Bibliography Ref ID : ACKROYD1986 1. Ackroyd, J.S., Lea Thomas, M., and Browse, N.L. Deep vein reflux: an assessment by descending phlebography. Brit.J.Surg. 73:31-33, 1986. Keywords : vein; REFLUX; PHLEBOGRAPHY; VEINS; INCIDENCE; POST- THROMBOTIC; Syndrome; PT; TECHNIQUES; NASP; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; an; ab; in; varicose; is Notes : AB - This study of 51 patients aims to define the 'normal' range of reflux in the deep veins and the incidence of pathological reflux in patients with the post-thrombotic syndrome (PTS). 'Normal' limbs, limbs with simple varicose veins and limbs with post-thrombotic syndrome have been studied using a standardized technique for descending phlebography, supine and with a controlled Valsalva. The 'normal' range of reflux has been found to be grade 0-2. The incidence of pathological reflux in patients with proven post- thrombotic damage to the deep veins is 31 per cent UI - 86132329. Ref ID : ADAMICK1990 2. Adamick, R. and Zoneraich, S. Echocardiographic visualization of a large mobile right atrial thrombus with sudden embolization during real- time scanning. Am.Heart J. 120:699-701, 1990. Keywords : PHLEBITIS; THROMBUS; EMBOLIZATION; SCANNING; AGED; CORONARY DISEASE; DIAGNOSIS; coronary thrombosis; COMPLICATIONS; Echocardiography; Heart Atrium; HUMAN; LEG; blood supply; MALE; PULMONARY EMBOLISM; ETIOLOGY; THROMBOPHLEBITIS Ref ID : ADAMS1965 3. Adams, J.T., McEvoy, R.K., and DeWeese, J.A. Primary deep venous thrombosis of upper extremity. Arch.Surg. 91:29-41, 1965. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; UPPER EXTREMITY; PULMONARY EMBOLISM; Extremities Ref ID : AGNELLI1990 4. Agnelli, G. Rationale for bolus t-PA therapy to improve efficacy and safety. Chest 97(4 Suppl):161S-167S, 1990. Keywords : 96-suzy-001; t-PA; THERAPY; Safety; PLASMINOGEN; PLASMINOGEN ACTIVATOR; FIBRIN; is; CAUSE; BLEEDING; COMPLICATIONS; in; CLINICAL TRIALS; THROMBOLYSIS; RISK; FIBRIN DEGRADATION PRODUCTS; HYPOFIBRINOGENEMIA; HEMORRHAGE; TPA; an; THROMBOLYTIC; TREATMENT; ALTEPLASE; administration & dosage; adverse effects; therapeutic use; ANIMAL; chemically induced; Infusions,Intravenous; Injections,Intravenous; RABBITS; STREPTOKINASE; THROMBOLYTIC THERAPY; Methods Notes : Tissue-type plasminogen activator has high affinity for fibrin and is activated by fibrin. Because of these properties, t-PA was initially expected to cause minimal bleeding complications. This prediction has been only partially confirmed in major clinical trials in which t-PA was given in the doses necessary for effective coronary thrombolysis. The risk of bleeding in patients receiving t-PA is correlated with increased levels of fibrin degradation products and hypofibrinogenemia, consistent with a link between systemic plasminemia and hemorrhage. Limiting t-PA-associated bleeding may therefore require measures aimed at decreasing hyperplasminemia. These measures include a short infusion of a high t-PA dose. This article presents new experimental evidence that has confirmed our previous results showing that a short infusion of t-PA is an effective and safe thrombolytic treatment. Ref ID : AGNELLI1991 5. Agnelli, G., Cosmi, B., Ranucci, V., Renga, C., Mosca, S., Lupatelli, L., Di Filippo, P., Rinonapoli, E., and Nenci, G. Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery. A venography-controlled study. Arch.Intern.Med. 151:2167- 2171, 1991. Keywords : IMPEDANCE PLETHYSMOGRAPHY; DIAGNOSIS; VEINS; THROMBOSIS; HIP; SURGERY; POSTOPERATIVE; IPG; DVT; VENOGRAPHY; PULMONARY EMBOLISM; ASYMPTOMATIC; DEEP VEIN THROMBOSIS; LEG; SENSITIVITY; Plethysmography; in; vein Notes : 440 legs of asymptomatic postoperative (hip surgery) patients underwent IPG and venograpy. 145 were found to have DVT on venography. The sensitivity of IPG was only 22% in the non-operated leg. Ref ID : AGNELLI1992 6. Agnelli, G. and Parise, P. Bolus thrombolysis in venous thromboembolism. Chest 101:172S-182S, 1992. Keywords : THROMBOLYSIS; VENOUS; THROMBOEMBOLISM; THERAPY; HEMORRHAGIC; COMPLICATIONS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; VEINS; THROMBOSIS; CAUSE; THROMBUS; HEMOSTATIC; PLATELET; BLEEDING; ANIMAL; ANIMAL MODELS; TREATMENT; THROMBI; LYSIS; HEPARIN; THROMBOPLASTIN; APTT; PULMONARY EMBOLISM; EMBOLISM; PA; ALTEPLASE; THROMBOLYTIC THERAPY; BLOOD COAGULATION; DRUG THERAPY COMBINATION; FIBRIN; FIBRINOLYSIS; HIRUDIN; RABBITS; RECOMBINANT PROTEINS; rt-PA; in; is; DEEP VEIN THROMBOSIS; vein; an; LYTIC; SIDE EFFECTS; Antithrombotic; Half-Life Notes : AB-Thrombolytic therapy is rarely used in venous thromboembolism because of the fear of hemorrhagic complications. Preliminary clinical experiences with recombinant tissue-type plasminogen activator (rt-PA) in patients with deep vein thrombosis have shown that even this fibrin- specific plasminogen activator causes an unacceptable rate of hemorrhagic complications. Theoretical considerations and the available experimental and clinical data suggest that infusion of rt-PA over a short period of time would result in a more favorable risk-benefit ratio. Shortening the period of rt-PA infusion results in higher peak plasma levels, thus allowing a higher concentration of the plasminogen activator on the surface and inside the occluding thrombus. In addition, a bolus infusion can prevent or minimize the interaction between rt-PA and the hemostatic system, reducing the likelihood of a systemic lytic state, of a platelet function defect, and, possibly, of bleeding side effects. In venous thromboembolism animal models, the efficacy of bolus rt-PA can be further increased by the adjunctive administration of an effective antithrombotic treatment. This is because the accretion of new fibrin on the thrombi counteracts the lysis of preformed fibrin and influences negatively the final thrombus size. Effective adjunctive antithrombotic treatment includes either high doses of heparin, producing an unclottable activated partial thromboplastin time (aPTT), or doses of recombinant hirudin, doubling the aPTT. When used as an alternative to rt-PA, bolus doses of a hybrid plasminogen activator with prolonged half-life efficiently reduce thrombus size by lysing preformed and newly formed fibrin. Preliminary clinical experience in patients with pulmonary embolism seems to confirm that rt-PA infused as a bolus is at least as effective as, and probably more effective than, rt-PA infused over a longer period. Ref ID : AGNELLI1992A 7. Agnelli, G., Renga, C., Weitz, J.I., Nenci, G.G., and Hirsh, J. Sustained antithrombotic activity of hirudin after its plasma clearance: comparison with heparin. Blood 80(4):960-965, 1992. Keywords : Antithrombotic; HIRUDIN; HEPARIN; THROMBUS; Extension; VENOUS; THROMBOEMBOLISM; FIBRIN; THROMBI; THROMBIN; FIBRINOGEN; INHIBITION; TREATMENT; RABBITS; jugular veins; vein; partial thromboplastin time; THROMBOPLASTIN; APTT; ANIMAL; CLOTTING TIME; IN VITRO; HUMAN; FIBRINOPEPTIDES; CONTRAST; in; is; an; 951217; COMPARATIVE STUDY; FEMALE; me; FIBRINOPEPTIDES A; bl; pd; tu; kinetics; MALE; RECOMBINANT PROTEINS; thrombin time; THROMBOSIS; pc; Medline File; di; Italy Notes : Thrombus extension in patients with venous thromboembolism is due to the accretion of fibrin onto existing thrombi. Extension is promoted by both circulating and thrombus-bound thrombin, which convert fibrinogen to fibrin. Heparin is an effective antithrombotic agent, but it requires continuous administration to achieve persistent inhibition of thrombus extension. Heparin is highly effective in inhibiting fluid phase thrombin, but is a relatively ineffective inhibitor of thrombus- bound thrombin. Hirudin, unlike heparin, inactivates both circulating and fibrin-bound thrombin and, therefore, has the potential to prevent thrombus extension even after a short course of treatment. The aim of this study was to evaluate the time course of the accretion of new fibrin onto preexisting rabbit jugular vein thrombi after a 3-hour infusion of saline, heparin, and hirudin. Heparin and recombinant (r)- hirudin (CGP 39399) were infused at doses that doubled the activated partial thromboplastin time (aPTT). At the end of the 3-hour infusions in rabbits treated with saline, heparin (0.75 mg/kg), or r-hirudin (1.25 mg/kg), accretion of 125I-fibrinogen was 59 +/- 5 micrograms, 34 +/- 4 micrograms, and 21 +/- 2 micrograms, respectively (heparin and r-hirudin v saline, P less than .01; r-hirudin v heparin, P less than .01). Three hours after the end of the infusions, the accreted 125I-fibrinogen in the saline-, heparin-, and hirudin-treated animals was 89 +/- 6 micrograms, 51 +/- 7 micrograms, and 23 +/- 3 micrograms, respectively; 9 hours after the end of the infusions, the accreted 125I-fibrinogen was 112 +/- 9 micrograms, 82 +/- 7 micrograms, and 25 +/- 3 micrograms, respectively. aPTT and thrombin clotting time (TCT) returned to the baseline value 90 minutes after the end of heparin or r-hirudin infusion. During in vitro experiments, human fibrin clots previously incubated in human plasma containing r-hirudin did not promote fibrinopeptide A (FPA) generation when washed and then incubated in human plasma in the absence of thrombin inhibitors. This persistent inhibition of FPA production was not observed after incubation in human plasma of human plasma clots preincubated with heparin. We conclude that heparin is effective in inhibiting thrombus extension while it is present in the circulation, but that this effect is rapidly lost after its plasma clearance. In contrast, the antithrombotic activity of r- hirudin is sustained beyond its plasma clearance, presumably because of its ability to inactivate thrombus-bound thrombin. Our findings indicate that r-hirudin might be an effective antithrombotic agent even when used for short periods. Ref ID : AGNELLI1993 8. Agnelli, G., Cosmi, B., Radicchia, S., Veschi, F., Boschetti, E., Lupatelli, L., Rinonapoli, E., and Nenci, G.G. Features of thrombi and diagnostic accuracy of impedance plethysmography in symptomatic and asymptomatic deep vein thrombosis. Thromb.Haemost. 70:266-269, 1993. Keywords : THROMBI; diagnostics; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; ASYMPTOMATIC; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; IPG; DVT; THROMBUS; CAUSE; VENOUS; venous outflow; SCREENING; in; is Notes : IPG is inaccurate and unreliable at detecting DVT unless significant amounts of proximal thrombus cause venous outflow obstruction. Such patients are most often symptomatic. IPG is unsatisfactory as a screening test for high-risk patients with few or absent clinical symptoms. Ref ID : AKINBOBOYE1993 9. Akinboboye, O.O., Brown, E.J.J., Queirroz, R., Cusi, V.P., Horowitz, L.F., Jonas, E.A., and Freeman, I. Recurrent pulmonary embolism with second-degree atrioventricular block and near syncope. Am Heart J 126:731-732, 1993. Keywords : PULMONARY EMBOLISM; EMBOLISM; SYNCOPE; sdi-11/93 Ref ID : ALAMARTINE1986 10. Alamartine, E., Delafosse, B., Bouffard, Y., Guyon, M., Perrot, D., and Motin, J. [Gas embolism after withdrawal of central venous catheters. A little known iatrogenic accident (letter)]. Presse Med. 15:1379, 1986. Keywords : 951202; EMBOLISM; VENOUS; Catheters; ACCIDENTS; Catheterization; ae; embolism,air; et; HUMAN; Hyperbaric Oxygenation; Iatrogenic Disease; Medline File Notes : [No Abstract Available]. Ref ID : ALAVI1990 11. Alavi, A., Gupta, N., Palevsky, H.I., Kelley, M.A., Jatlow, A.D., Byar, A.A., and Berger, H.J. Detection of thrombophlebitis with 111In- labeled anti-fibrin antibody: preliminary results. Cancer Res. 50:958s- 961s, 1990. Keywords : THROMBOPHLEBITIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MORTALITY; MORBIDITY; TECHNIQUES; CONTRAST; VENOGRAPHY; RISK; COMPLICATIONS; Allergic; Iodine; vein; NONINVASIVE; Doppler; ULTRASOUND; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; diagnostics; Extremities; ANTICOAGULATION; HEPARIN; antibodies; in; an; adverse effects; is Notes : Deep venous thrombosis remains a major medical problem, affecting a large segment of the population and resulting in significant mortality and morbidity. Current techniques available for detecting deep venous thrombosis present limitations that may mitigate their potential benefit to the patient. Invasive techniques, such as ascending contrast venography, carry risks to the patient with regard to complications such as an allergic reaction to an iodine dye, adverse effects to renal functions, and clot formation in a normal vein. Noninvasive techniques, such as Doppler ultrasound and impedance plethysmography, evaluate only a limited segment of the venous bed. The need remains for a diagnostic technique that is safe, accurate, and widely accessible. A readily available noninvasive scintigraphic technique utilizing radiolabeled monoclonal anti-fibrin antibody may overcome some of these shortcomings. This imaging examination is quite effective in detecting clots in the lower extremities. Compared to contrast venography, 111In-labeled anti- fibrin antibody imaging appears to be as sensitive in identifying acute venous thrombosis. In addition, the preliminary data indicate that anticoagulation with heparin may interfere with adequate visualization of the clots with this technique. Ref ID : ALAVI1990A 12. Alavi, A., Palevsky, H.I., Gupta, N., Meranze, S., Kelley, M.A., Jatlow, A.D., Schaible, T.F., Brown, J., and Berger, H.J. Radiolabeled antifibrin antibody in the detection of venous thrombosis: preliminary results. Radiology 175:79-85, 1990. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DIAGNOSIS; SCANNING; CONTRAST; VENOGRAPHY; CALF; Thigh; Pelvis; Injections; HEPARIN; THERAPY; Venogram; antibodies; in; blood; an; adverse effects; is Notes : The recent development of monoclonal antibodies against components of coagulated blood may provide new approaches to the diagnosis of venous thrombosis. Scanning with an indium-111-labeled Fab fragment of a murine monoclonal antifibrin antibody (59D8) and ascending contrast venography were performed in 33 patients. Images of the calves, popliteal fossae, thighs, and pelvis were obtained immediately, 4-6 hours, and 24 hours after injection of 2 mCi (74 MBq) of the antibody. All images were read in a blinded manner. Findings in both studies were positive in 28 patients and negative in three. In 19 patients not undergoing heparin therapy, 19 specific anatomic sites were positive on venograms and 29 were positive on antibody images (19 sites matched). In 14 patients undergoing heparin therapy, 34 sites were positive on venograms and 27 were positive on antibody images (22 sites matched). In most patients, positive results were noted within 1 hour of antibody injection. No adverse effects were noted with the antibody preparation. Preliminary data suggest that antifibrin antibody imaging is sensitive in detecting clots, is safe to use, and may have a role in diagnosing and managing venous thrombosis. Ref ID : ALAVI1991 13. Alavi, A. and Palevsky, H.I. Deep venous thrombosis and pulmonary embolism [letter]. Semin.Nucl.Med. 21:274-275, 1991. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM Ref ID : ALBERS1991 14. Albers, G.W., Atwood, J.E., Hirsh, J., Sherman, D.G., Hughes, R.A., and Connolly, S.J. Stroke prevention in nonvalvular atrial fibrillation [see comments]. Ann.Intern.Med. 115:727-736, 1991. Keywords : LMWH; Low-Molecular-Weight-Heparin; STROKE; PREVENTION; Atrial fibrillation; WARFARIN; THERAPY; BLEEDING; COMPLICATIONS; THROMBOEMBOLIC; PROSPECTIVE; RANDOMIZED; RISK; PROPHYLAXIS; INCIDENCE; ASPIRIN; LONG TERM; in Notes : There has been considerable uncertainty about the best way to prevent stroke in patients with nonvalvular atrial fibrillation. Recent studies have suggested that low-dose warfarin therapy, in addition to producing fewer bleeding complications, may be as effective as higher- dose therapy in preventing thromboembolic events. Four large, prospective, randomized trials have examined the risks and benefits of warfarin therapy for stroke prophylaxis in patients with nonvalvular atrial fibrillation. All four studies showed a substantially reduced incidence of stroke and a low incidence of significant bleeding in patients treated with warfarin. One of these studies also showed that aspirin reduced the incidence of stroke. The benefits associated with long-term low-dose warfarin therapy appear to exceed the risks for serious bleeding in most patients with atrial fibrillation. Aspirin may be a viable therapeutic option for patients who are unable to take warfarin or for those in subgroups at a low risk for stroke. Ref ID : ALLISON1983 15. Allison, J.G. The role of injection sclerotherapy in the emergency and definitive management of bleeding esophageal varices. JAMA 249:1484- 1487, 1983. Keywords : SCLEROTHERAPY; EMERGENCY; MANAGEMENT; BLEEDING; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; COMPLICATIONS___; DVT; PE; PLEURAL EFFUSION; ASCITES; Injections; in Ref ID : ALPERT1975 16. Alpert, J.S., Smith, R.E., and Ockene, I.S. Treatment of massive pulmonary embolism: The role of pulmonary embolectomy. Am.Heart J. 89:413, 1975. Keywords : TREATMENT; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; EMBOLECTOMY Ref ID : ALTENKAMPER1980 17. Altenkamper, H. [The phlebological consultation. Part 2: Therapy and after-care]. Fortschr.Med. 98:1631-1635, 1980. Keywords : THERAPY; NASP; After Care; English Abstract; HUMAN; Lymphedema; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Venous Insufficiency; Medline File; Health Planning & Administration File; ab Notes : TT - Die phlebologische Sprechstunde Teil 2: Therapie, Nachsorge AB - [No Abstract Available] UI - 81115695. Ref ID : ALZAHRANI1993 18. al Zahrani, H., Gari, M., and Sejeni, S. Pattern of deep venous thrombosis in Jeddah area, western Saudi Arabia. Int.Angiol. 12:54-58, 1993. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; vein; Hospitals; FEMALE; MALE; AGE; RISK; RISK FACTORS; OBESITY; MALIGNANCY; POSTPARTUM; ANTITHROMBIN III; PROTEIN C; PROTEIN S; DVT; Extremities; VENA CAVA; sdi-11/93; Saudi Arabia; in; is; laboratories Notes : Little is known about the pattern of Deep Vein Thrombosis in Saudi Arabia. Over 4 year period, 62 cases with strong evidence of venous thrombosis were studied in King Abdulaziz University and King Fahad Hospitals to learn the pattern of deep vein thrombosis in Jeddah, Western Saudi Arabia. There were 32 females and 30 males. The mean age of the group was 36.0 years (range 6-90 years). One or more risk factors was/were detected in 40 patients. Among these 14 factors, age more than 50 years, obesity, vasculitis, malignancy and postpartum were the common factors encountered. In other 22 patients, no risk factor was found. However, extensive laboratory search diagnosed 9 rare disorders out of these 22 cases. Antithrombin III, protein C, protein S deficiencies in 5, 2, 1 patients, consecutively. The last patient had significantly shortened PTT. The other 13 (21.0%) patients were considered real idiopathic DVT. Extremities were involved in 54 patients compared to only 8 cases with inferior vena cava or visceral thrombosis. The upper limb was affected in only 10 patients unlike the lower limb which was more commonly affected n = 37. Ref ID : AMBRUS1975 19. Ambrus, J.L., Ambrus, C.M., Mink, I.B., and Pickren, J.W. Causes of death in cancer patients. J.Med. 6:61-64, 1975. Keywords : 951202; CAUSE; DEATH; in; CANCER; PATHOLOGIC; Hospitals; cause of death; INFECTION; an; HEMORRHAGIC; THROMBOEMBOLIC; RESPIRATORY FAILURE; CARDIOVASCULAR; AUTOPSY; bronchopneumonia; et; cachexia; heart arrest; HEMORRHAGE; hepatic encephalopathy; HUMAN; kidney failure,chronic; neoplasm metastasis; Neoplasms; co; mo; PERITONITIS; PULMONARY EMBOLISM; respiratory insufficiency; SEPTICEMIA; Support,U.S.Gov't,P.H.S. THROMBOEMBOLISM; Medline File Notes : Causes of death in the year 1970 were analyzed retrospectively on the basis of clinical and pathologic reports of 506 cases in the Roswell Park Memorial Institute and Hospital. The single major cause of death was infection (36%), which was also a contributory factor in an additional 68% of the cases. Other important causes of death were hemorrhagic and thromboembolic phenomena (18%), which also were contributory factors in an additional 43%. Organ invasion by neoplastic cells including hepatic failure was the major cause of death in 10% and was a contributory factor in 5%. Cachexia was reported as major cause of death in 1% and as contributory factor in 0.4%. Respiratory failure due to various causes (including aspiration) was the main mechanism of death in 19% and a contributory factor in 3%. Cardiovascular insufficiency was the major cause of death in 7% and a contributory factor in 3%. Ref ID : AMERY1970 20. Amery, A., Deloof, W., Vermylen, J., and Verstraete, M. Outcome of recent thromboembolic occlusions of limb arteries treated with streptokinase. Brit.Med.J. 4:639-644, 1970. Keywords : OUTCOME; THROMBOEMBOLIC; OCCLUSION; STREPTOKINASE; VENOUS; THROMBOLYSIS; ARTERY; Arteries Notes : Up to 2/3 of ischemic limbs may be reperfused using high-dose peripheral venous thrombolysis. Ref ID : ANDEL1986 21. Andel, Z. Le traitement actuel des varices des membres inferieurs en tchecoslovaquie. Phlebologie 39(1):157-161, 1986. Keywords : VARICES; TREATMENT; VARICOSE VEINS; VEINS; VENOUS; SURGERY; MANAGEMENT; SCLEROTHERAPY; COMPLICATIONS; INCIDENTS; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; FATAL; ARTERIAL; INJURY; CZECHOSLOVAKIA; EPIDEMIOLOGY; de; en; in; varicose; is; an Notes : In 1986 Andel gathered data from the past ten years on the treatment of varicose veins in Czechoslovakia, where venous surgery is the usual mode of management and sclerotherapy only an occasionally used as an adjunct. He admits that reports of complications may be incomplete and probably underestimate the problem. The numbers available include 95,000 operations on varicose veins, of which there were 70 reported incidents of deep venous thrombosis and another 39 cases of pulmonary thromboembolism, of which ten were fatal. He also reports 11 cases of arterial injury with ischemic complications. Ref ID : ANDERSON1950 22. Anderson, G.M. and Hull, E. The effect of dicoumarol upon the mortality and incidence of thromboembolic complications in congestive heart failure. Am.Heart J. 39:697-702, 1950. Keywords : MORTALITY; INCIDENCE; THROMBOEMBOLIC; COMPLICATIONS; MYOCARDIAL INFARCTION; DVT; PE; BEDREST; MI; ANTICOAGULATION; in; heart; infarction; an; Immobilization Notes : Myocardial infarction and congestive heart failure produce an increased likelihood of DVT and PE independent of bedrest or immobilization. Patients with acute MI who do not receive anticoagulation have a 26 to 38 percent incidence of DVT. Patients treated for acute MI but who are eventually 'ruled out' have a much lower incidence of DVT. Ref ID : ANDERSON1987 23. Anderson, A.J., Krasnow, S.H., Boyer, M.W., and et al Hickman catheter clots: A common occurrence despite daily heparin flushing. Cancer Treat.Rep. 71:651-653, 1987. Keywords : CATHETER; HEPARIN; THROMBUS; HICKMAN; ACEP93 Ref ID : ANDERSON1990 24. Anderson, B.J., Keeley, S.R., and Johnson, N.D. Prothrombinex- induced thrombosis and its management with regional plasminogen activator in hepatic failure. Med.J.Aust. 153:352, 355-352, 356, 1990. Keywords : THROMBOSIS; MANAGEMENT; PLASMINOGEN; PLASMINOGEN ACTIVATOR; ACEP93; in Ref ID : ANDERSON1992 25. Anderson, F.A.,Jr. and Wheeler, H.B. Physician practices in the management of venous thromboembolism: a community-wide survey. J.Vasc.Surg. 16:707-714, 1992. Keywords : PHYSICIAN PRACTICES; MANAGEMENT; VENOUS; THROMBOEMBOLISM; SURGERY; CONSENSUS; RECOMMENDATIONS; HEPARIN; WARFARIN; FILTER; INTRAVENOUS; DURATION; COST; ANTICOAGULATION; VENA CAVA; RECURRENCE; TREATMENT; in; ab; is; Hospitals; diagnostics; Vena caval filter; intravenous heparin; an; Vena Cava Filters Notes : CS- Department of Surgery, University of Massachusetts Medical School, Worcester 01655 AB- Although there is a broad consensus on the optimum approach to the management of venous thromboembolism, there are few data from which to assess the extent of compliance with these recommendations. A community-wide study was therefore conducted in 16 short-stay hospitals in central Massachusetts to assess the clinical management of venous thromboembolism. Based on validated discharge diagnostic codes, there were 1231 clinically recognized cases of venous thromboembolism, 0.8% of 148,730 discharges in the 18-month period from July 1, 1988, to December 31, 1989. Eighty-one percent of study patients were admitted with signs or symptoms of acute venous thromboembolism. Ninety-seven percent of patients were treated with either heparin, warfarin, or inferior vena caval filter. Intravenous heparin was given to 89% of patients (mean bolus 6674 IU; mean duration 6.6 days). After heparin administration, there was a mean delay of 2.3 days in starting warfarin. Assuming a corresponding decrease in the length of hospital stay, appreciable cost savings could have been realized by earlier start of oral anticoagulation. An inferior vena cava filter was placed in 14% of patients. There was a clinically recognized in-hospital recurrence of venous thromboembolism during treatment in 2% of patients. Despite a slightly lower rate of compliance with recommended treatment regimens in nonteaching hospitals, and despite less frequent use of the inferior vena cava filter, there was no significant difference in the rate of in- hospital recurrence of clinically recognized venous thromboembolism in 10 nonteaching hospitals compared with six teaching hospitals.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : ANDERSON1993 26. Anderson, D.R., Lensing, A.W., Wells, P.S., Levine, M.N., Weitz, J.I., and Hirsh, J. Limitations of impedance plethysmography in the diagnosis of clinically suspected deep-vein thrombosis. Ann.Intern.Med. 118(1):25-30, 1993. Keywords : LMWH; Low-Molecular-Weight-Heparin; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; DIAGNOSIS; THROMBOSIS; IPG; DVT; OUTPATIENT; DEEP VEIN THROMBOSIS; CANCER; analysis; FOLLOWUP; VENOGRAPHY; COMPRESSION; ULTRASOUND; SENSITIVITY; PREDICTIVE VALUE; THROMBI; Femoral Vein; VEINS; diagnostics; vein; Methods; THROMBUS; in; an; is; 951217; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBOGRAPHY; Plethysmography,Impedance; predictive value of tests; PROSPECTIVE STUDIES; Retrospective Studies; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; di; ra; us; Medline File; Cancerlit File; Hospitals; ontario; CANADA Notes : OBJECTIVE: To re-evaluate the accuracy of impedance plethysmography (IPG) for the detection of proximal deep-vein thrombosis (DVT). PATIENTS: A total of 384 of 390 consecutive outpatients referred with their first episode of clinically suspected deep-vein thrombosis. SETTING: University-based tertiary care medical center associated with a cancer clinic. DESIGN: A retrospective analysis of a cohort of patients whose data were recorded and stored prospectively on a computerized data base over a 22-month period. MEASUREMENTS: Patients were evaluated by a physician and underwent IPG testing. Patients with abnormal IPG tests and those with normal IPG results in whom there was a high clinical suspicion of DVT or in whom follow-up IPG testing was not feasible were referred for venography. Venography and IPG results were interpreted by a panel of independent observers. Two models of the IPG instrument were used (Codman 200 and Electrodiagnostic Instruments 800). RESULTS: Venography (or compression ultrasound) was done in 57 patients with an abnormal IPG test and in 85 patients with normal IPG results. Impedance plethysmography was abnormal in only 37 of 56 patients with confirmed proximal-vein thrombosis (sensitivity, 66%; 95% Cl, 52% to 78%). Of the 57 patients with an abnormal IPG result, 37 had DVT (positive predictive value, 65%). The sensitivity for the detection of proximal DVT did not differ between the IPG 200 and 800 instruments (sensitivity, 63% and 71%, respectively; P > 0.2). Of the 19 proximal-vein thrombi not detected by IPG, 12 (63%) were occlusive and 11 (58%) involved at least the popliteal and superficial femoral veins. CONCLUSIONS: At our center, IPG has a far lower sensitivity for proximal-vein thrombosis than has been previously reported for symptomatic outpatients. The reason for this low sensitivity is unclear. Our findings indicate that centers using IPG as the initial diagnostic test for suspected DVT should be aware of this potential problem and should consider re-evaluating the sensitivity of their IPG machines by performing venography in a cohort of their patients with normal test results [CFF: IPG had a sensitivity of at most 66% when compared to venography for the diagnosis of acute DVT. The positive predictive value of a positive IPG was also 66% in this patient population. 63% of the thrombi that were not detected by IPG were occlusive, and 58% were proximal. IPG is not a reliable method for detecting or ruling out DVT, even when thrombus is large, occlusive, and proximal]. Ref ID : ANDERSON1993A 27. Anderson, D.R., O'Brien, B.J., Levine, M.N., Roberts, R., Wells, P.S., and Hirsh, J. Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty [see comments]. Ann.Intern.Med. 119(11):1105-1112, 1993. Keywords : LMWH; Low-Molecular-Weight-Heparin; COST; Low-molecular- weight heparin; HEPARIN; standards; PREVENTION; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; HIP; Safety; REVIEW; Hospitals; BLEEDING; COMPLICATIONS; RANDOMIZED; PROPHYLAXIS; RANDOMIZED CONTROLLED TRIALS; META ANALYSIS; regression analysis; analysis; France; Molecular Weight; SENSITIVITY; North America; drugs; POSTOPERATIVE; MANAGEMENT; 951217; in; odds ratio; ci; is; COMPARATIVE STUDY; Cost-Benefit Analysis; drug costs; ec; tu; heparin,low-molecular-weight; hip prosthesis; ae; HUMAN; Support,Non-U.S.Gov't; pc; Medline File; Health Planning & Administration File; ontario; CANADA Notes : PURPOSE: To compare the efficacy, safety, and cost-effectiveness of low-molecular-weight heparin with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. DATA IDENTIFICATION: Studies were identified by MEDLINE search and review of bibliographies of retrieved articles. Hospital resources used in treating deep vein thrombosis and bleeding complications after total hip arthroplasty were estimated using retrospectively collected data from 447 patients who participated in a recently completed randomized controlled deep vein thrombosis prophylaxis trial at our center. STUDY SELECTION: Randomized controlled trials directly comparing a low- molecular-weight heparin preparation with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty were potentially eligible for the meta-analysis. DATA EXTRACTION: Data from eligible studies were extracted independently by two of the authors. Multiple regression analysis of data from the patient cohort was used to estimate the effect of deep vein thrombosis and bleeding on length of hospital stay. A hypothetical North American price for low-molecular- weight heparin was determined based on the ratio between low-molecular- weight heparin and standard heparin in France. Costs were based on weighted per-diem hospital expenditures and physician fees for procedures and reported in 1992 U.S. dollars. RESULTS OF DATA SYNTHESIS: Meta-analysis of six eligible trials determined that low-molecular- weight heparin was significantly more effective than standard heparin at preventing deep vein thrombosis after total hip arthroplasty (common odds ratio, 0.72; 95% CI, 0.53 to 0.95). However, this benefit was restricted to the prevention of proximal deep vein thrombosis (common odds ratio, 0.40; CI, 0.28 to 0.59). No significant differences were found in the rates of distal deep vein thrombosis or total, major, or minor bleeding between the two groups. Based on a 2.6 to 1 price ratio between low-molecular-weight heparin and standard heparin, use of low- molecular-weight heparin would save the health care system about $50,000 per 1000 patients treated. Sensitivity analysis shows that if the low- molecular-weight heparin/standard heparin price ratio exceeds 3.7 (the threshold value lies between 0.8 and 5.5 based on the extremes of the 95% CI of the common odds ratios for deep vein thrombosis and bleeding complications), use of low-molecular-weight heparin is more expensive. At a price ratio of 10, it would cost more than $250,000 to treat 1000 patients with low-molecular-weight heparin compared with standard heparin or about $5000 for each additional deep vein thrombosis prevented with low-molecular-weight heparin. CONCLUSIONS: Low-molecular- weight heparin is more effective and is at least as safe as standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Based on the current French price ratio of low-molecular- weight heparin to standard heparin, the use of low-molecular-weight heparin in North America would result in overall savings in cost; however, the relative cost-effectiveness is critically dependent on the price ratio between the two drugs. Further research is needed to compare the cost-effectiveness of low-molecular-weight heparin with other prophylactic regimens and postoperative deep vein thrombosis management strategies. Ref ID : ANDERSON1993D 28. Anderson, D.R., Ginsberg, J.S., Brill-Edwards, P., Demers, C., Burrows, R.F., and Hirsh, J. The use of an indwelling Teflon catheter for subcutaneous heparin administration during pregnancy. A randomized crossover study. Arch.Intern.Med. 153:841-844, 1993. Keywords : Teflon; CATHETER; SUBCUTANEOUS; HEPARIN; PREGNANCY; RANDOMIZED; THERAPY; ANTICOAGULANT; PROPHYLAXIS; Injections; LONG TERM; Methods; Questionnaires; SIDE EFFECTS; PAIN; COMPLICATION; Heparin dose; THROMBOPLASTIN; PREGNANT; an; is; in Notes : BACKGROUND: The use of subcutaneous heparin, the therapy of choice for women requiring anticoagulant prophylaxis during pregnancy, is problematic because of the discomfort produced by repeated injections. An indwelling subcutaneous Teflon catheter that can be left in place for 1 week recently became available for use as an entry port for parenteral therapy. Since the use of this catheter has the potential to overcome some of the problems of long-term heparin therapy, we decided to compare this Teflon catheter with twice-daily subcutaneous injections in women requiring heparin during pregnancy. METHODS: In a randomized, multiple-crossover study, patients alternated every 2 weeks between having heparin administered through the indwelling Teflon catheter and receiving heparin via subcutaneous injections. After each 4-week cycle, patients completed a questionnaire designed to determine their preferred method of heparin administration. The side effects, doses, and anticoagulant activity of heparin with the two delivery systems were also compared. RESULTS: Twelve patients completed one to five 4-week cycles of heparin therapy. Ten of the patients selected the Teflon catheter as the preferred route of heparin administration (P = .04) and 11 patients reported that the catheter caused less pain and bruising than twice-daily subcutaneous injections (P < .01). Five patients developed urticarial reactions at the sites of heparin injections. These reactions tended to be more severe when the Teflon catheter was used, and two women discontinued using the catheter after the first cycle because of this complication. There were no differences in heparin dose requirements or achieved activated partial thromboplastin times between the two routes of heparin administration. CONCLUSIONS: Most pregnant women in our study preferred to have subcutaneous heparin administered through an indwelling Teflon catheter rather than by twice-daily injections. Heparin given through the Teflon catheter was bioavailable and caused less local bruising than twice- daily injections. Urticarial reactions to heparin tended to be more severe with the use of the Teflon catheter and resulted in the discontinuation of the device's use in two of 12 patients. Ref ID : ANDREW1995 29. Andrew, M., Brigden, M., Bormanis, J., Cruickshank, M., Geerts, W., Giles, A., Hirsh, J., Hull, R., Johnson, J., and Johnston, M. INR reporting in Canadian medical laboratories. Thrombosis Interest Group of Canada. Am.J.Hematol. 48(4):237-239, 1995. Keywords : 951217; in; THROMBOSIS; CANADA; COAGULATION; PROTHROMBIN; prothrombin time; an; THROMBOPLASTIN; PT; is; UNITED STATES; Administration,Oral; ANTICOAGULANTS; ad; clinical laboratory information systems; HUMAN; laboratories; st; Medline File; Health Planning & Administration File; INR Notes : A written survey of all licensed medical laboratories in Canada performing coagulation testing was performed to investigate the level of knowledge and overall usage of the INR system for reporting prothrombin time results in medical laboratories. There was an overall response rate of 857 of 1,228 laboratories surveyed. Fifty- seven percent of responding laboratories utilized some format of INR reporting. The ISI of the individual thromboplastin utilized was known by 89% of laboratories. The ISI of the thromboplastin utilized was known to be specific for the particular reagent/instrument combination in 44% of cases. Fifty-five percent of client physicians preferred PT results to be reported in seconds while 42% desired an INR format. The situation in Canada is similar to the United States in that further education regarding the INR system for PT reporting is required by both medical laboratories and physicians Island Medical Laboratories Ltd Victoria BC Canada. Ref ID : ANGELOV1979 30. Angelov, A. [Ischemic heart disease and embolisms and thomboses in the lesser circulation]. Vutr.Boles. 18:214-218, 1979. Keywords : 951202; heart; heart diseases; EMBOLISM; in; THROMBOSIS; Pulmonary Circulation; infarction; MYOCARDIAL INFARCTION; DURATION; PATHOGENESIS; myocardium; Necrosis; CARDIAC; atherosclerosis; an; AUTOPSY; COMPARATIVE STUDY; CORONARY DISEASE; PA; English Abstract; HUMAN; PULMONARY EMBOLISM; Medline File Notes : All deceased with ischemic heart disease (IHD) -- 450 cases and with embolism and thrombosis in pulmonary circulation (ETPC) --601 cases were purposefully examined for a period of 10 years (1963--1972). In 75 of the examined a combination of IHD and ETPC was present. In 41 out of them only cicatrices of past infarctions were found and in 34 - - recent myocardial infarctions. In 14 of the examined (41%) it was established, clinically and morphologically, that ETPC are with a longer duration than the recent myocardial infarctions and very likely have played a role in their pathogenesis. The confirmation of acute ischemic changes in myocardium gives a support --undulation of the myofibrils and fuchsinophylic necrosis in the deceased of ETPC without preceeding IHD. The cardiac hypertrophy and coronary atherosclerosis lead to an intensification of the myocardial ischemic alterations in ETPC. Ref ID : ANGELOV1979A 31. Angelov, A. [Embolisms and thromboses in the lesser circulation and disseminated intravascular coagulation]. Vutr.Boles. 18:96-102, 1979. Keywords : 951202; in; THROMBOSIS; Pulmonary Circulation; COAGULATION; DIC; PULMONARY EMBOLISM; EMBOLISM; Microcirculation; LUNG; is; FIBRIN; an; THROMBOGENESIS; OCCLUSION; AGED; AUTOPSY; CASE REPORT; disseminated intravascular coagulation; PA; English Abstract; FEMALE; HUMAN; kidney glomerulus; Liver; Medline File Notes : thrombosis in pulmonary circulation (ETPC), in 53 of the cases (8.82%) a generalized, in two or more organs, disseminated intravasal coagulation (DIC) was found. Generalized DIC develops most often in autochthon pulmonary thrombosis (in 30.91%) and more rarely in pulmonary embolism with additional autochthon thrombformation (in 15.19%). In a great part of pulmonary embolism with additional autochthon thromb- formation (96.62%) and autochthon pulmonary thrombosis (87.27%) DIC develops locally only in pulmonary microcirculation. The local DIC in lungs is characterized morphologically by the formation of multiple fibrin microthrombus (2-- 3 microthrombuses per square cm section) in the microcirculatory system of lungs. The development of local or generalized DIC aggravates the course of ETPC and could play an essential role in thrombogenesis, both by mechanic occlusion of pulmonary vessels and by serotonun elimination from the destroying thrombocytes. Ref ID : ANGELOV1987 32. Angelov, A. and Alachverdjan, R.P. [Anatomical and medical laboratory parallels of various forms of thrombus formation]. Folia Haematol.Int.Mag.Klin.Morphol.Blutforsch. 114:414-422, 1987. Keywords : 951202; THROMBUS; Died; THROMBOEMBOLIC; COMPLICATIONS; in; MASSIVE; VENOUS; LUNG; COAGULATION; ARTERIAL; standards; FIBRINOGEN; PROTHROMBIN; BLEEDING; is; FIBRIN; AUTOPSY; Blood Coagulation Tests; COMPARATIVE STUDY; disseminated intravascular coagulation; di; PA; English Abstract; HUMAN; PULMONARY EMBOLISM; THROMBOEMBOLISM; THROMBOPHLEBITIS; THROMBOSIS; Medline File; laboratories; prothrombin time Notes : 77 patients who had suffered from various diseases and had died under clinical circumstances of thromboembolic complications were systematically examined in clinical and morphological respect. Depending on the pathological-anatomical character of thrombus formation determined they were classified into 4 groups: 1. Massive venous thromboses with embolus of the lung; 2. Disseminated intravasal coagulation; 3. Locally limited, mainly arterial thromboses or some microthromboses; 4. Without any thrombotic complications. A distinct dependence between the changes in the standard values of the coagulation status (fibrinogen, thrombocytes, prothrombin time, bleeding and coagulation time) and the character and extent of thrombotic processes could not be detected. It is solely the level of fibrin splitting products which, to a certain degree, reflects the extent and spread of thrombotic processes Medizinischen Akademie in Varna (Bulgarien) Lehrstuhl fur Pathologische Anatomie. Ref ID : ANON1977 33. Anonymous [Complications of venous insufficiency: a large medical and economical problem]. Nord.Med. 92:183-187, 1977. Keywords : VENOUS; Venous Insufficiency; NASP; AGED; Atrophy; Dermatitis; Economics,Medical; HEMORRHAGE; HUMAN; PROGNOSIS; Skin; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Wound Healing; Medline File; ab Notes : TT - Komplikationer till venos insufficiens ett stort medicinskt och ekonomiskt problem AB - [No Abstract Available] UI - 77193429. Ref ID : ANON1990 34. Anonymous Preliminary report of the Stroke Prevention in Atrial Fibrillation Study [see comments]. N.Engl.J.Med. 322:863-868, 1990. Keywords : STROKE; PREVENTION; COMPLICATIONS; THERAPY; PLACEBOS; WARFARIN; ASPIRIN; PROPHYLAXIS; EMBOLISM; TREATMENT; RISK; AGE; CAUSE; ANTICOAGULATION; DURATION; in; Atrial fibrillation; Antithrombotic; RANDOMIZED; ARM; confidence intervals; is Notes : Atrial fibrillation, even in the absence of rheumatic valvular disease, predisposes patients to embolic complications, but the role of antithrombotic therapy in the prevention of such complications has not been fully clarified. We therefore performed a randomized, placebo- controlled trial to evaluate warfarin and aspirin individually as prophylaxis against ischemic stroke and systemic embolism (the primary events) in such patients. Patients eligible to receive warfarin (group 1) were assigned to warfarin (open label), aspirin (325 mg per day), or placebo (aspirin and placebo were given in a doubleblind fashion). Those who were not eligible for warfarin (group 2) received either aspirin or placebo in a double-blind fashion. The placebo arm of group 1 was recently terminated, when evidence emerged that each active agent was superior to placebo. In this paper we report preliminary data on active therapy (with either warfarin or aspirin) as compared with placebo in group 1, and on aspirin as compared with placebo in groups 1 and 2 combined. By November 1989, 1244 patients had been followed for a mean of 1.13 years. The event rates were 1.6 percent per year in the 393 patients who made up the two active treatment arms (warfarin and aspirin) of group 1, and 8.3 percent per year in the 195 patients who made up the placebo arm (P less than 0.00005) (risk reduction, 81 percent; 95 percent confidence interval, 56 to 91). In all 517 patients given aspirin, the rate of primary events (3.2 percent per year) was lower than that in the 528 patients given placebo (6.3 percent per year; P = 0.014) (risk reduction, 49 percent; 95 percent confidence interval, 15 to 69). However, we were unable to show a benefit of aspirin in patients over 75 years of age. These preliminary data indicate that antithrombotic therapy with warfarin or aspirin is effective in the short term in reducing the risk of stroke and systemic embolism in patients with atrial fibrillation due to causes other than rheumatic valvular disease. The relative benefits of aspirin and warfarin remain unclear, and the trial is continuing in order to address this issue. Ref ID : ANON1990A 35. Anonymous Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators [see comments]. JAMA 263(20):2753-2759, 1990. Keywords : 96-suzy-001; VENTILATION/PERFUSION; SCAN; in; PULMONARY EMBOLISM; EMBOLISM; PROSPECTIVE; DIAGNOSIS; PIOPED; SENSITIVITY; SPECIFICITY; LUNG; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PROBABILITY; FOLLOWUP; ACUTE DISEASE; COMPARATIVE STUDY; FEMALE; Follow-Up Studies; HUMAN; radionuclide imaging; MALE; Methods; MIDDLE AGE; observer variation; Outcome and Process Assessment (Health Care); predictive value of tests; PROSPECTIVE STUDIES; PULMONARY ARTERY; radiography; RANDOM ALLOCATION; Support,U.S.Gov't,P.H.S. Notes : To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism (sensitivity, 98%; specificity, 10%). Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans (sensitivity, 41%; specificity, 97%). Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings. Ref ID : ANON1991 36. Anonymous Tomography in deep vein thrombosis [letter; comment]. BMJ. 302:346-347, 1991. Keywords : PHLEBITIS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; COMPARATIVE STUDY; HUMAN; LEG; blood supply; PHLEBOGRAPHY; PROSPECTIVE STUDIES; THROMBOPHLEBITIS; radiography; Ultrasonography; in Ref ID : ANON1992 37. Anonymous Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Research Committee of the British Thoracic Society. Lancet 340:873-876, 1992. Keywords : DURATION; ANTICOAGULATION; DEEP VEIN THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; THERAPY; vein; DVT; PE; TREATMENT; DIAGNOSIS; DEATH; THROMBOEMBOLISM; RECURRENCE; POSTOPERATIVE; CONTRAST; VENOUS; SURGERY; CAUSE; RISK; RISK FACTORS; ANTICOAGULANTS; VEINS; ab; is; in; Hospitals; adverse effects; Died; Treatment Failure Notes : AB- The optimum duration of anticoagulation therapy for deep- vein thrombosis (DVT) and pulmonary embolism (PE) is not clear. We have carried out a multicentre comparison of 4 weeks' and 3 months' anticoagulation in patients admitted to hospital with acute DVT, PE, or both. Of 712 patients enrolled, 358 were assigned 4 weeks' treatment and 354 3 months'. Objective confirmation of the diagnosis was obtained in 71%. PE caused or contributed to death in 7 patients (3 treated for 4 weeks, 4 for 3 months). Adverse effects were uncommon, although 1 patient (4-week group) died of haemorrhage. The numbers of patients whose thromboembolism failed to resolve on treatment was lower in the 3- month group than in the 4-week group (13 [3.7%] vs 24 [6.7%], p = 0.10) as was the number who had recurrences (14 [4.0%] vs 28 [7.8%], p = 0.04). Among patients with postoperative DVT or PE the rate of treatment failure and recurrence was low (2.6%) and there was little difference between the treatment groups. By contrast, among medical patients the rate was 12.8%, with a clear difference in favour of 3 months' treatment. If venous thromboembolism arises after surgery, 4 weeks of anticoagulation should be adequate. In other settings, patients with new DVT, PE, or both, who do not have a persisting underlying cause or risk factor should receive anticoagulants for 3 months. Ref ID : ANON1992A 38. Anonymous Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. The Stroke Prevention in Atrial Fibrillation Investigators. Ann.Intern.Med. 116:6-12, 1992. Keywords : THROMBOEMBOLISM; RISK; STROKE; PREVENTION; ARTERIAL; PLACEBOS; CLINICAL TRIAL; INPATIENTS; OUTPATIENT; THERAPY; PREDICTIVE VALUE; EMBOLISM; THROMBOEMBOLIC; RISK FACTORS; PATHOGENESIS; PROPHYLAXIS; ANTICOAGULATION; DURATION; in; Atrial fibrillation; cohort studies; RANDOMIZED; Echocardiogram; multivariate analysis; analysis; Hypertension; heart; standards; Echocardiography; Antithrombotic Notes : OBJECTIVE: To identify echocardiographic predictors of arterial thromboembolism in patients with nonrheumatic atrial fibrillation and to determine whether these add to clinical variables for risk stratification. DESIGN: Cohort study of patients assigned to placebo in a randomized clinical trial. SETTING: Five hundred sixty-eight inpatients and outpatients with nonrheumatic atrial fibrillation assigned to placebo therapy at 15 U.S. medical centers from 1987 to 1989 in the Stroke Prevention in Atrial Fibrillation study. Patients were followed for a mean of 1.3 years. MEASUREMENTS: M-mode and two- dimensional (2-D) echocardiograms performed at study entry and interpreted by local cardiologists. The predictive value of 14 echocardiographic variables for later ischemic stroke or systemic embolism was assessed by multivariate analysis. MAIN RESULTS: Left ventricular dysfunction from 2-D echocardiograms (P = 0.003) and the size of the left atrium from M-mode echocardiograms (P = 0.02) were the strongest independent predictors of later thromboembolism. Multivariate analysis of these two independent echocardiographic predictors with the three independent clinical predictors of thromboembolism (history of hypertension, recent congestive heart failure, previous thromboembolism) identified 26% of the cohort with a low risk for thromboembolism (1.0% per year; 95% Cl, 0.2% to 4.0%). Compared with risk stratification using clinical variables alone, echocardiographic results altered thromboembolic risk stratification in 18% of the entire cohort and in 38% of those without clinical risk factors. CONCLUSIONS: Both left ventricular and left atrial variables are significant predictors of thromboembolism in patients with nonvalvular atrial fibrillation. Our results challenge traditional views of the pathogenesis of ischemic stroke in patients with atrial fibrillation and suggest that standard echocardiography contributes to risk stratification, differentiating the one third of patients without clinical risk factors who are at increased risk for stroke from the remainder who may not need antithrombotic prophylaxis. Ref ID : AOKI1978 39. Aoki, N., Moroi, M., Sakata, Y., Yoshida, N., and Matsuda, M. Abnormal plasminogen. A hereditary molecular abnormality found in a patient with recurrent thrombosis. J.Clin.Invest. 61:1186-1195, 1978. Keywords : PLASMINOGEN; HEREDITARY; THROMBOSIS; abnormalities; in Ref ID : ARAI1992 40. Arai, N., Nakata, M., Yamazaki, J., Shirai, T., and Nonaka, H. [Sudden death due to bilateral pulmonary thromboembolism in a patient with multiple myeloma: an autopsy case report]. Nippon.Kyobu.Shikkan.Gakkai.Zasshi. 30:1756-1760, 1992. Keywords : 951202; DEATH; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; in; an; AUTOPSY; Died; PULMONARY ARTERY; ARTERY; THROMBOSIS; Hospitals; RECURRENCE; PAIN; VEINS; LONG TERM; CAUSE; VENOUS; VENOUS THROMBOSIS; SUDDEN DEATHS; CASE REPORT; Death,Sudden; et; English Abstract; FEMALE; HUMAN; MIDDLE AGE; multiple myeloma; co; PA; PULMONARY EMBOLISM; Medline File; Cancerlit File; dyspnea; japan Notes : We encountered a patient with multiple myeloma who died suddenly, in whom bilateral pulmonary artery thrombosis was found at autopsy. The patient was a 50-year-old woman who had received chemotherapy for multiple myeloma at a local clinic for 4 years, and was transferred to our hospital because of recurrence of multiple myeloma in August 1990. Despite chemotherapy performed after admission, serum globulin level increased and her low back pain worsened, and she was generally restricted to bed. On October 21, she developed sudden dyspnea, became markedly cyanotic, lost consciousness, and then suffered a cardiopulmonary arrest. Autopsy revealed bilateral pulmonary artery thrombosis as well as thrombosis in the pelvic veins. Hyperviscosity due to multiple myeloma and long-term recumbency were the probable causes of pelvic venous thrombosis and subsequent pulmonary artery thrombosis. We report a rare case of bilateral pulmonary artery thrombosis which developed during the course of multiple myeloma and led to sudden death First Department of Internal Medicine Toho University School of Medicine Tokyo Japan. Ref ID : ARAKAWA1964 41. Arakawa, T. and Spaet, T.H. Hypercoagulability and thrombosis: effect of injected thrombokinase and adenosine diphosphate on established microthrombi in rabbits. Proc.Soc.Exp.Biol.Med. 116:1034, 1964. Keywords : THROMBOSIS; SCLEROTHERAPY; ANIMAL; HYPERCOAGULABILITY; THROMBOKINASE; ADENOSINE DIPHOSPHATE; MICROTHROMBI; RABBITS; in Ref ID : ARCELUS1993 42. Arcelus, J.I., Caprini, J.A., and Traverso, C.I. Venous thromboembolism after hospital discharge. Semin.Thromb.Hemost. 19 Suppl 1:142-146, 1993. Keywords : VENOUS; THROMBOEMBOLISM; Hospitals; Methods; PROPHYLAXIS; RISK; COMPLICATIONS; DVT; PE; HEPARIN; WARFARIN; Molecular Weight; DOSAGE; Safety; sdi-11/93; is; in; standards; ge; an Notes : Several methods of prophylaxis have significantly reduced the risk of developing VTE during hospital admission. There is a current tendency toward a reduction in the hospital stay, which does not necessarily mean that patients are protected from experiencing thrombotic complications after leaving the hospital. A number of patients will develop DVT and PE after hospital discharge if prophylaxis is prematurely discontinued while they persist at risk. Further studies are necessary to establish whether extending prophylaxis beyond discharge will reduce the rate of late-onset thromboses and which are the best prophylactic alternatives for the different patient groups at risk. Meanwhile, it is our standard of practice to utilize a combination of GES and either low-dose heparin or warfarin, at least for 3 or 4 weeks after discharge in high-risk patients. In countries where low molecular weight heparins are available, these agents represent an attractive alternative to unfractionated heparin because of their better dosage schedule and safety profile. Ref ID : ARNESON1982 43. Arneson, H. and Hoseth, A. Streptokinase or heparin in the treatment of deep vein thrombosis, follow-up results of a prospective study. Acta.Med.Scand. 211:65, 1982. Keywords : STREPTOKINASE; HEPARIN; TREATMENT; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; FOLLOWUP; PROSPECTIVE; PULMONARY EMBOLISM; in; vein; PROSPECTIVE STUDIES; 96-suzy-002; THROMBOLYSIS; Died; Follow-Up Studies; PHLEBOGRAPHY; THERAPY; is; LEG; Leg Ulcer; Ulcer; LATE Notes : 01-03-96. Abstract : In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatment with streptokinase or heparin, we found that 71.4% of the streptokinase-treated patients achieved phlebographically significant thrombolysis as compared to 23.8% in the heparin group. These patients have been reevaluated after a mean observation period of 6.5 years. Seven patients had died and there were no other drop-outs. Thus, 35 patients were subjected to the follow-up study consisting of phlebography and clinical examination. The evaluation were performed without knowledge of the initial therapy. Seven patients had phlebographically normal veins, and all belonged to the streptokinase group. This difference between the treatment groups is statistically highly significant (p<0.01). At clinical examination, 13 of the 17 patients in the streptokinase group had normal legs and 4 exhibited moderate postthrombotic changes. In constrast, 3 of the heparin-treated patients showed serious postthrombotic changes with open leg ulcers, and only 6 of 18 patients in this group had normal legs. The present results strongly support the assumption that streptokinase therapy is the best treatment aat present in patients with acute deep vein thrombosis. This has been shown for the initial thrombolysis, and now also for the avoidance of late postthrombotic changes. Ref ID : ARNOLD1992 44. Arnold, A.Z., Mick, M.J., Mazurek, R.P., Loop, F.D., and Trohman, R.G. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter [see comments]. J.Am.Coll.Cardiol. 19:851-855, 1992. Keywords : ANTICOAGULATION; EMBOLISM; REVIEW; INCIDENCE; COMPLICATIONS; FATAL; ANTICOAGULANT; THERAPY; DURATION; PREVALENCE; STROKE; POSTOPERATIVE; Cardioversion; in; Atrial fibrillation; Cardiology; ab; is; an; Hypertension; diabetes mellitus Notes : CS- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195 AB- The need for prophylactic anticoagulation to prevent embolism before direct current cardioversion is performed for atrial fibrillation or atrial flutter is controversial. To examine this issue further, a retrospective review was undertaken to assess the incidence of embolic complications after cardioversion. The review involved 454 elective direct current cardioversions performed for atrial fibrillation or atrial flutter over a 7 year period. The incidence rate of embolic complications was 1.32% (six patients); the complications ranged from minor visual disturbances to a fatal cerebrovascular event. All six patients had atrial fibrillation, and none had been on anticoagulant therapy (p = 0.026). The duration of atrial fibrillation was less than 1 week in five of the six patients who had embolic complications. Baseline characteristics of patients with a postcardioversion embolic event are compared with those of patients who did not have an embolic event. There was no difference in the prevalence of hypertension, diabetes mellitus or prior stroke between the two groups, and there was no difference in the number of patients who were postoperative or had poor left ventricular function. Left atrial size was similar between the two groups. No patient in the embolic group had valvular disease. No patient with atrial flutter had an embolic event regardless of anticoagulant status; therefore, anticoagulation is not recommended for patients with atrial flutter undergoing cardioversion. Prophylactic anticoagulation is pivotal in patients undergoing elective direct current cardioversion for atrial fibrillation, even those with atrial fibrillation of less than 1 week's duration. Ref ID : ARNOLDI1973 45. Arnoldi, C.C. [Treatment of varicose veins and leg ulcer]. Ugeskr.Laeger 135:1302, 1973. Keywords : VARICOSE VEINS; VEINS; LEG; NASP; BANDAGES; HUMAN; Leg Ulcer; Sclerosing Solutions; THROMBOPHLEBITIS; Medline File; varicose; ab Notes : TT - Behandlingen af ~areknuder og skinnebenss~ar AB - [No Abstract Available] UI - 74041983. Ref ID : ASHBY1993 46. Ashby, E.C. Leg elevation in prophylaxis of thromboembolism [letter]. Lancet 342:1562-1563, 1993. Keywords : PHLEBITIS; LEG; PROPHYLAXIS; THROMBOEMBOLISM; AGED; ANTICOAGULANTS; therapeutic use; HUMAN; MALE; MIDDLE AGE; Postoperative Care; Postoperative Complications; prevention & control; Posture; THROMBOPHLEBITIS; in Ref ID : ASHFORD1967 47. Ashford, T.P. and Frieman, D.G. The role of the endothelium in the initial phases of thrombosis. Am.J.Pathol. 50:257, 1967. Keywords : ENDOTHELIUM; THROMBOSIS; PULMONARY EMBOLISM; PATHOGENESIS; in Ref ID : ASHIDA1989 48. Ashida, H., Kotoura, Y., Nishioka, A., Takagi, K., Yoshikawa, H., Ishikawa, Y., and Utsunomiya, J. Portal and mesenteric venous thrombosis as a complication of endoscopic sclerotherapy. Am.J.Gastroenterol. 84(3):306-310, 1989. Keywords : VENOUS; THROMBOSIS; COMPLICATION; SCLEROTHERAPY; COMPLICATIONS; VENOUS THROMBOSIS Ref ID : ASTED1973 49. Asted, B. Thrombosis and oral contraceptives: Possible predisposition. Brit.Med.J. 4:631-634, 1973. Keywords : THROMBOSIS; ORAL CONTRACEPTIVES; FIBRINOLYTIC Ref ID : ASTEDT1973 50. Astedt, B. and et al Thrombosis and oral contraceptives: possible predisposition. Brit.Med.J. 4:631, 1973. Keywords : THROMBOSIS; ORAL CONTRACEPTIVES; NASP Ref ID : ASTER1995 51. Aster, R.H. Heparin-induced thrombocytopenia and thrombosis [editorial; comment]. N.Engl.J.Med. 332(20):1374-1376, 1995. Keywords : 96-suzy-001; THROMBOCYTOPENIA; THROMBOSIS; HEPARIN; adverse effects; HUMAN; igg; immunology; PLATELET AGGREGATION; blood; chemically induced; COMPLICATIONS; ETIOLOGY Ref ID : AUGER1992 52. Auger, W.R., Fedullo, P.F., Moser, K.M., Buchbinder, M., and Peterson, K.L. Chronic major-vessel thromboembolic pulmonary artery obstruction: appearance at angiography. Radiology. 182:393-398, 1992. Keywords : CHRONIC; THROMBOEMBOLIC; PULMONARY ARTERY; ARTERY; ANGIOGRAPHY; PULMONARY HYPERTENSION; Hypertension; SURGICAL; DIAGNOSIS; diagnostics; PGM-8/94; critical care; ab; in; is Notes : CS- Pulmonary and Critical Care Division, University of California, San Diego Medical Center 92103-8381 AB- The pulmonary angiograms of 250 patients evaluated for chronic thromboembolic pulmonary hypertension were reviewed. Pulmonary thromboendarterectomy was performed in each of these individuals, and the surgical findings were correlated with abnormal angiographic patterns. The pulmonary angiographic findings suggestive of chronic thromboembolic disease included "pouching" defects, webs or bands, intimal irregularities, abrupt vascular narrowing, and complete vascular obstruction. Pouching is reported by the authors to be a previously undescribed angiographic feature of this disease. Carefully obtained and properly interpreted pulmonary angiograms are necessary to confirm the diagnosis of operable chronic thromboembolic disease. Differential diagnostic possibilities should be considered prior to a decision to perform surgical correction. Ref ID : AUGER1994 53. Auger, W.R., Fedullo, P.F., Channick, R.N., and Moser, K.M. Pulmonary embolism: when the acute becomes chronic. Emerg.Med. 26(8):19- 42, 1994. Keywords : PULMONARY EMBOLISM; EMBOLISM; CHRONIC; COR PULMONALE; PE; SURGICAL; endarterectomy; UCSD; is Notes : Chronic pulmonary embolism is underecognized. Cor pulmonale from chronic PE is potentially curable by surgical pulmonary endarterectomy. UCSD performed more than 350 of these procedures between 1988 and 1993, with a high rate of success. Ref ID : AWOTEDU1992 54. Awotedu, A.A., Igbokwe, E.O., Akang, E.E., and Aghadiuno, P.O. Pulmonary embolism in Ibadan, Nigeria: five years autopsy report. Cent.Afr.J.Med. 38:432-435, 1992. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; AUTOPSY; CLINICAL FEATURES; FATAL; PE; Hospitals; pc; MALE; FEMALE; AGE; Neoplasms; INFECTION; CARDIAC; CHEST; CHEST PAIN; PAIN; PULMONARY INFARCTION; infarction; DIAGNOSIS; THERAPY; RISK; Adolescence; ADULT; Age Factors; AGED; CHILD; HUMAN; LUNG; PA; MIDDLE AGE; nigeria; co; et; RISK FACTORS; Sex Factors; Medline File; Cancerlit File Notes : The autopsy findings and clinical features in 60 patients with fatal pulmonary embolism (PE) in University College Hospital, Ibadan, between 1985 and 1989 are analysed in the current study. Pulmonary embolism occurred in 3,8 pc of all autopsied patients during this period. There was a male to female ratio 1,4 to one and average age was 47 years. Malignant neoplasms, infections and cardiac failure were the leading predisposing factors to PE identified. The ante- mortem clinical features consisted largely of non-specific respiratory symptoms of dyspnoea, cough, chest pain and haemoptysis. Of these patients, 15,6 pc were diagnosed ante-mortem as having PE. Pulmonary infarction occurred in 13,3 pc of the cases and was commoner in females and in patients with underlying cardiac diseases. This study emphasises the need for a high clinical index of suspicion to improve the antemortem diagnosis of this potentially fatal condition and to advocate a greater use of prophylactic anti- coagulant therapy in high risk patients Department of Medicine University College Hospital Ibadan Nigeria. Ref ID : AYRES1983 55. Ayres, S.J., Goff, J.S., and Warren, H. Endoscopic sclerotherapy for bleeding esophageal varices: effects and complications. Ann.Intern.Med. 98:900-903, 1983. Keywords : SCLEROTHERAPY; THROMBOSIS; ESOPHAGEAL VARICES; COMPLICATIONS; BLEEDING; ESOPHAGEAL; VARICES Ref ID : BACHARACH1993 56. Bacharach, J.M., Stanson, A.W., Lie, J.T., and Nichols, D.A. Imaging spectrum of thrombo-occlusive vascular disease associated with antiphospholipid antibodies. Radiographics. 13:417-423, 1993. Keywords : Vascular Diseases; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ARTERIAL; Arterial Occlusive Diseases; MAGNETIC RESONANCE; ANGIOGRAPHY; VENOGRAPHY; THROMBOLYTIC; Punctures; Syndrome; DIAGNOSIS; RISK; RISK FACTORS; PROGNOSIS; THERAPY; sdi-11/93; antibodies; is; in; magnetic resonance imaging; Unexpected Notes : The association of antiphospholipid antibodies with unexplained thrombo-occlusive vascular disease is well known but often remains unrecognized. The most well-studied clinical manifestation is venous thrombosis, but arterial occlusive disease involving multiple sites is also well documented. Twenty-six cases of thrombo-occlusive disease were observed in 22 patients over a 3-year period. Magnetic resonance imaging and angiography were used to make the diagnoses. None of the patients who underwent angiography or venography developed thrombolytic disease related to the puncture site. This group of patients with antiphospholipid antibody syndrome had a wide distribution of arterial and venous thrombotic disease. Radiologists should consider antiphospholipid antibody syndrome in the differential diagnosis when evaluating thrombo-occlusive vascular disease that is unexpected or occurs without risk factors. Knowledge of antiphospholipid antibody status has important implications for prognosis and therapy. Ref ID : BACHER1993 57. Bacher, P., Horst, B., Breyer, H.G., Hoppensteadt, D.A., Walenga, J.M., and Fareed, J. Postoperative monitoring of low molecular weight heparin prophylaxis in high-risk patients. Semin.Thromb.Hemost. 19 Suppl 1:73-78, 1993. Keywords : POSTOPERATIVE; MONITORING; Molecular Weight; HEPARIN; PROPHYLAXIS; OUTCOME; TECHNIQUES; Low molecular weight heparin; DVT; THROMBOSIS; PROTEIN C; INCIDENCE; FIBRINOLYSIS; SURGERY; sdi-11/93; in; laboratories; an; is Notes : The alterations of the laboratory assays described for heparin monitoring in low molecular weight and unfractionated heparin prophylaxis groups did not correlate with the clinical outcome. Current laboratory techniques failed to detect an increased need for a higher dose of unfractionated or low molecular weight heparin to prevent DVT in these high-risk patients. The parameters commonly associated with thrombosis, that is, decreases in protein C and AT III were correlated with an increased incidence of DVT, but there was no difference in the assay values between the low molecular weight heparin and unfractionated heparin groups. Fibrinolysis activation is known to be associated with surgery; however, our data suggest an additional activation due to low molecular weight heparin compared with the unfractionated heparin group. Most interestingly, elevated PAI levels appear to correlate with thrombosis. Ref ID : BACKELJAUW1991 58. Backeljauw, P.F., Moodie, D.S., and Murphy, D.J.,Jr. High-dose urokinase therapy for the lysis of a central venous catheter-related thrombus in a young patient with Hodgkin's disease. Clin.Pediatr.(Phila). 30:274-277, 1991. Keywords : UROKINASE; THERAPY; LYSIS; VENOUS; THROMBUS; ACEP93; in Ref ID : BADING1994 59. Bading, B., Blank, S.G., Sculco, T.P., Pickering, T.G., and Sharrock, N.E. Augmentation of calf blood flow by epinephrine infusion during lumbar epidural anesthesia. Anesth.Analg. 78:1119-1124, 1994. Keywords : PHLEBITIS; CALF; BLOOD FLOW; EPINEPHRINE; EPIDURAL; AGED; anesthesia,epidural; administration & dosage; PHARMACOLOGY; FEMALE; hip prosthesis; HUMAN; Infusions,Intravenous; LEG; blood supply; MALE; MIDDLE AGE; Postoperative Complications; prevention & control; Regional Blood Flow; drug effects; THROMBOPHLEBITIS; vein; THROMBOSIS; HIP; SURGERY; INTRAVENOUS; Extremities; norepinephrine; VASCULAR RESISTANCE; FREQUENCY; DEEP VEIN THROMBOSIS; blood; in; an; is Notes : Lower rates of deep vein thrombosis after hip surgery performed under epidural anesthesia were noted in patients who received intravenous epinephrine infusion. To determine whether this effect could be mediated by enhanced lower extremity blood flow, 12 patients were studied immediately preoperatively. Calf blood flow increased from 3.7 +/- 1.6 to 5.0 +/- 2.2 mL.100 mL-1.min-1 with an intravenous epinephrine infusion (1.9 +/- 0.5 microgram/min). After epidural anesthesia calf blood flow increased to 6.3 +/- 3.3 mL.100 mL-1.min-1 with epinephrine infusion (2.7 +/- 1.0 micrograms/min) but was reduced to 2.6 +/-1.5 mL.100 mL-1.min-1 when norepinephrine (0.8 +/- 0.7 microgram/min) was infused. Calf vascular resistance decreased from 27.7 +/- 13.5 to 7.9 +/- 4.6 mmHg.mL-1.100 mL-1.min-1 after epidural anesthesia with epinephrine (2.7 +/- 1.0 micrograms/min) but was unchanged when norepinephrine (0.8 +/- 0.7 microgram/min) was infused. The augmentation of lower extremity blood flow when epinephrine is used in conjunction with epidural anesthesia may in part explain the low frequency of deep vein thrombosis with conduction anesthesia. Ref ID : BAETHGE1991 60. Baethge, B.A. and Payne, D.K. Phlegmasia cerulea dolens associated with the lupus anticoagulant. West.J.Med. 154:211-213, 1991. Keywords : PHLEBITIS; LUPUS; ANTICOAGULANT; BLOOD COAGULATION; CASE REPORT; FEMALE; HUMAN; LEG; physiopathology; blood; MIDDLE AGE; THROMBOPHLEBITIS; DIAGNOSIS; THERAPY Ref ID : BAGLIANI1973 61. Bagliani, A., Taborelli, R., and Parravicini, R. [On drug therapy of phlebopathies of the lower extremities with trihydroxyethylrutoside and trihydroxyethylrutoside associated with adrenochromomonosemicarbazone]. Minerva.Cardioangiol. 21:775-788, 1973. Keywords : THERAPY; Extremities; NASP; Adrenochrome; ADULT; AGED; COMPARATIVE STUDY; Drug Combinations; English Abstract; FEMALE; GANGRENE; HUMAN; Leg Ulcer; MALE; MIDDLE AGE; PHLEBITIS; Rutin; Semicarbazones; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; drugs; drug therapy; ad; ab Notes : TT - Sulla terapia farmacologica delle flebopatie degli arti inferiori con triidrossietilrutoside e con triidrossietilrutoside associato ad adrenocromomonosemicarbazone AB - [No Abstract Available] UI - 74106574. Ref ID : BAHRMANN1976 62. Bahrmann, E., Kleinschmidt, H.J., and Rahn, W. [The infarction of the right ventricle and the connections with coronary sclerosis and chronic cor pulmonale (author's transl)]. Zentralbl.Allg.Pathol. 120:88- 90, 1976. Keywords : 951202; infarction; SCLEROSIS; CHRONIC; COR PULMONALE; FREQUENCY; POSTMORTEM; ADULT; in; MALE; FEMALE; PATHOGENESIS; CARDIAC; PULMONARY EMBOLISM; EMBOLISM; AUTOPSY; Chronic Disease; CORONARY DISEASE; co; English Abstract; heart hypertrophy; HUMAN; MYOCARDIAL INFARCTION; PA; PULMONARY HEART DISEASE; Medline File Notes : The infarction of the right ventricle as a spatial and temporal mosaic-infarct and the lesions following it were investigated. Its frequency and its connections with the infarction of the left ventricle, coronary sclerosis and hypertrophy of the right ventricle as cor mitrale and cor pulmonale were reported, treated on 11 073 post-mortem examinations of adults separated in males and females. Three groups were divided: 1. isolated lesions of the right ventricle 2. separated lesions--spatially and/or temporally of the right and left ventricle 3. lesions overlapping from the left on the right ventricle. The infarct of the right ventricle respectively cicatrices were observed in 1.2%. The coronary sclerosis was detected in all cases, and specially the hypertrophy of the right ventricle as cor pulmonale or cor mitrale were important for the pathogenesis of right- cardiac infarcts. The pulmonary embolism was more frequent in isolated infarcts of the right ventricle. Ref ID : BAKER1993 63. Baker, S.R., Burnand, K.G., Sommerville, K.M., Thomas, M.L., Wilson, N.M., and Browse, N.L. Comparison of venous reflux assessed by duplex scanning and descending phlebography in chronic venous disease. Lancet 341:400-403, 1993. Keywords : PHLEBITIS; VENOUS; REFLUX; Duplex; SCANNING; PHLEBOGRAPHY; CHRONIC; ADULT; AGED; Aged,80 and over; Chronic Disease; COMPARATIVE STUDY; FEMALE; HUMAN; MALE; MIDDLE AGE; Regional Blood Flow; SAPHENOUS VEIN; Ultrasonography; THROMBOPHLEBITIS; radiography; Venous Insufficiency; physiopathology; vein; LEG; SCAN; BELOW-KNEE; TOURNIQUET; POST-THROMBOTIC; Methods; in; is; abnormalities Notes : Venous reflux was assessed by duplex scanning and descending phlebography in 98 limbs of 52 patients. There was moderately good agreement for deep vein reflux elicited by a standardised Valsalva manoeuvre, classified by a modified Kistner grading (0 to IV). The same grade was found in 58 limbs, with a difference of one grade in 27 limbs, and more than one grade in 13. Descending phlebography underestimated reflux in the lower leg compared with duplex scanning. The presence of reflux found on duplex scan correlated with the half-volume refilling time on a foot-volume plethysmogram with a below-knee tourniquet. There was no correlation between descending phlebography and the half- refilling time. Ascending phlebography showed post-thrombotic changes in 23 limbs. The duplex scan confirmed severe reflux (grades III and IV) in 14 of these 23 limbs, and demonstrated isolated reflux below normal valves in 4 other limbs. Severe reflux was seen on the descending phlebogram in only 10 of the 23 limbs with post-thrombotic changes. Duplex scanning may be a better method for detecting reflux than descending phlebography and is more acceptable to the patient. Ascending phlebography remains essential to display anatomical abnormalities found in some postthrombotic limbs that are not associated with reflux. Ref ID : BARNES1976 64. Barnes, R.W. and et al Accuracy of Doppler ultrasound in clinically suspected venous thrombosis of the calf. Surg.Gynecol.Obstet. 143:425, 1976. Keywords : Doppler; ULTRASOUND; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CALF; NASP; in Ref ID : BARNES1989 65. Barnes, R.W., Nix, M.L., Barnes, C.L., Lavender, R.C., Golden, W.E., Harmon, B.H., Ferris, E.J., and Nelson, C.L. Perioperative asymptomatic venous thrombosis: Role of duplex scanning versus venography. J Vasc Surg 9:251-260, 1989. Keywords : ASYMPTOMATIC; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Duplex; SCANNING; VENOGRAPHY; HIP; KNEE; PROPHYLAXIS; Thigh; DVT; PREVALENCE; POSTOPERATIVE; INCIDENCE; CALF; CALF VEIN THROMBOSIS; vein; PULMONARY EMBOLISM; EMBOLISM; SENSITIVITY; in Notes : 78 patients undergoing hip or knee replacement underwent examination by venography and duplex. Despite intensive prophylaxis, 'major' thigh DVT had a preoperative prevalence of 2.5% and a postoperative incidence of 14.1%, while isolated calf DVT had a preoperative prevalence of 2.5% and a postoperative incidence of 16.7%. Calf vein thrombosis accounted for the only two instances of documented pulmonary embolism in this study. Duplex had a sensitivity of 85.7% for proximal DVT. Postoperative DVT occurred in 7 of 11 patients (64%) with a prior history of DVT. Ref ID : BARR1991 66. Barr, H., Lancashire, M.J., Torrie, E.P., and Galland, R.B. Intra- arterial thrombolytic therapy in the management of acute and chronic limb ischaemia [see comments]. Brit.J.Surg. 78:284-287, 1991. Keywords : INTRAARTERIAL; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MANAGEMENT; CHRONIC; ACEP93; in Ref ID : BARRELLIER1992 67. Barrellier, M.T. [Venous echo Doppler: a future standard test in the diagnosis of thrombosis of the lower limbs?]. Ann.Fr.Anesth.Reanim. 11:370-376, 1992. Keywords : Doppler; DIAGNOSIS; THROMBOSIS; Duplex; ULTRASOUND; VENOUS; VENOUS THROMBOSIS; DVT; vein; Muscles; THROMBUS; PHLEBOGRAPHY; SENSITIVITY; sensitivity and specificity; SPECIFICITY; OBESITY; Skin; TECHNIQUES; diagnostics; COST; CAUSE; SCREENING; RISK; EARLY; LATE; FOLLOWUP; sdi-11/93; standards; in; an; pathology; is Notes : Duplex ultrasound imaging provides both an ultrasound picture of the tissue being explored and the sound of the flow speed in a particular area. Colour Doppler imaging gives colour codes for the different flow rates. Venous pathology is always investigated, with ultrasound, on both sides, at the iliac and caval, femoral, and foreleg levels. For the latter, excellent equipment and patient position are required. Ultrasound criteria of deep venous thrombosis (DVT) are the incompressibility of the vein being investigated, and detection of the thrombosis with the ultrasound probe. Doppler criteria are asymmetric spontaneous flows, the loss of their respiratory rhythm, and the lack of flow induced by contraction of muscle. The colour Doppler draws provides the contours of a partial or floating thrombus. Compared with phlebography, ultrasound imaging has a sensitivity and specificity of 96%. Colour Doppler imaging is even more accurate: both sensitivity and specificity increase to 100%. The limitations of ultrasound are: its dependence on the investigator, the difficulty of making the diagnosis of recurring DVT when there already are previous sequellae, obesity, intra-abdominal gas, skin lesions or inflammatory oedema. Phlebography remains necessary in 5% of cases. The advantages of this technique are its non invasiveness, excellent diagnostic performance, low cost, and the possibility of diagnosing another cause, whether responsible for the clinical signs or not. It is indicated for the diagnosis of DVT, routine screening in patients at risk, and the early and late follow-up of patients. Today, ultrasound imaging should always be carried out before other investigations.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : BARRITT1960 68. Barritt, D.W. and Jordan, S.C. Anticoagulant drugs in the treatment of pulmonary embolism: A controlled trial. Lancet 1:1309-1312, 1960. Keywords : ANTICOAGULANT; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; HEPARIN; WARFARIN; THERAPY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; MORTALITY; DEATH; drugs; in Notes : The first controlled trial comparing heparin and warfarin to no therapy for pulmonary thromboembolism. After 35 patients had been enrolled the mortality differences were already significant: 5 deaths in the patients not anticoagulated, compared with none in the patients who were anticoagulated. Ref ID : BARSOUM1982 69. Barsoum, M.S., Mooro, H.A., Bolous, F.I., Ramzy, A.F., Rizy-Allah, M.A., and Mahmoud, F.I. The complications of injection sclerotherapy of bleeding oesophageal varices. Brit.J.Surg. 69:79-81, 1982. Keywords : COMPLICATIONS; SCLEROTHERAPY; BLEEDING; VARICES; DVT; PE; PLEURAL EFFUSION; ASCITES; ESOPHAGEAL; Injections Ref ID : BASHIROV1977 70. Bashirov, A.B. [Skin plastic surgery in complex treatment of trophic ulcers caused by venous drainage disorders]. Klin.Khir. :66-68, 1977. Keywords : SURGERY; TREATMENT; Ulcer; VENOUS; NASP; ADULT; Age Factors; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; Skin; Skin Transplantation; Syndrome; THROMBOPHLEBITIS; Transplantation,Autologous; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; in; drainage; ab Notes : TT - Kozhnaia plastika v kompleksnom lechenii troficheskikh iazv na pochve narusheniia venoznogo ottoka AB - [No Abstract Available] UI - 78049285. Ref ID : BASS1970 71. Bass, H., Banas, J.J., and Dalen, J.E. Pulmonary function studies: Aids to diagnosis of pulmonary embolism. Arch.Intern.Med. 126:266, 1970. Keywords : PULMONARY FUNCTION; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM Ref ID : BASTIDE1992 72. Bastide, G., Barret, A., and Lefebvre, D. [Inter-related arterial and venous pathologies]. Phlebologie. 45:367-371, 1992. Keywords : ARTERIAL; VENOUS; THERAPY; NASP; Arteries; Arteritis; English Abstract; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; VEINS; Medline File; pathology; et; ab; ad; de Notes : TT - Pathologies arterielle et veineuse intriquees AB - The authors concomitant arterial and venous disorders. On the same patient. They point out the obvious preeminence of arterial disease on venous ones, and discuss about the panel of therapy association usable. They underline the necessity of saving the venous capital AD - Service de Chirurghie Generale et Vasculaire AD - Hopital Purpan AD - Toulouse UI - 93255023. Ref ID : BASU1972 73. Basu, D., Gallos, A., and Hirsh, J. A prospective study of the value of monitoring heparin treatment with the activated partial thromboplastin time. N.Engl.J.Med. 287:324, 1972. Keywords : PROSPECTIVE; HEPARIN; TREATMENT; THROMBOPLASTIN; PULMONARY EMBOLISM; MONITORING; APTT; PROSPECTIVE STUDIES; partial thromboplastin time Ref ID : BATISSE1966 74. Batisse, F., Sobel-Sicard, M., and Natali, J. Etude histologique de varices retiree par stripping et soumise anterieurement a un traitement sclerosant. Phlebologie 19(2):105-108, 1966. Keywords : VARICES; SCLEROSANT; VEINS; SCLEROTHERAPY; SCLEROSIS; EARLY; THROMBOSED; HISTOLOGICAL; RECANALIZATION; de; et; in; is Notes : Histological sections of veins after sclerotherapy, showing how in effective sclerosis the entire vessel is obliterated while ineffective sclerosis results in the early formation of narrow open (recanalized) channels within the thrombosed vessel. Ref ID : BATTEY1987 75. Battey, P.M., Fulenwider, J.T., Smith, R.B., Martin, L.G., Stewart, M.T., and Perdue, G.D. Intra-arterial thrombolysis for acute limb ischemia: a three-year experience. South.Med.J. 80:479-482, 1987. Keywords : INTRAARTERIAL; THROMBOLYSIS; ACEP93; Ischemia Ref ID : BAUDO1990 76. Baudo, F., Caimi, T.M., Redaelli, R., Nosari, A.M., Mauri, M., Leonardi, G., and deCataldo, F. Emergency treatment with recombinant tissue plasminogen activator of pulmonary embolism in a pregnant woman with antithrombin III deficiency. Am.J.Obstet.Gynecol. 163:1274-1275, 1990. Keywords : EMBOLISM; PREGNANCY; EMERGENCY; TREATMENT; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PULMONARY EMBOLISM; PREGNANT; ANTITHROMBIN III; Italy; THROMBOEMBOLIC; COMPLICATIONS; CONGENITAL; DIAGNOSIS; RISK; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; CASE REPORT; FEMALE; HUMAN; MALE; Alteplase ,Administration and Dosage ,AD; Antithrombin III ,Deficiency ,DF; Pregnancy Complications,Cardiovascular ,Drug Therapy ,DT; Pulmonary Embolism ,Drug Therapy ,DT; ADULT; Emergencies; Infant,Newborn; Infusions,Intravenous; in; ab; is Notes : CS- Department of Haematology, Ospedale Niguarda Ca Granda, Milano, Italy AB- Thromboembolic complications during pregnancy are frequent in patients with congenital antithrombin III deficiency. We report on a 29-year-old patient with congenital antithrombin III deficiency and severe pulmonary embolism treated with recombinant tissue plasminogen activator. The diagnosis of antithrombin deficiency is retrospective. This case indicates that the risk of thrombolytic therapy in this clinical setting might have been overemphasized. Ref ID : BAUER1942 77. Bauer, G. A roentgenological and clinical study of the sequels of thrombosis. Acta.Chir.Scand. 86:1, 1942. Keywords : THROMBOSIS; PULMONARY EMBOLISM; ROENTGENOLOGICAL Ref ID : BAUER1942A 78. Bauer, G. Heparin as a therapeutic against thrombosis: results of a one-year treatment at Mariestal Hospital. Acta Chir.Scand. 86:217, 1942. Keywords : HEPARIN; THROMBOSIS; TREATMENT; Hospitals; NASP Ref ID : BAUER1988 79. Bauer, P., Berrod, J.P., and Lambert, H. [Hyperbaric oxygenotherapy: current data]. Bull.Soc.Ophtalmol.Fr. 88:1417-1420, 1988. Keywords : 951202; carbon monoxide poisoning; th; embolism,air; English Abstract; eye diseases; gas gangrene; HUMAN; Hyperbaric Oxygenation; mt; Medline File Notes : [No Abstract Available]. Ref ID : BAUER1994 80. Bauer, K.A. Hypercoagulability--a new cofactor in the protein C anticoagulant pathway [editorial; comment]. N.Engl.J.Med. 330(8):566- 567, 1994. Keywords : PROTEIN C; ANTICOAGULANT; in; 96-suzy-001; BLOOD COAGULATION; Endothelium,Vascular; metabolism; HUMAN; partial thromboplastin time; THROMBIN; THROMBOEMBOLISM; blood Notes : AN-94134121. Ref ID : BEALL1975 81. Beall, A.C. and Collins, J.J. What is the role of pulmonary embolectomy? Am.Heart J. 89:411, 1975. Keywords : EMBOLECTOMY; PULMONARY EMBOLISM; is Ref ID : BEARD1993 82. Beard, J.D., Nyamekye, I., Earnshaw, J.J., Scott, D.J., and Thompson, J.F. Intraoperative streptokinase: a useful adjunct to balloon-catheter embolectomy. Brit.J.Surg. 80:21-24, 1993. Keywords : STREPTOKINASE; CATHETER; EMBOLECTOMY; ACEP93; Intraoperative Ref ID : BECKER1976 83. Becker, T., Schickedanz, H., and Petrat, H. [Contribution on prevention, diagnosis and treatment of pulmonary embolism (author's transl)]. Z.Erkr.Atmungsorgane. 146:24-33, 1976. Keywords : 951202; PREVENTION; DIAGNOSIS; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; in; SURGICAL; Died; AUTOPSY; THROMBUS; FATAL; POSTOPERATIVE; LUNG; SURGERY; Extremities; INCIDENCE; RISK; ADULT; AGED; ANTICOAGULANTS; tu; early ambulation; English Abstract; FEMALE; HUMAN; PA; MALE; MIDDLE AGE; Postoperative Complications; di; pc; th; THROMBOPHLEBITIS; co; et; Medline File Notes : In the 50 year period between 1917 and 1966, 915 patients, 0.44% of the total surgical patients at the Surgical Clinic of the University of Jena, died from pulmonary embolism. In 20% of the cases autopsy failed to disclose any thrombus. Among 714 fatal cases of postoperative lung embolism, 43% occurred after abdominal surgery, 18% after surgery on the extremities, and 14% followed urogenital operations. Peak incidence of lung embolism fell on the day of operation and on the 6th, 7th, and 13th postoperative day. Patients at risk of embolism can be identified beforehand. The incidence of pre- and postroperative pulmonary embolism can be reduced to a great extent by specific preventive measures carried out prior to, during, and after surgical intervention. Prevention, diagnosis, and present day treatment of pulmonary embolism are discussed. Ref ID : BECKER1983 84. Becker, G.J., Holden, R.W., Rabe, F.E., and et al Local thrombolytic therapy for subclavian and axillary vein thrombosis. Radiology 149:419-? 1983. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; SUBCLAVIAN; vein; THROMBOSIS; VEINS; Axillary Vein Ref ID : BEECHAM1993 85. Beecham, R.P., Dorfman, G.S., Cronan, J.J., Spearman, M.P., Murphy, T.P., and Scola, F.H. Is bilateral lower extremity compression sonography useful and cost-effective in the evaluation of suspected pulmonary embolism? AJR.Am.J.Roentgenol. 161:1289-1292, 1993. Keywords : Extremities; COMPRESSION; Sonography; PULMONARY EMBOLISM; EMBOLISM; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LUNG; SCAN; PROBABILITY; Methods; ARTERIOGRAPHY; VENTILATION; PERFUSION; SCANNING; PULMONARY ARTERIOGRAPHY; Hospitals; COST; is; in; an Notes : OBJECTIVE. Because deep venous thrombosis is clinically linked with pulmonary embolism and often treated similarly, we sought to assess the usefulness of obtaining bilateral lower extremity compression sonograms when findings on ventilation-perfusion lung scans indicate a low or indeterminate probability of pulmonary embolism. Demonstration of deep venous thrombosis would provide a rationale for treating both pulmonary embolism and deep venous thrombosis. MATERIALS AND METHODS. Two hundred twenty-three consecutive patients with suspected pulmonary embolism had ventilation-perfusion lung scans and concurrent bilateral lower extremity compression sonograms; 34 also had pulmonary arteriography. RESULTS. In 75 cases, the results of ventilation- perfusion lung scanning indicated an indeterminate probability of pulmonary embolism. Evidence of thrombosis was seen on sonograms in 11 of these 75. In the remaining 64, 17 underwent pulmonary arteriography and four (24%) had pulmonary embolism. Findings on lung scans indicated a low probability of pulmonary embolism in 70 of 223 patients. Evidence of thrombosis was seen on sonograms in 11 of these 70. Five of the remaining 59 underwent pulmonary arteriography and one (20%) had pulmonary embolism. According to the 1993 Medicare Fee Schedule, if all 145 patients whose lung scans were nondiagnostic had sonography and only those with normal sonograms had pulmonary arteriography, the professional and hospital charges would be $359,552. If all 145 had pulmonary arteriography without sonography, the charges would be $395,031. CONCLUSION. If ventilation-perfusion lung scans indicate a low or an indeterminate probability of pulmonary embolism and bilateral lower extremity compression sonography is performed, only those patients with normal sonographic findings would need further study. Thus, 15% (22/145) of patients could be spared pulmonary arteriography, and the estimated savings in cost would be 9%. Ref ID : BEHNKE1971 86. Behnke, A.R. The Harry G. Armstrong Lecture. Decompression sickness: advances and interpretations. Aerosp.Med. 42:255-267, 1971. Keywords : 951202; decompression sickness; aerospace medicine; Age Factors; ANIMAL; biological transport; Blood Platelets; Blood Pressure; Body Weight; Bone Diseases; et; co; pp; th; diving; embolism,air; embolism,fat; Fatigue; heart; helium; HUMAN; Hyperbaric Oxygenation; lipids; me; nitrogen; Oxygen Inhalation Therapy; PAIN; Pulmonary Circulation; PULMONARY EMBOLISM; Respiration; submarine medicine; Medline File Notes : [No Abstract Available]. Ref ID : BELCHEV1969 87. Belchev, V. [Surgical treatment of leg varices and results during a 12-year period]. Khirurgiia.(Sofiia). 22:483-488, 1969. Keywords : TREATMENT; LEG; VARICES; NASP; English Abstract; HUMAN; Leg Ulcer; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Khirurgichenoto lechenie na varices cruris i resultatite ni za 12 godini AB - [No Abstract Available] UI - 71005604. Ref ID : BELL1977 88. Bell, W.R., Simon, T.L., and DeMets, D.L. The clinical features of submassive and massive pulmonary embolism. Am.J.Med. 62:355, 1977. Keywords : CLINICAL FEATURES; SUBMASSIVE; MASSIVE; PULMONARY EMBOLISM; EMBOLISM Ref ID : BELL1982 89. Bell, W.R. and Simon, T.L. Current status of pulmonary thromboembolic disease. Am.Heart J. 103:239-262, 1982. Keywords : THROMBOEMBOLIC; PULMONARY EMBOLISM Ref ID : BELL1985 90. Bell, W.R. and Bartholomew, J.R. Pulmonary thromboembolic disease. Curr.Probl.Cardiol. 10(9):1-70, 1985. Keywords : THROMBOEMBOLIC; REVIEW Notes : Excellent comprehensive review. Ref ID : BELL1986 91. Bell, W.R., Simon, T.L., and DeMets, D.L. The clinical features of submassive and massive pulmonary emboli. Am.Rev.Resp.Dis. 133:679, 1986. Keywords : MASSIVE; EMBOLI; PULMONARY EMBOLISM; SUBMASSIVE; CLINICAL FEATURES; Pulmonary emboli Ref ID : BELLARY1992 92. Bellary, S.V. Disseminated intravascular coagulation (DIC) after endoscopic injection sclerotherapy with ethanolamine oleate. Endoscopy 22:151, 1992. Keywords : COAGULATION; DIC; SCLEROTHERAPY; ETHANOLAMINE OLEATE; THROMBOSIS; DEATH; CEREBRAL THROMBOSIS; MASSIVE; disseminated intravascular coagulation; Injections; CASE REPORT; Died; Cerebral Notes : A case report of disseminated intravascular coagulation which appeared three hours after injection sclerotherapy with ethanolamine oleate. The patient died on day 12 subsequent to massive cerebral thrombosis. Ref ID : BELMAN1990 93. Belman, A.L., Roque, C.T., Ancona, R., Anand, A.K., and Davis, R.P. Cerebral venous thrombosis in a child with iron deficiency anemia and thrombocytosis. Stroke. 21:488-493, 1990. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CHILD; Iron; THROMBOCYTOSIS; Headache; MAGNETIC RESONANCE; HEMORRHAGIC; Hemoglobins; ANGIOGRAPHY; sdi-11/93; Cerebral; in; infarction; magnetic resonance imaging Notes : We describe a 22-month-old boy with iron deficiency anemia and reactive thrombocytosis who developed vomiting, headache, mental status changes, and seizures. Computed tomography showed infarction of the basal ganglia and thalami. Magnetic resonance imaging revealed cerebral venous thrombosis, delineated the extent of the vascular and associated parenchymal involvement, showed the infarcts to be hemorrhagic (a finding not imaged by computed tomography due to our patient's depressed hemoglobin level), and obviated the need for invasive angiography. Ref ID : BENHAMOU1981 94. Benhamou, A.C. and Natali, J. Les accidents des traitements sclerosant et chirugical des varices des membres inferieurs. Phlebologie 34(1):41-51, 1981. Keywords : ACCIDENTS; SCLEROSANT; VARICES; SURGICAL; SCLEROTHERAPY; DEATH; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; CAUSE; TREATMENT; COMPLICATIONS; THROMBOPHLEBITIS; SUDDEN DEATHS; SEPTIC; MANAGEMENT; de; et; in; SEPTICEMIA; is Notes : Two cases of ileofemoral thrombophlebitis were identified in the surgical group, of which both survived with medical management. There were three cases of thrombophlebitis in the sclerotherapy group, with one death due to proven pulmonary thromboembolism. The sclerotherapy group also included two additional sudden deaths from unknown causes, suspected to be pulmonary thromboembolism, and one case of septicemia from septic thrombophlebitis. Unfortunately, there is no rational way to estimate the total treatment population from which these serious complications were culled. Ref ID : BENINSON1986 95. Beninson, J. Thrombophlebitis. In: Clinical dermatology, edited by Demis, D.J.Philadelphia:Harper and Row Publi, 1986, Keywords : THROMBOPHLEBITIS; NASP Ref ID : BERGQVIST1983 96. Bergqvist, D. and Hedner, U. Pregnancy and venous thrombo-embolism. Acta Obstet Gynecol (62):449-453, 1983. Keywords : 96-suzy-002; PREGNANCY; VENOUS; THROMBOEMBOLISM Notes : 01-05-96. Ref ID : BERGQVIST1985 97. Bergqvist, D. and Lindblad, B. A 30-year survey of pulmonary embolism verified at autopsy: an analysis of 1274 surgical patients. Brit.J.Surg. 72:105-108, 1985. Keywords : 951202; EMBOLISM; AUTOPSY; analysis; SURGICAL; Retrospective Studies; in; Sweden; Pulmonary emboli; EMBOLI; Died; FATAL; DEATH; POSTMORTEM; FREQUENCY; PULMONARY EMBOLISM; AGE; FEMALE; THROMBI; CENTRAL VENOUS CATHETER; VENOUS; Catheters; CAUSE; cause of death; ADULT; Age Factors; AGED; HUMAN; Length of Stay; MIDDLE AGE; Postoperative Complications; ep; Postoperative Period; mo; surgery,operative; Medline File; Health Planning & Administration File; an Notes : A retrospective study was undertaken of all surgical patients in Malmo, Sweden, during the period 1951-1980, in whom pulmonary emboli were found at autopsy. The autopsy rate was high throughout the period, ranging from 73 to 100 per cent. Of 5477 patients who died during the period, 1274 had pulmonary emboli (23.6 per cent), 349 of which were considered fatal, 353 contributory to death and 572 incidental. Fifty- one per cent of the patients were not operated upon. The number of contributory and incidental emboli increased over the period, to some extent probably reflecting greater thoroughness in postmortems. The frequency of fatal pulmonary emboli decreased in the last 5 year period. Pulmonary embolism was more rare in patients under 50 years of age. The proportion of females increased. In 24 cases major embolism emanated from thrombi around central venous catheters. This retrospective analysis of a large number of patients shows that pulmonary embolism continues to be a major cause of death in surgical patients, and in Malmo as common a cause of death in operated as in nonoperated patients. Ref ID : BERGQVIST1992 98. Bergqvist, D., Lowe, G.D., Berstad, A., Haas, S., Hirsh, J., Lassen, M.R., Samama, M., and Verhaeghe, R. Prevention of venous thromboembolism after surgery: a review of enoxaparin. Brit.J.Surg. 79(6):495-498, 1992. Keywords : PREVENTION; VENOUS; THROMBOEMBOLISM; SURGERY; REVIEW; vein; THROMBOSIS; DVT; RISK; TREATMENT; Low molecular weight heparin; Molecular Weight; HEPARIN; LMWH; thromboprophylaxis; COST; 951217; is; in; ADULT; AGED; Cost-Benefit Analysis; heparin,low-molecular-weight; tu; HUMAN; MIDDLE AGE; Postoperative Complications; pc; Medline File; Health Planning & Administration File; Hospitals; Sweden Notes : This review discusses the problem of deep vein thrombosis (DVT) after operation and identifies three levels of risk of DVT: low (less than 10 per cent), moderate (10-40 per cent) and high (40-80 per cent). Special emphasis is placed on the most recent prophylactic treatment, low molecular weight heparins (LMWHs), particularly enoxaparin. Several LMWHs are now available, but they differ slightly and each must be evaluated on its own merits. In general, however, LMWHs are both effective and safe in those patients at moderate or high risk of DVT. Thromboprophylaxis is cost effective when analysed using health-economic methodology. Ref ID : BERGQVIST1993 99. Bergqvist, D. Endpoints for diagnosis of postoperative thromboembolism in hip fracture surgery. Semin.Thromb.Hemost. 19 Suppl 1:175-177, 1993. Keywords : DIAGNOSIS; POSTOPERATIVE; THROMBOEMBOLISM; HIP; FRACTURES; SURGERY; sdi-11/93; in; hip fractures Ref ID : BERGQVIST1993A 100. Bergqvist, D., Lindblad, B., and M:atzsch, T. Risk of combining low molecular weight heparin for thromboprophylaxis and epidural or spinal anesthesia. Semin.Thromb.Hemost. 19 Suppl 1:147-151, 1993. Keywords : RISK; Molecular Weight; HEPARIN; EPIDURAL; sdi-11/93; Low molecular weight heparin; thromboprophylaxis; spinal anaesthesia Ref ID : BERGQVIST1995 101. Bergqvist, D. and Hedner, U. Pregnancy and venous thrombo-embolism. Correspondence. The New England Journal of Medicine 332(21):1447, 1995. Keywords : 96-suzy-002; PREGNANCY; VENOUS; THROMBOEMBOLISM Notes : 01-05-96. Ref ID : BERKOWITZ1995 102. Berkowitz, N. and Beckman, J. Heparin-induced thrombocytopenia [letter]. N.Engl.J.Med. 333(15):1006; discussion 100, 1995. Keywords : 96-suzy-001; THROMBOCYTOPENIA; HEPARIN; adverse effects; heparin,low-molecular-weight; HUMAN; chemically induced; THROMBOSIS; ETIOLOGY Ref ID : BERNARD1992 103. Bernard, S.A., Jones, B.M., and Stuckey, J.G. Pulmonary angiography in a non-teaching hospital over a 12-year period [see comments]. Med.J.Aust. 157:589-592, 1992. Keywords : EMBOLISM; TRAUMA; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; Hospitals; Safety; DIAGNOSIS; PULMONARY EMBOLISM; REVIEW; MONITORING; ARTERY; Pressure; DEATH; COMPLICATIONS; CARDIAC; V/Q; SCAN; V/Q SCAN; SPECIFICITY; in; intensive care; intensive care units Notes : OBJECTIVE: To report the safety of pulmonary angiography in a non-teaching hospital and discuss the place of this investigation in the diagnosis of pulmonary embolism. DESIGN AND SETTING: A retrospective review of all patients undergoing pulmonary angiography over a 12-year period, November 1979 to October 1991, at Dandenong Hospital, Melbourne. A protocol was established whereby each procedure was performed with the assistance of staff and equipment from the intensive care unit to provide haemodynamic monitoring and measurement of pulmonary artery pressures. PATIENTS: During the review period 114 patients underwent pulmonary angiography, most (108) for suspected pulmonary embolism. RESULTS: One hundred and fifteen pulmonary angiograms were performed, and no deaths related to the procedure occurred. Complications included perforation of the right atrium in three patients, with no sequelae. Cardiac arrhythmias were common but self-limiting. CONCLUSION: In our series, pulmonary angiography was a safe procedure if undertaken with the appropriate monitoring measures. A protocol which includes the participation of the intensive care unit has proved helpful. In addition, it was found that clinical symptoms and signs were unreliable and in 24 patients who also had ventilation-perfusion (V/Q) scans, only seven scans were accurate. A review of the literature indicates that V/Q scans lack specificity and that pulmonary angiography may be performed safely. The latter investigation should be more frequently performed. Ref ID : BERNARD1994 104. Bernard, E.J. Incidence of pulmonary embolism in single segment mismatch on lung scanning. J Nucl Med 35:1928-1931, 1994. Keywords : Single segment; Segmental; V/Q; PULMONARY EMBOLISM; EMBOLISM; LUNG; SCANNING; PE; PROBABILITY; INCIDENCE; in Notes : Single Segment V/Q Mismatches carry a 30% likelihood of angiographically proven PE and should NOT be classified as 'low probability'. Ref ID : BERNHARD1968 105. Bernhard, W.F. and Filler, R.M. Hyperbaric oxygenation: current concepts. Am.J.Surg. 115:661-668, 1968. Keywords : 951202; Hyperbaric Oxygenation; Adolescence; ADULT; AGED; aortic valve stenosis; su; carbon monoxide poisoning; th; CHILD; Child,Preschool; embolism,air; et; FEMALE; gas gangrene; HUMAN; ae; Infant; MALE; MIDDLE AGE; Osteomyelitis; OXYGEN; me; tu; Oxygen Consumption; ph; pulmonary valve stenosis; tetralogy of fallot; transposition of great vessels; tricuspid valve stenosis; Medline File Notes : [No Abstract Available]. Ref ID : BERNHARDT1988 106. Bernhardt, T.L., Goldmann, R.W., Thombs, P.A., and Kindwall, E.P. Hyperbaric oxygen treatment of cerebral air embolism from orogenital sex during pregnancy. Crit.Care Med. 16:729-730, 1988. Keywords : OXYGEN; TREATMENT; Cerebral; Air; EMBOLISM; PREGNANCY; Adolescence; CASE REPORT; cerebral embolism and thrombosis; et; pp; th; embolism,air; FEMALE; HUMAN; Hyperbaric Oxygenation; Pregnancy Complications; sex behavior; Medline File; Hospitals; sex; st Notes : [No Abstract Available] Department of Hyperbaric Medicine St Luke's Hospital Milwaukee WI 53215. Ref ID : BERNSTEIN1986 107. Bernstein, D., Coupey, S., and Schonberg, S.K. Pulmonary embolism in adolescents. Am.J.Dis.Child 140:667-671, 1986. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; EPIDEMIOLOGY; analysis; Hospitals; INCIDENCE; FEMALE; MALE; CHEST; PAIN; HYPOXEMIA; THROMBOSIS; RISK; RISK FACTORS; ORAL CONTRACEPTIVES; TRAUMA; ADULT; is; FATAL; CLINICAL FEATURES; EARLY; PULMONARY ARTERIOGRAPHY; ARTERIOGRAPHY; diagnostics; Adolescence; ANGIOGRAPHY; anoxemia; co; AUTOPSY; COMPARATIVE STUDY; diagnostic errors; HUMAN; new york; pleurisy; ep; ri; renal veins; Retrospective Studies; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; Medline File; an; dyspnea Notes : To clarify the epidemiology of pulmonary embolism in adolescents, a retrospective analysis of adolescent admissions to a general hospital over a 15-year period was performed. Eighteen patients had 19 episodes of pulmonary embolism, an incidence of 78 per 100, 000 hospitalized adolescents. There were twice as many female as male patients. Common complaints were chest pain, dyspnea, cough, and hemoptysis. Common findings were hypoxemia and deepvein thrombosis. Major risk factors were oral contraceptive use and elective abortion in 75% of female patients and trauma in 67% of male patients. Unlike its effect in adults, pulmonary embolism is rarely fatal in adolescents. Although clinical features in adolescents are similar to those in adults, there is a high incidence of both overdiagnosis and underdiagnosis. The early use of pulmonary arteriography in difficult diagnostic situations is suggested. Ref ID : BERRIDGE1990 108. Berridge, D.C., Gregson, R.H., Makin, G.S., and Hopkinson, B.R. Tissue plasminogen activator in peripheral arterial thrombolysis [see comments]. Brit.J.Surg. 77:179-182, 1990. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; ARTERIAL; THROMBOLYSIS; ACEP93; in Ref ID : BERRIDGE1990A 109. Berridge, D.C., Frier, M., Wastie, M., Makin, G.S., and Hopkinson, B.R. 111In platelet deposition following peripheral arterial thrombolysis. Nucl.Med.Commun. 11:565-572, 1990. Keywords : PLATELET; ARTERIAL; THROMBOLYSIS; ACEP-93; ACEP93 Ref ID : BERRIDGE1991 110. Berridge, D.C., Gregson, R.H.S., Hopkinson, B.R., and Makin, G.S. Randomized trial of intra-arterial recombinant tissue plasminogen activator, intravenous recombinant tissue plasminogen activator and intra-arterial streptokinase in peripheral arterial thrombolysis. Brit.J.Surg. 78:988-995, 1991. Keywords : INTRAARTERIAL; PLASMINOGEN; PLASMINOGEN ACTIVATOR; INTRAVENOUS; STREPTOKINASE; ARTERIAL; THROMBOLYSIS; RANDOMIZED; in Ref ID : BERRY1990 111. Berry, R.E., George, J.E., and Shaver, W.A. Free-floating deep venous thrombosis. A retrospective analysis. Ann.Surg. 211:719-2; discussion 722-3, 1990. Keywords : PHLEBITIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; AGED; FEMALE; HEPARIN; therapeutic use; HUMAN; INCIDENCE; LEG; blood supply; MALE; partial thromboplastin time; PULMONARY EMBOLISM; EPIDEMIOLOGY; Retrospective Studies; RISK FACTORS; THROMBOPHLEBITIS; COMPLICATIONS; DIAGNOSIS; THERAPY; TIME FACTORS; Ultrasonography; Methods; Duplex; SCAN; TECHNIQUES; THROMBI; REVIEW; TREATMENT; OUTCOME; THROMBOPLASTIN; FOLLOWUP; ANTICOAGULATION; THROMBUS; analysis; is; an Notes : Duplex scan to diagnose deep venous thrombosis is an established technique. As experience accumulated, patients with free-floating thrombi were identified. A retrospective review of 65 patients was performed to study these thrombi, to evaluate treatment regimens, and to analyze patient outcome. A 26% incidence of pulmonary embolus occurred. However patients who had bilateral free-floating thrombi had a 42.8% incidence of pulmonary embolus. Receiving a 7-day course of heparin therapy with a partial thromboplastin time (PTT) at 1.5 times control was 53.2% of patients; 55.4% of the patients underwent follow-up examination, and the mean time to clot attachment was 9.2 days. Patients should receive anticoagulation for 10 days or until clot attachment. Patients with persistent, bilateral free-floating thrombi, or propagation of thrombus are candidates for potential caval interruption. Serial scans should be performed to monitor the thrombus for attachment or alteration. Ref ID : BIAGI1989 112. Biagi, G., Lapilli, A., Zendron, R., Piccinni, L., and Coccheri, S. Prostanoid production in varicose veins: evidence for decreased prostacyclin with increased thromboxane A2 and prostaglandin E2 formation. Angiology 39:1036-1042, 1989. Keywords : varicose; VARICOSE VEINS; VEINS; THROMBOXANE A2; NASP; vein; in Ref ID : BIALOSTOZKY1975 113. Bialostozky, L., Rish, L., and Oropeza, G. [Varicose ulcer, Etiopathology and treatment]. Prensa.Med.Mex. 40:92-94, 1975. Keywords : Ulcer; NASP; ADULT; Age Factors; AGED; Antibiotics; English Abstract; Evaluation Studies; FEMALE; HUMAN; MALE; MIDDLE AGE; Rest; Sex Factors; Skin; Skin Transplantation; THROMBOPHLEBITIS; Transplantation,Autologous; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Ulcera varicosa. etiopatologia y tratamiento AB - [No Abstract Available] UI - 75217783. Ref ID : BICK1985 114. Bick, R.L. Hypercoagulability and thrombosis. In: Disorders of Hemostasis and Thrombosis: Principles of Clinical Practice,Anonymous New York:Thieme, 1985,p. 294-326. Keywords : HYPERCOAGULABILITY; THROMBOSIS; NASP; HEMOSTASIS Ref ID : BIEGER1976 115. Bieger, R., Boekhout-Mussert, R.J., Hohmann, F., and Loeliger, E. Is Streptokinase Useful in the Treaaatment of Deep Vein Thrombosis? Acta Med.Scand. 199:81-88, 1976. Keywords : 96-suzy-002; is; STREPTOKINASE; in; vein; THROMBOSIS; FIBRINOLYTIC; Syndrome; DEEP VEIN THROMBOSIS; PROSPECTIVE; Retrospective Studies; an; THERAPY; PROSPECTIVE STUDIES; Hospitals; HEPARIN; phenprocoumon; ANTICOAGULANT; PHLEBOGRAPHY; VENOUS; Venous Pressure; Pressure; SIDE EFFECTS; Iliac Vein; CONTRAST; Popliteal Vein; EARLY; FREQUENCY Notes : 01-04-96. Abstract : Because of its fibrinolytic action, streptokinase is believe to reduce the severity if the postthrombotic syndrome in patients with deep vein thrombosis. A prospective and a retrospective study have been undertaken in an attempt to determine when this therapy is useful for patients with deep vein thrombosis. The prospective study included 15 patients with deep vein thrombosis: 5 were treated in the hospital with streptokinase and heparin and 5 only with heparin, 5 were treated at home with only phenprocoumon. All the patients received oral anticoagulant therapy for at least 6 months. Three to four months after the acute episode, phlebography and venous pressure measurements were carried out. Streptokinase appeared to give the best results but with more side-effects. In the retrospective study, 51 patients who had deep vein thrombosis in 1969 were reexamined 31-47 months later. It was found that more than 50% of the patients with a thrombosisin the femoral and/or iliac vein developed a severe posttrombotic syndrome, in contrast to only 9% of those with a thrombosis in the popliteal vein or lower. It is recommended. on the basis of both the prospective and retrospective study, that patients with a thrombosis in the femoral and/or iliac vein should be treated with either heparin or streptokinase during the early stage. It is probable that streptokinase will significantly decrease the frequency and severity of the postthrombotic syndrome in these patients in particular, although this has not yet been proven. Ref ID : BIGGS1947 116. Biggs, R., Macfarlane, R.G., and Pilling, J. Observations on fibrinolysis. Experimental activity produced by exercise or adrenaline. Lancet ii:402-405, 1947. Keywords : FIBRINOLYSIS; THROMBOSIS; SCLEROTHERAPY; EXERCISE; ADRENALINE Ref ID : BIHARI1990 117. Bihari, I. Can varicectomy be performed if deep veins are occluded? J.Dermatol.Surg.Oncol. 16:806-807, 1990. Keywords : VEINS; VENOUS; OCCLUSION; VARICOSITIES; TOURNIQUET; walking; RISK; Blood Circulation; NASP; thrombophlebitis - complications; varicose veins - surgery; ADULT; AGED; Collateral Circulation; HUMAN; leg - blood supply; MIDDLE AGE; thrombophlebitis - diagnosis; thrombophlebitis - pathology; varicose veins - complications; varicose veins - pathology; veins - pathology; Tourniquets; in; is; blood; drainage Notes : The problem of varicectomy in the setting of deep venous occlusion is discussed. A new and simple test is applied to determine if the resulting varicosity is necessary to contribute to venous circulation in the limb and if subfascial collateral pathways are sufficient to maintain it. The test is a modification of the Perthes test. Instead of a rubber-strip tourniquet, a tensiometer cuff is used with 110 mmHg for 5 minutes on a walking patient. In negative cases the superficial varicosity can be removed radically, in spite of deep venous occlusion, to decrease the venous blood loading and ameliorate the venous drainage without risk to the blood circulation. Ref ID : BILANCINI1992A 118. Bilancini, S., Lucchi, M., Tucci, S., Fochetti, A., Cirillo, G., and Aiello, A. [Leukocyte entrapment in chronic venous stasis: myth or reality?]. Phlebologie. 45:513-518, 1992. Keywords : CHRONIC; VENOUS; STASIS; NASP; Capillaries; Cellulitis; Chronic Disease; Erythrocyte Count; FEMALE; HEMATOCRIT; HUMAN; Leukocyte Count; Leukocytes; MALE; Platelet Count; POSTPHLEBITIC SYNDROME; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; Health Planning & Administration File; in; ab; ad Notes : TT - Emprisonnement leucocytaire dans la stase veineuse chronique: mythe ou realite? AB - [No Abstract Available] AD -Centro Studi Malattie Vascolari AD - J.F. Merlen AD - Frosinone AD - Italie UI - 93255044. Ref ID : BIRKHOFF1970 119. Birkhoff, H.D. and Patel, K. [Treatment of varicose symptom complex in gynecology with Rexiluven]. Ther.Ggw. 109:1779-80 passim, 1970. Keywords : Gynecology; NASP; ADULT; AGED; FEMALE; HUMAN; MIDDLE AGE; Plants,Medicinal; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; in; de; ab Notes : TT - Zur Behandlung des varikosen Symptomenkomplexes in der Frauenheilkunde mit Reviluven AB - [No Abstract Available] UI -71086247. Ref ID : BITTL1995 120. Bittl, J.A., Strony, J., Brinker, J.A., Ahmed, W.H., Meckel, C.R., Chaitman, B.R., Maraganore, J., Deutsch, E., and Adelman, B. Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. Hirulog Angioplasty Study Investigators. N.Engl.J.Med. 333(12):764-769, 1995. Keywords : 96-suzy-001; TREATMENT; HEPARIN; Angioplasty; is; HEMORRHAGIC; COMPLICATIONS; in; THROMBIN; Methods; RANDOMIZED; DEATH; Hospitals; MYOCARDIAL INFARCTION; infarction; CARDIAC; INCIDENCE; BLEEDING; THERAPY; RISK; AGED; angina pectoris; ETIOLOGY; angina,unstable; angioplasty,transluminal,percutaneous coronary; COMPARATIVE STUDY; Double-Blind Method; FEMALE; HEMORRHAGE; chemically induced; prevention & control; adverse effects; therapeutic use; HIRUDIN; analogs & derivatives; HUMAN; Ischemia; MALE; MIDDLE AGE; peptide fragments; Postoperative Complications; MORTALITY; RECOMBINANT PROTEINS; serine proteinase inhibitors; Support,Non-U.S.Gov't Notes : BACKGROUND. Heparin is often administered during and after coronary angioplasty to prevent closure of the dilated vessel. However, ischemic or hemorrhagic complications occur in 5 to 10 percent of treated patients. We studied whether these complications could be prevented when the direct thrombin inhibitor bivalirudin (Hirulog) was used in place of heparin. METHODS. We performed a double-blind, randomized trial in 4098 patients undergoing angioplasty for unstable or postinfarction angina. Patients were assigned to receive either heparin or bivalirudin immediately before angioplasty. The primary end point were death in the hospital, myocardial infarction, abrupt vessel closure, or rapid clinical deterioration of cardiac origin. RESULTS. In the total study group, bivalirudin did not significantly reduce the incidence of the primary end point (11.4 percent, vs. 12.2 percent for heparin) but did result in a lower incidence of bleeding (3.8 percent vs. 9.8 percent, P < 0.001). In the prospectively stratified subgroup of 704 patients with postinfarction angina, bivalirudin therapy resulted in a lower incidence of the primary end point (9.1 percent vs. 14.2 percent, P = 0.04) and a lower incidence of bleeding (3.0 percent vs. 11.1 percent, P < 0.001), but in a similar cumulative rate of death, myocardial infarction, and repeated revascularization in the six months after angioplasty (20.5 percent vs. 25.1 percent, P = 0.17). CONCLUSIONS. Bivalirudin was at least as effective as high-dose heparin in preventing ischemic complications in patients who underwent angioplasty for unstable angina, and it carried a lower risk of bleeding. Bivalirudin, as compared with heparin, reduced the risk of immediate ischemic complications in patients with postinfarction angina, but this difference was no longer apparent after six months. Ref ID : BJELETICH1987 121. Bjeletich, J. Declotting central venous catheters with urokinase in the home by nurse clinicians. NITA 6:428-430, 1987. Keywords : CENTRAL VENOUS CATHETER; VENOUS; CATHETER; UROKINASE; NURSE; THROMBOSIS; THROMBOLYSIS; ACEP93; Catheters; in Ref ID : BJORDAL1988 122. Bjordal, R. Flow and pressure studies in venous insufficiency. Acta Chir.Scand.Suppl. 544:30-33, 1988. Keywords : Pressure; VENOUS; Venous Insufficiency; SURGERY; Norway; NASP; HUMAN; PROGNOSIS; Regional Blood Flow; SAPHENOUS VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Pressure; Medline File; in; ab; ad Notes : AB - [No Abstract Available] AD - Department of Surgery AD - Rikshospitalet AD - Oslo AD - Norway UI - 89021665. Ref ID : BJORNSSON1985A 123. Bjornsson, J. and Edwards, W.D. Primary pulmonary hypertension: a histopathologic study of 80 cases. Mayo Clin.Proc. 60:16-25, 1985. Keywords : PULMONARY HYPERTENSION; Hypertension; HISTOPATHOLOGIC; CLINICAL DIAGNOSIS; DIAGNOSIS; THROMBOEMBOLIC; Arteritis; VENOUS; AGE; FEMALE; MALE; SURVIVAL; SUDDEN DEATHS; DEATH; Fibrosis; Necrosis; THROMBOSIS; THROMBI; EMBOLIZATION; PLATELETS; HISTOLOGIC; pulmonary vascular resistance; VASCULAR RESISTANCE; ANTICOAGULANTS; PLATELET; HUMAN; Hypertension,Pulmonary ,Pathology ,PA; Adolescence; ADULT; AGED; Arteritis ,Pathology ,PA; CHILD; Child,Preschool; Hypertension,Pulmonary ,Classification ,CL Hypertension,Pulmonary ,Therapy ,TH; Microcirculation ,Pathology ,PA; MIDDLE AGE; Pulmonary Artery ,Pathology ,PA; Pulmonary Circulation; Pulmonary Veins ,Pathology ,PA; Thromboembolism ,Pathology ,PA; ab; in Notes : AB- Among 80 cases with a clinical diagnosis of primary (unexplained) pulmonary hypertension, 45 (56%) had thromboembolic disease and 22 (28%) had plexogenic arteriopathy; the remaining 13 (16%) had pulmonary veno-occlusive disease, primary medial hypertrophy, primary pulmonary arteritis, or changes consistent with pulmonary venous hypertension. The mean age was 16 years for primary pulmonary arteritis, 21 to 34 years for plexogenic pulmonary arteriopathy, primary medial hypertrophy, and pulmonary veno-occlusive disease, and 41 and 45 years for thromboembolic disease and pulmonary venous hypertension, respectively. In all forms except pulmonary veno-occlusive disease and apparent pulmonary venous hypertension, female patients were involved twice as often as male patients. With the exception of apparent pulmonary venous hypertension, patients with plexogenic pulmonary arteriopathy had the longest survival (63 months). Sudden death, however, occurred most frequently in patients with plexogenic disease (45%) and occurred 2.5 times as often in this group as in patients with thromboembolic disease. Among our 80 cases, the most frequent histopathologic lesions were medial hypertrophy, intimal proliferation and fibrosis, fibrinoid degeneration and necrosis, and thrombosis. Thrombi were commonly observed and may have developed in situ or by embolization; they were often rich in platelets when they occurred in small pulmonary vessels. These histologic features may form the morphologic substrate for elevated pulmonary vascular resistance, and their recognition may provide the rationale for possible intervention with pulmonary vasodilators, anticoagulants, or platelet inhibitors. Ref ID : BLACK1993 124. Black, M.D., Masters, R.G., Sochowski, R.A., Higginson, L.A., and Keon, W.J. Paradoxical embolism-in-transit: diagnosis and surgical treatment. Can.J Cardiol. 9:437-440, 1993. Keywords : DIAGNOSIS; SURGICAL; TREATMENT; THROMBOEMBOLISM; FEMALE; PULMONARY EMBOLISM; EMBOLISM; PULMONARY ARTERY; ARTERY; SURGERY; sdi- 11/93; is; an; Echocardiography; in; Intraoperative Notes : Paradoxical embolism-in-transit is an uncommon presentation of the thromboembolism complex. The advent of echocardiography has permitted its antemortem diagnosis and serves to guide treatment; this is illustrated by the case of a 51-year-old female who presented with paradoxical embolism-in-transit and pulmonary embolism following craniotomy. Echocardiography demonstrated mobile clot straddling the atrial septum and embolus in the right pulmonary artery. Surgery successfully removed all clots as demonstrated by intraoperative echocardiography, and the patient had an uneventful recovery. Ref ID : BLATTLER1984 125. Blattler, W., Haberli, A., Kindler, O., and Furrer, K. [Thrombocyte activation in sclerotherapy of varicose veins and in deep venous thrombosis]. Vasa. 13:220-223, 1984. Keywords : SCLEROTHERAPY; VARICOSE VEINS; VEINS; VENOUS; NASP; beta- Thromboglobulin; ADULT; AGED; Blood Platelets; English Abstract; FEMALE; FIBRINOPEPTIDES A; HUMAN; MIDDLE AGE; Platelet Factor 4; Sclerosing Solutions; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; Medline File; in; varicose; ab Notes : TT - Thrombozytenaktivierung bei der Sklerotherapie von Varizen und bei der tiefen Venenthrombose AB - [No Abstract Available] UI - 85018748. Ref ID : BLEGVAD1989 126. Blegvad, S., Lund, O., Nielsen, T.T., and Guldholt, I. Emergency embolectomy in a patient with massive pulmonary embolism during second trimester pregnancy. Acta Obstet.Gynecol.Scand. 68:267-270, 1989. Keywords : EMBOLISM; PREGNANCY; EMERGENCY; EMBOLECTOMY; MASSIVE; PULMONARY EMBOLISM; CARDIOVASCULAR; SURGERY; Hospitals; ARTERIAL; Infant; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; RISK; BLEEDING; TREATMENT; EMBOLI; CASE REPORT; FEMALE; HUMAN; Pregnancy Complications,Cardiovascular ,Surgery ,SU; Pulmonary Embolism ,Surgery ,SU; ADULT; ELECTROCARDIOGRAPHY; Emergencies; Infant,Newborn; Pregnancy Trimester,Second; Pulmonary Artery ,Radiography ,RA; in; denmark; ab; is Notes : CS- Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Denmark AB- Emergency pulmonary embolectomy was performed successfully on a patient in her second trimester of pregnancy. The patient had severe right ventricular failure due to obstruction of 85% of the pulmonary arterial circulation. Three months after embolectomy she was delivered of a normal infant. The problem of significant but misinterpreted or overlooked clinical and electrocardiographic signs of pulmonary embolism is discussed. Thrombolytic therapy during pregnancy imposes considerable risk of bleeding with deleterious effects on both mother and fetus. In our opinion, emergency embolectomy during extracorporeal circulation is the best treatment in case of massive emboli during pregnancy. Ref ID : BLUMGART1991 127. Blumgart, R.L., Immelman, E.J., Jeffery, P.C., and Lipinski, J.K. Thrombotic side-effects of lower limb venography. The use of heparin- saline flush. S.Afr.Med.J. 79:88-89, 1991. Keywords : PHLEBITIS; SIDE EFFECTS; VENOGRAPHY; ADULT; HEPARIN; administration & dosage; HUMAN; LEG; blood supply; PHLEBOGRAPHY; adverse effects; PROSPECTIVE STUDIES; Sodium Chloride; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; ETIOLOGY; prevention & control; PROSPECTIVE; POSTOPERATIVE; VEINS; COMPLICATIONS; DEEP VEIN THROMBOSIS; THROMBOSIS; Venogram; FIBRINOGEN; SCAN; Injections; Cellulitis; CONTRAST; MORTALITY; INCIDENCE; COMPLICATION; in; is Notes : In a prospective study of 256 postoperative patients, bilateral lower limb venography was performed using meglumine iothalamate followed by heparin-saline flushing of the deep veins, and the complications of the procedure were assessed. No patient developed clinical evidence of deep-vein thrombosis after the venogram. In 117 patients fibrinogen uptake was performed 24 hours after the venogram. A new positive area on the uptake scan developed in 3 patients (2.6%). Local swelling or haematoma at the injection site occurred in 15 patients (5.9%), cellulitis in 2 (0.8%) and minor contrast reactions in 6 (2.3%). There were no major reactions and no procedure-related mortality. The reasons for the wide variation in the reported incidence of post-venogram thrombosis are considered and the importance of heparin-saline flushing of the deep veins to prevent this complication is discussed. Ref ID : BOESPFLUG1975 128. Boespflug, O. Maladie thrombo-embolique et oestroprogestatifs de synthese. Phlebologie 28(3):373-374, 1975. Keywords : DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; SCLEROTHERAPY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; INTRAARTERIAL; PAIN; ORAL CONTRACEPTIVES; et; de; vein; an; Injections; in; MEDICATIONS Notes : Two cases of clinically diagnosed deep vein thrombosis after sclerotherapy, one with clinically diagnosed pulmonary thromboembolism. Neither case was diagnostically proven. One of the cases may actually represent an inadvertent intraarterial injection, since the patient had sudden pain in the posterior tibial distribution immediately after an injection. Both of the patients were taking oral contraceptive medications. Ref ID : BOHLE1993 129. Bohle, W. and Schaefer, H.E. Thrombendarteriitis pulmonalis carcinomatosa Ceelen: an immunohistological investigation. Virchows Arch.A.Pathol.Anat.Histopathol. 422:169-172, 1993. Keywords : 951202; an; Died; in; heart; Carcinoma; AUTOPSY; EMBOLI; PULMONARY ARTERY; Arteries; THROMBOSIS; Movement; Muscles; THROMBUS; AGED; antigens,cd3; me; CASE REPORT; cell movement; ph; Endarteritis; co; PA; FEMALE; HUMAN; immunohistochemistry; lung neoplasms; muscle,smooth,vascular; PULMONARY EMBOLISM; t-lymphocytes; im; Medline File; Cancerlit File; pathology Notes : A 65-year-old woman died in sudden right heart failure caused by thrombendarteriitis pulmonalis carcinomatosa Ceelen 16 months after resection of a rectal carcinoma. Autopsy disclosed a complex picture of multiple tumour cell emboli in small pulmonary arteries associated with local thrombosis and thrombus-associated vessel wall reaction. This was characterized by movement of medial muscle cells into the thrombus. In addition, affected vessels showed a prominent perivascular tumour- related infiltration by lymphocytes which are identified immunohistochemically as CD3-reactive T-cells Department of Pathology University of Freiburg Germany. Ref ID : BOHM1982 130. Bohm, N., Keller, K.M., and Kloke, W.D. Pulmonary and systemic cerebellar tissue embolism due to birth injury. Virchows Arch.A.Pathol.Anat.Histopathol. 