Prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos em unidade de terapia intensiva / Prevalence of risk factors for deep venous thrombosis in surgical patients in intensive care unit

Objetivo: Avaliar a prevalência dos fatores de risco e medidas de prevenção para trombose venosa profunda de pacientes cirúrgicos em Unidade de Terapia Intensiva. Métodos: Estudo transversal, conduzido em 2019, com utilização da escala de Caprini para classificação de cada paciente quanto ao risco para trombose venosa profunda, e análise das intervenções adotadas. Resultados: Foram avaliados 68 pacientes. Os fatores de risco mais prevalentes foram procedimento cirúrgico de grande porte (96%) e restrição ao leito (90%). O risco para tromboembolismo venoso foi alto (62/91%), moderado (5/7%) e baixo (1/2%). A mobilização de membros foi aplicada a todos os pacientes, deambulação precoce foi realizada em 62% e 56% foram submetidos à profilaxia medicamentosa. Conclusão: A alta prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos e a baixa aplicabilidade de medidas preventivas demonstram a importância da implementação de programas de educação continuada e medidas de monitoramento desses eventos.

Objective: To assess the prevalence of the risk factors and preventive measures for deep venous thrombosis in surgical patients in the Intensive Care Unit. Methods: Cross-sectional study held in 2019 using the Caprini scale to classify each patient regarding their risk for deep venous thrombosis, and analysis of the actions taken. Results: A total of 68 patients were evaluated. The most prevalent risk factors were being submitted to major surgical procedures (96%) and bed restriction (90%). The risk for venous thromboembolism was high (62/91%), moderate (5/7%), and low (1/2%). Limb mobilization was applied on all patients; early ambulation was performed in 62%; and 56% were submitted to drug prophylaxis. Conclusion: The high prevalence of risk factors for deep vein thrombosis in surgical patients and the low applicability of preventive measures show the importance of implementing continuing education programs and measures to monitor such events.

Factores de riesgo y clasificación de riesgo para enfermedad tromboembólica en mujeres posparto / Risk factors and risk classification for thromboembolic disease in postpartum women / Fatores de risco e classificação de risco para doença tromboembólica em mulheres no pós-parto

Introducción. Las mujeres en el periodo posparto presentan un mayor riesgo de morbilidad y mortalidad, con un incremento de hasta 10 veces el riesgo de enfermedad tromboembólica, en comparación con mujeres no embarazadas en edad fértil.Objetivo. Describir las características sociodemográficas, factores de riesgo y clasificación de riesgo para eventos tromboembó-licos de las mujeres posparto en un hospital de referencia del departamento de Boyacá durante el año 2018.Metodología. Estudio observacional, descriptivo, de corte transversal, realizado en 398 mujeres posparto, quienes fueron encuestadas y valoradas por el servicio de ginecobstetricia del Hospital Regional de Sogamoso, durante el año 2018; se identi-ficaron los factores y se hizo clasificación de riesgo para eventos tromboembólicos.Resultados y conclusiones. Las mujeres posparto cuentan con una mediana de edad de 26 años [RIQ; 10 años], procedentes del área urbana en el 62,6% y en su mayoría (69,6%) del estrato socioeconómico uno. Los factores de riesgo más frecuentes encontrados fueron la cesárea (33,2%), el sobrepeso (31,4%), la obesidad grado I y II (11,3%) y el parto pretérmino (7,5%). La clasificación de riesgo para eventos tromboembólicos en el total de la población se clasificó como: 6% riesgo bajo, 89,5% riesgo moderado y 4,5% riesgo alto. Es necesario contar en los servicios de ginecobstetricia con la identificación del nivel de riesgo para eventos tromboembólicos de las mujeres posparto, de forma estandarizada y sistemática; igualmente, mitigar estos riesgos y así garantizar la prevención de este tipo de complicaciones.

