The incidence of deep vein thrombosis and pulmonary embolism with the elective use of external fixators

Little evidence exists about the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of external fixators. We investigated this in a cohort of 207 consecutive patients undergoing 258 elective frame applications by case note review. Case notes were obtained for 84 % of the sample population. The type of surgery, demographic data, thromboembolic risk factors and the incidence of DVT/PE were recorded. One patient experienced DVT (0.39 %) and one a PE (0.39 %). Both were of high risk and had received mechanical and chemical thromboprophylaxis during their inpatient stay. These complications were identified at least 3 months post-operatively. These findings help to more accurately counsel patients undergoing elective frame surgery on the risks of DVT/PE and also contribute to the discussion between surgeons about whether or not extended course chemical thromboprophylaxis would be of overall benefit.     

Acute celiac trunk thrombosis revealed by biliary peritonitis

Acute thrombosis of the celiac trunk is a very uncommon condition, which is a life-threatening emergency. The clinical presentation is highly variable depending on the extent of the ischemic territory. We report a case of biliary peritonitis related to an acute thrombosis of the celiac trunk. This case highlights the role of abdominal computed tomography in the diagnosis of acute upper abdominal pain.     

Cerebral venous thrombosis in Behcet's disease. A report on 24 cases

IntroductionCerebral venous thrombosis (CVT) is the most common manifestation of vasculo-Behçet's disease and may be superficial and/or deep localization. The aim of our study was to evaluate the clinical and radiological features of CVT associated with Behçet's disease in our population and to compare findings with previous studies.Materials and methodsWe report a retrospective study of 24 cases of CVT secondary to Behçet's disease, collected between 1999 and 2019 in the neurology department of the Mohamed V Military Hospital (Rabat), the Avicenne Military Hospital (Marrakech) and the Mohamed VI Hospital (Marrakech). The diagnosis of Behçet's disease was made in all cases according to the 2014 International Study Group Criteria for Behçet diseases. Patients received antithrombotic treatment, combined with corticosteroids, in six cases of superficial CVT and with immunosuppressants in cases of deep CVT.ResultsClinical manifestations were dominated by motor deficit in deep localizations and intracranial hypertension in superficial locations. The diencephalic-mesencephalic syndrome was found in 18 patients, whereas intracranial hypertension (71%) and headache (57%) were the most common presentations of superficial CVT. Unlike previous studies, magnetic resonance angiography and conventional angiography performed in our patients confirmed the predominance of deep venous thrombosis (18 cases), whereas superficial CVT was observed only in six cases.DiscussionIn our series, the benefit of conventional angiography was undeniable, by confirming the diagnosis of basal vein of Rosenthal thrombosis in 75% of our patients. Short-term outcome was favorable, but sequelae of CVT were noted in 20 patients (75%). The outcome of patients was commonly mRS 02, however 70% of patients presenting with deep CVT at the beginning had a poor outcome (mRS 03) and we did not record any case of venous thrombosis relapse.     

急性颅内静脉窦血栓机械取栓1例

正患者女,23岁,因"突发头痛、头晕10天伴左侧肢体活动障碍5天"入院;10天前曾就诊于当地医院,因头部CTA/CTV示上矢状窦闭塞(图1A)而接受抗凝治疗,病情未见明显改善;5天前于当地医院复查头部CT平扫提示右侧中央区脑出血(图1B)。患者1年前曾因"左下肢静脉血栓形成"接受治疗,具体不详。查体:嗜睡,言语清楚;左侧肢体肌张力降低(上肢肌力2级,下肢肌力4级)。DSA示上矢状窦后部及右侧横窦闭塞     

