Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases

Aim. Superficial thrombophlebitis (ST) ascending the lower limbs is a common disease, which may be associated with deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of this study was to investigate the prevalence of DVT and PE as complications of ascending ST of the lower limbs in the great saphenous vein (GSV) or SSV (SSV) and probable risk factors.Methods. For this study 60 consecutive patients were enrolled with ascending ST of the GSV or SSV, seen between 2000 and 2003 at a public hospital in Botucatu, SP, Brazil. All patients were assessed clinically, by venous Duplex scanning of the lower limbs to confirm ST and test for DVT, and by means of pulmonary scintigraphy to test for PE.Results. In 13 ST cases (21.67%) there was concomitant DVT and 17 ST patients (28.33%) also had PE. Eleven patients had a clinical status suggestive of DVT, but only in eight of these (61.5%), this clinical diagnosis was confirmed. Fourteen patients had a clinical status suggestive of PE, and this diagnosis was confirmed in six cases (35.30%). ST patients who also had DVT and/or PE were given anticoagulant treatment with heparin and warfarin. None of the variables studied was predictive of DVT or PE (P>0.05). However, the presence of varicose veins reduced the risk of patients having DVT (relative risk=9.09; 95%CI:1.75 - 50.00 and P=0.023).Conclusion. The prevalence rates of PE (28.3%) and DVT (21.6%) were elevated in this sample of ascending ST cases, indicating a need for detailed assessment of patients for signs of these complications, including for therapeutic management decision making. [Int Angiol 2009;28:400-8]

Treatment for superficial infusion thrombophlebitis of the upper extremity.

BACKGROUND Although superficial thrombophlebitis of the upper extremity represents a frequent complication of intravenous catheters inserted into the peripheral veins of the forearm or hand, no consensus exists on the optimal management of this condition in clinical practice. OBJECTIVES To summarise the evidence from randomised clinical trials (RCTs) concerning the efficacy and safety of (topical, oral or parenteral) medical therapy of superficial thrombophlebitis of the upper extremity. SEARCH METHODS The Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (2015, Issue 3). Clinical trials registries were searched up to April 2015. SELECTION CRITERIA RCTs comparing any (topical, oral or parenteral) medical treatment to no intervention or placebo, or comparing two different medical interventions (e.g. a different variant scheme or regimen of the same intervention or a different pharmacological type of treatment). DATA COLLECTION AND ANALYSIS We extracted data on methodological quality, patient characteristics, interventions and outcomes, including improvement of signs and symptoms as the primary effectiveness outcome, and number of participants experiencing side effects of the study treatments as the primary safety outcome. MAIN RESULTS We identified 13 studies (917 participants). The evaluated treatment modalities consisted of a topical treatment (11 studies), an oral treatment (2 studies) and a parenteral treatment (2 studies). Seven studies used a placebo or no intervention control group, whereas all others also or solely compared active treatment groups. No study evaluated the effects of ice or the application of cold or hot bandages. Overall, the risk of bias in individual trials was moderate to high, although poor reporting hampered a full appreciation of the risk in most studies. The overall quality of the evidence for each of the outcomes varied from low to moderate mainly due to risk of bias and imprecision, with only single trials contributing to most comparisons. Data on primary outcomes improvement of signs and symptoms and side effects attributed to the study treatment could not be statistically pooled because of the between-study differences in comparisons, outcomes and type of instruments to measure outcomes.An array of topical treatments, such as heparinoid or diclofenac gels, improved pain compared to placebo or no intervention. Compared to placebo, oral non-steroidal anti-inflammatory drugs reduced signs and symptoms intensity. Safety issues were reported sparsely and were not available for some interventions, such as notoginseny creams, parenteral low-molecular-weight heparin or defibrotide. Although several trials reported on adverse events with topical heparinoid creams, Essaven gel or phlebolan versus control, the trials were underpowered to adequately measure any differences between treatment modalities. Where reported, adverse events with topical treatments consisted mainly of local allergic reactions. Only one study of 15 participants assessed thrombus extension and symptomatic venous thromboembolism with either oral non-steroidal anti-inflammatory drugs or low-molecular-weight heparin, and it reported no cases of either. No study reported on the development of suppurative phlebitis, catheter-related bloodstream infections or quality of life. AUTHORS' CONCLUSIONS The evidence about the treatment of acute infusion superficial thrombophlebitis is limited and of low quality. Data appear too preliminary to assess the effectiveness and safety of topical treatments, systemic anticoagulation or oral non-steroidal anti-inflammatory drugs.

