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1.
Article in Spanish | LILACS, CUMED | ID: biblio-1341400

ABSTRACT

Introducción: En los últimos años se ha comprobado que el riesgo de trombosis en pacientes con enfermedades oncohematológicas es elevado. Presentación del caso: Paciente masculino de 51 años de edad, con diagnóstico de leucemia promielocítica, recibió tratamiento de inducción con trióxido de arsénico y ya alcanzada la remisión morfológica de la leucemia, y sin antecedentes personales ni familiares de eventos trombóticos, presentó una trombosis venosa profunda del miembro inferior izquierdo, se trató con heparina de bajo peso molecular y warfarina. Conclusiones: El paciente evolutivamente tuvo una evolución favorable del evento trombótico y se alcanzó la remisión completa hematológica, citogenética y molecular con una adecuada calidad de vida que permitió su reinserción a su vida personal, familiar y social(AU)


Introduction: In recent years it has been proven that the risk of thrombosis in patients with oncohematological diseases has increased. Case presentation: A 51-year-old male patient, diagnosed with Promyelocytic Leukemia, received induction treatment with arsenic trioxide and the morphological remission of the leukemia had already been achieved and with no personal or family history of thrombotic events, presented a deep vein thrombosis of the left lower limb. He was treated with low molecular weight heparin and warfarin. Conclusions: The patient progressively had a favorable evolution of the thrombotic event and complete hematological, cytogenetic and molecular remission was achieved with an adequate quality of life that allowed his reinsertion into his personal, family and social life(AU)


Subject(s)
Humans , Male , Middle Aged , Leukemia, Promyelocytic, Acute/complications , Thrombophilia/prevention & control , Venous Thrombosis/complications
2.
Rev. cuba. med ; 58(4): e894, oct.-dic. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139033

ABSTRACT

En este trabajo se presentó a un paciente de 32 años que ingresó por pérdida de peso, decaimiento, orinas turbias y dolor en región inguinal derecha. Se describió la evolución clínica, los estudios imagenológicos y de laboratorio que permitieron diagnosticar la presencia del Síndrome de Behçet. Los principales signos presentados por el paciente fueron: ulceraciones bucales recurrentes, la presencia de uveítis anterior y trombosis venosas profundas en miembros inferiores. El cuadro clínico del paciente y la valoración conjunta de varias especialidades médicas constituyeron los factores claves para establecer el diagnóstico definitivo. La evolución del paciente fue satisfactoria con el tratamiento de prednisona y anticoagulantes(AU)


This paper reports a 32-year-old male patient who was hospitalized for weight loss, decay, cloudy urine and pain in the right inguinal region. The clinical evolution, imaging and laboratory studies allowed diagnosing Behçet Syndrome. The patient showed main signs as recurrent mouth ulcerations, anterior uveitis and deep vein thrombosis in the lower limbs. The clinical condition of this patient and the joint assessment of various medical specialties were the key factors in establishing the definitive diagnosis. The patient´s evolution was satisfactory treated with prednisone and anticoagulants(AU)


Subject(s)
Humans , Male , Adult , Prednisone/therapeutic use , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Behcet Syndrome/drug therapy , Oral Ulcer/etiology , Venous Thrombosis/complications , Lower Extremity/physiopathology
3.
Rev. bras. cir. plást ; 34(3): 310-314, jul.-sep. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1047144

ABSTRACT

Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.


Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.


Subject(s)
Humans , Female , Adult , History, 21st Century , Patients , Pulmonary Embolism , Surgery, Plastic , Breast , Medical Records , Retrospective Studies , Embolism and Thrombosis , Venous Thrombosis , Patients/statistics & numerical data , Pulmonary Embolism/surgery , Pulmonary Embolism/complications , Surgery, Plastic/statistics & numerical data , Breast/surgery , Medical Records/statistics & numerical data , Embolism and Thrombosis/surgery , Venous Thrombosis/surgery , Venous Thrombosis/complications
4.
Rev. cuba. med ; 58(2): e78, abr.-jun. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139016

ABSTRACT

En la actualidad la trombosis venosa cerebral (TVC) se considera un reto diagnóstico y terapéutico, debido a la alta variabilidad de presentación y a la falta de un consenso terapéutico claro. Representa 0,5 por ciento de los ictus y afecta con mayor frecuencia a sujetos jóvenes con factores de riesgo congénitos o adquiridos. Tiene manifestaciones clínicas variables que unidas a un estudio de neuroimagen adecuado, permiten realizar el diagnóstico. Se presenta un caso con el objetivo de describir la evolución clínico-radiológica de una paciente puérpera adolescente, con trombosis venosa cerebral que además tuvo un angioma venoso cerebral interauricular, que a los 21 días del puerperio presenta cefalea de moderada intensidad en región occipital y posteriormente hemiparesia derecha, con recuperación del defecto en 42 h. Se diagnóstica por Angio-TAC trombosis de seno recto, venas de galeno y venas cerebrales internas con evolución favorable luego de tratamiento anticoagulante(AU)


Cerebral venous thrombosis (CVT) is currently considered a diagnostic and therapeutic challenge, due to the high variability of presentation and the lack of a clear therapeutic consensus. It represents 0.5 percent of strokes and most frequently affects young subjects with congenital or acquired risk factors. The variable clinical manifestations, together with an adequate neuroimaging study, allow diagnosis. We report this case aiming to describe the clinical-radiological evolution of a postpartum adolescent patient with cerebral venous thrombosis who also had an interatrial cerebral venous angioma. She had moderate headache in the occipital region and, later, in right hemiparesis, 21 days after the puerperium. the defect was solved in 42 h. Thrombosis of the right sinus, veins of galen and internal cerebral veins was diagnosed by CT angiography. Favorable evolution was achieved after anticoagulant treatment(AU)


