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1.
Rev. cuba. anestesiol. reanim ; 20(2): e691, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289356

ABSTRACT

Introducción: La trombofilia es un desorden de la hemostasia congénito o adquirido que predispone al desarrollo de trombosis. Las trombofilias congénitas más frecuentes son las deficiencias de antitrombina III, proteína C y proteína S, el factor V Leiden, la mutación del gen de la protrombina (G20210A) y las mutaciones de la enzima metilentetrahidrofolato reductasa (MTHFR). Objetivo: Describir el manejo anestésico en un paciente portador de trombofilia congénita. Presentación del caso: Se reporta un paciente de 19 años de edad con antecedentes de historia familiar y personal de trombosis venosa profunda, tratamiento con doble antiagregación plaquetaria y asociación de tres mutaciones para trombofilia congénita, G20210A, A1298C MTHFR y C677T MTHFR que recibe anestesia espinal para una herniorrafia inguinal. Se mantiene tratamiento con aspirina, se suspende clopidogrel 7 días antes de la cirugía y durante ese tiempo se administra fraxiparina 0.6 Uds. subcutánea diarias hasta 12 h antes de la cirugía, se utiliza medias elásticas, deambulación precoz y reinicio de clopidogrel 24 h después de la cirugía, con evolución satisfactoria. Conclusiones: La tromboprofilaxis en pacientes portadores de trombofilia congénita es mandatoria, por eso resulta determinante la utilización de heparina de bajo peso molecular junto al resto de las medidas de prevención de la trombosis venosa profunda(AU)


Introduction: Thrombophilia is a congenital or acquired hemostasis disorder that predisposes to thrombosis development. The commonest congenital thrombophilias are deficiencies of antithrombin III, protein C and protein S, factor V Leiden, prothrombin gene mutation (G20210A), and methylenetetrahydrofolate reductase (MTHFR) mutations. Objective: To describe the anesthetic management in a patient with congenital thrombophilia. Case presentation: The case is reported of a 19-year-old patient with a family and personal history of deep-vein thrombosis, treatment with double antiplatelet therapy and association of three mutations for congenital thrombophilia (G20210A, A1298C MTHFR and C677T MTHFR), who receives spinal anesthesia for an inguinal herniorrhaphy. Aspirin treatment is maintained. Clopidogrel is suspended seven days before surgery. During this time, fraxiparin is administered subcutaneously in 0.6-mL units daily, up to twelve hours before surgery. Elastic stockings are used, early ambulation is allowed, and clopidogrel is restarted 24 hours after surgery, with satisfactory evolution. Conclusions: Thromboprophylaxis in patients with congenital thrombophilia is mandatory, a reason why the use of low-molecular-weight heparin, together with the rest of the prevention measures against deep-vein thrombosis, is decisive(AU)


Subject(s)
Humans , Male , Young Adult , Venous Thrombosis , Anesthesia, Spinal , Antithrombin III , Early Ambulation , Stockings, Compression
2.
Article in English | WPRIM | ID: wpr-714302

ABSTRACT

BACKGROUND: The beach-chair position (BCP) results in decreases in venous return, cardiac output, and cerebral perfusion pressure. In this randomized, prospective study, we investigated whether applying thigh-high compression stockings affected the maintenance of regional cerebral tissue oxygen saturation (rSO2) in the BCP. METHODS: Patients undergoing orthopedic surgery in the BCP under general anesthesia were included and assigned randomly to the control or the compression stocking group. Appropriately sized thigh-high compression stockings were applied to the patients in the stockings group. All patients were tilted, up to 45°, throughout the operation. Non-invasive blood pressure, invasive arterial blood pressure zeroed at the external auditory meatus, and rSO2 were recorded. RESULTS: Data were analyzed from 19 patients per group. In the BCP, the values of rSO2 and blood pressure decreased significantly compared with those at baseline, with no significant difference between the groups. The incidences of cerebral desaturation events (CDEs) were similar between the groups; however, that of hypotension was significantly lower in the compression stocking group. During 36 CDEs, the levels of rSO2 and blood pressure decreased significantly compared with those at baseline in both groups. No significant correlation was found between rSO2 and blood pressure. CONCLUSIONS: Thigh-high compression stockings reduced the incidence of hypotension but not that of CDEs. Our results suggest that other factors, beyond hypotension itself, contribute to CDEs and in other words, efforts just to reduce the incidence of hypotension may not mainly contribute to a reduction of CDEs occurrence in the BCP under general anesthesia.


Subject(s)
Anesthesia, General , Arterial Pressure , Blood Pressure , Cardiac Output , Cerebrovascular Circulation , Humans , Hypotension , Incidence , Orthopedics , Oxygen , Prospective Studies , Spectroscopy, Near-Infrared , Stockings, Compression
3.
Article in Korean | WPRIM | ID: wpr-717116

ABSTRACT

An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.