398:229-235, 1982. Keywords : 951202; EMBOLISM; INJURY; brain; in; PULMONARY ARTERY; Arteries; AUTOPSY; FEMALE; DEATH; ARM; VENOUS; blood; ARTERY; EMBOLIZATION; Died; Cerebral; PULMONARY EMBOLISM; MYOCARDIAL INFARCTION; infarction; SHOCK; birth injuries; co; PA; breech presentation; CASE REPORT; cerebellum; CEREBRAL HEMORRHAGE; et; Coronary Vessels; HUMAN; Infant,Newborn; meninges; bs; PREGNANCY; Medline File Notes : Brain tissue embolism in the coronary, leptomeningeal and pulmonary arteries was discovered microscopically following the autopsy of a female newborn. Death occurred 8 h after breech delivery, which had been complicated by both arms being turned up beside the head. The dislodged brain tissue originated from the left cerebellar hemisphere and had entered the venous blood stream through a rupture of the left sinus transversus. Both "paradoxical" systemic and pulmonary artery embolization ensued. The baby died from the combined effects of cerebral haemorrhage, pulmonary embolism, myocardial infarction and shock. Ref ID : BOLAN1993 131. Bolan, C.D., Krishnamurti, C., Tang, D.B., Carrington, L.R., and Alving, B.M. Association of protein S deficiency with thrombosis in a kindred with increased levels of plasminogen activator inhibitor-1. Ann.Intern.Med 119:779-785, 1993. Keywords : PROTEIN S; THROMBOSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; North America; VENOUS; VENOUS THROMBOSIS; FIBRINOLYSIS; THROMBOEMBOLISM; ADULT; AGE; Antigens; PROTEIN C; ANTITHROMBIN III; ASYMPTOMATIC; CAUSE; FAMILIAL; sdi-11/93; in; triglycerides; ci; is Notes : OBJECTIVE: A single kindred in North America with venous thrombosis was described as having defective fibrinolysis because of increased levels of plasminogen activator inhibitor-1 (PAI-1). Our study describes the discovery of protein S deficiency in this kindred and its association with venous thromboembolism. DESIGN: A family study. SETTING: Community. PARTICIPANTS: Twenty-eight adults (ages 21 to 71 years) from three generations of the kindred; seven had a history of venous thromboembolism. MEASUREMENTS: Plasma levels of total and free protein S antigen, as well as the activities of protein S, protein C, PAI-1, and antithrombin III. RESULTS: Six of 7 persons (86%) with a history of venous thromboembolism were deficient in total and free protein S; of 21 asymptomatic members, 9 were deficient in protein S (P = 0.08). When compared with these 9 asymptomatic family members, the 6 persons with protein S deficiency and a history of thrombosis tended to smoke (P = 0.01) and to have higher triglyceride levels (P = 0.001). Overall, the mean PAI-1 activity in the 7 persons who had thrombosis was 7.9 kAU/L (AU/mL) and was 9.3 kAU/L (AU/mL) in the 21 persons who did not have thrombosis (95% CI, -9.9 to 7.0). CONCLUSIONS: In this kindred, a deficiency of total and free or functional protein S is the cause of thrombosis. Measurement of PAI-1 activity was not useful in the evaluation of familial thrombosis. The utility of the routine measurement of PAI-1 activity in the evaluation of familial thrombosis has not been established. Ref ID : BONE1992 132. Bone, R.C. Pulmonary Embolism: New approaches to a complex problem. Emerg.Med. 24(14):144-150, 1992. Keywords : PULMONARY EMBOLISM; EMBOLISM; REVIEW Notes : Clinical review and unsupported opinion, but basically on-point. Ref ID : BONNAR1969 133. Bonnar, J., McNicol, G.P., and Douglas, A.S. Fibrinolytic enzyme system and pregnancy. Brit.Med.J. 3:387-389, 1969. Keywords : FIBRINOLYTIC; PREGNANCY; THROMBOSIS Ref ID : BORDT1977 134. Bordt, J. and Muller, K.M. [Pulmonary perfusion in embolism of pulmonar arteries without pulmonary infarction (author's transl)]. ROFO.Fortschr.Geb.Rontgenstr.Nuklearmed. 126:87-89, 1977. Keywords : 951202; PERFUSION; in; EMBOLISM; Arteries; PULMONARY INFARCTION; infarction; AUTOPSY; LUNG; PULMONARY ARTERY; PULMONARY EMBOLISM; HEMORRHAGIC; THROMBOEMBOLISM; CONTRAST; Contrast Media; an; CHRONIC; POSTMORTEM; ANGIOGRAPHY; pp; English Abstract; HUMAN; bs; ra; Pulmonary Circulation; Medline File Notes : Six autopsy lungs with embolism of the pulmonary arteries but without infarction, were subjected to comparative angiographic and morphologic examination of bronchial arteries. In pulmonary embolism without hemorrhagic infarction the disconnected vascular bed of pulmonary arteries can be demonstrated distally of the obstructive thrombo-embolism and with a noncapillary contrast medium. The vascular bed appears in intrapulmonal, precapillary, bronchopulmonal anastoses. The results of the investigation explain an intravital sufficient subsidiary circulation in the pulmonary areas separated from the normal circulation of pulmonary arteries. An extended subsidiary development of bronchial arteries in reaction to previous chronic pulmonary disease would help, according to our findings in postmortem lung angiographies, to support the circulation after embolism of pulmonary arteries. Ref ID : BORRIS1989 135. Borris, L.C., Christiansen, H.M., Lassen, M.R., Olsen, A.D., and Schott, P. Comparison of real-time B-mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. Thromb.Haemost. 61:363-365, 1989. Keywords : PHLEBOGRAPHY; POSTOPERATIVE; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; HIP; SURGERY; SENSITIVITY; ULTRASOUND; ASYMPTOMATIC; HIP REPLACEMENT; PREDICTIVE VALUE; VEINS; Ultrasonography; is; in Notes : The sensitivity of B-mode ultrasound is only 63 percent in asymptomatic patients following hip replacement. The positive predictive value is 83 percent and the negative predictive value is 69 percent. Ref ID : BORRIS1993 136. Borris, L.C. and Lassen, M.R. Venography used for deep vein thrombosis screening of asymptomatic patients undergoing total hip replacement. Semin.Thromb.Hemost. 19 Suppl 1:174, 1993. Keywords : VENOGRAPHY; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; SCREENING; ASYMPTOMATIC; HIP; HIP REPLACEMENT; sdi-11/93 Ref ID : BOUNAMEAUX1992 137. Bounameaux, H., Prins, T.R., Schmitt, H.E., and Schneider, P.A. Venography of the lower limbs. Pitfalls of the diagnostic standard. The ETTT Trial Investigators. Invest.Radiol. 27(12):1009-1011, 1992. Keywords : VENOGRAPHY; PITFALL; ACEP93; diagnostics; standards; 96-suzy- 001; PHLEBOGRAPHY; is; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; THROMBOLYTIC; ALTEPLASE; Methods; Venogram; THROMBOLYTIC THERAPY; THERAPY; QUANTITATIVE; THROMBOLYSIS; TREATMENT; an; Adolescence; ADULT; therapeutic use; Double-Blind Method; HUMAN; LEG; blood supply; MIDDLE AGE; observer variation; THROMBOPHLEBITIS; drug therapy; radiography Notes : RATIONALE AND OBJECTIVES. Phlebography is considered the diagnostic standard for suspected deep venous thrombosis. The authors studied the inter-observer variability of phlebogram interpretation in the setting of a multicenter therapeutic trial of the thrombolytic agent alteplase. METHODS. The interpretation of 31 pairs of venograms (before and after thrombolytic therapy) was studied by comparing the quantitative Marder's scores which were computed by three experts and the qualitative assessment of phlebographic changes induced by thrombolysis by the panel of experts and by the investigators. RESULTS. Although the scores of the three experts correlated fairly well (r = .67-.82; P < .001), they differed significantly from each other (P < .0001). Substantial differences also were found between local (by investigators) qualitative evaluation of the venographic changes induced by the treatment and central evaluation by the panel of experts (coefficient of agreement kappa = 0.19), local assessment being significantly more optimistic (P = .002) than central judgment. CONCLUSION. Significant differences were observed between assessment of changes in venographic scores after thrombolytic treatment both among three expert radiologists, and between the panel of experts and the local investigators of the multicenter trial. This observation points to the need for an a priori definition of well-characterized decision criteria to allow a valid interpretation of the effects of the therapeutic intervention. Ref ID : BOUNUMEAUX1990 138. Bounumeaux, H. and et al Severe ischemia of the hand following intra-arterial promazine injection: effects of vasodilatation anticoagulation and local thrombolysis with tissue type plasminogen activator. Vasa 19:68, 1990. Keywords : Ischemia; INTRAARTERIAL; Injections; ANTICOAGULATION; THROMBOLYSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; NASP Ref ID : BRAMMER1991 139. Brammer, W.M. Diagnosing deep venous thrombosis in the 1990s. J Okla.State.Med Assoc. 84:101-106, 1991. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DIAGNOSIS; CONTRAST; VENOGRAPHY; Plethysmography; ULTRASOUND; NUCLEAR; SCREENING; Venogram; COMPUTER; TECHNIQUES; VEINS; MAGNETIC RESONANCE; Pelvis; sdi-11/93; in; is; standards; antibodies; subtraction technique; magnetic resonance imaging; neck Notes : Deep venous thrombosis is a common problem afflicting millions of Americans yearly and encountered by all clinicians regardless of specialty. Every imaging tool available to the radiologist has been used to make this sometimes elusive diagnosis. Contrast venography is widely used and respected as the gold standard for evaluating any venous disease. But it can be difficult to perform or poorly tolerated by the patient. Plethysmography, once the only alternative examination, is now practically nonexistant. It has been displaced by ultrasound, mainly due to its ease of performance and patient acceptance. Nuclear imaging has provided a series of screening tests such as the nuclear venogram, but new clot-specific monoclonal antibody tests are becoming available now. High technology imaging also has proven useful for problem solving. Computer tomography and digital subtraction techniques can be used to evaluate central veins or high flow areas. The newest technique, magnetic resonance imaging, can provide even more information than other tests and is already considered the examination of choice for the most difficult areas of the pelvis and neck. Understanding the strengths and weaknesses of these tests can help in choosing the best examination for each patient. Ref ID : BRANCH1983 140. Branch, W.T.J., McNeil, B.J., and Branch, W.T.,Jr. Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults. Am.J.Med. 75(4):671-679, 1983. Keywords : DIAGNOSIS; PLEURITIC; CHEST; CHEST PAIN; PAIN; ADULT; BRIGHAM; analysis; in; 96-suzy-001; pleurisy; is; PULMONARY EMBOLISM; EMBOLISM; CLINICAL FEATURES; PHLEBITIS; LUNG; SCANNING; Segmental; VENTILATION/PERFUSION; ANTICOAGULATION; abnormalities; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PROBABILITY; Diagnosis,Differential; HUMAN; PLEURAL EFFUSION; radiography; radionuclide imaging; THERAPY; virus diseases; AGE; V/Q; V/Q SCAN; SCAN; CAUSE; PNEUMONIA; pericarditis; uremia; FOLLOWUP; PE; an; Air Notes : [CFF: 97 patients below 40 years of age who presented to the ED with pleuritic chest pain and who had a V/Q scan as part of their workup. 'Obvious' causes such as typical pneumonia, pericarditis, and uremia were excluded, as were cases believed to be musculoskeletal on the basis of clinical impression. After 6 months of followup, 53% of the 97 cases were attributed to viral pleurisy, 21% to pulmonary embolism, and 18% to pneumonia. The average PO2 was lower in those WITHOUT pulmonary embolism than in those with PE. Half of the patients with an ultimate diagnosis of PE had an initial room air PaO2 greater than 80 torr. AB-The most important problem in the approach to young patients with acute pleurisy is distinguishing those with idiopathic or viral pleurisy from patients with pulmonary embolism. Three clinical features are helpful in making this distinction: (1) pleural effusion(s) present on chest roentgenography, (2) history of predisposing factors for or past history of veno-occlusive disease, and (3) physical signs indicative of phlebitis. Lung scanning should be performed in patients with these findings. If results of scanning are highly characteristic of pulmonary embolism (segmental or lobar defect with ventilation/perfusion mismatch) in such a patient, anticoagulation may be considered immediately. Patients in whom scanning reveals indeterminate characteristics or abnormalities not characteristic of pulmonary embolism should undergo pulmonary angiography if other clinical features suggest that the probability of pulmonary embolism remains at least moderately high. Ref ID : BRANDJES1992 141. Brandjes, D.P.M., Heijboer, H., Buller, H.R., De Rijk, M., Jagt, H., and Wouter Ten Cate, J. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N.Engl.J.Med. 327:1485-1489, 1992. Keywords : HEPARIN; TREATMENT; THROMBOSIS; DVT; COUMADIN; MANAGEMENT; Extension; RECURRENCE; Sweden; Important article; in; is Notes : Extension of DVT was seen in 40 percent of patients treated with coumadin alone, compared with only 8 percent of those treated with heparin and coumadin together. Heparin is mandatory in the management of DVT. Ref ID : BRATHWAITE1992 142. Brathwaite, C.E., O'Malley, K.F., Ross, S.E., Pappas, P., Alexander, J., and Spence, R.K. Continuous pulse oximetry and the diagnosis of pulmonary embolism in critically ill trauma patients. J.Trauma. 33:528-30; discussion 530-1, 1992. Keywords : EMBOLISM; TRAUMA; Pulse; DIAGNOSIS; PULMONARY EMBOLISM; PE; Retrospective Studies; ARTERIAL; OXYGEN; LUNG; PULMONARY ARTERIOGRAPHY; ARTERIOGRAPHY; PA; CHEST; PATHOLOGIC; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; in Notes : The diagnosis of pulmonary embolism (PE) may be difficult to establish in trauma patients, particularly those who are unresponsive or mechanically ventilated. Based on a prior retrospective study, we hypothesized that patients monitored by continuous pulse oximetry who experienced a 10% or greater sudden sustained drop in arterial oxygen saturation (SaO2) without a change in static lung compliance (Cst) were most likely to have had a PE. We followed SaO2 in 972 patients admitted to our trauma ICU during the 18-month period ending in December 1990. Forty-eight patients (5%) with SaO2 changes, but no Cst changes, were evaluated for suspected PE using pulmonary arteriography (PA). Of these, 21 (44%) had a positive PA study. All patients with a positive PA had either clear chest roentgenograms or no change in underlying pulmonary pathologic processes. Of the remainder, 26 had evidence of a new pathologic entity on chest roentgenograms and only one patient had a SaO2 decrease, no change in Cst, and a negative PA. All mechanically ventilated trauma patients should have SaO2 monitored continuously. Patients with a > 10% drop in Sao2 with no change in Cst and no new roentgenographic chest findings should undergo PA. Based on our experience, this approach would yield a sensitivity, specificity, and predictive value of 100%, 99.9%, and 95%, respectively, for the diagnosis of clinically significant PE. Ref ID : BRATHWAITE1993 143. Brathwaite, C.E., Mure, A.J., O'Malley, K.F., Spence, R.K., and Ross, S.E. Complications of anticoagulation for pulmonary embolism in low risk trauma patients. Chest 104:718-720, 1993. Keywords : COMPLICATIONS; ANTICOAGULATION; PULMONARY EMBOLISM; EMBOLISM; RISK; TRAUMA; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; PE; THERAPY; CAUSE; HEPARIN; WARFARIN; THROMBOCYTOPENIA; HEMORRHAGIC; effusion; Hemoglobins; SHOCK; INJURY; AGE; FILTER; DEATH; EARLY; sdi-11/93; in; is; standards; brain Notes : Trauma patients are at significant risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). Anticoagulation is standard therapy for DVT/PE, but may cause severe complications. We reviewed the course of 70 trauma ICU patients treated over a 28-month period. Thirty-six patients (51.4 percent) were treated by continuous IV heparin and/or oral warfarin. Of these, 13 patients (36 percent) developed complications requiring termination of anticoagulation. These included recurrent PE (four), subdural hematomas (three), hemothorax (two), heparin-induced thrombocytopenia (one), hemorrhagic pericardial effusion (one), retroperitoneal hematoma (one), and sudden unexplained drop in hemoglobin and shock (one). All patients with subdural hematomas had no prior evidence of head injury on brain computed tomography. All patients with recurrent PE received adequate anticoagulation therapy. Age > 55 was associated with increased risk of complications (8 of 13; p = .02:chi 2). Thirty-four other patients (48.6 percent) received inferior vena caval filters with no related complications or deaths. Anticoagulation for DVT/PE should be used selectively in trauma patients and avoided in elderly patients. Such patients should undergo early caval filter placement. Ref ID : BRAUN1971 144. Braun, W. [Iatrogenic sensitization and leg lesions]. Med.Klin. 65:506-509, 1971. Keywords : LEG; NASP; Dermatologic Agents; Drug Eruptions; Eczema; FEMALE; HUMAN; Iatrogenic Disease; Leg Ulcer; MALE; Skin Tests; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Iatrogene Sensibilisierung und Beinleiden AB - [No Abstract Available] UI - 71232232. Ref ID : BRAY1983 145. Bray, P., Myers, R.A., and Cowley, R.A. Orogenital sex as a cause of nonfatal air embolism in pregnancy. Obstet.Gynecol. 61:653-657, 1983. Keywords : CAUSE; Air; EMBOLISM; PREGNANCY; DIAGNOSIS; OXYGEN; THERAPY; INCIDENTS; PATHOPHYSIOLOGY; TREATMENT; LONG TERM; Adolescence; ADULT; CASE REPORT; embolism,air; et; th; FEMALE; HUMAN; Hyperbaric Oxygenation; Pregnancy Complications; sex behavior; Medline File; sex; in; is Notes : A case of nonfatal air embolism from orogenital sex in the 30th week of pregnancy is described. Because of a delay in the diagnosis, the patient did not receive hyperbaric oxygen therapy until 39 hours after the incident. Severe neurologic dysfunction persisted despite hyperbaric therapy. The world literature on orogenital sex in pregnancy with resultant air embolism is reviewed. The pathophysiology of air embolism and the rationale for hyperbaric oxygen treatment are presented. It is strongly recommended that survivors of this form of air embolism be transferred to hyperbaric facilities as soon as possible to reduce the long-term neurologic sequelae. Ref ID : BREDDIN1993 146. Breddin, H.K. Pathophysiology of thromboembolism and its modulation by low molecular weight heparins. Semin.Thromb.Hemost. 19 Suppl 1:227- 228, 1993. Keywords : PATHOPHYSIOLOGY; THROMBOEMBOLISM; Low molecular weight heparin; Molecular Weight; HEPARIN; sdi-11/93 Ref ID : BRENNER1992 147. Brenner, B., Tavori, S., and Tatarsky, I. Prophylaxis of thromboembolism during pregnancy in hereditary AT-III deficiency [letter]. Am.J.Hematol. 39:71-72, 1992. Keywords : PROPHYLAXIS; THROMBOEMBOLISM; PREGNANCY; HEREDITARY; ANTICOAGULATION; DURATION; in Ref ID : BREZNIK1993 148. Breznik, R., Vlaisavljevic, V., and Borko, E. Treatment of varicocele and male fertility. Arch.Androl. 30:157-160, 1993. Keywords : TREATMENT; MALE; PROSPECTIVE; RANDOMIZED; EMBOLIZATION; THERAPY; PREGNANCY; NASP; Embolization,Therapeutic; FEMALE; HUMAN; Infertility,Male; PROSPECTIVE STUDIES; SCLEROTHERAPY; Sperm Count; Sperm Motility; Support,Non-U.S.Gov't; VARICOSE VEINS; Medline File; ab; in; ad Notes : AB - Ninety-six patients with varicocele were followed for 4 years in a prospective randomized study. Seventeen patients were excluded from the study in accordance with exclusion criteria. In 26 patients varicocele was treated surgically and 12 patients were treated either by sclerosation or embolization. Forty-one patients with varicocele had no therapy. In 54 patients oligoasthenozoospermia and in 25 normozoospermia was certified. In the group of patients without treatment, the pregnancy rate in the women was higher (22/41, or 53.7%) than in the group receiving treatment (13/38, or 34.2%). The difference was not statistically significant. After therapy, sperm concentration increased and sperm motility improved also. The differences were not statistically significant. The study showed that varicocele therapy bears no influence on male fertility AD - Department of Gynecology/Obstetrics AD - University of Ljubljana Faculty of Medicine AD - Maribor AD - Slovenia UI - 93270500. Ref ID : BRIDGES1993 149. Bridges, A.J. and Spadone, D.P. Tissue plasminogen activator treatment of digital thrombosis in severe Raynaud's phenomenon--a case report. Angiology 44:566-569, 1993. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; TREATMENT; THROMBOSIS; ACEP93; in; CASE REPORT Ref ID : BRILLEDWARDS1993 150. Brill-Edwards, P., Ginsberg, J.S., Johnston, M., and Hirsh, J. Establishing a therapeutic range for heparin therapy [see comments]. Ann.Intern.Med. 119(2):104-109, 1993. Keywords : LMWH; Low-Molecular-Weight-Heparin; HEPARIN; THERAPY; Methods; THROMBOPLASTIN; APTT; cohort studies; Hospitals; INPATIENTS; VENOUS; THROMBOEMBOLIC; standards; 951217; is; in; an; Dose-Response Relationship,Drug; ad; bl; HUMAN; indicators and reagents; partial thromboplastin time; reference values; regression analysis; Support,Non- U.S.Gov't; THROMBOEMBOLISM; dt; titrimetry; Medline File; ontario; CANADA; reference standards Notes : OBJECTIVE: To compare two methods of determining a therapeutic range of activated partial thromboplastin time (aPTT) results. DESIGN: Cohort studies. SETTING: Referral teaching hospital. PATIENTS: Inpatients who received unfractionated heparin intravenously for venous thromboembolic disease. MEASUREMENTS: A therapeutic range determined by aPTT ratios of 1.5 to 2.5 times the control value as compared with a therapeutic range determined by protamine titration heparin levels of 0.2 to 0.4 U/mL. RESULTS: For all aPTT reagents studied, a ratio of 1.5 times the control value is much less than a minimum protamine titration heparin level of 0.2 U/mL. Various manufacturers' aPTT reagents and reagent lots from the same manufacturer show considerable variation in response to heparin and therefore have different therapeutic ranges. CONCLUSIONS: A different dose of heparin would be required to produce an aPTT ratio of 1.5 times the control value, depending on the reagent used. Establishing a therapeutic range for aPTT results using protamine titration heparin levels of 0.2 to 0.4 U/mL as a reference standard is practical and compensates for the variable response of aPTT reagents to heparin. Ref ID : BRISMAR1972 151. Brismar, J. and Gothlin, J. Phlebography and thrombosis of the deep veins of the foot. Brit.J.Radiol. 45:199-202, 1972. Keywords : PHLEBOGRAPHY; THROMBOSIS; VEINS; Foot; NASP; vein Ref ID : BROEKMANS1983 152. Broekmans, A.W., Veltkamp, J.J., and Bertina, R.M. Congenital protein C deficiency and venous thromboembolism. A study of three Dutch families. N.Engl.J.Med. 309:340-344, 1983. Keywords : CONGENITAL; PROTEIN C; VENOUS; THROMBOEMBOLISM Ref ID : BROPHY1995 153. Brophy, J.M. and Joseph, L. Placing trials in context using Bayesian analysis. GUSTO revisited by Reverend Bayes. JAMA 273(11):871- 875, 1995. Keywords : 96-suzy-001; in; analysis; Bayes; standards; RANDOMIZED; CLINICAL TRIALS; TREATMENT; is; PROBABILITY; THROMBOLYTIC; MYOCARDIAL INFARCTION; infarction; PLASMINOGEN; PLASMINOGEN ACTIVATOR; STREPTOKINASE; ALTEPLASE; therapeutic use; bayes theorem; HUMAN; drug therapy; RANDOMIZED CONTROLLED TRIALS; THROMBOLYTIC THERAPY Notes : Standard statistical analyses of randomized clinical trials fail to provide a direct assessment of which treatment is superior or the probability of a clinically meaningful difference. A Bayesian analysis permits the calculation of the probability that a treatment is superior based on the observed data and prior beliefs. The subjectivity of prior beliefs in the Bayesian approach is not a liability, but rather explicitly allows different opinions to be formally expressed and evaluated. The usefulness of this approach is demonstrated using the results of the recent GUSTO study of various thrombolytic strategies in acute myocardial infarction. This analysis suggests that the clinical superiority of tissue-type plasminogen activator over streptokinase remains uncertain. Ref ID : BROWN1989 154. Brown, W.D. and Goldhaber, S.Z. How to select patients with deep vein thrombosis for tPA therapy. Chest 95(5 Suppl):276S-278S, 1989. Keywords : VEINS; THROMBOSIS; TPA; THERAPY; THROMBOLYTIC; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; DVT; LEG; VENOGRAPHY; CALF; TRAUMA; SURGERY; BLEEDING; THROMBOLYTIC THERAPY; SELECT; ALTEPLASE; HEPARIN; THROMBOPHLEBITIS; ADULT; AGED; CLINICAL TRIALS; COMPARATIVE STUDY; FEMALE; HUMAN; MALE; MIDDLE AGE; RANDOM ALLOCATION; 951216; DEEP VEIN THROMBOSIS; vein; is; BRIGHAM; Hospitals; in; Venogram; tu; bs; dt; Medline File; CARDIOVASCULAR Notes : AB-Despite enthusiasm for using thrombolytic therapy to treat proximal deep venous thrombosis (DVT), the proportion of patients eligible for this therapeutic strategy is unknown. Therefore, we screened all patients at Brigham and Women's Hospital who underwent leg venography in 1987. Of 240 patients with suspected DVT, 87 (36%) had positive venograms. Of those with positive venograms, 72 (83%) had proximal DVT, and 15 (17%) had DVT limited to calf veins. Overall, 22% of patients with proximal DVT were eligible for thrombolytic therapy. The major exclusion criteria were: (1) recent trauma or surgery, (2) recent GI bleeding, and (3) history of a bleeding disorder. Thus, thrombolytic therapy could be given to approximately one-fifth of our patients with proximal DVT. Ref ID : BROWN1993 155. Brown, K.T., Moore, E.D., Getrajdman, G.I., and Saddekni, S. Infrapopliteal angioplasty: long-term follow-up. J.Vasc.Interv.Radiol. 4:139-144, 1993. Keywords : LONG TERM; FOLLOWUP; ACEP-93; ACEP93; Angioplasty; 96-suzy- 001; Methods; RISK; RISK FACTORS; in; SAPHENOUS VEIN; vein; bypass graft; an; COMPLICATIONS; EMERGENCY; SURGERY; SURGICAL; is; TREATMENT; AGED; angioplasty,balloon; adverse effects; FEMALE; Follow-Up Studies; graft occlusion,vascular; EPIDEMIOLOGY; THERAPY; HUMAN; Ischemia; LEG; blood supply; MALE; Popliteal Artery; PROSPECTIVE STUDIES; THROMBOSIS; tibial arteries; TIME FACTORS; UROKINASE; therapeutic use Ref ID : BROWNSMITH1990 156. Brown-Smith, J.K., Stoner, M.H., and Barley, Z.A. Tunneled catheter thrombosis: factors related to incidence. Oncol.Nurs.Forum 17:543-549, 1990. Keywords : CATHETER; THROMBOSIS; INCIDENCE; ACEP-93; ACEP93 Ref ID : BROWSE1980 157. Browse, N.L., Clemenson, G., and Thomas, M.L. Is the postphlebitic leg always postphlebitic? Relation between phlebographic appearances of deep vein thrombosis and late sequelae. Brit.Med.J. 281:1167-1170, 1980. Keywords : POSTPHLEBITIC; LEG; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; LATE; LATE SEQUELAE; is; vein Ref ID : BROWSE1988 158. Browse, N.L., Burnard, K.G., and Thomas, M.L. Diseases of the veins: Pathology, diagnosis, treatment, London:Edward Arnold, 1988. Keywords : VEINS; DIAGNOSIS; TREATMENT; PAIN; SCLEROTHERAPY; CAUSE; SCLEROSANT; PHLEBITIS; ARTERIAL; INJURY; DEEP VEIN THROMBOSIS; THROMBOSIS; BEDREST; pathology; is; Myositis; vein; COMPRESSION; STOCKINGS Notes : Pain after sclerotherapy is a sign that something is wrong. The cause must be found and prompt, appropriate intervention instituted. Pain may result from many different causes including extravasated sclerosant, superficial phlebitis, chemical neuritis or myositis, arterial injury, deep vein thrombosis, or simply ill-fitting compression stockings. Bedrest will not help any of these. Ref ID : BROZINSKY1981 159. Brozinsky, S., DeSoto-Lapaix, F., Jimenez, F.A., and Ostrowitz, A. Bile emboli: a complication of PTD. J.Clin.Gastroenterol. 3:135-137, 1981. Keywords : 951202; EMBOLI; COMPLICATION; in; LUNG; AUTOPSY; Carcinoma; PERITONITIS; AGED; bile; th; CASE REPORT; drainage; ae; EMBOLISM; et; HUMAN; Liver; MALE; pancreatic neoplasms; PULMONARY EMBOLISM; Medline File Notes : Bile emboli in the kidneys and lungs were present at autopsy in a patient who had undergone percutaneous trans-hepatic drainage for pancreatic carcinoma obstructing the common bile duct. The patient also developed hemobilia and bile peritonitis. Ref ID : BROZOVIC1981 160. Brozovic, M. Acquired disorders of blood coagulation. In: Haemostasis and Thrombosis, edited by Bloom, A.L. and Thomas, D.P.Edinburgh:Churchill Livingstone, 1981,p. 422-426. Keywords : COAGULATION; THROMBOSIS; blood Ref ID : BRUNKWALL1987 161. Brunkwall, J. Postoperative deep vein thrombosis after renal transplantation. Transplantation 43:647-649, 1987. Keywords : POSTOPERATIVE; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; CLINICAL DIAGNOSIS; DIAGNOSIS; DVT; RENAL TRANSPLANT; INCIDENCE; PROSPECTIVE; postoperative deep vein thrombosis; vein; transplantation; in Notes : The clinical diagnosis of DVT following renal transplant, for example, reflects a 7 percent incidence of the disease, while prospective investigation without regard to the presence or absence of clinical suspicion leads to the diagnosis in 20 percent of cases. Ref ID : BRUNNER1970 162. Brunner, N. [A new possibility of drug treatment of leg diseases]. Z.Haut.Geschlechtskr. 45:85-90, 1970. Keywords : TREATMENT; LEG; NASP; Acrodermatitis; Anti-Inflammatory Agents; FEMALE; Furans; HUMAN; MALE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; drugs; in; ab Notes : TT - Eine neue medikamentose Moglichkeit in der Behandlung von Beinleiden AB - [No Abstract Available] UI - 70205578. Ref ID : BRUS1990 163. Brus, F., Witsenburg, M., Hofhuis, W.J., Hazelzet, J.A., and Hess, J. Streptokinase treatment for femoral artery thrombosis after arterial cardiac catheterisation in infants and children. Br.Heart J. 63:291-294, 1990. Keywords : STREPTOKINASE; TREATMENT; THROMBOSIS; ARTERIAL; CARDIAC; ACEP93; Femoral Artery; ARTERY; in; Infant Ref ID : BUCHBINDER1993 164. Buchbinder, D., McCullough, G.M., and Melick, C.F. Patients evaluated for venous disease may have other pathologic conditions contributing to symptomatology. Am J Surg. 166:211-215, 1993. Keywords : VENOUS; PATHOLOGIC; Extremities; PHLEBITIS; varicose; VARICOSE VEINS; VEINS; Palpation; Duplex; SCAN; MAGNETIC RESONANCE; MRI; CT; Hemangioma; VENOUS THROMBOSIS; THROMBOSIS; Popliteal Artery; ARTERY; Aneurysm; Popliteal Vein; vein; Physical Examination; SCANNING; DIAGNOSIS; Biopsy; MALIGNANCY; sdi-11/93; magnetic resonance imaging; an; in Notes : Of the more than 200 patients recently evaluated for venous disease, 8 were diagnosed with lower extremity masses. Three patients were referred for superficial phlebitis and four for deep venous obstructive disease. The eighth mass was found during work-up for varicose veins. Five masses were identified by palpation, and three were identified by duplex scan. All were confirmed by magnetic resonance imaging (MRI) or computed tomography (CT). Of the eight masses, three were malignant: a metastatic melanoma, a histiocytoma, and a myxoid liposarcoma. Nonmalignant masses included a hematoma, an inflammatory lesion, a hemangioma, and an intramuscular lipoma. One patient presented with deep venous thrombosis secondary to an occluded popliteal artery aneurysm compressing the popliteal vein. Thus, patients presenting with ostensible venous disease may have other pathologic conditions responsible for symptomatology. Careful physical examination will reveal a mass in a majority of patients who have one. Duplex scanning will identify masses that should be confirmed by MRI or CT. Definitive diagnosis should be made by biopsy, due to the high possibility of malignancy. Ref ID : BUCKENHAM1991 165. Buckenham, T.M. and Darby, M. Thrombolysis with t-PA [letter; comment]. Br.J.Hosp.Med. 46:269, 1991. Keywords : THROMBOLYSIS; t-PA; ACEP-93; ACEP93 Ref ID : BUERGER1993 166. Buerger, P.M., Peoples, J.B., Lemmon, G.W., and McCarthy, M.C. Risk of pulmonary emboli in patients with pelvic fractures. Am.Surg. 59:505- 508, 1993. Keywords : EMBOLISM; TRAUMA; RISK; Pulmonary emboli; EMBOLI; FRACTURES; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; INCIDENCE; INJURY; REVIEW; AGE; MALE; Died; MORTALITY; SCREENING; in; an; trauma centers; is; sex Notes : Multiply-injured patients with pelvic fractures are recognized to have an increased risk of deep venous thrombosis. The incidence of pulmonary emboli in patients with this injury has been reported to range from 0.5 to 8.3 per cent in several recent reviews. One hundred ninety- eight patients with pelvic fractures treated at a regional trauma center over a 3-year period were reviewed to evaluate the factors associated with an increased risk of clinically evident pulmonary embolism. The mean age SD was 44 24 years; 51 per cent were male, and mean Injury Severity Score (ISS) was 19 15. Eighteen patients (9%) died. Mortality was significantly correlated with ISS (P < 0.05), male sex, and type and severity of fracture but not with age, mechanism of injury, or operative fixation. Four patients (2.0%) had pulmonary emboli. The occurrence of clinically apparent pulmonary emboli correlated only with ISS (ISS < 15 = 0% vs ISS > 15 = 4%, P < 0.05). During the same time period, there were eight (0.2%) pulmonary emboli in 3337 trauma patients without pelvic fracture. This difference is highly significant (P < 0.0001). Pelvic fracture is indicative of severe injury and denotes a population at higher risk for pulmonary emboli than other trauma patients. Intensive screening and prophylactic measures to prevent deep venous thrombosis and subsequent pulmonary emboli should be intensively directed at this population. Ref ID : BULLER1991 167. Buller, H.R., Lensing, A.W., Hirsh, J., and Ten Cate, J.W. Deep vein thrombosis: new non-invasive diagnostic tests. Thromb.Haemost. 66(1):133-137, 1991. Keywords : 951217; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; NONINVASIVE; diagnostics; Evaluation Studies; HUMAN; iodine radioisotopes; du; PHLEBOGRAPHY; Plethysmography,Impedance; THROMBOPHLEBITIS; di; ra; us; Medline File Notes : [No Abstract Available]. Ref ID : BUNDENS1995 168. Bundens, W.P., Bergan, J.J., Halasz, N.A., Murray, J., and Drehobl, M. The Superficial Femoral Vein. A Potentially Lethal Misnomer. JAMA 274(16):1296-1298, 1995. Keywords : 96-suzy-002; Femoral Vein; vein; in; VENOUS; Duplex; ANATOMY; us; laboratories; OUTCOME; TREATMENT; LEG; PAIN; THROMBOSIS; Thigh; VEINS; is; ANTICOAGULANTS; an Notes : 01-04-96. Abstract : Objective.-To assess the potential for error in interpretation of venous duplex report that use the term ``superficial femoral vein." Design.-Three surveys conducted by mail. Setting.-Three multispecialty medical groups, anatomy departments of all US medical schools, and vascular laboratories. Participants.-A total of 46 family practitioners and general internists, 95 chairpersons of departments of anatomy, and 85 laboratory directors. Main Outcome Measures.-Proposed treatment of a patient with leg pain and acute thrombosis of the superficial femoral vein; what nomenclature(s) for the deep thigh veins is (are) felt to be correct, what are aacceptable alternatives, what is taught to students and which is preferred; and what terminology is being used in lower limb venous duplex reports. Results.-Only 24% (11/46) of the respondents would have administered anticoagulants to the patient as described. Only 3% (3/95) of anatomists felt the term ``superficial femoral vein" was correct, 22% (21/95) felt it was an acceptable alternative (though only 9% [9/95] taught it to medical students), and only 7% (7/95) of anatomists felt the term was preferred for everyday use. The term ``superficial femoral vein" is used by 93% (79/85) of vascular laboratories in lower limb venous duplex reports. Conclusion.- Although the overwhelming majority of vascular laboratories use the term ``superficial femoral vein" in venous duplex reports, the use of this term is potentially hazardous to patients. Most primary care physicians have not been taught and are not aware that the superficial femoral vein is a deep vein and that acute thrombosis of this vessel is potentially life threatening. Ref ID : BURKITT1972 169. Burkitt, D.P. Varicose veins deep vein thrombosis and haemorrhoids: epidemiology and suggested etiology. Brit.Med.J. 2:556, 1972. Keywords : varicose; VARICOSE VEINS; VEINS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; EPIDEMIOLOGY; ETIOLOGY; NASP Ref ID : BURNS1993 170. Burns, G.A., Cohn, S.M., Frumento, R.J., Degutis, L.C., and Hammers, L. Prospective ultrasound evaluation of venous thrombosis in high-risk trauma patients. J Trauma. 35:405-408, 1993. Keywords : PROSPECTIVE; ULTRASOUND; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; RISK; TRAUMA; INCIDENCE; Doppler; AGE; Rest; THROMBOEMBOLISM; FRACTURES; Spinal cord; INJURY; Extremities; Femoral Vein; vein; CATHETER; PROPHYLAXIS; HEPARIN; COMPRESSION; UPPER EXTREMITY; Catheters; THROMBI; Duplex; sdi-11/93; in; us; an; coma; spinal cord injuries; is Notes : To determine the incidence of venous thrombosis (VT), high-risk trauma patients were evaluated prospectively biweekly with Doppler ultrasound (US). Fifty-seven patients during an 8-month period met high- risk criteria for VT including age > 45 years, > 2 days bed rest, previous history of thromboembolism, spine fracture, coma, spinal cord injury, pelvic fracture, lower extremity injury, or femoral vein catheter. Doppler ultrasound showed 16 VTs in 12 patients. Venous thrombosis occurred despite prophylaxis (heparin or compression devices) in 9 of 12 patients. Iliac VT was noted in four patients, two of whom had no lower extremity VT. Upper extremity VT occurred in two patients who had received central venous catheters. Conclusions: (1) US surveillance may be valuable in high-risk trauma patients because VT is a common finding (21%), despite prophylactic measures. (2) Examination of the upper extremity and pelvic venous system appears to be important, since 33% (4 of 12) of our patients with VT developed thrombi isolated to these regions. These would not have been identified during routine lower extremity duplex studies. Ref ID : BURT1981 171. Burt, M.E., Dunnick, N.R., Krudy, A.C., and et al Prospective evaluation of subclavian vein thrombosis during total parenteral nutreition by contrast venography. Clin.Res. 29:264A-264A, 1981. (Abstract) Keywords : PROSPECTIVE; SUBCLAVIAN; SUBCLAVIAN VEIN; vein; THROMBOSIS; CONTRAST; VENOGRAPHY; VEINS; TPN Ref ID : BUSBY1988 172. Busby, W., Bayer, A., and Pathy, J. Pulmonary embolism in the elderly. Age.Ageing 17:205-209, 1988. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; Retrospective Studies; AGE; LUNG; SCAN; CLINICAL FEATURES; DIAGNOSIS; THROMBOSIS; ANTICOAGULANTS; POSTMORTEM; FREQUENCY; Pulmonary emboli; EMBOLI; AGED; Aged,80 and over; AUTOPSY; FEMALE; HUMAN; MALE; di; dt; ri; Support,Non- U.S.Gov't; WARFARIN; tu; Medline File Notes : A retrospective study was made of a consecutive series of patients over 65 years of age diagnosed as having a pulmonary embolus by either ventilation-perfusion lung scan or at necropsy. No clinical features were particularly helpful in making the diagnosis though signs of deep-vein thrombosis were present in 35%. Anticoagulants were well tolerated by all patients to whom they were prescribed. Postmortem findings showed a decreasing frequency of pulmonary emboli in the elderly which may indicate a reduction in predisposing factors University Department of Geriatric Medicine Cardiff Royal Infirmary South Glamorgan. Ref ID : BUSS1985 173. Buss, D.H., Stuart, J.J., and Lipscomb, G.E. The incidence of thrombotic and hemorrhagic disorders in association with extreme thrombocytosis; an analysis of 129 cases. Am.J.Hematol. 20:365-372, 1985. Keywords : INCIDENCE; HEMORRHAGIC; THROMBOCYTOSIS; RISK; THROMBOSIS; PLATELET; BLEEDING; in; an; analysis; Platelet Count Notes : It would seem logical that thrombocytosis should raise the risk of thrombosis, but in fact there are no good data to support this belief. In fact, several studies purport to show that platelet counts above one million lead to a reduced likelihood of thrombosis and an increased likelihood of bleeding problems. Ref ID : BUSSANI1990 174. Bussani, R. and Cosatti, C. [Pulmonary embolism: epidemiologic analysis of 27,410 autopsies during a 10-year period]. Medicina.(Firenze). 10:40-43, 1990. Keywords : 951202; EMBOLISM; analysis; AUTOPSY; FREQUENCY; PULMONARY EMBOLISM; PE; in; Hospitals; MALE; FEMALE; LUNG; infarction; MASSIVE; FATAL; Arteries; Neoplasms; CANCER; AGE; sex; RISK; RISK FACTORS; Age Factors; AGED; Aged,80 and over; COMPARATIVE STUDY; English Abstract; HUMAN; Italy; MIDDLE AGE; ovarian neoplasms; co; ep; Sex Factors; Medline File; Cancerlit File; di Notes : The frequency of pulmonary embolism (PE) among all patients at necropsy in a university hospital from 1979 through 1988 has been evaluated. Of 27,410 subjects, 1,984 males (14.6%) and 3,428 females (24.7%) had a PE with a highly significant increase in the elderly patients. The autoptic rate of PE remained unchanged during the period analyzed, while the frequency of PE with lung infarction increased (p less than 0.05). In 1,411 subjects (26% of all subjects with PE) a massive fatal embolism was found, and in 2,230 (41.2%) PE had occluded one or more arteries in both lungs. Among subjects with a malignant neoplasm, patients with pancreatic and gastric cancer, cancer of the large bowel and women with ovarian cancers had the highest frequency of PE. Old age, female sex, gastrointestinal and ovarian cancers must be considered as significant risk factors for PE Istituto di Anatomia Patologica Universita di Trieste Ospedale Maggiore. Ref ID : BYARD1990 175. Byard, R.W. and Cutz, E. Sudden and unexpected death in infancy and childhood due to pulmonary thromboembolism. An autopsy study. Arch.Pathol.Lab.Med. 114:142-144, 1990. Keywords : 951202; DEATH; in; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; AUTOPSY; MASSIVE; is; CAUSE; PEDIATRIC; AGE; REVIEW; Hospitals; CANADA; INCIDENCE; SURGERY; CONGENITAL; heart; heart diseases; VENOUS; Catheters; OCCULT; MALIGNANCY; DIAGNOSIS; RISK; Adolescence; CHILD; Child,Preschool; Death,Sudden; PA; FEMALE; HUMAN; Infant; Infant,Newborn; MALE; PULMONARY EMBOLISM; Medline File; Unexpected; an Notes : Because massive pulmonary thromboembolism is a rarely described cause of sudden and unexpected death in the pediatric age group, a 50- year retrospective review of autopsy cases at the Hospital for Sick Children, Toronto, Canada, was conducted to determine the local incidence and clinicopathologic features of such patients. Only 8 cases (0.05%) from a total of approximately 17, 500 autopsies were found. The ages ranged from 1 month to 13 years and predisposing factors included recent surgery, congenital heart disease, in- dwelling venous catheters, sepsis, an arteriovenous malformation, occult malignancy, and prolonged immobility. This study confirms that pulmonary thromboembolism is a diagnosis that must be considered in cases of sudden and unexpected death in the pediatric age group. Its incidence, however, appears to be extremely low even in a relatively high-risk population Department of Histopathology Adelaide Children's Hospital Australia. Ref ID : CABASSI1985 176. Cabassi, A. and Gatti, A. [Palliative operations in the post- thrombotic syndrome]. Minerva.Chir. 40:759-760, 1985. Keywords : POST-THROMBOTIC; NASP; English Abstract; HUMAN; Syndrome; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Interventi palliativi nella sindrome post-trombotica AB - [No Abstract Available] UI - 85296812. Ref ID : CADE1982 177. Cade, J.F. High risk of the critically ill for venous thromboembolism. Crit.Care.Med. 10:448-450, 1982. Keywords : RISK; VENOUS; THROMBOEMBOLISM; INCIDENCE; DVT; FIBRINOGEN; SCANNING; in; Hospitals; Rest; an; intensive care; intensive care units Notes : The incidence of DVT in a nonsurgical hospital population was prospectively determined using radiolabelled fibrinogen scanning. Patients placed at bed rest in a general medical ward had a 10 percent incidence of DVT, while 29 percent of the much sicker patients placed in an intensive care unit developed DVT. Ref ID : CAIRNS1995 178. Cairns, J., Armstrong, P.W., Belenkie, I., Hirsh, J., Johnstone, D.E., Knudtson, M., Lemieux, M., Massel, D., Naylor, C.D., and Roy, L. Maximizing the benefits of thrombolytic therapy for acute myocardial infarction [editorial]. Can.Med.Assoc.J. 152:819-822, 1995. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MYOCARDIAL INFARCTION; MANAGEMENT; COST; Cerebral; CEREBRAL HEMORRHAGE; HEMORRHAGE; CANADA; infarction; is; in Notes : Thrombolytic therapy is a huge advance in the management of acute myocardial infarction (AMI). The results of large clinical trials over the past 9 years have unequivocally demonstrated its benefit: of every 1000 patients treated 30 will be saved, at a cost of two cases of nonfatal cerebral hemorrhage and seven of noncerebral major hemorrhage. The concurrent use of acetylsalicylic acid increases the benefit of thrombolytic therapy. Sales figures for thrombolytic agents indicate that their use in Canada is less than optimal and lags behind that in several European countries. Major educational efforts are needed to promote awareness of the efficacy of thrombolytic therapy and of optimal approaches for maximizing its potential benefit for patients with AMI. Ref ID : CAMPBELL1989 179. Campbell, W.B. and Magee, T.R. Managing acute limb ischaemia [see comments]. BMJ. 299:526, 1989. Keywords : PHLEBITIS; HUMAN; Ischemia; drug therapy; THERAPY; LEG; blood supply; SURGERY; THROMBOPHLEBITIS Ref ID : CANGE1987 180. Cang‰, S., Laberge, L.C., Rivard, G.E., and Garel, L. Streptokinase in the management of limb arterial thrombosis following free-flap surgery. Plast.Reconstr.Surg. 79:974-976, 1987. Keywords : STREPTOKINASE; MANAGEMENT; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; SURGERY; ACEP93; in Ref ID : CANNON1995 181. Cannon, C.P. and Goldhaber, S.Z. The importance of rapidly treating patients with acute myocardial infarction [editorial]. Chest 107(3):598- 600, 1995. Keywords : 951216; MYOCARDIAL INFARCTION; infarction; HUMAN; dt; THROMBOLYTIC THERAPY; TIME FACTORS; TREATMENT OUTCOME; Medline File; Health Planning & Administration File Notes : [No Abstract Available]. Ref ID : CAPEK1993A 182. Capek, P. and Holcroft, J. Traumatic ischemia of the hand in a tennis player: successful treatment with urokinase [see comments]. J.Vasc.Interv.Radiol. 4(2):279-281, 1993. Keywords : 96-suzy-001; Ischemia; in; TREATMENT; UROKINASE; ADULT; angiography,digital subtraction; CASE REPORT; hand; blood supply; hand injuries; COMPLICATIONS; radiography; HUMAN; ETIOLOGY; MALE; radial artery; tennis; injuries; THROMBOLYTIC THERAPY; THROMBOSIS; drug therapy; ulnar artery; therapeutic use Ref ID : CARPENTER1993 183. Carpenter, J.P., Holland, G.A., Baum, R.A., Owen, R.S., Carpenter, J.T., and Cope, C. Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex doppler ultrasonography. J.Vasc.Surg. 18:734-741, 1993. Keywords : MAGNETIC RESONANCE; VENOGRAPHY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CONTRAST; Duplex; Doppler; Ultrasonography; MRI; ULTRASOUND; SENSITIVITY; SPECIFICITY; Thigh; vein; DVT Notes : MRI, duplex ultrasound and venography are of comparable sensitivity and specificity for thigh vein DVT. Ref ID : CARSON1992 184. Carson, J.L., Kelley, M.A., Duff, A., Weg, J.G., Fulkerson, W.J., Palevsky, H.I., Schwartz, J.S., Thompson, B.T., Popovich, J.,Jr., and Hobbins, T.E. The clinical course of pulmonary embolism [see comments]. N.Engl.J.Med. 326:1240-1245, 1992. Keywords : PULMONARY EMBOLISM; EMBOLISM; FATAL; OUTCOME; TREATMENT; Methods; LUNG; SCANNING; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; diagnostics; DEATH; DIAGNOSIS; ANTICOAGULATION; Died; FOLLOWUP; CANCER; RISK; CHRONIC; CAUSE; INFECTION; CARDIAC; is; in; hospitalization; confidence intervals; heart; lung diseases; an; cause of death Notes : BACKGROUND. Pulmonary embolism is a potentially fatal disorder. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now available. METHODS. We prospectively followed 399 patients with pulmonary embolism diagnosed by lung scanning and pulmonary angiography, who were enrolled in a multicenter diagnostic trial. We reviewed all hospitalizations, all new investigations of pulmonary embolism, and all deaths among the patients within one year of diagnosis. RESULTS. Of the 399 patients, 375 (94 percent) received treatment for pulmonary embolism, usually conventional anticoagulation. Only 10 patients (2.5 percent) died of pulmonary embolism; 9 of them had clinically suspected recurrent pulmonary embolism. Clinically apparent pulmonary embolism recurred in 33 patients (8.3 percent), of whom 45 percent died during follow-up. Ninety-five patients with pulmonary embolism (23.8 percent) died within one year. The conditions associated with these deaths were cancer (relative risk, 3.8; 95 percent confidence interval, 2.3 to 6.4), left-sided congestive heart failure (relative risk, 2.7; 95 percent confidence interval, 1.5 to 4.6), and chronic lung disease (relative risk, 2.2; 95 percent confidence interval, 1.2 to 4.0). The most frequent causes of death in patients with pulmonary embolism were cancer (in 34.7 percent), infection (22.1 percent), and cardiac disease (16.8 percent). CONCLUSIONS. When properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death, and it recurred in only a small minority of patients. Most deaths were due to underlying diseases. Patients with pulmonary embolism who had cancer, congestive heart failure, or chronic lung disease had a higher risk of dying within one year than did other patients with pulmonary embolism. Ref ID : CARTER1987 185. Carter, C., Gent, M., and LeClerc, J. The epidemiology of venous thrombosis. In: Hemostasis and thrombosis, edited by Colman, R.W., Hirsh, J., Marder, V.J., and Salzman, E.W.Philadelphia:J.B. Lippincott, 1987, Keywords : EPIDEMIOLOGY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; HEMOSTASIS Ref ID : CARTER1990 186. Carter, C.J. Incidence of post-phlebitic syndrome after streptokinase therapy for deep vein thrombosis [letter; comment]. Am.J.Med. 89:697-698, 1990. Keywords : PHLEBITIS; INCIDENCE; POST-PHLEBITIC; POST PHLEBITIC SYNDROME; Syndrome; STREPTOKINASE; THERAPY; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; HUMAN; prevention & control; therapeutic use; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; drug therapy; radiography Ref ID : CELI1989 187. Celi, A. and Palla, A. Prospective study of a standardized questionnaire to improve clinical estimate of pulmonary embolism. Chest 95:332, 1989. Keywords : PROSPECTIVE; PULMONARY EMBOLISM; EMBOLISM; CLINICAL QUESTIONNAIRE; PROSPECTIVE STUDIES; Questionnaires Ref ID : CEPELAK1982 188. Cepelak, V. Effect of sclerosing agents on platelet aggregation. Folia.Angiologica. 30-31(4-6):363-367, 1982. Keywords : PLATELETS; THROMBOSIS; SCLEROTHERAPY; SCLEROSING AGENTS; PLATELET; PLATELET AGGREGATION Ref ID : CEREL1993 189. Cerel, A. and Burger, A.J. The diagnosis of a pulmonary artery thrombus by transesophageal echocardiography. Chest 103:944-945, 1993. Keywords : DIAGNOSIS; PULMONARY ARTERY; ARTERY; THROMBUS; MYOCARDIAL INFARCTION; CARDIAC; ANGIOGRAPHY; THERAPY; ANTICOAGULATION; sdi-11/93; Echocardiography; Transesophageal; Angioplasty; Cardiac arrest; an; infarction Notes : We describe a patient with an acute inferior wall myocardial infarction who underwent percutaneous coronary angioplasty. He subsequently had a cardiac arrest and developed progressive severe hypoxia. Although findings from pulmonary angiography were nondiagnostic, transesophageal echocardiography demonstrated a nonocclusive, right pulmonary artery thrombus. Therapy was changed, and the patient recovered. Transesophageal echocardiography was also used to monitor anticoagulation therapy. Ref ID : CHABANEL1994 190. Chabanel, A., Horellou, M.H., Conard, J., and Samama, M.M. Red blood cell aggregability in patients with a history of leg vein thrombosis: influence of post-thrombotic treatment. Br.J.Haematol. 88:174-179, 1994. Keywords : PHLEBITIS; blood; LEG; vein; THROMBOSIS; POST-THROMBOTIC; TREATMENT; ADULT; BANDAGES; Blood Viscosity; cardiovascular agents; therapeutic use; Chronic Disease; erythrocyte aggregation,intravascular; FEMALE; FIBRIN; analysis; HEMATOCRIT; HUMAN; blood supply; MALE; MIDDLE AGE; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; drug therapy; physiopathology; THERAPY; Venous Insufficiency; BLOOD FLOW; VENOUS; THROMBI; STASIS; VENOUS THROMBOSIS; France; AGE; THROMBUS; RECURRENCE; COMPRESSION; STOCKINGS; drugs; COMPLICATIONS; in; an; is; abnormalities Notes : Reversible aggregation of red blood cells (RBC) plays an important role in determining blood flow properties, and it is this aggregation which increases blood viscosity at low shear rates. The structure and sites of venous thrombi, as well as the fact that stasis is a major predisposing factor in venous thrombosis, suggest a strong association between vein thrombosis, slow blood flow and increased blood viscosity. RBC aggregation and disaggregation were measured (SEFAM erythroaggregameter, France) in 54 patients with a history of unexplained leg vein thrombosis. Results were compared to those of controls classified according to age. Increased RBC aggregability was observed in 41% of the patients, and the mean values indicated a significant elevation of RBC aggregability in patients when compared with controls (P < 0.05). Subgroups were compared to study the influence of thrombus recurrence and thrombosis type (deep versus superficial vein thrombosis) on the aggregation parameters. No significant difference was found between these subgroups. The use of compression stockings and veinotropic drugs tended to reduce the abnormalities in RBC aggregability (P < 0.05). An increase in RBC aggregability and in the shear resistance of RBC aggregates, by predisposing to circulatory stasis, is likely to contribute to the evolution and complications of leg vein thrombosis. Ref ID : CHAMBERLIN1995 191. Chamberlin, J.R., Lewis, B., Leya, F., Wallis, D., Messmore, H., Hoppensteadt, D., Walenga, J.M., Moran, S., Fareed, J., and McKiernan, T. Successful treatment of heparin-associated thrombocytopenia and thrombosis using Hirulog. Can.J.Cardiol. 11(6):511-514, 1995. Keywords : 96-suzy-001; TREATMENT; Heparin-associated thrombocytopenia; THROMBOCYTOPENIA; THROMBOSIS; is; ANTICOAGULATION; an; INTRAVENOUS; ANTICOAGULANT; HEPARIN; in; Syndrome; coronary artery; CORONARY ARTERY BYPASS; ARTERY; SURGERY; Angioplasty; adverse effects; AGED; angioplasty,balloon; ANTICOAGULANTS; therapeutic use; CASE REPORT; coronary thrombosis; blood; drug therapy; HIRUDIN; analogs & derivatives; administration & dosage; HUMAN; Injections,Intravenous; MALE; peptide fragments; Postoperative Complications; RECOMBINANT PROTEINS; THROMBIN; antagonists & inhibitors; chemically induced Notes : Heparin-associated thrombocytopenia is a serious medical problem, especially when the patient requires continued anticoagulation. Hirulog is an immediate-acting intravenous anticoagulant that can be substituted for heparin. A new use of Hirulog in the treatment of life- threatening heparin-associated thrombocytopenia with thrombosis (HATT) is presented. Two patients suffering from the HATT syndrome were successfully treated with Hirulog to prevent further thrombosis. A third patient had developed heparin-associated thrombocytopenia after coronary artery bypass surgery in the past and was subsequently treated with Hirulog during a peripheral angioplasty procedure. Hirulog was an effective and predictable anticoagulant for these patients and was free from adverse effects. Ref ID : CHANCE1991 192. Chance, J.F., Abbitt, P.L., Tegtmeyer, C.J., and Powers, R.D. Real- time ultrasound for the detection of deep venous thrombosis. Ann.Emerg.Med. 20:494-496, 1991. Keywords : ULTRASOUND; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PREDICTIVE VALUE; DVT; KNEE; is; in Notes : The negative predictive value of ultrasound is 100 percent for DVT above the knee in a symptomatic ED patient population, but the positive predictive value is only 78 percent. Ref ID : CHANT1972 193. Chant, A.D. The effects of posture, exercise, and bandage pressure on the clearance of 24 Na from the subcutaneous tissues of the foot. Brit.J.Surg. 59:552-555, 1972. Keywords : EXERCISE; BANDAGES; Pressure; SUBCUTANEOUS; Foot; NASP; ADULT; AGED; Exertion; FEMALE; HUMAN; MALE; MIDDLE AGE; Posture; Regional Blood Flow; Sclerosing Solutions; Sodium Isotopes; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; ab Notes : AB - [No Abstract Available] UI - 72227979. Ref ID : CHARASH1994 194. Charash, W.E., Fabian, T.C., and Croce, M.A. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J.Trauma. 37:667-672, 1994. Keywords : EMBOLISM; TRAUMA; SURGICAL; FRACTURES; RISK; RISK FACTORS; EARLY; BLUNT; POSTOPERATIVE; REVIEW; MORTALITY; HEMORRHAGIC; SHOCK; INJURY; AGE; Length of Stay; DURATION; VENTILATION; PNEUMONIA; is; analysis; in; ai; thorax; trauma centers; injury severity score; glasgow coma scale; coma Notes : A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax > or = 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS > or = 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. One hundred thirty-eight patients met these criteria. Four patient groups were created: N1--no thoracic trauma (AIS score for thorax < 2), and early surgical fixation (< 24 hours after injury, n = 49); N2--no thoracic trauma and delayed fixation (> or = 24 hours, n = 8); T1--thoracic trauma (AIS score for Thorax > or = 2) and early fixation (n = 56); T2-- thoracic trauma and delayed fixation (n = 25). There were no significant differences in age, Injury Severity Score, or Glasgow Coma Scale score between the four groups. Mortality rate, length of stay (LOS), LOS in the TICU, and duration of mechanical ventilation tended to be greater in patients with delayed fracture fixation, however, this was not statistically significant. The N2 patients had a pneumonia rate of 38% compared with 10% in group N1 (p = 0.07). The T2 patients had a pneumonia rate of 48% compared with 14% in group T1 (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : CHAU1991 195. Chau, K.Y., Yuen, S.T., Ng, T.H., and Ng, W.F. An autopsy study of pulmonary thromboembolism in Hong Kong Chinese [see comments]. Pathology. 23:181-184, 1991. Keywords : 951202; an; AUTOPSY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; in; hong kong; Retrospective Studies; is; INCIDENCE; Adolescence; ADULT; AGED; Aged,80 and over; CHILD; china; eh; ep; HUMAN; LUNG; PA; MIDDLE AGE; PULMONARY EMBOLISM; Medline File; pathology; Hospitals Notes : A retrospective study of autopsied material in the last 15 yrs is documented an increasing incidence of pulmonary thromboembolism (PTE) in Hong Kong Chinese. The incidence of significant PTE increased from 0.58% in the first 5 yr period to 2.08% in recent years. The topographic features and characteristics of these PTE patients are analysed and the factors contributing to the changes are discussed Department of Pathology Queen Mary Hospital University of Hong Kong. Ref ID : CHAU1995 196. Chau, K.Y., Yuen, S.T., and Wong, M.P. Seasonal variation in the necropsy incidence of pulmonary thromboembolism in Hong Kong. J.Clin.Pathol. 48:578-579, 1995. Keywords : 951202; in; INCIDENCE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; ADULT; Hospitals; EARLY; Rest; Adolescence; AUTOPSY; china; eh; COMPARATIVE STUDY; Great Britain; hong kong; ep; HUMAN; PULMONARY EMBOLISM; mo; seasons; Medline File; Health Planning & Administration File; pathology; an Notes : The seasonal variation in the necropsy incidence of significant pulmonary thromboembolism in Hong Kong was investigated. A total of 3446 adult Chinese necropsies carried out in Queen Mary Hospital, Hong Kong, from 1987 to 1992 showed an overall rate of 3.77% for significant pulmonary thromboembolism. The rates for individual months were calculated and compared. The pattern of seasonal variation showed that there are two troughs in early summer (June, July) and early winter (November, December), with rates between 1.6% and 2.4%. The rates in the months for the rest of the year were between 4.0% and 5.5%. The overall pattern was similar to that of the temperate zone although the climate was quite different Department of Pathology Queen Mary Hospital Hong Kong. Ref ID : CHEATLE1991B 197. Cheatle, T.R., Scurr, J.H., and Smith, P.D. Drug treatment of chronic venous insufficiency and venous ulceration: a review. Journal of the Royal Society of Medicine 84:354-358, 1991. Keywords : drugs; TREATMENT; CHRONIC; CHRONIC VENOUS INSUFFICIENCY; VENOUS; Venous Insufficiency; venous ulceration; ULCERATION; REVIEW; NASP; varicose ulcer - drug therapy; venous insufficiency - drug therapy; antibiotics - therapeutic use; Chronic Disease; diuretics - therapeutic use; HUMAN; rutin - analogs & derivatives; rutin - therapeutic use; thrombolytic therapy - methods; zinc - therapeutic use Ref ID : CHEN1991 198. Chen, P.S., Moser, K.M., Dembitsky, W.P., Auger, W.R., Daily, P.O., Calisi, C.M., Jamieson, S.W., and Feld, G.K. Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy. Circulation 83:104-118, 1991. Keywords : Cardiology; UCSD; CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; TECHNIQUES; EARLY; Methods; CARDIOPULMONARY BYPASS; DURATION; PGM-8/94; in; ab; is Notes : CS- Division of Cardiology, UCSD Medical Center 92103 AB- To map global epicardial repolarization patterns and test the "SI" model of T wave generation, the patterns of epicardial activation and repolarization in patients with chronic pulmonary thromboembolism and right ventricular hypertrophy were studied by computerized mapping techniques and monophasic action potential (MAP) recording. The ventricular activation patterns were characterized by delayed right ventricular activation and the absence of normal early epicardial ventricular breakthrough in some cases. The repolarization patterns were characterized by nonuniform distribution of T wave morphologies. The T waves were predominantly positive over the left ventricular epicardium and negative or biphasic over the right ventricular epicardium. The activation-recovery (A-R) intervals were measured from the local activation to the maximal dV/dt of the upstroke of the T waves (Wyatt method). The difference between the A-R intervals and the MAP from onset of activation to 90% repolarization (MAP90) varies according to T wave morphology and could be as high as 96 msec with positive T waves, despite significant correlations (r = 0.56-0.90) between MAP90 and A-R intervals for each morphology. Better overall correlations were found if the minimal dV/dt on the downslope of the positive T waves was chosen to estimate the time of local repolarization (alternative method). Using this method, the mean A-R intervals were the same over the right and left ventricles. Cardiopulmonary bypass significantly prolonged the action potential duration equally at all parts of the epicardium. We conclude that in patients with right ventricular hypertrophy, the time of local repolarization can be estimated by our alternative method; the right ventricle completes activation and repolarization later than the left ventricle, and the distribution of T wave morphologies is nonuniform, with predominantly positive T waves observed over the left ventricle and negative or biphasic T waves observed over the right ventricle. These findings are compatible with the SI model of the generation of T waves. Ref ID : CHIEVITZ1962 199. Chievitz, E. and Thiede, T. Complications and causes of death in polycythemia vera. Acta.Med.Scand. 