Median age at implant was 60 years (range 18 to 79 years). Outcomes were analyzed for the association of GI bleeding events and subsequent TE events, defined as stroke, transient ischemic attack, hemolysis or suspected or confirmed pump thrombosis. Median survival was 10 months (maximum 7.2 years, total 439 patient-years). TE events occurring within the first 30 days were not counted. Overall survival and freedom from an outcome event were assessed using the Kaplan-Meier method. Associations between GI bleeding and subsequent TE events and survival impact were analyzed as time-dependent covariates. One hundred ninety-nine GI bleeding episodes occurred in 116 of 389 patients (30%) for an event rate of 0.45 GI bleed/patient-year of support. One hundred thirty-eight TE events occurred in 97 of 389 patients (25%) for an event rate of 0.31 TE event/patient-year of support. Median time from LVAD implant to first GI bleed was 5 months (range 1 to 116 months) and to first TE event was 6 months (range 1 to 29 months). For patients who had a TE event after GI bleed, the median interval was 5 months (range 0.5 to 25 months). TE events were 7.4-fold more likely in patients who had a prior GI bleed (range 4.9- to 11.1-fold) (p cause of this relationship is unknown, it suggests that a reduction in anti-coagulation and anti

  4. Measles outbreak in a pediatric oncology unit and the role of ribavirin in prevention of complications and containment of the outbreak.

    Science.gov (United States)

    Roy Moulik, Nirmalya; Kumar, Archana; Jain, Amita; Jain, Parul

    2013-10-01

    The role of oral ribavirin in treatment and containment of a measles outbreak in 15 children in an oncology unit is presented. Measles was diagnosed on clinical features and history of contact. Measles specific IgM ELISA and RNA were positive in 7 of 15 and 2 of 7 tested children, respectively. Duration of illness was longer in unimmunized as compared to immunized children (P = 0.02). Complications were higher in hematological malignancies (P = 0.025). Delay in starting ribavirin was associated with fatal complications (2 of 2 vs. 0 of 13, P = 0.009). Ribavirin prevented measles in all (21 of 21) patients exposed to the cases. Copyright © 2013 Wiley Periodicals, Inc.

  5. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Valkenet, Karin; Trappenburg, Jaap Ca; Gosselink, Rik; Sosef, Meindert N; Willms, Jerome; Rosman, Camiel; Pieters, Heleen; Scheepers, Joris Jg; de Heus, Saskia C; Reynolds, John V; Guinan, Emer; Ruurda, Jelle P; Rodrigo, Els He; Nafteux, Philippe; Fontaine, Marianne; Kouwenhoven, Ewout A; Kerkemeyer, Margot; van der Peet, Donald L; Hania, Sylvia W; van Hillegersberg, Richard; Backx, Frank Jg

    2014-04-27

    Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design. The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study). In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion.The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications, quality of life, and on

  6. Successful selective arterial thrombolysis in patient with acute abdominal thromboembolism

    Directory of Open Access Journals (Sweden)

    Christo Tsekov

    2016-06-01

    Full Text Available The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS. The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk. Keywords: Mesenterial circulation, Abdominal thromboembolism, Arterial thrombolysis

  7. Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

    Directory of Open Access Journals (Sweden)

    Babak Amra

    2014-01-01

    Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

  8. Venous thromboembolism prophylaxis in plastic surgery: a survey of the practice in Denmark.

    Science.gov (United States)

    Nielsen, Lea Juul; Matzen, Steen H

    2017-04-01

    Venous thromboembolism is a well-documented complication of surgery, including plastic surgery. However, few consensus guidelines on thromboembolism prophylaxis exist in plastic surgery and, thus, the different approaches in the public as well as the private clinics in Denmark were investigated using a web-based survey. Forty-two clinics were contacted and 45% responded. The collected data reveals a lack of consensus in plastic surgery in Denmark, not only regarding the use of mechanical and chemical prophylaxis, but also which type of prophylaxis to apply, the duration of prophylaxis, and how to risk stratify the patients. The development of a guideline, based on plastic surgical data, using a validated risk assessment model, which combines the surgical risk with the patient related risk and recommends guidelines for mechanical as well as chemoprophylaxis is advised.

  9. [Prevention of extravasation necroses as a complication following intravenous cytostatic drug therapy. Results of an open pilot study].

    Science.gov (United States)

    Kolarić, K; Zupanc, D; Stahl, K W; Hinz, J; Kempf, S R; Ivankovic, S

    1988-10-01

    Extravasation of some cytostatics applied i.v. can often cause local edema with skin redness, thrombophlebitis and not infrequently skin necrosis with chronic ulcera. Local treatment is usually ineffective, and so far surgical excision of ulcera is the only curative approach. Tetrachlorodecaoxygen anion complex (TCDO) has shown high activity in healing chronic leg ulcera, by increasing pO2 in hypoxic wound tissue and stimulating phagocytosis as one of anti-inflammatory processes To study the local activity of TCDO in tissue necrosis and chronic ulcera caused by cytostatic extravasation, 23 patients with local skin complications underwent local treatment with TCDO, made as isotonic water solution. Seventeen patients experienced only local edema with redness, while 6 patients showed deep chronic ulcera. All the skin changes were complications after i.v. doxorubicin, cisplatinum, dactinomycin or vinblastine application. The treatments with TCDO followed 1-3 months after ulcera appeared, while skin inflammations were treated 1-8 days after they occurred. TCDO was applied locally twice a day by impregnated cotton tissue for 4-6 weeks. Evaluable were only measurable lesions. From 17 patients with only skin inflammation 3 patients obtained complete resolution, 8 partial resolution and 6 had stable lesions. Thus, overall response was recorded in 65% of patients (11/17). In 6 patients with deep chronic ulcera a longer treatment (6 weeks) was needed, and in 5 of them the complete epithelization and resolution occurred. One patient had a partial wound healing. No side effects of treatment were observed. The effect of locally applied TCDO in chronic ulcera seems to be preferable to surgical treatment. A controlled study will show the exact therapeutic value of this new anti-inflammatory compound.

  10. [Physiopathology and treatment of nephrotic syndrome complications].

    Science.gov (United States)

    Ducloux, Didier

    2011-02-01

    The nephrotic syndrome is defined by a urinary protein excretion exceeding 3g per day, associated with hypoalbuminaemia (syndrome are multiple, essentially dominated by sodium retention and oedema formation. The oedema physiopathology is related to both increased capillary permeability and primary activation of the Na/K pump in the collect duct. Other complications of the nephrotic syndrome include thromboembolic complications, dyslipidaemia, and infections. The treatment of these complications represents an important part of the general management of the nephritic syndrome. Copyright © 2010 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  11. Primary and secondary prevention of acute complications of radiotherapy of head and neck cancers; Prevention primaire et secondaire des complications aigues de la radiotherapie des cancers de la tete et du cou

    Energy Technology Data Exchange (ETDEWEB)

    Lambrexhe, M.; Frederick, B.; Burie, D.; Cavuto, C.; Rob, L.; Rasquin, I.; Coiffier, N.; Untereiner, M. [Centre national de Radiotherapie, Centre Francois-Baclesse (CFB), Esch-sur-Alzette (Luxembourg)

    2009-10-15

    Purpose: the standard treatment of head and neck cancers associates a 70 Gy irradiation and weekly concomitant chemotherapy by 5-fluoro-uracils and cisplatin or targeted therapy by Erbitux. A retrospective study realised at the Francois Baclesse center in 2004-2005 for 84 patients suffering of ear-nose-throat cancers whom treatment was a concomitant chemoradiotherapy, showed the noxious effects of the treatment on the patients nutritional situation: weight loss for 90% of patients; temporary interruption or definitive stop of radiotherapy for 28% of patients. based on this observation, a preventive approach of the nutritional risk was implemented. The objective was to reduce the malnutrition risk linked to radiotherapy associated to chemotherapy or to the targeted therapy. (N.C.)

  12. Pregnancy-related venous thromboembolism and risk of occult cancer

    DEFF Research Database (Denmark)

    Tarp Hansen, Anette; Veres, Katalin; Horváth-Puhó, Erzsébet

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  13. Long-Term Effects of Goshajinkigan in Prevention of Diabetic Complications: A Randomized Open-Labeled Clinical Trial

    Directory of Open Access Journals (Sweden)

    K. Watanabe

    2014-01-01

    Full Text Available Objective. This clinical trial was designed to investigate whether goshajinkigan reduces the onset of diabetic complications or not. Materials and Methods. A total of 332 type 2 diabetic mellitus patients were registered from 9 clinical centers from March 2000 to August 2007. Patients were randomly assigned to take goshajinkigan extract powder, 2.5 grams for 3 times a day or no kampo therapy, additionally to the regular treatment. The primary endpoints were the onset of macrovascular diseases or progression of nephropathy or retinopathy. Statistical analysis was performed by the intention-to-treat method. Results. After 5 years of observation, 116 patients were submitted to analysis. Among them, no macrovascular events were observed in both groups. Although 43 participants had upstaging of retinopathy or nephropathy in total, there was no significant difference between goshajinkigan group and control group. Deterioration of ankle reflex was suppressed in goshajinkigan group. Also glycated hemoglobin, and fasting plasma glucose were decreased in the goshajinkigan group. Conclusion. Although the power of analysis was too low to demonstrate any effects of goshajinkigan on the progression of macrovascular diseases, retinopathy or nephropathy, goshajinkigan may be beneficial for diabetic neuropathy and glycemic control.

  14. Feasibility and safety of rehabilitation after venous thromboembolism

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    Noack F

    2015-07-01

    Full Text Available Frank Noack,1,2 Bernd Schmidt,1 Mroawan Amoury,2 Dietrich Stoevesandt,3 Stephan Gielen,4 Birgit Pflaumbaum,5 Christiane Girschick,5 Heinz Völler,6 Axel Schlitt5,7 1Department of Medicine I, 2Department of Emergency Medicine, 3Department of Diagnostic Radiology, 4Department of Medicine III, University Clinic Halle (Saale, Halle, Germany; 5Department of Cardiology and Pulmology, Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany; 6Klinik am See, Rüdersdorf, Germany; 7Medical Faculty, Martin Luther University Halle, Wittenberg, Germany Background: Venous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension. Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center. Methods: Data from consecutive pulmonary embolism (PE patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated. Results: In all, 422 patients were identified. The mean age was 63.9±13.5 years, the mean body mass index (BMI was 30.6±6.2 kg/m2, and 51.9% were female. Deep vein thrombosis according to PE was known for 55.5% of all patients. We applied a wide range of therapeutic interventions such as bicycle training with monitored heart rate in 86.7%, respiratory training in 82.5%, aquatic therapy/swimming in 40.1%, and medical training therapy in 14.9% of all patients. Adverse events (AEs occurred in 57 patients during the 3-week rehabilitation period. The most common AEs were cold (n=6, diarrhea (n=5, and infection of the upper or lower respiratory tract that was treated with antibiotics (n=5. However, three patients under anticoagulation therapy suffered from bleeding, which was clinically relevant in

  15. A complicated case of deep vein thrombosis

    OpenAIRE

    Cerutti, Elena; Colagrande, Paola; Provera, Edoardo; Giusti, Massimo

    2011-01-01

    We report a case of a patient with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) associated to portal vein thrombosis (PVT), complicated by hospital-acquired pneumonia (HAP). The pathogenesis of DVT is multifactorial; among risk factors we can list: transitory situations (surgical interventions, infectious diseases with fever, traumas), acquired conditions (neoplasms, antiphospholipid syndrome) or genetically determined situations (thrombophilia). PVT of the sovrahepatic vein...

  16. The role of apixaban for venous and arterial thromboembolic disease.

    Science.gov (United States)

    Prom, Rathasen; Spinler, Sarah A

    2011-10-01

    To provide a comprehensive review of the pharmacology, pharmacokinetics, pharmacodynamics, clinical trial data, adverse effects, and drug interactions of apixaban. An English-language literature search was performed with MEDLINE/PubMed from January 2007 to August 2011 using the search terms apixaban, factor Xa inhibitors, FXa inhibitors, BMS-562247-01, venous thromboembolism, deep vein thrombosis, pulmonary embolism, myocardial infarction, acute coronary syndrome, ACS, atrial fibrillation, atrial arrhythmias, total hip replacement or arthroplasty, total knee replacement or arthroplasty, and orthopedic surgery to identify relevant articles. The references of the retrieved articles, professional society meeting abstracts, and the Web site www.clinicaltrials.gov were reviewed to identify other pertinent articles. Pertinent original studies involving apixaban's pharmacology, pharmacokinetics, drug interactions, and clinical efficacy and safety data were included. Results of 2 large Phase 3 trials suggest that apixaban is superior for stroke and systemic embolism prevention compared to both aspirin and warfarin in patients with atrial fibrillation (AF); rates of major bleeding and intracranial hemorrhage were similar to those of aspirin but significantly reduced compared to warfarin. Completed trials in orthopedic surgery found apixaban to be superior to enoxaparin in total hip replacement (THR) surgery but inferior in total knee replacement (TKR) surgery, with similar rates of major bleeding. A Phase 3 trial of apixaban in acute coronary syndrome was stopped early because of excess bleeding. Future Phase 3 trials will help to determine apixaban's role for treatment of deep vein thrombosis and pulmonary embolism. Currently, apixaban is approved only in Europe for prophylaxis of venous thromboembolism in adults who have undergone elective THR or TKR. A Phase 3 trial in patients with AF revealed apixaban to be superior to warfarin for stroke and systemic embolism

  17. Enfermedad tromboembólica venosa y cirrosis hepática Venous thromboembolism and liver cirrhosis

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    M. J. García-Fuster

    2008-05-01

    Full Text Available Objetivos: la enfermedad tromboembólica venosa (ETV es poco frecuente en la cirrosis hepática, no estando su tratamiento contemplado en las guías del American College of Chest Physicians. El objetivo del presente trabajo es aportar la experiencia de pacientes cirróticos con ETV hospitalizados en nuestro centro en los últimos 15 años. Material y método: de enero de 1992 a diciembre de 2007 fueron hospitalizados en nuestro centro 2.074 pacientes con cirrosis hepática. Presentaron una ETV no esplácnica 17, siendo ellos la población a estudio. Se recogen datos epidemiológicos y analíticos: hemograma, VSG, química hemática, coagulación, trombofilia congénita, anticuerpos antifosfolípidos (AAFL y homocisteinemia. Se valoran factores de riesgo adquiridos, características de la trombosis, el tratamiento y las complicaciones. Resultados y conclusiones: la ETV no esplácnica se observa en el 0,8% de pacientes cirróticos. En ellos es frecuente observar hipoalbuminemia, disminución de factores anticoagulantes (ATIII, PC, y PS, presencia de AAFL e hiperhomocisteinemia, así como la presencia de factores de riesgo adquiridos: intervenciones quirúrgicas, insuficiencia venosa, inmovilización e infecciones. Tras la anticoagulación, se observan complicaciones hemorrágicas mayores en el 35% de los pacientes.Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained. Material and method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data

  18. Managing venous thromboembolism in Asia: winds of change in the era of new oral anticoagulants.

    Science.gov (United States)

    Cohen, Alexander; Chiu, Kuan Ming; Park, Kihyuk; Jeyaindran, Sinnadurai; Tambunan, Karmel L; Ward, Christopher; Wong, Raymond; Yoon, Sung-Soo

    2012-09-01

    Despite advances in the management of venous thromboembolism (VTE), treatment of many patients worldwide, especially in Asia, remains inadequate and/or discordant with prevailing guidelines. Although epidemiological studies consistently report lower incidences of VTE in Asians than Caucasians, VTE rates in Asia have probably been gravely underestimated, partly due to comparatively lesser ascertainment. It is becoming evident that Asians are at much higher risk of VTE than was hitherto supposed. Nevertheless, VTE risk-assessment is not routine in Asia and thromboprophylaxis rates are much lower than in Western nations. It is important to base decisions about anticoagulation on individual circumstances and weigh the potential benefits and risks. The conventional VTE management paradigm is not ideal. New oral anticoagulants offer advantages over current modalities that may help to streamline patient care and reduce healthcare costs. Initially, they will be mainly used in uncomplicated cases and, in the absence of clear differences in efficacy or safety, convenience, tolerability/adherence and cost will determine treatment choice. There is clear scope to improve VTE prevention and treatment in Asia. Key priorities are raising awareness of best practice and properly implementing guidelines. Uncertainty about the burden of VTE and concern about bleeding are barriers. High-quality Asian epidemiological data are needed to guide healthcare policy and evidence-based practice. More data on the occurrence and management of bleeding complications in Asian patients are also required. Meanwhile, physicians should remain vigilant and strive to act early, decisively and appropriately to diagnose and treat VTE, particularly in patients at high risk. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. The role of the neurophysiological intraoperative monitoring to prevention of postoperative neurological complication in the surgical treatment of scoliosis

    Directory of Open Access Journals (Sweden)

    M. A. Khit

    2014-01-01

    Full Text Available Bearing in mind that the technique of surgical treatment of scoliosis and skills are high enough, iatrogenic spinal cord injury is still one of the most feared complication of scoliosis surgery. It is well known that the function of the spinal cord may be estimated by combining somatosensory evoked potentials (SSEP and motor evoked potentials (MEP. We have retrospectively evaluated the results of intraoperative neurophysiological monitoring (IOM in a large population of patients underwent surgical treatment of spinal deformity. Intraoperative neuromonitoring SSEP and transcranial electrostimulation (TES – MEP in conjunction with the assessment of the correct position of the screws was performed in 142 consecutive cases, i. e. all patients who had undergone surgical treatment of idiopathic (127 pts, congenital (10 pts or neurogenic (5 pts scoliosis. A neurophysiological “alarm” was defined as a decrease in amplitude (uni- or bilateral of at least 50 % for SEPs and of 70 % for TES-MEP compared with baseline. Total intravenous anesthesia (TIVA in 138 cases was achieved by infusion of propofol (8–16 mg / kg / h and in 4 cases by halogenate anesthesia – sevoflurane (0.4–1.8 MAC. Seven patients (4.9 % were reported intraoperative neurophysiological parameters significant changes that require action by the surgeons and anesthetists, with deterioration of ostoperative neurologic status in one case. Of these three cases, the amplitude drop SSEPs and TESMEPs-was due, to the pharmacological aspects of anesthetic management, in the other four cases – with surgical procedures (response halo-traction – 1 case, mechanical damage of sheath of the spinal cord by pliers Kerrison – 1case, overcorrection – 2 cases. In five cases (3.5 % required reposting of pedicle screws (1–2 levels. Only one patient (0.7 % had a persistent postoperative neurological disorder (neuropathic pain, respectively from a level of re-reposition of

  20. Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth.

    Science.gov (United States)

    Mwansa-Kambafwile, Judith; Cousens, Simon; Hansen, Thomas; Lawn, Joy E

    2010-04-01

    In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although >1 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur. To review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries. We conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed. We identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings. Based on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually.

  1. Interventions for replacing missing teeth: Antibiotics in dental implant placement to prevent complications: Evidence summary of Cochrane review.

    Science.gov (United States)

    Jayaraman, Srinivasan

    2015-01-01

    The failure of dental implant can occurs at the preoperative planning stage, at the surgical stage, and at the postoperative stage. The success of this treatment can be increased if the clinical implant practice guidelines are prepared based on the recommendations from the highest level of research evidence (i.e.,) from systematic review of randomized controlled trials (RCTs) with meta-analysis. The Cochrane reviews of interventions are basically systematic reviews of RCTs with meta-analysis but follow a systematic methodological approach following the guidelines from Cochrane handbook for Systematic Reviews of Intervention. They give the current best evidence as they are updated every 2 years which is being the minimum period for an update. This evidence summary recommends the use of antibiotics, single dose of 2 g of amoxicillin 1 h prior to implant surgery to prevent implant failure, based on the body of evidence from the Cochrane review that was first published in 2003, 2008, and then updated twice in 2010 and 2013. The included studies are not from our population for the research question asked in this updated Cochrane review; hence, the need to do primary research in our population to support the available evidence is mandatory.