Introduction. Women in the postpartum period have a higher risk of morbidity and mortality, with an increase of up to 10 times the risk of thromboembolic disease compared to non-pregnant women of childbearing age.Objective. To describe the sociodemographic characteristics, risk factors, and risk classification for thromboembolic events of postpartum women in a reference hospital in the department of Boyacá during 2018.Methodology. Observational, descriptive, cross-sectional study, carried out in 398 postpartum women, who were surveyed and assessed by the Gynecology and Obstetrics Service of the Sogamoso Regional Hospital during 2018, the factors and risk classification for thromboembolic events were identified.Results and conclusions. Postpartum women have a median age of 26 years [RIQ; 10 years], from the urban area in 62.6% and mostly from the socioeconomic stratum one with 69.6%. The most frequent risk factors found were caesarean section with 33.2%, overweight with 31.4%, obesity grade I and II with 11.3% and preterm delivery with 7.5%. The risk classification for thromboembolic events in the total population was classified as: 6% low risk, 89.5% moderate risk and 4.5% high risk. Identification of the level of risk for thromboembolic events in postpartum women is necessary in the gynecology and obstetrics services in a standardized and systematic way, as well as mitigating these risks and thus guaranteeing the prevention of this type of complications.

Introdução: Mulheres no período pós-parto apresentam maior risco de morbilidade e mortalidade, com aumento de até 10 vezes o risco de doenças tromboembólicas, em comparação com mulheres não grávidas em idade reprodutiva. Objetivo: Descrever as características sociodemográficas, fatores de risco e classificação de risco para eventos tromboembólicos em mulheres pós-parto no hospital de referência no departamento de Boyacá durante o ano 2018. Metodologia: Estudo observacional, des-critivo, transversal, realizado em 398 mulheres pós-parto, que foram inquiridas e avaliadas pelo servi-ço de ginecologia e obstetrícia do Hospital Regional de Sogamoso, durante o ano de 2018; Identifica-ram-se fatores e classificação de risco para eventos tromboembólicos. Resultados e conclusões: as mulheres no pós-parto têm uma idade mediana de 26 anos [RIQ; 10 anos], 62,6% da zona urbana e a maioria (69,6%) do estrato socioeconômico um. Os fatores de risco mais frequentes encontrados fo-ram cesárea (33,2%), sobrepeso (31,4%), obesidade graus I e II (11,3%) e parto prematuro (7,5%). A classificação de risco para eventos tromboembólicos na po-pulação total foi classificada em: 6% de baixo risco, 89,5% de risco moderado e 4,5% de alto risco. É necessário contar com os serviços de ginecoobstetrícia com a identificação do grau de risco para eventos tromboembólicos em mulheres pós-parto, de forma padronizada e sistematizada; da mesma forma, mitigar esses riscos e, assim, ga-rantir a prevenção deste tipo de complicações.

An Acute Pulmonary Embolism Accompanying Greater Saphenous Vein Thrombosis / 대한내과학회지

Pulmonary embolism is most commonly related to deep vein thrombosis of the lower extremities. However, recent studies show that the thrombosis of superficial veins can also progress to deep vein thrombosis and pulmonary embolism. To our knowledge, there is no Korean report of pulmonary embolism associated with superficial vein thrombosis. We experienced an 82-year-old woman complaining of dyspnea and chest pain. On chest dynamic computed tomography (CT), pulmonary embolism was diagnosed. To evaluate the origin of the pulmonary embolism, abdominal CT, Doppler ultrasonography, and ascending venography of both lower extremities were done. We found no deep vein thrombosis, while thrombus of the proximal left greater saphenous vein was seen. We report a case of pulmonary embolism accompanying greater saphenous vein thrombosis without deep vein thrombosis.

Pulsed and Color Doppler Sonographic Findings of Penile Mondor's Disease

This report describes the color and pulsed Doppler US findings of penile Mondor's disease. The pulsed Doppler US findings of penile Mondor's disease have not been previously published, so we report here for the first time on the cavernosal arterial flow signal pattern of penile Mondor's disease. Penile Mondor's disease is rare disease that's characterized by thrombosis in the dorsal vein of the penis. The previous reports on penile Mondor's disease are concerned with the color Doppler US finding without the flow signals in this area, but these findings are insufficient to understand the hemodynamics in penile Mondor's disease. We report for the first time on a cavernosal artery flow signal pattern of low peak systolic velocity and high-resistance.

