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 valuable information to be learned by performing autopsies in the elderly population Department of Geriatrics Mount Sinai School of Medicine New York. Ref ID : GRUBER1987 491. Gruber, S.A. Thromboembolic complications in renal allograft recipients. Transplantation 44:775-778, 1987. Keywords : THROMBOEMBOLIC; COMPLICATIONS; CLINICAL DIAGNOSIS; DIAGNOSIS; DVT; INCIDENCE; PROSPECTIVE; RENAL TRANSPLANT; 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 : GUGELFRANK1971 492. Gugel-Frank, M. [Experiences with Venopyronum triplex capsules]. Med.Monatsschr. 25:132-133, 1971. Keywords : NASP; Capsules; HUMAN; PHLEBITIS; Plant Extracts; Plants,Medicinal; Rutin; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; ab Notes : TT - Erfahrungen mit Venopyronum triplex Kapseln AB - [No Abstract Available] UI - 72010479. Ref ID : GUIGAY1993 493. Guigay, J., Carette, M.F., Rosencher, L., and Milleron, B. [Accidental finding of pulmonary embolism by tomodensitometry during follow up of bronchial carcinoma]. Rev.Pneumol.Clin. 49:40-41, 1993. Keywords : EMBOLISM; sdi-11/93; CT scan; Carcinoma Ref ID : GUSS1981 494. Guss, H. [Treatment of varicose veins in pregnancy]. Fortschr.Med. 99:62-65, 1981. Keywords : VARICOSE VEINS; VEINS; NASP; FEMALE; HUMAN; PREGNANCY; Pregnancy Complications,Cardiovascular; Sclerosing Solutions; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; varicose; in; ab Notes : TT - Die Behandlung der Varikosis in der Schwangerschaft AB -[No Abstract Available] UI - 81140210. Ref ID : HAAKE1986 495. Haake, D.A. and Berkman, S.A. Hypercoagulable states and venous thrombosis. Hosp.Pract. 21(2):88C-88DD, 1986. Keywords : HYPERCOAGULABLE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS Ref ID : HAAS1993A 496. Haas, S. and Flosbach, C.W. Prevention of postoperative thromboembolism with Enoxaparin in general surgery: a German multicenter trial. Semin.Thromb.Hemost. 19 Suppl 1:164-173, 1993. Keywords : PREVENTION; POSTOPERATIVE; THROMBOEMBOLISM; SURGERY; Safety; Low molecular weight heparin; Molecular Weight; HEPARIN; PROSPECTIVE; RANDOMIZED; SURGICAL; SUBCUTANEOUS; Injections; AGE; RISK; RISK FACTORS; DVT; PE; INCIDENCE; PROPHYLAXIS; FATAL; BLEEDING; Blood Transfusion; COMPLICATIONS; HEMATOCRIT; THROMBOCYTOPENIA; drugs; THROMBOEMBOLIC; TREATMENT; sdi-11/93; in; an; analysis; blood; drainage; is Notes : The antithromboembolic efficacy and safety of Enoxaparin, a low molecular weight heparin preparation, has been studied in a multicenter prospective randomized trial in 10,032 patients scheduled for a variety of elective general surgical, gynecologic, and urologic procedures. There were 9919 patients operated on and who received Enoxaparin, of whom 9907 patients were randomized into two groups. The morning group, composed of 4987 patients, received a subcutaneous injection of 20 mg Enoxaparin 2 hours before surgery and each morning for 7 postoperative days. The evening group, composed of 4920 patients, received the identical injection the evening before surgery and postsurgically for 7 days in the evening. Both groups were comparable in age, gender, weight, surgical category, anesthesia, and any risk factors that could predispose to the development of DVT or PE. The objective of this study was to detect efficacy and safety of Enoxaparin 20 mg under typical clinical conditions. The results were the following: PE was reported in 24 patients, leading to an incidence of PE under Enoxaparin prophylaxis of 0.24% in total, 0.21% for nonfatal and 0.03% for fatal PE. There were no differences in the incidence between the morning and evening groups. The incidence of DVT diagnosed by clinical signs was found to be 0.11%, with six cases in the morning group and five cases in the evening group. An analysis of operative and postoperative bleeding showed no difference between the groups in terms of blood transfusion requirements and drainage volumes, excessive bleeding in the wound area, or other bleeding complications. There was a slight postoperative decrease in haemoglobin and hematocrit in both groups. However, no severe Enoxaparin-induced thrombocytopenia was observed. Only 71 patients (0.72%) reported adverse drug reactions, most of which were local reactions. The results from this study indicate that a single daily injection of 20 mg Enoxaparin is a safe and efficient prophylaxis for thromboembolic complications in patients undergoing any of a variety of general surgical procedures. This study indicates that prevention of thromboembolism is not strictly limited to a 2-hour interval between start of prophylaxis and onset of surgery but may also be provided by starting prophylaxis with 20 mg Enoxaparin during the evening before surgery and continuing treatment postoperatively. Ref ID : HAAVERSTAD1992 497. Haaverstad, R., Nilsen, G., Myhre, H.O., Saether, O.D., and Rinck, P.A. The use of MRI in the investigation of leg oedema. Eur.J Vasc.Surg. 6:124-129, 1992. Keywords : MRI; LEG; MAGNETIC RESONANCE; DIAGNOSIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CHRONIC; Syndrome; Pressure; TECHNIQUES; GRADIENT; SUBCUTANEOUS; CONTRAST; Muscles; sdi- 11/93; in; magnetic resonance imaging; atherosclerosis; is Notes : Magnetic resonance imaging (MRI) was used in the diagnosis of various conditions giving rise to leg oedema, with special attention to the oedema after femoro-distal vascular reconstruction for obliterative atherosclerosis (n = 14). Patients with deep venous thrombosis (n = 6), chronic lymphoedema (n = 6) and closed muscular compartment syndrome (n = 2) were also investigated. Leg volume increase was measured according to the formula of a truncated cone. Interstitial fluid hydrostatic pressure (Pif) was recorded with the wick-in-needle technique. Spin echo series with 10 mm transverse slices were obtained with MRI. Following vascular reconstructions, leg volume increased 26% on the operated side. In the operated leg, no gradient in Pif was found between the posterior muscular compartment and the subcutaneous tissue. However, there was a significantly higher Pif in the subcutaneous tissue compared to the anterior muscular compartment (p less than 0.05). In the operated group, MRI revealed oedema around the entire circumference of the leg, mainly restricted to the subcutaneous tissue. In contrast, oedema of the leg muscles, particularly in the posterior compartments, was typical for patients having deep venous thrombosis. The group with chronic lymphoedema showed circumferential subcutaneous oedema alone or in combination with a fibrotic honeycomb pattern. Oedema of the affected muscular compartment was easily observed in patients who had a closed compartment syndrome. In conclusion, the use of MRI is promising in the investigation of conditions giving rise to leg oedema. It is likely that the formation of post-reconstructive oedema is taking place in the subcutaneous tissue.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : HACKE1995 498. Hacke, W., Kaste, M., Fieschi, C., Toni, D., Lesaffre, E., Kummer, R., Boysen, G., Bluhmki, E., Hoxter, G., Mahagne, M., and Hennerici, M. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: The european cooperative acute stroke study (ECASS). JAMA 274(13):1017-1025, 1995. Keywords : INTRAVENOUS; THROMBOLYSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; STROKE; is; in; HEMORRHAGIC; an; DEATH; EARLY; RISK; CVA; ECASS Notes : Thrombolysis is effective in a subset of stroke patients, and can restore normal neurologic function to many patients who would otherwise have a permanent disability. Unfortunately, another subset of patients will have more and larger hemorrhagic intracranial events, with an increased hemorrhagic stroke death rate. Better enrollment criteria and better early discriminators for hemorrhagic risk are needed before routine intravenous thrombolysis can be recommended for patients with acute CVA. Ref ID : HAEGER1969 499. Haeger, K. The treatment of varicosis in the post-thrombotic state. Zentralbl.Phlebol. 8(1):56-59, 1969. Keywords : TREATMENT; THROMBOSIS; SCLEROTHERAPY; POST-THROMBOTIC; EMBOLIZATION; ANTICOAGULANT; EMBOLISM; in; PHLEBOGRAPHY; LEG; ANTICOAGULANTS Notes : The author has performed 'many hundreds' of phlebograms in the postthrombotic state, and 250 phlebographies in acute thrombosis, 40 cases repeatedly during the first week, and no evidence of embolization has been seen. 300 operations on post-thrombotic legs without prophylactic anticoagulants, and no evidence of embolism in any patient. Ref ID : HAEGER1969A 500. Haeger, K. Problems of acute deep venous thrombosis. The interpretation of signs and symptoms. Angiology 20:219-223, 1969. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CLINICAL DIAGNOSIS; DIAGNOSIS; PAIN; LEG; DEEP VENOUS THROMBOSIS; is; in Notes : The clinical diagnosis of deep venous system thrombosis is only accurate 50 percent of the time, with as many false positives as negatives, even in the presence of pain, tenderness, and unilateral leg swelling. Ref ID : HAID1970 501. Haid, H. [Conservative therapy in venous diseases]. Dtsch.Med.J. 21:453-456, 1970. Keywords : THERAPY; VENOUS; NASP; ANTICOAGULANTS; BANDAGES; EMBOLISM; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; in; ab Notes : TT - Konservative Therapie der Venererkrankungen AB - [No Abstract Available] UI - 72070613. Ref ID : HAIMOVICI1966 502. Haimovici, H., Steinman, C., and Caplan, L.H. Role of arteriovenous anastomoses in vascular diseases of the lower extremity. Ann.Surg. 164:990-1002, 1966. Keywords : NASP; ANGIOGRAPHY; Arteriosclerosis Obliterans; Arteriovenous Anastomosis; Blood Flow Velocity; Capillaries; Femoral Artery; HUMAN; Intermittent Claudication; Ischemia; LEG; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; Vascular Diseases; Extremities; ab Notes : AB - [No Abstract Available] UI - 67048725. Ref ID : HALEVY1988 503. Halevy, A., Leonov, Y., Lewinsohn, G., Witz, E., and Orda, R. Thrombosis of superior vena cava during total parenteral nutrition, managed successfully with low dose streptokinase. Intensive.Care.Med. 14:72-73, 1988. Keywords : THROMBOSIS; VENA CAVA; STREPTOKINASE; ACEP93 Ref ID : HALLIDAY1994 504. Halliday, P., Anderson, D.N., Davidson, A.I., and Page, J.G. Management of cerebral air embolism secondary to a disconnected central venous catheter. Brit.J.Surg. 81:71, 1994. Keywords : 951202; MANAGEMENT; Cerebral; Air; EMBOLISM; CENTRAL VENOUS CATHETER; VENOUS; CATHETER; ADULT; CASE REPORT; catheterization,central venous; ae; is; embolism,air; co; et; th; equipment failure; FEMALE; HUMAN; Hyperbaric Oxygenation; motor cortex; visual cortex; Medline File; SURGERY Notes : [No Abstract Available] Department of General Surgery Aberdeen Royal Infirmary Foresterhill UK. Ref ID : HAMER1981 505. Hamer, J.D., Malone, P.C., and Silver, I.A. The PO2 in venous valve pockets; its possible bearing on thrombogenesis. Brit.J.Surg. 68:166- 170, 1981. Keywords : VENOUS; venous valve; THROMBOGENESIS; NASP; in Ref ID : HAMILTON1994 506. Hamilton, M.G., Hull, R.D., and Pineo, G.F. Prophylaxis of venous thromboembolism in brain tumor patients. J.Neurooncol. 22:111-126, 1994. Keywords : PROPHYLAXIS; VENOUS; THROMBOEMBOLISM; RISK; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; INCIDENCE; standards; Methods; THROMBOEMBOLIC; LEG; STOCKINGS; CALF; COMPRESSION; HEPARIN; Molecular Weight; Heparinoid; REVIEW; in; brain; is; Pneumatic Notes : Thromboembolism is a common problem in patients with brain tumors. Within this population are subpopulations of patients at varying but substantial risk for deep vein thrombosis and pulmonary embolism. Prophylactic strategies can be applied to these various risk groups that will dramatically reduce the incidence of thromboembolism, and these should be applied on a routine basis. The standard prophylactic methods for thromboembolic prophylaxis include mechanical devices (e.g., graduated leg stockings; external pneumatic calf compression) and pharmacological agents (e.g., low dose heparin). In addition, a basic knowledge of low molecular weight heparins and heparinoids is essential because these new agents have a potentially promising role in the prophylaxis of neurological disease in certain patients. The principles concerning the prophylaxis of venous thromboembolic disease in patients with brain tumors are addressed in this review. Ref ID : HAMILTON1994A 507. Hamilton, M.G., Hull, R.D., and Pineo, G.F. Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:280- 96; discussion 296, 1994. Keywords : VENOUS; THROMBOEMBOLISM; REVIEW; THROMBOEMBOLIC; RISK; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; INJURY; HEMORRHAGE; TRAUMA; STROKE; INCIDENCE; FATAL; BLEEDING; PROPHYLAXIS; TECHNIQUES; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; Methods; DIAGNOSIS; HEPARIN; WARFARIN; TREATMENT; Safety; Low molecular weight heparin; Molecular Weight; Heparinoid; MANAGEMENT; in; is; brain; subarachnoid hemorrhage; an Notes : Thromboembolism is a common problem in neurosurgery and neurology patients. Within this diverse population are subpopulations of patients with varying degrees of thromboembolic risk: low, moderate, and high. Patients at substantial risk for deep vein thrombosis and pulmonary embolism include those with spinal cord injury, brain tumor, subarachnoid hemorrhage, head trauma, stroke, and patients undergoing a neurosurgical operation. There are prophylactic strategies that can be applied to these various risk groups that will dramatically reduce the incidence of thromboembolism. The risk of pulmonary embolism or fatal pulmonary embolism typically exceeds the risk of severe or fatal bleeding from adequate prophylaxis, and these techniques should be applied on a routine basis. To adequately care for patients with deep venous thrombosis and pulmonary embolism, the physician requires a thorough understanding of the methods of diagnosis, the pharmacokinetics of heparin and warfarin, and a knowledge of their role in the treatment strategies that have proven efficacy and safety. In addition, an awareness of the low molecular weight heparins and heparinoids is becoming essential. These new agents have a potentially promising role in both the prophylaxis and treatment of patients with neurological disease. The principles concerning the prophylaxis, diagnosis, and clinical management of venous thromboembolic disease in neurosurgery and neurology patients are dealt with in this review. Ref ID : HAMSEN1985 508. Hamsen, A., Wiman, B., deFaire, U., and Blomback, M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N.Engl.J.Med. 313:1557-1563, 1985. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; TPA; MI; THROMBOSIS; in; infarction Ref ID : HANDLER1995 509. Handler, J.A. and Feied, C.F. Acute Pulmonary Embolism: Aggressive therapy with anticoagulants and thrombolytics. Postgraduate Medicine 97(1):61-72, 1995. Keywords : PULMONARY EMBOLISM; EMBOLISM; THERAPY; ANTICOAGULANTS; THROMBOLYTIC Ref ID : HANNAH1991 510. Hannah, A. and Buttimore, A.L. Thrombolysis of blocked hemodialysis catheter using recombinant tissue-type plasminogen activator [letter]. Nephron. 59:517-518, 1991. Keywords : THROMBOLYSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; ACEP93; hemodialysis; CATHETER Ref ID : HANSS1994 511. Hanss, M., Coppere, B., Gineyts, E., Bonvoisin, S., Ninet, J., Delmas, P.D., and Dechavanne, M. Increased plasma free gamma carboxyglutamic acid levels during deep vein thrombosis and intravascular disseminated coagulation. Thromb.Res. 73:185-192, 1994. Keywords : PHLEBITIS; vein; THROMBOSIS; COAGULATION; Adolescence; ADULT; AGED; Aged,80 and over; biological markers; blood; carcinoma,hepatocellular; Chronic Disease; COMPARATIVE STUDY; disseminated intravascular coagulation; FEMALE; Hemangioma; HUMAN; LEG; Liver Diseases; Liver Neoplasms; MALE; MIDDLE AGE; PAIN; PULMONARY EMBOLISM; Skin Neoplasms; THROMBOPHLEBITIS; Vitamin K; antagonists & inhibitors; 1-carboxyglutamic acid; amino acids; Vitamins; DEEP VEIN THROMBOSIS; BLOOD COAGULATION; THERAPY; Liver; Carcinoma; is; in; an Notes : Gammacarboxyglutamic acid (gla) is a non essential amino acid synthesized in presence of vitamin K, predominantly found in coagulation and bone proteins. In 14 cases of deep vein thrombosis and in 11 cases of disseminated intravascular coagulation, compared to 19 normal subjects and 9 patients hospitalized for leg pain, free plasma gla levels were found significantly elevated (respectively 372 +/- 244 and 559 +/- 361 versus 146 +/- 34 and 120 +/- 40 pmol/mL). In six paired plasma and serum, gla levels were similar. These results suggest an involvement of blood coagulation in gla generation with need of a catabolism of the activated factors. A significant decrease was noticed during vitamin K antagonist therapy and liver disease, both instances in which the synthesis of gla containing coagulation factors is affected. During hepatocellular carcinoma with elevated desgamma carboxyprothrombin, gla was found normal, denying an global impairement of the vitamin K metabolism. Ref ID : HARLEY1984 512. Harley, D.P., White, R.A., Nelson, R.J., and et al Pulmonary embolism secondary to venous thrombosis of the arm. Am.J.Surg. 147:221- 224, 1984. Keywords : PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ARM; SUBCLAVIAN VEIN; 96-suzy-002; secondary Notes : 01-04-96. Abstract : Abstract not available. Ref ID : HARPEL1987 513. Harpel, P.C. Blood proteolytic enzyme inhibitors: Their role in modulating blood coagulation and fibrinolytic enzyme pathways. In: Hemostasis and thrombosis: Basic principles and clinical practice, edited by Colman, R.W.Philadelphia:J.B. Lippincott, 1987, Keywords : COAGULATION; FIBRINOLYTIC; HEMOSTASIS; THROMBOSIS; blood; in; BLOOD COAGULATION Ref ID : HARRIS1994 514. Harris, K.A. Venous gangrene--further understanding [editorial; comment]. Can.J.Surg. 37:368-369, 1994. Keywords : PHLEBITIS; VENOUS; GANGRENE; HEPARIN; adverse effects; HUMAN; Ischemia; pathology; LEG; blood supply; Necrosis; THROMBOCYTOPENIA; chemically induced; THROMBOPHLEBITIS; DIAGNOSIS Ref ID : HARTEL1984 515. Hartel, S. [Complications and side effects of sclerotherapy]. Z.Arztl.Fortbild.(Jena) 78:331-332, 1984. Keywords : SIDE EFFECTS; NASP; Drug Hypersensitivity; HUMAN; Sclerosing Solutions; THROMBOPHLEBITIS; VARICOSE VEINS; Venous Insufficiency; Medline File; ab Notes : TT - Komplikationen und Nebenwirkungen der Sklerotherapie AB - [No Abstract Available] UI - 84226252. Ref ID : HARTWEGER1965 516. Hartweger, E.W. [A contribution to the therapy of the varicose symptom complex]. Dtsch.Med.J. 16:654-655, 1965. Keywords : THERAPY; NASP; HUMAN; Phenylephrine; Theophylline; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - Ein Beitrag zur Therapie des varikosen Symptomenkomplexes AB - [No Abstract Available] UI - 66099318. Ref ID : HARVEY1950 517. Harvey, W.P. and Finch, C.A. Dicoumarol prophylaxis of thromboembolic disease in congestive heart failure. N.Engl.J.Med. 242:208-211, 1950. Keywords : PROPHYLAXIS; THROMBOEMBOLIC; MYOCARDIAL INFARCTION; DVT; PE; BEDREST; MI; ANTICOAGULATION; INCIDENCE; 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 : HASINOFF1990 518. Hasinoff, I., Ducas, J., Schick, U., and Prewitt, R.M. Pulmonary vascular pressure-flow characteristics in canine pulmonary embolism. J.Appl.Physiol. 68:462-467, 1990. Keywords : PULMONARY EMBOLISM; EMBOLISM; CANADA; PULMONARY HYPERTENSION; Hypertension; Pressure; Fistula; DOGS; ARTERIAL; EMBOLIZATION; ANIMAL; Support,Non-U.S.Gov't; Blood Pressure ,Physiology ,PH; Hypertension,Pulmonary ,Physiopathology ,PP; Pulmonary Circulation ,Physiology ,PH; Pulmonary Embolism ,Physiopathology ,PP; Heart Atrium; in; ab; is; blood; an Notes : CS- Department of Medicine, University of Manitoba Health Sciences Centre, Winnipeg, Canada AB- We tested the hypothesis that, in canine embolic pulmonary hypertension, upstream transmission of increased left atrial pressure (LAP) is inversely related to the level of the pressure intercept (PI) obtained by extrapolation from the linear pulmonary vascular pressure-flow (P-Q) plot. P-Q coordinates were obtained by varying Q through systemic fistulas. Seven group 1 dogs were embolized with autologous blood clot to produce marked pulmonary hypertension and mean pulmonary arterial pressure (PAP), and PI increased from 15 to 41 mmHg (P less than 0.001) and from 8.8 to 31 mmHg (P less than 0.001), respectively. Before and after embolization we assessed effects of increased LAP, produced by inflation of a left atrial balloon, on PAP at constant Q. Embolization depressed the mean slope of this relationship from 0.78 to 0.16 (P less than 0.001). Subsequently, six group 2 dogs were embolized to produce moderate pulmonary hypertension with a mean PI of 22 mmHg. This value was significantly less than PI in group 1 (P less than 0.01). After embolization, the slope of the PAP-LAP relationship was greater in group 2 than group 1: 0.47 vs. 0.16 (P less than 0.01). We conclude that the upstream transmission of left atrial pressure is inversely related to PI and that marked embolic pulmonary hypertension produces an effective vascular waterfall. Ref ID : HASKAL1994 519. Haskal, Z.J., Soulen, M.C., Huettl, E.A., Palevsky, H.I., and Cope, C. Life-threatening pulmonary emboli and cor pulmonale: treatment with percutaneous pulmonary artery stent placement. Radiology 191:473-475, 1994. Keywords : Pulmonary emboli; EMBOLI; COR PULMONALE; TREATMENT; PULMONARY ARTERY; ARTERY; HYPOXEMIA; CARDIAC; SURGERY; CATHETER; THROMBOLYSIS; Arteries; PERFUSION; in Notes : Large, central bilateral pulmonary emboli led to cor pulmonale and severe hypoxemia in a patient who had recently undergone cardiac surgery. After percutaneous catheter fragmentation and thrombolysis of the emboli failed, the left and right interlobal pulmonary arteries were recanalized by placement of self-expanding Wallstent endoprostheses through the clots. Pulmonary perfusion was restored to the lower lobes, and the patient demonstrated rapid clinical improvement. Ref ID : HATABU1992 520. Hatabu, H., Gefter, W.B., Listerud, J., Hoffman, E.A., Axel, L., McGowan, J.C., Palevsky, H.I., Hayes, C.E., Konishi, J., and Kressel, H.Y. Pulmonary MR angiography utilizing phased-array surface coils. J Comput.Assist.Tomogr. 16:410-417, 1992. Keywords : MR; ANGIOGRAPHY; MAGNETIC RESONANCE; GRADIENT; SCAN; LUNG; ANATOMY; CHEST; TECHNIQUES; PULMONARY EMBOLISM; EMBOLISM; RESOLUTION; NONINVASIVE; sdi-11/93; in; algorithms; an; is Notes : Magnetic resonance angiography of the pulmonary vasculature was evaluated in 12 subjects using breath-hold gradient echo scans and surface coils at 1.5 T. Flow-compensated GRASS, spoiled GRASS (SPGR), and WARP-SPGR sequences were utilized. Comparisons were made among flip angles of 10-60 degrees, slice thicknesses of 3-10 mm, and body coil as well as Helmholtz pair and phased-array multiple coils. With 30-40 contiguous slices encompassing the lung, intrathoracic vasculature was segmented using a UNIX/X-windows based package dubbed VIDA. Three- dimensional anatomy was visualized by a brightest voxel projection algorithm, following reduction of chest wall pixel intensities by an operator-interactive module. Both SPGR (30 degrees flip angle, 4 mm slice thickness) and WARPSPGR (15 degrees flip angle, 5 mm slice thickness) in combination with phased-array multiple coils provided the most satisfactory images, based upon observations by three radiologists and signal-to-noise ratio measurements. The MR angiograms visualized vessels as distal as sixth to seventh order branches. The technique was successfully applied to three patients with pulmonary embolism. The results of this study demonstrate that the pulmonary vascular tree can be imaged by MR angiography combining a high resolution technique utilizing phased-array multiple coils, fast gradient echo sequences with breath-holding, and postprocessing of the volumetric image data. The technique is attractive since it is noninvasive and provides a full three-dimensional portrayal of the pulmonary vasculature. Ref ID : HATABU1994 521. Hatabu, H., Gefter, W.B., Axel, L., Palevsky, H.I., Cope, C., Reichek, N., Dougherty, L., Listerud, J., and Kressel, H.Y. MR imaging with spatial modulation of magnetization in the evaluation of chronic central pulmonary thromboemboli. Radiology 190:791-796, 1994. Keywords : MR; CHRONIC; THROMBOEMBOLI; diagnostics; MAGNETIC RESONANCE; Methods; PULMONARY HYPERTENSION; Hypertension; TECHNIQUES; PULMONARY ARTERY; Arteries; SENSITIVITY; SPECIFICITY; ARTERIAL; in Notes : PURPOSE: To assess the diagnostic value of magnetic resonance (MR) imaging with SPAMM (spatial modulation of magnetization) in the identification of chronic central pulmonary thromboemboli. MATERIALS AND METHODS: Twelve patients with pulmonary hypertension and five healthy volunteers were prospectively studied with a 1.5-T MR imaging system. The SPAMM technique was integrated into a conventional cardiac- synchronized spin-echo (SE) sequence. Six of the 12 patients had central thromboemboli. RESULTS: In the healthy subjects, intravascular stripes in the central pulmonary arteries disappeared as a result of flow within 100 msec after the R wave. Areas of persistent stripes were identified in seven of eight central pulmonary arteries with thromboemboli. Conversely, in the 16 central pulmonary arteries without clot, intraluminal stripes disappeared despite the presence of flow-related signal (sensitivity = 88%, specificity = 100%, accuracy = 96%). CONCLUSION: SPAMM appears to be a simple and effective technique for differentiating central pulmonary arterial thromboemboli from flow- related signal frequently observed with pulmonary hypertension. Ref ID : HAUCH1990 522. Hauch, O., Jorgensen, L.N., Khattar, S.C., Teglbjaerg, C.S., Wahlin, A.B., Rathenborg, P., and Wille-Jorgensen, P. Fatal pulmonary embolism associated with surgery. An autopsy study. Acta Chir.Scand. 156:747-749, 1990. Keywords : 951202; FATAL; PULMONARY EMBOLISM; EMBOLISM; SURGERY; an; AUTOPSY; Hospitals; in; DEATH; CAUSE; POSTOPERATIVE; AGE; PROGNOSIS; THROMBOEMBOLIC; PROPHYLAXIS; INCIDENCE; Age Factors; FEMALE; HEPARIN; tu; HUMAN; MALE; Postoperative Complications; pc; et; mo; THROMBOLYTIC THERAPY; Medline File; denmark Notes : The records of all autopsies performed at two major Danish hospitals in 1986 were reviewed in order to analyze cases of fatal pulmonary embolism. There were 2,609 hospital deaths and 1, 603 post mortem examinations. Pulmonary embolism was the primary cause of 74 deaths, 16 of which were postoperative. The median age of these ten men and six women was 72 years. In nine of the 16 cases the prognosis would have been favorable had embolism not occurred. Only three of the 16 had received thromboembolic prophylaxis. Four of the deaths from embolism occurred less than 24 hours after surgery, five within 7 days and seven between postoperative days 7 and 30. The estimated incidence of fatal pulmonary embolism following surgery was 1.2-1.3 per thousand Department of Surgery D Gentofte Hospital Denmark. Ref ID : HAVIG1977 523. Havig, O. Deep vein thrombosis and pulmonary embolism. An autopsy study with multiple regression analysis of possible risk factors. Acta.Chir.Scand. 478:1-120, 1977. Keywords : DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; AUTOPSY; RISK; DVT; vein; an; regression analysis; analysis; RISK FACTORS; in Notes : Evidence of prior DVT in up to 60 percent of patients at autopsy. Ref ID : HAVLIK1982 524. Havlik, P. [The significance of deep crural thrombosis and pulmonary embolism in the sclerotherapy of varices (practical experience)]. Cesk.Dermatol. 57:182-185, 1982. Keywords : THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; SCLEROTHERAPY; VARICES; NASP; English Abstract; HUMAN; Sclerosing Solutions; THROMBOPHLEBITIS; VARICOSE VEINS; Medline File; in; ab Notes : TT - Vyznam hlubokych tromboz berc~u a plicnich embolii pri skleroterapii varix~u AB - [No Abstract Available] UI - 83002013. Ref ID : HAYNES1990 525. Haynes, D.F., Kerstein, M.D., Roberts, M.P., Bell, W.H., Rush, D.S., Kadowitz, P.J., and McNamara, D.B. Increased prostacyclin and thromboxane A2 formation in human varicose veins. J.Surg.Res. 49:228- 232, 1990. Keywords : HUMAN; varicose; VARICOSE VEINS; VEINS; NASP; thromboxane a2 - biosynthesis; in Ref ID : HEARN1991 526. Hearn, M. Venous stasis and vein lumen changes during surgery [letter; comment]. Brit.J.Surg. 78:505, 1991. Keywords : PHLEBITIS; VENOUS; STASIS; vein; SURGERY; HUMAN; INTRAOPERATIVE COMPLICATIONS; ETIOLOGY; LEG; blood supply; surgery,operative; adverse effects; THROMBOPHLEBITIS; VEINS; physiopathology Ref ID : HEATON1993 527. Heaton, B.W., Sorenson, C.W.J., and Middleton, R.G. Renal cell cancer tumor thrombi causing a massive pulmonary embolus in a 34-year- old man. J Urol. 150:1225-1226, 1993. Keywords : CANCER; THROMBI; MASSIVE; EMBOLI; sdi-11/93; Tumor emboli; in Notes : We describe a 34-year-old man who survived a massive pulmonary embolus caused by renal cell cancer tumor emboli. The literature and clinical presentation are discussed. Ref ID : HEIJBOER1990 528. Heijboer, H., Brandjes, D.P., Buller, H.R., Sturk, A., and Ten Cate, J.W. Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis. N.Engl.J.Med. 323(22):1512-1516, 1990. Keywords : FIBRINOLYTIC; DEEP VEIN THROMBOSIS; THROMBOSIS; THROMBOEMBOLIC; COMPLICATIONS; PLASMINOGEN; OUTPATIENT; in Ref ID : HEIT1992 529. Heit, J. Thrombolytic agent dosage for pulmonary embolism: Current research and clinical experience. In: Latest concepts and management of acute venous thromboembolic disease, edited by Comerota, A.J.Coronado:Abbott Pharmaceuticals, 1992,p. 24-33. Keywords : THROMBOLYTIC; EMBOLISM; DOSAGE; BLEEDING; COMPLICATIONS; MANAGEMENT; VENOUS; THROMBOEMBOLIC; PULMONARY EMBOLISM Ref ID : HELDAL1993 530. Heldal, M., Seem, E., Sandset, P.M., and Abildgaard, U. Deep vein thrombosis: a 7-year follow-up study. J.Intern.Med. 234:71-75, 1993. Keywords : DEEP VEIN THROMBOSIS; vein; THROMBOSIS; FOLLOWUP; Follow-Up Studies; DVT; LEG; VENOUS; Venous Insufficiency; Dead; in Notes : 76 patients were followed up seven years after initial presentation for DVT. 41 of the patients were dead and 10 were not available for re-study. Of the remaining 25 patients, none had symptoms in a leg that did not have DVT, but 42% of the legs with prior DVT had symptoms and 68% had deep venous insufficiency. Distal DVT was as likely to produce symptoms as was proximal DVT. Ref ID : HELMRICH1987 531. Helmrich, S.P., Rosenberg, L., Kaufman, D.W., Strom, B., and Shapiro, S. Venous thromboembolism in relation to oral contraceptive use. Obstet.Gynecol. 69:91-95, 1987. Keywords : VENOUS; THROMBOEMBOLISM; ORAL CONTRACEPTIVES; RISK; DVT; PE; PROSPECTIVE; INCIDENCE; THROMBOSIS; in; is; RANDOMIZED; cohort studies Notes : Oral contraceptive use raises the risk of DVT and PE, but the magnitude of the risk is difficult to quantify. There are no prospective randomized studies using definitive testing to compare the incidence of DVT or PE in patients with and without oral contraceptives. Case-control and cohort studies based on clinical signs and symptoms of thrombosis suggest a relative risk somewhere between 3 and 12 times as high for patients taking oral contraceptives as for those not taking them.{349, 350}. Ref ID : HENDERSON1982 532. Henderson, J.M., Millikan, W.J.,Jr., Chipponi, J., Wright, L., Soner, P.J., Meier, L., and Warren, W.D. The incidence and natural history of thrombus in the portal vein following distal splenorenal shunt. Ann.Surg. 196:1-7, 1982. Keywords : THROMBUS; PORTAL VEIN; VEINS; SHUNT; THROMBOSIS; SHUNT SURGERY; INCIDENCE; NATURAL HISTORY; in; vein Ref ID : HENNEKENS1990 533. Hennekens, C.H. Role of aspirin with thrombolytic therapy in acute myocardial infarction. Chest 97(4 Suppl):151S-155S, 1990. Keywords : ASPIRIN; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MYOCARDIAL INFARCTION; MORTALITY; MI; STROKE; THROMBOLYSIS; HEPARIN; ALTEPLASE; DOUBLE BLIND METHOD; HUMAN; MULTICENTER STUDIES; RANDOMIZED CONTROLLED TRIALS; STREPTOKINASE; CLINICAL TRIALS; MULTICENTER STUDY; in; infarction; is; 96-suzy-001; therapeutic use; adverse effects; Double-Blind Method; drug therapy Notes : AB-Thrombolytic therapy has been shown to limit infarct size, improve ventricular function, and decrease mortality in suspected evolving myocardial infarction (MI). Aspirin therapy also decreases mortality as well as stroke and reinfarction in suspected evolving MI. The combined ability of both agents to lyse as well as to prevent clots yields a greater benefit than either alone. The use of aspirin with thrombolysis also protects against the increase in reinfarction observed when thrombolytic therapy is given alone. While ongoing research is evaluating the optimal thrombolytic agent as well as the possible role of heparin, it is already clear that the use of aspirin with thrombolytic therapy will significantly decrease reinfarction, stroke, and vascular mortality in suspected evolving MI. Ref ID : HERMANS1992 534. Hermans, H., Eisenbud, D.E., Cluley, S., Brener, B.J., Russel, H., Villanueva, A., Ferrara-Ryan, M., and Parsonnet, V. Valvular function and prostacyclin production following clot lysis and balloon thrombectomy in thrombosed canine veins. Proceedings of the American Venous Forum 4:35-35, 1992. (Abstract) Keywords : LYSIS; THROMBOSED; VEINS; ANTICOAGULATION; THROMBUS; Extension; TREATMENT; DEEP VEIN THROMBOSIS; THROMBOSIS; ANIMAL; ANIMAL MODELS; ENDOTHELIAL; VENOUS; VENOUS VALVES; THROMBOLYSIS; VALVULAR FUNCTION; TIME TO TREATMENT; THROMBECTOMY; in; is; an; vein; DURATION Notes : Anticoagulation prevents thrombus extension, but does not promote lysis of preformed thrombus, thus anticoagulation alone is not an optimal treatment for deep vein thrombosis. Hermans and others have demonstrated in an animal model that endothelial cell damage in a thrombosed vein is directly related to the duration of thrombosis. They showed that 76 percent of venous valves were functional if thrombolysis or thrombectomy occurred within 24 hours, but that only 6 percent of valves were competent when thrombolysis was delayed more than 24 hours. Ref ID : HERRMANN1984 535. Herrmann, K.S. and Voigt, W.H. Ultrastructural observations of an electron-dense amorphous layer on selectively damaged endothelial cells, a possible trigger of thrombogenesis in vivo and its inhibition by nofazotrom. Thromb.Res. 36:205-215, 1984. Keywords : ENDOTHELIAL; THROMBOGENESIS; AEDS; an; in; INHIBITION Ref ID : HERRMANN1987 536. Herrmann, K.S., Voigt, W.H., and Kreuzer, H. Influence of heparin, aspirin, streptokinase, and factor VIII (AHF) on amorphous electron- dense substance, a mediator of platelet and thrombus adhesion in vivo. Haemostasis 7:59-65, 1987. Keywords : HEPARIN; PLATELET; THROMBUS; AEDS; ASPIRIN; STREPTOKINASE; FACTOR VIII; in Ref ID : HERZOG1978 537. Herzog, H., Perruchoud, A., Dalquen, P., and Tschan, M. Chronisch rezidivierende Lungenembolie. Dtsch Med Wochenschr 103:1473-1478, 1978. Keywords : 96-suzy-002; AUTOPSY; in; Switzerland; Pulmonary emboli; EMBOLI Notes : 01-05-96 According to data from intensive autopsy and clinical studies in Basel, Switzerland, there are 62.8 cases of multiple pulmonary emboli per 100,000 population per year! Ref ID : HESS1987 538. Hess, H., Mietaschk, A., and Br:uckl, R. Peripheral arterial occlusions: a 6-year experience with local low-dose thrombolytic therapy. Radiology. 163:753-758, 1987. Keywords : ARTERIAL; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ACEP93; OCCLUSION Ref ID : HESS1990 539. Hess, H. Thrombolytic therapy in peripheral vascular disease. Brit.J.Surg. 77:1083-1084, 1990. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PERIPHERAL ARTERY; in; Peripheral Vascular Diseases; Vascular Diseases Ref ID : HIEMEYER1968 540. Hiemeyer, V. The fibrinolytic activity of blood derived from vessel wall. Angiologica 5:95-104, 1968. Keywords : FIBRINOLYTIC; EARLY; FIBRINOLYSIS; THROMBOSIS; SCLEROTHERAPY; VESSEL ENDOTHELIUM; ENDOTHELIUM; blood; REVIEW; REVIEW ARTICLE Notes : Excellent review article discusses the findings of early researchers with respect to fibrinolysis mediated by the vessel endothelium. Ref ID : HIGASHIDA1989 541. Higashida, R.T., Helmer, E., Halbach, V.V., and Hieshima, G.B. Direct thrombolytic therapy for superior sagittal sinus thrombosis. AJNR.Am.J.Neuroradiol. 10:S4-S6, 1989. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; THROMBOSIS; ACEP93; Sagittal Sinus Thrombosis Ref ID : HIGASHIYAMA1993 542. Higashiyama, M., Doi, O., Kodama, K., Yokouchi, H., Kobayashi, T., Hiraishi, T., Tateishi, R., and Nomura, S. Successful surgery of malignant fibrous histiocytoma in the lung with gross extension into the right main pulmonary artery. Thorac.Cardiovasc.Surg. 41:73-76, 1993. Keywords : SURGERY; LUNG; Extension; PULMONARY ARTERY; ARTERY; SURGICAL; TREATMENT; FEMALE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; MANAGEMENT; sdi-11/93; Mimic; Pseudoembolus; in Notes : We report on successful surgical treatment of a 49-year-old female suffering from malignant fibrous histiocytoma which arose from the lower lobe of the right lung with gross extension into the right main pulmonary artery, mimicking pulmonary thromboembolism. With the aid of a percutaneous cardiopulmonary support system, right pneumonectomy with resection of the right main pulmonary artery and reconstruction of the pulmonary artery was performed. Surgical management and the unique clinicopathological features of this case are discussed. Ref ID : HILL1992 543. Hill, L., Muir, D., Black, A.J., and Madhok, R. Duration of anticoagulation for deep-vein thrombosis and pulmonary embolism [letter]. Lancet 340:1296, 1992. Keywords : DURATION; ANTICOAGULATION; DEEP VEIN THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM Ref ID : HILL1992A 544. Hill, J.A. and Grabowski, E.F. Relationship of anticoagulation and radiographic contrast agents to thrombosis during coronary angiography and angioplasty: are there real concerns? Cathet.Cardiovasc.Diagn. 25:200-208, 1992. Keywords : ANTICOAGULATION; CONTRAST; THROMBOSIS; ANGIOGRAPHY; ACEP93; Angioplasty Ref ID : HILL1993 545. Hill, B.F. and Jones, J.S. Venous air embolism following orogenital sex during pregnancy. Am.J.Emerg.Med. 11:155-157, 1993. Keywords : VENOUS; Air; EMBOLISM; PREGNANCY; COMPLICATION; FETAL; DEATH; Hospitals; EMERGENCY; abnormalities; TREATMENT; Syndrome; THERAPY; ACUTE DISEASE; ADULT; CASE REPORT; embolism,air; di; et; Emergencies; FEMALE; HUMAN; Pregnancy Complications,Cardiovascular; pregnancy trimester,third; sex behavior; Medline File; EMERGENCY MEDICINE; sex; is; an; vagina; in; laboratories Notes : Venous air embolism is an infrequent complication of pregnancy but may occur if air is blown into the vagina during orogenital sex. Air passes beneath the fetal membranes and into the circulation of the subplacental sinuses, invariably causing death to both mother and fetus within minutes. Reported is the case of a nonfatal air embolism following vaginal air insufflation in the 38th week of pregnancy. The hospital course was complicated by hypotension, metabolic acidosis, acute neurologic changes, and emergency caesarean section with eventual fetal demise. Clinical and laboratory abnormalities as well as treatment measures are discussed. Familiarity with this syndrome is essential if prompt and appropriate therapy is to be rendered Emergency Medicine Residency Program Butterworth Hospital Michigan State University College of Human Medicine Grand Rapids. Ref ID : HILLS1972 546. Hills, N.H., Pflug, J.J., Jeyasingh, K., Boardman, L., and Calnan, J.S. Prevention of deep vein thrombosis by intermittent pneumatic compression of the calf. Brit.Med.J. 1:131-135, 1972. Keywords : PREVENTION; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; CALF; OBESITY; RISK; DVT; PE; AGE; vein; Intermittent pneumatic compression; Pneumatic; COMPRESSION; RISK FACTORS; is; an Notes : Obesity, defined as weight greater than 20 percent above ideal weight, has long been accepted as a risk factor for DVT and PE, but the evidence supporting this association has been questioned. When associated factors such as past history, illness, immobility, and age are taken into account it is possible that obesity may not truly be an independent risk factor. Ref ID : HIRSCH1990 547. Hirsch, D.R. and Goldhaber, S.Z. The bleeding time: its potential utility among patients receiving thrombolytic therapy. Am.Heart J. 119(1):158-167, 1990. Keywords : 951216; BLEEDING; bleeding time; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; HEMOSTATIC; in; TECHNIQUES; SCREENING; Biopsy; FIBRINOGEN; HEMORRHAGIC; COMPLICATIONS; is; THROMBOLYSIS; PLATELET; PLATELETS; LYSIS; RISK; Blood Platelets; ph; Blood Vessels; Forecasting; HEMORRHAGE; et; HUMAN; platelet function tests; ae; TIME FACTORS; UNITED STATES; Medline File; BRIGHAM; Hospitals; boston Notes : The BT as a test of hemostatic function was first described 80 years ago. It has generally been considered a primitive and tedious test. Improvements in technique and standardization have increased the BT's reliability and led to its consideration as a preoperative screening measure. Current use has not been widespread, however, except for patients undergoing neurosurgery and organ biopsy. Recently, though, there has been a renewed interest in the BT for patients receiving thrombolytic therapy because levels of fibrinogen and fibrin(ogen) degradation products have been only weak predictors of hemorrhagic complications. The rationale for using the BT in this setting is that thrombolysis appears to impair platelet function, either through depletion of platelet granules or through direct proteolytic actions on platelets. Further research will determine whether these platelet effects are manifest as BT prolongation; whether increased BT will correlate with hemorrhagic complications; and, finally, whether patients who fail to achieve clot lysis or those at risk for bleeding can be identified prospectively Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : HIRSCH1990A 548. Hirsch, D.R. and Goldhaber, S.Z. Bleeding time and other laboratory tests to monitor the safety and efficacy of thrombolytic therapy. Chest 97(4 Suppl):124S-131S, 1990. Keywords : 951216; BLEEDING; bleeding time; Safety; THROMBOLYTIC; THERAPY; in; FIBRINOGEN; HEMORRHAGIC; RISK; PLATELET; PLATELETS; COAGULATION; THROMBOLYSIS; HEMOSTATIC; ALTEPLASE; ae; pd; tu; Fibrin Fibrinogen Degradation Products; an; hematologic tests; HEMORRHAGE; bl; ci; pc; HUMAN; MYOCARDIAL INFARCTION; dt; platelet function tests; STREPTOKINASE; THROMBOLYTIC THERAPY; THROMBOSIS; pp; UROKINASE; Medline File; BRIGHAM; Hospitals; laboratories; boston; 96-suzy-001; adverse effects; PHARMACOLOGY; therapeutic use; analysis; blood; chemically induced; prevention & control; drug therapy; physiopathology Notes : Widespread use of thrombolytic agents in a variety of settings has highlighted the need for measures of safety and efficacy. Previously used laboratory parameters, such as decreasing levels of fibrinogen and increasing levels of fibrin(ogen) degradation products (FDPs), have failed to correlate consistently with hemorrhagic events and have not yet been useful in predicting patients at risk for bleeding. Although the bleeding time (BT) has been considered primarily to reflect platelet function, it also reflects the interaction of platelets with vessel wall and coagulation pathways. Recently, the BT has been considered as a potential predictor of clinical bleeding during thrombolysis. The BT, as a measure of in vivo hemostatic competence, may be particularly well- suited for this application. Serial BTs during thrombolytic therapy may provide valuable information regarding safety and efficacy, but further studies are needed to confirm preliminary findings Department of Medicine Brigham and Women's Hospital Boston 02115. Ref ID : HIRSCH1991 549. Hirsch, D.R., Reis, S.E., Polak, J.F., Donovan, B.C., and Goldhaber, S.Z. Prolonged bleeding time as a marker of venous clot lysis during streptokinase therapy. Am.Heart J. 122(4 Pt 1):965-971, 1991. Keywords : 951216; BLEEDING; VENOUS; LYSIS; STREPTOKINASE; THERAPY; ULTRASOUND; Methods; THROMBOLYSIS; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; DVT; is; in; LYTIC; DURATION; THROMBOLYTIC; AGE; Extremities; UPPER EXTREMITY; renal veins; vein; TREATMENT; Venogram; MAGNETIC RESONANCE; magnetic resonance imaging; MRI; FOLLOWUP; Follow-Up Studies; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; NONINVASIVE; ADULT; AGED; bleeding time; FEMALE; HUMAN; MALE; MIDDLE AGE; predictive value of tests; PROSPECTIVE STUDIES; sensitivity and specificity; tu; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; bl; dt; Medline File; BRIGHAM; Hospitals; boston Notes : Despite their expense and inconvenience, serial ultrasound or venographic examinations are currently the only available methods to assess the efficacy of thrombolysis for deep venous thrombosis (DVT). We therefore tested whether the bleeding time (BT), a simple and inexpensive test, is useful in assessing lytic efficacy and might thus be a valuable adjunct in guiding the dose and duration of the thrombolytic agent. Serial BTs were obtained daily in 16 patients (eight men and eight women, average age 45.5 years, range 19 to 70) receiving streptokinase (SK) for proximal lower extremity DVT (n = 5), for upper extremity DVT (n = 10), or for renal vein thrombosis (n = 1). Duration of treatment averaged 89.9 +/- 43.6 hours (range 35 to 198 hours). Clot lysis on ultrasound, venogram, or magnetic resonance imaging (MRI) was defined as: complete (greater than or equal to 90%), moderate (50% to 90%), minimal (less than 50%), or none. Important (complete or moderate) clot lysis occurred in 9 of 15 patients for whom follow-up studies were available. BT prolongation was defined as greater than 9.5 minutes and, during SK therapy, had a sensitivity of 0.67 and a specificity of 0.67 for important clot lysis. The positive predictive value of prolonged BT for clot lysis was 0.75. Calculated likelihood ratios revealed that a patient with BT prolongation was twice as likely to have important clot lysis rather than minimal or no lysis. These findings suggest that the BT should undergo further investigation as a simple, adjunctive, noninvasive marker of thrombolytic efficacy among DVT patients treated with SK Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : HIRSCH1991A 550. Hirsch, D.R. and Goldhaber, S.Z. Laboratory parameters to monitor safety and efficacy during thrombolytic therapy. Chest 99(4 Suppl):113S- 120S, 1991. Keywords : 951216; Safety; THROMBOLYTIC; THERAPY; THROMBOLYTIC THERAPY; is; FREQUENCY; in; MYOCARDIAL INFARCTION; infarction; MI; PULMONARY EMBOLISM; EMBOLISM; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; ARTERIAL; OCCLUSION; MONITORING; RISK; BLEEDING; COMPLICATIONS; FIBRINOGEN; bleeding time; D-DIMER; FIBRIN; LYSIS; THROMBOEMBOLISM; an; HEMOSTASIS; PLATELET; NONINVASIVE; FIBRINOLYTIC AGENTS; ae; tu; HEMORRHAGE; et; HUMAN; Medline File; BRIGHAM; Hospitals; laboratories; polymers; boston Notes : Thrombolytic therapy is being used with increasing frequency in myocardial infarction (MI), pulmonary embolism, deep venous thrombosis (DVT), and peripheral arterial occlusion. Use of these agents, however, is hampered by concerns regarding safety and efficacy. Numerous laboratory parameters have been evaluated for monitoring the risk of bleeding complications, with levels of fibrinogen (and percentage of decrease) and fibrin/fibrinogen degradation products (FDPs) correlating to a variable extent with clinical bleeding. The bleeding time (BT) test has also been proposed as a potential predictor of bleeding during thrombolytic therapy. With respect to efficacy, the D-dimer fragment of FDPs, when corrected for soluble fibrin polymers, has been shown to correlate with clot lysis in venous thromboembolism but not MI. The BT also is being considered as a marker of lysis in patients with DVT. Given the increasing concomitant use of antiplatelet agents during thrombolytic therapy, the BT, as an in vivo test of hemostasis and platelet function, has potential utility as a noninvasive, adjunctive marker of thrombolytic efficacy Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston. Ref ID : HIRSCH1992 551. Hirsch, D.R. and Goldhaber, S.Z. Contemporary use of laboratory tests to monitor safety and efficacy of thrombolytic therapy. Chest 101(4 Suppl):98S-105S, 1992. Keywords : 951216; Safety; THROMBOLYTIC; THERAPY; hematologic tests; HUMAN; THROMBOLYTIC THERAPY; ae; TREATMENT OUTCOME; Medline File; Health Planning & Administration File; BRIGHAM; Hospitals; laboratories; boston Notes : [No Abstract Available] Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : HIRSCH1995 552. Hirsch, D.R., Ingenito, E.P., and Goldhaber, S.Z. Prevalence of deep venous thrombosis among patients in medical intensive care. JAMA 274(4):335-337, 1995. Keywords : 951216; PREVALENCE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; intensive care; FREQUENCY; DVT; intensive care units; PROSPECTIVE; ULTRASOUND; Hospitals; AGE; an; OUTCOME; Ultrasonography; color; Doppler; confidence intervals; Extremities; UPPER EXTREMITY; Catheters; VENA CAVA; Vena Cava Filters; FILTER; ANTICOAGULATION; SUBCUTANEOUS; HEPARIN; FOLLOWUP; BLEEDING; THROMBOCYTOPENIA; DIAGNOSIS; CANCER; SURGERY; DURATION; hospitalization; PROPHYLAXIS; RISK; RISK FACTORS; ADULT; AGED; Aged,80 and over; boston; FEMALE; hospital mortality; HUMAN; sn; MALE; MIDDLE AGE; PROSPECTIVE STUDIES; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; ep; th; us; Medline File; Health Planning & Administration File; BRIGHAM Notes : OBJECTIVE--To determine the frequency of deep venous thrombosis (DVT) in medical intensive care unit (MICU) patients. DESIGN-- Prospective ultrasound case series. SETTING--An MICU in a large tertiary care hospital in Boston, Mass. SUBJECTS--Patients older than 18 years of age admitted to the MICU with an anticipated stay of more than 48 hours. MAIN OUTCOME MEASURE--Deep venous thrombosis as detected by ultrasonography with color Doppler imaging performed twice weekly in the MICU and once within 1 week of discharge from the MICU. RESULTS-- Deep venous thrombosis was detected in 33% (95% confidence interval, 24% to 43%) of 100 eligible patients during the 8-month study period. Forty- eight percent (16/33) were proximal lower extremity DVT, and 15% (5/33) were upper extremity DVT associated with central venous catheters, with one patient having both upper and proximal lower extremity DVT. Ultrasound examination results led to inferior vena cava filter placement in three patients, initiation of full-dose anticoagulation in four patients, initiation or continuation of low- dose subcutaneous heparin in 10 patients, follow-up ultrasound studies in three patients, central line removal in one patient, and no intervention in 10 patients due to active bleeding, prior filter, or heparin-induced thrombocytopenia. Two patients remained anticoagulated for other reasons. In this series, there was no difference in age, gender, body mass index, diagnosis of cancer, recent surgery, duration of hospitalization prior to DVT detection, and DVT prophylaxis between patients with DVT and those without. CONCLUSIONS--An unexpectedly high rate of DVT was detected by ultrasound in these MICU patients despite prophylaxis in 61%. Traditionally recognized DVT risk factors failed to identify patients who developed DVT. Routine ultrasound surveillance or more intensive prophylaxis regimens may be warranted in this patient population if these DVT rates are confirmed in other settings Department of Medicine Brigham and Women's Hospital Boston MA 02115 USA. Ref ID : HIRSH1981 553. Hirsh, J., Genton, E., and Hull, R.D. Venous thromboembolism, New York:Grune & Stratton, 1981. Keywords : VENOUS; THROMBOEMBOLISM; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; KNEE; EMBOLIZATION; CAUSE; POSTPHLEBITIC; POSTPHLEBITIC SYNDROME; Syndrome; PULMONARY EMBOLISM; EMBOLISM; vein; is; in Notes : Deep vein thrombosis, whether above or below the knee, is of concern even in the absence of embolization because it causes a lifelong debilitating postphlebitic syndrome in more than 50 percent of cases. This postphlebitic syndrome is responsible for many cases of recurrent deep vein thrombosis and pulmonary embolism. Ref ID : HIRSH1990 554. Hirsh, J. Diagnosis of venous thrombosis and pulmonary embolism. Am.J.Cardiol. 65:45C-49C, 1990. Keywords : LMWH; Low-Molecular-Weight-Heparin; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; CLINICAL DIAGNOSIS; standards; TRENDS; NONINVASIVE; Methods; RISK; is; reference standards; an; in Notes : Venous thrombosis and pulmonary embolism are closely related disorders. As many as 70 to 80% of patients with pulmonary embolism have associated proximal deep venous thrombosis. The clinical diagnosis alone of both venous thrombosis and pulmonary embolism is inaccurate because of the insensitivity and nonspecificity of findings, a problem that also occurs with a variety of other disorders. Invasive, objective tests are still the reference standard, but they are not always easy to perform, they cannot be used for a considerable number of very ill patients, and they create some patient discomfort. There is an increasing trend toward using noninvasive methods, either alone or in combination. These methods entail less risk, can be performed more quickly and conveniently, and are usually more cost-effective. Practical approaches to diagnosing venous thrombosis and pulmonary embolism in the clinical setting are discussed. Ref ID : HIRSH1990A 555. Hirsh, J. Prevention of venous thrombosis in patients undergoing major orthopaedic surgical procedures. Acta Chir.Scand.Suppl. 556:30- 5:30-35, 1990. Keywords : 951217; PREVENTION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; SURGICAL; RISK; THROMBOEMBOLISM; THROMBI; HIP; SURGERY; VEINS; vein; SCREENING; VENOGRAPHY; Methods; ANTICOAGULANTS; HEPARIN; Molecular Weight; Pneumatic; COMPRESSION; KNEE; bone and bones; su; HUMAN; joints; Postoperative Complications; pc; THROMBOPHLEBITIS; Medline File; Hospitals; ontario; CANADA Notes : Patients having major orthopaedic surgical procedures have a high risk of venous thromboembolism. The distribution of thrombi following hip surgery differs from most other high risk situations, as 30-40% of all thrombi occur in proximal veins and many are unassociated with distal vein thrombosis. Many of these thrombi are undetected by currently available screening tests, but are detected by venography. Of the various prophylactic methods available, oral anticoagulants, adjusted-dose heparin and low molecular weight heparins are most effective in hip surgery, and oral anticoagulants and external pneumatic compression are most effective in knee surgery Hamilton Civic Hospitals Research Centre Henderson General Division Ontario Canada. Ref ID : HIRSH1990B 556. Hirsh, J. Anticoagulant therapy in venous thromboembolism. Baillieres.Clin.Haematol. 3(3):685-692, 1990. Keywords : 951217; ANTICOAGULANT; THERAPY; in; VENOUS; THROMBOEMBOLISM; Administration,Oral; ANTICOAGULANTS; ad; ae; tu; Blood Coagulation Tests; COMPARATIVE STUDY; Drug Administration Schedule; HEPARIN; HUMAN; Injections,Intravenous; injections,subcutaneous; monitoring,physiologic; Plethysmography,Impedance; PROSPECTIVE STUDIES; RECURRENCE; Retrospective Studies; dt; pc; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; di; Medline File Notes : [No Abstract Available]. Ref ID : HIRSH1990C 557. Hirsh, J. and Turpie, A.G. Use of plasminogen activators in venous thrombosis. World J.Surg. 14(5):688-693, 1990. Keywords : 951217; PLASMINOGEN; plasminogen activators; in; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; TREATMENT; THROMBOLYTIC; STREPTOKINASE; UROKINASE; standards; PLASMINOGEN ACTIVATOR; FIBRIN; SPECIFICITY; THROMBOLYSIS; COMPLICATIONS; RANDOMIZED; COMPLICATION; THROMBOLYTIC THERAPY; THERAPY; is; HEMORRHAGE; RISK; Needles; Punctures; SURGICAL; Pressure; Half-Life; drugs; ci; HUMAN; ad; ae; pd; tu; PULMONARY EMBOLISM; dt; THROMBOPHLEBITIS; Medline File; Hospitals; ontario; CANADA Notes : A major advance in the treatment of thrombosis has been the development of thrombolytic agents. Streptokinase and urokinase have been the standard agents available for many years, but in recent years the most exciting change in the field has been the development of a new generation of plasminogen activators, the principal one being tissue plasminogen activator. The first generation of plasminogen activators-- streptokinase and urokinase--do not have fibrin specificity and predictably induce plasma proteolysis when administered systemically in doses which introduce thrombolysis. The second generation of plasminogen activators are much more fibrin- specific and offer a promise of fewer complications. In a number of major randomized studies, these thrombolytic agents have proved effective clinically. The major complication of thrombolytic therapy, however, is hemorrhage. The risk of hemorrhage increases with the length of infusion and occurs most often from sites of vascular invasion such as needle punctures or cutdown sites from surgical wounds. This can be treated by applying pressure over the wound and discontinuing the thrombolytic agent whose half-life is measured in hours. It is believed that as more experience is acquired with the second-generation plasminogen activators, better control of these drugs will result in fewer complications and more effective and wider application of therapy Department of Medicine Hamilton Civic Hospital Ontario Canada. Ref ID : HIRSH1991 558. Hirsh, J. Rationale for development of low-molecular-weight heparins and their clinical potential in the prevention of postoperative venous thrombosis. Am.J.Surg. 161(4):512-518, 1991. Keywords : LMWH; Low-Molecular-Weight-Heparin; Low-molecular-weight heparin; HEPARIN; PREVENTION; POSTOPERATIVE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Antithrombotic; EARLY; partial thromboplastin time; THROMBOPLASTIN; APTT; ANIMAL; ANIMAL MODELS; BLEEDING; PLATELET; standards; Half-Life; CLINICAL TRIALS; Orthopedic; SURGERY; TREATMENT; OUTCOME; 951217; in; an; heparin,low-molecular-weight; ip; pd; tu; HUMAN; Postoperative Complications; pc; THROMBOPHLEBITIS; Medline File; Hospitals; ontario; CANADA; factor xa Notes : Interest in low-molecular-weight heparins (LMWHs) as potential antithrombotic agents was stimulated by two observations in the mid- 1970s and early 1980s. The first was finding that LMWH fractions prepared from unfractionated heparin (UFH) progressively lost their ability to prolong the activated partial thromboplastin time (APTT) while retaining their ability to inhibit Factor Xa. The second was the observation that LMWHs prepared by chemical depolarization of UFH are antithrombotic in experimental animal models but produce less microvascular bleeding in experimental models for an equivalent antithrombotic effect than the UFH from which they are derived. Subsequently, it was shown that LMWHs inhibit platelet function and impair vascular permeability less than standard heparin and that LMWHs have a longer biological half-life than standard heparin. A number of LMWHs have been evaluated in clinical trials in general and orthopedic surgery and in the treatment of venous thrombosis. LMWHs are highly effective in orthopedic surgery, where they appear to be more effective than standard heparin. LMWHs have also been shown to be either as effective or more effective than UFH in preventing postoperative thrombosis following general surgery. In preliminary studies, LMWHs appear to be as effective as standard heparin in the treatment of venous thrombosis, but larger studies are required using clinically relevant outcome measures. Ref ID : HIRSH1991B 559. Hirsh, J. Heparin [see comments]. N.Engl.J.Med. 324(22):1565-1574, 1991. Keywords : HEPARIN; 951217; CORONARY DISEASE; dt; FEMALE; ae; tu; HUMAN; PREGNANCY; Support,Non-U.S.Gov't; THROMBOEMBOLISM; Medline File; Hospitals; CANADA Notes : [No Abstract Available] Hamilton Civic Hospitals Research Centre Ont Canada. Ref ID : HIRSH1991D 560. Hirsh, J. Pulmonary embolism in the elderly. Cardiol.Clin. 9(3):457-474, 1991. Keywords : 951217; PULMONARY EMBOLISM; EMBOLISM; in; RISK; AGE; RISK FACTORS; STASIS; VENOUS; Orthopedic; HIP; KNEE; FIBRINOLYTIC; LEG; VEINS; DIAGNOSIS; is; PROBABILITY; LUNG; SCAN; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; Age Factors; AGED; algorithms; ANTICOAGULANTS; tu; HEPARIN; HUMAN; Postoperative Complications; pc; co; di; et; th; RECURRENCE; THROMBOLYTIC THERAPY; ventilation-perfusion ratio; Medline File; Hospitals; ontario; CANADA Notes : The risk of pulmonary embolism increases with age. Risk factors in the elderly include stasis caused by immobility and reduced venous tone, the increasing need for operative procedures, particularly orthopedic procedures to hip and knee, and reduced fibrinolytic activity in leg veins. The diagnosis of pulmonary embolism is difficult and is made on the basis of clinical probability, lung scan findings, investigations for deep venous thrombosis and, when indicated, by pulmonary angiography. Effective prophylactic and therapeutic approaches are now available Hamilton Civic Hospitals Research Centre Ontario Canada. Ref ID : HIRSH1991E 561. Hirsh, J. Reliability of non-invasive tests for the diagnosis of venous thrombosis [editorial; comment] [see comments]. Thromb.Haemost. 65(3):221-222, 1991. Keywords : 951217; NONINVASIVE; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; computers; HUMAN; Plethysmography,Impedance; mt; predictive value of tests; Reproducibility of Results; THROMBOPHLEBITIS; di; Medline File Notes : [No Abstract Available]. Ref ID : HIRSH1992 562. Hirsh, J. Relationship between dose, anticoagulant effect and the clinical efficacy and safety of heparin. Adv.Exp.Med.Biol. 313:283-295, 1992. Keywords : LMWH; Low-Molecular-Weight-Heparin; ANTICOAGULANT; Safety; HEPARIN; 951217; BLOOD COAGULATION; de; CORONARY DISEASE; dt; Dose- Response Relationship,Drug; Half-Life; HEMORRHAGE; ci; ad; ae; pk; HUMAN; RISK FACTORS; THROMBOSIS; pc; Medline File; Hospitals; ontario Notes : [No Abstract Available] Hamilton Civic Hospitals Research Centre Ontario. Ref ID : HIRSH1992A 563. Hirsh, J. Antithrombotic therapy in deep vein thrombosis and pulmonary embolism. Am.Heart J. 123:1115-1122, 1992. Keywords : LMWH; Low-Molecular-Weight-Heparin; Antithrombotic; THERAPY; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; ANTICOAGULANTS; TREATMENT; VENOUS; THROMBOEMBOLISM; ANTICOAGULANT; HEPARIN; RISK; RECURRENCE; Safety; INTRAVENOUS; Injections; BLEEDING; SUBCUTANEOUS; THROMBOPLASTIN; partial thromboplastin time; RECOMMENDATIONS; MANAGEMENT; in; an; is Notes : After 50 years of clinical use anticoagulants are still the mainstay of treatment for venous thromboembolism. Several studies have demonstrated that failure to attain or to maintain an adequate anticoagulant effect with heparin after venous thromboembolism is associated with an increased risk of recurrence. The safety and effectiveness of heparin administered by continuous intravenous infusion has been compared with administration by intermittent intravenous injection; three studies reported less bleeding with the former. The relative efficacy and safety of continuous intravenous and intermittent subcutaneous heparin appear to be comparable. The readily available and relatively inexpensive activated partial thromboplastin time test is used most commonly to monitor heparin therapy. Recent audits indicate that current practices in the administration of heparin are often suboptimal because of an inadequate starting dose, a delay in obtaining or responding to activated partial thromboplastin time test results, or inappropriate adjustments of heparin doses. Attempts have recently been made to improve practices in the administration of heparin by developing a standardization protocol. Recommendations for patient management are discussed. Ref ID : HIRSH1992B 564. Hirsh, J. Subcutaneous compared with intravenous heparin for deep vein thrombosis [letter]. Ann.Intern.Med. 117(3):266, 1992. Keywords : LMWH; Low-Molecular-Weight-Heparin; SUBCUTANEOUS; INTRAVENOUS; intravenous heparin; HEPARIN; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; 951217; ad; HUMAN; THROMBOPHLEBITIS; dt; Medline File Ref ID : HIRSH1992D 565. Hirsh, J., Dalen, J.E., Fuster, V., Harker, L.B., and Salzman, E.W. Aspirin and other platelet-active drugs. The relationship between dose, effectiveness, and side effects. Chest 102(4 Suppl):327S-336S, 1992. Keywords : ASPIRIN; drugs; SIDE EFFECTS; 951217; ANTICOAGULANTS; tu; ad; ae; pd; Cerebrovascular Disorders; ci; pc; DIPYRIDAMOLE; Dose-Response Relationship,Drug; Drug Synergism; Drug Therapy,Combination; HUMAN; MYOCARDIAL INFARCTION; THROMBOSIS; ticlopidine; Medline File Ref ID : HIRSH1992F 566. Hirsh, J. and Levine, M.N. Low molecular weight heparin. Blood 79(1):1-17, 1992. Keywords : 951217; Low molecular weight heparin; Molecular Weight; HEPARIN; ANIMAL; BLOOD COAGULATION; de; HEMORRHAGE; ci; heparin,low- molecular-weight; ae; bl; pd; pk; tu; HUMAN; protein binding; THROMBOSIS; dt; pc; Medline File; Hospitals; ontario; CANADA Notes : [No Abstract Available] HCH Research Centre Henderson Hospital Ontario Canada. Ref ID : HIRSH1993 567. Hirsh, J. Low molecular weight heparin. Thromb.Haemost. 