ABSTRACT
Ninety patients with venographically proven deep venous thrombosis(DVT) but without clinical signs of pulmonary embolism(PE) were randomized into two different treatment regimens to compare the safety and efficacy of continuous intravenous heparin and oral anticoagulant(AC) treatment versus non-AC treatment. All patients in the two treatment groups were actively mobilized from the day of admission and wore graduated compressing stockings. In the non-AC-group the patients were treated with phenylbutazone for ten days. Treatment with heparin was maintained for 6 days and oral AC treatment was given from the third day and continued for 3 months. Venography was repeated after 30 days. A perfusion-ventilation lung scan was performed on day 1-2, 10 and 60. In fifty-nine patients a revenography was performed, twenty nine in the AC-group and thirty in the non-AC group. For distal veins regression was found in nine and eight respectively (4.4% in favour of AC, 95% confidence limit 27.5% to -18.7%) and in proximal veins regression was found in five and eight, respectively (10.9% in favour of AC, 95% confidence limit 32.0% to -10.1%). No difference in lung scans was found after 10 days (0.8% in favour of AC, 95% confidence limit 21.5% to -19.9%) or after 60 days (3.3% in favour of non-AC treatment, 95% confidence limit 21.8% to -28.5%). In the AC group the incidence of bleeding complications was 8.3%. No side-effects of phenylbutazone was found. The present controlled clinical study demonstrated no effect of AC-treatment on DVT progression in actively mobilized patients wearing graduated compressing stockings when compared to a non-AC treated group receiving analgetic therapy with phenylbutazone. However, the patient population of the study is relatively small with wide confidence intervals for differences between groups. Before more general recommendations can be made, a large scale placebo-controlled study is needed to evaluate the possible effect of AC-treatment in DVT patients, who can be mobilized from the first day.
Subject(s)
Heparin/therapeutic use , Phenylbutazone/therapeutic use , Thrombophlebitis/drug therapy , Administration, Oral , Adolescent , Adult , Aged , Aged, 80 and over , Bandages , Combined Modality Therapy , Female , Hemorrhage/chemically induced , Heparin/administration & dosage , Heparin/adverse effects , Humans , Injections, Intravenous , Male , Middle Aged , Patient Dropouts , Phenylbutazone/administration & dosage , Prospective Studies , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/prevention & control , Radionuclide Imaging , Recurrence , Safety , Single-Blind Method , Thrombophlebitis/prevention & control , Thrombophlebitis/therapy , Treatment Outcome , WalkingSubject(s)
Hypertension/mortality , Aged , Denmark , Female , Follow-Up Studies , Humans , Hypertension/diagnosis , Male , Middle AgedSubject(s)
Pain/etiology , Tietze's Syndrome/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Thoracic Diseases/diagnosisSubject(s)
Coronary Disease/epidemiology , Pain/etiology , Thoracic Diseases/diagnosis , Adolescent , Adult , Aged , Angina Pectoris/diagnosis , Angina Pectoris/epidemiology , Child , Coronary Care Units , Coronary Disease/diagnosis , Denmark , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Spinal Diseases/diagnosisSubject(s)
Pulmonary Embolism/mortality , Aged , Denmark , Female , Humans , Male , Pulmonary Embolism/drug therapyABSTRACT
The frequency of segmental thoracic pain in 1097 patients admitted complaining of chest pain was investigated by specific examination of the thoracic vertebrae and segments. The examination is easily performed with minimal risk to possible coronary patients. Segmental thoracic pain accounts for 13% of chest pains in a medical department, making it the third most common chest pain (behind coronary thrombosis pain 39%, angina pectoris 20%). Treatment by local paravertebral anaesthesia is simple and effective in most cases.
Subject(s)
Pain/etiology , Thorax , Adolescent , Adult , Aged , Child , Diagnosis, Differential , Female , Heart Diseases/complications , Heart Diseases/diagnosis , Humans , Male , Middle Aged , Pain/epidemiology , Thoracic VertebraeABSTRACT
The diagnosis of pulmonary embolism was established during a 6-year period in 284 patients hospitalized in medical departments of a general hospital. Of the 183 patients who died, 178 were autopsied. A retrospective study was performed on the autopsy-verified fatal cases to correlate their clinical state to relevant postmortem findings. Two groups made thorough, independent evaluations of data from the medical and pathological records. In 95% of the patients a confirmed fatal pulmonary embolism constituted only a slight modification of life expectancy, because of concomitant complicating, severe, terminal disease. Reflecting this poor clinical state, only 26 patients (15%) had a diagnosis of pulmonary embolism premortally and of these patient, 13 died within 5 hours after onset of symptoms and 10 were treated with antithrombotic drugs. Our results seem to indicate an increase in the incidence of terminal diseases in the population of elderly, hospitalized patients and change the concept of fatal pulmonary embolism into an agonal incident in a terminal-care medical patient.
Subject(s)
Pulmonary Embolism/mortality , Aged , Female , Humans , Male , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Retrospective StudiesSubject(s)
Pain/etiology , Thorax , Adolescent , Adult , Aged , Child , Female , Humans , Intercostal Nerves , Male , Middle Aged , Neuralgia/complications , Ribs/pathology , Spine/pathologyABSTRACT
1. This study includes 1038 patients (325 men and 713 women) who consulted the medical out-patient clinic, Rigshospitalet, Copenhagen, during the years 1932-38. All these patients had a blood pressure of 160/100 mmHg or 180 mmHg or more. 2. The average age at the first examination was 54 years; 97% were followed at intervals of 10 years until 1975, when sixty patients were still alive. Treatment was minimal until 1970. 3. Sixty percent of the men and 76% of the women reached an age of 65 years or more. Nine percent of the total patients lived to 85 years or more. Excess mortality was far higher in men than in women. 4. Causes of death were stroke in 17%, heart failure in 24%, coronary occlusion in 16%, uraemia in 4% and other diseases in 39%. At the first examination, thirteen cases of malignant hypertension were registered, none at later sessions.
