Clinical status of etiology, diagnosis, treatment and prevention of venous thromboembolism after gynecological pelvic surgery / 中国医师杂志

Venous thromboembolism ( VTE) is one of the common complications of gynecological pelvic surgery. The incidence of VTE is increased year by year and the mortality was increased. Therefore the prevention and treatment of postoperative VTE in patients with gynecological pelvic surgery should be given high attention. Reviewing and summarizing the related literatures on the etiology, diagnosis, treatment and prevention of VTE after gynecological pelvic surgery, it is concluded that the early clinical symptoms of VTE after gynecological pelvic surgery are atypical, and clinical diagnosis needs to be made by means of platelet count, D-Dimer, coagulation function and color Doppler ultrasonography of both lower extremities. Anticoagulation, anti-platelet, elastic socks, intermittent pneumatic pressure pump and inferior vena cava filter are the main prevention and treatment methods. Preventive treatment before and after surgery is partic-ularly important.

Clinical Analysis of Human Soluble Endothelial Protein C Receptor after Heart Valve Replacement / 现代检验医学杂志

Objective To investigate the clinical value of human soluble endothelial protein C receptor (sEPCR) after heart valve replacement.Methods 78 cases of patients with heart valve replacement in the Second Affiliated Hospital of Nantong University from January 2005 to June 2016 were selected as the research objects,who were divided into embolic group and control group,38 cases in embolic group and 40 cases in control group,the index of two groups 1 d preoperative,while dynamic monitoring international standardization ratio (INR) and embolism,were detected,of which INR and sEPCR were examined.The INR and sEPCR oftwo groups was compared with t test.Results The INR and sEPCR of two groups 1 d preoperative had no significant difference (1.24±0.32 vs 1.23±0.19,34.91±9.14 μg/L vs 35.56±10.22 μg/L;t=0.17,P =0.868;t=0.30,P=0.768,respectively).The average value of dynamic monitoring INR in control group had no significant difference when compared with the results of embolism (1.86±0.95 vs 1.93±0.97,t=0.32,P=0.748).But the sEPCR had significant difference (101.33±27.15 μg/L vs 41.67±11.82 μg/L,t=12.69,P=0.000).Conclusion The important indexes of sEPCR could effectively guide the anticoagulant treatment,especially those who with the sEPCR value too high,the embolic threatening should be paid attention to.

Development and application of venous thromboembolism intelligent evaluation and automatic warning system / 医疗卫生装备

Objective To develop an intelligent evaluation and automatic warning system to improve the diagnosis rate of venous thrombo embolism (VTE) and strengthen its standardized treatment.Methods A clinical data center was constructed by using data extraction,conversion and loading,which involved in military medical system,clinical laboratory system,electronic medical record system and surgical anesthesia system.The warning model was established with international standards,clinician experiences,warning parameters selection by statistical method and weighted assignment.Results The system could predict the risk of the hospitalized patient for VTE rapidly and inform the doctor in time.Conclusion The system facilitates the doctor to prevent and control VTE,and thus is worthy promoting practically.

Prevalence of deep vein thrombosis in acute stroke in Government Dharmapuri Medical College Hospital

Introduction: Venous thrombo embolism (VTE) is a frequent cause of preventable illness and death in hospitalized patients. 25% of all cases of venous thrombo embolism are associated with hospitalization and 50 to 75% of cases of VTE in hospitalized patients occur on those in medical wards. Aim of the Study: Prevalence of Deep vein thrombosis in patients admitted with acute stroke. The need for routine anticoagulation for prophylaxis against DVT in acute stroke patients. Materials and methods: Out of 145 patients enrolled for the study after applying the exclusion criteria 50 patients were selected for duplex ultrasonography of lower limb venous system. Results: In our study the prevalence of DVT in acute stroke was analyzed by ultrasound venous Doppler of lower limbs. The analysis of co morbid conditions like diabetes, systemic hypertension, ischemic heart disease, smoking and alcoholism were analyzed to find out if there was any association between their presence and occurrence of DVT. In all these parameters compared within the group of DVT positive patients the p value was more than 0.05 which is statistically insignificant. Conclusion: The prevalence of DVT in acute stroke patients in our hospital group was 6% which is significantly less than that observed in western population. Duplex USG is a useful tool which can be used as a screening tool for early diagnosis of DVT. DVT occurs more commonly in paralyzed limb than non paralyzed limb.