Tromboflebite superficial: epidemiologia, fisiopatologia, diagnóstico e tratamento

A tromboflebite superficial de membros inferiores é doença de ocorrência comum, estando associada a diversas condições clínicas e cirúrgicas. Historicamente considerada doença benigna, devido à sua localização superficial e ao fácil diagnóstico, o tratamento foi conservador durante muito tempo, na maioria dos casos. Entretanto, relatos recentes de freqüências altas de complicações tromboembólicas associadas - 22 a 37% para trombose venosa profunda e até 33% para embolia pulmonar - alertaram para a necessidade de abordagens diagnósticas e terapêuticas mais amplas, visando diagnosticar e tratar essas possíveis complicações. A possibilidade da coexistência dessas e de outras desordens sistêmicas (colagenoses, neoplasias, trombofilias) interfere na avaliação e influencia a conduta terapêutica, que pode ser clínica, cirúrgica ou combinada. No entanto, devido à falta de ensaios clínicos controlados e às incertezas quanto a sua história natural, o diagnóstico e o tratamento da tromboflebite superficial continuam indefinidos. Neste trabalho, foi feita uma revisão da literatura analisando-se a epidemiologia, fisiopatologia e estado atual do diagnóstico e tratamento da tromboflebite superficial.

Prevalência de trombose venosa profunda e embolia pulmonar em tromboflebite superficial de membros inferiores

Pós-graduação em Bases Gerais da Cirurgia - FMB

Variability in the international normalised ratio (INR) in patients with antiphospholipid syndrome and positive lupus anticoagulant: should the INR targets be higher?

El síndrome antifosfolípido es un desorden autoinmune caracterizado por hipercoagulabilidad que requiere terapia anticoagulante como pilar fundamental, siendo la warfarina el tratamiento de elección en los casos que requieren manejo por largos periodos. Sin embargo, los pacientes con anticoagulante lúpico positivo representan un reto porque tienen mayor riesgo de presentar eventos trombóticos, sumado a que el seguimiento con el International Normalized Ratio (INR) no es confiable, ya que estos anticuerpos generan interferencia con las pruebas de laboratorio basadas en fosfolípidos, como es el caso del tiempo de protrombina (PT) con INR basal prolongado, incluso antes del inicio de la terapia anticoagulante. Por tal razón, se ilustra el caso de una paciente con síndrome antifosfolípido primario y anticoagulante lúpico positivo quien ha presentado múltiples episodios trombóticos, a pesar de recibir terapia anticoagulante. Además se hace una revisión de la literatura disponible y se postulan nuevas metas de INR en estos pacientes diferentes de las que se plantean actualmente.

Thrombophlebitis of the temporal vein as an extracranial complication of acute bacterial rhinosinusitis

A 39-year-old white man presented with a swollen left upper eyelid secondary to progressive acute bacterial rhinosinusitis (ABRS). Physical examination found a 40% reduction in vision in the left eye and right-sided erythematous temporal swelling with tenderness to palpation. Computed tomography revealed the presence of an inflammatory lesion in the left orbit. Duplex ultrasonography demonstrated a thrombotic occlusion in the right superficial temporal vein (STV). For treatment of the complicated ARBS, the patient received intravenous antibiotics and underwent surgery. The STV thrombophlebitis was treated with low-molecular-weight heparin. Postoperatively, the patient recovered completely and his vision normalized; 10 days later, duplex ultrasonography showed a patent STV. The development of contralateral STV thrombophlebitis is conceivably facilitated by venous anastomoses of the scalp in the front of the head. As a result, embolic spread would be a possible complication of infectious ABRS foci communicating with intraorbital and pericranial veins. To the best of our knowledge, this is the first reported case of such a complication of ARBS in the literature.

Reduced Thrombospondin-1 at presentation predicts disease progression in superficial bladder cancer

Objectives: Superficial bladder cancer (SBC) presents a difficult clinical dilemma at diagnosis as only a small subgroup of patients will subsequently develop invasive disease. Study of cancer biology has found that angiogenesis is central to growth and spread. This study examines the relationship between the angiogenic inhibitory factor Thrombospondin-1 (TSP-1) at initial presentation and subsequent progression of SBC. Methods: Using immunohistochemistry, 220 cases of SBC were examined for pattern and extent of expression of TSP-1 at initial presentation. Results: TSP-1 was detected in perivascular tissue, at the epithelial-stromal junction, in the stroma and in tumour cells and reduced perivascular TSP-1 staining at presentation was an independent predictive factor for the subsequent development of muscle invasive or metastatic disease. Conclusion: This adds further weight to the theory that TSP-1 plays a major part in the biology of bladder cancer possibly through the control of angiogenesis. © 2002 Elsevier Science B.V. All rights reserved.