  2. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

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    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  3. Anticoagulation Quality and Complications of using Vitamin K Antagonists in the Cardiac Surgery Outpatient Clinic

    Directory of Open Access Journals (Sweden)

    Mário Augusto Cray da Costa

    Full Text Available ABSTRACT Introduction: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications. Objective: To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists. Methods: A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times. Results: There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli; 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001. Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04. Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03, less annual consultations (P=0.02 and less dose adjustments (P=0.003. Patients with longer duration of anticoagulation have more complications (P=0.001. Conclusion: There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of

  4. EARLY COMPLICATIONS IN BARIATRIC SURGERY:

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    Marco Aurelio SANTO

    Full Text Available ContextBariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control.MethodThe medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2.ResultsEarly complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%.ConclusionThe incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

  5. Supplementation with Phycocyanobilin, Citrulline, Taurine, and Supranutritional Doses of Folic Acid and Biotin—Potential for Preventing or Slowing the Progression of Diabetic Complications

    Directory of Open Access Journals (Sweden)

    Mark F. McCarty

    2017-03-01

    Full Text Available Oxidative stress, the resulting uncoupling of endothelial nitric oxide synthase (eNOS, and loss of nitric oxide (NO bioactivity, are key mediators of the vascular and microvascular complications of diabetes. Much of this oxidative stress arises from up-regulated nicotinamide adenine dinucleotide phosphate (NADPH oxidase activity. Phycocyanobilin (PhyCB, the light-harvesting chromophore in edible cyanobacteria such as spirulina, is a biliverdin derivative that shares the ability of free bilirubin to inhibit certain isoforms of NADPH oxidase. Epidemiological studies reveal that diabetics with relatively elevated serum bilirubin are less likely to develop coronary disease or microvascular complications; this may reflect the ability of bilirubin to ward off these complications via inhibition of NADPH oxidase. Oral PhyCB may likewise have potential in this regard, and has been shown to protect diabetic mice from glomerulosclerosis. With respect to oxidant-mediated uncoupling of eNOS, high-dose folate can help to reverse this by modulating the oxidation status of the eNOS cofactor tetrahydrobiopterin (BH4. Oxidation of BH4 yields dihydrobiopterin (BH2, which competes with BH4 for binding to eNOS and promotes its uncoupling. The reduced intracellular metabolites of folate have versatile oxidant-scavenging activity that can prevent oxidation of BH4; concurrently, these metabolites promote induction of dihydrofolate reductase, which functions to reconvert BH2 to BH4, and hence alleviate the uncoupling of eNOS. The arginine metabolite asymmetric dimethylarginine (ADMA, typically elevated in diabetics, also uncouples eNOS by competitively inhibiting binding of arginine to eNOS; this effect is exacerbated by the increased expression of arginase that accompanies diabetes. These effects can be countered via supplementation with citrulline, which efficiently enhances tissue levels of arginine. With respect to the loss of NO bioactivity that contributes to

  6. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials.

    Science.gov (United States)

    Scally, Benjamin; Emberson, Jonathan R; Spata, Enti; Reith, Christina; Davies, Kelly; Halls, Heather; Holland, Lisa; Wilson, Kate; Bhala, Neeraj; Hawkey, Christopher; Hochberg, Marc; Hunt, Richard; Laine, Loren; Lanas, Angel; Patrono, Carlo; Baigent, Colin

    2018-04-01

    Gastroprotectant drugs are used for the prevention and treatment of peptic ulcer disease and might reduce its associated complications, but reliable estimates of the effects of gastroprotectants in different clinical settings are scarce. We aimed to examine the effects of proton-pump inhibitors (PPIs), prostaglandin analogues, and histamine-2 receptor antagonists (H2RAs) in different clinical circumstances by doing meta-analyses of tabular data from all relevant unconfounded randomised trials of gastroprotectant drugs. We searched MEDLINE and Embase from Jan 1, 1950, to Dec 31, 2015, to identify unconfounded, randomised trials of a gastroprotectant drug (defined as a PPI, prostaglandin analogue, or H2RA) versus control, or versus another gastroprotectant. Two independent researchers reviewed the search results and extracted the prespecified outcomes and key characteristics for each trial. We did meta-analyses of the effects of gastroprotectant drugs on ulcer development, bleeding, and mortality overall, according to the class of gastroprotectant, and according to the individual drug within a gastroprotectant class. We identified comparisons of gastroprotectant versus control in 849 trials (142 485 participants): 580 prevention trials (110 626 participants), 233 healing trials (24 033 participants), and 36 trials for the treatment of acute upper gastrointestinal bleeding (7826 participants). Comparisons of one gastroprotectant drug versus another were available in 345 trials (64 905 participants), comprising 160 prevention trials (32 959 participants), 167 healing trials (28 306 participants), and 18 trials for treatment of acute upper gastrointestinal bleeding (3640 participants). The median number of patients in each trial was 78 (IQR 44·0-210·5) and the median duration was 1·4 months (0·9-2·8). In prevention trials, gastroprotectant drugs reduced development of endoscopic ulcers (odds ratio [OR] 0·27, 95% CI 0·25-0·29; pulcers (0·25, 0·22-0

  7. [Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications].

    Science.gov (United States)

    2017-01-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are a broad class of non glucocorticoid drugs which are extensively used in anti-inflammatory, analgesic, and antipyretic therapies. However, NSAIDs may cause many side effects, most commonly in gastrointestinal(GI) tract. Cardiovascular system, kidney, liver, central nervous system and hematopoietic system are also involved. NSAID-induced GI side effects not only endanger the patients' health, increase mortality, but also greatly increase the cost of medical care. Therefore, how to reduce GI side effects is of particular concern to clinicians. The Chinese Rheumatism Data Center(CRDC) and Chinese Systemic Lupus Erythematosus Treatment and Research Group(CSTAR) compose a "Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications" , as following: (1) GI lesions are the most common side effects of NSAIDs. (2) NSAID-induced GI side effects include gastritis, esophagitis, gastric and duodenal ulcers, bleeding, perforation and obstruction. (3) With the application of capsule endoscopy and small intestinal endoscopy, growing attention is being paid to the NASID-induced small intestine mucosa damage, which is mainly erosion and ulcer. (4) Risk factors related to NSAID-induced GI ulcers include: Helicobacter pylori (Hp) infection, age> 65 years, past history of GI ulcers, high doses of NSAIDs, multiple-drug combination therapy, and comorbidities, such as cardiovascular disease and nephropathy.(5) GI and cardiovascular function should be evaluated before using NSAIDs and gastric mucosal protective agents. (6) The risk of GI ulcers and complications caused by selective cyclooxygenase-2 (COX-2) inhibitors is less than that of non-selective COX-2 inhibitors. (7)Hp eradication therapy helps to cure GI ulcers and prevent recurrence when Hp infection is positive in NSAID-induced ulcers. (8) Proton pump inhibitor (PPI) is the first choice for the

  8. Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism

    NARCIS (Netherlands)

    Büller, Harry R.; Décousus, Hervé; Grosso, Michael A.; Mercuri, Michele; Middeldorp, Saskia; Prins, Martin H.; Raskob, Gary E.; Schellong, Sebastian M.; Schwocho, Lee; Segers, Annelise; Shi, Minggao; Verhamme, Peter; Wells, Phil; Agnelli, Giancarlo; Angchaisuksiri, Pantep; Banyai, Martin; Bauersachs, Rupert; van Bellen, Bonno; Blüguermann, Julio; Boda, Zoltán; Bounameaux, Henri; Brenner, Benjamin; Brighton, Tim; Castañon, Javier Diaz; Chechulov, Pavel; Chlumský, Yaromir; Cohen, Alexander; Davidson, Bruce; Decousus, Hervé; Eriksson, Henry; Gallus, Alexander; Gudz, Ivan; Jacobson, Barry; Heng, Lee Lai; Lyons, Roger; Meijer, Karina; Minar, Erich; Monreal, Manuel; Nakamura, Mashio; Oh, Doyeun; Öngen, Gül; Parakh, Rajiv; Piovella, Franco; Raskob, Gary; Rehm, Jeffery; Sandset, Per Morten; Schellong, Sebastian; Smith, Mark; Sokurenko, German; Tomkowski, Witold; Torp-Pedersen, Christian; Wang, Chen; Wang, Yuqi; Weitz, Jeff; Yanushko, Vyacheslav; Yin, Wei-Hsian; Prins, Martin; Beenen, Ludo; Brandjes, Dees; MacGillavry, Melvin; Kaplowitz, Neil; Otten, Hans-Martin; Pessayre, Dominique; Peters, Ron; Roos, Yvo; Slagboom, Ton; Eikelboom, John; Crowther, Mark; Roberts, Robin; Vanassche, Thomas; Vandenbriele, Christophe; Debaveye, Barbara; Dani, Viddhi; van Bergen, Petro; Gerrits, Paul; van Kranen, Robbert; Lanz, Hans; Grosso, Michael; Kappelhoff, John; Franc, John; Zhang, George; Lin, Min; Crerand, William; Giordano, Chris; Skinner, Maureen; Hurley, Steve; Lovelace, Gregg; Barrier, Robert; Betcher, Josh; Alvarez, C.; Amuchastegui, L. M.; Blüguermann, J.; Cassettari, A.; Ceressetto, J.; Hrabar, NN; Macin, S.; Mahuad, C.; Oberti, P.; Santini, F.; Baker, R. I.; Blombery, P.; Brighton, T.; Carroll, P.; Chong, B.; Coughlin, P.; Crispin, P.; Fletcher, J.; Gallus, A.; Serisier, D. J.; Tran, H.; Chan, N.; Stafford, L.; Ward, C.; Baghestanian, M.; Kyrle, P. A.; Eischer, L.; Traby, L.; Marschang, P.; Mathies, R.; Pilger, E.; Brodmann, M.; Roithinger, F.; Weltermann, A.; Adzerikho, I.; Davidovskaya, E.; Gorokhovsky, S.; Maslianski, B.; Kulik, A.; Yanushka, A.; de Vleeschauwer, P.; Debing, E.; Duchateau, J.; Gustin, M.; Hainaut, P.; Vandekerkhof, J.; Verhamme, P.; Peerlinck, K.; Verstraeten, P.; Wautrecht, J. C.; Motte, S.; Annichino-Bizzacchi, J. M.; Mello, T. B. T.; Menezes, F. H.; Burihan, M.; Cavalcanti, M.; Correa, J.; Correa de Carvalho, F.; Cukier, A.; Manenti, E.; Manenti, E. R.; Sacilotto, R.; Timi, J. M.; van Bellen, B.; Kahn, S. R.; Kovacs, M.; Langner, A. Lazo; VanSpronsen, H.; Ritchie, B.; Shafai-Sarshar, R.; Shivakumar, S.; Anderson, D.; Robinson, K.; Gallant, B.; Wells, P.; Karovitch, A.; Scarvelis, D.; Carrier, M.; Bai, C. X.; Chen, R. C.; Cheng, Z. Z.; Du, Y. C.; Hu, X. Y.; Gu, Y. Q.; Hao, Q. L.; Sun, S. B.; Wang, C.; Jiang, L.; Liu, C. J.; Liu, C. W.; Liu, S.; Wang, X. X.; Ye, X. F.; Ma, Z.; Qin, Z. Q.; Qin, X. J.; Tian, H. Y.; Wang, Y. Q.; Shi, Z. Y.; Wen, F. Q.; Wu, Q.; Yang, Y. H.; Kuang, T. G.; Yang, H.; Ying, K. J.; Ma, G. F.; Yuan, Y. D.; Yu, J.; Gong, X. W.; Zhang, F. X.; Zhang, J.; Zhang, S. X.; Zhang, J. W.; Zhang, L.; Zhao, J. C.; Huang, B.; Zhao, J.; Chlumsky, J.; Hola, D.; Hirmerova, J.; Hutyra, M.; Klimsa, Z.; Holub, M.; Kovarova, K.; Lang, P.; Ryba, M.; Podoubský, R.; Matoska, P.; Mayer, O.; Patek, F.; Tupa, M.; Spacek, R.; Urbanova, R.; Blazejova, S.; Vitovec, M.; Andersen, B.; Brønnum-Schou, J.; Dominguez, H.; Egstrup, K.; Auscher, S.; Jeppesen, J.; Asferg, C.; Vishram, J.; Nielsen, H.; Galsgaard, I.; Michaelsen, M.; Haugaard-Nielsen, B.; Ostergaard, O.; Poulsen, S. H.; Torp-Pedersen, C.; Masik, S.; Kadarik, M.; Meriste, S.; Paumets, M.; Laheäär, M.; Raidjuk, L.; Accassat, S.; Buchmuller, A.; Mismetti, P.; Achkar, A.; Aquilanti, S.; Rifaï, A.; Breuil, N.; Schmidt, J.; Brisot, D.; Brousse, C.; de la Fuentes, P. Tarodo; Chakra, M.; Crestani, B.; Desormais, I.; Lacroix, P.; Diamand, J. M.; El Kouri, D.; Clairand, R.; Elias, A.; Ferrari, E.; Doyen, D.; Chiche, O.; Grange, C.; Guenneguez, H.; Lacut, K.; Couturaud, F.; Mottier, D.; Leroux, L.; Lorcerie, B.; de Maistre, E.; Berthier, S.; Mahe, I.; Martin, M.; Meneveau, N.; Meyer, G.; Sanchez, O.; Montaclair, K.; Pavic, M.; Pernod, G.; Imbert, B.; Quere, I.; Galanaud, J. P.; Roy, P. M.; Sevestre, M. A.; Simoneau, G.; Stephan, D.; Aleil, B.; Mirea, C.; Trinh-Duc, A.; von Bilderling, P. Baron; Beyer-Westendorf, J.; Werth, S.; Köhler, C.; Halbritter, K.; Diehm, C.; Espinola-Klein, C.; Weisser, G.; Franke, D.; Heuer, H.; Horacek, T.; Kahrmann, G.; Kroening, R.; Lawall, H.; Roecken, M.; Schellong, S. M.; Pomper, L.; Voigts, B.; Bernhard, S.; Frommhold, R.; Stellbrink, C.; Boda, Z.; Ilonczai, P.; Olah, Z.; Razso, K.; Schlammadinger, A.; Farkas, K.; Kolossváry, E.; Szabó, I.; Frankfurter, Z.; Gasztonyi, B.; Gurzó, M.; Klucsik, Z.; Kovacs, A.; Szigeti, S.; Varga, C.; Landi, A.; Nyirati, G.; Pecsvarady, Zs; Riba, M.; Sámson, Z.; Sipos, Gy; Szigyártó, M.; Sebő, N.; Szabó, T. Janossikné; Toth, K.; Agarwal, S.; Arneja, J.; Babhulkar, S.; Balaji, R.; Banker, D.; Bhagavan, N. K.; Bhonagiri, S.; Mehta, A.; Dayasagar Rao, V.; Desai, P.; Desai, S. C.; Chandrashekar, A. R.; Singh, R.; Deshpande, A.; Dharmadhikari, A.; Durairaj, N.; Ghaisas, N.; Gupta, S.; Jain, R.; Jindal, R.; Kamerkar, D.; Kothiwale, V. A.; Kothurkar, A.; Kulkarni, R.; Kumar, S.; Mody, B.; Nagabhushan, K. N.; Pandharpurkar, H. K.; Joshi, S.; Parakh, R.; Grover, T.; Patel, J.; Patel, K.; Dudhagra, N.; Pawar, N.; Penurkar, M.; Pinjala, R.; Rai, K.; Rao, B.; Raval, M.; Raval, A.; Mehta, P.; Ravi Kishore, A. G.; Saravanan, S.; Shetty, P.; Srinivas, A.; Suresh, K. R.; Sumanthraj, K.; Girija, K. R.; Vinod, M. Vijan; Gavish, D.; Ashkenazy, B.; Braester, A.; Caraco, Y.; Elias, M.; Goldstein, L.; Grossman, E.; Lahav, M.; Lishner, M.; Lugassy, G.; Oliven, A.; Rachmilevitz, R.; Tzoran, I.; Brenner, B.; Yeganeh, S.; Zeltser, D.; Zimlichman, R.; Ageno, W.; Barillari, G.; Pasca, S.; Bortoluzzi, C.; Cattaneo, M.; Falanga, A.; Ghirarduzzi, A.; Lodigiani, C.; Picchi, C.; Iosub, D. I.; Porreca, E.; Prandoni, P.; Quintavalla, R.; Siragusa, S.; Akita, T.; Aoyama, T.; Fujimoto, K.; Hanzawa, K.; Ikeda, U.; Iwata, H.; Kobayashi, T.; Kondo, K.; Kurimoto, T.; Maeda, H.; Mo, M.; Munemasa, M.; Murakami, H.; Nishi, Y.; Nishibe, T.; Nishigami, K.; Nunohiro, T.; Obayashi, T.; Satoh, T.; Satokawa, H.; Shimizu, K.; Shiroma, H.; Sonoda, M.; Suzuki, Y.; Taniguchi, S.; Tsujita, K.; Yamada, N.; Yasuda, C.; Yoshida, H.; Chang, H. J.; Choi, W. I.; Kwon, K. Y.; Rho, B. H.; Choi, J. S.; Hong, Y. S.; Joh, J. H.; Kim, D. J.; Kim, H. S.; Kim, S. H.; Kim, Y. K.; Kim, K. U.; Kim, J. Y.; Kwon, T. W.; Lee, T. S.; Lim, S. Y.; Mun, Y. C.; Oh, D. Y.; Park, K. H.; Yun, W. S.; Yoon, H. I.; Diaz-Castañon, J.; Flota, L. F.; Galindo, J.; Gomez Lara, J.; Jerjes-Sanchez, C.; Palomar-Lever, A.; Rodriguez, D.; Higareda, I.; Boersma, W. G.; de Graaff, C. S.; Oudeman, L.; Brans, E.; Bredie, S. J. H.; Dees, A.; Erdkamp, F.; Peters, F.; Fijnheer, R.; Gerdes, V. E. A.; Griffioen, A.; Jie, K.-S. G.; Meijer, K.; Kooistra, H.; Wiewel-Verschueren, S.; Kamphuisen, P. W.; van Es, J.; Eerenberg, E. S.; Swart Heikens, J.; ten Cate, H.; ten Wolde, M.; Hes, R.; Atalay, S.; Harper, P.; Merriman, E.; Ockelford, P.; Hulton, M. H.; Phillips, J.; Royle, G.; Ford, A.; Smith, M.; Ghanima, W.; Amundsen, H.; Sandset, P. M.; Abola, M. T.; Ganzon, M. S.; Germar, A.; Checinski, P.; Kwasniewski, A.; Tomkowski, W.; Zechowicz, T.; Apartsin, K.; Arutyunov, G.; Barbarash, O.; Burov, Y.; Chechulov, P.; Varaksina, E.; Chernyatina, M.; Gladchenko, M.; Belikov, L.; Fokin, A.; Gubenko, A.; Igor, K.; Olga, M.; Kazakov, Y.; Kazakov, A.; Krasavin, V.; Linev, K.; Plechev, V.; Shesternya, P.; Shkurin, V.; Shvalb, P.; Sokurenko, G.; Sonkin, I.; Remizov, A.; Chernykh, K.; Staroverov, I.; Subbotin, Y.; Zeltser, M.; Seletsky, A.; Iliynykh, A.; Zilber, A.; Zubareva, N.; Tkachenko, I.; Pakhomova, A.; Raghuram, J.; Ng, H. J.; Sin, K.; Adler, D.; Weber, F.; van der Jagt, R.; Basson, M.; Becker, J.; Ellis, G.; Isaacs, R.; Jacobson, B.; Louw, S.; van Rensburg, Jansen; Siebert, H.; Skosana, F.; van Marle, J.; van Zyl, L.; le Roux, R.; Williams, P.; Cereto, F.; Garcia-Bragado, F.; Miranda, R. Tirado; Carlsson, A.; Eriksson, H.; Villegas-Scivetti, M.; Ottosson, E.; Sjalander, A.; Torstensson, I.; Banyai, M.; Afarideh, R.; Gallino, A.; Mazzolai, L.; Righini, M.; Staub, D.; Chen, C. J.; Chiang, C. E.; Wang, K. L.; Chiu, K. M.; Huang, J. H.; Lai, W. T.; Pai, P. Y.; Lin, K. H.; Wang, J. H.; Wu, C. C.; Yin, W. H.; Huang, C. L.; Angchaisuksiri, P.; Kulpraneet, M.; Rojnuckarin, P.; Öngen, G.; Duman, B.; Ozkan, S.; Savas, I.; Selçuk, T.; Tuncay, E.; Gerasymov, V.; Gubka, O.; Gudz, I.; Voloshyn, M.; Nikulnikov, P.; Danylets, A.; Prasol, V.; Rusyn, V.; Sergeev, O.; Shtutin, O.; Skupyy, O.; Tatarin, A.; Venger, I.; Cohen, A. T.; Patel, R.; Hunt, B. J.; Kesteven, P.; Robson, L.; MacCallum, P.; Nokes, T.; Rose, P.; Acs, P.; Gordan, L.; Bhatia, A.; Ali, M.; Amin, D.; Masson, J.; Gavi, E.; Ayele, E.; Ayeni, O.; Canosa, R.; Chavous, D.; Chen, D.; Comerota, A.; Concha, M.; Cunanan-Bush, M.; Daboul, N.; Daggubati, S.; Dang, N.; DiBella, N.; Driver, A.; Dulgeroff, A.; Fraiz, J.; Friedlander, A.; Galvez, A.; Jani, C.; Johnson, S.; Khandelwal, P.; Kingsley, E.; Kingsley, J.; Hutchinson, L.; Lavender, R.; Lyons, R.; Guzley, G.; Martinez, R.; Metjian, A.; Moran, J.; Nadar, V.; Pish, R.; Pullman, J.; Quaranta, A. J.; Ravi, C.; Refaai, M.; Rehm, J.; Richards, D.; Richwine, R.; Sachdeva, S.; Seibert, A.; Sharma, A.; Stricklin, D.; Tannenbaum, A.; Tin-U, C.; Vora, K.; Watkins, D.; Willms, D.