Subject(s)
Humans , Female , Pregnancy , Adolescent , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Computed Tomography Angiography/methods , Anticoagulants/therapeutic use
5.
J. vasc. bras ; 18: e20180107, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1012631

ABSTRACT

O tromboembolismo venoso (TEV), que compreende o espectro de manifestações de trombose venosa profunda e/ou embolia pulmonar, é uma complicação comum, grave e evitável em pacientes hospitalizados. Embora a perda da mobilidade recente ou continuada represente um dos principais fatores de risco relacionados ao desenvolvimento de TEV, não existem critérios claros e uniformes para a definição do conceito de imobilidade. A diversidade dessas descrições dificulta a interpretação e a comparação dos resultados de estudos clínicos randomizados no que se refere à influência dos diferentes níveis de imobilidade na magnitude do risco de TEV e ao papel da deambulação precoce, de forma isolada, na prevenção de tais eventos. O entendimento dessas limitações é mandatório para a utilização e interpretação adequadas das ferramentas de avaliação de risco de TEV, e para a indicação da melhor estratégia de prevenção de trombose em pacientes clínicos hospitalizados. O objetivo deste estudo é revisar as principais evidências da literatura quanto ao papel da deambulação na prevenção do TEV


Venous thromboembolism (VTE) encompasses the spectrum of manifestations of deep venous thrombosis and/or pulmonary embolism and is a common, serious, and preventable complication in hospitalized patients. Although immobility plays an important role in determining VTE risk in medical patients, no clear and uniform criteria exist to guide clinicians in assessing immobility. The variation in the descriptions that do exist makes it difficult to interpret and compare the results of randomized clinical trials with respect to the influence of different levels of immobility on the magnitude of VTE risk and the role that early ambulation as an isolated factor plays in prevention of such events. Understanding these limitations is a prerequisite for the proper use and interpretation of VTE risk assessment tools and for indicating the best strategy for preventing venous thrombosis in hospitalized medical patients. The objective of this study was to review the main evidence reported in the literature on the role of ambulation in prevention of VTE


Subject(s)
Humans , Male , Female , Adult , Patients , Walking , Venous Thromboembolism/prevention & control , Pulmonary Embolism/therapy , Thrombolytic Therapy/methods , Acute Disease/therapy , Risk Factors , Venous Thrombosis/complications , Venous Thrombosis/diagnosis , Mobility Limitation , Patient Safety
6.
Bol. méd. postgrado ; 34(2): 7-11, Jul-Dic. 2018. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1120809

ABSTRACT

El objetivo fue describir la utilidad del modelo de Khorana como estratificador de riesgo de enfermedad tromboembólica venosa (ETV) en pacientes oncológicos hospitalizados en el Servicio de Medicina del Hospital Central Universitario Dr. Antonio María Pineda en el lapso de febrero ­ abril 2018. La muestra estuvo constituida por 20 pacientes a quienes se le aplicó una ficha técnica con el fin de caracterizar la edad, sexo, localización y la estirpe tumoral en pacientes con ETV, el tipo de enfermedad tromboembólica desarrollada e individualmente cada una de las variables incluidas en el modelo de Khorana. Los resultados obtenidos fueron: predominio del sexo femenino con respecto al masculino (1:0,3), promedio de edad entre 52,9 ± 13,1 años, mayor porcentaje de localización del cáncer fue el sistema ginecológico (30%), seguido del sistema digestivo (25%) y estirpe tumoral predominantemente carcinoma (82,3%). Según el tipo de ETV el mayor porcentaje de pacientes presentó trombosis venosa profunda en miembro inferior izquierdo (65%) y tromboembolismo pulmonar (20%). Según el modelo de Khorana, 55% de los pacientes presentaron riesgo intermedio y 45% riesgo alto. El uso del modelo de Khorana permitió estratificar al mayor porcentaje de pacientes en riesgo intermedio y todos dentro de riesgo intermedio/alto, por lo que el uso de éste constituye una herramienta útil y aplicable en la estratificación de riesgo de ETV(AU)


The goal of this study was to describe the utility of the Khorana model as a risk stratifier for venous thromboembolic disease (VTE) in oncological patients hospitalized in the Servicio de Medicina of the Hospital Central Universitario Dr. Antonio María Pineda during the period February-April 2018. 20 patients were evaluated. The results showed predominance of female sex (1:0.3) with an average age of 52.9 ± 13.1 years. Regarding the location of cancer, the highest percentage (30%) was gynecological followed by digestive (25%) and hematological (15%). According to the histological type of tumor, the highest percentage was carcinoma (82.3%). The distribution of patients according to the type of VTE was deep vein thrombosis in the left lower limb in 65% of cases and pulmonary thromboembolism in 20% of cases. According to the Khorana model, 55% of patients were stratified in the intermediate risk group and 45% in the high-risk group. The use of the Khorana model allowed stratification of most patients at intermediate risk and all within intermediate/high risk. The use of the Khorana model constitutes a useful and applicable tool in the risk stratification of VTE(AU)


Subject(s)
Humans , Male , Female , Venous Thrombosis/complications , Drug Therapy , Neoplasms , Pulmonary Embolism , Medical Oncology
7.
Rev. chil. pediatr ; 89(5): 621-629, oct. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978134

