RESUMO
Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and important questions have been raised regarding their appropriateness. Although there have been instances where eponyms were abandoned, the remainder are largely embedded within the established literature making their disappearance unlikely. Physicians used a variety of techniques to describe signs of medical eponyms as a method for diagnosing deep venous thrombosis (DVT), pulmonary embolism (PE) or venothromboembolism (VTE). These methods (observation, palpation, pressure, or maneuvers), were detected during the physical examination and using bedside sphygmomanometer or radiographic imaging. Reviewed are both common and less frequently encountered VTE eponyms identified during the physical examination and radiologic imaging. Most of these signs have not been further studied and, therefore, there is a lack of information regarding their accuracy and reliability in clinical practice.
Assuntos
Embolia Pulmonar/diagnóstico , Tromboembolia Venosa/diagnóstico , Trombose Venosa/diagnóstico , Epônimos , História do Século XX , História do Século XXI , Humanos , Palpação/história , Percussão/história , Embolia Pulmonar/história , Radiografia/história , Radiologia/história , Esfigmomanômetros/história , Tromboembolia Venosa/história , Trombose Venosa/históriaRESUMO
Eponyms are honorific terms ascribed to individuals who discovered a sign, test, syndrome, technique, or instrument. Despite some contentions, eponyms continue to be widely ingrained and incorporated into the medical literature and contemporary language. Physical signs are considered unreliable methods alone for detecting deep venous thrombosis (DVT). The accuracy of the majority of these signs is unknown. For those signs that have been studied, there are a number of methodological limitations hindering the ability to draw meaningful conclusions about their accuracy and validity in clinical practice. Nevertheless, some findings when present and used in conjunction with other key signs, symptoms, and aspects of the patients history may be useful in further supporting the clinical suspicion and likelihood of DVT and/or pulmonary embolism (PE) or venothromboembolism (VTE). These signs also provide the means to better recognize the relationship between clinical findings and VTE. The acquisition of historical knowledge about these signs is important as it further enhances our understanding and appreciation of the diagnostic acumen that physicians were required to employ and to diagnose VTE prior to the advent of advanced imaging methods. Described in this paper is a brief overview of thrombosis as enumerated by Rudolf Virchow, and eponymous signs described in the late eighteenth and nineteenth centuries.
Assuntos
Artéria Pulmonar/patologia , Embolia Pulmonar/diagnóstico , Tromboembolia Venosa/diagnóstico , Trombose Venosa/diagnóstico , Educação Médica/história , Epônimos , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Embolia Pulmonar/história , Embolia Pulmonar/patologia , Tromboembolia Venosa/história , Tromboembolia Venosa/patologia , Trombose Venosa/história , Trombose Venosa/patologiaRESUMO
The emergence of direct oral anticoagulants (DOACs) represents a major advancement and paradigm shift in the treatment of venous thromboembolism. Currently, dabigatran, rivaroxaban, apixiban, and edoxoban are approved and used routinely for the prevention and treatment of patients with venous thromboembolism. Because each of the DOACs has different doses and dosing regimens, clinicians need to become familiar with their use. This article focuses on the practical considerations of how and when to use the DOACs. It also aims to explore follow-up monitoring, use in special populations, reversal agents, periprocedural management, and how to handle bleeding complications with the DOACs.