Subject(s)
Abdomen , Abdominal Pain , Aged, 80 and over , Catheters , Dabigatran , Drainage , Edema , Ethanol , Extremities , Female , Follow-Up Studies , Humans , Leg , Leukocytosis , Liver , Lower Extremity , Pelvis , Pulmonary Embolism , Risk Factors , Sclerotherapy , Stockings, Compression , Thromboembolism , Thrombosis , Tomography, X-Ray Computed , Veins , Vena Cava Filters , Vena Cava, Inferior , Venous Thrombosis
4.
Article in Chinese | WPRIM | ID: wpr-317612

ABSTRACT

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 treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.


Subject(s)
Anastomosis, Surgical , Anticoagulants , Therapeutic Uses , Bariatric Surgery , Catheterization , China , Conservative Treatment , Constriction, Pathologic , Therapeutics , Digestive System Fistula , Therapeutics , Endoscopy, Gastrointestinal , Methods , Extracorporeal Membrane Oxygenation , Gastrectomy , Gastric Bypass , Gastric Mucosa , Pathology , Gastric Stump , General Surgery , Gastrointestinal Hemorrhage , General Surgery , Hemostasis, Surgical , Methods , Hemostatic Techniques , Heparin , Therapeutic Uses , Humans , Intermittent Pneumatic Compression Devices , Intestine, Small , Pathology , Laparoscopy , Margins of Excision , Peptic Ulcer , Therapeutics , Postoperative Complications , Diagnosis , Therapeutics , Pulmonary Embolism , Therapeutics , Stents , Stockings, Compression , Thrombectomy , Thrombolytic Therapy , Venous Thrombosis , Therapeutics
5.
Rev. cuba. med. gen. integr ; 32(3): 0-0, jul.-set. 2016. ilus
Article in Spanish | LILACS | ID: biblio-960489

ABSTRACT

El Síndrome de Klippel Trenaunay es una malformación vascular congénita caracterizada por una triada de manifestaciones clínicas que comprende una malformación vascular venular, linfática y venosa, junto con hipertrofia esquelética y aumento de tejidos blandos de uno o más miembros. De etiología desconocida, patogénicamente se cree que se produce una alteración en el desarrollo del mesodermo en el feto, que afecta a las líneas angioblástica, linfoblástica y osteoblástica. Se presenta el caso de un paciente femenino de 5 años de edad quien presenta una malformación vascular, diagnosticada inicialmente como hemangioma vascular y posteriormente se asoció a Síndrome de Klippel Trenaunay. El objetivo de la presentación de este caso es generar conocimiento sobre las características clínicas del síndrome de Klippel Trenaunay para un diagnóstico y tratamiento oportuno(AU)


Klippel - Trenaunay -Weber congenital vascular malformation characterized by a triad of clinical manifestations comprising a venular, venous and lymphatic vascular malformation, with hypertrophy increased skeletal and soft tissue of one or more members. Of unknown etiology, it is believed to pathogenically an alteration occurs in mesoderm development in the fetus, which affects angioblastic , and osteoblastic lymphoblastoid lines. Is presentedthe case of a 5 year old that has a vascular malformation, initially diagnosed as vascular hemangioma and later was associated with Klippel- Trenaunay -Weber.Objective: To generate knowledge about the clinical features of KlippelTrenaunay Syndrome for diagnosis and treatment(AU)


Subject(s)
Humans , Female , Child , Propranolol/therapeutic use , Klippel-Trenaunay-Weber Syndrome/diagnosis , Klippel-Trenaunay-Weber Syndrome/etiology , Klippel-Trenaunay-Weber Syndrome/drug therapy , Magnetic Resonance Angiography/methods , Stockings, Compression
6.
Article in English | WPRIM | ID: wpr-759230

ABSTRACT

PURPOSE: The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. MATERIALS AND METHODS: The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. RESULTS: The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. CONCLUSIONS: The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future.


Subject(s)
Arthroplasty , Arthroplasty, Replacement, Knee , Asian Continental Ancestry Group , Factor Xa , Heparin, Low-Molecular-Weight , Humans , Incidence , Knee , Korea , Leg , Postal Service , Stockings, Compression , Surgeons , Surveys and Questionnaires , Thromboembolism , Venous Thromboembolism
7.
Article in Korean | WPRIM | ID: wpr-218574