ABSTRACT

Resumen: Introducción: La trombosis venosa intracraneal (TVI) es una condición infrecuente y poco estudiada en población pediátrica. Objetivos: Describir y comparar características clínicas/radiológicas de ni ños no neonatos con TVI según edad y analizar la asociación de estas variables con deterioro funcio nal al alta o mortalidad aguda. Metodología: Estudio observacional de una cohorte de niños > 30 días con una primera TVI diagnosticada con imágenes/venografía por resonancia magnética encefálica. Medimos funcionalidad con la escala modificada de Rankin definiendo compromiso funcional mar cado con 3 a 5 puntos. Comparamos los promedios de edades entre grupos con y sin las diferentes variables estudiadas con la prueba U-Mann-Whitney (significancia < 0,05). Realizamos análisis de regresión logística para estimar el riesgo de resultado adverso de cada variable expresado en Odds Ra tios (ORs) e intervalos de confianza (IC) al 95%. Resultados: De 21 pacientes, 42.8% eran niñas, me diana de edad 6,27 años (rango intercuartil: 0,74-10). El promedio de edad fue menor en niños con retardo diagnóstico > 48 h (p = 0,041), puntaje < 12 en la escala coma de Glasgow (p = 0,013), crisis epilépticas (p = 0,041), trombosis de seno recto (p = 0,011) y hemorragia intracraneal (p = 0,049); mientras que fue mayor en niños con síndrome de hipertensión endocraneal (p = 0,008). La presen cia de alguna condición crónica sistémica (OR = 11,2; IC = 1,04-120,4), TVI profunda (OR = 14; IC = 1,3-150,8) e infarto encefálico (OR = 15,8; IC = 1,4-174,2) se asoció a compromiso funcional marcado o mortalidad al alta. Conclusiones: Las características clínicas/radiológicas de la TVI varían según la edad. Las patologías crónicas, compromiso del sistema venoso profundo e infarto encefálico predicen mal pronóstico a corto plazo.


Abstract: Introduction: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. Objectives: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. Methodology: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). Results: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. Conclusions: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cerebral Veins/diagnostic imaging , Magnetic Resonance Imaging , Venous Thrombosis/diagnosis , Neuroimaging , Prognosis , Logistic Models , Cohort Studies , Age Factors , Venous Thrombosis/complications , Venous Thrombosis/mortality
8.
Rev. chil. radiol ; 24(3): 94-104, jul. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978162

ABSTRACT

La hemorragia subaracnoidea (HSA) no traumática es un subtipo de ictus hemorrágico que representa aproximadamente el 5% de todos los accidentes vasculares encefálicos (AVE). El 85% de los casos de HSA espontánea (no traumática) son secundarios a un aneurisma intracraneano roto, el 10% a hemorragia perimesencefálica no aneurismática y el otro 5% a otras causas. Entre estas se incluyen malformaciones arterio-venosas, fístulas durales, vasculits, trombosis de vena cortical, síndrome de vasoconstricción reversible, angiopatía amiloidea y síndrome de encefalopatía posterior reversible. La aproximación inicial a una HSA no traumática requiere un estudio angiográfico no invasivo con tomografía computada para la toma de decisiones terapéuticas. Si no se detecta un aneurisma sacular intradural que explique el sangrado, las conductas a seguir dependerán del patrón de distribución de la sangre. En esta revisión sugerimos una aproximación basada en 1) revisar el estudio inicial tomando en cuenta los puntos ciegos para la detección de aneurismas, 2) analizar el patrón de distribución de la sangre y 3) analizar los hallazgos en imágenes de acuerdo a las posibles causas según patrón.


Non-traumatic subarachnoid hemorrhage represents approximately 5% of strokes. From these, 85% of nontraumatic subarachnoid hemorrhage are secondary to a ruptured aneurysm, 10% to nonaneurysmal perimesencephalic hemorrhage and the other 5% to other causes. These include but are not limited to arteriovenous malformations, dural fistulae, vasculitis, cortical vein thrombosis, reversible cerebral vasoconstriction syndrome, amyloid angiopathy and posterior reversible encephalopathy syndrome. Initial workup of nontraumatic subarachnoid hemorrhage requires a non-enhanced CT and CT angiography for decision making and management. If there is no aneurysm as a source of hemorrhage, subsequent imaging studies will depend on blood distribution pattern. In this review we suggest an approach: 1) review blind spots for aneurysm detection in the initial CT angiography, 2) analyze blood distribution pattern and 3) evaluate imaging findings and possible causes according to each pattern.


Subject(s)
Humans , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/diagnostic imaging , Vasculitis/complications , Intracranial Aneurysm/complications , Cerebral Amyloid Angiopathy/complications , Venous Thrombosis/complications , Computed Tomography Angiography
9.
Yonsei Medical Journal ; : 162-166, 2018.
Article in English | WPRIM | ID: wpr-742488

ABSTRACT

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.


Subject(s)
Adolescent , Chronic Disease , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/diagnostic imaging , Esophageal and Gastric Varices/therapy , Female , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Humans , Jejunum/pathology , Portacaval Shunt, Surgical , Portal Vein/diagnostic imaging , Portal Vein/pathology , Portal Vein/surgery , Tomography, X-Ray Computed , Treatment Outcome , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapy
10.
Rev. med. interna Guatem ; 21(3): 18-21, ago.-oct. 2017.
Article in Spanish | LILACS | ID: biblio-996083