Assuntos
Anticoagulantes/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Embolia Pulmonar/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Anticoagulantes/história , Esquema de Medicação , Interações Medicamentosas , Hemorragia/induzido quimicamente , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/história , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/história , Trombose Venosa/sangue , Trombose Venosa/diagnóstico , Trombose Venosa/históriaRESUMO
La frecuencia de la trombosis venosa profunda distal oscila entre un 20 y un 50% de todas las trombosis profundas de los miembros inferiores y presenta los mismos factores de riesgo que las proximales y que el embolismo pulmonar, con un 50% menos de riesgo de recurrencia. Su historia natural, deficientemente conocida, explica el debate sobre su importancia. La complicación más frecuente es el síndrome postrombótico. El ecodoppler es el método diagnóstico más empleado. El dímero D solo no excluye la trombosis, no es útil como factor pronóstico de recurrencia ni se asocia con el síndrome postrombótico. La selectina P soluble combinada con el índice de Wells es una prueba diagnóstica excelente. La anticoagulación varía entre 3 meses e indefinidamente según la trombosis sea provocada o idiopática. En caso de cáncer se recomienda continuar el tratamiento hasta pasados 6 meses después de su curación o de su remisión completa
The frequency of the distal deep vein thrombosis is between 20 and 50% of all deep lower limb thrombosis, and has the same risk factors as proximal and pulmonary embolism, and with 50% lower risk of recurrence. Its natural history is not well-known, and may explain the debate about its importance. The most common complication is post-thrombotic syndrome. The echo-Doppler is the most used diagnostic method. D-dimer alone does not exclude thrombosis, is not useful predictors of recurrence, and is associated with post-thrombotic syndrome. Soluble P-selectin, combined with the Wells index is an excellent diagnostic test. Anticoagulation varies between 3 months and indefinitely depending on whether the thrombosis is provoked or idiopathic. If cancer, it is recommended to continue treatment until 6 months after cure or complete remission
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Trombose Venosa/complicações , Trombose Venosa/história , Trombose Venosa , Extremidade Inferior/lesões , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia , Selectina-P/fisiologia , Selectina-P/uso terapêutico , Ultrassonografia Doppler/instrumentação , Ultrassonografia Doppler/métodos , Ultrassonografia Doppler , Heparina/administração & dosagem , Heparina/farmacologia , Heparina/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Síndrome Pós-Trombótica/complicações , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/prevenção & controle , Meias de CompressãoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Férias e Feriados/história , Embolia Pulmonar/história , Trombose Venosa/história , Comportamento Sedentário , Biografias como Assunto , HistoriografiaRESUMO
BACKGROUND: Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. OBJECTIVES: To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. METHODS: All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a "topical group&" (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an intravenous; (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. RESULTS: Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). CONCLUSIONS: Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.
CONTEXTO: O ácido tranexâmico é amplamente utilizado em cirurgia ortopédica para reduzir a hemorragia perioperatória. Como o ácido tranexâmico inibe a fibrinólise, há uma preocupação de que ele possa aumentar o risco de eventos tromboembólicos. OBJETIVOS: Verificar se o uso do ácido tranexâmico é seguro em relação à prevalência de trombose venosa profunda em pacientes submetidos a artroplastia total do joelho, e comparar as administrações tópica e intravenosa desse medicamento. MÉTODOS: Todos os pacientes consecutivamente admitidos para artroplastia total do joelho devido a artrose primária entre junho e novembro de 2014 foram recrutados. Os pacientes foram randomizados em um "grupo tópico" (1,5 g de ácido tranexâmico diluído em 50 ml de solução salina cobrindo toda a área operada antes de liberar o torniquete), um "grupo intravenoso" (20 mg/kg de ácido tranexâmico em 100 ml de solução salina no momento da anestesia) e um "grupo controle" (100 ml de solução salina com a anestesia). No 15º dia de pós-operatório, todos os pacientes foram submetidos a ultrassonografia vascular com Doppler de membros inferiores, independentemente de sintomas. RESULTADOS: Dos 90 pacientes operados, apenas cinco apresentaram trombose venosa profunda (um no grupo tópico e quatro no grupo controle). CONCLUSÕES: Tanto a administração tópica quanto a intravenosa de ácido tranexâmico são seguras em termos de ocorrência de trombose venosa profunda, pois o número de casos de trombose venosa profunda foi semelhante quando comparamos os pacientes que receberam ácido tranexâmico e os que receberam placebo. Novos estudos, com amostras maiores, são necessários para confirmar esse achado.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ácido Tranexâmico/administração & dosagem , Artroplastia do Joelho/reabilitação , Trombose Venosa , Trombose Venosa/história , Ortopedia/classificação , Ortopedia/história , Ortopedia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevalência , Antifibrinolíticos/administração & dosagemRESUMO
Venous thromboembolism (VTE) is a prevalent and life-threatening condition that requires an accurate and timely diagnosis. The current diagnostic approach to this condition, entailing an efficient integration of clinical judgment, diagnostic imaging, and laboratory testing, is the result of decades of scientific and medical research. This article aims to present and discuss the major breakthroughs that have occurred in the diagnostic imaging of both deep vein thrombosis and pulmonary embolism, along with the various biological markers that have emerged from the laboratory bench and which have only marginally migrated to the bedside. Despite decades of research, the current diagnostic armamentarium for an efficient diagnosis of VTE remains suboptimal, and some wiggle room remains for the development of more efficient diagnostic tools, which may include thrombus-targeted molecular imaging, infrared thermal imaging, thrombin generation, and proteomics.