70(1):204- 207, 1993. Keywords : 951217; Low molecular weight heparin; Molecular Weight; HEPARIN; COMPARATIVE STUDY; disease models,animal; ae; ch; pd; heparin,low-molecular-weight; HUMAN; THROMBOSIS; dt; Medline File; ontario; CANADA Notes : [No Abstract Available] McMaster University Hamilton Ontario Canada. Ref ID : HIRSH1994B 568. Hirsh, J. and Fuster, V. Guide to anticoagulant therapy. Part 1: Heparin. American Heart Association. Circulation 89(3):1449-1468, 1994. Keywords : ANTICOAGULANT; THERAPY; HEPARIN; 951217; american heart association; heart; CORONARY DISEASE; dt; FEMALE; tu; heparin,low- molecular-weight; HUMAN; MALE; PREGNANCY; THROMBOEMBOLISM; Medline File; Health Planning & Administration File Notes : [No Abstract Available] Office of Scientific Affairs American Heart Association Dallas TX 75231-4596. Ref ID : HIRSH1994C 569. Hirsh, J. Low-molecular-weight heparin vs. warfarin for prophylaxis against deep-vein thrombosis [letter; comment]. N.Engl.J.Med. 330(12):862-863, 1994. Keywords : Low-molecular-weight heparin; HEPARIN; WARFARIN; PROPHYLAXIS; DEEP VEIN THROMBOSIS; THROMBOSIS; 951217; Drug Administration Schedule; ad; tu; heparin,low-molecular-weight; HUMAN; THROMBOPHLEBITIS; pc; Medline File Notes : [No Abstract Available]. Ref ID : HIRSH1994D 570. Hirsh, J. and Fuster, V. Guide to anticoagulant therapy. Part 2: Oral anticoagulants. American Heart Association [published erratum appears in Circulation 1995 Jan 15;91(2):A55-A56]. Circulation 89(3):1469-1480, 1994. Keywords : 951217; ANTICOAGULANT; THERAPY; ANTICOAGULANTS; heart; in; Administration,Oral; american heart association; tu; Atrial fibrillation; co; Cerebrovascular Disorders; pc; drug interactions; FEMALE; heart valve diseases; HUMAN; MALE; MYOCARDIAL INFARCTION; dt; PREGNANCY; THROMBOEMBOLISM; WARFARIN; Medline File; Health Planning & Administration File Notes : [No Abstract Available] Office of Scientific Affairs American Heart Association Dallas TX 75231-4596. Ref ID : HIRSH1995 571. Hirsh, J. Optimal intensity and monitoring warfarin. Am.J.Cardiol. 75:39B-42B, 1995. Keywords : LMWH; Low-Molecular-Weight-Heparin; MONITORING; WARFARIN; RISK; BLEEDING; PROTHROMBIN; THROMBOPLASTIN; DOSAGE; MEDICATIONS; Vitamins; Vitamin K; ANTICOAGULANT; HEPARIN; TREATMENT; PT; PATHOLOGIC; PREGNANCY; Nursing; International normalized ratio; INR; prothrombin time; laboratories; is; in; an Notes : The risk of bleeding with warfarin can be markedly reduced without affecting efficacy by using a low-intensity therapeutic range. The reliability of warfarin monitoring has also improved with the development of the international normalized ratio (INR) to standardize prothrombin time despite use of nonuniform thromboplastins by different laboratories. There are 2 recommended therapeutic ranges of intensity for warfarin: the less intense corresponds to INR 2.0-3.0, the more intense, to INR 2.5-3.5. Dosage response to warfarin is influenced by concomitant medication, dietary vitamin K, hepatic dysfunction, and hypermetabolic states. For rapid anticoagulant effect, the initial dosage is 10 mg/day (plus heparin). For nonemergent treatment, the initial dosage is 4-5 mg/day, which achieves a steady-state anticoagulant effect in 5-7 days; this is also the anticipated maintenance dosage. Prothrombin time (PT) monitoring is performed daily until the therapeutic range is achieved, then progressively less often, depending on stability of PT results. Bleeding while on warfarin (INR > 3.0) may respond to reduced dosage; for severe bleeding, vitamin K reverses warfarin effects in 6-12 hours. Bleeding on low-intensity warfarin (INR < 3.0) suggests an underlying pathologic condition. Warfarin is contraindicated in pregnancy because of its teratogenicity but may be used by nursing mothers, as it does not pass into breast milk. Ref ID : HIRSH1995A 572. Hirsh, J. Thrombosis. Am.J.Cardiol. 75(6):3B-4B, 1995. Keywords : LMWH; Low-Molecular-Weight-Heparin; THROMBOSIS; 951217; Arteriosclerosis; dt; et; FIBRINOLYTIC AGENTS; tu; HUMAN; co; Medline File; Hospitals; ontario; CANADA Ref ID : HIRSH1995B 573. Hirsh, J. Deep vein thrombosis: recovery or recurrence? Hosp.Pract.(Off.Ed). 30(3):71-4, 76, 79; quiz 93-4, 1995. Keywords : DEEP VEIN THROMBOSIS; vein; THROMBOSIS; RECURRENCE; DVT; POSTPHLEBITIC; POSTPHLEBITIC SYNDROME; Syndrome; NONINVASIVE; ANTICOAGULATION; THERAPY; HEPARIN; WARFARIN; 951217; is; in; BANDAGES; CASE REPORT; Drug Therapy,Combination; ad; HUMAN; MALE; MIDDLE AGE; Popliteal Vein; Postoperative Complications; di; dt; RISK FACTORS; TIME FACTORS; Medline File; Hospitals Notes : As many as two thirds of patients with new symptoms after documented DVT have postphlebitic syndrome, not DVT. Noninvasive imaging is central to the differentiation so that unnecessary anticoagulation therapy can be avoided. Recent changes in heparin and warfarin protocols for DVT are also outlined As many as two thirds of patients with new symptoms after documented DVT have postphlebitic syndrome, not DVT. Noninvasive imaging is central to the differentiation so that unnecessary anticoagulation therapy can be avoided. Recent changes in heparin and warfarin protocols for DVT are also outlined Hamilton Civic Hospitals Research Centre Ont. Ref ID : HIRSH1995C 574. Hirsh, J. The optimal duration of anticoagulant therapy for venous thrombosis [editorial; comment]. N.Engl.J.Med. 332(25):1710-1711, 1995. Keywords : 951217; DURATION; ANTICOAGULANT; THERAPY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Administration,Oral; ANTICOAGULANTS; ad; tu; Drug Administration Schedule; HUMAN; PULMONARY EMBOLISM; dt; RISK FACTORS; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; et; Medline File Notes : [No Abstract Available]. Ref ID : HJORTH1995 575. Hjorth, L., Jensen, H.S., Noer, H., Rasmussen, K.S., Sorensen, I.M., and Srensen, I.M. [Survey of clinical diagnoses and autopsy findings. Autopsy findings and sensitivity, specificity and predictive values for clinical diagnosis during the periods 1 July 1980-30 June 1081 and 1 July 1990- 30 June 1993]. Ugeskr.Laeger 157:3055-3058, 1995. Keywords : 951202; AUTOPSY; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; CLINICAL DIAGNOSIS; DIAGNOSIS; analysis; in; PULMONARY EMBOLISM; EMBOLISM; MALIGNANCY; heart; heart diseases; is; diagnostics; an; sn; st; cause of death; COMPARATIVE STUDY; coronary arteriosclerosis; mo; PA; denmark; ep; English Abstract; FEMALE; HUMAN; MALE; Neoplasms; PNEUMONIA; PROGNOSIS; Medline File; Cancerlit File Notes : The sensitivity, specificity and clinical accuracy of clinical diagnoses were determined and compared for two periods of time: 1.7.1980-30.6.1981 and 1.7.1990-30.6.1993 based on the analysis of 286 and 138 autopsies respectively. The autopsy rate decreased from 82.7% in the first period to 11.2% in the second. The first period shows a generally higher sensitivity and accuracy for positive diagnosis. Both periods reveal the lowest sensitivity for pulmonary embolism and the lowest accuracy for positive clinical diagnosis of pneumonia/bronchopneumonia. For malignancies and arteriosclerotic heart diseases significant discrepancy between the periods was demonstrated using the chi 2-test. The results are influenced by low autopsy rates causing fewer true-positive diagnoses and a declining sensitivity. This type of study is a useful tool for demonstrating changes in the diagnostic procedure. The present investigation demonstrates a need for further analysis of malignancies to explain the simultaneous decrease in sensitivity, specificity and accuracy in spite of an increasing number of malignancies in autopsy findings Patologisk Anatomisk Institut Hjorring Sygehus. Ref ID : HOBBS1977 576. Hobbs, J.T. A random trial of the treatment of varicose veins by surgery and sclerotherapy. In: The treatment of venous thrombosis, edited by Hobbs, J.T.Philadelphia:JB Lippincott Co. 1977, Keywords : TREATMENT; varicose; VARICOSE VEINS; VEINS; SURGERY; SCLEROTHERAPY; NASP; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; vein; bib-2 Ref ID : HOGBERG1986 577. Hogberg, U. Maternal deaths in Sweden, 1971 - 1980. Acta.Obstet.Gynecol.Scand. 65:161-167, 1986. Keywords : MATERNAL; DEATH; THROMBOPHLEBITIS; PULMONARY EMBOLISM; EMBOLISM; PREGNANCY; POSTPARTUM; CAUSE; INCIDENCE; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; in; Sweden; Superficial thrombophlebitis; is Notes : Deep and superficial thrombophlebitis and pulmonary embolism are of concern in pregnancy and in the postpartum period. Pulmonary embolism is the most common nontraumatic cause of maternal death in pregnancy, and the incidence is even higher in the postpartum period. In Sweden there were 53 peripartum maternal deaths between 1971 and 1980, and 10 of these were due to pulmonary thromboembolism. Ref ID : HOHLBAUM1970 578. Hohlbaum, G.G. [Postthrombotic syndrome in accident expert testimony]. Monatsschr.Unfallheilkd.Versicher.Versorg.Verkehrsmed. 73:377-384, 1970. Keywords : Syndrome; ACCIDENTS; NASP; Edema; Expert Testimony; Germany,West; HUMAN; Insurance,Accident; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Das postthrombotische Syndrom in der Unfallbegutachtung AB -[No Abstract Available] UI - 71285577. Ref ID : HOHLBAUM1990 579. Hohlbaum, G.G. [Iatrogenic damage in sclerotherapy of varicose veins]. Z.Lymphol. 14:32-35, 1990. Keywords : SCLEROTHERAPY; NASP; Endothelium,Vascular; HUMAN; RISK FACTORS; Sclerosing Solutions; THROMBOPHLEBITIS; VARICOSE VEINS; Medline File; in; varicose; ab; ad Notes : TT - Uber iatrogene Schaden bei der Varizensklerosierung AB -[No Abstract Available] AD - Arzt fur Chirurgie AD - Essen UI -91049872. Ref ID : HOLMSTROM1990 580. Holmstrom, M., Bratt, G., Tornebohm, E., Rhedin, A.S., and Lockner, D. Fatal pulmonary embolism caused by streptokinase treatment of deep venous thrombosis of the leg? J.Intern.Med. 228:647-649, 1990. Keywords : PHLEBITIS; FATAL; PULMONARY EMBOLISM; EMBOLISM; STREPTOKINASE; TREATMENT; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LEG; ADULT; AGED; CASE REPORT; FEMALE; HUMAN; blood supply; MALE; ETIOLOGY; Retrospective Studies; adverse effects; therapeutic use; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; drug therapy; DVT; Died; PE; HEPARIN; MORTALITY; FREQUENCY; in Notes : During the last 10 years, four of 150 (2.7%) patients with deep venous thrombosis (DVT) treated with streptokinase (SK) at our department have died of pulmonary embolism (PE). A retrospective study of 1393 DVT patients treated with heparin during the period 1973-1986 showed that five (0.36%) of these patients died of PE while still on heparin. In this paper we describe the four patients treated with SK who developed fatal PE. In our opinion this increase in mortality does not warrant the use of SK in routine treatment of DVT of the leg before a proper trial has been conducted to compare the frequencies of pulmonary embolism after both treatments. Ref ID : HOPKINS1992 581. Hopkins, N.F. and Wolfe, J.H. ABC of vascular diseases. Deep venous insufficiency and occlusion. Brit.Med.J. 304:107-110, 1992. Keywords : Vascular Diseases; VENOUS; Venous Insufficiency; OCCLUSION; NASP; thrombophlebitis - diagnosis; venous insufficiency - diagnosis; blood pressure - physiology; HUMAN; Plethysmography; thrombophlebitis - therapy; venous insufficiency - therapy Ref ID : HORAKOVANEDVIDK1991 582. Horakova-Nedvidkova, M. [Sclerotization as a proven method of treatment for varices]. Vnitr.Lek. 37:178-185, 1991. Keywords : Methods; TREATMENT; TECHNIQUES; COMPLICATIONS; VARICOSITIES; SCLEROTHERAPY; INCIDENCE; SURGICAL; SURGICAL OPERATIONS; PERFORATING VEINS; VEINS; DIAGNOSIS; EMBOLISM; LUNG; ANAPHYLACTIC; SHOCK; AMBULATORY; NASP; English Abstract; HUMAN; VARICOSE VEINS; Medline File; ab; is; in; ad Notes : TT - Sklerotizace jako proverena metoda lecby varix~u AB - The author evaluates the importance, technique, mechanism of action, complications and relapses of varicosities treated by sclerotherapy. With improving technique complications are diminishing. Their incidence is minimal and not higher than after surgical operations. In the investigated group of 2250 treated patients within ten years 80.7% major varicosities and 40.5% perforating veins relapsed. The incidence of relapses, in particular of perforating veins depends on the accurate diagnosis. From a group of 7500 patients who attended our out-patient department the most serious complications were two cases of embolism of the lungs and one anaphylactic shock. There was a total of 0.37% serious complications. With regard to all aspects, the author reached the conclusion that sclerotization performed lege artis can be extended in ambulatory practices. However, it is better to operate varicosities with a large lumen and sclerotize their branches. The very small varicosities are influenced by sclerotization very slowly AD - Kozni oddeleni 2 LF UK v Praze-Motole UI - 91213469. Ref ID : HOUGARDY1995 583. Hougardy, N., Machiels, J.P., and Ravoet, C. Heparin-induced thrombocytopenia [letter]. N.Engl.J.Med. 333(15):1007, 1995. Keywords : 96-suzy-001; THROMBOCYTOPENIA; HEPARIN; adverse effects; heparin,low-molecular-weight; therapeutic use; HUMAN; chemically induced; THROMBOSIS Ref ID : HOYT1993 584. Hoyt, D.B., Simons, R.K., Winchell, R.J., Cushman, J., Hollingsworth-Fridlund, P., Holbrook, T., and Fortlage, D. A risk analysis of pulmonary complications following major trauma. J.Trauma. 35:524-531, 1993. Keywords : EMBOLISM; TRAUMA; RISK; COMPLICATIONS; INCIDENCE; PROSPECTIVE; REVIEW; regression analysis; PNEUMONIA; AGE; SHOCK; INJURY; SURGERY; CHEST; BLUNT; RESPIRATORY FAILURE; RISK FACTORS; ARDS; PULMONARY EMBOLISM; Extremities; Pelvis; analysis; odds ratio; in; is; injuries Notes : Varying institutional definitions and degrees of surveillance limit awareness of the true incidence of posttraumatic pulmonary complications. Prospective review with standardized definitions of 25 categories of pulmonary complications was applied to a university level I trauma service over 3 years to establish the true incidence. Potential injury-related predictors of individual complications were determined using multiple logistic regression analysis and adjusted odds ratios were calculated, thereby controlling for the effect of other covariants. Significance was attributed to p < 0.05. Of 3289 patients meeting MTOS criteria, pulmonary complications occurred in 368 (11.2%). Pulmonary complications account for one third of all disease complications. Significant associations with pneumonia included age, the presence of shock on admission, significant head injury, and surgery to the head and chest. Significant risk for atelectasis occurred in patients with blunt injury mechanism, ISS > 16, shock on admission, and severe head injury. Risks for development of respiratory failure included age > 55 years, the mechanism of "pedestrian struck", and the presence of significant head injury. Risk factors for ARDS included surgery to the head and a Trauma Score < 13 on arrival. Significant predictors for pulmonary embolism included ISS > 16, shock on admission, and extremity and pelvis injuries. The true incidence of pulmonary complications is established with this kind of analysis and focuses attention on (1) groups at high risk for developing complications, (2) groups for which current therapeutic modalities are still ineffective, and (3) defining the need to refocus on prospective research rather than ineffective processes of care. Ref ID : HRYNIUK1972 585. Hryniuk, S. Lymph vessel changes in legs with varicose ulcer. Pol.Med.J. 11:1264-1270, 1972. Keywords : LEG; Varicose Ulcer; Ulcer; NASP; ADULT; AGED; ANGIOGRAPHY; Collateral Circulation; Fistula; HUMAN; Lymphatic Diseases; Lymphatic System; Lymphography; MIDDLE AGE; PHLEBOGRAPHY; THROMBOPHLEBITIS; Vascular Diseases; VEINS; Medline File; in; varicose; ab Notes : AB - [No Abstract Available] UI - 73085350. Ref ID : HUBER1992 586. Huber, O. Postoperative Pulmonary Embolism After Hospital Discharge: An Underestimated Risk. Arch Surg 127:310-313, 1992. Keywords : 96-suzy-002; POSTOPERATIVE; PULMONARY EMBOLISM; EMBOLISM; Hospitals; an; RISK; SURGERY; Switzerland; PE; in; confidence intervals; INCIDENCE Notes : 01-05-96. Abstract : During a 10-year period (1980 through 1989), 28 953 patients were admitted to our Clinic of Digesstive Surgery, Geneva, Switzerland. Two third of them were operated on, and one third were treated conservatively. Symptomatic pulmonary embolism (PE) was reported in 90 patients (0.31%; 95% confidence interval, 0.25% to 0.38%) during their hospital stay. Within 30 days of hospital discharge, 29 pattients were reported admitted because of PE (incidence of delayed PE, 0.10%; 95% confidence interval, 0.07% to 0.14%; total incidence of PE, 0.41%; 95% confidence interval, 0.34% to 0.49%). In the operated-on-group, the delayed embolic events occured a median of 6 days (range, 2 to 25 days) after dischargeand 18 days (range,6 to 35 days) after surgery. Thus, the rate of postoprative PE increased by 30% when PEs occurring within 30 days of hospital discharge were considered, and this provides a useful basis for prolonged prophylactic measure after hospital stay. Ref ID : HUISMAN1986 587. Huisman, M.V., Buller, H.R., Ten Cate, J.W., and Vreeken, J. Plethysmography for Deep Venous Thrombosis -Huisman et Al. Serial Impedance Plethysmography for Suspected Deep Venous Thrombosis in Outpatients The Amsterdam General Practitioner Study. The New England Journal of Medicine 314(13):823-828, 1986. Keywords : 96-suzy-002; Plethysmography; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; et; IMPEDANCE PLETHYSMOGRAPHY; in; OUTPATIENT; DIAGNOSIS; is; CONTRAST; VENOGRAPHY; NONINVASIVE; ANTICOAGULANTS; FOLLOWUP; Died; EMBOLISM; diagnostics; TECHNIQUES Notes : 01-03-96. Abstract : Diagnosis of deep venous thrombosis by clinical and symptoms is unreliable, but contrast venography is relatively expensive and invasive. We therefore evaluated the use of impedance plethysmography as a noninvasive alternative in 426 consecutive outpatients with clinically suspected acute deep venous thrombosis. Four sequential impedance plethysmography were obtained on days 1, 2, 5, and 10 of the study. In 289 patients (68 percent), the results of all four studies were normal, and these patients were not treated with anticoagulants. One of these patients may have had a minor pulmonary embolus during the 10-day study period. During a six- month follow-up of all patients, none of the 289 patients whose plethysmograms were normal died of venous thromboebolism or presented with suspected pulmonary embolism. In 137 patients (32 percent), the impedance plethysmograms were abnormal; 117 (85 percent) had the abnormal results on their first test, and 20 (15 percent) had them on subsequent tests. All patients with abnormal plethysmograms also underwent contrast venography, which confirmed the diagnosis of deep venous thrombosis in 92 percent. We conclude that the diagnostic accuracy of repected impedance plethysmography compares favorably with that of venography and that the technique is a safe and effective noninvasive approach to the diagnosis and care of outpatients with clinically suspected acute deep venous thrombosis. (N Engl J Med 1986; 314:823-8.). Ref ID : HUISMAN1989 588. Huisman, M.V., Buller, H.R., Ten Cate, J.W., van Royen, E.A., Vreeken, J., Kersten, M.J., and Bakx, B. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 95:498-502, 1989. Keywords : PREVALENCE; PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DEEP VEIN THROMBOSIS; VEINS; OUTPATIENT; PERFUSION; VENTILATION; LUNG; SCAN; TREATMENT; SCANNING; ANTICOAGULANT; ASYMPTOMATIC; DEEP VENOUS THROMBOSIS; EMBOLI; RESOLUTION; THROMBOPHLEBITIS; ADULT; AGED; AGED 80 AND OVER; FEMALE; HEPARIN; HUMAN; MALE; MIDDLE AGE; PLETHYSMOGRAPHY IMPEDANCE; PROBABILITY; SUPPORT NON U S GOVT; Unexpected; in; vein; is Notes : AB-In patients presenting with clinically suspected deep vein thrombosis, symptomatic pulmonary embolism is rarely apparent. To assess the prevalence of silent pulmonary embolism in outpatients with proven deep vein thrombosis but without symptoms of pulmonary embolism, perfusion ventilation lung scans were performed in 101 consecutive patients at presentation. Fifty-one percent of these patients had a high probability lung scan at the initiation of treatment. In comparison, in patients referred with suspected venous thrombosis, but who on subsequent objective testing did not have venous thrombosis (n = 44), the prevalence of a high probability-scan for pulmonary embolus was only 5 percent. At repeat lung scanning, performed after one week of anticoagulant treatment, complete to partial improvement was observed in 68 percent of the patients with initially abnormal scans. Lung-scan detected asymptomatic pulmonary embolism occurs frequently in patients presenting with symptomatic deep venous thrombosis, and the majority of these emboli showed significant to complete resolution within one week of anticoagulant treatment. Ref ID : HULL1979 589. Hull, R.D. and Delmore, T. Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N.Engl.J.Med. 301:855, 1979. Keywords : WARFARIN; HEPARIN; LONG TERM; TREATMENT; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MONITORING; ANTICOAGULATION; SUBCUTANEOUS; APTT; THERAPY; PROPHYLAXIS; RECURRENCE; VEINS; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; COUMADIN; PULMONARY EMBOLISM; Sodium; in; is; DEEP VEIN THROMBOSIS; vein; hi Notes : Heparin assays may be follwed in lieu of monitoring the PTT; anticoagulation is achieved with serum heparin levels of 0.3 to 0.5 Units/ml. Low-dose subcutaneous heparin does not adequately prolong the APTT, and is not acceptable as primary therapy nor as subsequent prophylaxis against recurrence for patients following deep vein thrombosis or pulmonary thromboembolism. Hull found that 47 percent of patients maintained on subcutaneous heparin will suffer recurrent deep vein thrombosis, while no patient on a full anticoagulating dose of coumadin suffered recurrence during his study period. Ref ID : HULL1981 590. Hull, R.D., Hirsh, J., Sackett, D.L., Taylor, D.W., Carter, C., Turpie, A.G., Powers, P., and Gent, M. Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis. Circulation 64:622-625, 1981. Keywords : VALIDITY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; VENOGRAPHY; Venogram; in Notes : Up to 4 percent of patients develop thrombosis after venography. Ref ID : HULL1982 591. Hull, R.D., Hirsh, J., Jay, R., Carter, C.J., England, C., and Gent, M. Different intensities of oral anticoagulant therapy in the treatment of proximal vein thrombosis. N.Engl.J.Med. 307:1676-1681, 1982. Keywords : ANTICOAGULANT; THERAPY; TREATMENT; VEINS; THROMBOSIS; WARFARIN; COUMADIN; DEEP VEIN THROMBOSIS; in; vein Ref ID : HULL1983 592. Hull, R.D., Hirsh, J., Carter, C.J., Jay, R.M., Dodd, P.E., Ockleford, P.A., Coates, G., Gill, G.J., Turpie, A.G., Doyle, D.J., Buller, H.R., and Raskob, G.E. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann.Intern.Med. 98:891-899, 1983. Keywords : PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; LUNG; VENOGRAPHY; EMBOLISM; SCAN; PULMONARY EMBOLISM; VENTILATION; PERFUSION; SCANNING; V/Q Ref ID : HULL1985 593. Hull, R.D., Hirsh, J., and Carter, C.J. Diagnostic value of ventilation perfusion lung scanning in patients with suspected pulmonary embolism. Chest 88:819, 1985. Keywords : VENTILATION; PERFUSION; LUNG; SCANNING; EMBOLISM; PULMONARY EMBOLISM; diagnostics; in Ref ID : HULL1985A 594. Hull, R.D., Hirsh, J., Carter, C.J., Jay, R.M., Ockelford, P.A., Buller, H.R., Turpie, A.G., Powers, P., Kinch, D., Dodd, P.E., Gill, G.J., Leclerc, J.R., and Gent, M. Diagnostic Efficacy of Impedance Plethysmography for Clinically Suspected Deep Vein Thrombosis. Annals of Internal Medicine 102(1):21-28, 1985. Keywords : 96-suzy-002; diagnostics; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; vein; THROMBOSIS; is; an; NONINVASIVE; Methods; THROMBI; LEG; SCANNING; VENOGRAPHY; LONG TERM; OUTCOME; DEEP VEIN THROMBOSIS; in; FOLLOWUP; Died; PULMONARY EMBOLISM; EMBOLISM; CALF Notes : 01-02-96. Abstract : Impedance plethysmography is an accurate noninvasive method to test for proximal vein thrombosis, but it is insensitive to calf-vein thrombi. we randomly assigned patients on referral with clinically suspected deep-vein thrombosis and normal impedance plethysmographic findings to either serial impedance plethysmography alone or combined impedance plethysmography and leg scanning (which has been shown to be essentially as sensitive as venography) and compared the long-term outcomes. During the initial surveillance, deep-vein thrombosis was detected in 6 of 311 patients (1.9%) tested by serial impedance plethysmography alone and in 30 of 323 patients (9.3%) (most with calf- vein thrombi) tested by the combined approach (p < 0.001). During long- term follow-up, no patient died from pulmonary embolism; but 6 patients (1.9%; 95% confidence limits,0.7% to 4.2%) tested by serial impedance plethysmography developed deep-vein thrombosis compared with 7 patients (2.2%; 95% confidence limits, 0.9% to 4.4%) tested by the combined approach. Serial impedance plethysmography used alone is an effective strategy to evaluate such symptomatic patients. Ref ID : HULL1986 595. Hull, R.D., Raskob, G.E., and Hirsh, J. Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis. N.Engl.J.Med. 315:1109-1114, 1986. Keywords : HEPARIN; TREATMENT; THROMBOSIS; INCIDENCE; EARLY; RECURRENCE; DVT; PE; APTT; PULMONARY EMBOLISM; INTRAVENOUS; SUBCUTANEOUS; Progression; intravenous heparin; in; is Notes : High incidence of early progression or recurrence of DVT & PE if a therapeutic APTT is not achieved within 48 hours. Ref ID : HULL1988 596. Hull, R.D., Raskob, G.E., Carter, C.J., Coates, G., Gill, G.J., Sackett, D.L., Hirsh, J., and Thompson, M. Pulmonary embolism in outpatients with pleuritic chest pain. Arch.Intern.Med. 148(4):838-844, 1988. Keywords : PULMONARY EMBOLISM; EMBOLISM; OUTPATIENT; PLEURITIC; CHEST; CHEST PAIN; PAIN; in; 96-suzy-001; is; EMERGENCY; PROSPECTIVE; PROSPECTIVE STUDIES; diagnostics; OUTCOME; ANGIOGRAPHY; AUTOPSY; SENSITIVITY; SPECIFICITY; TREATMENT; sensitivity and specificity; PULMONARY ANGIOGRAPHY; LUNG; SCANNING; VENTILATION; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; PERFUSION; ADULT; AGED; Aged,80 and over; Ambulatory Care; Diagnosis,Differential; FEMALE; HUMAN; MALE; MIDDLE AGE; Plethysmography,Impedance; pleurisy; ETIOLOGY; PULMONARY ARTERY; radiography; radionuclide imaging; COMPLICATIONS; DIAGNOSIS; RADIONUCLIDE; Support,Non-U.S.Gov't; ventilation-perfusion ratio Notes : Pleuritic chest pain is a frequent complaint in patients coming to the emergency room, but the proportion of such patients with pulmonary embolism is uncertain. In a prospective study, we evaluated the diagnostic outcomes in 173 consecutive patients who came to the emergency room with pleuritic chest pain. Pulmonary embolism, as demonstrated by angiography or autopsy, was present in 36 (21%). The need for objective testing is clearly indicated by our finding that the sensitivity (85%) and specificity (37%) of predetermined clinical variables for pulmonary embolism were insufficient to allow a definitive treatment decision. Optimal sensitivity and specificity are obtained by using pulmonary angiography in combination with lung scanning. The proportion of patients requiring angiography is substantially reduced, from 43% to 26%, without significant loss of accuracy, if ventilation imaging and impedance plethysmography are used together with perfusion scanning. Ref ID : HULL1990 597. Hull, R.D., Raskob, G.E., and Carter, C.J. Serial impedance plethysmography in pregnant patients with clinically suspected deep-vein thrombosis. Clinical validity of negative findings. Ann.Intern.Med. 112:663-667, 1990. Keywords : PHLEBITIS; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; PREGNANT; THROMBOSIS; VALIDITY; Adolescence; ADULT; FEMALE; Follow-Up Studies; HUMAN; LEG; blood supply; PHLEBOGRAPHY; Plethysmography,Impedance; Methods; PREGNANCY; Pregnancy Complications,Cardiovascular; PROSPECTIVE STUDIES; Support,Non- U.S.Gov't; THROMBOPHLEBITIS; DIAGNOSIS; radiography; TIME FACTORS; Safety; ANTICOAGULANT; THERAPY; PROSPECTIVE; PROGNOSIS; LONG TERM; FOLLOWUP; POSTPARTUM; Hospitals; DEEP VEIN THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; OUTCOME; VENOGRAPHY; NONINVASIVE; vein; in; ci; confidence intervals Notes : STUDY OBJECTIVE: To determine the safety of withholding anticoagulant therapy in pregnant patients with clinically suspected deep-vein thrombosis who have negative results by serial impedance plethysmography. DESIGN: Prospective study evaluating prognosis by long- term follow-up to 3 months postpartum in all patients. SETTING: University-affiliated community hospital and referral center. PATIENTS: One hundred fifty-two consecutive pregnant patients referred with clinically suspected deep-vein thrombosis. All patients completed the study. INTERVENTIONS: Anticoagulant therapy was withheld in 139 patients negative by serial impedance plethysmography, and the patients were followed long term. MEASUREMENTS AND MAIN RESULTS: None of 139 patients (0%; 95% CI, 0% to 2.6%) had symptomatic pulmonary embolism or recurrent venous thrombosis. CONCLUSIONS: The findings establish the safety of withholding anticoagulant therapy in pregnant patients who have negative results after serial impedance plethysmography. Sufficient patients were entered to provide narrow confidence intervals on the outcomes observed in patients with negative findings by impedance plethysmography. These findings are similar to those seen after venography in symptomatic patients. These data extend the role of non-invasive testing in patients with clinically suspected deep-vein thrombosis to the pregnant symptomatic patient. Ref ID : HULL1990A 598. Hull, R.D., Raskob, G.E., Rosenbloom, D., Panju, A.A., Brill- Edwards, P., Ginsberg, J.S., Hirsh, J., Martin, G.J., and Green, D. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis [see comments]. N.Engl.J.Med. 322(18):1260- 1264, 1990. Keywords : HEPARIN; TREATMENT; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ANTICOAGULANT; DEEP VEIN THROMBOSIS; vein; INTRAVENOUS; WARFARIN; RANDOMIZED; intravenous heparin; Sodium; VENOGRAPHY; FREQUENCY; THROMBOEMBOLISM; BLEEDING; DEEP VENOUS THROMBOSIS; Hospitals; COST; 951217; in; is; ACUTE DISEASE; ADULT; AGED; COMPARATIVE STUDY; Double- Blind Method; Drug Administration Schedule; FEMALE; Follow-Up Studies; HEMORRHAGE; ci; ad; ae; tu; HUMAN; Injections,Intravenous; MALE; MIDDLE AGE; RANDOMIZED CONTROLLED TRIALS; RECURRENCE; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; dt; Medline File; internal medicine; CANADA Notes : It is common practice to begin anticoagulant treatment of deep- vein thrombosis with a 10-day course of intravenous heparin, with warfarin added on day 5 to 10 and continued for several months. We performed a randomized, double-blind trial comparing a shorter course of continuous intravenous heparin (5 days, with warfarin sodium begun on the first day) with the conventional 10-day course of heparin (with warfarin sodium begun on the fifth day) in the initial treatment of 199 patients with acute proximal venous thrombosis documented by venography. The frequency of objectively documented recurrent venous thromboembolism was low and essentially the same in the two groups (7.1 percent in the short-course group vs. 7.0 percent in the long-course group). Because the observed difference between the groups was 0.1 percent in favor of the long-course group, it is unlikely (P less than 0.05) that a true difference in favor of this group would be greater than 7.5 percent; the difference could be as much as 7.3 percent in favor of the short-course group. Major bleeding episodes were infrequent, and the rate was similar in both groups. We conclude that a five-day course of heparin is as effective as a 10-day course in treating deep venous thrombosis. Furthermore, using the shorter course would permit earlier discharge from the hospital and thus offer substantial cost savings It is common practice to begin anticoagulant treatment of deep-vein thrombosis with a 10-day course of intravenous heparin, with warfarin added on day 5 to 10 and continued for several months. We performed a randomized, double- blind trial comparing a shorter course of continuous intravenous heparin (5 days, with warfarin sodium begun on the first day) with the conventional 10-day course of heparin (with warfarin sodium begun on the fifth day) in the initial treatment of 199 patients with acute proximal venous thrombosis documented by venography. The frequency of objectively documented recurrent venous thromboembolism was low and essentially the same in the two groups (7.1 percent in the short-course group vs. 7.0 percent in the long- course group). Because the observed difference between the groups was 0.1 percent in favor of the long-course group, it is unlikely (P less than 0.05) that a true difference in favor of this group would be greater than 7.5 percent; the difference could be as much as 7.3 percent in favor of the short-course group. Major bleeding episodes were infrequent, and the rate was similar in both groups. We conclude that a five-day course of heparin is as effective as a 10-day course in treating deep venous thrombosis. Furthermore, using the shorter course would permit earlier discharge from the hospital and thus offer substantial cost savings Division of General Internal Medicine University of Calgary Alb Canada. Ref ID : HULL1990B 599. Hull, R.D., Raskob, G.E., Coates, G., and Panju, A.A. Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism [see comments]. Chest 97:23-26, 1990. Keywords : VALIDITY; PERFUSION; LUNG; SCAN; PULMONARY EMBOLISM; EMBOLISM; Safety; ANTICOAGULANT; THERAPY; DEEP VEIN THROMBOSIS; THROMBOSIS; VENOUS; THROMBOEMBOLISM; FREQUENCY; FOLLOWUP; SCANNING; DIAGNOSIS; CAUSE; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; in; an; is Notes : The objective of this study was to test the safety of withholding anticoagulant therapy in patients with clinically suspected pulmonary embolism who have normal perfusion lung scans, regardless of the clinical manifestations. Anticoagulant therapy was withheld or withdrawn in 515 consecutive patients except in patients in whom deep- vein thrombosis was detected. Only three of the 515 patients had symptomatic venous thromboembolism on follow-up. The frequency of symptomatic pulmonary embolism on follow-up was one of 515 patients. With knowledge of the normal findings by perfusion scanning, an alternative diagnosis was established in 367 of the 515 patients. Cause of symptoms remained uncertain in 148 patients. It is safe to withhold anticoagulant therapy in patients with suspected pulmonary embolism and normal perfusion scans, regardless of the clinical manifestations. The finding of a normal perfusion scan excludes the presence of clinically important pulmonary embolism and makes pulmonary angiography unnecessary. Ref ID : HULL1990C 600. Hull, R.D., Raskob, G.E., Gent, M., McLoughlin, D., Julian, D., Smith, F.C., Dale, N.I., Reed-Davis, R., Lofthouse, R.N., and Anderson, C. Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement [see comments]. JAMA 263:2313-2317, 1990. Keywords : LEG; COMPRESSION; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; HIP; HIP REPLACEMENT; RANDOMIZED; CALF; Thigh; VENOUS; VENOUS THROMBOSIS; PROPHYLAXIS; FIBRINOGEN; SCANNING; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; VENOGRAPHY; SENSITIVITY; FREQUENCY; CALF VEIN THROMBOSIS; EARLY; Early detection; TREATMENT; Pneumatic; in Notes : A randomized trial was performed in consecutive patients undergoing total hip replacement to evaluate the effectiveness of sequential intermittent calf and thigh compression for preventing venous thrombosis compared with a control group given no prophylaxis. Both groups underwent case finding for deep vein thrombosis using combined fibrinogen I 125 leg scanning, impedance plethysmography, and venography. Deep vein thrombosis by venography was present in 77 (49%) of 158 control patients compared with 36 (24%) of 152 patients given intermittent compression. Proximal vein thrombosis was present in 42 controls (27%) compared with 22 patients (14%) given intermittent compression. Combined impedance plethysmography and leg scanning was insensitive in this patient group (sensitivity, 46%); venography was required to detect more than half the patients with venous thrombosis. Sequential intermittent leg compression clinically and statistically significantly reduced the frequency of both proximal vein and calf vein thrombosis. Case finding resulted in early detection and treatment of patients with venous thrombosis. Ref ID : HULL1992 601. Hull, R.D., Raskob, G.E., Rosenbloom, D., Lemaire, J., Pineo, G.F., Baylis, B., Ginsberg, J.S., Panju, A.A., Brill-Edwards, P., and Brant, R. Optimal therapeutic level of heparin therapy in patients with venous thrombosis. Arch.Intern.Med. 152:1589-1595, 1992. Keywords : HEPARIN; THERAPY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Sodium; BLEEDING; PROSPECTIVE; CLINICAL TRIALS; THROMBOEMBOLISM; RISK; Safety; DOSAGE; THROMBOPLASTIN; APTT; WARFARIN; Methods; RANDOMIZED; THROMBOEMBOLIC; COMPLICATIONS; CONTRAST; in; is; an Notes : BACKGROUND. Audits of heparin sodium therapy suggest that heparin administration is fraught with difficulty. The literature indicates that the current clinical practice of intuitive ordering of heparin results in inadequate therapy because of fear of bleeding. The importance of exceeding the lower limit of the therapeutic range has been strongly supported by findings of prospective clinical trials. Firm evidence indicates that failure to exceed the lower limit is associated with unacceptably high rates of recurrent venous thromboembolism. By comparison, evidence supporting the risk of exceeding the upper limit of the therapeutic range is weak. OBJECTIVES. The purposes of this study were (1) to validate prospectively an approach designed to minimize the proportion of patients receiving subtherapeutic doses of heparin and (2) to determine the effectiveness and safety of decreasing the heparin dosage infused on the basis of activated partial thromboplastin time (APTT) prolongation reflecting both heparin and warfarin sodium effects. METHODS. We performed a randomized double-blind study evaluating a prescriptive approach to heparin administration in patients receiving heparin or heparin with warfarin. Thromboembolic and bleeding complications were objectively documented. RESULTS. Only 1% and 2% of patients had subtherapeutic heparin levels for 24 hours or more in the heparin and combined groups, respectively. Recurrent venous thromboembolism occurred infrequently in both groups (7%). Sixty-nine (69%) of 99 patients receiving combined therapy had supratherapeutic values, compared with 24 (24%) of 100 receiving heparin; bleeding complications occurred in 9% and 12%, respectively. CONCLUSIONS. Our findings demonstrate that no association exists between supratherapeutic APTT responses and bleeding, which is in direct contrast to the observed association between subtherapeutic APTT responses and recurrent venous thromboembolism. Ref ID : HULL1992A 602. Hull, R.D. Venous thromboembolism in spinal cord injury patients. Chest 102:658S-663S, 1992. Keywords : VENOUS; THROMBOEMBOLISM; Spinal cord; spinal cord injuries; INJURY; in Ref ID : HULL1992B 603. Hull, R.D., Raskob, G.E., Pineo, G.F., Green, D., Trowbridge, A.A., Elliott, C.G., Lerner, R.G., Hall, J., Sparling, T., and Brettell, H.R. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis [see comments]. N.Engl.J.Med. 326:975-982, 1992. Keywords : SUBCUTANEOUS; Low-molecular-weight heparin; HEPARIN; INTRAVENOUS; TREATMENT; THROMBOSIS; Half-Life; DEEP VEIN THROMBOSIS; Methods; CLINICAL TRIAL; intravenous heparin; OUTCOME; VENOUS; THROMBOEMBOLISM; BLEEDING; THERAPY; RISK; LONG TERM; HEMORRHAGIC; COMPLICATIONS; Molecular Weight; Died; OUTPATIENT; in; confidence intervals; is; an Notes : BACKGROUND. Low-molecular-weight heparin has a high bioavailability and a prolonged half-life in comparison with conventional unfractionated heparin. Limited data are available for low- molecular-weight heparin as compared with unfractionated heparin for the treatment of deep-vein thrombosis. METHODS. In a multicenter, double- blind clinical trial, we compared fixed-dose subcutaneous low-molecular- weight heparin given once daily with adjusted-dose intravenous heparin given by continuous infusion for the initial treatment of patients with proximal-vein thrombosis, using objective documentation of clinical outcomes. RESULTS. Six of 213 patients who received low-molecular-weight heparin (2.8 percent) and 15 of 219 patients who received intravenous heparin (6.9 percent) had new episodes of venous thromboembolism (P = 0.07; 95 percent confidence interval for the difference, 0.02 percent to 8.1 percent). Major bleeding associated with initial therapy occurred in 1 patient receiving low-molecular-weight heparin (0.5 percent) and in 11 patients receiving intravenous heparin (5.0 percent), a reduction in risk of 91 percent (P = 0.006). This apparent protection against major bleeding was lost during long-term therapy. Minor hemorrhagic complications were infrequent. Ten patients receiving low-molecular- weight heparin (4.7 percent) died, as compared with 21 patients receiving intravenous heparin (9.6 percent), a risk reduction of 51 percent (P = 0.049). CONCLUSIONS. Low-molecular-weight heparin is at least as effective and as safe as classic intravenous heparin therapy under the conditions of this study and more convenient to administer. The simplified therapy provided by low-molecular-weight heparin may allow patients with uncomplicated proximal deep-vein thrombosis to be cared for in an outpatient setting. Ref ID : HULL1993 604. Hull, R.D. and Pineo, G.F. Therapeutic use of low molecular weight heparins: the knowledge to date as applied to therapy. Semin.Thromb.Hemost. 19 Suppl 1:111-115, 1993. Keywords : Molecular Weight; HEPARIN; THERAPY; INTRAVENOUS; MONITORING; Hospitals; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; OUTPATIENT; CLINICAL TRIALS; sdi-11/93; LMWH; therapeutic use; intravenous heparin; in; is; an Notes : Indeed, the accumulating evidence indicates that certain LMWH administered subcutaneously may replace classic intravenous heparin therapy. Certain of these subcutaneously administered LMWH do not require monitoring. The simplified care offered by LMWH therapy presents the possibility of transferring care from in-hospital to out of hospital in uncomplicated patients with deep vein thrombosis. The advantages to the patient of avoidig in-hospital care and its associated hazards are obvious. Outpatient LMWH therapy will likely prove to be highly cost- effective. It is uncertain at present whether the findings associated with an individual LMWH preparation can be extrapolated to a different LMWH. For this reason, the findings of clinical trials apply only to the particular LMWH evaluated and cannot be generalized to the LMWH at large. Ref ID : HULL1993A 605. Hull, R., Raskob, G., Pineo, G., Rosenbloom, D., Evans, W., Mallory, T., Anquist, K., Smith, F., Hughes, G., and Green, D. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation [see comments]. N.Engl.J.Med. 329:1370-1376, 1993. Keywords : SUBCUTANEOUS; Low-molecular-weight heparin; HEPARIN; WARFARIN; Sodium; PROPHYLAXIS; DEEP VEIN THROMBOSIS; THROMBOSIS; HIP; KNEE; COMPLICATION; Safety; Methods; RANDOMIZED; VENOUS; VENOUS THROMBOSIS; TREATMENT; drugs; CONTRAST; VENOGRAPHY; SURGERY; Venogram; RISK; INCIDENCE; Molecular Weight; BLEEDING; Low-Molecular-Weight- Heparin; COMPLICATIONS; MONITORING; COST; ANTICOAGULATION; is; in; confidence intervals; an Notes : BACKGROUND. Deep-vein thrombosis is a potentially life- threatening complication of total hip or knee replacement. There are few data on the effectiveness and safety of warfarin as compared with low- molecular-weight heparin as prophylaxis against this problem. METHODS. We therefore performed a randomized, double-blind trial in 1436 patients to evaluate the effectiveness and safety of low-molecular-weight heparin (given subcutaneously once daily) as compared with adjusted-dose warfarin to prevent venous thrombosis after hip or knee replacement. Treatment with the drugs was started postoperatively. The primary end point was deep-vein thrombosis as detected by contrast venography (performed a mean of 9.4 days after surgery in each group). RESULTS. Among the 1207 patients with interpretable venograms, 231 of 617 patients (37.4 percent) in the warfarin group and 185 of 590 patients (31.4 percent) in the low-molecular-weight-heparin group had deep-vein thrombosis (P = 0.03). The reduction in risk with low-molecular-weight heparin as compared with warfarin was 16 percent, and the absolute difference in the incidence of venous thrombosis was 6 percent in favor of low-molecular-weight heparin (95 percent confidence interval, 0.8 to 11.4 percent). The incidence of major bleeding was 1.2 percent (9 of 721 patients) in the warfarin group and 2.8 percent (20 of 715 patients) in the low-molecular-weight-heparin group (P = 0.04), and the absolute difference was 1.5 percent in favor of warfarin (95 percent confidence interval, 0.1 to 3.0 percent). CONCLUSIONS. Our data demonstrate that the small reduction in the incidence of venous thrombosis with low- molecular-weight heparin, as compared with warfarin, was offset by an increase in bleeding complications. Although the use of low-molecular- weight heparin is simpler, because it is administered subcutaneously without the need for monitoring, it may be more costly than warfarin. Warfarin is inexpensive, but the overall cost of its use is increased by the need to monitor the intensity of anticoagulation. At this time it is unclear which of these approaches is the most cost effective. Ref ID : HULL1994 606. Hull, R.D., Raskob, G.E., Ginsberg, J.S., Panju, A.A., Brill- Edwards, P., Coates, G., and Pineo, G.F. A noninvasive strategy for the treatment of patients with suspected pulmonary embolism. Arch.Intern.Med. 154:289-297, 1994. Keywords : NONINVASIVE; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; diagnostics; LUNG; SCANNING; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; LEG; PROBABILITY; SCAN; OUTCOME; Methods; PROSPECTIVE; COMPARATIVE STUDY; THROMBOSIS; LONG TERM; FOLLOWUP; ANTICOAGULANT; THERAPY; VENOUS; THROMBOEMBOLISM; in; an Notes : BACKGROUND: Pulmonary embolism has historically presented a formidable diagnostic problem because of the nonspecificity of the clinical findings associated with this disorder and the diagnostic uncertainties and challenges presented by both ventilation-perfusion lung scanning and pulmonary angiography. We have reported previously that serial noninvasive leg testing provides a practical noninvasive alternative to pulmonary angiography in patients with non-high probability (nondiagnostic) lung scans and adequate cardiorespiratory reserve. We have reevaluated this observation prospectively to (1) confirm or refute our original observation in an independent cohort and (2) to increase the numbers sufficiently to provide narrow confidence limits for the observed outcomes. METHODS: A prospective comparative study in 1564 consecutive patients with suspected pulmonary embolism who underwent ventilation-perfusion lung scanning and objective testing for proximal-vein thrombosis. RESULTS: On long-term follow-up of 627 patients with the following characteristics: (1) abnormal, nondiagnostic lung scans, (2) not taking anticoagulant therapy, and (3) serial noninvasive test results negative for proximal-vein thrombosis, only 12 patients (1.9%; 95% confidence limits, 0.8% to 3.0%) had venous thromboembolism. By comparison, venous thromboembolism on follow-up occurred in four (0.7%) of 586 patients (95% confidence limits, 0.02% to 1.3%) with normal lung scans in whom anticoagulant therapy was withheld and in eight (5.5%) of 145 patients (95% confidence limits, 1.8% to 9.2%) with high probability lung scans who received anticoagulant therapy. CONCLUSIONS: Our findings indicate that the clinician has a practical noninvasive strategy in patients with adequate cardiorespiratory reserve and nondiagnostic lung scans that (1) avoids pulmonary angiography, (2) identifies patients with proximal-vein thrombosis who require treatment, and (3) avoids the need for treatment and further investigation in the majority of patients. Ref ID : HULL1994A 607. Hull, R.D. and Pineo, G.F. Low molecular weight heparin treatment of venous thromboembolism. Prog.Cardiovasc.Dis. 37:71-78, 1994. Keywords : Low molecular weight heparin; Molecular Weight; HEPARIN; TREATMENT; VENOUS; THROMBOEMBOLISM Ref ID : HUME1967 608. Hume, M. Selection of women at risk (for venous thrombosis). Brit.Med.J. :637-638, 1967. Keywords : RISK; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; INCIDENCE; VARICES; COLLAGEN; CAUSE; APTT; ORAL CONTRACEPTIVES; in; CANCER; heart; heart diseases; OBESITY; AGE Notes : The incidence of venous thrombosis has been reported to be increased in the presence of cancer, heart disease, obesity, varices, gout, arthritis, collagen vascular disorders, anemia, and advancing age. Oral contraceptive use causes a shortening of the APTT in many or most cases. Ref ID : HUME1970 609. Hume, M. Venous thrombosis and pulmonary embolism, Cambridge:Harvard University Press, 1970. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; DEEP VENOUS THROMBOSIS; CALF; THROMBUS; VEINS; in; Thigh; Pelvis Notes : Furthermore, most cases of proximal deep venous thrombosis had their origins in the venous sinuses of the calf, whence thrombus propagates proximally to involve the deep veins of the thigh and pelvis. Ref ID : HURTUBISE1980 610. Hurtubise, M.R., Bottino, J.C., and Lawson, M. Restoring patency of occluded central venous catheters. Arch.Surg. 115:212-213, 1980. Keywords : CENTRAL VENOUS CATHETER; VENOUS; CATHETER; THROMBOSIS; THROMBOLYSIS; ACEP93; Catheters Ref ID : HURWITZ1989 611. Hurwitz, R.L. and Gelabert, H. Thrombosed iliac venous aneurysm: a rare cause of left lower extremity venous obstruction. J.Vasc.Surg. 9:822-824, 1989. Keywords : THROMBOSED; VENOUS; CAUSE; ACEP93; Aneurysm; Extremities; VENOUS OBSTRUCTION Ref ID : HUSNI1967 612. Husni, E.A., Pena, L.I., and Lenhert, A.E. Thrombophlebitis in pregnancy. Am.J.Obstet.Gynecol. 97:901, 1967. Keywords : THROMBOPHLEBITIS; PREGNANCY; NASP; bib-2; in Ref ID : HUSNI1982 613. Husni, E.A. and Williams, W.A. Superficial thrombophlebitis of the lower limbs. Surgery 91:70, 1982. Keywords : THROMBOPHLEBITIS; NASP; bib-2; Superficial thrombophlebitis Ref ID : HWANG1990 614. Hwang, M.H., Piao, Z.E., Murdock, D.K., Messmore, H.L., Giardina, J.J., and Scanlon, P.J. Risk of thromboembolism during diagnostic and interventional cardiac procedures with nonionic contrast media. Radiology 174:453-457, 1990. Keywords : RISK; THROMBOEMBOLISM; CARDIAC; CONTRAST; ACEP93; CATHETER; DOG; diagnostics Ref ID : HYERS1989 615. Hyers, T.M., Hull, R.D., and Weg, J.G. Antithrombotic therapy for venous thromboembolic disease. Chest 95:37S-51S, 1989. Keywords : THERAPY; VENOUS; THROMBOEMBOLIC; ANTICOAGULANTS; FIBRINOLYTIC AGENTS; THROMBOEMBOLISM; COUMARINS; HEPARIN; HUMAN; RISK FACTORS; REVIEW; REVIEW TUTORIAL; Antithrombotic Ref ID : HYERS1992 616. Hyers, T.M., Hull, R.D., and Weg, J.G. Antithrombotic therapy for venous thromboembolic disease [published erratum appears in Chest 1993 May;103(5):1636]. Chest 102:408S-425S, 1992. Keywords : Antithrombotic; THERAPY; VENOUS; THROMBOEMBOLIC; CHEST; in Ref ID : IABLOKOV1990 617. Iablokov, E.G., Prokubovskii, V.I., Muradian, R.A., and Krasnova, T.A. [The endovascular prevention of thromboembolism of the pulmonary artery in obstetrics and gynecology] Endovaskuliarnaia profilaktika tromboembolii legochnoi arterii v akusherstve i ginekologii. Akush.Ginekol.(Mosk). :76-78, 1990. Keywords : EMBOLISM; PREGNANCY; PREVENTION; THROMBOEMBOLISM; PULMONARY ARTERY; ARTERY; FEMALE; HUMAN; Genital Neoplasms,Female ,Complications ,CO; Pregnancy Complications ,Prevention and Control ,PC; Puerperal Disorders ,Complications ,CO; Pulmonary Embolism ,Prevention and Control ,PC; Vena Cava Filters; Combined Modality Therapy; equipment design; Evaluation Studies; Follow-Up Studies; Pulmonary Embolism ,Epidemiology ,EP Pulmonary Embolism ,Etiology ,ET; Thrombolytic Therapy ,Adverse Effects ,AE; in Ref ID : IAKOVLEV1994 618. Iakovlev, V.B. [The pulmonary thromboembolism problem: the means for its resolution in a general clinical hospital]. Voen.Med.Zh. :25-32, 80, 1994. Keywords : 951202; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; RESOLUTION; in; LUNG; ARTERY; ETIOLOGY; FREQUENCY; RISK; ARTERIAL; Methods; ECG; CHEST; Echocardiography; TREATMENT; PROPHYLAXIS; ADULT; AGED; AUTOPSY; sn; English Abstract; FEMALE; hospitals,general; hospitals,military; HUMAN; MALE; MIDDLE AGE; military personnel; PULMONARY EMBOLISM; di; ep; PA; th; russia; Medline File Notes : The article summarizes the results of clinical examination of 992 patients with thromboembolism of lung artery (TLA), its etiology, frequency of development and risk factors. The author describes clinical symptoms of TLA depending on the diameter of the obturated lung arterial vessel. The estimation of special methods was made from the point of view of its diagnostical significance: ECG, chest roentgenography, echocardiography, angiopneumography. The article contains questions concerning pathogenetical treatment and prophylaxis of TLA. Ref ID : IBARRAPEREZ1988 619. Ibarra-Perez, C., Lau-Cortes, E., Colmenero-Zubiate, S., Arevila- Ceballos, N., Fong, J.H., Sanchez-Martinez, R., Dominguez, M.V., and Elizalde-Gonzalez, J. Prevalence and prevention of deep venous thrombosis of the lower extremities in high-risk pulmonary patients. Angiology. 39(6):505-513, 1988. Keywords : 951208; PREVALENCE; PREVENTION; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Extremities; in; is; Methods; DVT; RISK; PULMONARY EMBOLISM; EMBOLISM; PE; AGED; FIBRINOGEN; SCAN; Doppler; Plethysmography; AMBULATORY; COMPRESSION; STOCKINGS; BANDAGES; SUBCUTANEOUS; HEPARIN; CONTRAST; VENOGRAPHY; PROPHYLAXIS; AGE; sex; Length of Stay; HEMORRHAGIC; COMPLICATIONS; Hospitals; de Notes : Information is lacking about the prevalence of, and the best method of preventing deep venous thrombosis (DVT) of the lower extremities in patients forty years or older with pulmonary disease that keeps them in bed for three consecutive days or more and who are thus at high risk of developing DVT or pulmonary embolism (PE). In this study, 192 high-risk patients, aged forty to ninety-two, received 125I fibrinogen and had daily radioactive scans, venous Doppler, and strain gauge plethysmography. Four preventive methods were used until patients became ambulatory: graded compression stockings (GCS) in 39, elastic bandages (EB) in 33, subcutaneous administration of 5,000 USP units of heparin (HEP) bid in 39, and oral administration of 0.5 g of acetylsalicyclic acid (ASA) bid in 35. Results were compared with those in 46 patients in a control group (CG). Twelve patients in CG, none in GCS, 4 in EB, 1 in HEP, and 2 in ASA developed DVT proved by contrast venography. There was a statistically significant difference between GCS and CG (P less than 0.0003), HEP and CG (P less than 0.0022), and ASA and CG (P less than 0.0148) but not between EB and CG (P greater than 0.10); no significant differences were found between any pair of prophylaxis groups. The significant differences could not be attributed to differences in age, sex, or length of stay in bed. PE occurred in 3 patients in CG and 1 in EB. Hemorrhagic complications occurred in 7 patients in HEP and 4 in ASA, requiring exclusion of 2 patients and 1 patient, respectively, from the study.(ABSTRACT TRUNCATED AT 250 WORDS) Hospital de Cardiologia y Neumologia Luis Mendez Instituto Mexicano del Seguro Social Mexico City. Ref ID : ILIC1992 620. Ilic, S., Popovic, L., Vrcelj, V., Radojkovic, M., and Karan, Z. [Pulmonary thromboembolism--an autopsy study with clinico-pathologic correlations]. Vojnosanit.Pregl. 49:444-451, 1992. Keywords : 951202; AUTOPSY; PATHOLOGIC; pathology; forensic medicine; in; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; is; CAUSE; DEATH; an; FREQUENCY; FATAL; fatal outcome; OUTCOME; CLINICAL DIAGNOSIS; DIAGNOSIS; Neoplasms; MYOCARDIAL INFARCTION; infarction; Adolescence; ADULT; AGED; Aged,80 and over; CASE REPORT; CHILD; Child,Preschool; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; PA; Medline File; Cancerlit File Notes : The study comprised 3.629 autopsies performed at the Institute of Pathology and Forensic Medicine of the M.M.A. in the period 1980- 1990. Pulmonary thromboembolism (PTE) was found in 533 (14.68%) of autopsied cases, that is, 10.88% of all causes of death. In the studied period there is an increased frequency of all PTE, especially of those with fatal outcome (p < 0.05). Of the total number of PTE found at autopsy (533), clinical diagnosis was established in 136 (25.51%), and of all fatal PTE found at autopsy (395) the clinical diagnosis was established in 123 (31.14%) during life. The clinical diagnosis of PTE was confirmed by autopsy in 42.42% of cases. Operations and neoplasms are the most frequent conditions in which PTE is occurred while myocardial infarction is the most frequently misdiagnosed for PTE during establishment of clinical diagnosis Vojnomedicinska akademija Institut za patologiju i sudsku medicinu. Ref ID : ILLIG1978 621. Illig, H. [Death from or in asthma ? (author's transl)]. Med.Klin. 73:357-360, 1978. Keywords : 951202; in; ASTHMA; DEATH; CAUSE; POSTMORTEM; cause of death; FREQUENCY; PNEUMOTHORAX; PULMONARY EMBOLISM; EMBOLISM; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; HEMORRHAGIC; MYOCARDIAL INFARCTION; infarction; CHRONIC; Cortisone; LONG TERM; THERAPY; OUTCOME; ADULT; Age Factors; AGED; co; mo; PA; AUTOPSY; English Abstract; FEMALE; Germany,West; HEMORRHAGE; HUMAN; LUNG; MALE; MIDDLE AGE; pancreatitis; et; Medline File; dyspnea Notes : 23 deaths of patients with severe asthmatic dyspnea were analyzed. There was no correlation between clinical presentation and cause of death certified by post-mortem examination. The cause of death was found outside the airways in 14 patients. Of diagnostic-therapeutic implications are the relative frequency of spontaneous pneumothorax (5) and pulmonary embolism (3). Six times another cause of death was discovered (like tumor invasion, arterial thrombosis, hemorrhagic pancreatitis, myocardial infarction). Acute asthmatic death was prone to happen in the middle-aged asthmatic with less than two years of bronchial astham. Here like in 5 patients with chronic obstructive airways disease lack of awareness of the seriousness of the patients' state, sometimes cessation of cortisone long-term therapy, seldom abuse of bronchodilator-aerosols seems to be important for the lethal outcome. Ref ID : IMPERIALE1994 622. Imperiale, T.F. and Speroff, T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement [see comments] [published erratum appears in JAMA 1995 Jan 25;273(4):288]. JAMA 271(22):1780-1785, 1994. Keywords : 951217; META ANALYSIS; Methods; VENOUS; THROMBOEMBOLISM; HIP; HIP REPLACEMENT; in; PROPHYLAXIS; RISK; is; RANDOMIZED; HUMAN; hip prosthesis; RANDOMIZED CONTROLLED TRIALS; SELECT; CLINICAL TRIAL; WARFARIN; Dextrans; HEPARIN; Low-molecular-weight heparin; COMPRESSION; STOCKINGS; HEMORRHAGE; QUANTITATIVE; OUTCOME; TREATMENT; ARM; ASPIRIN; VENOUS THROMBOSIS; THROMBOSIS; Molecular Weight; PULMONARY EMBOLISM; EMBOLISM; BLEEDING; tu; BANDAGES; heparin,low-molecular-weight; Postoperative Complications; pc; research design; Medline File Notes : OBJECTIVE--While several methods of prophylaxis have been shown to reduce the risk of venous thromboembolism following total hip replacement, the safest and most effective agent is unclear. To clarify this issue, we performed a meta-analysis of the randomized trials of methods used to prevent venous thromboembolism following total hip replacement. DATA SOURCE--English-language human studies articles from 1966 through 1993 were obtained from a MEDLINE database search with indexing terms including thromboembolism, hip replacement or hip prosthesis, and randomized controlled trials. Additional references were obtained from study bibliographies. STUDY SELECTION-- The following criteria were used to select studies for inclusion: study design-- randomized clinical trial; study population--patients undergoing elective total hip replacement; interventions--aspirin, warfarin, dextran, heparin, low-molecular-weight heparin, compression stockings; and outcomes--venous thromboembolism, major hemorrhage. DATA EXTRACTION- -Methodological and descriptive data from each study were abstracted by one author who was blinded to quantitative outcomes data. DATA SYNTHESIS--Ninety-one treatment groups and 25 control groups were identified from 56 trials. Four treatment groups were excluded because of rarely used combinations. Trial populations were clinically homogeneous. When compared with the control arm, all treatments except aspirin reduced the risk of all deep venous thromboses (risk differences range, 0.18 to 0.31; all P values < .05). All treatments except aspirin reduced the risk of proximal venous thrombosis (risk differences range, 0.09 to 0.18; all P values < .05). Only low-molecular-weight heparin and stockings reduced the risk of pulmonary embolism, both with risk differences equal to 0.02. The crude risks of clinically important bleeding as defined by the individual trials were 0% for stockings, 0.3% for controls, and 1.8% for low-molecular-weight heparin. CONCLUSIONS-- The results suggest that low-molecular-weight heparin and compression stockings have the greatest relative efficacy in preventing venous thromboembolism following total hip replacement. Low-molecular-weight heparin may be more effective, though at a small risk of clinically important bleeding Department of Medicine Case Western Reserve University at MetroHealth Medical Center Cleveland Ohio 44109-1998. Ref ID : IMPERIALE1995 623. Imperiale, T.F. and Speroff, T. Reply to letters regarding 'A meta- analysis of Methods to Prevent Venous Thromboembolism Following Total Hip Replacement'. JAMA 273(4):288, 1995. Keywords : LETTER; META ANALYSIS; Methods; VENOUS; THROMBOEMBOLISM; HIP; HIP REPLACEMENT; Intermittent pneumatic compression; COMPRESSION; GRADIENT; in; INCIDENCE; DVT; PE; Pneumatic Notes : Active intermittent pneumatic compression and static gradient compression hose work by different mechanisms to reduce the incidence of DVT and PE, but are equal in their clinical efficacy. Ref ID : INO1988 624. Ino, T., Benson, L.N., Freedom, R.M., Barker, G.A., Aipursky, A., and Rowe, R.D. Thrombolytic therapy for femoral artery thrombosis after pediatric cardiac catheterization. Am.Heart J. 115:633-639, 1988. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; THROMBOSIS; CARDIAC; ACEP93; Femoral Artery; ARTERY; PEDIATRIC; Catheterization Ref ID : ISACSON1972 625. Isacson, S. and Nilsson, I.M. Defective fibrinolysis in blood and vein walls in recurrent "idiopathic" venous thrombosis. Acta.Chir.Scand. 138(4):313-319, 1972. Keywords : FIBRINOLYSIS; VEINS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; blood; vein Ref ID : ISHIKAWA1993 626. Ishikawa, K., Fujino, T., Shinozaki, Y., and Mukai, M. [Autopsy- proven cases of fatal saddle thromboembolism in the pulmonary artery]. Nippon.Kyobu.Shikkan.Gakkai.Zasshi. 31:1416-1421, 1993. Keywords : 951202; FATAL; THROMBOEMBOLISM; in; AUTOPSY; Hospitals; PULMONARY THROMBOEMBOLISM; DIAGNOSIS; is; PULMONARY ARTERY; ARTERY; FEMALE; MALE; AGE; CHEST; CHEST PAIN; PAIN; DEATH; SUDDEN DEATHS; CENTRAL VENOUS CATHETER; VENOUS; CATHETER; VENA CAVA; vein; THROMBOEMBOLI; POSTMORTEM; POSTOPERATIVE; abnormalities; COAGULATION; Iliac Vein; VEINS; FIBRIN; PLATELETS; ENDOTHELIAL; THROMBOSIS; PERIPHERAL ARTERY; AGED; CASE REPORT; Death,Sudden; PA; English Abstract; HUMAN; MIDDLE AGE; PULMONARY EMBOLISM; Medline File; internal medicine; dyspnea; laboratories; japan Notes : In 544 autopsy cases during the period from 1984 through 1990 at National Okura Hospital, there were 7 cases of fatal saddle pulmonary thromboembolism (1.3%). Pulmonary thromboembolism was included in the differential diagnosis, but not as a primary consideration. Therefore, no case was diagnosed antemortem. Saddle thromboembolus is defined here as a thromboembolus which impacted in the main pulmonary artery or lodged astride the bifurcation. The cases were 5 females and 2 males ranging in age from 53 to 76 years. During the clinical course of the initial disease, sudden symptoms including dyspnea, chest pain or tachypnea developed, and death occurred within one hour or in a relatively short period of time. In case 6, sudden death followed removal of a central venous catheter inserted in the inferior vena cava one week previously. In cases 2, 3, and 5, deep vein thromboemboli were detected at postmortem examination. In cases 3 and 4, the patients were 3- and 5-days postoperative, respectively. Laboratory data obtained before death showed no abnormalities of hematologic and coagulation profiles. At autopsy, the pulmonary artery trunk was completely occluded by embolus, and thromboemboli were detected in the femoral and iliac veins in 3 cases. These thromboemboli were composed of fibrin and red cells enmeshed with platelets. On microscopic examination, endothelial disruption was not observed at the levels of the large and smaller pulmonary vessels, which underlies thrombosis in situ or creates a procoagulant environment. Proximal pulmonary thromboemboli were demonstrated in only one out of seven cases (Case 1). Saddle thromboembolism, in our limited observation, resulted from the impact of large floating embolus, emanating from elsewhere, against the large pulmonary artery, rather than the propagation of a smaller pulmonary embolus originating in a peripheral artery Department of Internal Medicine National Okura Hospital Tokyo Japan. Ref ID : IVASKOVA1991 627. Ivaskova, E., Prerovsky, I., Riedel, M., Kupkova, L., Fajtova, A., Stedry, V., and Slavik, M. HLA and venous thrombosis: a prospective study. Cor.Vasa 33:424-427, 1991. Keywords : HLA; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROSPECTIVE; PROSPECTIVE STUDIES; CZECHOSLOVAKIA; FREQUENCY; FIBRINOGEN; ULTRASOUND; HIP; HIP REPLACEMENT; RISK; PGM-8/94; ab; in; an; laboratories; RISK FACTORS Notes : CS- Institute for Clinical and Experimental Medicine, Prague, Czechoslovakia AB- The frequency of venous thrombosis diagnosed by the fibrinogen uptake test and ultrasound in relation to HLA typing was examined in a prospective study of 154 patients undergoing total hip replacement. The results demonstrate an association between venous thrombosis and the presence of HLA Cw4 and B35 (being in a linkage disequilibrium with Cw4) (Cw4 34.4% and B35 27.3%, relative risk 2.531 and 1.935 respectively). These results suggest that the presence of HLA Cw4 can be regarded as one of laboratory risk factors of venous thrombosis. Ref ID : JAMES1989 628. James, P.B. The treatment of decompression sickness. Schweiz.Z.Sportmed. 