ABSTRACT

Antecedentes: La enfermedad tromboembólica venosa (ETV) es catalogada como la causa prevenible más frecuente de muerte hospitalaria y la tercer causa de morbilidad se ha calculado que en EEUU pueden existir 600,000 casos anuales. Metodología: Estudio descriptivo transversal con el objetivo de identificar pacientes con factores de riesgo para desarrollar ETV y no tienen profilaxis en servicios de medicina interna, ortopedia y cirugía del Hospital Roosevelt en agosto, 2016. Resultados: Se incluyeron 124 pacientes, 75/124 (60.4%) son de sexo masculino. El promedio de la edad fue de 44 años, rango de 14 ­ 87, 40/124 (32.2%) tenían indicación de reposo absoluto, 80/124 (64.5%) eran pacientes quirúrgicos, 16/124 (12.9%) tenían cáncer, 110/124 (88.7%) pacientes no recibieron profilaxis. Doce de 124 pacientes (9.6%) tenían al menos un factor de riesgo, 8/124 (6.4%) tenían 2 factores de riesgo, 16/124 (12.9%) tenían 3 factores de riesgo y 80/124 (64.5%) tenían 4 o más factores de riesgo. Conclusiones: Todos los pacientes encuestados poseen al menos un factor de riesgo para ETV, de los cuales 88.7% no recibe profilaxis...(AU)


Background: Venous thromboembolic disease (VTE) is listed as the most frequent preventable cause of hospital death and the third cause of morbidity has been estimated that in the US there may be 600,000 cases per year. Methodology: Cross-sectional descriptive study with the objective of identifying patients with risk factors to develop VTE and have no prophylaxis in services of internal medicine, orthopedics and surgery of the Roosevelt Hospital in August, 2016. Results: 124 patients were included, 75/124 ( 60.4%) are male. The average age was 44 years, range of 14 - 87, 40/124 (32.2%) had absolute rest indication, 80/124 (64.5%) were surgical patients, 16/124 (12.9%) had cancer, 110/124 (88.7%) patients did not receive prophylaxis . Twelve of 124 patients (9.6%) had at least one risk factor, 8/124 (6.4%) had 2 risk factors, 16/124 (12.9%) had 3 risk factors and 80/124 (64.5%) had 4 or more risk factors. Conclusions: All the patients surveyed have at least one risk factor for VTE, of which 88.7% do not receive prophylaxis ... (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Venous Thrombosis/complications , Venous Thrombosis/prevention & control , Venous Thrombosis/epidemiology , Epidemiology, Descriptive , Risk Factors , Guatemala
11.
J. vasc. bras ; 16(3): f:199-l:204, jul.-set. 2017. tab
Article in Portuguese | LILACS | ID: biblio-876806

ABSTRACT

Contexto: Embora preconizada, a profilaxia de tromboembolismo venoso (TEV) deixa de ser realizada sistematicamente em pacientes internados. Objetivo: Verificar se os pacientes hospitalizados recebem a prescrição correta da profilaxia de TEV do médico responsável por sua internação, conforme sua categoria de risco. Métodos: Estudo transversal com análise de prontuários de pacientes internados no Hospital Santa Casa de Misericórdia de Curitiba, PR, entre 20 de março e 25 de maio de 2015. Excluíram-se os pacientes em uso de anticoagulantes ou com sangramento ativo. Analisou-se gênero, idade, tipo de cobertura de saúde, especialidade responsável pelo paciente e fatores de risco dos pacientes para classificá-los em alto, moderado ou baixo risco para TEV. Comparou-se o uso ou não da profilaxia entre as prescrições das especialidades clínicas e cirúrgicas, pacientes internados pelo Sistema Único de Saúde (SUS) e por convênios e de acordo com seu risco para TEV. Resultados: Dos 78 pacientes avaliados, oito preencheram os critérios de exclusão. Dos 70 pacientes elegíveis (média etária 56,9 anos; 41 homens; 62 cobertos pelo SUS), 31 eram tratados por clínicos e 39 por cirurgiões. Apenas 46 (65,71%) pacientes receberam profilaxia para TEV. Dentre os pacientes clínicos, 29 (93,5%) receberam profilaxia, contra 17 (43,6%) do grupo cirúrgico (p < 0,001). Pacientes clínicos de moderado e alto risco receberam mais profilaxia que os cirúrgicos (p < 0,001 e p = 0,002). Não houve diferenças quanto à cobertura de saúde (SUS versus convênios médicos). Conclusões: No Hospital Santa Casa de Misericórdia de Curitiba, pacientes cirúrgicos estão menos protegidos de eventos tromboembólicos em relação aos clínicos


Background: Although prophylaxis to prevent venous thromboembolism is recommended, it is rarely systematically performed in hospitalized patients. Objective: To investigate whether hospitalized patients are given the correct VTE prophylaxis prescription by the physician responsible for them while in hospital, analyzed by risk category. Methods: This was a cross-sectional study based on analysis of medical records for patients admitted to the Hospital Santa Casa de Misericórdia, Curitiba, PR, Brazil, from March 20 to May 25, 2015. Patients on anticoagulants or with active bleeding were excluded. The following variables were analyzed: sex, age, type of healthcare coverage, specialty responsible for the patient, and patients' risk factors to classify them as at high, moderate, or low risk of VTE. Use or not of prophylaxis was compared across prescriptions made by clinical and surgical specialties, between patients treated on the Brazilian National Health Service (SUS - Sistema Único de Saúde) and private health insurance, and according to patients' risk of VTE. Results: Eight of the 78 patients assessed met exclusion criteria. The remaining 70 eligible patients had a mean age of 56.9 years, 41 were male, 62 were treated on the SUS, 31 were treated by clinicians, and 39 were treated by surgeons. Just 46 (65.71%) patients were given prophylaxis for VTE. Among the clinical patients, 29 (93.5%) were given prophylaxis, against 17 (43.6%) in the surgical group (p < 0.001). Moderate and high risk clinical patients were more likely to be given prophylaxis than surgical patients (p < 0.001 and p = 0.002). There were no differences with relation to type of healthcare coverage (SUS vs. private healthcare). Conclusions: At the Hospital Santa Casa de Misericórdia in Curitiba, surgical patients are less well protected from thromboembolic events than clinical patients