    2013-01-01

    BackgroundWhether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. MethodsIn a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received

  9. Pulmonary thromboembolism as first presentation of childhood membranous nephropathy

    Directory of Open Access Journals (Sweden)

    Mohit Madken

    2017-01-01

    Full Text Available Nephrotic syndrome is associated with an increased risk of thromboembolism. Pulmonary thromboembolism has been described in nephrotic syndrome with or without deep vein thrombosis. In this case report, we describe an unusual first presentation of childhood membranous nephropathy with massive pulmonary thrombus with pulmonary infarction with right renal vein thrombosis.

  10. Thromboembolic stroke associated with thoracic outlet syndrome.

    Science.gov (United States)

    Meumann, Ella M; Chuen, Jason; Fitt, Greg; Perchyonok, Yuliya; Pond, Franklin; Dewey, Helen M

    2014-05-01

    Thoracic outlet syndrome occurs due to compression of the neurovascular structures as they exit the thorax. Subclavian arterial compression is usually due to a cervical rib, and is rarely associated with thromboembolic stroke. The mechanism of cerebral embolisation associated with the thoracic outlet syndrome is poorly understood, but may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction. We report an illustrative patient and review the clinical features, imaging findings and management of stroke associated with thoracic outlet syndrome. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Thromboembolic risks of recombinant factor VIIa Use in warfarin-associated intracranial hemorrhage: a case-control study.

    Science.gov (United States)

    H-Y, Chou Sherry; Xuemei, Cai; G, Konigsberg Rachael; M, Bresette Linda; V, Henderson Galen; A, Sorond Farzaneh; K, Feske Steven

    2012-12-15

    Recombinant factor VIIa (rFVIIa) may be used for rapid hemostasis in life-threatening hemorrhage. In warfarin-associated intracerebral hemorrhage (wICH), FVIIa use is controversial and may carry significant thromboembolic risks. We compared incidence of baseline thromboembolic risk factors and thromboembolism rates in wICH patients treated with additional rFVIIa to those treated with standard therapy of fresh frozen plasma (FFP) and vitamin K alone. We identified 45 consecutive wICH patients treated with additional rFVIIa over 5-year period, and 34 consecutive wICH patients treated with standard therapy alone as comparison group. We compared the incidence of post-hemorrhage cardiac and extra-cardiac thromboembolic complications between two treatment groups, and used logistic regression to adjust for significant confounders such as baseline thromboembolic risk factors. We performed secondary analysis comparing the quantity of FFP transfused between two treatment cohorts. Both rFVIIa-treated and standard therapy-treated wICH patients had a high prevalence of pre-existing thromboembolic diseases including atrial fibrillation (73% vs 68%), deep venous thrombosis (DVT) or pulmonary embolism (PE) (22% vs 18%), coronary artery disease (CAD) (38% vs 32%), and abnormal electrocardiogram (EKG) (78% vs 85%). Troponin elevation following wICH was prevalent in both groups (47% vs 41%). Clinically significant myocardial infarction (MI), defined as troponin > 1.0 ng/dL, occurred in 13% of rFVIIa-treated and 6% of standard therapy-treated patients (p=0.52). Past history of CAD (p=0.0061) and baseline abnormal EKG (p=0.02) were independently associated with clinically significant MI following wICH while rFVIIa use was not. The incidences of DVT/PE (2% vs 9%; p=0.18) and ischemic stroke (2% vs 0%; p=0.38) were similar between two treatment groups. Recombinant FVIIa-treated patients had lower mean INR at 3 (p=0.0001) and 6 hours (ptransfusion (3 vs 5; p=0.003). Pre

  12. Newly diagnosed type 1 diabetes complicated by ketoacidosis and peripheral thrombosis leading to transfemoral amputation

    DEFF Research Database (Denmark)

    Bisgaard Jørgensen, Line; Skov, Ole; Yderstræde, Knud Bonnet

    2014-01-01

    Peripheral vascular thromboembolism is a rarely described complication of diabetic ketoacidosis. We report a 41-year-old otherwise healthy man admitted with ketoacidosis and ischaemia of the left foot. The patient was unsuccessfully treated with thromboendarterectomy, and the extremity...... was ultimately amputated. The patient had no family history of cardiovascular disease, and all blood sample analyses for hypercoagulability were negative. We recommend an increased focus on peripheral thromboembolism, when treating patients with severe ketoacidosis....

  13. Epidemiology of the contraceptive pill and venous thromboembolism.

    Science.gov (United States)

    Hannaford, Philip C

    2011-02-01

    Current users of combined oral contraceptives have an increased risk of venous thromboembolism. The risk appears to be higher during the first year of use and disappears rapidly once oral contraception is stopped. There is a strong interaction between hereditary defects of coagulation, combined oral contraceptive use and venous thromboembolism. Nevertheless, the routine screening of women before they use combined oral contraception is not recommended. Venous thromboembolism seems to be higher in overweight users, and after air, and possibly other forms of, travel. Both the oestrogen and progestogen content of combined oral contraceptives have been implicated in differences in venous thrombotic risk between products. Even if real, the absolute difference in risk between products is small, because the background incidence of venous thromboembolism in young women is low. All currently available combined oral contraceptives are safe. Progestogen-only oral contraceptives are not associated with an increased risk of venous thromboembolism. © 2011 Elsevier Ltd. All rights reserved.

  14. Complement C3 and High Risk of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Nørgaard, Ina; Nielsen, Sune Fallgaard; Nordestgaard, Børge Grønne

    2016-01-01

    BACKGROUND: Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS: We...... included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003-2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals...... were lost to follow-up. RESULTS: Complement C3 concentrations were approximately normally distributed, with a mean value of 1.13 g/L (interquartile range 0.98-1.26; SD 0.21). The cumulative incidence of venous thromboembolism was higher with progressively higher tertiles of complement C3 (log...

  15. Antiradiation Vaccine: Technology Development Of Prophylaxis, Prevention And Treatment Of Biological Consequences And Complications After Neutron Irradiation.

    Science.gov (United States)

    Popov, Dmitri; Maliev, Slava; Jones, Jeffrey

    Introduction: Neutrons irradiation produce a unique biological effectiveness compare to different types of radiation because their ability to create a denser trail of ionized atoms in biological living tissues[Straume 1982; Latif et al.2010; Katz 1978; Bogatyrev 1982]. The efficacy of an Anti-Radiation Vaccine for the prophylaxis, prevention and therapy of acute radiation pathology was studied in a neutron exposure facility. The biological effects of fast neutrons include damage of central nervous system and cardiovascular system with development of Acute Cerebrovascular and Cardiovascular forms of acute radiation pathology. After irradiation by high doses of fast neutron, formation of neurotoxins, hematotoxins,cytotoxins forming from cell's or tissue structures. High doses of Neutron Irradiation generate general and specific toxicity, inflammation reactions. Current Acute Medical Management and Methods of Radiation Protection are not effective against moderate and high doses of neutron irradiation. Our experiments demonstrate that Antiradiation Vaccine is the most effective radioprotectant against high doses of neutron-radiation. Radiation Toxins(biological substances with radio-mimetic properties) isolated from central lymph of gamma-irradiated animals could be working substance with specific antigenic properties for vaccination against neutron irradiation. Methods: Antiradiation Vaccine preparation standard - mixture of a toxoid form of Radiation Toxins - include Cerebrovascular RT Neurotoxin, Cardiovascular RT Neurotoxin, Gastrointestinal RT Neurotoxin, Hematopoietic RT Hematotoxin. Radiation Toxins were isolated from the central lymph of gamma-irradiated animals with different forms of Acute Radiation Syndromes - Cerebrovascular, Cardiovascular, Gastrointestinal, Hematopoietic forms. Devices for Y-radiation were "Panorama","Puma". Neutron exposure was accomplished at the Department of Research Institute of Nuclear Physics, Dubna, Russia. The neutrons

  16. A fatal case of post-operative pulmonary thromboembolism with cosmetic liposuction.

    Science.gov (United States)

    Uemura, Koichi; Kikuchi, Yousuke; Shintani-Ishida, Kaori; Nakajima, Makoto; Yoshida, Ken-ichi

    2006-01-01

    Pulmonary thromboembolism (PTE) has been regarded as rare in Japan. However, PTE has been increasingly recognised because either of increased incidence, diagnostic progress, or social recognition. Recently, 10 Japanese Medical Associations have submitted preventive guidelines for PTE in post-operative patients and the government decided to fund this, as results of the increase in cases and concern regarding medical negligence. A fatal case of PTE after liposuction is reported. A female patient was in the home toilet after two days of immobilization following day-surgery liposuction. Clinicians must be aware of appropriate methods for the prevention of post operative PTE with cosmetic surgery.

  17. Effectiveness of negative pressure wound therapy/closed incision management in the prevention of post-surgical wound complications: a systematic review and meta-analysis.

    Science.gov (United States)

    Sandy-Hodgetts, Kylie; Watts, Robin

    2015-01-01

    The treatment of post-surgical wound complications, such as surgical site infections and surgical wound dehiscence, generates a significant burden for patients and healthcare systems. The effectiveness of negative pressure wound therapy has been under investigation but to date no systematic review has been published in relation to its effectiveness in the prevention of surgical wound complications. To identify the effectiveness of negative pressure wound therapy in the prevention of post-surgical wound complications in adults with a closed surgical incision compared to standard surgical dressings. Male and female adults who have had negative pressure wound therapy applied to their surgical incision following a procedure in one of the following areas: trauma, cardiothoracic, orthopedic, abdominal, or vascular surgery.The intervention of interest was the use of negative pressure wound therapy directly over an incision following a surgical procedure; the comparator was standard surgical dressings.Both experimental and epidemiological study designs, including randomized controlled trials, pseudo-randomized trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies, and analytical cross sectional studies were sought.The primary outcome was the occurrence of post-surgical wound infection or dehiscence as measured by the following: surgical site infections - superficial and deep; surgical wound dehiscence; wound pain; wound seroma; wound hematoma. Published and unpublished studies in English from 1990 to 2013 were identified by searching a variety of electronic databases. Reference lists of all papers selected for retrieval were then searched for additional studies. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of

  18. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin

    DEFF Research Database (Denmark)

    Andersen, Anita Sylvest; Berthelsen, Jørgen G; Bergholt, Thomas

    2010-01-01

    OBJECTIVE: To evaluate the safety of individually dosed low molecular weight heparin (LMWH) for prophylaxis and treatment of thromboembolic complications in pregnancy. DESIGN: Cohort study with a chronologic register-based control group. SETTING: Department of Obstetrics and Gynecology, Hillerød...... side effects of treatment and no osteoporotic fractures or episodes of heparin-induced thrombocytopenia. The 166 pregnancies resulted in 159 live infants. There was a significantly higher risk of preterm delivery (13% vs. 6%) and intrauterine growth restriction (4.4% vs. 3.5%). Delivery by cesarean...

  19. Nanodiamonds activate blood platelets and induce thromboembolism.

    Science.gov (United States)

    Kumari, Sharda; Singh, Manoj K; Singh, Sunil K; Grácio, José J A; Dash, Debabrata

    2014-03-01

    Nanodiamonds (NDs) have been evaluated for a wide range of biomedical applications. Thus, thorough investigation of the biocompatibility of NDs has become a research priority. Platelets are highly sensitive and are one of the most abundant cell types found in blood. They have a central role in hemostasis and arterial thrombosis. In this study, we aim to investigate the direct and acute effects of carboxylated NDs on platelet function. In this study, pro-coagulant parameters such as platelet aggregability, intracellular Ca(2+) flux, mitochondrial transmembrane potential (ΔΨm), generation of reactive oxygen species, surface exposure of phosphatidylserine, electron microscopy, cell viability assay and in vivo thromboembolism were analyzed in great detail. Carboxylated NDs evoked significant activation of human platelets. When administered intravenously in mice, NDs were found to induce widespread pulmonary thromboembolism, indicating the remarkable thrombogenic potential of this nanomaterial. Our findings raise concerns regarding the putative biomedical applications of NDs pertaining to diagnostics and therapeutics, and their toxicity and prothrombotic properties should be critically evaluated.

  20. Experimental thromboembolic stroke in cynomolgus monkey.

    Science.gov (United States)

    Kito, G; Nishimura, A; Susumu, T; Nagata, R; Kuge, Y; Yokota, C; Minematsu, K

    2001-01-30

    To develop an experimental model of thromboembolic stroke without intracranial surgery, an autologous blood clot was delivered to the middle cerebral artery (MCA) via the internal carotid artery in cynomolgus monkeys. Male cynomolgus monkeys, in which a chronic catheter had been earlier implanted in the left internal carotid artery, were used. The clot was flushed into the internal carotid artery under sevofluorane anesthesia. A neurologic deficit score was assigned after MCA embolization. After 24 h, cerebral infarct size and location were determined by the TTC staining method. Cerebral blood flow (CBF) was measured prior to and after MCA embolization, using positron emission tomography (PET). After embolization, long-lasting and profound extensor hypotonia of the contralateral upper and lower limbs, and mild to severe incoordination were observed. Contralateral hemiplegia was observed over the following 24 h. In gross morphologic observation of the brain, the lesions involved mostly the caudate nucleus, putamen, globus pallidus and insular cortex. CBF was maximally reduced in the left MCA territory, but not in the right MCA territory. This model is relevant to thromboembolic stroke in human in neurologic dysfunction and histopathologic brain damage.

  1. CT findings in patients with chronic thromboembolic pulmonary hypertension

    International Nuclear Information System (INIS)

    Heinrich, M.; Grgic, A.; Heckmann, M.; Kramann, B.; Tscholl, D.; Schaefers, H.J.; Uder, M.

    2005-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to be a rare complication of pulmonary embolism. However, it was recently demonstrated that CTEPH is more common than previously thought after pulmonary embolism. Without treatment, CTEPH is associated with a very high mortality rate. Making the correct diagnosis early is essential, because there is a potential curative treatment in the form of pulmonary thromboendarterectomy (PTE). Because of the unspecific clinical symptoms of CTEPH, the different imaging modalities play a crucial role in diagnosis making. Since the introduction of the multi-detector CT technology, CT has become an important part in the diagnostic work up of pulmonary embolism and CTEPH and is often used as a first-line diagnostic tool. CT is not only a reliable tool for the diagnosis of CTEPH, but also is helpful in estimating the operability of these patients. PTE is still associated with a mortality rate of about 10%. Particularly an insufficient decrease of the pulmonary vascular resistance after PTE leads to a very high mortality rate. Therefore, it is crucial to correlate the degree of the surgical accessible obstruction of the pulmonary vasculature with the degree of pulmonary hypertension in deciding for or against PTE. The aim of this review is to describe the CT findings in patients with CTEPH and their use in differentiating CTEPH from other diseases like acute pulmonary embolism and primary pulmonary hypertension. Moreover, the correlation of different CT imaging features with surgical success after PTE will be discussed. (orig.)

  2. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

    Science.gov (United States)

    Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

    2017-01-01

    Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

  3. Idiopathic versus secondary venous thromboembolism. Findings of the RIETE registry.

    Science.gov (United States)

    Pedrajas, J M; Garmendia, C; Portillo, J; Gabriel, F; Mainez, C; Yera, C; Monreal, M

    2014-10-01

    The Computerized Registry of Patients with Venous Thromboembolism (RIETE) is a prospective registry that consecutively includes patients diagnosed with venous thromboembolism. We compared the clinical presentation and response to anticoagulant treatment in patients with idiopathic venous thromboembolism (IVT) versus secondary venous thromboembolism (SVT, associated with a risk factor). We analyzed the differences in clinical characteristics, comorbidity, treatment and events during the first 3months after the diagnosis of venous thromboembolism in patients with IVT or SVT and according to their initial clinical presentation. A total of 39,921 patients with IVT (n=18,029; 45.1%) or SVT (n=21,892; 54.9%) were enrolled. The patients with IVT had a greater history of venous thromboembolism than those diagnosed with SVT (pSVT group (pSVT group than in the IVT group. At 90days, bleeding, death and the recurrence of venous thromboembolism were significantly more frequent in the SVT group. The multivariate analysis confirmed that IVT was associated with fewer major (OR, 0.60; 95%CI, 0.50-0.61; pSVT at 90days of the diagnosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. Prevention

    Science.gov (United States)

    ... Error processing SSI file About Heart Disease & Stroke Prevention Heart disease and stroke are an epidemic in ... secondhand smoke. Barriers to Effective Heart Disease & Stroke Prevention Many people with key risk factors for heart ...

  5. Diabetic Complications and Amputation Prevention

    Science.gov (United States)

    ... little activity could mean you have a blocked artery. Seek care immediately. Nail cutting. If you have ... Terms and Conditions | Site Map 8725 West Higgins Road, Suite 555, Chicago, IL 60631-2724 Phone: (773) ...

  6. Perfusion lung scanning: differentiation of primary from thromboembolic pulmonary hypertension

    International Nuclear Information System (INIS)

    Lisbona, R.; Kreisman, H.; Novales-Diaz, J.; Derbekyan, V.

