ABSTRACT
Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.
La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hipercoagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.
Subject(s)
Thrombophlebitis , Venous Thrombosis , Fibrinolysis , Heparin , Humans , Thrombectomy , Thrombophlebitis/diagnostic imaging , Thrombophlebitis/drug therapy , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapyABSTRACT
Resumen La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hiper coagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.
Abstract Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.
Subject(s)
Humans , Thrombophlebitis/drug therapy , Thrombophlebitis/diagnostic imaging , Venous Thrombosis/drug therapy , Venous Thrombosis/diagnostic imaging , Heparin , Thrombectomy , FibrinolysisABSTRACT
Cu pollution is a problem in mining areas in Peru. Here we evaluate the phytoextraction capacity, physiological and proteomic responses of four species growing in copper-contaminated areas in Arequipa, Peru. The plants used in the experiments were obtained by collecting seedlings (Tessaria integrifolia, Bacharis salicifolia), rhizomes (Eleocharis montevidensis) and seeds (Chenopodium murale) along a polluted river. They were exposed to solutions containing 2, 4, 8, 16 and 32 mg Cu L-1 during 20 days. Growth was affected in a concentration-dependent way. According to the tolerance index, B. salicifolia and C. murale were the most sensitive species, but with greater Cu phytoextraction capacity and accumulation in the biomass. The content and ratio of photosynthetic pigments changed differently for each specie and carotenoids level were less affected than chlorophyll. Cu also induced changes in the protein and sugar contents. Antioxidant enzyme activities (catalase and superoxide dismutase) increased with a decrease in the malondialdehyde. There were marked changes in the protein 2D-PAGE profiles with an increase in the abundance of metallothioneins (MT) of class II type I and II. Our results suggest that these species can grow in Cu polluted areas because they developed multiple tolerance mechanisms, such as and MTs production seems a important one.