ABSTRACT

Pregnancy-related venous thromboembolism (VTE) is one of the leading causes of maternal morbidity and mortality, developed in the antenatal and postpartum periods of pregnancy. The incidence of VTE during normal pregnancy is four- to six-fold higher than in the general reproductive aged female population. Physiologic changes such as hypercoagulable state, decreased venous capacitance, and reduced venous blood flow due to mechanical obstruction from gravid uterus compromise this condition. The prominent risk factors for VTE are thrombophilia, history of circulatory disease and previous VTE, preeclampsia and related disorders, and Cesarean section. In case of suspicion of VTE, prompt diagnosis and management are needed with the caution of potential adverse effects on the fetus. Low molecular weight heparin treatment is preferred due to better safety, more consistent bioavailability, ease of administration, lower risk of drug-related osteoporosis and thrombocytopenia and easier monitoring. For pregnant women with acute VTE, adjusted-dose subcutaneous low molecular weight heparin should be administrated antenatally and continued for at least 6 weeks postpartum. For prevention of VTE, mechanical prophylaxis such as physiotherapy, exercise, compression stockings, and intermittent pneumatic compression devices could be used. Thromboprophylaxis should also be considered for pregnant subjects with certain risks such as carriers of molecular thrombophilia or previously experienced VTE.


Subject(s)
Biological Availability , Cesarean Section , Diagnosis , Female , Fetus , Heparin, Low-Molecular-Weight , Humans , Incidence , Intermittent Pneumatic Compression Devices , Mortality , Osteoporosis , Postpartum Period , Pre-Eclampsia , Pregnancy , Pregnant Women , Risk Factors , Stockings, Compression , Thrombocytopenia , Thromboembolism , Thrombophilia , Uterus , Venous Thromboembolism
8.
REME rev. min. enferm ; 19(4): 943-950, out.-dez. 2015. ilus, tab
Article in Portuguese | BDENF, LILACS | ID: lil-782757

ABSTRACT

Os profissionais responsáveis pelo tratamento de pacientes com úlcera varicosa devem ser competentes na escolha e aplicação de terapias de compressão em consonância com as necessidades individuais dos pacientes. Para isso, faz-se necessário conhecer a performance dos produtos. OBJETIVO: avaliar o desempenho do sistema de compressão de duas bandagens no tratamento de úlcera varicosa. MÉTODO: estudo de caso descritivo de avaliação de produto com seguimento por 12 semanas de pacientes com idade superior a 20 anos, diagnóstico médico de úlcera varicosa, índice de pressão tornozelo/braço (ITB) > 0,8 e medidas da circunferência do tornozelo entre 18 e 25 cm ou 25 e 32 cm. As variáveis de desempenho foram a porcentagem da alteração da área; edema da perna; deslizamento da bandagem; eventos adversos. RESULTADOS: os participantes eram obesos, idade superior a 36 anos, ITB =1, edema na perna, relação circunferência panturrilha/tornozelo de 1,5, variação reduzida do movimento do tornozelo, úlceras com área de 1,0 a 5,4 cm². CONCLUSÃO: as variáveis utilizadas são adequadas para avaliação do desempenho de sistemas de compressão no tocante à porcentagem da alteração da área; edema da perna; deslizamento da bandagem; evento adverso (necrose na pele) e o sistema de dois componentes avaliado pode representar uma terapia adequada para tratamento de úlcera varicosa na prática clínica, no Brasil.


The professionals responsible for treating patients with varicose ulcer should be competent in the selection and application of compression therapy along with the patient's individual needs. For that, it is necessary to know the performance of the products. OBJECTIVE: To evaluate the performance of two compression systems bandages in the treatment of varicose ulcer. METHODS: descriptive case study of product evaluation with follow-up by 12 weeks of patients older than 20 years, medical diagnosis of varicose ulcers, ankle-brachial index (ABI) > 0.8 and measures of ankle circumference between 18 and 25 cm or 25 and 32 cm. The performance variables were the percentage of change in the area; leg edema; bandage slip; adverse events. RESULTS: The participants were obese, older than 36 years, ABI = 1, leg edema, calf/ankle circumference ratio of 1.5, reduced range of ankle motion, ulcers with an area from 1.0 to 5.4 cm². CONCLUSION: the variables used are suitable for performance assessment of compression systems with regard to the percentage of change in the area; leg edema; bandage slip; adverse event (necrosis of the skin) and the analyzed two-component system may be an appropriate therapy for the treatment of varicose ulcer in clinical practice in Brazil.