铁蓄积骨质疏松模型凝血状态及微血栓和血管密度变化的研究

目的：了解铁蓄积骨质疏松模型中凝血状态、微血栓、微血管床及骨密度的变化,探讨骨质疏松范畴铁蓄积对凝血功能、血管方面的影响。方法：选取健康24只6月龄雄性SPF级SD大鼠,体重（250±20）g,随机分为对照组和铁蓄积组,每组12只。铁蓄积组用枸橼酸铁（ferric ammonium citrate,FAC）90 mg/kg腹腔注射干预,对照组采用等体积生理盐水腹腔注射,每周2次,干预9周。干预完成后,检测两组血清铁蛋白、凝血功能、微血栓、血管密度及股骨远端骨小梁三维形态重建和空间结构参数,并进行统计学分析。结果：铁蓄积组血清铁蛋白（136.36±35.41）μg/L较对照组（68.44±16.86）μg/L显著升高,铁蓄积组骨密度（0.167±0.024）g/cm³较对照组（0.400±0.030）g/cm³显著下降;铁蓄积组的纤维蛋白原（2.03±0.13）g/L较对照组（1.78±0.46）g/L明显升高,D-二聚体含量（534.95±31.81）ng/ml较对照组（329.02±84.99）ng/ml明显增高（P<0.05）,而凝血酶时间（39.64±2.18）s和凝血酶原时间（8.70±0.39）s较对照组（44.92±2.98）s、（9.44±0.49）s明显缩短（P<0.05）;墨汁染色后,铁蓄积组的微血管密度（17.46±2.07）%较对照组（23.81±2.98）%明显缩小（P<0.05）。HE和MSB染色均显示铁蓄积大鼠骨髓中存在微血栓,同时在心肌中也存在微血栓。结论：在铁蓄积影响的骨质疏松模型中,铁蓄积对凝血功能有显著影响,血液相对呈高凝状态,骨血管床减少,骨髓中有微血栓存在,血液的高凝状态及微血栓的形成可能是铁蓄积骨质疏松症发生的重要影响因素。     

Frequency of and factors associated with vascular complications after pediatric liver transplantation

Objectiveto evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation.Methodrisk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival.Resultsvascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter ≤ 3 mm, donor‐to‐recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts.Conclusionthe choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.     

Risk of thromboembolic complications in patients with inflammatory bowel disease

A large number of hemostasis measurements complications were performed in 20 patients with inflammatory bowel disease; whose changes have been associated with an increased risk of thromboembolic. Of the 20 patients, 9 (45%) had one or more changes suggestive of activation of the hemostatic system. Such changes were more frequently observed in patients with active disease. Two patients had changes in the fibrinolytic system (high plasminogen activator inhibitor-1 levels) and 2 in the natural anticoagulants (low antithrombin III activity). Nine patients had increased plasma fibrinogen levels and 6 patients had slightly increased levels of anticardiolipin antibodies. Most of the changes observed were not related to the type, location or activity of the disease. These data show that various biochemical abnormalities may be found in patients with inflammatory bowel disease, which may account for their increased risk of thrombosis, and suggest that multiple mechanisms may interact in determining such complications.     

恶性肿瘤患者下腔静脉滤器的应用研究

目的研究下腔静脉滤器在恶性肿瘤患者中的应用,探讨其在预防肺栓塞发生中的作用。方法回顾性分析1998年至2004年,经病理学或细胞学确诊为恶性肿瘤,并于治疗前存在血栓栓塞性疾病的37例患者,安放下腔静脉滤器后肺栓塞的发生情况。结果下腔静脉滤器全部安全置入下腔静脉内,随访1～36个月,滤器无移位,无肺栓塞发生。结论对恶性肿瘤合并血栓栓塞性疾病的患者放置下腔静脉滤器,能安全有效地预防肺栓塞的发生。     

Safety and Efficacy of Low Dosage of Urokinase for Catheter-directed Thrombolysis of Deep Venous Thrombosis

Background:

Catheter-directed thrombolysis (CDT) has been a mainstay in treating deep venous thrombosis (DVT). However, the optimal dosage of a thrombolytic agent is still controversial. The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT.

Methods:

A retrospective analysis was performed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012. Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography. The therapeutic safety was evaluated by adverse events. A venography or duplex ultrasound was performed to assess the outcome at 6 months, 1 year and 2 years postoperatively.

Results:

The mean total dose of 3.34 (standard deviation [SD] 1.38) million units of urokinase was administered during a mean of 5.18 (SD 2.28) days. Prior to discharge, Grade III (complete lysis) was achieved in 154 (36%) patients; Grade II (50–99% lysis) in 222 (52%); and Grade I (50% lysis) in 51 (12%). The major complications included one intracranial hemorrhage, one hematochezia, five gross hematuria, and one pulmonary embolism. Moreover, no death occurred in the study.

Conclusions:

Treatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.