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Disease Prevention , Patients , Venous Thromboembolism/complications , Age Factors , Cross-Sectional Studies , Drug Therapy/methods , Heparin/administration & dosage , Hospitalization , Risk Factors , Venous Thrombosis/complications , Venous Thrombosis/diagnosis
12.
Rev. bras. anestesiol ; 67(3): 305-310, Mar.-June 2017. graf
Article in English | LILACS | ID: biblio-843401

ABSTRACT

Abstract Introduction Cerebral venous thrombosis (CVT) is a rare but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia and had postoperative headache complicated with CVT. Case report Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged on the eighth day without sequelae. Discussion Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to CVT in some patients with prothrombotic conditions.


Resumo Introdução: A trombose venosa cerebral (TVC) é uma complicação rara, mas grave, após raquianestesia. Está frequentemente relacionada com a presença de fatores predisponentes, como gestação, puerpério, uso de contraceptivos orais e doenças malignas. O sintoma mais frequente é a cefaleia. Descrevemos um caso de um paciente submetido à raquianestesia que apresentou cefaleia no período pós-operatório complicada com TVC. Relato de caso: Paciente de 30 anos, ASA 1, submetido à cirurgia de artroscopia de joelho sob raquianestesia, sem intercorrências. Quarenta e oito horas após o procedimento apresentou cefaleia frontal, ortostática, que melhorava com o decúbito. Foi feito diagnóstico de sinusite em pronto socorro geral e recebeu medicação sintomática. Nos dias subsequentes teve pioria da cefaleia, que passou a ter localização holocraniana e mais intensa e com pequena melhora com o decúbito dorsal. Evoluiu com hemiplegia esquerda seguida de convulsões tônico-clônicas generalizadas. Foi submetido à ressonância magnética com venografia que fez o diagnóstico de TVC. A pesquisa para fatores pró-coagulantes identificou a presença de anticorpo lúpico. Recebeu como medicamentos anticonvulsivantes e anticoagulantes e teve alta hospitalar em oito dias, sem sequelas. Discussão: Qualquer paciente que apresente cefaleia postural após uma raquianestesia, e que intensifica após um platô, perca sua característica ortostática ou se torne muito prolongada, deve ser submetido a exames de imagem para excluir complicações mais sérias como a TVC. A perda de líquido cefalorraquidiano leva à dilatação e à estase venosa, que, associadas à tração provocada pela posição ereta, podem, em alguns pacientes com estados protrombóticos, levar à TVC.


Subject(s)
Humans , Male , Adult , Venous Thrombosis/etiology , Intracranial Thrombosis/etiology , Post-Dural Puncture Headache/etiology , Anesthesia, Spinal/adverse effects , Venous Thrombosis/complications , Intracranial Thrombosis/complications , Post-Dural Puncture Headache/complications
13.
J. vasc. bras ; 16(2): f:104-l:112, abr.-jun. 2017. ilus, tab, graf
Article in Portuguese | LILACS | ID: biblio-859594

ABSTRACT

Contexto: Os cateteres venosos centrais de inserção periférica (PICC) são dispositivos intravenosos, introduzidos através de uma veia superficial ou profunda da extremidade superior ou inferior até o terço distal da veia cava superior ou proximal da veia cava inferior. Apresentam maior segurança para infusão de soluções vesicantes/irritantes e hiperosmolares, antibioticoterapia, nutrição parenteral prolongada (NPT) e uso de quimioterápicos; demonstram reduzido risco de infecção em comparação a outros cateteres vasculares e maior relação custo/benefício se comparados ao cateter venoso de inserção central (CVCIC). Objetivos: Apresentar os resultados de implantes de PICCs ecoguiados e posicionados por fluoroscopia realizados no Hospital e Maternidade São Luiz (HMSL) Itaim, Rede D'or, Brasil. Métodos: Estudo prospectivo, não randomizado, realizado entre fevereiro de 2015 e novembro de 2016. Utilizou-se protocolo pré-estabelecido pela instituição em casos de solicitação de acesso vascular. Foram analisadas indicações, doenças prevalentes, tipo do cateter implantado, sucesso técnico, complicações relacionadas ao cateter, e estabelecidos critérios de inclusão e exclusão. Resultados: Solicitados 256 acessos vasculares, sendo implantados 236 PICCs (92,1%) e 20 CVCICs (7,9%). Principais indicações: antibioticoterapia prolongada (52,0%), NPT (19,3%) e acesso venoso difícil (16,0%). Houve sucesso técnico em 246 cateteres implantados (96,1%). A veia basílica direita foi a principal veia puncionada em 192 pacientes (75,0%), seguida da braquial direita em 28 pacientes (10,9%). Conclusões: O implante dos PICCs ecoguiados e posicionados por fluoroscopia demonstrou baixa incidência de complicações, reduzidos índices de infecção e é seguro e eficaz em casos de acessos vasculares difíceis, sendo esses cateteres considerados dispositivos de escolha em acesso vascular central