    1985-01-01

    Of eight patients with pulmonary arterial hypertension, final diagnosis established by autopsy or angiography, four had primary hypertension and four hypertension from thromboembolism. The perfusion lung scan was distinctly different in the two groups. The lung scan in primary pulmonary hypertension was associated with nonsegmental, patchy defects of perfusion, while in thromboembolic hypertensives it was characterized by segmental and/or lobar defects of perfusion with or without subsegmental defects. The perfusion lung scan is a valuable, noninvasive study in the evaluation of the patient with pulmonary hypertension of undetermined cause and in the exclusion of occult large-vessel pulmonary thromboembolism

  7. Long-term Thromboembolic Risk in Patients With Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery and Patients With Nonvalvular Atrial Fibrillation

    DEFF Research Database (Denmark)

    Butt, Jawad H; Xian, Ying; Peterson, Eric D

    2018-01-01

    Importance: New-onset postoperative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. However, the long-term risk of thromboembolism in patients who develop POAF after CABG surgery remains unknown. In addition, information on stroke prophylaxis...... in this setting is lacking. Objective: To examine stroke prophylaxis and the long-term risk of thromboembolism in patients with new-onset POAF after first-time isolated CABG surgery compared with patients with nonsurgical, nonvalvular atrial fibrillation (NVAF). Design, Setting, and Participants: This cohort...... with POAF (8.4%) and 3549 patients with NVAF (42.9%). The risk of thromboembolism was lower in the POAF group than in the NVAF group (18.3 vs 29.7 events per 1000 person-years; adjusted hazard ratio [HR], 0.67; 95% CI, 0.55-0.81; P follow-up was associated...

  8. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Valkenet, Karin; Trappenburg, Jaap Ca; Gosselink, Rik; Sosef, Meindert N; Willms, Jerome; Rosman, Camiel; Pieters, Heleen; Scheepers, Joris Jg; de Heus, Saskia C; Reynolds, John V; Guinan, Emer; Ruurda, Jelle P; Rodrigo, Els He; Nafteux, Philippe; Fontaine, Marianne; Kouwenhoven, Ewout A; Kerkemeyer, Margot; van der Peet, Donald L; Hania, Sylvia W; van Hillegersberg, Richard; Backx, Frank JG

    2014-01-01

    BACKGROUND: Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare

  9. Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis.

    Science.gov (United States)

    Trudzinski, Franziska C; Minko, Peter; Rapp, Daniel; Fähndrich, Sebastian; Haake, Hendrik; Haab, Myriam; Bohle, Rainer M; Flaig, Monika; Kaestner, Franziska; Bals, Robert; Wilkens, Heinrike; Muellenbach, Ralf M; Link, Andreas; Groesdonk, Heinrich V; Lensch, Christian; Langer, Frank; Lepper, Philipp M

    2016-12-01

    Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure. Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients. Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings. Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events.

  10. Predicting the risks of venous thromboembolism versus post-pancreatectomy haemorrhage: analysis of 13 771 NSQIP patients

    Science.gov (United States)

    Tzeng, Ching-Wei D; Katz, Matthew H G; Lee, Jeffrey E; Fleming, Jason B; Pisters, Peter W T; Vauthey, Jean-Nicolas; Aloia, Thomas A

    2014-01-01

    Background The fear of an early post-pancreatectomy haemorrhage (PPH) may prevent surgeons from prescribing post-operative venous thromboembolism (VTE) chemoprophylaxis. The primary hypothesis of this study was that the national post-pancreatectomy early PPH rate was lower than the rate of VTE. The secondary hypothesis was that patients at high risk for post-discharge VTE could be identified, potentially facilitating the selective use of extended chemoprophylaxis. Patients and methods All elective pancreatectomies were identified in the 2005 to 2010 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. Factors associated with 30-day rates of (pre-versus post-discharge) VTE, early PPH (transfusions > 4 units within 72 h) and return to the operating room (ROR) with PPH were analysed. Results Pancreaticoduodenectomies (PD) and distal pancreatectomies (DP) numbered 9140 (66.4%) and 4631 (33.6%) out of 13 771 pancreatectomies, respectively. Event rates included: VTE (3.1%), PPH (1.1%) and ROR+PPH (0.7%). PD and DP had similar VTE rates (P > 0.05) with 31.9% of VTE occurring post-discharge. Independent risk factors for late VTE included obesity [odds ratio (OR), 1.5], age ≥ 75 years (OR, 1.8), DP (OR, 2.4) and organ space infection (OR, 2.1) (all P pancreatectomy VTE outnumber early haemorrhagic complications, which are rare. The fear of PPH should not prevent routine and timely post-pancreatectomy VTE chemoprophylaxis. Because one-third of VTE occur post-discharge, high-risk patients may benefit from post-discharge chemoprophylaxis. PMID:23869628

  11. Early diagnosis of congenital vascular malformation as a condition to rapid prevention of complications – case study

    Directory of Open Access Journals (Sweden)

    Dominika Jaguś

    2017-06-01

    Full Text Available Klippel–Trénaunay syndrome is a rare congenital condition characterised by a triad of symptoms: capillary-lymphatic-venous malformations, varicose veins and venous malformations as well as soft tissue and skeletal hypertrophy of the affected limb. In this article, we present a case of a 5-year-old boy with extensive vascular malformations of the lower limbs and the buttock region. In this case, manifestation of all three symptoms was gradual. At the age of 4 years, the patient was admitted to the Department of Imaging Diagnostics for further diagnosis, where the triad characteristic for Klippel–Trénaunay syndrome and popliteal vein agenesis were diagnosed. Currently, a multidisciplinary team takes care of the boy in the Children’s Memorial Health Institute. Early and accurate diagnosis allows for rapid prevention of complications associated with Klippel–Trénaunay syndrome and enables patient-tailored treatment.

  12. Diagnostic Indication for Venous Echo-Doppler of the Lower Limbs in the Diagnosis of Thromboembolic; Indicacion de eco-Doppler venosa de extremidades inferiores en el diagnostico de la enfermedad tromboembolica ante una sospecha de tromboembolismo pulmonar

    Energy Technology Data Exchange (ETDEWEB)

    Bolado, A. G.; Barcena, M. V.; Cura, J. L. del; Gorrno, O.; Grande, D. [Hospital de Basurto. Bilbao (Spain)

    2003-07-01

    To study the effectiveness of Doppler echography in the deep venous system of the lower limbs for deep venous thrombosis detection in patients suspected of having pulmonary thromboembolism. There were received 341 consecutive suspected pulmonary thromboembolism patients, all of whom were emergency room attended. All were submitted to CT pulmonary angiography in order to evaluate thrombus presence in the pulmonary tree. Without knowing the results of the previous exploration, we studied 301 of the patients using Doppler echography in deep venous system of the lower limbs in order to evaluate thrombus presence. In the group of CT-detected pulmonary thromboembolism patients, the percentage of Doppler echography-detected deep venous thrombosis was 46.3%, while in the group of non-detected patients this percentage decreased to 4.7%. Additional deep venous system exploration in clinically suspected pulmonary thiolcarbamate patients is useful, since it can increase the detection rate of venous thromboembolic disease, thereby leading to early treatment and prevention of the disease's manifestation in the lungs. Realization of Doppler echography is especially beneficial in those patients who exhibit no factors which predispose them to thromboembolic disease, as well as in patients who have previously had venous thrombosis. This exploration account for 4.7% of non-detected pulmonary embolism patients being added to the ranks of those with thromboembolic disease, an important percentage when taking into consideration the high pulmonary thromboembolism morbimortality rate. (Author) 30 refs.

  13. Pulmonary thromboembolism after caesarean section: A case report

    Directory of Open Access Journals (Sweden)

    Uğur Çom

    2014-12-01

    Full Text Available The death of a female during pregnancy period, independent from the gestational age and localization or in a 42 day period after the end of pregnancy due to pregnancy related reasons or reasons aggravated by the pregnancy, but containing no relation with accidental or forced incidents, is defined as maternal death by the World Health Organization. Discussion of the requirements for an emboli diagnosis in an autopsy practice through literature data is aimed in our study. It has been reported that the case was 38 years old, G5 P4 and died with a respiratory distress occurred during the follow ups in 24 hours after the caesarean section. In autopsy, the body mass index was calculated as 32.8 kg/m2 (obese and thrombus was detected in pulmonary arteries of both lungs. Thrombus was confirmed also through histopathological analysis. Evaluation of the medical history and data obtained from a detailed autopsy are of great importance for maternal deathswhich may occur after a caesarean section and involve a pulmonary thromboembolism diagnosis in order to determine the cause of death and prevent a loss of right in medical malpractice claims.

  14. Statin treatment and risk of recurrent venous thromboembolism

    DEFF Research Database (Denmark)

    Nguyen, Cu Dinh; Andersson, Charlotte; Jensen, Thomas Bo

    2013-01-01

    Objectives Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin...... hospitalised VTE (ie, fatal or non-fatal DVT or PE) associated with use of statins. Results 44330 patients with VTE were included in the study. Of these 3914 were receiving statin therapy at baseline. Patients receiving statins were older (6811 compared to 62 +/- 18years), had more comorbidity and used more...... medications. The incidence rate for recurrent VTE was 24.4 (95% CI 22.8 to 26.2) per 1000 person-years among statin users and 48.5 (95% CI 47.4 to 49.7) per 1000 person-years among non-statin users. Statin use was associated with a significantly lower risk of a recurrent VTE, adjusted HR 0.74 (95% CI 0...

  15. Risk of venous thromboembolism during treatment with antipsychotic agents.

    Science.gov (United States)

    Masopust, Jiří; Malý, Radovan; Vališ, Martin

    2012-12-01

    The evidence to date on the relation between the risk of venous thromboembolic disease (VTE) and antipsychotic agents derives primarily from observational and case history studies. While an increased risk of VTE has been associated with first-generation low-potency antipsychotic agents, particularly clozapine, there appears to be a growing number of reports on the occurrence of this adverse reaction during the use of second-generation antipsychotics, such as risperidone and olanzapine. The highest risk of pathological blood clotting emerges during the first 3 months after initiation of treatment with the product. Potential etiopathogenetic factors leading to VTE during treatment with antipsychotic agents include sedation, obesity, elevation of antiphospholipid antibodies, increased platelet activation and aggregation, hyperhomocysteinemia, and hyperprolactinemia. Diagnoses of schizophrenia and/or bipolar affective disorder, as well as hospitalization or stress with sympathetic activation and elevation of catecholamine levels, have been reported as known prothrombogenic factors. The present article contains the new version of the guideline for the prevention of VTE in psychiatric patients with limited mobility. Further prospective studies are necessary to elucidate the biological mechanisms of the relations between antipsychotic agents and VTE. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

  16. Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: New Horizons in the Interventional Management of Pulmonary Embolism.

    Science.gov (United States)

    Rivers-Bowerman, Michael D; Zener, Rebecca; Jaberi, Arash; de Perrot, Marc; Granton, John; Moriarty, John M; Tan, Kong T

    2017-09-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed potential complication of acute or recurrent pulmonary thromboembolic disease. Multiple studies suggest that up to 5% of patients with acute pulmonary thromboembolic disease go on to develop CTEPH. The prognosis of untreated CTEPH is poor, but advances in medical and surgical treatments over the past few decades have improved patient outcomes. The gold standard and curative treatment for CTEPH is pulmonary endarterectomy; however, some patients are inoperable and others who have undergone pulmonary endarterectomy experience persistent or recurrent pulmonary hypertension despite medical therapy. In recent years, balloon pulmonary angioplasty has emerged as a primary and adjunctive treatment for these CTEPH patients at expert or specialized centers. This review outlines an approach to balloon pulmonary angioplasty for CTEPH, including clinical presentation and evaluation; patient selection and indications; treatment planning; equipment and technique; overcoming technical challenges; recognition and management of complications; postprocedural care and clinical follow-up; and expected outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. ABO Blood Group and Risk of Thromboembolic and Arterial Disease

    DEFF Research Database (Denmark)

    Vasan, Senthil K; Rostgaard, Klaus; Majeed, Ammar

    2016-01-01

    BACKGROUND: ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from small-scale studies. METHODS AND RESULTS: We used the SCANDAT2...... (Scandinavian Donations and Transfusions) database of blood donors linked with other nationwide health data registers to investigate the association between ABO blood groups and the incidence of first and recurrent venous thromboembolic and arterial events. Blood donors in Denmark and Sweden between 1987......-up. Compared with blood group O, non-O blood groups were associated with higher incidence of both venous and arterial thromboembolic events. The highest rate ratios were observed for pregnancy-related venous thromboembolism (incidence rate ratio, 2.22; 95% confidence interval, 1.77-2.79), deep vein thrombosis...

  18. The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics.

    Science.gov (United States)

    Adelborg, Kasper; Sundbøll, Jens; Videbech, Poul; Grove, Erik L

    2017-01-01

    Arterial and venous thromboembolism are common causes of morbidity and mortality in the Western world. Mental disorders are also highly prevalent with a lifetime risk of experiencing any psychiatric disease ranging between 32 % and 37 %. Depression and schizophrenia may increase the risk of thromboembolism through genetic, behavioral, and biological mechanisms. Treatment of psychiatric patients with psychotropic drugs is imperative to improve quality of life and to reduce morbidity and mortality. However, studies have shown that psychotropic drugs themselves may modify the risk of arterial and venous thromboembolism, which should be taken into consideration when using these drugs in clinical practice. This association is, however, multifactorial, complex and susceptible to several confounding factors. Psychotropic drugs are widely prescribed, also among patients with cardiovascular disease. Therefore, understanding the association with thromboembolism and the underlying pathophysiological mechanisms is of major importance and will be reviewed in this chapter.

  19. Diagnosis and treatment of chronic thromboembolic pulmonary hypertension in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Charles Marinus; Mellemkjær, Søren; Nielsen-Kudsk, Jens Erik

    2016-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is an important differential diagnosis in patients with unexplained dyspnoea. CTEPH is under-recognized and carries a poor prognosis without treatment. Surgical pulmonary endarterectomy is the preferred treatment for the majority of patients...

  20. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9.

    Science.gov (United States)

    Lidegaard, Øjvind; Nielsen, Lars Hougaard; Skovlund, Charlotte Wessel; Skjeldestad, Finn Egil; Løkkegaard, Ellen

    2011-10-25

    To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose. National historical registry based cohort study. Four registries in Denmark. Non-pregnant Danish women aged 15-49 with no history of thrombotic disease and followed from January 2001 to December 2009. Relative and absolute risks of first time venous thromboembolism. Within 8,010,290 women years of observation, 4307 first ever venous thromboembolic events were recorded and 4246 included, among which 2847 (67%) events were confirmed as certain. Compared with non-users of hormonal contraception, the relative risk of confirmed venous thromboembolism in users of oral contraceptives containing 30-40 µg ethinylestradiol with levonorgestrel was 2.9 (95% confidence interval 2.2 to 3.8), with desogestrel was 6.6 (5.6 to 7.8), with gestodene was 6.2 (5.6 to 7.0), and with drospirenone was 6.4 (5.4 to 7.5). With users of oral contraceptives with levonorgestrel as reference and after adjusting for length of use, the rate ratio of confirmed venous thromboembolism for users of oral contraceptives with desogestrel was 2.2 (1.7 to 3.0), with gestodene was 2.1 (1.6 to 2.8), and with drospirenone was 2.1 (1.6 to 2.8). The risk of confirmed venous thromboembolism was not increased with use of progestogen only pills or hormone releasing intrauterine devices. If oral contraceptives with desogestrel, gestodene, or drospirenone are anticipated to increase the risk of venous thromboembolism sixfold and those with levonorgestrel threefold, and the absolute risk of venous thromboembolism in current users of the former group is on average 10 per 10,000 women years, then 2000 women would need to shift from using oral contraceptives with desogestrel, gestodene, or drospirenone to those with levonorgestrel to prevent one event of venous thromboembolism in one year. After adjustment for length of use, users of oral contraceptives with desogestrel, gestodene, or

  1. Advances in multidetector CT diagnosis of pediatric pulmonary thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Thacker, Paul G. [Dept. of Radiology and Radiological Science, Medical University of South Carolina, Charleston (United States); Lee, Edward Y. [Divi. of Thoracic Imaging, Dept. of Radiology and Medicine, Pulmonary Division Boston Children' s Hospital, Harvard Medical School, Boston (United States)

    2016-04-15

    Although pediatric pulmonary thromboembolism is historically believed to be rare with relatively little information available in the medical literature regarding its imaging evaluation, it is more common than previously thought. Thus, it is imperative for radiologists to be aware of the most recent advances in its imaging information, particularly multidetector computed tomography (MDCT), the imaging modality of choice in the pediatric population. The overarching goal of this article is to review the most recent updates on MDCT diagnosis of pediatric pulmonary thromboembolism.

  2. Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). Protocol of a controlled clinical trial developed by consensus of an international study group. Part three: individual patient, complication algorithm and quality manage.

    NARCIS (Netherlands)

    Stinner, B.; Bauhofer, A.; Lorenz, W.; Rothmund, M.; Plaul, U.; Torossian, A.; Celik, I.; Sitter, H.; Koller, M.; Black, A.; Duda, D.; Encke, A.; Greger, B.; Goor, H. van; Hanisch, E.; Hesterberg, R.; Klose, K.J.; Lacaine, F.; Lorijn, R.H.; Margolis, C.; Neugebauer, E.; Nystrom, P.O.; Reemst, P.H.M.; Schein, M.; Solovera, J.

    2001-01-01

    GENERAL DESIGN: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased

  3. Complications of ERCP.

    Science.gov (United States)

    Talukdar, Rupjyoti

    2016-10-01

    Even though considered safe, endoscopic retrograde cholangiopancreatography (ERCP) is among the endoscopic procedures associated with the highest rate of complications. Post ERCP pancreatitis (PEP) is the most common complication of ERCP. Several independent risk factors have been associated with PEP. Prophylactic PD stenting has been shown to be highly effective in preventing PEP. More recent studies have suggested that NSAIDs, especially rectal indomethacin, could by itself be effective in preventing PEP. However, head to head RCTs comparing PD stents with NSAIDs would be required to confirm this. Other complications include ERCP induced bleeding, perforation, and cholangitis. Bleeding is related to morphological, procedural, and patient related factors. Early identification and correction of the risk factors are of paramount importance in preventing bleeding. Risk of infection is particularly high during ERCP. It is important to ensure complete drainage of obstructed biliary system in order to reduce the risk of post-ERCP cholangitis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. A study of the blood flow restriction pressure of a tourniquet system to facilitate development of a system that can prevent musculoskeletal complications.

    Science.gov (United States)

    Maeda, Hiroyuki; Iwase, Hideaki; Kanda, Akio; Morohashi, Itaru; Kaneko, Kazuo; Maeda, Mutsuhiro; Kakinuma, Yuki; Takei, Yusuke; Amemiya, Shota; Mitsui, Kazuyuki

    2017-01-01

    After an emergency or disaster, subsequent trauma can cause severe bleeding and this can often prove fatal, so promptly stopping that bleeding is crucial to preventing avoidable trauma deaths. A tourniquet is often used to restrict blood flow to an extremity. In operation and hospital, the tourniquet systems currently in use are pneumatically actuated by an air compressor, so they must have a steady power supply. These devices have several drawbacks: they vibrate and are noisy since they are pneumatically actuated and they are far from portable since they are large and heavy. Presumably, the drawbacks of pneumatic tourniquets could be overcome by developing a small, lightweight, vibration-free, quiet, and battery-powered tourniquet system. The current study built a small, vibration-free electrohydrodynamic (EHD) pump and then used that pump to restrict blood flow to the leg of rats in an experiment. This study explored the optimal conditions for effective restriction of blood flow by assessing biochemical and musculoskeletal complications following the restriction of blood flow, and this study also examined whether or not an EHD pump could be used to actuate a tourniquet system. A tourniquet cuff (width 12 mm × length 150 mm, material: polyolefin) was placed on the thigh of Wistar rats and pressure was applied for 2 hours by a device that uses EHD phenomena to generate pressure (an EHD pump). Animals were divided into four groups based on how much compressive pressure was applied with a tourniquet: 40 kPa (300 mm Hg, n = 13), 30 kPa (225 mm Hg, n = 12), 20 kPa (150 mm Hg, n = 15), or 0 kPa (controls, n = 25). Tissue oxygen saturation (regional oxygen saturation, denoted here as rSO 2 ) was measured to assess the restriction of blood flow. To assess behavior once blood flow resumed, animal activity was monitored for third day and the amount of movement was counted with digital counters. Body weight was measured before and after the behavioral experiment, and

  5. Preventing preeclampsia and its fetal complications with low-dose aspirin in East Asians and non-East Asians:A systematic review and meta-analysis.