Los profesionales encargados del tratamiento de pacientes con úlcera varicosa deben ser competentes en la selección y aplicación de la terapia de compresión de acuerdo con las necesidades individuales de los pacientes. Para tal, es necesario conocer la performance de los productos. El objetivo del presente estudio ha sido evaluar el desempeho del sistema de compresión de dos vendajes en el tratamiento de úlcera varicosa. Se trata de un estudio de caso descriptivo de evaluación del producto con un seguimiento de 12 semanas de pacientes mayores de 20 ahos, con diagnóstico médico de úlceras varicosas, índice de presión tobillo/brazo (ITB) > 0,8 y medidas de la circunferencia del tobillo entre 18 y 25 cm o 25 y 32 cm. Las variables de desempeho fueron el porcentaje de alteración en la zona; edema en la pierna; deslizamiento del vendaje; eventos adversos. Los participantes eran obesos, mayores de 36 ahos, ITB = 1, edema en la pierna, relación de la circunferencia de pantorrilla/tobillo de 1.5, reducción de la amplitud de movimiento del tobillo, úlceras con un área de 1,0 a 5,4 cm2. Las variables utilizadas son apropiadas para la evaluación del rendimiento de sistemas de compresión con respecto al porcentaje de alteración en el área; edema en la pierna; deslizamiento del vendaje; evento adverso (necrosis de la piel) y el sistema de dos componentes evaluado puede ser una terapia adecuada para el tratamiento de úlcera varicosa en la práctica clínica en Brasil.


Subject(s)
Humans , Male , Female , Varicose Ulcer , Treatment Outcome , Evaluation Studies as Topic , Stockings, Compression , Compression Bandages
9.
J. vasc. bras ; 14(1): 62-67, Jan-Mar/2015. tab
Article in English | LILACS | ID: lil-744456

ABSTRACT

Wearing elastic compression stockings is of considerable significance for patients with chronic venous disease (CVD), since their physiological effect is to improve venous hemodynamic parameters, making them a good treatment option that can impact on patients' quality of life. OBJECTIVE: To assess quality of life in patients with chronic venous disease who do or do not wear elastic stockings. METHODS: This was a cross-sectional observational study assessing a sample of 50 CVD patients of both sexes, divided into two groups, one who wear elastic stockings and another who do not. Primary variables were the domains of the SF-36 (Medical Outcomes Study Short-form 36) and AVVQ (Aberdeen Varicose Veins Questionnaire) and secondary variables were: age; sex; physical activity; educational level; profession; wearing elastic stockings (frequency, pressure and type); elevation of lower limbs; itching and CEAP classification. The SF-36 and AVVQ quality of life questionnaires were administered to patients. Statistical significance was set at p<0.05. RESULTS: Wearing elastic stockings proved beneficial for the quality of life of people with chronic venous disease. For the AVVQ disease-specific questionnaire the greatest improvements were in overall score (p=0.0028) and the extent of varicosity domain (p=0.000). The SF-36 domains role emotional (p=0.017) and functional capacity (p=0.000) both improved. CONCLUSIONS: Wearing elastic stockings is an effective treatment for CVD that improves disease-specific quality of life and also leads to improvements in general quality of life...


O uso de Meias Elásticas Compressivas em pacientes com doença venosa crônica (DVC) é de grande significância, na medida em que reflete, na sua atuação fisiológica, melhora nos padrões hemodinâmicos venosos, configurando-se como boa opção terapêutica e podendo interferir na qualidade de vida do indivíduo. OBJETIVO: Avaliar a qualidade de vida de indivíduos com doença venosa crônica usuários e não usuários de meias elásticas. MÉTODOS: Trata-se de um estudo observacional de corte transversal, no qual foram avaliados 50 pacientes de ambos os sexos, com DVC, compondo dois grupos: um de usuários e o outro, de não usuários de meias elásticas. Teve, como variáveis primárias, os domínios dos questionários SF-36 (Medical Outcomes Study Short-form 36) e AVVQ (Aberdeen Varicose Veins Questionnaire); constituíram as variáveis secundárias: idade; sexo; atividade física; escolaridade; profissão; uso de meias elásticas (frequência de uso, pressão e tipo); elevação de membros inferiores; presença de prurido, e CEAP. Os pacientes responderam aos questionários de qualidade de vida SF-36 e AVVQ. A significância estatística considerada foi p<0,05. RESULTADOS: A utilização da meia elástica mostrou benefício na qualidade de vida dos indivíduos portadores de doença venosa crônica. O aspecto mais favorecido no questionário específico AVVQ relacionou-se à sua pontuação total (p=0,0028) e ao domínio Extensão da varicosidade (p=0,000). Já quanto ao SF-36, podem-se apontar o aspecto emocional (p=0,017) e a capacidade funcional (p=0,000). CONCLUSÃO: O uso de meias elásticas apresenta-se como uma terapêutica eficaz na DVC, melhorando a qualidade de vida específica e havendo, também, ganho na qualidade de vida geral...


Subject(s)
Humans , Male , Female , Adult , Aged , Venous Insufficiency/pathology , Stockings, Compression , Quality of Life , Cross-Sectional Studies/methods , Observational Study , Surveys and Questionnaires
10.
Article in Korean | WPRIM | ID: wpr-657115

ABSTRACT

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.