37:109-14; discussion 124-3, 1989. Keywords : 951202; TREATMENT; decompression sickness; in; is; PAIN; blood; Pressure; RESOLUTION; partial pressure; OXYGEN; standards; THERAPY; Air; RECURRENCE; helium; EMBOLISM; diving; DIAGNOSIS; INTRAVENOUS; atmospheric pressure; blood-brain barrier; pp; th; embolism,air; ad; HUMAN; Hyperbaric Oxygenation; Oxygen Inhalation Therapy; Medline File; joints; brain Notes : The initial event in decompression sickness is the separation of gas from solution because of supersaturation. If this event gives rise to immediate symptoms, recompression is remarkably effective. This end- point is characteristic of joint pain, that is, Type 1 decompression sickness. Unfortunately the onset of serious Type 2 decompression sickness may be insidious and the delay may be associated with blood- brain barrier dysfunction. Pressure is less effective in the resolution of this problem than a raised partial pressure of oxygen. Standard therapy using oxygen may be associated with worsening of symptoms and air tables with recurrence. Recompression to 4 ata and the use of a mixture of 50% oxygen and 50% helium offers a good working compromise in the treatment of both serious decompression sickness and gas embolism arising in air diving, avoiding the need for a differential diagnosis. Only oxygen or helium and oxygen mixtures should be used in the therapy of decompression sickness in helium and oxygen diving. When therapy has been delayed, intravenous fluids and steroids are important adjuncts. Ref ID : JAMES1993 629. James, P.B. Dysbarism: the medical problems from high and low atmospheric pressure [see comments]. J.R.Coll.Physicians.Lond. 27:367- 374, 1993. Keywords : 951202; Pressure; Air; EMBOLISM; decompression sickness; LUNG; diving; DEATH; Cerebral; Arteries; CAUSE; nitrogen; helium; VEINS; Syndrome; FILTER; is; Spinal cord; SCLEROSIS; COMPRESSION; partial pressure; OXYGEN; atmospheric pressure; barotrauma; di; et; pp; th; embolism,air; HUMAN; Hyperbaric Oxygenation; in; magnetic resonance imaging; Medline File; Hospitals; an; infarction; joints; blood-brain barrier; brain Notes : The most serious problems resulting from a change in ambient pressure are pulmonary barotrauma with air embolism and decompression sickness. The small differential pressures used in ventilators at atmospheric pressure may tear lung tissue and, in diving, deaths have occurred from the expansion of pulmonary gas on an ascent of less than two metres. The bubbles of respired gas that enter the systemic circulation often occlude cerebral arteries and may cause infarction. In decompression sickness, bubbles form in the tissues from supersaturation of the nitrogen or helium absorbed under pressure. Joint pain--the 'bends'--is associated with gas in particular connective tissue. Serious decompression sickness results from the entry of microbubbles into the systemic veins. Large numbers of bubbles trapped in the lung cause an acute respiratory syndrome known as 'chokes'. If the lung filter is overwhelmed, or microbubbles pass into the systemic arteries through an atrial septal defect, they may open the blood-brain barrier, affecting brain and spinal cord function. Untreated, demyelination with relative preservation of axons may occur, the pathological hallmarks of multiple sclerosis. Gas bubble disease requires urgent compression in a hyperbaric chamber and the use of high partial pressures of oxygen Wolfson Hyperbaric Medicine Unit Ninewells Hospital Medical School Dundee. Ref ID : JAMIESON1989 630. Jamieson, C. The management of varicose veins. Practitioner. 233:578-581, 1989. Keywords : MANAGEMENT; VARICOSE VEINS; VEINS; TREATMENT; COMPLICATIONS; NASP; COMPARATIVE STUDY; Diagnosis,Differential; HUMAN; SCLEROTHERAPY; Severity of Illness Index; THROMBOPHLEBITIS; Venous Insufficiency; Medline File; Health Planning & Administration File; varicose; ab; in Notes : AB - The treatment of most of the complications of varicose veins lies in a knowledge of the pathophysiological mechanisms at work and the appropriate management of the veins themselves UI -90099139. Ref ID : JAMIESON1989A 631. Jamieson, C. The management of varicose veins. Practitioner 233:578-581, 1989. Keywords : MANAGEMENT; varicose; VARICOSE VEINS; VEINS; NASP; varicose veins - diagnosis; COMPARATIVE STUDY; Diagnosis,Differential; HUMAN; SCLEROTHERAPY; Severity of Illness Index; thrombophlebitis - diagnosis; thrombophlebitis - etiology; thrombophlebitis - therapy; varicose veins - complications; varicose veins - therapy; veins - surgery; venous insufficiency - diagnosis; venous insufficiency - etiology; venous insufficiency - therapy Ref ID : JAMIESON1993A 632. Jamieson, S.W., Auger, W.R., Fedullo, P.F., Channick, R.N., Kriett, J.M., Tarazi, R.Y., and Moser, K.M. Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Thorac.Cardiovasc.Surg. 106:116-26; discussion 126, 1993. Keywords : SURGERY; CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; diagnostics; SURGICAL; POSTOPERATIVE; MANAGEMENT; CARDIOPULMONARY BYPASS; PULMONARY ARTERY; Arteries; THROMBUS; endarterectomy; TECHNIQUES; MORTALITY; HEMODYNAMICS; RISK; PGM-8/94; ab; in; is; an Notes : CS- Division of Cardiothoracic Surgery, University of California, School of Medicine, San Diego 92103-8892 AB- A program to alleviate chronic, major vessel thromboembolic pulmonary hypertension by pulmonary thromboendarterectomy was initiated at this institution in 1970. Multiple evolutionary changes in the diagnostic evaluation, surgical approach, and postoperative management have been implemented over the series of 323 thromboendarterectomies performed through March 1992. A sequence of five surgeons at the University of California at San Diego have performed these procedures, with the last 150 having been performed by one surgeon. We report here the changes in surgical approach developed over the last 150 cases and the results obtained. The operation involves a median sternotomy incision, the institution of cardiopulmonary bypass, and deep hypothermia with circulatory arrest periods. Incisions are made in both pulmonary arteries into the lower lobe branches. Pulmonary thromboendarterectomy is always bilateral, with removal of both organized thrombus and an endarterectomy plane from all involved vessels. The right atrium is routinely explored for atrial septal defects. Current techniques appear to allow more thorough revascularization and shorter circulatory arrest times. The surgical mortality of 8.7% over this span is below that previously reported from this and other institutions. Among survivors, the hemodynamic and functional results have been excellent. Surgically correctable chronic thromboembolic pulmonary hypertension likely remains underdiagnosed. The diagnostic, surgical, and postoperative management evolution provided by the coordinated team involved at this institution has established that pulmonary thromboendarterectomy can be performed with an acceptable risk and good hemodynamic and symptomatic results. Ref ID : JANNER1965 633. Janner, M. [The saluretic furosemide in the treatment of sequelae of venous insufficiency]. Munch.Med.Wochenschr. 107:1420-1423, 1965. Keywords : TREATMENT; VENOUS; NASP; Diuretics; Furosemide; HUMAN; Leg Ulcer; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Das Salidiuretikum Furosemid bei der Behandlung von Folgezustanden der venosen Insuffizienz AB - [No Abstract Available] UI - 66030705. Ref ID : JANSSEN1987 634. Janssen, H.F., Schachner, J., Hubbard, J., and Hartman, J.T. The risk of deep venous thrombosis: A computerized epidemiologic approach. Surgery 101:205-212, 1987. Keywords : RISK; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; RECURRENCE Notes : Patients with a past history of DVT have a five times higher risk of recurrence compared to those who have not had prior DVT. Ref ID : JARDIN1991 635. Jardin, F., Lacombe, P., Dubourg, O., Delorme, G., Hardy, A., and Beauchet, A. [Quantitative two-dimensional echocardiography in acute pulmonary embolism]. Presse.Med 20:2085-2089, 1991. Keywords : Echocardiography; EMERGENCY; PULMONARY EMBOLISM; EMBOLISM; COR PULMONALE; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; DIAGNOSIS; sdi-11/93; in; an; intensive care; intensive care units Notes : Emergency two-dimensional echocardiography was carried out in 61 patients admitted to an intensive care unit for suspected pulmonary embolism, in order to find out whether signs of acute cor pulmonale (ACP) were present or absent. Pulmonary angiography was subsequently performed to confirm or infirm the diagnosis of pulmonary embolism. Only 7 out of 13 patients with normal echocardiography had no pulmonary embolism. All other patients who showed echocardiographic signs of ACP had pulmonary embolism. Thus, the finding of normal echocardiographic results does not necessarily exclude a diagnosis of pulmonary embolism. Conversely, the presence of echocardiographic signs of ACP in a suggestive context provides a near-certain diagnosis of pulmonary embolism. Ref ID : JEFFERY1990 636. Jeffery, P.C. and Nicolaides, A.N. Graduated compression stockings in the prevention of postoperative deep vein thrombosis [see comments]. Brit.J.Surg. 77:380-383, 1990. Keywords : PHLEBITIS; graduated compression stockings; COMPRESSION; STOCKINGS; PREVENTION; POSTOPERATIVE; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; BANDAGES; FEMALE; HEPARIN; therapeutic use; HUMAN; LEG; Postoperative Complications; prevention & control; Pressure; THROMBOPHLEBITIS; REVIEW; elastic compression stocking; INCIDENCE; Methods; CALF; in Notes : This review examines the role of graduated elastic compression stockings in the prevention of postoperative deep vein thrombosis. Used alone compression stockings reduce the incidence of postoperative deep vein thrombosis by approximately 60 per cent and when used in combination with other preventive methods, such as low dose heparin or intermittent calf compression, they further reduce the incidence by up to 85 per cent. Ref ID : JEFFREY1986 637. Jeffrey, P.C., Immelman, E., and Amoore, J. Treatment of deep vein thrombosis with heparin or streptokinase: long-term venous function assessment. Proceedings of the second international vascular symposium (London)S20.3, 1986. (Abstract) Keywords : TREATMENT; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; HEPARIN; STREPTOKINASE; LONG TERM; VENOUS; VENOUS FUNCTION; vein Ref ID : JICK1969 638. Jick, H., Slone, D., Westerholm, B., Inman, W.H., Vessey, M.P., Shapiro, S., Lewis, G.P., and Worcester, J. Venous thromboembolic disease and ABO blood type. A cooperative study. Lancet i:539-542, 1969. Keywords : VENOUS; THROMBOEMBOLIC; AGE; VENOUS THROMBOSIS; THROMBOSIS; ABO; BLOOD TYPE; blood; in Notes : Women in the reproductive age group with type A blood suffer venous thrombosis two to four times more often than women with type O blood. Ref ID : JICK1969A 639. Jick, H., Westerholm, B., Vessey, M.P., Lewis, G.P., Slone, D., Inman, W.H.W., Shapiro, S., and Worchester, J. Venous thromboembolic disease and ABO blood type. Lancet :539-542, 1969. Keywords : VENOUS; THROMBOEMBOLIC; ABO; BLOOD TYPE; NASP; blood Ref ID : JICK1978 640. Jick, H. and Porter, J. Thrombophlebitis of the lower extremities and the ABO type. Arch.Intern.Med. 138:1566, 1978. Keywords : THROMBOPHLEBITIS; Extremities; ABO; NASP; bib-2 Ref ID : JOHNS1991 641. Johns, C.M. and Sumkin, J.H. US-guided venipuncture for venography in the edematous leg. Radiology 180:573, 1991. Keywords : PHLEBITIS; VENOGRAPHY; LEG; Bloodletting; Methods; Catheterization,Peripheral; instrumentation; Edema; pathology; Ultrasonography; HUMAN; blood supply; PHLEBOGRAPHY; radiology,interventional; THROMBOPHLEBITIS; radiography; VEINS; TECHNIQUES; VENOUS; vein; Palpation; in; is Notes : A technique for sonographic-guided venipuncture was developed especially for venography made difficult by gross leg edema. Five patients were evaluated in whom venography had been attempted but was initially unsuccessful because of difficult venous access. All five underwent successful venipuncture after sonographic localization of a vein. Ultrasound-guided venipuncture is simple and useful when venous access by palpation is difficult. Ref ID : JOHNSON1992 642. Johnson, M.E., Furlong, R., and Schrank, K. Diagnostic use of emergency department echocardiogram in massive pulmonary emboli. Ann.Emerg Med 21:760-763, 1992. Keywords : diagnostics; EMERGENCY; MASSIVE; EMBOLI; PULMONARY EMBOLISM; EMBOLISM; THERAPY; THROMBOLYTIC; EMBOLECTOMY; CLINICAL DIAGNOSIS; DIAGNOSIS; sdi-11/93; Echocardiogram; diagnostic use; in; Pulmonary emboli; is Notes : Massive pulmonary embolism represents a small percentage of patients presenting to the emergency department with clinical symptoms suggestive of embolic phenomenon. Definitive therapy with thrombolytics or embolectomy is usually delayed until angiographic verification of the clinical suspicion can be obtained. A case is described in which embolectomy was based on clinical diagnosis and confirmatory echocardiogram obtained in the ED. The rapid diagnostic role of echocardiographic data in a subset of patients presenting with clinical symptoms suggestive of massive pulmonary emboli deserves further evaluation. Ref ID : JONES1967 643. Jones, H.O., Townsend, J.C.F., and Roberts, J.T. Varicose veins, oral contraceptives, and thromboembolism. Brit.Med.J. 2:637-638, 1967. Keywords : VARICOSE VEINS; VEINS; ORAL CONTRACEPTIVES; THROMBOEMBOLISM; DEATH; PULMONARY THROMBOEMBOLISM; SCLEROTHERAPY; SODIUM TETRADECYL SULFATE; TREATMENT; THROMBUS; PLATELETS; varicose; Injections; Sodium; Extremities; an; MEDICATIONS; Died Notes : A report of a death from pulmonary thromboembolism after injection sclerotherapy using sodium tetradecyl sulfate for varicose veins of the lower extremities. The patient was taking an oral contraceptive medication at the time of the sclerotherapy treatment, and died 21 hours later. Examination of the thrombus revealed a primarily platelet-based thrombus. Ref ID : JONES1989 644. Jones, B., Fink, J.A., Donovan, D.L., and Sharp, W.V. Analysis of benefit of anticoagulation after placement of Kimray-Greenfield filter. Surg.Gynecol.Obstet. 169:400-402, 1989. Keywords : PHLEBITIS; analysis; ANTICOAGULATION; FILTER; ANTICOAGULANTS; therapeutic use; Edema; ETIOLOGY; FEMALE; filtration; instrumentation; HUMAN; LEG; MALE; MIDDLE AGE; PULMONARY EMBOLISM; prevention & control; RECURRENCE; Retrospective Studies; THROMBOPHLEBITIS; EPIDEMIOLOGY; EMBOLISM; COMPLICATIONS; THROMBOEMBOLIC; POSTPHLEBITIC; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; THROMBOEMBOLISM; STASIS; is; in Notes : The Kimray-Greenfield venal caval filter is widely accepted as a means of preventing pulmonary embolism when medical anticoagulation has failed or complications have developed. When indicated, anticoagulants are usually resumed after placement of the filter. A retrospective study was performed comparing the thromboembolic and postphlebitic complications in patients who continued to receive anticoagulants after placement of the filter versus those who did not. Sixty-eight Kimray- Greenfield filters were placed in 68 patients (43 men and 25 women) during a four year period. After placement of the filter, 26 patients received anticoagulants and 42 did not. Three of those receiving anticoagulants and six of those who did not had significant swelling of the leg; two of those receiving anticoagulants and two of those who did not had a recurrent deep venous thrombosis. There were no instances of recurrent pulmonary embolism. There were no significant differences in the results of these two groups of patients. These results are consistent with those reported in the literature in that no correlation has been found between the use of anticoagulants after placement of the filter and recurrent thromboembolism or stasis sequelae. In view of the complications associated with medical anticoagulation, we recommend its discontinuation in all patients after placement of the Kimray-Greenfield filter. Ref ID : JORGENSEN1989 645. Jorgensen, L.N., Hauch, O., Teglbjaerg, C.S., Wahlin, A.B., Rathenborg, P., Khattar, S.C., and Wille-Jorgensen, P. [Presence of pulmonary emboli in Danish autopsy material]. Ugeskr.Laeger 151:1305- 1307, 1989. Keywords : 951202; Pulmonary emboli; EMBOLI; in; AUTOPSY; CAUSE; cause of death; DEATH; an; Immobilization; is; SURGICAL; PROGNOSIS; FATAL; REVIEW; Hospitals; death certificates; statistics; INDICATIONS; PROPHYLAXIS; THROMBOSIS; DIAGNOSIS; Immobilized; denmark; English Abstract; HUMAN; PULMONARY EMBOLISM; mo; PA; Retrospective Studies; Medline File Notes : Two hundred and ten patients with verified pulmonary emboli (LE) at autopsy were assessed retrospectively. These patients comprised 13% of all those submitted to autopsy. LE was the primary cause of death, a contributory cause of death or an incidental finding in 35%, 31% and 34%, respectively, of the cases. Two thirds of the lethal cases were not recognized prior to autopsy. LE was preceded by medical conditions and operation with subsequent immobilization in 55% and 22% of the cases, respectively. Out of these, it is estimated that 17% of the medical patients and 56% of the surgical patients would have had a good prognosis if LE had not occurred. If foreign results can be applied to Danish conditions, approximately 1,400 fatal cases of LE should occur in Denmark per annum. This review confirms that the actual Danish figures are of this magnitude, at least, as approximately 1,500 lethal cases must be assumed to occur per annum solely among patients dying in hospital. In 1986, a total of 278 cases of LE were stated as the primary cause of death on the death certificates. Despite the limitations of a retrospective investigation, it is concluded that the vital statistics of the Danish Board of Health underestimate the genuine number of cases. The range of indications for prophylaxis of thrombosis is possibly too narrow. LE should be considered in the differential diagnosis more frequently, particularly in elderly immobilized patients. Ref ID : JOSEPHSON1993 646. Josephson, G.D., Tiefenbrun, J., and Harvey, J. Thrombosis of the descending thoracic aorta: a case report. Surgery 114:598-600, 1993. Keywords : THROMBOSIS; CASE REPORT; POLYCYTHEMIA; EMBOLI; Femoral Artery; Arteries; ARTERY; THROMBOEMBOLIC; BLOOD FLOW; CARDIAC; ESOPHAGEAL; THROMBUS; MAGNETIC RESONANCE; THROMBECTOMY; POSTOPERATIVE; sdi-11/93; Aorta; is; bone marrow; in; blood; an; magnetic resonance imaging Notes : A 76-year-old woman with primary polycythemia vera had emboli to both superficial femoral arteries and to a branch of the superior mesenteric artery. Polycythemia vera is a neoplastic disease of bone marrow stem cells in which increased red cell production leads to hyperviscosity manifested by propensity to thromboembolic phenomena. These problems usually occur in smaller vessels, sparing large vessels that have high blood flow. The patient underwent an extensive investigation to determine the source of the emboli. Abdominal aortic angiograms and cardiac echogram failed to reveal the source. An esophageal echogram showed free-floating thrombus in the descending thoracic aorta, which was confirmed by magnetic resonance imaging. A thoracic aortic thrombectomy was performed. Embolic phenomena ceased and postoperative esophageal echogram confirmed a clear thoracic aorta. Although extremely rare in the descending thoracic aorta, thrombus formation may occur in association with polycythemia vera and should be sought when usual investigations fail to reveal the source. Ref ID : JUHANVAGUE1987 647. Juhan-Vague, I., Valadier, J., Alessi, M.C., Aillaud, M.F., Ansaldi, J., and Philip-Joet, C. Deficient t-PA release and elevated PA inhibitor levels in patients with spontaneous or recurrent deep venous thrombosis. Thromb.Haemost. 57:67-72, 1987. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; TPA; t-PA; PA; in Ref ID : JUNG1989 648. Jung, M., Kletter, K., Dudczak, R., Koppensteiner, R., Minar, E., Kahls, P., Stumpflen, A., Pokieser, P., and Ehringer, H. Deep vein thrombosis: scintigraphic diagnosis with In-111-labeled monoclonal antifibrin antibodies. Radiology 173:469-475, 1989. Keywords : PHLEBITIS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; DIAGNOSIS; antibodies; Adolescence; ADULT; AGED; antibodies,monoclonal; diagnostic use; FEMALE; FIBRIN; immunology; HUMAN; indium radioisotopes; LEG; blood supply; MALE; MIDDLE AGE; PHLEBOGRAPHY; sensitivity and specificity; THROMBOPHLEBITIS; radiography; radionuclide imaging; VENOGRAPHY; Injections; SPECIFICITY; SENSITIVITY; CALF; Thigh; Pelvis; QUANTITATIVE; analysis; Serum Albumin; Methods; an; in; is Notes : Fifty-two patients suspected of having deep vein thrombosis under-went scintigraphy with an indium-111-labeled monoclonal antifibrin antibody. Venography disclosed deep vein thrombosis in 31 patients. With the whole limb considered an anatomic entity, antifibrin antibody scintigrams obtained 2 hours after injection had a specificity and sensitivity of 81% and 84%, respectively. A higher sensitivity (92%) was found for a subgroup of patients (n = 44) with symptoms for less than 10 days. Regional sensitivities for all patients and for the subgroup, respectively, were 92% and 100% in the calf, 82% and 94% in the popliteal region, 63% and 71% in the thigh, and only 18% and 13% in the pelvis. Additional imaging performed 6 hours and 21 hours after injection in 12 patients and quantitative analysis done from scintigrams with and without blood-pool (technetium-99m human serum albumin) correction did not improve sensitivity. In-111-antifibrin antibody scintigraphy is an accurate method for diagnosis of acute established deep vein thrombosis of the calf and popliteal region; its sensitivity in the thigh is lower, and it is not feasible for diagnosis in the pelvic area. Ref ID : JUZOVA1975 649. Juzova, V. and Marek, J. [Chronic thrombosis of the truncus of the pulmonary artery at the foramen ovale late patens]. Cesk.Patol. 11:50- 53, 1975. Keywords : 951202; THROMBOSIS; PULMONARY ARTERY; ARTERY; Foramen ovale; LATE; in; CHRONIC; CARDIAC; Cyanosis; MASSIVE; is; AUTOPSY; Chronic Disease; English Abstract; heart septum; PA; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; co; et; Medline File Notes : In a 54-year-old man who suffered from chronic cardiac insufficiency with terminal graded cyanosis on necropsy a foramen ovale late patens was found with massive chronic thrombosis of the trunk and main branches of the pulmonary artery above extensive partly ulcerous atheromatous plaques. The thrombosis is considered autochthonous by the authors. Ref ID : KAHN1985 650. Kahn, S.E., Goldstein, J., and Cope, C. Low-dose streptokinase therapy for Swan-Ganz catheter-induced thrombosis. Am.Heart J. 110:891- 893, 1985. Keywords : STREPTOKINASE; THERAPY; THROMBOSIS; ACEP93; SWAN-GANZ Ref ID : KAISER1994 651. Kaiser, R.T. Air embolism death of a pregnant woman secondary to orogenital sex. Acad.Emerg.Med. 1:555-558, 1994. Keywords : Air; EMBOLISM; DEATH; PREGNANT; CARDIAC; Cardiac arrest; Died; Infant; Cesarean Section; OXYGEN; THERAPY; SURGICAL; EMERGENCY; INDICATIONS; ADULT; CASE REPORT; embolism,air; co; et; FEMALE; heart arrest; HUMAN; Infant,Newborn; MALE; PREGNANCY; Pregnancy Complications,Cardiovascular; sex; Medline File; Hospitals; sexual; is; an; in; resuscitation Notes : Air embolism produced by vaginal insufflation is an unusual but potentially lethal consequence of sexual activity, especially in the pregnant patient. Reported here is the case of a young pregnant woman who presented to the ED in full cardiac arrest, with little history to explain her condition. Despite aggressive resuscitative measures, the patient died, but her infant son was delivered via perimortem cesarean section and survived. A high level of suspicion for air embolism should be maintained for young women who unexpectedly develop cardiac arrest, particularly during sexual activity. Air embolism patients may require vigorous medical resuscitation, hyperbaric oxygen therapy, or surgical intervention to survive. The emergency physician should be familiar with the indications for perimortem cesarean delivery in the third-trimester patient presenting to the ED with cardiac arrest Section of Emergency Medicine University of Chicago Hospitals USA. Ref ID : KAKKAR1969 652. Kakkar, V.V. Natural history of postoperative deep-vein thrombosis. Lancet ii:230-232, 1969. Keywords : NATURAL HISTORY; THROMBOSIS; VEINS; THROMBI; VENOUS; ENDOTHELIAL; INJURY; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; DEEP VEIN THROMBOSIS; POSTOPERATIVE; postoperative deep vein thrombosis; vein; in; STASIS; is Notes : Spontaneous deep vein thrombi may occur in the setting of venous endothelial injury, even if mild. Most cases of postoperative deep venous thrombosis are believed to start in the area of the valve cusps, where stasis is at its maximum.{135}. Ref ID : KAKKAR1969B 653. Kakkar, V.V., Howe, C.T., Laws, J.W., and Flanc, C. Late Results of Treatment of Deep Vein Thrombosis. Brit.Med.J. (March 29):810-811, 1969. Keywords : 96-suzy-002; LATE; TREATMENT; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; an; in; LEG; TECHNIQUES; THROMBUS; DIAGNOSIS; RISK Notes : 01-03-96. Abstract : Summary: Twenty-two patients who had an acute episode of thrombosis in the deep vein of the legs were studied by a new technique of ascending functional cinephlebography 6 to 12 months after the episode of thrombosis. If the condition was diagnosed within 36 hours and the thrombus was dissolved rapidly valve function was preserved. When diagnosis was delayed there was a very great risk of permanent damage tto the valves. Ref ID : KAKKAR1970 654. Kakkar, V.V., Howe, C.T., Nicolaides, A.N., Renney, J.T., and Clarke, M.B. Deep vein thrombosis of the leg: Is there a "high-risk" group? Am.J.Surg. 120:527-530, 1970. Keywords : DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; LEG; DVT; RISK; RECURRENCE; AGE; PROSPECTIVE; POSTOPERATIVE; VENOUS; VENOUS THROMBOSIS; PE; INCIDENCE; VARICOSITIES; vein; is; an; RISK FACTORS; PROSPECTIVE STUDIES Notes : Patients with a past history of DVT have a five times higher risk of recurrence compared to those who have not had prior DVT. It is widely believed, although unproven, that superficial varicosities are an independent risk factor for DVT. Kakkar and Nicolaides have both found that patients below age 60 with varicosities were 3 times more likely to have DVT when compared with those who had no varicosities. This finding has been disputed by Sigal, who found no such association. Prospective studies show that a past history of DVT raises the likelihood of new postoperative venous thrombosis from 26 percent to 68 percent. Patients with a past history of DVT and confirmed PE had a 100 percent incidence of postoperative new venous thrombosis. Ref ID : KAKKAR1985 655. Kakkar, V.V. Pathophysiologic characteristics of venous thrombosis. Am.J.Surg. 150(4A):1, 1985. Keywords : VENOUS; THROMBOSIS; PATHOPHYSIOLOGY; ETIOLOGY Ref ID : KAKKAR1985A 656. Kakkar, V.V. and Lawrence, D. Hemodynamic and clinical assessment after therapy for acute deep vein thrombosis. A prospective study. Am.J.Surg. 150:54-63, 1985. Keywords : HEMODYNAMICS; THERAPY; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PROSPECTIVE; PROSPECTIVE STUDIES; THROMBOLYSIS; HEPARIN; DVT; CLINICAL TRIALS; ACEP93; VEINS; in; an Notes : A prospective study of thrombolysis versus heparin in acute DVT, with an excellent discussion of other clinical trials. Ref ID : KAKKAR1990 657. Kakkar, V.V. Prevention of venous thrombosis and pulmonary embolism. Am.J.Cardiol. 65(6):50-54, 1990. Keywords : PREVENTION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; VEINS; EPIDEMIOLOGY; PREVALENCE; UNITED STATES; DEEP VEIN THROMBOSIS; hospitalization; in; vein Notes : More than 600,000 hospitalizations in the United States each year result from deep vein thrombosis and its sequelae. Ref ID : KANDARPA1993 658. Kandarpa, K., Chopra, P.S., Aruny, J.E., Polak, J.F., Donaldson, M.C., Whittemore, A.D., Mannick, J.A., Goldhaber, S.Z., and Meyerovitz, M.F. Intraarterial thrombolysis of lower extremity occlusions: prospective, randomized comparison of forced periodic infusion and conventional slow continuous infusion [see comments]. Radiology 188(3):861-867, 1993. Keywords : 951216; INTRAARTERIAL; THROMBOLYSIS; Extremities; OCCLUSION; PROSPECTIVE; RANDOMIZED; RANDOMIZED CONTROLLED TRIALS; UROKINASE; ci; in; Ischemia; THROMBUS; TECHNIQUES; HEPARIN; THROMBI; LYSIS; COMPLICATION; OUTCOME; LYTIC; THERAPY; AGED; Arterial Occlusive Diseases; th; COMPARATIVE STUDY; FEMALE; HUMAN; infusions,intra- arterial; mt; LEG; bs; MALE; MIDDLE AGE; PROSPECTIVE STUDIES; Support,Non-U.S.Gov't; THROMBOLYTIC THERAPY; ad; Medline File; BRIGHAM; Hospitals; boston Notes : A prospective randomized controlled trial compared forced infusion (FI) of urokinase (UK) with conventional slow continuous infusion (CI) in 25 patients with 25 acutely ischemic lower limbs. Demographics, ischemia categories, and infusion rates and doses were similar for both groups. A preliminary single-pass bolus of UK was injected into the thrombus in all patients with a pulsed-spray technique, and heparin was administered. UK was then infused with a CI pump (n = 13) or a prototype pulsed-spray pump (n = 12). The primary end point was patency, defined as at least 95% thrombolysis by volume, with brisk antegrade flow occurring within 4 hours. Eleven of the 12 patients (92%) who underwent FI and nine of the 13 (70%) who underwent CI had patency within 4 hours. However, 10 patients who underwent FI and nine who underwent CI had residual thrombi prolonging infusion. No significant differences between the two groups were apparent in speed of lysis, initial success rates, complication rates, or 30-day clinical outcome. Lytic therapy, however, was completed within 24 hours in 18 of 23 (78%) successfully treated patients (P = .01) Department of Radiology Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : KANDARPA1994 659. Kandarpa, K., Goldhaber, S.Z., and Meyerovitz, M.F. Pulse-spray thrombolysis: the "careful analysis" [comment] [see comments]. Radiology 193(2):320-324, 1994. Keywords : 951216; THROMBOLYSIS; analysis; COMPARATIVE STUDY; HUMAN; infusions,intra-arterial; mt; LEG; bs; pulsatile flow; THROMBOLYTIC THERAPY; THROMBOSIS; dt; Medline File; BRIGHAM; Hospitals; boston Notes : [No Abstract Available] Department of Radiology Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : KAPITAN1990 660. Kapitan, K.S., Clausen, J.L., and Moser, K.M. Gas exchange in chronic thromboembolism after pulmonary thromboendarterectomy. Chest 98:14-19, 1990. Keywords : CHRONIC; THROMBOEMBOLISM; UCSD; TREATMENT; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; SURGERY; TECHNIQUES; CARDIAC; CARDIAC OUTPUT; PGM-8/94; in; critical care; ab; is; an Notes : CS- Division of Pulmonary and Critical Care Medicine, UCSD Medical Center AB- Thromboendarterectomy is the treatment of choice for chronic large vessel thromboembolic pulmonary hypertension. To identify the mechanisms responsible for the improvement in gas exchange following thromboendarterectomy, we studied nine patients with chronic thromboembolic pulmonary hypertension before and eight to 18 months after surgery using the multiple inert gas elimination technique. Preoperatively, all subjects had pulmonary hypertension and were hypoxemic or had an elevated P(A-a)O2. The VA/Q distribution was widened with an elevated VD/VT and a low cardiac index. After thromboendarterectomy, significant improvement had occurred. The VA/Q distribution had narrowed to near normal, and the cardiac index increased. It was concluded that thromboendarterectomy improved gas exchange both by improving VA/Q relationships and by increasing cardiac output. Ref ID : KARWINSKI1989 661. Karwinski, B. and Svendsen, E. Comparison of clinical and postmortem diagnosis of pulmonary embolism. J.Clin.Pathol. 42:135-139, 1989. Keywords : 951202; POSTMORTEM; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; INCIDENCE; in; CONTRAST; CAUSE; cause of death; DEATH; Pulmonary emboli; EMBOLI; CLINICAL DIAGNOSIS; heart; heart diseases; CANCER; statistics; FATAL; AGED; AUTOPSY; COMPARATIVE STUDY; FEMALE; HUMAN; MALE; di; mo; PA; Retrospective Studies; Medline File; Health Planning & Administration File; Cancerlit File; pathology; Norway; PE; MISSED DIAGNOSIS; Important article Notes : The incidence of pulmonary embolism and the number of clinically missed diagnoses of it in necropsies carried out between 1960 and 1984 at this department were investigated. Pulmonary embolism primarily affects elderly people with serious underlying disease; in this study it was found more often in women. The incidence of pulmonary embolism (9% of all necropsies) was unchanged during the period studied. In contrast, pulmonary embolism as the "sole" cause of death increased (p less than 0.0005). Although most pulmonary emboli were the immediate cause of death, the clinical diagnosis was often missed (in 84% of all cases). Furthermore, such clinically missed diagnoses increased over the years (p less than 0.005), especially in patients with heart disease and cancer. Without necropsy there will be considerable underdiagnosis of pulmonary embolism, therefore providing a misleading figure in the death statistics for this often fatal disease Department of Pathology Gade Institute University of Bergen Norway [CFF:PE was found in 9% of all autopsies performed at the University of Bergen between 1960 and 1984. Most were the immediate cause of death, but the clinical diagnosis was made in only 16% of cases]. Ref ID : KARWINSKI1993 662. Karwinski, B., Svendsen, E., and Seim, S. Pulmonary embolism and heart disease. An autopsy study. Pathol.Res.Pract. 189:1058-1062, 1993. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; heart; heart diseases; an; AUTOPSY; FREQUENCY; in; MYOCARDIAL INFARCTION; infarction; MI; CHRONIC; rheumatic heart disease; Hospitals; DEATH; CAUSE; DURATION; THERAPY; TRENDS; ANTICOAGULATION; TREATMENT; Adolescence; ADULT; Age Factors; AGED; Aged,80 and over; HUMAN; MIDDLE AGE; co; ep; Medline File; pathology; Norway Notes : The frequency of pulmonary embolism in patients with myocardial infarction (MI) and chronic rheumatic heart disease (RHE) has been investigated in an autopsy series. The series comprised 21530 hospital autopsies from 1960 to 1984. Altogether 5351 patients with MI and 289 patients with RHE as underlying death cause were selected for this study. Patients with RHE or old myocardial infarction (OMI) had a significantly higher frequency of pulmonary embolism than patients with acute myocardial infarction (AMI) or acute and old myocardial infarction combined (AOMI). This was true irrespective of duration of stay in the hospital during last admission. The frequency of pulmonary embolism decreased in patients with OMI or RHE from 1960 to 1984 suggestive of better therapy of chronic heart failure. A similar trend was seen in patients with AMI during a period with consistent anticoagulation treatment Department of Pathology Gade Institute University of Bergen Norway. Ref ID : KASPER1975 663. Kasper, C.K. Thromboembolic complications. Thromb.Haemost. 33:640- 644, 1975. Keywords : THROMBOEMBOLIC; COMPLICATIONS; ANTITHROMBIN III Ref ID : KAUFMAN1987 664. Kaufman, B.S., Kaminsky, S.J., Rackow, E.C., and Weil, M.H. Adult respiratory distress syndrome following orogenital sex during pregnancy. Crit.Care Med. 15:703-704, 1987. Keywords : ADULT; RESPIRATORY DISTRESS; RESPIRATORY DISTRESS SYNDROME; Syndrome; PREGNANCY; Adolescence; CASE REPORT; critical care; embolism,air; co; et; FEMALE; fetal death; HUMAN; Pregnancy Complications; respiratory distress syndrome,adult; th; sex behavior; vagina; Medline File; sex Notes : [No Abstract Available]. Ref ID : KAUFMANN1988 665. Kaufmann, R. [Phlebology--current therapeutic aspects from the dermatologic viewpoint]. Z.Hautkr. 63:577-584, 1988. Keywords : PATHOPHYSIOLOGY; VENOUS; TREATMENT; THERAPY; CHRONIC; CHRONIC VENOUS INSUFFICIENCY; Venous Insufficiency; SURGICAL; NASP; English Abstract; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab; diagnostics; in; dermatologist; is; ad Notes : TT - Phlebologie--aktuelle therapeutische Aspekte aus dermatologischer Sicht AB - Modern diagnostic procedures in phlebology have not only enhanced our understanding of the pathophysiology of the venous system; they also provide considerable help in the planning and evaluation of phlebotherapeutical measures. Thus the dermatologist involved in phlebology has become able to proceed in a differentiated way regarding the treatment of primary varicosis as well as preventive measures and therapy of chronic venous insufficiency. The treatment includes both conservative and surgical procedures and is based on experiences in phlebology, allergology, topical dermatotherapy, and dermatosurgery AD - Abteilung Dermatologie AD - Universitat Ulm UI - 89045976. Ref ID : KAWASAKI1992 666. Kawasaki, S., Henderson, J.M., Riepe, S.P., Brooks, W.S., and Hertzler, G. Endoscopic variceal sclerosis does not increase the risk of portal venous thrombosis. Gastroenterol. 102:206-215, 1992. Keywords : SCLEROSIS; RISK; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SCLEROTHERAPY; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; CHRONIC; in; an Notes : Contrary to reports from other investigators, chronic sclerotherapy of esophageal varices does not result in an increased risk of portal venous thrombosis. Ref ID : KAY1991 667. Kay, S. and Gilpin, D.J. Combined microsurgical and thrombolytic salvage of an ischaemic lower limb in a 1079 gram preterm neonate. Br.J.Plast.Surg. 44:310-311, 1991. Keywords : THROMBOLYTIC; ACEP93; an; in Ref ID : KAY1995 668. Kay, R., Wong, K.S., Yu, Y.L., Chan, Y.W., Tsoi, T.H., Ahuja, A.T., Chan, F.L., Fong, K.Y., Law, C.B., Wong, A., and Woo, J. Low-Molecular- Weight Heparin for the Treatment of Acute Ischemic Stroke. The New England Journal of Medicine 333(24):1588-1593, 1995. Keywords : 96-suzy-002; Low-molecular-weight heparin; HEPARIN; TREATMENT; STROKE; Safety; Antithrombotic; in; THROMBOEMBOLIC; SUBCUTANEOUS; standards; Methods; RANDOMIZED; DOSAGE; PLACEBOS; OUTCOME; DEATH; HEMORRHAGIC; infarction; COMPLICATIONS; Died; TRENDS; secondary Notes : 01-04-96. Abstract : Background. Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute ischemic stroke. Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin. Methods. We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke. Patients were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti-factor Xa IU twice a day), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was death or dependency regarding activities of daily living six months after randomization. Secondary outcomes were death, hemorrhagic transformation of the infarction, and other complications at 10 days, and death or dependency at 3 months. Results. A total of 2750 patients were screened for the study. Among 312 patients randomized, 306 had outcomes that were analyzed at six months. Forty-five patients (45 percent) in the high- dose group, 53 patients (52 percent) in the low- dose group, and 68 patients (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P=0.005 by the chi square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days. Conclusions. For patients with ischemic stroke treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomesat six months. Ref ID : KEANE1994 669. Keane, M.G., Ingenito, E.P., and Goldhaber, S.Z. Utilization of venous thromboembolism prophylaxis in the medical intensive care unit [see comments]. Chest 106(1):13-14, 1994. Keywords : 951216; VENOUS; THROMBOEMBOLISM; PROPHYLAXIS; in; intensive care; intensive care units; PROSPECTIVE; RISK; is; Adolescence; ADULT; AGED; Aged,80 and over; BANDAGES; Data Collection; FEMALE; HEPARIN; ad; HUMAN; MALE; MIDDLE AGE; Pressure; RISK FACTORS; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. et; pc; WARFARIN; Medline File; Health Planning & Administration File; BRIGHAM; Hospitals; boston Notes : We conducted a prospective survey of the utilization of venous thromboembolism (VTE) prophylaxis in 152 Medical ICU (MICU) patients. Utilization of prophylaxis was recorded daily, and commonly accepted risk factors for VTE were noted. Only 32.9 percent of patients received prophylaxis, and there was a delay of 2.0 +/- 2.8 days prior to institution. Eighty-seven percent of patients had one VTE risk factor and 52 percent had multiple factors. We conclude that utilization of prophylaxis is low in MICU patients even though they are at high risk for VTE Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston 02115. Ref ID : KEARON1993 670. Kearon, C. and Hirsh, J. Optimal dose for starting and maintaining low-dose aspirin. Arch.Intern.Med. 153(6):700-702, 1993. Keywords : 951217; ASPIRIN; ad; tu; HUMAN; THROMBOSIS; bl; pc; thromboxane b2; Medline File; Hospitals; ontario; CANADA Notes : [No Abstract Available] Hamilton Civic Hospitals Research Center Ontario Canada. Ref ID : KEARON1994 671. Kearon, C. and Hirsh, J. Factors influencing the reported sensitivity and specificity of impedance plethysmography for proximal deep vein thrombosis. Thromb.Haemost. 72(5):652-658, 1994. Keywords : 951217; SENSITIVITY; sensitivity and specificity; SPECIFICITY; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; IPG; DVT; in; VENOGRAPHY; is; VENOUS; ULTRASOUND; Extension; CALF; RISK; PREDICTIVE VALUE; HUMAN; Plethysmography,Impedance; predictive value of tests; PREVALENCE; Reproducibility of Results; THROMBOPHLEBITIS; di; ep; Medline File; Health Planning & Administration File; Hospitals; ontario; CANADA Notes : A number of recent studies have found a considerably lower sensitivity of the IPG for proximal DVT than originally reported. We reviewed the literature to try and identify reasons for the between study differences in sensitivity and specificity of the IPG for proximal DVT. A number of biases were identified which may have inflated the sensitivity reported by some earlier studies including: repeated IPG testing prior to venography; inclusion of data from patients used to derive the IPG discriminant line in the final calculation of sensitivity; and inclusion of patients with a known abnormal IPG in the study population. In addition, there is emerging evidence that, at least in some centers, the sensitivity of the IPG may have decreased due to a shift in the spectrum of proximal DVTs to smaller clots. Furthermore, rates of conversion during serial follow- up are considerably higher for IPG than for venous ultrasound, suggesting that IPG conversion is often due to extension of small missed proximal DVTs rather than just extension of calf vein clots. As the smaller proximal DVTs which IPG is prone to miss are likely to be clinically less important than more extensive clots, it is unclear whether the recently reported drop in sensitivity of the IPG places patients at increased risk. IPG users need to be aware of its limitations, and we recommend that additional testing is performed in patients with a high clinical suspicion of DVT who have a normal IPG, as the negative predictive value of IPG may be unacceptable in these circumstances McMaster University Hamilton Civic Hospitals Research Center Ontario Canada. Ref ID : KEARON1995 672. Kearon, C. and Hirsh, J. Starting prophylaxis for venous thromboembolism postoperatively. Arch.Intern.Med. 155:366-372, 1995. Keywords : LMWH; Low-Molecular-Weight-Heparin; PROPHYLAXIS; VENOUS; THROMBOEMBOLISM; RISK; SURGICAL; BLEEDING; ANTICOAGULANTS; Literature review; REVIEW; RANDOMIZED; OUTCOME; Methods; SURGERY; Low-molecular- weight heparin; HEPARIN; Orthopedic; in; is Notes : A large proportion of hospitalized patients who are at high risk for venous thromboembolism (VTE) do not receive prophylaxis. Reluctance to use VTE prophylaxis in surgical patients may be due to fear of perioperative bleeding when anticoagulants are given preoperatively. We preformed a literature review to determine (1) whether prophylaxis for VTE is effective when it is started postoperatively and (2) the relative efficacy of preoperatively and postoperatively initiated prophylaxis. Studies were included in the review (1) if they were randomized trials with "blind" assessment of appropriate VTE outcomes, and (2) if prophylaxis was started postoperatively. Randomized, controlled trials establish that pharmacologic and nonpharmacologic methods of prophylaxis that are effective when started preoperatively are also effective when they are started postoperatively, with relative risks for VTE of 0.16 to 0.49. Low rates of VTE in noncontrolled randomized trials that included postoperatively initiated prophylactic regimens support this finding. The relative efficacy of preoperatively and postoperatively initiated VTE prophylaxis could not be determined definitively, as direct comparisons of the same regimens have not been performed. Indirect comparisons suggest that any loss of efficacy resulting from deferring VTE prophylaxis until after surgery is unlikely to be marked. Randomized trials are required to resolve this question. This comparison may be of greatest clinical importance when twice-daily, low-molecular-weight heparin is used to prevent VTE after major orthopedic surgery. Ref ID : KEARON1995A 673. Kearon, C. and Hirsh, J. Starting prophylaxis for venous thromboembolism postoperatively [see comments]. Arch.Intern.Med. 155(4):366-372, 1995. Keywords : 951217; PROPHYLAXIS; VENOUS; THROMBOEMBOLISM; RISK; in; SURGICAL; BLEEDING; ANTICOAGULANTS; Literature review; REVIEW; is; RANDOMIZED; OUTCOME; Methods; SURGERY; Low-molecular-weight heparin; HEPARIN; Orthopedic; CLINICAL TRIALS; HUMAN; Postoperative Care; Postoperative Complications; pc; Preoperative Care; research design; Support,Non-U.S.Gov't; et; Medline File; Health Planning & Administration File; ontario Notes : A large proportion of hospitalized patients who are at high risk for venous thromboembolism (VTE) do not receive prophylaxis. Reluctance to use VTE prophylaxis in surgical patients may be due to fear of perioperative bleeding when anticoagulants are given preoperatively. We preformed a literature review to determine (1) whether prophylaxis for VTE is effective when it is started postoperatively and (2) the relative efficacy of preoperatively and postoperatively initiated prophylaxis. Studies were included in the review (1) if they were randomized trials with "blind" assessment of appropriate VTE outcomes, and (2) if prophylaxis was started postoperatively. Randomized, controlled trials establish that pharmacologic and nonpharmacologic methods of prophylaxis that are effective when started preoperatively are also effective when they are started postoperatively, with relative risks for VTE of 0.16 to 0.49. Low rates of VTE in noncontrolled randomized trials that included postoperatively initiated prophylactic regimens support this finding. The relative efficacy of preoperatively and postoperatively initiated VTE prophylaxis could not be determined definitively, as direct comparisons of the same regimens have not been performed. Indirect comparisons suggest that any loss of efficacy resulting from deferring VTE prophylaxis until after surgery is unlikely to be marked. Randomized trials are required to resolve this question. This comparison may be of greatest clinical importance when twice-daily, low-molecular-weight heparin is used to prevent VTE after major orthopedic surgery McMaster University Hamilton Ontario. Ref ID : KEARON1995B 674. Kearon, C. and Hirsh, J. The diagnosis of pulmonary embolism. Haemostasis 25(1-2):72-87, 1995. Keywords : 951217; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; CLINICAL DIAGNOSIS; PE; is; MANAGEMENT; LUNG; SCANNING; PROBABILITY; THERAPY; THROMBOSIS; in; VEINS; LEG; DVT; NONINVASIVE; VENOGRAPHY; ANTICOAGULATION; SCAN; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PREGNANCY; D- DIMER; PREDICTIVE VALUE; diagnostics; hematologic tests; HUMAN; likelihood functions; PHLEBOGRAPHY; predictive value of tests; PULMONARY ARTERY; ra; di; ri; Medline File; CANADA Notes : Although clinical diagnosis of pulmonary embolism (PE) is not sufficiently reliable to determine management, it is valuable for stratifying patients into high, intermediate, and low clinical suspicion of embolism. Clinical assessment can then be combined with lung scanning to identify groups of patients with a sufficiently high or low probability of PE that a decision to anticoagulate or withhold therapy can be made. Approximately half of patients with suspected PE will fall into one of these categories. Thrombosis in the deep veins of the leg (DVT) can be detected by noninvasive tests in approximately 50%, and by bilateral venography in approximately 70% of patients with PE, and provides grounds for anticoagulation of some patients with nondiagnostic combinations of clinical and lung scan assessments. Failure to detect DVT makes it less likely but does not exclude the possibility that the patient had a PE. Preliminary evidence suggests that the majority of patients with nondiagnostic combinations of clinical assessment, lung scanning, and negative noninvasive tests for DVT can safely be managed without anticoagulation, provided serial noninvasive tests for DVT remain normal over a 2-week period. Pulmonary angiography may be advisable in patients with nondiagnostic combinations of the above tests in whom (a) the probability of PE remains high (e.g. 30-80%), (b) cardiopulmonary reserve is poor, (c) serial follow-up is not feasible, or (d) future management (e.g. subsequent pregnancy) would be influenced by the result. D-Dimer measurements are sensitive but nonspecific for PE and therefore may have a high negative predictive value, further simplifying the diagnostic approach to PE McMaster University Hamilton Ont Canada. Ref ID : KECHAVARZ1992 675. Kechavarz, B., Oburger, K., Konig, B., Kohn, H., and Partsch, H. [Follow-up after conservative therapy of leg-pelvic vein thrombosis. Isotope phlebography and lung scan in the acute stage]. Vasa.Suppl. 37:36-7:36-37, 1992. Keywords : 951217; THERAPY; vein; THROMBOSIS; PHLEBOGRAPHY; LUNG; SCAN; in; Adolescence; ADULT; AGED; Aged,80 and over; BANDAGES; Combined Modality Therapy; FEMALE; Follow-Up Studies; HEPARIN; ad; heparin,low- molecular-weight; HUMAN; injections,subcutaneous; MALE; MIDDLE AGE; phenprocoumon; PROSPECTIVE STUDIES; PULMONARY EMBOLISM; ri; th; radionuclide angiography; THROMBOPHLEBITIS; Medline File Notes : [No Abstract Available] Dermatologische Abteilung Wilhelminenspital. Ref ID : KEEMAN1976 676. Keeman, J.N. [The treatment of varicose veins]. Ned.Tijdschr.Geneeskd. 120:2156-2166, 1976. Keywords : TREATMENT; NASP; BANDAGES; Electrocoagulation; HUMAN; Ligation; Methods; Postoperative Complications; SAPHENOUS VEIN; Sclerosing Solutions; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - De behandeling van varicosis AB - [No Abstract Available] UI - 77100533. Ref ID : KELBEL1994 677. Kelbel, C., Hafner, G., Schinzel, H., Prellwitz, W., and Weilemann, L.S. [The use of low-molecular heparin for anticoagulation in pregnancy] Einsatz von niedermolekularem Heparin zur Antikoagulation in der Schwangerschaft. Dtsch.Med.Wochenschr. 119:1497-1500, 1994. Keywords : EMBOLISM; PREGNANCY; HEPARIN; ANTICOAGULATION; BEDREST; THROMBOSIS; Femoral Vein; VEINS; Pulmonary emboli; EMBOLI; DOSAGE; THROMBOLYSIS; TREATMENT; COAGULATION; Molecular Weight; LMWH; COMPLICATIONS; MATERNAL; VENOUS; CASE REPORT; FEMALE; HUMAN; Heparin,Low-Molecular-Weight ,Administration and Dosage ,AD; Pregnancy Complications,Hematologic ,Drug Therapy ,DT; Abortion,Threatened ,Complications ,CO Abortion,Threatened ,Prevention and Control ,PC; ADULT; Iliac Vein; Pregnancy Complications,Hematologic ,Diagnosis ,DI Pregnancy Complications,Hematologic ,Etiology ,ET; Pregnancy Outcome; Pulmonary Embolism ,Diagnosis ,DI Pulmonary Embolism ,Drug Therapy ,DT Pulmonary Embolism ,Etiology ,ET; RECURRENCE; Thrombosis ,Diagnosis ,DI Thrombosis ,Drug Therapy ,DT Thrombosis ,Etiology ,ET; in; ab; an; blood; is Notes : CS- Abteilung fur Innere Medizin mit Schwerpunkt Pneumologie, Universitat Mainz AB- A 26-year-old woman, on bedrest since the 6th week of pregnancy because of threatened abortion, developed thrombosis in the left iliac, superficial femoral and common femoral veins with small pulmonary emboli in the 11th week. Inhibitor deficiency was excluded. The thrombosis was only partially recanalized by unfractionated heparin at therapeutic dosage (38,400 IU per 24 h). As thrombolysis treatment and oral anticoagulation were contraindicated because of the threatened abortion, coagulation with low molecular weight heparin (LMWH) was started in the 18th week (5000 anti-Xa units daily subcutaneously). Maximal anti-Xa activity in plasma never exceeded 0.3 U/ml and there were no complications. The patient was delivered of a healthy girl (2,660 g, 48 cm) by caesarean section in the 37th week. Immediately post-partum LMWH was demonstrated with an anti-Xa activity of 0.3 U/ml in maternal blood, but none in simultaneously obtained cord venous blood. This case suggests that treatment of phlebothrombosis with LMWH is a reasonable measure even during pregnancy. Ref ID : KELLAM1987 678. Kellam, B., Fraze, D., and Kanarek, K.S. Clot lysis for thrombosed central venous catheters in pediatric patients. J.Perinatol. 7:242-244, 1987. Keywords : LYSIS; THROMBOSED; CENTRAL VENOUS CATHETER; VENOUS; CATHETER; PEDIATRIC; ACEP-93; ACEP93; Catheters; in Ref ID : KELLEY1991 679. Kelley, M.A., Carson, J.L., Palevsky, H.I., and Schwartz, J.S. Diagnosing pulmonary embolism: new facts and strategies [see comments]. Ann.Intern.Med. 114:300-306, 1991. Keywords : PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; REVIEW; diagnostics; PROSPECTIVE; PREVALENCE; SENSITIVITY; sensitivity and specificity; SPECIFICITY; PREDICTIVE VALUE; LUNG; SCAN; PROBABILITY; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; Extremities; THROMBOEMBOLISM; an; in; analysis; is Notes : PURPOSE: To provide a clinical approach to the diagnosis of pulmonary embolism. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1982 to 1990) and bibliographic reviews of textbooks and review articles. STUDY SELECTION: In addition to several reviews, studies that evaluated the diagnostic technology of pulmonary embolism were selected. Preference was given to studies with a prospective design, particularly those done within the past decade. DATA EXTRACTION: Studies were assessed independently by three unblinded observers. Data were chosen to describe the efficacy of diagnostic technology on the basis of disease prevalence, sensitivity and specificity, and predictive value. RESULTS OF DATA ANALYSIS: A normal lung scan or pulmonary angiogram rules out the diagnosis of clinically important pulmonary embolism with at least 95% certainty. Lung scan interpretations indicating high or low probability have approximately a 15% error in diagnosing or ruling out pulmonary embolism. The accuracy of either scan result improves when the clinical suspicion of pulmonary embolism matches the lung scan result. Serial impedance plethysmography of the lower extremities may exclude thromboembolism with 95% certainty in patients without high-probability lung scan results or cardiopulmonary disease. CONCLUSIONS: The combination of clinical suspicion and the results of the lung scan and impedance plethysmography appear to offer acceptable diagnostic accuracy in evaluating many patients suspected of having pulmonary embolism. The usefulness of this approach for patients with cardiopulmonary disease is still unknown. Ref ID : KEMONA1989 680. Kemona, A., Nowak, H.F., Dzieciol, J., Sulik, M., Sulkowski, S., and Dziecio, J. [Pulmonary bone marrow embolism in nonselected autopsy material]. Patol.Pol. 40:197-204, 1989. Keywords : 951202; EMBOLISM; in; AUTOPSY; INCIDENCE; EMBOLI; PULMONARY ARTERY; Arteries; AGE; sex; AGED; FRACTURES; Neoplasms; SHOCK; ADULT; bone marrow; English Abstract; FEMALE; co; HUMAN; MALE; MIDDLE AGE; Poland; ep; PULMONARY EMBOLISM; et; PA; Medline File; Cancerlit File Notes : We analyzed the incidence of bone marrow emboli of the pulmonary arteries in nonselected autopsy material involving 620 cases. We evaluated the incidence of these emboli, age, sex, underlying disease and microscopic picture. It was found that bone marrow emboli of the pulmonary arteries occurred in 7% of cases, most frequently in patients aged from 50 to 69 years and they were located in the medium and small- lumen arteries. It was found that bone marrow emboli of the pulmonary arteries may complicate posttraumatic bone fractures, costal and sternal fractures in the course of reanimation as well as malignant neoplasms and shock. Ref ID : KERR1990 681. Kerr, T.M., Cranley, J.J., Johnson, J.R., Lutter, K.S., Riechmann, G.C., Cranley, R.D., True, M.A., and Sampson, M. Analysis of 1084 consecutive lower extremities involved with acute venous thrombosis diagnosed by duplex scanning. Surgery 108:520-527, 1990. Keywords : PHLEBITIS; analysis; Extremities; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Duplex; SCANNING; ACUTE DISEASE; ADULT; Age Factors; AGED; FEMALE; HUMAN; INCIDENCE; LEG; blood supply; MALE; MIDDLE AGE; Sex Factors; THROMBOPHLEBITIS; DIAGNOSIS; EPIDEMIOLOGY; SCAN; THROMBI; AGE; VEINS; VARICOSITIES; THROMBUS; FREQUENCY; in; sex Notes : A retrospective analysis of 8658 consecutive lower extremity venous duplex scans performed between the years 1982 to 1988 revealed 953 patients with involvement of 1084 extremities with acute deep or superficial thrombi. Records of patients with acute thrombi were then evaluated for the incidence, location, and patterns of distribution. There were 485 women (50.9%) and 468 men (49.1%), with a mean age of 62.9 +/- 16.7 years and 58.8 +/-15.2 years, respectively. There were 371 right-sided thrombi (180 women and 191 men), 451 left-sided thrombi (235 women and 216 men), and 131 (70 women and 61 men) patients with thrombi in both lower extremities. Women were found to be uniformly older, and the left leg was found to be involved more frequently (p less than 0.05). The overall distribution of the 3169 veins involved with acute thrombi in decreasing order were: popliteal, 16.1%; superficial femoral, 15.0%; posterior tibial, 13.4%; common femoral, 13.2%; greater saphenous, 9.9%; soleal, 9.1%; peroneal, 7.2%; deep femoral, 6.6%; lesser saphenous, 5.7%; anterior tibial, 2.0%; varicosities, 1.6%; and perforating, 0.3%. A different rank order was found in analysis of single thrombus patterns as follows: greater saphenous, 27.5%; soleal, 20.1%; lesser saphenous, 13.4%; varicosities, 8.8%; popliteal, 8.1%; posterior tibial, 9.1%; common femoral, 3.5%; superficial femoral, 4.9%; peroneal, 2.8%; deep femoral, 1.0%; anterior tibial, 0.3%; and perforating, 0.3%. In patients with multiple and bilateral thrombi there was a large number of unique patterns of thrombosis. Locations, patterns, and frequency of acute venous thrombi vary with age, sex, and leg involved. Patterns and statistical analyses of pertinent observations were performed. Ref ID : KERSTEIN1987 682. Kerstein, M.D., McSwain, N.E.,Jr., O'Connell, R.C., Webb, W.R., and Brennan, L.A. Obesity: Is it really a risk factor in thrombophlebitis? South.Med.J. 80:1236-1238, 1987. Keywords : OBESITY; RISK; THROMBOPHLEBITIS; DVT; PE; AGE; is; RISK FACTORS; in; an Notes : Obesity, defined as weight greater than 20 percent above ideal weight, has long been accepted as a risk factor for DVT and PE, but the evidence supporting this association has been questioned. When associated factors such as past history, illness, immobility, and age are taken into account it is possible that obesity may not truly be an independent risk factor. Ref ID : KESSLER1988 683. Kessler, C.M., Druy, E., and Goldhaber, S.Z. Acute pulmonary embolism treated with thrombolytic agents: Current status of tPA and future implications for emergency medicine. Ann.Emerg.Med. 17(11):1216- 1220, 1988. Keywords : PULMONARY EMBOLISM; EMBOLISM; THROMBOLYTIC; TPA; EMERGENCY; 951216; EMERGENCY MEDICINE; is; in; UNITED STATES; DEATH; an; INCIDENCE; MASSIVE; AUTOPSY; MORTALITY; THROMBOLYSIS; SURVIVAL; TREATMENT; REVIEW; PLASMINOGEN; PLASMINOGEN ACTIVATOR; FIBRIN; SPECIFICITY; UROKINASE; STREPTOKINASE; ALTEPLASE; tu; Emergencies; mt; td; FIBRINOLYTIC AGENTS; HUMAN; dt; Medline File Notes : Pulmonary embolism is diagnosed 120,000 times yearly in the United States and contributes to 30,000 deaths. This probably represents an underestimate of incidence because massive acute pulmonary embolism may often result in rapid and therefore unexplained death in the absence of autopsy confirmation. The innovative and judicious use of thrombolytic agents by emergency department and paramedical ambulance personnel may lead to a decreased mortality for this disease. Clinical studies are necessary to determine if the cardiopulmonary compromise associated with massive pulmonary embolism can be rapidly reversed through thrombolysis and whether that reversal will lead to increased survival. The use of thrombolytic agents will gain favor only if their risk:benefit and cost:benefit ratios are acceptable. We discuss the results of using first- and second-generation thrombolytic agents in the treatment of pulmonary embolism and review the encouraging data that have emerged from our studies with recombinant tissue-type plasminogen activator (tPA). This agent has relative fibrin specificity and may provide therapeutic advantages over the conventional thrombolytic agents, urokinase and streptokinase, particularly when the latter are administered in the currently recommended dose schedules for treatment of pulmonary embolism Department of Medicine School of Medicine George Washington University Washington DC 20037. Ref ID : KESSLER1989 684. Kessler, C.M. Anticoagulation and thrombolytic therapy: Practical considerations. Chest 95(5) Supp:245S-256S, 1989. Keywords : THERAPY; THROMBOSIS; THROMBOLYSIS; PLATELET; COAGULATION; ANTICOAGULATION; THROMBOLYTIC; THROMBOLYTIC THERAPY; REVIEW Notes : A detailed review of the mechanisms of thrombosis and of thrombolysis. Ref ID : KESSLER1991 685. Kessler, C.M. The pharmacology of aspirin, heparin, coumarin, and thrombolytic agents. Implications for therapeutic use in cardiopulmonary disease. Chest 99:97S-112S, 1991. Keywords : PHARMACOLOGY; ASPIRIN; HEPARIN; THROMBOLYTIC; TREATMENT; MEDICATIONS; RISK; COAGULATION; COMPLICATIONS; CLINICAL TRIAL; COUMARINS; FIBRINOLYTIC AGENTS; THROMBOLYTIC THERAPY; HUMAN; THROMBOEMBOLISM; THROMBOSIS; REVIEW; REVIEW TUTORIAL; therapeutic use; in; is; Vascular Patency; LYTIC; drugs; an; Safety; CLINICAL TRIALS Notes : AB-The modern treatment of cardiopulmonary disease is increasingly predicated on the goal of dissolving the offending clot to establish vascular patency as rapidly as possible and then preventing rethrombosis. The availability of thrombolytic agents has made this therapeutic approach possible and the adjunctive use of heparin, coumarin, and aspirin has increased the efficacy of lytic drugs. The administration of any of these medications is associated with inherent risks, which are enhanced when they are used concomitantly. An understanding of coagulation and an appreciation of the pathophysiologic processes of the thrombotic events occurring in cardiopulmonary disease states are critical to the formulation of innovative therapeutic regimens that maximize efficacy and safety. Furthermore, knowledge of the comparative pharmacology of the various thrombolytic agents is useful in explaining the benefits and complications observed in clinical trials. Ref ID : KESSLER1991A 686. Kessler, R., Fraisse, P., Krause, D., Veillon, F., and Vandevenne, A. Magnetic resonance imaging in the diagnosis of pulmonary infarction. Chest 99:298-300, 1991. Keywords : MAGNETIC RESONANCE; DIAGNOSIS; PULMONARY INFARCTION; MRI; PNEUMONIA; EMBOLI; sdi-11/93; magnetic resonance imaging; in; infarction Notes : We report for the first time, to our knowledge, MRI features which could differentiate noninvasively pulmonary infarction from pneumonia. Three subjects with angiographically proven pulmonary infarction showed high T1 weighted MRI signals located in the embolic territory. Three patients with pneumonia and one patient with emboli, but without infarction, did not have these T1 weighted images. Ref ID : KESSLER1992 687. Kessler, C.M. Personal communication. 1992. Keywords : RABBITS; LYSIS; THROMBOSIS; is Notes : Rabbit model is not a good one for lysis and thrombosis, because 'rabbits will lyse anything...'. Ref ID : KESSLER1995 688. Kessler, C.M., Esparraguera, I.M., Jacobs, H.M., Druy, E., Fortune, W.P., Holloway, D.S., Giordano, J., and Davidson, B.L. Monitoring the anticoagulant effects of a low molecular weight heparin preparation. Correlation of assays in orthopedic surgery patients receiving ardeparin sodium for prophylaxis of deep venous thrombosis. Am.J.Clin.Pathol. 103:642-648, 1995. Keywords : LMWH; Low-Molecular-Weight-Heparin; MONITORING; ANTICOAGULANT; Low molecular weight heparin; Molecular Weight; HEPARIN; Orthopedic; SURGERY; Sodium; PROPHYLAXIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROSPECTIVE; DOSAGE; PA; ANTICOAGULATION; Methods; partial thromboplastin time; THROMBOPLASTIN; APTT; HIP; KNEE; SUBCUTANEOUS; Antithrombotic; Injections; Body Weight; in; an; factor xa; st; mo Notes : This prospective, uncontrolled trial explored the relationship between varying dosages of a low molecular weight heparin (LMWH) preparation, ardeparin sodium (Normiflo, Wyeth-Ayerst, Philadelphia, PA), and anticoagulant effects, monitored by an amidolytic anticoagulation factor Xa (aXa) assay and by global coagulometric methods, including the activated partial thromboplastin time (APTT) and the Heptest (Haemachem, St. Louis, MO). Thirty-three patients undergoing elective unilateral total hip or knee replacement received subcutaneous ardeparin prophylaxis initiated 12 to 18 hours following surgery, administered at a fixed 40-mg dose twice daily, 50 aXa U/kg twice daily or 90 aXa U/kg once daily for up to 14 days. The target antithrombotic aXa levels, determined by amidolytic assay in plasma 6 hours after each ardeparin injection, were most optimally attained and maintained by twice-daily dosing based on body weight and correlated well with incremental increases in Heptest values measured chronometrically. The Heptest results at 12 hours after ardeparin administration indicated that the global anticoagulant effects produced by LMWH are sustained for many hours after subcutaneous dosing. Ref ID : KHASABOV1974 689. Khasabov, L.M. and Protsenko, N.P. [Blood coagulability in chronic leg ulcers against a background of varicose veins]. Vestn.Dermatol.Venerol. 