    Science.gov (United States)

    Gan, Jie; He, Huan; Qi, Hongbo

    2016-08-01

    Low-dose aspirin can reduce the incidence of preeclampsia and intrauterine growth restriction (IUGR). However, the effects of ethnicity upon low-dose aspirin's efficacy has not been analyzed. Here, we comparatively evaluated the efficacy of low-dose aspirin in preventing preeclampsia and related fetal complications in East Asian and non-East Asian pregnant women at risk for preeclampsia. Several databases were searched for randomized controlled trials (RCTs) comparing low-dose aspirin with either placebo or no treatment in pregnant women at risk for preeclampsia. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for preeclampsia and related fetal outcomes were tabulated. Low-dose aspirin significantly reduced preeclampsia risk in both East Asians (OR = 0.20, 95% CI: 0.11-0.35) and non-East Asians (OR = 0.84, 95% CI: 0.77-0.92). Low-dose aspirin significantly reduced IUGR risk in East Asians (OR = 0.36, 95% CI: 0.20-0.67) but not in non-East Asians (OR = 0.85, 95% CI: 0.41-1.77). Low-dose aspirin did not significantly reduce the risk of cesarean section in either East Asians (OR = 0.67, 95% CI: 0.14-3.22) or non-East Asians (OR = 1.01, 95% CI: 0.86-1.19). Low-dose aspirin is effective in reducing preeclampsia risk in both East Asians and non-East Asians and has differential effects in East Asians and non-East Asians with respect to IUGR.

  6. Prevention

    Science.gov (United States)

    ... Contact Aging & Health A to Z Find a Geriatrics Healthcare Professional Medications & Older Adults Making Your Wishes ... Prevention Hearing Loss Heart Attack High Blood Pressure Nutrition Osteoporosis Shingles Skin Cancer Related News Quitting Smoking, ...

  7. Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients.

    Science.gov (United States)

    Nimeri, Abdelrahman A; Bautista, Jejomar; Ibrahim, Maha; Philip, Ruby; Al Shaban, Talat; Maasher, Ahmed; Altinoz, Ajda

    2018-02-01

    Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.

  8. SEPSIS-ASSOCIATED DISSEMINATED INTRAVASCULAR COAGULATION AND THROMBOEMBOLIC DISEASE

    Directory of Open Access Journals (Sweden)

    Nicola Semeraro

    2010-08-01

    Full Text Available Sepsis is almost invariably associated with haemostatic abnormalities ranging from subclinical activation of blood coagulation (hypercoagulability, which may contribute to localized venous thromboembolism, to acute disseminated intravascular coagulation (DIC, characterized by massive thrombin formation and widespread microvascular thrombosis, partly responsible of the multiple organ dysfunction syndrome (MODS, and subsequent consumption of platelets and coagulation proteins causing, in most severe cases, bleeding manifestations. There is general agreement that the key event underlying this life-threatening sepsis complication is the overwhelming inflammatory host response to the infectious agent leading to the overexpression of inflammatory mediators. Mechanistically, the latter, together with the micro-organism and its derivatives, causes DIC by 1 up-regulation of procoagulant molecules, primarily tissue factor (TF, which is produced mainly by stimulated monocytes-macrophages and by specific cells in target tissues; 2 impairment of physiological anticoagulant pathways (antithrombin, protein C pathway, tissue factor pathway inhibitor, which is orchestrated mainly by dysfunctional endothelial cells (ECs; and 3 suppression of fibrinolysis due to increased plasminogen activator inhibitor-1 (PAI-1 by ECs and likely also to thrombin-mediated  activation of thrombin-activatable fibrinolysis inhibitor (TAFI. Notably, clotting enzymes non only lead to microvascular thrombosis but can also elicit cellular responses that amplify the inflammatory reactions. Inflammatory mediators can also cause, directly or indirectly, cell apoptosis or necrosis and recent evidence indicates that products released from dead cells, such as nuclear proteins (particularly extracellular histones, are able to propagate further inflammation, coagulation, cell death and MODS. These insights into the pathogenetic mechanisms of DIC and MODS may have important implications for the

  9. Decisions to withhold diagnostic investigations in nursing home patients with a clinical suspicion of venous thromboembolism.

    Directory of Open Access Journals (Sweden)

    Henrike J Schouten

    Full Text Available This study aimed to gather insights in physicians' considerations for decisions to either refer for- or to withhold additional diagnostic investigations in nursing home patients with a suspicion of venous thromboembolism.Our study was nested in an observational study on diagnostic strategies for suspected venous thromboembolism in nursing home patients. Patient characteristics, bleeding-complications and mortality were related to the decision to withhold investigations. For a better understanding of the physicians' decisions, 21 individual face-to-face in-depth interviews were performed and analysed using the grounded theory approach.Referal for additional diagnostic investigations was forgone in 126/322 (39.1% patients with an indication for diagnostic work-up. 'Blind' anticoagulant treatment was initiated in 95 (75.4% of these patients. The 3 month mortality rates were higher for patients in whom investigations were withheld than in the referred patients, irrespective of anticoagulant treatment (odds ratio 2.45; 95% confidence interval 1.40 to 4.29 but when adjusted for the probability of being referred (i.e. the propensity score, there was no relation of non-diagnosis decisions to mortality (odds ratio 1.75; 0.98 to 3.11. In their decisions to forgo diagnostic investigations, physicians incorporated the estimated relative impact of the potential disease; the potential net-benefits of diagnostic investigations and whether performing investigations agreed with established management goals in advance care planning.Referral for additional diagnostic investigations is withheld in almost 40% of Dutch nursing home patients with suspected venous thromboembolism and an indication for diagnostic work-up. We propose that, given the complexity of these decisions and the uncertainty regarding their indirect effects on patient outcome, more attention should be focused on the decision to either use or withhold additional diagnostic tests.

  10. Comparison of Two Preoperative Inspiratory Muscle Training Programs to Prevent Pulmonary Complications in Patients Undergoing Esophagectomy : A Randomized Controlled Pilot Study

    NARCIS (Netherlands)

    van Adrichem, Edwin J.; Meulenbroek, Renee L.; Plukker, John T. M.; Groen, Henk; van Weert, Ellen

    Postoperative pulmonary complications (PPCs) are the most commonly reported complications after esophagectomy. The aim of this study was to examine the effect and feasibility of preoperative inspiratory muscle training-high intensity (IMT-HI), and IMT-endurance (IMT-E) on the incidence of PPCs in

  11. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study

    NARCIS (Netherlands)

    Edwin van Adrichem; John T.M. Plukker; Ellen van Weert; Renee L. Meulenbroek; Henk Groen

    2014-01-01

    BACKGROUND: Postoperative pulmonary complications (PPCs) are the most commonly reported complications after esophagectomy. The aim of this study was to examine the effect and feasibility of preoperative inspiratory muscle training-high intensity (IMT-HI), and IMT-endurance (IMT-E) on the incidence

  12. Venous Thromboembolism in Pediatric Vascular Anomalies

    Directory of Open Access Journals (Sweden)

    Taizo A. Nakano

    2017-07-01

    Full Text Available The presence of a vascular anomaly suggests that capillaries, veins, arteries, and/or lymphatic vessels have demonstrated abnormal development and growth. Often dilated and misshaped, these vessels augment normal flow of blood and lymphatic fluids that increases the overall risk to develop intralesional thrombosis. Abnormal endothelial and lymphoendothelial cells activate hemostasis and hyperfibrinolytic pathways through poorly understood mechanisms, which contribute to the development of localized intravascular coagulopathy. Vascular malformations, tumors, and complex combined syndromes demonstrate varying degrees of prothrombotic activity and consumptive coagulopathy depending on the vessels involved and the pattern and extent of abnormal growth. The clinical impact of venous thromboembolism in pediatric vascular anomalies varies from painful syndromes that disrupt quality of life to life-threatening embolic disease. There remains little literature on the study, evaluation, and treatment of thrombosis in pediatric vascular anomalies. However, there have been great advances in our ability to image complex lesions, to surgically and interventionally augment disease, and to provide enhanced supportive care including patient education, compression therapy, and strategic use of anticoagulation.

  13. [Peripheral arterial thromboembolism in Crohn's disease].

    Science.gov (United States)

    Ferrer, Isabel; Benavent, Guillem; Bastida, Guillermo; Arnau, Miguel Ángel; Iborra, Marisa; Beltrán, Belén; Aguas, Mariam; Hinojosa, Joaquín; Nos, Pilar

    2013-01-01

    Inflammatory Bowel Disease (IBD) usually affects the gastrointestinal tract, although some patients can also develop extraintestinal manifestations, such as vascular symptoms both venous and arterial ones. The former being more frequent than the latter. We report the case of a 62-year-old male, diagnosed of Crohńs disease (CD) (A3,L1+L4,B3), admitted to hospital for treatment of a retroperitoneal abscess. He presented a peripheral arterial thromboembolism during his stay, which required urgent embolectomy. After anticoagulation with low-molecular-weight heparin (LMWH), vascular magnetic resonance imaging revealed a large thrombus involving the descent aorta, which was solved with surgery and long-term anticoagulation. Peripheral arterial thrombosis is a rare extraintestinal manifestation of IBD. Nevertheless it is always important to consider it in patients with IBD. Prophylactic treatment should be made with low-molecular-weight heparin (LMWH) and definitive treatment with a combination of LMWH and surgery. Copyright © 2012 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  14. Death Associated with Inadequate Reassessment of Venous Thromboembolism Prophylaxis at and after Hospital Discharge.

    Science.gov (United States)

    2015-01-01

    Venous thromboembolism (VTE) prophylaxis, also known as thromboprophylaxis, reduces the risk of deep vein thrombosis, pulmonary embolism, and associated complications, including death, in high-risk patients. VTE prophylaxis is recommended for acutely ill, hospitalized medical patients at risk of thrombosis. Anticoagulants, the pharmacologic agents of choice to prevent VTE, are considered high-alert medications. By definition, therefore, anticoagulants bear a hightened risk of causing significant patient harm when they are used in error. As part of ongoing collaboration with a provincial death investigation service, ISMP Canada received a report of a fatal incident that involved continuation of VTE prophylaxis with enoxaparin for a patient discharge to a long-term care (LTC) facility from an acute care setting. The findings and recommendations from this case are charged to highlight the need to build routine reassessment of VTE prophylaxis into the process for discharging patients from the acute care setting and upon transfer to another facility or to primary care. The incident described in this bulletin highlights the importance of continually reassessing the need for VTE prophylaxis, especially at transitions of care, such as discharge from an acute care setting. Evidence and guidelines confirm the benefits of VTE prophylaxis in certain patients during a hospital stay for an acute illness, but the balance of benefits and risks may become unfavourable once the patient is discharged. Clear documentation from the acute care facility can assist the receiving facility and health-care providers, as well as family caregivers, when determining whether thromboprophylaxis is still warranted. Until clear guidance to continue thromboprophylaxis after acute care is available, health-care organizations and practitioners across the spectrum of care are urged to share and consider the strategies presented in this bulletin to ensure the safe use of VTE prophylaxis and improved

  15. Postpartum complications

    International Nuclear Information System (INIS)

    Kronthal, A.J.; Kuhlman, J.E.; Fishman, E.K.

    1990-01-01

    This paper reports the CT findings of major postpartum complications and determine what role CT plays in their evaluation. The CT scans of nine patients with major postpartum complications were retrospectively reviewed. Patients had been referred to CT for evaluation of postpartum fever, abdominal pain, and elevated results of liver function tests. Complications identified at CT included hepatic infarctions (n = 2), endometritis (n = 2), postoperative wound abscess (n = 1), massive abdominal hemorrhage (n = 1), septic thrombophlebitis (n = 1), and renal vein thrombosis (n = 1). CT findings of hepatic infarction included wedge-shaped areas of decreased enhancement conforming to a vascular distribution

  16. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  17. Bleeding complications after systematic switch of routine thromboprophylaxis for major orthopaedic surgery

    OpenAIRE

    Kistler, U; Kramers-de Quervain, I; Munzinger, U; Kucher, N

    2008-01-01

    The rate of bleeding complications after major orthopedic surgery approximates 2%. It is unclear whether a systematic switch of routine thromboprophylaxis has an impact on the rate of postoperative bleeding complications. We analyzed prospectively recorded postoperative bleeding complications and symptomatic venous thromboembolic events in 8,176 consecutive orthopedic patients at the Schulthess Clinic Zurich during a systematic switch of thromboprophylaxis from nadroparin to enoxaparin in the...

  18. Diphtheria Complications

    Science.gov (United States)

    ... Search Form Controls Cancel Submit Search The CDC Diphtheria Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Diphtheria Home About Diphtheria Causes and Transmission Symptoms Complications ...

  19. Complicated Pancreatitis

    NARCIS (Netherlands)

    Bakker, O.J.

    2015-01-01

    Research questions addressed in this thesis: What is the accuracy of serum blood urea nitrogen as early predictor of complicated pancreatitis? ; What is difference in clinical outcome between patients with pancreatic parenchymal necrosis and patients with extrapancreatic necrosis without necrosis

  20. Efficacy and safety of venous thromboembolism prophylaxis with apixaban in major orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Werth S

    2012-03-01

    Full Text Available Sebastian Werth, Kai Halbritter, Jan Beyer-WestendorfCenter for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, GermanyAbstract: Over the last 15 years, low-molecular-weight heparins (LMWHs have been accepted as the “gold standard” for pharmaceutical thromboprophylaxis in patients at high risk of venous thromboembolism (VTE in most countries around the world. Patients undergoing major orthopedic surgery (MOS represent a population with high risk of VTE, which may remain asymptomatic or become symptomatic as deep vein thrombosis or pulmonary embolism. Numerous trials have investigated LMWH thromboprophylaxis in this population and demonstrated high efficacy and safety of these substances. However, LMWHs have a number of disadvantages, which limit the acceptance of patients and physicians, especially in prolonged prophylaxis up to 35 days after MOS. Consequently, new oral anticoagulants (NOACs were developed that are of synthetic origin and act as direct and very specific inhibitors of different factors in the coagulation cascade. The most developed NOACs are dabigatran, rivaroxaban, and apixaban, all of which are approved for thromboprophylaxis in MOS in a number of countries around the world. This review is focused on the pharmacological characteristics of apixaban in comparison with other NOACs, on the impact of NOAC on VTE prophylaxis in daily care, and on the management of specific situations such as bleeding complications during NOAC therapy.Keywords: major orthopedic surgery, apixaban, dabigatran, edoxaban, rivaroxaban, deep vein thrombosis, venous thromboembolism, VTE prophylaxis

  1. Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    David Jenkins

    2015-06-01

    Full Text Available Pulmonary endarterectomy (PEA is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH. It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH and alleviate right ventricular dysfunction. In the majority of patients there is symptomatic and prognostic benefit. However, not all patients with CTEPH are suitable for treatment with PEA. Operability assessment is not always easy, being largely subjective and based on experience. It is therefore important that all patients are referred to an experienced CTEPH centre for careful evaluation of suitability for surgery. The most common reason for inoperability is distal vasculopathy accounting for a high proportion of the vascular resistance. Surgery requires cardiopulmonary bypass and periods of deep hypothermic circulatory arrest. Complications include reperfusion lung injury and persistent PH. However, with careful patient selection, surgical technique and post-operative management, PEA is a highly effective treatment with mortality rates <5% at experienced centres. Patients who are unsuitable for surgery may be candidates for medical therapy.

  2. Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux in women at risk after cesarean section.

    Science.gov (United States)

    Kawaguchi, Ryuji; Haruta, Shoji; Kobayashi, Hiroshi

    2017-11-01

    Cesarean section is associated with an increased risk for venous thromboembolism (VTE). The safety and efficacy of primary prophylaxis of fondaparinux, a synthetic sulfated pentasaccharide heparin analog, in women at risk after cesarean section is uncertain. This was a retrospective study of 295 cases of pregnant women presenting to a tertiary referral center of Nara, Japan, to evaluate the usefulness of thromboprophylaxis with fondaparinux after cesarean delivery between 2011 and 2012. Patients were initially received unfractionated heparin (once 5,000 IU subcutaneously, twice a day), starting 6 hours after cesarean section for 24 hours, and then treated with fondaparinux (once 2.5 mg daily, subcutaneously) for 5 days. The primary efficacy end-point was an improvement in the incidence of symptomatic VTE or fatal post-cesarean pulmonary thromboembolism. The primary safety end-point was major bleeding during treatment. There were neither any episodes of symptomatic VTE cases nor maternal deaths. A total of 10 patients had a bleeding event. Major bleeding complication was observed in 2 (0.68%) of 295 patients receiving fondaparinux. Non-major bleeding into critical sites was observed in 8 patients, often at surgical sites, and recovery was not delayed. This study demonstrates the safety and efficacy of fondaparinux in women at high risk of VTE after cesarean section. Large phase trials comparing clinical outcomes with fondaparinux across a wide spectrum of patients are needed to confirm these observations.

  3. Risk of a venous thromboembolic episode due to caesarean section and BMI

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Ladelund, S; Rasmussen, S

    2014-01-01

    BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery.......BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery....

  4. Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?

    NARCIS (Netherlands)

    Rutten, F.H.; Hak, E.; Stalman, W.A.B.; Verheij, T.J.M.; Hoes, A.W.

    2003-01-01

    Background. Antithrombotic treatment in atrial fibrillation should be guided by the risk of thromboembolic events. Although practice studies have shown underutilization of antithrombotics, it is not clear whether physicians make use of thromboembolic risk stratification in their treatment decisions,

  5. Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?

    NARCIS (Netherlands)

    Rutten, Frans H; Hak, Eelko; Stalman, Wim A B; Verheij, Theo J M; Hoes, Arno W

    BACKGROUND: Antithrombotic treatment in atrial fibrillation should be guided by the risk of thromboembolic events. Although practice studies have shown underutilization of antithrombotics, it is not clear whether physicians make use of thromboembolic risk stratification in their treatment decisions,

  6. Oral contraceptives and venous thromboembolism: a five-year national case-control study

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Edström, Birgitte; Kreiner, Svend

    2002-01-01

    Venous thromboembolism; Oral contraceptives; Pulmonary embolism; Third-generation; Second-generation; Pill Scare......Venous thromboembolism; Oral contraceptives; Pulmonary embolism; Third-generation; Second-generation; Pill Scare...

  7. Is thromboembolism prophylaxis necessary for low and moderate risk patients in maxillofacial trauma? A retrospective analysis

    NARCIS (Netherlands)

    Skorpil, N.E.; van den Bergh, B.; Heymans, M.W.; Forouzanfar, T.