172:513-523, 1962. Keywords : COMPLICATIONS; CAUSE; DEATH; POLYCYTHEMIA; THROMBOSIS; VENOUS; VENOUS THROMBOSIS; in; REVIEW Notes : A retrospective review determined that fully 40 percent of deaths in patients with polycythemia vera were related to thrombosis, but only a third of these were due to venous thrombosis. Ref ID : CHONG1993 200. Chong, D.K. and Panju, A. Deep venous thrombosis as a cause of stump swelling in two lower extremity amputee patients. Arch.Phys.Med Rehabil. 74:1002-1003, 1993. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CAUSE; Extremities; INFECTION; DIAGNOSIS; ULTRASOUND; SCANNING; DVT; sdi-11/93; Amputation; Stump swelling; in; an Notes : Two patients who were initially treated for an infection as a cause for their swollen stump were subsequently found to have deep venous thrombosis. The diagnosis was made noninvasively by compressive ultrasound (CU) scanning. DVT should be considered in the different diagnosis of stump swelling in the otherwise stable, post-rehabilitated lower extremity amputee patient. Ref ID : CHOPRA1983 201. Chopra, P., Datta, R.K., Dasgupta, A., and Bhargava, S. Non specific aortoarteritis (Takayasu's disease). An immunologic and autopsy study. Jpn.Heart J. 24:549-556, 1983. Keywords : 951202; AUTOPSY; Aorta; in; Renal Artery; Arteries; SUBCLAVIAN; ARTERY; VENA CAVA; THROMBOSIS; antibodies; Adolescence; ADULT; AGED; im; PA; aortic aneurysm; et; aortic arch syndromes; autoantibodies; an; autoimmune diseases; co; CHILD; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; Support,Non-U.S.Gov't; takayasu's arteritis; Medline File Notes : Large segments of the aorta and its major branches were found to be diseased in 14 autopsied cases of aortoarteritis. Both renal arteries and the left subclavian artery were frequently affected. Superior vena cava thrombosis and thickening of the inferior vena cava were noted in one case each. Tuberculosis was present as small foci in only 3 of the 14 cases. Angiographic evaluation also revealed thickening and narrowing of diseased segments. The descending thoracic and abdominal aorta and renal arteries were frequently involved. Aneurysmal lesions were infrequent. Antiaorta antibodies were investigated using 4 different parameters. None of our cases showed their presence. The role of tuberculosis and/or autoimmunity appears unlikely in the etiopathogenesis of aortitis. Ref ID : CHRISTOPOULOS1991A 202. Christopoulos, D.C., Nicolaides, A.N., Belcaro, G., and Kalodiki, E. Venous hypertensive microangiopathy in relation to clinical severity and effect of elastic compression. J.Dermatol.Surg.Oncol. 17:809-813, 1991. Keywords : VENOUS; COMPRESSION; ARTERIAL; Skin; BLOOD FLOW; OCCLUSION; Lasers; Doppler; varicose; VARICOSE VEINS; VEINS; STOCKINGS; CHRONIC; Venous Insufficiency; NASP; BANDAGES; edema - physiopathology; LEG; thrombosis - physiopathology; varicose veins - physiopathology; ADULT; AGED; Aged,80 and over; Arteries; edema - therapy; HUMAN; hypertension - complications; hypertension - physiopathology; lasers - diagnostic use; leg - blood supply; MIDDLE AGE; Plethysmography; regional blood flow - physiology; skin - blood supply; thrombosis - therapy; varicose veins - therapy; venous insufficiency - physiopathology; venous insufficiency - therapy; in; blood; Elastic Stockings; is; an Notes : Arterial inflow in mL/minute and perimalleolar skin blood flow were measured with venous occlusion air-plethysmography and laser- Doppler flowmetry in 20 normal limbs, 40 limbs with uncomplicated primary varicose veins, 32 limbs with primary varicose veins and skin changes, and 36 limbs with deep venous disease. Limbs with complicated varicose veins (skin changes) and deep venous disease showed a marked increase (2 to 4 times) in both arterial inflow and skin blood flow when compared with the normal controls and uncomplicated varicose veins. The measurements were repeated 30 minutes after the application of graduated elastic stockings. There was a 16% reduction in the mean arterial inflow (P less than .01) and a 45% decrease in skin blood flow (P less than .01). The results indicate that in limbs with chronic venous insufficiency and skin changes there is an increased blood flow which is mainly in the skin. This is irrespective of whether the venous problem is in the superficial or deep venous system. Elastic compression tends to reduce the hyperemia towards the normal range. Ref ID : CIANCI1993 203. Cianci, J. Deep venous thrombosis [letter]. Orthop.Nurs. 12:6, 1993. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; sdi-11/93 Ref ID : CILLIERS1986 204. Cilliers, P.H. Arterial embolism and fibrinolysis. A case report. S.Afr.Med.J. 69:447-450, 1986. Keywords : ARTERIAL; EMBOLISM; FIBRINOLYSIS; CASE REPORT; ACEP-93; ACEP93 Ref ID : CLARKE1960 205. Clarke, R.L., Orandi, A., and Cliffton, E.E. Induction of fibrinolysis by venous obstruction. Angiology 11:367-370, 1960. Keywords : FIBRINOLYSIS; THROMBOSIS; SCLEROTHERAPY; TOURNIQUET; VENOUS; VENOUS OBSTRUCTION Ref ID : CLARKEPEARSON1984 206. Clarke-Pearson, D.L., Synan, I.S., Colemen, R.E., Hinshaw, W., and Creasman, W.T. The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients. Am.J.Obstet.Gynecol. 148:1051-1054, 1984. Keywords : NATURAL HISTORY; POSTOPERATIVE; VENOUS; PROSPECTIVE; THROMBOEMBOLI; in; PROSPECTIVE STUDIES Ref ID : CLAYTON1976 207. Clayton, J.K., Anderson, J.A., and McNicol, G.P. Preoperative prediction of postoperative deep vein thrombosis. Brit.Med.J. 2:910-912, 1976. Keywords : POSTOPERATIVE; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; NASP Ref ID : CLYNE1985 208. Clyne, C.A., Ramsden, W.H., Chant, A.D., and Webster, J.H. Oxygen tension on the skin of the gaiter area of limbs with venous disease. Brit.J.Surg. 72:644-647, 1985. Keywords : OXYGEN; Skin; VENOUS; ULCERATION; VARICOSE VEINS; VEINS; Ulcer; AGE; Venous Insufficiency; EXERCISE; NASP; ACUTE DISEASE; ADULT; AGED; Exertion; HUMAN; MIDDLE AGE; Posture; THROMBOPHLEBITIS; Varicose Ulcer; Vascular Diseases; Medline File; ab; varicose; an; standards; in; diffusion Notes : AB - We examined the levels of oxygen on the skin of the gaiter areas of limbs with venous disease using a Roche Transcutaneous pO2 Monitor to determine whether hypoxia contributes to the skin changes and ulceration associated with severe venous disease. We studied patients with superficial varicose veins and no skin changes (Group 1: n = 25), patients with skin changes and healed ulcers (Group 2: n = 15), and an age matched normal control group (controls: n = 25). TcpO2 measurements were taken 5 cm above the medial malleolus with the limb both horizontal and vertical using a Roche Transcutaneous pO2 Monitor. A standard heel- raising test using a Medisonics Photoplethysmograph indicated the degree of venous insufficiency present. Results show that Group 1 patients and controls have similar skin oxygen levels (Group 1: TcpO2 66.48 + 14.12 mmHg; controls: TcpO2 61.60 +/- 11.02 mmHg) whereas those with skin changes and ulceration have significantly lower oxygen levels (Group 2: TcpO2 46.57 +/- 9.70 mmHg, t = 4.29, P less than 0.001). Group 2 patients did not show a significant rise in TcpO2 levels in the standing position whereas Group 1 patients and controls did (t = 2.6, P less than 0.02). PPG post-exercise recovery times confirmed differences between the three groups. These findings show that significant skin hypoxia occurs on the gaiter area of limbs with severe venous disease and support the concept of an oxygen diffusion block UI - 85281173. Ref ID : COCKETT1970 209. Cockett, F.B. The post-phlebitic syndrome. Proc.R.Soc.Med. 63:131- 132, 1970. Keywords : POST-PHLEBITIC; POST PHLEBITIC SYNDROME; Syndrome; NASP; ADULT; HUMAN; Iliac Vein; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : AB - [No Abstract Available] UI - 70166063. Ref ID : COGO1993 210. Cogo, A., Lensing, A.W., Prandoni, P., and Hirsh, J. Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound. Arch.Intern.Med. 153(24):2777-2780, 1993. Keywords : THROMBOSIS; vein; diagnostics; COMPRESSION; ULTRASOUND; DIAGNOSIS; VENOUS; Popliteal Vein; PROSPECTIVE; THROMBI; Safety; LONG TERM; FOLLOWUP; Venogram; VENOUS THROMBOSIS; Methods; CONTRAST; CALF VEIN THROMBOSIS; DURATION; DEEP VEIN THROMBOSIS; PREVALENCE; VEINS; CALF; Femoral Vein; Iliac Vein; 951217; in; is; confidence intervals; analysis of variance; HUMAN; PHLEBOGRAPHY; Pressure; THROMBOPHLEBITIS; ra; us; Ultrasonography; mt; Medline File; Italy Notes : BACKGROUND: Two different diagnostic strategies are used to perform compression (real-time) ultrasound for the diagnosis of clinically suspected deep-vein thrombosis. One is to examine the entire proximal venous system from common femoral to distal popliteal vein; the other is a limited examination of only the common femoral and the entire popliteal vein. The latter strategy, which is less time-consuming and requires less expensive equipment, is based on a strong impression from prospective studies using limited compression ultrasound that proximal vein thrombi always involve the common femoral or popliteal vein. This impression, which is supported by the demonstrated safety at long-term follow-up of not treating patients whose limited compression ultrasound is normal at presentation and then repeated within the next week, has not been tested in a formal study. Therefore, we reviewed a large series of venograms performed in consecutive patients with clinically suspected venous thrombosis to determine the distribution of venous thrombosis in symptomatic patients. METHODS: Venograms were performed using 150 mL of radiographic contrast material. Before the study, a panel of experts agreed on the standardized criteria for the assessment of venograms. Venograms were adjudicated blindly for the presence of deep vein thrombosis and to determine the distribution of proximal vein thrombosis and isolated calf-vein thrombosis, the size of proximal thrombi, and whether they were occlusive or nonocclusive. Subsequently, the duration of symptoms was related to the venographic findings. RESULTS: Five hundred sixty-two venograms from consecutive patients with a first episode of clinically suspected deep vein thrombosis were adjudicated. Of these, 20 (3.6%) were inadequate for interpretation. In the remaining 542, venous thrombosis was demonstrated in 189 instances (prevalence, 35%; 95% confidence interval, 31% to 39%) and were located in the proximal veins in 166 (88%; 95% confidence interval, 82% to 92%) venograms. Isolated calf-vein thrombosis was present in the remaining 23 (12%; 95% confidence interval, 8% to 18%) venograms. Proximal with concurrent calf thrombosis was detected in 164 (99%) of the 166 patients. Proximal thrombi involved only the popliteal vein in 16 (10%); the popliteal and superficial femoral veins in 70 (42%); and the popliteal, superficial, and common femoral vein in eight (5%); whereas thrombi involving the entire proximal deep venous system were detected in 58 (35%) venograms. Isolated thrombosis of the superficial femoral, common femoral, and iliac vein was not observed. Proximal venous thrombi were occlusive in 146 (88%) patients. No relation between the duration of symptoms and the extent or the occlusiveness of venous thrombi could be demonstrated. CONCLUSIONS: Most symptomatic patients have extensive occlusive proximal vein thrombosis at the time of presentation. Thrombi isolated to the superficial femoral or iliac vein were not observed in this large sample of consecutive patients. Our data support the use of the relatively simple, inexpensive, and rapid compression ultrasound method that limits the examination of the proximal veins to the common femoral and popliteal veins. Ref ID : COHEN1986 211. Cohen, L.H., Kaplan, M., and Bernhard, V.M. Intraoperative streptokinase. An adjunct to mechanical thrombectomy in the management of acute ischemia. Arch.Surg. 121:708-715, 1986. Keywords : STREPTOKINASE; MANAGEMENT; ACEP93; Intraoperative; an; THROMBECTOMY; in; Ischemia Ref ID : COLANTONIO1990 212. Colantonio, D., Ventura, T., Casale, F., Leocata, P., Coletti, G., and Pasqualetti, P. [Morphological and clinical aspects of isolated right ventricular myocardial infarction]. Medicina.(Firenze). 10:163- 165, 1990. Keywords : 951202; in; an; AUTOPSY; MYOCARDIAL INFARCTION; infarction; HISTOLOGICAL; CHRONIC; PULMONARY HYPERTENSION; Hypertension; MASSIVE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; COR PULMONALE; coronary artery; Arteries; is; DIAGNOSIS; standards; AGED; Aged,80 and over; COMPARATIVE STUDY; ELECTROCARDIOGRAPHY; English Abstract; FEMALE; heart ventricle; HUMAN; MALE; MIDDLE AGE; di; et; PA; myocardium; PULMONARY EMBOLISM; co; Medline File Notes : In an autopsy study of 2569 subjects, during the period 1971- 1988, 289 cases of myocardial infarction were found. On the basis of morphological and histological data 8 (2.8%) of such cases were diagnosed as isolated right ventricular myocardial infarction. Clinical data relating to these 8 cases were also considered. The right ventricular myocardial infarction may be secondary to acute or chronic pulmonary hypertension, in the setting of massive pulmonary thromboembolism or cor pulmonale, especially in the presence of right ventricular hypertrophy and with normal or stenotic coronary arteries. Isolated right ventricular myocardial infarction is clinically underestimated due to the great difficult to make a correct diagnosis in life. The low accuracy of the standard electrocardiographic records does not allow to pose a diagnosis of isolated right ventricular myocardial infarction Dipartimento di Medicina Interna Universita dell'Aquila. Ref ID : COLERIDGESMITH1990 213. Coleridge-Smith, P.D., Hasty, J.H., and Scurr, J.H. Venous stasis and vein lumen changes during surgery [see comments]. Brit.J.Surg. 77:1055-1059, 1990. Keywords : PHLEBITIS; VENOUS; STASIS; vein; SURGERY; ADULT; AGED; Anesthesia,General; HUMAN; intraoperative period; LEG; blood supply; MIDDLE AGE; Postoperative Complications; ETIOLOGY; Sodium Chloride; PHARMACOLOGY; Support,Non-U.S.Gov't; surgery,operative; THROMBOPHLEBITIS; Ultrasonography; vasodilation; drug effects; physiology; VEINS; anatomy & histology; physiopathology; POSTOPERATIVE; DEEP VEIN THROMBOSIS; THROMBOSIS; THROMBOEMBOLISM; RESOLUTION; ULTRASOUND; SURGICAL; ANAESTHESIA; Dilatation; Intraoperative; in; an; is Notes : The mechanisms underlying the development of postoperative deep vein thrombosis remain to be fully elucidated. Previous studies have suggested that peroperative venous distension may be a factor associated with venous thromboembolism. In this study we have obtained high resolution ultrasound images of gastrocnemius and posterior tibial veins in 62 patients undergoing a range of general surgical procedures. From these we determined the changes in vein diameter occurring during the operative procedures, in response to induction of anaesthesia, and after completion of surgery. Veins showed no evidence of dilatation in response to the induction of anaesthesia, but by the end of the operative procedure showed distension of 22-28 per cent. Distension was most prominent in the gastrocnemius veins, and lesser distension was observed in the posterior tibial veins. In a series of patients who received an infusion of 1 litre of saline in addition to basal requirements, distension was 57 per cent compared with 22 per cent in the corresponding control group. Intraoperative venous distension is associated with factors that lead to deep vein thrombosis and may be involved in the mechanisms which result in the commencement of deep vein thrombosis. Ref ID : COLERIDGESMITH1991 214. Coleridge Smith, P.D., Hasty, J.H., and Scurr, J.H. Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf. Brit.J.Surg. 78:724-726, 1991. Keywords : PHLEBITIS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; COMPRESSION; STOCKINGS; VEINS; CALF; abdomen; SURGERY; Adolescence; ADULT; AGED; BANDAGES; FEMALE; HUMAN; intraoperative period; LEG; blood supply; MALE; MIDDLE AGE; neck; Postoperative Complications; prevention & control; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; vasodilation; graduated compression stockings; VENOUS; SURGICAL; TREATMENT; ULTRASOUND; in Notes : The mechanisms by which graduated compression stockings prevent deep vein thrombosis are not completely understood. Recent work has suggested that venous distension plays a role in initiating the process. Our previous work has shown that the deep veins of the lower limb distend in patients undergoing surgical procedures. We have investigated 40 patients receiving surgical treatment on the abdomen or neck. A medial gastrocnemius vein was studied using ultrasound imaging during the operations. In half the patients a graduated compression anti- embolism stocking was applied to the limb under study at the start of the operation, immediately after initial measurements of vein diameter. The median vein diameter in both groups was the same at the start of the operative procedures (control, 2.6 mm, interquartile range 2.1-3.3 mm; stocking, 2.6 mm, interquartile range 2.1-3.7 mm). After application of a stocking the median diameter in this group fell to 1.6 mm (interquartile range 1.3-2.8 mm) and then decreased slightly at the end of the operation. In the control group the vein diameter increased to 2.9 mm (interquartile range 2.3-4.0 mm) during the operative procedure. Ref ID : COLLER1987 215. Coller, B.S., Owen, J., Jesty, J., Horowitz, D., Reitman, M.J., and Spear, J. Deficiency of plasma protein S, protein C, or antithrombin III and arterial thrombosis. Arteriosclerosis 7:456-462, 1987. Keywords : PROTEIN C; ANTITHROMBIN III; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; PROTEIN S Ref ID : COLLINS1988 216. Collins, R., Scrimgeour, A., Yusuf, S., and Peto, R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N.Engl.J.Med. 318:1162-1173, 1988. Keywords : FATAL; PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SUBCUTANEOUS; HEPARIN; PROSPECTIVE; CLINICAL TRIAL; PROPHYLAXIS; SURGICAL; INCIDENCE; DEEP VEIN THROMBOSIS; VEINS; SURGERY; INJURY; META ANALYSIS; in; CLINICAL TRIALS; an; vein; Orthopedic; injuries Notes : A 1988 meta-analysis of all prospective clinical trials comparing prophylactic subcutaneous heparin to no prophylaxis for surgical procedures revealed an unexpectedly high incidence of thrombosis and embolism in those patients who did not receive prophylaxis. The incidence of deep vein thrombosis in the group without prophylaxis ranged from a high of 48 percent following orthopedic surgery for traumatic injuries to a low of 12 percent following elective general surgery. Ref ID : COLLINS1992 217. Collins, R., Sleight, P., and Maggioni, A.P. The risk of stroke after thrombolytic therapy [letter; comment]. N.Engl.J.Med. 327(21):1531-1532, 1992. Keywords : 96-suzy-001; RISK; STROKE; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; AGED; ALTEPLASE; adverse effects; body mass index; Cerebrovascular Disorders; chemically induced; COMPARATIVE STUDY; HUMAN; STREPTOKINASE Ref ID : COME1987 218. Come, P., Kim, D., Come, P.C., Parker, J.A., Goldhaber, S.Z., Braunwald, E., and Markis, J.E. Early reversal of right ventricular dysfunction in patients with acute pulmonary embolism after treatment with intravenous tissue plasminogen activator. J.Am.Coll.Cardiol. 10(5):971-978, 1987. Keywords : EARLY; EMBOLISM; TREATMENT; INTRAVENOUS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PULMONARY EMBOLISM; RIGHT VENTRICULAR DYSFUNCTION; TPA; 951216; in; abnormalities; heart; THROMBOLYSIS; Doppler; rt-PA; Segmental; PULMONARY HYPERTENSION; Hypertension; LYSIS; blood; BLOOD FLOW; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PERFUSION; LUNG; SCANNING; PULMONARY ARTERY; ARTERY; Pressure; Movement; LYTIC; THERAPY; GRADIENT; Pulmonary emboli; EMBOLI; ACUTE DISEASE; ADULT; AGED; ALTEPLASE; ad; tu; Echocardiography; FEMALE; heart hypertrophy; dt; HEMODYNAMICS; HUMAN; Infusions,Intravenous; MALE; MIDDLE AGE; PROSPECTIVE STUDIES; Pulmonary Circulation; co; pp; ra; TIME FACTORS; Medline File; Cardiology; Hospitals; boston Notes : To assess abnormalities of right heart function and their reversal with thrombolysis in pulmonary embolism, serial imaging and Doppler echocardiographic studies were performed before and after a 6 hour intravenous infusion of 80 to 90 mg of recombinant tissue-type plasminogen activator (rt-PA) in seven patients with segmental or lobar acute pulmonary embolism. None of the five men and two women had known prior pulmonary hypertension. Substantial clot lysis and improvement in pulmonary blood flow, as determined by serial pulmonary angiography and perfusion lung scanning, were achieved in all. Coincident with clot lysis, pulmonary artery systolic pressure decreased (from 42 +/- 11 to 26 +/- 7 mm Hg, p less than 0.005), right ventricular diameter decreased (from 3.9 +/- 1.0 to 2.0 +/- 0.5 cm, p less than 0.005) and left ventricular diameter increased (from 3.7 +/- 0.9 to 4.4 +/- 0.6 cm, p less than 0.01). Right ventricular wall movement, initially mildly, moderately or severely hypokinetic in one, two and four patients, respectively, normalized in five and improved to mild hypokinesia in two. Tricuspid regurgitation was present before lytic therapy in six patients. In five, flow velocity in the tricuspid regurgitant jets indicated a peak systolic right ventricular minus right atrial pressure gradient of 25 to 52 mm Hg. Tricuspid regurgitation was detected early after lytic therapy in only two patients. Systolic septal flattening was noted before but not after lysis. These findings confirm that pulmonary emboli may result in appreciable right ventricular dysfunction and dilation, resultant tricuspid regurgitation, abnormal septal position and decreased left ventricular size.(ABSTRACT TRUNCATED AT 250 WORDS) Cardiology Division Beth Israel Hospital Boston Massachusetts 02215. Ref ID : COME1992 219. Come, P.C. Echocardiographic evaluation of pulmonary embolism and its response to therapeutic interventions. Chest 101:151S-162S, 1992. Keywords : PULMONARY EMBOLISM; EMBOLISM; Doppler; Echocardiography; ARTERIAL; Pressure; THROMBOEMBOLI; PULMONARY ARTERY; ARTERY; Hypertension; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; HEPARIN; sdi- 11/93; heart; in; is; pathology; abnormalities Notes : Imaging and Doppler echocardiography permits assessment of right ventricular size and systolic function and of pulmonary arterial pressures, and it may facilitate detection of thromboemboli within the heart or pulmonary artery. In patients with acute pulmonary embolism of sufficient severity to appreciably increase right ventricular afterload, the right ventricle becomes dilated and hypokinetic. Tricuspid regurgitation is generally apparent, but in the absence of preexisting pulmonary arterial or left heart pathology, the regurgitant flow velocity suggests only mild to mild-moderate elevation of pulmonary arterial systolic pressure. The absence of a greater degree of pulmonary hypertension reflects the inability of the previously normal, nonhypertrophied right ventricle to generate a mean pulmonary arterial pressure in excess of about 40 mm Hg. The echocardiographic abnormalities resolve during recovery from pulmonary embolism. Currently being investigated is the question of whether right heart abnormalities resolve more rapidly with thrombolytic therapy than with heparin therapy alone. Ref ID : COMEROTA1989 220. Comerota, A.J., White, J.V., and Grosh, J.D. Intraoperative intra- arterial thrombolytic therapy for salvage of limbs in patients with distal arterial thrombosis. Surg.Gynecol.Obstet. 169:283-289, 1989. Keywords : INTRAARTERIAL; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ARTERIAL; THROMBOSIS; ACEP93; Intraoperative; in; ARTERIAL THROMBOSIS Ref ID : COMEROTA1992 221. Comerota, A.J. Deep vein thrombosis: to treat or not to treat using lytic therapy. In: Latest concepts and management of acute venous thromboembolic disease, edited by Comerota, A.J.Coronado:Abbott Pharmaceuticals, 1992,p. 8-15. Keywords : DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; THERAPY; REVIEW; THROMBOLYTIC; MANAGEMENT; VENOUS; THROMBOEMBOLIC; vein; LYTIC; in; THROMBOLYTIC THERAPY Notes : A review of the evidence in favor of thrombolytic therapy for acute deep vein thrombosis. Ref ID : COMEROTA1992A 222. Comerota, A.J., Katz, M.L., and White, J.V. Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail? Am.J.Surg. 164:265-268, 1992. Keywords : PROPHYLAXIS; Pneumatic; COMPRESSION; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; in; an; intensive care; intensive care units; Nursing Notes : External pneumatic compression devices are incorrectly applied in 22 percent of patients in an intensive care unit and in 52 percent of patients in a routine nursing unit. Ref ID : COMEROTA1993 223. Comerota, A.J., Katz, M.L., and Hashemi, H.A. Venous duplex imaging for the diagnosis of acute deep venous thrombosis. Haemostasis. 23 Suppl 1:61-71, 1993. Keywords : VENOUS; Duplex; DIAGNOSIS; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; DVT; HEMODYNAMICS; ASYMPTOMATIC; CALF; vein; THROMBI; NONINVASIVE; TECHNIQUES; PHLEBOGRAPHY; SENSITIVITY; REVIEW; CALF VEIN THROMBOSIS; diagnostics; SCREENING; Doppler; sdi-11/93; Color- flow; Meta-Review; is; in; an; color Notes : Acute deep venous thrombosis (DVT) continues to be a common clinical problem requiring objective evaluation. Hemodynamic testing for acute DVT has been popular, but is inadequate for evaluating asymptomatic patients and symptomatic patients with isolated calf vein thrombi. Venous duplex imaging (VDI) has rapidly gained in popularity, and is generally accepted to be the noninvasive technique of choice for the evaluation of patients with acute DVT. Twenty-five reports evaluate gray-scale venous duplex imaging versus ascending phlebography in 2,781 symptomatic patients. The sensitivity for proximal DVT and calf DVT is 96 and 80%, respectively. Seven reports review the use of VDI for surveillance in 857 asymptomatic patients, with an overall sensitivity of 76% for proximal DVT and of 11% for isolated calf vein thrombosis. The results of color-flow duplex appear to be somewhat better; however, the numbers are considerably smaller. The results for identification of calf vein thrombosis in asymptomatic surveillance patients continue to be poor. VDI appears to be the best noninvasive diagnostic test for acute DVT, and may challenge ascending phlebography as the best diagnostic test for proximal DVT in symptomatic patients, although it will miss 20% of isolated calf DVT. VDI appears to be the best noninvasive screening technique for high-risk asymptomatic patients under surveillance; however, additional correlative studies with ascending phlebography are required. The addition of color Doppler images appears to have improved results, although these higher sensitivities may be the consequence of improved experience as much as the addition of color to the image. Ref ID : COMEROTA1993A 224. Comerota, A.J. and Aldridge, S.C. Thrombolytic therapy for deep venous thrombosis: a clinical review. Can.J Surg. 36:359-364, 1993. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; REVIEW; ANTICOAGULATION; TREATMENT; DVT; THROMBUS; INCIDENCE; POST-THROMBOTIC; Syndrome; ANTICOAGULANT; HEPARIN; LYSIS; LYTIC; LONG TERM; FOLLOWUP; RANDOMIZED; VENOUS FUNCTION; THROMBOLYSIS; CATHETER; TECHNIQUES; Important article; sdi-11/93; is; in; an Notes : Although anticoagulation is the treatment most commonly chosen for patients suffering from deep venous thrombosis (DVT), thrombolytic therapy offers the promise of dissolving the thrombus within the deep venous system, restoring patency and preserving valve function. If this is achieved, the incidence and severity of post-thrombotic syndrome can be reduced. Data from 13 studies comparing anticoagulant therapy with thrombolytic therapy for DVT in 591 patients have shown that, among those treated with heparin, 4% had significant or complete lysis, 14% had partial lysis and 82% failed to improve or worsened. Of those receiving lytic therapy, 45% had significant or complete lysis, 18% had partial lysis and 37% failed to improve or worsened. Long-term follow-up of randomized patients has shown that those with successful lysis had a lower incidence of post-thrombotic syndrome and improved long-term venous function. The failure rate of systemic lytic therapy among patients suffering iliofemoral venous thrombosis is high; therefore, catheter-directed thrombolysis has been adopted with increasing success. Thrombolytic therapy, delivered systemically using catheter-directed techniques, should be considered as an important alternative in the treatment of patients with DVT. Ref ID : COMEROTA1995 225. Comerota, A.J. Thrombolytic Therapy for Peripheral Vascular Disease, Philadelphia:J.B. Lippincott, 1995. Keywords : 96-suzy-002; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; Peripheral Vascular Diseases; Vascular Diseases Notes : 01-03-96. Ref ID : COMP1984 226. Comp, P.C., Nixon, R.R., Cooper, M.R., and Esmon, C.T. Familial protein S deficiency is associated with recurrent thrombosis. J.Clin.Invest. 74:2082-2088, 1984. Keywords : FAMILIAL; PROTEIN S; THROMBOSIS; CONGENITAL; is Ref ID : COMP1986 227. Comp, P.C. Hereditary disorders predisposing to thrombosis. Prog.Hemost.Thromb. 8:71-102, 1986. Keywords : THROMBOSIS; HEMOSTASIS; PROTEIN C; ANTITHROMBIN III; PROTEIN S; ANTICOAGULANT; HEREDITARY Ref ID : CONNOLLY1991 228. Connolly, S.J., Laupacis, A., Gent, M., Roberts, R.S., Cairns, J.A., and Joyner, C. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J.Am.Coll.Cardiol. 18:349-355, 1991. Keywords : ANTICOAGULATION; WARFARIN; THROMBOEMBOLISM; RISK; HEMORRHAGE; EARLY; PLACEBOS; MEDICATIONS; FATAL; BLEEDING; OUTCOME; STROKE; EMBOLISM; DURATION; Atrial fibrillation; RANDOMIZED; in; International normalized ratio; analysis Notes : The Canadian Atrial Fibrillation Anticoagulation Study was a randomized double-blind placebo-controlled trial to assess the potential of warfarin to reduce systemic thromboembolism and its inherent risk of hemorrhage. As a result of the publication of two other "positive studies of similar design and objective, this study was stopped early before completion of its planned recruitment of 630 patients. There were 187 patients randomized to warfarin and 191 to placebo. Permanent discontinuation of study medication occurred in 26% of warfarin-treated and 23% of placebo-treated patients. The target range of the international normalized ratio was 2 to 3. For the warfarin-treated patients, the international normalized ratio was in the target range 43.7% of the study days, above it 16.6% of the study days and below it 39.6% of the study days. Fatal or major bleeding occurred at annual rates of 2.5% in warfarin-treated and 0.5% in placebo-treated patients. Minor bleeding occurred in 16% of patients receiving warfarin and 9% receiving placebo. The primary outcome event cluster was nonlacunar stroke, noncentral nervous systemic embolism and fatal or intracranial hemorrhage. Events were included in the primary analysis of efficacy if they occurred within 28 days of permanent discontinuation of the study medication. The annual rates of the primary outcome event cluster were 3.5% in warfarin-treated and 5.2% in placebo-treated patients, with a relative risk reduction of 37% (95% confidence limits, -63.5%, 75.5%, p = 0.17).(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : CONNOR1961 229. Connor, W.E. and Poole, J.C.F. The effect of fatty acids on the formation of thrombi. Q.J.Exp.Physiol. 46:1, 1961. Keywords : FATTY ACIDS; THROMBI; NASP Ref ID : CONNOR1963 230. Connor, W.E., Hoak, J.G., and Warner, E.A. Massive thrombosis produced by fatty acid infusion. J.Clin.Invest. 42:860, 1963. Keywords : MASSIVE; THROMBOSIS; FATTY ACIDS; NASP Ref ID : CONNORS1985 231. Connors, A.F.,Jr., Castele, R.J., Farhat, N.Z., and Tomashefski, J.F.,Jr. Complications of right heart catheterization. A prospective autopsy study. Chest 88:567-572, 1985. Keywords : 951202; COMPLICATIONS; heart; Heart Catheterization; Catheterization; PROSPECTIVE; AUTOPSY; PREVALENCE; abnormalities; POSTMORTEM; CATHETER; in; PULMONARY ARTERY; ARTERY; THROMBOSIS; HEMORRHAGIC; FIBRIN; HEMORRHAGE; VENA CAVA; INCIDENCE; THROMBOEMBOLI; Arteries; is; Catheters; RISK; DURATION; ADULT; AGED; FEMALE; ae; heart diseases; et; PA; HUMAN; MALE; MIDDLE AGE; PROSPECTIVE STUDIES; PULMONARY EMBOLISM; TIME FACTORS; vena cava,superior; Medline File Notes : The purpose of this study was to characterize the type and prevalence of abnormalities associated with right heart catheterization. We performed detailed post-mortem examinations of 32 consecutive patients brought to autopsy with a right heart catheter in the pulmonary artery. Thrombosis (17 patients, 53 percent), hemorrhagic lesions (25 patients, 78 percent), and intimal fibrin deposition (21 patients, 66 percent) were found at sites along the entire path of the catheter. Twenty-nine patients (91 percent) had either thrombosis, hemorrhage or both. While the superior vena cava was the most common site for all lesions, seven patients had thrombosis involving the chambers and valves of the heart and four had thrombosis involving the pulmonary artery. The incidence of thrombosis was significantly higher after 36 hours of catheterization (p less than 0.05). All five patients with thromboemboli in the more proximal pulmonary arteries had catheter-related thrombosis. We conclude that there is a high prevalence of thrombotic and hemorrhagic lesions in patients dying with pulmonary catheters in place; that the risk of thrombotic complications increases with duration of catheterization; and that patients with catheter-related thrombosis are at increased risk of thromboemboli to the proximal pulmonary arteries. Ref ID : CONSENSUSSTATEM1986 232. Consensus Statement National Institutes of Health consensus development conference statement: Prevention of venous thrombosis and pulmonary embolism. JAMA 256:744-749, 1986. Keywords : PREVENTION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; RECOMMENDATIONS; PROPHYLAXIS; CONSENSUS; NIH Notes : Recommendations for prophylaxis of venous thrmboembolic disease. Ref ID : CONSTANTINIDES1961 233. Constantinides, P. and Chakravarti, R.N. Rabbit arterial thrombosis production by systemic procedures. Arch.Path. 72:197, 1961. Keywords : RABBITS; ARTERIAL; THROMBOSIS; SCLEROTHERAPY; ARTERIAL THROMBOSIS Ref ID : CONWAY1987 234. Conway, E.M., Bauer, K.A., Barzegar, S., and Rosenberg, R.D. Suppression of hemostatic system activation by oral anticoagulants in the blood of patients with thrombotic diatheses. J.Clin.Invest. 80:1535- 1544, 1987. Keywords : HEMOSTATIC; ANTICOAGULANTS; WARFARIN; PROTHROMBIN; PROTEIN C; THERAPY; PT; THROMBOEMBOLISM; ANTICOAGULATION; DURATION; in; blood; an; prothrombin time; is Notes : RIAs for hemostatic system activation were employed to study patients who were anticoagulated with warfarin. The mean prothrombin fragment F1 + 2 concentration in stably anticoagulated individuals without an inherited thrombotic diathesis (mean prothrombin time [PT] ratio [PT of patient/PT of normal plasma pool] = 1.74) was 0.231 nM as compared with a mean plasma F1 + 2 level of 1.68 nM for a nonanticoagulated control group (P less than 0.0001). The initiation of oral anticoagulants in two subjects who did not exhibit protein C deficiency led to a paradoxical increase in F1 + 2 levels during the first day of therapy. We have also shown that a relatively low intensity regimen of warfarin (PT ratio less than 1.2) may reduce elevated concentrations of F1 + 2 into the normal range in patients with a history of recurrent thromboembolism. The mean F1 + 2 level in antithrombin-deficient individuals on warfarin was significantly elevated (mean = 0.714 nM) as compared with that in anticoagulated subjects with protein C deficiency (mean = 0.205 nM) or in those without an inherited thrombotic disorder (P less than 0.01) at equivalent levels of intensity of oral anticoagulation. We therefore conclude that the effect of warfarin on hemostatic system activation is modulated by the endogenous heparan sulfate-antithrombin mechanism. Ref ID : COON1973 235. Coon, W.W., Willis, P.W., and Keller, J.B. Venous thromboembolism and other venous disease in the Tecumseh Community Health Study. Circulation 48:839-846, 1973. Keywords : VENOUS; THROMBOEMBOLISM; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; CLINICAL DIAGNOSIS; DIAGNOSIS; RISK; DVT; PE; EPIDEMIOLOGY; PREVALENCE; AGE; an; is; INCIDENCE; vein; THROMBOPHLEBITIS; us; varicose; STASIS; in; Skin; LEG; Varicose Ulcer; Ulcer; FREQUENCY Notes : A rough estimate of annual incidence of clinically recognized deep vein thrombosis is over 250,000 cases while that of superficial thrombophlebitis is over 123,000. An estimated 24 million US citizens have significant varicose veins while 6 to 7 million have stasis changes in the skin of the legs and 400,000 to 500,000 have or have had a varicose ulcer. Increasing age leads to an increased risk of DVT and PE, although it is not known whether this is entirely independent of associated factors such as other underlying illness and immobility. The frequency of recurrent DVT or PE is 15 to 30 times higher than the frequency of primary DVT or PE. Ref ID : COON1976 236. Coon, W.W. Spectrum of pulmonary embolism: Twenty years later. Arch.Surg. 111:398-402, 1976. Keywords : PULMONARY EMBOLISM; EMBOLISM Ref ID : COON1984 237. Coon, W.W. Venous thromboembolism -- Prevalence: Risk factors and prevention. Clin.Chest Med. 5:391, 1984. Keywords : VENOUS; THROMBOEMBOLISM; PREVALENCE; RISK; PREVENTION; PULMONARY EMBOLISM; RISK FACTORS Ref ID : CORSER1985 238. Corser, G., Masey, S., Jacob, G., Kernoff, P., and Browne, D. Ischaemia following selfadministered intra-arterial injection of methylphenidate and diamorphine. A case report of treatment with intra- arterial urokinase and review. Anaesthesia. 40:51-54, 1985. Keywords : INTRAARTERIAL; CASE REPORT; TREATMENT; UROKINASE; REVIEW; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; Sclerosing Solutions; THROMBOLYTIC; rt-PA; SCLEROTHERAPY; ACEP93; Injections; drugs; in Notes : Arterial thrombosis followed the accidental arterial injection of a recognized sclerosing solution (drugs of abuse). Intraarterial infusions of a thrombolytic agent allowed salvage of the limb. This suggests that intraarterial infusions of urokinase or rt-PA should be used in patients who have suffered inadvertent intraarterial injection during sclerotherapy. Ref ID : CORTELAZZO1995 239. Cortelazzo, S., Finazzi, G., Ruggeri, M., Vestri, O., Galli, M., Rodeghiero, F., and Barbui, T. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N.Engl.J.Med. 332(17):1132-1136, 1995. Keywords : 96-suzy-001; RISK; THROMBOSIS; abnormalities; in; PLATELETS; THROMBOEMBOLIC; COMPLICATIONS; PLATELET; Platelet Count; INCIDENCE; Methods; AGE; THERAPY; sex; PROPHYLAXIS; ASPIRIN; ticlopidine; FOLLOWUP; STROKE; MYOCARDIAL INFARCTION; infarction; ARTERIAL; OCCLUSION; DEEP VEIN THROMBOSIS; Superficial thrombophlebitis; THROMBOPHLEBITIS; confidence intervals; df; is; ADULT; AGED; Aged,80 and over; adverse effects; therapeutic use; FEMALE; Follow-Up Studies; HEMORRHAGE; chemically induced; HUMAN; hydroxyurea; MALE; MIDDLE AGE; multivariate analysis; PROSPECTIVE STUDIES; THROMBOCYTOSIS; drug therapy; THROMBOEMBOLISM; ETIOLOGY; prevention & control Notes : BACKGROUND. Abnormalities in the number and function of platelets may contribute to thromboembolic complications in patients with essential thrombocythemia. We assessed whether maintaining the platelet count below 600,000 per cubic millimeter with hydroxyurea reduces the incidence of thrombosis in patients with essential thrombocythemia and a high risk of thrombosis. METHODS. A total of 114 patients with essential thrombocythemia (77 women and 37 men; median age, 68 years; range, 40 to 85) and a median platelet count of 788,000 per cubic millimeter (range, 533,000 to 1,240,000 per cubic millimeter) were randomly assigned to receive hydroxyurea (56 patients) or no myelosuppressive therapy (58 patients). Ninety-seven (85 percent) were over 60 years old, and 52 (46 percent) had had thrombosis. The two groups were matched for age, sex, and platelet count at randomization. Antiplatelet prophylaxis with aspirin or ticlopidine was not stopped. Follow-up lasted a median of 27 months in both groups. RESULTS. Two patients (3.6 percent) treated with hydroxyurea had thrombotic episodes (one stroke and one myocardial infarction), whereas 14 patients (24 percent) in the control group had thrombotic episodes (one stroke, five transient ischemic attacks, five peripheral arterial occlusions, one deep-vein thrombosis, and two cases of superficial thrombophlebitis). The difference (20.4 percentage points; 95 percent confidence interval, 8.5 to 32 percent) was statistically significant (chi-square with Yates' correction, 8.3; 1 df; P = 0.003). CONCLUSIONS. Hydroxyurea is effective in preventing thrombosis in high-risk patients with essential thrombocythemia. Ref ID : CRAIG1966 240. Craig, O. and Snell, M. External iliac vein obstruction. Brit.J.Surg. 53:668-671, 1966. Keywords : Iliac Vein; vein; NASP; VEINS; AGED; Eczema; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBOGRAPHY; THROMBOEMBOLISM; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : AB - [No Abstract Available] UI - 67004679. Ref ID : CRANDON1980 241. Crandon, A.J., Peel, K.R., Anderson, J.A., Thompson, V., and McNicol, G.P. Postoperative deep vein thrombosis: Identifying high-risk patients. Brit.Med.J. 281:343-344, 1980. Keywords : POSTOPERATIVE; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; RISK; postoperative deep vein thrombosis; vein Ref ID : CRANLEY1972 242. Cranley, J.J., Krause, R.J., Strasser, E.S., and Hafner, C.D. Results of vena cava ligation. J.Cardiovasc.Surg.(Torino). 13:403-408, 1972. Keywords : VENA CAVA; Ligation; NASP; Affective Symptoms; Edema; HEPARIN; HUMAN; LEG; Pelvis; Postoperative Care; PULMONARY EMBOLISM; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vena Cava,Inferior; Medline File; ab Notes : AB - [No Abstract Available] UI - 73084006. Ref ID : CROCKETT1987 243. Crockett, F.B. Complications arterielles de la chirurgie et de la sclerose des varices. Phlebologie 40(1):107-110, 1987. Keywords : COMPLICATIONS; SCLEROSE; VARICES; VEINS; SURGICAL; ARTERIAL; INJURY; SCLEROTHERAPY; INTRAARTERIAL; SCLEROSANT; THROMBOSIS; LEGAL; PERFORATING VEINS; CALF; de; et; in; is; Femoral Vein; vein; Ligation; Injections; an Notes : There are on the average, 3 to 4 cases per year in the United Kingdom (UK) in which suit is brought against a surgeon because the common femoral vein has been obliterated in the course of a surgical saphenofemoral ligation. Arterial injury in the course of this surgical procedure is more catastrophic, but less common, with only 9 legal suits brought in the UK over a 10 year period from 1976 to 1986. Sclerotherapy, during the same period, resulted in 18 cases of legal action following inadvertent intraarterial injection of sclerosant. In each of these 18 cases the arterial injection occurred during an attempt to inject an apparent internal perforating vein along the medial calf approximately 10 centimeters above the medial malleolus. Ref ID : CRONAN1993 244. Cronan, J.J. Venous thromboembolic disease: the role of US. Radiology 186:619-630, 1993. Keywords : PHLEBITIS; VENOUS; THROMBOEMBOLIC; ARM; blood supply; HUMAN; LEG; POSTPHLEBITIC SYNDROME; Ultrasonography; PULMONARY EMBOLISM; ETIOLOGY; RISK FACTORS; THROMBOPHLEBITIS; EPIDEMIOLOGY; Methods; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; DVT; EMBOLISM; POSTPHLEBITIC; Syndrome; PAIN; ULCERATION; Mimic; NONINVASIVE; diagnostics; TECHNIQUES; COMPRESSION; ULTRASOUND; Extremities; Popliteal Vein; VEINS; CALF; CHRONIC; blood; UPPER EXTREMITY; VENOUS THROMBOSIS; Catheters; us; is; in; an Notes : Deep vein thrombosis (DVT) is a ubiquitous process that in the acute setting can lead to pulmonary embolism. Chronically, permanent changes that develop within the venous system following an episode of DVT can produce the postphlebitic syndrome, which is associated with pain, swelling, and ulceration. The postphlebitis syndrome can often mimic acute DVT or coexist with it. The clinical evaluation of DVT is ineffective and necessitates a reliable noninvasive diagnostic technique. Compression ultrasound (US) has proved to be the diagnostic method of choice for detection of extremity clot. Femoral and popliteal veins are routinely evaluated for acute clot, but uncertainty exists concerning the need to evaluate the calf veins similarly. US also can be used to diagnose chronic venous changes, which are indicated by the presence of incompetent valves and retrograde blood flow. Upper- extremity venous thrombosis, often induced by indwelling catheters, can also be diagnosed with US. Ref ID : CROWELL1960 245. Crowell, D.L. Effort thrombosis of the subclavian and axillary veins: Review of the literature and case report with two-year follow-up with venography. Ann.Intern.Med. 52:1337-1343, 1960. Keywords : THROMBOSIS; SUBCLAVIAN; VEINS; REVIEW; CASE REPORT; FOLLOWUP; VENOGRAPHY; Axillary Vein Ref ID : CRUICKSHANK1991 246. Cruickshank, M.K., Levine, M.N., Hirsh, J., Roberts, R., and Siguenza, M. A standard heparin nomogram for the management of heparin therapy [see comments]. Arch.Intern.Med. 151(2):333-337, 1991. Keywords : standards; HEPARIN; MANAGEMENT; THERAPY; DOSAGE; partial thromboplastin time; THROMBOPLASTIN; APTT; VENOUS; THROMBOEMBOLISM; INTRAVENOUS; CONTRAST; ANTICOAGULATION; 951217; in; AGED; Dose-Response Relationship,Drug; FEMALE; ad; HUMAN; Infusions,Intravenous; st; MALE; MIDDLE AGE; monitoring,physiologic; Support,Non-U.S.Gov't; dt; THROMBOLYTIC THERAPY; Medline File; ontario Notes : A nomogram for the adjustment of heparin dosage was developed to standardize heparin therapy and to reduce delays in achieving and maintaining a therapeutic activated partial thromboplastin time (APTT) result. Fifty consecutive patients with acute venous thromboembolism had their continuous intravenous heparin therapy adjusted according to this heparin nomogram. The effect of the nomogram on heparin therapy in these patients was compared with data from 53 historical control patients. The proportion of patients in the nomogram group who reached a therapeutic APTT at 24 hours after the start of heparin therapy was 66%, which increased to 81% at 48 hours. In contrast, 37% and 58% of the control patients reached a therapeutic APTT at 24 and 48 hours, respectively. The percentage of therapeutic APTT results of the total number of APTT determinations was greater in the nomogram patients than controls. The use of this heparin nomogram resulted in (1) achieving a therapeutic APTT at 24 and 48 hours in a large proportion of patients and (2) reduced periods of inadequate anticoagulation and overanticoagulation during heparin therapy. Ref ID : CULLEN1986 247. Cullen, D.J. and Nemeskal, A.R. The autopsy incidence of acute pulmonary embolism in critically ill surgical patients. Intensive.Care Med. 12:399-403, 1986. Keywords : 951202; AUTOPSY; INCIDENCE; PULMONARY EMBOLISM; EMBOLISM; in; SURGICAL; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; Hospitals; MASSIVE; CAUSE; cause of death; DEATH; an; MORBIDITY; MORTALITY; OBESITY; POLYCYTHEMIA; PLATELET; Platelet Count; PT; CATHETER; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; pulmonary vascular resistance; VASCULAR RESISTANCE; MANAGEMENT; HUMAN; Medical Records; ep; PA; recovery room; RISK; surgery,operative; Medline File; Health Planning & Administration File Notes : Critically ill patients should be susceptible to pulmonary thromboembolism (PTE). To determine the incidence of acute PTE in this patient population, we reviewed hospital charts and autopsy findings of all Class IV critically ill patients admitted to our hospital's Recovery Room-Acute Care Unit, between 1972 and 1982. Massive PTE either contributed to or was the sole cause of death in only two of the 152 patients studied (1.3%). Small single or scattered PTE were an incidental finding not contributing to morbidity or mortality in 13 patients. No gross evidence of PTE was found in the remaining 137 patients. There was no relationship between the occurrence of PTE and obesity, polycythemia, platelet count, PT or PTT, ventilatory support, level of PEEP, fluid balance, intravascular catheter days, pulmonary artery pressure, or pulmonary vascular resistance. Twelve patients did not have PTE at autopsy though it was seriously considered during ICU management. Unlike many other types of hospitalized patients, Class IV critically ill surgical patients are highly unlikely to suffer from PTE. When acute cardiorespiratory decompensation occurs, other more common causes should be given primary consideration. Ref ID : CUMMINGS1986 248. Cummings, J.M., Mason, T.J., Chomka, E.V., and Pouget, J.M. Fibrinolytic therapy of acute myocardial infarction in the heparin thrombosis syndrome. Am.Heart J. 112:407-409, 1986. Keywords : FIBRINOLYTIC; THERAPY; MYOCARDIAL INFARCTION; HEPARIN; THROMBOSIS; Syndrome; ACEP93; infarction; in Ref ID : CUNILLERA1991 249. Cunillera, R., Porcel, J.M., Ordi, J., and Vilardell, M. Bilateral pseudothrombophlebitis [letter]. Ann.Rheum.Dis. 50:67, 1991. Keywords : PHLEBITIS; CASE REPORT; HUMAN; LEG; pathology; magnetic resonance imaging; MALE; MIDDLE AGE; popliteal cyst; COMPLICATIONS; DIAGNOSIS; THROMBOPHLEBITIS; ETIOLOGY Ref ID : DADDATO1966 250. D'Addato, M. Gangrene of a limb with complete thrombosis of the venous system. J.Cardiovasc.Surg. 7(5):434-440, 1966. Keywords : THROMBOSIS; VENOUS; SCLEROSANT; VEINS; TREATMENT; SCLEROTHERAPY; DVT; GANGRENE; INTRAARTERIAL; ARTERIAL; LEG; Injections; SAPHENOUS VEIN; vein; Amputation; OCCLUSION Notes : The authors report a case of loss of a leg following injection of a sclerosant into the distal portion of the greater saphenous vein. Approximately 15 hours post treatment the patient's leg became painful, edematous, cold, cyanotic, and pulseless. Gangrene developed, and amputation was ultimately necessary. Pathological studies showed that this was not, as might have been supposed, the result of inadvertent intraarterial injection. The arterial system of the amputated limb was shown to be intact and patent throughout. Rather, this was a case of complete thrombotic occlusion of the entire deep and superficial venous systems of the leg. Ref ID : DAHL1993 251. Dahl, O.E., Pedersen, T., Kierulf, P., Westvik, A.B., Lund, P., Arnesen, H., Seljeflot, I., Abdelnoor, M., and Lyberg, T. Sequential intrapulmonary and systemic activation of coagulation and fibrinolysis during and after total hip replacement surgery. Thromb.Res. 70:451-458, 1993. Keywords : COAGULATION; FIBRINOLYSIS; HIP; HIP REPLACEMENT; SURGERY; Intraoperative; FREQUENCY; POSTOPERATIVE; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; DVT; PROTHROMBIN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; Antigens; t-PA; D-DIMER; ARTERIAL; VENOUS; FIBRINOLYTIC; LUNG; sdi- 11/93; joints; is; in; ab; blood; an Notes : Hip joint replacement surgery, using acrylic cement for prosthesis fixation, is associated with intraoperative cardiorespiratory dysfunction, and a high frequency of postoperative proximal deep vein thrombosis (DVT). Levels of prothrombin fragments 1+2 (F1+2), tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor 1 activity (PAI-1), D-dimer and interleukin 6 (IL-6) were measured in arterial (AB) and mixed venous blood (MVB) in five patients during and after total hip replacement operation with acrylic cement prosthesis fixation. Sequential peaks of F1+2, t-PA, PAI-1 and IL-6 appeared, starting with activation of coagulation during preparation of bone, closely followed by activation of fibrinolysis. Later, this was counteracted by an antifibrinolytic response and increase of IL-6. After a fibrinolytic shutdown on the third postoperative day as evidenced by a drop in t-PA and D-dimer concentrations, a second wave of coagulation was seen at the end of the first week. The present model, with frequent sampling of blood entering and leaving the lungs, confirms our earlier findings of the lung as a key organ in promoting coagulation following traumatic activation. Ref ID : DAILY1990 252. Daily, P.O., Dembitzsky, W.P., Iversen, S., Moser, K.M., and Auger, W. Current early results of pulmonary thromboendarterectomy for chronic pulmonary embolism [see comments]. Eur.J Cardiothorac.Surg. 4:117-21; discussion 122, 1990. Keywords : EARLY; CHRONIC; PULMONARY EMBOLISM; EMBOLISM; Hospitals; Hypertension; MORTALITY; MORBIDITY; CARDIOPULMONARY BYPASS; DEATH; CAUSE; HEMORRHAGE; PGM-8/94; ab; transplantation; an; hospital mortality; in Notes : CS- Sharp Memorial Hospital, San Diego, CA AB- Some patients with chronic pulmonary embolism causing severely symptomatic pulmonary hypertension have been managed by heart-lung transplantation with an associated hospital mortality of 24%. To allow comparison with pulmonary thromboendarterectomy (PTE), we have reviewed the hospital morbidity and mortality in 149 consecutive patients. From 1 October 1984 to 18 September 1989, these patients underwent PTE utilizing a standardized procedure consisting of median sternotomy, cardiopulmonary bypass, deep hypothermia and circulatory arrest for bilateral PTE in 91% (136/149) of the procedures with 7.4% (11/149) and 1.3% (2/149) undergoing right or left PTE, respectively. Ventilator dependency (greater than or equal to 5 days on respirator) occurred in 28.3% (41/146). Hospital mortality (death within 30 days or in hospital) was 11.4% (17/149). The most common causes of death were respiratory and multiorgan failure, 10 (59% of deaths) and acute pulmonary hemorrhage, 3 (17% of deaths). We conclude that PTE with an operative mortality of half that of heart-lung transplantation (11.4% vs. 24%) should be the procedure of choice for significantly symptomatic chronic pulmonary embolism. Furthermore, the hazards of immunosuppression and chronic graft rejection are avoided. Ref ID : DAILY1990A 253. Daily, P.O., Dembitsky, W.P., Iversen, S., Moser, K.M., and Auger, W. Risk factors for pulmonary thromboendarterectomy. J Thorac.Cardiovasc.Surg. 99:670-678, 1990. Keywords : RISK; RISK FACTORS; Hospitals; FREQUENCY; PULMONARY HYPERTENSION; Hypertension; CHRONIC; PULMONARY EMBOLISM; EMBOLISM; COMPLICATIONS; MORBIDITY; MORTALITY; MALE; AGE; PULMONARY ARTERY; Arteries; Methods; Edema; ASCITES; CARDIOPULMONARY BYPASS; VASCULAR RESISTANCE; DEATH; TRENDS; PGM-8/94; ab; is; in; respiratory insufficiency; hospital mortality; blood; pulmonary vascular resistance; transplantation Notes : CS- Sharp Memorial Hospital, San Diego, Calif AB- Pulmonary thromboendarterectomy is being performed with increasing frequency for incapacitating pulmonary hypertension caused by chronic large-vessel pulmonary embolism. However, patient-related risk factors and procedural complications associated with morbidity and mortality have not been fully defined. From Oct. 1, 1984, to April 10, 1989, we performed pulmonary thromboendarterectomy using deep hypothermia and circulatory arrest in 127 consecutive patients (62.2% male, mean age 50 +/-16 [standard deviation], range 20 to 82 years) in whom the exposure and dissection of the pulmonary arteries and methods for myocardial protection have been standardized. End points for univariate and multivariate analyses of risk factors were reperfusion pulmonary edema leading to respiratory insufficiency as defined by ventilator dependency (greater than or equal to 5 days) (31.5%, 39/124) and hospital mortality (12.6%, 16/127). Multivariate analyses showed that ascites and need for 4 units of blood or more predicted ventilator dependency (p less than 0.03). Increased cardiopulmonary bypass times predicted both end points (p less than 0.03 to less than 0.0001), and failure to achieve at least a 50% reduction in pulmonary vascular resistance strongly predicted hospital death (p less than 0.0001). However, other factors that exhibited trends for association with one of the end points may prove important with a larger sample size. A hospital mortality rate of 12.6% for pulmonary thromboendarterectomy is acceptable when compared with approximately 25% for heart-lung transplantation, which is the only therapeutic alternative. Increased ventilator dependency and hospital mortality can be anticipated with longer cardiopulmonary bypass times and inadequate reduction of pulmonary vascular resistance. Ref ID : DAILY1990B 254. Daily, P.O., Dembitsky, W.P., Iversen, S., Moser, K.M., and Auger, W. Risk factors for pulmonary thromboendarterectomy. J.Thorac.Cardiovasc.Surg. 99:670-678, 1990. Keywords : RISK; RISK FACTORS; FREQUENCY; PULMONARY HYPERTENSION; Hypertension; CHRONIC; PULMONARY EMBOLISM; EMBOLISM; COMPLICATIONS; MORBIDITY; MORTALITY; MALE; AGE; PULMONARY ARTERY; Arteries; Methods; Edema; Hospitals; ASCITES; CARDIOPULMONARY BYPASS; pulmonary vascular resistance; VASCULAR RESISTANCE; DEATH; TRENDS; is; in; respiratory insufficiency; hospital mortality; blood; transplantation Notes : Pulmonary thromboendarterectomy is being performed with increasing frequency for incapacitating pulmonary hypertension caused by chronic large-vessel pulmonary embolism. However, patient-related risk factors and procedural complications associated with morbidity and mortality have not been fully defined. From Oct. 1, 1984, to April 10, 1989, we performed pulmonary thromboendarterectomy using deep hypothermia and circulatory arrest in 127 consecutive patients (62.2% male, mean age 50 +/- 16 [standard deviation], range 20 to 82 years) in whom the exposure and dissection of the pulmonary arteries and methods for myocardial protection have been standardized. End points for univariate and multivariate analyses of risk factors were reperfusion pulmonary edema leading to respiratory insufficiency as defined by ventilator dependency (greater than or equal to 5 days) (31.5%, 39/124) and hospital mortality (12.6%, 16/127). Multivariate analyses showed that ascites and need for 4 units of blood or more predicted ventilator dependency (p less than 0.03). Increased cardiopulmonary bypass times predicted both end points (p less than 0.03 to less than 0.0001), and failure to achieve at least a 50% reduction in pulmonary vascular resistance strongly predicted hospital death (p less than 0.0001). However, other factors that exhibited trends for association with one of the end points may prove important with a larger sample size. A hospital mortality rate of 12.6% for pulmonary thromboendarterectomy is acceptable when compared with approximately 25% for heart-lung transplantation, which is the only therapeutic alternative. Increased ventilator dependency and hospital mortality can be anticipated with longer cardiopulmonary bypass times and inadequate reduction of pulmonary vascular resistance. Ref ID : DALEN1969 255. Dalen, J.E. and Dexter, L. Pulmonary embolism. JAMA 207:1505, 1969. Keywords : PULMONARY EMBOLISM; EMBOLISM Ref ID : DALEN1969A 256. Dalen, J.E., Alpert, J., and Paraskos, J. Resolution of acute pulmonary embolism in man. New.Engl.J.Med. 280:1194-1199, 1969. Keywords : RESOLUTION; PULMONARY EMBOLISM; EMBOLISM; in Ref ID : DALEN1971 257. Dalen, J.E. and Brooks, H.L. Pulmonary angiography in acute pulmonary embolism: Indications, techniques, and results in 367 patients. Am.Heart J. 81:175, 1971. Keywords : PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PULMONARY EMBOLISM; EMBOLISM; INDICATIONS; TECHNIQUES; in Ref ID : DALEN1975 258. Dalen, J.E. and Alpert, J.S. Natural history of pulmonary embolism. Prog.Cardiovasc.Dis. 17(4):257-270, 1975. Keywords : NATURAL HISTORY; PULMONARY EMBOLISM; EMBOLISM; 96-suzy-001; ACUTE DISEASE; ADULT; AGED; ANGIOGRAPHY; ANIMAL; Blood Pressure; DOGS; FIBRINOLYSIS; Follow-Up Studies; HEMODYNAMICS; HEPARIN; therapeutic use; HUMAN; Ligation; MIDDLE AGE; Pressure; PROGNOSIS; DIAGNOSIS; MORTALITY; THERAPY; PULMONARY HEART DISEASE; ETIOLOGY; radionuclide imaging; RECURRENCE; TIME FACTORS; WARFARIN Ref ID : DALEN1992 259. Dalen, J.E. and Hirsh, J. Antithrombotic therapy. Introduction. Chest 102(4 Suppl):303S-304S, 1992. Keywords : Antithrombotic; THERAPY; 951217; ASPIRIN; tu; Cerebrovascular Disorders; pc; HUMAN; MYOCARDIAL INFARCTION; THROMBOSIS; WARFARIN; Medline File Ref ID : DALONZO1983 260. D'Alonzo, G.E., Bower, J.S., DeHart, P., and Dantzker, D.R. The mechanisms of abnormal gas exchange in acute massive pulmonary embolism. Am. Rev. Respir. Dis. 128:170-172, 1983. Keywords : in; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; PE; aa; GRADIENT; V/Q Notes : The mechanisms of hypoxia investigated in two patients with acute PE and markedly increased A-a gradient. Multiple inert gas elimination was used to determine the distribution of V/Q ratios. Ref ID : DALONZO1984 261. D'Alonzo, G.E. and Dantzker, D.R. Gas exchange alterations following pulmonary embolism. Clin. Chest Med. 5(3):411-419, 1984. Keywords : EMBOLISM; in; PULMONARY EMBOLISM; V/Q; SHUNT Notes : Convincing discussion of the sources of abnormal gas exchange in pulmonary embolism, with reference to v/q mismatch and true shunt. Ref ID : DAMICO1992 262. D'Amico, A. Imaging for deep venous thrombosis. Emerg.Med.Clin.North Am. 10:121-132, 1992. Keywords : PHLEBITIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; algorithms; diagnostic imaging; Emergencies; HUMAN; LEG; blood supply; PHLEBOGRAPHY; Plethysmography; THROMBOPHLEBITIS; DIAGNOSIS; Ultrasonography; DVT; EMERGENCY; NONINVASIVE; ANTICOAGULANT; THERAPY; FOLLOWUP; EARLY; is; in; et Notes : The diagnosis of DVT is a perplexing clinical challenge for the emergency physician. The algorithm depicted in Figure 9 from Hobson et al represents a logical strategy for the application of noninvasive studies. Positive studies in the proper setting that are reliably interpreted can dictate anticoagulant therapy, but equivocal or uninterpretable tests must be followed by invasive testing to exclude clot. Negative tests require close follow-up and serial evaluation to detect potentially silent early clot formation. Ref ID : DANZA1991 263. Danza, R., Navarro, T., and Baldizan, J. Reconstructive surgery in chronic venous obstruction of the lower limbs. Journal of Cardiovascular Surgery 32:98-103, 1991. Keywords : SURGERY; CHRONIC; VENOUS; VENOUS OBSTRUCTION; CHRONIC VENOUS INSUFFICIENCY; Venous Insufficiency; Edema; walking; Doppler; ULTRASOUND; TECHNIQUES; DIAGNOSIS; PHLEBOGRAPHY; Iliac Vein; vein; Femoral Vein; Arteriovenous Fistula; Fistula; POSTOPERATIVE; FOLLOWUP; NASP; Blood Vessel Prosthesis; saphenous vein - transplantation; thrombosis - complications; venous insufficiency - surgery; Femoral Artery; HUMAN; Plethysmography; thrombosis - surgery; Ultrasonography; Vascular Patency; vascular surgery - methods; venous insufficiency - diagnosis; venous insufficiency - etiology; VEINS; in; an Notes : Forty-one patients with chronic venous insufficiency due to venous trunk obstruction of the lower limbs underwent 43 flow reconstruction procedures consisting of either free veno-venous bypass or venous transposition. The indicating symptoms for these procedures were (1) progressive chronic edema, (2) claudication while walking, or (3) trophic lesions. Doppler ultrasound and plethysmographic techniques were employed in the diagnosis while phlebography was considered the most useful and most essential technique. Iliac vein obstruction was the most common venous obstruction, followed by superficial femoral vein obstruction. Two patients were operated on for combined obstruction at both levels. Free veno-venous bypass was the most frequently used procedure. In two cases of cavo-iliac obstruction, an original technique of femoro-axillary veno-venous bypass yielded good results. Temporary arteriovenous fistulas to improve patency at sites distal to venous bypass were used in the most complex cases. Good results were obtained in 80% of the operated cases. Postoperative follow-up phlebograms were obtained in 30 of 43 operations. Ref ID : DASTAIN1981 264. Dastain, J.Y. Scleroses des varices sous anticoagulant. A propos de deux patients sous anticoagulant. Phlebologie 34(1):73-76, 1981. Keywords : SCLEROSE; VARICES; ANTICOAGULANT; SCLEROTHERAPY; POLIDOCANOL; PROTHROMBIN; SCLEROSIS; THROMBUS; INJURY; REFLUX; de; hi; in; Thigh; Injections; CONTRAST; injuries Notes : Dastain has reported his experience with sclerotherapy of large symptomatic varices using polidocanol in two patients who were fully anticoagulated for important medical problems.