Non-invasive MDCT Pulmonary Angiography in Unselected Patients with suspected Pulmonary Thrombo- Embolism.

Background: Pulmonary Thrombo-Embolism (PE) is a common and potentially lethal complication of deep venous Thrombosis (DVT). High sensitivity and specificity of Multi Detector Computed Tomography Pulmonary Angiography (MDCT-PA) in direct visualization of embolic material within the pulmonary arteries is due to its improved spatial and temporal resolution. Methods: We conducted a Prospective study to evaluate Non-invasive 256 Slice MDCT-PA in one hundred unselected patients with clinically suspected Pulmonary Embolism. Results: The total number of patients with thrombo-embolic disease in our study was 35 (35%), out of which acute PE & acute DVT were observed in 32% and 8% respectively. The percentage of Sub-segmental emboli among patients with acute PE was 34.37%, segmental thrombi was 87.5% and central thrombi was 96.87%.Conclusion: MDCT-PA possess the advantage of direct visualization and quantification of thrombo-embolic material and hence we advocate it to be the first-line imaging study for patients with clinically suspected PE.

Comparison between primary pulmonary artery sarcoma and pulmonary thromboembolism / 中国综合临床

Objective To investigate the clinical characteristics of pulmonary artery sarcoma (PAS) and pulmonary thromboembolism(PTE), to improve doctors' awareness and the early diagnosis of PAS.Methods The clinical data of 10 PAS cases confirmed with biopsy were retrospectively analyzed,and 10 cases with PTE were selected as control group.Results (1) Main clinical manifestations of the two groups were chest tightness, shortness of breath, intermittent syncope, palpitations, chest pain and cough, and there were no statistical significance differences between the two groups (P＞0.05).(2)There were 2 cases (20.0％) PaO2 ＜80 mmHg in patients with PAS.However, there were 8 cases (80.0％)PaO2 ＜ 80 mmHg in control group.The two groups had statistically significant difference (x2 =7.200, P =0.023).(3) Wells score : the cases with PAS was in low risk (80.0％ and 10.0％),however, the cases of control group was in medium and high risk(90.0％ and 20.0％).The two groups had statistically significant difference (P =0.005, 0.001).(4) The two groups had no statistically significant difference in ECG, UCG, X-ray, lung ventilation/perfusion (P＞ 0.05).(5) There had statistically significant difference in terms of LDH and CRP between PAS and PET group (100％ vs.0, x-2 =10.796,P=0.003;100％ vs.0, x2 =15.000, P =0.000).There was faster ESR in PAS group than control group,and the two groups had statistically significant difference (75％ vs.0, x2=1.400, P =0.011).There was no case of D-Dimer＞500 μg,/L in PAS group, while 10 cases in control group, and the two groups had significant statistical difference (x2 =17.000, P =0.000).(6) There was 1 case (12.5％) with DVT in PAS group, 6 cases (60.0％) in PTE group, and the two groups had significant statistical difference (x2=10.568, P =0.001).(7) The CTPA in PAS group showed filling defect in the main pulmonary artery trunk (85.7％ vs.0) ,left pulmonary artery (85.7％ vs.10.0％) ,right pulmonary artery(100％ vs.10.0％) and both left and right pulmonary artery (85.7％ vs.10.0％), the two groups had significant statistical difference (x2 =13.247, P =0.001;x2 =9.746, P=0.004;x2 =13.388, P =0.000;x2 =9.746, P =0.004).Conclusion PAS and PTE can' t be distinguished from the clinical symptoms, ECG, UCG, X-ray,lung ventilation/perfusion imaging.PAS is easily misdiagnosed as PTE.More attention should be given.PAS can be identified early through the blood gas analysis, hypoxemia,Wells score, LDH, CRP, ESR, D-Dimer, DVT and CTPA.

Atrial fibrillation in the elderly / 老年心脏病学杂志（英文版）

This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.