    2012-01-01

    This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial

  8. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry

    NARCIS (Netherlands)

    Pepke-Zaba, Joanna; Delcroix, Marion; Lang, Irene; Mayer, Eckhard; Jansa, Pavel; Ambroz, David; Treacy, Carmen; D'Armini, Andrea M.; Morsolini, Marco; Snijder, Repke; Bresser, Paul; Torbicki, Adam; Kristensen, Bent; Lewczuk, Jerzy; Simkova, Iveta; Barberà, Joan A.; de Perrot, Marc; Hoeper, Marius M.; Gaine, Sean; Speich, Rudolf; Gomez-Sanchez, Miguel A.; Kovacs, Gabor; Hamid, Abdul Monem; Jaïs, Xavier; Simonneau, Gérald

    2011-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is often a sequel of venous thromboembolism with fatal natural history; however, many cases can be cured by pulmonary endarterectomy. The clinical characteristics and current management of patients enrolled in an international CTEPH registry was

  9. Complications of Circumcision

    Directory of Open Access Journals (Sweden)

    Aaron J. Krill

    2011-01-01

    Full Text Available In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

  10. Cisplatin chemotherapy (without erythropoietin) and risk of life-threatening thromboembolic events in carcinoma of the uterine cervix: the tip of the iceberg? A review of the literature

    International Nuclear Information System (INIS)

    Anders, Jon C; Grigsby, Perry W; Singh, Anurag K

    2006-01-01

    The risk of severe cardiovascular toxicity, specifically thromboembolic events (TE), in patients with cervical cancer receiving concurrent irradiation and cisplatin chemotherapy is reported to be less than 1% in several large prospective trials. However, the anecdotal risk appears to be far higher. A review of several prospective trials demonstrates no treatment related grade 4 cardiovascular toxicities and only two grade 5 toxicities in 1424 (0.1%) collective patients. A recent publication and our own unpublished experience finds 6 of 128 (4.7%) patients developed grade 4 to 5 cardiovascular (thrombosis/embolism) toxicity. The differenc in incidence of severe or life threatening cardiovascular toxicity of 0.1 versus 4.7% is highly statistically significant (p < 0.00001.) This dramatic difference in incidence of cardiovascular toxicity raises the possibility that cardiovascular toxicities were inadequately reported on the listed prospective trials. For those patients enrolled in prospective trials, we suggest that thromboses should be diligently documented and reported. Only after the true incidence of thromboses is established can we implement appropriate levels of early screening and intervention that may prevent life threatening complications

  11. Prevention of severe infectious complications after colorectal surgery using preoperative orally administered antibiotic prophylaxis (PreCaution) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Mulder, Tessa; Kluytmans-van den Bergh, Marjolein F Q; de Smet, Anne Marie G A; van 't Veer, Nils E; Roos, Daphne; Nikolakopoulos, Stavros; Bonten, Marc J M; Kluytmans, Jan A J W

    2018-01-01

    BACKGROUND: Colorectal surgery is frequently complicated by surgical site infections (SSIs). The most important consequences of SSIs are prolonged hospitalization, an increased risk of surgical reintervention and an increase in mortality. Perioperative intravenously administered antibiotic

  12. Thromboembolic tendency (TE) in IBD (Inflammatory bowel disease) patients.

    Science.gov (United States)

    Canero, Antonio; Parmeggiani, Domenico; Avenia, Nicola; Atelli, Pietro Francesco; Goffredi, Luigi; Peltrini, Roberto; Madonna, Imma; Ambrosino, Pasquale; Apperti, Sarah; Apperti, Marco

    2012-01-01

    The incidence of TE events in IBD patients is higher then in population control. The main reason of it, is the hypercoaugulable state. Our aim was to detect serum markers related to TE, that can assume preventing and prognostic meanings. We performed a 3 years study on 71 patients with IBD, evaluating hypercoaugulability, and then we compared the results with a 71 patients non IBD group control. We also investigated patients of both groups concerning TE events occurred already. In IBD group we found out that 16 patients (22.5%) had history of TE versus >1% of group control. Nineteen of them, already had knowledge of their previous hypercoaugulating condition. 48 (67%) had increased markers value versus less then 6% detected in group control. In IBD group 43% ,20% and 4.2% had respectively 1, 1-3 or > 3 markers higher levels then normal range. Among the markers investigated, we detected increased levels of plated in 33%, homocysteine in 26.7%, d-dimero 25.3%, c3 in 15.4%, apcr in 5.6%. From our study we detected highest incidence of TE events, and hypercoaugulating status in IBD group. In our previous investigations, plated, homocysteine, d-dimero, c3, and apcr, seems to be the TE markers with higher sensibility. It seems reasonable, according our experience, to propose a new TE risk score index for IBD patients: low, mild and high risk respectively for patients with 1, 1-3 and >3 markers with higher serum levels then normal range. Inflammatory bowel disease, Thromboembolism risk score.

  13. MRA for diagnosis of venous thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Sostman, H. D. [Cornell University, Weill Medical College, Chair of Radiology, New York (United States)

    2001-12-01

    Direct imaging of pulmonary embolism (PE) and deep vein thrombosis (DVT) with CT, and potentially with MR, will continue to replace V/Q scintigraphy. Venous imaging with MR far detecting DVT is used in a few centers, and their published accuracy figures are impressive. Recent studies of MR pulmonary angiography for PE reported that sensitivity of MRA was 85-100%, specificity 95-96%, but this data must be confirmed in other centers and patient populations. MR has advantages compared with CT, which make it worthwhile to continue MR development. Ionizing radiation and iodinated contrast material are not used. Imaging the pulmonary arteries and then imaging whichever venous region is of clinical interest is practical in a single examination. Repeated examinations can be performed safely. New contrast materials will facilitate the practically and accuracy of the MR technique and perfusion imaging may increase sensitivity. MR also has disadvantages compared with CT. It does not image effectively the non-vascular compartment of the lungs. It is more expensive, patient monitoring is more cumbersome, and a routine technique, which embodies all of MR's potential advantages, has not been packaged and tested. Accordingly, helical CT is a realistic option in clinical management of patients with suspected PE in most centers, while clinical application of MR is limited to centers with appropriate MR expertise and technology. However, MR has a number of fundamental characteristics that make it potentially ideal modality for evaluating patients with suspected acute venous thromboembolic disease and further clinical research with MRA is warranted.

  14. The relationship of the factor V Leiden mutation or the deletion-deletion polymorphism of the angiotensin converting enzyme to postoperative thromboembolic events following total joint arthroplasty

    Directory of Open Access Journals (Sweden)

    Fang Carrie

    2001-04-01

    Full Text Available Abstract Background Although all patients undergoing total joint arthroplasty are subjected to similar risk factors that predispose to thromboembolism, only a subset of patients develop this complication. The objective of this study was to determine whether a specific genetic profile is associated with a higher risk of developing a postoperative thromboembolic complication. Specifically, we examined if the Factor V Leiden (FVL mutation or the deletion polymorphism of the angiotensin-converting enzyme (ACE gene increased a patient's risk for postoperative thromboembolic events. The FVL mutation has been associated with an increased risk of idiopathic thromboembolism and the deletion polymorphism of the ACE gene has been associated with increased vascular tone, attenuated fibrinolysis and increased platelet aggregation. Methods The presence of these genetic profiles was determined for 38 patients who had a postoperative symptomatic pulmonary embolus or proximal deep venous thrombosis and 241 control patients without thrombosis using molecular biological techniques. Results The Factor V Leiden mutation was present in none of the 38 experimental patients and in 3% or 8 of the 241 controls (p = 0.26. Similarly there was no difference detected in the distribution of polymorphisms for the ACE gene with the deletion-deletion genotype present in 36% or 13 of the 38 experimental patients and in 31% or 74 of the 241 controls (p = 0.32. Conclusions Our results suggest that neither of these potentially hypercoaguable states are associated with an increased risk of symptomatic thromboembolic events following total hip or knee arthroplasty in patients receiving pharmacological thromboprophylaxis.

  15. Chronic thromboembolic pulmonary hypertension - assessment by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, Karl-Friedrich; Kunz, R.P.; Oberholzer, Katja; Neeb, Daniel; Gast, Klaus K.; Dueber, Christoph [Johannes-Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Ley, Sebastian [Johannes-Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz (Germany); German Cancer Research Center, Department of Radiology, Heidelberg (Germany); Heussel, Claus-Peter [Johannes-Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Chest Clinic at University of Heidelberg, Department of Radiology, Heidelberg (Germany); Eberle, Balthasar [Johannes-Gutenberg-University, Department of Anesthesiology, Mainz (Germany); Inselspital, Department of Anesthesiology, Bern (Switzerland); Mayer, Eckhard [Johannes-Gutenberg-University, Department of Heart, Thorax and Vascular Surgery, Mainz (Germany); Kauczor, Hans-Ulrich [German Cancer Research Center, Department of Radiology, Heidelberg (Germany)

    2007-01-15

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease that has been ignored for a long time. However, with the development of improved therapeutic modalities, cardiologists and thoracic surgeons have shown increasing interest in the diagnostic work-up of this entity. The diagnosis and management of chronic thromboembolic pulmonary hypertension require a multidisciplinary approach involving the specialties of pulmonary medicine, cardiology, radiology, anesthesiology and thoracic surgery. With this approach, pulmonary endarterectomy (PEA) can be performed with an acceptable mortality rate. This review article describes the developments in magnetic resonance (MR) imaging techniques for the diagnosis of chronic thromboembolic pulmonary hypertension. Techniques include contrast-enhanced MR angiography (ce-MRA), MR perfusion imaging, phase-contrast imaging of the great vessels, cine imaging of the heart and combined perfusion-ventilation MR imaging with hyperpolarized noble gases. It is anticipated that MR imaging will play a central role in the initial diagnosis and follow-up of patients with CTEPH. (orig.)

  16. Chronic thromboembolic pulmonary hypertension - assessment by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Kreitner, Karl-Friedrich; Kunz, R.P.; Oberholzer, Katja; Neeb, Daniel; Gast, Klaus K.; Dueber, Christoph; Ley, Sebastian; Heussel, Claus-Peter; Eberle, Balthasar; Mayer, Eckhard; Kauczor, Hans-Ulrich

    2007-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease that has been ignored for a long time. However, with the development of improved therapeutic modalities, cardiologists and thoracic surgeons have shown increasing interest in the diagnostic work-up of this entity. The diagnosis and management of chronic thromboembolic pulmonary hypertension require a multidisciplinary approach involving the specialties of pulmonary medicine, cardiology, radiology, anesthesiology and thoracic surgery. With this approach, pulmonary endarterectomy (PEA) can be performed with an acceptable mortality rate. This review article describes the developments in magnetic resonance (MR) imaging techniques for the diagnosis of chronic thromboembolic pulmonary hypertension. Techniques include contrast-enhanced MR angiography (ce-MRA), MR perfusion imaging, phase-contrast imaging of the great vessels, cine imaging of the heart and combined perfusion-ventilation MR imaging with hyperpolarized noble gases. It is anticipated that MR imaging will play a central role in the initial diagnosis and follow-up of patients with CTEPH. (orig.)

  17. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Hemmingsen, Bianca; Gimenez-Perez, Gabriel; Mauricio, Didac

    2017-01-01

    BACKGROUND: The projected rise in the incidence of type 2 diabetes mellitus (T2DM) could develop into a substantial health problem worldwide. Whether diet, physical activity or both can prevent or delay T2DM and its associated complications in at-risk people is unknown. OBJECTIVES: To assess...... the effects of diet, physical activity or both on the prevention or delay of T2DM and its associated complications in people at increased risk of developing T2DM. SEARCH METHODS: This is an update of the Cochrane Review published in 2008. We searched the CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, ICTRP...... RESULTS: We included 12 RCTs randomising 5238 people. One trial contributed 41% of all participants. The duration of the interventions varied from two to six years. We judged none of the included trials at low risk of bias for all 'Risk of bias' domains.Eleven trials compared diet plus physical activity...

  18. Neurologic complications of bariatric surgery.

    Science.gov (United States)

    Kumar, Neeraj

    2014-06-01

    The increasing utilization of bariatric surgery has been accompanied by an increased incidence and awareness of related neurologic complications. The purpose of this review is to provide up-to-date information on the neurologic complications related to bariatric surgery. Neurologic complications related to bariatric surgery are predominantly due to nutrient deficiencies. Common early complications include Wernicke encephalopathy due to thiamine deficiency, and late complications include myelopathy or myeloneuropathy due to vitamin B12 or copper deficiency. Early recognition and prompt institution of treatment is essential to prevent long-term disability. Often, life-long supplementation may be required.

  19. Frequency of venous thromboembolism events during acute inpatient rehabilitation in a comprehensive cancer centre

    Directory of Open Access Journals (Sweden)

    Amy H. Ng

    2017-09-01

    Conclusion: Cancer patients with low FIM transfer scores and lower extremity oedema are at higher risk of venous thromboembolism. Patients with these clinical findings at admission may require measures for more aggressive surveillance for the presence of venous thromboembolism. Patients with venous thromboembolism had an increased length of stay in rehabilitation, but ultimately did not have significant differences in FIM score changes.

  20. Pulmonary thromboembolism after long car travel (Tromboembolismo pulmonar tras viaje prolongado en automóvil).

    Science.gov (United States)

    Bertos-Polo, Juan; Ortega-Carnicer, Julian; Gutiérrez-Tirado, Carlos; Ambros-Checa, Alfonso

    2003-06-01

    Prolonged immobility, especially bed rest for medical or surgical processes, constitutes one of the main risk factors for developing pulmonary thromboembolism. Immobility during extended plane or coach journeys (economy class syndrome) is not a frequent cause of serious pulmonary thromboembolism in healthy travellers. We report a case of serious pulmonary thromboembolism after a prolonged journey by car.

  1. Point-of-care washing of allogeneic red blood cells for the prevention of transfusion-related respiratory complications (WAR-PRC): a protocol for a multicenter randomised clinical trial in patients undergoing cardiac surgery

    OpenAIRE

    Warner, Matthew A; Welsby, Ian J; Norris, Phillip J; Silliman, Christopher C; Armour, Sarah; Wittwer, Erica D; Santrach, Paula J; Meade, Laurie A; Liedl, Lavonne M; Nieuwenkamp, Chelsea M; Douthit, Brian; van Buskirk, Camille M; Schulte, Phillip J; Carter, Rickey E; Kor, Daryl J

    2017-01-01

    Introduction The transfusion-related respiratory complications, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are leading causes of transfusion-related morbidity and mortality. At present, there are no effective preventive strategies with red blood cell (RBC) transfusion. Although mechanisms remain incompletely defined, soluble biological response modifiers (BRMs) within the RBC storage solution may play an important role. Point-of-care ...

  2. Chronic Thromboembolic Pulmonary Hypertension: Pearls and Pitfalls of Diagnosis.

    Science.gov (United States)

    Memon, Humna Abid; Lin, C Huie; Guha, Ashrith

    2016-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic obstruction of major pulmonary arteries by organized thromboembolic material. Untreated CTEPH can result in pulmonary hypertension and eventually right heart failure, yet it is the only form of pulmonary hypertension that is potentially curable with surgical or catheter-based intervention. While early diagnosis is key to increasing the likelihood of successful treatment, CTEPH remains largely underdiagnosed. This article reviews the role of echocardiogram, ventilation/perfusion scan, and other available modalities in the diagnosis of CTEPH.

  3. Adipsic diabetes insipidus and venous thromboembolism (VTE): recommendations for addressing its hypercoagulability.

    Science.gov (United States)

    Miljic, Dragana; Miljic, Predrag; Doknic, Mirjana; Pekic, Sandra; Stojanovic, Marko; Petakov, Milan; Popovic, Vera

    2014-01-01

    Adipsic diabetes insipidus (ADI) is a rare disorder. It can occur after transcranial surgery for craniopharyngeoma, suprasellar pituitary adenoma and anterior communicating artery aneurysm but also with head injury, toluene exposure and developmental disorders. It is often associated with significant hypothalamic dysfunction and complications like obesity, sleep apnea, thermoregulatory disorders, seizures and venous thromboembolism (VTE). Morbidity and mortality data have been reported as single case reports with only one large series suggesting increased risk for VTE in patients with ADI. Here we report a mini-series of four patients with ADI and VTE. Post-surgery immobilization, obesity, infection, with prolonged hospitalization, hemoconcentration and changes in coagulation which might be induced by inadequate hormone treatment in the postoperative period (high doses of glucocorticoids, sex steroids and DDAVP replacement) may all contribute to the pathogenesis of VTE. Thromboprophylactic treatment after pituitary surgery and during episodes of hypernatremia is therefore warranted.

  4. Bilateral Pulmonary Thromboembolism: An Unusual Presentation of Infection with Influenza A (H1N1 Virus

    Directory of Open Access Journals (Sweden)

    Parviz Saleh

    2010-06-01

    Full Text Available AbstractSwine flue is a highly contagious acute respiratory diseasecaused by a subtype of influenza A virus. Herein we presentthree patients with H1N1 infection complicated with pulmonarythromboembolism. The patients had chest pain and unexplaineddyspnea. Imaging studies showed bilateral hilar predominance.Computed tomographic angiography confirmed bilateral thromboembolism(an unusual presentation of H1N1 infection. We didnot find any predisposing factor including endothelial damage,stasis, or hypercoagulable state in these patients. They did notreceive any medication. After anticoagulation and treatment withoseltamivir, all the patients were discharged in good condition.To the best of our knowledge bilateral pulmonary thromboembolismhas not been reported in English language literature inpatients with swine flu infection. Appropriate diagnosis andtreatment will be life saving in this condition.Iran J Med Sci 2010; 35(2: 149-153.

  5. Controversies in venous thromboembolism: to treat or not to treat superficial vein thrombosis.

    Science.gov (United States)

    Beyer-Westendorf, Jan

    2017-12-08

    The management of superficial vein thrombosis (SVT) is poorly defined and remains controversial overall. SVT has long been considered a benign, self-limited disease, but recent studies show that SVT carries a nonnegligible risk for recurrence, deep vein thrombosis, or pulmonary embolism. Current guidelines recommend the use of low-molecular-weight heparin or fondaparinux, but results of several surveys indicate that the majority of patients with SVT receive nonanticoagulant therapy only, which includes compression stockings or bandages, nonsteroidal anti-inflammatory drugs, topical application of heparin gel, or surgical interventions. However, several recent observational and interventional studies provide better insight into the optimal treatment of patients with SVT who are at different risks for thromboembolic complications. This educational review summarizes the available evidence and aims to provide practical guidance based on a clinical decision pathway. © 2016 by The American Society of Hematology. All rights reserved.