Subject(s)
Critical Care , Critical Illness , Diagnosis , Humans , Incidence , Critical Care , Intermittent Pneumatic Compression Devices , Male , Pilot Projects , Stockings, Compression , Venous Thrombosis
11.
Article in English | WPRIM | ID: wpr-190403

ABSTRACT

OBJECTIVE: Venous thromboembolism (VTE) after spinal surgery affects a patients' postoperative recovery and also carries a mortality risk. Some studies recommended chemical prophylaxis for high-risk patients and for those after complex spinal surgeries. However, chemoprophylaxis for VTE in spinal surgery is underemployed and there is no agreement on the use of VTE prophylaxis in spinal surgery. The aim of this study was to document the incidence of VTE after an elective instrumental spinal surgery, among those receiving preoperative chemoprophylaxis as compared with patients who did not receive it. METHODS: This study was carried out on eighty-nine patients allocated randomly to receive either low molecular weight heparin (LMWH) or no prophylaxis before elective instrumental spinal surgery. All patients received postoperative compression stockings. A compression Doppler ultrasonography was performed for all patients to detect postoperative deep vein thrombosis. In addition, further imaging studies were performed for patients suspected of VTE. RESULTS: Three (3.3%) patients were diagnosed with VTE. One of them had received preoperative chemoprophylaxis. There were no significant difference in incidence of VTE between the two groups (p>0.95; 95% confidence interval, 0.06-8.7). Laterality of gender and postsurgical recumbence duration were all independent predictors of VTE (p=0.01 and p<0.001, respectively). CONCLUSION: The difference in the incidence of thromboembolic complications between the two groups was not significant. Moreover, we found that preoperative prophylactic LMWH injection has no major bleeding complications altering postoperative course; still, the issue concerning the initiation time of chemoprophylaxis in spinal surgery remains unclear.


Subject(s)
Chemoprevention , Hemorrhage , Heparin, Low-Molecular-Weight , Humans , Incidence , Mortality , Pulmonary Embolism , Stockings, Compression , Ultrasonography, Doppler , Venous Thromboembolism , Venous Thrombosis
12.
Article in English | WPRIM | ID: wpr-56487

ABSTRACT

We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding. One of three options was administered according to the groups (aspirin in group 1 or 4; enoxaparin and following aspirin in group 2; antithrombotic stocking in group 3). Incidences of symptomatic deep vein thrombosis (DVT) and PE, and major or minor bleeding complications were evaluated. Majority of the patients (86%) were assessed to be with standard risks both for PE and bleeding. No patient experienced symptomatic DVT or PE and major bleeding. Eleven percent of the patients discontinued chemoprophylaxis because of bleeding-related wound complication. In conclusion, the 1st AAOS guideline functions successfully in Korean patients undergoing TKA in terms of prevention of symptomatic DVT and PE while avoiding major bleeding complications.


Subject(s)
Aged , Arthroplasty, Replacement, Knee/adverse effects , Aspirin/administration & dosage , Cohort Studies , Enoxaparin/administration & dosage , Female , Fibrinolytic Agents/administration & dosage , Humans , Male , Middle Aged , Orthopedics , Postoperative Complications/etiology , Postoperative Hemorrhage/etiology , Practice Guidelines as Topic , Pulmonary Embolism/etiology , Republic of Korea , Retrospective Studies , Risk Factors , Societies, Medical , Stockings, Compression , Venous Thrombosis/etiology
13.
Rev. bras. queimaduras ; 13(4): 236-239, out-dez. 2014. ilus
Article in Portuguese | LILACS | ID: lil-754564

ABSTRACT

Introdução: As vestes compressivas são parte do tratamento ambulatorial das queimaduras profundas. Muitas vezes, os pacientes acabam por não utilizar a malha compressiva devido, principalmente, ao incômodo, à vergonha e ao desconhecimento sobre a importância do uso. Objetivo: Descrever o processo de construção de um vídeo educativo sobre a importância do uso da malha compressiva para indivíduos que sofreram queimaduras. Métodos: A construção do material educativo ocorreu nas seguintes etapas: revisão da literatura, análise dos dados coletados, elaboração e avaliação de roteiro e filmagem de três pacientes e dois pais e/ou responsáveis, no Ambulatório do Centro de Tratamento de Queimados do Hospital Universitário da Universidade Estadual de Londrina (CTQ/HU/UEL) e edição do vídeo. Resultados: Obteve-se um vídeo educativo que aborda a cicatrização hipertrófica, a colocação da malha compressiva, esclarecimentos de dúvidas e dicas de cuidados. Conclusão: O desenvolvimento de tecnologias educativas direcionadas ao tratamento do paciente vítima de queimadura constitui grande desafio, havendo a necessidade urgente em desenvolver novos materiais.