Effect of Low Dose 5-Fluorouracil and Cisplatin Intra-arterial Infusion Chemotherapy in Advanced Hepatocellular Carcinoma with Decompensated Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of repeated arterial infusions of low dose cisplatin and 5-fluorouracil (FU) in patients with advanced HCC with decompensated cirrhosis. METHODS: Between January 1995 and December 2003, a total of 79 decompensated cirrhotic patients having HCC and PVT were enrolled and divided into 2 groups. Group 1 (n=40) received intra-arterial infusion chemotherapy with cisplatin (10 mg for 5 days) and 5-FU (250 mg for 5 days) via an implanted chemoport every 4 weeks' and group 2 (n=39) was managed with only conservative treatment. RESULTS: The two groups were well matched with respect to the features relating to the prognosis, including age, gender and the Child- Pugh class. Although diffuse tumor involvement, main portal vein tumor thrombosis and bi-lobar involvement were more frequent in group 1, the median survival period of group 1 was significantly longer than group 2 (5 months vs. 3 months, respectively, P=0.016). Also, the 1-year survival rate of group 1 (7.5%) was higher than that of group 2 (5.1%) (P=0.016). When we analyzed the patients with the Child class B, the survival benefits of intra-arterial chemotherapy were more significant (P=0.008). CONCLUSIONS: Intra-arterial chemotherapy consisting of low dose 5-FU and cisplatin achieved favorable results for advanced HCC patients who had decompensated cirrhosis, and it showed better survival in selected patients. This therapy may be useful as a palliative treatment for HCC patients with decompensated cirrhosis.

Effect of Cause of Iliac Vein Stenosis and Extent of Thrombus in the Lower Extremity on Patency of Iliac Venous Stent Placed after Catheter-Directed Thrombolysis of Acute Deep Venous Thrombosis in the Lower Extremity

PURPOSE: To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. MATERIALS AND METHODS: Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. RESULTS: All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. CONCLUSION: Factors which can affect the patency of an iliac venous stent positioned affer catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thronbus revealed at CT of acute DVT and occurring in a lower extremity prior to thrombolysis.

Deep Venous Thrombosis in the Lower Extremity: Catheter-Directed Thrombolysis

PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. MATERIALS AND METHODS: Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1 -90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000 -10,000,000 (mean 4, 84,000) IU, and the total procedural time was 25 -115 (mean, 64) hours. RESULTS: Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=4) or Wallstent placement (n=6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs.

Primary Antiphospholipid Antibody Syndrome: Neuro radiologic Findings in 11 Patients

OBJECTIVE: To describe the neuroradiologic findings of primary antiphospholipid antibody syndrome (PAPS). MATERIALS AND METHODS: During a recent two-year period, abnormally elevated antiphospholipid antibodies were detected in a total of 751 patients. In any cases in which risk factors for stroke were detected-hypertension, diabetes mellitus, hyperlipidemia, smoking, and the presence of SLE or other connective tissue diseases-PAPS was not diagnosed. Neuroradiologic studies were performed in 11 of 32 patients with PAPS. We retrospectively reviewed brain CT (n = 7), MR (n = 8), and cerebral angiography (n = 8) in 11 patients with special attention to the presence of brain parenchymal lesions and cerebral arterial or venous abnormalities. RESULTS: CT or MR findings of PAPS included nonspecific multiple hyper-inten-sity foci in deep white matter on T2-weighted images (5/11), a large infarct in the territory of the middle cerebral artery (4/11), diffuse cortical atrophy (2/11), focal hemorrhage (2/11), and dural sinus thrombosis (1/11). Angiographic findings were normal (5/8) or reflected either occlusion of a large cerebral artery (2/8) or dural sinus thrombosis (1/8). CONCLUSION: Neuroradiologic findings of PAPS are nonspecific but in young or middle-aged adults who show the above mentioned CT or MR findings, and in whom risk factors for stroke are not present, the condition should be suspected.

Imaging Spectrum of Primary Antiphospholipid Antibody Syndrome

Antiphospholipid antibody syndrome is recognized as one of the most important causes of hypercoagulability. Itcan be clinically diagnosed if patients have experienced unexplained recurrent venous or arterial thrombosis,recurrent fetal loss, or thrombocytopenia in the presence of circulating autoantibodies to phospholipids, such asanticardiolipin antibody or lupus anticoagulant. Approximately half of all patients with this syndrome do not haveassociated systemic disease, and their condition is described as primary antiphospholipid antibody syndrome(PAPS). In the remainder, the syndrome is accompanied by systemic lupus erythematosus or other connective tissuediseases, and is known as secondary antiphospholipid syndrome (1). The purpose of this paper is to illustrate thesystemic manifestations of PAPS, focusing on the radiological findings of CT, MR and angiography in clinicallyproven patients.