48:47-51, 1974. Keywords : CHRONIC; LEG; Leg Ulcer; Ulcer; NASP; ADULT; BLOOD COAGULATION; Blood Coagulation Tests; Chronic Disease; COMPARATIVE STUDY; English Abstract; FEMALE; HUMAN; MIDDLE AGE; Thrombelastography; Varicose Ulcer; VARICOSE VEINS; Medline File; in; varicose; ab Notes : TT - Svertyvaiushchaia sposobnost' krovi pri khronicheskikh iazvakh goleni na fone varikoznogo rasshireniia ven AB - [No Abstract Available] UI - 74253833. Ref ID : KIERKEGAARD1983 690. Kierkegaard, A. Incidence and diagnosis of deep vein thrombosis associated with pregnancy. Acta.Obstet.Gynecol.Scand. 62:239-243, 1983. Keywords : INCIDENCE; DIAGNOSIS; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; PREGNANCY; POSTPARTUM; vein Ref ID : KIERKEGAARD1987 691. Kierkegaard, A., Norgren, L., Olsson, C.G., Castenfors, J., Persson, G., and Persson, S. Incidence of deep vein thrombosis in bedridden non-surgical patients. Acta Med.Scand. 222(5):409-414, 1987. Keywords : 951208; INCIDENCE; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; in; BEDRIDDEN; NON-SURGICAL; DVT; FIBRINOGEN; is; heart; PNEUMONIA; RISK; RISK FACTORS; internal medicine; Sweden Notes : In order to detect deep vein thrombosis (DVT), 101 patients with acute medical or infectious disorders were examined with the 125I- fibrinogen uptake test. All patients were bedridden on admission and were scanned daily from the second to the eighth day. Thirteen patients developed a positive fibrinogen uptake test. Thus, if a positive test is interpreted as DVT, the incidence of DVT was 13% in our bedridden patients. Of the patients admitted because of heart disease or pneumonia 20% had DVT, but only 4% of those admitted with other diagnoses. Other clinical "risk factors" studied, could not identify patients who developed DVT Department of Internal Medicine University of Lund Sweden. Ref ID : KIERKEGAARD1992 692. Kierkegaard, A., Norgren, L., Olsson, C.G., Castenfors, J., Persson, G., and Persson, S. Incidence of deep vein thrombosis in bedridden non-surgical patients. Acta.Med.Scand. 222:409-414, 1992. Keywords : INCIDENCE; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; NON- SURGICAL; BEDRIDDEN; vein; in Ref ID : KIEV1990 693. Kiev, J., Noyes, L.D., Rice, J.C., and Kerstein, M.D. Patient compliance with fitted compression hosiery monitored by photoplethysmography. Arch.Phys.Med.Rehabil. 71:376-379, 1990. Keywords : PHLEBITIS; COMPRESSION; ADULT; BANDAGES; Chronic Disease; FEMALE; HUMAN; LEG; blood supply; MALE; Microcirculation; MIDDLE AGE; monitoring,physiologic; patient compliance; Plethysmography; Methods; pulsatile flow; socioeconomic factors; THROMBOPHLEBITIS; DIAGNOSIS; THERAPY; MONITORING; compression hosiery; CHRONIC; VENOUS; diagnostics; TREATMENT; Progression; Hospitals; LONG TERM; in; is Notes : This study assessed the compliance useage and impact by monitoring of graded compression hosiery in chronic venous disease. Diagnostic methods, such as qualitative photoplethysmography (PPG), have enabled the physician to assess deep-vein valvular incompetence earlier and begin specific treatment measures to slow the progression of symptoms. This study group, comprised of 100 patients, was diagnosed initially with deep-venous thrombophlebitis and evaluated by phleborrheography and PPG at three-month intervals for one year. The patients were instructed to wear fitted, graded compression hosiery after hospital discharge; compliance was 37% at one year. The primary reason for noncompliance was socioeconomic. The price of the ideal graded compression hosiery was not easily within reach of this population and insurance reimbursement was difficult or impossible to obtain. Complaint patients felt better while wearing the compression hosiery. Increasing deterioration of qualitative PPG values of deep- valve assessment was found in both compliant and noncompliant patients at each testing interval. The PPG value deteriorated as time increased with or without the compression hose, although symptoms lessened when the prescribed hosiery was worn. The long-term sequelae of wearing or not wearing the hosiery are yet to be determined, but PPG assessment is normalized with the hosiery in place. Ref ID : KIM1976 694. Kim, H.S., Suzuki, M., Lie, J.T., and Titus, J.L. Clinically unsuspected disseminated intravascular coagulation (DIC): an autopsy survey. Am.J.Clin.Pathol. 66:31-39, 1976. Keywords : 951202; COAGULATION; DIC; AUTOPSY; in; REVIEW; disseminated intravascular coagulation; Syndrome; HISTOLOGIC; FIBRIN; THROMBI; Arterioles; Capillaries; VEINS; FREQUENCY; heart; LUNG; Liver; INFECTION; blood; POSTMORTEM; Adolescence; adrenal glands; PA; ADULT; AGED; bacterial infections; brain; cerebral embolism and thrombosis; cerebrovascular circulation; Child,Preschool; Coronary Circulation; CORONARY DISEASE; di; et; FEMALE; HUMAN; Infant; Infant,Newborn; kidney glomerulus; MALE; MIDDLE AGE; myocardium; PULMONARY EMBOLISM; pulmonary veins; Support,U.S.Gov't,P.H.S. Medline File; an Notes : In a review of 768 consecutive autopsies, 21 (2.7%) clinically unsuspected cases of disseminated intravascular coagulation (DIC) syndrome were diagnosed by histologic examination. DIC was diagnosed by the presence of fibrin thrombi in arterioles, capillaries, venules, and medium-sized veins. Fibrin thrombi were found, in the descending order of frequency, in the brain, heart, lungs, kidneys, adrenals, spleen and liver. Most patients had multiple visceral involvement, with three showing fibrin thrombi in as many as ten organs. The density of fibrin thrombi was greatest in the spleen, followed by kidneys, liver, lungs, adrenals, brain, and heart. A review of clinical data showed that infections were the most common underlying conditions in 13 cases, including nine with positive bacterial cultures from blood or cerebrospinal fluid, or both. The results suggest that, despite increasing clinical recognition of DIC, a great number of patients remain unsuspected of having the DIC syndrome prior to postmortem examination. Ref ID : KIM1994 695. Kim, S.W., Charallel, J.T., Park, K.W., Bauerle, L.C., Shang, C.C., Gordon, S.K., and Bauman, W.A. Prevalence of deep venous thrombosis in patients with chronic spinal cord injury. Arch.Phys.Med.Rehabil. 75(9):965-968, 1994. Keywords : 951208; PREVALENCE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; CHRONIC; Spinal cord; spinal cord injuries; INJURY; an; veterans; PROSPECTIVE; PROSPECTIVE STUDIES; DVT; RADIONUCLIDE; VENOGRAPHY; DIAGNOSIS; Physical Examination; CONTRAST; Immobilized; is; SURGICAL Notes : From a group of 229 patients with chronic spinal cord injury (SCI) who were admitted to an SCI Service of a Veterans Affairs Medical Center, a prospective study was performed to determine the prevalence of deep venous thrombosis (DVT) using radionuclide venography on 43 patients in whom this diagnosis was entertained by clinical examination. By physical examination of the total population of 229 patients on admission, patients were selected and then divided into two groups: the clinically DVT-free group (22 patients) and the clinically DVT-suspected group (21 patients). In the clinically DVT- free group, two cases of chronic DVT (9.1%) were detected incidentally. In the clinically DVT- suspected group, 2 cases of chronic DVT (9.5%) and 4 cases of acute DVT (19.0%) were found. In one subject in the DVT-free group, a false positive radionuclide study was suspected and proven by contrast venography. In the 43 patients studied by radionuclide venography, the prevalence of acute DVTs was 9.3% and chronic DVTs, 9.3% (7.0% "true" chronic DVTs). No subjects in the clinically DVT-free group had an acute DVT. Five of 8 DVTs (62.5%) were detected greater than 6 years after SCI and 3 of 4 (75%) of the acute DVTs developed 17 to 33 years after SCI. Thus, the prevalence of acute DVT cases in this chronically immobilized cohort was found to be relatively low when compared with that in prior reports in those with acute SCI, but the prevalence rate of acute DVT cases in the study herein is similar to or lower than that found in the surgical or medical nonambulatory, non-SCI population Spinal Cord Injury Service Veterans Affairs Medical Center Bronx NY 10468. Ref ID : KIMURA1984 696. Kimura, K., Morita, M., Matsutani, S., Saisho, H., Ohto, M., and Okuda, K. [Comparison with percutaneous transhepatic embolization and endoscopic injection sclerotherapy in esophageal varices]. Nippon.Rinsho. 42:2332-2336, 1984. Keywords : EMBOLIZATION; Injections; SCLEROTHERAPY; ESOPHAGEAL; NASP; Catheterization; COMPARATIVE STUDY; Embolization,Therapeutic; Esophagus; HUMAN; Sclerosing Solutions; VARICOSE VEINS; Medline File; in; ab Notes : AB - [No Abstract Available] UI - 85108553. Ref ID : KING1994 697. King, M.A., Bergin, C.J., Yeung, D.W., Belezzouli, E.E., Olson, L.K., Ashburn, W.L., Auger, W.R., and Moser, K.M. Chronic pulmonary thromboembolism: detection of regional hypoperfusion with CT. Radiology. 191:359-363, 1994. Keywords : CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; CT; LUNG; SCAN; Methods; CT scan; AGED; PERFUSION; SENSITIVITY; SPECIFICITY; CAUSE; PULMONARY HYPERTENSION; Hypertension; PGM-8/94; ab; in; is Notes : CS- Department of Radiology, University of California San Diego Medical Center 92103 AB- PURPOSE: To study the relationship of regional hypoperfusion and areas of decreased lung attenuation on computed tomographic (CT) scans of patients with chronic pulmonary thromboembolism. MATERIALS AND METHODS: Preoperative CT scans of five patients (four men and one woman, aged 29-72 years) with chronic pulmonary thromboembolism were reviewed and compared with axial single photon emission CT (SPECT) perfusion scans obtained at similar levels. Regions of varying attenuation and perfusion were scored on a three- point scale. RESULTS: In the five patients, 198 regions were identified. Of 176 abnormal regions at SPECT, 133 were abnormal at CT (sensitivity, 75.6%). Eleven of 22 regions interpreted as normal at SPECT were judged to have normal attenuation at CT (specificity, 50%). The overall accuracy of CT for detecting areas of hypoperfusion was 72.7% (P = .011). CONCLUSION: A mosaic pattern of lung attenuation at CT is a sign of variable regional perfusion and may suggest chronic pulmonary thromboembolism as a cause for pulmonary hypertension. Ref ID : KISTLER1993 698. Kistler, J.P., Singer, D.E., Millenson, M.M., Bauer, K.A., Gress, D.R., Barzegar, S., Hughes, R.A., Sheehan, M.A., Maraventano, S.W., and Oertel, L.B. Effect of low-intensity warfarin anticoagulation on level of activity of the hemostatic system in patients with atrial fibrillation. BAATAF Investigators. Stroke. 24:1360-1365, 1993. Keywords : WARFARIN; ANTICOAGULATION; HEMOSTATIC; Atrial fibrillation; Safety; STROKE; CARDIAC; EMBOLIZATION; Methods; THERAPY; PROTHROMBIN; AGE; CHRONIC; ASPIRIN; TREATMENT; sdi-11/93; in; boston Notes : BACKGROUND AND PURPOSE: The Boston Area Anticoagulation Trial for Atrial Fibrillation (BAATAF) demonstrated that low-intensity warfarin anticoagulation can, with safety, sharply reduce the rate of stroke in patients with nonvalvular atrial fibrillation. The beneficial effect of warfarin was presumably related to a decrease in clot formation in the cardiac atria and subsequent embolization. METHODS: To assess the effect of warfarin therapy on in vivo clotting in patients in the BAATAF, we measured the plasma level of prothrombin activation fragment F1+2. One sample was obtained from 125 patients from the BAATAF; 62 were taking warfarin and 63 were not taking warfarin (control group). RESULTS: The warfarin group had a 71% lower mean F1+2 level than the control group (mean F1+2 of 1.57 nmol/L in the control group compared with a mean of 0.46 nmol/L in the warfarin group; P < .001). F1+2 levels were higher in older subjects but were consistently lower in the warfarin group at all ages. Fifty-two percent of patients in the control group were taking chronic aspirin therapy at the time their F1+2 level was measured. Control patients taking aspirin had F1+2 levels very similar to control patients not taking aspirin (mean of 1.52 nmol/L for control patients on aspirin compared with 1.64 nmol/L for control patients off aspirin; P > .1). CONCLUSIONS: We conclude that prothrombin activation was significantly suppressed in vivo by warfarin but not aspirin among patients in the BAATAF. These findings correlate with the marked reduction in ischemic stroke noted among patients in the warfarin treatment group observed in the BAATAF. Ref ID : KISTNER1972 699. Kistner, R.L., Ball, J.J., Nordyke, R.A., and Freeman, G.C. Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities. Am.J.Surg. 124:169-176, 1972. Keywords : INCIDENCE; PULMONARY EMBOLISM; EMBOLISM; THROMBOPHLEBITIS; EPIDEMIOLOGY; in; Extremities Ref ID : KLEMENT1992 700. Klement, P., Borm, A., Hirsh, J., Maraganore, J., Wilson, G., and Weitz, J. The effect of thrombin inhibitors on tissue plasminogen activator induced thrombolysis in a rat model. Thromb.Haemost. 68(1):64- 68, 1992. Keywords : 951217; THROMBIN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; THROMBOLYSIS; in; Rats; blood; BLOOD FLOW; ARTERY; an; LYTIC; THERAPY; HEPARIN; is; t-PA; HIRUDIN; THROMBOPLASTIN; APTT; THROMBUS; FIBRIN; Aorta; ENDOTHELIUM; CATHETER; RANDOMIZED; MONITORING; Blood Pressure; Pressure; LYSIS; ALTEPLASE; tu; amino acid chloromethyl ketones; amino acid sequence; ANIMAL; Arterial Occlusive Diseases; ci; COMPARATIVE STUDY; disease models,animal; MALE; molecular sequence data; partial thromboplastin time; peptides; rats,inbred strains; Regional Blood Flow; de; Support,Non-U.S.Gov't; ai; THROMBOLYTIC THERAPY; mt; THROMBOSIS; dt; pp; Medline File Notes : Successful coronary thrombolysis depends on rapidly restoring blood flow and maintaining patency of the infarct-related artery. Although widely used as an adjunct to lytic therapy, heparin is limited in its ability to produce these effects. Since the limitations of heparin may reflect its inability to inactivate clot-bound thrombin, we developed a rat model of tissue plasminogen activator (t-PA) induced thrombolysis to compare doses of heparin, hirudin, hirulog (a synthetic hirudin-derived peptide), and D-Phe-Pro-ArgCH2Cl (PPACK) that produced a 4-fold prolongation of the baseline activated partial thromboplastin time (APTT) with saline in terms of their ability to accelerate thrombolysis and to prevent reocclusion. A thrombus rich in red cells and fibrin was formed in the distal aorta by applying an external constrictor after denuding the endothelium with a balloon catheter. Thrombolysis was induced with t-PA (1 mg/kg bolus, followed by 1 mg kg-1 h-1 over 30 min) and the rats were then randomized to receive a concomitant 80 min infusion of a thrombin inhibitor or saline. By continuously monitoring blood flow and pre- and post- stenotic blood pressures, the time to clot lysis, and the number of reocclusions were determined. Compared to saline, heparin had no significant effect on these variables.(ABSTRACT TRUNCATED AT 250 WORDS) Dept of Medicine McMaster University Cambridge MA. Ref ID : KLUKEN1970 701. Kluken, N. [Chronic venous insufficiency]. Arch.Klin.Exp.Dermatol. 237:117-139, 1970. Keywords : VENOUS; NASP; ADULT; Chronic Disease; Climacteric; Diagnosis,Differential; Eczema; Edema; Erythema; FEMALE; HUMAN; MALE; MIDDLE AGE; Physical Therapy; Skin Diseases; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vena Cava,Inferior; Medline File; ab Notes : TT - Die chronisch-venose Insuffizienz AB - [No Abstract Available] UI - 70130138. Ref ID : KNIGHT1980 702. Knight, B. and Zaini, M.R. Pulmonary embolism and venous thrombosis. A pattern of incidence and predisposing factors over 70 years. Am.J.Forensic Med.Pathol. 1:227-232, 1980. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; INCIDENCE; FREQUENCY; FATAL; INJURY; SURGICAL; is; pathology; EARLY; AUTOPSY; TECHNIQUES; TRAUMA; Pulmonary emboli; EMBOLI; in; an; Adolescence; ADULT; Age Factors; AGED; st; FEMALE; HUMAN; MALE; MIDDLE AGE; Postoperative Complications; ep; et; mo; Sex Factors; THROMBOPHLEBITIS; co; Wounds and Injuries; Medline File Notes : Due to the frequency with which fatal pulmonary embolism gives rise to medicolegal issues when allegedly a sequel to some injury or surgical intervention, some baseline information as to the general incidence and major predisposing factors is offered, extracted from the records of a university pathology institute over a 70-year period. It is clear that the condition was vitually unrecognized during the early part of the century. Using modern autopsy techniques, the incidence of venous thrombosis can be shown to considerably higher than that revealed by more cursory routine examination. Though trauma and medical and surgical procedures are associated with the majority of fatal pulmonary emboli, there is medicolegal significance in the fact that an appreciable residue have no evidence of such predisposing factors. Ref ID : KNUDSON1992 703. Knudson, M.M., Collins, J.A., Goodman, S.B., and McCrory, D.W. Thromboembolism following multiple trauma. J.Trauma. 32:2-11, 1992. Keywords : EMBOLISM; TRAUMA; THROMBOEMBOLISM; INCIDENCE; THROMBOEMBOLIC; COMPLICATIONS; Methods; PROPHYLAXIS; PROSPECTIVE; PROSPECTIVE STUDIES; HEPARIN; COMPRESSION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; Duplex; ULTRASOUND; THROMBUS; VEINS; Thigh; LUNG; SCAN; PULMONARY EMBOLISM; PE; Died; Hospitals; Immobilized; RISK; multiple trauma; is; in; abnormalities; an Notes : The true incidence of thromboembolic complications following multiple trauma is unknown, and no method of prophylaxis has been shown to be both safe and effective in managing seriously injured patients. In this prospective study, 113 trauma patients were assigned on admission to receive either low-dose heparin (LDH), (5,000 U subcutaneously every 12 hours) or to wear sequential compression devices (SCDs) as prophylaxis against the development of deep venous thrombosis (DVT). Both groups of patients were serially studied with duplex venous ultrasound imaging to detect thrombus in the veins of the thigh. Ventilation-perfusion lung scans and pulmonary angiograms were performed when pulmonary embolism (PE) was suspected clinically. There were 12 patients who had thromboembolic complications, including 9 of 76 in the SCD group (12%) and 3 of 37 in the LDH group (8%). Five patients had DVT only, four had PE without detectable DVT, and three had both DVT and PE. None of the patients with PE died, and there were no major complications associated with either method of prophylaxis. Compared with the patients who did not develop DVT/PE, those with thromboembolic complications were older (49 +/-23 vs. 36 +/- 17 years, p less than 0.02), spent more hospital days immobilized (24 +/- 15 vs. 10 +/- 13 days, p less than 0.001), received more transfusions (11 +/- 12 vs. 3 +/- 5 U, p less than 0.001) and had clotting abnormalities on admission, as demonstrated by prolonged PTT values (39 +/- 28 vs. 26 +/- 5 seconds, p less than 0.001). It appears that there is an identifiable subgroup of injured patients at highest risk for PE who warrant both prophylaxis and close surveillance for DVT. Ref ID : KOHLER1977 704. Kohler, F. and Schmitt, C.G. [About some rare complications caused by transvenous pacemaker electrodes. Morphological and clinical findings (author's transl)]. Z.Kardiol. 66:44-51, 1977. Keywords : 951202; COMPLICATIONS; Pacemaker; EARLY; LATE; myocardium; INFECTION; in; AUTOPSY; THROMBOEMBOLI; PULMONARY ARTERY; Arteries; CHRONIC; Fistula; DEATH; is; ACCIDENTS; AGED; electrodes; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; pacemaker,artificial; ae; PULMONARY EMBOLISM; et; PA; VEINS; Medline File Notes : Early and late dislocation of electrodes incl. perforation of myocardium and infections of pacemaker systems are the most frequent complications during endocardial pacing. Next functional disorders caused by a risen threshold for stimulation and sensing problems as well as pure technical defects have to be mentioned. The following rare complications were observed in three autopsies: 1. Electrode located in the vena cordis media. 2. Bipolar pacemaker electrode in unstable position near the atrioventricular boundary. 3. Infected transvenous pacemaker electrode migrated into the right vena iliaca externa. Letal thromboemboli sm of the pulmonary arteries. 4. Electrode fragment causing chronic cervical fistula. Consecutive death of the patient by bacterial endocarditis of the mitral valves. Some morphological and clinical aspects of these complications are discussed, the literature is reviewed. Special sight is kept on "trapped" electrodes and coincident infection. It is considered how to avoid those accidents. Ref ID : KOHN1987 705. Kohn, H., Konig, B., and Mostbeck, A. Incidence and clinical feature of pulmonary embolism in patients with deep vein thrombosis: a prospective study. Eur.J.Nucl.Med. 13 Suppl:S11-5:S11-5, 1987. Keywords : 951217; INCIDENCE; CLINICAL FEATURES; PULMONARY EMBOLISM; EMBOLISM; in; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PROSPECTIVE; PROSPECTIVE STUDIES; DVT; PE; NONINVASIVE; RADIONUCLIDE; VENOGRAPHY; VENTILATION; PERFUSION; LUNG; SCANNING; is; AUTOPSY; EMBOLI; CALF; Thigh; VEINS; CHEST; AGE; ADULT; AGED; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY ARTERY; PA; ri; THROMBOPHLEBITIS; ventilation-perfusion ratio; Medline File Notes : In 169 patients with suspected deep vein thrombosis (DVT), the incidence and clinical feature of pulmonary embolism (PE) was prospectively studied by means of noninvasive thrombosis tests (uptake tests, radionuclide venography) and combined ventilation (133Xe, 81mKr) and perfusion (99mTc microspheres) lung scanning. DVT was detected in 62% of patients (105/169). The incidence of PE in patients with confirmed DVT was 57% (60/105), a figure which is in excellent agreement with data from autopsy studies. Concerning the thrombotic source of emboli, the incidence of PE was 46% in patients with DVT confined to the calf but increased to 67% if the thigh, and to 77% if the pelvic veins were involved as well. Fifty-nine percent of PE were clinically silent, 19% had "minor signs", and 22% "major signs". The size of the perfusion defects correlated significantly with clinical symptoms. Only 23% of clinically symptomatic patients had a pathological chest X-ray. Incidence of both DVT and PE increased with advancing age, but in old patients the incidence of PE rose disproportionately. Ref ID : KOHN1990 706. Kohn, H. and Kohler, D. Diagnostic modalities for detection of pulmonary embolism in clinical routine: a European survey. Lung 168 Suppl:833-40:833-840, 1990. Keywords : 951217; diagnostics; PULMONARY EMBOLISM; EMBOLISM; in; Questionnaires; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; PE; Hospitals; CONTRAST; VENOGRAPHY; is; Doppler; ULTRASOUND; NONINVASIVE; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PA; FREQUENCY; COMPARATIVE STUDY; diagnostic imaging; europe; HUMAN; di; THROMBOPHLEBITIS; Medline File; NUCLEAR; austria Notes : A questionnaire asking for routinely performed modalities to diagnose deep venous thrombosis (DVT) and pulmonary embolism (PE) was sent to 2,500 departments in 23 European countries. Five-hundred-seventy (23%) were received back and evaluated according to hospital size and regional differences. Countries were grouped into: Anglo-Scandinavian (a), German-speaking (g), and Roman (r). Contrast venography is most frequently performed (94%) to diagnose DVT, independent of hospital size and without regional differences. With exception of Doppler ultrasound (71%), noninvasive DVT tests are rarely performed (6-28%). To diagnose PE, pulmonary angiography (PA) and ventilation-perfusion (V-P) scintigraphy are performed in 71%, digital subtraction angiography in only 50%. Frequencies of PE tests strongly depend on hospital size (PA: small hospitals 53-66%, large 83-89%; V-P: small hosp. greater than 80%, large greater than 90%, with 2 exceptions: small German hospitals = 48%, primarily performing only P-scans and large Roman hospitals = 59%, primarily performing PA). Regional differences were also significant (PA: r = 85%, a = 74%, g = 63%, V- P: a = 95%, r = 66%, g = 63%, respectively) Department of Nuclear Medicine Wilhelminenspital Vienna Austria. Ref ID : KORN1969 707. Korn, M.B. Micro-angiography of the skin veins in the lower limbs. Bibl.Anat. 10:168-173, 1969. Keywords : Skin; VEINS; NASP; ADULT; AUTOPSY; FEMALE; HUMAN; LEG; MALE; Methods; PHLEBOGRAPHY; Regional Blood Flow; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : AB - [No Abstract Available] UI - 72180089. Ref ID : KOSTER1974 708. Koster, R. [Venous diseases in the doctor's consulting room. Clinical basis and diagnostic possibilities in general practice]. Z.Allgemeinmed. 50:1019-1022, 1974. Keywords : NASP; Diagnosis,Differential; Family Practice; HUMAN; LEG; Leg Ulcer; PHLEBITIS; THROMBOEMBOLISM; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; in; diagnostics; ab Notes : TT - Venenkrankheiten in der Sprechstunde. Klinische Grundlagen und diagnostischen Moglichkeiten der Praxis AB - [No Abstract Available] UI - 75069220. Ref ID : KOVALEV1971 709. Kovalev, M.M., Teplyi, V.K., Ivanova, N.A., and Etinzon, M.G. [Complex treatment of thrombosis and thrombophlebitis of the veins of the lower extremities]. Vrach.Delo. :77-82, 1971. Keywords : TREATMENT; THROMBOSIS; THROMBOPHLEBITIS; VEINS; NASP; ADULT; AGED; Aminopyrine; ANTICOAGULANTS; English Abstract; FIBRINOLYTIC AGENTS; HEPARIN; HUMAN; LEG; MIDDLE AGE; Parasympatholytics; Phenylacetates; Phenylbutazone; Plasmin; Procaine; Sclerosing Solutions; Trypsin; Varicose Ulcer; VARICOSE VEINS; Vitamin E; Medline File; ab Notes : TT - Kompleksnoe lechenie trombozov i tromboflebitov ven nizhnikh konechnostei AB - [No Abstract Available] UI - 71191209. Ref ID : KRAHENBUHL1984 710. Krahenbuhl, B. [Conservative treatment of varicose disease]. Ther.Umsch. 41:857-862, 1984. Keywords : TREATMENT; NASP; Combined Modality Therapy; English Abstract; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; varicose; de; ab Notes : TT - Traitement conservateur de la maladie variqueuse AB - [No Abstract Available] UI - 85116124. Ref ID : KRUPSKI1989 711. Krupski, W.C., Feldman, R.K., and Rapp, J.H. Recombinant human tissue-type plasminogen activator is an effective agent for thrombolysis of peripheral arteries and bypass grafts: preliminary report [see comments]. J.Vasc.Surg. 10:491-8; discussion 499-50, 1989. Keywords : HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; THROMBOLYSIS; ACEP93; is; an; PERIPHERAL ARTERY; Arteries; bypass graft Ref ID : KRUTSAY1994 712. Krutsay, M. and Vigh, E. [Pathological diagnosis of polyganglioradiculitis in apropos of a case]. Orv.Hetil. 135:1637-1639, 1994. Keywords : 951202; DIAGNOSIS; in; is; Died; EMBOLISM; AUTOPSY; mt; CASE REPORT; English Abstract; FEMALE; ganglia,spinal; PA; HUMAN; MIDDLE AGE; polyradiculoneuritis; PULMONARY EMBOLISM; Spinal cord; Medline File Notes : The case of a 60-year-old woman is reported, who died from polyganglioradiculitis and pulmonary embolism. The authors emphasize the importance of the suitable autopsy technic for the exploration of the spinal ganglia Ajkai Varosi Korhaz Pathologiai Osztalya. Ref ID : KUHLMANN1992 713. Kuhlmann, T.P., Sistrom, C.L., and Chance, J.F. Light reflection rheography as a noninvasive screening test for deep venous thrombosis. Ann.Emerg.Med. 21(5):513-517, 1992. Keywords : 96-suzy-001; light; NONINVASIVE; SCREENING; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; is; DIAGNOSIS; LEG; Duplex; Ultrasonography; CONTRAST; VENOGRAPHY; EMERGENCY; Hospitals; Extremities; diagnostics; FALSE-NEGATIVE; SENSITIVITY; confidence intervals; ci; SPECIFICITY; PREDICTIVE VALUE; an; ADULT; AGED; Aged,80 and over; COMPARATIVE STUDY; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBOGRAPHY; Plethysmography,Impedance; Methods; predictive value of tests; sensitivity and specificity Notes : STUDY OBJECTIVE: To determine if light reflection rheography is a useful screening tool for the diagnosis of proximal leg deep venous thrombosis. DESIGN: Light reflection rheography was compared with duplex ultrasonography and/or contrast venography on emergency patients being evaluated for proximal leg deep venous thrombosis. SETTING: University hospital emergency department. TYPE OF PARTICIPANTS: Seventy-five ED patients being evaluated for acute leg deep venous thrombosis. INTERVENTIONS: Seventy-five patients being evaluated for clinically suspected deep venous thrombosis had light reflection rheography performed on the involved extremity immediately before duplex ultrasonography and/or contrast venography. Duplex ultrasonography and/or contrast venography was the definitive diagnostic test. MEASUREMENTS AND RESULTS: Seventy-five patients had light reflection rheography performed, 72 had duplex ultrasonography, 19 had contrast venography, three had contrast venography alone, and 16 had both duplex ultrasonography and contrast venography. A comparison of light reflection rheography with duplex ultrasonography and/or contrast venography reveals that 39 light reflection rheography examinations were true-negative, 17 were true-positive, one was false-negative, and 18 were false-positive. The sensitivity of light reflection rheography for the detection of proximal leg deep venous thrombosis is 94.4% (95% confidence interval [CI], 72.7-99.9%), the negative-predictive value is 97.5% (95% CI, 86.8-99.9%), the specificity is 68.4% (95% CI, 54.8- 80.1%), and the positive-predictive value is 48.6% (95% CI, 31.4-66%). CONCLUSION: Light reflection rheography proved to be an excellent screening tool for emergency patients with the clinical suspicion for an acute proximal leg deep venous thrombosis. A normal light reflection rheography examination was 97.5% accurate as a negative predictor. That is, a normal light reflection rheography excluded the diagnosis of proximal leg deep venous thrombosis when compared with duplex ultrasonography and/or contrast venography when the duplex ultrasonography and/or contrast venography showed no evidence of proximal leg deep venous thrombosis. An abnormal light reflection rheography does not equate to an acute leg deep venous thrombosis as the specificity was only 68.4%. An abnormal light reflection rheography mandates further diagnostic studies such as duplex ultrasonography and/or contrast venography to confirm a diagnosis of proximal leg deep venous thrombosis. Ref ID : KUJATH1993 714. Kujath, P., Spannagel, U., and Habscheid, W. Incidence and prophylaxis of deep venous thrombosis in outpatients with injury of the lower limb. Haemostasis 23 Suppl 1:20-6:20-26, 1993. Keywords : 951208; INCIDENCE; PROPHYLAXIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; OUTPATIENT; INJURY; PROSPECTIVE; RANDOMIZED; injuries; Immobilized; Cast; SUBCUTANEOUS; Injections; thromboprophylaxis; an; Molecular Weight; HEPARIN; is; Hospitals; SURGERY Notes : 253 outpatients were included in a prospective randomized study. All patients had incidence of injuries of the lower limb immobilized by a plaster cast. 126 patients (group I) received a subcutaneous injection of Fraxiparin daily, and 127 patients (group II) received no thromboprophylaxis. Without prophylaxis 21 (16.5%) cases developed a thrombosis, and with prophylaxis a thrombosis could be proven in 6 (4.8%) patients only (p < 0.01). Thus, for all patients with an injury of the lower limb being immobilized by a plaster cast, a thromboprophylaxis with a low-molecular-weight heparin is recommended Hospital for Surgery Medical University of Lubeck FRG. Ref ID : KULARATNE1993 715. Kularatne, S.A. and Dewapura, D.S. Acute pulmonary embolism in a patient with nephrotic syndrome. Ceylon.Med J 38:90-91, 1993. Keywords : PULMONARY EMBOLISM; EMBOLISM; Syndrome; COMPLICATION; Cyanosis; TREATMENT; ECG; sdi-11/93; Nephrotic syndrome; in; is Notes : Pulmonary embolism is a rare complication of nephrotic syndrome. We report the case history of a 30 year old man who presented with nephrotic syndrome and became acutely dyspnoeic with cyanosis and peripheral circulatory failure while on treatment. The clinical and ECG findings were strongly suggestive of acute pulmonary embolism. Ref ID : KUMPMANN1969 716. Kumpmann, U. [Possibilities of a complex etiologic therapy of veinous diseases]. Z.Allgemeinmed. 45:1327-1331, 1969. Keywords : THERAPY; NASP; ADULT; Cyanosis; FEMALE; Hemorrhoids; HUMAN; LEG; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Moglichkeiten einer komplexen kausalen Therapie der Venenerkrankungen AB - [No Abstract Available] UI - 70276892. Ref ID : KWAAN1958 717. Kwaan, H.C., Lo, R., and McFadzean, A.J.S. On the lysis of thrombi experimentally produced within veins. Brit.J.Haemat. 4:51-62, 1958. Keywords : THROMBOSIS; SCLEROTHERAPY; LYSIS; THROMBI; VEINS Ref ID : KWAAN1965 718. Kwaan, H.C. and Astrup, T. Fibrinolytic activity in thrombosed veins. Circ.Res. 17:477-483, 1965. Keywords : VEINS; THROMBOSIS; SCLEROTHERAPY; FIBRINOLYTIC; THROMBOSED; in Ref ID : LAGERSTEDT1985 719. Lagerstedt, C.I., Olsson, C.G., Fagher, B.O., Oqvist, B.W., and Albrechtsson, U. Need for long-term anticoagulant treatment in symptomatic calf vein thrombosis. Lancet ii:515-518, 1985. Keywords : ANTICOAGULANT; TREATMENT; CALF; VEINS; THROMBOSIS; CALF VEIN THROMBOSIS; LONG TERM; in; vein; 96-suzy-002 Notes : 01-05-96. Ref ID : LAGERSTEDT1989 720. Lagerstedt, C., Olsson, C.G., Fagher, B., and Oqvist, B. 99mTc plasmin in 394 consecutive patients with suspected deep venous thrombosis. Eur.J.Nucl.Med. 15:771-775, 1989. Keywords : PHLEBITIS; Plasmin; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; COMPARATIVE STUDY; FEMALE; HUMAN; LEG; blood supply; MALE; MIDDLE AGE; organotechnetium compounds; diagnostic use; PHLEBOGRAPHY; Physical Examination; predictive value of tests; THROMBOPHLEBITIS; DIAGNOSIS; radionuclide imaging; OUTPATIENT; DVT; THROMBI; SENSITIVITY; KNEE; FILMS; PREDICTIVE VALUE; Injections; ANTICOAGULANT; THERAPY; CALF; SCREENING; in; an; inflammation Notes : Three hundred and ninety four consecutive out-patients with suspected deep venous thrombosis (DVT) were investigated with the 99mTc- plasmin test and physical examination and 307 of them with phlebography. Fresh thrombi were present in 124 patients and the plasmin test was pathological in 118 of these (sensitivity 95%). The thrombi that were missed were all located below the knee and measured less than 10 cm on the phlebographic films. The predictive values of negative and positive tests were 91% and 49%, respectively. The predictive value of a positive test was higher with an increasing number of measuring points with a pathological uptake. To get the final result, a single series of measurements 5 min after injection was sufficient. If clinical signs of inflammation were present. the plasmin test was usually pathological. Median time for the plasmin test to become normal during anticoagulant therapy was 14 days for calf DVT and 6 months for proximal DVT. The plasmin test was found to be useful as a screening test in patients without extensive signs of inflammation in the legs. It has a high sensitivity even in patients with long-standing symptoms. Ref ID : LAISSUE1984 721. Laissue, J.A., Gebbers, J.O., and Musy, J.P. [Pulmonary embolism: epidemiology and pathology]. Schweiz.Med.Wochenschr. 114:1711-1720, 1984. Keywords : 951202; EMBOLISM; EPIDEMIOLOGY; PE; DEATH; MORTALITY; TRENDS; in; Switzerland; INCIDENCE; AUTOPSY; is; death certificates; DIAGNOSIS; ADULT; AGED; ANIMAL; Burns; co; CASE REPORT; CORONARY DISEASE; DOGS; English Abstract; europe; FEMALE; HUMAN; japan; MALE; MIDDLE AGE; PULMONARY ARTERY; PA; PULMONARY EMBOLISM; ep; et; mo; UNITED STATES; Wounds and Injuries; Medline File Notes : The following facets of pulmonary embolism (PE) are reviewed: 1. Main pathological aspects. 2. When can death be attributed to PE? 3. PE and life expectancy. 4. Mortality trends from PE in Switzerland from 1920 to 1982. The incidence of PE, as assessed from published data on approximately 300 000 autopsies, is plotted versus time and compared with death certificate diagnoses from Switzerland and other countries. In spite of the discrepancies between death certificate and autoptic diagnosis of PE, the results are consistent with a marked increase in mortality from PE during recent decades, at least in some countries. However, the rate of increase has slowed since 1975. Ref ID : LAMB1993 722. Lamb, G.C., Tomski, M.A., Kaufman, J., and Maiman, D.J. Is chronic spinal cord injury associated with increased risk of venous thromboembolism? J Am Paraplegia.Soc. 16:153-156, 1993. Keywords : CHRONIC; Spinal cord; INJURY; RISK; VENOUS; THROMBOEMBOLISM; INCIDENCE; REVIEW; Immobilization; RISK FACTORS; sdi-11/93; is; spinal cord injuries; in; an Notes : To determine the incidence of symptomatic thromboembolism in patients with chronic spinal cord injury, a retrospective review of patients followed in a Veteran's Affairs Spinal Cord Injury Unit was conducted. Followed for a mean of 13.7 years after injury, 287 patients were reviewed. Forty events were identified, an incidence of 10 percent. Thirty-three (83 percent) occurred in the first 6 months following injury. The remainder occurred at 1, 1.5, 7, 9, 10, 12, and 14 years after injury, an incidence of 0.17 percent per year. The incidence of clinically significant thromboembolism in spinal cord injury decreases dramatically after the first 6 months to a level similar to that in the general population (0.18 percent). Possible explanations for this include: 1) immobilization by itself may not be a risk factor for thromboembolism; 2) physiologic adaptations in the chronic state may protect against thromboembolism; and, 3) thromboembolism occurs, but remains subclinical in most patients. Ref ID : LAMBIASE1991 723. Lambiase, R.E., Paolella, L.P., Haas, R.A., and Dorfman, G.S. Extensive thromboembolic disease of the hand and forearm: treatment with thrombolytic therapy. J.Vasc.Interv.Radiol. 2:201-208, 1991. Keywords : THROMBOEMBOLIC; TREATMENT; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ACEP-93; ACEP93 Ref ID : LAMBRECHT1987 724. Lambrecht, L., Baele, G., and Barbier, F. Hemostatic alterations in Crohn's disease. Acta.Clin.Belg. 42:5-11, 1987. Keywords : HEMOSTATIC; CROHN'S DISEASE; ULCERATIVE COLITIS; RISK; DVT; PE; FIBRINOGEN; FACTOR VIII; PLATELET; ANTITHROMBIN III; MACROGLOBULIN; in; 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 : LAMY1968 725. Lamy, M. and Hanquet, M. [Hyperbaric oxygenotherapy. 1st applications]. Acta Anaesthesiol.Belg. 19:46-82, 1968. Keywords : 951202; ANIMAL; asphyxia neonatorum; th; Burns; carbon monoxide poisoning; cardiovascular diseases; su; embolism,air; Frostbite; hepatitis; HUMAN; Hyperbaric Oxygenation; ae; Infant,Newborn; INFECTION; Neoplasms; poisoning; SHOCK; surgery,plastic; tissue preservation; Medline File Notes : [No Abstract Available]. Ref ID : LANG1989 726. Lang, E.V. and Bookstein, J.J. Accelerated thrombolysis and angioplasty for hand ischemia in Buerger's disease. Cardiovasc.Intervent.Radiol. 12:95-97, 1989. Keywords : THROMBOLYSIS; ACEP-93; ACEP93; Angioplasty; Ischemia; in Ref ID : LANG1993 727. Lang, I.M., Marsh, J.J., Konopka, R.G., Olman, M.A., Binder, B.R., Moser, K.M., and Schleef, R.R. Factors contributing to increased vascular fibrinolytic activity in mongrel dogs. Circulation 87:1990- 2000, 1993. Keywords : FIBRINOLYTIC; DOGS; Pulmonary emboli; EMBOLI; Methods; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PA; PLATELET; ENDOTHELIAL; Sodium; Electrophoresis; FIBRIN; LYTIC; UROKINASE; INHIBITION; PLATELETS; LYSIS; FIBRINOLYSIS; PULMONARY ARTERY; ARTERY; PGM-8/94; in; ab; blood; standards; analysis; ec Notes : CS- University of California, San Diego AB- BACKGROUND. Numerous investigators have observed that pulmonary emboli are rapidly lysed in a canine model system. This study was undertaken to delineate the unique mechanism that accounts for the rapid dissolution of pulmonary emboli in mongrel dogs. METHODS AND RESULTS. Canine plasminogen activator (PA) activity (2.6 +/- 1.1 IU/mL acidified platelet-poor plasma [PPP], < 0.3 IU/mL acidified whole blood serum [WBS], mean +/- SD; n = 6) and PA inhibitor activity (6.1 +/- 2.6 U/mL PPP, 35.4 +/- 7.8 U/mL WBS; n = 6) were determined in standard plasminogen-based chromogenic assays. Analysis of canine PPP, WBS, platelet lysates, and primary canine endothelial cell (EC) cultures by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fibrin autography revealed a plasminogen- dependent lytic zone at 45-kd relative molecular mass that was shown to be related to urokinase- type PA (u-PA) by its selective inhibition through amiloride. Analysis of canine platelets on standard 125I fibrin plate assays revealed a net fibrinolytic activity. In a clot lysis assay system, canine platelets were able to stimulate fibrinolysis when layered on the outside of fibrin clots containing autologous PPP. Moreover, net fibrinolytic activity of primary canine pulmonary artery endothelial cells was higher than the activities expressed by canine aortic or carotid artery endothelial cells. CONCLUSIONS. Rapid lysis of pulmonary emboli in mongrel dogs appears to be a result of 1) the high u-PA activity in canine PPP and 2) the predominant association of u-PA activity with canine platelets and canine pulmonary artery endothelial cells. Ref ID : LANG1994 728. Lang, I.M., Marsh, J.J., Olman, M.A., Moser, K.M., XXXXXXXX, and Schleef, R.R. Expression of type 1 plasminogen activator inhibitor in chronic pulmonary thromboemboli. Circulation 89:2715-2721, 1994. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; CHRONIC; THROMBOEMBOLI; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; EMBOLI; PULMONARY ARTERY; Arteries; Methods; Antigens; FIBRIN; THROMBI; ENDOTHELIAL; CONTRAST; Muscles; ARTERY; THROMBUS; PREVALENCE; PGM-8/94; in; critical care; ab; is; immunohistochemistry Notes : CS- Division of Pulmonary and Critical Care Medicine, University of California at San Diego AB- BACKGROUND: Chronic thromboembolic pulmonary hypertension is the result of nonresolving pulmonary emboli that lead to chronic obstruction of the central pulmonary arteries. METHODS AND RESULTS: To determine if the failure to lyse pulmonary thromboemboli is caused by the local expression of the primary inhibitor of tissue-type plasminogen activator (type 1 plasminogen activator inhibitor, PAI-1), levels of PAI-1 antigen and mRNA were analyzed by immunohistochemistry and in situ hybridization in specimens harvested from a series of patients during pulmonary thromboendarterectomies. Red, fibrin-rich thrombi within the thromboendarterectomy specimens were lined with a single layer of endothelial cells exhibiting high levels of PAI-1 antigen. Quantitation of the in situ hybridization signal revealed that a significant increase in PAI-1 mRNA was present in the endothelial cells lining the fresh thrombi in comparison to the signal present in the endothelial cells from noninvolved areas of patients' pulmonary arteries (n = 16, P < .001). In contrast, tissue-type plasminogen activator antigen levels were low in all samples. Yellowish-white thrombi were composed of smooth muscle cells and endothelial cells in numerous vessels that stained prominently for PAI-1 antigen. Both types of cells within the highly organized tissues also exhibited elevated PAI-1 mRNA levels in comparison to patient pulmonary artery specimens that were free of thrombus (n = 16, P < .02). CONCLUSIONS: The prevalence of PAI-1 expression within pulmonary thromboemboli suggests that this inhibitory may play a role in the stabilization of vascular thrombi. Ref ID : LANGE1983 729. Lange, H.W., Galliani, C.A., and Edwards, J.E. Local complications associated with indwelling Swan-Ganz catheters: Autopsy study of 36 cases. Am.J.Cardiol. 52:1108-1983, 1983. Keywords : COMPLICATIONS; CATHETER; AUTOPSY; SWAN-GANZ; ACEP93; 951202; Catheters; heart; Died; in; INCIDENCE; THROMBOSIS; VENA CAVA; PULMONARY ARTERY; ARTERY; Catheterization; ANTICOAGULATION; HEMORRHAGE; AGED; CORONARY DISEASE; PA; endocardium; FEMALE; Heart Catheterization; ae; is; heart injuries; heart valve diseases; HUMAN; MALE; MIDDLE AGE; myocardium; PULMONARY EMBOLISM; Support,U.S.Gov't,P.H.S. vena cava,superior; Medline File; Health Planning & Administration File; infarction Notes : Thirty-six hearts of patients who died with indwelling Swan-Ganz catheters in place were prospectively examined to assess the incidence and extent of localized lesions in the right side of the heart. Bland mural thrombosis in the superior vena cava, the right atrium and the pulmonary artery was found in 22 of 36 cases (61%). Patients with catheter periods greater than 2 days had a greater incidence and extent of bland mural thrombosis (79%) than patients with short-term catheterization (41%, p less than 0.01). Anticoagulation had no influence on bland mural thrombosis. Valvular hemorrhage occurred in 31% and aseptic valvular vegetations in 8% of the hearts. No case of infective endocarditis was found. Four of 36 cases (11%) had evidence of pulmonary infarction that appeared to be unrelated to the lesions in the right side of the heart. Endocardial lesions were common complications of indwelling Swan-Ganz catheters but had no significant impact on the clinical courses of the patients. Ref ID : LANZER1991 730. Lanzer, P., Gross, G.M., Keller, F.S., and Pohost, G.M. Sequential 2D inflow venography: initial clinical observations. Magn.Reson.Med 19:470-476, 1991. Keywords : VENOGRAPHY; VENOUS; ANATOMY; AGE; vein; THROMBOSIS; diagnostics; Venogram; CONTRAST; CALF; Methods; VEINS; sdi-11/93; pathology; in; is Notes : Sequential 2D inflow NMR (SDI) venography was employed to define venous anatomy and pathology in five healthy subjects and five patients, mean age 48 +/- 7 years, with documented deep vein thrombosis. SDI images were graded independently by two observers on a scale of 1,2 nondiagnostic and 3,4 diagnostic categories. All iliac and femoropopliteal SDI venograms were diagnostic. In contrast, only one out of nine calf SDI venograms was diagnostic. SDI is a promising new method to assess the proximal peripheral venous system. Improved imaging strategy is needed to produce flow images of the calf veins. Ref ID : LASPADA1995 731. La Spada, A.R., Sk~alhegg, B.S., Henderson, R., Schmer, G., Pierce, R., and Chandler, W. Brief report: fatal hemorrhage in a patient with an acquired inhibitor of human thrombin. N.Engl.J.Med. 333(8):494-497, 1995. Keywords : 96-suzy-001; FATAL; HEMORRHAGE; in; an; HUMAN; THROMBIN; AGED; autoantibodies; blood; blood coagulation factors; analysis; Blood Coagulation Tests; CASE REPORT; fatal outcome; FEMALE; immunology; igg; Support,Non-U.S.Gov't Ref ID : LATNER1947 732. Latner, A.L. Anxiety as a cause of fibrinolysis. Lancet 1:194-195, 1947. Keywords : THROMBOSIS; SCLEROTHERAPY; ANXIETY; FIBRINOLYSIS; CAUSE Ref ID : LAWHORNE1986 733. Lawhorne, T.W.J. and Sanders, R.A. Ulnar artery aneurysm complicated by distal embolization: management with regional thrombolysis and resection. J.Vasc.Surg. 3:663-665, 1986. Keywords : ARTERY; EMBOLIZATION; MANAGEMENT; THROMBOLYSIS; ACEP-93; ACEP93; Aneurysm; Regional thrombolysis Ref ID : LAWSON1982 734. Lawson, M., Bottino, J.C., Hurtubise, M.R., and et al The use of urokinase to restore the patency of occluded central venous catheters. Am.J.Intraven.Ther.Clin.Nutr. 9:29-32, 1982. Keywords : UROKINASE; VENOUS; CATHETER; THROMBOSIS; ACEP93; Catheters Ref ID : LEACH1989 735. Leach, S.J., Meier, G.H., and Gusberg, R.J. Endoscopic sclerotherapy: A risk factor for splanchnic venous thrombosis. J.Vasc.Surg. 10:9-13, 1989. Keywords : SCLEROTHERAPY; RISK; VENOUS; THROMBOSIS; VEINS; ESOPHAGEAL; SHUNT; DEEP VEIN THROMBOSIS; VENOUS THROMBOSIS; SHUNT SURGERY; SURGERY; RISK FACTORS; vein; is; et; Splenic Vein Notes : The true risk of deep vein thrombosis following sclerotherapy is unknown. Leach et al. examined 27 patients and reported that 54.5 percent of patients who had undergone esophageal sclerotherapy with sotradecol were found to have portal or splenic vein thrombosis at the time of shunt surgery, as compared to only 12.5 percent of those who had not undergone prior sclerotherapy. Ref ID : LEACH1994 736. Leach, T.A., Pastena, J.A., Swan, K.G., Tikellis, J.I., Blackwood, J.M., and Odom, J.W. Surgical prophylaxis for pulmonary embolism. Am.Surg. 60:292-295, 1994. Keywords : EMBOLISM; TRAUMA; SURGICAL; PROPHYLAXIS; PULMONARY EMBOLISM; RISK; FATAL; RISK FACTORS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ANTICOAGULATION; INJURY; FRACTURES; COMPRESSION; FILTER; MORTALITY; MORBIDITY; Died; Vena caval filter; is; in; injuries; Pneumatic; filtration; hospitalization Notes : The trauma patient population is at special risk for fatal pulmonary embolism. We experienced 11 fatalities in one 12-month period. Specific risk factors for both deep venous thrombosis and pulmonary embolism can be identified among trauma patients. The latter usually cannot be offered prophylactic anticoagulation, and the nature of their injuries (e.g., long bone fractures) makes not only bedside surveillance difficult but also precludes use of pneumatic compression, etc. We have developed a protocol for prophylactic inferior vena caval filtration for our trauma patients deemed at particular risk for pulmonary embolism. Since 1986 we have inserted 205 Greenfield filters in 201 patients. Two hundred were inserted prophylactically. There was no mortality, and morbidity was minimal. No patient with a Greenfield filter sustained a fatal pulmonary embolism during this period. Four patients died from pulmonary embolism before vena caval filters could be inserted. We believe that the trauma patient, at risk for pulmonary embolism, should be offered a Greenfield filter prophylactically as soon after hospitalization as logistically possible. Ref ID : LECERF1986 737. Lecerf, C., Hutinel, B., Combe-Tamzali, S., Conard, J., and Samama, M. [Sclerotherapy of varices and protein C deficiency]. Phlebologie. 39:415-429, 1986. Keywords : VARICES; PROTEIN C; SCLEROSE; VENOUS; THROMBOSIS; SCLEROSIS; AGED; QUANTITATIVE; PREGNANCY; ACCIDENTS; TREATMENT; THROMBOEMBOLIC; COMPLICATIONS; HEPARIN; ASYMPTOMATIC; ANTICOAGULANT; NASP; ANTICOAGULANTS; ADULT; Blood Coagulation Disorders; Blood Proteins; CASE REPORT; CHILD; English Abstract; FEMALE; Glycoproteins; HUMAN; MALE; Pedigree; Pregnancy Complications,Cardiovascular; RECURRENCE; Sclerosing Solutions; THROMBOPHLEBITIS; VARICOSE VEINS; Vitamin K; Medline File; de; et; en; ab; in; us; is Notes : TT - Sclerose de varices et deficit en proteine C AB - The appearance of relapsing venous thrombosis after sclerosis of varices in a woman aged 30 led us to discover a quantitative protein C deficiency, found in her father and 4 of her brothers and sisters. The transmission mode is autosomal and dominant. Within this family, 6 subjects are affected, 4 showing symptoms, clearly showing the heterogeneity of the clinical manifestation of the deficiency. Dealing with the special problem of pregnancy in women with the biological disorder, one ought to consider the literature on the subject, showing the large occurrence of ante-and post-natal accidents. The treatments of thromboembolic complications is based on the use of heparin administered appropriately through antivitamins K for a period which is till to be defined. In asymptomatic subjects, a preventive anticoagulant treatment is recommended in all circumstances likely to encourage the relapse of thrombosis UI - 86314198. Ref ID : LEE1990 738. Lee, R.V., McComb, L.E., and Mezzadri, F.C. Pregnant patients, painful legs: the obstetrician's dilemma. Obstet.Gynecol.Surv. 45:290- 298, 1990. Keywords : PHLEBITIS; PREGNANT; LEG; ADULT; CASE REPORT; FEMALE; HUMAN; physiopathology; PAIN; ETIOLOGY; Posture; PREGNANCY; Pregnancy Complications,Cardiovascular; THROMBOEMBOLISM; COMPLICATIONS; THROMBOPHLEBITIS; THROMBOSIS Ref ID : LEEBEEK1989 739. Leebeek, F.W., Knot, E.A., Ten Cate, J.W., and Traas, D.W. Severe thrombotic tendency associated with a type I plasminogen deficiency. Am.J.Hematol. 30:32-35, 1989. Keywords : PLASMINOGEN; THROMBOSIS Ref ID : LEEPER1988 740. Leeper, K.V.,Jr., Popovich, J.,Jr., Lesser, B.A., Adams, D., Froelich, J.W., Burke, M.W., Shetty, P.C., Thrall, J.H., and Stein, P.D. Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin. Chest 93:234-240, 1988. Keywords : TREATMENT; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; ARTERIAL; STREPTOKINASE; HEPARIN; PULMONARY ARTERY; LUNG; SCAN; OXYGEN; BLEEDING; INTRAVENOUS; THERAPY; RISK; AGED; DRUG THERAPY COMBINATION; FEMALE; HEMORRHAGE; HUMAN; INFUSIONS INTRAVENOUS; MALE; MIDDLE AGE; RISK FACTORS; SUPPORT U S GOVT P H S; ANGIOGRAPHY; ARTERY; in; partial pressure; Pressure; blood; Blood Transfusion; intravenous heparin; LYTIC Notes : AB-The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase, 10,000-20, 000 units/ hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 [/- 2 to 2 [/- 1 after 12-24 hours (p less than .01). No change was shown in the contralateral lung. The angiographic index of severity score in the infused lung decreased from 16 [/- 1 to 9 [/- 4 (p less than .01). The partial pressure of oxygen in arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk. Ref ID : LEJEUNNE1993 741. Le Jeunne, C., La Batide-Alanore, S., Denis, M., and Hugues, F.C. [Phlebitis of the upper limbs on pacemaker electrodes. 4 cases and review of the literature]. Rev.Med Interne. 14:157-159, 1993. Keywords : REVIEW; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; UPPER EXTREMITY; Extremities; AGE; PHLEBITIS; Immobilization; Catheterization; PHLEBOGRAPHY; DIAGNOSIS; Collateral Circulation; ANTICOAGULANT; THERAPY; SUBCUTANEOUS; HEPARIN; ARM; DOSAGE; sdi-11/93; Pacemaker; electrodes; in; is; us; Immobilized Notes : We report four cases of deep venous thrombosis of the upper extremity, which occurred in two women and two men (mean age 79 years) in whom a pacemaker electrode had been inserted 4 years on averages previously. In three of these four cases phlebitis developed after immobilization of the limb containing the electrode. Deep venous thrombosis of the upper extremity is rare, but 28% of catheterizations are responsible for phlebitis. One to 3% of patients fitted with a pacemaker have symptomatic phlebitis, but these figures rise to 28-65% when phlebography is systematically performed in subjects wearing a pacemaker. The clinical signs are the same as those of the classical forms, and the diagnosis is made by doppler-ultrasonography and by phlebography which informs on the collateral circulation. Cure is obtained with efficient anticoagulant therapy. These cases prompt us to prescribe a preventive subcutaneous heparin therapy in those pacemaker- fitted subjects whose arm is immobilized. The heparin dosage remains to be determined precisely. Ref ID : LENSING1989 742. Lensing, A.W.A., Prandoni, P., and Brandjes, D. Detection of deep- vein thrombosis by real-time B-mode ultrasonography. N.Engl.J.Med. 320:342-345, 1989. Keywords : DEEP VEIN THROMBOSIS; THROMBOSIS; DIAGNOSIS; DVT; BELOW-KNEE; ULTRASOUND; PREDICTIVE VALUE; Ultrasonography; an; is Notes : Clinical signs and symptoms are unreliable for the diagnosis of DVT, with an accuracy of only 35 percent. Below-knee DVT is not reliably diagnosed by B-mode ultrasound. Ref ID : LENSING1990 743. Lensing, A.W., Levi, M.M., Buller, H.R., Prandoni, P., Vigo, M., Agnelli, G., Lupatelli, L., Huisman, M.V., and Ten Cate, J.W. Diagnosis of deep-vein thrombosis using an objective Doppler method. Ann.Intern.Med. 113:9-13, 1990. Keywords : PHLEBITIS; DIAGNOSIS; DEEP VEIN THROMBOSIS; THROMBOSIS; Doppler; Methods; abdomen; physiology; Adolescence; ADULT; AGED; Aged,80 and over; clinical protocols; FEMALE; HUMAN; LEG; blood supply; MALE; MIDDLE AGE; observer variation; PHLEBOGRAPHY; predictive value of tests; Pressure; PROSPECTIVE STUDIES; Regional Blood Flow; Reproducibility of Results; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; transducers,pressure; Ultrasonography; Valsalva's Maneuver; diagnostics; CONTRAST; VENOGRAPHY; OUTPATIENT; PROSPECTIVE; ULTRASOUND; Venogram; VENOUS; VENOUS THROMBOSIS; vein; PREVALENCE; SENSITIVITY; SPECIFICITY; CALF VEIN THROMBOSIS; an; in; ci; is Notes : STUDY OBJECTIVE: To determine the diagnostic criteria (phase I) and to assess the accuracy (phase II) of an objective Doppler-Valsalva pressure method as compared with contrast venography for the diagnosis of acute deep-leg-vein thrombosis in symptomatic outpatients. DESIGN: A two-phase prospective study in consecutive patients. Doppler ultrasound strip-chart recordings and venograms were independently analyzed by experienced observers. SETTING: Referral-based medical clinics at university medical centers. PATIENTS: One hundred and ten (phase I) and one hundred and fifty-five (phase II) patients who had clinically suspected venous thrombosis and were referred by their general practitioners were included. METHODS AND MEASUREMENTS: A normal Doppler test result was defined as a cyclic spontaneous signal (S-signal), a continuous S-signal with a Valsalva pressure of less than 6.5 mm Hg, or an absent S-signal with flow after cessation of the Valsalva maneuver. A continuous S-signal with a Valsalva pressure of 6.5 mm Hg or more or an absent S-signal without flow after cessation of the Valsalva maneuver were defined as abnormal test results. The accuracy indices for proximal vein thrombosis in phase II (155 patients; prevalence, 31%) were sensitivity, 91% (95% CI, 79% to 98%), and specificity, 99% (CI, 97% to 100%). All 3 patients with isolated calf-vein thrombosis had normal Doppler test results. CONCLUSIONS: The objective Doppler method is an accurate, reproducible, and simple method for detection of venous thrombosis in symptomatic outpatients. Ref ID : LENSING1992 744. Lensing, A.W., van Beek, E.J., Demers, C., Tiel-van Buul, M.M., Yakemchuk, V., van Dongen, A., Coates, G., Ginsberg, J.S., Hirsh, J., and Ten Cate, J.W. Ventilation-perfusion lung scanning and the diagnosis of pulmonary embolism: improvement of observer agreement by the use of a lung segment reference chart. Thromb.Haemost. 68(3):245-249, 1992. Keywords : 951217; LUNG; SCANNING; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; VENTILATION; PERFUSION; SCAN; RANDOMIZED; in; diagnostics; NUCLEAR; classification; PROBABILITY; statistics; is; MANAGEMENT; HUMAN; ri; observer variation; pp; reference standards; Retrospective Studies; Support,Non-U.S.Gov't; ventilation-perfusion ratio; Medline File; HEMOSTASIS; THROMBOSIS; atherosclerosis; inflammation; netherlands Notes : OBJECTIVE. To test the hypothesis that the systematic use of a lung segment reference chart can improve the inter- and intra-observer agreement for the interpretation of ventilation-perfusion lung scans. DESIGN. A randomized trial. STUDY POPULATION. Ventilation-perfusion lung scans were obtained in a series of 220 consecutive patients with clinically suspected pulmonary embolism. INTERVENTION. Ventilation- perfusion scans were randomly allocated to one of two series each consisting of 110 ventilation-perfusion lung scans. The first series of lung scans was interpreted according to the routine diagnostic approach, and the second series was interpreted with the mandatory use of a lung segment reference chart on which observed ventilation and perfusion defects were drawn. The two nuclear medicine physicians agreed a priori on the diagnostic criteria of the classification scheme. MEASUREMENTS. Lung scans were classified as normal, non-high probability, or high probability for pulmonary embolism. The extent of disagreement between the nuclear medicine physicians (inter- observer disagreement) and the lack of internal consistency of each nuclear medicine physician (intra- observer disagreement) was assessed by the percentage disagreement and by kappa statistic. RESULTS. Inter-observer disagreement which was 20% in the first series, decreased significantly in the second series to 7%; P = 0.003. Intra-observer disagreement for the first series was 10% and 22% for the nuclear medicine physicians, respectively. Intra-observer disagreement for the second series of lung scans decreased significantly for one nuclear medicine physician (intra-observer disagreement, 0%; P less than 0.01), whereas intra-observer disagreement was reduced to 10% for the other nuclear medicine physician (P = 0.09). CONCLUSION. Inter- and intra-observer disagreement were significantly reduced when two nuclear medicine specialists interpreted ventilation- perfusion lung scans according to the routine diagnostic approach plus the use of a lung segment reference chart. The use of the lung segment reference chart for the interpretation of lung scans is likely to improve the management of patients with clinically suspected pulmonary embolism Centre for Hemostasis Thrombosis Atherosclerosis and Inflammation Research University of Amsterdam The Netherlands. Ref ID : LENSING1993 745. Lensing, A.W. and Hirsh, J. 125I-fibrinogen leg scanning: reassessment of its role for the diagnosis of venous thrombosis in post- operative patients. Thromb.Haemost. 69(1):2-7, 1993. Keywords : 951217; LEG; SCANNING; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; POSTOPERATIVE; SCREENING; SENSITIVITY; COMPUTER; an; SURGICAL; VENOGRAPHY; PREDICTIVE VALUE; FIBRINOGEN; CALF; CALF VEIN THROMBOSIS; vein; SPECIFICITY; is; Methods; VALIDITY; du; HUMAN; iodine radioisotopes; Postoperative Complications; ri; predictive value of tests; Reproducibility of Results; sensitivity and specificity; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; Medline File; Hospitals; ontario; CANADA Notes : OBJECTIVE: To determine the reasons why 125I-fibrinogen leg scanning, a screening test which was reported to be very sensitive for the detection of post-operative thrombosis, has shown poor sensitivity in contemporary studies. STUDY IDENTIFICATION: English-language reports were identified through a Medline computer search (1965-1991), Current Contents, and an extensive manual search of the bibliographies in identified articles. STUDY SELECTION: Studies in orthopaedic or general surgical patients were reviewed that compared 125I-fibrinogen leg scanning with venography in all patients (accuracy studies) or in patients in whom 125I-fibrinogen leg scanning became positive (positive predictive value studies). DATA EXTRACTION: A systematic appraisal of study design and specific descriptive information concerning the selection of patients. RESULTS OF DATA SYNTHESIS: Six of the 15 studies which compared 125I- fibrinogen leg scanning with venography were level 1 studies (potential for bias minimized) and nine were classified as level 2 studies (potential for bias not minimized). In orthopaedic surgical patients, the pooled sensitivity of leg scanning for isolated calf vein thrombosis, for all venous thrombosis, and the pooled specificity were 55%, 45%, and 92% for the level 1 studies, respectively. These indices were 88%, 82%, and 79%, respectively for the level 2 studies (P < 0.001). Only two (level 2) studies were found that evaluated the accuracy of leg scanning for venous thrombosis in general surgical patients. CONCLUSION: We conclude that leg scanning is an insensitive method for the screening of post- operative venous thrombosis in orthopaedic patients. Our findings call into question the validity of the many studies (including meta- analyses) evaluating prophylactic agents for venous thrombosis which used leg scanning as the only test for the assessment of efficacy Hamilton Civic Hospital Research Centre Ontario Canada. Ref ID : LENSING1995 746. Lensing, A.W., Prins, M.H., Davidson, B.L., and Hirsh, J. Treatment of deep venous thrombosis with low-molecular-weight heparins. A meta- analysis. Arch.Intern.Med. 155(6):601-607, 1995. Keywords : LMWH; Low-Molecular-Weight-Heparin; TREATMENT; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Low-molecular-weight heparin; HEPARIN; META ANALYSIS; INTRAVENOUS; partial thromboplastin time; THROMBOPLASTIN; THROMBOEMBOLISM; MONITORING; Safety; standards; Methods; RANDOMIZED; analysis; DOSAGE; INCIDENCE; THROMBOEMBOLIC; BLEEDING; MORTALITY; RISK; COMPLICATIONS; Body Weight; RANDOMIZED CONTROLLED TRIALS; 951217; an; is; in; confidence intervals; HEMORRHAGE; ci; heparin,low-molecular-weight; ae; tu; HUMAN; PHLEBOGRAPHY; RECURRENCE; THROMBOPHLEBITIS; dt; mo; ra; Medline File; Health Planning & Administration File; atherosclerosis; inflammation; netherlands; laboratories Notes : BACKGROUND: An intravenous course of unfractionated heparin adjusted on the basis of the activated partial thromboplastin time is the initial treatment of choice for most patients with venous thromboembolism. Recently introduced low-molecular-weight heparin preparations can be administered subcutaneously, once or twice daily, without laboratory monitoring. We quantitatively assessed the relative efficacy and safety of low-molecular-weight heparin vs standard heparin for the initial treatment of deep venous thrombosis. METHODS: English- language reports of randomized trials were identified through a MEDLINE search (1984 through 1994) and a complementary extensive manual search. Reasons for exclusion from the analysis were no heparin dosage adjustments, the lack of use of objective tests for deep venous thrombosis, duplicate reports, preliminary reports of data later presented in full, dose-ranging studies that used higher doses of low- molecular-weight heparin than are currently in use, and the failure to provide blind end-point assessment. We assessed the incidence of symptomatic recurrent venous thromboembolic disease, the incidence of clinically important bleeding, and mortality. RESULTS: Ten of the 19 identified trials satisfied the predetermined criteria. The relative risk reductions for symptomatic thromboembolic complications (53% [95% confidence interval, 18% to 73%]), clinically important bleeding (68% [95% confidence interval, 31% to 85%]), and mortality (47% [95% confidence interval, 10% to 69%]) were all statistically significantly in favor of low-molecular-weight heparin. CONCLUSIONS: Low-molecular- weight heparins administered subcutaneously in fixed doses adjusted for body weight and without laboratory monitoring are more effective and safer than adjusted-dose standard heparin. Since low-molecular-weight heparins may not be interchangeable and the conclusions of our meta- analysis are based mainly on the findings of three trials that used two different low-molecular-weight heparins, definitive randomized controlled trials for the other low-molecular-weight heparins are required. Ref ID : LESSER1992 747. Lesser, B.A., Leeper, K.V.,Jr., Stein, P.D., Saltzman, H.A., Chen, J., Thompson, B.T., Hales, C.A., Popovich, J.,Jr., Greenspan, R.H., and Weg, J.G. The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease. Chest 102:17-22, 1992. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; CHRONIC; CLINICAL FEATURES; NONINVASIVE; VENTILATION; PERFUSION; V/Q; LUNG; SCAN; COPD; PE; ANGIOGRAPHY; V/Q SCAN; PROBABILITY; OXYGEN; GRADIENT; FREQUENCY; PREDICTIVE VALUE; Hospitals; in; abnormalities; is Notes : The clinical features and noninvasive tests, including ventilation perfusion (V/Q) lung scans, were assessed in 108 patients with chronic obstructive pulmonary disease (COPD) suspected of having pulmonary embolism (PE). Twenty-one (19 percent) of 108 patients had PE. In the majority of patients, it was impossible to distinguish between patients with and without PE by clinical assessment alone. However, when a high clinical index of suspicion was present, PE was confirmed by angiography in three of three patients, but the V/Q scan was of intermediate probability. No roentgenographic abnormalities distinguished between PE and no PE. There was no difference between the alveolar-arterial oxygen gradients in either group, nor was there evidence of a reduction in the PaCO2 in patients with PE who had prior hypercapnia. Among the 108 patients with COPD, high, intermediate, low, and normal/near normal probability scans were present in 5 percent, 60 percent, 30 percent, and 5 percent, respectively. The frequency of PE in these V/Q scan categories was five (100 percent) of five, 14 (22 percent) of 65, two (6 percent) of 33, and zero (0 percent) of five, respectively. In conclusion, in the majority of patients, the V/Q scan diagnosis is usually intermediate and such patients require further investigational studies, including angiography. However, among the few patients who demonstrated a high probability lung scan, there was a high positive predictive value for PE effectively avoiding the need for further studies. In those patients with low probability or near normal/normal V/Q scans, the negative predictive value was not lower than the general hospital population. Ref ID : LEU1974 748. Leu, H.J. and Brunner, U. Les thromboses iatrogenes dans les veines profondes at dans les arteres. Phlebologie 27(1):89-94, 1974. Keywords : SCLEROTHERAPY; THROMBUS; VEINS; ARTERIAL; DEEP VEIN THROMBOSIS; PATHOLOGIC; in; SAPHENOUS VEIN; vein; Extension; Femoral Vein; Injections; ARTERY; Foot Notes : Pathologic observation of a case in which sclerotherapy produced a well organised thrombus of the lower and mid pertions of the long saphenous vein with subsequent (2 week later) extension into the saphenofemoral junction and thence into the deep femoral vein. Pathologic observations in two cases of inadvertent injection into the posterior tibial artery at the level of the medial malleolus, with subsequent loss ot the distal portion of the foot. Ref ID : LEUNG1993 749. Leung, D.Y., Seah, P.W., Lee, L.C., Cranney, G.B., and Walsh, W.F. Embolic chondrosarcoma: an unusual cause of pulmonary embolism. Am Heart J 126:732-734, 1993. Keywords : CAUSE; PULMONARY EMBOLISM; EMBOLISM; sdi-11/93; chondrosarcoma; an Ref ID : LEVINE1990 750. Levine, M., Hirsh, J., Weitz, J., Cruickshank, M., Neemeh, J., Turpie, A.G., and Gent, M. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest 98(6):1473-1479, 1990. Keywords : RANDOMIZED; DOSAGE; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PULMONARY EMBOLISM; EMBOLISM; ANIMAL; rt-PA; THROMBOLYSIS; BLEEDING; PA; THROMBOLYTIC; HEPARIN; PLACEBOS; PERFUSION; LUNG; SCANNING; drugs; RESOLUTION; SCAN; THROMBOLYTIC THERAPY; THERAPY; 951217; in; is; an; ACUTE DISEASE; ALTEPLASE; ad; ae; tu; Double-Blind Method; Drug Administration Schedule; FEMALE; HUMAN; Injections,Intravenous; ri; MALE; MIDDLE AGE; dt; mo; RECOMBINANT PROTEINS; RECURRENCE; Support,Non- U.S.Gov't; Medline File; ontario; CANADA Notes : Experiments in animals have demonstrated that recombinant tissue plasminogen activator (rt-PA) produces continuing thrombolysis after it is cleared from the circulation and that thrombolysis is both increased and accelerated, and bleeding is reduced when rt-PA is administered over a short period. In previous studies in patients with thrombotic disease, rt-PA has been shown to be an effective thrombolytic agent when administered by continuous infusion over a period between 90 minutes and 8 hours. To determine whether a short course regimen of rt-PA can achieve thrombolysis, a double-blind randomized trial has been conducted in which patients with objectively established acute symptomatic pulmonary embolism who were receiving heparin were allocated to either a 2-minute infusion of rt-PA at a dose of 0.6 mg/kg (33 patients) or saline placebo (25 patients). Perfusion lung scanning was used to assess the change in pulmonary perfusion at 24 hours and seven days post-study drug administration. Thirty-four percent of the rt-PA patients had a greater than 50 percent resolution in the perfusion defect at 24 hours compared to 12 percent of placebo patients (p = 0.026). At 24 hours, the mean relative improvement in the perfusion defect was 37.0 percent in rt-PA treated patients compared to 18.8 percent in the placebo group (p = 0.017). By day 7, no difference in lung scan resolution was detected between the groups. There were no major bleeds in either group nor were there any differences in transfusion requirements between groups. Minor bleeding occurred in 15 of the rt-PA patients mainly at angiogram- catheter insertion and venipuncture sites. These results suggest that a bolus regimen of rt-PA produces accelerated thrombolysis and provides an alternative and convenient approach to thrombolytic therapy in patients with pulmonary embolism. Ref ID : LEVINE1990A 751. Levine, M.N., Weitz, J., Turpie, A.G., Andrew, M., Cruickshank, M., and Hirsh, J. A new short infusion dosage regimen of recombinant tissue plasminogen activator in patients with venous thromboembolic disease. Chest 97(4 Suppl):168S-171S, 1990. Keywords : DOSAGE; PLASMINOGEN; PLASMINOGEN ACTIVATOR; VENOUS; THROMBOEMBOLIC; rt-PA; THROMBOLYSIS; COAGULOPATHY; FIBRINOLYTIC; BLEEDING; ANIMAL; Injections; HEPARIN; THROMBOEMBOLISM; EMBOLISM; PERFUSION; LUNG; SCAN; THROMBOSIS; VEINS; UPPER EXTREMITY; Extremities; FIBRINOGEN; TREATMENT; 951217; in; is; ALTEPLASE; ad; tu; Axillary Vein; Blood Coagulation Tests; HUMAN; Injections,Intravenous; PULMONARY EMBOLISM; bl; dt; ri; RECOMBINANT PROTEINS; SUBCLAVIAN VEIN; Support,Non-U.S.Gov't; THROMBOLYTIC THERAPY; Medline File; ontario; CANADA Notes : Although recombinant tissue-type plasminogen activator (rt-PA) has the potential to induce thrombolysis without producing a generalized coagulopathy, the dosage regimens in present use induce a plasma fibrinolytic state and are associated with bleeding. Animal experiments have demonstrated that rt-PA produces continuing thrombolysis after it is cleared from the circulation and that thrombolysis is increased and bleeding is reduced when rt-PA is administered over a short time period. To determine whether a short course regimen of rt-PA has potential in man, we gave a bolus injection of rt-PA (0.6 mg/kg) concurrently with heparin to five patients with venous thromboembolism. Three patients with angiographically proven pulmonary embolism had marked improvement of the perfusion defects when lung scans were repeated 24 h after rt-PA administration. In one of two patients with thrombosis of the deep veins of the upper extremity the venographic defect resolved completely. In three of four patients there was a mild decrease in fibrinogen and a moderate decrease in alpha 2-antiplasmin levels. There was no excessive bleeding. These results suggest that a bolus injection regimen of rt-PA has considerable potential in the treatment of thromboembolic disease. Ref ID : LEVINE1990B 752. Levine, M.N. and Hirsh, J. Clinical potential of low molecular weight heparins. Baillieres.Clin.Haematol. 3(3):545-554, 1990. Keywords : 951217; Molecular Weight; HEPARIN; in; an; CLINICAL TRIALS; PREVENTION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; TREATMENT; is; Methods; PROPHYLAXIS; RISK; BLEEDING; Injections; SURGICAL; standards; Antithrombotic; KNEE; SURGERY; CARDIAC; EARLY; RANDOMIZED; COMPARATIVE STUDY; factor xa; ai; hemorrhagic diathesis; ci; ae; pk; tu; heparin,low-molecular-weight; HUMAN; Postoperative Complications; pc; THROMBOEMBOLISM; dt; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; Medline File Notes : In recent years there has been an explosion of clinical trials evaluating low molecular weight (LMW) heparin both in the prevention of venous thrombosis and in the treatment of established venous thrombosis. Results to date would indicate that LMW heparin is an effective method of prophylaxis and has a negligible risk of bleeding, provided the anti- factor Xa levels 4-6 h after injection do not exceed 0.2 units/ml. There is suggestive evidence that, if LMW heparin is given in doses which produce anti-factor Xa levels of more than 0.4 units/ml, there is an increased risk of perioperative bleeding in surgical patients. Although three studies have reported that LMW heparin is more effective than standard unfractionated low dose heparin in the prevention of venous thrombosis, further studies evaluating risks and benefits are required. The promising experimental findings that LMW heparin produces less bleeding for equivalent antithrombotic efficacy has yet to be established in man. Results of clinical trials in neurosurgical patients, patients undergoing knee surgery and patients undergoing cardiac surgery may establish whether LMW heparin is advantageous in such patients at very high risk for bleeding. Finally, the early results from randomized trials suggest that LMW heparins are effective in the treatment of established venous thrombosis, but further trials are required. Ref ID : LEVINE1990C 753. Levine, M. and Hirsh, J. The diagnosis and treatment of thrombosis in the cancer patient. Semin.Oncol. 17(2):160-171, 1990. Keywords : 951217; DIAGNOSIS; TREATMENT; THROMBOSIS; in; CANCER; ANTICOAGULANTS; tu; HUMAN; Neoplasms; co; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; di; dt; et; Medline File; Cancerlit File; ontario; CANADA Notes : [No Abstract Available] Department of Medicine McMaster University Hamilton Ontario Canada. Ref ID : LEVINE1991 754. Levine, M.N., Hirsh, J., Gent, M., Turpie, A.G., LeClerc, J., Powers, P.J., Jay, R.M., and Neemeh, J. Prevention of deep vein thrombosis after elective hip surgery. A randomized trial comparing low molecular weight heparin with standard unfractionated heparin [see comments]. Ann.Intern.Med. 114(7):545-551, 1991. Keywords : LMWH; Low-Molecular-Weight-Heparin; PREVENTION; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; HIP; SURGERY; RANDOMIZED; Molecular Weight; HEPARIN; standards; Safety; Calcium; POSTOPERATIVE; HIP REPLACEMENT; Hospitals; LEG; SCANNING; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; VENOGRAPHY; Venogram; VENOUS; VENOUS THROMBOSIS; HEMORRHAGIC; COMPLICATIONS; RISK; BLEEDING; Low molecular weight heparin; 951217; in; ci; is; ADULT; AGED; COMPARATIVE STUDY; Double- Blind Method; Drug Administration Schedule; FEMALE; Follow-Up Studies; HEMORRHAGE; ae; tu; heparin,low-molecular-weight; hip prosthesis; HUMAN; MALE; MIDDLE AGE; Postoperative Care; Postoperative Complications; pc; ra; PULMONARY EMBOLISM; et; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; Medline File; ontario Notes : OBJECTIVE: To determine the relative efficacy and safety of low molecular weight (LMW) heparin (Enoxaparin) compared with standard calcium heparin for the prevention of postoperative deep vein thrombosis in patients undergoing elective hip surgery. DESIGN: A double-blind, randomized, controlled trial. PATIENTS: Six hundred sixty-five consecutive patients undergoing hip replacement at five participating hospitals. INTERVENTIONS: Patients received either fixed-dose LMW heparin, 30 mg subcutaneously twice daily, or fixed-dose standard calcium heparin, 7500 units subcutaneously twice daily; both regimens were started 12 to 24 hours after surgery and continued for 14 days or until discharge if sooner. MEASUREMENTS: All patients had postoperative I-125-fibrinogen leg scanning and impedance plethysmography. If results of one or both tests were positive, then venography was done. Otherwise, venography was done between day 10 and day 14, or sooner if the patient was ready for discharge. RESULTS: Evaluable venograms were obtained in 258 of the 333 patients randomly assigned to receive LMW heparin and in 263 of the 332 patients assigned to receive calcium heparin. For patients with evaluable venograms, thrombosis was detected in 50 patients (19.4%) who received LMW heparin compared with 61 patients (23.2%) who received standard heparin (difference, -3.8%; 95% CI, -11.1% to 3.6%) (P greater than 0.2). Proximal deep vein thrombosis was detected in 5.4% of the patients receiving LMW heparin and in 6.5% of the patients receiving standard heparin (difference, -1.1%; CI, - 5.2% to 3.3%) (P greater than 0.2). For the entire group of 665 patients, venous thrombosis occurred in 17.1% given LMW heparin and in 19.0% given standard heparin. Hemorrhagic complications occurred in 31 patients (9.3%) given standard heparin and in 17 patients (5.1%) given LMW heparin (difference, 4.2%; CI, 0.3% to 8.2%) (P = 0.035). The relative risk reduction was 45%. The rate of major bleeding in the standard heparin group was 5.7% compared with 3.3% in the LMW heparin group (difference, 2.4%; CI, -1.0% to 5.4%) (P = 0.13). The relative risk reduction was 42%. CONCLUSION: Low molecular weight heparin is significantly less hemorrhagic than standard unfractionated heparin; the difference in the rate of deep vein thrombosis, although not statistically significant (P greater than 0.2), favors the use of LMW heparin. Ref ID : LEVINE1992 755. Levine, M.N., Goldhaber, S.Z., Califf, R.M., Gore, J.M., and Hirsh, J. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism. Chest 102(4 Suppl):364S-373S, 1992. Keywords : HEMORRHAGIC; COMPLICATIONS; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; TREATMENT; MYOCARDIAL INFARCTION; VENOUS; THROMBOEMBOLISM; 951216; in; infarction; HEMORRHAGE; ci; ep; th; HUMAN; dt; PULMONARY EMBOLISM; RISK FACTORS; ae; THROMBOPHLEBITIS; Medline File; 951217 Notes : [No Abstract Available]. Ref ID : LEVINE1992B 756. Levine, S. The risk of stroke after thrombolytic therapy [letter; comment]. N.Engl.J.Med. 327(21):1532, 1992. Keywords : 96-suzy-001; RISK; STROKE; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; CEREBRAL HEMORRHAGE; chemically induced; HEMORRHAGE; ETIOLOGY; HUMAN; MYOCARDIAL INFARCTION; COMPLICATIONS; adverse effects Ref ID : LEVINE1993 757. Levine, M., Hirsh, J., Gent, M., Arnold, A., Warr, D., Falanga, A., Samosh, M., Bramwell, V., Pritchard, K., and Stewart, D. A double-blind randomized trial of low-dose warfarin for the prevention of thromboembolism (TE) in patients with Stage IV breast cancer (Meeting abstract). Proc.Annu.Meet.Am.Soc.Clin.Oncol. 12:A38 1993:A38 1993, 1993. Keywords : 951217; RANDOMIZED; WARFARIN; PREVENTION; THROMBOEMBOLISM; in; CANCER; PT; RISK; MANAGEMENT; PLACEBOS; PROTHROMBIN; prothrombin time; an; is; THROMBOPLASTIN; TREATMENT; AGE; THROMBOSIS; DURATION; mo; THROMBOEMBOLIC; DEEP VEIN THROMBOSIS; vein; PULMONARY EMBOLISM; EMBOLISM; PE; BLEEDING; SURVIVAL; Methods; breast neoplasms; dt; PA; Dose-Response Relationship,Drug; Double-Blind Method; FEMALE; HUMAN; neoplasm metastasis; neoplasm staging; pc; ad; Cancerlit File; ontario; CANADA; International normalized ratio Notes : Patients (pts) with metastatic breast cancer receiving chemotherapy (chemoRx) are at high risk for TE and its occurrence complicates their management. A multi-centre trial was conducted in which women with metastatic breast cancer who were receiving chemoRx were allocated to either low-dose warfarin (152 pts) or placebo (159 pts). The dose of warfarin was 1 mg/day for the first 6 wk and then was adjusted to maintain the prothrombin time (PT) at an international normalized ratio of 1.3-1.9, which is equivalent to a PT ratio of 1.1 to 1.3, using a less responsive thromboplastin. The treatment groups were reasonably comparable for baseline characteristics (eg, age, site of metastases, thrombosis history). The av dose/day of warfarin was 2.6 mg and the median duration of warfarin treatment was 5.4 mo. There were 7 thromboembolic events (4.4%) in the placebo group, compared to 1 (0.7%) in the warfarin group, p=0.03. In the placebo group, there were 6 pts with deep vein thrombosis and 1 with pulmonary embolism (PE) compared to 1 PE in the warfarin group. Two placebo pts experienced major bleeding, compared to 1 warfarin pt. No difference was detected in survival between groups. Thus, low-dose warfarin is a safe and effective method for the prevention of TE in pts with metastatic breast cancer receiving chemoRx Ontario Clinical Oncology Group Hamilton L8V 5C2 Canada. Ref ID : LEVINE1994 758. Levine, M.N., Hirsh, J., Gent, M., Turpie, A.G., Cruickshank, M., Weitz, J., Anderson, D., and Johnson, M. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Arch.Intern.Med. 154(1):49-56, 1994. Keywords : LMWH; Low-Molecular-Weight-Heparin; RANDOMIZED; THROMBOPLASTIN; HEPARIN; VENOUS; THROMBOEMBOLISM; MANAGEMENT; THERAPY; APTT; RISK; BLEEDING; ANIMAL; MONITORING; TREATMENT; Methods; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; Axillary Vein; INTRAVENOUS; intravenous heparin; WARFARIN; DOSAGE; 951217; in; is; confidence intervals; ACUTE DISEASE; ADULT; AGED; Drug Administration Schedule; drug monitoring; mt; drug resistance; factor xa; an; FEMALE; ad; tu; HUMAN; MALE; MIDDLE AGE; partial thromboplastin time; RECURRENCE; Support,Non-U.S.Gov't; bl; dt; Medline File; ontario Notes : BACKGROUND: The management of heparin therapy in patients who have a subtherapeutic activated partial thromboplastin time (APTT) despite high doses of heparin is problematic because the risk of heparin-associated bleeding increases with dose. Results of experimental studies in animals indicate that when the APTT response to heparin is blunted by infusion of procoagulants, dose escalation can be avoided without compromising efficacy, by monitoring treatment with a heparin assay. METHODS: A randomized, controlled trial was conducted in which patients with acute deep vein thrombosis, pulmonary embolism, or axillary vein thrombosis who required 35,000 U or more of intravenous heparin by continuous infusion during the previous 24 hours were allocated to have their heparin therapy monitored either by anti-factor Xa levels (targeted range, 0.35 to 0.67 U/mL) or by the APTT (targeted range, 60 to 85 seconds). Both ranges were equivalent to a heparin level of 0.2 to 0.4 U/mL by protamine titration. RESULTS: Three (4.6%) of 65 patients in the anti-factor Xa group experienced recurrent venous thromboembolism compared with four (6.1%) of 66 patients in the APTT group (difference, 1.5%; confidence interval, -6.7% to 8.4%) (P = .7). There were four bleeding events (6.1%) in the APTT group compared with one (1.5%) in the anti-factor Xa group (difference, 4.6%; confidence interval, -3.3% to 7.5%) (P = .4). During the period of heparin therapy before warfarin treatment was begun, the patients in the APTT group required a statistically significantly greater amount of heparin compared with the patients in the anti-factor Xa group. The daily mean APTT was subtherapeutic in patients in the anti-factor Xa group, and it was within the therapeutic range in the APTT group. The daily mean anti- factor Xa levels for both groups were within the therapeutic range. CONCLUSION: The heparin assay is a safe and effective method for monitoring heparin treatment in patients with acute venous thromboembolism whose APTT remains subtherapeutic despite large daily doses of heparin. In such patients, dosage escalation can be avoided if the heparin level is therapeutic. Ref ID : LEVINE1994A 759. Levine, M., Hirsh, J., Gent, M., Arnold, A., Warr, D., Falanga, A., Samosh, M., Bramwell, V., Pritchard, K.I., and Stewart, D. Double-blind randomised trial of a very-low-dose warfarin for prevention of thromboembolism in stage IV breast cancer [see comments]. Lancet 343(8902):886-889, 1994. Keywords : WARFARIN; PREVENTION; THROMBOEMBOLISM; CANCER; RISK; THROMBOEMBOLIC; LONG TERM; ANTICOAGULANT; THERAPY; COMPLICATIONS; Safety; PROPHYLAXIS; PLACEBOS; PROTHROMBIN; TREATMENT; THROMBOSIS; DEEP VEIN THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; BLEEDING; SURVIVAL; Methods; 951217; in; is; prothrombin time; an; antineoplastic agents; ae; breast neoplasms; dt; PA; Double-Blind Method; FEMALE; HUMAN; MIDDLE AGE; neoplasm metastasis; neoplasm staging; Support,Non-U.S.Gov't; ci; pc; THROMBOPHLEBITIS; TREATMENT OUTCOME; ad; Medline File; Health Planning & Administration File; Cancerlit File; ontario; CANADA; INR Notes : Patients receiving chemotherapy for metastatic breast cancer are at high risk of thromboembolic disease. Long-term oral anticoagulant therapy is needed but increases the risk of haemorrhagic complications. We have assessed the safety and efficacy of warfarin in very low doses as prophylaxis. Women receiving chemotherapy for metastatic breast cancer were randomly assigned either very-low-dose warfarin (152 patients) or placebo (159). The warfarin dose was 1 mg daily for 6 weeks and was then adjusted to maintain the prothrombin time at an international normalised ratio (INR) of 1.3 to 1.9. Study treatment continued until 1 week after the end of chemotherapy. The average daily dose from initiation of titration was 2.6 (SD 1.2) mg for the warfarin group and the mean INR was 1.52. The mean time at risk of thrombosis was 199 (126) days for warfarin-treated patients and 188 (137) days for placebo recipients (p = 0.45). There were 7 thromboembolic events (6 deep-vein thrombosis, 1 pulmonary embolism) in the placebo group and 1 (pulmonary embolism) in the warfarin group, a relative risk reduction of about 85% (p = 0.031). Major bleeding occurred in 2 placebo recipients and 1 warfarin-treated patient. There was no detectable difference in survival between the treatment groups. Very-low-dose warfarin is a safe and effective method for prevention of thromboembolism in patients with metastatic breast cancer who are receiving chemotherapy. Ref ID : LEVINE1996 760. Levine, M.N., Hirsh, J., and Gent, M. Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis. Thromb.Haemost. , 1996. Keywords : DURATION; ANTICOAGULANT; THERAPY; RANDOMIZED; WARFARIN; in; vein; THROMBOSIS Ref ID : LEVY1975 761. Levy, R.P. and Miraldi, F.D. The frequency and detection of serious postoperative thromboembolic disease. Surg.Gynecol.Obstet. 140:903-908, 1975. Keywords : 951202; FREQUENCY; POSTOPERATIVE; THROMBOEMBOLIC; TECHNIQUES; FIBRINOGEN; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; AGE; HEPARIN; SURGICAL; PREVENTION; PHLEBITIS; ARM; INTRAVENOUS; THERAPY; ANTICOAGULANTS; LEG; PULMONARY EMBOLISM; EMBOLISM; FIBRINOGEN SCAN; SCAN; REVIEW; Hospitals; CAUSE; MORBIDITY; MORTALITY; ADULT; AUTOPSY; INCIDENCE; DEATH; Methods; is; ANIMAL; COMPARATIVE STUDY; du; tu; HUMAN; iodine radioisotopes; Postoperative Complications; PROSPECTIVE STUDIES; di; ep; et; RABBITS; Retrospective Studies; Support,U.S.Gov't,P.H.S. THROMBOEMBOLISM; THROMBOPHLEBITIS; Medline File Notes : A safe, sensitive and convenient technique using 131-I fibrinogen for detecting deep venous thrombosis in postoperative patients has been developed. A total of 47 volunteers over age 40 years about to undergo major operation were studied prospectively. Neither in 20 patients given heparin as part of the surgical procedure or for prevention of superficial phlebitis in the arm during intravenous therapy nor in the 27 others not given anticoagulants before, during or after operations was there evidence of venous thrombosis in the leg or pulmonary embolism either by the 131-I fibrinogen scan nor by clinical course. A retrospective review of hospital records confirmed the relative rarity of pulmonary embolism as a cause of identified morbidity and mortality in surgical patients. Of 54, 183 adult patients discharged from the University Hospitals of Cleveland during 1972 and 1973, 197, or 0.4 per cent, were diagnosed as having pulmonary embolism, and of these only 32, or 16 per cent, occurred in postoperative surgical patients. A review of the autopsy records of the same institution for the same time also revealed a low incidence of deaths due to pulmonary embolism among the surgical population, only 180, or 0.8 per cent, of the 22, 449 adult surgical admissions. Although feasible to perform, the value of the radiofibrinogen method of detecting deep venous thrombosis in postoperative patients as a routine measure is questioned. Ref ID : LEWIS1976 762. Lewis, C.E., Antoine, J., Mueller, C., Talbot, W.A., Swaroop, R., and Edwards, W.S. Elastic compression in the prevention of venous stasis: A critical appraisal. Am.J.Surg. 132:739-743, 1976. Keywords : COMPRESSION; PREVENTION; VENOUS; STASIS; PROSPECTIVE; REVIEW; STOCKINGS; DVT; RISK; PROSPECTIVE STUDIES; CONTRAST; in; an; is Notes : Prospective study of the effects of compression hose on the rate of clearance of radiographic contrast, along with an excellent review of the evidence in favor of compression stockings for patients with DVT or at risk for DVT. Contrast is cleared in an average of 18.3 minutes with stockings, compared to 32 minutes without stockings. Ref ID : LEWIS1994 763. Lewis, B.D., James, E.M., Welch, T.J., Joyce, J.W., Hallett, J.W., and Weaver, A.L. Diagnosis of acute deep venous thrombosis of the lower extremities: prospective evaluation of color Doppler flow imaging versus venography. Radiology 192:651-655, 1994. Keywords : PHLEBITIS; DIAGNOSIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Extremities; PROSPECTIVE; Doppler; VENOGRAPHY; ACUTE DISEASE; ADULT; AGED; Aged,80 and over; COMPARATIVE STUDY; FEMALE; HUMAN; LEG; blood supply; MALE; MIDDLE AGE; PHLEBOGRAPHY; predictive value of tests; PROSPECTIVE STUDIES; sensitivity and specificity; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; radiography; Ultrasonography; DVT; COMPRESSION; Methods; CHRONIC; SENSITIVITY; SPECIFICITY; color; in; is Notes : PURPOSE: To determine the value of color Doppler flow imaging in identification of deep venous thrombosis (DVT) of the femoropopliteal system without use of venous compression. MATERIALS AND METHODS: Color Doppler flow imaging was compared with venography in 103 lower extremities in 101 patients. Results of each examination were recorded as positive or negative for acute DVT or consistent with chronic DVT. RESULTS: Color Doppler flow imaging in 97 of 103 cases had a sensitivity of 95%, specificity of 99%, positive and negative predictive values of 95% and 99%, respectively, and accuracy of 98% in detection of acute DVT and was also helpful in differentiation of chronic from acute DVT. Color Doppler flow imaging prospectively identified six of eight patients with chronic DVT and correctly identified acute DVT in two patients with underlying chronic DVT. No results were false-positive for acute DVT in a patient with chronic DVT. CONCLUSION: Color Doppler flow imaging is complementary to compression ultrasonography in evaluation of suspected acute DVT and may be helpful in evaluation of suspected DVT in patients with previous or chronic DVT. Ref ID : LI1991 764. Li, E.K., Kay, R.L., and Cohen, M.G. Cerebral venous thrombosis in systemic lupus erythematosus [letter; comment]. Stroke. 22:281-283, 1991. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LUPUS; sdi-11/93; Cerebral; in Ref ID : LICCIARDELLO1985 765. Licciardello, J.T., Moake, J.L., Rudy, C.K., Karp, D.D., and Hong, W.K. Elevated plasma von Willebrand factor levels and arterial occlusive complications associated with cisplatin-based chemotherapy. Oncology 42:296-300, 1985. Keywords : ARTERIAL; COMPLICATIONS; RISK; DVT; PE; CANCER; ANTICOAGULANT; ANTITHROMBIN III; PROTEIN C; CAUSE; ANTICOAGULANTS; an; in 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 act to decrease circulating anticoagulants such as antithrombin III or protein C or S. Some cause an increase in circulating procoagulants, such as von Willebrand factor. Ref ID : LIEBERMAN1961 766. Lieberman, J.S., Borrero, J., Urdanetta, E., and Wright, I.S. Thrombophlebitis and cancer. JAMA 177:542-545, 1961. Keywords : THROMBOPHLEBITIS; CANCER; MALIGNANCY; RISK; DVT; OCCULT; is; RISK FACTORS; in Notes : Malignancy, whether known or occult, is a recognized risk factor for VT.{323} In 38 percent of cases of concommittent cancer and DVT, the DVT was detected first. Ref ID : LINDBLAD1991 767. Lindblad, B., Sternby, N.H., and Bergqvist, D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ. 302:709-711, 1991. Keywords : 951202; INCIDENCE; VENOUS; THROMBOEMBOLISM; in; Hospitals; analysis; SURGERY; internal medicine; OUTCOME; PULMONARY EMBOLISM; EMBOLISM; FATAL; POSTOPERATIVE; Pulmonary emboli; EMBOLI; CALF; VEINS; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; AGED; PROPHYLAXIS; EARLY; PREVALENCE; AGE; AUTOPSY; HUMAN; longitudinal studies; ep; mo; Support,Non-U.S.Gov't; Sweden; PA; THROMBOPHLEBITIS; TIME FACTORS; Medline File; Cancerlit File Notes : OBJECTIVE--To determine the incidence of venous thromboembolism in all necropsy reports over 30 years. DESIGN--Study of all necropsies in one hospital in 1987 and longitudinal analysis of results of necropsy in 1957, 1964, 1975, and 1987. SETTING--Departments of general surgery, infectious diseases, internal medicine, oncology, and orthopaedics in a Swedish general hospital. MAIN OUTCOME MEASURE-- Number of cases of venous thromboembolism. RESULTS--About a third of all necropsies showed venous thromboembolism. In 1987, 260 of 347 necropsies showing venous thromboembolism found pulmonary embolism, of which 93 were classified as fatal, 90 as contributory, and 77 as incidental. Only 21 contributory or fatal postoperative pulmonary emboli were seen. In only 106 of 260 patients with pulmonary embolism did routine necropsy not show the source of embolism. Calf veins were not routinely examined. Deep venous thrombosis was seen in 239 patients in 1987. The incidence of venous thromboembolism in the four years studied was remarkably stable except in the department of orthopaedics, where the proportion fell from 60.7% in 1975 to 32.2% in 1987 (p less than 0.05), although there were only a few patients. CONCLUSIONS--The overall incidence of venous thromboembolism has not changed over 30 years. During this period the proportion of the population aged over 65 has doubled, and this may have masked the beneficial effects of prophylaxis and early mobilisation. Prevalences corrected for age are needed Department of Surgery Malmo General Hospital Lund University Sweden. Ref ID : LINDBLAD1991A 768. Lindblad, B., Eriksson, A., and Bergqvist, D. Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Brit.J.Surg. 78:849-852, 1991. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; in; SURGICAL; analysis; Sweden; Pulmonary emboli; EMBOLI; AUTOPSY; FREQUENCY; DEATH; FATAL; vein; THROMBOSIS; POSTOPERATIVE; thromboprophylaxis; CAUSE; cause of death; ADULT; AGED; Aged,80 and over; COMPARATIVE STUDY; FEMALE; HUMAN; MALE; MIDDLE AGE; Postoperative Complications; et; di; ep; mo; Retrospective Studies; Support,Non-U.S.Gov't; Medline File; SURGERY; Hospitals; an Notes : A retrospective analysis was undertaken of all surgical patients in Malmo, Sweden, during the period from 1951 to 1988 in whom pulmonary emboli were found at autopsy. The analysis included a comparison with the earlier analysed and reported time period from 1951 to 1980. A continued high frequency of pulmonary embolism at autopsy was seen during the 1980s (20.3 per cent of deaths, 31.7 per cent of autopsies). Of the 391 autopsy-verified pulmonary emboli found between 1981 and 1988, 113 (28.9 per cent) were considered fatal, 104 (26.6 per cent) contributed to death and 174 (44.5 per cent) were incidental. Few patients had symptomatic deep vein thrombosis or pulmonary embolism before death. The overall frequency of major pulmonary embolism in surgical patients remained unchanged (0.3 per cent). The frequency of major postoperative pulmonary embolism showed an increase during the 1950s and 1960s (maximum 0.4 per cent) but a decrease in the last 5-year period of the 1970s (0.3 per cent), which has earlier been reported upon. This decrease continued during the 1980s (0.2 per cent) (P less than 0.05). An increase was found in the number of patients operated on who had autopsy-proven pulmonary embolism and who received thromboprophylaxis. Pulmonary embolism continues to be a major cause of death in surgical patients; however, postoperative major pulmonary embolism has shown a reduction in the last 15-year period Department of Surgery University Lund Malmo General Hospital Sweden. Ref ID : LINDHAGEN1985 769. Lindhagen, A., Bergqvist, D., Hallbook, T., and Efsing, H.O. Venous function five to eight years after clinically suspected deep venous thrombosis. Acta.Med.Scand. 217:389-395, 1985. Keywords : VENOUS; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; VENOUS FUNCTION; POSTPHLEBITIC SYNDROME; CHRONIC VENOUS INSUFFICIENCY; 96-suzy-002; SURGERY; Sweden; PHLEBOGRAPHY; DVT; FREQUENCY; Venous Insufficiency; Plethysmography; Venous Pressure; Pressure; Doppler; ULTRASOUND; in; LEG; CALF; CALF VEIN THROMBOSIS; vein; Popliteal Vein; FOLLOWUP Notes : 01-03-96. Abstract : Lindhagen A, Bergqvist D, Hallbook T, Efsing HO, (Department of Surgery and Radiology, Karnsjukhuset, Skovde, Sweden.) Venous function five to eight years after clinically suspected deep venous thrombosis. Acta Med Scand 1985; 217:389-95. One hundred and fifty-four patients, who had been subjected to phlebography 5-8 years previously because of clinical suspicion of deep venous thrombosis (DVT), were investigated to evaluate the frequency of deep venous insufficiency (DVI). The evaluation included clinical examination, registration of subjective complaints and objective measurements with plethysmography, venous pressure and Doppler ultrasound. DVT had been presented in 75 legs. There were no statistically significant differences between legs with and without earlier DVT apart from more venous outflow obstructions in the former. DVT was as common after calf vein thrombosis as after proximal DVT. DVI was more frequent in elderly patients and in patients with a history with previous DVI or DVT. The sufficiency of the popliteal vein seemed to be of great importance in the development of DVI. More than one third of legs without DVT had developed DVI at follow-up. Ref ID : LIPPMANN1993 770. Lippmann, M.L. and Fein, A.M. Diagnosis of acute pulmonary embolism in patients with COPD [letter]. Chest 104:983-984, 1993. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; COPD; sdi-11/93; in Ref ID : LOFGREN1974 771. Lofgren, K.A. Stasis ulcer. Diagnosis and treatment. Minn.Med. 57:135-137, 1974. Keywords : STASIS; Ulcer; DIAGNOSIS; TREATMENT; NASP; BANDAGES; Diagnosis,Differential; HUMAN; Postoperative Care; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; ab Notes : AB - [No Abstract Available] UI - 74102609. Ref ID : LOFGREN1981 772. Lofgren, E.P. and Lofgren, K.A. The surgical treatment of superficial thrombophlebitis. Surgery 90:49, 1981. Keywords : SURGICAL; TREATMENT; THROMBOPHLEBITIS; NASP; bib-3; Superficial thrombophlebitis Ref ID : LOKICH1983 773. Lokich, J.J. and Becker, B. Subclavian vein thrombosis in patients treated with infusion chemotherapy for advanced malignancy. Cancer 52:1586-1589, 1983. Keywords : SUBCLAVIAN; SUBCLAVIAN VEIN; vein; THROMBOSIS; MALIGNANCY; VEINS; SVC SYNDROME; in Ref ID : LONG1991 774. Long, A.A., Ginsberg, J.S., Brill-Edwards, P., Johnston, M., Turner, C., Denburg, J.A., Bensen, W.G., Cividino, A., Andrew, M., and Hirsh, J. The relationship of antiphospholipid antibodies to thromboembolic disease in systemic lupus erythematosus: a cross- sectional study. Thromb.Haemost. 66(5):520-524, 1991. Keywords : 951217; antibodies; THROMBOEMBOLIC; in; LUPUS; an; SLE; cross-sectional studies; REVIEW; VENOUS; Doppler; ULTRASOUND; LEG; REFLUX; INDICATIONS; VENOUS THROMBOSIS; THROMBOSIS; COAGULATION; ANTICOAGULANT; TRENDS; abnormalities; is; THROMBOEMBOLISM; autoantibodies; Blood Coagulation Tests; factor xa; me; HUMAN; lupus erythematosus,systemic; bl; im; pp; partial thromboplastin time; phospholipids; Support,Non-U.S.Gov't; et; Medline File; ontario; CANADA Notes : In order to determine whether an association exists between antiphospholipid antibodies (APLA) and thromboembolic events in patients with systemic lupus erythematosus (SLE), we performed a cross-sectional study of consecutive unselected SLE patients. The occurrence of previous thromboembolic events was determined by investigators blinded to the APLA status of the patients by critical review of objective tests that had been performed at the time of symptomatic presentation and by performing venous Doppler ultrasound of the legs to elicit venous reflux as an indication of previous venous thrombosis. The presence of APLA was determined by coagulation assays for the lupus anticoagulant (LA) using five tests with well- defined control ranges and by ELISA assay for anticardiolipin antibodies (ACLA). These tests were measured on two separate occasions. The results of the study demonstrate a statistically significant association between persistently abnormal ACLA assays and thromboembolic events and a non-significant trend between persistently abnormal LA and thromboembolic events. Transient abnormalities of LA and ACLA were less strongly associated with thromboembolic events. We conclude that in patients with SLE, there is a significant association between thromboembolism and APLA Department of Medicine McMaster University Hamilton Ontario Canada. Ref ID : LONSDALE1991 775. Lonsdale, R.J. Intra-arterial thrombolytic therapy in the management of acute and chronic limb ischaemia [letter; comment]. Brit.J.Surg. 78:1020, 1991. Keywords : INTRAARTERIAL; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MANAGEMENT; CHRONIC; ACEP-93; ACEP93; in Ref ID : LONSDALE1991A 776. Lonsdale, R.J., Makin, G.S., Wenham, P.W., and Hopkinson, B.R. Thrombolysis in critical ischaemia [letter]. Eur.J.Vasc.Surg. 5:361, 1991. Keywords : THROMBOLYSIS; ACEP-93; ACEP93; in Ref ID : LONSDALE1991B 777. Lonsdale, R.J. Results of a recently instituted programme of thrombolytic therapy in acute lower limb ischemia [letter; comment]. Brit.J.Surg. 78(10):1273, 1991. Keywords : 96-suzy-001; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; in; Ischemia; ALTEPLASE; therapeutic use; HUMAN; Methods; THROMBOSIS; drug therapy; TIME FACTORS Ref ID : LONSDALE1992 778. Lonsdale, R.J., Berridge, D.C., Earnshaw, J.J., and et al Recombinant tissue plasminogen activator is superior to streptokinase for local intra-arterial thrombolysis. Brit.J.Surg. 79:272-275, 1992. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; STREPTOKINASE; INTRAARTERIAL; THROMBOLYSIS; is Ref ID : LORENTE1991 779. Lorente, J.A., Pinto, J., Lia:no, F., Sureda, A., and Ortu:no, J. Thrombosed internal hemodialysis access fistula: success of systemic fibrinolytic treatment [letter]. Nephron. 59:349-350, 1991. Keywords : THROMBOSED; FIBRINOLYTIC; TREATMENT; ACEP93; hemodialysis; Fistula Ref ID : LORIMER1994 780. Lorimer, J.W., Semelhago, L.C., and Barber, G.G. Venous gangrene of the extremities [see comments]. Can.J.Surg. 37:379-384, 1994. Keywords : EMBOLISM; TRAUMA; VENOUS; GANGRENE; Extremities; REVIEW; TREATMENT; SURGICAL; COMPUTER; diagnostics; THROMBOSIS; PROGNOSIS; ANTICOAGULANTS; HYPERCOAGULABLE; VEINS; DIAGNOSIS; ANTICOAGULATION; THERAPY; in; is Notes : OBJECTIVE: To review the rare clinical condition of venous gangrene of the extremities, particularly in association with malignant disease; to develop a treatment scheme for this difficult condition. DATA SOURCES: Surgical articles on phlegmasia cerulea dolens, venous gangrene and other forms of noninfectious, nonarterial gangrene of the extremities from 1937 to the present were identified from published indexes and computer databases; experience with four additional cases treated by the authors is incorporated. STUDY SELECTION: Studies selected for detailed review include those involved directly with venous gangrene and its investigation and treatment, and those relating to investigation of clinically similar conditions. DATA EXTRACTION: Because of the rarity of venous gangrene, much of the available literature is descriptive, involves small numbers of cases and describes only limited experience with investigation and treatment; data extraction was done by a single reviewer. DATA SYNTHESIS: Because of advances in diagnostic technology and thrombosis research, the assessment of suspected venous gangrene has changed significantly in recent years. Despite these advances, the prognosis for patients with this condition continues to be poor. The possible confounding roles of paradoxical reactions to anticoagulants and of primary hypercoagulable states are considered. CONCLUSIONS: Objective demonstration of extensive thrombosis of the large veins of the involved extremity remains central to the diagnosis. The presence and stage of any associated malignant lesion must be rapidly determined to allow planning for further treatment. Because conventional anticoagulation frequently fails, it may be necessary to consider less well-established modes of therapy. Ref ID : LOSCALZO1990 781. Loscalzo, J. An overview of thrombolytic agents. Chest 97(4 Suppl):117S-123S, 1990. Keywords : 96-suzy-001; an; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; in; MYOCARDIAL INFARCTION; infarction; HUMAN; STREPTOKINASE; UROKINASE; PLASMINOGEN; PLASMINOGEN ACTIVATOR; FIBRIN; REVIEW; THROMBI; FIBRINOLYSIS; FIBRINOLYTIC AGENTS; PHARMACOLOGY; therapeutic use; HEMOSTASIS; plasminogen activators; THROMBOSIS; blood; drug therapy Notes : The use of thrombolytic therapy has increased considerably in the past five years, particularly in patients with acute myocardial infarction. The agents that have been used in humans thus far include streptokinase and urokinase, as well as tissue-type plasminogen activator and, most recently, single-chain urokinase-type plasminogen activator or pro-urokinase. Each of these agents works by very different mechanisms to activate plasminogen and, as a result, to lyse fibrin clots. This article reviews the mechanisms by which pathophysiologic thrombi develop, the pharmacologic agents available to lyse thrombi, and the mechanisms of action of these agents. Ref ID : LOWE1982 782. Lowe, G.D.O., McArdle, B.M., Carter, D.C., McLaren, D., Osborne, D.H., Smith, A., Forbes, C.D., and Prentice, C.R.M. Prediction and selective prophylaxis of venous thrombosis in elective gastrointestinal surgery. Lancet 1:409-412, 1982. Keywords : PROPHYLAXIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SURGERY; NASP; in Ref ID : LOWENBERG1952 783. Lowenberg, E.L. Significance and management of acute spontaneous thrombophlebitis in the superficial veins of the lower extremities. J.Internat.Col.Surg. 18:422, 1952. Keywords : MANAGEMENT; THROMBOPHLEBITIS; VEINS; Extremities; NASP; vein; bib-3; in Ref ID : LUCAS1993 784. Lucas, K.G. and Urbach, A.H. An unusual case of relapsing myositis in a 12-year-old child. Clin.Pediatr.(Phila). 32:438-442, 1993. Keywords : CHILD; sdi-11/93; Myositis; EMBOLISM; an; in Ref ID : LUDWIG1973 785. Ludwig, H. Results of streptokinase therapy in deep venous thrombosis during pregnancy. Postgrad.Med.J. Aug:65-67, 1973. Keywords : STREPTOKINASE; THERAPY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PREGNANCY; PREGNANT; DEEP VEIN THROMBOSIS; vein; PULMONARY EMBOLISM; EMBOLISM; VEINS; THROMBOLYSIS; LYTIC; in Notes : A small series of pregnant patients treated with streptokinase for deep vein thrombosis and pulmonary embolism. Ref ID : LUFT1975 786. Luft, F.C., Walker, P.D., Hamburger, R.J., and Kleit, S.A. Thrombosis of the renal veins and vena cava. Occurrence in morbid obesity. JAMA 234:1158-1160, 1975. Keywords : 951202; THROMBOSIS; renal veins; VEINS; VENA CAVA; in; OBESITY; vein; Nephrotic syndrome; Syndrome; PULMONARY EMBOLISM; EMBOLISM; ANTICOAGULANTS; Died; AUTOPSY; CASE REPORT; coma; PA; HUMAN; kidney glomerulus; MALE; MIDDLE AGE; et; co; proteinuria; di; uremia; Vena Cava,Inferior; Medline File Notes : Renal vein thrombosis caused the nephrotic syndrome in a patient with morbid obesity. Pulmonary embolism occurred initially, but not after anticoagulants were administered. Surviving for three years, the patient died of profound uremia and hyperosmolar coma. At autopsy, membranous glomerular changes were found. Conclusive exclusion of renal vein thrombosis in the morbidly obese patient with nephrotic syndrome appears advisable. Ref ID : LUTTER1991 787. Lutter, K.S., Kerr, T.M., Roedersheimer, L.R., Lohr, J.M., Sampson, M.G., and Cranley, J.J. Superficial thrombophlebitis diagnosed by duplex scanning. Surgery 110:42-46, 1991. Keywords : PHLEBITIS; Superficial thrombophlebitis; THROMBOPHLEBITIS; Duplex; SCANNING; AGED; FEMALE; HUMAN; LEG; blood supply; MALE; MIDDLE AGE; RISK FACTORS; SAPHENOUS VEIN; COMPLICATIONS; ETIOLOGY; Ultrasonography; Methods; VARICOSE VEINS; NONINVASIVE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; COMPUTER; AGE; PULMONARY EMBOLISM; EMBOLISM; COMPLICATION; RISK; DEEP VENOUS THROMBOSIS; Rest; INFECTION; THROMBUS; vein; VARICOSITIES; laboratories; an; sex; in Notes : Since July 1982, this noninvasive vascular laboratory has performed 12,856 lower extermity venous duplex examinations. All cases of acute venous thrombosis have been categorized and entered into a computer data base. One thousand four hundred twelve examinations were positive for acute venous thrombosis. This report analyzes the laboratory's entire experience with superficial thrombophlebitis (SVT). One hundred eighty-six patients were diagnosed by duplex scanning to have SVT. Women outnumbered men 99 to 87. They were slightly older (average age 58.4 +/- 16.2 years) compared with the men (53.8 +/- 14.2 years). Men were more likely to have a complicated course of SVT (40% vs 22%; p less than 0.01). Complications included either radiographically documented pulmonary embolism or deep venous involvement. Fifty-seven (31%) patients had at least one complication of SVT. A series of predisposing factors was analyzed and six factors were associated with an increased risk of complications. They are bilateral SVT (p less than 0.01), age greater than 60 years (p less than 0.01), male sex (p less than 0.01), history of deep venous thrombosis (p less than 0.01), bed rest (p less than 0.02), and presence of infection (p less than 0.02). Location of thrombus within the greater saphenous vein (35%) was most likely to be associated with complications. Isolated varicosities (8%) were least likely to be associated with complications. Duplex scanning identifies a significant number of complications of patients with SVT and should be obtained in cases of saphenous vein involvement or in the presence of associated risk factors. Ref ID : LYNCH1972 788. Lynch, R.E., Stein, P.D., and Bruce, T.A. Leftward shift of frontal plane axis as a frequent manifestation of acute pulmonary embolism. Chest 61:443, 1972. Keywords : AXIS; PULMONARY EMBOLISM; EMBOLISM; EKG; ECG Ref ID : MADIEDO1980 789. Madiedo Unknown. J.Clin.Pathol. 33:864, 1980. Keywords : ABG; CAUSE; Aa GRADIENT; GRADIENT; PE; Air; in; an; is; aa Notes : Air bubbles in ABG syringes cause an average rise in measured PO2 of 11 Torr. The maximum rise in this study was 29 Torr in one patient. The average effect, then, is to reduce the calculated Aa gradient by 11 -- easily enough to move most patients with PE from abnormal to the normal range. Ref ID : MAGEE1993 790. Magee, K.P., Blanco, J.D., and Graham, J.M. Massive septic pelvic thrombophlebitis. Obstet.Gynecol. 82:662-664, 1993. Keywords : MASSIVE; SEPTIC; THROMBOPHLEBITIS; COMPLICATION; THROMBI; Ovarian vein; VEINS; VENA CAVA; POSTPARTUM; vein; Femoral Vein; HEPARIN; Antibiotics; ANTICOAGULANTS; FOLLOWUP; RESOLUTION; THROMBUS; Pelvis; sdi-11/93; is; in; an Notes : BACKGROUND: Septic pelvic thrombophlebitis is a major complication of endometritis. The thrombi commonly occur in the uterine and/or ovarian veins and may extend into the inferior vena cava. CASE: Following vaginal delivery, a 19-year-old woman, gravida 2, developed postpartum septic pelvic thrombophlebitis extending from the right ovarian vein up to the diaphragm and down to the femoral vein. The patient was treated successfully with heparin and antibiotics, and eventually was discharged on oral anticoagulants for an extended period. Follow-up revealed complete resolution of the thrombus. CONCLUSION: Septic pelvic thrombophlebitis is not limited to the pelvis and lower abdominal vessels. Ref ID : MAGGIONI1990 791. Maggioni, A.P., Franzosi, M.G., Fresco, C., Turazza, F., and Tognoni, G. GISSI trials in acute myocardial infarction. Rationale, design, and results. Chest 97(4 Suppl):146S-150S, 1990. Keywords : 96-suzy-001; in; MYOCARDIAL INFARCTION; infarction; Safety; INTRAVENOUS; THROMBOLYTIC; TREATMENT; MI; THROMBOLYSIS; Italy; VENTRICULAR FIBRILLATION; STROKE; ASPIRIN; MORTALITY; Hospitals; is; CLINICAL TRIALS; HUMAN; MULTICENTER STUDIES; drug therapy; THROMBOLYTIC THERAPY Notes : The first Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto (GISSI) study showed striking evidence of the effectiveness and safety of intravenous thrombolytic treatment in acute myocardial infarction (MI). Since publication in The Lancet, the original report has become a reference work for every paper which deals with thrombolysis. In addition to GISSI's scientific value, these studies applied formal research to routine clinical practice outside of referral centers. Nearly all Italian CCUs took part in the GISSI projects, so that the results provide a profile of the patient who seeks care for acute MI in Italy. This wide data base allowed GISSI investigators to look into some relevant clinical events, eg, primary ventricular fibrillation, stroke, and in-hospital reinfarction. The GISSI-2 trial followed the GISSI-1 philosophy. The package of treatments recommended after extensive discussion with all the investigators (beta-blocker, aspirin, nitrates) was widely adopted. Now, only five years after the start of the GISSI-1, the overall mortality of Italian patients with acute MI has decreased from 13.0 percent to about 9 percent, and the number of patients with acute MI arriving in hospital within 1 h of the onset of symptoms has increased 50 percent. It is the wish of the GISSI investigators that this approach to treating acute MI will be regarded and acknowledged as their major contribution to the problem. Ref ID : MALLIWAH1992 792. Malliwah, J.A., Aziz, M.R., and Amir, H. Experience with subfascial ligation for varicose veins in Tanzania: a brief communication. Hiroshima.J.Med.Sci. 41:57-59, 1992. Keywords : Ligation; VARICOSE VEINS; VEINS; POSTPHLEBITIC; Ulcer; PERFORATING VEINS; TECHNIQUES; Skin; RECURRENCE; INDICATIONS; STASIS; SURGERY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Varicose Ulcer; Eczema; LEG; ULCERATION; NASP; ADULT; Evaluation Studies; FEMALE; HUMAN; MALE; PHLEBITIS; Tanzania; Medline File; varicose; in; ab; ad Notes : AB - From January 1987 through December 1989, ten patients with varicose veins complicated by postphlebitic ulcers were treated at Muhimbili Medical Center, Tanzania, by subfascial ligation of perforating veins. The technique employed was a posterior subfascial approach which avoids making the skin incision through the ulcer itself. The follow up periods ranged from one to three years and there was no recurrence of the ulcer in any of the patients in the study. The major indication for performing the procedure was the presence of a varicose stasis ulcer. Before surgery, all patients had a complete peripheral vascular examination to exclude deep venous thrombosis. Healing of varicose ulcers and elimination of stasis eczema had to be achieved four weeks before surgery. The authors maintain that patients who present with varicose veins of the lower leg and a postphlebitic stasis ulceration invariably have incompetence of the valves in the perforating veins and should be treated by subfascial ligation of the perforating veins AD - Department of Surgery AD - Faculty of Medicine AD - Muhimbili Medical Center AD - Dar es Salaam AD - Tanzania UI - 93186424. Ref ID : MALONE1978 793. Malone, P.C. and Morris, J.C. The sequestration and margination of platelets and leucocytes in veins during conditions of hypokinetic and anaemic hypoxia: potential significance in clinical post-operative venous thrombosis. Journal of Pathology 125:119-129, 1978. Keywords : PLATELETS; VEINS; POSTOPERATIVE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; NASP; vein; in Ref ID : MAMMEN1992 794. Mammen, E.F. Pathogenesis of venous thrombosis. Chest 102:640S- 644S, 1992. Keywords : PHLEBITIS; PATHOGENESIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; BLOOD COAGULATION; physiology; Endothelium,Vascular; physiopathology; HUMAN; Immobilization; LEG; blood supply; PULMONARY EMBOLISM; EPIDEMIOLOGY; ETIOLOGY; Regional Blood Flow; RISK FACTORS; THROMBOPHLEBITIS; REVIEW; THROMBOEMBOLISM; Spinal cord; INJURY; THROMBI; blood; BLOOD FLOW; CALF; Thigh; STASIS; Muscles; COAGULATION; HYPERCOAGULABILITY; FIBRINOLYSIS; ENDOTHELIAL; HEMOSTASIS; FIBRINOGEN; TRAUMA; Immobilized; PLATELET; INHIBITION; FIBRINOLYTIC; RISK; PROPHYLAXIS; INCIDENCE; COMPLICATION; in; spinal cord injuries; paralysis; is; an Notes : This brief review attempts to describe the present understanding of the pathogenesis of venous thrombosis in general with special reference to venous thromboembolism in spinal cord injury patients with paralysis. The component parts of Virchow's triad are examined. Most venous thrombi seem to originate in regions of slow blood flow, ie, the large venous sinuses of the calf and thigh or in valve cusp pockets. Decreased blood flow or even stasis due to lack of the pumping action of the large muscle packages in paralyzed patients is undoubtedly one of the major factors. As blood pools, activation products of the coagulation system accumulate locally leading potentially to local hypercoagulability. Activation products of clotting and fibrinolysis can induce endothelial damage which in turn leads to further activation of the hemostasis system. Endothelial damage may also result from distension of the vessel walls by the pooling blood. Blood flow is further decreased by hyperviscosity due to elevated fibrinogen levels and dehydration. Some spinal cord injury patients may sustain direct trauma to the legs; others may encounter vessel wall damage by the immobilized limbs. Shortly after injury, certain changes develop in the clotting system, especially increases in components of the von Willebrand factor macromolecular complex and increased platelet aggregability which could further contribute to hypercoagulability. Recently, an inhibition of the fibrinolytic system was suggested which also could add to a prothrombotic state. All of these interrelated processes clearly explain the high risk of venous thromboembolism in spinal cord injury patients with paralysis which has been clearly demonstrated by many investigators. It is hoped that intense thrombosis prophylaxis will reduce the incidence of this potentially devastating complication. Ref ID : MANCINI1987 795. Mancini, S. and Tani, F. [Treatment of ulcers of the lower limbs. Experience at the Pabisch Interdisciplinary Center of Phlebology Sclerotherapy and Elasto- compression, University of Sienna]. Phlebologie. 40:759-765, 1987. Keywords : Ulcer; SCLEROTHERAPY; COMPRESSION; NASP; ADULT; AGED; Aged,80 and over; Aprotinin; BANDAGES; Combined Modality Therapy; Drug Combinations; Factor XIII; FEMALE; FIBRINOGEN; HUMAN; Leg Ulcer; MALE; MIDDLE AGE; Pressure; Retrospective Studies; Sclerosing Solutions; THROMBIN; Medline File; de; du; et; ab; ad Notes : TT - Traitement des ulceres des membres inferieurs. Experience du Centre Interdisciplinaire "W. Pabisch" de phlebologie, sclerotherapie et elasto-compression de l'Universite de Sienne AB - [No Abstract Available] AD - Universite d'etudes de Sienne AD -chaire de chirurgie d'urgence UI - 88068894. Ref ID : MANCINI1991 796. Mancini, S., Lassueur, F., and Mariani, F. La sclerose de la veine grande saphene: Etude experimentale chez l'homme sur laction sclerosante de la solution iodo-iodoree et le polidodecane (histologie et microscopie electronique). Phlebologie 44(2):461-468, 1991. Keywords : SCLEROSE; EARLY; SCLEROSANT; HISTOLOGIC; POLIDOCANOL; VEINS; TREATMENT; ENDOTHELIAL; INJURY; ENDOTHELIUM; COLLAGEN; VENOUS; PLATELET; THROMBUS; TECHNIQUES; SCLEROTHERAPY; ELECTRON MICROSCOPY; HUMAN; de; et; an; in; Methods; Iodine; Fibrosis; vein; is; light; Edema; varicose; Injections; FIBRIN; blood Notes : Mancini performed an electron microscopic study of the early events in the vessel wall after the infusion of sclerosant. He reports several interesting findings which contradict earlier beliefs based on less exact methods of investigation. He found no difference between the histologic and ultrastructural effects caused by polidocanol and those induced by iodine. He found no perivenous changes, and noted that the tissues around the treated vessels remained perfectly normal even after complete fibrosis of the vein itself. He noted a normal macroscopic appearance of treated vessels up to three days after treatment. After the infusion of sclerosant, the endothelial injury occurs rapidly. For the first fifteen minutes the lesion is visible by electron microscopy but not yet by light microscopy. Early loss of endothelial intracellular bridges and necrotic alterations are appreciated, with subendothelial edema. Later, elevation of the endothelium is seen, and finally separation of the endothelial cells occurs. The endothelial injury progresses to completion in 2 to 3 hours. Subendothelial changes which have been previously reported include a thinning and fragmentation of the elastic layer, a diffuse collagen deposition, and a loss of fibrocellular muscular component. These changes are correctly attributed to the underlying venous disease (the varicose condition) and are neither brought about nor accentuated by the injection of sclerosant. The first few strands of fibrin attached to blood elements are detected at the site of injury within the first fifteen minutes. The earliest adherent platelet microthrombus does not appear until 2 to 3 hours after injection. This is not a true thrombus, nor does it significantly occlude the vessel lumen. The first sign of obstructing thrombus is noted on the second or third day after injection. This thrombus is soft, fresh and loosely bound, but soon begins to undergo organisation. At two months, the thrombus has been completely organised and obliterated by fibrous infiltration of the venous lumen. Samples were taken from the first fifteen minutes until the 60th day after treatment. At no time during this period was any external wall or perivenous infiltration seen. The authors suggest that the perivenous inflammatory infiltration reported by others may be the result of incorrect technique, either the result of too stong a concentration of sclerosant or the result of perivascular deposition of sclerosant. Ref ID : MANCINI1991A 797. Mancini, S., Lassueur, F., and Mariani, F. [Sclerosis of the great saphenous vein: an experimental study in humans of the sclerosing effect of an iodo-iodide solution and polidodecane (histology and electron microscopy)]. Phlebologie. 44:461-468, 1991. Keywords : SAPHENOUS VEIN; vein; HUMAN; HISTOLOGY; SCLEROSE; ELECTRON MICROSCOPY; Injections; ENDOTHELIAL; Edema; FIBRIN; PLATELET; THROMBOSIS; MASSIVE; THROMBUS; NASP; VEINS; Benzyl Alcohols; Detergents; Drug Combinations; Endothelium,Vascular; English Abstract; FEMALE; Iodides; MALE; Microscopy,Electron; Polyethylene Glycols; Sclerosing Solutions; SCLEROTHERAPY; Sodium; VARICOSE VEINS; Medline File; an; in; de; et; ab; is; blood; ad; di Notes : TT - La sclerose de la veine grande saphene: etude experimentale chez l'homme sur l'action sclerosante de la solution iodo-ioduree et le polidodecane (histologie et microscopie electronique) AB -The authors describe an experimental study in man, using electron microscopy to study the effect of sclerosing injections on the great saphenous vein, in particular concerning the initial phases of the process. Results may be summarised as follows: The endothelial lesion develops immediately and is visible only by electron microscopy during the first 15 minutes. It involves necrotic changes with subendothelial edema and, finally, detachment of the endothelial cells. This process is complete on average 2 hours and 30 minutes after the injection. The first deposits of fibrin, which are not abundant, englobe blood cells and loosen already within the first 15 minutes. The first lamellar platelet microclot forms on average 2 hours and a half after the injection but this involves a microclot and not a thrombosis which will become organised. The first massive thrombosis seen occurred between the second and third day after injection and involved a recent thrombus AD - Cattedra ed Unita Operativa di Chirurgia d'Urgenza AD - Universita' degli studi di SIENA UI - 92052597. Ref ID : MANIER1985 798. Manier, G., Castaing, Y., and Guenard, H. Determinants of hypoxemia during the acute phase of pulmonary embolism in humans. Am.Rev.Resp.Dis. 132:332, 1985. Keywords : EMBOLISM; HUMAN; PULMONARY EMBOLISM; HYPOXEMIA; in Ref ID : MANIER1985A 799. Manier, G., Castaing, Y., and Guenard, H. Determinants of hypoxemia during the acute phase of pulmonary embolism in humans. Am.Rev.Respir.Dis. 132(2):332-338, 1985. Keywords : 96-suzy-001; HYPOXEMIA; PULMONARY EMBOLISM; EMBOLISM; in; HUMAN; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; Air; ARTERIAL; VENTILATION; PERFUSION; TECHNIQUES; an; blood; BLOOD FLOW; SHUNT; OXYGEN; VENOUS; CAUSE; CARDIAC; CARDIAC OUTPUT; Hemoglobins; Oxygen Consumption; is; diffusion; ACUTE DISEASE; AGED; anoxemia; ETIOLOGY; physiopathology; FEMALE; HEMODYNAMICS; MALE; MIDDLE AGE; Pulmonary Circulation; COMPLICATIONS; PULMONARY GAS EXCHANGE; Respiration; ventilation- perfusion ratio Notes : The determinants of hypoxemia were studied in 10 patients with acute pulmonary embolism demonstrated by pulmonary angiography. Two patients were mechanically ventilated, and in the 8 who breathed room air spontaneously, the mean arterial PO2 was 61.5 mmHg. Measurements of the distributions of ventilation (VA) and perfusion (Q) against VA/Q ratios by the multiple inert gas infusion technique demonstrated an increase in VA/Q inequality. The major part of pulmonary blood flow was distributed in a mode near to, or slightly above, a VA/Q ratio of 1. The cumulative fraction of blood in true shunt and low VA/Q mode (VA/Q less than 0.01) was 9.1%. For a small part of the AaDO2 (13%), an oxygen diffusional component was found. The remaining hypoxemia was due to the fall in the mixed venous PO2 (PVO2), irrespective of its cause: low cardiac output, low hemoglobin concentration, high oxygen consumption, low P50. The fall in PVO2 led to a fall in end-capillary blood PO2 in both shunt or ventilated and perfused units. We conclude that the major determinant of hypoxemia in these patients suffering from acute pulmonary embolism is the fall in PVO2. This is enhanced by a moderate increase in the fraction of blood flowing through low VA/Q units. Diffusion impairment plays only a minor role. Ref ID : MANNUCCI1986 800. Mannucci, P.M., Kluft, C., Traas, D.W., Seveso, P., and D'Angelo, A. Congenital plasminogen deficiency associated with venous thromboembolism: therapeutic trial with stanozolol. Br.J.Haematol. 