Introduction: The compressive garments are part of outpatient treatment of deep burns. Often patients end up not using the compression garment mainly due to discomfort, shame and ignorance of the importance of using. Objective: To describe the process of building an educational video on the importance of using the compression garment for individuals who have suffered burns. Methods: The construction of educational material occurred in the following steps: literature review, data analysis, drafting and review script and shooting of three patients and two parents and/or guardians in the Outpatient Burn Treatment Center University Hospital of the State University of Londrina (CTQ/HU/UEL) and editing the video. Results: An educational video that addresses the hypertrophic scarring, the placement of the compression garment, clarification of doubts and care tips was obtained. Conclusion: The development of educational technologies targeted to the treatment of burn victim patient is a great challenge and there is an urgent need to develop new materials.


Subject(s)
Humans , Burns , Cicatrix, Hypertrophic , Health Education , Physical Therapy Specialty , Rehabilitation , Audiovisual Aids/standards , Stockings, Compression
14.
Rev. enferm. UERJ ; 22(4): 482-488, jul.-ago. 2014. tab
Article in Portuguese | LILACS, BDENF | ID: lil-748728

ABSTRACT

Buscou-se verificar se profissionais de enfermagem usam meias de compressão elásticas (MCE), visando à proteçãoe promoção da saúde; identificar o que leva esses profissionais a usarem ou não MCE; discutir os achados e suas implicações para a saúde desses trabalhadores. Estudo descritivo-exploratório, quantitativo, realizado em unidade de emergência do Rio deJaneiro - Brasil, entre abril de 2012 e outubro de 2013. Participaram 40 sujeitos, entre enfermeiros e técnicos de enfermagem. Os resultados indicaram que 20% usam MCE, 12,5% dos quais o fazem conforme o preconizado em literatura. Emergiu a categoria temática ‘Cuidam e esquecem de se cuidar - o desconhecimento dos benefícios do uso de MCE’. Os sujeitos justificam o não uso de MCE por considerarem o seu alto custo e o desconhecimento dos seus benefícios, apontado pela maioria dos profissionais. Concluiu-se que os elevados custos associados ao desconhecimento desses recursos determinam a não utilização das MCE.


Objectives were [1] to assess the use of compression hosiery by nurses for health protection and promotion; [2] toidentify whether or not and why or why not those professionals wear compression hosiery; and [3] to discuss the implications of the findings to the health of those professionals. This is a descriptive exploratory study on the basis of a quantitative method, developed in an emergency unit of Rio de Janeiro, RJ, Brazil, from April, 2012 to October, 2013. It included 40 subjects, including nurses and nursing staff and the results indicated that only 20% of the population in the study wear compression hosiery and only 12.5% of those follow literature for hosiery wear. High product cost accounted for not wearing compression hosiery. An analysis category emerged ‘Care and forget to take self-care - ignoring benefits of use of compression hosiery’. Subjects explained non-use on the basis of their high cost as well as for ignoring benefits, acknowledged by most professionals. Conclusions show that both high cost and ignorance of effects of compression hosiery wear determine non-use by those professionals.


Se buscó verificar se profesionales de enfermería usan medias elásticas de compresión (MCE), mirando a la protecejón y promoción de la salud; Identificar lo que lleva eses profesionales a usar o no MCE; Discutir los hallazgos y sus implicacionespara la salud de eses trabajadores. Estudio descriptivo-exploratorio, cuantitativo, hecho em unidad de emergência de Rio de Janeiro – Brasil, entre abril de 2012 y octubre de 2013. Participaron 40 sujetos, entre enfermeros y técnicos de enfermería. Los resultados indicaron que 20% usan MCE, 12,5 de los cuales lo hacen según es preconizado em literatura. Emergió la categoría temática. Cuidan y olvidan de cuidarse – el desconocimiento de los benefícios del uso de MCE. Los sujetos justifican no usar MCE por considerar su alto costo y por desconocer sus benefícios, todo eso apuntado por la mayoría de los professionales. Seconcluyó que el costo elevado asociado al desconocimiento de esos recursos determinan la no utilización de las MCE.


Subject(s)
Humans , Male , Female , Self Care , Nursing Care , Nurses, Male , Stockings, Compression , Health Promotion , Occupational Health , Brazil , Epidemiology, Descriptive
15.
Article in English | WPRIM | ID: wpr-106551

ABSTRACT

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.