  6. Isolated traumatic brain injury and venous thromboembolism.

    Science.gov (United States)

    Van Gent, Jan-Michael; Bandle, Jesse; Calvo, Richard Y; Zander, Ashley L; Olson, Erik J; Shackford, Steven R; Peck, Kimberly A; Sise, C Beth; Sise, Michael J

    2014-08-01

    Traumatic brain injury (TBI) is considered an independent risk factor of venous thromboembolism (VTE). However, the role of TBI severity in VTE risk has not been determined. We hypothesized that increased severity of brain injury in patients with isolated TBI (iTBI) is associated with an increased incidence of VTE. The records of patients admitted from June 2006 to December 2011 were reviewed for injury data, VTE risk factors, results of lower extremity surveillance ultrasound, and severity of TBI. Patients were identified by DRG International Classification of Diseases-9th Rev. codes for TBI, and only those with a nonhead Abbreviated Injury Scale (AIS) score of 1 or lower, indicating minimal associated injury, were included. The association of iTBI and VTE was determined using a case-control design. Among iTBI patients, those diagnosed with VTE (cases) were matched for age, sex, and admission year to those without VTE (controls). Data were analyzed using conditional logistic regression. There were 345 iTBI patients: 41 cases (12%) and 304 controls (88%). A total of 151 controls could not be matched to an appropriate case and were excluded. Of the remaining 153 controls, 1 to 16 controls were matched to each of the 41 VTE cases. Compared with the controls, the cases had a higher mean head-AIS score (4.4 vs. 3.9, p = 0.001) and overall Injury Severity Score (20.4 vs. 16.8, p = 0.001). Following adjustment for all factors found to be associated with VTE (ventilator days, central line placement, operative time > 2 hours, chemoprophylaxis, history of VTE, and history of cancer), the cases were significantly more likely to have a greater head injury severity (head-AIS score ≥ 5; odds ratio, 5.25; 95% confidence interval, 1.59-17.30; p = 0.006). The incidence of VTE in iTBI patients was significantly associated with the severity of TBI. VTE surveillance protocols may be warranted in these high-risk patients, as early detection of VTE could guide subsequent therapy

  7. QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION, CORONARY HEART DISEASE, AND ATHEROSCLEROTIC LESION OF LOWER EXTREMITY ARTERIES IN THE SECONDARY PREVENTION OF COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    A. A. Karlov

    2014-07-01

    Full Text Available Atherosclerotic lesion of lower extremity arteries frequently complicates the long-term course of hypertension and it is generally associated with coronary heart disease. Our study has attempted to evaluate the impact of combination antihypertensive therapy involving amlodipine, bisoprolol, and lisinopril on quality of life in this category of patients.

  8. Cancer of the uterine cervix: dosimetric guidelines for prevention of late rectal and rectosigmoid complications as a result of radiotherapeutic treatment

    International Nuclear Information System (INIS)

    Pourquier, H.; Dubois, J.B.; Delard, R.

    1982-01-01

    This paper is the report of a dosimetric study of 41 rectal and rectosigmoid complications after radiotherapeutic treatment (1974-1978) of 287 cervical uterine tumors. Treatment consisted of external irradiation (25 MeV linear accelerator) and intracavitary irradiation (Fletcher-Suit applicator) at different doses depending on tumor stage. Dosimetric measurements were expressed as the maximum rectal dose and mean rectal dose on the anterior surface of the rectum, as proposed by the Groupe Europeen de Curietherapie. Rectal doses were also studied as a function of intracavitary irradiation and intracavitary + external irradiation (maximum rectal and mean cummulative doses for each). The results show a significant difference in the state of the patients with and without complications, based on the dose reaching the rectum. The maximum and the mean cumulative rectal doses serve as one of the primary indicators for predicting complications. These values should therefore be determined before placement of intracavitary sources or, at the latest, before the second intracavitary applications. We have shown that there is no fixed threshold dose, but that it varies from one region to another, depending on level of external irradiation. Our results argue in favor of adapting individual patient therapy based on simple precautions, which are adjustable to all treatment modalities. This method could lead to complete elimination of late rectal and rectosigmoid complications arising from radiotherapeutic treatment of cervical uterine cancer

  9. QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION, CORONARY HEART DISEASE, AND ATHEROSCLEROTIC LESION OF LOWER EXTREMITY ARTERIES IN THE SECONDARY PREVENTION OF COMPLICATIONS

    OpenAIRE

    A. A. Karlov; N. A. Karlova; E. A. Zolozova; E. V. Sayutina; V. V. Chigineva

    2013-01-01

    Atherosclerotic lesion of lower extremity arteries frequently complicates the long-term course of hypertension and it is generally associated with coronary heart disease. Our study has attempted to evaluate the impact of combination antihypertensive therapy involving amlodipine, bisoprolol, and lisinopril on quality of life in this category of patients.

  10. Dabigatran versus warfarin in the treatment of acute venous thromboembolism

    NARCIS (Netherlands)

    Schulman, Sam; Kearon, Clive; Kakkar, Ajay K.; Mismetti, Patrick; Schellong, Sebastian; Eriksson, Henry; Baanstra, David; Schnee, Janet; Goldhaber, Samuel Z.; Schulman, S.; Eriksson, H.; Goldhaber, S.; Kakkar, A.; Kearon, C.; Mismetti, P.; Schellong, S.; Minar, E.; Bergqvist, D.; Tijssen, J.; Prins, M. [=Martin H.; Büller, H.; Otten, J.; Peters, R.; Mac Gillavry, M.; Pol, S.; Burroughs, A.; Gilmore, I.; Bluguermann, J.; Carlevaro, O.; Dipaola, L.; Gitelman, P.; Santos, D.; Schygiel, P.; Baker, R.; Blombery, P.; Gallus, A.; Gan, E.; Gibbs, H.; Salem, H.; Baghestanian, M.; Pilger, E.; Sturm, W.; Debing, E.; Gadisseur, A.; Hainaut, P.; Verhamme, P.; Wautrecht, J.-C.; Zicot, M.; Bizzachi, J. M. Annichino; Araujo, G.; de Araujo, J. Dalmo; Panico, F. M. Duarte Brandão; Nagato, Y.; Pereira, A. H.; Leao, P. Puech; Ramaciotti, E.; Moreira, R. C. Rocha; Timi, J.; Anderson, D.; Crowther, M.; Dolan, S.; Eikelboom, J.; Spencer, F.; Game, M.; Kahn, S.; Kassis, J.; Klinke, P.; Kovacs, M.; Milot, A.; Ritchie, B.; Rodger, M.; Solymoss, S.; Villeneuve, J.; Yeo, E.; Cervinka, P.; Homza, M.; Hrdy, P.; Klimsa, Z.; Lang, P.; Maly, R.; Oral, I.; Reichert, P.; Spinar, J.; Varejka, P.; Vladimir, J.; Brønnum-Schou, J.; Jensen, S.; Jensen, S. E.; Kristensen, K. S.; Nielsen, H.; Wiemann, O.; Bost, V.; Buchmuller, A.; Guillot, K.; Laurent, P.; Lecomte, F.; Mottier, D.; Quere, I.; Wahl, D.; Beyer, J.; Dormann, A.; Hoffmann, U.; Maier, M.; Mietaschk, A.; Katsenis, K.; Klonaris, C.; Liappis, C.; Acsady, G.; Berhes, I.; Boda, Z.; Farkas, K.; Jakucs, J.; Kollar, L.; Matyas, L.; Riba, M.; Sereg, M.; Aggarwal, R.; Banker, D.; Bharani, A.; Gadkari, M.; Hiremath, J.; Jain, A.; Kareem, S.; Lyengar, S.; Parakh, R.; Sekar, N.; Srinivas, A.; Suresh, K.; Vujay, T.; Brenner, B.; Efrati, S.; Elias, M.; Gavish, D.; Grossman, E.; Lahav, M.; Lishner, M.; Zeltser, D.; Agnelli, G.; Cimminiello, C.; Palareti, G.; Prandoni, P.; Santonastaso, M.; Silingardi, M.; Lee, E. Aldrett; Andrade, J. M. Fontes; Valles, J. Jaurrieta; Biesma, D.; Dees, A.; Fijnheer, R.; Hamulyak, K.; Kramer, M. H. H.; Leebeek, F. W. G.; Lieverse, L.; Nurmohamed, M. T.; Chunilal, S.; Jackson, S.; Ockelford, P.; Smith, M.; Njaastad, A. M.; Sandseth, P. M.; Tveit, A.; Waage, A.; Barata, J.; Capitao, M.; Fernandes, F. E.; Leitão, A.; Providência, L.; Alohin, D. I.; Belentsov, S.; Chernyatina, M.; Chernyavsky, A.; Fokin, A.; Gubenko, A.; Guz, V. Alexander V.; Katelnitsky, I.; Khamitov, A. A. A.; Khitaryan, A.; Khubulava, G.; Mikhailov, I.; Shkurin, V.; Staroverov, I.; Tchumakov, A.; Zaporozhsky, A.; Duris, T.; Poliacik, P.; Spisak, V.; Szentivanyi, M.; Zubek, V.; Adler, D.; Kelbe, D.; Le Roux, D.; Pieterse, A.; Routier, R.; Siebert, R.; Sloane, B.; Smith, C.; van Rensburg, H.; del Toro, J.; García-Fuster, M. J.; Mateo, J.; Monreal, M.; Nieto, J. A.; Sánchez-Molini, P.; Sedano, C.; Trujillo, J.; Valle, R.; Villalta, J.; Aagesen, J.; Carlsson, A.; Johansson, L.; Lärfars, G.; Lindmarker, P.; Säfvenberg, U.; Själander, A.; Bengisun, U.; Calkavur, T.; Guney, M. R.; Karahan, S.; Kurtoglu, M.; Sakinci, U.; Gubka, A.; Mishalov, V.; Skupyy, O.; Cohen, A.; Keeling, D.; Kesteven, P.; MacCallum, P.; Maclean, R.; Shah, P.; Watson, H.; Bartkowiak, A.; Bolster, E.; Botnick, W. C.; Burnett, B.; Chervu, A.; Comerota, A. J.; Dy, N. M.; Fulco, F. A.; Gossage, J. R.; Kaatz, S.; Lahiri, B.; Lerner, R. G.; Masson, J. A.; Moll, S.; Morganroth, M.; Patel, K.; Paulson, R.; Powell, R.; Samson, R.; Seibert, A.; Spyropoulos, A.; Vrooman, P. S.

    2009-01-01

    BACKGROUND: The direct oral thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative therapy to warfarin for patients who have acute venous thromboembolism. METHODS: In a randomized, double-blind, noninferiority trial involving patients with acute venous

  11. The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics

    DEFF Research Database (Denmark)

    Adelborg, Kasper; Sundbøll, Jens; Videbech, Poul Bror Hemming

    2017-01-01

    Arterial and venous thromboembolism are common causes of morbidity and mortality in the Western world. Mental disorders are also highly prevalent with a lifetime risk of experiencing any psychiatric disease ranging between 32 % and 37 %. Depression and schizophrenia may increase the risk...

  12. Oral contraception and menstrual bleeding during treatment of venous thromboembolism

    DEFF Research Database (Denmark)

    Klok, F A; Schreiber, K; Stach, K

    2017-01-01

    INTRODUCTION: The optimal management of oral contraception and menstrual bleeding during treatment of venous thromboembolism (VTE) is largely unknown. We aimed to elicit expert opinion and compare that to current practice as assessed by a world-wide international web-based survey among physicians...

  13. Oral Apixaban for the Treatment of Acute Venous Thromboembolism

    NARCIS (Netherlands)

    Agnelli, Giancarlo; Buller, Harry R.; Cohen, Alexander; Curto, Madelyn; Gallus, Alexander S.; Johnson, Margot; Masiukiewicz, Urszula; Pak, Raphael; Thompson, John; Raskob, Gary E.; Weitz, Jeffrey I.; Gallus, Alexander; Raskob, Gary; Weitz, Jeffrey; Prins, Martin; Brandjes, Dees; Kolbach, Dinanda; Limburg, Martinus; Mac Gillavry, Melvin; Otten, Johannes Martinus; Peters, Ron; Roos, Yvo; Segers, Annelise; Slagboom, Ton; Bounameaux, Henry; Hirsh, Jack; Samama, Meyer Michel; Wedel, Hans; Porcari, Anthony; Sanders, Paul; Sisson, Melanie; Sullivan, Beth; Auerbach, Jennifer; Cesario, Lynne; Crawford, Jennifer; Gordon, Margot; Noble, Melanie; Pennington, Ann; Reinhold, Peggy; Simmons, Melanie; Urwin, Keri; Ceresetto, Jose; McRae, Simon; Pabinger, Ingrid; Pereira, Adamastor Humberto; Spencer, Fred; Wang, Chen; Zhang, Jiwei; Gorican, Karel; Husted, Steen Elkiaer; Mottier, Dominique; Harenberg, Job; Vértes, András; Pinjala, Ramakrishna; Zeltser, David; Prandoni, Pablo; Sandset, Morten; Torbicki, Adam; Fijalkowska, Anna; Alvares, Jose Pereira; Kirienko, Alexander; Shvarts, Yury; Sala, Luis Alvarez; Jacobson, Barry; Gudz, Ivan; Ortel, Tom; Spyropoulos, Alex; Beyer-Westendorf, J.; Sipos, G.; Bredikhin, R.; Della Siega, A.; Klinke, W.; Lawall, H.; Zwettler, U.; Prasol, V.; Cannon, K.; Vasylyuk, S.; Jin, B.; Prandoni, P.; Desai, S.; Zaichuk, A.; Katelnitskiy, I.; de Pellegrin, A.; Santonastaso, M.; Skupyy, O.; Pesant, Y.; Shvalb, P.; Spacek, R.; Visonà, A.; Alvarez Sala, L.; Borja, V.; Gudz, I.; Noori, E.; Sereg, M.; Ortel, T.; Braester, A.; Falvo, N.; Mottier, D.; Jacobson, B.; Vöhringer, H.; LaPerna, L.; Oliven, A.; Skalicka, L.; Bolster, D.; Haidar, A.; Schellong, S.; Vértes, A.; Smith, S.; Sergeev, O.; Pullman, J.; Torp-Pedersen, C.; Zimlichman, R.; Elias, M.; Fourie, N.; Pernod, G.; Panchenko, E.; Pendleton, R.; van Nieuwenhuizen, E.; Vinereanu, D.; Agnelli, G.; Becattini, C.; Manina, G.; Leduc, J.; Dunaj, M.; Frost, L.; Gavish, D.; Jakobsen, T.; Lishner, M.; Morales, L. Solis; Chochola, J.; Gubka, O.; Holaj, R.; Hussein, O.; Katona, A.; Sergeeva, E.; Bova, C.; Cepeda, J.; Cohen, K.; Sobkowicz, B.; Grzelakowski, P.; Husted, S.; Lupkovics, G.; Spencer, F.; Dedek, V.; Liu, C.; Puskas, A.; Ritchie, B.; Ambrosio, G.; Parisi, R.; Heuer, H.; Livneh, A.; Podpera, I.; Stanbro, M.; Caraco, Y.; Fulmer, J.; Ghirarduzzi, A.; Schmidt-Lucke, J.; Bergmann, J.; Cizek, V.; Leyden, M.; Stein, R.; Abramov, I.; Chong, B.; Colan, D.; Jindal, R.; Liu, S.; Pereira, A.; Porreca, E.; Salem, H.; Welker, J.; Yusen, R.; Dhar, A.; Gallus, A.; Podczeck-Schweighofer, A.; Shtutin, O.; Vital Durand, D.; Zeltser, D.; Zhang, J.; Balaji, V.; Correa, J.; Harenberg, J.; Kline, J.; Runyon, M.; Laszlo, Z.; Martelet, M.; Parakh, R.; Sandset, P. M.; Schmidt, J.; Yeo, E.; Bhagavan, N.; Bura-Riviere, A.; Ferrer, J. Mirete; Lacroix, P.; Lewczuk, J.; Pilger, E.; Sokurenko, G.; Yu, H.; Nikulnikov, P.; Pabinger-Fasching, I.; Sanchez-Diaz, C.; Schuller, D.; Shvarts, Y.; Suresh, K.; Wang, C.; Lobo, S.; Lyons, R.; Marschang, P.; Palla, A.; Schulman, S.; Spyropoulous, A.; Fraiz, J.; Gerasymov, V.; Lerner, R.; Llamas Esperón, G.; Manenti, E.; Masson, J.; Moreira, R.; Poy, C.; Rodoman, G.; Bruckner, I.; Gurghean, A.; Carrier, M.; Freire, A.; Gan, E.; Gibson, K.; Herold, M.; Hudcovic, M.; Kamath, G.; Koslow, A.; Meneveau, N.; Roos, J.; Zahn, R.; Balanda, J.; Bratsch, H.; Dolan, S.; Gould, T.; Hirschl, M.; Hoffmann, U.; Kaatz, S.; Shah, V.; Kadapatti, K.; Kræmmer Nielsen, H.; Lahav, M.; Natarajan, S.; Tuxen, C.; Tveit, A.; Alves, C.; Formiga, A.; Brudevold, R.; Cardozo, M.; Gorican, K.; Lorch, D.; Marais, H.; Mismetti, P.; Panico, M.; Pop, C.; Quist-Paulsen, P.; Stevens, D.; Tarleton, G.; Yoshida, W.; Cox, M.; Crispin, P.; Czekalski, P.; Ebrahim, I.; Game, M.; Ghanima, W.; Harrington, D.; Jackson, D.; Lee, A.; Matoska, P.; Meade, A.; Camargo, A. C.; Nishinari, K.; Sanchez Llamas, F.; Tosetto, A.; Vejby-Christensen, H.; Basson, M.; Blombery, P.; Fu, G.; Jha, V.; Keltai, K.; Le Jeunne, C.; Lodigiani, C.; Ma, Y.; Nagy, A.; Neumeister, A.; Pinjala, R.; Shotan, A.; Wong, T.; Ying, K.; Anderson, S.; Brenner, B.; Carnovali, M.; Cerana, S.; Cunha, C.; Diaz-Castañon, J.; Graham, M.; Kirenko, A.; Palareti, G.; Rodriguez-Cintron, W.; Nathanson, A.; Rosenthal, S.; Sanders, D.; Scheinberg, P.; Schjesvold, F.; Torp, R.; van Zyl, L.; Venher, I.; Xia, G.; Brockmyre, A.; Chen, Z.; Hakki, S.; Hanefield, C.; Mügge, A.; Janczak, D.; Karpovych, D.; Lancaster, G.; Lavigne, C.; Lugassy, G.; Melaniuk, M.; Moran, J.; Oliver, M.; Schattner, A.; Staroverov, I.; Timi, J.; Vöhringer, F.; von Bilderling, P.; Warr, T.; White, R.; Wronski, J.; Wu, C.; Almeida, C.; Blum, A.; Bono, J.; Durán, M.; Erzinger, F.; Fu, W.; Jagadesan, R.; Jurecka, W.; Korban, E.; Nguyen, D.; Raval, M.; Willms, D.; Zevin, S.; Zhu, H.; Abdullah, I.; Achkar, A.; Albuquerque, L.; Ali, M.; Bai, C.; Bloomfield, D.; Chen, J.; Fajardo Campos, P.; Garcia Bragado, F.; Kobza, I.; Lindhoff-Last, E.; Lourenço, A.; Marchena Yglesias, P.; Marshall, P.; Siegel, M.; Mikhailova, O.; Oliva, M.; Pottier, P.; Pruszczyk, P.; Sauer, M.; Baloira, A.; Cromer, M.; D'Angelo, A.; Faucher, J.; Gutowski, P.; Hong, S.; Lissauer, M.; Lopes, A.; Lopes, R.; Maholtz, M.; Mesquita, E.; Miekus, P.; Mohan, B.; Ng, H.; Peterson, M.; Piovella, F.; Siragusa, S.; Srinivas, R.; Tiberio, G.; van Bellen, B.; Arutyunov, G.; Assi, N.; Baker, R.; Blanc, F.; Curnow, J.; Fu, C.; Gonzalez-Porras, J.; Guijarro Merino, R.; Gunasingam, S.; Gupta, P.; Laule, M.; Liu, Z.; Luber, J.; Serifilippi, G.; Paulson, R.; Shevela, A.; Simonneau, G.; Siu, D.; Sosa Liprandi, M.; Takács, J.; Tay, J.; Vora, K.; Witkiewicz, W.; Zhao, L.; Aquilanti, S.; Dabbagh, O.; Dellas, C.; Denaro, C.; Doshi, A.; Fijalkowska, A.; Flippo, G.; Giumelli, C.; Gomez Cerezo, J.; Han, D.; Harris, L.; Hofmann, L.; Kamerkar, D.; Kaminski, L.; Kazimir, M.; Kloczko, J.; Ko, Y.; Koura, F.; Lavender, R.; Maly, J.; Margolis, B.; McRae, S.; Mos, L.; Sanchez-Escalante, L.; Solvang, A.; Soroka, V.; Szopinski, P.; Thawani, H.; Vickars, L.; Yip, G.; Zangroniz, P.