63:753-759, 1986. Keywords : CONGENITAL; PLASMINOGEN; VENOUS; THROMBOEMBOLISM Ref ID : MARCINIAK1974 801. Marciniak, E., Farley, C.H., and De Simone, P.A. Familial thrombosis due to antithrombin III deficiency. Blood 43:219-231, 1974. Keywords : THROMBOSIS; ANTITHROMBIN III; FAMILIAL Ref ID : MARCUS1985 802. Marcus, C.S., Mason, G.R., Kuperus, J.H., and Mena, I. Pulmonary imaging in pregnancy. Maternal risk and fetal dosimetry. Clin.Nucl.Med. 10:1-4, 1985. Keywords : PREGNANCY; MATERNAL; RISK; FETAL; PULMONARY EMBOLISM; EMBOLISM; DEATH; PE; V/Q; SCAN; V/Q SCAN; RADIATION; NUCLEAR; in; is Notes : The risk of documented pulmonary embolism in pregnancy is estimated as 0.09 per thousand pregnancies, and the risk of death is estimated as 12.8% for untreated PE and 0.7% for treated PE. Fetal radiation exposure during a V/Q scan is insignificant compared to the risk to mother and fetus from undiagnosed and untreated pulmonary embolism. Ref ID : MARDER1977 803. Marder, V.J., Soulen, R.L., Atichartakarn, V., Budzynski, A.Z., Parulekar, S., Kim, J.R., Edward, N., Zahavi, J., and Algazy, K.M. Quantitative venographic assessment of deep vein thrombosis in the evaluation of streptokinase and heparin therapy. J.Lab.Cin.Med. 89(5):1018-1029, 1977. Keywords : 96-suzy-002; QUANTITATIVE; vein; THROMBOSIS; in; STREPTOKINASE; HEPARIN; THERAPY; TECHNIQUES; VENOGRAPHY; VEINS; CALF; KNEE; Thigh; Pelvis; OCCLUSION; VENOUS; RANDOMIZED; TREATMENT; FOLLOWUP; Venogram; DURATION; VENOUS OBSTRUCTION; an; COAGULATION; FIBRINOLYSIS; LYTIC; HEMORRHAGIC; COMPLICATIONS; ANAPHYLACTIC; Died; HEMORRHAGE; is; THROMBUS Notes : 01-03-96. Abstract : A technique of quantitative venography has been developed in which values are assigned to the deep veins of the calf, knee, thigh, and pelvis, based upon the calculated volume and degree of occlusion of these venous segments. A maximum score of 40 units reflects complete thrombosis of all segments. This technique has been applied to a randomized, single-blind study of streptokinase versus heparin treatment. Each group of 12 patients had similar mean initial venographic scores; follow-up venograms were performed 5 days after the start of therapy. Streptokinase patients with high initial scores (>20) showed a mean improvement of 12.1 units, while those with low initial scores(<20) were essentially uncharged. Heparin patients with high scores had a minimal mean improvement of 1.1 units, but those with low scores had a significant mean extensionof thrombosis of 8.6 units. Patients with symptoms for less than 7 days showed greater mean improvement (12.7 units) with streptokinase than those with a longer duration of symptoms (2.0 units); heparin patients in these subgroups showed a mean worsening of 7.5 units and no change, respectively. Extrinsic venous obstruction by tumor did not prevent an excellent response to streptokinase. No single test of coagulation or fibrinolysis was a reliable indicator of the degree of venographic response to lytic therapy. Pyrexia and hemorrhagic complications occurred in over one-half of the streptokinase patients; one had an anaphylactic reaction, and one died of intracerebral hemorrhage during therapy. The data suggest that lytic therapy is best restricted to the patients with acute extensive thrombosis. Also, continuous infusions of heparin according to current guidelines may be inadequate to prevent thrombus growth in some patients. Ref ID : MARKEL1992 804. Markel, A., Manzo, R.A., Bergelin, R.O., and Strandness, D.E.,Jr. Valvular reflux after deep vein thrombosis: incidence and time of occurrence. J.Vasc.Surg. 15:377-82; discus, 1992. Keywords : REFLUX; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; INCIDENCE; LEG; LONG TERM; FOLLOWUP; Duplex; SCANNING; CHRONIC; CHRONIC VENOUS INSUFFICIENCY; VENOUS; Venous Insufficiency; Popliteal Vein; Femoral Vein; SAPHENOUS VEIN; THROMBI; NASP; VEINS; thrombophlebitis - complications; venous insufficiency - etiology; Adolescence; ADULT; AGED; Aged,80 and over; CHILD; FEMALE; Follow-Up Studies; HUMAN; MALE; MIDDLE AGE; postphlebitic syndrome - epidemiology; RISK FACTORS; Support,U.S.Gov't,P.H.S. TIME FACTORS; venous insufficiency - epidemiology; venous insufficiency - us; in; laboratories Notes : From December 1986 to December 1990, 268 patients with acute deep vein thrombosis were studied in our laboratory. From this group 107 patients (123 legs with deep vein thrombosis) were placed in our long- term follow-up program. The documentation of valvular reflux and its site was demonstrated by duplex scanning. The duplex studies were done at intervals of 1 and 7 days, 1 month, every 3 months for the first year, and then yearly thereafter. The mean follow-up time for these patients was 341 days. In addition, reflux was evaluated in 502 patients with negative duplex study results and no previous history of deep vein thrombosis or chronic venous insufficiency. In the patients with acute deep vein thrombosis, valvular incompetence was noted in 17 limbs (14%) at the time of the initial study. Reflux was absent in 106 limbs (86%). In this last group reflux developed in 17% of the limbs by day 7. By the end of the first month, 37% demonstrated reflux. By the end of the first year, more than two thirds of the involved limbs had developed valvular incompetence. The distribution of reflux at the end of the first year of follow-up was the following: (1) popliteal vein, 58%; (2) superficial femoral vein, 37%; (3) greater saphenous vein, 25%; and (4) posterior tibial vein, 18%. Reflux seems to be more frequent in the segments previously affected with deep vein thrombosis. Among cases where segments were initially affected with thrombi, after 1 year the incidence of reflux was 53%, 44%, 59%, and 33% for the common femoral vein, superficial femoral, popliteal vein, and posterior tibial vein, respectively.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : MARKS1974 805. Marks, C.G. Localized hirsuties following compression sclerotherapy with sodium tetradecyl sulphate. Brit.J.Surg. 61:127-128, 1974. Keywords : COMPRESSION; SCLEROTHERAPY; NASP; ADULT; BANDAGES; FEMALE; Hirsutism; HUMAN; MIDDLE AGE; Pressure; Sclerosing Solutions; Skin; THROMBOPHLEBITIS; VARICOSE VEINS; Medline File; Sodium; ab Notes : AB - [No Abstract Available] UI - 74117667. Ref ID : MARLER1995 806. Marler, J.R. Tissue Plasminogen Activator for Acute Ischemic Stroke. The New England Journal of Medicine 333(24):1581-1587, 1995. Keywords : 96-suzy-002; PLASMINOGEN; PLASMINOGEN ACTIVATOR; STROKE; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; HEMORRHAGE; in; EARLY; CLINICAL TRIALS; RANDOMIZED; INTRAVENOUS; t-PA; TREATMENT; Methods; an; RESOLUTION; statistics; OUTCOME; PLACEBOS; LONG TERM; confidence intervals; MORTALITY; INCIDENCE; PA; NINDS Notes : 01-04-96. Abstract : Background. Thrombolytic therapy for acute ischemic stroke has been approached cautiously because there were high rates of intracerebral hemorrhage in early clinical trials. We performed a randomized, double-blind trial of intravenous recombinant tissue plasminogen activator(t-PA) for ischemic stroke after recent pilot studies suggested that t-PA was beneficial when treatment was begun within three hours of the onset of stroke. Method. The trial had two parts. Part 1 (in which 291 patients were enrolled) tested whether t-PA had clinical activity, as indicated by an improvement of 4 points over base-line values in the score of the National Institutes of Health stroke scale (NIHSS) or the resolution of the neurologic deficit within 24 hours of the onset of stroke. Part 2 (in which 333 patients were enrolled) used a global test statistic to assess clinical outcome at three months, according to scores on the Barthel index, modified Rankin scale, Glasgow outcome scale, and NIHSS. Results. In part 1, there was no significant difference between the group given t-PA and that given placebo in the percentages of patients with neurologic improvement at 24 hours, although a benefit was observed for the t-PA group at three months for all four outcome measures. In part 2, the long-term clinical benefit of t-PA predicted by the results of part 1 was comfirmed (global odd ratio for a favorable outcome, 1.7; 95 percent confidence interval, 1.2 to 2.6). As compared with patients given placebo, patients treated with t-PA were at least 30 percent more likely to have minimal or no disability at three months on the assessment scales. Symptomatic intracerebral hemorrhage within 36 hours after the onset of stroke occurred in 6.4 percent of patients given t- PA but only 0.6 percent of patients given placebo (P<0.001). Mortality at three months was 17 percent in the t-PA group and 21 percent in the placebo group (P=0.30). Conclusions. Despite an increased incidence of symptomatic intracerebral hemorrhage, treatment with intravenous t-PA within three hours of the onset of ischemic stroke improved clinical outcome at three months. Ref ID : MARMASSE1965 807. Marmasse, J. Du Nouveau dans le traitement chirurgical des phlebites et dans celui des embolies pulmonaires massives. Phlebologie 18(3):215-228, 1965. Keywords : SURGICAL; TREATMENT; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PHLEBITIS; PULMONARY EMBOLISM; EMBOLISM; INCIDENCE; du; de; et; in Notes : New approaches in surgical treatment of venous thrombosis, phlebitis, and pulmonary embolism. Incidence. Ref ID : MARMASSE1966 808. Marmasse, J. Quelques reflexions sur la maladie thrombo-embolique et son traitement. A propos d'un article recent. Phlebologie 19(4):333- 334, 1966. Keywords : RISK; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; INCIDENCE; WORLDWIDE; et Notes : Worldwide risk of pulmonary thromboembolism. Ref ID : MARMASSE1969 809. Marmasse, J. [Effort-induced venous pain in the lower extremities]. Phlebologie. 22:255-257, 1969. Keywords : VENOUS; PAIN; NASP; ADULT; HUMAN; LEG; Sports; Sports Medicine; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Douleurs veineuses a l'effort aux membres inferieurs AB - [No Abstract Available] UI - 70056400. Ref ID : MASSEY1966 810. Massey, T.N. Pulmonary Embolism. Review of fifty autopsy cases in which pulmonary embolism was the cause or a major contributing cause of death. North Carolina Medical Journal (February):63-66, 1966. Keywords : 96-suzy-002; PULMONARY EMBOLISM; EMBOLISM; REVIEW; AUTOPSY; in; CAUSE; DEATH; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; is; ACCIDENTS; UNITED STATES; Methods; TREATMENT; THERAPY; MANAGEMENT; EARLY; DIAGNOSIS; Hospitals Notes : 01-03-96. Abstract : The importanceof pulmonary embolism and associated venous thrombosis is emphasized by the estimate that this vascular accident may be the sole cause of about 50,000 deaths annually in the United States. It also probably contributes to at least four times that many fatalities. It is all the more unfortunate that the underlying cause of venous thrombosis and embolism is poorly understood, that clinical recognition of these disorders is difficult, and that the methods of treatment are still controversial. The effectiveness of some forms of treatment is clearly established, and a growing experience indicates that appropriate therapy may be life-saving in many cases. Needlee to say, the cornerstone of rational management is early diagnosis. This is a report based on autopsy reports and review of the clinical records of 50 cases, 42 from Presbyterian Hospital in Charlotte and 8 from Charlotte Memorial Hospital. In all cases, pulmonary embolism was the cause, of death. Ref ID : MATANIC1970 811. Matanic, V. [Treatment of varicose syndrome with Venopyronum]. Ther.Ggw. 109:1805-6 passim, 1970. Keywords : Syndrome; NASP; Administration,Oral; Adolescence; ADULT; AGED; FEMALE; HEPARIN; HUMAN; MIDDLE AGE; Morpholines; Ointments; Plant Extracts; Plants,Medicinal; Pyrazoles; Rutin; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - Zur Behandlung des varikosen Syndroms mit Venopyronum AB - [No Abstract Available] UI - 71086249. Ref ID : MATANIC1970A 812. Matanic, V. [Clinical studies and therapeutic trials with a new phlebotropic substance]. Z.Allgemeinmed. 46:530-534, 1970. Keywords : NASP; Benzyl Compounds; CLINICAL TRIALS; Electrophoresis; FEMALE; Glucose; Glycosides; HUMAN; MALE; THROMBOPHLEBITIS; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Vasodilator Agents; Medline File; ab Notes : TT - Klinische Untersuchungen und therapeutische Erfahrungen mit einer neuartigen phlebotropen Substanz AB - [No Abstract Available] UI - 72099270. Ref ID : MATHIS1993 813. Mathis, G., Metzler, J., Fussenegger, D., Sutterl:utti, G., Feurstein, M., and Fritzsche, H. Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism. Eur.Heart J 14:804-808, 1993. Keywords : EARLY; PULMONARY EMBOLISM; EMBOLISM; ULTRASOUND; DIAGNOSIS; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; CLINICAL DIAGNOSIS; LUNG; Biopsy; PLEURAL EFFUSION; Air; SENSITIVITY; SPECIFICITY; PREVALENCE; diagnostics; CHEST; TECHNIQUES; PULMONARY INFARCTION; sdi-11/93; infarction; in; Died; an; effusion; Segmental; Sonography Notes : Fifty-eight consecutive patients with clinical symptoms of pulmonary embolism/infarction were examined by ultrasound as the first imaging modality. The diagnosis was confirmed in 35 patients by ventilation-perfusion scintigraphy; 13 underwent pulmonary angiography for verification of clinical diagnosis. Seven patients died, necropsy was performed and the diagnosis of pulmonary embolism was confirmed in six cases; three patients were submitted to transthoracic lung biopsy. Intercostal space and an additional small pleural effusion in 48% of the examined patients served as a sonic window for the 5 MHz sector scanner. In 42 of the 54 cases with a final diagnosis of pulmonary embolism/infarction a total of 69, hypoechoic, lesions with a pleural basis were detected. These were conspicuous, predominantly triangular, of a mean size 4.6 x 3.7 cm (range 9 x 8 to 2 x 1.5). A hyperechoic structure with reverberation artefacts suggestive of air was frequently visible in the centre: a sign of segmental involvement. The ultrasound examination yielded a true positive result in 41 cases. The overall sensitivity was 98% and the specificity 66%. The prevalence of pulmonary embolism was 83% and the diagnostic accuracy 90%. This suggests that chest sonography can be an efficient technique in the detection of pulmonary infarction. Ref ID : MATSUBARA1989 814. Matsubara, O., Sato, T., Kitagawa, M., and Kasuga, T. Pulmonary thromboembolism: frequency, site, and vascular change in 103 autopsy cases. Am.J.Cardiovasc.Pathol. 2:321-328, 1989. Keywords : 951202; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; FREQUENCY; in; AUTOPSY; INCIDENCE; THROMBOEMBOLI; HISTOLOGICAL; ADULT; FEMALE; CANCER; Arterioles; Arteries; ENDOTHELIAL; PULMONARY ARTERY; Constriction; vasoconstriction; is; PATHOGENESIS; PATHOPHYSIOLOGY; Adolescence; Age Factors; AGED; Aged,80 and over; HUMAN; LUNG; bs; PA; MALE; MIDDLE AGE; PULMONARY EMBOLISM; ep; pp; pulmonary veins; Sex Factors; Support,Non-U.S.Gov't; Medline File; Health Planning & Administration File; Cancerlit File; pathology; japan Notes : For investigation of the incidence of pulmonary thromboembolism, the sites of thromboemboli, pulmonary vascular changes, detailed clinical and autopsy records, and histological sections of a series of 103 autopsied adults were reviewed. Pulmonary thromboembolism was observed in 38.8% of these cases. Pulmonary thromboembolism tended to be more frequent in older, younger, female, and cancer patients. Thromboembolism was found most frequently in arterioles, followed by muscular arteries. A significant correlation (P less than 0.02) was found between the incidence of pulmonary thromboembolism and the histological changes of endothelial protrusion and vacuolization of the intima in these small pulmonary arteries, but no correlation was found between that of pulmonary thromboembolism and constriction figures. These endothelial changes probably represent previous vasoconstriction. The present observations suggest a significant relationship between pulmonary thromboembolism and vasoconstriction of small pulmonary arteries and suggest that widespread vasoconstriction of pulmonary arteries is important in the pathogenesis and pathophysiology of this condition Department of Pathology Faculty of Medicine Tokyo Medical and Dental University Japan. Ref ID : MATSUMOTO1990 815. Matsumoto, A.H., Barth, K.H., and Teitelbaum, G.P. Percutaneous management of emboli associated with hot tip laser-assisted angioplasty. Cardiovasc.Intervent.Radiol. 13:71-74, 1990. Keywords : MANAGEMENT; EMBOLI; ACEP93; Lasers; Angioplasty Ref ID : MATTHEWS1987 816. Matthews, J.A., Blake, H.A., and Hall, D.J. Iatrogenic superior vena cava syndrome treated with streptokinase. Radiol.Oncol. 26:119-122, 1987. Keywords : VENA CAVA; Syndrome; STREPTOKINASE; CATHETER; ACEP93; THROMBOSIS Ref ID : MAY1988 817. May, K.J.J., Cardone, J.T., Stroebel, P.P., and Riba, A.L. Streptokinase dissolution of a right atrial thrombus associated with a temporary pacemaker. Arch.Intern.Med. 148:903-904, 1988. Keywords : STREPTOKINASE; THROMBUS; ACEP93; Pacemaker Ref ID : MAZEIKA1994 818. Mazeika, P.K. and Oakley, C.M. Massive pulmonary embolism in pregnancy treated with streptokinase and percutaneous catheter fragmentation. Eur.Heart J. 15:1281-1283, 1994. Keywords : EMBOLISM; PREGNANCY; MASSIVE; PULMONARY EMBOLISM; STREPTOKINASE; CATHETER; Hospitals; CAUSE; MATERNAL; MORTALITY; INCIDENCE; INTRAVENOUS; THROMBUS; THROMBOLYSIS; CARDIAC; Catheterization; CASE REPORT; FEMALE; HUMAN; Pregnancy Complications,Cardiovascular ,Therapy ,TH; Pulmonary Embolism ,Therapy ,TH; Streptokinase ,Therapeutic Use ,TU; Thrombolytic Therapy ,Methods ,MT; ADULT; Injections,Intravenous; Streptokinase ,Administration and Dosage ,AD; in; ab; an; is; laboratories Notes : CS- Department of Medicine, Hammersmith Hospital, London, U.K AB- Despite heightened awareness, pulmonary embolism remains a major cause of maternal mortality in the antenatal period and one which has not decreased in incidence over the four triennia since 1976. We report a patient who suffered massive pulmonary embolism with circulatory collapse in the second trimester and who was treated with intravenous streptokinase followed by percutaneous mechanical dispersion of thrombus using a catheter and guide wire. She made an excellent recovery despite complicating antepartum haemorrhage. In life-threatening circumstances pharmacological thrombolysis is mandatory particularly for hospitals without a cardiac catheterization laboratory on site. Ref ID : MCBRIDE1994 819. McBride, W.J., Gadowski, G.R., Keller, M.S., and Vane, D.W. Pulmonary embolism in pediatric trauma patients. J.Trauma. 37:913-915, 1994. Keywords : EMBOLISM; TRAUMA; PULMONARY EMBOLISM; PEDIATRIC; ADULT; PROPHYLAXIS; PE; INCIDENCE; RISK; TREATMENT; AGE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Extremities; INJURY; Spinal cord; in; is; registries; spinal cord injuries; injury severity score; injuries; glasgow coma scale; coma; an; paralysis Notes : Recent articles in the literature on adults have recommended prophylaxis for pulmonary embolism (PE) in selected trauma patients; however, to date no information is available regarding pediatric patients. We decided to investigate whether the incidence of PE in pediatric trauma patients is as high as that reported in adults, and identify those children who might be at high risk and benefit from prophylactic treatment. Utilizing the data from the National Pediatric Trauma Registry (NPTR), records were reviewed of all pediatric trauma patients (age < 19 years) admitted to the participating institutions between December 1987 and February 1993. Patients with documented PE were identified as well as those having associated risk factors as identified in adult trauma patients (deep venous thrombosis, extremity injury, spinal cord injury, and head injury). A total of 28,692 pediatric trauma patients were reviewed from the NPTR. The mean age was 9 years and the mean Injury Severity Score for the group was 11. Two thousand one children (7%) had serious head injuries (Glasgow Coma Scale score < 8), over 5700 (20%) had an isolated extremity injury, 290 had an identified spinal cord injury (108 with associated paralysis), and deep venous thrombosis was identified in 6 patients. Pulmonary embolism occurred in only two of the children in this series. Both patients with PE had spinal cord injuries with associated paraplegia, significant pulmonary injury, and high ISSs (25 and 27). The overall incidence of PE in the group was 0.000069%, and for those children with paralysis from spinal cord injury 1.85%.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : MCDONAGH1987 820. McDonagh, J. and Carrell, N. Disorders of fibrinogen structure and function. In: Thrombosis and hemostasis: Basic principles and clinical practice, edited by Colman, R.W.Philadelphia:J.B. Lippincott, 1987, Keywords : FIBRINOGEN; THROMBOSIS; HEMOSTASIS; ABNORMAL STRUCTURE Ref ID : MCFARLANE1994 821. McFarlane, M.J. and Imperiale, T.F. Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism. Am.J.Med. 96(1):57-62, 1994. Keywords : 951217; OXYGEN; GRADIENT; in; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; ARTERIAL; blood; ABG; ALVEOLAR; pathology; diagnostics; PE; Methods; VENTILATION/PERFUSION; V/Q; SCAN; RISK; RISK FACTORS; A-a GRADIENT; standards; V/Q SCAN; Air; confidence intervals; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; ci; ADULT; Arteries; blood gas analysis; FEMALE; HUMAN; LUNG; ph; MALE; odds ratio; bl; pulmonary alveoli; me; reference values; co; ventilation-perfusion ratio; Medline File; aa; laboratories Notes : BACKGROUND: Arterial blood gas (ABG) values and the alveolar- arterial oxygen (A-a) gradient are sensitive indicators of pulmonary pathology. Alone, they are not diagnostic of pulmonary embolism (PE), but they may be useful in excluding the diagnosis of PE if their values fall within the normal range. The purpose of this study was to determine the diagnostic value of a normal A-a gradient in ruling out PE. PATIENTS AND METHODS: The Derivation Set came from the records of all patients at Cleveland MetroHealth Medical Center who received a ventilation/perfusion (V/Q) scan for suspected PE in 1988 or 1989. Demographic and clinical data were obtained that included risk factors, symptoms, signs, and laboratory tests. A-a gradients were calculated using a standard equation; a normal gradient was defined as less than or equal to (age/4 + 4). The A-a gradient was examined before and after controlling for PE risk factors. The Validation Set was comprised of patients who had V/Q scans in 1987 and 1990. RESULTS: Among the 873 patients in the Derivation Set, 540 had simultaneous room air ABG determinations. Of these patients, 109 (20%) had a discharge diagnosis of PE. Only 1 of 57 (1.8%; 95% confidence interval [CI]: 0.9%-10.7%) patients without a history of PE or deep venous thrombosis (DVT) and with a normal A-a gradient had PE. Among the 805 V/Q patients in the Validation Set, 489 had simultaneous room air/ABG determinations. Of these, 75 (15%) had PE. Only 1 of 54 (1.9%; 95% CI: 0.1%-11.2%) patients without a history of PE or DVT and with a normal A-a gradient had PE. CONCLUSIONS: A normal A-a gradient among patients without a history of PE or DVT makes the diagnosis of PE unlikely. Further diagnostic evaluation may be unnecessary in this subgroup of patients Department of Medicine Case Western Reserve University MetroHealth Medical Center Cleveland Ohio 44109-1998. Ref ID : MCINTYRE1972 822. McIntyre, K.M. and Sasahara, A.A. Angiography, scanning, and hemodynamics in pulmonary embolism: Critical review and correlations. Critical.Reviews.in.Radiological.Sciences. 3:489, 1972. Keywords : ANGIOGRAPHY; SCANNING; HEMODYNAMICS; PULMONARY EMBOLISM; EMBOLISM; in; REVIEW Ref ID : MCINTYRE1973 823. McIntyre, K.M. and Sasahara, A.A. Determinants of cardiovascular response to pulmonary embolism. In: Pulmonary Thromboembolism, edited by Moser, K.M. and Steins, M.Chicago:Year Book Medical, 1973, Keywords : CARDIOVASCULAR; PULMONARY EMBOLISM; EMBOLISM; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM Ref ID : MCKELVIE1994 824. McKelvie, P.A. Autopsy evidence of pulmonary thromboembolism. Med.J.Aust. 160:127-128, 1994. Keywords : 951202; AUTOPSY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PREVALENCE; PE; RISK; RISK FACTORS; CLINICAL DIAGNOSIS; DIAGNOSIS; REVIEW; DEATH; death certificates; st; Hospitals; in; PULMONARY INFARCTION; infarction; AGE; CANCER; heart; heart diseases; SURGERY; PULMONARY EMBOLISM; EMBOLISM; is; AGED; false positive reactions; FEMALE; HUMAN; MALE; MIDDLE AGE; di; ep; PA; Retrospective Studies; Medline File; Health Planning & Administration File; Cancerlit File; pathology Notes : OBJECTIVE: To determine the prevalence of pulmonary thromboembolism (PE) and underlying risk factors at autopsy, compared with clinical diagnosis. DESIGN: Retrospective review of autopsy records, death certificates and medical histories. PATIENTS AND SETTING: All 132 patients who underwent autopsy at St Vincent's Hospital, Melbourne, in 1992. RESULTS: Sixteen cases (12% of autopsies) of PE were found at autopsy. In only two had PE been recorded on the death certificate; in one other, diagnosis had been made before death. Associated pulmonary infarction and/or haemorrhage was found in only six patients with PE. All 16 had at least one underlying risk factor: advanced age, cancer, heart disease, or recent pelvic or abdominal surgery. In four patients with missed PE, clinical records showed episodes consistent with PE. There were four false-positive diagnoses. CONCLUSIONS: Significant undiagnosed pulmonary embolism is not uncommon at autopsy. Many episodes are clinically silent, but the diagnosis should be suspected in at-risk patients with unexplained episodes of dyspnoea and tachycardia Department of Anatomical Pathology St Vincent's Hospital Fitzroy Vic. Ref ID : MCMASTER1973 825. McMaster, P. and Everett, W.G. Fatal pulmonary embolism following compression sclerotherapy for varicose veins. Postgrad.Med.J. 49:517- 518, 1973. Keywords : FATAL; PULMONARY EMBOLISM; EMBOLISM; SCLEROTHERAPY; VARICOSE VEINS; VEINS; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; TREATMENT; THROMBUS; CALF; TOURNIQUET; COMPRESSION; varicose; is; in; Injections; BANDAGES Notes : The authors erroneously state that they are the first to report a case of fatal pulmonary thromboembolism following compression sclerotherapy for the treatment of varicose veins. The case is remarkable because although postmortum thrombus was noted in the deep veins of the calf, thrombus was not identified within the superficial veins at the site of the injections themselves. Confounding factors include the fact that the patient had been placed in wrapping bandages which may have produced some tourniquet effect, as well as the fact that the patient undertook a long car ride immediately following the treatment session. Ref ID : MCMULLIN1992 826. McMullin, G.M. and Coleridge Smith, P.D. An evaluation of Doppler ultrasound and photoplethysmography in the investigation of venous insufficiency. Aust.N.Z.J.Med. 62:270-275, 1992. Keywords : Doppler; ULTRASOUND; VENOUS; Venous Insufficiency; NONINVASIVE; Methods; diagnostics; Duplex; SCANNING; OUTPATIENT; Hospitals; TECHNIQUES; DIAGNOSIS; SENSITIVITY; SPECIFICITY; ANATOMY; vein; REFLUX; PERFORATING VEINS; VEINS; ARTERIAL; NASP; plethysmography - methods; saphenous vein - us; Ultrasonography; venous insufficiency - diagnosis; HUMAN; predictive value of tests; sensitivity and specificity; thrombophlebitis - diagnosis; thrombophlebitis - us; venous insufficiency - us; an; in Notes : Non-invasive methods of venous assessment have been developed to improve diagnostic accuracy in the assessment of venous insufficiency. Of these, continuous wave Doppler (CWD) ultrasound and photoplethysmography are the cheapest and most simple to perform. In this study duplex scanning was used to test the accuracy of these two methods. One hundred and thirty-six patients attending the venous outpatient clinic at Middlesex Hospital, London were examined by all three techniques and a diagnosis was reached using each technique. The technicians performing the examinations were unaware of the diagnoses reached by the other methods. Continuous wave Doppler ultrasound was found to be most accurate in the diagnosis of long saphenous incompetence (sensitivity 73%, specificity 85%). Due to the variability of venous anatomy at the popliteal fossa and the 'blindness' of the technique, it was inaccurate in the diagnosis of short saphenous incompetence (sensitivity 33%) and deep vein reflux (sensitivity 48%). Photoplethysmography was found to be most accurate in the diagnosis of deep vein reflux (sensitivity 79%, specificity 70%) but was inaccurate in identification of the site of superficial vein reflux. Inaccuracies may be attributed to the presence of incompetent perforating veins and variation in arterial inflow. Ref ID : MCNALLY1993 827. McNally, M.A. and Mollan, R.A. Total hip replacement, lower limb blood flow and venous thrombogenesis. J.Bone Joint Surg.Br. 75:640-644, 1993. Keywords : PHLEBITIS; HIP; HIP REPLACEMENT; blood; BLOOD FLOW; VENOUS; THROMBOGENESIS; ADULT; AGED; Aged,80 and over; COMPARATIVE STUDY; HEMODYNAMICS; hip prosthesis; HUMAN; LEG; blood supply; MIDDLE AGE; PHLEBOGRAPHY; Postoperative Complications; ETIOLOGY; physiopathology; radiography; prosthesis design; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; TIME FACTORS; DEEP VEIN THROMBOSIS; THROMBOSIS; strain-gauge plethysmography; Plethysmography; SURGERY; Hospitals; venous capacitance; venous outflow; POSTOPERATIVE; STASIS; in Notes : The effect of Charnley cemented total hip replacement on venous blood flow in the legs and its relationship to deep-vein thrombosis were investigated in 413 patients. Blood flow was measured using strain-gauge plethysmography before operation, after surgery, and after discharge from hospital. There was a significant reduction in both venous capacitance and venous outflow, affecting both legs but greater in the operated leg. Venous flow remained significantly below preoperative levels in the operated leg six weeks after surgery. There was a highly significant correlation between the degree of reduction in blood flow and the development of postoperative deep-vein thrombosis. Venous stasis was shown to be a major factor in venous thrombogenesis. Ref ID : MCNAMARA1987 828. McNamara, T.O. Role of thrombolysis in peripheral arterial occlusion. Am.J.Med. 83:6-10, 1987. Keywords : THROMBOLYSIS; ARTERIAL; ACEP93; in; OCCLUSION Ref ID : MEILMAN1994 829. Meilman, E. Leg elevation in prophylaxis of thromboembolism [letter]. Lancet 343:428, 1994. Keywords : PHLEBITIS; LEG; PROPHYLAXIS; THROMBOEMBOLISM; HUMAN; Postoperative Care; Postoperative Complications; prevention & control; THROMBOPHLEBITIS; in Ref ID : MELLBRING1986 830. Mellbring, G., Strand, T., and Erickson, S. Venous thromboembolism after cerebral infarction and the prophylactic effect of dextran 40. Acta.Med.Scand. 220:425-429, 1986. Keywords : VENOUS; THROMBOEMBOLISM; INCIDENCE; DVT; STROKE; TRAUMA; Cerebral; infarction; Dextrans; is; in Notes : The incidence of DVT is extremely high following stroke or neurological trauma. In one study fully half of patients developed acute DVT within a median time of five days following a stroke. Ref ID : MENDELSOHN1979 831. Mendelsohn, G. and Hutchins, G.M. Infective endocarditis during the first decade of life. An autopsy review of 33 cases. Am.J.Dis.Child 133:619-622, 1979. Keywords : 951202; AUTOPSY; REVIEW; FATAL; INCIDENCE; in; rheumatic heart disease; heart; heart diseases; CONGENITAL; SEPTIC; INFECTION; Cardiology; CARDIOVASCULAR; SURGERY; bacteria; Age Factors; aneurysm,infected; et; aortic rupture; CHILD; Child,Preschool; EMBOLISM; endocarditis,bacterial; ep; PA; FEMALE; glomerulonephritis; co; heart defects,congenital; HUMAN; Infant; Infant,Newborn; MALE; myocardium; pericarditis; PULMONARY EMBOLISM; RISK; Medline File; an Notes : Twenty-six cases of infective endocarditis seen at autopsy during the first decade of life, between 1911 and 1944, are compared with seven fatal cases between 1944 and 1977. The incidence of infective endocarditis at autopsy in this age-group has decreased since 1944 (0.60% to 0.23%). Before 1944, Gram-positive cocci were most frequently responsible. Rheumatic heart disease (31%) more often predisposed to infective endocarditis than did congenital heart disease and left-sided valves were most frequently involved. Peripheral septic foci and penumonia were the most frequent sources of infection. The introduction of penicillin and advances in cardiology and cardiovascular surgery have had considerable impact of the spectrum and evolution of the diseases. Fungi and uncommon opportunistic bacteria are now frequently encountered. Rheumatic heart disease rarely predisposes to infective endocarditis in this age-group, congenital heart disease being the major underlying disease. Ref ID : MENZOIAN1979 832. Menzoian, J.O. and Williams, L.F. Is pulmonary arteriography essential for the diagnosis of pulmonary embolism? Am.J.Surg. 137:543- 548, 1979. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; PULMONARY ARTERIOGRAPHY; ARTERIOGRAPHY; PE; is Notes : The likelihood of angiographically proven PE was slightly greater (47%) for patients with PO2 above 80 torr than it was (45%) for those with PO2 less than 80 torr. If the criterion value is lowered to a PO2 of 70, the fraction of patients with positive angiograms is equal (45%) for those with PO2 above and those with PO2 below the criterion value. Ref ID : MERLEN1969 833. Merlen, J.F. [Varices in football playing]. Phlebologie. 22:259- 261, 1969. Keywords : VARICES; NASP; HUMAN; Leg Injuries; Sports Medicine; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; en; du; ab Notes : TT - Les varices en pratique du football AB - [No Abstract Available] UI - 70056401. Ref ID : MERRETT1993 834. Merrett, N.D. and Hanel, K.C. Ischaemic complications of graduated compression stockings in the treatment of deep venous thrombosis. Postgrad.Med.J. 69:232-234, 1993. Keywords : PHLEBITIS; COMPLICATIONS; graduated compression stockings; COMPRESSION; STOCKINGS; TREATMENT; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ADULT; AGED; BANDAGES; adverse effects; CASE REPORT; Foot; blood supply; HUMAN; Ischemia; ETIOLOGY; LEG; MALE; THROMBOPHLEBITIS; THERAPY; TIME FACTORS; Venous Insufficiency; PREVENTION; REVIEW; Pressure; blood; in Notes : Graduated compression stockings are frequently used in the prevention of deep venous thrombosis and the treatment of venous insufficiency. Two patients are discussed who sustained ischaemic complications after application of graduated compression stockings. Review of the literature demonstrates that low cutaneous pressures significantly decrease local blood flow and that the amount of pressure exerted by graduated compression stockings increases significantly with increases in leg girth. Ischaemic complications associated with the use of these stockings also appears to be more common than previously thought and any policy of routine prescription to patients should be questioned. Ref ID : MESSINA1993 835. Messina, L.M., Sarpa, M.S., Smith, M.A., and Greenfield, L.J. Clinical significance of routine imaging of iliac and calf veins by color flow duplex scanning in patients suspected of having acute lower extremity deep venous thrombosis. Surgery 114:921-927, 1993. Keywords : PHLEBITIS; CALF; VEINS; Color-flow; Duplex; SCANNING; Extremities; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ACUTE DISEASE; color; Femoral Vein; Ultrasonography; HUMAN; Iliac Vein; LEG; blood supply; Popliteal Vein; PROSPECTIVE STUDIES; THROMBOPHLEBITIS; Methods; FREQUENCY; SCAN; vein; CALF VEIN THROMBOSIS; in; is; an Notes : BACKGROUND. Because duplex ultrasonography is used increasingly to evaluate patients suspected of having acute deep venous thrombosis of the lower extremity, the clinical significance of limiting venous duplex scanning to the common femoral, superficial femoral, and popliteal veins becomes an important question. METHODS. We prospectively studied by venous color flow duplex ultrasonography 181 patients referred for evaluation to rule out acute deep venous thrombosis to determine (1) the frequency with which the iliac and calf veins could be imaged adequately to determine the presence or absence of acute deep venous thrombosis, (2) the frequency of acute venous thrombosis in these venous segments, and (3) the time required to scan these additional segments. RESULTS: In 79% of the patients studied, one segment of the iliac venous system was imaged adequately to determine the presence or absence of venous thrombosis. In the lower extremity, the common femoral vein, the superficial femoral vein, and the popliteal vein were imaged adequately in 94% of the patients. In 76% of the patients all three calf veins were imaged adequately to determine whether acute deep venous thrombosis was present or absent. The anterior tibial vein was the most difficult vein to image consistently and was imaged adequately in 76% of the patients referred. The mean time to scan the affected limb was 8 minutes 37 seconds. Forty-seven patients (26%) of the 180 patients studied had positive venous scans. Twenty-three percent of the patients who had positive scans were found to have iliac vein involvement. Thirty-two percent who had positive venous scans were found to have thrombosis of the calf veins. Fifteen percent of the 47 patients who had positive scans had either an isolated iliac or calf vein thrombosis. CONCLUSIONS. We believe this frequency of isolated iliac or calf vein thrombosis coupled with the frequency of successful imaging of these venous segments and the short additional time required to image these segments justifies the inclusion of routine imaging of the iliac and calf veins in patients undergoing venous duplex scanning to rule out acute deep venous thrombosis. Ref ID : MEWISSEN1990 836. Mewissen, M.W., Minor, P.L., Beyer, G.A., and Lipchik, E.O. Symptomatic native arterial occlusions: early experience with "over-the- wire" thrombolysis. J.Vasc.Interv.Radiol. 1:43-47, 1990. Keywords : ARTERIAL; OCCLUSION; EARLY; THROMBOLYSIS; ACEP-93; ACEP93 Ref ID : MEYER1992 837. Meyer, G., Sors, H., and Charbonnier, B. Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: A European multicenter double-blind trial. J.Am.Coll.Cardio. 19:239, 1992. Keywords : INTRAVENOUS; UROKINASE; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; ALTEPLASE; TPA; in Ref ID : MEYEROVITZ1990 838. Meyerovitz, M.F., Goldhaber, S.Z., Reagan, K., Polak, J.F., Kandarpa, K., Grassi, C.J., Donovan, B.C., Bettmann, M.A., and Harrington, D.P. Recombinant tissue-type plasminogen activator versus urokinase in peripheral arterial and graft occlusions: a randomized trial [see comments]. Radiology 175(1):75-78, 1990. Keywords : 951216; PLASMINOGEN; PLASMINOGEN ACTIVATOR; UROKINASE; in; ARTERIAL; OCCLUSION; RANDOMIZED; PROSPECTIVE; INTRAARTERIAL; HUMAN; rt- PA; bypass graft; THROMBUS; LYSIS; THROMBOLYSIS; BLEEDING; COMPLICATIONS; FIBRINOGEN; ADULT; AGED; ALTEPLASE; tu; Arterial Occlusive Diseases; dt; COMPARATIVE STUDY; FEMALE; graft occlusion,vascular; MALE; MIDDLE AGE; RANDOMIZED CONTROLLED TRIALS; RECOMBINANT PROTEINS; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOLYTIC THERAPY; Medline File; BRIGHAM; Hospitals; boston Notes : A randomized prospective trial was undertaken to compare intraarterial administration of recombinant human tissue-type plasminogen activator (rt-PA) with urokinase (UK) in 32 patients with peripheral arterial or bypass graft occlusions. Sixteen patients were randomized to receive rt-PA and 16 to receive UK. The rt-PA dose was administered as a 10-mg bolus into the thrombus, followed by 5 mg/h for up to 24 hours. The UK dose was administered as a 60,000 IU bolus into the thrombus, followed by 240,000 IU/h for 2 hours, 120,000 IU/h for 2 hours, and 60,000 IU/h for up to 20 hours. Serial arteriograms were obtained at baseline and at 4, 8 or 16, and 24 hours. The endpoint was defined as 95% of greater clot lysis. The cumulative numbers of patients with successful thrombolysis (rt-PA vs UK) were four vs none at 4 hours, seven vs one at 8 hours, seven vs three at 16 hours, and eight vs six at 24 hours. Lysis occurred more rapidly in the rt-PA group (P = .04). Major bleeding complications occurred in five rt-PA patients and two UK patients (P = .39). At 24 hours, fibrinogen levels were significantly lower in the rt-PA group than in the UK group (P = .01). There was no apparent difference in 30-day clinical success Department of Radiology Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : MEYEROVITZ1990A 839. Meyerovitz, M.F. How to maximize the safety of coronary and pulmonary angiography in patients receiving thrombolytic therapy. Chest 97(4 Suppl):132S-135S, 1990. Keywords : 96-suzy-001; Safety; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; in; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; RISK; HEMORRHAGIC; COMPLICATIONS; Punctures; TECHNIQUES; CATHETER; DURATION; adverse effects; Methods; Catheterization; Coronary Vessels; radiography; HEMORRHAGE; chemically induced; ETIOLOGY; HUMAN; PULMONARY ARTERY Notes : Patients who receive thrombolytic therapy in close temporal relationship to undergoing coronary or pulmonary angiography are at high risk of developing hemorrhagic complications, particularly at the vascular access site. A single-wall percutaneous puncture technique, use of a sheath for vascular access, use of a pigtail catheter for pulmonary angiography, avoidance of a temporary pacing catheter, and shortening the duration of thrombolytic therapy will decrease these complications. However, to maximize the safety of thrombolytic therapy, invasive vascular procedures should be avoided whenever possible. Ref ID : MEYEROVITZ1992 840. Meyerovitz, M.F., Polak, J.F., and Goldhaber, S.Z. Short-term response to thrombolytic therapy in deep venous thrombosis: predictive value of venographic appearance. Radiology 184(2):345-348, 1992. Keywords : 951216; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; in; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PREDICTIVE VALUE; Extremities; DVT; THROMBOSED; FOLLOWUP; Venogram; RANDOMIZED; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; HEPARIN; Segmental; REVIEW; LYSIS; THROMBI; THROMBUS; ADULT; AGED; ALTEPLASE; ad; tu; FEMALE; Injections,Intravenous; MALE; MIDDLE AGE; PHLEBOGRAPHY; PROGNOSIS; PROSPECTIVE STUDIES; RANDOM ALLOCATION; RECOMBINANT PROTEINS; THROMBOPHLEBITIS; dt; ep; ra; TIME FACTORS; Medline File; BRIGHAM; Hospitals; boston Notes : To determine whether the response to thrombolytic therapy for lower- extremity deep venous thrombosis (DVT) can be predicted from the venographic appearance, 139 thrombosed venous segments were analyzed. Initial and follow-up venograms were obtained in 62 patients randomized to 24-hour infusions of recombinant human-tissue-type plasminogen activator (rTPA) (n = 34), rTPA plus heparin (n = 16), or heparin alone (n = 12). Segmental response to therapy was evaluated by means of blinded review of the paired venograms. The response (50%- 100% lysis) to rTPA alone was significantly greater in venous segments involved with nonobstructive thrombi than in those with obstructive thrombi (12 of 23 vs five of 51; P less than .005). Results were similar for the combination of rTPA and heparin (five of six vs six of 30, P less than .01). No significant difference was seen in the response of either obstructive or nonobstructive thrombus to heparin alone. Thrombotic tails responded substantially (greater than 50% decrease in size) to rTPA with or without heparin in 22 of 24 patients. The venographic appearance of DVT appears to help in predicting the therapeutic response to thrombolytic therapy Department of Radiology Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : MIGRAINE1993 841. Migraine, M.S., Carette, M.F., Faintuch, J.M., Guigay, J., and Bigot, J.M. [Thoracic x-ray computed tomography and unexpected diagnosis of pulmonary embolism]. Rev.Pneumol.Clin. 49:5-11, 1993. Keywords : XRAY; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; CHEST; CT; SCAN; Injections; CONTRAST; Contrast Media; Retrospective Studies; Methods; INDICATIONS; sdi-11/93; Pulmonary emboli; EMBOLI; CT scan; V/Q; standards; is; in; an; Unexpected Notes : [CFF: Half of pulmonary emboli seen on chest CT scan were completely unsuspected by the clinician, and the other half had been clinically believed to be not likely enough to warrant V/Q or angiography.] The gold standard for the diagnosis of pulmonary embolism is still pulmonary angiography. Chest CT scan with injection of contrast medium can demonstrate a pulmonary embolism. In some cases, CT may discover a non suspected embolism. The aim of this retrospective study was to point out when an injection of contrast medium is necessary during CT scan of the chest to avoid to overlook and unsuspected pulmonary embolism. Ten cases of suspected pulmonary embolism on CT were retrospectively studied. Two cases were false positives. Our method did not allow to study false negatives. Out of the eight true positive cases, four were not suspected by the physician and in all cases, the exam record was not really clear. At the end of this study and referring to the literature, we conclude that CT scan of the chest can be performed with injection of contrast medium if a pulmonary embolism is one of the eventual diagnosis when an other suspected affection is an indication for CT. Ref ID : MILETICH1987 842. Miletich, J., Sherman, L., and Broze, G.,Jr. Absence of thrombosis in subjects with heterozygous protein C deficiency. New Engl.J.Med. 317:991, 1987. Keywords : THROMBOSIS; NASP; bib-3; in Ref ID : MILLAIRE1993 843. Millaire, A., Goullard, L., Chammas, E., de Groote, P., Houdas, Y., and Ducloux, G. [Evaluation of embolic cerebrovascular complication: contribution of transesophageal echography]. Ann.Cardiol.Angeiol.(Paris). 42:317-323, 1993. Keywords : COMPLICATION; Transesophageal; ACCIDENTS; EMBOLISM; CARDIAC; Echocardiography; INCIDENCE; THROMBUS; CONTRAST; Foramen ovale; Aneurysm; RISK; RISK FACTORS; sdi-11/93; an; in; is; Cerebral; abnormalities; Atrial fibrillation; heart; heart diseases Notes : Ischemic cerebrovascular accidents are classically attributed to an embolism of cardiac origin in 15% of cases. This longstanding concept is questioned by trans-esophageal echocardiography (TEE). The incidence of anomalies which could be the origin of a cerebral embolism involves more than 50% of cases in certain series. The superiority of TEE over trans-thoracic echocardiography (TTE) emerges in particular when certain abnormalities such as an intra-atrial thrombus, spontaneous atrial contrast, an intra-aortic atherosclerotic plaque, a patent foramen ovale or an aneurysm of the inter-atrial septum are sought. The high incidence of such abnormalities in a population having sustained an ischemic cerebrovascular accident is not sufficient to establish a cause-and- effect relationship between the abnormality and the cerebral event. Certain abnormalities are commonly associated with each other or with emboligenic arrhythmias (atrial fibrillation). Studies hence remain required to determine the respective responsibilities of these various abnormalities and stratify their embolic risk by defining certain risk factors. While awaiting the result of such studies, it would seem valid to suggest the more routine use of TEE in the investigation of ischemic cerebrovascular accidents in young patients free of clinically obvious heart disease, and this regardless of the result of TTE. Ref ID : MILLER1969 844. Miller, G.H., Gibson, R.V., Honey, M., and Sutton, G.C. Treatment of Pulmonary Embolism with Streptokinase. A Preliminary Report. Brit.Med.J. (March 29):812-815, 1969. Keywords : 96-suzy-002; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; STREPTOKINASE; RESOLUTION; in; MASSIVE; THROMBOEMBOLIC; DURATION Notes : 01-03-96. Abstract : Summary: Nine patients with arteriographically proved pulmonary embolism have been treated by a 36-hour infusion if streptokinase. Satisfactory haemodynamic and arteriographic resolution was obtained in four patients with acute massive pulmonary embolism and in two with recent minor embolism. Little or no haemodynamic or arteriographic improvement was obtained in three patients with pulmonary thromboembolic disease of longer duration. Ref ID : MILLER1982 845. Miller, K.E. and Pizzo, S.V. Venous and arterial thromboembolic disease in women using oral contraceptives. Am.J.Obstet.Gynecol. 144:824, 1982. Keywords : VENOUS; ARTERIAL; THROMBOEMBOLIC; ORAL CONTRACEPTIVES; NASP; bib-3; in Ref ID : MILLER1995 846. Miller, G.H. and Feied, C.F. Suspected pulmonary embolism. Postgraduate Medicine 97(1):51-58, 1995. Keywords : PULMONARY EMBOLISM; EMBOLISM Ref ID : MILNE1994 847. Milne, A.A., Stonebridge, P.A., Bradbury, A.W., and Ruckley, C.V. Venous function and clinical outcome following deep vein thrombosis. Brit.J.Surg. 81:847-849, 1994. Keywords : PHLEBITIS; VENOUS; VENOUS FUNCTION; OUTCOME; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; ADULT; AGED; Aged,80 and over; Foot; blood supply; pathology; HUMAN; LEG; MIDDLE AGE; Peripheral Vascular Diseases; ETIOLOGY; Ultrasonography; SAPHENOUS VEIN; THROMBOPHLEBITIS; COMPLICATIONS; physiopathology; VEINS; POST-THROMBOTIC; DVT; Duplex; TOURNIQUET; OCCLUSION; TRENDS; SCANNING; REFLUX; SCAN; POSTPHLEBITIC; POSTPHLEBITIC SYNDROME; Syndrome; in; is Notes : The severity of post-thrombotic symptoms in 111 limbs (107 patients) with previous phlebographically proven deep vein thrombosis (DVT) was correlated with superficial and deep venous function as determined by foot volumetry (n = 90) and duplex ultrasonography (n = 62). The median delay between DVT and assessment was 8 (range 1-34) years. Symptoms were mild (group 1) in 31 limbs (28 per cent), moderate (group 2) in 41 (37 per cent) and severe (group 3) in 39 (35 per cent). There was no significant relationship between the site of DVT, or the time since DVT, and the severity of symptoms. Without tourniquet occlusion of superficial veins, limbs in group 3 had a significantly shorter half-refilling time than those in groups 1 and 2 (P = 0.01). Although a similar trend was observed after tourniquet occlusion of superficial veins, this was not statistically significant. There was no significant difference in the expelled volumes between the three clinical groups. On duplex scanning, deep and superficial venous reflux was detected in just over half of the limbs in each group. Eight patients had entirely normal scans and none of them had severe symptoms (P = 0.04). This study identifies a strong association between severe postphlebitic syndrome and venous reflux, such that it may be considered that venous reflux is necessary for the development of severe post- thrombotic symptoms. However, many patients with severe reflux have only mild symptoms and additional factors must therefore contribute to the development of severe postphlebitic syndrome. Ref ID : MISHNEV1991 848. Mishnev, O.D., Shchegolev, A.I., and Ragozin, A.I. [The histophotometric characteristics of the hepatocytes in acute blood loss and pulmonary artery thromboembolism (based on the data from early autopsies)]. Vrach.Delo. :43-45, 1991. Keywords : 951202; in; blood; Blood loss; PULMONARY ARTERY; ARTERY; THROMBOEMBOLISM; EARLY; Liver; MASSIVE; AUTOPSY; analysis; ACUTE DISEASE; AGED; COMPARATIVE STUDY; English Abstract; HEMORRHAGE; en; PA; histocytochemistry; HUMAN; MIDDLE AGE; oxidoreductases; me; Photometry; PULMONARY EMBOLISM; TIME FACTORS; Medline File Notes : A comparative morphological study of the liver in acute blood loss and massive thromboembolism of the pulmonary artery was carried on basis of early autopsies. Histoenzymatic and correlation analysis was used to study the characteristic features of the metabolism of hepatocytes in conditions of acute blood loss and massive pulmonary artery thromboembolism. Ref ID : MISHNEV1993 849. Mishnev, O.D., Karpova, V.V., Tverskaia, M.S., Trysov, O.A., Tsareva, L.A., and Satylganov, I.Z. [Status of the myocardial ventricles in thromboembolism of the pulmonary arteries and their branches (based on early autopsy material)]. Arkh.Patol. 55:19-24, 1993. Keywords : 951202; in; THROMBOEMBOLISM; PULMONARY ARTERY; Arteries; EARLY; AUTOPSY; myocardium; Died; is; OCCLUSION; THROMBUS; CHRONIC; LUNG; heart; heart diseases; AGE; ACUTE DISEASE; ADULT; AGED; Arterial Occlusive Diseases; co; PA; English Abstract; heart ventricle; en; HUMAN; MIDDLE AGE; PULMONARY EMBOLISM; et; RISK FACTORS; TIME FACTORS; Medline File Notes : Ventricle myocardium of 16 patients who had died from acute thromboembolism (TE) of the pulmonary arteries was studied. The most important factor in the development of myocardial alterations is the degree of a vascular occlusion by the thrombus. Chronic lung and heart diseases as well as patient age may considerably aggravate the structural changes of the cardiomyocytes. Relatively low activity of catabolic enzymes in the myocardium of patients with TE correlates with a small size of embolic damage, the presence of chronic lung and heart diseases and with advanced age. Ref ID : MODAN1972 850. Modan, B., Sharon, E., and Jelin, N. Factors contributing to the incorrect diagnosis of pulmonary embolic disease. Chest 62:388-393, 1972. Keywords : 951202; DIAGNOSIS; ADULT; AGED; AUTOPSY; Cerebrovascular Disorders; co; diagnostic errors; ELECTROCARDIOGRAPHY; FEMALE; HUMAN; lung diseases; MALE; MIDDLE AGE; MYOCARDIAL INFARCTION; Neoplasms; PNEUMONIA; Postoperative Complications; PULMONARY EMBOLISM; di; ra; Retrospective Studies; rheumatic heart disease; THROMBOPHLEBITIS; Medline File Notes : [No Abstract Available]. Ref ID : MODIGLIANI1966 851. Modigliani, U., Rossi, C., and Pivetti, F. [A new drug with antiphlogistic-analgesic activity, useful in diseases of the venous system of the lower extremities]. Policlinico.[Med]. 73:361-375, 1966. Keywords : VENOUS; NASP; ADULT; AGED; Anti-Inflammatory Agents; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBITIS; SAPHENOUS VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; drugs; in; ad; di; ab Notes : TT - Un nuovo farmaco ad azione antiflogistica-analgesica, utile nelle malattie del circolo di ritorno degli arti inferiori AB -[No Abstract Available] UI - 68323181. Ref ID : MOGENSEN1989 852. Mogensen, K., Skibsted, L., Wadt, J., and Nissen, F. Thrombectomy of acute iliofemoral venous thrombosis during pregnancy. Surg.Gynecol.Obstet. 169:50-54, 1989. Keywords : EMBOLISM; PREGNANCY; THROMBECTOMY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SURGERY; PREGNANT; RISK; PULMONARY EMBOLISM; TREATMENT; PREVENTION; POST-THROMBOTIC; THROMBOLYSIS; Arteriovenous Fistula; Fistula; ANTICOAGULANT; Cesarean Section; INCIDENCE; FOLLOWUP; ASYMPTOMATIC; AMBULATORY; OCCLUSION; Plethysmography; HEPARIN; FEMALE; HUMAN; Femoral Vein ,Surgery ,SU; Iliac Vein ,Surgery ,SU; Pregnancy Complications,Cardiovascular ,Surgery ,SU; Thrombosis ,Surgery ,SU; ADULT; Postoperative Complications; Pregnancy Complications,Infectious ,Etiology ,ET; Pulmonary Embolism ,Etiology ,ET; Staphylococcal Infections ,Etiology ,ET; Surgical Wound Infection ,Etiology ,ET; Thrombosis ,Complications ,CO; ab; is; in; an Notes : CS- Department of Surgery H, University of Copenhagen AB- Acute iliofemoral venous thrombosis is six times more frequent among pregnant than nonpregnant women. The disease is serious because of the risk of pulmonary embolism. The treatment of choice with regard to prevention of post-thrombotic disorders is controversial. Pregnant women represent a therapeutic problem because thrombolysis is hazardous to the fetus. We have performed thrombectomy and temporary arteriovenous fistula in combination with anticoagulant treatment upon all pregnant or recently pregnant women coming to our department with acute iliofemoral venous thrombosis from August 1985 to March 1987. In this period, eight pregnant women and one woman 12 days after cesarean section were admitted. This is an incidence of 0.83 per 1,000 deliveries. All of the women were evaluated with a mean follow-up time of 15 months. Six of nine patients were clinically asymptomatic. Six had a normal ambulatory strain gauge volumetry and seven, a normal occlusion strain gauge plethysmography. Two women delivered by cesarean section, one woman had an induced abortion because of the disease, two women delivered after partus provocatus and four delivered spontaneously. We conclude that thrombectomy and temporary arteriovenous fistula together with heparin is a safe treatment of acute iliofemoral venous thrombosis during pregnancy. There is no need to interrupt the pregnancies except for obstetric reasons. Ref ID : MOHIUDDIN1992 853. Mohiuddin, S.M., Hilleman, D.E., Destache, C.J., Stoysich, A.M., Gannon, J.M., and Sketch, M.H. Efficacy and safety of early versus late initiation of warfarin during heparin therapy in acute thromboembolism. Am.Heart J. 123:729-732, 1992. Keywords : EARLY; LATE; WARFARIN; HEPARIN; THERAPY; THROMBOEMBOLISM; ANTICOAGULANT; THROMBOEMBOLIC; THROMBOPLASTIN; PROTHROMBIN; AGE; INDICATIONS; ANTICOAGULATION; BLEEDING; MORTALITY; COST; INCIDENCE; PHLEBITIS; THROMBOCYTOPENIA; DURATION; Safety; in; is; an; RANDOMIZED; partial thromboplastin time; prothrombin time; sex; Heparin dose; hospitalization; Hospitals Notes : There is no universally accepted approach to the initiation of systemic anticoagulant therapy. In an open, randomized study, two anticoagulant regimens that differed only in the timing of warfarin therapy after the start of heparin were compared. We randomized 119 patients with acute thromboembolic events to receive warfarin either within 48 hours of the start of heparin (early group, n = 63) or 96 hours or later after the start of heparin (late group, n = 56). Heparin was given as a 5000 IU bolus as a constant infusion titrated to maintain the activated partial thromboplastin time at 1.5 to 2 times control values. Warfarin was started at 10 mg daily for 3 days and the dose was titrated to maintain the prothrombin time at 1.2 to 1.5 times control values. There were no significant differences between the early and late warfarin groups with regard to age, sex, indication for anticoagulation, heparin dose, mean activated partial thromboplastin time during heparin, warfarin dose at discharge, length of warfarin therapy before discharge, bleeding, recurrent thromboembolic events, or mortality rates. Time to the start of warfarin after heparin was 31 hours and 108 hours in the early and late groups, respectively. Length of hospitalization, hospital costs, and the incidence of heparin-induced infusion phlebitis and thrombocytopenia were significantly less in the early group compared with the late group. Early initiation of warfarin after heparin is safer, less expensive, and as effective as the late initiation of warfarin. Ref ID : MONREAL1989 854. Monreal, M., Ruiz, J., Salvador, R., Morera, J., and Arias, A. Recurrent pulmonary embolism. A prospective study [see comments]. Chest 95:976-979, 1989. Keywords : PULMONARY EMBOLISM; EMBOLISM; PROSPECTIVE; PROSPECTIVE STUDIES; VENOUS; THROMBOEMBOLISM; VENOUS THROMBOSIS; THROMBOSIS; RECURRENCE; HEPARIN; THERAPY; LUNG; SCAN; DIAGNOSIS; CHEST; TREATMENT; THROMBUS; VENOGRAPHY; RISK; ADULT; AGED; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBOGRAPHY; RISK FACTORS; THROMBOPHLEBITIS; VENTILATION PERFUSION RATIO; Extremities; in; laboratories; an Notes : AB-We have prospectively studied a series of 121 consecutive patients with venous thromboembolism (38 with pulmonary embolism, 83 with venous thrombosis of the lower extremities) searching for recurrences of pulmonary embolism despite adequate heparin therapy. A baseline ventilation-perfusion lung scan was obtained initially in every patient, whether the original diagnosis was pulmonary embolism or venous thrombosis. Repeat chest roentgenograms and lung scans were obtained routinely at eight days of heparin treatment. The primary trial endpoints were a finding of a clinically apparent recurrent pulmonary embolism, or laboratory evidence of subclinical pulmonary embolism. Eight items of clinical and laboratory information were recorded at admission and then correlated with the lung scan results. Recurrences were seen in seven of 38 patients with an original diagnosis of pulmonary embolism, and in five of 83 patients admitted because of venous thrombosis (p = 0.034). Recurrences were also more frequent in patients with a free-floating thrombus on venography (p = 0.014). The risk of new defects in patients with venous thrombosis and without free- floating thrombus was 3.05 percent, venous thrombosis with free-floating thrombus, 13.33 percent; patients with pulmonary embolism without free- floating thrombus, 11.42 percent; and with free-floating thrombus, 38.67 percent. Venography seems thus mandatory in patients with pulmonary embolism, as it recognizes a subgroup of patients at a high risk of recurrences. Ref ID : MONREAL1989A 855. Monreal, M., Foz, M., and Audi, L. Warfarin to prevent thromboembolism in chronic atrial fibrillation [letter]. Lancet 1:720- 721, 1989. Keywords : WARFARIN; THROMBOEMBOLISM; CHRONIC; ANTICOAGULATION; DURATION; in; Atrial fibrillation Ref ID : MONREAL1989B 856. Monreal, M., Boix, J., Humbert, P., Lafoz, E., Aguado, A., and Rey- Joly, C. Gastroduodenal ulcer incidence in patients with venous thromboembolism. Gastrointest.Endosc. 35:386-388, 1989. Keywords : Ulcer; INCIDENCE; VENOUS; THROMBOEMBOLISM; RISK; BLEEDING; HEPARIN; THERAPY; Endoscopy; Duodenal Ulcer; FREQUENCY; EARLY; ANTICOAGULANTS; OCCULT; TREATMENT; in; an; is; blood Notes : The presence of peptic ulcer disease implies a high risk of bleeding in patients on heparin therapy. We reviewed our experience with 166 consecutive patients admitted because of venous thromboembolism. Of these 166 patients, 29 were referred for upper gastrointestinal endoscopy in order to detect the presence of any lesion that might contraindicate heparin therapy. A gastric ulcer was found in 10 patients, a duodenal ulcer in 11, and gastric erosions with signs of bleeding in 3 patients. Given the unexpectedly high frequency of ulcer in these patients, an upper gastrointestinal endoscopy was routinely performed early in the course of admission in 50 consecutive patients with venous thromboembolism. A gastric ulcer was found in 5 patients (10%), a duodenal ulcer in 7 (14%), and erosions in 2. Five of these patients had an unsuspected ulcer. A case can be made for prophylactic antiulcer therapy for all patients placed on anticoagulants for venous thromboembolism. Upper gastrointestinal endoscopy is indicated in patients with ulcer symptoms, in those with a previous history of peptic ulcer disease, and perhaps, in patients developing occult blood in the stools while on treatment with anticoagulants. Ref ID : MONREAL1989C 857. Monreal, M., Lafoz, E., Navarro, A., Granero, X., Caja, V., Caceres, E., Salvador, R., and Ruiz, J. A prospective double-blind trial of a low molecular weight heparin once daily compared with conventional low-dose heparin three times daily to prevent pulmonary embolism and venous thrombosis in patients with hip fracture [see comments]. J.Trauma. 29:873-875, 1989. Keywords : PROSPECTIVE; Low molecular weight heparin; Molecular Weight; HEPARIN; PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; HIP; FRACTURES; RANDOMIZED; LMWH; SURGERY; DEEP VEIN THROMBOSIS; vein; Died; diagnostics; LUNG; SCAN; VENOGRAPHY; DEEP VENOUS THROMBOSIS; SCREENING; MORTALITY; COMPLICATIONS; DOSAGE; in; hip fractures; ab; is Notes : In a randomized, prospective, double-blind trial, the effect of conventional low-dose heparin (5,000 units every 8 hours) was compared with that of a low molecular weight fragment (2165 LMWH, Kabi Vitrum AB, starting 2,500 units 2 hr before surgery, and then 5,000 units admitted because of hip fracture fulfilled the inclusion criteria and were analyzed for development of pulmonary embolism and deep vein thrombosis: 46 patients were included in the low molecular weight heparin (LMWH) group, and 44 in the conventional heparin group. Two and three, respectively, died before diagnostic tests were performed. In the remaining patients a ventilation-perfusion lung scan was performed 8 days after intervention. In the first 57 patients studied a bilateral ascending venography was performed on the ninth day only if clinical symptoms suggested a deep venous thrombosis. Because of the rate of venous thrombosis detected in those patients was unexpectedly low, venography was requested in the remaining 33 patients, even if the screening tests were negative. Pulmonary embolism occurred in six patients, all in the LMWH group. Deep vein thrombosis occurred in 14 patients in the LMWH group and in six patients in the conventional heparin group. Both differences are statistically significant. Mortality did not differ between the groups, nor did haemorrhagic complications. Our findings suggest that, in patients with hip fracture, LMWH is not useful at the dosage used. Ref ID : MONREAL1990 858. Monreal, M., Ruiz, J., Roig, J., Lafoz, E., and Inaraja, L. Prevention of recurrent pulmonary embolism [letter; comment]. Chest 98:781-782, 1990. Keywords : PREVENTION; PULMONARY EMBOLISM; EMBOLISM; ADULT; AGED; AGED 80 AND OVER; DIPYRIDAMOLE; DRUG THERAPY COMBINATION; FEMALE; HEPARIN; HUMAN; MALE; MIDDLE AGE; RECURRENCE; COMMENT; LETTER Ref ID : MONREAL1991 859. Monreal, M., Lafoz, E., Ruiz, J., Valls, R., and Alastrue, A. Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 99:280-283, 1991. Keywords : UPPER EXTREMITY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; PROSPECTIVE; PROSPECTIVE STUDIES; PREVALENCE; PE; DVT; Extremities; MALE; FEMALE; AGE; LUNG; SCAN; Hospitals; Died; DIAGNOSIS; MASSIVE; CONTRAST; PERFUSION; COMPLICATION; RISK; in; is Notes : We prospectively evaluated the prevalence of pulmonary embolism (PE) in 30 consecutive patients with proved deep venous thrombosis (DVT) of the upper extremity. Ten patients (seven male and three female; mean age, 43 years) had primary DVT, and 20 patients (14 male and six female; mean age, 52 years) had catheter-related DVT. Ventilation-perfusion lung scans were routinely performed at the time of hospital admission to all but one patient (one patient was critically ill, and he died four days after DVT diagnosis because of massive PE). Lung scan findings were normal in nine of ten patients with primary DVT, and they were indetermine in the remaining patient. By contrast, perfusion defects were considered highly suggestive of PE in four patients with catheter- related DVT; two patients had indeterminate lung scans, and 13 patients had normal scans. We conclude that PE is not a rare complication in upper extremity DVT, and that patients with catheter-related DVT seem to be at a higher risk. Ref ID : MONREAL1991A 860. Monreal, M., Lafoz, E., Casals, A., Inaraja, L., Montserrat, E., Callejas, J.M., and Martorell, A. Occult cancer in patients with deep venous thrombosis. A systematic approach. Cancer 67:541-545, 1991. Keywords : OCCULT; CANCER; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Extremities; Physical Examination; Antigens; CHEST; CHEST RADIOGRAPH; Endoscopy; ULTRASOUND; CT; SCAN; FOLLOWUP; OUTPATIENT; Neoplasms; ASYMPTOMATIC; THROMBOPHLEBITIS; vein; DVT; DIAGNOSIS; CT scan; Carcinoma; EARLY; Colon; VENA CAVA; Ultrasonography; MALIGNANCY; in; blood; abdomen; cell count Notes : The authors prospectively studied 113 consecutive patients with deep venous thrombosis of the lower extremities to determine the most appropriate workup study for searching for a hidden cancer. After a careful physical examination, the following routine tests were performed: erythrocyte sedimentation rate (ESR), whole blood counts, biochemistry, carcinoembryonic antigen (CEA) levels, chest radiograph, upper gastrointestinal endoscopy, abdominal ultrasound and computed tomography (CT) scan. If a malignant lesion was suspected, further appropriate studies were performed. After discharge, periodic follow-up was performed on all patients in the outpatient clinic. A malignant neoplasm was detected in 12 patients. Of these 12 patients, six were asymptomatic with the exception of experiencing thrombophlebitis. Cancer was found more commonly in patients with idiopathic deep vein thrombosis (DVT) (7 of 31 versus 5 of 82 patients with secondary DVT; P = 0.012), and in those patients with abnormal lactic dehydrogenase (LDH) levels (6 of 23 versus 6 of 90; P = 0.007). Abnormal CEA levels allowed diagnosis of two cases of colonic cancer (on colonoscopy). Both ultrasound and CT scan of the abdomen showed two cases of urinary bladder carcinoma at a very early stage. Furthermore, two cases of adenomatous polyps in colon were found, a condition considered by most authors to be a colorectal cancer precursor. In addition, there were five patients with large benign pelvic tumors, and two patients with absent inferior vena cava. The most striking finding was that some cases of cancer were at a very early stage. It was concluded that blood cell counts, LDH, CEA, chest radiograph, and abdominal ultrasonography (or CT scan) should be routinely performed on all patients with deep venous thrombosis (particularly those with idiopathic DVT). Malignancy would not have been recognized in some patients if these tests had not been performed. Ref ID : MONREAL1991B 861. Monreal, M., Lafoz, E., Casals, A., Ruiz, J., and Arias, A. Platelet count and venous thromboembolism. A useful test for suspected pulmonary embolism. Chest 100:1493-1496, 1991. Keywords : PLATELET; Platelet Count; VENOUS; THROMBOEMBOLISM; PULMONARY EMBOLISM; EMBOLISM; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; DVT; PE; PROSPECTIVE; PROSPECTIVE STUDIES; DIAGNOSIS; analysis of variance; POSTOPERATIVE; LUNG; SCAN; PROBABILITY; in; blood; cell count; analysis; is Notes : We have previously reported that patients with deep vein thrombosis (DVT) and scintigraphic evidence of pulmonary embolism (PE) had a fall in platelet count, as compared with their levels before thrombosis had developed. Otherwise, no changes were found in DVT patients without embolism. We recently conducted a prospective study with a larger series of patients and studied platelet count behavior in 189 consecutive patients with acute venous thromboembolism (VTE) in whom a baseline blood cell count was available (obtained before thromboembolism developed). We found no significant differences in baseline platelet counts between groups. However, at the time of VTE diagnosis the analysis of variance demonstrated that mean platelet count was significantly higher in patients without embolism as compared with PE patients (p less than 0.001). On the other hand, no differences were found between patients with silent PE and those with clinically obvious PE. When patients with postoperative VTE and those with nonpostoperative VTE were analyzed separately, mean platelet count increased only in postoperative DVT patients without embolism (p less than 0.001). In the absence of a previous intervention, DVT did not produce any change in platelet count, while PE significantly reduced platelet number (p less than 0.008). In DVT patients without respiratory symptoms of embolism, we suggest that a lung scan should be performed when platelet count is lower than baseline value. For patients with a higher count, the probability of finding PE is very low, and scintigraphy is not cost- effective. Ref ID : MONREAL1991C 862. Monreal, M., Boix, J., Romeu, J., Arias, A., and Pujol, M.A. Acute gastroduodenal lesions in patients with venous thromboembolism. Identification of patients at risk. Chest 100:1488-1492, 1991. Keywords : VENOUS; THROMBOEMBOLISM; RISK; COMPLICATION; HEPARIN; THERAPY; BLEEDING; Endoscopy; vein; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; Ulcer; VENOUS THROMBOSIS; HYPOXEMIA; EARLY; AGE; drugs; INCIDENCE; LONG TERM; in; is; an; sex; smoking Notes : The prime complication of heparin therapy is bleeding, and the gastrointestinal tract is the most common site of bleeding in patients treated with heparin. We recently reported that gastroduodenal lesions are common in patients admitted because of acute venous thromboembolism, and now we present our experience in a larger series of patients. The aims of the study were to try to validate our previous findings and to identify clinical factors that could increase the likelihood of having an acute, potential bleeding lesion in the gastroduodenal tract. Upper gastrointestinal endoscopy was performed on admission in 155 consecutive patients with acute venous thromboembolism (118 with deep vein thrombosis, 37 with pulmonary embolism). Acute lesions (both peptic ulcers and diffuse erosions) were found in 19 of 118 patients (16 percent) with venous thrombosis, and in 14 of 37 patients (38 percent) with pulmonary embolism (p = 0.005). When only patients with pulmonary embolism were considered, lesions were more commonly found in men, and in patients with severe hypoxemia on admission. When considered overall, only the timing of endoscopy was statistically significant; acute lesions were more commonly found when endoscopy was performed early after admission. No significant differences were found in terms of age, sex, smoking habits, alcohol intake, concomitant drug ingestion, comorbid diseases, or previous history of ulcer. The very high incidence of upper GI tract lesions in these patients will have long-term diagnostic/therapeutic implications which cannot be ignored. Who should receive prophylactic H2 blockers and for how long remains to be determined. Ref ID : MONREAL1992 863. Monreal, M., Ruiz, J., Olazabal, A., Arias, A., and Roca, J. Deep venous thrombosis and the risk of pulmonary embolism. A systematic study [see comments]. Chest 102:677-681, 1992. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; RISK; PULMONARY EMBOLISM; EMBOLISM; PE; DVT; Extremities; LUNG; SCAN; AGE; LEG; DIAGNOSIS; THROMBUS; ASYMPTOMATIC; Immobilized; INCIDENCE; THROMBOEMBOLISM; regression analysis; in; sex; analysis; an Notes : The influence of several diseases and clinical conditions on the presence of pulmonary embolism (PE) in a large series of patients with deep venous thrombosis (DVT) in the lower extremities was analyzed prospectively. Lung scan findings from a series of 434 consecutive patients with DVT (with and without symptoms of PE) were studied and then correlated to five clinical variables: age, sex, elapsed time since clinical symptoms had appeared in the leg to diagnosis, degree of proximity of venous thrombus, and the presence or not of several risk factors that could have predisposed to thrombus development. According to scintigraphic findings, 164 patients were considered to have PE (asymptomatic in 76 of them), while 200 patients were classified as having only DVT. Lung scan was considered to be indeterminate for PE in 70 patients, and they were not included in the study. No differences were found in terms of age, sex, interval of time elapsed since onset of symptoms to diagnosis, or in the degree of proximity of the thrombus. However, several differences between groups were found when comparing the presence or absence of several predisposing factors for thrombosis: DVT developing in immobilized patients was associated with a significantly lower incidence of PE as compared with nonimmobilized patients (p = 0.005). Conversely, patients with a history of venous thromboembolism (VTE) had a significantly higher rate of embolism (31/51 vs 133/313; p = 0.01). On logistic regression analysis, a history of VTE showed a statistically significant association with more than a twofold higher risk of having PE for patients with such an antecedent. Our findings suggest that different pathophysiologic pathways could perhaps explain differences in embolic potential. Ref ID : MONREAL1993 864. Monreal, M., Casals, A., Boix, J., Olazabal, A., Montserrat, E., and Mundo, M.R. Occult cancer in patients with acute pulmonary embolism. A prospective study. Chest 103:816-819, 1993. Keywords : OCCULT; CANCER; PULMONARY EMBOLISM; EMBOLISM; PROSPECTIVE; PROSPECTIVE STUDIES; PE; Physical Examination; Antigens; CHEST; CHEST RADIOGRAPH; Endoscopy; ULTRASOUND; Hospitals; FOLLOWUP; OUTPATIENT; ASYMPTOMATIC; DIAGNOSIS; ESOPHAGEAL; Carcinoma; RISK; RISK FACTORS; Died; MASSIVE; Biopsy; Hematuria; HEPARIN; Heparin dose; BLEEDING; in; blood; cell count; abnormalities; an Notes : We prospectively studied 78 consecutive patients with acute pulmonary embolism (PE) to determine the most appropriate workup study for searching for hidden cancer. After a careful physical examination, the following tests were performed: erythrocyte sedimentation rate (ESR), complete blood cell counts, biochemistry, carcinoembryonic antigen levels, chest radiograph, upper gastrointestinal endoscopy, and abdominal ultrasound. If a malignant lesion was suspected, further appropriate tests were performed. After hospital discharge, periodic follow-up was performed on all patients in our outpatient clinic. A malignant lesion was detected in 9 of 78 patients: in 7 of them, cancer was diagnosed during the hospital admission because of acute PE. All but one of these 7 patients were asymptomatic, except for PE symptoms. In three of them some abnormalities on physical examination led to the diagnosis of cancer; in the remaining three patients the diagnosis was suspected from abnormal results of blood tests. Cancer was detected several months after hospital discharge in two additional patients: an esophageal cancer was diagnosed 5 months later in one of the 23 patients who refused endoscopy; and a colonic carcinoma was detected 21 months after hospital discharge in a patient in whom colonoscopy was not performed at the time of hospital admission. When considered overall, cancer was more commonly found in patients with "idiopathic" PE as compared with patients with known risk factors for PE development (6 of 21 patients vs 3 of 51 patients; p < 0.05). On the other hand, one patient died because of massive recurrent PE after a biopsy sample was obtained because of a prostatic node. Gross hematuria had developed shortly after biopsy, and any attempt to increase heparin doses was followed by recurrent hematuria. According to our experience, any decision about procedures that potentially involve bleeding should be carefully individualized in patients with acute PE. Ref ID : MONREAL1993A 865. Monreal, M., Martorell, A., Callejas, J.M., Valls, R., Llamazares, J.F., Lafoz, E., and Arias, A. Venographic assessment of deep vein thrombosis and risk of developing post-thrombotic syndrome: a prospective study. J.Intern.Med. 233:233-238, 1993. Keywords : vein; THROMBOSIS; RISK; POST-THROMBOTIC; Syndrome; PROSPECTIVE; PROSPECTIVE STUDIES; DEEP VEIN THROMBOSIS; DVT; PULMONARY EMBOLISM; EMBOLISM; PT; LEG; Popliteal Vein; INCIDENCE; regression analysis; is; in; analysis; confidence intervals Notes : It is well known that patients with deep vein thrombosis (DVT) constitute a risk group for development of pulmonary embolism. However, the relation of DVT and the extent thereof with the subsequent sequelae (post-thrombotic syndrome) are insufficiently investigated. We have prospectively studied a series of consecutive patients admitted because of DVT on lower limbs, trying to correlate venographic findings during acute DVT with post-thrombotic (PTS) symptoms that develop later. Seventy-nine patients (84 limbs) with acute DVT were followed-up in our out-patient clinic at 4-monthly intervals for 3 years. At each visit patients were carefully examined regarding the appearance of PTS symptoms and/or signs from the DVT-affected leg. Three years after discharge, presence of PTS signs was assessed according to a simple scoring system. And then correlated to venographic findings during acute DVT. Patients were classified as having no (37 legs), mild (30 legs), or severe PTS signs (17 legs). Patients with popliteal vein involvement showed a significantly higher incidence of PTS 3 years later (P < 0.001). The risk of PTS also increased as DVT extent increased (P < 0.001). Nevertheless, the logistic regression analysis showed that DVT location explained all the differences (P < 0.001). In other words, DVT extent was overriden by the significance of DVT location, being popliteal the only location that showed a relevant contribution to the PTS incidence (95% confidence interval = 2.49-71.5). Ref ID : MONTEFUSCOVONKL1993 866. Montefusco-von Kleist, C.M., Bakal, C., Sprayregen, S., Rhodes, B.A., and Veith, F.J. Comparison of duplex ultrasonography and ascending contrast venography in the diagnosis of venous thrombosis. Angiology 44:169-175, 1993. Keywords : Duplex; Ultrasonography; CONTRAST; VENOGRAPHY; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; VEINS; ULTRASOUND; SENSITIVITY; SPECIFICITY; in Notes : 2534 veins were examined by contrast venography and by duplex ultrasound. The sensitivity of the duplex exam was 100% and the specificity was 99%. There were some problems with the methodology and the criteria for enrollment. Ref ID : MONTURO1990 867. Monturo, C.A., Dickerson, R.N., and Mullen, J.L. Efficacy of thrombolytic therapy for occlusion of long-term catheters. JPEN 14:312- 314, 1990. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; LONG TERM; ACEP93; OCCLUSION; Catheters Ref ID : MOORE1982 868. Moore, G.W., Smith, R.R., and Hutchins, G.M. Pulmonary artery atherosclerosis: correlation with systemic atherosclerosis and hypertensive pulmonary vascular disease. Arch.Pathol.Lab.Med. 106:378- 380, 1982. Keywords : 951202; PULMONARY ARTERY; ARTERY; Vascular Diseases; Arteries; is; AUTOPSY; ADULT; AGE; CARDIAC; THROMBOEMBOLI; in; EMBOLIZATION; PATHOLOGIC; Adolescence; AGED; aging; aortic diseases; co; Arteriosclerosis; PA; atherosclerosis; et; CORONARY DISEASE; FEMALE; heart hypertrophy; HUMAN; hypertension,pulmonary; MALE; MIDDLE AGE; PULMONARY EMBOLISM; pulmonary emphysema; Support,U.S.Gov't,P.H.S. Medline File Notes : Atherosclerosis of the pulmonary arteries is a common autopsy finding and is associated with a variety of clinical conditions. To delineate the morphologic changes associated with pulmonary artery atherosclerosis, autopsies of 337 consecutive adults (greater than 15 years of age) were studied. For each, 35 features were studied, including age, coronary vascular disease, cardiac chamber hypertrophy and dilation, pulmonary artery and aortic atherosclerosis, and pulmonary thromboemboli and emphysema. These were compared using correlation coefficients and forward and backward stepwise regression procedures for selected variables. Pulmonary artery atherosclerosis correlated significantly with age, right ventricular dilation and hypertrophy, pulmonary emphysema, and aortic atherosclerosis. Regional evaluations of systemic and pulmonary atherosclerosis showed highly significant internal correlations. In the ligamentum arteriosum, the intensity of atherosclerosis over the aortic insertion correlated with the severity of a similar atheroma at the pulmonary artery insertion. With the multiple-regression procedure, pulmonary artery atherosclerosis was a significant predictor of aortic atherosclerosis, right ventricular hypertrophy, and pulmonary embolization. Our study shows that pulmonary embolization. Our study shows that pulmonary embolization. Our study shows that pulmonary artery atherosclerosis is accelerated in patients with atherosclerosis of the systemic arteries and the pathologic lesions associated with hypertensive pulmonary vascular disease. Ref ID : MORE1993 869. More, R.S., Brack, M.J., and Gershlick, A.H. Lone atrial fibrillation and anticoagulant therapy. Clin.Cardiol. 16:504-506, 1993. Keywords : Atrial fibrillation; ANTICOAGULANT; THERAPY; RISK; THROMBOEMBOLISM; PROPHYLAXIS; LONG TERM; CONSENSUS; AGE; THROMBOEMBOLIC; ANTICOAGULANTS; Hypertension; sdi-11/93; in; is; an Notes : Assessment of risk of thromboembolism and potential benefit of prophylaxis with long-term anticoagulant therapy in lone atrial fibrillation is hampered by a lack of consensus regarding definition of lone atrial fibrillation. In general, patients less than 60 years of age with normal left ventricular function and left atrial size have a low risk of thromboembolic events and are unlikely to gain any significant benefit with anticoagulants; however, patients older than 60 years with impaired left ventricular function, enlarged left atrium, and/or associated conditions such as hypertension have an increased risk of thromboembolism and would benefit from long-term anticoagulant therapy. Decisions regarding anticoagulant usage would be simplified by using a scoring system containing clinical and investigational variables. Ref ID : MORENOCABRAL1976 870. Moreno-Cabral, R., Kistner, R.L., and Nordyke, R.A. Importance of calf vein thrombophlebitis. Surgery 80:735-742, 1976. Keywords : CALF; VEINS; THROMBOPHLEBITIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DEEP VEIN THROMBOSIS; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; DEATH; MASSIVE; EMBOLI; TREATMENT; HEPARIN; BELOW-KNEE; KNEE; PROSPECTIVE; vein; in; LEG; Foot; is; PROSPECTIVE STUDIES; Orthopedic; Pulmonary emboli Notes : In the lower leg there are three groups of deep veins: the anterior tibial, (draining the dorsum of the foot) the posterior tibial (draining the sole of the foot) and the peroneal (draining the lateral aspect of the foot). Although it is widely believed that deep venous thrombosis below the knee is benign, this is untrue. Deep vein thrombosis isolated to the anterior tibial vein, for example, results in pulmonary thromboembolism in 30 percent of cases. One prospective study in orthopedic patients found several deaths and massive pulmonary emboli (despite treatment with heparin) in patients with isolated anterior tibial vein thrombosis. Ref ID : MORGENTHALER1995 871. Morgenthaler, T.I. and Ryu, J.H. Clinical characteristics of fatal pulmonary embolism in a referral hospital. Mayo Clin.Proc. 70:417-424, 1995. Keywords : 951202; FATAL; PULMONARY EMBOLISM; EMBOLISM; in; Hospitals; Died; AUTOPSY; Methods; Tumor emboli; EMBOLI; THROMBOEMBOLIC; diagnostics; DEATH; RISK; RISK FACTORS; PROPHYLAXIS; THROMBOEMBOLISM; CHEST; CHEST PAIN; PAIN; CAUSE; cause of death; death certificates; Medical Records; VENOUS; SUDDEN DEATHS; MASSIVE; ADULT; AGED; Aged,80 and over; comorbidity; FEMALE; HUMAN; INPATIENTS; MALE; MIDDLE AGE; PROGNOSIS; di; mo; pc; Respiratory Function Tests; Retrospective Studies; co; Medline File; Health Planning & Administration File; critical care; dyspnea Notes : OBJECTIVE: To determine the clinical characteristics of hospitalized patients who died of pulmonary embolism, confirmed by evaluative autopsy. DESIGN: We retrospectively analyzed a series of autopsy cases of pulmonary embolism at a tertiary-care center for the period Jan. 1, 1985, through Dec. 31, 1989. MATERIAL AND METHODS: The medical and autopsy records of all hospitalized patients with autopsy- proven fatal pulmonary embolism were reviewed. Cases of tumor emboli, fat emboli, and contributory-only thromboembolic disease were excluded from the study. Specific symptoms and signs, diagnostic studies, and prophylactic measures were noted. RESULTS: Among 2,427 autopsies performed during the 5-year study period, death in 92 (3.8%) was clinically and pathologically judged to be caused by pulmonary embolism. No risk factors were noted in only 11 patients (12%). Prophylaxis against thromboembolism was used in 46%. Classic symptoms were often absent: dyspnea was present in only 59%, chest pain in only 17%, and hemoptysis in 3%. Pulmonary embolism was considered in 49% of the 92 patients and was correctly assigned as the cause of death on the death certificate or in the medical records in 32%. Testing for venous thromboembolic disease was performed in 22%. Comorbidity was present in most patients: 54% had guarded or poor prognoses independent of pulmonary embolism. CONCLUSION: The usual signs and symptoms associated with pulmonary embolism did not adequately identify most of our patients who died of pulmonary embolism. The reasons included the absence of these signs and symptoms, inability to communicate (for example, sedated or comatose patient), sudden death from acute massive pulmonary embolism, and presence of comorbid factors Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN 55905 USA. Ref ID : MORPURGO1984 872. Morpurgo, M. Pulmonary embolism: the dimensions of the problem. G.Ital.Cardiol. Suppl., N(1/84):3-5, 1984. Keywords : 96-suzy-002; PULMONARY EMBOLISM; EMBOLISM; FREQUENCY; PROGNOSIS Notes : 01-03-96. Abstract : The present article deals with the following points: a) the historical dimensions of the problem; b) the frequency of antemortem misinterpreted or ignored pulmonary embolism; c) the << topographical >> dimensions of the problem; d) the polymorphism of pulmonary embolism; e) the prognostic of the problem, limitedly to short-term prognosis. For the sake of brevity the relationship between size and site of the embolism and clinical symptoms will not be dealt with. Ref ID : MOSER1981 873. Moser, K.M. and LeMoine, J.R. Is embolic risk conditioned by location of deep venous thrombosis? Ann.Intern.Med. 94(4 pt 1):439-444, 1981. Keywords : 96-suzy-001; is; RISK; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DEEP VENOUS THROMBOSIS; CONTRAST; VENOGRAPHY; LEG; SCANNING; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; VENTILATION; PERFUSION; LUNG; SCAN; VEINS; in; CALF; EMBOLISM; Thigh; NONINVASIVE; Methods; PROPHYLAXIS; TREATMENT; HUMAN; blood supply; radiography; radionuclide imaging; PHLEBOGRAPHY; PULMONARY EMBOLISM; ETIOLOGY; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; COMPLICATIONS; DIAGNOSIS Notes : Sixty-eight patients clinically suspected of having (33), or at high risk for (35), deep venous thrombosis were studied with contrast venography, radiofibrinogen leg scanning, and impedance plethysmography as well as ventilation and perfusion lung scans. Thrombosis limited to the veins in the calf of the leg (unilateral or bilateral) was shown by venography in 12 patients. None of these patients had clinical symptoms or scan results indicating embolism. Fifteen patients had thrombosis involving proximal (thigh) as well as distal (calf) veins by venography. Eight had scan evidence of embolism, although only one was symptomatic. The combination of radiofibrinogen and impedance tests allows accurate detection of both the presence and location of deep venous thrombosis. The availability of sensitive and specific, noninvasive methods for detecting and localizing venous thrombosis, as well as the apparently low embolic risk of calf-only thrombosis may condition future approaches to prophylaxis and treatment of patients with or at high risk for deep venous thrombosis. Ref ID : MOSER1981A 874. Moser, K.M. and LeMoine, J.R. Is Embolic Risk Conditioned By Location of Deep Venous Thrombosis? Annals of Internal Medicine 94((Part 1)):439-444, 1981. Keywords : 96-suzy-002; is; RISK; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DEEP VENOUS THROMBOSIS; CONTRAST; VENOGRAPHY; LEG; SCANNING; VENTILATION; PERFUSION; LUNG; SCAN; VEINS; in; CALF; EMBOLISM; Thigh; NONINVASIVE; Methods; TREATMENT Notes : 01-02-96. Abstract : Sixty-eight patients clinically suspected of having (33), or at high risk for (35), deep venous thrombosis were studied with contrast venography, radiofibrinogen leg scanning, and impedance plethysmograhy as well as ventilation and perfusion lung scans. Thrombosis limited to the veins in the calf of the leg (unilateral or bilateral ) was shown by venography in 21 patients. None of these patients had clinical symptoms or scan results indicating embolism. Fifteen patients had thrombosis involving proximal (thigh) as well as distal (calf) veins by venography. Eight had scan evidence of embolism, although only one was symptomatic. The combination of radiofibrinogen and impedance tests allows accurate detection of both the presence and location of deep venous thrombosis. The availability of sensitive and specific, noninvasive methods for detection and localizing venous thrombosis, as well as the apparently low embolic risk of calf-only thrombosis may condition future approaches to prophyaxis and treatment of patients with or at high risk for deep venous thrombosis. Ref ID : MOSER1988 875. Moser, K.M., Hull, R., Saltzman, H.A., Dantzker, D.R., Goldhaber, S.Z., and Greenfield, L.J. Recent advances in diagnosis of pulmonary embolism and deep venous thrombosis. Am.Rev.Respir.Dis. 138(4):1046- 1047, 1988. Keywords : 951216; in; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ANGIOGRAPHY; ANTICOAGULANTS; tu; FIBRINOLYTIC AGENTS; HEMODYNAMICS; HUMAN; internal medicine; td; lung diseases; co; PHLEBOGRAPHY; Plethysmography,Impedance; di; pp; th; PULMONARY GAS EXCHANGE; THROMBOEMBOLISM; THROMBOPHLEBITIS; Medline File Notes : [No Abstract Available]. Ref ID : MOSER1989 876. Moser, K.M., Olson, L.K., Schlusselberg, M., Daily, P.O., and Dembitsky, W.P. Chronic thromboembolic occlusion in the adult can mimic pulmonary artery agenesis. Chest 95:503-508, 1989. Keywords : CHRONIC; THROMBOEMBOLIC; OCCLUSION; ADULT; Mimic; PULMONARY ARTERY; ARTERY; DIAGNOSIS; CHEST; CHEST X-RAY; XRAY; FILMS; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; CT; CT scan; SCAN; MRI; Methods; SURGICAL; diagnostics; in; ph; is Notes : In the first 100 patients operated on for C T-E PH, three were referred with the diagnosis of UPAA having been made elsewhere. We found that many features of these two conditions are so similar that differential diagnosis is very difficult. Shared features may include findings on chest x-ray film, pulmonary angiography, CT scan and MRI studies. Since the two conditions vary substantially with respect to the methods of potential surgical correction, recognition of this possible differential diagnostic dilemma is important. Ref ID : MOSER1990A 877. Moser, K.M., Auger, W.R., and Fedullo, P.F. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation 81:1735-1743, 1990. Keywords : CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; PGM-8/94 Notes : CS- Department of Medicine, University of California San Diego School of Medicine. Ref ID : MOSER1990B 878. Moser, K.M. Venous thromboembolism [see comments]. Am Rev.Respir.Dis. 141:235-249, 1990. Keywords : VENOUS; THROMBOEMBOLISM; PGM-8/94 Notes : CS- Department of Medicine, University of California, San Diego, School of Medicine. Ref ID : MOSER1991 879. Moser, K.M., Cantor, J.P., Olman, M., Villespin, I., Graif, J.L., Konopka, R., Marsh, J.J., and Pedersen, C. Chronic pulmonary thromboembolism in dogs treated with tranexamic acid. Circulation 83:1371-1379, 1991. Keywords : CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; DOGS; PATHOGENESIS; NATURAL HISTORY; DIAGNOSIS; TREATMENT; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; ANIMAL; ANIMAL MODELS; THROMBOLYTIC; EMBOLISM; Methods; FIBRINOLYTIC; Pulmonary emboli; EMBOLI; VENOUS; THROMBI; Femoral Vein; VEINS; VENA CAVA; vein; CAUSE; RESOLUTION; HUMAN; PERFUSION; LUNG; SCAN; PGM-8/94; in; critical care; ab; an; is Notes : CS- Pulmonary and Critical Care Division, University of California, School of Medicine, San Diego 92103-1990 AB-BACKGROUND. Many questions remain regarding the pathogenesis, natural history, diagnosis, and treatment of chronic thromboembolic pulmonary hypertension in patients. To answer such questions, we developed an animal model of this disorder. The brisk thrombolytic response of canines to acute embolism has, previously, prevented the establishment of such a model. METHODS AND RESULTS. The fibrinolytic inhibitor tranexamic acid was given orally to canines before, and for intervals after, pulmonary emboli were released from venous thrombi formed in vivo in femoral veins or the inferior vena cava. Preliminary studies disclosed that embolic residuals from femoral vein thrombi were not sufficient to cause significant, persistent pulmonary hypertension. With repetitive, larger thrombi embolized from the inferior vena cava, however, persistent pulmonary hypertension was achieved in most animals. CONCLUSIONS. Resolution of emboli in the canine can be inhibited by tranexamic acid. As in humans, a spectrum of embolic residuals is encountered, and the perfusion lung scan consistently underestimates the extent of embolic residuals. Studies of this animal model continue. Ref ID : MOSER1992 880. Moser, K.M. and Fedullo, P.F. Subcutaneous compared with intravenous heparin for deep vein thrombosis [letter; comment]. Ann.Intern.Med 117:265; discussion 265-265; discussion 266, 1992. Keywords : SUBCUTANEOUS; INTRAVENOUS; intravenous heparin; HEPARIN; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PGM-8/94 Ref ID : MOSER1992A 881. Moser, K.M., Auger, W.R., Fedullo, P.F., and Jamieson, S.W. Chronic thromboembolic pulmonary hypertension: clinical picture and surgical treatment. Eur.Respir.J 5:334-342, 1992. Keywords : CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; SURGICAL; TREATMENT; AUTOPSY; diagnostics; TECHNIQUES; POSTOPERATIVE; MANAGEMENT; Exertion; PITFALL; PERFUSION; LUNG; SCAN; DIAGNOSIS; ARTERIAL; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; THROMBUS; RECANALIZATION; SURGERY; EMBOLECTOMY; Vascular Patency; COMPLICATIONS; SURVIVAL; OUTCOME; LONG TERM; MORTALITY; PGM-8/94; ab; is; an; in; co Notes : CS- Dept of Medicine, University of California, School of Medicine, San Diego AB- Chronic, major vessel thromboembolic pulmonary hypertension (CTEPH), is an uncommon condition which, in the past, was an autopsy curiosity. Advances in diagnostic approaches, surgical techniques and postoperative management have transformed this disorder into a potentially curable form of pulmonary hypertension. The predominant symptom is unexplained dyspnoea on exertion. In patients with this complaint, CTEPH should be considered. Numerous pitfalls exist along the diagnostic path. Perfusion lung scans point toward the diagnosis, but often underestimate the extent of central arterial obstruction. Pulmonary angiography is the key diagnostic procedure, but the many patterns of thrombus organization-recanalization require a base of experience for proper interpretation. Criteria for selection of patients for surgery are evolving, but assurance of thrombus accessibility to surgery is critical. Surgical thromboendarterectomy bears no resemblance to acute pulmonary embolectomy. Recognition of thrombus (versus normal intima), meticulous dissection and a bloodless surgical field are essential for adequate restoration of pulmonary vascular patency. Multiple complications may arise postoperatively, and detailed attention to these is required for patient survival. With a co- ordinated, multi-specialty team effort, however, haemodynamic and clinical outcomes have been rewarding and persist long-term. Surgical mortality should steadily decline with such a co- ordinated effort, as well as earlier diagnosis and advances in surgical and postoperative management techniques. Ref ID : MOSER1993A 882. Moser, K.M. and Bloor, C.M. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 103:685-692, 1993. Keywords : CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; Arteries; DIAGNOSIS; SURGICAL; POSTOPERATIVE; OUTCOME; LUNG; Biopsy; AUTOPSY; HISTOPATHOLOGIC; PATHOLOGIC; HEMODYNAMICS; AGE; DURATION; PULMONARY ARTERY; HISTOLOGIC; PGM-8/94; in; ab Notes : CS- Department of Medicine, University of California, School of Medicine, San Diego AB- The status of small pulmonary arteries may influence diagnosis, surgical selection and postoperative outcome of patients with chronic major vessel thromboembolic pulmonary hypertension (CTEPH). Therefore, in patients with the established diagnosis of CTEPH, lung tissue was obtained by biopsy (15 patients) or at autopsy (16 patients) to assess the histopathologic composition of small pulmonary arteries. Pathologic examination disclosed the full range of pulmonary hypertensive lesions in the small arteries, including plexogenic lesions. The type and extent of hypertensive lesions did not relate to preoperative hemodynamic values, to patient age, or to symptom duration. The findings indicate that primary pulmonary hypertension cannot be differentiated from potentially correctable CTEPH on the basis of histopathologic findings in small pulmonary arteries. Furthermore, none of the histologic findings preclude a positive hemodynamic and clinical result from pulmonary thromboendarterectomy. However, development of these hypertensive changes may explain the deterioration which these patients experience preoperatively over time. Ref ID : MOSER1993B 883. Moser, K.M., Metersky, M.L., Auger, W.R., and Fedullo, P.F. Resolution of vascular steal after pulmonary thromboendarterectomy. Chest 104:1441-1444, 1993. Keywords : RESOLUTION; CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; PULMONARY ARTERY; Arteries; PERFUSION; SCAN; LUNG; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; SURGERY; THROMBI; Catheterization; POSTOPERATIVE; HEMODYNAMICS; FOLLOWUP; CT; PGM-8/94; ab; ph; in; Segmental; heart; Heart Catheterization Notes : CS- Department of Medicine, University of California, San Diego, School of Medicine AB- Patients who undergo thromboendarterectomy for relief of chronic, major-vessel thromboembolic pulmonary hypertension (CT-E PH) offer a unique opportunity to evaluate potential resolution of hypertensive lesions in the small, nonelastic pulmonary arteries. Prior studies have demonstrated that, postoperatively, these patients commonly develop new perfusion scan defects. This "vascular steal" phenomenon occurs almost exclusively in lung segments which, preoperatively, were normally perfused by lung scan, were served by segmental arteries normal by pulmonary angiography, and, at surgery, were uninvolved with thrombi by direct inspection. In this study, we explored whether this intriguing "steal" phenomenon resolves over time. Twenty-nine patients who returned at 11 or more months following thromboendarterectomy were reevaluated by perfusion lung scan, repeated right heart catheterization (26 patients), and pulmonary angiography (25 patients). "Steal" of one or more lung segments occurred in 79 percent of patients in postoperative, predischarge perfusion scans. All demonstrated postoperative improvement in pulmonary hemodynamics, which persisted at follow-up. Postoperative "steal" improved in 96 percent of patients and 86 percent of the "stolen" segments. The results suggest that, in CT-E PH, hypertensive lesions in the small, nonelastic pulmonary arteries are responsible for "steal," and that, with relief of pulmonary hypertension, these lesions can resolve. The study also indicates that postoperative "steal" does not connote either new thromboembolic events or a poor hemodynamic result. Ref ID : MOSER1994 884. Moser, K.M., Fedullo, P.F., LitteJohn, J.K., and Crawford, R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA 271:223-225, 1994. Keywords : ASYMPTOMATIC; PULMONARY EMBOLISM; EMBOLISM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; FREQUENCY; TREATMENT; DEEP VENOUS THROMBOSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; PERFUSION; VENTILATION; LUNG; SCAN; CHEST; THERAPY; HEPARIN; DIAGNOSIS; INTRAVENOUS; OUTCOME; INCIDENCE; THROMBOEMBOLISM; PGM-8/94; Safety; Venogram; Hospitals; intravenous heparin; in; ab; an; is Notes : CS- Department of Medicine, University of California, School of Medicine, San Diego AB- OBJECTIVE--To determine the frequency of pulmonary embolism in patients admitted for treatment of deep venous thrombosis. DESIGN--An open, multicenter, dose-ranging study to assess the safety and pharmacokinetic characteristics of tissue-type plasminogen activator in deep venous thrombosis and pulmonary embolism. Perfusion and ventilation lung scans, chest roentgenograms, and venograms (in deep venous thrombosis) or pulmonary angiograms (in pulmonary embolism) were obtained before and 24 hours after inception of therapy. Heparin therapy was then administered. SETTINGS--Five tertiary- care hospitals. PATIENTS--All patients with suspected deep venous thrombosis or pulmonary embolism seen from August 1987 through November 1988 entered the study if they met inclusion criteria and if the diagnosis was confirmed by venogram (deep venous thrombosis) or pulmonary angiogram (pulmonary embolism). INTERVENTIONS--All patients received tissue-type plasminogen activator followed by intravenous heparin therapy. MAIN OUTCOME MEASURES--The primary measure was the frequency of pulmonary embolism in patients with deep venous thrombosis who had no symptoms of pulmonary embolism. This was not the original purpose of the study but emerged as an important finding as the data were analyzed. RESULTS--Nearly 40% of patients with deep venous thrombosis who had no symptoms of pulmonary embolism had evidence of pulmonary embolism based on ventilation-perfusion scan and chest roentgenogram findings. CONCLUSIONS--Because all of those considered to have embolism had so-called high-probability scan results, the frequency of embolism reported likely represents the minimum incidence of pulmonary embolism in patients with deep venous thrombosis who have no embolic symptoms. These data emphasize that venous thromboembolism is one disorder. Ref ID : MOSER1994A 885. Moser, K.M. and Fedullo, P.F. The diagnosis of deep-vein thrombosis [letter]. N.Engl.J Med 330:863-864, 1994. Keywords : DIAGNOSIS; DEEP VEIN THROMBOSIS; THROMBOSIS; PGM-8/94 Ref ID : MOSTBECK1980 886. Mostbeck, A., Partsch, H., Kohn, H., and Konig, B. [Pulmonary embolism in leg and pelvic vein thrombosis. Results of a prospective study - diagnosis, frequency, nuclearmedical and clinical appearance (author's transl)]. Wien.Klin.Wochenschr. 92(13):464-471, 1980. Keywords : 951217; EMBOLISM; in; LEG; vein; THROMBOSIS; PROSPECTIVE; PROSPECTIVE STUDIES; DIAGNOSIS; FREQUENCY; FIBRINOGEN; RADIONUCLIDE; VENOGRAPHY; LUNG; an; PERFUSION; SCAN; VENTILATION; SENSITIVITY; PULMONARY EMBOLISM; SPECIFICITY; is; Krypton; Thigh; VEINS; Iliac Vein; Pulmonary emboli; EMBOLI; PATHOLOGIC; analysis; Pelvis; CHEST; CHEST X- RAY; XRAY; ADULT; AGED; doppler effect; English Abstract; FEMALE; HUMAN; ri; MALE; MIDDLE AGE; di; et; THROMBOPHLEBITIS; co; Ultrasonics; du; ventilation-perfusion ratio; Medline File Notes : In a prospective study 169 patients with clinically suspected leg/pelvic-vein thrombosis were tested by 131 I fibrinogen uptake-test and radionuclide venography for confirmation of this diagnosis and also by a nuclearmedical lung investigation. In all cases of an abnormal perfusion scan a supplementary ventilation scan was performed. The perfusion scan has a sensitivity for pulmonary embolism of near 1.0 but its specificity is only 0.57. An additional ventilation study (133 Xenon, 81m Krypton) improves the specificity to 0.95. A mismatch of regional ventilation and perfusion is the nuclearmedical substrate of pulmonary embolism. The diagnosis of thrombosis was confirmed in 105 of 169 cases (62%). Thrombosis was located in the lower legs in 56%, in the thigh veins in 23% and in the external iliac veins in 21%. From 105 patients with leg/pelvic- vein thrombosis 60 (57.1%) had pulmonary emboli, from 64 patients with negative tests concerning thrombosis only 3 (4.7%) (p < 0.001). Pulmonary emboli were present in 46% when thrombosis was located in the lower legs, in 67% when thigh veins and in 77% when pelvic veins were involved. The average frequency of 57% emboli found in patients with leg and pelvic vein thrombosis agrees with data from pathologic-anatomical studies. An analysis of these patients with embolism showed that 70% of them were over 70 years old, that 52% of the emboli originated from thigh and pelvis and 43% from the lower leg and that 59% had no clinical signs of embolism. 80.4% of the patients had multiple perfusion defects (up to 9) which correlated in size with the severity of the clinical symptoms and which were about equally distributed in both lungs. Larger perfusion defects occure more frequently with thromboses of the thigh and pelvis than in thromboses of the lower leg. According to the chest x-ray pulmonary emboli were suspected to only 6 of 26 patients with clinical evidence of embolism (23%). Ref ID : MULLER1965 887. Muller, P. [Contemporary ambulatory treatment of varices, phlebothromboses and varicose leg ulcer]. Z.Arztl.Fortbild.(Jena) 59:1253-1257, 1965. Keywords : AMBULATORY; TREATMENT; VARICES; LEG; NASP; Ambulatory Care; BANDAGES; Hospitals; HUMAN; Injections,Intramuscular; Phenylbutazone; Progressive Patient Care; Sclerosing Solutions; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - Neuzeitliche ambulante Behandlung der Varizen, Phlebothrombosen und des Ulcus cruris varicosum AB - [No Abstract Available] UI - 66173973. Ref ID : MULLER1976 888. Muller, K.M. and Blaeser, B. [Fatal thrombo-embolism after central- vein catheterisation (author's transl)]. Dtsch.Med.Wochenschr. 101:411- 413, 1976. Keywords : 951202; THROMBOEMBOLISM; FATAL; VENOUS; AUTOPSY; CAUSE; DEATH; PULMONARY EMBOLISM; EMBOLISM; Cerebral; OCCLUSION; jugular veins; VEINS; in; THROMBI; VENA CAVA; SUBCLAVIAN; SUBCLAVIAN VEIN; Catheters; CATHETER; heart; Adolescence; ADULT; AGED; brachiocephalic veins; cerebral embolism and thrombosis; et; English Abstract; FEMALE; heart septal defects,ventricular; co; HUMAN; Infant; MALE; MIDDLE AGE; PA; THROMBOPHLEBITIS; TIME FACTORS; vena cava,superior; Medline File Notes : Ten cases of fatal thromboembolism after central venous catheterisation were found among the autopsies of one year. The immediate causes of death were protracted pulmonary embolism (n = 8), cerebral embolism with defect of ventricular septum (n = 1), and central regulatory disturbance following complete thrombotic occlusion of the jugular veins (n = 1). The sources of the fatal embolisms were found in thrombi in the superior vena cava, the innominate veins or subclavian veins. The relation of these thrombi to catheter-dependent lesions in the venous walls was beyond doubt. The catheters had been left in position for periods of 2 to 56 days. In 40 further autopsies with different causes of death, catheter- dependent mural lesions of varying extent were found in the venous system near the heart. Local thrombi were identified after catheterisation of not more than 24 hours. Macroscopic and microscopic appearance of these thrombi was characterised by a groove- like structure corresponding to the apposition of thrombi around the plastic catheter. Ref ID : MURRAY1970 889. Murray, T.S., Lorimer, A.R., Cox, F.C., and Lawrie, T.D.V. Leg vein thrombosis following myocardial infarction. Lancet ii:792-793, 1970. Keywords : LEG; VEINS; THROMBOSIS; MYOCARDIAL INFARCTION; CALF; PE; VENOUS; VENOUS THROMBOSIS; vein; infarction; in Notes : Most thromboses in patients after myocardial infarction were found in calf veins. Four patients in this series developed PE which was detected clinically. Two of the patients had no clinical signs of venous thrombosis. Ref ID : MURRAY1979 890. Murray, H.W., Ellis, G.C., Blumenthal, D.S., and Sos, T.A. Fever and pulmonary thromboembolism. Am.J.Med. 67(2):232-235, 1979. Keywords : FEVER; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PE; is; in; 96-suzy-001; REVIEW; EMBOLI; analysis; Temperature; EARLY; CAUSE; DIAGNOSIS; THERAPY; ADULT; AGED; FEMALE; ETIOLOGY; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; COMPLICATIONS; TIME FACTORS Notes : Fever is common in patients with thromboembolism. In 35 consecutive cases of PE fever was found in 60 percent on the first day. The percentages of patients with fever above 38 degrees centigrade on each of the first 8 days were: 60, 48, 58, 35, 30, 22, 10, and 4 Fever patterns associated with pulmonary thromboembolism have not been well characterized. Upon review of 35 consecutive patients with angiographically documented pulmonary emboli, fever was present in 24 patients; and in 20, it was attributed solely to pulmonary thromboembolism. Analysis of these cases indicates that high fever (temperature greater than 39 degrees C) due to pulmonary thromboembolism may occur early, and low-grade fever may continue for a week or more. Fever persisting beyond six days, however, especially with temperatures over 38.5 degrees C, should not be ascribed to pulmonary thromboembolism unless other causes have been carefully excluded. If the clinical setting and patient's findings are consistent with pulmonary thromboembolism, one should not be deterred from presumptively making this diagnosis and initiating therapy because of the presence of high fever. Ref ID : MUSTARD1070 891. Mustard, J.F. and Packham, M.A. Thromboembolism. A manifestation of the response of blood to injury. Circulation. 42:1, 1070. Keywords : THROMBOSIS; SCLEROTHERAPY; THROMBOEMBOLISM; INJURY; blood Ref ID : MUSTARD1970 892. Mustard, J.F. Platelets in thromboembolic disease. Advances.Cardiol. 4:131, 1970. Keywords : PLATELETS; THROMBOSIS; SCLEROTHERAPY; THROMBOEMBOLIC; in Ref ID : NAGELHOUT1991 893. Nagelhout, D.A., Pearson, A.C., and Labovitz, A.J. Diagnosis of paradoxic embolism by transesophageal echocardiography. Am Heart J 121:1552-1554, 1991. Keywords : DIAGNOSIS; EMBOLISM; Transesophageal; Echocardiography; sdi- 11/93; Paradoxic embolism Ref ID : NAKANO1990 894. Nakano, A., Kanda, T., Fuse, S., Ohshima, S., Yuasa, K., Takayanagi, N., and Suzuki, T. [An autopsy case of chronic pulmonary thromboembolism associated with congenital portal hypoplasty and pulmonary artery aneurysm]. Nippon.Kyobu.Shikkan.Gakkai.Zasshi. 28:1012- 1017, 1990. Keywords : 951202; AUTOPSY; CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; CONGENITAL; PULMONARY ARTERY; ARTERY; Died; heart; ROENTGENOLOGICAL; Aneurysm; HEMODYNAMICS; Rest; PULMONARY HYPERTENSION; Hypertension; DIAGNOSIS; MRI; in; THROMBUS; HEMORRHAGIC; infarction; Arteries; PORTAL VEIN; vein; SHUNT; CAUSE; atherosclerosis; is; ADULT; co; CASE REPORT; Chronic Disease; English Abstract; FEMALE; HUMAN; ab; PULMONARY EMBOLISM; Medline File; Hospitals Notes : A 44 year-old woman died after a history of chronic right heart failure for 25 years. Roentgenological studies showed marked pulmonary aneurysm, and hemodynamics at rest revealed severe pulmonary hypertension. The diagnosis of chronic pulmonary thromboembolism was made by MRI which identified a high intensity mass in the dilated right pulmonary artery. At autopsy, a large organized thrombus adhered to the atherosclerotic pulmonary artery, and pulmonary thromboembolism or hemorrhagic infarction were identified. Microscopic examination revealed intimal and medial proliferation in small arteries and plexiform lesions. In addition, hypoplasty of the portal vein and portacaval shunt, which were thought to be congenital, were present. It has been recognized that the portacaval shunt can be attributed to pulmonary hypertension. In this case it was considered that the main cause of pulmonary thrombus formation was both pulmonary atherosclerosis and pulmonary artery aneurysm caused by prolonged pulmonary hypertension. This is the first case of chronic pulmonary thromboembolism associated with congenital hypoplasty of portal vein Gunma Prefectural Maebashi Hospital. Ref ID : NAND1985 895. Nand, S., Fisher, S.G., Salgia, R., and Fisher, R.I. Hemostatic abnormalities in untreated cancer: Incidence and correlation with thrombotic complications. J.Clin.Oncol. 5:1998-2003, 1985. Keywords : HEMOSTATIC; INCIDENCE; COMPLICATIONS; RISK; CANCER; THROMBOSIS; MALIGNANCY; abnormalities; in; OCCULT; is; RISK FACTORS Notes : Malignancy, whether known or occult, is a recognized risk factor for VT. Ref ID : NAND1993 896. Nand, S. Hirudin therapy for heparin-associated thrombocytopenia and deep venous thrombosis. Am J Hematol. 43:310-311, 1993. Keywords : HIRUDIN; THERAPY; THROMBOCYTOPENIA; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; sdi-11/93; Heparin-associated thrombocytopenia; HAT Ref ID : NATALI1962 897. Natali, J. and Marmasse, J. Enquete sur le traitement chirugical des varices. Phlebologie 15:2, 1962. Keywords : VARICES; INCIDENCE; PULMONARY EMBOLISM; SCLEROTHERAPY; THROMBOSIS; VEINS; de Ref ID : NAVARINI1981 898. Navarini, E.A., Tomasini, M., Giordano, C., and Ripolles, J. [Surgical treatment of chronic post-thrombotic venous insufficiency. Personal experience]. Angiologia. 33:283-290, 1981. Keywords : TREATMENT; CHRONIC; POST-THROMBOTIC; VENOUS; Venous Insufficiency; NASP; Chronic Disease; Edema; English Abstract; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; VEINS; Medline File; de; ab Notes : TT - Tratamiento quirurgico de la insuficiencia venosa cronica postrombotica. Experiencia AB - [No Abstract Available] UI -82111644. Ref ID : NG1988 899. Ng, W.D. and Chan, Y.T. Digital gangrene complicating intraoperative injection sclerotherapy. Gastrointest.Endosc. 34(2):151- 153, 1988. Keywords : GANGRENE; SCLEROTHERAPY; EMBOLIZATION; THROMBUS; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; ARTERIAL; Intraoperative; Injections; Paradoxical embolization; ARTERY; OCCLUSION Notes : Paradoxical embolization of thrombus from esophageal varices to the arterial circulation producing radial artery occlusion. Ref ID : NICOLAIDES1970 900. Nicolaides, A.N., Kakkar, V.V., Renney, J.T., Kidner, P.H., Hutchinson, D.C., and Clarke, M.B. Myocardial infarction and deep vein thrombosis. Brit.Med.J. 1:432-434, 1970. Keywords : VEINS; THROMBOSIS; DIAGNOSIS; DEEP VEIN THROMBOSIS; DVT; PE; MI; ANTICOAGULATION; INCIDENCE; BEDREST; MYOCARDIAL INFARCTION; EPIDEMIOLOGY; infarction; vein; in; heart; an; Immobilization Notes : If sought, the diagnosis of deep vein thrombosis may be made in 40 percent of those admitted and placed at bedrest for acute myocardial infarction. 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 : NICOLAIDES1971 901. Nicolaides, A.N., Kakkar, V.V., Field, E.S., and Renney, J.T. The origin of deep vein thrombosis: A venographic study. Brit.J.Radiol. 44:653-663, 1971. Keywords : VEINS; THROMBOSIS; THROMBI; VENOUS; ENDOTHELIAL; INJURY; POSTOPERATIVE; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; VENOGRAPHY; vein; in; STASIS; is Notes : Spontaneous deep vein thrombi may occur in the setting of venous endothelial injury, even if mild. Most cases of postoperative deep venous thrombosis are believed to start in the area of the valve cusps, where stasis is at its maximum. Ref ID : NICOLAIDES1975 902. Nicolaides, A.N. and Irving, D. Clinical factors and the risk of deep venous thrombosis. In: Thromboembolism: Aetiology, advances in prevention and management, edited by Nicolaides, A.N.Lancaster, England:MTP Press, 1975, Keywords : RISK; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; RECURRENCE; VARICOSITIES; AGE; THROMBOEMBOLISM; PREVENTION; MANAGEMENT; in; is; an; RISK FACTORS Notes : Patients with a past history of DVT have a five times higher risk of recurrence compared to those who have not had prior DVT. It is widely believed, although unproven, that superficial varicosities are an independent risk factor for DVT. Kakkar and Nicolaides have both found that patients below age 60 with varicosities were 3 times more likely to have DVT when compared with those who had no varicosities. This finding has been disputed by Sigal, who found no such association. Ref ID : NILSSON1966 903. Nilsson, I.M., Nilehn, J.E., Cronberg, S., and Norden, G. Hypofibrinogenaemia and massive thrombosis. Acta.Med.Scand. 180(1):65- 76, 1966. Keywords : MASSIVE; THROMBOSIS; PLASMINOGEN; FIBRINOLYSIS; HYPOFIBRINOGENEMIA Ref ID : NILSSON1973 904. Nilsson, I.M. and Isacson, S. New aspects of the pathogenesis of thrombo-embolism. Prog.Surg. 11:46-68, 1973. Keywords : PATHOGENESIS; THROMBOEMBOLISM Ref ID : NORCROSS1991 905. Norcross, E.D., Alexander, J.B., O'Malley, K.F., Spence, R.K., and Ross, S.E. The failure of serial pneumatic cuff venous occlusion plethysmography to predict patients at risk for pulmonary emboli after trauma. Am.Surg. 57:169-170, 1991. Keywords : EMBOLISM; TRAUMA; VENOUS; OCCLUSION; Plethysmography; RISK; Pulmonary emboli; EMBOLI; PE; INJURY; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; DVT; VENOGRAPHY; DIAGNOSIS; Pneumatic; in; injuries; is; an Notes : Over a three month period, attempts to perform serial Pneumatic Cuff Venous Occlusion Plethysmography (VP) were carried out in 51 severely injured patients felt to be at risk for Pulmonary Embolus (PE). Studies could not be performed in 25 of these patients due to the nature of their injuries. Of the remaining 26 patients, two showed evidence of deep vein thrombosis (DVT). Venography confirmed the diagnosis in only one of these patients. Serial VP failed to predict PE in all five patients in whom it was diagnosed. This article concludes that serial VP is not an effective predictor of PE in these patients. Ref ID : NORGREN1991 906. Norgren, L. The limited applicability of thrombolysis [letter]. Eur.J.Vasc.Surg. 5:361, 1991. Keywords : THROMBOLYSIS; ACEP-93; ACEP93 Ref ID : NOSZCZYK1992 907. Noszczyk, W. [The minimum one should know about diseases of the veins]. Kardiol.Pol. 36:44-48, 1992. Keywords : NASP; ADULT; AGED; Catheterization,Peripheral; Combined Modality Therapy; HUMAN; Iatrogenic Disease; MIDDLE AGE; PHLEBITIS; POSTPHLEBITIC SYNDROME; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; co; ab; ad Notes : TT - Co (minimum) trzeba wiedziec o chorobach ~zyl AB - [No Abstract Available] AD - I Katedry i Kliniki Chirurgii II Wydzialu Lekarskiego Akademii Medycznej AD - Warszawie UI -92260844. Ref ID : OBURGER1992 908. Oburger, K., Kechavarz, B., and Kohn, H. [Long-term results in patients with deep leg-pelvic vein thrombosis]. Vasa.Suppl. 37:40:40, 1992. Keywords : 951217; in; vein; BANDAGES; early ambulation; Follow-Up Studies; HUMAN; PHLEBOGRAPHY; POSTPHLEBITIC SYNDROME; di; th; PULMONARY EMBOLISM; THROMBOPHLEBITIS; Venous Insufficiency; Medline File Notes : [No Abstract Available] Dermatologische Abteilung Wilhelminenspital Wien. Ref ID : ODONNELL1977 909. O'Donnell, T.F., Browse, N.L., and Burnand, K.G. The socioeconomic effects of an ileofemoral venous thrombosis. J.Surg.Res. 22:483-488, 1977. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; INCIDENCE; VENOUS ULCERS; DVT; an; Ulcer; is Notes : The incidence of venous ulcers after dvt is 50 to 90 percent. Ref ID : ODONNELL1993 910. O'Donnell, T.F.,Jr. Arterial diagnosis and management of acute thrombosis of the lower extremity. Can.J Surg. 36:349-353, 1993. Keywords : ARTERIAL; DIAGNOSIS; MANAGEMENT; THROMBOSIS; Extremities; Ischemia; Muscles; SUBCUTANEOUS; Skin; OCCLUSION; bypass graft; CATHETER; THROMBECTOMY; TREATMENT; Methods; THROMBUS; CAUSE; THROMBOLYSIS; diagnostics; TECHNIQUES; sdi-11/93; is; blood; an; in Notes : Acute ischemia of the lower extremity is associated with reduced blood flow to muscle, nerve, subcutaneous tissue and skin. This condition may be caused by thrombosis on an atherosclerotic plaque or embolus or by the occlusion of a previously placed arterial bypass graft. The difficulties in differentiating embolic arterial occlusion from acute thrombotic arterial occlusion are discussed. Although balloon catheter thrombectomy has been the traditional approach to treatment of patients with acute ischemia, this method has several disadvantages: it may not remove all of the thrombus, the thrombus may be inaccessible, it may damage vessels and atherosclerotic plaque and it does not identify or correct the underlying cause of the thrombosis. The advantages of catheter-directed thrombolysis are discussed, including its use as a diagnostic tool. Detailed techniques are presented along with data from extensive studies. Ref ID : OESCH1991 911. Oesch, A. [Indications for and results of ambulatory varices therapy]. Ther.Umsch. 48:692-696, 1991. Keywords : AMBULATORY; VARICES; Ambulatory Surgery; SURGERY; VEINS; SAPHENOUS VEIN; Cosmetics; SCLEROTHERAPY; TREATMENT; COST; RISK; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; DVT; PE; NASP; English Abstract; HUMAN; VARICOSE VEINS; Vascular Surgery; Medline File; Health Planning & Administration File; ab; is; in; varicose; telangiectasia Notes : TT - Indikationen und Ergebnisse der ambulanten Varizentherapie AB - The introduction of the stab-incision--phlebectomy (Muller's technique)--has opened a large field for ambulatory surgery. This is specially true when phlebectomy is combined with a saphena-femoral or saphena-popliteal ligature. In a series of 1825 operations including 1592 incompetent saphenous veins 1216 (67%) were performed under local anesthesia. Radical surgery of incompetent short saphenous veins as well as of minor forms of varicose long saphenous veins is feasible in local anesthesia. Regional or general anesthesia (609 operations) are still recommended for stripping procedures in advanced long saphenous varices. In most cases phlebectomy of varices (553) provides a better cosmetic result than sclerotherapy, the latter being the treatment of choice for small veins and telangiectasias. Ambulatory surgery and sclerotherapy are cost- effective and low-risk treatments. No deep vent thrombosis or pulmonary embolism was observed in this group, whereas 1 DVT and 2 PE occurred in the 609 operations performed under general anesthesia UI - 92141932. Ref ID : OGILBY1989 912. Ogilby, J.D., Kopelman, H.A., Klein, L.W., and Agarwal, J.B. Adequate heparinization during PTCA: Assessment using activated clotting times. Cath.Cardiovasc.Diag. 18:206-209, 1989. Keywords : HEPARIN; CLOTTING TIME; THROMBOSIS; PTCA Ref ID : OGSTON1987 913. Ogston, D. Venous thrombosis -- causation and prediction, Chichester:John Wiley and Sons, 1987. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CAUSE; PLASMINOGEN; FIBRINOGEN; COAGULATION; FIBRINOLYSIS Ref ID : OHYA1994 914. Ohya, I. [Some findings of the lung in medicolegal autopsy cases]. Nippon.Hoigaku.Zasshi. 48:379-394, 1994. Keywords : 951202; LUNG; in; AUTOPSY; pathology; neck; Esophagus; Aorta; HUMAN; CAUSE; DEATH; an; cause of death; PULMONARY EMBOLISM; EMBOLISM; Edema; Skin; color; blood; EARLY; SHOCK; HEMORRHAGE; INCIDENCE; Adolescence; ADULT; AGED; Aged,80 and over; alcohol oxidoreductases; me; CHILD; Child,Preschool; English Abstract; forensic medicine; Infant; Infant,Newborn; en; PA; MIDDLE AGE; sudden infant death; Support,Non- U.S.Gov't; Medline File; LEGAL; megakaryocytes; japan Notes : "At first glance the lungs may seem uncomplicated, but many wise men have gone astray in their labyrinths." These words were written by Dr. A.A. Liebow, a famous pathologist, in a foreword to the first edition of Pathology of the Lung by H. Spencer. This same thought can also be applied to the field of medicolegal autopsies. 1. The gross appearance of the lungs in medicolegal autopsies Plucks consisting of the lungs, neck organs, the esophagus and the aorta were removed from human cadavers and after taking photos of the frontal and rear view, the lungs were carefully examined to reveal whether the lung shows characteristic morphological changes depending on causes of death. Based on their appearance, the lungs were classified into the 3 following types: a collapsed, a non-collapsed and an inflated type, each of these types reflecting the probable cause of death. The collapsed type of lung was seen in cases of death from exanguination, and the lung falling into shrinkage due to traumatic pneumo- and/or hemo-thorax was also classified into the collapsed type. The non- collapsed type of lung was seen in cases whose lungs were thermo- coagulated and in a case of death from a pulmonary embolism. Also, the deflating lungs of drowning victims before falling into collapse, were classified into a non-collapsed type. The inflated type of lung consisted of lungs that showed ballooning soon after death by drowning, and lungs that had inflated due to emphysema or edema from various causes. This lung study has reconfirmed that the lungs show hypostatic changes more clearly than any other organs of the body, and in the absence of skin color changes reflecting hypostasis, the settling of the blood in the lung could be detected in most cases. 2. Early histopathological lung changes induced by shock One hundred and thirty medicolegal cases were reviewed to detect early histopathological changes of the lung induced by shock. In many cases of death from various causes, pulmonary edema and hemorrhage were noted, but the incidence of such changes did not reveal any significant differences among the causes of death. When death had resulted from a hemorrhage or occurred during a state of shock, megakaryocytes in the pulmonary vessels tended to increase. However, if death from such causes had occurred shortly after the event, no increase in megakaryocytes was noted.(ABSTRACT TRUNCATED AT 400 WORDS) Department of Legal Medicine Gifu University School of Medicine Japan. Ref ID : OKUDA1985 915. Okuda, K., Ohnishi, K., and Kimura, K. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterol. 89:279-286, 1985. Keywords : INCIDENCE; PORTAL VEIN; PORTAL VEIN THROMBOSIS; VEINS; THROMBOSIS; Liver; CIRRHOSIS; ANGIOGRAPHY; vein; in; Liver Cirrhosis; an Ref ID : OLAZABAL1968 916. Olazabal, F.J., Roman-Irixarry, L.A., and Oms, J.D. Pulmonary embolism masquerading as asthma. N.Engl.J.Med. 278:999, 1968. Keywords : PULMONARY EMBOLISM; EMBOLISM; ASTHMA Ref ID : OLMAN1990 917. Olman, M.A., Auger, W.R., Fedullo, P.F., and Moser, K.M. Pulmonary vascular steal in chronic thromboembolic pulmonary hypertension. Chest 98:1430-1434, 1990. Keywords : CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; PERFUSION; LUNG; SCAN; PULMONARY ARTERY; Arteries; POSTOPERATIVE; FREQUENCY; OCCLUSION; INCIDENCE; RADIONUCLIDE; SURGERY; ARTERIAL; PGM-8/94; in; ab; is Notes : CS- Department of Medicine, University of California, San Diego AB- After pulmonary thromboendarterectomy, performed for relief of chronic thromboembolic pulmonary hypertension, perfusion lung scans have frequently disclosed new perfusion defects in segments served by undissected pulmonary arteries. Our hypotheses were that these new postoperative defects occurred with great frequency and did not represent postoperative vessel occlusion. We retrospectively reviewed the preoperative and postoperative perfusion scans of 33 consecutive patients undergoing pulmonary thromboendarterectomy. New postoperative perfusion defects were noted in 23 of 33 patients. The incidence of new defects was increased tenfold in segments that had (1) normal preoperative angiographic findings, (2) normal preoperative radionuclide perfusion, and (3) not been entered at the time of surgery. Postoperative angiograms, available in 15 of 33 patients, documented the nonembolic, nonocclusive nature of the new perfusion scan defects. The most plausible alternate explanation for this previously undescribed finding is a redistribution of pulmonary arterial resistance induced by the thromboendarterectomy, namely, a pulmonary vascular "steal.". Ref ID : OLMAN1992 918. Olman, M.A., Marsh, J.J., Lang, I.M., Moser, K.M., Binder, B.R., and Schleef, R.R. Endogenous fibrinolytic system in chronic large-vessel thromboembolic pulmonary hypertension. Circulation 86:1241-1248, 1992. Keywords : FIBRINOLYTIC; CHRONIC; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; PULMONARY ARTERIAL HYPERTENSION; ARTERIAL; PULMONARY ARTERY; Arteries; RESOLUTION; Pulmonary emboli; EMBOLI; THROMBUS; FIBRINOLYSIS; Methods; PLASMINOGEN; PLASMINOGEN ACTIVATOR; t- PA; Antigens; PA; VENOUS; OCCLUSION; FIBRIN; ETIOLOGY; PGM-8/94; in; critical care; ab; is; an; abnormalities Notes : CS- Division of Pulmonary and Critical Care Medicine, University of California, San Diego AB- BACKGROUND. Chronic thromboembolic pulmonary hypertension (CTEPH) is a disorder characterized by pulmonary arterial hypertension as a consequence of organized thrombotic material in the central pulmonary arteries. Incomplete resolution of acute pulmonary emboli is believed to be pathogenically important; however, the mechanism for poor thrombus dissolution remains to be explained. We undertook this study to assess the major determinants of plasma fibrinolysis in patients with CTEPH (n = 32). METHODS AND RESULTS. Immunological and functional levels of tissue-type plasminogen activator (t-PA) and type 1 plasminogen activator inhibitor (PAI-1) were quantified in platelet-poor plasma (PPP) from patients with CTEPH as well as age-matched controls. Although basal PPP t-PA antigen levels (CTEPH mean, 29.5 ng/ml; control mean, 2.7 ng/ml) and PAI-1 antigen levels (CTEPH mean, 55.8 ng/ml; control mean, 21.0 ng/ml) were higher in the CTEPH group, no between-group differences were detected in the enzymatic activities of these two molecules. The CTEPH group demonstrated a greater rise in t-PA antigen (CTEPH mean rise, 53.0 ng/ml; control mean rise, 5.6 ng/ml) and PA activity (CTEPH mean rise, 10.5 IU/ml; control mean rise, 1.2 IU/ml) than controls in response to an experimentally induced venous occlusion. Immunoprecipitation and fibrin autography of PPP from two patients with markedly elevated basal t-PA antigen levels demonstrate that the t-PA antigen was present in PPP primarily in complex with PAI-1. CONCLUSIONS. Although abnormalities of the fibrinolytic system were detected, neither a high resting plasma PAI-1 activity nor a blunted response of t-PA to venous occlusion can be invoked as an etiology for CTEPH. Ref ID : OLMAN1994 919. Olman, M.A., Gan, R.Z., Yen, R.T., Villespin, I., Maxwell, R., Pedersen, C., Konopka, R., Debes, J., and Moser, K.M. Effect of chronic thromboembolism on the pulmonary artery pressure-flow relationship in dogs. J Appl.Physiol. 