Background: Peripherally inserted central catheters (PICC) are intravenous devices inserted through a superficial or deep vein of an upper or lower extremity and advanced to the distal third of the superior vena cava or proximal third of the inferior vena cava. They offer the advantages of greater safety for infusion of vesicant/irritant and hyperosmolar solutions and enable administration of antibiotics, prolonged parenteral nutrition (PPN), and chemotherapy agents. They also involve reduced risk of infection compared to other vascular catheters and are more cost-effective than centrally inserted venous catheters (CICVC). Objectives: To present the results of our team's experience with US-guided and fluoroscopy-positioned PICC placement at the Hospital and Maternidade São Luiz (HMSL) Itaim, Rede D'or, Brazil. Methods: This was a prospective, non-randomized study, conducted from February 2015 to November 2016. The institution's preestablished protocol was followed when vascular access was requested. Indications, prevalent diseases, type of catheter implanted, technical success, and complications related to the catheters were analyzed and inclusion and exclusion criteria are described. Results: A total of 256 vascular accesses were requested, and 236 PICCs (92.1%) and 20 CICVCs (7.9%) were implanted. The main indications were as follows: prolonged antibiotic therapy (52%), PPN (19.3%), and difficult venous access (16%). Technical successes was achieved in 246 catheter placements (96.1%). The right basilic vein was the most common vein punctured for access, in 192 patients (75%), followed by the right brachial vein, in 28 patients (10.9%). Conclusions: Ultrasound-guided and fluoroscopy-positioned PICC placement had a low incidence of complications, reduced infection rates, and proved safe and effective in cases of difficult vascular access. PICCs can be considered the devices of choice for central vascular access


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Catheters , Central Venous Catheters/adverse effects , Fluoroscopy/methods , Prevalence , Prospective Studies , Prostheses and Implants , Surgical Procedures, Operative/methods , Treatment Outcome , Upper Extremity , Vena Cava, Superior , Venous Thrombosis/complications , Venous Thrombosis/diagnosis
14.
J. vasc. bras ; 16(2): f:128-l:139, abr.-jun. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-859607

ABSTRACT

O acesso ao sistema venoso, seja para coleta de amostras de sangue ou para infusão de soluções, é de vital importância para o diagnóstico e tratamento de pacientes com as mais variadas condições clínicas. Desde que Harvey, em 1616, descreveu o sistema circulatório a partir de estudos em animais e que Sir Christopher Wren, 4 décadas depois, realizou a primeira infusão endovenosa em seres vivos, a evolução na técnica de acesso e nos dispositivos para infusão tem sido constante. Merece destaque a criação dos cateteres de longa duração na década de 1970, em especial os totalmente implantáveis, que revolucionaram o tratamento do câncer, aumentando a segurança e o conforto dos pacientes oncológicos. Este artigo tem como objetivo a revisão de dados históricos relativos ao acesso vascular e a discussão da técnica de implante e das principais complicações associadas ao procedimento de colocação e ao uso dos cateteres totalmente implantáveis


Access to the venous system is of vital importance for diagnosis and treatment of patients with the most varied range of clinical conditions, whether for taking blood samples or for infusion of solutions. In 1616, Harvey described the circulatory system on the basis of studies in animals and 4 decades later Sir Christopher Wren conducted the first intravenous infusions in living beings. Since then there has been constant evolution in access technique and infusion devices. Of particular note is the creation of long-term catheters in the 1970s, particularly totally implantable devices, which revolutionized cancer treatment, increasing both safety and comfort for oncology patients. The objectives of this article are to review historical data on vascular access and discuss the implantation technique and the main complications associated with procedures for placement and use of totally implantable venous access devices


Subject(s)
Humans , Male , Female , Blood Vessels/physiology , Central Venous Catheters , Prostheses and Implants/adverse effects , Prostheses and Implants/history , Vascular Access Devices/history , Catheters , Femoral Vein/physiology , Infections , Neoplasms/therapy , Ultrasonography, Interventional/methods , Veins/physiology , Venous Thrombosis/complications , Venous Thrombosis/therapy
15.
Ann. hepatol ; 16(2): 236-246, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-887228

ABSTRACT

ABSTRACT Introduction. To identify the impact of portal vein thrombosis (PVT) and associated medical and surgical factors on outcomes post liver transplant (LT). Material and methods. Two analyses were performed. Analysis One: cohort study of 505 consecutive patients who underwent LT (Alberta) between 01/2002-12/2012. PVT was identified in 61 (14%) patients. Analysis Two: cohort study of 144 consecutive PVT patients from two sites (Alberta and London) during the same period. Cox multivariable survival analysis was used to identify independent associations with post-LT mortality. Results. In Analysis One (Alberta), PVT was not associated with post-LT mortality (log rank p = 0.99). On adjusted analysis, complete/occlusive PVT was associated with increased mortality (Hazard Ratio (HR) 8.4, p < 0.001). In Analysis Two (Alberta and London), complete/occlusive PVT was associated with increased mortality only on unadjusted analysis (HR 3.7, p = 0.02). On adjusted analysis, Hepatitis C (HR 2.1, p = 0.03) and post-LT portal vein re-occlusion (HR 3.2, p = 0.01) were independently associated with increased mortality. Conclusion: Well-selected LT patients who had PVT prior to LT had similar post-LT outcomes to non-PVT LT recipients. Subgroups of PVT patients who did worse post-LT (complete/occlusive thrombosis pre-LT, Hepatitis C or post-LT portal vein re-occlusion) warrant closer evaluation in listing and management post-LT.