Deeply superficial digital media engagement? The case of Twitter and Movember 2013

Using activity generated with Twitter during Movember 2013, we interrogate the natures of superficiality running through what can be defined as a highly successful public health engagement intervention. Indeed, Movember arguably has not just been successful in one year in terms of raising funds for the causes it is concerned with, it has done this year-on-year since 2004. We tracked the keyword 'movember' (without the hash symbol) using an in-house installation of YourTwapperkeeper hosted on a NECTAR server. Data collection ran from 01 October - 04 December 2013, covering the ramp-up and wind-down periods of the event. We collected a total of 1,313,426 tweets from 759,345 unique users.

Miconazole in the treatment of superficial mycoses

Miconazole nitrate (2%) cream was evaluated in the treatment of superficial mycoses. Out of 116 patients having multiple clinical diagnoses, 66 cases were found to be positive by culture. Species of Trichophyton were the predominant etiological agents (in over 60%) followed by Candida species (20%) and Epidermophyton floccosum (15%). All the cases selected for study were followed up to a period of 4–18 months. A cure rate of 94.6 per cent was observed in all the cases where causal organisms were isolated. Significantly high cure rate (66%) was also seen in cases where causal organisms could not be isolated, including cases of tinea versicolor. Results of mycological examination were in confirmity with the clinical results

A fixed-grid finite element based enthalpy formulation for generalized phase change problems: role of superficial mushy region

The enthalpy method is primarily developed for studying phase change in a multicomponent material, characterized by a continuous liquid volume fraction (phi(1)) vs temperature (T) relationship. Using the Galerkin finite element method we obtain solutions to the enthalpy formulation for phase change in 1D slabs of pure material, by assuming a superficial phase change region (linear (phi(1) vs T) around the discontinuity at the melting point. Errors between the computed and analytical solutions are evaluated for the fluxes at, and positions of, the freezing front, for different widths of the superficial phase change region and spatial discretizations with linear and quadratic basis functions. For Stefan number (St) varying between 0.1 and 10 the method is relatively insensitive to spatial discretization and widths of the superficial phase change region. Greater sensitivity is observed at St = 0.01, where the variation in the enthalpy is large. In general the width of the superficial phase change region should span at least 2-3 Gauss quadrature points for the enthalpy to be computed accurately. The method is applied to study conventional melting of slabs of frozen brine and ice. Regardless of the forms for the phi(1) vs T relationships, the thawing times were found to scale as the square of the slab thickness. The ability of the method to efficiently capture multiple thawing fronts which may originate at any spatial location within the sample, is illustrated with the microwave thawing of slabs and 2D cylinders. (C) 2002 Elsevier Science Ltd. All rights reserved.

"Aplicación de un sistema multimétrico para evaluar la calidad del agua superficial en la microcuenca El Coyote del Rio Estelí, Nicaragua"

En la microcuenca El Coyote localizada en el municipio de Condega, Estelí, se evaluó la calidad del agua superficial de sde febrero del 2010 a febrero del 2011. El propósito fue la identificación de indicadores que faciliten la vigilancia y monitoreo de la calidad del agua . Se integró un sistema multimétrico utilizando las características físicoquímicas y bacteriológicas, macro invertebrados acuáticos, la caracterización morfométrica de la microcuenca y la información resultante a nivel de comunidad (cambios en el uso del suelo). En la determinación de la relación de la calidad del agua con la estructura de la macrofauna acuática (macroinvertebrados) se usó el método Biological Monitoring Working Party (BMWP/Col ) . La microcuenca tiene 144 afluentes con una forma oval - oblonga - alargada, y su curva hipsométrica refleja un estado de equilibrio relativo de juvenil a madurez. El uso del suelo es inadecuado y su entorno natural fue valorado como subóptimo. Aunque los parámetros fisico químicos indicaron que las aguas son alcalinas, con un nivel aceptable de oxigeno disuelto, categorizadas según el Diagrama de Riverside como aguas aptas par a riego (C2 - S1), y aceptables según valores determinados para DBO 5 y DQO; sin embargo, requieren de un tratamiento de descontaminación previo a su uso doméstico y agropecuario. Además, debido a la presencia de coliformes fecales estas aguas no están aptas para consumo humano . Los macroinvertebrados varían, según la estacionalidad, en riqueza, abundancia y distribución, presentando una disminución en el número de individuos en la época lluviosa (t= 5.21, p<2.18E - 07). E l 6 8 . 91 % de los macroinvertebrados bioin dicadores se distribuyeron en cinco familias : Leptohyphidae , Baetidae , Hydropsychidae , Chironomidae y Physidae , siendo el cariotipo piedra el que present ó mayor diversidad y abundancia . El promedio del BMWP /Col fue de 60.06, indicando una calidad del agua entre dudosa y aceptable , y el índice ASPT de 6.71 señala una contaminación moderada ; estos resultados coincide n con los obtenidos utilizando la batería de indicadores fisicoquímicos y bacteriológicos .