Assuntos
Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/história , Trombose Venosa/diagnóstico , Trombose Venosa/história , História do Século XIX , História do Século XX , História do Século XXI , HumanosRESUMO
The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.
O processo de recanalização das veias dos membros inferiores, após um episódio de trombose venosa profunda aguda em pacientes anticoagulados com heparina e inibidores da vitamina K, faz parte da evolução natural da remodelagem do trombo venoso. Esse complexo processo de remodelagem envolve a adesão do trombo à parede da veia, à resposta inflamatória da parede do vaso, levando à organização e subsequente contração do trombo, à neovascularização e à lise espontânea de áreas no interior do trombo. A presença de fluxo arterial espontâneo em veias com trombose recanalizada tem sido descrita como secundária à neovascularização e se caracteriza pelo desenvolvimento de fluxo com padrão de fístulas arteriovenosas, identificadas por meio de mapeamento dúplex colorido. Nesta revisão, são discutidos alguns aspectos controversos da história natural da trombose venosa profunda, para uma melhor compreensão da sua evolução e do seu impacto sobre a doença venosa.
Assuntos
Adulto , Extremidade Inferior/fisiopatologia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/história , Antagonistas de Heparina/administração & dosagem , Ecocardiografia Doppler/métodos , Heparina/administração & dosagem , Fatores de RiscoRESUMO
Deep vein thrombosis (DVT) is a common disease. However, unlike that of varicose veins, which have been depicted since antiquity in art and literature, its description was more recent in the history of medicine. The first well-documented case of DVT was reported during the Middle Ages: in 1271, Raoul developed a unilateral edema in the ankle, which then extended to the leg. The number of reported DVT cases steadily increased thereafter, particularly in pregnant and postpartum women. During the first half of the 20th century, well before the discovery of anticoagulants, many therapeutic approaches were used, and arose from the pathologic hypotheses that prevailed at their time. Despite the development of anticoagulants, and the fact that they were thought to dramatically decrease DVT mortality, numerous complementary treatments have also been developed during the last 50 years: they include vena cava clips and surgical thrombectomy, and are intended to decrease mortality or to prevent late complications. Most of these treatments have now been abandoned, or even forgotten. In this review, we recall also the discovery and the use of vitamin K antagonists and heparin, which have constituted the mainstay of treatment for decades. We also bring some perspective to historical aspects of this disease and its treatment, notably regarding elastic compression and early mobilization, but also abandoned and complementary treatments. In these times of change regarding DVT treatment, mainly marked by the arrival of new oral anticoagulants, efforts of physicians through the ages to treat this common disease provide a beautiful example of the history of knowledge.
Assuntos
Anticoagulantes/história , Trombose Venosa/história , Animais , Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/história , Feminino , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Medieval , Humanos , Masculino , Medicina nas Artes , Pinturas , Gravidez , Meias de Compressão/história , Trombectomia/história , Terapia Trombolítica/história , Trombose Venosa/diagnóstico , Trombose Venosa/terapiaRESUMO
In September of 1974, Richard Nixon resigned the Presidency of the United States during an impeachment investigation concerning the Watergate Affair. One month after his resignation, the former President had an exacerbation of his chronic deep vein thrombosis. He also received a Presidential pardon from Gerald Ford on the same day that his recurrent deep vein thrombosis was diagnosed. The political, legal, and medical events that unfolded in the fall of 1974 are the substance of this report. Presidents often receive medical care that stretches the ordinary as a result of their position and the importance of their actions. The events surrounding Richard Nixon's care for deep vein thrombosis and its complications were not unusual for Presidential health care but were closely intertwined with the legal proceedings during the prosecution of the Watergate defendants.
Assuntos
Pessoas Famosas , Política , Embolia Pulmonar/história , Tromboflebite/história , Trombose Venosa/história , Doença Crônica , Progressão da Doença , História do Século XX , Humanos , Masculino , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Recidiva , Tromboflebite/complicações , Tromboflebite/diagnóstico , Tromboflebite/terapia , Estados Unidos , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/terapiaRESUMO
BACKGROUND: Rubens was a master of European Baroque painting and a practitioner of realism. A female model for his paintings of Samson and Delilah and the Three Graces has apparent right-sided breast abnormalities. METHOD AND RESULTS: Examination of the images shows persistent changes. The clinical scenario suggests Mondor's disease, possibly related to rheumatoid arthritis or chronic infection. DISCUSSION: Visible breast changes such as distortion, skin retraction and nipple deviation warrant concern and require investigation.