Subject(s)
Portal Vein , Liver Transplantation , Venous Thrombosis/complications , End Stage Liver Disease/surgery , Liver Cirrhosis/surgery , Portal Vein/diagnostic imaging , Time Factors , Chi-Square Distribution , Proportional Hazards Models , Multivariate Analysis , Retrospective Studies , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Treatment Outcome , Hepatitis C/complications , Venous Thrombosis/surgery , Venous Thrombosis/mortality , Venous Thrombosis/diagnostic imaging , Kaplan-Meier Estimate , End Stage Liver Disease/diagnosis , End Stage Liver Disease/mortality , End Stage Liver Disease/virology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/mortality , Liver Cirrhosis/virology
16.
J. vasc. bras ; 16(1): f:60-l:62, Jan.-Mar. 2017.
Article in Portuguese | LILACS | ID: biblio-841406

ABSTRACT

Resumo Algumas infecções virais sistêmicas podem estar relacionadas ao desenvolvimento de trombose venosa profunda e/ou embolia pulmonar. Essa associação já está bem descrita em pacientes com infeções pelo vírus da imunodeficiência humana (HIV), hepatite C ou influenza. Recentemente introduzido no continente americano, o vírus chicungunha, agente etiológico da febre de chicungunha, ainda não tem essa relação bem sedimentada, mas com o aumento progressivo de sua incidência e pelo fato dessa infecção causar, muitas vezes, uma restrição severa da locomoção por poliartralgia e uma possível lesão endotelial direta, casos de tromboembolismo venoso podem começar a ser descritos. Neste relato de caso, descrevemos um paciente que desenvolveu trombose de veia poplítea direita durante internação para tratamento de febre por infecção por vírus chicungunha e poliartralgia severa.


Abstract Some systemic viral infections can be linked to development of deep venous thrombosis and/or pulmonary embolism. This association has already been well described in patients infected by human immunodeficiency virus (HIV), hepatitis C, and influenza. The chikungunya virus is the etiologic agent of chikungunya fever and it has recently been introduced to the American continent. As yet, there is no firm foundation for a relationship between chikungunya and thromboembolism, but the progressive increase in its incidence, the fact that this infection very often causes severe locomotion restrictions due to polyathralgia, and the possibility of direct endothelial injury suggest that cases of venous thromboembolism may begin to be described. In this case report, we describe a patient who developed thrombosis of the right popliteal vein after being admitted for treatment of severe polyathralgia and fever caused by chikungunya virus infection.


Subject(s)
Humans , Male , Middle Aged , Chikungunya virus , Venous Thrombosis/complications , Aedes/parasitology , Chikungunya Fever/complications , Fever/complications , Infections/complications , Popliteal Vein
17.
Med. interna (Caracas) ; 33(4): 208-214, 2017. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1008945

ABSTRACT

La enfermedad tromboembólica venosa (TEV) en el embarazo y puerperio continúa siendo una de la primeras causas de muerte materna en los países desarrollados; su incidencia es 5 a 10 veces mayor en comparación con mujeres no embarazadas, debido a las modificaciones que el propio embarazo produce tanto en el sistema de la coagulación, como en el sistema venoso por el útero gestante. El riesgo se distribuye a lo largo de todo el embarazo, siendo el periodo de mayor riesgo las primeras 6 semanas post parto donde se incrementa 20 veces (el 80% de los eventos sucede en las primeras 3 semanas); se suman factores de riesgo como edad, multiparidad, enfermedades del colágeno, trombofilias o TEV previo, se facilita aún más la presencia de ésta. La prevención, diagnóstico y manejo terapéutico del embolismo pulmonar (TEP) en las embarazadas se ve complicado por pocos abordajes validados en esta población particular. Sin embargo, la sospecha clínica y el examen físico son de vital importancia. El valor predictivo negativo del dímero D, la angiotomografía pulmonar helicoidal con su alta sensibilidad y especificidad y el estándar de oro, la arteriografía pulmonar, son útiles para el diagnóstico definitivo. El tratamiento oportuno con heparina no fraccionada así como las de bajo peso molecular, son los medicamentos de elección sobre los antagonistas de la vitamina K, debido a sus bajos efectos adversos,vida media corta y la no circulación a la barrera feto placentaria(AU)


Venous thromboembolic disease (VTD) in pregnancy continues to be one of the leading causes of maternal death in developed countries; it's incidence is 5 to 10 times compared to non-pregnant women; this is due to the modifications that pregnancy itself produces in both the coagulation system, as well as the changes produced in the venous system by the pregnant uterus. The risk is distributed throughout the pregnancy, being the period of greatest risk the first 6 weeks postpartum where it increases 20 times (80% of events occur in the first 3 weeks) and if aditional factors such as age, multiparity, collagen diseases, thrombophilia or prior VTD, even more complicates the presence of this entity. The prevention, diagnosis and therapeutic management of pulmonary embolism (PE) in pregnant women are complicated by the scarcity of validated approaches in this particular population. However clinical suspicion, physical examination is of vital importance. The negative predictive value of D dimer, helical pulmonary angiotomography with its high sensitivity and specificity, and the gold standard pulmonary: arteriography are useful for definitive diagnosis. Timely treatment with unfractionated heparin as well as low-molecular-weight heparin are the drugs of choice for vitamin K antagonists because of their low adverse effects, short half-life, and no circulation to the fetal-placental barrier(AU)


Subject(s)
Humans , Female , Pregnancy Complications , Pulmonary Embolism/pathology , Venous Thrombosis/complications , Postpartum Period , Internal Medicine
18.
Säo Paulo med. j ; 134(4): 355-358, July-Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-792822

ABSTRACT

ABSTRACT: CONTEXT: Umbilical cord thrombosis is related to greater fetal and perinatal morbidity and mortality. It is usually associated with umbilical cord abnormalities that lead to mechanical compression with consequent vascular ectasia. Its correct diagnosis and clinical management remains a challenge that has not yet been resolved. CASE REPORT: This study reports a case of umbilical artery thrombosis that occurred in the second half of a pregnancy. The umbilical cord was long, thin and overly twisted and the fetus presented severe intrauterine growth restriction. The clinical and histopathological findings from this case are described. CONCLUSIONS: This case report emphasizes the difficulty in diagnosing and clinically managing abnormalities of intrauterine life with a high chance of perinatal complications.