{ } Both patients had therapeutically prolonged prothrombin times. The high point of reflux in the first patient was identified as a Hunterian thigh perforator, and in this patient a concentration of 0.5% polidocanol was used. Aliquots of 1.5cc were used at each injection site, and up to four sites were treated per session. The patient had excellent results with this regimen. The second patient had saphenofemoral incompetence, and required concentrations up to 2% to effect sclerosis of proximal thigh varices. In contrast to his usual experience, he noted no thrombus formation within treated vessels during the sclerosis and healing process. No significant extravascular hematoma was noted at injection sites, although the patients continued to experience spontaneous superficial hematomas from minor injuries both before and after the period of sclerotherapy. Ref ID : DATTA1986 265. Datta, B.N., Ramesh, K., and Bhusnurmath, B. Autopsy incidence of pulmonary vascular episodes. A study of 218 cases. Angiology. 37:744- 750, 1986. Keywords : 951202; AUTOPSY; INCIDENCE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; is; in; MALE; FEMALE; THROMBOSIS; EMBOLISM; LUNG; CARDIAC; SEPTICEMIA; MALIGNANCY; Liver; THROMBOEMBOLI; heart diseases; co; HUMAN; india; lung diseases; Neoplasms; PULMONARY EMBOLISM; ep; et; Medline File; Cancerlit File; pathology; infarction; africa Notes : Pulmonary thromboembolism is a rarity in India. This common clinical impression has so far not been tested. Among 7000 autopsies between 1964 and 1980, a total of 218 cases (126 males and 92 females) were recorded to have thrombosis and/or embolism and/or infarction in the lungs. This incidence of 3.1% is far lower than that reported in the West and similar to the low incidence in Africa. Of the 218 cases, 42.6% had a cardiac disease, 18.3% had systemic septicemia, 13% had a malignancy, 12.8% had pulmonary disease, and the remaining suffered from diseases of liver, kidney, CNS, etc. Of the 218 cases, 141 (64.6%) showed only infarcts, 40 (18.3%) had only thromboemboli, and 37 (16.9%) showed both events. In view of the overlap among these three conditions and their essential pathophysiologic identity (thrombus/embolism/infarction), it is suggested that these be grouped under the name "pulmonary vascular episode." Department of Pathology Institute of Medical Education & Research Chandigarh North India. Ref ID : DAVIDSON1993 266. Davidson, J.E., Willms, D.C., and Hoffman, M.S. Effect of intermittent pneumatic leg compression on intracranial pressure in brain-injured patients. Crit.Care Med. 21:224-227, 1993. Keywords : PHLEBITIS; LEG; COMPRESSION; Pressure; Blood Pressure; brain injuries; ETIOLOGY; physiopathology; FEMALE; g suits; glasgow coma scale; HUMAN; intracranial pressure; MALE; PROSPECTIVE STUDIES; THROMBOPHLEBITIS; prevention & control; trauma centers; Cerebral; PERFUSION; PROSPECTIVE; Hospitals; TRAUMA; ADULT; HEMODYNAMICS; MONITORING; PREVENTION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ARTERIAL; Heart Rate; Venous Pressure; Pneumatic; in; coma; heart Notes : OBJECTIVE: To evaluate the effect of intermittent pneumatic leg compression on intracranial pressure and cerebral perfusion pressure in brain-injured patients. DESIGN: Prospective, sequential patient study. SETTING: Surgical/trauma ICU of a community hospital providing regional trauma care. PATIENTS: Twenty-four adult, brain-injured patients (mean Glasgow Coma Scale score = 6) who required hemodynamic and intracranial pressure monitoring. INTERVENTIONS: Placement of intermittent sequential pneumatic leg compression devices for prevention of venous thrombosis. MEASUREMENTS: Mean arterial pressure (MAP), heart rate, central venous pressure, and intracranial pressure were measured at baseline, and at 0, 10, 20, and 30 mins of intermittent pneumatic leg compression. Cerebral perfusion pressure was calculated as the difference between MAP and intracranial pressure. RESULTS: No significant changes in MAP, central venous pressure, or intracranial pressure occurred during the study interval. Calculated cerebral perfusion pressure remained unchanged. A total of 23 of 24 study patients had intracranial pressure controlled by hyperventilation or pharmacologic measures within the normal range at the time of study. CONCLUSION: Intermittent pneumatic leg compression results in no significant changes in intracranial pressure or cerebral perfusion pressure in stable, brain-injured patients who have intracranial pressure controlled by medical means. Ref ID : DAWLEY1987 267. Dawley, D. and Goldhaber, S.Z. Impact of lung scanning on the management of suspected pulmonary embolism [editorial]. Am.Heart J. 114(3):669-671, 1987. Keywords : 951216; LUNG; SCANNING; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; Adolescence; ADULT; AGED; Aged,80 and over; ANGIOGRAPHY; FEMALE; HUMAN; ra; ri; MALE; MIDDLE AGE; PHLEBOGRAPHY; th; Support,U.S.Gov't,P.H.S. ventilation-perfusion ratio; Medline File Notes : [No Abstract Available]. Ref ID : DAWSON1991 268. Dawson, K.J., Reddy, K., Platts, A.D., and Hamilton, G. Results of a recently instituted programme of thrombolytic therapy in acute lower limb ischaemia [see comments]. Brit.J.Surg. 78(4):409-411, 1991. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ACEP93; in; 96- suzy-001; INTRAARTERIAL; STREPTOKINASE; PLASMINOGEN; PLASMINOGEN ACTIVATOR; INDICATIONS; ARTERIAL; THROMBOEMBOLI; TREATMENT; LYSIS; Angioplasty; Punctures; BLEEDING; Amputation; Died; LYTIC; Cerebral; OUTCOME; THROMBOLYSIS; MORTALITY; MORBIDITY; ACUTE DISEASE; ADULT; AGED; Aged,80 and over; ALTEPLASE; administration & dosage; therapeutic use; FEMALE; HUMAN; Injections,Intra-Arterial; Ischemia; drug therapy; LEG; blood supply; MALE; MIDDLE AGE; RECOMBINANT PROTEINS Notes : Twenty-eight patients with acute lower limb ischaemia received low dose intra-arterial thrombolytic therapy over a 2-year period. Eighteen patients received streptokinase and ten patients received recombinant tissue plasminogen activator (rTPA). Indications included arterial thromboemboli and graft failures. Mean ischaemic times were similar in both groups. Treatment time to achieve lysis was significantly less with rTPA (P less than 0.01). Subsequent vascular procedures, including angioplasty or reconstruction, were undertaken in 36 per cent of patients. Arterial puncture site bleeding occurred in eight (29 per cent) patients. Three (11 per cent) patients suffered rethrombosis after initial successful lysis. All rethromboses were successfully lysed with rTPA. There were two major amputations. Five (18 per cent) patients died, all lytic failures in the streptokinase treatment group. There were no cerebral haemorrhagic events and no patient died as a result of thrombolytic therapy. Good clinical outcome was obtained in nine of 18 patients treated with streptokinase and in nine of ten patients treated with rTPA. Intra-arterial thrombolysis provides effective therapy with high rates of limb salvage and a low mortality rate. This study suggests that rTPA may be a more effective agent, causing less morbidity, than streptokinase. Ref ID : DAY1976 269. Day, T.K., Rish, P.J., and Kakkar, V.V. Detection of deep vein thrombosis by Doppler angiography. Brit.Med.J. 1:618, 1976. Keywords : vein; THROMBOSIS; Doppler; ANGIOGRAPHY; NASP Ref ID : DAYRAS1968 270. Dayras, J.C. and Griton, P. [Survey on vascular disorders in children and adolescents]. Phlebologie. 21:339-342, 1968. Keywords : NASP; Adolescence; Aneurysm; Angiomatosis; Arteriovenous Fistula; Arteritis; Belgium; CHILD; Child,Preschool; FEMALE; HUMAN; Infant; Lymphangioma; Lymphedema; MALE; Neoplasms,Vascular Tissue; Questionnaires; Raynaud's Disease; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; in; de; et; ab Notes : TT - Rapport de l'enquete sur les troubles vasculaires de l'enfant et de l'adolescent AB - [No Abstract Available] UI -72137489. Ref ID : DEFRANCHIS1987 271. De Franchis, R., Cipolla, M., Primignani, M., Agape, F., Antoniozzi, F., Torgano, G., Vecchi, M., Vitagliano, P., Vigano, S., and D'Angelo, A. Activation of coagulation in cirrhotics after endoscopic variceal sclerotherapy. Am.J.Gastroenterol. 82:1287-1289, 1987. Keywords : SCLEROTHERAPY; THROMBOSIS; COAGULATION; FIBRINOPEPTIDES; FIBRINOPEPTIDE A; SODIUM MORRHUATE; THROMBIN; in; Sodium Notes : Plasma fibrinopeptide A levels increased sharply in 37 of 39 patients after endoscopic variceal sclerotherapy using sodium morrhuate and sodium morrhuate with thrombin. Other coagulation parameters did not change. Ref ID : DELCLOS1986 272. Delclos, G.L. and Davila, F. Thrombolytic therapy for pulmonary embolism in pregnancy: a case report. Am.J.Obstet.Gynecol. 155:375-376, 1986. Keywords : EMBOLISM; PREGNANCY; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PULMONARY EMBOLISM; CASE REPORT; THROMBOEMBOLI; DIAGNOSIS; RADIONUCLIDE; LUNG; SCANNING; UROKINASE; FEMALE; HUMAN; Pregnancy Complications,Cardiovascular ,Drug Therapy ,DT; Pulmonary Embolism ,Drug Therapy ,DT; Urokinase ,Therapeutic Use ,TU; ADULT; in; ab; is Notes : AB- A case of a 19-year-old woman whose pregnancy was complicated by hemodynamically significant pulmonary thromboemboli is reported. The diagnosis was confirmed by radionuclide ventilation- perfusion lung scanning, and urokinase thrombolytic therapy resulted in a good therapeutic response with minimal adverse effects. Ref ID : DELEUZE1991 273. Deleuze, P., Saada, M., De Paulis, R., Brochard, L., Mazzucotelli, J.P., Rotman, N., Loisance, D.Y., and Cachera, J.P. Intraoperative transesophageal echocardiography for pulmonary embolectomy without cardiopulmonary bypass. Ann.Thorac.Surg. 52:137-138, 1991. Keywords : Intraoperative; Transesophageal; Echocardiography; EMBOLECTOMY; CARDIOPULMONARY BYPASS; CASE REPORT; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; THROMBI; SURGICAL; VENOUS; OCCLUSION; HEPARIN; TECHNIQUES; sdi-11/93; in Notes : This case report describes a patient with massive pulmonary embolism and acute circulatory failure in whom transesophageal echocardiography permitted the diagnosis of thrombi in the main pulmonary truncus and in the right branch and guided intraoperatively the surgical embolectomy performed under simple venous inflow occlusion because of a contraindication to heparin administration. Transesophageal echocardiography seems to be a very helpful technique to diagnose promptly massive pulmonary embolism and a very useful tool at the time of operation to guide the embolectomy. Ref ID : DEMAIORIBUS1993 274. DeMaioribus, C.A., Mills, J.L., Fujitani, R.M., Taylor, S.M., and Joseph, A.E. A reevaluation of intraarterial thrombolytic therapy for acute lower extremity ischemia. J.Vasc.Surg. 17:888-895, 1993. Keywords : INTRAARTERIAL; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ACEP93; Extremities; Ischemia Ref ID : DEMERS1992 275. Demers, C., Ginsberg, J.S., Hirsh, J., Henderson, P., and Blajchman, M.A. Thrombosis in antithrombin-III-deficient persons. Report of a large kindred and literature review [see comments]. Ann.Intern.Med. 116(9):754-761, 1992. Keywords : LMWH; Low-Molecular-Weight-Heparin; THROMBOSIS; REVIEW; PREVALENCE; COMPLICATIONS; diagnostics; VENOUS; REFLUX; Doppler; Ultrasonography; Literature review; RISK; RISK FACTORS; SURGERY; PREGNANCY; POSTPARTUM; ORAL CONTRACEPTIVES; Immobilization; CANCER; TRAUMA; AGE; VALIDITY; VENOUS THROMBOSIS; ANTICOAGULANT; PROPHYLAXIS; ASYMPTOMATIC; 951217; in; cross-sectional studies; an; Adolescence; ADULT; AGED; ANTITHROMBIN III; df; CHILD; Child,Preschool; FEMALE; HUMAN; MALE; MIDDLE AGE; Pedigree; PULMONARY EMBOLISM; ge; Support,Non- U.S.Gov't; THROMBOPHLEBITIS; bl; Medline File; Health Planning & Administration File; Cancerlit File; ontario; CANADA Notes : PURPOSE: To estimate the prevalence of objectively proven thrombotic complications in antithrombin-III-deficient persons. STUDY DESIGN: Cross-sectional study and a critical review of the literature. DATA SOURCES AND EXTRACTION: The prevalence of thrombosis in antithrombin III-deficient and -nondeficient family members of a large kindred was estimated by history, review of diagnostic tests, and examination for venous reflux by Doppler ultrasonography, as an indicator of previous venous thrombosis. A MEDLINE search and literature review of the published English-and French-language literature from 1966 to 1990 that described antithrombin-III-deficient families was done, and the following information was obtained: the prevalence of thrombosis in deficient and nondeficient family members, the presence or absence of risk factors for thrombosis (surgery, pregnancy, the postpartum state, use of oral contraceptives, immobilization, metastatic cancer, major trauma) at the time of the thrombotic event, and age of onset of the first episode of thrombosis. The validity of the studies was assessed according to predetermined criteria. RESULTS: Sixty-seven research subjects were evaluated. Six of 31 (19.4%) antithrombin-III-deficient subjects compared with none of 36 (0%) nondeficient subjects had had one or more thrombotic events. The initial episode in five of six subjects had occurred in association with risk factors for thrombosis. The literature search indicated that the pooled prevalence of symptomatic venous thrombosis among the deficient subjects was 51%, but objective testing was done in only 17% of these subjects at the time of presentation. CONCLUSION: Based on the data from this antithrombin-III- deficient kindred, lifelong anticoagulant prophylaxis does not appear to be warranted in asymptomatic carriers, and prophylaxis could be limited to periods of high risk for thrombosis. Ref ID : DENNIS1993 276. Dennis, J.W., Menawat, S., Von Thron, J., Fallon, W.F.,Jr., Vinsant, G.O., Laneve, L.M., Jagger, C., and Frykberg, E.R. Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high-risk groups. J.Trauma. 35:132-8; discussion 138-9, 1993. Keywords : EMBOLISM; TRAUMA; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROPHYLAXIS; INCIDENCE; DEEP VENOUS THROMBOSIS; DVT; INJURY; Doppler; ULTRASOUND; HEPARIN; COMPRESSION; Extremities; Pulmonary emboli; EMBOLI; PE; FATAL; BLUNT; FRACTURES; RISK; Spinal cord; FILTER; in; trauma centers; injury severity score; is; hospitalization; injuries Notes : The incidence of deep venous thrombosis (DVT) and the efficacy of prophylactic measures were prospectively evaluated in all patients admitted to a level I trauma center during 1991. Patients with Injury Severity Scores (ISS) > 9 who survived a minimum of 48 hours (n = 395) were monitored using venous Doppler and ultrasound studies during hospitalization (total, 1308 studies). Two hundred eighty-one patients (71%) were randomly assigned to low-dose heparin or sequential compression devices. There were 18 cases of lower extremity DVT (4.6%) and four cases (1.0%) of pulmonary emboli (PE), three of which were fatal. Eight patients (2.9%) on prophylaxis and 10 (8.8%) without prophylaxis developed DVT (p < 0.02 by Chi-square). There were two PEs in each group. Fourteen of these 18 patients sustained blunt trauma and included seven spinal fractures or subluxations (four paraplegic) and four severe head injuries. This represented 14.0% of 50 patients admitted with spinal injuries and 4.3% of 92 patients with severe head injuries. Compared with those with no neurologic injury (7 of 253 or 2.7%), the risk of DVT is significantly higher in the spinal injury patients (p < 0.001, Chi-square) and twice as high as in the head injury group, although not statistically significant (p = 0.4, Chi-square). Three of the four patients with penetrating trauma and DVT had venous injuries. We conclude that DVT prophylaxis can significantly reduce the incidence of DVT in trauma patients with ISS > 9. Patients with severe neurologic injuries (particularly spinal cord) are at high risk for DVT and PE and may be considered for a prophylactic Greenfield filter. Ref ID : DEPUEY1988 277. DePuey, E.G., Richards, W.O., Millikan, W.J.,Jr., and Henderson, J.M. Scintigraphic detection of pulmonary embolization of esophageal variceal sclerosant. Endoscopy 20:91-94, 1988. Keywords : EMBOLIZATION; ESOPHAGEAL; SCLEROSANT; ESOPHAGEAL VARICES; VARICES; TREATMENT; FEVER; CHEST X-RAY; CHEST; XRAY; Pulmonary Circulation; in; effusion Notes : Embolization of sclerosant from esophageal varices to the pulmonary circulation occurs in 60 percent of treatments, and may result in post-sclerosis fever or in findings of atelectasis, infiltrate, or effusion on the chest x-ray. Ref ID : DESAI1989 278. Desai, M.H., Linares, H.A., and Herndon, D.N. Pulmonary embolism in burned children. Burns. 15:376-380, 1989. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; INCIDENCE; CLINICAL DIAGNOSIS; DIAGNOSIS; is; COMPLICATIONS; PNEUMONIA; RESPIRATORY DISTRESS; RESPIRATORY DISTRESS SYNDROME; Syndrome; INJURY; REVIEW; DEATH; Died; vein; THROMBOSIS; an; RISK; VENOUS; ARTERIAL; SURGICAL; RISK FACTORS; Adolescence; AUTOPSY; Burns; co; mo; CASE REPORT; CHILD; FEMALE; HUMAN; Infant; MALE; PULMONARY ARTERY; PA; ep; et; Retrospective Studies; vena cava,superior; Medline File; bronchopneumonia Notes : There are occasional reports in the literature concerning the incidence of pulmonary embolism in the postburn population, but reports of burned children are especially rare. The clinical diagnosis of pulmonary embolism is particularly difficult in these populations due to the postburn pulmonary complications of pneumonia, bronchopneumonia, respiratory distress syndrome, and changes incurred through inhalation injury. A retrospective review of all patient deaths occurring at this institution during the past 22 years was performed in order to document the incidence of pulmonary embolism in burned children. Of the 6589 patients admitted during this time, 178 patients died (2.7%) and three (1.7%) deaths were attributable to pulmonary embolism. Two other deaths (1.1%) were associated with deep vein thrombosis. The incidence of pulmonary embolism can then be calculated at 46 per 100,000 admissions in this population of burned children. Burned patients always pose an increased risk for the development of pulmonary embolism. These patients are traumatized, require multiple venous and/or arterial cannulations, undergo multiple surgical procedures, are immobile for prolonged periods, prone to infectious processes and fluid and electrolyte imbalances. Despite all these risk factors, the incidence of pulmonary embolism is less than 2 per cent of all deaths in this postburn paediatric population Shriners Burns Institute Galveston TX 77550. Ref ID : DIACONESCU1978 279. Diaconescu, M., Murarescu, C., and Niculescu, D. [Local therapy with ditaven in some types of venous insufficiency]. Rev.Med.Chir.Soc.Med.Nat.Iasi. 82:564, 1978. Keywords : THERAPY; VENOUS; NASP; Administration,Topical; Anti- Inflammatory Agents; Digitoxin; HUMAN; Ointments; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; in; ab Notes : TT - Terapia locala cu ditaven in unele insuficiente venoase AB -[No Abstract Available] UI - 80058102. Ref ID : DIAZ1992 280. Diaz, J.M., Schiffman, J.S., Urban, E.S., and Maccario, M. Superior sagittal sinus thrombosis and pulmonary embolism: a syndrome rediscovered. Acta Neurol.Scand. 86:390-396, 1992. Keywords : THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; Syndrome; EMBOLI; FATAL; COMPLICATION; THROMBOSED; REVIEW; VENOUS; VENOUS THROMBOSIS; MORTALITY; ANTICOAGULATION; THERAPY; OUTCOME; sdi-11/93; Sagittal Sinus Thrombosis; Saddle embolism; Literature review; Pulmonary emboli; in Notes : Pulmonary emboli as a fatal complication of superior sagittal sinus thrombosis was once well recognized in the literature but appears to have been forgotten. The sagittal sinus appeared to be the source of pulmonary emboli in previously reported cases. Even in patients with no evidence of systemic thrombosis, but who have sagittal sinus thrombosis, the possibility of dislodging pulmonary emboli should be strongly considered. We report a case of nontraumatic sagittal sinus thrombosis complicated by multiple pulmonary emboli and a fatal saddle embolism, likely originating from the thrombosed sinus. Our review of the literature between 1942 and 1990 yielded 203 cases of intracranial venous thrombosis. The overall mortality rate was 49.3%. In 23 cases (11.3%), the venous sinus thrombosis was associated with pulmonary emboli and in these the overall mortality rate was 95.6%. In the 203 cases in our review, those patients who received anticoagulation therapy also had a statistically significant better outcome. Therefore, the presence of pulmonary emboli in association with sagittal sinus thrombosis mandates a sober assessment of the need of anticoagulation therapy in the absence of obvious contraindication. Ref ID : DIDISHEIM1972 281. Didisheim, P. Animal models useful in the study of thrombosis and antithrombotic agents. Prog.Hemost.Thromb. 1:165-197, 1972. Keywords : ANIMAL; THROMBOSIS; SCLEROTHERAPY; ANIMAL MODELS; in; Antithrombotic Ref ID : DIEBOLD1991 282. Diebold, J. and Lohrs, U. Venous thrombosis and pulmonary embolism. A study of 5039 autopsies. Pathol.Res.Pract. 187:260-266, 1991. Keywords : 951202; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; AUTOPSY; FREQUENCY; POSTMORTEM; Hospitals; in; THROMBI; VENA CAVA; THROMBUS; jugular veins; vein; Femoral Vein; Pulmonary emboli; EMBOLI; FATAL; heart; catheterization,central venous; ae; FEMALE; HUMAN; MALE; PREVALENCE; ep; et; Retrospective Studies; THROMBOPHLEBITIS; co; di; Medline File; Health Planning & Administration File; pathology Notes : The frequency and the localisation pattern of venous thrombosis and subsequent pulmonary embolism detected postmortem was studied by reviewing 5039 autopsy records from 1975 through 1980 and from 1987/88 of two university hospitals. The autopsy procedure was identical in both study periods. Thrombosis was documented overall in 34.2% with a slight increase from the first to the second series. Taking in account the cases of pulmonary embolism without detected source, the thrombosis rate was 42.6%. The rate of cases with thrombi in the vena cava superior system almost doubled (1975: 9.2%, 1987/88: 17.0%; p less than 0.05). Regarding the list of thrombus localisations the right internal jugular vein (16.9%) was second only to the left femoral vein (17.8%) in 1987/88. Pulmonary emboli were seen in 1500 of 5039 autopsies (29.8%); in 59.4% the source was found in the lower venous tree, in 12.6% in the upper venous tree. In 28.0% no source could be detected. In these cases we supposed a complete detachment of thrombi from the lower venous tree to be the most likely reason. In 628 of the 1500 cases (42.5%) pulmonary embolism was classified as fatal. Both rates, for total pulmonary embolism and for fatal thrombembolism showed a small, but significant decrease during the study period. In 8.3% (52/628) the source of fatal pulmonary emboli was situated in the upper venous tree including the right heart. This means that 10.2% (52/512) of all cases with isolated thrombosis in the vena cava superior system were associated with fatal pulmonary embolism. Venous thrombosis and pulmonary embolism are still frequent findings at autopsy.(ABSTRACT TRUNCATED AT 250 WORDS) Department of Pathology Medical University of Luebeck FRG. Ref ID : DIECK1990 283. Dieck, J.A., Rizo Patron, C., Unisa, A., Mathur, V., and Massumi, G.A. A new manifestation and treatment alternative for heparin-induced thrombosis. Chest 98:1524-1526, 1990. Keywords : TREATMENT; HEPARIN; THROMBOSIS; CORONARY ARTERY BYPASS; POSTOPERATIVE; VEINS; THROMBOEMBOLI; BLOOD FLOW; PLASMINOGEN; PLASMINOGEN ACTIVATOR; TPA; WARFARIN; THERAPY; PULMONARY ARTERY; THROMBOLYTIC; THROMBOLYTIC THERAPY; ALTEPLASE; ANGIOPLASTY TRANSLUMINAL PERCUTANEOUS CORONARY; CASE REPORT; GRAFT OCCLUSION VASCULAR; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; SAPHENOUS VEIN; THROMBOCYTOPENIA; coronary artery; ARTERY; vein; blood; Angioplasty; PTCA; an; Sodium; in; Arteries; is Notes : AB-We treated a coronary artery bypass patient whose postoperative course was complicated by heparin-induced thrombocytopenia and resultant pulmonary artery and saphenous vein graft thromboses. The pulmonary thromboemboli were found first, and pulmonary blood flow was restored with intravenously administered tissue plasminogen activator (tPA). A short time later, the vein grafts were found to be occluded, and we subsequently performed multivessel percutaneous transluminal coronary angioplasty (PTCA) using tPA as an adjuvant to oral warfarin sodium therapy with excellent results. We conclude that heparin-induced thromboses in the pulmonary arteries are amenable to thrombolytic therapy, including tPA, whereas this regimen appears to have little effect on saphenous vein grafts. We also found that a combination of warfarin and thrombolytic therapy is an alternative regimen for heparin- intolerant patients who require PTCA. Ref ID : DIEUDONNE1993 284. Dieudonn‰, P. [Pulmonary embolism (letter)]. Rev.Med Brux. 14:49, 1993. Keywords : EMBOLISM; sdi-11/93 Ref ID : DISMUKE1984 285. Dismuke, S.E. and VanderZwaag Accuracy and epidemiological implications of the death certificate diagnosis of pulmonary embolism. J.Chronic.Dis. 37:67-73, 1984. Keywords : 951202; DEATH; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; PE; AUTOPSY; in; diagnostics; RISK; RISK FACTORS; SENSITIVITY; PREDICTIVE VALUE; MYOCARDIAL INFARCTION; infarction; Neoplasms; MASSIVE; is; EPIDEMIOLOGY; ADULT; COMPARATIVE STUDY; death certificates; Evaluation Studies; FEMALE; HUMAN; maryland; di; mo; PA; Medline File; Health Planning & Administration File; Cancerlit File Notes : The death certificate (DC) diagnosis of pulmonary embolism (PE) has been compared to autopsy findings in 2398 patients dying between 1966 and 1976. Accuracy of the death certificate and the effect of diagnostic misclassification errors on the association between PE and potential risk factors were analyzed in this study. Sensitivity of the DC diagnosis of PE was less than 40% and the predictive value of a positive diagnosis was less than 50%. The epidemiological associations derived using the DC diagnosis of PE were very unreliable for myocardial infarction and malignant neoplasm because errors of diagnostic misclassification were not randomly distributed. Associations with risk factors derived using massive embolism were conservative estimates of the associations derived by using any embolism found at autopsy. We conclude that the death certificate diagnosis of PE is extremely inaccurate and should be used with great caution to study the epidemiology of PE Department of Medicine University of Tennessee Center for the Health Sciences Memphis. Ref ID : DISMUKE1986 286. Dismuke, S.E. and Wagner, E.H. Pulmonary embolism as a cause of death. The changing mortality in hospitalized patients. JAMA 255:2039- 2042, 1986. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; CAUSE; cause of death; DEATH; MORTALITY; in; FREQUENCY; Hospitals; SURGICAL; AUTOPSY; TECHNIQUES; MASSIVE; FATAL; ANTICOAGULANTS; INCIDENCE; Adolescence; ADULT; AGED; tu; death certificates; hospitalization; HUMAN; MIDDLE AGE; north carolina; mo; pc; RISK; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. TIME FACTORS; Medline File; Health Planning & Administration File; hospital mortality Notes : We studied the frequency and characteristics of death due to pulmonary embolism among all hospital and surgical patients in a university hospital from 1966 through 1980. Of 6,858 deaths, 3, 412 autopsies were performed using a standardized and sensitive technique for pulmonary dissection. Our study showed that 6% of deceased patients (4.7% of surgical patients) had massive fatal embolism. Significant declines in embolism mortality were noted during this time period for hospital and surgical patients. The percentage of embolism cases among autopsies fell from 9.3% in the first five years to 3.8% in the last five years. Excluding patients receiving anticoagulants at the time of death, these percentages fell from 8.8% to 2.7%. The estimated hospital mortality rate for embolism fell during the same years from 0.37% of hospital discharges to 0.13%. patients at the hospital increased from 4% of patients to nearly 12.3%. This and other evidence suggest the possibility that both the incidence rate and the case-fatality rate for pulmonary embolism have decreased in the hospital population we studied. Ref ID : DODD1972A 287. Dodd, H. Varicose veins and venous disorders of the lower limb. 1. Introduction to venous disorders. Nurs.Mirror.Midwives.J. 135:42-47, 1972. Keywords : VARICOSE VEINS; VEINS; VENOUS; NASP; Arteriovenous Fistula; LEG; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; varicose; ab Notes : AB - [No Abstract Available] UI - 73050991. Ref ID : DOOREY1992 288. Doorey, A.J., Stillabower, M.E., Gale, N., and Goldenberg, E.M. Catastrophic thrombus development despite systemic heparinization during coronary angioplasty: possible relationship to nonionic contrast. Clin.Cardiol. 15:117-120, 1992. Keywords : THROMBUS; CONTRAST; ACEP93; Angioplasty Ref ID : DORFMAN1992 289. Dorfman, G.S. and Cronan, J.J. Venous ultrasonography. Radiol.Clin.North Am. 30:879-894, 1992. Keywords : PHLEBITIS; VENOUS; Ultrasonography; COMPARATIVE STUDY; HUMAN; LEG; blood supply; THROMBOPHLEBITIS; classification; physiopathology; instrumentation; Methods; VEINS; anatomy & histology; COMPRESSION; Doppler; diagnostics; Extremities; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; ASYMPTOMATIC; TECHNIQUES; CHRONIC; DIAGNOSIS; color; is; in; an Notes : Compression ultrasonography supplemented by pulsed and color Doppler imaging is the diagnostic modality of choice for evaluating lower extremity deep vein thrombosis in symptomatic and asymptomatic high-risk patients. Furthermore, this technique frequently can characterize the clot as occlusive or nonocclusive or acute or chronic and can define the extent of disease. In patients without thrombosis, this modality can suggest an alternative diagnosis in 12% of patients. Ref ID : DRAPANAS1966 290. Drapanas, T. and Curran, W.L. Thrombectomy in the treatment of "effort" thrombosis of the axillary and subclavian veins. J.Trauma 6:107-119, 1966. Keywords : TREATMENT; THROMBOSIS; SUBCLAVIAN; SUBCLAVIAN VEIN; VEINS; THROMBECTOMY; in Ref ID : DREVET1991 291. Drevet, D., Revel, D., Marx, P., Amiel, M., and Pinet, F. [Obstruction of pulmonary arteries. Contribution of the scanner and MRI. Apropos of 10 cases]. Ann.Radiol.(Paris). 34:349-354, 1991. Keywords : PULMONARY ARTERY; Arteries; MRI; Retrospective Studies; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; CT; SCAN; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; TECHNIQUES; ARTERY; NONINVASIVE; ETIOLOGY; sdi-11/93; in; CT scan Notes : We present a retrospective study of ten patients presenting non specific clinical manifestations in whom the diagnosis of pulmonary embolism was documented by CT scan and/or MRI. Results of CT scan and/or MRI were compared to DSA bi-selective pulmonary angiography findings. In a large number of cases, CT scan and MRI allowed the detection of the obstruction within the right and left pulmonary arteries (RPA and LPA). Although these techniques did not permit the diagnosis of peripheral clots, pulmonary infarcts were usually depicted by these two procedures. CT scan and/or MRI could be performed as first-line investigations in case of atypical clinical symptoms because of their high relevance for proximal pulmonary artery obstruction, although these two non-invasive procedures cannot indicate the aetiology of the obstruction etiology. Ref ID : DREYER1980 292. Dreyer, N.A. and Pizzo, S.V. Blood coagulation and idiopathic thromboembolism among fertile women. Contraception 22:123, 1980. Keywords : BLOOD COAGULATION; COAGULATION; THROMBOEMBOLISM; NASP; blood Ref ID : DREYFUSS1984 293. Dreyfuss, A.I. and Weiland, D.S. Chest wall tenderness as a pitfall in the diagnosis of acute pulmonary embolism. Arch.Intern.Med. 144:2057, 1984. Keywords : CHEST; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; CHEST WALL TENDERNESS; PAIN; PITFALL; in Notes : page 2057 only. Ref ID : DREYFUSS1984A 294. Dreyfuss, A.I. and Weiland, D.S. Chest wall tenderness as a pitfall in the diagnosis of pulmonary embolism. A report of two cases. Arch.Intern.Med. 144(10):2057, 1984. Keywords : 96-suzy-001; CHEST; CHEST WALL TENDERNESS; PITFALL; in; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; is; EMBOLI; ADULT; CASE REPORT; Diagnosis,Differential; FEMALE; HUMAN; PAIN; ETIOLOGY; COMPLICATIONS; thorax Notes : Chest wall tenderness is commonly indicative of chest wall disease. Two patients with angiographically proved pulmonary emboli had clinical presentations dominated by chest wall tenderness. Clinicians should be alert to this mode of presentation and not exclude pulmonary embolism on the basis of such findings. Ref ID : DRILL1968 295. Drill, V.A. and Calhoun, D.W. Oral contraceptives and thromboembolic disease. JAMA 206:77-84, 1968. Keywords : ORAL CONTRACEPTIVES; THROMBOEMBOLIC; POSTPARTUM; INCIDENCE; DVT; is Notes : The postpartum incidence of DVT is up to 2 percent per month. Ref ID : DRUY1985 296. Druy, E.M. Thrombolytic therapy in the treatment of axillary and subclavian vein thrombosis. J.Vasc.Surg. 2:821-827, 1985. Keywords : THROMBOLYTIC; THERAPY; TREATMENT; VEINS; THROMBOSIS; THROMBUS; THROMBOLYTIC THERAPY; in; SUBCLAVIAN; SUBCLAVIAN VEIN; vein; LYTIC; is; CATHETER Notes : If peripheral systemic lytic therapy is ineffective, direct infusion of lytic agents into the thrombus via catheter may be more effective for large deep vein thrombus in a low-flow area. Ref ID : DUCAS1986 297. Ducas, J., Girling, L., Schick, U., and Prewitt, R.M. Pulmonary vascular effects of hydralazine in a canine preparation of pulmonary thromboembolism. Circulation 73:1050-1057, 1986. Keywords : hydralazine; THROMBOEMBOLISM; ARTERIAL; Pressure; DOGS; PULMONARY HYPERTENSION; Hypertension; CARDIAC; CARDIAC OUTPUT; Arteriovenous Fistula; Fistula; EMBOLI; ANIMAL; Support,Non-U.S.Gov't; Hemodynamics ,Drug Effects ,DE; Hydralazine ,Pharmacology ,PD; Pulmonary Circulation ,Drug Effects ,DE; Pulmonary Embolism ,Physiopathology ,PP; Blood Pressure ,Drug Effects ,DE; Cardiac Output ,Drug Effects ,DE; disease models,animal; Hypertension,Pulmonary ,Physiopathology ,PP; Pulmonary Gas Exchange ,Drug Effects ,DE; Stroke Volume ,Drug Effects ,DE; TIME FACTORS; Vascular Resistance ,Drug Effects ,DE; in; ab; blood; co; an Notes : AB- Pulmonary arterial pressure (PAP)-flow coordinates were obtained in 14 anesthetized dogs before and after pulmonary hypertension was induced with autologous blood clots. Cardiac output (CO) was altered by systemic arteriovenous fistulas. The PAP-CO coordinates were always rectilinear. Before emboli, the mean vascular closing or outflow pressure (the pressure intercept of the PAP-CO line) was 8.8 +/- 2.1 (SD) mm Hg. Emboli increased PAP (15.1 +/- 1.6 to 36.5 +/- 3.5 mm Hg; p less than .001) and decreased CO (3.8 +/- 0.6 to 2.4 +/- 0.8 liters X min-1; p less than .001). Incremental resistance (the slope of the PAP- CO line) only increased slightly. On the other hand, the marked increase in PAP was predominantly due to an increase in effective outflow pressure (from 8.8 +/- 2.1 to 28.6 +/- 3.6; p less than .001). Hydralazine was administered in a dose sufficient to double CO. This did not affect PAP and caused an inconsistent and small decrease in incremental resistance. However, a consistently significant decrease in effective outflow pressure, averaging 23%, was observed. In this canine preparation of pulmonary hypertension the predominant effect of hydralazine appears to be a decrease in the mean vascular closing or outflow pressure. Ref ID : DUCAS1987 298. Ducas, J. and Prewitt, R.M. Pathophysiology and therapy of right ventricular dysfunction due to pulmonary embolism. Cardiovasc.Clin. 17:191-202, 1987. Keywords : PATHOPHYSIOLOGY; THERAPY; RIGHT VENTRICULAR DYSFUNCTION; PULMONARY EMBOLISM; EMBOLISM; SHOCK; PERFUSION; Pressure; norepinephrine; drugs; HEMODYNAMICS; THROMBOLYTIC; THROMBOLYTIC THERAPY; LYTIC; TECHNIQUES; hydralazine; PULMONARY HYPERTENSION; Hypertension; VASCULAR RESISTANCE; ANIMAL; HUMAN; Heart Diseases ,Etiology ,ET; Heart Ventricle ,Physiopathology ,PP; Pulmonary Embolism ,Complications ,CO; DOGS; Heart Diseases ,Drug Therapy ,DT Heart Diseases ,Physiopathology ,PP; Pulmonary Embolism ,Drug Therapy ,DT Pulmonary Embolism ,Physiopathology ,PP; ab; an; in; co; resuscitation; is Notes : AB- When shock complicates an acute increase in RV afterload, initial therapy should be directed toward restoration of an adequate BP (RV coronary perfusion pressure) and CO. Current results indicate that norepinephrine, a drug with direct inotropic and pressor effects, may be an excellent agent for acute resuscitation and short-term maintenance of hemodynamic stability when frank circulatory instability complicates pulmonary embolism. Following hemodynamic stabilization, thrombolytic therapy should be initiated. Recent evidence suggests that the lytic agent can be given by bolus technique, but more work is required to determine the optimum dosing regimen. In the absence of shock, when a moderate decrease in CO complicates pulmonary embolism, isoproterenol or hydralazine may be used to improve flow. However, both of these agents may decrease systemic vascular resistance and BP. Accordingly, the latter parameter should be carefully monitored to ensure that excessive falls in BP and RV coronary perfusion pressure do not occur. Whereas in certain conditions volume expansion is appropriate therapy to increase CO, in acute pulmonary hypertension with excessive RV afterload, volume expansion may worsen RV function. Recent canine studies indicate that an increase in vascular closing pressure is the predominant mechanism explaining the increase in PAP and apparent increase in PVR complicating pulmonary embolism. Accordingly, in addition to decreasing vascular resistance, therapy to decrease RV afterload could be directed toward decreasing the vascular response producing excessive closing pressures. Ref ID : DUCAS1992 299. Ducas, J., Stitz, M., Gu, S., Schick, U., and Prewitt, R.M. Pulmonary vascular pressure-flow characteristics. Effects of dopamine before and after pulmonary embolism. Am.Rev.Respir.Dis. 146:307-312, 1992. Keywords : PULMONARY EMBOLISM; EMBOLISM; CANADA; HEMODYNAMICS; DOGS; PULMONARY HYPERTENSION; Hypertension; CARDIAC; CARDIAC OUTPUT; Injections; EMBOLI; ARTERY; Pressure; VASCULAR RESISTANCE; drugs; ANIMAL; COMPARATIVE STUDY; Support,Non-U.S.Gov't; Cardiac Output,Low ,Drug Therapy ,DT; Dobutamine ,Therapeutic Use ,TU; Dopamine ,Therapeutic Use ,TU; Hypertension,Pulmonary ,Drug Therapy ,DT; Pulmonary Circulation ,Drug Effects ,DE; Pulmonary Embolism ,Complications ,CO; Pulmonary Wedge Pressure ,Drug Effects ,DE; Cardiac Output,Low ,Etiology ,ET Cardiac Output,Low ,Physiopathology ,PP; disease models,animal; Dobutamine ,Administration and Dosage ,AD Dobutamine ,Pharmacology ,PD; Dopamine ,Administration and Dosage ,AD Dopamine ,Pharmacology ,PD; DRUG SCREENING; Embolization,Therapeutic ,Standards ,ST; Heart Rate ,Drug Effects ,DE; Hypertension,Pulmonary ,Etiology ,ET Hypertension,Pulmonary ,Physiopathology ,PP; Stroke Volume ,Drug Effects ,DE; Vascular Resistance ,Drug Effects ,DE; ab; in; co; blood; is; an Notes : CS- Department of Medicine, University of Manitoba Health Sciences Centre, Winnipeg, Canada AB- We compared the general hemodynamic effects of dopamine and dobutamine in dogs with acute pulmonary hypertension complicated by a decrease in cardiac output (CO). The pulmonary hypertension was induced by injection of autologous blood clot. Emboli markedly increased mean pulmonary artery pressure (Ppa) and decreased CO (both p < 0.001). Both dopamine and dobutamine increased CO 50% (p < 0.05) and decreased pulmonary vascular resistance (PVR) (p < 0.05), calculated as (PAP - left ventricular end diastolic pressure)/CO. Mean PVR (mm Hg/L/min) decreased from 16.1 to 12.4 with dopamine and from 16. to 11.9 with dobutamine, both p < 0.05. Ventricular filling pressures were not affected. In another 12 dogs we investigated the effects of both drugs on pulmonary pressure-flow (P-Q) characteristics. P-Q characteristics were determined in dogs with normal Ppa values and in those with embolic pulmonary hypertension. The slope of the P-Q relationship defines the incremental vascular resistance and the extrapolated pressure intercept, the effective vascular outflow pressure. All P-Q relationships were described well by a linear equation. Despite significant systemic effects in both groups and despite a decrease in PVR with both drugs in embolized dogs, neither drug significantly affected pulmonary P-Q characteristics. The discrepancy between PVR and incremental resistance is explained by an incorrect assumption in PVR that the left ventricular filling pressure is the effective vascular outflow pressure. We conclude that both before and after the induction of pulmonary hypertension, both dopamine and dobutamine improve CO without affecting pulmonary vascular tone. Ref ID : DUCKERT1975 300. Duckert, F., Muller, G., Nyman, D., Benz, A., Prisander, S., Madar, G., Da Silva, M.A., Widmer, L.K., and Schmitt, H.E. Treatment of deep vein thrombosis with streptokinase. Brit.Med.J. 1:479-481, 1975. Keywords : TREATMENT; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; STREPTOKINASE; DVT; THROMBOLYSIS; HEPARIN; COUMADIN; RESOLUTION; INCIDENCE; PULMONARY EMBOLISM; EMBOLISM; VEINS; VENOGRAPHY; LYSIS; Venogram; in Notes : 145 patients with DVT were treated with streptokinase and 42 patients considered unfit for thrombolysis were treated with heparin and coumadin. 93 of the streptokinase patients and all of the heparin patients had repeated venograms within 2 weeks. Good clot resolution was seen in 42% of streptokinase patients but in none of the heparin patients. Moderate clot resolution was seen in 25% of the streptokinase patients and in 10% of the heparin patients. No improvement was seen in 32% of streptokinase patients and in 88% of the heparin patients. There was no significant difference in the incidence of pulmonary embolism during treatment with heparin or streptokinase. ot different for the streptokinase group. Ref ID : DUKIC1989A 301. Dukic, V. [Venous surgery]. Acta Chir.Iugosl. 36 Suppl 1:181-191, 1989. Keywords : NASP; ACUTE DISEASE; HUMAN; SCLEROTHERAPY; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Hirurgija vena AB - [No Abstract Available] UI - 90143311. Ref ID : DUMPE1971 302. Dumpe, E.P., Konstantinova, G.D., and Skvortsov, A.S. [Lymphography in patients with edema and trophic disorders of the skin of the extremities]. Vestn.Khir. 107:70-75, 1971. Keywords : Edema; Skin; NASP; ADULT; English Abstract; Extremities; FEMALE; HUMAN; Leg Ulcer; Lymphedema; Lymphography; MALE; MIDDLE AGE; SUBCLAVIAN VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Limfografiia u bol'nykh otekami i troficheskimi narusheniiami kozhi konechnostei AB - [No Abstract Available] UI - 72134860. Ref ID : DUNBAR1990 303. Dunbar, E.M., Fox, R., Watson, B., and Akrill, P. Successful late treatment of venous air embolism with hyperbaric oxygen. Postgrad.Med.J. 66:469-470, 1990. Keywords : 951202; LATE; TREATMENT; VENOUS; Air; EMBOLISM; OXYGEN; is; THERAPY; Cerebral; CASE REPORT; embolism,air; et; th; hemodialysis; ae; HUMAN; Hyperbaric Oxygenation; MALE; MIDDLE AGE; TIME FACTORS; Medline File; Tropical Medicine; Hospitals Notes : A case of haemodialysis-associated venous air embolism is described. The patient commenced hyperbaric oxygen therapy 21 hours after the event when, despite appearing decerebrate, he made a complete recovery. This case underlines the importance of all clinicians being aware of those centres with facilities for hyperbaric therapy and the need to refer all patients with cerebral air embolism even following a prolonged delay Department of Infectious Diseases and Tropical Medicine Monsall Hospital Newton Heath Manchester UK. Ref ID : DUNCAN1991 304. Duncan, B.W., Adzick, N.S., Longaker, M.T., Edwards, J.R., Nelson, R.M., and Koerper, M.A. In utero arterial embolism from renal vein thrombosis with successful postnatal thrombolytic therapy. J.Pediatr.Surg. 26:741-743, 1991. Keywords : ARTERIAL; EMBOLISM; vein; THROMBOSIS; THROMBOLYTIC; THERAPY; ACEP93; VEINS; in; renal veins Ref ID : DUNMIRE1989 305. Dunmire, S.M. Pulmonary Embolism. Emerg.Med.Clin.N.Am. 7:339, 1989. Keywords : PULMONARY EMBOLISM; EMBOLISM Ref ID : DUNMIRE1995 306. Dunmire, S.M. Thromboembolic Diseases. Foresight (36):1-8, 1995. Keywords : 96-suzy-002; THROMBOEMBOLIC; EMERGENCY; in; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; DVT; is; Mimic; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; PE; an; hospitalization; DEATH; EARLY; MANAGEMENT; MORTALITY; RISK; POSTPARTUM; TRAUMA; laboratories; diagnostics; TREATMENT Notes : 01-02-96. Abstract : Patients who present to the emergency department with thromboembolic conditions often represent significant clinical challenges. In many cases, deep venous-thrombosis (DVT) is silent or mimics other clinical conditions until a catastrophic event occurs. The diagnosis of pulmonary embolism (PE) also can be elusive even for the experienced physician. Annually, up to 2.5 million people develop DVT; 25% of them will also have PE, so it is inevitable that these patients will comprise a substantial part of our patient volume.1,2 Despite efforts to prevent DVT and PE, these conditions combined account for an estimated 300,000 to 600,000 hospitalizations annually, and almost 100,000 deaths from PE alone.3,4 Early diagnosis and management can reduce overall mortality rates by 8%, compared with 30% when the diagnosis is delayed.4-7 Approximately 10% of patients with acute PE die within the first hour of the onset of symptoms.4 Patients populations known to be at risk for thromboembolic disease include postpartum patients, patients with malignant conditions, and trauma patients. The emergency department presentation of a thromoembolic condition, however, may not always be so conspicuous. The patient's complaints, physical findings, and routine laboratory data often are not sensitive or specific for thromboembolic conditions.8-10 This issue of Foresight will present clinical scenarios involving patients who have thromboembolic conditions. Advance in diagnostic and therapeutic approaches will be highlighted. The reader should come away with heightened awareness of the presentation, evaluation, and treatment of these potentially life- threatening conditions. Ref ID : EARNSHAW1988 307. Earnshaw, J.J., Westby, J.C., Gregson, R.H., Makin, G.S., and Hopkinson, B.R. Local thrombolytic therapy of acute peripheral arterial ischaemia with tissue plasminogen activator: a dose-ranging study. Brit.J.Surg. 75:1196-1200, 1988. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ARTERIAL; PLASMINOGEN; PLASMINOGEN ACTIVATOR; ACEP93 Ref ID : EARNSHAW1989 308. Earnshaw, J.J., Gregson, R.H., Makin, G.S., and Hopkinson, B.R. Acute peripheral arterial ischemia: a prospective evaluation of differential management with surgery or thrombolysis. Ann.Vasc.Surg. 3:374-379, 1989. Keywords : ARTERIAL; ARTERIAL ISCHEMIA; PROSPECTIVE; MANAGEMENT; SURGERY; THROMBOLYSIS; ACEP-93; ACEP93; Ischemia Ref ID : EARNSHAW1990A 309. Earnshaw, J.J. and Shaw, J.F. Survey of the use of thrombolysis for acute limb ischaemia in the UK and Ireland. Brit.J.Surg. 77:1041-1042, 1990. Keywords : THROMBOLYSIS; ACEP93; in Ref ID : EARNSHAW1991 310. Earnshaw, J.J. Thrombolytic therapy in the management of acute limb ischaemia. Brit.J.Surg. 78:261-269, 1991. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MANAGEMENT; REVIEW; THROMBOLYSIS; ACEP93; HISTORICAL PERSPECTIVE; REVIEW ARTICLE; STREPTOKINASE; UROKINASE; TPA; in Notes : Excellent review with good historical discussion of thrombolysis. Ref ID : EARNSHAW1993 311. Earnshaw, J.J., Scott, D.J., Horrocks, M., and Baird, R.N. Choice of agent for peripheral thrombolysis. Brit.J.Surg. 80:25-27, 1993. Keywords : THROMBOLYSIS; ACEP93 Ref ID : EBELL1994 312. Ebell, M.H. Low molecular weight heparins for DVT. J.Fam.Pract. 39:501-502, 1994. Keywords : LMWH; Low-Molecular-Weight-Heparin; Low molecular weight heparin; Molecular Weight; HEPARIN; DVT Ref ID : EDWARDS1937 313. Edwards, E.A. and Edwards, J.E. Unknown. Surg.Gynecol.Obstet. 65:310, 1937. Keywords : THROMBOSED; VEINS; VENOUS; VENOUS VALVES; DEEP VEIN THROMBOSIS; RECANALIZATION; in Notes : The recanalization of thrombosed deep veins results in the destruction of the venous valves. Ref ID : EDWARDS1938 314. Edwards, E.A. Thrombophlebitis of varicose veins. Gynecol.Obstet. 60:236, 1938. Keywords : THROMBOPHLEBITIS; varicose; VARICOSE VEINS; VEINS; NASP; vein; bib-2 Ref ID : EISENBERG1992 315. Eisenberg, P.R. Role of heparin in coronary thrombolysis. Chest 101:131S-139S, 1992. Keywords : HEPARIN; THROMBOLYSIS; LYSIS; THROMBOSIS; FIBRINOLYTIC; THROMBIN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; t-PA; EARLY; CLINICAL TRIAL; TREATMENT; SURVIVAL; STREPTOKINASE; MORTALITY; DOSAGE; ANTICOAGULATION; SUBCUTANEOUS; THERAPY; INTRAVENOUS; MYOCARDIAL INFARCTION; THROMBOLYTIC THERAPY; DRUG THERAPY COMBINATION; FIBRINOLYSIS; FIBRINOLYTIC AGENTS; HUMAN; TREATMENT OUTCOME; REVIEW; REVIEW TUTORIAL; in; coronary artery; ARTERY; is; coronary thrombosis; CLINICAL TRIALS; intravenous heparin; infarction Notes : AB-Although the benefits of coronary thrombolysis are well established, the optimal therapeutic strategy for ensuring rapid and sustained coronary artery patency remains controversial. The available data suggest that the success of coronary thrombolysis depends not only on the induction of clot lysis, but also on the extent to which procoagulant activity that promotes recurrent thrombosis is inhibited. Procoagulant activity increases almost immediately in patients treated with fibrinolytic agents, and persistent increases in thrombin activity have been associated with recurrent coronary thrombosis. Heparin administered intravenously appears to markedly attenuate the thrombin activity associated with thrombolysis and, in patients treated with tissue plasminogen activator (t-PA), prevents early recurrent coronary thrombosis. The results of clinical trials of coronary thrombolysis indicate that conjunctive treatment of patients with heparin improves survival compared with treatment with fibrinolytic agents alone. Although recent clinical trials in which patients were treated with streptokinase suggested that 12, 500 units of heparin administered subcutaneously twice daily decreases mortality, this dosage regimen does not induce therapeutic levels of anticoagulation within the first 24 h in most patients. The failure to achieve early therapeutic anticoagulation may account for the lack of mortality benefit in trials in which patients given t-PA were treated with conjunctive subcutaneous heparin therapy. Thus, the available experimental and clinical data suggest that intravenous heparin should be given to patients treated with fibrinolytic agents for acute myocardial infarction. Ref ID : ELBAZ1982 316. Elbaz, C. [Perforating veins]. Phlebologie. 35:551-559, 1982. Keywords : PERFORATING VEINS; VEINS; TREATMENT; POST-PHLEBITIC; Syndrome; SURGERY; POST PHLEBITIC SYNDROME; Doppler; PHLEBOGRAPHY; NASP; POSTPHLEBITIC SYNDROME; English Abstract; HUMAN; RECURRENCE; SAPHENOUS VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; de; ab; in; physiopathology; varicose; is Notes : TT - A propos des perforantes AB - The role of the perforating veins in the physiopathology and treatment of varicose disorder and of post-phlebitic syndromes is the subject of this study, based on the results of 5 000 observations of surgery of the veins in the lower limbs. Neglect of the perforators is responsible for a sizeable percentage of relapse after the simple stripping of the saphenous axes. In post-phlebitic syndrome and, more particularly, in trophic disorders, they play a major part, and ought to be the object of thorough investigation, using clinical examination, the Doppler and phlebography UI - 82275484. Ref ID : ELEGBELEYE1975 317. Elegbeleye, O.O. and Femi-pearse, D. Pulmonary embolism in Africans. Trop.Geogr.Med. 27:31-33, 1975. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; AUTOPSY; Hospitals; INCIDENCE; MORTALITY; is; heart; heart diseases; sex; AGE; SURGICAL; PROSPECTIVE; PROSPECTIVE STUDIES; Adolescence; ADULT; africa; Age Factors; AGED; CHILD; Child,Preschool; Contraceptives,Oral; ae; FEMALE; co; HUMAN; Infant; MALE; Medical Records; MIDDLE AGE; Postoperative Complications; et; ep; mo; Sex Factors; support,u.s.gov't,non-p.h.s. Tetanus; Medline File; Health Planning & Administration File Notes : The clinical and autopsy records of 54 cases of pulmanary embolism seen at the Lagos University Teaching Hospital over the period 1966- 1972 are analysed. The incidence of pulmonary embolism during this period was 0.1 per cent of all patients admitted, and there was a 78 per cent mortality. The primary medical condition associated with pulmonary embolism is heart disease. Sex has little influence on the liability to pulmonary embolism. Age has a pronounced influence, the incidence increases steadily after the age of 40. Medical cases are more liable than surgical cases to suffer from pulmonary embolism in each age group. The view is expressed that pulmonary embolism is not rare in Africans. Our results support the opinion that the possession of the haemoglobin S predisposes although the final veridct must await the result of a larger prospective study. Ref ID : ELIAS1991 318. Elias, A. [Venous Doppler echography in acute pulmonary embolism]. Presse.Med 20:1499-1505, 1991. Keywords : Doppler; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LATE; vein; PHLEBOGRAPHY; Ultrasonography; THROMBUS; Plethysmography; THROMBI; Ultrasonics; Duplex; SCANNING; DIAGNOSIS; TECHNIQUES; CARDIAC; THROMBOEMBOLISM; sdi-11/93; in; is Notes : In patients with clinically suspected pulmonary embolism, the signs and symptoms of venous thrombosis are late, insensitive and non specific. Detection of vein thrombosis requires more objective tests: (1) anatomical such as phlebography and ultrasonography which directly visualize the thrombus; the latter has the advantage of being non invasive and of providing a means to study extravascular structures as well as functional information, especially when combined with doppler velocimetry; (2) haemodynamic tests such as doppler and plethysmography which show impairment on venous return. These indirect tests are less reliable for detecting non occlusive and distal thrombi and are less specific than phlebography. Compared with phlebography, ultrasonic duplex scanning is very reliable and competitive for diagnosis and exact localization of the thrombosis, irrespective of its site (distal or proximal), its extent (isolated or extensive) and the degree of obstruction (partial or complete). However to be fully efficient, this technique must be performed by a trained specialist using specific equipment; it must always include doppler examination and explore the entire venous network. In addition, this technique makes it possible to explore the inferior and superior caval systems and the cardiac structures on the path of the migrating thrombus. Like phlebography, ultrasonography indicates venous thromboembolism only when it is positive; negative results do not exclude the diagnosis. Ref ID : ELKOURI1993 319. el Kouri, D., De Faucal, P., Raffi, F., and Planchon, B. [Septic Campylobacter fetus thrombophlebitis: a new case]. Rev.Med Interne. 14:41-42, 1993. Keywords : THROMBOPHLEBITIS; DIAGNOSIS; SEPTIC; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; INFECTION; HEPARIN; THERAPY; sdi-11/93; is; in Notes : The diagnosis of septic thrombophlebitis is difficult and often delayed, but it must be borne in mind in all cases of venous thrombosis accompanied by signs of local and/or systemic infection, or deteriorating under heparin therapy. We report a case of septic thrombophlebitis caused by Campylobacter fetus subspecies fetus. The characteristic features, obtained from the literature, of septic thrombophlebitis caused by Campylobacter spp are presented. Ref ID : ELLERBROEK1971 320. Ellerbroek, U. and Trede, H. [Roentgenologic changes of the lower leg in chronic leg diseases]. Fortschr.Geb.Rontgenstr.Nuklearmed. 115:590-595, 1971. Keywords : LEG; CHRONIC; NASP; AGED; Chronic Disease; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; Periostitis; SCLEROSIS; THROMBOPHLEBITIS; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; VEINS; Medline File; in; ab Notes : TT - Rontgenologische Verandungen am Unterschenkel bei chronischen Beinleiden AB - [No Abstract Available] UI - 72092843. Ref ID : ELLIOT1979 321. Elliot, M.S., Immelman, E.J., Jeffrey, P.C., Benatar, S.R., Funston, M.R., Smith, J.A., Shepstone, B.J., Ferguson, A.D., Jacobs, P., Walker, W., and Louw, J.H. A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: an interim report of a prospective trial. Brit.J.Surg. 66:838-843, 1979. Keywords : HEPARIN; STREPTOKINASE; TREATMENT; VENOUS; THROMBOSIS; PROSPECTIVE; PULMONARY EMBOLISM; RANDOMIZED; in; VENOUS THROMBOSIS; an Ref ID : ELLIOTT1994 322. Elliott, C.G., Hiltunen, S.J., Suchyta, M., Hull, R.D., Raskob, G.E., Pineo, G.F., Jensen, R.L., Yeates, S., and Kitterman, N. Physician-guided treatment compared with a heparin protocol for deep vein thrombosis. Arch.Intern.Med. 154:999-1004, 1994. Keywords : TREATMENT; HEPARIN; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; THERAPY; partial thromboplastin time; THROMBOPLASTIN; APTT; RISK; VENOUS; THROMBOEMBOLISM; BLEEDING; COMPLICATIONS; ANTICOAGULANT; INCIDENCE; Methods; AGE; RISK FACTORS; analysis; MANAGEMENT; an; confidence intervals Notes : BACKGROUND: Effective heparin therapy, defined by therapeutic prolongation of the activated partial thromboplastin time (APTT), decreases the risk of recurrent venous thromboembolism. Achieving therapeutic prolongation of the APTT within 24 hours of the start of heparin therapy has proved difficult. We hypothesized that a protocol that delivered high initial heparin infusions to patients without identifiable risk for bleeding complications would decrease the time to achieve a therapeutic anticoagulant effect without increasing the incidence of major bleeding complications. METHODS: To test this hypothesis, we studied concurrent patient cohorts. We defined a therapeutic anticoagulant effect (APTT > 55 seconds) to be an APTT more than 1.5 times the upper limit of normal. Twenty patients with acute symptomatic deep vein thrombosis received a 5000-U heparin bolus, followed by 1680 U/h (low risk to bleed) or 1240 U/h (high risk to bleed), adjusted by protocol-directed response to APTT results. Forty- eight patients with deep vein thrombosis were treated by their physicians. The Kaplan-Meier method was used to examine the proportion of patients who achieved an APTT greater than 55 seconds as a function of time. RESULTS: The two study cohorts did not differ with respect to age, weight, or risk factors for venous thromboembolism. Analysis of Kaplan-Meier curves showed that the heparin protocol decreased the time to achieve a therapeutic anticoagulant effect (P = .025). Ten (91%) of 11 patients (95% confidence interval, 59% to 100%) without risks to bleed who were treated by the heparin protocol and 29 (60%) of 48 patients (95% confidence interval, 45% to 74%) not treated by the protocol had an initial therapeutic APTT (P = .006). CONCLUSION: A protocol that delivers higher initial heparin infusions to patients without identifiable risks for bleeding decreases the time needed to achieve therapeutic prolongation of APTT, when compared with nonprotocol physician management. Ref ID : EMILE1993 323. Emile, J.F., Rambaud, C., Canioni, D., Jaubert, F., Brousse, N., and Ch‰ron, G. [Myxoma of the pulmonary infundibulum as the cause of sudden death in an 18-month-old infant]. Arch.Fr.Pediatr. 