    2013-01-01

    Background Apixaban, an oral factor Xa inhibitor administered in fixed doses, may simplify the treatment of venous thromboembolism. Methods In this randomized, double-blind study, we compared apixaban (at a dose of 10 mg twice daily for 7 days, followed by 5 mg twice daily for 6 months) with

  14. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism

    NARCIS (Netherlands)

    Schulman, Sam; Kearon, Clive; Kakkar, Ajay K.; Schellong, Sebastian; Eriksson, Henry; Baanstra, David; Kvamme, Anne Mathilde; Friedman, Jeffrey; Mismetti, Patrick; Goldhaber, Samuel Z.; Schulman, S.; Eriksson, H.; Goldhaber, S.; Kakkar, A.; Kearon, C.; Mismetti, P.; Schellong, S.; Minar, E.; Bergqvist, D.; Tijssen, J.; Prins, M. [=Martin H.; Büller, H.; Otten, J.; Mac Gillavry, M.; Brandjes, D.; Otten, H.; Peters, R.; Pol, S.; Burroughs, A.; Gilmore, I.; Bluguermann, J.; Bustos, B.; Carlevaro, O.; Cartasegna, L.; Cuello, J.; Gabito, A.; Gitelman, P.; Gutierrez Carrillo, N.; Hrabar, A.; Mackinon, I.; Santos, D.; Schygiel, P.; Sosa Liprandi, M.; Baker, R.; Blombery, P.; Gallus, A.; Gan, E.; McCann, A.; Salem, H.; Koppensteiner, R.; Kyrle, P.; Pilger, E.; Sturm, W.; Hainaut, P.; Verhamme, P.; Wautrecht, J.-C.; Zicot, M.; Bizzachi, J. Annichino; Joyce, M.; Araújo, G.; de Araújo Filho, J. Dalmo; Panico, M. Duarte Brandão; Pereira, A.; Rocha Moreira, R.; Timi, J.; Yamashita, E.; Anastasov, V.; Georgiev, G.; Guirov, K.; Lozev, I.; Milanov, S.; Peneva, M.; Petrov, V.; Yordanov, Y.; Anderson, D.; Crowther, M.; Dolan, S.; Eikelboom, J.; Game, M.; Kahn, S.; Kassis, J.; Klinke, P.; Ritchie, B.; Rodger, M.; Solymoss, S.; Spencer, F.; Yeo, E.; Bai, C.; Liu, C.; Liu, J.; Shen, H.; Wan, H.; Wang, C.; Wang, Y.; Wen, F.; Ying, K.; Yuan, Y.; Zhang, J.; Zhang, L.; Zheng, Q.; Zhong, N.; Bercikova, J.; Cervinka, P.; Cizek, V.; Jirka, V.; Lang, P.; Maly, R.; Oral, I.; Prochazka, P.; Spinar, J.; Brønnum-Schou, J.; Friis, E.; Jensen, S.; Nielsen, H.; Skødebjerg Kristensen, K.; Wiemann, O.; Husted, S.; Kuusisto, A.; Lassila, R.; Melin, J.; Nikkilä, M.; Nousiainen, T.; Bost, V.; Buchmuller, A.; Guillot, K.; Lecomte, F.; Mottier, D.; Wahl, D.; Beyer-Westendorf, J.; Dormann, A.; Harenberg, J.; Hoffmann, U.; Maier, M.; Mietaschk, A.; Salbach, P.; Cohen, A.; Keeling, D.; Kesteven, P.; Maclean, M. R.; Shah, P.; Katsenis, K.; Klonaris, C.; Liappis, C.; Mihailidis, D.; Acsady, G.; Boda, Z.; Farkas, K.; Jakucs, J.; Kollar, L.; Matyas, L.; Muranyi, A.; Riba, M.; Sereg, M.; Banker, D.; Durairaj, N.; Gadkari, M.; Grant, P.; Hiremath, J.; Kareem, S.; Mahajan, R.; Naik, A.; Parakh, R.; Rai, K.; Santhosh, M.; Sekar, N.; Srinivas, A.; Suresh, K.; Vijayaraghavan, G.; Brenner, B.; Efrati, S.; Mazen, E.; Gavish, D.; Grossman, E.; Lahav, M.; Lishner, M.; Lugassy, G.; Zeltser, D.; Barillari, G.; D' Angelo, A.; Palareti, G.; Santonasto, M.; Schenone, A.; Silingardi, M.; Testa, S.; Aldrett Lee, E.; Fontes Andrade, J.; Jaurrieta Valles, J.; Montaño-González, E.; Sánchez-Escalante, L.-R.; Dees, A.; Hamulyak, K.; Jie, A.; Kamphuisen, P.; Leebeek, F.; Nurmohamed, M.; Pruijt, J.; Wittebol, S.; Hanna, M.; Jackson, S.; Ockelford, P.; Smith, M.; Njaastad, A.; Sandseth, P.; Tveit, A.; Waage, A.; Czarnobilski, K.; Gaciong, Z.; Gluszek, S.; Krolczyk, J.; Zawilska, K.; Barata, J.; Capitao, M.; e Fernandes, F.; Martinez, J.; Providência, L.; Sarmento, P.; Belentsov, S.; Chernyatina, M.; Chernyavsky, A.; Degterev, M.; Fokin, A.; Gubenko, A.; Guz, V.; Katelnitsky, I.; Khamitov, A.; Khitaryan, A.; Khubulava, G.; Koulikovsky, V.; Nelaev, V.; Shkurin, V.; Smirnov, G.; Sokurenko, G.; Soroka, V.; Staroverov, I.; Zaporozhsky, S.; Duris, T.; Poliacik, P.; Spisak, V.; Szentivanyi, M.; Zubek, V.; Adler, D.; Le Roux, D.; Routier, R.; Siebert, R.; Sloane, B.; Smith, C.; del Toro, J.; García-Fuster, M.; Marco, P.; Mateo, J.; Monreal, M.; Nieto J, J.; Sedano, C.; Trujillo, J.; Villalta, J.; Aagesen, J.; Carlsson, A.; Lärfars, G.; Lindmarker, P.; Säfwenberg, U.; Själander, A.; Aslim, E.; Bengisun, U.; Calkavur, T.; Eren, E.; Karahan, S.; Karatepe, O.; Kurtoglu, M.; Sakinci, U.; Gubka, O.; Karpovych, D.; Mishalov, V.; Skupyy, O.; Bartkowiak, A.; Bolster, E.; Burnett, B.; Comerota, A.; Fulco, F.; Gleeson, J.; Gossage, J.; Kaatz, S.; Kuehl, S.; Lahiri, B.; Masson, J.; Moll, S.; Nathanson, A.; Paulson, R.; Powell, R.; Seibert, A.; Vrooman, P.; Sandgren, G.; Wallin, J.; Kälebo, P.; Angerås, U.; Falk, A.; Eriksson, B.; Dellborg, M.; Eriksson, P.; Johansson, P.; Hansson, P. O.; Nicol, A.; Jeffries, B.; Benson, M.; Kyrle, P. A.; Hirschl, M.; Böhler, K.; de Vleeschauwer, P.; Haerens, M.; Duchateau, J.; Verstraeten, P.; Milot, A.; Kotik, L.; Roztocil, K.; Joerg, I.; Holy, M.; Cernosek, B.; Kasalova, Z.; Mandakova, E.; Povolny, J.; Matoska, P.; Hulinsky, V.; Podoubsky, R.; Votocek, S.; Zarubova, D.; Ellervee, T.; Lind, J.; Sukles, K.; Uebel, P.; Bauersachs, R.; Kemkes-Matthes, B.; Beyer, J.; Siragusa, S.; Bova, C.; Cortellaro, M.; Falanga, A.; Palla, A.; Pini, M.; Poggio, R.; Porro, F.; Prisco, D.; Tiraferri, E.; Villalta, S.; Visona, A.; Zanatta, N.; Mazzucconi, M. G.; Porreca, E.; Cattaneo, M.; Di Minno, G.; Oh, D.; Kim, C. S.; Kwon, T. W.; Lee, T. S.; Park, J. S.; Hong, Y. S.; Yoon, S. S.; Kim, Y. K.; Laucevicius, A.; Miliauskas, S.; Novikovs, N.; Zvirgzdins, V.; Meijer, K.; Nijziel, M. R.; van Guldener, C.; van Essen, G. G.; Ouwehand, M. E.; Jie, K. S. G.; Swart-Heikens, J.; Viergever, P. P.; Dullemond, A. C.; Tomkowski, W.; Torbicki, A.; Psuja, P.; Staszkiewicz, W.; Szopinski, P.; Pruszczyk, P.; Ciostek, P.; Windyga, J.; Stepien, J.; Khamitov, A. A.; Ng, H. J.; Elf, J.; Engquist, L.; Sharo, S.; Holmström, M.; Lapidus, L.; Cederin, B.; Brack, T.; Binkert, M.; Canova, C.; Franzeck, U.; Allmann, J. K.; Zehnder, T.; Jeanneret, C.; Jäger, K.; Erni, D.; Banyai, M.; Rödel, C.; Engelbrecht, J.; Bruning, A.; van Rensburg, H.; Vermooten, I. H.; Norasetthada, L.; Thungthong, P.; Angchaisuksiri, P.; Numbenjapon, T.; Cook, R.; Deck, K.; Evans, B.; Hearne, S.; Kaelin, T.; Kuno, R.; Pendelton, R.; Speer, J.; Yood, R.; Kahn, R.; Sheehan, K.; Feldman, G.; Chen, Y. C. J.; Fanning, J.; Hartley, P.; Kulback, S.; McIvor, M. E.; LaPerna, L.; Gibson, K.; Vaid, B. R.; Changlani, M.

    2013-01-01

    Dabigatran, which is administered in a fixed dose and does not require laboratory monitoring, may be suitable for extended treatment of venous thromboembolism. In two double-blind, randomized trials, we compared dabigatran at a dose of 150 mg twice daily with warfarin (active-control study) or with

  15. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism

    NARCIS (Netherlands)

    Weitz, Jeffrey I.; Lensing, Anthonie W. A.; Prins, Martin H.; Bauersachs, Rupert; Beyer-Westendorf, Jan; Bounameaux, Henri; Brighton, Timothy A.; Cohen, Alexander T.; Davidson, Bruce L.; Decousus, Hervé; Freitas, Maria C. S.; Holberg, Gerlind; Kakkar, Ajay K.; Haskell, Lloyd; van Bellen, Bonno; Pap, Akos F.; Berkowitz, Scott D.; Verhamme, Peter; Wells, Philip S.; Prandoni, Paolo; Bianchi, Alessandra; Brighton, Tim; Carroll, Patrick; Chong, Beng; Chunilal, Sanjeev; Coughlin, Paul; Curnow, Jennifer; Jackson, David; Tran, Huyen; Ward, Chris; Brodmann, Marianne; Kyrle, Paul; Marschang, Peter; Petkov, Ventzislav; Hainaut, Philippe; Jordens, Paul; Vandekerkhof, Jos; Wautrecht, Jean-Claude; Annichino-Bizzacchi, Joyce; Correa, Joao; Cukier, Alberto; Freire, Antonio; Pereira, Adamastor; Porto, Carmen; Sacilotto, Roberto; Vasconcelos Costa, Agenor; Della Siega, Anthony; Dolan, Sean; Le Gal, Gré goire; Gross, Peter; Kahn, Susan; Kassis, Jeannine; Kovacs, Michael; Pesant, Yves; Ritchie, Bruce; Schulman, Sam; Shivakumar, Sudeep; Solymoss, Susan; Chang, Shu; Chen, Rongchang; Chen, Zhong; Chen, Hong; Dai, Xiangchen; Fang, Baoming; Fu, Weiguo; Gao, Xinglin; Huang, Jinhua; Lai, Yanping; Li, Li; Li, Xiaoqiang; Li, Yiqing; Liu, Jinming; Liu, Shuang; Ma, Wenjiang; Ni, Songshi; Qin, Zhiqiang; Shi, Guochao; Tian, Hongyan; Wang, Shenming; Wang, Lie; Xiao, Wei; Ying, Kejing; Yu, Guanfeng; Yuan, Yadong; Zhang, Jie; Zhang, Jin; Zhang, Xinri; Zhang, Liyan; Zhu, Lei; Chlumský , Jaromir; Chochola, Jiri; Dunaj, Milna; Kovarova, Katerina; Lang, Pavel; Matoš ka, Petr; Podpera, Ivo; Spacek, Rudolf; Stehlikova, Olga; Brø nnum-Schou, Jens; Egstrup, Kenneth; Gislason, Gunnar; Jeppesen, Jorgen; May, Ole; Nielsen, Henrik; Wiggers, Henrik; Achkar, Antoine; Aquilanti, Sandro; Benhamou, Ygal; Brisot, Dominique; Bura-Riviere, Alessandra; Castella, Nadine; Elias, Antoine; Falvo, Nicolas; Ferrari, Emile; Lacroix, Philippe; Mahe, Isabelle; Meneveau, Nicolas; Messas, Emmanuel; Mismetti, Patrick; Montaclair, Karine; Mottier, Dominique; Moumneh, Thomas; Paleiron, Nicolas; Parent, Florence; Pernod, Gilles; Sanchez, Olivier; Schmidt, Jeannot; Simoneau, Guy; Stephan, Dominique; Amann, Berthold; Blessing, Erwin; Czihal, Michael; Espinola-Klein, Christine; Kahrmann, Gerd; Licka, Manuela; Neumeister, Axel; Schellong, Sebastian; Boda, Zoltan; Farkas, Katalin; Gurzo, Mihaly; Katona, Andras; Riba, Maria; Sipos, Gyula; Tó th, Kalman; Braester, Andrei; Elias, Mazen; Gafter-Gvili, Anat; Gavish, Dov; Hussein, Osamah; Lishner, Michael; Schiff, Elad; Spectre, Galia; Tzoran-Rozenthal, Inna; Zimlichman, Reuven; Ageno, Walter; Agnelli, Giancarlo; Bova, Carlo; Garbelotto, Raffaella; Ghirarduzzi, Angelo; Imberti, Davide; Pesavento, Raffaele; Porreca, Ettore; Visonà , Adriana; Flota Cervera, Luis; Llamas Esperó n, Guillermo; Rodriguez-Gonzalez, Daniel; Solis Morales, Lucas; Boersma, Willem; ten Cate, Hugo; Erdkamp, Franciscus; Grifioen-Keijzer, Anita; Marwijk Kooy, Marinus; Meijer, Karina; Middeldorp, Saskia; Swart-Heikens, Janneke; ten Wolde, Marije; Westerweel, Peter; Braithwaite, Irene; Harper, Paul; Merriman, Eileen; Ockelford, Paul; Royle, Gordon; Smith, Mark; Ghanima, Waleed; Sandset, Per Morten; Abola, Maria; Chę ciń ski, Pawel; Grzelakowski, Pawel; Lewczuk, Jerzy; Sobkowicz, Bozena; Tomkowski, Witold; Abramov, Igor; Chechulov, Pavel; Karpenko, Andrey; Katelnitskiy, Ivan; Kazakov, Andrey; Makarova, Olga; Panchenko, Elizaveta; Sergeeva, Elena; Subbotin, Yuriy; Suchkov, Igor; Zeltser, Mikhail; Adler, David; Breedt, Johannes; Fourie, Nyda; Isaacs, Rashid; Jacobson, Barry; Siebert, Heidi; van Zyl, Louis; Choi, Jung-Hyun; Kang, Seok-Min; Kim, Kye-Hun; Kim, Hyo-Soo; Kim, Dong-Ik; Min, Seung-Kee; Park, Ki Hyuk; Garcí a-Bragado Dalmau, Fernando; Gó mez Cerezo, Jorge; Mirete, Jose Carlos Ferrer; Riera, Antonio; del Toro, Jorge; Eriksson, Henry; Torstensson, Ingemar; Banyai, Martin; Baumgartner, Iris; Mazzolai, Lucia; Periard, Daniel; Righini, Marc; Staub, Daniel; Chiang, Chern-En; Chiu, Kuan-Ming; Pai, Pei-Ying; Angchaisuksiri, Pantep; Chansung, Kanchana; Ö ngen, Gul; Tuncay, Esin; Alikhan, Raza; Chetter, Ian; Kesteven, Patrick; Nokes, Tim; Bauer, Kenneth; Comerota, Anthony; Elias, Darlene; Garcia, David; Gibson, Kathleen; Ginsberg, Daniel; Jenkins, Jeffrey; Kingsley, Edwin; Lambert, Richard; Lyons, Roger; Pullman, John; Shah, Vinay; Smith, S. Wayne; Stein, Robert; Tapson, Victor; Walsh, John; Wang, Tzu-Fei; Do Loi, Doan; Do Quang, Huan; Pham, Nguyen

    2017-01-01

    BACKGROUND Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin. METHODS In this randomized, double-blind, phase 3 study, we assigned 3396 patients with venous

  16. Increased risk of arterial thromboembolic events after Staphylococcus aureus bacteremia

    DEFF Research Database (Denmark)

    Mejer, N; Gotland, N; Uhre, M L

    2015-01-01

    OBJECTIVES: An association between infection and arterial thromboembolic events (ATE) has been suggested. Here we examined the risk of myocardial infarction (MI), stroke and other ATE after Staphylococcus aureus bacteremia (SAB). METHODS: Danish register-based nation-wide observational cohort study...

  17. Incidental venous thromboembolism in cancer patients: prevalence and consequence

    NARCIS (Netherlands)

    Douma, Renée A.; Kok, Maayke G.M.; Verberne, Lisa M.; Kamphuisen, Pieter W.; Büller, Harry R.

    2010-01-01

    Introduction: Careful re-evaluation of CT-scans for cancer staging frequently reveals unsuspected venous thromboembolism (VTE) on CT-scans. However, it is unknown how often these findings lead to anticoagulant treatment in daily clinical practice. Methods: Reports from thoracic and/or abdominal

  18. New developments in parenteral anticoagulation for arterial and venous thromboembolism

    NARCIS (Netherlands)

    van Es, Nick; Bleker, Suzanne M.; Büller, Harry R.; Coppens, Michiel

    2013-01-01

    The efficacy and safety of heparin and low-molecular-weight heparins (LMWHs) are well documented in venous and arterial thromboembolism. Several drawbacks of heparins have inspired the development of newer parenteral anticoagulants for specific indications, including heparin-induced thrombocytopenia

  19. Venous Thromboembolism Prophylaxis – The Other Side of the Coin ...

    African Journals Online (AJOL)

    Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any guidelines, most of the information available has been provided mainly by the pharmaceutical industry which is an interested party. There have been publications in local journals that lean more on ...

  20. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism

    NARCIS (Netherlands)

    Raskob, Gary E.; van Es, Nick; Verhamme, Peter; Carrier, Marc; Di Nisio, Marcello; Garcia, David; Grosso, Michael A.; Kakkar, Ajay K.; Kovacs, Michael J.; Mercuri, Michele F.; Meyer, Guy; Segers, Annelise; Shi, Minggao; Wang, Tzu-Fei; Yeo, Erik; Zhang, George; Zwicker, Jeffrey I.; Weitz, Jeffrey I.; Büller, Harry R.; Beyer-Westendorf, Jan; Boda, Zoltan; Chlumsky, Yaromir; Gibbs, Harry; Kamphuizen, P. W.; Monreal, Manuel; Ockleford, Paul; Pabinger-Fasching, Ingrid; Sinnaeve, Peter; Beenen, Ludo; Gerdes, Victor