RESUMO: CONTEXTO: A trombose do cordão umbilical está relacionada com o aumento da morbimortalidade fetal e perinatal. É geralmente associada a alterações do cordão umbilical que levam à compressão mecânica com consequente ectasia vascular. Seu correto diagnóstico e manejo clínico é um desafio que não está ainda bem esclarecido. RELATO DE CASO: Neste relato se descreve caso de trombose da artéria umbilical de ocorrência na segunda metade da gravidez associada a cordão umbilical longo, fino, excessivamente retorcido, associado a feto com restrição de crescimento intrauterino grave. São descritos seus achados clínicos e histopatológicos correlacionados. CONCLUSÃO: Este relato de caso reforça a dificuldade diagnóstica e de manejo clínico em alteração da vida intrauterina com grande possibilidade de complicações perinatais.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Umbilical Arteries/blood supply , Umbilical Arteries/pathology , Venous Thrombosis/pathology , Fetus/abnormalities , Pregnancy Trimester, Third , Prenatal Diagnosis , Umbilical Arteries/diagnostic imaging , Pregnancy Outcome , Risk Factors , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Fetal Growth Retardation/etiology , Fetus/diagnostic imaging
19.
J. vasc. bras ; 15(2): 126-133, tab
Article in English, Portuguese | LILACS | ID: lil-787535

ABSTRACT

CONTEXTO: O consumo de crack é um dos grandes desafios em saúde pública, e o uso dessa droga tem efeitos diretos na saúde de seus usuários. OBJETIVOS: Avaliar o perfil das alterações vasculares em pacientes com dependência de crack em Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-AD) e observar os possíveis efeitos vasculares periféricos. MÉTODOS: Trata-se de um estudo observacional, descritivo, de corte transversal. Os pacientes da amostra foram submetidos a um questionário objetivo para avaliar questões demográficas, padrão de uso da droga, coexistência de diabetes melito, hipertensão arterial ou tabagismo, exame físico e ecográfico. Os dados foram sumarizados e analisados estatisticamente com teste qui-quadrado ou teste exato de Fisher. RESULTADOS: A média de idade da amostra foi de 33,29 (±7,15) anos, e 74% eram do gênero masculino. A média de idade de início de uso da droga foi de 23,4 (±7,78) anos, com tempo médio de uso de 9,58 (±5,64) anos. O consumo médio diário de pedras de crack foi de 21,45 (±8,32) pedras. A alteração de pulsos em membros inferiores foi mais frequente em mulheres. A prevalência do espessamento da parede arterial nos membros inferiores foi de 94,8%. O tempo de uso da droga apresentou associação estatística (p = 0,0096) com alteração do padrão de curva espectral das artérias dos membros inferiores. CONCLUSÕES: Há alterações vasculares periféricas em usuários de crack. O tempo de uso da droga exerceu um maior impacto nesse sistema, o que sugere associação entre o uso do crack e a diminuição de fluxo arterial.


BACKGROUND: Consumption of crack is one of the major challenges in public health and taking this drug has direct effects on the health of those who use it. OBJECTIVES: To evaluate the profile of vascular abnormalities in patients receiving treatment for crack dependency at a Psychosocial Care Center for Alcohol and Drugs and to observe possible peripheral vascular effects. METHODS: The study design is observational, descriptive and cross-sectional. An objective questionnaire was administered to the patients in the sample to collect data on demographic details; drug use profile; and concomitant diabetes mellitus, arterial hypertension and/or smoking; and physical and ultrasound examinations were conducted. Data were summarized and analyzed statistically with the chi-square test or Fisher’s exact test. RESULTS: The mean age of the sample was 33.29 (±7.15) years, and 74% were male. Mean age at onset of drug use was 23.4 (±7.78) years and mean time since onset was 9.58 (±5.64) years. Mean consumption of crack rocks was 21.45 (±8.32) per day. The rate of abnormal lower limb pulses was higher among women. The prevalence of artery wall thickening in lower limbs was 94.8%. Time since starting to use crack exhibited a statistically significant association (p = 0.0096) with abnormalities in the spectral curve profiles of lower limb arteries. CONCLUSIONS: Crack users exhibit peripheral vascular disorders. Length of time since starting to use the drug had the greatest impact on this system, suggesting an association between crack use and reduced arterial flow.


Subject(s)
Humans , Male , Female , Adult , Crack Cocaine/adverse effects , Crack Cocaine/history , Crack Cocaine/metabolism , Substance-Related Disorders , Substance-Related Disorders/complications , Time Factors , Comorbidity , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires/classification , Venous Thrombosis/complications , Lower Extremity/physiopathology
20.
Article in English | WPRIM | ID: wpr-46328

ABSTRACT

BACKGROUND/AIMS: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. METHODS: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). RESULTS: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012). CONCLUSIONS: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.


Subject(s)
Adult , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/complications , Chemoembolization, Therapeutic , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Liver Neoplasms/complications , Male , Middle Aged , Niacinamide/analogs & derivatives , Phenylurea Compounds/therapeutic use , Portal Vein , Proportional Hazards Models , Retrospective Studies , Severity of Illness Index , Survival Rate , Treatment Outcome , Venous Thrombosis/complications
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