Subject(s)
Baths , Catheter Ablation , Catheters , Consensus , Heparin , Knee Joint , Lidocaine , Saphenous Vein , Sclerotherapy , Skin , Stockings, Compression , Swimming , Thrombosis , Varicose Veins , Walking
16.
Article in English | WPRIM | ID: wpr-112286

ABSTRACT

PURPOSE: Deep vein thrombosis (DVT) is a severe and common complication that occurs after the major operation. Despite the commonality of DVT there is limited data on the incidence of DVT after kidney transplantation (KT). Furthermore, most studies have been retrospective in design and were conducted in western countries. The aim of this study was to evaluate the incidence of lower extremity DVT with mechanical thromboprophylaxis within 1 month of KT in Korea. METHODS: A total of 187 consecutive patients who underwent KT were included in this study. Patients used a graduated elastic stocking (n = 93) or an intermittent pneumatic compression device (n = 94) to prevent DVT. The frequency of DVT during the first month after KT was evaluated using serial color duplex ultrasound on postoperative days 7 +/- 2, 14 +/- 2, and 28 +/- 3. All patients were tested for eight thrombophilic factors before KT. RESULTS: DVT occurred in four patients (2.1%) during the first month after KT. All DVT developed in the graduated elastic stocking group. Interestingly, none of the patients had the factor V Leiden mutation or the prothrombin gene 20210A mutation. CONCLUSION: The incidence of DVT in this study was relatively lower than that of western populations. We did not encounter a factor V Leiden mutation or a prothrombin gene 20210A mutation in our study population. These findings suggest that inherited thrombophilic risk factors may be partially responsible for the difference in DVT incidence rates between different nationalities and/or ethnicities.


Subject(s)
Ethnic Groups , Factor V , Humans , Incidence , Kidney Transplantation , Korea , Lower Extremity , Prothrombin , Retrospective Studies , Risk Factors , Stockings, Compression , Ultrasonography , Venous Thrombosis
17.
Chinese Journal of Oncology ; (12): 39-42, 2014.
Article in Chinese | WPRIM | ID: wpr-329002

ABSTRACT

<p><b>OBJECTIVE</b>The aim of this study was to compare the efficacy of low molecular weight heparin (LMWH) combined with graduated compression stockings (GCS) with GCS alone as prophylactic measures for venous thromboembolism (VTE) in post-operative patients with gynecologic cancer.</p><p><b>METHODS</b>Patients diagnosed with gynecologic cancer undergoing primary major surgery between 2010 and 2011 in our institute were randomized to receive LMWH+GCS or GCS as VTE prophylaxis post-operatively.</p><p><b>RESULTS</b>Altogether 247 patients were enrolled. The incidence of VTE in patients treated with LMWH + GCS was significantly lower than that in patients using GCS alone (0.8% Vs. 8.1%, P = 0.01). There were no severe bleeding complications in the patients with prophylactic use of LMWH and the occurrence rate of wound dehiscence was comparable between the two groups (P > 0.05). Multivariable logistic regression analysis revealed that age over 60 years (P = 0.015) , duration of operation over 3 hours (P = 0.04) and without prophylactic use of LMWH (P = 0.02) were independent risk factors for VTE.</p><p><b>CONCLUSIONS</b>Dual prophylaxis with LMWH and GCS should be recommended for gynecologic cancer patients undergoing major surgery for its better efficacy than GCS. Prophylactic use of LMWH is safe and convenient. Patients with older age and prolonged operation time are at highest risk of developing VTE post-operatively.</p>


Subject(s)
Anticoagulants , Therapeutic Uses , Female , Genital Neoplasms, Female , General Surgery , Heparin, Low-Molecular-Weight , Therapeutic Uses , Humans , Postoperative Complications , Postoperative Period , Stockings, Compression , Venous Thromboembolism
18.
An. bras. dermatol ; 88(6,supl.1): 200-202, Nov-Dec/2013. tab, graf
Article in English | LILACS | ID: lil-696778

ABSTRACT

Kaposi's sarcoma is a multifactorial angioproliferative disorder. The herpes virus 8 human contributes to its pathogenesis, but it is uncertain whether these lesions are only reactive hyperplasia to the virus or neoplasia. Four clinical types are described: classic, endemic, iatrogenic and HIV-associated. Classic Kaposi's sarcoma has no standard staging or treatment protocols. Some studies have shown the use of compression stockings in the treatment of lymphedema associated with Kaposi's sarcoma. We report the case of a 90 year-old patient with classic Kaposi's sarcoma treated with compression stockings who showed a satisfactory response.


O sarcoma de Kaposi é uma desordem angioproliferativa de causa multifatorial. O vírus herpes 8 participa na sua patogenia, porém há dúvidas se a origem das lesões é apenas por hiperplasia reacional ao vírus ou uma neoplasia propriamente dita. Quatro tipos clínicos são descritos: clássico, endêmico, iatrogênico e associado ao HIV. O tipo clássico de sarcoma de Kaposi mantém-se sem padronização de estadiamento ou protocolos de tratamento. Há alguns estudos mostrando o uso de meias compressivas no tratamento do linfedema associado ao Kaposi Comunicamos um caso de uma paciente de 90 anos com sarcoma de Kaposi clássico tratado com meias elásticas compressivas, mostrando uma resposta satisfatória.