Assuntos
Pessoas Famosas , Medicina nas Artes , Pinturas/história , Trombose Venosa/história , História do Século XVII , Humanos , MasculinoRESUMO
Mondor's disease (MD) is a rare and self-limited benign disease first described in 1939. Originally its clinical presentation was a superficial vein thrombosis (SVT) without contiguous skin inflammation of the chest wall veins. Over time its definition has evolved and now also includes subcutaneous thrombosis of the dorsal vein of the penis but also retractile scarring of the fascia after breast surgery without concomitant SVT. In all cases clinical examination constitutes the first step of diagnostic management. It is followed by an ultrasound exploration (US) to search for a thrombus. In about half of all cases the disease is considered as idiopathic and cancer is rare. Whatever the location considered, the follow-up is usually uneventful with low rates of recurrence and of subsequent cancer. Treatment is debated and ranges from therapeutic abstention to anticoagulants or even surgery. It is likely that the new locations and mechanisms (without thrombosis) of the MD have lead to the constitution of a heterogeneous entity precluding from a consensual mode of care.
Assuntos
Doenças Mamárias , Doenças do Pênis , Doenças Torácicas , Trombose Venosa , Anticoagulantes/uso terapêutico , Doenças Mamárias/classificação , Doenças Mamárias/diagnóstico , Doenças Mamárias/epidemiologia , Doenças Mamárias/história , Doenças Mamárias/terapia , Feminino , História do Século XX , História do Século XXI , Humanos , Masculino , Mamografia , Doenças do Pênis/classificação , Doenças do Pênis/diagnóstico , Doenças do Pênis/epidemiologia , Doenças do Pênis/história , Doenças do Pênis/terapia , Valor Preditivo dos Testes , Recidiva , Fatores de Risco , Doenças Torácicas/classificação , Doenças Torácicas/diagnóstico , Doenças Torácicas/epidemiologia , Doenças Torácicas/história , Doenças Torácicas/terapia , Trombectomia , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Trombose Venosa/classificação , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/história , Trombose Venosa/terapiaAssuntos
Pessoas Famosas , Úlcera da Perna/história , Obesidade/história , Trombose Venosa/história , Traumatismos Craniocerebrais/história , Fraturas Ósseas/história , História do Século XVI , Humanos , Traumatismos da Perna/complicações , Traumatismos da Perna/história , Masculino , Insuficiência Venosa/história , Trombose Venosa/etiologiaRESUMO
Although enormous progress has been made in understanding the physiology of pulmonary embolism, developing new diagnostic modalities and strategies, and constant refinement in the use of heparin therapy and thrombolytic therapy, venous thromboembolism remains a common and lethal process. As the history of this disease illustrates, advances continue to be made and it is anticipated that with newer diagnostic studies and anticoagulants under development, diagnosis and treatment of pulmonary embolism will continue to improve.
Assuntos
Embolia Pulmonar/história , Trombose Venosa/história , Angiografia/história , Anticoagulantes/história , Anticoagulantes/uso terapêutico , Pesquisa Biomédica/história , Gasometria/história , Cuidados Críticos/história , Ecocardiografia/história , Eletrocardiografia/história , Embolectomia/história , Embolectomia/instrumentação , Europa (Continente) , Heparina/história , Heparina/uso terapêutico , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , Humanos , Pulmão/diagnóstico por imagem , Imagem de Perfusão/história , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Doença Cardiopulmonar/diagnóstico , Doença Cardiopulmonar/etiologia , Radiografia Torácica/história , Terapia Trombolítica/história , Tomografia Computadorizada por Raios X/história , Trombose Venosa/diagnóstico , Trombose Venosa/terapiaRESUMO
Virchow's triad describes three factors that contribute to the development of venous thrombosis: hypercoagulability, stasis and endothelial injury. Yet, extensive review of the historical literature casts doubt on the existence of a triad described by Virchow in the form it is currently quoted throughout contemporary medical literature. Certainly his work involved extensive study of venous thrombosis and pulmonary embolism, with these two terms being coined by Virchow, but a triad of factors relating to the development of venous thrombosis is elusive. Interestingly, Virchow only began to be routinely credited with this triad one hundred years after publication of his work on venous thrombosis. This acknowledgement coincided with the accumulation of experimental evidence for the role these factors play in thrombogenesis. Controversial as the origins of Virchow's triad might be, it is apt given his substantial contribution to our knowledge of venous thromboembolism, and the fact that the triad continues to be clinically relevant today that a triad pertaining to Virchow should remain.