Effectiveness and Necessity of Early Postoperative Rehabilitation for Total Hip Arthroplasty / The Japanese Journal of Rehabilitation Medicine

When treating coxarthrosis, each treatment method including conservative treatment, osteotomy, or artificial joint replacement, has an optimal stage for treatment of the disease. Joint preservation surgery has a good result for cases in the early stage, but total hip arthroplasty (THA) is selected for advanced stage hip osteoarthritis, and in Japan, more than a 40000 THAs are performed each year. Good postoperative results lasting up to 15 years are reported today, but, on the other hand, postoperative problems still clearly exist. Deep venous thrombosis/pulmonary embolism (VTE/PTE) are given as perioperative problems, and postoperative dislocation and postoperative range of motion of the hip joint are given as the problems that most relate to ADL. These days, information about THA is abundant so that there is extensive demand for the procedure amongst patients, and elevated technique is demanded of the surgeon. The onset of postoperative VTE/PTE as a lethal complication and interest about its prevention have risen these days with the increase in the number of artificial joint replacements performed in Japan. This time, we introduce a postoperative THA rehabilitation schedule and report the results of our postoperative complication prevention efforts carried out in our hospital. When THA of late years is thought about, for a patient, it is natural that the long-term results are good, and the postoperative satisfaction degree from an early stage is the demand that it is necessary. In consideration of these things, the range of hip motion needed about the origin and preventing dislocation that were one element of long-term satisfaction since only a short-term of normal ADL movement was investigated, and this was viewed from the aspect of joint stability against postoperative dislocation by difference in the approach method of surgery. Finally, we also discussed the importance of early rehabilitation after surgery for the prevention of VTE/PTE as a serious complication of surgery.

Trombolisis para Tromboembolismo pulmonar masivo en el servicio de urgencias: Reporte de un caso / Thrombolysis in massive pulmonary embolism in emergency room: case report

El tromboembolismo pulmonar (TEP) es una posibilidad diagnóstica que obliga a determinar una probabilidad a través del puntaje (score) de Wells, con el fin de evitar subdiagnósticos o realizar diagnósticos tardíos en el servicio de urgencias. En ocasiones el TEP se presenta como una condición amenazante de la vida que requiere intervención inmediata, siendo la trombolisis el tratamiento adecuado cuando se acompaña de inestabilidad hemodinámica y no hay contraindicaciones para su realización. Se presenta el caso de un hombre de 61 años que ingresa a un servicio de urgencias de alto nivel de complejidad, con diagnóstico de TEP masivo y se procede a trombolisis con Alteplase®, obteniéndose adecuada reperfusión de la circulación pulmonar y estabilidad cardiorrespiratoria luego de realizar el procedimiento.

Pulmonary thromboembolism (PTE) is a diagnosis possibility that implies determining a probability with Wells score in order to avoid subdiagnosis or late diagnosis in emergency services. In some occasions, it presents as a life threatening condition that requires immediate intervention. Thrombolysis is the adequate treatment when PTE is accompanied with hemodynamic instability and when there are no counter-indications. The following article describes the case of a 61 year old man who enters a high complexity level emergency service with a diagnosis of massive PTE and thrombolysis is carried out with Alteplase ®. Adequate reperfusion of pulmonary circulation is obtained as well as cardio respiratory stability following the procedure.

A propósito de la muerte de Cano de Aponte y los accidentes ecuestres / On the death of Gabriel Cano de Aponte

Gabriel Cano de Aponte was Governor of Chile since 1717 and util his death in 1733, being 68 years old. As a soldier, he was an experimented horse rider. The sequence ofevents that caused his death three months after an equestrian accident are unclear. A systematic clinical analysis of the later is the main objective of this review. Historians have documented Cano de Aponte's "inclination for unbridled fun and equestrian exercises". During a holiday Cano de Aponte suffered a horse fall and subsequent crushing by the latter. It has been stated that a spinal lesion caused by the accident kept him bedridden for a period of three months, clear in reason and with intense pain, before his death. However, there is no evidence on historie data that conveys any typical sign associated to spinal injury following the accident. Therefore we suggest that Cano de Aponte suffered a complex pelvic ring fracture. The fact that he was prostrated, lucid, but suffered and intense pain best sustains the hypothesis of a pelvic fracture. After the initial period, one ofthe most common causes of death resulting from a pelvic fracture is deep venous thrombosis with secondary pulmonary thromboembolism. This must have been the sequence ofevents that most probably caused Cano de Aponte's death).

Pulmonary Thromboembolism Following Spinal Anesthesia: A case report / 대한마취과학회지

Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.