Subject(s)
Aged, 80 and over , Female , Humans , Stockings, Compression , Sarcoma, Kaposi/therapy , Skin Neoplasms/therapy , Follow-Up Studies , Sarcoma, Kaposi/pathology , Skin Neoplasms/pathology , Treatment Outcome
19.
Article in English | WPRIM | ID: wpr-169026

ABSTRACT

PURPOSE: Venous thromboembolism (VTE) after bariatric surgery is a significant cause of morbidity and mortality. Current modalities of thromboprophylaxis include subcutaneous injection of unfractionated or low-molecular-weight heparin (LMWH), pneumatic compression, elastic stockings, and inferior vena cava filters. Despite universal agreement on the need for thromboprophylaxis, no clear consensus has been reached regarding the best regimen and treatment duration of bariatric surgery. METHODS: From April, 2009 to December, 2011, we performed 200 bariatric surgery (191 with primary intent, 9 with revisional intent). There was no history of VTE prior to surgery. Clexane therapy was done with 4000 U SQ once daily for 2 weeks to the day before surgery. Development of VTE was assessed by direct interview, physical examination in out-patient clinic, and phone calls to patients for history taking if needed. The history taking was presented in questionnaire format. The patients were asked to state their symptoms of VTE by answering the questionnaire. The patients were followed up for a minimum of 6 months after surgery to determine the incidence of clinical VTE. RESULTS: Two-week Clexane therapy was completed in 193 patients. Clexane was stopped in 5 due to surgical related complications (4 bleeding, 1 reoperation due to leak), in 2 due to Clexane related complications (1 epistaxis, 1 metrorrhagia). Follow-up of out-patient clinic were 68%, those who could follow up by telephone were 89%. There was no evidence of VTE. CONCLUSION: A 2-week VTE prophylaxis regimen using LMWH is simple, effective and associated with a low incidence of complications.


Subject(s)
Bariatric Surgery , Collodion , Consensus , Enoxaparin , Epistaxis , Follow-Up Studies , Hemorrhage , Heparin, Low-Molecular-Weight , Humans , Incidence , Injections, Subcutaneous , Outpatients , Physical Examination , Surveys and Questionnaires , Reoperation , Stockings, Compression , Telephone , Vena Cava Filters , Venous Thromboembolism
20.
Acta paul. enferm ; 25(3): 435-440, 2012. ilus
Article in Portuguese | LILACS, BDENF | ID: lil-641576

ABSTRACT

OBJETIVO: Descrever a elaboração de um curso on-line sobre úlcera venosa, com enfoque em terapia compressiva, para capacitação de enfermeiros. MÉTODOS: O desenvolvimento do curso on-line seguiu as fases de análise, design, desenvolvimento, implementação e avaliação, baseadas no design instrucional contextualizado. RESULTADOS: O curso dividiu-se em dez módulos estruturados no ambiente virtual de aprendizagem Moodle. Caracterizou-se por uma proposta construtivista, visando ampliar a participação do aluno, disponibilizar as principais referências, revisões e consensos, bem como utilizar objetos multimídia e recursos didáticos interativos. CONCLUSÃO: O curso possibilita a capacitação profissional do enfermeiro em terapia compressiva de maneira inovadora, flexível, interativa em diversos ambientes de cuidado.


OBJECTIVE: To describe the development of an online course about venous ulcer, with a focus on compression therapy, for the educating of nurses. METHODS: The development of an online course followed the phases of analysis, design, development, implementation and evaluation, based on contextualized instructional design. RESULTS: The course was divided into ten modules structured in the Moodle virtual learning environment. It was characterized by a constructivist approach, aimed at increasing student participation, to provide principal references, reviews and consensus, and to utilize multimedia objects and interactive educational resources. CONCLUSION: The course provides professional nursing education in compression therapy in an innovative, flexible, interactive manner in various care settings.


OBJETIVO: Describir la elaboración de un curso online sobre úlcera venosa, con enfoque en terapia compresiva, para la capacitación de enfermeros. MÉTODOS: El curso online se desarrolló siguiendo las fases de análisis, diseño, desarrollo, implementación y evaluación, basadas en el diseño instruccional contextualizado. RESULTADOS: El curso se dividió en diez módulos estructurados en el ambiente virtual de aprendizaje Moodle. Se caracterizó por una propuesta constructivista, pretendiendo ampliar la participación del alumno, poner a disposición las principales referencias, revisiones y consensos, así como utilizar objetos multimedia y recursos didácticos interactivos. CONCLUSIÓN: El curso permite la capacitación profesional del enfermero en terapia compresiva de manera innovadora, flexible, interactiva en diversos ambientes de cuidado.


Subject(s)
Compression Bandages , Education, Distance , Education, Nursing , Nursing Informatics , Online Systems , Professional Training , Stockings, Compression , Varicose Ulcer/therapy
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