50:323-325, 1993. Keywords : CAUSE; SUDDEN DEATHS; DEATH; CARDIAC; CASE REPORT; POSTMORTEM; Edema; EMBOLI; HISTOLOGICAL; EMBOLISM; PATHOLOGIC; sdi- 11/93; in; an; is; resuscitation; Pulmonary emboli; blood Notes : BACKGROUND. Myxoma, a benign cardiac tumor, develops in intracavitary locations. It is most frequent in the left atrium, but rare in the pulmonary infundibulum. CASE REPORT. An 18 month-old girl suddenly became cyanotic during playing and lost consciousness. Resuscitation was ineffective. Post-mortem examination showed diffuse pulmonary edema and multiple small pulmonary emboli. There was a myxoma of the septal wall of pulmonary infundibulum and histological examination showed that the infundibulum and the pulmonary valve were completely infiltrated by myxoid tissue. CONCLUSION. The death of this girl was probably due to a sudden embolism of blood clots developed in contact with the myxoma. This case emphasizes the need for pathologic investigation in all cases of sudden death. Ref ID : ENCK1985 324. Enck, R.E. and Rios, C.N. Tamoxifen treatment of metastatic breast cancer and antithrombin III levels. Cancer 53:2607-2609, 1985. Keywords : TREATMENT; CANCER; ANTITHROMBIN III; RISK; DVT; PE; ANTICOAGULANT; ANTICOAGULANTS Notes : Chemotherapy increases the risk of DVT and PE above and beyond the risk associated with the underlying cancer. Several mechanisms for this effect have been demonstrated. Some agents, like tamoxifen, act to decrease circulating anticoagulants such as antithrombin III. Ref ID : EPSTEIN1960 325. Epstein, F.H. An epidemiological study in a total community. The Tecumseh Project. Univ. Mich.Med. Bull. 26:307, 1960. Keywords : an; in; THROMBOEMBOLIC; MORBIDITY; MORTALITY Notes : In the Tecumseh community health study, thromboembolic disease was responsible for approximately half of all obstetric morbidity and mortality. Ref ID : ERDMAN1990 326. Erdman, W.A., Jayson, H.T., Redman, H.C., Miller, G.L., Parkey, R.W., and Peshock, R.W. Deep venous thrombosis of extremities: role of MR imaging in the diagnosis. Radiology. 174:425-431, 1990. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Extremities; MR; DIAGNOSIS; NONINVASIVE; TECHNIQUES; DVT; vein; CHRONIC; PROSPECTIVE; CONTRAST; VENOGRAPHY; SENSITIVITY; SPECIFICITY; THROMBUS; UPPER EXTREMITY; Chronic Disease; SCREENING; sdi- 11/93; in; MAGNETIC RESONANCE; abnormalities; is Notes : Current noninvasive imaging techniques for diagnosis of deep venous thrombosis (DVT) of extremities are limited in their ability to demonstrate central vein involvement and to distinguish acute from chronic changes. The utility of spin-echo magnetic resonance (MR) imaging for DVT was evaluated in 100 patients suspected of having either upper- (n = 25) or lower-extremity (n = 75) DVT. Ninety-seven patients were imaged successfully. In a subset of 36 patients, prospective comparison of MR imaging with contrast venography revealed a sensitivity of 90%, specificity of 100%, and Kappa level of agreement of .752 (P less than .0001). MR imaging showed more central extent of thrombus than did venography in all five patients with upper-extremity DVT and in 13 of 25 patients (52%) with lower-extremity DVT. Although all patients in the study were evaluated for acute symptoms, 13 of 59 (22%) MR imaging studies positive for DVT demonstrated chronic disease. MR images demonstrated ancillary abnormalities in 18 of 41 (44%) patients who did not have DVT. Thus, MR imaging has a role as the definitive examination when the results of initial screening studies are unsatisfactory, or as a first-line examination if (a) there is suspicion of upper-extremity or pelvic vein thrombosis, (b) there is a history of prior DVT that necessitates distinction of acute from chronic changes, or (c) other tests are unavailable. Ref ID : ERDMAN1990A 327. Erdman, W.A. and Parkey, R.W. MR imaging of deep venous thrombosis [letter; comment]. AJR.Am J Roentgenol. 155:897, 1990. Keywords : MR; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; sdi-11/93 Ref ID : ERIKSSON1993 328. Eriksson, B.I., K:alebo, P., and Risberg, B. Clinical experience of a low molecular weight heparin (Fragmin) in the prevention of thromboembolism after total hip replacement. Semin.Thromb.Hemost. 19 Suppl 1:122-127, 1993. Keywords : Low molecular weight heparin; Molecular Weight; HEPARIN; PREVENTION; THROMBOEMBOLISM; HIP; HIP REPLACEMENT; sdi-11/93; in Ref ID : EROL1993 329. Erol, C. and Candan, I. Non-invasive methods in the diagnosis of chronic major-vessel thromboembolic pulmonary hypertension. Eur.Heart J 14:1004-1005, 1993. Keywords : NONINVASIVE; Methods; DIAGNOSIS; CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; CT; MRI; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; SURGERY; sdi-11/93; in Notes : The diagnosis of chronic major-vessel thromboembolic pulmonary hypertension was made in a 63-year-old man by noninvasive methods (Echo, CT, MRI) and confirmed by pulmonary angiography and surgery. All these methods proved very useful in detecting and defining this rare entity. Ref ID : ESKELAND1966 330. Eskeland, G., Solhemin, K., and Skjorten, F. Anticoagulant prophylaxis, thromboembolism and mortality in elderly patients with hip fractures. Acta.Chir.Scand. 131:16-29, 1966. Keywords : ANTICOAGULANT; PROPHYLAXIS; THROMBOEMBOLISM; MORTALITY; HIP; SURGERY; PE; DEATH; FRACTURES; in; hip fractures; Orthopedic Notes : Other studies have shown that in patients undergoing elective orthopedic surgery, PE occurs in 5 to 10 percent of cases; 46 percent of all deaths in these patients were due to PE. Ref ID : ETCHELLS1993 331. Etchells, E.E., Wong, D.T., Davidson, G., and Houston, P.L. Fatal cerebral fat embolism associated with a patent foramen ovale. Chest 104:962-963, 1993. Keywords : FATAL; Fat embolism; EMBOLISM; Foramen ovale; RESPIRATORY FAILURE; DEATH; FRACTURES; AUTOPSY; LUNG; MASSIVE; sdi-11/93; Cerebral; brain; in Notes : A healthy 22-year-old woman developed respiratory failure and brain death within 48 h of bilateral tibial fractures. Autopsy showed fat embolism in the lung and brain, and a large patent foramen ovale that may have contributed to massive cerebral fat embolism. Ref ID : EVANS1992 332. Evans, A.J., Sostman, H.D., Knelson, M.H., Spritzer, C.E., Newman, G.E., Paine, S.S., and Beam, C.A. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography. AJR 161:131-139, 1992. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROSPECTIVE; MR; CONTRAST; VENOGRAPHY; DVT; MRI; Pelvis; Thigh; CALF; in Notes : 61 consecutive patients were prospectively evaluated for suspected DVT using venography and MRI. Compared to venography, MR imaging was 100% sensitive in the pelvis and thigh and was 87% sensitive in the calf. Ref ID : EVANS1993 333. Evans, A.J., Sostman, H.D., Knelson, M.H., Spritzer, C.E., Newman, G.E., Paine, S.S., and Beam, C.A. 1992 ARRS Executive Council Award. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography. AJR.Am J Roentgenol. 161:131-139, 1993. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROSPECTIVE; MR; CONTRAST; VENOGRAPHY; PROSPECTIVE STUDIES; DIAGNOSIS; Methods; DEEP VENOUS THROMBOSIS; Pelvis; SENSITIVITY; SPECIFICITY; Thigh; CALF; sdi- 11/93; standards; in; confidence intervals; is Notes : OBJECTIVE. Preliminary reports have described the use of MR imaging for the detection of deep venous thrombosis. However, no prospective study comparing MR imaging with contrast venography (the gold standard) has been reported. Accordingly, we performed a prospective, blinded study of the efficacy of MR imaging in 61 consecutive patients with clinically suspected deep venous thrombosis. In cases of disagreement, additional testing was performed to determine the diagnosis. SUBJECTS AND METHODS. From June 1991 to February 1992, 61 patients with clinically suspected deep venous thrombosis were examined with venography and MR imaging. The average time between studies was 3 hr. In 21 of the 61 patients, the final diagnosis was deep venous thrombosis. RESULTS. For detection of deep venous thrombosis in the pelvis, the sensitivity of MR imaging was 100% (9/9) with a 95% confidence interval of 72-100% and the specificity was 95% (52/55) with a 95% confidence interval of 85-99%. In the thigh, the sensitivity (16/16) and specificity (43/43) were both 100% with 95% confidence intervals of 83-100% and 93-100%, respectively. In the calf, the sensitivity was 87% (13/15) with a 95% confidence interval of 60-98% and the specificity was 97% (36/37) with a 95% confidence interval of 86- 100%. CONCLUSION. We found no statistically significant difference between MR imaging and contrast venography in the detection of deep venous thrombosis. This result suggests that MR imaging is at least as sensitive and specific as contrast venography in the detection of deep venous thrombosis. Ref ID : EVANS1993A 334. Evans, A.J., Sostman, H.D., Knelson, M.H., Spritzer, C.E., Newman, G.E., Paine, S.S., and Beam, C.A. 1992 ARRS Executive Council Award. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography. AJR.Am.J.Roentgenol. 161:131-139, 1993. Keywords : PHLEBITIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROSPECTIVE; MR; CONTRAST; VENOGRAPHY; COMPARATIVE STUDY; FEMALE; HUMAN; LEG; blood supply; magnetic resonance imaging; MALE; MIDDLE AGE; PHLEBOGRAPHY; PROSPECTIVE STUDIES; sensitivity and specificity; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; DIAGNOSIS; radiography; Methods; DEEP VENOUS THROMBOSIS; Pelvis; SENSITIVITY; SPECIFICITY; Thigh; CALF; standards; in; confidence intervals; is Notes : OBJECTIVE. Preliminary reports have described the use of MR imaging for the detection of deep venous thrombosis. However, no prospective study comparing MR imaging with contrast venography (the gold standard) has been reported. Accordingly, we performed a prospective, blinded study of the efficacy of MR imaging in 61 consecutive patients with clinically suspected deep venous thrombosis. In cases of disagreement, additional testing was performed to determine the diagnosis. SUBJECTS AND METHODS. From June 1991 to February 1992, 61 patients with clinically suspected deep venous thrombosis were examined with venography and MR imaging. The average time between studies was 3 hr. In 21 of the 61 patients, the final diagnosis was deep venous thrombosis. RESULTS. For detection of deep venous thrombosis in the pelvis, the sensitivity of MR imaging was 100% (9/9) with a 95% confidence interval of 72-100% and the specificity was 95% (52/55) with a 95% confidence interval of 85-99%. In the thigh, the sensitivity (16/16) and specificity (43/43) were both 100% with 95% confidence intervals of 83-100% and 93-100%, respectively. In the calf, the sensitivity was 87% (13/15) with a 95% confidence interval of 60-98% and the specificity was 97% (36/37) with a 95% confidence interval of 86- 100%. CONCLUSION. We found no statistically significant difference between MR imaging and contrast venography in the detection of deep venous thrombosis. This result suggests that MR imaging is at least as sensitive and specific as contrast venography in the detection of deep venous thrombosis. Ref ID : EZEKOWITZ1990 335. Ezekowitz, M.D., Migliaccio, F., Farlow, D., Pope, C., Denny, D., Markowitz, D., Hammers, L., Ali, A., and Hirsh, J. Comparison of platelet scintigraphy, impedance plethysmography gray scale and color flow duplex ultrasound and venography for the diagnosis of venous thrombosis. Prog.Clin.Biol.Res. 355:23-7:23-27, 1990. Keywords : 951217; PLATELET; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; color; Duplex; ULTRASOUND; VENOGRAPHY; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; TECHNIQUES; in; IPG; Hospitals; CALF; SPECIFICITY; an; SENSITIVITY; Color-flow; diagnostics; Popliteal Vein; VEINS; Blood Platelets; COMPARATIVE STUDY; Double-Blind Method; Evaluation Studies; HUMAN; LEG; bs; PHLEBOGRAPHY; Plethysmography,Impedance; single-blind method; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; di; ri; us; Ultrasonography; mt; Medline File Notes : The several techniques available for the diagnosis of venous thrombosis have not been directly compared in the same patient population. Thus color and gray scale duplex ultrasound (U), impedance plethysmography (IPG), 3-4 hr platelet imaging (PS) were compared to venography (V), in 104 consecutive patients (in hospital and out). PS and V were read by two, and IPG and U by one, blinded reader. Comparisons were made for the calf (CA), popliteal (Pop) and femoral (Fem) vessels. Reproducibility of V and PS was 84 and 87%. (table; see text) We conclude that PS, while having a very high specificity, has an unacceptably low sensitivity. However, while both impedance plethysmography and color flow ultrasound have excellent and similar diagnostic accuracy in the femoral, these techniques have either a low sensitivity or low technical success rate in the calf or popliteal veins Department of Medicine Yale University School of Medicine. Ref ID : FAGERHOL1971 336. Fagerhol, M.K., Abildgaard, U., and Kornstad, L. Antithrombin III concentration and ABO blood groups. Lancet ii:664-665, 1971. Keywords : ANTITHROMBIN III; ABO; FACTOR VIII; THROMBOSIS; EMBOLISM; BLOOD GROUPS; blood; is Notes : There is some evidence that Type A blood is associated with lower levels of antithrombin III and higher levels of factor VIII than type O blood. Ref ID : FAGHER1990 337. Fagher, B., Ahlgren, M., and Astedt, B. Acute massive pulmonary embolism treated with streptokinase during labor and the early puerperium. Acta Obstet.Gynecol.Scand. 69:659-661, 1990. Keywords : EMBOLISM; PREGNANCY; MASSIVE; PULMONARY EMBOLISM; STREPTOKINASE; Labor; EARLY; Puerperium; Hospitals; Sweden; Pulmonary Circulation; HEPARIN; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; TREATMENT; Infant; HEMORRHAGE; PERFUSION; LUNG; SCAN; RESOLUTION; EMBOLI; CASE REPORT; FEMALE; HUMAN; Labor Complications ,Drug Therapy ,DT; Pregnancy Complications,Hematologic ,Drug Therapy ,DT; Pulmonary Embolism ,Drug Therapy ,DT; Streptokinase ,Therapeutic Use ,TU; ACUTE DISEASE; ADULT; Puerperal Disorders ,Drug Therapy ,DT; ab; in; blood Notes : CS- Department of Internal Medicine, University Hospital, Lund, Sweden AB- Acute massive pulmonary embolism occluding 60-70% of the pulmonary circulation occurred in a young primipara during the 28th week of pregnancy. She was critically ill despite 40 h of heparin infusion and thrombolytic therapy with streptokinase was initiated. After a 10-h infusion she went into labor and streptokinase treatment was stopped. One hour later she gave birth spontaneously to a preterm infant in footling breech delivery. The infant did well neonatally. Streptokinase infusion was recommenced 8 h after delivery. Because of increasing blood loss on the second day after delivery, streptokinase was withdrawn after a total treatment time of 29 h. Total hemorrhage amounted to 8.9 litres. Serial perfusion lung scans showed complete resolution of the emboli and normal lung function was restored. Ref ID : FALCINI1991 338. Falcini, F., Taccetti, G., Trapani, S., Tafi, L., Petralli, S., and Matucci-Cerinic, M. Primary antiphospholipid syndrome: a report of two pediatric cases. J.Rheumatol. 18:1085-1087, 1991. Keywords : PHLEBITIS; Syndrome; PEDIATRIC; antibodies; analysis; antiphospholipid syndrome; COMPLICATIONS; DIAGNOSIS; cardiolipins; immunology; CASE REPORT; CHILD; cranial sinuses; FEMALE; HUMAN; LEG; blood supply; lupus coagulation inhibitor; MALE; MYOCARDIAL INFARCTION; THROMBOPHLEBITIS; AGE; THROMBOCYTOPENIA; LUPUS; ANTICOAGULANT; Hypertension; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; THROMBOEMBOLIC; infarction; an; in; autoimmune diseases Notes : Two cases of primary antiphospholipid syndrome are described. A girl presented with myocardial infarction at the age of 6. afterward developed chorea, livedo reticularis, thrombocytopenia and circulating lupus anticoagulant (LAC). A boy, age 7, had an episode of intracranial hypertension and a deep venous thrombosis of a lower left limb, both recurrent in the following years. A high titer of IgG anticardiolipin antibodies (aCI) was detected. These observations suggest that both LAC and aCI tests should be performed in children with thromboembolic phenomena when the criteria for a definite autoimmune disease are lacking. Ref ID : FARQUHARSON1984 339. Farquharson, D.I. and Orr, J.W. Prophylaxis Against Thromboembolism in Gynecologic Patients. Clinical Prespectives. The Journal of Reproductive Medicine 29(12):845-862, 1984. Keywords : 96-suzy-002; PROPHYLAXIS; THROMBOEMBOLISM; in; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Pulmonary emboli; EMBOLI; POSTOPERATIVE; MORBIDITY; MORTALITY; Methods; REVIEW; is; RISK Notes : 01-03-96. Abstract : Deep venous thrombosis and pulmonary emboli remain a significant cases of postoperative morbidity and mortality in gynecologic patients. While numerous reports indicate the benefits of different prophylactic measures, no clear ``best'' method of prophylaxis has emerged. This review is intended to familiarized the practicing gynecologist with risk factors, methods of detection and risks and benefits associated with prophylactic regimens. Ref ID : FATTEH1973 340. Fatteh, A., Leach, W.B., and Wilkinson, C.A. Fatal air embolism in pregnancy resulting from orogenital sex play. Forensic Sci. 2:247-250, 1973. Keywords : FATAL; Air; EMBOLISM; PREGNANCY; Adolescence; embolism,air; mo; FEMALE; HUMAN; Pregnancy Complications; sex behavior; Medline File; in; sex Notes : [No Abstract Available]. Ref ID : FEGAN1971 341. Fegan, W.G. The complications of compression sclerotherapy. Practitioner. 207(242):797-799, 1971. Keywords : COMPLICATIONS; SCLEROTHERAPY; VEINS; THROMBOSIS; THROMBOEMBOLISM; SCLEROSANT; PULMONARY THROMBOEMBOLISM; COMPRESSION; vein; is; blood Notes : Fegan, one of the fathers of modern compression sclerotherapy, has stated that deep vein thrombosis and pulmonary thromboembolism are extremely rare complications (he cites only one known fatality) and postulates that this is because "the sclerosant... affects only the intima of the vein and not the blood" (as above). This we now know to be false. [statement of effects on circulating blood, etc.]. Ref ID : FEIED1991 342. Feied, C.F. Diagnosis and management of pulmonary embolism. Clinical Courier 9 (1):1-4, 1991. Keywords : DIAGNOSIS; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM Ref ID : FEIED1992 343. Feied, C.F. Pulmonary Embolism. In: Emergency Medicine: Concepts and clinical practice, edited by Rosen, P. and Barkin, R.M.St. Louis:Mosby Year Book, 1992,p. 1285-1311. Keywords : PULMONARY EMBOLISM; EMBOLISM; EMERGENCY MEDICINE; THROMBOSIS; REVIEW; DIAGNOSIS; TREATMENT; THROMBOLYSIS; EMERGENCY Ref ID : FEIED1992A 344. Feied, C.F. Pulmonary embolism: PIOPED & lytic therapy. Clinical Courier 10 (2):1-4, 1992. Keywords : PULMONARY EMBOLISM; EMBOLISM; PIOPED; LYTIC; THERAPY Ref ID : FEIED1993 345. Feied, C.F. Deep vein thrombosis: The risks of sclerotherapy in hypercoagulable states. Seminars in Dermatology 12(2):135-149, 1993. Keywords : DEEP VEIN THROMBOSIS; vein; THROMBOSIS; RISK; SCLEROTHERAPY; HYPERCOAGULABLE; VEINS; in Ref ID : FEIED1993A 346. Feied, C.F. Venous thromboembolism. Clinical Courier 11:1-4, 1993. Keywords : VENOUS; THROMBOEMBOLISM Ref ID : FEIED1994 347. Feied, C.F. Pulmonary chest pain, cor pulmonale, and pulmonary thromboembolism. In: Emergency Cardiac Care, edited by Aufderheide, T. and Gibler, B.New York:Mosby Year Book Co. 1994,p. 243-303. Keywords : CHEST; CHEST PAIN; PAIN; COR PULMONALE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; EMERGENCY; CARDIAC; PULMONARY EMBOLISM; PE Ref ID : FEIED1995 348. Feied, C.F., Miller, G.H., Stephen, J.M., and Handler, J.A. Chronic pulmonary embolism. Postgraduate Medicine 97(1):75-84, 1995. Keywords : CHRONIC; PULMONARY EMBOLISM; EMBOLISM Ref ID : FEIED1995A 349. Feied, C.F. Pulmonary embolism and thrombophlebitis. In: Essentials of Emergency Medicine, edited by Rund, D.A., Rosen, P., Barkin, R.M., and Sternbach, G.L.St. Louis:Mosby Book Co. 1995, Keywords : PULMONARY EMBOLISM; EMBOLISM; THROMBOPHLEBITIS; EMERGENCY; EMERGENCY MEDICINE Ref ID : FEIED1996 350. Feied, C.F. Pulmonary Embolism. In: Emergency Medicine: Concepts and clinical practice, edited by Rosen, P. and Barkin, R.M.St. Louis:Mosby Year Book, 1996, Keywords : PULMONARY EMBOLISM; EMBOLISM; EMERGENCY MEDICINE; THROMBOSIS; REVIEW; DIAGNOSIS; TREATMENT; THROMBOLYSIS; EMERGENCY Ref ID : FEIED1996A 351. Feied, C.F. Venous disease of the extremities. In: Emergency Medicine: Concepts and clinical practice, edited by Rosen, P. and Barkin, R.M.St. Louis:Mosby Year Book, 1996, Keywords : PULMONARY EMBOLISM; EMBOLISM; EMERGENCY MEDICINE; THROMBOSIS; REVIEW; DIAGNOSIS; TREATMENT; THROMBOLYSIS; EMERGENCY; VENOUS; Extremities Ref ID : FEIED1996B 352. Feied, C.F. Thrombophlebitis. In: Sclerotherapy, edited by Weiss, R.A. and Weiss, M.A.New York:McGraw Hill, 1996, Keywords : THROMBOPHLEBITIS; SCLEROTHERAPY Ref ID : FEIHL1990 353. Feihl, F. [The pathogenesis of decompression sickness]. Rev.Med.Suisse.Romande. 110:933-938, 1990. Keywords : 951202; PATHOGENESIS; atmospheric pressure; blood-air barrier; decompression sickness; pp; th; embolism,air; HUMAN; Hyperbaric Oxygenation; nitrogen; bl; Medline File; de Notes : [No Abstract Available] Institut de physiopathologie CHUV Lausanne. Ref ID : FENDRICK1994 354. Fendrick, A.M., Ridker, P.M., and Bloom, B.S. Improved health benefits of increased use of thrombolytic therapy. Arch.Intern.Med. 154(14):1605-1609, 1994. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MYOCARDIAL INFARCTION; UNITED STATES; Methods; OUTCOME; TREATMENT; standards; AGE; MORTALITY; SENSITIVITY; ASPIRIN; ELECTROCARDIOGRAM; CHEST; CHEST PAIN; PAIN; analysis; DEATH; infarction; in; is Notes : AN-94304300 AB-BACKGROUND: To quantify population health consequences of increased use of thrombolytic therapy for acute myocardial infarction in the United States. METHODS: A decision analytic model was constructed to evaluate treatment-related outcomes for two myocardial infarction treatment strategies: standard therapy and standard therapy plus combination aspirin-thrombolytic therapy. Patients were entered into the model by age, electrocardiographic presentation, and time to medical evaluation. Estimated mortality changes associated with increased use of thrombolytic therapy were calculated both for populations for which thrombolytic therapy is recommended and for specific patient populations for which thrombolytic therapy is not recommended under current guidelines. Sensitivity analyses tested the robustness of results when input variables were altered. RESULTS: If every patient with acute myocardial infarction for whom thrombolytic therapy is recommended under current guidelines were treated with aspirin and a thrombolytic agent, more than 4000 additional lives would be saved annually in the United States. The model projected that approximately 8000 additional lives could be saved if use of thrombolytic therapy were expanded to include the following patient groups: age greater than 75 years (approximately 4500 lives saved), left bundle-branch block on electrocardiogram (approximately 2500 lives saved), and presentation 6 to 12 hours after the onset of chest pain (approximately 2000 lives saved). Sensitivity analysis demonstrated a mortality advantage attributable to the use of thrombolytic therapy in each clinical scenario tested. CONCLUSIONS: Providing thrombolytic therapy more aggressively could prevent over 12,000 deaths from acute myocardial infarction each year in the United States. Ref ID : FENNERTY1988 355. Fennerty, A., Campbell, I.A., and Routledge, P.A. Anticoagulants in venous thromboembolism [see comments]. BMJ. 297:1285-1288, 1988. Keywords : ANTICOAGULANTS; VENOUS; THROMBOEMBOLISM; ANTICOAGULATION; DURATION; in Ref ID : FERRARI1992 356. Ferrari, E., Taillan, B., Leonetti, J., and Morand, P. [Echography as a diagnostic aid for pulmonary embolism (letter)]. Presse.Med 21:439, 1992. Keywords : diagnostics; PULMONARY EMBOLISM; EMBOLISM; sdi-11/93 Ref ID : FERREE1993 357. Ferree, B.A. and Wright, A.M. Deep venous thrombosis following posterior lumbar spinal surgery. Spine. 18:1079-1082, 1993. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SURGERY; POSTOPERATIVE; Duplex; SCAN; DVT; elastic compression stocking; COMPRESSION; STOCKINGS; PROPHYLAXIS; Intermittent pneumatic compression; INCIDENCE; DURATION; Rest; AGE; COMPLICATIONS; ANTICOAGULATION; sdi-11/93; PROSPECTIVE; Elastic Stockings; in; Pneumatic Notes : Postoperative duplex scans were performed on 185 patients undergoing posterior lumbar spinal surgery in order to identify deep venous thrombosis (DVT). Elastic compression stockings were used for prophylaxis in 74 patients (Group E.S.); intermittent pneumatic compression was used in the remaining 111 patients (Group P.C.). High- risk patients were not eliminated from either group. Laminectomy was performed on 84 patients (40 from Group E.S. and 44 from Group P.C.), and spinal fusion, on 101 patients (34 from Group E.S. and 67 from Group P.C.). A total of four patients, all from Group E.S., developed acute postoperative DVT. Intermittent pneumatic compression significantly reduced the incidence of acute postoperative DVT (P < 0.05). No statistically significant differences were found in the incidence of DVT in relation to the type of spinal procedure, length of procedure, duration of bed rest, or age of the patient. In conclusion, considering the low rate of DVT (2%) following posterior lumbar surgery and the potential complications of prophylactic anticoagulation, we continue to use intermittent pneumatic compression rather than elastic stockings for prophylaxis. Ref ID : FERRIS1992 358. Ferris, E.J. George W. Holmes Lecture. Deep venous thrombosis and pulmonary embolism: correlative evaluation and therapeutic implications. AJR.Am.J.Roentgenol. 159:1149-1155, 1992. Keywords : PHLEBITIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; ADULT; AGED; ANGIOGRAPHY; FEMALE; HUMAN; LEG; blood supply; LUNG; radionuclide imaging; MALE; PULMONARY ARTERY; radiography; DIAGNOSIS; THERAPY; THROMBOPHLEBITIS; CAUSE; MORBIDITY; MORTALITY; UNITED STATES; DEATH; OCCULT; Popliteal Vein; vein; Pulmonary emboli; EMBOLI; INDICATIONS; FILTER; COMPLICATION; Extremities; Femoral Vein; Pulmonary Circulation; D-DIMER; SCAN; Segmental; OCCLUSION; VEINS; in; is; renal veins Notes : Deep venous thrombosis and pulmonary embolism are significant causes of morbidity and mortality in the United States; estimates range from 120,000 to 150,000 deaths annually. Although usually symptomatic, deep venous thrombosis can be clinically occult, in part due to incomplete obstruction or in part related to duplication, triplication, and fenestration anomalies, primarily of the superficial femoral or popliteal vein. Additionally, pulmonary emboli caused by deep venous thrombosis may be clinically silent. Because of therapeutic implications, especially indications for insertion of inferior vena caval filters, comprehensive assessments of both the disease process (i.e., deep venous thrombosis) and the complication (i.e., pulmonary emboli) are important. Thus, when a pulmonary embolus is the presenting process, correlative assessment of deep venous thrombosis, even in the absence of symptoms or signs in the lower extremity, may be of therapeutic significance. Conversely, when deep venous thrombosis of the lower extremities involving the popliteal or superficial femoral vein is the presenting process, correlative assessment of the pulmonary circulation, even when no pulmonary symptoms or signs are present, may be of therapeutic significance. Relative to the diagnosis of pulmonary embolism, the roles of assays of D-dimer, ventilation-perfusion lung scans, and segmental occlusion studies of the pulmonary circulation are discussed. Finally, the indications for insertion of inferior vena caval filters above the renal veins are presented and examples are shown. Ref ID : FIESSINGER1990 359. Fiessinger, J.N. and Martelli, L. [Echography and venous pathology]. Rev.Prat. 40:2775-2778, 1990. Keywords : VENOUS; Ultrasonics; VEINS; SENSITIVITY; SPECIFICITY; DIAGNOSIS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; VENOUS THROMBOSIS; LEG; CALF; Ultrasonography; PHLEBOGRAPHY; PHLEBITIS; ULTRASOUND; varicose; varicose vein; TREATMENT; sdi-11/93; in; is Notes : When performed by a well-trained operator, ultrasonic exploration of the deep veins has a more than 90% sensitivity and specificity in the diagnosis of deep vein thrombosis. Despite technical problems in the ileal and sural regions, it is the first examination to be carried out in patients with clinical signs of venous thrombosis. In distal thrombosis of the leg and calf ultrasonography might even be more sensitive than phlebography. In superficial phlebitis ultrasounds can be used to evaluate the extent of thrombosis. In varicose vein disease, they are also a crucial element in the choice of treatment. Ref ID : FILIPECKI1994 360. Filipecki, S., Vertun-Baranowska, B., Rozycka, J., Tomkowski, W., and Polowiec, Z. [Evaluation of agreement between clinical and pathomorphologic diagnosis of pulmonary embolism]. Pneumonol.Alergol.Pol. 62:154-162, 1994. Keywords : 951202; DIAGNOSIS; FALSE-NEGATIVE; PULMONARY EMBOLISM; EMBOLISM; PE; is; AUTOPSY; in; MYOCARDIAL INFARCTION; infarction; PNEUMONIA; MALIGNANCY; VENOUS; ADULT; AGED; Aged,80 and over; mt; COMPARATIVE STUDY; diagnostic errors; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; predictive value of tests; di; Medline File Notes : The rate of both: false-positive and false-negative diagnoses of pulmonary embolism (PE) is high. To determine the accuracy of the ante- mortem diagnosis of PE we reviewed 78 autopsies and compared the clinical and pathological diagnoses in that group. In 64 cases PE was diagnosed clinically: in 43 it was confirmed by autopsy (67%). In 21 cases (33%) the clinical diagnoses were false-positive. There were 57 pathological diagnoses altogether: in 14 cases (25%) the clinical diagnoses were false-negative. Among falsely diagnosed patients, the diagnoses of myocardial infarction, pneumonia and malignancy were most frequent. We tried to find some distinctive features separating the cases in the subgroups. Among them venous diseases were more frequent in PE than in falsely diagnosed patients Kliniki Chorob Wewnetrznych Instytutu Gruzlicy i Chorob Pluc w Warszawie. Ref ID : FISCHER1970 361. Fischer, H. [The expert testimony on leg diseases (chronic venous insufficiency)]. Berufsdermatosen. 18:2-24, 1970. Keywords : LEG; CHRONIC; VENOUS; NASP; ADULT; Collateral Circulation; Eczema; English Abstract; Expert Testimony; FEMALE; HUMAN; Leg Dermatoses; MALE; MIDDLE AGE; Occupational Diseases; PHLEBOGRAPHY; THROMBOPHLEBITIS; TIME FACTORS; Varicose Ulcer; VARICOSE VEINS; Wounds and Injuries; Medline File; ab Notes : TT - Die Begutachtung der Beinleiden (chronisch venose Insuffizienz) AB - [No Abstract Available] UI - 71000154. Ref ID : FISCHER1971 362. Fischer, H. and Muller, R. [Skin manifestations in venous back-flow disorders]. Hautarzt. 22:476-481, 1971. Keywords : VENOUS; NASP; Eczema; Edema; FEMALE; Hemosiderosis; HUMAN; LEG; Lichen Planus; MALE; Regional Blood Flow; Skin Manifestations; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; VEINS; Medline File; in; de; ab Notes : TT - Hautveranderungen bei Storungen des venosen Ruckstroms AB - [No Abstract Available] UI - 72083119. Ref ID : FISCHER1990 363. Fischer, R. [Surgical treatment of varices--principles and current status]. Schweiz.Rundsch.Med.Prax. 79:155-167, 1990. Keywords : TREATMENT; SURGICAL; VARICOSE VEINS; VEINS; SAPHENOUS VEIN; vein; Ligation; PERFORATING VEINS; TECHNIQUES; SCLEROTHERAPY; TRENDS; DIAGNOSIS; KNEE; Cosmetics; Sutures; CAUSE; Skin; TOURNIQUET; PHLEBOGRAPHY; SURGERY; NASP; Tourniquets; English Abstract; HUMAN; LEG; Methods; Patient Education; PHLEBITIS; THROMBOSIS; Medline File; Health Planning & Administration File; ab; varicose; is; incompetent perforating veins; in; Pneumatic; blood; diagnostics; hi; Duplex; Sonography; ad; st Notes : TT - Die chirurgische Behandlung der Varizen--Grundlagen und heutiger Stand AB - The basis of surgical treatment for varicose veins is still the stripping operation. This operation consists of four components: The "crossectomy", the stripping propper of the greater or smaller saphenous vein, the ligation of the incompetent perforating veins and the removal of the side branches. However this complete stripping procedure is not always necessary or suitable. Combination of one or two components of this operation with other techniques such as sclerotherapy may lead to results almost or just as good as the complete conventional stripping operation. These combinations are usually less invasive and often less costly. However in many instances comprehensive surgical treatment is still preferred. Then the present trend is to make also this treatment less invasive, both surgically and cosmetically. A number of new surgical technical details allow for a reduced invasivity: The endoscopic procedure for the incompetent Cockett perforating veins permits at the same time their diagnosis and treatment. It is done from a small incision below the knee. The technique of phlebectomy with incisions only 2 to 5 mm long is less invasive and produces better cosmetic results. Instead of closing the wounds with sutures, small incisions up to 1 cm long can be closed with elastic adhesive bands. They work on a convex surface according to the tension band principle. Due to their isoelasticity they seldom cause skin problems. These techniques are facilitated by the bloodless limb technique with a pneumatic tourniquet. In extensive cases this technique also saves blood to the patient and facilitates surgical precision. The newer diagnostic techniques help the surgeon to be more certain about his diagnosis. This in turn improves his results and again reduces invasivity. Many surgeons rely mostly on phlebography, but duplex sonography is picking up. It is estimated that all these factors reduce the invasivity of surgery of varicose veins by 50 percent, allows for better cosmetic results and by this makes the treatment more attractive for the patient AD - Chirurgie FMH AD -Phlebologie SGP St. Gallen UI - 90161686. Ref ID : FISHER1986 364. Fisher, M.R. and Higgins, C.B. Central thrombi in pulmonary arterial hypertension detected by MR imaging. Radiology 158(1):223-226, 1986. Keywords : 951217; THROMBI; in; PULMONARY ARTERIAL HYPERTENSION; ARTERIAL; Hypertension; MR; PULMONARY ARTERY; Arteries; MAGNETIC RESONANCE; CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; an; TECHNIQUES; PULMONARY HYPERTENSION; CARDIAC; CAUSE; is; NONINVASIVE; Methods; THROMBUS; ADULT; AGED; Chronic Disease; ELECTROCARDIOGRAPHY; FEMALE; HUMAN; hypertension,pulmonary; co; MALE; nuclear magnetic resonance; du; mt; PA; PULMONARY EMBOLISM; di; Medline File Notes : Differentiation of thrombi from slow flow in the pulmonary arteries, sometimes observed in the presence of pulmonary arterial hypertension, can be equivocal. Magnetic resonance (MR) imaging was performed in a patient with chronic pulmonary thromboembolism and pulmonary arterial hypertension using an electrocardiographically gated technique that allowed visualization of the pulmonary arteries at the end of diastole and multiple times during systole. These images were compared with those of a patient with primary pulmonary hypertension and those of healthy subjects. Thrombi were discrete structures, seen throughout the cardiac cycle on both the first and second spin-echo images, and decreased in signal intensity on the second image. Slow flow increased in signal intensity and changed in structure during the cardiac cycle and was seen best on the second image. MR may play an important role in excluding large central thrombi as the cause of pulmonary arterial hypertension. It is a noninvasive method for defining pulmonary arterial wall thickness and for direct visualization of chronic pulmonary thrombus. Ref ID : FISHER1995 365. Fisher, M., Pessin, M.S., and Furian, A.J. ECASS: Lessons for future thrombolytic stroke trials. JAMA 274(13):1058-1059, 1995. Keywords : THROMBOLYTIC; STROKE; TPA; ECASS Notes : Editorial about the european cooperative acute stroke study. Ref ID : FLACHSBART1995 366. Flachsbart, F. Clinical problem-solving: recurrent pulmonary emboli [letter; comment]. N.Engl.J.Med. 332(16):1104; discussion 110-5, 1995. Keywords : 96-suzy-001; Pulmonary emboli; EMBOLI; AGED; FEMALE; HUMAN; MALE; PULMONARY EMBOLISM; DIAGNOSIS; RECURRENCE; RISK FACTORS Ref ID : FLETCHER1990 367. Fletcher, J.P., Kershaw, L.Z., Barker, D.S., Koutts, J., and Varnava, A. Ultrasound diagnosis of lower limb deep venous thrombosis. Med.J.Aust. 153:453-455, 1990. Keywords : PHLEBITIS; ULTRASOUND; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ADULT; AGED; Aged,80 and over; COMPARATIVE STUDY; Contrast Media; FEMALE; Femoral Vein; Ultrasonography; HUMAN; LEG; MALE; MIDDLE AGE; Muscles; blood supply; PHLEBOGRAPHY; Popliteal Vein; sensitivity and specificity; THROMBOPHLEBITIS; radiography; CONTRAST; VENOGRAPHY; vein; DVT; CALF; SENSITIVITY; SPECIFICITY; CALF VEIN THROMBOSIS; RECOMMENDATIONS; SCAN; Superficial thrombophlebitis; in; an; is Notes : Venous ultrasound imaging was compared with ascending contrast venography for the diagnosis of suspected deep vein thrombosis (DVT) in the femoral, popliteal and calf vein segments of 44 limbs in 44 patients. One femoral and one calf vein segment could not be imaged (1.5% of the segments examined), but during the same period venography failed in six patients because of an inability to cannulate a swollen limb. Ultrasound imaging compared with venography as a means of diagnosing DVT showed an overall sensitivity of 95% and a specificity of 92%. The sensitivity and specificity of ultrasound imaging for the diagnosis of both femoral and popliteal vein thromboses were 100% and 97%, respectively, and for calf vein thrombosis were 85% and 83%, respectively. This study supports the recommendation that ultrasound imaging is now the investigation of choice for the diagnosis of DVT provided that the scan is performed by an experienced vascular technologist. Ultrasound imaging may also define other pathological conditions presenting in the differential diagnosis of DVT, such as superficial thrombophlebitis and Baker's cyst. Ref ID : FLORIO1993 368. Florio, F., Balzano, S., Nardella, M., and Villani, G. [Ovarian varicocele treated with percutaneous scleroembolization. Description of a case]. Radiol.Med.(Torino). 85:295-297, 1993. Keywords : NASP; ADULT; CASE REPORT; Embolization,Therapeutic; FEMALE; HUMAN; MALE; Ovary; SCLEROTHERAPY; Skin; VARICOSE VEINS; Medline File; di; ab; ad Notes : TT - Varicocele ovarico trattato con scleroembolizzazione percutanea. Descrizione di un caso AB - [No Abstract Available] AD - Dipartimento di Diagnostica per Immagini AD - Ospedale Casa Sollievo della Sofferenza AD - San Giovanni Rotondo AD - Foggia UI - 93262235. Ref ID : FLOSSDORF1990 369. Flossdorf, T., Breulmann, M., and Hopf, H.B. Successful treatment of massive pulmonary embolism with recombinant tissue type plasminogen activator (rt-PA) in a pregnant woman with intact gravidity and preterm labour. Intensive.Care Med. 16:454-456, 1990. Keywords : EMBOLISM; PREGNANCY; TREATMENT; MASSIVE; PULMONARY EMBOLISM; PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; PREGNANT; SHOCK; THROMBOLYSIS; RESOLUTION; BLEEDING; Punctures; COMPLICATIONS; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MALE; Infant; CASE REPORT; FEMALE; HUMAN; Alteplase ,Therapeutic Use ,TU; Pregnancy Complications,Cardiovascular ,Drug Therapy ,DT; Pulmonary Embolism ,Drug Therapy ,DT; ADULT; Blood Pressure; Carbon Dioxide ,Blood ,BL; Heart Rate; Infant,Newborn; Labor,Premature; Oxygen ,Blood ,BL; Pulmonary Artery ,Physiopathology ,PP; Pulmonary Embolism ,Physiopathology ,PP; Recombinant Proteins ,Therapeutic Use ,TU; in; ab; is Notes : CS- Abteilung fur Klinische Anaesthesiologie, Zentrum fur Anaesthesiologie Heinrich-Heine-Universitat, Dusseldorf, FRG AB- We report a patient with massive pulmonary embolism and circulatory shock during pregnancy (31st gestational week) and preterm labour who has been successfully treated with recombinant tissue type plasminogen activator. Thrombolysis was performed using 10 mg.h-1 over 4 h followed by 2 mg.h-1 for 1 h 30 min resulting in complete resolution of cardio-respiratory symptoms. Except for slight bleeding from one puncture site no complications occurred. At 48 h after the end of thrombolytic therapy the patient was delivered spontaneously of a male preterm healthy infant. The relevance of this new thrombolytic agent in the treatment of massive life-threatening pulmonary embolism during pregnancy is discussed. Ref ID : FOLEY1989 370. Foley, M., Maslack, M.M., and Rothman, R.H. Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients. Radiology 172:481-485, 1989. Keywords : PULMONARY EMBOLISM; EMBOLISM; HIP; KNEE; POSTOPERATIVE; ASYMPTOMATIC; V/Q; PROSPECTIVE; in Ref ID : FORMANEK1970 371. Formanek, G., French, R.S., and Amplatz, K. Arterial thrombus formation during clinical percutaneous catheterization. Circulation 41:833-839, 1970. Keywords : ARTERIAL; THROMBUS; Catheterization Ref ID : FRANCIS1989 372. Francis, C.W., Foster, T.H., Totterman, S., Brenner, B., Marder, V.J., and Bryant, R.G. Monitoring of therapy for deep vein thrombosis using magnetic resonance imaging. Acta Radiol. 30:445-446, 1989. Keywords : MONITORING; THERAPY; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; GRADIENT; ANTICOAGULANT; FIBRINOLYTIC; TECHNIQUES; TREATMENT; RESOLUTION; sdi-11/93; vein; MAGNETIC RESONANCE; Pulse; magnetic resonance imaging; in Notes : Magnetic resonance imaging using limited-flip-angle, gradient refocused pulse sequences has been used to monitor the course of anticoagulant or fibrinolytic therapy for deep vein thrombosis in two patients. The findings demonstrate the capacity of this technique to delineate the extent of thrombosis and characterize changes in size in response to treatment. Advantages of this approach include high anatomic resolution, speed of examination and non-invasiveness, properties that make it well-suited to following the progress of therapy with potentially significant implications for improving treatment. Ref ID : FRANK1980 373. Frank, G., Tyers, O., Larrieu, A.J., Stout, L.C., Tonnesen, A.S., and Williams, E.H. Delayed recurrent massive thromboembolism through a vena caval clip after pulmonary embolectomy. Chest 77:114-115, 1980. Keywords : 951202; MASSIVE; THROMBOEMBOLISM; EMBOLECTOMY; EMBOLIZATION; EMERGENCY; is; Ligation; in; AUTOPSY; breast neoplasms; su; carcinoma,intraductal,noninfiltrating; CASE REPORT; FEMALE; HUMAN; mastectomy; MIDDLE AGE; Postoperative Complications; PULMONARY EMBOLISM; PA; RECURRENCE; Medline File Notes : A case of recurrent massive pulmonary embolization through a modified Miles' clip two weeks after successful emergency pulmonary embolectomy is reported. Vena caval ligation is probably a safer alternative in these critically ill patients. Ref ID : FRANKEL1986 374. Frankel, N., Coleman, R.E., Pryor, D.B., Sostman, H.D., and Ravin, C.E. Utilization of lung scans by clinicians. J. Nucl. Med. 27(3):366- 369, 1986. Keywords : LUNG; SCAN; PROBABILITY; PULMONARY EMBOLISM; EMBOLISM; MANAGEMENT; in; TREATMENT; V/Q; V/Q SCAN; PREDICTIVE VALUE Notes : 566 consecutive patients undergoing lung scan were studied. Clinician's estimates of the probability of pulmonary embolism were determined before the scan, and the management was assessed 2 to 3 days after the scan. The results were discouraging: readings of low- probability or intermediate-probability resulted in no treatment and no further workup in most patients. Readings of high-probability resulted in treatment of some sort for pulmonary embolism without further workup. Clinical management was inappropriately influenced by the V/Q scan pattern out of proportion to the predictive value of the scan. Ref ID : FRASCHINI1987 375. Fraschini, G., Jadeja, J., Lawson, M., Holmes, F.A., Carrasco, H.C., and Wallace, S. Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients. J.Clin.Oncol. 5:672-678, 1987. Keywords : UROKINASE; LYSIS; THROMBOSIS; VENOUS; CATHETER; CANCER; ACEP93; Catheters; in Ref ID : FRIEDELL1992 376. Friedell, M.L., Samson, R.H., Cohen, M.J., Simmons, G.T., Rollins, D.L., Mawyer, L., and Semrow, C.M. High ligation of the greater saphenous vein for treatment of lower extremity varicosities: the fate of the vein and therapeutic results. Ann.Vasc.Surg. 6:5-8, 1992. Keywords : Ligation; SAPHENOUS VEIN; vein; TREATMENT; VARICOSITIES; SURGICAL; SCLEROTHERAPY; VARICOSE VEINS; AGE; ULTRASOUND; FOLLOWUP; THERAPY; COMPLICATIONS; POSTOPERATIVE; SCAN; VEINS; THROMBOSED; ARTERIAL; MORBIDITY; SURGERY; NASP; Combined Modality Therapy; FEMALE; HUMAN; MALE; MIDDLE AGE; Postoperative Complications; THROMBOSIS; Vascular Patency; Medline File; Extremities; ab; varicose; varicose vein; Duplex; in; is; an; ad Notes : AB - This study was carried out to determine the subsequent fate of the greater saphenous vein and the efficacy of its high ligation along with surgical excision or sclerotherapy of varicosities. From 1988 to 1990, 22 patients underwent high ligation and sclerotherapy, 22 underwent high ligation and varicose vein excision, and four underwent high ligation alone. There were 36 women and 12 men patients. The average patient age was 48. Sixty limbs were scanned by duplex ultrasound pre- and postoperatively to determine the status of the greater saphenous vein. Average follow-up time was 10 months. Patients and surgeons rated the results of therapy for ablation of varicosities and alleviation of symptoms. Surgical complications were evaluated. At postoperative scan, 47 greater saphenous veins (78%) were found to be completely patent, nine (15%) were thrombosed for a short segment (less than 10 cm) and four (7%) were more significantly thrombosed. Those limbs in which high ligation and sclerotherapy were performed had the highest complete patency rate (96%). Patient and surgeon satisfaction was good to excellent in every case. The only complications were three symptomatic greater saphenous vein thromboses. Although follow-up is relatively brief, complete patency of the ligated greater saphenous vein was found in most cases. High ligation allows preservation of a patent greater saphenous vein, which can be used as an arterial conduit at a later date and gives therapeutic results comparable to stripping without the additional morbidity AD - Department of Surgery AD - Orlando Regional Medical Center AD - Florida UI - 92189975. Ref ID : FRIEMAN1965 377. Frieman, D.G., Suyemoto, J., and Wessler, S. Frequency of pulmonary thromboembolism in man. N.Engl.J.Med. 272:1278-1280, 1965. Keywords : PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PULMONARY EMBOLISM; FREQUENCY; EPIDEMIOLOGY; in Ref ID : FUSTER1984 378. Fuster, V., Steele, P.M., and Edwards, W.D. Primary pulmonary hypertension: Natural history and the importance of thrombosis. Circulation 70:580-587, 1984. Keywords : PULMONARY HYPERTENSION; NATURAL HISTORY; THROMBOSIS; PULMONARY EMBOLISM; CLINICAL DIAGNOSIS; DIAGNOSIS; Hypertension; HEMODYNAMICS; LONG TERM; MORTALITY; AUTOPSY; CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; ANTICOAGULATION; in Notes : 120 patients with a clinical diagnosis of primary pulmonary hypertension (diagnosed by strict clinical and hemodynamic criteria) were followed on a long-term basis. The 5-year mortality in this patient population was 79%. 56 of these patients underwent autopsy: more than half of them (57%) were found to have had chronic pulmonary thromboembolism rather than primary pulmonary hypertension. For this reason, anticoagulation may be recommended for all patients with a presumed diagnosis of primary pulmonary hypertension. Ref ID : FYKE1985 379. Fyke, F.E.,3d, Kazmier, F.J., and Harms, R.W. Venous air embolism. Life-threatening complication of orogenital sex during pregnancy. Am.J.Med. 78:333-336, 1985. Keywords : VENOUS; Air; EMBOLISM; COMPLICATION; PREGNANCY; PREGNANT; Powders; TREATMENT; abnormalities; Syndrome; THERAPY; ACUTE DISEASE; ADULT; CASE REPORT; embolism,air; et; th; FEMALE; HUMAN; Infant,Newborn; MALE; Pregnancy Complications,Cardiovascular; sex behavior; VEINS; Medline File; sex; in; is; laboratories Notes : Vaginal insufflation in pregnant women leading to acute venous air embolism has been appreciated by obstetricians and pathologists for several decades. Initially described as a complication of powder insufflation for treatment of trichomonal vaginitis, insufflation- induced air embolism has been more recently associated with orogenital sex. The case herein illustrates a typical history that is almost pathognomonic. Clinical and laboratory abnormalities as well as treatment measures are briefly described. Familiarity with this syndrome is essential if prompt and appropriate therapy is to be rendered. Ref ID : GABRIELSEN1992 380. Gabrielsen, F., Schmidt, A., Eggeling, T., Hoeher, M., Kochs, M., and Hombach, V. Massive main pulmonary artery embolism diagnosed with two-dimensional Doppler echocardiography. Clin.Cardiol. 15:545-546, 1992. Keywords : MASSIVE; PULMONARY ARTERY; ARTERY; EMBOLISM; Doppler; Echocardiography; DIAGNOSIS; CARDIOVASCULAR; THROMBUS; sdi-11/93; in; dyspnea Notes : This report describes the usefulness of echocardiography in the differential diagnosis of acute cardiovascular events. In a 66-year-old patient with known aortic stenosis and mitral valve prosthesis, who suddenly deteriorated with severe dyspnea, a thrombus within the pulmonary artery could be detected with 2-D echo. Pulsed-wave Doppler disclosed the resulting flow-velocity disturbances. Ref ID : GALE1984 381. Gale, G.B., O'Connor, D.M., Chu, J., and et al Restoring patency of thrombosed catheters with cryopreserved urokinase. JPEN 8:298-299, 1984. Keywords : THROMBOSED; CATHETER; UROKINASE; THROMBOLYSIS; ACEP93; Catheters Ref ID : GALGANO1973 382. Galgano, E. and Musumeci, R. [Lymphography in the study of venous pathology of the lower limbs]. Minerva.Med. 64:3699-3704, 1973. Keywords : VENOUS; NASP; English Abstract; HUMAN; LEG; Lymphography; PHLEBITIS; Skin Ulcer; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; in; pathology; ab Notes : TT - La linfografia nello studio della patologia venosa dell'arto inferiore AB - [No Abstract Available] UI - 74068711. Ref ID : GALLUS1973 383. Gallus, A.S., Hirsh, J., and Gent, M. Relevance of preoperative and postoperative blood tests to postoperative leg vein thrombosis. Lancet ii:805-809, 1973. Keywords : POSTOPERATIVE; VEINS; THROMBOSIS; PLASMINOGEN ACTIVATOR; FIBRINOLYSIS; ANTIPLASMIN; blood; LEG; vein Ref ID : GALLUS1976 384. Gallus, A.S. and Hirsh, J. Prevention of venous thromboembolism. Semin.Thromb.Hemost. 2:232-290, 1976. Keywords : 951202; PREVENTION; VENOUS; THROMBOEMBOLISM; ANTICOAGULANTS; HEPARIN; BLOOD FLOW; in; LEG; Dextrans; HIP; SURGERY; TREATMENT; POSTOPERATIVE; Postoperative Period; MORTALITY; AUTOPSY; THROMBOSIS; VENOGRAPHY; INCIDENCE; SCANNING; ANTICOAGULANT; is; Extension; THROMBUS; BLEEDING; COMPLICATION; SURGICAL; PROPHYLAXIS; MONITORING; hip fractures; FRACTURES; PULMONARY EMBOLISM; EMBOLISM; LUNG; CALF; Thigh; vein; FREQUENCY; HEMATOCRIT; Injections; SUBCUTANEOUS; Methods; COMPRESSION; Muscles; RISK; abdomen; su; Administration,Oral; ancrod; tu; Blood Coagulation Tests; Blood Platelets; de; FIBRINOLYSIS; ae; HUMAN; injections,subcutaneous; ra; MYOCARDIAL INFARCTION; pc; PHLEBOGRAPHY; di; mo; radionuclide imaging; Regional Blood Flow; THROMBOPHLEBITIS; Medline File; laboratories; Pneumatic Notes : Of the various prophylactic agents evaluated, four have been found to be effective. These are oral anticoagulants, low-dose heparin, mechanical devices which increase venous blood-flow in the leg, and Dextran. Oral anticoagulants have been shown to be effective in patients having abdominal, thoracic, or hip surgery, when treatment was started either before surgery or in the immediate postoperative period. They have also been shown to be effective in medical patients. The evidence derives from studies which showed that treatment can reduce total mortality, prevents venous thromboembolism detected clinically or at autopsy, and prevents thrombosis diagnosed with venography. On the other hand, the incidence of thrombosis diagnosed by 125I-fibrinogen scanning was not reduced when oral anticoagulants were started just before or just after surgery. This suggests that oral anticoagulant treatment starting in the immediate postoperative period may not prevent formation of the initial thrombotic nidus, but is clinically effective because it prevents extension of the nidus to form a significant thrombus. Bleeding has been a significant complication in almost all studies of surgical patients, and this is the major factor which has prevented widespread use of oral anticoagulant prophylaxis. In addition, the need for careful laboratory monitoring makes this approach inconvenient and adds to its expense. Low-dose heparin has been shown to be effective in general surgical and medical patients, but results have been inconclusive in patients having elective hip surgery, and this approach is probably ineffective in patients with hip fracture. In general surgical patients, low-dose heparin prophylaxis has been shown to prevent pulmonary embolism diagnosed at autopsy examination or with lung scanning, and calf and thigh vein thrombosis diagnosed with 125I-fibrinogen leg- scanning. A slight, but statistically significant, increase in the frequency of wound hematoma and a greater postoperative hematocrit fall have been reported when heparin was given three times daily, but not with the twice daily heparin injection regimen. In these studies, low- dose heparin was given without laboratory control of its anticoagulant effect, so that this prophylactic approach is simple, but the need for subcutaneous injections is a disadvantage of this approach. Results with methods which increase venous blood-flow in the leg have varied, depending on the technic used. Active measures, such as intermittent pneumatic calf compression or peroperative electrical calf muscle stimulation, have been shown to prevent thrombosis detected with 125I- fibrinogen leg-scanning. However, while the evidence suggests that both methods are effective in relatively low risk patients, they may have limited value in the high risk patient who is confined to bed for a long time. These methods are free of side effects and relatively inexpensive, but intermittent calf compression, in particular, is slightly cumbersome. Ref ID : GARCIA1990 385. Garcia, R., Saroyan, R.M., Senkowsky, J., Smith, F., and Kerstein, M. Intraoperative intra-arterial urokinase infusion as an adjunct to Fogarty catheter embolectomy in acute arterial occlusion. Surg.Gynecol.Obstet. 171:201-205, 1990. Keywords : INTRAARTERIAL; UROKINASE; CATHETER; EMBOLECTOMY; ARTERIAL; ACEP93; Intraoperative; an; in; OCCLUSION Ref ID : GARCIARODEJA1990 386. Garcia-Rodeja, M.E., Gamallo, C., Arribas, J.R., Monereo, A., Lahoz, C., and Arnalich, F. [Importance of risk factors in the extension of pulmonary thromboembolism]. Med.Clin.(Barc). 95:92-94, 1990. Keywords : 951202; RISK; RISK FACTORS; in; Extension; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; AUTOPSY; Hospitals; INCIDENCE; CANCER; Pulmonary Circulation; EMBOLISM; CARDIOVASCULAR; cardiovascular diseases; THROMBOPHLEBITIS; ACUTE DISEASE; ADULT; AGED; Aged,80 and over; cross-sectional studies; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; co; ep; pp; Retrospective Studies; Medline File; Cancerlit File; de Notes : The cases of pulmonary thromboembolism (PTE) diagnosed in the clinical autopsies performed in our hospital during a 15-year period were reviewed. The incidence was 2.7% (63 cases). The most common disease associated with thromboembolism was cancer (41%). In 30 cases, thromboembolism involved more than 60% of the pulmonary circulation (group I), between 40% and 60% in 18 cases (group II), and less than 40% in 15 cases (group III). 30% of the embolisms were recurrent. A statistically significant correlation between the extension of the involved pulmonary circulation and the condition associated with thromboembolism was found. Whereas in patients with neoplasia the extension of pulmonary circulation involved by PTE was quite variable, the patients with cardiovascular disease or thrombophlebitis had PTE with invariably severe compromise of pulmonary vasculature (groups I and II) Servicio de Anatomia Patologica Hospital La Paz Facultad de Medicina Universidad Autonoma de Madrid. Ref ID : GARDINER1989 387. Gardiner, G.A.J., Harrington, D.P., Koltun, W., Whittemore, A., Mannick, J.A., and Levin, D.C. Salvage of occluded arterial bypass grafts by means of thrombolysis. J.Vasc.Surg. 9:426-431, 1989. Keywords : ARTERIAL; THROMBOLYSIS; ACEP93; bypass graft Ref ID : GARREAU1993 388. Garreau, C., Garreau-Gomez, B., Doumenjou, J.M., Bianchi, D., and Portail, M. [Venous insufficiency and varicose disease. Sequelae of lower limb thrombosis. The role of crenotherapy]. Phlebologie 46:303- 311, 1993. Keywords : varicose; THROMBOSIS; CONSENSUS; INDICATIONS; EARLY; TREATMENT; sdi-11/93; classification; is; an; laboratories; in Notes : The writers reminded that a consensus on Classification of veinous diseases, necessary to build up homogeneous samples, was being set up. Now, they are introducing a thermal nosology that is as useful. Next, the history of spas, the characteristics of Thermal Springs and thermal practices as well as their results are described. The writers present a standardization of the observation and control parameters of the therapeutic effects. The rigorous and scientific process was defined by an interdisciplinary scientific process was defined by an interdisciplinary scientific Council and it is based on the creation of a Computerized Laboratory of Research and a Thermal University. It has become an example in the field of thermalism. According to the results and the modern indications, the water cure has to be prescribed at an early stage. The practitioner must think about it and insert the water cure in the arsenal of veinous diseases. According to the hydrogeologists' estimates, BARBOTAN les thermes, the first European spa with about 22,000 patients is thought to possess enough water to allow from 40,000 to 60,000 people to be treated yearly. A thermal environment is the ideal place for an efficient vascular rehabilitation and functional re-education. In phlebology, more than one million people should benefit from a water cure yearly ... Only 70,000 follow this treatment. Everyone has to wonder about this situation, which, to those who do not benefit from a thermal cure in phlebology, is as astonishing as prejudicial. Ref ID : GEERTS1994 389. Geerts, W.H., Code, K.I., Jay, R.M., Chen, E., and Szalai, J.P. A prospective study of venous thromboembolism after major trauma. N.Engl.J.Med. 331:1601-1606, 1994. Keywords : EMBOLISM; TRAUMA; PROSPECTIVE; PROSPECTIVE STUDIES; VENOUS; THROMBOEMBOLISM; DEEP VEIN THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; COMPLICATIONS; FREQUENCY; RISK; RISK FACTORS; Methods; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; CONTRAST; VENOGRAPHY; PROPHYLAXIS; Extremities; Died; MASSIVE; CLINICAL FEATURES; INJURY; CHEST; Orthopedic; THROMBI; FRACTURES; AGE; Blood Transfusion; SURGERY; Tibia; Spinal cord; COMPLICATION; in; injuries; abdomen; femoral fractures; multivariate analysis; analysis; odds ratio; confidence intervals; blood; spinal cord injuries; is Notes : BACKGROUND. Although deep-vein thrombosis and pulmonary embolism are considered common complications after major trauma, their frequency and the associated risk factors have not been carefully quantified. METHODS. We performed serial impedance plethysmography and lower- extremity contrast venography to detect deep-vein thrombosis in a cohort of 716 patients admitted to a regional trauma unit. Prophylaxis against thromboembolism was not used. RESULTS. Deep-vein thrombosis in the lower extremities was found in 201 of the 349 patients (58 percent) with adequate venographic studies, and proximal-vein thrombosis was found in 63 (18 percent). Three patients died of massive pulmonary embolism before venography could be performed. Before venography, only three of the patients with deep-vein thrombosis had clinical features suggestive of the condition. Deep-vein thrombosis was found in 65 of the 129 patients with major injuries involving the face, chest, or abdomen (50 percent); in 49 of the 91 patients with major head injuries (53.8 percent); in 41 of the 66 with spinal injuries (62 percent); and in 126 of the 182 with lower-extremity orthopedic injuries (69 percent). Thrombi were detected in 61 of the 100 patients with pelvic fractures (61 percent), in 59 of the 74 with femoral fractures (80 percent), and in 66 of the 86 with tibial fractures (77 percent). A multivariate analysis identified five independent risk factors for deep-vein thrombosis: older age (odds ratio, 1.05 per year of age; 95 percent confidence interval, 1.03 to 1.06), blood transfusion (odds ratio, 1.74; 95 percent confidence interval, 1.03 to 2.93), surgery (odds ratio, 2.30; 95 percent confidence interval, 1.08 to 4.89), fracture of the femur or tibia (odds ratio, 4.82; 95 percent confidence interval, 2.79 to 8.33), and spinal cord injury (odds ratio, 8.59; 95 percent confidence interval, 2.92 to 25.28). CONCLUSIONS. Venous thromboembolism is a common complication in patients with major trauma, and effective, safe prophylactic regimens are needed. Ref ID : GEERTS1994A 390. Geerts, W.H., Code, K.I., Jay, R.M., Chen, E., and Szalai, J.P. A prospective study of venous thromboembolism after major trauma [see comments]. N.Engl.J.Med. 331(24):1601-1606, 1994. Keywords : 96-suzy-001; PROSPECTIVE; PROSPECTIVE STUDIES; VENOUS; THROMBOEMBOLISM; TRAUMA; DEEP VEIN THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; COMPLICATIONS; FREQUENCY; RISK; RISK FACTORS; Methods; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; CONTRAST; VENOGRAPHY; in; PROPHYLAXIS; Extremities; Died; MASSIVE; CLINICAL FEATURES; injuries; CHEST; abdomen; Orthopedic; THROMBI; FRACTURES; femoral fractures; multivariate analysis; analysis; AGE; odds ratio; confidence intervals; blood; Blood Transfusion; SURGERY; Tibia; Spinal cord; spinal cord injuries; INJURY; is; COMPLICATION; ADULT; FEMALE; head injuries; HUMAN; injury severity score; MALE; ETIOLOGY; spinal injuries; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; Wounds and Injuries Notes : BACKGROUND. Although deep-vein thrombosis and pulmonary embolism are considered common complications after major trauma, their frequency and the associated risk factors have not been carefully quantified. METHODS. We performed serial impedance plethysmography and lower- extremity contrast venography to detect deep-vein thrombosis in a cohort of 716 patients admitted to a regional trauma unit. Prophylaxis against thromboembolism was not used. RESULTS. Deep-vein thrombosis in the lower extremities was found in 201 of the 349 patients (58 percent) with adequate venographic studies, and proximal-vein thrombosis was found in 63 (18 percent). Three patients died of massive pulmonary embolism before venography could be performed. Before venography, only three of the patients with deep-vein thrombosis had clinical features suggestive of the condition. Deep-vein thrombosis was found in 65 of the 129 patients with major injuries involving the face, chest, or abdomen (50 percent); in 49 of the 91 patients with major head injuries (53.8 percent); in 41 of the 66 with spinal injuries (62 percent); and in 126 of the 182 with lower-extremity orthopedic injuries (69 percent). Thrombi were detected in 61 of the 100 patients with pelvic fractures (61 percent), in 59 of the 74 with femoral fractures (80 percent), and in 66 of the 86 with tibial fractures (77 percent). A multivariate analysis identified five independent risk factors for deep-vein thrombosis: older age (odds ratio, 1.05 per year of age; 95 percent confidence interval, 1.03 to 1.06), blood transfusion (odds ratio, 1.74; 95 percent confidence interval, 1.03 to 2.93), surgery (odds ratio, 2.30; 95 percent confidence interval, 1.08 to 4.89), fracture of the femur or tibia (odds ratio, 4.82; 95 percent confidence interval, 2.79 to 8.33), and spinal cord injury (odds ratio, 8.59; 95 percent confidence interval, 2.92 to 25.28). CONCLUSIONS. Venous thromboembolism is a common complication in patients with major trauma, and effective, safe prophylactic regimens are needed. Ref ID : GELERNT1992 391. Gelernt, M.D., Mogtader, A., and Hahn, R.T. Transesophageal echocardiography to diagnose and demonstrate resolution of an acute massive pulmonary embolus. Chest 102:297-299, 1992. Keywords : Transesophageal; Echocardiography; RESOLUTION; MASSIVE; RESPIRATORY FAILURE; HEMODYNAMICS; THROMBUS; THROMBOLYSIS; DIAGNOSIS; THERAPY; SELECT; PULMONARY EMBOLISM; EMBOLISM; sdi-11/93; an; in Notes : A 54-yr-old man presented with acute respiratory failure and hemodynamic collapse. Acute massive pulmonary embolus was confirmed with visualization of the thrombus by transesophageal echocardiography. Successful resolution after thrombolysis was confirmed by a repeat study. Transesophageal echocardiography can be used for both diagnosis and assessment of therapy in select cases of acute massive pulmonary embolism. Ref ID : GELFAND1976 392. Gelfand, M. and Ross, M. Pulmonary embolism in the Rhodesian Black. S.Afr.Med.J. 50:19-21, 1976. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; is; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; POSTOPERATIVE; Adolescence; ADULT; Age Factors; AGED; AUTOPSY; blacks; CHILD; ethnic groups; europe; eh; FEMALE; HUMAN; Infant; MALE; MIDDLE AGE; PREGNANCY; Pregnancy Complications,Cardiovascular; mo; ep; Sex Factors; zimbabwe; Medline File Notes : Pulmonary embolism is less frequent in Blacks than in Whites. Deep vein thrombosis is probably not uncommon in Blacks, but relatively few of them develop pulmonary embolism. Postoperative pulmonary embolism in Blacks is probably far less common than in Whites. We are dealing with a relatively young Black population, compared with the White one, and therefore more cases might be expected among the Black population as its life expectancy improves. Ref ID : GERSIN1994 393. Gersin, K., Grindlinger, G.A., Lee, V., Dennis, R.C., Wedel, S.K., and Cachecho, R. The efficacy of sequential compression devices in multiple trauma patients with severe head injury. J.Trauma. 37:205-208, 1994. Keywords : EMBOLISM; TRAUMA; COMPRESSION; INJURY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; PULMONARY EMBOLISM; PE; VENTILATION; PROPHYLAXIS; THROMBOEMBOLISM; Extremities; Technetium; VENTILATION/PERFUSION; V/Q; LUNG; SCAN; DEEP VENOUS THROMBOSIS; PROBABILITY; V/Q SCAN; AGE; Vena caval filter; FILTER; RISK; PREVENTION; DIAGNOSIS; in; multiple trauma; glasgow coma scale; coma; injury severity score; is Notes : Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients required mechanical ventilation. A sequential compression device (SCD) was used in 14 patients and 18 patients received no prophylaxis for thromboembolism. Bilateral lower extremity technetium venoscans and ventilation/perfusion (V/Q) lung scans were performed within 6 days of admission and every week for 1 month or until the patient developed DVT or PE or was discharged from the SICU. Deep venous thrombosis occurred in two patients (6%) at 16 and 28 days following trauma. Twenty-five patients had normal or low probability V/Q scans. Six had high probability V/Q scans confirmed by pulmonary arteriograms (PAGs) at 12.5 +/- 4 days. Clinical signs of PE were absent in all patients with a positive PAG. There were no differences in age, Injury Severity Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who developed DVT or PE and those who did not. A SCD was used in four of the eight patients with DVT or PE. All but one patient with DVT or PE underwent placement of a vena caval filter. Multiple trauma patients with severe head injury (GCS score < or = 8) are at high risk for thromboembolism. The available means of prevention and diagnosis of DVT or PE in multiple trauma patients with severe head injury are not entirely effective. Ref ID : GHOSH1983 394. Ghosh, S., Mackie, M.J., McVerry, B.A., Galloway, M., Ellis, A., and McKay, J. Chronic inflammatory bowel disease. Deep venous thrombosis and antithrombin activity. Acta.Haematol. 70:50-53, 1983. Keywords : CHRONIC; INFLAMMATORY BOWEL; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ULCERATIVE COLITIS; CROHN'S DISEASE; RISK; DVT; PE; FIBRINOGEN; FACTOR VIII; PLATELET; ANTITHROMBIN III; MACROGLOBULIN; an Notes : Ulcerative colitis and Crohn's disease have been associated with an excess risk of DVT and PE. The mechanism of this risk seems to be related to elevations of fibrinogen, factor VIII, and platelet activity along with depressions of antithrombin III and alpha-2 macroglobulin levels. Ref ID : GIBBS1957 395. Gibbs, N.M. Venous thrombosis of the lower limbs with particular reference to bedrest. Brit.J.Surg. 45:209-236, 1957. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; BEDREST; RISK; DVT; PE; INCIDENCE; CAUSE; Immobilization; is; RISK FACTORS; in; Rest; Died Notes : Immobilization is one of the most important risk factors for DVT and PE. The incidence of VT is 15 percent in patients dying (from all causes) after less than one week at bed rest, but rises to 80 percent in patients who died after more prolonged periods of immobilization. Ref ID : GILLUM1987 396. Gillum, R.F. Pulmonary embolism and thrombophlebitis in the United States, 1970 - 1985. Am.Heart J. 114:1262-1264, 1987. Keywords : PULMONARY EMBOLISM; EMBOLISM; THROMBOPHLEBITIS; UNITED STATES; INCIDENCE; DVT; PE; AGE; RISK; in; is; an Notes : The overall population incidence of DVT is estimated as 80 cases per 100,000 persons per year, and that of PE as 50 cases per 100, 000 persons per year. Increasing age leads to an increased risk of DVT and PE, although it is not known whether this is entirely independent of associated factors such as other underlying illness and immobility. Ref ID : GIN1992 397. Gin, K.G., Thompson, C.R., Jue, J., and Ling, H. Embolic occlusion of a patent foramen ovale: a cause of false negative contrast echocardiogram. J Am Soc.Echocardiogr. 5:444-446, 1992. Keywords : OCCLUSION; CAUSE; FALSE-NEGATIVE; CONTRAST; Cyanosis; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LUNG; EMBOLI; Echocardiography; SHUNT; Transesophageal; sdi-11/93; Paradoxical embolization; Foramen ovale; Echocardiogram; dyspnea; Pulmonary emboli; an; in; is Notes : A 74-year-old man who had dyspnea and cyanosis demonstrated venous thrombosis and multiple lung ventilation-perfusion mismatches suggesting pulmonary emboli. Transthoracic echocardiography demonstrated a right atrial mass and a microbubble contrast study did not reveal right-to-left shunt. Transesophageal echocardiography revealed an embolus entrapped in the foramen ovale projecting into the left atrium that was subsequently removed. Embolic occlusion of patent foramen ovale is an important cause of false negative microbubble contrast study. Ref ID : GINSBERG1992A 398. Ginsberg, J.S., Brill-Edwards, P., and Burrows, R.F. Venous thrombosis during pregnanc: leg and trimester of presentation. Thromb Haemost 67:519-520, 1992. Keywords : 96-suzy-002; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LEG Notes : 01-05-96. Ref ID : GINSBERG1994 399. Ginsberg, J.S., Wells, P.S., Hirsh, J., Panju, A.A., Patel, M.A., Malone, D.E., McGinnis, J., Stevens, P., and Brill-Edwards, P. Reevaluation of the sensitivity of impedance plethysmography for the detection of proximal deep vein thrombosis. Arch.Intern.Med. 154(17):1930-1933, 1994. Keywords : LMWH; Low-Molecular-Weight-Heparin; SENSITIVITY; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; vein; THROMBOSIS; IPG; DEEP VEIN THROMBOSIS; DVT; THROMBI; PROSPECTIVE; cohort studies; Methods; VENOGRAPHY; VENOUS; Ultrasonography; THROMBUS; ULTRASOUND; CALF; sensitivity and specificity; SPECIFICITY; Popliteal Vein; Femoral Vein; 951217; in; is; an; ADULT; AGED; Aged,80 and over; Evaluation Studies; FEMALE; HUMAN; MIDDLE AGE; PHLEBOGRAPHY; Plethysmography,Impedance; st; predictive value of tests; PROSPECTIVE STUDIES; PULMONARY EMBOLISM; di; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; ep; ultrasonography,interventional; Medline File; ontario Notes : BACKGROUND: To reevaluate the sensitivity of impedance plethysmography (IPG) for proximal deep vein thrombosis (DVT) and to establish a relationship between the location and size of thrombi and the results of IPG. DESIGN: Prospective cohort study. METHODS: One hundred thirty-two consecutive patients with clinically suspected DVT underwent IPG testing and most (n = 118) underwent contrast-enhanced venography; in 14 patients, venous ultrasonography was performed and demonstrated definitive proximal DVT in which the size and extent of the thrombus could be delineated. All patients with dubious or normal ultrasound results underwent contrast-enhanced venography. All tests were performed and test results were interpreted without knowledge of the results of the other tests. Patients were considered to have proximal DVT if this was demonstrated on venography or ultrasound, calf DVT if this was demonstrated on venography, or no DVT if venography yielded normal findings. The sensitivity and specificity of IPG for DVT were calculated. RESULTS: Of the 132 patients, 40 (30%) had proximal DVT, seven (5%) had calf DVT, and 85 (64%) had no DVT. The sensitivity of IPG for proximal DVT was 65% and the specificity was 93%. Of the proximal vein thrombi, IPG detected three (23%) of 13 that involved the popliteal vein but not the superficial femoral vein and 23 (85%) of 27 proximal vein thrombi that involved the superficial femoral vein. CONCLUSIONS: Our study demonstrated that the sensitivity of IPG for proximal DVT at our center is only 65%, a figure that is much lower than those reported in earlier studies from our institution. We hypothesize that because of a change in referral practice, an increased proportion of patients with less severe symptoms are now referred to our center than in the past. These patients have thrombi that are smaller, less likely to be occlusive, and therefore less likely to yield abnormal IPG findings. Ref ID : GINSBERG1994A 400. Ginsberg, J.S., Nurmohamed, M.T., Gent, M., MacKinnon, B., Stevens, P., Weitz, J., Maraganore, J., and Hirsh, J. Effects on thrombin generation of single injections of Hirulog in patients with calf vein thrombosis. Thromb.Haemost. 72(4):523-525, 1994. Keywords : 951217; THROMBIN; Injections; in; CALF; CALF VEIN THROMBOSIS; vein; THROMBOSIS; INHIBITION; is; cohort studies; Hospitals; INTRAVENOUS; PROTHROMBIN; an; NONINVASIVE; THROMBUS; Extension; VEINS; Popliteal Vein; ANTICOAGULANTS; SUBCUTANEOUS; AGED; FEMALE; HIRUDIN; aa; ad; tu; HUMAN; Infusions,Intravenous; injections,subcutaneous; MALE; MIDDLE AGE; partial thromboplastin time; peptide fragments; RECOMBINANT PROTEINS; Support,Non-U.S.Gov't; ai; bi; THROMBOPHLEBITIS; bl; dt; Treatment Failure; Medline File; Health Planning & Administration File; CANADA Notes : 1. STUDY OBJECTIVE: To determine whether single injections of Hirulog, a direct thrombin inhibitor, can inhibit thrombin generation in patients with calf vein thrombosis and, if so, if the inhibition is sustained. 2. DESIGN: Phase II open label cohort study. 3. SETTING: Tertiary-care referral centres, university affiliated hospitals. 4. PATIENTS: 10 patients with venographically-demonstrated calf vein thrombosis. 5. INTERVENTION: Patients received a single injection of Hirulog, either 1.0 mg/kg subcutaneously or 0.6 mg/kg as a 15 min intravenous infusion. Prothrombin fragment (F1++2) levels, as an index of thrombin generation, were measured before as well as 6 h post- and 24 h post-Hirulog administration. Patients were followed with non-invasive tests to detect thrombus extension into the proximal veins. 6. RESULTS: There was a significant reduction in the levels of F1+2 with both regimens, 6 h after Hirulog. The F1+2 levels 24 h post-Hirulog showed a significant increase relative to the 6 h post-Hirulog results. One patient developed thrombus extension into the popliteal vein and was treated with conventional anticoagulants. 7. CONCLUSION: The single injections of Hirulog used in the study produced incomplete and temporary suppression of F1+2. Complete and permanent inhibition of thrombin generation with Hirulog in patients with calf vein thrombosis may require higher doses, multiple subcutaneous injections and/or prolonged intravenous infusion Department of Medicine McMaster University Hamilton Canada. Ref ID : GINSBURG1992 401. Ginsburg, K.S., Liang, M.H., Newcomer, L., Goldhaber, S.Z., Schur, P.H., Hennekens, C.H., and Stampfer, M.J. Anticardiolipin antibodies and the risk for ischemic stroke and venous thrombosis [see comments]. Ann.Intern.Med. 117(12):997-1002, 1992. Keywords : 951216; antibodies; RISK; STROKE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; is; RISK FACTORS; in; ADULT; PROSPECTIVE; RANDOMIZED; PLACEBOS; ASPIRIN; MALE; FOLLOWUP; OUTCOME; FATAL; fatal outcome; DEEP VENOUS THROMBOSIS; LEG; AGE; smoking; enzyme-linked immunosorbent assay; diagnostics; ci; TRENDS; an; AGED; Aged,80 and over; antibodies,anticardiolipin; bl; case-control studies; cerebral ischemia; im; HUMAN; MIDDLE AGE; PROSPECTIVE STUDIES; PULMONARY EMBOLISM; statistics; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; Medline File; immunology; BRIGHAM; Hospitals; boston Notes : OBJECTIVE: To determine whether the presence of anticardiolipin antibodies is a risk factor for ischemic stroke and venous thrombosis in healthy adult men. DESIGN: A nested, case-control study in a prospective cohort. SETTING: A nationwide study of physicians. PARTICIPANTS: The study sample was drawn from the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 male physicians. At entry, 68% of the participants submitted plasma samples that were subsequently frozen at -80 degrees C. During 60.2 months of follow-up, follow-up for nonfatal outcomes was 99.7% complete and ascertainment of fatal outcomes was 100% complete. We identified men with documented ischemic stroke, deep venous thrombosis of the leg, or pulmonary embolus and for whom a plasma sample was available. A control was matched by age, smoking history, and length of follow-up to each of the 100 patients with ischemic stroke and the 90 patients with deep venous thrombosis or pulmonary embolus. MEASUREMENTS: Plasma samples were assessed for IgG anticardiolipin antibodies by enzyme-linked immunosorbent assay. The mean anticardiolipin antibody titers of the case patients in the two diagnostic groups (ischemic stroke; venous thrombosis or pulmonary embolus) were compared with those of the control groups, and relative risks were calculated for patients in increasing percentile categories of anticardiolipin antibodies by conditional logistic regression. RESULTS: The anticardiolipin antibody titers were higher in case patients with deep venous thrombosis and pulmonary embolus than in their matched controls (P = 0.01). Persons with anticardiolipin antibody titers above the 95th percentile had a relative risk for developing deep venous thrombosis or pulmonary embolus of 5.3 (95% CI, 1.55 to 18.3; P = 0.01). The anticardiolipin antibody titers in case patients with ischemic stroke and controls were not significantly different (P > 0.2), and no clear trend of higher risks among those with elevated levels of anticardiolipin antibodies was observed. CONCLUSION: An anticardiolipin antibody level above the 95th percentile is an important risk factor for deep venous thrombosis or pulmonary embolus but not for ischemic stroke in healthy adult men Department of Rheumatology and Immunology Brigham and Women's Hospital Boston MA 02115. Ref ID : GIRARD1989 402. Girard, P., Hauuy, M.P., Musset, D., Simonneau, G., and Petitpretz, P. Acute inferior vena cava thrombosis. Early results of heparin therapy. Chest 95:284-291, 1989. Keywords : VENA CAVA; THROMBOSIS; EARLY; HEPARIN; THERAPY; RISK; PROSPECTIVE; PHLEBOGRAPHY; PERFUSION; LUNG; SCANNING; PULMONARY EMBOLISM; EMBOLISM; THROMBUS; VENOUS; ANTICOAGULATION; ACUTE DISEASE; ADULT; AGED; AGED 80 AND OVER; FEMALE; HUMAN; INFUSIONS INTRAVENOUS; MALE; MIDDLE AGE; VENA CAVA INFERIOR; Hospitals; Extension; in Notes : AB-STUDY OBJECTIVE: To determine, during heparin therapy, the embolic risk associated with acute inferior vena cava thrombosis compared with noncaval thrombosis. DESIGN: Prospective controlled study. SETTING: University-affiliated general hospital. PATIENTS: Of 68 consecutive patients considered, 18 with cavographically proved inferior vena cava thrombosis and 45 with phlebography-proved noncaval proximal thrombosis met all other eligibility criteria and completed the study. INTERVENTIONS: All patients received adjusted continuous IV heparin therapy for ten days. MEASUREMENTS AND RESULTS: All 63 patients underwent systematic baseline and "day 10 perfusion lung scanning and phlebocavography. None suffered pulmonary embolism within the ten days, but 11/63 patients showed thrombus extension on day 10 phlebocavograms. Retrospectively, no significant difference could be found between the groups with and without extension. CONCLUSIONS: (a) The early embolic risk associated with heparin-treated venous thromboses appears low and does not seem to depend on the location (caval or more peripheral) of venous clots. (b) Thrombus extension may occur in spite of apparently "adequate anticoagulation with heparin. Ref ID : GIRAUD1986 403. Giraud, C., Joffre, F., Puel, P., and Cerene, A. Is a combination of urokinase and Lys-plasminogen by regional infusion indicated in ischaemia due to popliteal or infra-popliteal thrombosis? Haemostasis. 16 Suppl 3:79-82, 1986. Keywords : UROKINASE; THROMBOSIS; ACEP93; is; in Ref ID : GIROD1982 404. Girod, D.A., Hurwitz, R.A., and Caldwell, R.L. Heparinization for prevention of thrombosis following pediatric percutaneous arterial catheterization. Pediatr.Cardiol. 3:175-180, 1982. Keywords : PREVENTION; THROMBOSIS; ARTERIAL; HEPARIN; PEDIATRIC; ACEP93; Catheterization Ref ID : GIUNTA1991 405. Giunta, A., Itri, F., Biagini, R., Losardo, L., and Maione, S. Sudden appearance of echocardiographic changes in a case of acute massive pulmonary embolism. Acta Cardiol. 46:583-587, 1991. Keywords : MASSIVE; PULMONARY EMBOLISM; EMBOLISM; CARDIAC; sdi-11/93; in; hospitalization; heart Notes : We report a case of a 68-years-old woman who developed during hospitalization a massive pulmonary embolism. Since the patient had undergone routine cardiac examination, comparison between the echo features immediately preceding and following the event allowed to detail the time interval required for the occurrence of the anatomical and functional changes of the heart chambers. Ref ID : GJORES1956 406. Gjores, J.E. The incidence of venous thrombosis and its sequelae in certain districts in Sweden. Acta.Chir.Scand. 206(supp):1, 1956. Keywords : INCIDENCE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DEEP VEIN THROMBOSIS; VEINS; CLINICAL DIAGNOSIS; DIAGNOSIS; PREVALENCE; EPIDEMIOLOGY; in; Sweden; hospitalization; vein; is Notes : More than 600,000 hospitalizations each year result from deep vein thrombosis and its sequelae, and because the clinical diagnosis of deep vein thrombosis is difficult and fraught with uncertainty, it is certain that a large proportion of cases go undiagnosed. The prevalence in the general population has been estimated at 5 percent. Ref ID : GJORES1956A 407. Gjores, J.E. The incidence of venous thrombosis and its sequellae in certain districts of Sweden. Acta Chir.Scand.[suppl]. 206:11, 1956. Keywords : INCIDENCE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Sweden; NASP; bib-2; in Ref ID : GLADMAN1980 408. Gladman, D.D. and Urowitz, M.B. Venous syndromes and pulmonary embolism in systemic lupus erythematosus. Ann.Rheum.Dis. 39:340-343, 1980. Keywords : VENOUS; Syndrome; PULMONARY EMBOLISM; EMBOLISM; LUPUS; SLE; VENOUS THROMBOSIS; in Ref ID : GLOVER1957 409. Glover, W.J. and et al Venous thrombectomy in the management of acute venous thrombosis of the saphenous system. Am.J.Surg. 93:798, 1957. Keywords : VENOUS; THROMBECTOMY; MANAGEMENT; VENOUS THROMBOSIS; THROMBOSIS; NASP; bib-2; in Ref ID : GLOVICZKI1992 410. Gloviczki, P. and Merrell, S.W. Surgical treatment of venous disease. Cardiovasc.Clin. 22:81-100, 1992. Keywords : SURGICAL; TREATMENT; VENOUS; NASP; Arteriovenous Shunt,Surgical; HUMAN; Surgical Instruments; Suture Techniques; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; VEINS; Venous Insufficiency; Medline File; ab Notes : AB - [No Abstract Available] UI - 92288949. Ref ID : GLYNN1983 411. Glynn, M.F.X., Path, N.R.C., Langer, B., and et al Therapy for thrombotic occlusion of long-term intravenous alimentation catheters. JPEN 4:387-390, 1983. Keywords : THERAPY; LONG TERM; INTRAVENOUS; CATHETER; THROMBOSIS; THROMBOLYTIC; ACEP93; OCCLUSION; Catheters Ref ID : GOFFETTE1991 412. Goffette, P., Kurdziel, J.C., and Dondelinger, R.F. Percutaneous local arterial thrombolytic infusion. Therapeutic effects and complications. Acta Radiol. 32:305-310, 1991. Keywords : ARTERIAL; THROMBOLYTIC; COMPLICATIONS; ACEP93 Ref ID : GOLDBERG1987 413. Goldberg, R.J., Seneff, M., Gore, J.M., Anderson, F.A.,Jr., Greene, H.L., Wheeler, H.B., and Dalen, J.E. Occult malignant neoplasm in patients with deep venous thrombosis. Arch.Int.Med. 147:251-253, 1987. Keywords : OCCULT; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MALIGNANCY; RISK; CANCER; DVT; ANGIOGRAPHY; PE; AGE; Neoplasms; in; DEEP VENOUS THROMBOSIS; is; RISK FACTORS Notes : Malignancy, whether known or occult, is a recognized risk factor for VT. Lieberman in 1961 demonstrated that in 38 percent of cases of concommittent cancer and DVT, the DVT was detected first. Further evidence has been supplied by Gore, who followed patients for 5 years after angiography and found that 16 percent of the patients with PE had been diagnosed with cancer within two years, whereas none of the patients without PE were found to have developed PE at two years. Goldberg reported that the relative risk for cancer is 19 times higher for patients under age 50 who have had DVT than for those without a history of DVT. Ref ID : GOLDBERG1989 414. Goldberg, H. and Fabry, T.L. Mesenteric thrombosis following sclerotherapy during vasopressin infusion: Mechanism and therapeutic implications. J.Clin.Gastroenterol. 11(1):56-57, 1989. Keywords : THROMBOSIS; SCLEROTHERAPY; VASOPRESSIN; MESENTERIC THROMBOSIS Ref ID : GOLDHABER1982 415. Goldhaber, S.Z., Hennekens, C.H., Evans, D.A., Newton, E.C., and Godleski, J.J. Factors associated with correct antemortem diagnosis of major pulmonary embolism. Am.J.Med. 73:822-826, 1982. Keywords : 951202; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; in; CLINICAL DIAGNOSIS; LUNG; SCAN; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; AUTOPSY; BRIGHAM; Hospitals; POSTOPERATIVE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SCANNING; DEATH; CONTRAST; PNEUMONIA; AGE; POSTMORTEM; AGED; HUMAN; MIDDLE AGE; co; di; PA; ri; Retrospective Studies; Support,U.S.Gov't,P.H.S. Medline File; an Notes : Difficulties persist in the accurate clinical diagnosis of major pulmonary embolism despite the availability of lung scans and pulmonary angiography. To evaluate factors associated with the correct antemortem diagnosis of pulmonary embolism, we reviewed all 1,455 autopsy reports at the Peter Bent Brigham Hospital from 1973 to 1977. Of 54 patients identified with anatomically major pulmonary embolism at autopsy, 16 (30 percent) had correct antemortem diagnosis. Accuracy was far greater in postoperative patients (64 percent) (p = 0.02) and in patients with autopsy-proved venous thrombosis (55 percent) (p = 0.005). Lung scanning (82 percent) (p = 0.0002) and pulmonary angiography (80 percent) (p = 0.05) during the 10 days prior to death were also associated with an increased tendency to correct clinical diagnosis of pulmonary embolism. In contrast, among 21 patients with autopsy-proved major pulmonary embolism who also had pneumonia, no pulmonary embolism was diagnosed before death (p = 0.0001). Furthermore, among patients 70 years of age or older, only 10 percent with pulmonary embolism at postmortem examination had a correct diagnosis prior to death (p = 0.02). In patients with pneumonia or in elderly patients, an increased awareness of the possibility of pulmonary embolism and more frequent use of lung scanning and pulmonary angiography may increase the accurate clinical diagnosis of pulmonary embolism. Ref ID : GOLDHABER1982A 416. Goldhaber, S.Z. and Hennekens, C.H. Time trends in hospital mortality and diagnosis of pulmonary embolism. Am.Heart J. 104(2 Pt 1):305-306, 1982. Keywords : 951216; TRENDS; in; Hospitals; hospital mortality; MORTALITY; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; Age Factors; AGED; hospitalization; HUMAN; patient discharge; td; di; mo; Support,U.S.Gov't,P.H.S. UNITED STATES; Medline File; Health Planning & Administration File Notes : [No Abstract Available]. Ref ID : GOLDHABER1982B 417. Goldhaber, S.Z., Hennekens, C.H., Markisz, J.A., McNeil, B.J., Glynn, M.A., Bettmann, M.A., and Schur, P.H. Low sensitivity of plasma DNA in screening for pulmonary embolism. Am.Rev.Respir.Dis. 126(2):360- 361, 1982. Keywords : 951216; SENSITIVITY; in; SCREENING; PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; PE; blood; LUNG; SCANNING; PROBABILITY; SCAN; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; AUTOPSY; SPECIFICITY; counterimmunoelectrophoresis; dna; bl; Evaluation Studies; HUMAN; di; ri; Support,U.S.Gov't,P.H.S. Medline File Notes : Detection of plasma deoxyribonucleic acid (DNA) by counterimmunoelectrophoresis (CIE) has been proposed as a rapid, inexpensive screening test for the diagnosis of pulmonary embolism (PE). To test the sensitivity of plasma DNA detection for the diagnosis of PE, we obtained blood samples from 89 patients when they underwent lung scanning for suspected PE. Plasma was analyzed qualitatively for DNA by CIE, using antiserum that could detect as little as 0.2 micrograms DNA/ml. Among 16 patients with PE diagnosed by high probability lung scan, pulmonary angiography, or at autopsy, plasma DNA was detected in 3 patients--a sensitivity of 19%. Of 6 patients with indeterminate lung scans and a possible diagnosis of PE, 1 had detectable plasma DNA. None of the 67 patients without a diagnosis of PE had detectable plasma DNA, so the specificity was 100%. Thus, although detection of plasma DNA by CIE has many desirable features of a screening test, further studies are needed before this test can be recommended in routine screening for PE. Ref ID : GOLDHABER1983 418. Goldhaber, S.Z., Savage, D.D., Garrison, R.J., Castelli, W.P., Kannel, W.B., McNamara, P.M., Gherardi, G., and Feinleib, M. Risk factors for pulmonary embolism. The Framingham study. Am.J.Med. 74:1023- 1028, 1983. Keywords : RISK; PULMONARY EMBOLISM; EMBOLISM; PE; CAUSE; DEATH; INCIDENCE; FRAMINGHAM; 951216; RISK FACTORS; LONG TERM; heart; AUTOPSY; in; AGE; blood; Blood Pressure; Pressure; Glucose; varicose; VARICOSE VEINS; VEINS; Died; FOLLOWUP; analysis; is; an; Age Factors; blood glucose; Body Weight; cholesterol; bl; FEMALE; HUMAN; MALE; et; Sex Factors; smoking; Support,U.S.Gov't,P.H.S. co; Medline File; cause of death Notes : In the Framingham study population, PE was an autopsy-proven principal or contributing cause of death in 16 percent of cases. Ref ID : GOLDHABER1984 419. Goldhaber, S.Z., Buring, J.E., Lipnick, R.J., Stubblefield, F., and Hennekens, C.H. Interruption of the inferior vena cava by clip or filter. Am.J.Med. 76(3):512-516, 1984. Keywords : 951216; VENA CAVA; FILTER; is; in; VENA CAVAL INTERRUPTION; AGE; CANCER; VENOUS; THROMBOEMBOLISM; EMBOLISM; MORTALITY; PROSPECTIVE; LONG TERM; RANDOMIZED; RANDOMIZED CONTROLLED TRIALS; CLINICAL TRIALS; COMPARATIVE STUDY; HUMAN; PULMONARY EMBOLISM; th; Support,U.S.Gov't,P.H.S. surgical equipment; surgical mesh; Vena Cava,Inferior; su; Medline File; Cancerlit File; BRIGHAM; Hospitals; laboratories; boston Notes : Interruption of the inferior vena cava is usually performed with either external clipping or transvenous filter placement. For patients unable to tolerate general anesthesia and laparotomy, the advantages of transvenous filters rather than clips are obvious. However, for some patients, the use of either clips or filters is possible. In general, retrospective observational studies of inferior vena caval interruption have not adequately accounted for baseline patient characteristics such as age, presence of cancer, and history of prior venous thromboembolism. These confounding factors can independently affect subsequent rates of both recurrent embolism and overall mortality. A comparative, controlled, prospective evaluation of inferior vena caval clipping versus transvenous filter placement among patients who are appropriate candidates for either procedure has not been undertaken. It is suggested that, among patients with good long-term prognoses, a randomized controlled trial would be necessary to help determine whether clipping or transvenous filter placement is more efficacious Channing Laboratory Brigham and Women's Hospital Boston Massachusetts. Ref ID : GOLDHABER1984A 420. Goldhaber, S.Z., Buring, J.E., Lipnick, R.J., and Hennekens, C.H. Pooled analyses of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. Am.J.Med. 76(3):393-397, 1984. Keywords : 951216; RANDOMIZED; STREPTOKINASE; HEPARIN; in; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; THROMBOLYSIS; ANTICOAGULATION; Safety; PHLEBOGRAPHY; DIAGNOSIS; THERAPY; drugs; BLEEDING; COMPLICATIONS; FIBRINOLYTIC; FIBRINOLYTIC AGENTS; CLINICAL TRIALS; HEMORRHAGE; ci; ae; tu; HUMAN; RANDOM ALLOCATION; Retrospective Studies; RISK; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; dt; Medline File Notes : Although thrombolysis with streptokinase has been compared with heparin anticoagulation for treating acute proximal deep venous thrombosis in several randomized trials, no individual study has had a sample of sufficient size to determine with adequate power both efficacy and safety. Therefore, results were pooled from six randomized studies in which phlebography was used to confirm the diagnosis and to assess therapy. Thrombolysis was achieved 3.7 times more often among patients treated with streptokinase than among patients treated with heparin (95 percent confidence limits 2.5, 5.7; p less than 0.0001). Only three studies allowed comparison of these drugs for major bleeding complications, which were 2.9 times greater with streptokinase than with heparin (95 percent confidence limits 1.1, 8.1; p = 0.04). Thus, in aggregate, streptokinase-treated patients achieved thrombolysis but also seemed to experience major bleeding complications more frequently than those assigned at random to receive heparin. Future trials of sufficient sample size should be undertaken to evaluate efficacy and safety. Such trials, which should include newer fibrinolytic agents, are necessary to determine optimal therapy for acute proximal deep venous thrombosis. Ref ID : GOLDHABER1986 421. Goldhaber, S.Z., Vaughan, D.E., Markis, J.E., Selwyn, A.P., Meyerovitz, M.F., Loscalzo, J., Kim, D.S., Kessler, C.M., Dawley, D.L., and Sharma, G.V. Acute pulmonary embolism treated with tissue plasminogen activator. Lancet 2(8512):886-889, 1986. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; PLASMINOGEN; PLASMINOGEN ACTIVATOR; HUMAN; rt-PA; vein; ANGIOGRAPHY; an; LYSIS; in; QUANTITATIVE; FIBRINOGEN; COMPLICATIONS; BLEEDING; SURGERY; ARTERY; INTRAVENOUS; ACUTE DISEASE; ADULT; AGED; ALTEPLASE; ae; tu; HEMORRHAGE; ci; MIDDLE AGE; PULMONARY ARTERY; ra; dt; RECOMBINANT PROTEINS; Support,U.S.Gov't,P.H.S. TIME FACTORS; Medline File; Cancerlit File; BRIGHAM; Hospitals; boston Notes : Recombinant human tissue-type plasminogen activator (rt-PA) was given via a peripheral vein to 36 patients with angiographically documented pulmonary embolism. The regimen was 50 mg/2 h followed by repeat angiography and, if necessary, an additional 40 mg/4 h. By 6 h, 34 of 36 patients had angiographic evidence of clot lysis, slight in 4, moderate in 6, and marked in 24. The quantitative score improved 21% by 2 h and 49% by 6 h. Fibrinogen decreased 30% from baseline at 2 h and 38% from baseline at 6 h. 2 patients had major complications: in one, bleeding from a pelvic tumour required surgery; in the other, who had had coronary artery bypass surgery eight days earlier, pericardial tamponade developed. These initial results in selected patients make a case for expanded investigational use of peripheral intravenous rt-PA in pulmonary embolism Department of Medicine and Radiology Brigham and Women's Hospital Boston MA 02115. Ref ID : GOLDHABER1987 422. Goldhaber, S.Z., Meyerovitz, M.F., Markis, J.E., Kim, D., Kessler, C.M., Sharma, G.V., Vaughan, D.E., Selwyn, A.P., Dawley, D.L., and Loscalzo, J. Thrombolytic therapy of acute pulmonary embolism: current status and future potential. J.Am.Coll.Cardiol. 10(5 Suppl B):96B-104B, 1987. Keywords : 951216; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PULMONARY EMBOLISM; EMBOLISM; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; FIBRINOLYTIC; FIBRINOLYTIC AGENTS; Safety; INTRAVENOUS; in; drugs; ANGIOGRAPHY; an; LYSIS; PULMONARY HYPERTENSION; Hypertension; TREATMENT; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; FIBRINOGEN; COMPLICATIONS; SURGICAL; BLEEDING; HEMORRHAGE; coronary artery; CORONARY ARTERY BYPASS; SURGERY; ACUTE DISEASE; ALTEPLASE; ae; tu; CLINICAL TRIALS; ra; dt; RECOMBINANT PROTEINS; TIME FACTORS; UROKINASE; Medline File; Cancerlit File; BRIGHAM; Hospitals; boston Notes : Recombinant human tissue-type plasminogen activator (rt-PA), a relatively clot-specific fibrinolytic agent, represents a novel and promising approach to thrombolytic therapy of pulmonary embolism. Therefore, the efficacy and safety of peripheral intravenous rt-PA therapy were assessed in 47 patients with angiographically documented pulmonary embolism. The drug regimen was 50 mg over 2 hours followed by repeat angiography and, if necessary, an additional 40 mg over 4 hours. By 6 hours, 44 of the 47 patients had angiographic evidence of clot lysis that was slight (n = 5), moderate (n = 12) or marked (n = 27). Among the 34 patients with pulmonary hypertension before treatment (mean pulmonary artery pressure exceeding 17 mm Hg), the pressure decreased from 43/17 (mean 27) to 31/13 (mean 19) mm Hg (p less than 0.0001). Fibrinogen decreased 33% from baseline at 2 hours and 42% from baseline at 6 hours. There were two major complications that required surgical control of bleeding: hemorrhage from a pelvic tumor and mediastinal tamponade in a patient 8 days after coronary artery bypass surgery. The initial results demonstrate that, among selected patients, peripheral intravenous rt-PA can rapidly and, for the most part, safely lyse pulmonary embolism within 6 hours Department of Medicine Brigham and Women's Hospital Boston Massachusetts 02115. Ref ID : GOLDHABER1987A 423. Goldhaber, S.Z., Dricker, E., Buring, J.E., Eberlein, K., Godleski, J.J., Mayer, R.J., and Hennekens, C.H. Clinical suspicion of autopsy- proven thrombotic and tumor pulmonary embolism in cancer patients. Am.Heart J. 114:1432-1435, 1987. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; CANCER; PE; CLINICAL FEATURES; AUTOPSY; BRIGHAM; Hospitals; LUNG; DIAGNOSIS; CONTRAST; is; FEMALE; HUMAN; lung neoplasms; co; MALE; MIDDLE AGE; neoplasm circulating cells; di; et; PA; Support,U.S.Gov't,P.H.S. Medline File; Cancerlit File; laboratories Notes : Cancer patients are prone to both thrombotic and tumor pulmonary embolism (PE). To identify similarities and differences in their clinical features, we reviewed all autopsies from 1978 to 1982 at Brigham and Women's Hospital and the Dana Farber Cancer Institute. Of 73 patients with solid malignant tumors and PE, 56 had major thrombotic PE and 17 had major tumor embolism to the lungs. Of the 56 with cancer and thrombotic PE, 25 (45%) had the correct diagnosis suspected antemortem. By contrast, only 1 of 17 (6%) patients with tumor embolism was diagnosed correctly antemortem (p = 0.005). Most presenting symptoms, signs, laboratory values, and associated conditions were not markedly different in patients with thrombotic PE and tumor embolism. These findings indicate that tumor PE is more difficult to diagnose clinically and may be misdiagnosed as thrombotic PE. Finally, these data suggest that in all cancer patients, the presence of both thrombotic and tumor PE should be considered because of similarities in their clinical features Department of Medicine Brigham and Women's Hospital Brookline MA. Ref ID : GOLDHABER1987B 424. Goldhaber, S.Z., Buring, J.E., and Hennekens, C.H. Cancer and venous thromboembolism [editorial]. Arch.Intern.Med. 147(2):216, 1987. Keywords : 951216; CANCER; VENOUS; THROMBOEMBOLISM; HUMAN; Neoplasms; co; RISK; THROMBOPHLEBITIS; Medline File; Cancerlit File Notes : [No Abstract Available]. Ref ID : GOLDHABER1987D 425. Goldhaber, S.Z., Markis, J.E., Kessler, C.M., Meyerovitz, M.F., Kim, D., Vauchan, D.E., Selwyn, A.P., Loscalzo, J., Dawley, D.L., and Sharma, G.V. Perspectives on treatment of acute pulmonary embolism with tissue plasminogen activator. Semin.Thromb.Hemost. 13(2):171-177, 1987. Keywords : 951216; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; PLASMINOGEN; PLASMINOGEN ACTIVATOR; ADULT; ALTEPLASE; pd; tu; ANGIOGRAPHY; CASE REPORT; CLINICAL TRIALS; FEMALE; Fibrin Fibrinogen Degradation Products; an; FIBRINOGEN; me; HEPARIN; HUMAN; dt; Pulmonary Wedge Pressure; RECOMBINANT PROTEINS; Support,U.S.Gov't,P.H.S. Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1988 426. Goldhaber, S.Z., Kessler, C.M., Heit, J., Markis, J., Sharma, G.V.R.K., Dawley, D., Sharma, G.V., Nagel, J.S., Meyerovitz, M., Kim, D., and Vaughan, D.E. Randomized controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 2(8606):293-298, 1988. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; UROKINASE; TPA; CLINICAL TRIAL; 951216; in; INTRAVENOUS; HUMAN; rt-PA; PE; LYSIS; ANGIOGRAPHY; PERFUSION; LUNG; SCANNING; ALLERGY; BLEEDING; ci; SCAN; FIBRINOGEN; is; ACUTE DISEASE; ADULT; ALTEPLASE; tu; CLINICAL TRIALS; COMPARATIVE STUDY; FEMALE; MALE; MIDDLE AGE; dt; ra; RANDOM ALLOCATION; Medline File; BRIGHAM; Hospitals; boston; RANDOMIZED; RANDOMIZED CONTROLLED TRIALS Notes : The effect of intravenous recombinant human tissue-type plasminogen activator (rt-PA) was compared with that of urokinase in 45 patients with angiographically documented pulmonary embolism (PE) in a randomised controlled trial. The two principal end-points were clot lysis at 2 h, as assessed by angiography, and pulmonary reperfusion at 24 h, as assessed by perfusion lung scanning. All patients received the full dose of rt-PA but urokinase infusions were terminated prematurely (on average after 18 h) in 9 patients because of allergy in 1 and uncontrollable bleeding in 8. By 2 h, 82% of rt- PA-treated patients showed clot lysis, compared with 48% of urokinase- treated patients (p = 0.008; 95% CI for the difference = 10-58%). Improvement in lung scan reperfusion at 24 h was identical in the two treatment groups. The reduction in fibrinogen did not differ significantly between the rt-PA and urokinase groups (45% vs 39% at 2 h and 34% vs 40% at 24 h). The results indicate that in the dose regimens employed, rt-PA acts more rapidly and is safer than urokinase in the treatment of acute PE Brigham and Women's Hospital Boston Massachusetts. Ref ID : GOLDHABER1988A 427. Goldhaber, S.Z., Vaughan, D.E., Tumeh, S.S., and Loscalzo, J. Utility of cross-linked fibrin degradation products in the diagnosis of pulmonary embolism. Am.Heart J. 116(2 Pt 1):505-508, 1988. Keywords : 951216; FIBRIN; FIBRIN DEGRADATION PRODUCTS; in; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; blood; PE; diagnostics; LUNG; SCANNING; FIBRINOLYTIC; SCREENING; QUANTITATIVE; antibodies; D-DIMER; Molecular Weight; FIBRINOGEN; Plasmin; SCAN; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; an; CONTRAST; ADULT; antibodies,monoclonal; du; enzyme-linked immunosorbent assay; FEMALE; Fibrin Fibrinogen Degradation Products; HUMAN; MALE; MIDDLE AGE; di; ra; ri; Support,U.S.Gov't,P.H.S. Medline File; BRIGHAM; Hospitals; boston Notes : Blood samples from patients with suspected pulmonary embolism (PE) were obtained at the time of diagnostic lung scanning to determine whether identification of those with activation of endogenous fibrinolytic pathways could serve as a screening test for PE. Cross- linked fibrin degradation products (XDPs) were measured by a quantitative enzyme-linked immunoassay with a specific monoclonal antibody (MabCO Dimertest EIA) that recognizes cross-linked D-dimer fragments and related high molecular weight fibrin derivatives containing D-dimer but that does not cross-react with fibrinogen or its plasmin degradation products. PE was present in 19 with positive pulmonary angiograms and absent in 50 with completely normal lung scans. Elevated levels of XDPs (greater than 144 ng/ml) were present in 17 of 19 patients (89%) with PE and in 28 of 50 (56%) without PE (p = 0.30). Among those with PE present, the XDP levels were (means +/-sd) 864 +/- 1,068 ng/ml (median = 470 ng/ml) compared with 285 +/-395 ng/ml (median = 155 ng/ml) among those with PE absent (p = 0.003). For PE detection, elevated XDP levels provided a sensitivity of 89%, a specificity of 44%, a positive predictive value of 38%, a negative predictive value of 92%, and an accuracy of 57%. Among those with elevated XDP levels and PE absent, 75% had no apparent reason for XDP elevations. These data indicate that XDPs are significantly elevated in patients with PE but that, in contrast to earlier reports, measurement of XDPs among individuals with suspected PE may not be sufficiently accurate to be clinically useful in screening Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : GOLDHABER1988B 428. Goldhaber, S.Z. Pulmonary embolism death rates [letter]. Am.Heart J. 115(6):1342-1343, 1988. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; DEATH; HUMAN; mo; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1988C 429. Goldhaber, S.Z., Nagel, J.S., Theard, M., Levine, J.D., and Sutton, M.G. Treatment of right atrial thrombus with urokinase. Am.Heart J. 115(4):894-897, 1988. Keywords : 951216; TREATMENT; THROMBUS; UROKINASE; ADULT; AGED; CASE REPORT; CORONARY DISEASE; dt; coronary thrombosis; FEMALE; HUMAN; tu; Medline File; BRIGHAM; Hospitals; boston Notes : [No Abstract Available] Department of Medicine Brigham and Women's Hospital Boston MA 02115. Ref ID : GOLDHABER1988D 430. Goldhaber, S.Z. Venous thromboembolism: how to prevent a tragedy. Hosp.Pract.(Off.Ed). 23(10):164, 169-70, 173-4, 1988. Keywords : 951216; VENOUS; THROMBOEMBOLISM; ANTICOAGULANTS; tu; Clothing; Cost-Benefit Analysis; HUMAN; PULMONARY EMBOLISM; et; pc; co; Medline File; Health Planning & Administration File; boston Notes : [No Abstract Available] Harvard Medical School Boston. Ref ID : GOLDHABER1988E 431. Goldhaber, S.Z. and Loscalzo, J. Urokinase versus tissue plasminogen activator in pulmonary embolism [letter]. Lancet 2(8616):915, 1988. Keywords : 951216; UROKINASE; PLASMINOGEN; PLASMINOGEN ACTIVATOR; in; PULMONARY EMBOLISM; EMBOLISM; ACUTE DISEASE; ALTEPLASE; tu; COMPARATIVE STUDY; HUMAN; dt; RECOMBINANT PROTEINS; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1988F 432. Goldhaber, S.Z. Optimal strategy for diagnosis and treatment of pulmonary embolism due to right atrial thrombus. Mayo Clin.Proc. 63(12):1261-1264, 1988. Keywords : 951216; DIAGNOSIS; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; THROMBUS; Echocardiography; Heart Atrium; HUMAN; di; dt; et; STREPTOKINASE; tu; THROMBOSIS; co; UROKINASE; Medline File; CARDIOVASCULAR; BRIGHAM; Hospitals; boston Notes : [No Abstract Available] Cardiovascular Division Brigham and Women's Hospital Boston MA 02115. Ref ID : GOLDHABER1988G 433. Goldhaber, S.Z., Kessler, C.M., Heit, J., Markis, J.E., Sharma, G.V., Dawley, D.L., Meyerovitz, M.F., Vaughan, D.E., Parker, J.A., and Come, P.C. Tissue plasminogen activator and acute pulmonary embolism. J.Cell Biochem. 38(4):303-312, 1988. Keywords : 951216; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PULMONARY EMBOLISM; EMBOLISM; Safety; INTRAVENOUS; HUMAN; rt-PA; in; PE; an; LYSIS; PULMONARY HYPERTENSION; Hypertension; TREATMENT; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; LUNG; SCAN; PERFUSION; THERAPY; Doppler; Echocardiogram; Movement; FIBRINOGEN; FIBRINOLYSIS; FIBRIN; FIBRIN DEGRADATION PRODUCTS; is; ALTEPLASE; tu; biological markers; bl; ra; Pulmonary Circulation; dt; RECOMBINANT PROTEINS; Medline File; BRIGHAM; Hospitals; boston Notes : We assessed the efficacy and safety of peripheral intravenous recombinant human tissue-type plasminogen activator (rt-PA) in 47 patients with angiographically documented pulmonary embolism (PE). We administered 50 mg/2 h and, if necessary, an additional 40 mg/4 h. By 6 hours, 94% of the patients had angiographic evidence of clot lysis that was slight in 5, moderate in 12, and marked in 27 patients. Among the 34 patients with pulmonary hypertension prior to treatment, average pulmonary artery pressure decreased from 43/17 (27) to 31/13 (19) mm Hg (P less than 0.0001). The average lung scan perfusion defect decreased from 37% before therapy to 16% (P less than 0.01) after therapy among the 19 patients who had pre- and post-treatment lung scans. Of 7 patients with pre- and post-treatment imaging and Doppler echocardiograms, hypokinetic right ventricular wall movement (mild in 1, moderate in 2, and severe in 4) normalized in 5 and improved to mild hypokinesis in 2. Right ventricular diameter decreased from 3.9 +/- 1.0 to 2.0 +/- 0.5 cm (P less than 0.005). Fibrinogen decreased 33% from baseline at 2 h and 42% from baseline at 6 h. However, patients with the greatest degree of angiographic clot lysis at 2 h had a preponderance of fibrinogenolysis over fibrinolysis, demonstrated by a lower ratio of cross-linked fibrin degradation products to fibrin(ogen) degradation products (0.14 +/- 0.09 vs. 0.54 +/- 0.82) (P less than 0.04). Among selected patients, peripheral intravenous rt-PA is associated with rapid lysis of PE, improved pulmonary perfusion, and improved right ventricular function Department of Medicine Brigham and Women's Hospital Boston Massachusetts 02115. Ref ID : GOLDHABER1989 434. Goldhaber, S.Z. Tissue plasminogen activator in acute pulmonary embolism. Chest 95(5 Suppl):282S-289S, 1989. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; PULMONARY EMBOLISM; EMBOLISM; TPA; 951216; in; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; THROMBOLYSIS; PE; HUMAN; an; Safety; UROKINASE; is; HEPARIN; Echocardiography; MORTALITY; ALTEPLASE; tu; CLINICAL TRIALS; COMPARATIVE STUDY; dt; RECOMBINANT PROTEINS; Medline File; CARDIOVASCULAR; BRIGHAM; Hospitals; boston Notes : The use of thrombolytic therapy to treat AMI has reawakened interest in thrombolysis for acute pulmonary embolism (PE). We have investigated the use of recombinant human tissue-type plasminogen activator (rtPA) in patients with acute PE. In an open label study, rtPA achieved more than 90% efficacy and safety. In a trial comparing rtPA with an FDA-approved dose of urokinase (UK), rtPA appeared more rapid and safer. We are now conducting a comparative trial of rtPA with a novel dosing regimen of UK. In addition, a concurrent trial is comparing rtPA vs heparin for improvement in right ventricular function, assessed by echocardiography, among PE patients. However, the greatest challenge in PE research is to undertake a large-scale trial that compares thrombolysis and heparin for reduction of clinically relevant end points such as mortality and recurrent PE Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston 12005. Ref ID : GOLDHABER1989A 435. Goldhaber, S.Z. TPA versus urokinase in acute pulmonary embolism: results of a randomized controlled trial. Vasa.Suppl. 27:292-4:292-294, 1989. Keywords : 951216; TPA; UROKINASE; in; PULMONARY EMBOLISM; EMBOLISM; RANDOMIZED; RANDOMIZED CONTROLLED TRIALS; ALTEPLASE; ad; COMPARATIVE STUDY; Dose-Response Relationship,Drug; HUMAN; th; RECOMBINANT PROTEINS; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1990 436. Goldhaber, S.Z., Meyerovitz, M.F., Green, D., Vogelzang, R.L., Citrin, P., Heit, J., Sobel, M., Wheeler, H.B., Plante, D., and Kim, H. Randomized controlled trial of tissue plasminogen activator in proximal deep venous thrombosis. Am.J.Med. 88(3):235-240, 1990. Keywords : RANDOMIZED CONTROLLED TRIALS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ACEP93; TPA; DVT; 951216; RANDOMIZED; in; Safety; HUMAN; rt- PA; HEPARIN; TREATMENT; LEG; Methods; PROSPECTIVE; vein; WARFARIN; hospitalization; FOLLOWUP; VENOGRAPHY; THERAPY; LYSIS; COMPLICATION; HEMORRHAGE; CAUSE; is; RISK; BLEEDING; Adolescence; ADULT; AGED; ALTEPLASE; tu; aspartate aminotransferase; bl; Drug Therapy,Combination; FEMALE; Fibrin Fibrinogen Degradation Products; an; ad; Infusions,Intravenous; bs; MALE; MIDDLE AGE; MULTICENTER STUDIES; PHLEBOGRAPHY; RECOMBINANT PROTEINS; Support,Non-U.S.Gov't; dt; Medline File; CARDIOVASCULAR; BRIGHAM; Hospitals; boston Notes : PURPOSE: To compare the efficacy and safety of recombinant human tissue-type plasminogen activator (rt-PA, supplied as Activase) with heparin alone or rt-PA plus heparin in the treatment of venographically documented proximal deep venous thrombosis (DVT) of the leg. PATIENTS AND METHODS: Sixty-four patients underwent 65 randomizations to rt-PA alone (n = 36), rt-PA plus heparin (n = 17), or heparin alone (n = 12) in a prospective, multicenter, randomized, open-label trial, with efficacy assessed by a radiology panel unaware of treatment assignment. Patients randomly assigned to rt-PA received 0.05 mg/kg/hour for 24 hours via a peripheral vein, with a maximum dose of 150 mg. All patients then received heparin and warfarin for the remainder of the hospitalization. Follow-up venography was performed 24 to 36 hours after initiation of therapy. RESULTS: Complete or more than 50% lysis occurred in 10 (28%) patients treated with rt-PA, five (29%) patients with rt-PA plus heparin, and no patient treated with heparin. No lysis occurred in 16 (44%) patients treated with rt-PA plus heparin, and 10 (83%) patients who received heparin alone (p = 0.04). There was one major complication, a nonfatal intracranial hemorrhage in a patient who received rt-PA alone. At 7 to 10 days after initiation of treatment, the level of serum glutamic oxaloacetic transaminase nearly doubled among all patients, including those assigned to receive heparin alone. CONCLUSION: (1) rt-PA and rt-PA plus heparin cause more clot lysis than heparin alone; (2) the addition of heparin to rt-PA does not improve the lysis rate; (3) DVT treated with heparin is commonly associated with a rise in the transaminase level; (4) heparin does not increase the risk of bleeding from rt-PA therapy; and (5) alternative dosing regimens and modes of administration of rt-PA should be investigated to improve further its efficacy and safety in the treatment of acute DVT Cardiovascular Division Brigham and Women's Hospital Boston Massachusetts 02115. Ref ID : GOLDHABER1990A 437. Goldhaber, S.Z. Thrombolysis in venous thromboembolism. An international perspective. Chest 97(4 Suppl):176S-181S, 1990. Keywords : 951216; THROMBOLYSIS; in; VENOUS; THROMBOEMBOLISM; an; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PA; PULMONARY EMBOLISM; EMBOLISM; PE; INTRAVENOUS; rt-PA; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; DVT; is; THROMBOLYTIC; CLINICAL TRIALS; ANTICOAGULATION; ALTEPLASE; tu; HUMAN; dt; RECOMBINANT PROTEINS; THROMBOLYTIC THERAPY; ae; THROMBOPHLEBITIS; UROKINASE; Medline File; CARDIOVASCULAR; BRIGHAM; Hospitals; boston Notes : Two promising novel recombinant tissue-type plasminogen activator (rt- PA) regimens for pulmonary embolism (PE) are being actively investigated: 100 mg/2 h as a continuous peripheral intravenous infusion, and bolus rt-PA, adjusted to weight, as a 2-min infusion. For deep venous thrombosis (DVT), less progress has been made in finding an optimal dosing regimen of rt-PA. Our mandate for the 1990s is to use the best possible thrombolytic dosing regimens in large clinical trials of PE and DVT. The primary objective of these planned clinical studies is to determine which patients with PE and DVT will benefit the most from thrombolysis followed by anticoagulation rather than anticoagulation alone Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston 02115. Ref ID : GOLDHABER1990B 438. Goldhaber, S.Z. Thrombolytic therapy for venous thromboembolism. Baillieres.Clin.Haematol. 3(3):693-704, 1990. Keywords : 951216; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; VENOUS; THROMBOEMBOLISM; ANTICOAGULANTS; ad; tu; FIBRINOLYTIC AGENTS; HEPARIN; HUMAN; plasminogen activators; PULMONARY EMBOLISM; di; dt; RECOMBINANT PROTEINS; RECURRENCE; STREPTOKINASE; THROMBOPHLEBITIS; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1991 439. Goldhaber, S.Z. Managing pulmonary embolism. Hosp.Pract.(Off.Ed). 26:37-48, 1991. Keywords : PHLEBITIS; PULMONARY EMBOLISM; EMBOLISM; ANTICOAGULANTS; therapeutic use; BANDAGES; HEPARIN; administration & dosage; HUMAN; LEG; Ultrasonography; LUNG; radionuclide imaging; PULMONARY ARTERY; radiography; DIAGNOSIS; drug therapy; prevention & control; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; MORBIDITY; MORTALITY; RISK; PROPHYLAXIS; diagnostics; ANTICOAGULATION; THERAPY; WARFARIN; THROMBOLYSIS; OUTCOME; in Notes : Although morbidity and mortality remain high, we now have effective strategies to prevent development of the disease in many patients at risk. For those who do not benefit from prophylaxis, our understanding of optimal diagnostic strategy has improved, as has that of classic anticoagulation therapy with heparin and warfarin. Thrombolysis may also improve outcome. Ref ID : GOLDHABER1991A 440. Goldhaber, S.Z. Recent advances in the diagnosis and lytic therapy of pulmonary embolism. Chest 99(4 Suppl):173S-179S, 1991. Keywords : 951216; in; DIAGNOSIS; LYTIC; THERAPY; PULMONARY EMBOLISM; EMBOLISM; MANAGEMENT; PE; PROSPECTIVE; PIOPED; LUNG; SCANNING; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; heart; blood; is; us; Ultrasonography; LEG; VEINS; VENOUS; THROMBOEMBOLISM; drugs; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; TREATMENT; INTRAVENOUS; Safety; THROMBOLYSIS; diagnostic imaging; FIBRINOLYTIC AGENTS; tu; di; dt; THROMBOLYTIC THERAPY; Medline File; BRIGHAM; Hospitals; boston Notes : During the past year, there have been 2 major advances in the management of pulmonary embolism (PE). First, the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) investigators published the results of their comparison of ventilation-perfusion lung scanning and pulmonary angiography. This multimillion-dollar trial sponsored by the National Heart, Lung, and Blood Institute indicated that lung scanning is surprisingly insensitive to the diagnosis of PE. High-probability lung scanning detects fewer than half of the cases of PE that are found at pulmonary angiography. The PIOPED results force us to conclude that increased utilization of both ultrasonography of the deep leg veins and pulmonary angiography is warranted in order to detect the majority of cases of venous thromboembolism. Second, in June 1990, the Food and Drug Administration approved recombinant human tissue-type plasminogen activator (rt-PA) for use in the treatment of acute PE. The dosing regimen is 100 mg of rt-PA as a continuous peripheral intravenous infusion administered over 2 h. The convenience, rapid effect, and relative safety of this therapeutic approach may result in increased use of thrombolysis for management of PE Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : GOLDHABER1991B 441. Goldhaber, S.Z. Managing pulmonary embolism. Hosp.Pract.(Off.Ed). 26(9):37-48, 1991. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; MORBIDITY; MORTALITY; in; RISK; PROPHYLAXIS; diagnostics; ANTICOAGULATION; THERAPY; HEPARIN; WARFARIN; THROMBOLYSIS; OUTCOME; ANTICOAGULANTS; tu; BANDAGES; ad; HUMAN; LEG; us; LUNG; ri; PULMONARY ARTERY; ra; di; dt; pc; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; Medline File; boston Notes : Although morbidity and mortality remain high, we now have effective strategies to prevent development of the disease in many patients at risk. For those who do not benefit from prophylaxis, our understanding of optimal diagnostic strategy has improved, as has that of classic anticoagulation therapy with heparin and warfarin. Thrombolysis may also improve outcome Harvard University Harvard Medical School Boston. Ref ID : GOLDHABER1991C 442. Goldhaber, S.Z. Thrombolysis for pulmonary embolism. Prog.Cardiovasc.Dis. 34(2):113-134, 1991. Keywords : 951216; THROMBOLYSIS; PULMONARY EMBOLISM; EMBOLISM; AGED; ALTEPLASE; tu; HUMAN; MALE; dt; THROMBOLYTIC THERAPY; ae; CT; Medline File; boston Notes : [No Abstract Available] Harvard Medical School Boston MA. Ref ID : GOLDHABER1992 443. Goldhaber, S.Z. Evolving concepts in thrombolytic therapy for pulmonary embolism [see comments]. Chest 101(4 Suppl):183S-185S, 1992. Keywords : 951216; in; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PULMONARY EMBOLISM; EMBOLISM; EARLY; PE; THROMBOLYSIS; an; Hospitals; HEMORRHAGIC; COMPLICATION; CLINICAL TRIALS; us; ALTEPLASE; ad; tu; Blood Coagulation Tests; HUMAN; intensive care units; di; dt; STREPTOKINASE; mt; TIME FACTORS; UROKINASE; Medline File; Health Planning & Administration File; BRIGHAM; boston Notes : Many clinicians who practiced in the early and mid-1970s remember PE thrombolysis as an extraordinary enterprise that consumed hospital resources and physicians' time around the clock for at least several days. Indeed, more than 1 in every 4 patients suffered a major hemorrhagic complication when a 24-h dosing regimen was utilized. This unfavorable experience soured some physicians, who have been reluctant to reconsider PE thrombolysis in the 1990s. Fortunately, recently completed clinical trials have taught us many ways to make thrombolytic therapy safer, more streamlined, and more economical (Fig 1) Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : GOLDHABER1992A 444. Goldhaber, S.Z. Conjunctive heparin therapy. Limitations of subcutaneous administration [editorial; comment]. Circulation 86(5):1639-1641, 1992. Keywords : 951216; HEPARIN; THERAPY; SUBCUTANEOUS; ad; pk; tu; HUMAN; injections,subcutaneous; MYOCARDIAL INFARCTION; bl; dt; THROMBOLYTIC THERAPY; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1992B 445. Goldhaber, S.Z. Pulmonary embolism thrombolysis: a clarion call for international collaboration [editorial; comment]. J.Am.Coll.Cardiol. 19(2):246-247, 1992. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; THROMBOLYSIS; ALTEPLASE; tu; HUMAN; international cooperation; dt; research design; THROMBOLYTIC THERAPY; UROKINASE; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1992C 446. Goldhaber, S.Z. and Morpurgo, M. Diagnosis, treatment, and prevention of pulmonary embolism. Report of the WHO/International Society and Federation of Cardiology Task Force. JAMA 268(13):1727-1733, 1992. Keywords : 951216; DIAGNOSIS; TREATMENT; PREVENTION; PULMONARY EMBOLISM; EMBOLISM; Cardiology; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; world health; in; Switzerland; QUANTITATIVE; is; FREQUENCY; OUTPATIENT; RISK; INCIDENCE; SURVIVAL; LONG TERM; COMPLICATIONS; PROPHYLAXIS; TECHNIQUES; PHYSICIAN PRACTICES; AGED; ANTICOAGULANTS; tu; BANDAGES; FEMALE; HUMAN; MALE; MIDDLE AGE; di; dt; pc; th; Support,Non-U.S.Gov't; THROMBOLYTIC THERAPY; Medline File Notes : To assess the state of the art of venous thrombosis and pulmonary embolism for the medical and other health-related professions, the World Health Organization (WHO) and the International Society and Federation of Cardiology (ISFC) convened a task force in Geneva, Switzerland. Members of the task force prepared position papers and presented brief oral presentations. A report was subsequently prepared by the task force members, who contributed sections in their areas of expertise. Revisions of the report occurred both during the task force meeting itself in Geneva and during the ensuing months. The final report was approved by the WHO-ISFC Task Force on Pulmonary Embolism Steering Committee. More quantitative information is needed on the frequency of venous thrombosis and pulmonary embolism in hospitalized medical patients as well as in outpatients at high risk. Population studies should focus on incidence, survival, and long-term complications in different parts of the world with respect to gender and race. Further educational efforts are needed to increase awareness about venous thrombosis and pulmonary embolism prophylaxis. Finally, research into effective techniques for changing physician practice would be useful World Health Organization (WHO)/International Society Geneva Switzerland. Ref ID : GOLDHABER1993 447. Goldhaber, S.Z., Simons, G.R., Elliott, C.G., Haire, W.D., Toltzis, R., Blacklow, S.C., Doolittle, M.H., and Weinberg, D.S. Quantitative plasma D-dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism. JAMA 270 (23):2819-2822, 1993. Keywords : QUANTITATIVE; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PULMONARY EMBOLISM; EMBOLISM; PREDICTIVE VALUE; PE; SENSITIVITY; SPECIFICITY; D- DIMER; 951216; diagnostics; antibodies; in; PULMONARY ARTERIOGRAPHY; ARTERIOGRAPHY; OUTCOME; DIAGNOSIS; standards; confidence intervals; ci; SCREENING; is; ADULT; AGED; antifibrinolytic agents; bl; COMPARATIVE STUDY; enzyme-linked immunosorbent assay; mt; FEMALE; Fibrin Fibrinogen Degradation Products; an; HUMAN; MALE; MIDDLE AGE; predictive value of tests; ra; sensitivity and specificity; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. Medline File; BRIGHAM; Hospitals; boston; blood; creatine kinase; MI; FIBRINOLYSIS; FIBRIN; INDICATIONS; PT; ab; LETTER; st; France; reference standards; HEPARIN; DURATION; THERAPY; et; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; laboratories; Methods; FIBRINOLYTIC; disseminated intravascular coagulation; COAGULATION; TRENDS; EMERGENCY Notes : Of 35 patients with D-dimer levels less than 500 ng/ml, only three had abnormal pulmonary angiograms. The negative predictive value of a plasma D-dimer level less than 500 ng/ml for acute PE was 91.4%. D- dimer levels were greater than 500 ng/ml in 42 of 45 patients with PE and in 96 of 128 patients without PE. Sensitivity, specificity, and positive predictive value of a plasma D-dimer level greater than 500 ng/ml for acute PE were 93%, 25%, and 30.4% respectively TX ABSTRACT Introduction.--It would be very helpful to have a blood test for pulmonary embolism (PE) that possesses a high negative predictive value, comparable to the serum creatine kinase assay that is used to exclude acute MI. D-dimer is a degradatory product of endogenous fibrinolysis, which is seen when cross-linked fibrin clots are lysed. There are indications that plasma D-dimer levels, which are estimated by enzyme- linked immunosorbent assay, usually are elevated in patients with acute PE. Objective and Methods.--The negative predictive value of a D-dimer level of less than 500 ng/mL was examined in 173 patients with suspected acute PE who underwent diagnostic pulmonary arteriography. The plasma D- dimer level, which was quantified by a monoclonal antibody assay, was compared with the results of pulmonary angiography in a blinded manner. Results.--Angiography revealed abnormal findings in 45 patients. Most demographic and clinical features were similar in patients with and without PE. Only 3 of 35 patients whose D-dimer value was less than 500 ng/mL had abnormal angiograms, for a negative predictive value of 91.4%. A level greater than 500 ng/mL was 93% sensitive for acute PE, but it was only 25% specific and had a positive predictive value of only 30%. Sensitivity was about the same at levels of 300-600 ng/mL, but it was more specific at a cutoff level of 600 ng/mL. Conclusion.--A plasma D- dimer level less than 500 ng/mL strongly indicates that the pulmonary angiogram will be negative, despite symptoms suggestive of acute PE. COMMENTARY The finding of a plasma D-dimer level less than 500 ng/mL can be clinically useful by making the diagnosis of recent, significant pulmonary embolism highly unlikely; on the other hand, the finding of a level greater than 500 ng/mL is only 25% specific and is associated with a positive predictive value of only 30%.--R.C. Schlant, M.D. PT Abstracts (ABS). Yearbook (YBK). UP 95043 AU Heit, John A. Nichols, William L. Goldhaber, Samuel Z. Simons, Grant R. TI Letters: Plasma D- Dimer Levels and Diagnosis of Pulmonary Embolism. IN Mayo Clinic, Rochester, Minn. Brigham and Women's Hospital, Boston, Mass. SO JAMA. 1994 May 11. 271(18). p 1404. PU Copyright 1994 by the American Medical Association, 515 N State St, Chicago, IL 60610 TX To the Editor.--Dr Goldhaber and colleagues *RF 1 * report a 93.3% sensitivity and 91.4% negative predictive value for a fibrin D-dimer value less than 500 ng/mL (Asserachrom D-Di enzyme immunoassay kit, Diagnostica Stago, Asnieres-sur-Seine, France) for acute pulmonary embolism using pulmonary angiography as the diagnostic reference standard. The authors report "no significant relationship between heparin use and D-dimer levels (P=.78)," but do not report the duration of heparin therapy or duration of symptoms prior to D-dimer measurement. Using the same assay, Bounameaux et al *RF 2 * found D-dimer levels to be significantly lower on days 3 and 7 compared with the day of presentation (day 1). Speiser et al *RF 3 * reported that elevated levels of D-dimer decrease within 24 hours in patients with acute deep vein thrombosis who are treated with heparin. Therefore, the D-dimer sensitivity for acute pulmonary embolism may be appreciably reduced in patients who have been symptomatic for several days or who have received several days of heparin therapy. Do the authors have additional data regarding the impact of either duration of symptoms or duration of heparin therapy on the operating characteristics of the D-dimer assay for acute pulmonary embolism? We agree with the authors' conclusion that "plasma D-dimer levels measured using an ELISA (enzyme-linked immunosorbent assay) hold promise as a useful tool in the evaluation of medical patients with suspected acute PE." However, it is important to emphasize that this study used a very sensitive laboratory method (ELISA) for measuring the D-dimer level. The ELISA is relatively time consuming and generally not amenable to rapid turnaround laboratory reporting on an around-the-clock basis. Most laboratories measure D-dimer levels using latex agglutination, which may have a lower sensitivity for acute pulmonary embolism *RF 4 *. Furthermore, the correlation among commercial ELISA or latex D-dimer kits is poor, possibly attributable to recognition of different epitopes or different fibrinolytic fragment analytes by D- dimer antibodies *RF 4,5 *. Additional studies of the influence of D- dimer assay methods on test operating characteristics for acute pulmonary embolism are needed. We caution physicians to be aware of the D-dimer laboratory method being used by their respective laboratories in order to use the test appropriately in the diagnostic evaluation of patients with clinically suspected acute pulmonary embolism. John A. Heit, MD William L. Nichols, MD Mayo Clinic Rochester, Minn In Reply.-- We emphasize, as do Drs Heit and Nichols, that in the diagnostic work-up of pulmonary embolism a quantitative plasma D-dimer ELISA should be used, rather than the more commonly employed but semi-quantitative latex agglutination assay. Though rapid and simple, the latex agglutination D- dimer is just not sufficiently sensitive to be useful clinically as a screening test for pulmonary embolism. (It is adequate, however, to test for disseminated intravascular coagulation.) Fortunately, skilled technologists can set up and perform the quantitative ELISA for D-dimer in about 4 hours. The resources and training required to use the D-dimer ELISA on short notice are substantial, but not nearly as demanding as the maintenance of around-the-clock availability of pulmonary angiography. Even at hospitals capable of performing angiography, it often takes 4 hours to orchestrate the logistics and to perform this invasive diagnostic test. We observed no difference (P=.78) in the average (+- SD) D-dimer levels of those patients who received heparin (2560 (+- 2421) ng/mL) compared with those who did not (2382 (+- 2287) ng/mL). Although Bounameaux et al *RF 1 * reported a diminution in the sensitivity of plasma D-dimer ELISA over time, this trend was actually quite modest. They found a sensitivity of 98% at baseline, 96% on day 3, and 93% at 1 week after admission among patients who presented to their emergency department with suspected pulmonary embolism. We have no additional data on duration of symptoms or of heparin therapy. Samuel Z. Goldhaber, MD Grant R. Simons, MD Brigham and Women's Hospital Boston, Mass OBJECTIVE--To test the hypothesis that a low D-dimer level has a high negative predictive value for acute pulmonary embolism (PE) among patients undergoing diagnostic pulmonary angiography. DESIGN--Blinded comparison of quantitative plasma D-dimer levels, measured using a monoclonal antibody assay, with pulmonary angiographic results from 173 patients with suspected acute PE. SETTING--Tertiary care setting at fur participating institutions. PATIENTS--Plasma samples were analyzed in 173 patients who underwent diagnostic pulmonary arteriography for suspected acute PE. MAIN OUTCOME MEASURES-- Sensitivity, specificity, and predictive values of quantitative plasma D-dimer levels for the diagnosis of PE, using pulmonary angiographic data as the criterion standard test. RESULTS--Of 35 patients with D-dimer values less than 500 ng/mL, only three had abnormal pulmonary angiograms. The negative predictive value of a plasma D-dimer level less than 500 ng/mL for acute PE was 91.4% (95% confidence interval [CI], 76.9% to 98.2%). D-dimer levels were greater than 500 ng/mL in 42 of 45 patients with PE and in 96 of 128 patients without PE (P = .016). Sensitivity, specificity, and positive predictive value of a plasma D-dimer level greater than 500 ng/mL for acute PE were 93.3% (95% CI, 81.7% to 98.6%), 25.0% (95% CI, 17.5% to 32.5%), and 30.4% (95% CI, 22.8% to 38.1%), respectively. CONCLUSIONS--The results of our study indicate that quantitative plasma D-dimer levels can be useful in screening patients with suspected PE who require pulmonary angiography. Plasma D-dimer values less than 500 ng/mL may obviate the need for pulmonary angiography, particularly among medical patients for whom the clinical suspicion of PE is low. The plasma D-dimer value, assayed using a commercially available enzyme- linked immunosorbent assay kit, is a sensitive but nonspecific test for the presence of acute PE Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA. Ref ID : GOLDHABER1993A 448. Goldhaber, S.Z., Haire, W.D., Feldstein, M.L., Miller, M., Toltzis, R., Smith, J.L., Taveira da Silva, A.M., Come, P.C., Lee, R.T., and Parker, J.A. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 341(8844):507-511, 1993. Keywords : 951216; ALTEPLASE; HEPARIN; in; PULMONARY EMBOLISM; EMBOLISM; PERFUSION; PE; THROMBOLYSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PA; INTRAVENOUS; intravenous heparin; Echocardiogram; SCAN; rt-PA; FATAL; OUTCOME; ACUTE DISEASE; AGED; ae; tu; COMPARATIVE STUDY; Echocardiography; FEMALE; HUMAN; LUNG; ri; MALE; MIDDLE AGE; Pulmonary Circulation; de; dt; pp; Support,Non-U.S.Gov't; THROMBOLYTIC THERAPY; ventricular function,left; Medline File; Health Planning & Administration File; BRIGHAM; Hospitals; boston Notes : Data from a non-randomised study have hinted that in patients with acute pulmonary embolism (PE), thrombolysis followed by heparin more rapidly reverses right-ventricular dysfunction and restores pulmonary tissue perfusion than does heparin alone. We have pursued this idea in a randomised protocol. 46 haemodynamically stable patients were randomised to recombinant tissue plasminogen activator (alteplase, rt- PA) 100 mg over 2 h followed by intravenous heparin and 55 to heparin alone. Right-ventricular wall motion was assessed qualitatively, and right-ventricular end diastolic area was estimated by planimetry from echocardiograms at baseline and at 3 and 24 hours. Pulmonary perfusion scans were obtained at baseline and 24 hours. In 39% of rt- PA patients but in only 17% of heparin alone patients right-ventricular wall motion at 24 hours had improved from baseline and in 2% and 17%, respectively, it worsened (p = 0.005). rt-PA patients also had a significant decrease in right-ventricular end-diastolic area during the 24 hours after randomisation and a significant absolute improvement in pulmonary perfusion (14.6% vs 1.5%). No clinical episodes of recurrent PE were noted among rt-PA patients, but there were 2 fatal and 3 non-fatal clinically suspected recurrent PEs within 14 days in patients randomised to heparin alone. rt-PA rapidly improves right-ventricular function and pulmonary perfusion among patients with PE and may lead to a lower rate of adverse clinical outcomes Department of Medicine Brigham and Women's Hospital Boston Massachusetts 02115. Ref ID : GOLDHABER1993B 449. Goldhaber, S.Z. Recognition and management of pulmonary embolism. Heart Dis.Stroke 2(2):142-146, 1993. Keywords : 951216; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; HUMAN; di; pp; th; THROMBOLYTIC THERAPY; Medline File; CARDIOVASCULAR; BRIGHAM; Hospitals; boston Notes : [No Abstract Available] Cardiovascular Division Brigham and Women's Hospital Boston MA 02115. Ref ID : GOLDHABER1994 450. Goldhaber, S.Z., Polak, J.F., Feldstein, M.L., Meyerovitz, M.F., and Creager, M.A. Efficacy and safety of repeated boluses of urokinase in the treatment of deep venous thrombosis. Am.J.Cardiol. 73(1):75-79, 1994. Keywords : 951216; Safety; UROKINASE; in; TREATMENT; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; drugs; THROMBOLYTIC; DVT; is; INTRAVENOUS; STREPTOKINASE; THROMBOLYSIS; BLEEDING; COMPLICATIONS; THERAPY; HEPARIN; ULTRASOUND; CONTRAST; VENOGRAPHY; LYSIS; FIBRINOGEN; bleeding time; ANTICOAGULATION; ADULT; AGED; Drug Administration Schedule; FEMALE; HUMAN; Infusions,Intravenous; MALE; MIDDLE AGE; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; dt; TREATMENT OUTCOME; ad; ae; tu; Medline File; Health Planning & Administration File; BRIGHAM; Hospitals; boston Notes : The only Food and Drug Administration-approved thrombolytic regimen for treatment of deep venous thrombosis (DVT) is a 24- to 72- hour continuous infusion of intravenous streptokinase. This approach to DVT thrombolysis is not entirely satisfactory because of the bleeding complications that may accompany this therapy. In the current study, we treated 27 patients with DVT with a novel dosing regimen of urokinase: 1,000,000 U administered as a 10-minute bolus, with a total of 3 boluses given over approximately 24 hours. Patients were given heparin overnight between bolus urokinase doses. Efficacy was assessed by comparing baseline and prehospital discharge vascular imaging studies, which constituted either venous ultrasound or contrast venography. A vascular- imaging panel of physicians, unaware of the sequence of paired studies, found that 14 patients (52%) had clot lysis (6 slight, 6 moderate and 2 marked), 9 (33%) had no change, and 4 (15%) had more extensive thrombosis after treatment (1 slight, 2 moderate and 1 marked). There were no bleeding complications. At 48 hours after starting urokinase, mean plasma fibrinogen levels had decreased 61% from baseline, and the mean bleeding time had increased 28% from baseline (but remained within the normal range). Because of the promising efficacy and safety that were found in this case series, it is concluded that further testing of bolus urokinase is warranted against anticoagulation alone Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts 02115. Ref ID : GOLDHABER1994A 451. Goldhaber, S.Z., Feldstein, M.L., and Sors, H. Two trials of reduced bolus alteplase in the treatment of pulmonary embolism. An overview [comment]. Chest 106(3):725-726, 1994. Keywords : 951216; ALTEPLASE; in; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; an; PE; BLEEDING; COMPLICATIONS; Safety; rt-PA; RANDOMIZED; RANDOMIZED CONTROLLED TRIALS; COST; MORTALITY; ad; ae; COMPARATIVE STUDY; HUMAN; co; dt; RECOMBINANT PROTEINS; Support,Non-U.S.Gov't; TIME FACTORS; Medline File; BRIGHAM; Hospitals; boston Notes : The Bolus Alteplase Pulmonary Embolism (BAPE) Group and a consortium of French investigators utilized essentially the same investigational protocol to test reduced dose bolus alteplase vs full dose 100 mg/2 h alteplase in the treatment of pulmonary embolism (PE). The principal hypothesis was that reduced dose bolus alteplase (n = 96) would result in fewer bleeding complications than full dose 100 mg of 2 h alteplase (n = 44) administered as a continuous infusion to hemodynamically stable patients with PE. To provide data on bolus alteplase's safety profile in a larger sample size than would have been feasible in either trial alone, we present an overview of the BAPE and French trials. There were no differences between the reduced dose bolus and full dose 2 h rt-PA groups with respect to bleeding complications. Therefore, the principal hypothesis of these two randomized controlled trials could not be confirmed. Efficacy was similar in the two treatment groups. Interpretation of the results will vary because the increased convenience and cost savings from using a reduced dose of bolus alteplase may be offset by a higher mortality rate. However, a trial that compared the mortality rates of the two treatment regimens would have required more than 800 patients Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston 02115. Ref ID : GOLDHABER1994B 452. Goldhaber, S.Z., Agnelli, G., and Levine, M.N. Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. The Bolus Alteplase Pulmonary Embolism Group [see comments]. Chest 106(3):718-724, 1994. Keywords : 951216; ALTEPLASE; PULMONARY EMBOLISM; EMBOLISM; THROMBOLYSIS; an; RANDOMIZED; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; in; BLEEDING; COMPLICATIONS; standards; PE; PERFUSION; LUNG; SCAN; Echocardiogram; COAGULATION; Hospitals; UNITED STATES; Italy; CANADA; PROBABILITY; PA; FOLLOWUP; ANGIOGRAPHY; Echocardiography; FIBRINOGEN; FIBRIN; FIBRIN DEGRADATION PRODUCTS; DEATH; THERAPY; TREATMENT; ADULT; AGED; ad; ae; BLOOD COAGULATION; de; chi-square distribution; COMPARATIVE STUDY; confidence intervals; FEMALE; Infusions,Intravenous; MALE; MIDDLE AGE; bl; co; di; dt; ep; RECOMBINANT PROTEINS; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. TIME FACTORS; Medline File Notes : STUDY OBJECTIVE: To test the hypothesis that a reduced dose of bolus recombinant human tissue-type plasminogen activator (rt-PA) (0.6 mg/kg/15 min, maximum of 50 mg) would result in fewer bleeding complications than standard 100 mg of rt-PA administered as a continuous infusion over 2 h among hemodynamically stable patients with pulmonary embolism (PE). Subsidiary objectives were to compare the two rt-PA regimens with respect to the following: (1) the rate of other adverse clinical events; (2) the magnitude of change from baseline on perfusion lung scans, pulmonary angiograms, or echocardiograms; and (3) the differences in coagulation parameters over time. DESIGN: A double-blind, double-dummy, randomized, controlled trial. SETTING: Twenty-eight participating hospitals in the United States, Italy, and Canada. PATIENTS: Patients could be included if they had symptoms or signs of PE within 14 days of presentation as well as high-probability lung scans and/or pulmonary angiograms demonstrating PE. INTERVENTIONS: Randomization was undertaken with a 2:1 allocation ratio to rt-PA 0.6 mg/kg/15 min (maximum of 50 mg) or to 100 mg/2 h. Ninety patients were randomized, and 87 patients were treated: 60 with bolus rt-PA and 27 with 2-h rt- PA. All patients underwent baseline and 20- to 28-h follow- up perfusion lung scintigraphy. Patients at angiogram centers underwent baseline and 2-h follow-up angiography, while patients at echocardiogram centers underwent baseline, 3-h, and 20- to 28-h echocardiography. Forty-eight patients also participated in an ancillary study of serial fibrinogen and fibrin degradation product levels. RESULTS: In the first 14 days after randomization, there were six deaths: five (8.3 percent) in the bolus group vs one death (3.7 percent) in the 2-h group (p = 0.66). There were two clinically suspected nonfatal recurrent PEs during the first 14 days after therapy, one in each treatment group. Overall, 14 patients suffered major or other important bleeding: 8 in the bolus group and 6 in the 2-h group (p = 0.35). Changes in efficacy parameters (scans, angiograms, or echocardiograms) were similar in the two treatment groups. After initiation of therapy, patients who had received bolus rt-PA had less depression of fibrinogen levels (p = 0.007) and smaller increases in fibrinogen degradation products (p = 0.013) than patients who had received 100 mg of rt-PA over 2 h. CONCLUSIONS: No significant differences were detected between the bolus rt-PA and 2-h rt-PA with respect to bleeding complications, adverse clinical events, or imaging studies. There was less fibrinogenolysis with the bolus dosing regimen. Ref ID : GOLDHABER1994C 453. Goldhaber, S.Z. Venous thrombosis: prevention, treatment, and relationship to paradoxical embolization. Cardiol.Clin. 12(3):505-516, 1994. Keywords : 951216; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PREVENTION; TREATMENT; Paradoxical embolization; EMBOLIZATION; DEEP VENOUS THROMBOSIS; DVT; is; hospitalization; in; UNITED STATES; SURGERY; PROPHYLAXIS; COST; THROMBI; THERAPY; THROMBUS; RISK; PULMONARY EMBOLISM; EMBOLISM; CHRONIC; CHRONIC VENOUS INSUFFICIENCY; Venous Insufficiency; Foramen ovale; OCCULT; LEG; vein; CALF; ANIMAL; ANTICOAGULANTS; ad; et; pc; FEMALE; heparin,low-molecular-weight; HUMAN; PREGNANCY; premedication; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; co; th; WARFARIN; Medline File; boston; health care costs Notes : Deep venous thrombosis (DVT) is responsible for approximately 200,000 hospitalizations annually in the United States. DVT is easier and less expensive to prevent than to diagnose and treat. For every one million patients undergoing surgery who do receive prophylaxis against venous thrombosis, approximately $60 million will be saved in direct health care costs because effective mechanical and pharmacologic modalities are available to prevent most venous thrombi. The therapy for DVT should be based upon the anatomic extent of the thrombus as well as upon the patient's risk for pulmonary embolism, recurrent DVT, and chronic venous insufficiency. In patients with paradoxical embolism, a patent foramen ovale, occult leg vein thrombosis (particularly isolated calf vein thrombosis) is frequently present Department of Medicine Harvard Medical School Boston Massachusetts. Ref ID : GOLDHABER1995 454. Goldhaber, S.Z. and Visani, L. The International Cooperative Pulmonary Embolism Registry [editorial]. Chest 108(2):302-304, 1995. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; HUMAN; international cooperation; di; ep; registries; RISK FACTORS; world health; Medline File; Health Planning & Administration File Notes : [No Abstract Available]. Ref ID : GOLDHABER1995A 455. Goldhaber, S.Z. Bolus and accelerated thrombolysis. Experimental observations and clinical management of myocardial infarction and pulmonary embolism [editorial; comment]. Chest 107(4):889-892, 1995. Keywords : 951216; THROMBOLYSIS; MANAGEMENT; MYOCARDIAL INFARCTION; infarction; PULMONARY EMBOLISM; EMBOLISM; HUMAN; dt; Support,U.S.Gov't,P.H.S. THROMBOLYTIC THERAPY; mt; Medline File Notes : [No Abstract Available]. Ref ID : GOLDHABER1995B 456. Goldhaber, S.Z. Contemporary pulmonary embolism thrombolysis. Chest 107(1 Suppl):45S-51S, 1995. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; THROMBOLYSIS; PE; is; Hospitals; MASSIVE; in; MYOCARDIAL INFARCTION; infarction; UNITED STATES; INDICATIONS; TREATMENT; ANGIOGRAPHY; vein; ALTEPLASE; tu; CLINICAL TRIALS; FIBRINOLYTIC AGENTS; HEMORRHAGE; et; HEPARIN; HUMAN; dt; pp; STREPTOKINASE; Support,U.S.Gov't,P.H.S. THROMBOLYTIC THERAPY; ae; UROKINASE; Medline File; CARDIOVASCULAR; BRIGHAM; laboratories; boston Notes : Lack of familiarity with pulmonary embolism (PE) thrombolysis is understandable because most hospitals treat just a few patients each year with recognized massive PE. Therefore, most physicians are inexperienced in administering PE thrombolysis, even though they utilize these agents routinely for acute myocardial infarction. Current estimates are that no more than 10% of patients with PE receive thrombolysis in the United States. This situation may be changing now, because PE thrombolysis appears to have expanded indications. Contemporary PE thrombolysis can now be given with simpler, less expensive protocols than were previously available. In the past, this treatment strategy had been rightly regarded as a heroic measure that consumed hospital resources and physicians' time. Today, PE thrombolysis can be applied with a 2 week "time window," no mandatory angiography in many cases, a brief infusion through a peripheral vein, and no special laboratory tests Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : GOLDHABER1995C 457. Goldhaber, S.Z. Thrombolytic therapy in venous thromboembolism. Clinical trials and current indications. Clin.Chest Med. 16(2):307-320, 1995. Keywords : 951216; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; in; VENOUS; THROMBOEMBOLISM; CLINICAL TRIALS; INDICATIONS; is; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; RIGHT VENTRICULAR DYSFUNCTION; an; blood; Blood Pressure; Pressure; heart; Heart Rate; THROMBOLYSIS; BLEEDING; COMPLICATIONS; COST; DEATH; ANTICOAGULANTS; tu; FIBRINOLYTIC AGENTS; HUMAN; dt; THROMBOPHLEBITIS; Medline File; boston Notes : Thrombolytic therapy for venous thromboembolism is returning, especially for the management of acute pulmonary embolism patients who present with either hypotension or with right ventricular dysfunction despite an initially normal blood pressure and heart rate. Clinicians have learned to use thrombolysis to improve efficacy, minimize bleeding complications, and achieve savings in cost. The objective of therapy is rapid reversal of right ventricular dysfunction, which might otherwise lead to intractable right ventricular failure and death Harvard Medical School Boston Massachusetts USA. Ref ID : GOLDMAN1984 458. Goldman, L. Diagnostic advances v the value of the autopsy. 1912- 1980. Arch.Pathol.Lab.Med. 108:501-505, 1984. Keywords : 951202; diagnostics; AUTOPSY; POSTMORTEM; CAUSE; DEATH; PNEUMONIA; CIRRHOSIS; in; PULMONARY EMBOLISM; EMBOLISM; is; INFECTION; DIAGNOSIS; TREATMENT; hi; diagnostic errors; europe; History of Medicine,20th Cent. HUMAN; scotland; UNITED STATES; Medline File; Cancerlit File; BRIGHAM; Hospitals; an; boston Notes : Between 1912 and 1980, many English language publications analyzed the correlation between clinicians' diagnoses and postmortem examinations. Surprisingly, the percentage of cases with undiagnosed principal underlying diseases or primary causes of death has not diminished during this period. The autopsy's unvarying percentage yield does not indicate a lack of progress, however, since bacterial pneumonia, hepatic cirrhosis, and common tumors were missed routinely in earlier eras but were rarely missed after 1970. Pulmonary embolism remains commonly missed, but the striking recent finding is the emergence of fungal and other systemic infections that were rarely noted in prior eras. Progress in diagnosis and treatment may allow patients to live longer and new or obscure diseases may develop that will often be missed clinically. An appropriately high autopsy rate will be required if medical progress is to continue Department of Medicine Brigham and Women's Hospital Boston MA. Ref ID : GOLDMAN1990C 459. Goldman, M.P., Martin, D.E., Fitzpatrick, R.E., and Ruiz-Esparza, J. Pulsed dye laser treatment of telangiectases with and without subtherapeutic sclerotherapy. Clinical and histologic examination in the rabbit ear vein model. J.Am.Acad.Dermatol. 23:23-30, 1990. Keywords : Lasers; TREATMENT; SCLEROTHERAPY; HISTOLOGIC; RABBITS; vein; LEG; CARBON DIOXIDE; RISK; THERAPY; Injections; SCLEROSANT; NASP; VEINS; lasers - therapeutic use; telangiectasis - radiotherapy; ANIMAL; Combined Modality Therapy; COMPARATIVE STUDY; ear - blood supply; endothelium,vascular - pathology; erythrocytes - pathology; polyethylene glycols - therapeutic use; RANDOM ALLOCATION; sclerosing solutions - therapeutic use; Support,Non-U.S.Gov't; telangiectasis - pathology; telangiectasis - therapy; thrombophlebitis - pathology; in; an; is; inflammation Notes : The treatment of leg telangiectases with the carbon dioxide or argon laser results in a low success rate and an unacceptable risk of scarring. Sclerotherapy is effective; however, pigmentation and telangiectatic matting induced by extravasation of RBCs and excessive posttreatment inflammation are common. We conducted a clinical and histologic study of therapy with the 585 nm pulsed dye laser alone and in combination with subtherapeutic sclerotherapy in the rabbit ear vein model. The pulsed dye laser alone was effective when 10 joule/cm2 was used. In combination with immediate injection of the sclerosant, effective endosclerosis occurred with all tested laser energies (8 to 10 joule/cm2). Ref ID : GOLDSTEIN1979 460. Goldstein, M. [Complications of sclerotherapy]. Phlebologie. 32:221-228, 1979. Keywords : COMPLICATIONS; Injections; VARICOSE VEINS; VEINS; INTRAARTERIAL; Necrosis; TREATMENT; ARTERY; Ischemia; EMERGENCY; Sympathectomy; SHOCK; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; vein; LEG; THROMBOSIS; NASP; ACUTE DISEASE; CASE REPORT; English Abstract; FEMALE; HUMAN; Lumbosacral Region; MIDDLE AGE; Sclerosing Solutions; Medline File; de; ab; varicose; in; an; us; varicose vein Notes : TT - Les complications de la sclerotherapie AB - The authors recently treated three patients showing rather marked complications following sclerosing injections for varicose veins. In the first case, the intra-arterial injection brought about a tissular necrosis in the form of a distal-based triangle. The preservative treatment, undertaken 4 weeks after the injection, did not make it possible to save three toes, that had to be amputated. The second patient was sent to use after an injection in the posterior tibial artery. Acute ischemia was treated on an emergency basis with a lumbar sympathectomy. I believe that the approach we took allowed us to cure the trophic problems and to loose only one small phalanx. The third case reported on concerns a patient brought to us in a state of shock after a massive pulmonary embolism. She had been given a sclerosing injection in a large varicose vein of the leg 48 hours previously. The leg had rapidly increased in volume and was apparently the site of a deep veinous thrombosis UI - 80013431. Ref ID : GONZALEZJUANATE1992 461. Gonzalez Juanatey, J.R., Valdes, L., Amaro, A., Iglesias, C., Alvarez, D., Garcia Acuna, J.M., and de la Pena, M.G. Treatment of massive pulmonary thromboembolism with low intrapulmonary dosages of urokinase. Short-term angiographic and hemodynamic evolution. Chest 102:341-346, 1992. Keywords : TREATMENT; MASSIVE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; DOSAGE; UROKINASE; HEMODYNAMICS; SHOCK; FIBRINOLYTIC; INTRAVENOUS; HEPARIN; CARDIAC; CARDIAC OUTPUT; HEMORRHAGE; ANGIOGRAPHY; PULMONARY ARTERY; PULMONARY EMBOLISM; ADULT; COMPARATIVE STUDY; DRUG EVALUATION; DRUG THERAPY COMBINATION; FEMALE; HUMAN; INFUSIONS INTRA ARTERIAL; INFUSIONS INTRAVENOUS; MALE; MIDDLE AGE; REMISSION INDUCTION; TIME FACTORS; an; pulmonary vascular resistance; VASCULAR RESISTANCE; Pressure; in; is Notes : AB-Sixteen patients who had massive pulmonary thromboembolism and shock had no history of cardiopulmonary disease. We present an evaluation of the short-term effects of fibrinolytic treatment consisting of intrapulmonary administration of a bolus of 500,000 IU of urokinase followed by infusion of 1 x 10(6) IU into the right auricle over 12 h and subsequent intravenous infusion of heparin. For each patient, the effectiveness of treatment was evaluated by comparing pretreatment angiographic and hemodynamic parameters with those measured 48 h after the start of treatment. The Miller index fell from 22.9 +/- 5.9 to 9.8 +/- 3.3 (p less than 0.001), with a mean improvement of 57.2 percent. All the hemodynamic parameters studied (cardiac output and index, total pulmonary vascular resistance, and systolic, diastolic, and mean pulmonary vascular pressure) also exhibited statistically significant differences between pretreatment and posttreatment values (p less than 0.001 for each parameter), with a mean improvement of over 30 percent in each case. All the patients survived, and in no case did treatment fail; only one patient (6.2 percent) suffered severe hemorrhage. We conclude that this form of administration of urokinase is useful for patients with critical massive pulmonary thromboembolism. Ref ID : GOODALE1982 462. Goodale, R.L., Silvis, O'Leary, J.F., Gebhard, R., Mjollness, L., Johnson, M., and Fryd, D. Early survival after sclerotherapy for bleeding esophageal varices. Surg.Gynecol.Obstet. 155:523-528, 1982. Keywords : SCLEROTHERAPY; ESOPHAGEAL VARICES; COMPLICATIONS; SURGICAL; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; NASP; EARLY; SURVIVAL; BLEEDING; ESOPHAGEAL; VARICES; CHILD; Liver; Actuarial Analysis; ADULT; AGED; Esophageal and Gastric Varices; Esophageal Diseases; Esophagoscopy; FEMALE; Gastrointestinal Hemorrhage; HUMAN; Liver Function Tests; MALE; MIDDLE AGE; Sclerosing Solutions; Support,Non-U.S.Gov't; VARICOSE VEINS; Medline File; COMPLICATION; DEATH; TREATMENT; SHUNT; EMERGENCY; ab; Hospitals; veterans; co; in; an Notes : AB - Forty-two patients from the University of Minnesota Hospitals and Minneapolis Veterans Administration Hospital underwent sclerotherapy for endoscopically verified esophageal varices. No patient was excluded because of poor hepatic functional reserve or serious co- morbid condition. Eleven patients were actively bleeding at the time of sclerotherapy. Thirty-one were listed as Child class B and C. After sclerotherapy, six of 25 survivors have had obliteration of varices. Substantial improvement was noted endoscopically in eight others. The most frequent complication was rebleeding, which occurred in 20 patients. Rebleeding led to surgical intervention in seven and to seven nonoperative deaths. There were two instances of mesenteric venous thrombosis complication not previously described following sclerotherapy. Twenty-nine patients survived two months, and 16 patients are alive at six months. These figures compare quite favorably with survival figures from other groups of patients who had roughly comparable liver impairment and who underwent medical treatment or portacaval shunts as an emergency measure UI - 83017075. Ref ID : GOODMAN1995 463. Goodman, L.R., Curtin, J.J., and Mewissen, M.W. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: Herical CT versus angiography. AJR Am J Roentgenol (June):1369-1374, 1995. Keywords : 96-suzy-002; PULMONARY EMBOLISM; EMBOLISM; in; DIAGNOSIS; CT; ANGIOGRAPHY; PULMONARY ANGIOGRAPHY; PE; is; NONINVASIVE; ARTERIAL; SCANNING; VENTILATION/PERFUSION; PROBABILITY; Duplex; Doppler; Extremities; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CHEST; EMBOLI; CT scan; SCAN; reference standards; standards; SENSITIVITY; SPECIFICITY; Arteries; RISK; ANTICOAGULATION Notes : 01-03-96. Abstract : The authors in this study sought to evaluate helical computed tomography (CT) as a reliable alternaative to pulmonary angiography in the detection of pulmonary embolus (PE) in patients with equivocal clinical and scintigraphic diagnosis. Helical or ''spiral'' CT is becoming more widely available in institutions and offers fast (less than 30 seconds) and noninvasive imaging of the pulmonary arterial vasculature. All patients sent for ventilation-perfusion scanning were initially eligible, but all patients were excluded if they showed a low ventilation/perfusion probability combined with a low clinical suspicion for PE, or conversely if they had a high ventilation/perfusion probability coupled with a high clinical likelihood of PE. Patients were also excluded if a duplex Doppler study of the lower extremities showed deep venous thrombosis. Twenty-five patients were prospectively enrolled, with 5 subsequently excluded (1 patient refused pulmonary angiography after CT, in 1 a large central tumor was found on CT, and equipment problems precluded inclusion of the other 3). Of the remaining 20 individuals, all underwent pulmonary angiography and constrast- enhanced helical CT scanning (10 had angiography first, the other 10 CT first). The angiographers had ventilation/perfusion results available to them but were blinded to the CT data. The conclusion from CT were derived from the consenus of two of four radiologists, all with a background in chest CT and all blinded to the ventilation/perfusion and pulmonary angiography findings, In 19 of 20 instances, less than 24 hours elapsed between the two studies. The study determined that 11 of 20 patients had PE proven by pulmonary angiography, 7 with emboli in the central pulmonary arterial circulation and 4 with emboli in the subsegmental vessels only. Of the 20 CT scans, 18 were judged to be adequate, and 2 had poor dye opacification in limited regions. For the larger central vessels only, CT was 86% sensitive, 92% specific, and had a likelihood ratio (sensitive/[1_specificity]) of 10.7, with pulmonary angiography as the reference standard. The authors found that CT did not reliably visualized the subsegments vessel distribution, and when taken into account, the overall sensitivity of CT dropped to 63%, the specificity to 89%, and the likelihood ratio to 5.7. It was emphasized that the detection of emboli in these smaller arteries is important because they are probably predictive if larger emboli to come. The authors concede that their study population included the most difficult cases for CT to diagnose. They conclude that, given the importance of certain diagnosis (and the risk of unnecessary anticoagulation), CT has a limited role in the detection of PE and hold pulmonary angiography to be the procedure of choice. Ref ID : GOODNIGHT1974 464. Goodnight, S.H., Kenoyer, G., Rapaport, S.I., Patch, M.J., Lee, J.A., and Kurze, T. Defibrination after brain tissue destruction: A serious complication of head injury. N.Engl.J.Med. 290:1043-1047, 1974. Keywords : DEFIBRINATION; COMPLICATION; INJURY; TRAUMA; DIC; DVT; POSTOPERATIVE; brain; in Notes : Head trauma has been seen to result in defibrination, DIC, and DVT, and the rate of DVT in postoperative neurosurgical patients probably exceeds 40 percent. Ref ID : GOOR1987 465. Goor, W., Leu, H.J., and Mahler, F.TT. Thrombosen in tiefen venen und in arterien nach varizensklerosierung. Vasa 16(2):124-129, 1987. Keywords : VENOUS; THROMBOSIS; THROMBOEMBOLISM; SCLEROSANTS; SCLEROTHERAPY; DEEP VENOUS THROMBOSIS; PULMONARY THROMBOEMBOLISM; VENOUS THROMBOSIS; in Notes : A report of two cases of verified deep venous thrombosis and two cases of suspected but unproven pulmonary thromboembolism following the infusion of small volumes of sclerosants into small intradermal venectasias. Ref ID : GORE1982 466. Gore, J.M., Appelbaum, J.S., Greene, H.L., Dexter, L., and Dalen, J.E. Occult cancer in patients with acute pulmonary embolism. Ann.Intern.Med. 96:556-560, 1982. Keywords : OCCULT; CANCER; EMBOLISM; MALIGNANCY; RISK; DVT; ANGIOGRAPHY; PE; AGE; in; PULMONARY EMBOLISM; is; RISK FACTORS Notes : Malignancy, whether known or occult, is a recognized risk factor for VT. Lieberman in 1961 demonstrated that in 38 percent of cases of concommittent cancer and DVT, the DVT was detected first. Further evidence has been supplied by Gore, who followed patients for 5 years after angiography and found that 16 percent of the patients with PE had been diagnosed with cancer within two years, whereas none of the patients without PE were found to have developed PE at two years. Goldberg reported that the relative risk for cancer is 19 times higher for patients under age 50 who have had DVT than for those without a history of DVT. Ref ID : GORGE1991 467. G”rge, G., Erbel, R., Schuster, S., Ge, J., and Meyer, J. Intravascular ultrasound in diagnosis of acute pulmonary embolism [letter]. Lancet 337:623-624, 1991. Keywords : Intravascular ultrasound; ULTRASOUND; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; sdi-11/93; in Ref ID : GRAHAM1990 468. Graham, W.R. Rheumatoid pleuritis [see comments]. South.Med.J. 83:973-975, 1990. Keywords : EMBOLISM; TRAUMA; light; PLEURAL EFFUSION; effusion; is; in; pleurisy; an Notes : My case is one in which the principal manifestation of rheumatoid arthritis is pleurisy. It is a case that underscores the clinical nuances of rheumatoid pleuritis. The major articles that have shaped our view of rheumatoid pleuritis are discussed in light of my case, a perspective that raises the possibility that some of the established biases about rheumatoid pleuritis may be misleading. It is necessary to consider rheumatoid pleuritis in any patient with an unexplained pleural effusion. Ref ID : GRANDI1978 469. Grandi, G., Antonini, E., and Bianchi, C. [Pulmonary bone-marrow embolism. Analysis of 53 cases]. Minerva.Med. 69:491-494, 1978. Keywords : 951202; EMBOLISM; analysis; Medical Records; LUNG; in; EMBOLI; CARDIAC; Massage; ACCIDENTS; is; ADULT; AGED; AUTOPSY; bone marrow diseases; et; PA; English Abstract; FEMALE; heart massage; ae; HUMAN; MALE; MIDDLE AGE; PULMONARY ARTERY; PULMONARY EMBOLISM; Medline File; bone marrow Notes : The medical record and the lung sections were reviewed in 53 autoptic cases with pulmonary bone marrow embolism. In 31 cases the emboli could be ascribed to external cardiac massage, in one case to accident; in the other cases a definite aetiologic factor was lacking. The number of the emboli was largely variable from one section to another and sometimes very high (up to 16). The pulmonary bone marrow embolism has probably a clinical significance particularly when the underlying condition is severe. Ref ID : GRANTHAM1991 470. Grantham, J.R. Outcome of sonography for deep venous thrombosis [letter]. AJR.Am.J.Roentgenol. 157:1126, 1991. Keywords : PHLEBITIS; OUTCOME; Sonography; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; HUMAN; LEG; blood supply; THROMBOPHLEBITIS; Ultrasonography Ref ID : GRAOR1986 471. Graor, R.A., Risius, B., Lucas, F.V., Young, J.R., Ruschhaupt, W.F., Beven, E.G., and Grossbard, E.B. Thrombolysis with recombinant human tissue-type plasminogen activator in patients with peripheral artery and bypass graft occlusions. Circulation 74:I15-I20, 1986. Keywords : THROMBOLYSIS; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PERIPHERAL ARTERY; ARTERY; OCCLUSION; ACEP-93; ACEP93; in; bypass graft Ref ID : GRAOR1986A 472. Graor, R.A., Risius, B., Young, J.R., Denny, K., Beven, E.G., Geisinger, M.A., Hertzer, N.R., Krajewski, L.P., Lucas, F.V., and O'Hara, P.J. Peripheral artery and bypass graft thrombolysis with recombinant human tissue-type plasminogen activator. J.Vasc.Surg. 3:115- 124, 1986. Keywords : PERIPHERAL ARTERY; ARTERY; THROMBOLYSIS; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; ACEP-93; ACEP93; bypass graft Ref ID : GRASSI1989 473. Grassi, C.J. and Goldhaber, S.Z. Interruption of the inferior vena cava for prevention of pulmonary embolism: transvenous filter devices. Herz. 14(3):182-191, 1989. Keywords : 951216; VENA CAVA; PREVENTION; PULMONARY EMBOLISM; EMBOLISM; FILTER; Vena Cava Filters; is; in; MANAGEMENT; THROMBOLYTIC; ANTICOAGULANT; THERAPY; blood; BLOOD FLOW; INDICATIONS; ANTICOAGULATION; jugular veins; vein; Femoral Vein; VEINS; COMPLICATIONS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; HEMORRHAGE; SURGICAL; VENA CAVAL INTERRUPTION; us; europe; COMPARATIVE STUDY; filtration; HUMAN; pc; RISK FACTORS; THROMBOPHLEBITIS; co; Vena Cava,Inferior; Medline File; BRIGHAM; Hospitals; boston Notes : The availability of a safe, effective, and easily introducible percutaneous vena cava filter is crucial in the management of certain patients with pulmonary embolism. If thrombolytic or anticoagulant therapy for pulmonary embolism is contraindicated or fails, interruption of the inferior vena cava (IVC) blood flow is the logical alternative. Indications for filter insertion include a contraindication to anticoagulation, or recurrent pulmonary embolism despite adequate anticoagulation therapy. Common routes of filter insertion are from the right internal jugular vein, or the right or left femoral veins. The Mobin-Uddin umbrella filter (no longer available in the USA) and the Kimray-Greenfield filters have been the most widely used. Complications of vena cava filters include malpositioning, migration, venous thrombosis proximal or distal to the filter, hemorrhage at the percutaneous site of insertion, or sepsis. Despite these problems, IVC filters have been extremely useful in the management of pulmonary embolism among certain subsets of patients. Percutaneously inserted filters have now superseded surgical vena caval interruption in most US centers. Newer filters are currently under development in the US and Europe, and feature improved filtering function, anti-tilt abilities, retrievability, memory wire properties, and improved ease of insertion Department of Radiology Brigham and Women's Hospital Harvard Medical School Boston MA. Ref ID : GRAY1991 474. Gray, B.H., Olin, J.W., Graor, R.A., Young, J.R., Bartholemew, J.R., and Ruschhaupt, W.E. Safety and efficacy of thrombolytic therapy for superior vena cava syndrome. Chest 99:54-59, 1991. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; VENA CAVA; Syndrome; Safety Ref ID : GRAYBURN1991 475. Grayburn, P.A., Willard, J.E., Brickner, M.E., and Eichhorn, E.J. In vivo thrombus formation on a guidewire during intravascular ultrasound imaging: evidence for inadequate heparinization. Cathet.Cardiovasc.Diagn. 23:141-143, 1991. Keywords : THROMBUS; ULTRASOUND; ACEP93; coronary artery; HEPARIN; Guidewire; CATHETER; in; Intravascular ultrasound Ref ID : GRECH1992 476. Grech, E.D., Dodds, P.A., and Perry, R.A. Delayed complications after myocardial contusion. Br.Heart J. 68:529-530, 1992. Keywords : EMBOLISM; TRAUMA; COMPLICATIONS; CHEST; INJURY; Hospitals; Pulmonary emboli; EMBOLI; Echocardiography; THROMBUS; TREATMENT; ANTICOAGULANT; Pacemaker; in Notes : A 45 year old farmer was kicked in the chest by a horse. In the days following the injury episodic breathlessness developed and he was admitted to hospital with right ventricular failure and pulmonary emboli. Echocardiography showed global right ventricular dysfunction but a right ventricular mural thrombus, the likely source of the pulmonary emboli, was not seen. He gradually recovered after treatment with anticoagulant. One month later he presented with a further complication- -complete atrioventricular dissociation--that required a dual chamber pacemaker implantation. This patient had few initial manifestations of right ventricular myocardial contusion and this case illustrates that such patients should be closely monitored for delayed complications. Ref ID : GREEN1992A 477. Green, D., Hull, R.D., Mammen, E.F., Merli, G.J., Weingarden, S.I., and Yao, J.S. Deep vein thrombosis in spinal cord injury. Summary and recommendations. Chest 102:633S-635S, 1992. Keywords : DEEP VEIN THROMBOSIS; vein; THROMBOSIS; Spinal cord; spinal cord injuries; INJURY; RECOMMENDATIONS; in Ref ID : GREEN1994 478. Green, D., Hirsh, J., Heit, J., Prins, M., Davidson, B., and Lensing, A.W. Low molecular weight heparin: a critical analysis of clinical trials. Pharmacol.Rev. 46(1):89-109, 1994. Keywords : Low molecular weight heparin; Molecular Weight; HEPARIN; analysis; CLINICAL TRIALS; LMWH; Antithrombotic; Half-Life; ANTICOAGULANT; MONITORING; INCIDENCE; THROMBOCYTOPENIA; thromboprophylaxis; TREATMENT; Orthopedic; SURGERY; HIP; WARFARIN; THERAPY; KNEE; BLEEDING; PREVALENCE; DVT; FRACTURES; Methods; COMPRESSION; PROPHYLAXIS; Injections; SURGICAL; RISK; THROMBOEMBOLISM; TRENDS; STROKE; Spinal cord; spinal cord injuries; injuries; COMPLICATIONS; INDICATIONS; CARDIOPULMONARY BYPASS; VENOUS; META ANALYSIS; REVIEW; INTRAVENOUS; MORTALITY; SUBCUTANEOUS; THROMBOEMBOLIC; 951217; an; in; hip fractures; Pneumatic; hemodialysis; is; ANIMAL; Double-Blind Method; HEMORRHAGE; ci; heparin,low-molecular-weight; ae; pk; tu; HUMAN; Postoperative Complications; pc; THROMBOSIS; Medline File; laboratories Notes : LMWHs are an important new class of antithrombotic agents. They differ from UFH in having relatively more anti-Xa activity, greater bioavailability at low doses, longer half-life, and more predictable anticoagulant response when administered in fixed doses. These properties allow LMWHs to be administered QD or at most BID and without laboratory monitoring. The incidence of heparin-induced thrombocytopenia also appears to be lower with an LMWH than with heparin. Given their favorable pharmacological profile, it was of interest to critically appraise clinical trials of thromboprophylaxis and treatment with these new agents. In orthopedic trials, it was noted that LMWH provided safe and effective thromboprophylaxis for patients undergoing major orthopedic surgery of the lower limb. In those having hip arthroplasty, LMWH was as effective as low-intensity warfarin therapy, but its use was associated with more wound hematomas. In those having total knee arthroplasty, LMWH was more effective than warfarin and did not increase bleeding. However, the prevalence of DVTs complicating this procedure as well as acute hip fracture remains unacceptably high, and additional studies of LMWH in combination with other prophylactic methods, such as external pneumatic compression, are needed. Only one adequately designed trial found less bleeding resulted from LMWH prophylaxis administered at an equivalent antithrombotic dose to UFH. In general medical patients, LMWH appeared to be as effective as UFH and had the advantages of less frequent injections and fewer injection site hematomas. In general surgical patients, there was a lower risk of thromboembolism but a trend toward an increase in bleeding events. Subjects with strokes and spinal cord injuries benefited from fewer thrombotic events, and the latter had fewer bleeding complications. Other potential indications for LMWH, such as cardiopulmonary bypass, hemodialysis, and preservation of graft patency, are presently under study. Perhaps the most impressive benefits of LMWH will be realized when it is used for the treatment of venous thromboembolism. The meta-analysis presented in this review showed a trend toward greater efficacy with LMWH and fewer major bleeding events in comparison with adjusted-dose intravenous UFH. Also, during the months following the thrombotic event, there was significantly less mortality in patients receiving LMWH. A further advantage was the subcutaneous route of administration and lack of requirement for laboratory monitoring. Additional treatment trials are presently in progress and may establish LMWH as the treatment of choice for patients with thromboembolic disorders. Ref ID : GREEN1994A 479. Green, J. and Edwards, C. Seasonal variation in the necropsy incidence of massive pulmonary embolism [see comments]. J.Clin.Pathol. 47:58-60, 1994. Keywords : 951202; in; INCIDENCE; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; PULMONARY ARTERY; Arteries; CAUSE; cause of death; DEATH; Hospitals; is; AUTOPSY; england; ep; FEMALE; HUMAN; MALE; mo; Retrospective Studies; seasons; Medline File Notes : AIMS--To investigate the seasonal incidence of massive pulmonary embolism at necropsy. METHODS--Massive pulmonary embolism was defined as a recent thromboembolus occluding the pulmonary trunk or one or both main pulmonary arteries and constituting the main cause of death. A total of 4289 necropsies carried out at East Birmingham Hospital from 1979 to 1988 was reviewed. The number of subjects with massive pulmonary embolism was noted and the accumulated percentage for each calendar month was calculated. RESULTS--Massive pulmonary embolism was found in 13.02% of necropsies carried out in April; in September and October the percentage rose to 14.29 and 14.19, respectively, after falling to 8.04 and 7.80 in June and July. In January and February the incidence fell again to about 9%. CONCLUSIONS--The incidence of massive pulmonary embolism at East Birmingham Hospital is highest in the spring and autumn. Investigation of the seasonal incidence in arctic and tropical areas would be of interest Department of Histopathology East Birmingham Hospital. Ref ID : GREENBERG1991 480. Greenberg, S., Kosinski, R., and Daniels, J. Treatment of superior vena cava thrombosis with recombinant tissue type plasminogen activator. Chest 99:1298-1301, 1991. Keywords : TREATMENT; VENA CAVA; THROMBOSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR Ref ID : GREENE1995 481. Greene, K.A., Marciano, F.F., Dickman, C.A., Coons, S.W., Johnson, P.C., Bailes, J.E., and Spetzler, R.F. Anterior communicating artery aneurysm paraparesis syndrome: clinical manifestations and pathologic correlates. Neurology 45:45-50, 1995. Keywords : 951202; ARTERY; Aneurysm; Syndrome; PATHOLOGIC; Extremities; REVIEW; subarachnoid hemorrhage; HEMORRHAGE; OUTCOME; FOLLOWUP; Hypertension; DURATION; in; Cerebral; RESOLUTION; POSTOPERATIVE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Pulmonary emboli; EMBOLI; CAUSE; MORBIDITY; MORTALITY; AUTOPSY; Ischemia; ETIOLOGY; is; AGED; brain; PA; cerebral aneurysm; pp; ra; cerebral angiography; cerebral ischemia; cerebrovascular circulation; FEMALE; HUMAN; MALE; Microcirculation; MIDDLE AGE; neurologic examination; paralysis; et; PULMONARY EMBOLISM; Retrospective Studies; su; tomography,x-ray computed; TREATMENT OUTCOME; Medline File; Health Planning & Administration File; SURGERY; st; Hospitals Notes : OBJECTIVE: Clinicopathologic evaluation of patients with lower extremity paraparesis/-plegia following rupture and repair of anterior communicating artery (ACoA) aneurysms. DESIGN: Institution- based retrospective review. SETTING: A tertiary neurologic referral center. PATIENTS, PARTICIPANTS: Seven of 101 patients with subarachnoid hemorrhage from ruptured ACoA aneurysms treated between January 1987 and December 1992. MAIN OUTCOME MEASURES: Neurologic status at latest follow-up examination. RESULTS: All patients presented with severe hemorrhage, poor clinical grade, and intracranial hypertension. Motor deficits developed within 7 days of aneurysm rupture and persisted for a mean duration of 39 days. Angiographic evidence of vasospasm in the anterior cerebral artery (ACA) distribution was documented in all cases, and paraparesis persisted beyond the angiographic resolution of vasospasm. All patients had evidence of frontal lobe dysfunction throughout their postoperative courses, and deep venous thrombosis and pulmonary emboli were common causes of morbidity and mortality. Autopsy data supported regional microvascular ischemia within the ACA distribution as the etiology of these motor deficits. CONCLUSIONS: The combination of vasospasm in the ACA distribution and lower extremity weakness associated with cognitive and affective impairment that resolves with time is common in patients with ACoA aneurysms. We propose that this constellation of clinical, radiographic, and pathologic findings be referred to as the "ACoA aneurysm paraparesis syndrome." Division of Neurological Surgery Barrow Neurological Institute St Joseph's Hospital and Medical Center Phoenix AZ. Ref ID : GREENFIELD1984 482. Greenfield, L.J. Vena caval interruption and pulmonary embolectomy. Clin.Chest Med. 5:495, 1984. Keywords : EMBOLECTOMY; PULMONARY EMBOLISM; VENA CAVAL INTERRUPTION; VENA CAVA; FILTER Ref ID : GREENFIELD1993 483. Greenfield, L.J., Proctor, M.C., Williams, D.M., and Wakefield, T.W. Long-term experience with transvenous catheter pulmonary embolectomy. J Vasc.Surg. 18:450-7; discussion 457-8, 1993. Keywords : LONG TERM; CATHETER; EMBOLECTOMY; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; PE; MORTALITY; Anesthetics; LYTIC; THERAPY; CARDIOPULMONARY BYPASS; Methods; INDICATIONS; HEMODYNAMICS; FILTER; EMBOLI; SURVIVAL; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; CARDIAC; CARDIAC OUTPUT; COMPLICATIONS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PLEURAL EFFUSION; MYOCARDIAL INFARCTION; CHRONIC; sdi-11/93; an; in; Vena caval filter; effusion; infarction; is Notes : PURPOSE: Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open embolectomy on cardiopulmonary bypass. METHODS: The indication for embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used. RESULTS: Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min (p = 0.003) after embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%). CONCLUSIONS: Successful embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) (p < 0.03). Successful embolectomy also predicted long-term survival (p < 0.01), which was 89 months for the series (range 1 to 237 months). Catheter pulmonary embolectomy by surgeon and radiologist is of maximal benefit for major or massive PE but less likely to benefit patients with chronic recurrent PE. Ref ID : GREENFIELD1995 484. Greenfield, L.J. Clinical problem-solving: recurrent pulmonary emboli [letter; comment]. N.Engl.J.Med. 332(16):1104; discussion 110-5, 1995. Keywords : 96-suzy-001; Pulmonary emboli; EMBOLI; AGED; FEMALE; HUMAN; MALE; PULMONARY EMBOLISM; THERAPY; RECURRENCE; Vena Cava Filters Ref ID : GREENGARD1994 485. Greengard, J.S., Eichinger, S., Griffin, J.H., and Bauer, K.A. Brief report: variability of thrombosis among homozygous siblings with resistance to activated protein C due to an Arg-->Gln mutation in the gene for factor V [see comments]. N.Engl.J.Med. 331(23):1559-1562, 1994. Keywords : THROMBOSIS; PROTEIN C; FACTOR V; an; in; 96-suzy-001; arginine; chemistry; base sequence; CHILD; exons; genetics; FEMALE; glutamine; homozygote; HUMAN; MALE; molecular sequence data; mutation; metabolism; Support,Non-U.S.Gov't; support,u.s.gov't,non-p.h.s. Support,U.S.Gov't,P.H.S. blood Notes : AN-95059283. Ref ID : GREENSPAN1984 486. Greenspan, R.H., Ravin, C.E., and Polansky, S.M. Accuracy of the chest radiograph in the diagnosis of pulmonary embolism. Invest.Radiol. 17:539, 1984. Keywords : CHEST; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; CHEST RADIOGRAPH; CXR; XRAY; in Ref ID : GRIFFIN1981 487. Griffin, J.H., Evatt, B., Zimmerman, T.S., Kleiss, A.J., and Wideman, C. Deficiency of protein C in congenital thrombotic disease. J.Clin.Invest. 68:1370-1373, 1981. Keywords : PROTEIN C; THROMBOSIS; CONGENITAL; HYPERCOAGULABLE; in Ref ID : GRIM1990 488. Grim, P.S., Gottlieb, L.J., Boddie, A., and Batson, E. Hyperbaric oxygen therapy [see comments]. JAMA 263:2216-2220, 1990. Keywords : 951202; OXYGEN; THERAPY; Pressure; REVIEW; INDICATIONS; ANIMAL; is; carbon monoxide poisoning; th; clostridium infections; decompression sickness; embolism,air; HUMAN; Hyperbaric Oxygenation; mt; Wound Healing; Medline File; SURGERY; Hospitals; in Notes : Hyperbaric oxygen therapy involves intermittent inhalation of 100% oxygen under a pressure greater than 1 atm. Despite over a century of use in medical settings, hyperbaric oxygen remains a controversial therapy. The last 20 years have seen a clarification of the mechanism of action of hyperbaric therapy and a greater understanding of its potential benefit. However, despite the substantial evidence that hyperbaric oxygen may have a therapeutic effect in certain carefully defined disease states, many practitioners remain unaware of these findings or are concerned about using hyperbaric therapy because of the controversy it has engendered. This review examines the indications currently considered appropriate for hyperbaric oxygen and briefly evaluates animal and clinical data substantiating these indications. Areas in which the mechanism of action of hyperbaric oxygen is still not well understood, as well as possible new areas of applications, are discussed Section of Plastic and Reconstructive Surgery University of Chicago Hospitals IL. Ref ID : GROB1990 489. Grob, J.J., Collet-Villette, A.M., Aillaud, M.F., Capo, C., Farnarier, M.F., Kaplanski, S., Monges, G., Arnaud, A., Hassoun, J., and Juhan-Vague, I. Spontaneous adult scurvy in a developed country: new insight in an ancient disease [letter]. Arch.Dermatol. 126:249-251, 1990. Keywords : PHLEBITIS; ADULT; AGED; Ascorbic Acid; blood; CASE REPORT; ecchymosis; pathology; gingivitis; HUMAN; LEG; MALE; scurvy; THROMBOPHLEBITIS; in; an Ref ID : GROSS1988 490. Gross, J.S., Neufeld, R.R., Libow, L.S., Gerber, I., and Rodstein, M. Autopsy study of the elderly institutionalized patient. Review of 234 autopsies. Arch.Intern.Med. 148:173-176, 1988. Keywords : 951202; AUTOPSY; REVIEW; in; CAUSE; DEATH; diagnostics; diagnostic errors; Died; CHRONIC; cause of death; PATHOLOGIC; heart; Carcinoma; PULMONARY EMBOLISM; EMBOLISM; MYOCARDIAL INFARCTION; ACCIDENTS; PNEUMONIA; is; AGED; Aged,80 and over; Cerebrovascular Disorders; di; homes for the aged; HUMAN; MIDDLE AGE; Neoplasms; mo; nursing homes; th; Medline File; Health Planning & Administration File; Cancerlit File; new york; bronchopneumonia; infarction Notes : Autopsies are performed much less frequently in the elderly than in younger patients. Little information exists as to causes of death in the institutionalized elderly. The clinical diagnostic error rate documented by autopsy studies ranges from 6% to 68%. We analyzed the clinical and autopsy records of 234 patients who died during a 14 1/2- year period at our chronic care institution to determine the accuracy of clinical cause of death in addition to the pathologic cause of death. The most common causes of death included bronchopneumonia (33%), congestive heart failure (15%), metastatic carcinoma (14%), pulmonary embolism (8%), myocardial infarction (7%), cerebrovascular accident (6%), unknown cause of death (8%), and a miscellaneous group (9%). The highest diagnostic error rate was in the underdiagnosis of pulmonary embolism (39% antemortem accuracy rate). The most accurately diagnosed condition was cerebrovascular accident (92% antemortem accuracy rate). Pneumonia was correctly diagnosed antemortem in 73% of the patients studied. These data suggest that serious and potentially treatable illnesses are underdiagnosed in the elderly institutionalized patient and that there is va