76:875-881, 1994. Keywords : CHRONIC; THROMBOEMBOLISM; PULMONARY ARTERY; ARTERY; DOGS; HEMODYNAMICS; THROMBOEMBOLIC; PULMONARY HYPERTENSION; Hypertension; Arteries; THROMBI; ARTERIAL; Pressure; PGM-8/94; in; critical care; ab; Pulmonary Circulation; analysis Notes : CS- Division of Pulmonary and Critical Care, University of California at San Diego, La Jolla 92103 AB- To understand the hemodynamic alterations associated with chronic thromboembolic pulmonary hypertension, the large pulmonary arteries of mongrel dogs were chronically obstructed with lysis-resistant thrombi. Pulmonary hemodynamics were experimentally measured and described by multipoint pulmonary arterial pressure (PAP) vs. flow plots. In nine anesthetized chronically embolized dogs, but not in six control dogs, the PAP- flow line shifted significantly upward in a parallel fashion by 4.2 +/- 0.7 mmHg. The postembolic pulmonary circulation was further characterized by predictions from a morphometric-based elastic tube and sheet flow model of the canine pulmonary circulation. After model validation with the preembolic PAP-flow data, the derived postembolic PAP matched the in vivo results to within 1 mmHg. A detailed analysis of the model-derived PAP drop revealed that the PAP-flow line shift can be accounted for by a novel fixed resistor in the largest obstructed pulmonary artery. Ref ID : OLSEN1985 920. Olsen, M.M., Blumer, J.L., Gauderer, M.W., and Izant, R.J.,Jr. Streptokinase dissolution of a right atrial thrombus. J.Pediatr.Surg. 20:19-21, 1985. Keywords : STREPTOKINASE; THROMBUS; ACEP93 Ref ID : OMALLEY1990 921. O'Malley, K.F. and Ross, S.E. Pulmonary embolism in major trauma patients. J.Trauma. 30:748-750, 1990. Keywords : EMBOLISM; TRAUMA; PULMONARY EMBOLISM; REVIEW; Pulmonary emboli; EMBOLI; FRACTURES; AGE; VEINS; RISK; EARLY; ETIOLOGY; Immobilization; THROMBOEMBOLIC; DIAGNOSIS; in; trauma centers; an; hospitalization; is Notes : In a 1-year retrospective review, 30 pulmonary emboli were diagnosed among 1,316 trauma patients who survived for at least 24 hours after admission to a Level I trauma center. Pelvic fractures, age over 55 years, severe single or multiple system trauma, and cannulation of central veins all appear to place injured patients at increased risk. Long bone fractures were not associated with an increased risk. The majority of pulmonary emboli were diagnosed during the first week of hospitalization with some as early as 24 hours and none later than 15 days postinjury. Although the etiology of these early emboli is uncertain, prolonged immobilization does not appear to play a role in placing these patients at increased risk for thromboembolic events. Pulmonary embolism should be suspected in any injured patient with respiratory compromise, and an aggressive approach to diagnosis is warranted. Ref ID : ONEILL1947 922. O'Neill, J.F. The effects on venous endothelium of alterations in blood flow through the vessels in vein walls, and the possible relation to thrombosis. Ann.Surg. 126:270-288, 1947. Keywords : VENOUS; ENDOTHELIUM; BLOOD FLOW; vein; THROMBOSIS; NASP; in; blood Ref ID : ORBACH1966 923. Orbach, E.J. The place of injection therapy in the treatment of venous disorders of the lower extremity -- with comments on its technique. Angiology 17(1):18-23, 1966. Keywords : THERAPY; TREATMENT; VENOUS; TECHNIQUES; INCIDENCE; PULMONARY EMBOLISM; EMBOLISM; SCLEROTHERAPY; Injections; in; Extremities; COMMENT; WORLDWIDE Notes : The worldwide incidence of pulmonary embolism following sclerotherapy. Ref ID : OUDKERK1993 924. Oudkerk, M., van Beek, E.J., van Putten, W.L., and Buller, H.R. Cost-effectiveness analysis of various strategies in the diagnostic management of pulmonary embolism. Arch.Intern.Med. 153:947-954, 1993. Keywords : diagnostics; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; CLINICAL DIAGNOSIS; DIAGNOSIS; Methods; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; SCREENING; NONINVASIVE; MORTALITY; MORBIDITY; INDICATIONS; ANTICOAGULANT; THERAPY; COST; TREATMENT; PERFUSION; SCAN; VENTILATION; LUNG; Ultrasonography; LEG; analysis; in; is; an Notes : BACKGROUND: Since the clinical diagnosis of pulmonary embolism is unreliable, various objective diagnostic methods (or combinations thereof) are advocated. Pulmonary angiography is the accepted reference method but is considered less suitable for initial screening due to its invasive nature. Therefore, at least nine different diagnostic management strategies employing invasive and noninvasive diagnostic tests are used in clinical practice. We assessed the cost-effectiveness of these strategies to help identify the optimal approach. METHODS: Based on assumptions derived from published data, we calculated mortality, morbidity, adequacy for the indication of anticoagulant therapy, and associated diagnostic and therapeutic costs using a decision analytic model. Additionally, a cost-effectiveness analysis was performed using incremental costs per additional life saved. RESULTS: The analysis identified three separate categories of diagnostic management strategies: (1) Treatment of all patients (or of those with an abnormal perfusion scan) results in the lowest mortality and morbidity rates but the highest costs due to inappropriate treatment of 55% to 70% of patients. (2) Pulmonary angiography strategies with or without prior perfusion-ventilation lung scintigraphy and ultrasonography of the legs have comparable low mortality and morbidity rates, costs savings of approximately 40%, and inappropriate treatment in fewer than 5% of patients. (3) Use of perfusion-ventilation scintigraphy with or without ultrasonography results in unacceptably high mortality rates. CONCLUSIONS: At present, the optimal diagnostic management strategy should include pulmonary angiography. Use of perfusion-ventilation lung scintigraphy and ultrasonography results in a 40% to 50% reduction in the number of patients requiring pulmonary angiography and is cost-effective. Ref ID : OVERTON1988 925. Overton, D.T. and Bocka, J.J. The alveolar-arterial oxygen gradient in patients with documented pulmonary embolism. Arch.Intern.Med. 148:1617, 1988. Keywords : EMBOLISM; PULMONARY EMBOLISM; ALVEOLAR; ARTERIAL; OXYGEN; GRADIENT; Aa GRADIENT; AGE; DIAGNOSIS; diagnostics; in; aa; is Notes : In 64 patients with angiographically proven pulmonary embolism the Aa gradient ranged from 11.6 to 83.9 mm Hg. In three patients the Aa gradient was normal for age. A normal Aa oxygen gradient does not exclude the diagnosis of pulmonary embolism, and should not preclude forther diagnostic procedures if there is a high index of suspicion. Ref ID : PAIEMENT1991 926. Paiement, G.D., Wessinger, S.J., and Harris, W.H. Cost- effectiveness of prophylaxis in total hip replacement. Am.J.Surg. 161:519-524, 1991. Keywords : PROPHYLAXIS; HIP; HIP REPLACEMENT; COST; FATAL; PULMONARY EMBOLISM; EMBOLISM; PREVENTION; TREATMENT; MANAGEMENT; VENOUS; THROMBOEMBOLIC; AGE; WARFARIN; vein; THROMBOSIS; INCIDENCE; PE; VENOGRAPHY; SCREENING; POSTOPERATIVE; ANTICOAGULATION; DURATION; VEINS; in; analysis; Duplex; Sonography; is Notes : A theoretical analysis was performed regarding the cost- effectiveness in terms of lives saved (reduction of fatal pulmonary embolism [PE]) and in terms of money (dollars spent for prevention and treatment) of seven strategies in the management of venous thromboembolic disease in patients over 39 years of age undergoing elective total hip replacement (THR). Strikingly, this theoretical analysis suggests that low-dose warfarin combined with clinical surveillance of deep vein thrombosis would reduce the incidence of fatal PE from 20 per 1,000 patients to 4 per 1, 000 patients and simultaneously reduce the charges for venous thromboembolic disease from $550,000 to about $400,000 per 1,000 patients. Based on this analysis, we strongly recommend this measure on a routine basis. Adding venography or duplex sonography routinely to this prophylactic regimen would, in this theoretical analysis, reduce the incidence of fatal PE from 4 per 1,000 patients to 0.15 per 1,000, but adds charges of $200,000 per extra life saved in the case of routine venography and $50, 000 in the case of routine sonography. Low- dose warfarin prophylaxis combined with routine sonography does not generate more charges than no prophylaxis with no screening while drastically reducing the incidence of fatal PE from 20 to 0.3 per 1,000 patients. Where duplex sonography is not easily available, a 12-week postoperative course of low-dose warfarin for every patient with no routine screening will be efficacious in reducing fatal PE and as cost- effective. Ref ID : PALARETI1994 927. Palareti, G., Legnani, C., Guazzaloca, G., Frascaro, M., Grauso, F., De Rosa, F., Fortunato, G., and Coccheri, S. Activation of blood coagulation after abrupt or stepwise withdrawal of oral anticoagulants-- a prospective study. Thromb.Haemost. 72(2):222-226, 1994. Keywords : 951217; blood; BLOOD COAGULATION; COAGULATION; PROSPECTIVE; PROSPECTIVE STUDIES; HYPERCOAGULABLE; in; ANTICOAGULANTS; is; RECOMMENDATIONS; ANTICOAGULANT; PT; WARFARIN; TREATMENT; VENOUS; THROMBOEMBOLIC; DVT; RECURRENCE; THROMBOPHLEBITIS; varicose; varicose vein; vein; ADULT; AGED; Aged,80 and over; ANTITHROMBIN III; an; Blood Coagulation Tests; COMPARATIVE STUDY; Drug Administration Schedule; FEMALE; Fibrin Fibrinogen Degradation Products; HUMAN; MALE; MIDDLE AGE; peptide fragments; peptide hydrolases; PROTHROMBIN; substance withdrawal syndrome; bl; et; THROMBOEMBOLISM; ci; dt; ad; ae; pd; Medline File; Health Planning & Administration File; Hospitals; Italy; INR Notes : The occurrence of a "rebound hypercoagulable state" in patients after dicontinuation of oral anticoagulants is still a matter of debate and no definite recommendation can be made on the best procedure for anticoagulant withdrawal. The present study investigated the changes in the levels of markers of activated blood coagulation in 32 patients (pts) in whom warfarin treatment (for venous thromboembolic disease) was randomly withdrawn abruptly (n = 17, group A) or gradually (n = 15, group B: 2/3 of initial dose the 1st week, 1/3 the 2nd weeks and nothing from the 3rd week on). Blood was sampled at baseline, once a week for the first three weeks and after 2 months. At the 1st week group A had significantly higher F1+2 and TAT values (p < 0.001); at the 2nd week F1+2 levels remained higher (p < 0.05) though INR values were not different from those of group B. After baseline, higher than normal F1+2 levels were recorded in 32/66 (48%) controls in group A vs 15/60 (25%) in group B (p < 0.01); at the 2nd week, 10/17 (59%) patients in group A vs 1/15 (7%) in group B still had higher than normal F1+2 levels (p < 0.01). The values of areas under curve (AUC) and maximum concentrations of all variables were not statistically different in the two groups; however, very high levels were observed in a few cases of group A. Thrombotic events (one DVT recurrence and one thrombophlebitis in a varicose vein) occurred in 2 pts of group A, both with high F1+2 and TAT AUC values.(ABSTRACT TRUNCATED AT 250 WORDS) Department of Angiology and Blood Coagulation University Hospital S Orsola Bologna Italy. Ref ID : PALEVSKY1990B 928. Palevsky, H.I. and Weiss, D.W. Pulmonary hypertension secondary to chronic thromboembolism [clinical conference]. J.Nucl.Med. 31:1-9, 1990. Keywords : PULMONARY HYPERTENSION; Hypertension; CHRONIC; THROMBOEMBOLISM Ref ID : PALEVSKY1991B 929. Palevsky, H.I. and Alavi, A. A noninvasive strategy for the management of patients suspected of pulmonary embolism. Semin.Nucl.Med. 21:325-331, 1991. Keywords : NONINVASIVE; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; LUNG; SCANNING; DIAGNOSIS; diagnostics; SCAN; Extremities; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; an; algorithms; is Notes : As a consequence of recent studies that have (1) established the role for ventilation-perfusion lung scanning in the diagnosis of pulmonary embolism, (2) clarified the contribution of clinical assessment to the diagnostic utility of lung scans, and (3) established a role for the noninvasive assessment of the lower extremities for deep venous thrombosis in patients suspected of having pulmonary embolism, we can now manage clinically stable patients suspected of pulmonary embolism without need for invasive diagnostic procedures. The various studies establishing this approach are reviewed, and an algorithm is presented that allows for the noninvasive workup of clinically stable patients suspected of having pulmonary embolism. Ref ID : PALEVSKY1991C 930. Palevsky, H.I. The problems of the clinical and laboratory diagnosis of pulmonary embolism. Semin.Nucl.Med. 21:276-280, 1991. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; VENOUS; THROMBOSIS; CARDIAC; Pulmonary emboli; EMBOLI; HEMODYNAMICS; CHEST; ARTERIAL; diagnostics; laboratories; in; blood Notes : Suspecting and diagnosing venous thrombosis and pulmonary embolism remain major clinical problems. For a variety of reasons, including the patient's pre-existing cardiac and pulmonary status and the release of humoral mediators, pulmonary emboli evoke varied responses in different patients. Symptoms and signs of pulmonary embolism are not specific; they depend on the size and the hemodynamic and humoral consequences of the embolus. Conversely, they may not be present at all. Chest radiographic and electrocardiographic findings are nonspecific, and may be most helpful in establishing the presence of other conditions that may be confused with pulmonary embolism. Arterial blood gases can only heighten the suspicion of pulmonary embolism; they should never be used to exclude the diagnosis. Clinical and laboratory findings therefore do not diagnose pulmonary embolism; rather, they raise the level of concern and set the stage for the performance of subsequent diagnostic studies. Ref ID : PALEVSKY1992A 931. Palevsky, H.I. and Raffin, T.A. Thrombolytic treatment of pulmonary embolism. West.J.Med. 157:171, 1992. Keywords : THROMBOLYTIC; TREATMENT; PULMONARY EMBOLISM; EMBOLISM Ref ID : PALLAN1991 932. Pallan, T., Wulkan, I.A., Flores, L., Chaudhry, M.R., Gintautas, J., and Abadir, A.R. Radiologic contrast material and a vasodilator can produce arterial thrombosis. Proc.West.Pharmacol.Soc. 34:315-317, 1991. Keywords : RADIOLOGIC; CONTRAST; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; ACEP-93; ACEP93 Ref ID : PALOMBO1993 933. Palombo, D., Porta, C., Brustia, P., Peinetti, F., Udini, M., Antico, A., Maione, M., Meloni, T., and Carbonato, P. [Loco-regional thrombolysis in deep venous thrombosis]. Phlebologie 46:293-302, 1993. Keywords : THROMBOLYSIS; VENOUS; ANTICOAGULATION; HEPARIN; WARFARIN; TREATMENT; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; THROMBOLYTIC; INCIDENCE; BLEEDING; RISK; PULMONARY EMBOLISM; EMBOLISM; THROMBI; THERAPY; CATHETER; THROMBUS; VENA CAVA; FILTER; LYSIS; THROMBOLYTIC THERAPY; PLASMINOGEN; PLASMINOGEN ACTIVATOR; COMPLICATIONS; rt-PA; ARTERIAL; POST-PHLEBITIC; POST PHLEBITIC SYNDROME; Syndrome; sdi- 11/93; Regional thrombolysis; in; is; an Notes : Anticoagulation, by means of heparin and warfarin is, till now, the most common treatment in deep venous thrombosis. Although thrombolytic agents have been available for over 10 years, their use remains quite low, ranging from 15 to 20% of deep venous thromboses. This is due to the relatively high incidence of contraindications as well as to the fact that the potential advantages versus heparin are diminished by the increased bleeding risk and by the potential risk of pulmonary embolism (migration of partially lysed thrombi). Following the example of the "triple armed therapy" proposed by Rosenthal for the treatment of pulmonary embolism, we will evaluate if loco-regional thrombolysis, with the catheter wedged against the thrombus, associated with a temporary vena cava interruption by means of an intraluminal filter, can achieve a better lysis of the thrombus without pulmonary embolism. In our Unit 18 patients affected by proximal deep venous thrombosis were submitted to thrombolytic therapy, 6 to systemic treatment, 3 to local treatment and the last 9 to loco-regional thrombolysis, using recombinant tissue-type Plasminogen Activator. We obtained 10 complete lyses, 1 with systemic and 9 with loco-regional treatment. There were no major complications. Thus, we think that venous loco-regional thrombolysis with rt-PA at lower doses, associated with temporary caval interruption, can probably achieve a better lysis than systemic treatment without risk of pulmonary embolism and with a very low haemorrhagic risk, as in arterial loco-regional thrombolysis. Furthermore, loco-regional thrombolysis, by means of a faster thrombus dissolution, could better prevent post-phlebitic syndrome. Ref ID : PANASIUK1993 934. Panasiuk, A., Dzieciol, J., Nowak, H.F., Kemona, A., Barwijuk- Machala, M., Dziecio, J., and Barwijuk-Machaa, M. [Pulmonary thromboembolism--random analysis of autopsy material]. Pneumonol.Alergol.Pol. 61:171-176, 1993. Keywords : 951202; analysis; AUTOPSY; in; an; FREQUENCY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; INCIDENCE; Segmental; Arteries; atherosclerosis; SEPTIC; Adolescence; ADULT; AGED; Aged,80 and over; CHILD; Child,Preschool; English Abstract; FEMALE; HUMAN; Infant; MALE; MIDDLE AGE; Poland; ep; PULMONARY EMBOLISM; PA; Medline File; Cancerlit File Notes : In the study an analysis of 13216 autopsy materials was performed to evaluate a frequency of pulmonary thromboembolism incidence including localisation of detected changes. Pulmonary thromboembolism was determined in 5.5% autopsies, with evident increase in older subjects (up to 31.3% in 70-79 years old group). The most frequently (67.8%) pulmonary thromboembolism was observed in lobar and segmental arteries in a course of atherosclerosis (28.6%), neoplasmas (20.8%) and septic diseases (15.5%). In 25% cases of pulmonary thromboembolism has been diagnosed during clinical observations and has been confirmed by autopsy procedure Zakladu Anatomii Patologicznej Kierownik. Ref ID : PAPADAKIS1991 935. Papadakis, M.A., Mangione, C.M., Lee, K.K., and Kristof, M. Treatable abdominal pathologic conditions and unsuspected malignant neoplasms at autopsy in veterans who received mechanical ventilation. JAMA 265:885-887, 1991. Keywords : 951202; PATHOLOGIC; Neoplasms; AUTOPSY; in; VENTILATION; FREQUENCY; DEATH; SURVIVAL; MANAGEMENT; cohort studies; intensive care; Died; Hospitals; Pulmonary emboli; EMBOLI; CAUSE; PAIN; abdomen; is; PA; abscess; di; th; analysis of variance; diagnostic errors; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; respiration,artificial; Retrospective Studies; support,u.s.gov't,non-p.h.s. veterans; Medline File; Cancerlit File; Unexpected; intensive care units Notes : STUDY OBJECTIVE: To determine, in medical patients who received mechanical ventilation, the frequency and types of major unexpected diagnoses at autopsy that, if known before death, would probably have led to improved survival (class I errors) or substantively changed management but not survival (class IIB errors). DESIGN: Retrospective cohort study. SETTING: Six medical intensive care units in a Department of Veterans Affairs Cooperative Study. PATIENTS: One hundred seventy-two autopsied patients of the 401 veterans who received mechanical ventilation and died in the hospital. RESULTS: The class I error rate was 12%. Abdominal pathologic conditions-- abscesses, bowel perforations, or infarction--were as frequent as pulmonary emboli as a cause of class I errors. While patients with abdominal pathologic conditions generally complained of abdominal pain, results of examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued. Six percent of patients had extensive malignant neoplasms (class IIB errors). CONCLUSIONS: Atypical presentation of potentially treatable abdominal pathologic conditions is a common cause of class I errors in veterans who receive mechanical ventilation. Conversely, several patients with unrecognized terminal conditions underwent intensive intervention. If the information gained at autopsy had been known before death, management would have probably changed substantively in 18% of patients Department of Medicine University of California San Francisco. Ref ID : PAPPAS1993 936. Pappas, A.A., Dalrymple, G., Harrison, K., Purnell, G., Canton, M., and Palmer, S. The application of a rapid D-dimer test in suspected pulmonary embolus. Arch Pathol Lab Med 117:977-980, 1993. Keywords : D-DIMER; PREDICTIVE VALUE; PE; diagnostics; DIAGNOSIS; V/Q; V/Q SCAN; SCAN; ANGIOGRAPHY; in Notes : D-dimer had a 100% negative predictive value for acute PE in a study of 169 patients. Unfortunately, only 20 patients in this study had a pulmonary angiogram, and only 10 of the patients with D-dimer levels less than 500 ng/ml underwent a definitive diagnostic test to disprove the diagnosis. This study failed to investigate the predictive value of D-dimer in the 15%-40% of patients with low-probability V/Q scans who had negative D-dimer but would have been found to have PE if they had undergone angiography. Ref ID : PARENT1989 937. Parent, F.N., Bernhard, V.M., Pabst, T.S., McIntyre, K.E., Hunter, G.C., and Malone, J.M. Fibrinolytic treatment of residual thrombus after catheter embolectomy for severe lower limb ischemia. J.Vasc.Surg. 9:153- 160, 1989. Keywords : FIBRINOLYTIC; TREATMENT; THROMBUS; CATHETER; EMBOLECTOMY; ACEP93; Ischemia Ref ID : PARKER1988 938. Parker, J.A., Markis, J.E., Palla, A., Goldhaber, S.Z., Royal, H.D., Tumeh, S., Kim, D., Rustgi, A.K., Holman, B.L., and Kolodny, G.M. Pulmonary perfusion after rt-PA therapy for acute embolism: early improvement assessed with segmental perfusion scanning. Radiology 166(2):441-445, 1988. Keywords : 951216; PERFUSION; rt-PA; THERAPY; EMBOLISM; EARLY; Segmental; SCANNING; in; PULMONARY EMBOLISM; HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; LUNG; SCAN; Methods; UROKINASE; ANATOMY; an; is; TECHNIQUES; ADULT; AGED; ALTEPLASE; tu; FEMALE; ri; MALE; MIDDLE AGE; Pulmonary Circulation; dt; RECOMBINANT PROTEINS; technetium tc 99m aggregated albumin; du; Medline File; Hospitals; boston Notes : To determine if pulmonary perfusion was improved in acute pulmonary embolism after therapy with recombinant human tissue-type plasminogen activator (rt-PA), lung scans were obtained before and a mean of 22 hours after therapy in 19 patients. The posttherapy lung scans were compared with baseline, pretherapy scans with use of two semiquantitative methods--an anteroposterior view method, similar to that used in the Urokinase Pulmonary Embolism Trial, and a segmental method that emphasized pulmonary anatomy. There was an improvement in the defect score from 0.35 to 0.14 (P less than .01) when the anteroposterior view method was used and from 0.37 to 0.16 (P less than .01) when the segmental method was used. These encouraging results in the early posttherapy period suggest that rt-PA is especially effective in improving regional perfusion after pulmonary embolism and that a larger controlled trial of therapy with rt-PA for acute pulmonary embolism should be performed. Scoring lung scans with a segmental method is feasible and appropriate for present-day lung scan technique and should be considered in future studies Charles A Dana Research Institute Beth Israel Hospital Boston MA 02215. Ref ID : PARKER1990 939. Parker, J.A., Nagel, J.S., Drum, D.E., Tumeh, S.S., and Goldhaber, S.Z. Pulmonary embolism: segmental appearance of perfusion lung scan defects correlates with successful response to thrombolytic therapy. Radiology 174(2):483-486, 1990. Keywords : 951216; PULMONARY EMBOLISM; EMBOLISM; Segmental; PERFUSION; LUNG; SCAN; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; in; ALTEPLASE; tu; FEMALE; HUMAN; ri; MALE; MIDDLE AGE; PROBABILITY; dt; RECOMBINANT PROTEINS; technetium tc 99m aggregated albumin; du; UROKINASE; ventilation-perfusion ratio; Medline File; Hospitals; boston Notes : Lung scan data from a series of 45 patients receiving thrombolytic therapy were reviewed to determine if any pattern on the pretherapy perfusion lung scans could be identified that predicted response to therapy. A segmental appearance on the pretherapy scans (complete or nearly complete absence of perfusion in a whole segment or a very large subsegment) was correlated with the amount of improvement in perfusion on lung scans obtained 24 hours after the start of thrombolytic therapy. As a group, patients with a segmental appearance on the pretherapy lung scans had more improvement in the perfusion reduction score than patients with a nonsegmental appearance (P less than .005). However, the correlation between segmental appearance and a favorable response to thrombolytic therapy was not strong enough to allow use of this appearance in the selection of patients for therapy Department of Radiology Beth Israel Hospital Boston MA 02215. Ref ID : PARKER1995 940. Parker, J.A., Drum, D.E., Feldstein, M.L., and Goldhaber, S.Z. Lung scan evaluation of thrombolytic therapy for pulmonary embolism [see comments]. J.Nucl.Med. 36(3):364-368, 1995. Keywords : 951216; LUNG; SCAN; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PULMONARY EMBOLISM; EMBOLISM; PE; PERFUSION; in; Methods; DURATION; HEPARIN; Segmental; regression analysis; analysis; ALTEPLASE; tu; HUMAN; ri; observer variation; dt; UROKINASE; Medline File; Hospitals Notes : Data from three trials of thrombolytic therapy for pulmonary embolism (PE) were combined to assess the utility of perfusion lung scan defect scoring in predicting the response to thrombolytic therapy. METHODS: Pre- and post-therapy lung scans and duration of symptoms were available for a total of 221 patients, 167 were treated with various thrombolytic regimes and 54 were treated with heparin alone. RESULTS: Improvement in the lung scan defect score was correlated with larger initial defect score (r = 0.53), segmental appearance (r = 0.31) and shorter duration of symptoms (r = 0.20). There was no significant residual correlation between improvement and segmental appearance in a multiple regression analysis after accounting for initial defect score and duration of symptoms. Two lung scan scoring methods (segmental and anterior-posterior method) provided similar results with low interobserver variability (r = 0.90 for both methods). CONCLUSION: This study indicates that the baseline perfusion lung scan defect severity helps to predict the response to thrombolytic therapy Department of Radiology Beth Israel Hospital MA 02215. Ref ID : PARRA1989 941. Parra, R.O., Farber, R., and Feigl, A. Pressure necrosis from intermittent-pneumatic-compression stockings [letter]. N.Engl.J.Med. 321:1615, 1989. Keywords : PHLEBITIS; Pressure; Necrosis; Intermittent pneumatic compression; STOCKINGS; CASE REPORT; g suits; adverse effects; HUMAN; LEG; blood supply; MALE; MIDDLE AGE; ETIOLOGY; THROMBOPHLEBITIS; prevention & control Ref ID : PARTSCH1974 942. Partsch, H., Lofferer, O., and Mostbeck, A. Diagnosis of established deep vein thrombosis in the leg using 131 I fibrinogen. Angiology 25(11):719-728, 1974. Keywords : DIAGNOSIS; VEINS; THROMBOSIS; FIBRINOGEN; THROMBUS; DVT; SCLEROTHERAPY; CHRONIC; DEEP VEIN THROMBOSIS; FIBRINOGEN SCAN; I-131; RADIOLABELLED FIBRINOGEN; PHLEBITIS; SCAN; vein; in; LEG; Iodine; COMPRESSION; kinetics; is; Methods Notes : Fibrinogen labelled with radioactive iodine (I-131) was tested for the ability to bind, and thus identify, newly forming deep vein thrombus as well as established thrombus in patients with clinical signs and symptoms of DVT. Patients undergoing compression sclerotherapy were also studied in order to assess the kinetics and time course of the thrombus formation and fibrinogen incorporation. It was found that radiolabelled fibrinogen is able to detect subacute fully formed thrombus, but not truly chronic thrombus which has been in place for several months. Superficial chemical phlebitis due to sclerotherapy gives a positive fibrinogen scan, and it does not appear possible to distinguish between superficial and deep vein thrombosis using this method. Ref ID : PARTSCH1991 943. Partsch, H. [Indications for active varicose vein therapy]. Vasa.Suppl. 33:36-38, 1991. Keywords : VARICOSE VEINS; vein; NASP; VEINS; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; Venous Insufficiency; Medline File; varicose; varicose vein; ab; ad Notes : TT - Indikationen fur aktive Varizentherapie AB - [No Abstract Available] AD - Dermatologische Abteilung AD - Wilhelminenspital AD - Wien UI - 92160004. Ref ID : PARTSCH1992 944. Partsch, H., O'Burger, K., and Mostbeck, A. Frequency of pulmonary emboli in walking patients with pelvic vein thrombosis. Proceedings of the American Venous Forum 4:60-60, 1992. (Abstract) Keywords : FREQUENCY; EMBOLI; VEINS; THROMBOSIS; DVT; PE; ASYMPTOMATIC; MANAGEMENT; COMPRESSION; BANDAGES; SUBCUTANEOUS; HEPARIN; V/Q; SCAN; AMBULATORY; Pulmonary emboli; in; walking; vein; groin; V/Q SCAN Notes : Of 139 patients with proven proximal DVT extending above the groin there were 15 patients with symptomatic PE and 65 patients with asymptomatic PE. (80% of PE's were asymptomatic) After 11 days of ambulatory management with compression bandages and subcutaneous heparin, 11 of these patients developed new emboli which were visible on V/Q scan. Ref ID : PARTSCH1992A 945. Partsch, H., Oburger, K., Mostbeck, A., Konig, B., and Kohn, H. Frequency of pulmonary embolism in ambulant patients with pelvic vein thrombosis: a prospective study. J.Vasc.Surg. 16(5):715-722, 1992. Keywords : 951217; FREQUENCY; PULMONARY EMBOLISM; EMBOLISM; in; vein; THROMBOSIS; PROSPECTIVE; PROSPECTIVE STUDIES; AGE; LEG; DIAGNOSIS; DEEP VEIN THROMBOSIS; DVT; Pelvis; Technetium; Foot; RADIONUCLIDE; VENOGRAPHY; PERFUSION; LUNG; SCAN; PE; standards; HEPARIN; BANDAGES; AUTOPSY; Carcinoma; Died; MASSIVE; Rest; is; ANTICOAGULATION; COMPRESSION; Immobilization; Adolescence; ADULT; AGED; Aged,80 and over; FEMALE; HUMAN; ri; MALE; MIDDLE AGE; bs; et; RISK FACTORS; co; th; VEINS; walking; Medline File; Cancerlit File; austria Notes : One hundred thirty-nine consecutive patients (average age 70.1 years) who were able to walk with a swollen leg were seen at the clinic where diagnosis of acute deep vein thrombosis (DVT) extending to the pelvis was confirmed by injecting microspheres labeled with technetium 99m into the dorsal foot vein (radionuclide venography). Thirty-nine (28%) of these patients had malignant disease. Perfusion lung scans performed immediately after radionuclide venography were supplemented by inhalation scans (99mTc-labeled diethylenetriamine pentaacetic acid aerosol) in case of perfusion defects. During scintigraphy patterns highly indicative of pulmonary embolism (PE) were found in 80 patients (58%), but only 11 (7.9%) had minor clinical symptoms. All patients were admitted to the ward, were given standard heparin subcutaneously (35,000 to 40,000 units/24 hr) and firm bandages, and were encouraged to walk. After 11 days pulmonary scintigraphy was repeated and revealed no change in 55 of 59 patients without PE and in 40 of 80 patients with PE. Thirty-three patients (23.7%) showed regression of perfusion defects. New PE developed in 11 patients (7.9%, four without and seven with previous PE). Autopsy revealed that one 80-year-old patient with prostatic carcinoma had died of massive PE. When comparing this frequency of newly developed PE during ambulation with the occurrence of PE after bed rest, according to the literature, it is no more dangerous for a mobile patient with proximal DVT to walk wearing a firm bandage than it is for the patient to be in bed. Therefore we recommend treating mobile patients with DVT by use of anticoagulation and firm compression bandages and without immobilization Department of Dermatology Wilhelminenspital Vienna Austria. Ref ID : PASTAKIA1987 946. Pastakia, B. Radiological diagnosis of deep vein thrombosis [letter]. Br.Med J (Clin.Res.Ed). 295:1417, 1987. Keywords : DIAGNOSIS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; sdi-11/93 Ref ID : PATIL1993 947. Patil, S., Henry, J.W., Rubenfire, M., and Stein, P.D. Neural network in the clinical diagnosis of acute pulmonary embolism. Chest 104:1685-1689, 1993. Keywords : CLINICAL DIAGNOSIS; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; PE; PROSPECTIVE; PIOPED; Physical Examination; CHEST; CHEST RADIOGRAPH; ARTERIAL; VENTILATION/PERFUSION; V/Q; SCAN; V/Q SCAN; in; blood; an Notes : The purpose of this investigation was to test the hypothesis that computer-based pattern recognition can accurately assess the likelihood of acute pulmonary embolism (PE) based on readily obtainable clinical characteristics. Data were obtained from 1, 213 patients who participated in the collaborative study of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Characteristics of the history, physical examination, electrocardiograph, chest radiograph, and arterial blood gases of patients with suspected acute PE were presented to a back propagation neural network. The 1,213 patients were divided into training set A (n = 606) and test set B (n = 607). These groups were then reversed into training set B (n = 607) and test set A (n = 606). A receiver operating characteristic (ROC) curve was constructed from PIOPED clinical assessment, and from neural network clinical assessment in groups A and B. Areas under the respective ROC curves were 0.7450, 0.7477, and 0.7324. All differences were not significant. Areas under ROC curves for PIOPED clinical assessment combined with ventilation/perfusion (V/Q) scan results were compared with neural network clinical assessment combined with V/Q scan results in groups A and B. The respective ROC areas were 0.8324, 0.8203, 0.8496 (all differences not significant). These data show that neural networks were able to predict the clinical likelihood of PE with an accuracy comparable to experienced clinicians. Ref ID : PATTARELLI1967 948. Pattarelli, M., Panazzolo, A., and Lombardi, M. [New treatment of varicose angiopathies in the obstetrico-gynecological field]. Minerva.Ginecol. 19:280-285, 1967. Keywords : TREATMENT; NASP; ADULT; FEMALE; Genital Diseases,Female; HUMAN; MIDDLE AGE; PREGNANCY; Pregnancy Complications; Puerperal Disorders; Telangiectasis; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; in; ab Notes : TT - Nuovo trattamento delle agniopatie varicose in campo ostetrico- ginecologico AB - [No Abstract Available] UI - 69012932. Ref ID : PATTISSON1971 949. Pattisson, P.H. and Tretbar, L.L. The injection treatment of varicose veins: a follow-up study of 264 patients. Vasc.Surg. 5:1-5, 1971. Keywords : Injections; TREATMENT; VARICOSE VEINS; VEINS; FOLLOWUP; Follow-Up Studies; NASP; Asthenia; BANDAGES; Constriction; FEMALE; HUMAN; LEG; MALE; Methods; Nausea; Postoperative Complications; Pressure; Sclerosing Solutions; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; varicose; ab Notes : AB - [No Abstract Available] UI - 71154874. Ref ID : PAYNE1967 950. Payne, R.F. Gravitational ulceration. Brit.J.Radiol. 40:436-440, 1967. Keywords : ULCERATION; NASP; ADULT; AGED; Bone Regeneration; Calcinosis; HUMAN; MIDDLE AGE; Osteomyelitis; Periosteum; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : AB - [No Abstract Available] UI - 67166417. Ref ID : PEARSON1978 951. Pearson, T.C. and Wetherly-Mein, G. Vascular occlusive episodes and venous hematocrit in primary proliferative polycythemia. Lancet ii:1219- 1222, 1978. Keywords : VENOUS; HEMATOCRIT; RISK; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; THROMBOEMBOLISM; POLYCYTHEMIA; in Notes : The risk of venous and arterial thrombosis increases linearly with increasing hematocrit. Ref ID : PEARSON1995 952. Pearson, S.D., Polak, J.L., Cartwright, S., McCabe-Hassan, S., Lee, T.H., and Goldhaber, S.Z. A critical pathway to evaluate suspected deep vein thrombosis. Arch.Intern.Med. 155(16):1773-1778, 1995. Keywords : 951216; vein; THROMBOSIS; DVT; in; EMERGENCY; RECOMMENDATIONS; REVIEW; CONSENSUS; ULTRASOUND; HEPARIN; Sodium; ANTICOAGULATION; TREATMENT; SCAN; decision making; Diagnosis,Differential; HUMAN; patient advocacy; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; di; us; Medline File; Health Planning & Administration File; BRIGHAM; Hospitals; boston Notes : Uncertainty regarding the optimal evaluation of suspected deep vein thrombosis (DVT) results in wide variations in practice, even within the same institution. To address variation in practice while maximizing the efficiency and quality of care, our institution developed a critical pathway guideline for the emergency department evaluation of patients suspected of having DVT. We present the critical pathway and the clinical rationale underlying its recommendations. The critical pathway was developed by a multidisciplinary team using chart review of practice at our institution, benchmarking at other institutions, and review and discussion of the medical literature. Consensus was achieved for the selection of ultrasound as the primary imaging test for all patients and for recommending initial doses of heparin sodium that are higher than the current norm at our institution to reduce the length of time required to achieve therapeutic anticoagulation. A total time for patient evaluation of 5 hours or less was established as the target. Controversy arose in two key areas: (1) the treatment of patients with normal ultrasound scans when high clinical suspicion for DVT exists and (2) the evaluation and treatment of suspected isolated calf-vein DVT. In its final form, the critical pathway recommendations seek to balance the benefits of standardization with the prerogatives of physicians to make decisions tailored to individual patients Department of Medicine Brigham and Women's Hospital Boston Mass USA. Ref ID : PEDERSEN1993 953. Pedersen, L.M., Lerche, A., Jorgensen, M., Urhammer, S., Steenberg, P., and Jensen, R. Follow-up study of patients with clinically suspected deep venous thrombosis and a normal venogram. J.Intern.Med. 234:457-460, 1993. Keywords : FOLLOWUP; Follow-Up Studies; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Venogram; OUTPATIENT; DVT; DIAGNOSIS; an; in Notes : 133 consecutive outpatients with clinically suspected DVT but a normal venogram were followed prospectively for 4 to 12 months. An acceptable alternate diagnosis was initially made in 70% of patients, and after followup a diagnosis was eventually established in 89% of the patients. Ref ID : PERDIGAO1989 954. Perdigao, C., Monteiro, J., Andrade, A., and Ribeiro, E.C. [Pulmonary embolism in acute myocardial infarct. Clinico-anatomic study of 19 cases]. Acta Med.Port. 2:65-71, 1989. Keywords : 951202; EMBOLISM; in; INCIDENCE; PULMONARY EMBOLISM; CAUSE; cause of death; DEATH; MYOCARDIAL INFARCTION; infarction; Pulmonary emboli; EMBOLI; an; clinical protocols; Hospitals; ACCIDENTS; heart; THROMBOSIS; PULMONARY ARTERY; ARTERY; AGED; AUTOPSY; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; co; PA; PROSPECTIVE STUDIES; et; mo; Medline File Notes : The aim of this study was to evaluate the incidence of pulmonary embolism as the cause of death in acute myocardial infarction; to define the anatomic and clinical profile of a subset of patients deceased by pulmonary embolism; to study the localization and characteristics of pulmonary emboli. An anatomic and clinical protocol was systematically applied to the dying patients with acute myocardial infarction admitted in a CCU of an University Hospital. Therefore, 193 patients consecutively deceased by acute myocardial infarction were studied. Sixty-four clinical parameters were evaluated together with 34 anatomic parameters concerning a very discriminative anatomic study protocol. The sole exclusion criterion for necrotic study was the lack of family consent; necropsy was thus performed in 77% of patients. Therefore, we verified that the incidence of pulmonary embolism as the cause of death was 9.8%. Delay in admission as well as the interval between the onset of symptoms and death, were longer in the deceased by pulmonary embolism than in subjects showing other causes of death. Bradycardia was absent in pulmonary embolism patients, and asystole was the terminal electric accident in the great majority of cases; heart weight was greater, and biventricular infarction and right ventricular thrombosis were also more frequent in this subset of patients. In almost half of cases, pulmonary emboli were located in the main pulmonary artery, being multiple and peripheral in four. Ref ID : PERDIGAO1989A 955. Perdigao, C., Tuna, J.L., Andrade, A., Pais, F., Monteiro, A.P., and Ribeiro, C. [2 cases of acute myocardial infarct complicated by fatal pulmonary embolism]. Rev.Port.Cardiol. 8:111-117, 1989. Keywords : 951202; FATAL; PULMONARY EMBOLISM; EMBOLISM; in; MYOCARDIAL INFARCTION; infarction; LATE; heart; ANTICOAGULANT; THERAPY; COMPLICATION; VENOUS; THROMBOSIS; AGED; AUTOPSY; CASE REPORT; ELECTROCARDIOGRAPHY; English Abstract; HUMAN; MALE; co; PA; pp; myocardium; et; Medline File Notes : Two cases of pulmonary embolism with lethal course in the setting of acute myocardial infarction are presented. Both cases are clinically characterized by a late pulmonary embolism occurrence (2nd and 3rd week, respectively), and the presence of a large infarct, heart failure during acute myocardial infarction evolution and the interruption of anticoagulant therapy due to a complication. From the anatomic point of view, both cases had large hearts and very large biventricular infarctions. On the other hand, deep venous plexus constituted the pulmonary embolism origin in one case, and right ventricular thrombosis in the other. Ref ID : PEREZ1995 956. Perez, J.V., Warwick, D.J., Case, C.P., and Bannister, G.C. Death after proximal femoral fracture--an autopsy study. Injury. 26:237-240, 1995. Keywords : 951202; DEATH; AUTOPSY; in; Hospitals; FRACTURES; HIP; hip fractures; CAUSE; SURGERY; THROMBOEMBOLIC; CARDIAC; MYOCARDIAL INFARCTION; infarction; PULMONARY EMBOLISM; EMBOLISM; SURGICAL; INJURY; EARLY; ANTICOAGULATION; RISK; Methods; AGED; Aged,80 and over; cause of death; england; ep; FEMALE; femoral fractures; co; mo; HUMAN; MALE; et; Retrospective Studies; RISK FACTORS; Support,Non-U.S.Gov't; TIME FACTORS; Medline File; Health Planning & Administration File; bronchopneumonia Notes : We reviewed 22,486 consecutive autopsy reports in a single District General Hospital, from 1953 to 1992. Five hundred and eighty- one patients with fractures of the proximal femur (hip fracture) were identified. Causes of death were correlated with timing of surgery and change of clinical practice. Thromboembolic and haemorrhagic potential were analysed. The principal causes of death after hip fracture were bronchopneumonia, cardiac failure, myocardial infarction and pulmonary embolism. Surgical intervention, within 24 h of injury significantly reduced death from bronchopneumonia and pulmonary embolism. Early mobilization reduced death from bronchopneumonia. Pulmonary embolism may be reduced by prophylactic anticoagulation, but 17 per cent of patients are at risk of haemorrhage, and mechanical methods seem safer in this population Southmead Hospital Bristol UK. Ref ID : PERHONIEMI1990 957. Perhoniemi, V., Salo, J.A., Haapiainen, R., and Salo, H. Strain gauge plethysmography in the assessment of venous reflux after subfascial closure of perforating veins: a prospective study of twenty patients. J.Vasc.Surg. 12:34-37, 1990. Keywords : Plethysmography; VENOUS; REFLUX; VEINS; PROSPECTIVE; PROSPECTIVE STUDIES; Doppler; Ultrasonography; HEMODYNAMICS; LEG; PERFORATING VEINS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; ARTERIAL; SURGERY; Fistula; Ligation; NASP; veins - physiopathology; venous insufficiency - surgery; ADULT; FEMALE; HUMAN; leg - blood supply; MALE; MIDDLE AGE; Regional Blood Flow; thrombophlebitis - physiopathology; veins - surgery; venous insufficiency - physiopathology; in; is Notes : Doppler ultrasonography and strain gauge plethysmography were used prospectively to study the hemodynamic changes in 20 patients' (5 men and 15 women) legs operated on by means of subfascial closure for insufficiency of perforating veins. In 10 patients (50%) the valves of the deep veins were incompetent as verified by Doppler ultrasonography, and deep vein thrombosis had previously been diagnosed in seven patients. After subfascial ligature, strain gauge plethysmography showed no changes in arterial flow, venous capacity, or in venous emptying rate. However, both venous reflux flow and reflux volume were significantly lowered (p less than 0.01) after surgery as compared to values before operation. The clinical objective results were good in all cases. In two of four patients with fair subjective results the arterial flow was pathologically high, which probably implies the presence of microscopic arteriovenous fistulas. It is concluded that strain gauge plethysmography can quantitate the change in deep venous reflux after ligation of perforating veins. Ref ID : PERLIN1992 958. Perlin, S.J. Pulmonary embolism during compression US of the lower extremity [see comments]. Radiology 184:165-166, 1992. Keywords : PHLEBITIS; PULMONARY EMBOLISM; EMBOLISM; COMPRESSION; Extremities; CASE REPORT; Femoral Vein; Ultrasonography; HUMAN; LEG; MALE; MIDDLE AGE; ETIOLOGY; radionuclide imaging; THROMBOPHLEBITIS; adverse effects; Methods; ULTRASOUND; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; vein; PERFUSION; LUNG; SCANNING; us; in Notes : To the author's knowledge, occurrence of pulmonary embolism during performance of compression ultrasound (US) of the lower extremity has not previously been reported in the radiology literature. The author describes a case in which pulmonary embolism was witnessed during compression US of venous thrombosis in a superficial femoral vein of a 64-year-old man. The embolism was documented with perfusion lung scanning. Ref ID : PERRAULT1965 959. Perrault, M., Duchesnay, G., and Griesser, J. Les accidents therapeutiques relevant de la prise prolongee ou inconsideree de medicaments d'usage courant. Rev.Prat. 15(11):1319-1327, 1965. Keywords : ACCIDENTS; INCIDENCE; PULMONARY EMBOLISM; EMBOLISM; SCLEROTHERAPY; MEDICATIONS; de; in; is; Injections Notes : Therapeutic accidents related to prolonged or careless administration of medications in current use. The incidence of pulmonary embolism following sclerotherapy is on the order of one in 50,000 injections, or one in every 2500 patients. Ref ID : PERRY1988 960. Perry, M.O. Anticoagulation: a surgical perspective. Am.J.Surg. 155:268-276, 1988. Keywords : ANTICOAGULATION; SURGICAL; HEPARIN; ANTITHROMBIN III; COAGULATION; INHIBITION; WARFARIN; ANTICOAGULANT; PROTHROMBIN; TREATMENT; THROMBOEMBOLISM; DURATION; in; is; blood; Half-Life; Vitamins; Vitamin K; drugs; drug interactions Notes : Heparin combines with antithrombin III, and the resulting complex inactivates several clotting factors (all are serine proteases) in the coagulation cascade, but the most important steps are inhibition of the conversion of factor X to Xa and the antithrombin effect. Heparin pharmacokinetics are poorly understood, but when the usual doses are given intravenously, heparin is rapidly removed from the blood and has a half-life of approximately 90 minutes. Warfarin is not a true anticoagulant but is readily absorbed after oral administration. It interrupts the coagulation mechanism by interfering with the vitamin K- dependent synthesis of prothrombin and factors VII, IX, and X. This process takes 4 to 5 days. The drug has a long half-life, and its activity is enhanced or blunted by many chemicals. The effective treatment of thromboembolism with heparin, followed by warfarin, requires a basic understanding of the complex pharmacologic aspects and drug interactions. Ref ID : PETERSEN1989 961. Petersen, P., Boysen, G., Godtfredsen, J., Andersen, E.D., and Andersen, B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet 1:175-179, 1989. Keywords : WARFARIN; ASPIRIN; PREVENTION; THROMBOEMBOLIC; COMPLICATIONS; CHRONIC; OUTPATIENT; ANTICOAGULATION; PLACEBOS; COMPLICATION; STROKE; DEATH; INCIDENCE; MORTALITY; BLEEDING; THERAPY; DURATION; in; Atrial fibrillation; Cerebral; Extremities Notes : From November, 1985, to June, 1988, 1007 outpatients with chronic non- rheumatic atrial fibrillation (AF) entered a randomised trial; 335 received anticoagulation with warfarin openly, and in a double-blind study 336 received aspirin 75 mg once daily and 336 placebo. Each patient was followed up for 2 years or until termination of the trial. The primary endpoint was a thromboembolic complication (stroke, transient cerebral ischaemic attack, or embolic complications to the viscera and extremities). The secondary endpoint was death. The incidence of thromboembolic complications and vascular mortality were significantly lower in the warfarin group than in the aspirin and placebo groups, which did not differ significantly. 5 patients on warfarin had thromboembolic complications compared with 20 patients on aspirin and 21 on placebo. 21 patients on warfarin were withdrawn because of non-fatal bleeding complications compared with 2 on aspirin and none on placebo. Thus, anticoagulation therapy with warfarin can be recommended to prevent thromboembolic complications in patients with chronic non-rheumatic AF. Ref ID : PETERSEN1990 962. Petersen, P., Kastrup, J., Helweg-Larsen, S., Boysen, G., and Godtfredsen, J. Risk factors for thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Arch.Intern.Med. 150:819-821, 1990. Keywords : RISK; RISK FACTORS; THROMBOEMBOLIC; COMPLICATIONS; CHRONIC; CHEST; CARDIOVASCULAR; TREATMENT; PLACEBOS; MYOCARDIAL INFARCTION; AGE; CHEST PAIN; PAIN; ANTICOAGULATION; DURATION; in; Atrial fibrillation; Physical Examination; Echocardiogram; infarction; heart; heart diseases; blood; Pressure; smoking Notes : As previously reported, 1007 patients with chronic atrial fibrillation participated in the Copenhagen AFASAK study. Before inclusion to trial, they all had a physical examination, chest roentgenogram, and echocardiogram with determination of left atrial size. This study evaluated the importance of cardiovascular risk factors for development of thromboembolic complications. To exclude any treatment effects on occurrence of thromboembolic complications, we included only the 336 patients from the placebo group. Using Cox's regression model, previous myocardial infarction was a significant risk factor for development of thromboembolic complications. Age, gender, heart failure, chest pain, hypertensive heart disease, diabetes, systolic and diastolic blood pressure, smoking, relative heart volume, and left atrial size were all without statistical importance. Ref ID : PETERSON1992 963. Peterson, J. and Zucker, M.B. The effect of adenosine monophosphate, arcaine, and anti-inflammatory agents on thrombosis and platelet function in rabbits. unknown , 1992. Keywords : THROMBOSIS; PLATELET; RABBITS; in Ref ID : PETITTI1986 964. Petitti, D.B., Strom, B.L., and Melmon, K.L. Duration of warfarin anticoagulant therapy and the probabilities of recurrent pulmonary embolism. Am.J.Med. 81:255, 1986. Keywords : WARFARIN; ANTICOAGULANT; THERAPY; EMBOLISM; ANTICOAGULATION; INCIDENCE; PE; RISK; CAUSE; MORBIDITY; MORTALITY; LONG TERM; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; RECURRENCE; HEMORRHAGE; DURATION; PROBABILITY; an; RISK FACTORS Notes : Six weeks of anticoagulation reduces the incidence of recurrent PE to 8 percent, and more prolonged anticoagulation seems to offer no further improvement. The risk of hemorrhage, on the other hand, remains constant over time. Prolonged anticoagulation may cause the cumulative morbidity and mortality of the anticoagulant to exceed that of the underlying disease. Long-term anticoagulation should be reserved for patients with recurrent venous thrombosis or with an irreversible underlying risk factor. Ref ID : PETROV1976 965. Petrov, M.L. and Penin, V.A. [Surgical treatment of post- thrombophlebitic syndrome]. Vestn.Khir. 116:48-50, 1976. Keywords : TREATMENT; Syndrome; Extremities; SURGICAL; Methods; VENOUS; INDICATIONS; SURGERY; NASP; ADULT; AGED; English Abstract; FEMALE; HUMAN; LEG; MALE; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; VEINS; Venous Insufficiency; Medline File; ab; in; an Notes : TT - Khirurgicheskoe lechenie pri posttromboflebiticheskom sindrome AB - Under observation were 125 patients with postthrombophlebitic syndrome of the lower extremities. Along with the routine surgical methods of treatment the authors suggested and performed in 30 patients a new operative procedure--communicotomy, that consists in separation of the superficial and profound venous systems in the lower crural third via a separate incision in the upper crural third. To this end a new instrument--a communicotome was devised. Indications to some or other kind of surgery were elaborated by the authors. 76% of patients showed an improvement within the terms from 1 to 6 years postoperatively UI - 76200562. Ref ID : PEZZUOLI1989 966. Pezzuoli, G., Neri Serneri, G.G., Settembrini, P., Coggi, G., Olivari, N., Buzzetti, G., Chierichetti, S., Scotti, A., Scatigna, M., and Carnovali, M. Prophylaxis of fatal pulmonary embolism in general surgery using low-molecular weight heparin Cy 216: a multicentre, double-blind, randomized, controlled, clinical trial versus placebo (STEP). STEP-Study Group. Int.Surg. 74(4):205-210, 1989. Keywords : 96-suzy-001; PROPHYLAXIS; FATAL; PULMONARY EMBOLISM; EMBOLISM; in; SURGERY; Low molecular weight heparin; HEPARIN; RANDOMIZED; CLINICAL TRIAL; PLACEBOS; AGED; SUBCUTANEOUS; Injections; Died; AGE; sex; DURATION; INCIDENCE; RISK; RISK FACTORS; THROMBOEMBOLISM; DEATH; POSTMORTEM; CAUSE; cause of death; MYOCARDIAL INFARCTION; infarction; disseminated intravascular coagulation; COAGULATION; Cerebral; Double-Blind Method; FEMALE; heparin,low- molecular-weight; therapeutic use; HUMAN; intraoperative care; MALE; MIDDLE AGE; MULTICENTER STUDIES; Postoperative Care; drug therapy; MORTALITY; RANDOM ALLOCATION; RANDOMIZED CONTROLLED TRIALS Notes : The effectiveness of low-molecular weight heparin CY 216 in the prophylaxis of fatal pulmonary embolism in patients undergoing general surgery was assessed in a multicentre, double-blind, randomized, clinical trial against placebo. A total of 4,498 patients aged over 40 undergoing general surgery were enrolled in the 18 centres which took part in the trial. Patients received a single daily subcutaneous injection of 7,500 anti-Xa units I.C. of CY 216 or placebo two hours before surgery, 12 hours after the initial injection and then daily for at least seven days. A post-mortem examination had to be carried out in every patient who died. The two groups of patients were well-matched for age, sex, type of disease, site and duration of operation as well as for incidence of risk factors which could predispose to the development of thromboembolism. Twenty-six deaths were recorded and validated: eight (0.36%) in the CY 216 group and 18 (0.80%) in the placebo group (p less than 0.05). At the post-mortem examination, carried out in 23 patients (88.5%), two deaths were found to be directly due to pulmonary embolism (0.09%) in the CY 216 group and four (0.18%) in the placebo group. Pulmonary embolism contributed to death in four other placebo-treated patients. Pulmonary or extrapulmonary thromboembolism was a significantly less frequent direct cause of death (p less than 0.05) in the CY 216 group (two pulmonary embolisms) than in the placebo group (four pulmonary embolisms, one acute myocardial infarction, one disseminated intravascular coagulation, two ischemic cerebral strokes).(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : PFLUG1967 967. Pflug, J. [The possibilities of surgical therapy in the post- thrombotic syndrome of insufficiency]. Zentralbl.Phlebol. 6:45-51, 1967. Keywords : SURGICAL; THERAPY; POST-THROMBOTIC; Syndrome; NASP; FEMALE; HUMAN; MALE; MIDDLE AGE; SAPHENOUS VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Die Moglichkeiten der chirurgischen Therapie beim postthrombotischen Insuffizienz-Syndrom AB - [No Abstract Available] UI - 67258765. Ref ID : PFUHL1989 968. Pfuhl, J.P., Jansen, H.H., and Hubschen, U. [Diagnosis in the aged from the pathologic-anatomic viewpoint]. Z.Gerontol. 22:271-278, 1989. Keywords : 951202; in; AGED; diagnostics; AGE; AUTOPSY; MYOCARDIAL INFARCTION; infarction; Carcinoma; PULMONARY EMBOLISM; EMBOLISM; Colon; DEATH; is; Aged,80 and over; cause of death; Chronic Disease; mo; cross- sectional studies; English Abstract; FEMALE; Germany,West; ep; HUMAN; INCIDENCE; Liver Cirrhosis; MALE; MIDDLE AGE; Neoplasms; Sex Factors; tuberculosis,pulmonary; Medline File; Health Planning & Administration File; Cancerlit File Notes : The preciseness of clinical diagnostics for two different age groups was reviewed among 2033 unselected autopsies looking at eight single diagnoses. The younger age group was up to 59 years of age, the older one over 59 years. In the older age group myocardial infarction, hepatocirrhosis, bronchial and gastric carcinomas were less frequently diagnosed compared to the younger group. Pulmonary embolism, pulmonary tuberculosis, colon and breast carcinomas were almost evenly diagnosed before death in both groups. The multimorbidity in aged patients is discussed. Also in the geriatric diagnostic a high autopsy rate--86% in our collective--is important Zentrum der Frauenheilkunde und Geburtshilfe der Johann-Wolfgang-Goethe-Universitat Frankfurt. Ref ID : PHILBRICK1988 969. Philbrick, J.T. and Becker, D.M. Calf deep vein thrombosis: a wolf in sheep's clothing? Arch.Intern.Med. 148:2131, 1988. Keywords : CALF; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; CALF VEIN THROMBOSIS; vein; in; Clothing; 96-suzy-002; NATURAL HISTORY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; an; REVIEW; Thigh; EMBOLIZATION; FATAL; EMBOLI; ANTICOAGULATION; TREATMENT; HEPARIN; Sodium; WARFARIN; Extension; EARLY; RECURRENCE; is; CHRONIC; CHRONIC VENOUS INSUFFICIENCY; Venous Insufficiency; RISK; th; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; DVT Notes : 01-04-96. Abstract : To determine the natural history of calf deep venous thrombosis (C-DVT), an analytic review of the 20 relevant English- language papers published since 1942 was performed. Remarkablly little methodologically sound research on this subject was found. However, available evidence suggests that C-DVT propagates to the thigh in up to 20% of cases and that propagation invaribly occurs before embolization. No fatal emboli were reported in patients presenting with isolated C- DVT. Traditional anticoagulation treatment with heparin sodium and warfarin sodium of symptomatic patients with C-DVT appears to prevent extension, embolization, and early recurrence. There is no evidence that C-DVT leads to chronic venous insufficiency or whether the risk of anticoagulation exceed ths risks of no treatment. As an option to anticoagulation, physicians may choose to follow patients with C-DVT with serial impedance plethysmography, treating only if there is evidence of proximal extension. Ref ID : PINEO1994 970. Pineo, G.F. and Hull, R.D. Classical anticoagulant therapy for venous thromboembolism. Prog.Cardiovasc.Dis. 37:59-70, 1994. Keywords : ANTICOAGULANT; THERAPY; VENOUS; THROMBOEMBOLISM Ref ID : PIOPEDINVESTIGA1990 971. PIOPED investigators Value of the ventilation/perfusion scan in acute pulmonary embolism. JAMA 263:2753, 1990. Keywords : SCAN; PULMONARY EMBOLISM; EMBOLISM; VENTILATION/PERFUSION; PIOPED; in Ref ID : PIOPEDINVESTIGA1990A 972. PIOPED investigators Tissue plasminogen activator for the treatment of acute pulmonary embolism. A collaborative study by the PIOPED Investigators. Chest 97:528-533, 1990. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; PIOPED; rt-PA; HEPARIN; THERAPY; LUNG; SCAN; TRENDS; MASSIVE; BLEEDING; HEMODYNAMICS; RISK; ALTEPLASE; ACUTE DISEASE; ADULT; AGED; AGED 80 AND OVER; COMPARATIVE STUDY; DOUBLE BLIND METHOD; FEMALE; HUMAN; INFUSIONS INTRAVENOUS; MALE; MIDDLE AGE; MULTICENTER STUDIES; PLACEBOS; RANDOM ALLOCATION; RECOMBINANT PROTEINS; SUPPORT U S GOVT P H S; VASCULAR RESISTANCE; VENTILATION PERFUSION RATIO; CLINICAL TRIALS; MULTICENTER STUDY; ANGIOGRAPHY; in; RANDOMIZED; drugs; LYTIC; is Notes : AB-Thirteen patients with acute pulmonary embolism were treated in a randomized double-blind fashion either with recombinant tissue plasminogen activator (rt-PA) 40 to 80 mg, usually in combination with heparin, or with placebo plus heparin. The drug was administered intravenously over 40 to 90 minutes. Nine patients received rt-PA, and four received placebo. A lytic effect was observed 1.5 and three hours after the onset of therapy with rt-PA based upon elevated levels of fragment-D dimers. Among the patients who received rt-PA, there was a modest improvement of the total pulmonary resistance 1.5 hours after the start of therapy, but the angiograms showed no significant changes in two hours. After 24 hours, the lung scans showed a trend toward greater improvement with rt-PA, but the rate of improvement in comparison to control subjects was not statistically significant. Massive bleeding occurred in one patient. The observations in this study suggest that rt- PA has little effect in two hours on angiographic clot burden, but may produce some improvement in hemodynamics. The treatment, however, is not without risk. Ref ID : PIRNER1969 973. Pirner, F. [Venous injuries and sport]. Phlebologie. 22:279-281, 1969. Keywords : INJURY; NASP; Abdominal Injuries; Athletic Injuries; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; injuries; et; Sports; ab Notes : TT - Traumatismes veineux et sport AB - [No Abstract Available] UI - 70056404. Ref ID : PISKLIVETS1981 974. Pisklivets, Z.S. [Role of immunopathological processes in the pathogenesis of the postthrombophlebitis syndrome of the legs]. Klin.Khir. :6-9, 1981. Keywords : PATHOGENESIS; Syndrome; NASP; COMPARATIVE STUDY; English Abstract; HUMAN; Immunity; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Rol' immunopatologicheskikh protsessov v patogeneze posttromboflebiticheskogo sindroma nizhnikh konechnostei AB - [No Abstract Available] UI - 82011576. Ref ID : PIZZO1984 975. Pizzo, S.V. Venous thrombosis. In: Laboratory hematology, edited by Koepke, J.A.New York:Churchill Livingston, 1984, Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; NASP; bib-4; laboratories Ref ID : PLANJAR1977 976. Planjar, M., Plazibat, M., and Paripovic, N. [10-year experience in the surgery of varicose veins in the lower limbs]. Acta Chir.Iugosl. 24:397-400, 1977. Keywords : SURGERY; VARICOSE VEINS; VEINS; NASP; Adolescence; ADULT; AGED; CHILD; Evaluation Studies; FEMALE; HUMAN; LEG; MALE; MIDDLE AGE; Postoperative Complications; RECURRENCE; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; in; varicose; ab Notes : TT - Desetogodisnje iskustvo operacija varikoznih vena donjih ekstremiteta AB - [No Abstract Available] UI - 77178037. Ref ID : PODOPRIGOVA1973 977. Podoprigova, A.P. [Surgical treatment of superficial varicose veins of the lower extremities]. Klin.Khir. 11:82-83, 1973. Keywords : TREATMENT; VARICOSE VEINS; VEINS; NASP; ADULT; AGED; FEMALE; HUMAN; MALE; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; varicose; ab Notes : TT - Khirurgicheskie lechenie varikoznogo rasshireniia poverkhnostnykh ven nizhnukh konechnostei AB - [No Abstract Available] UI - 74150026. Ref ID : POIKOLAINEN1983 978. Poikolainen, E. and Hendolin, H. Effects of lumbar epidural anaesthesia and general anaesthesia on flow velocity in the femoral vein and postoperative deep vein thrombosis. Acta.Chir.Scand. 149:361-364, 1983. Keywords : VEINS; POSTOPERATIVE; DEEP VEIN THROMBOSIS; THROMBOSIS; RISK; DVT; SURGERY; INCIDENCE; ANAESTHESIA; EPIDURAL; in; Femoral Vein; vein; is; an; RISK FACTORS; RANDOMIZED; Prostatectomy Notes : General anaesthesia is an independent risk factor for the development of DVT following surgery: patients randomized to receive general anaesthesia for retropubic prostatectomy had a 52 percent incidence of postoperative DVT as compared to those randomized to epidural anaesthesia, in whom the incidence was only 12 percent. Ref ID : POLLAK1973 979. Pollak, C.W., Sparks, F.C., and Barker, W.F. Pulmonary embolism: An appraisal of therapy in 516 cases. Arch.Surg. 107:66, 1973. Keywords : PULMONARY EMBOLISM; EMBOLISM; THERAPY; an; in Ref ID : POOLE1962 980. Poole, J.C.F. Effective diet and lipidemia on coagulation and thrombosis. Fed.Proc. 21(4):20, 1962. Keywords : COAGULATION; THROMBOSIS; NASP; bib-4; diet Ref ID : POPE1991 981. Pope, C.F., Dietz, M.J., Ezekowitz, M.D., and Gore, J.C. Technical variables influencing the detection of acute deep vein thrombosis by magnetic resonance imaging. Magn.Reson.Imaging. 9:379-388, 1991. Keywords : DEEP VEIN THROMBOSIS; vein; THROMBOSIS; MAGNETIC RESONANCE; DOGS; GRADIENT; VENOUS; VENOUS THROMBOSIS; TECHNIQUES; MRI; DIAGNOSIS; Cellulitis; Muscles; COMPRESSION; sdi-11/93; magnetic resonance imaging; in Notes : To establish which technical variables influence the detection of deep vein thrombosis by magnetic resonance imaging, 2 dogs, 5 normal volunteers and 17 patients were studied using a 1.5 T whole-body system. A sequential slice gradient echo acquisition (TR 25, TE 13, 0 = 30 degrees, 2 NEX, flow compensation rephasing gradients) in the axial plane was found to be optimal for detecting venous thrombosis. Thus, when using appropriate technique, MRI may identify deep venous thrombosis accurately. It may also allow the diagnosis of conditions which may simulate venous thrombosis clinically since the most common of these, ruptured Baker's cyst, cellulitis, muscle tear, hematoma and external venous compression are all readily identified by MRI. Ref ID : POPOVIC1992 982. Popovic, A.D., Milovanovic, B., Neskovic, A.N., Pavlovski, K., Putnikovic, B., and Hadzagic, I. Detection of massive pulmonary embolism by transesophageal echocardiography. Cardiology. 80:94-99, 1992. Keywords : MASSIVE; PULMONARY EMBOLISM; EMBOLISM; Transesophageal; Echocardiography; TECHNIQUES; INDICATIONS; CASE REPORT; diagnostics; sdi-11/93; is; in Notes : Transesophageal echocardiography is a new echocardiographic technique with indications that are still expanding and being redefined. Recently, the usefulness of transesophageal echocardiography in pulmonary embolism has been demonstrated in several case reports. In this article, we present 3 cases with pulmonary embolism diagnosed by transesophageal echocardiography and discuss its diagnostic value in this clinical setting. Ref ID : POREDOS1989 983. Poredo:s, P., Keber, D., and Vide:cnik, V. Late results of local thrombolytic treatment of peripheral arterial occlusions. Angiology 40:941-947, 1989. Keywords : LATE; THROMBOLYTIC; TREATMENT; ARTERIAL; OCCLUSION; ACEP-93; ACEP93 Ref ID : POTTER1992 984. Potter, C., Gill, J.C., Scott, J.P., and McFarland, J.G. Heparin- induced thrombocytopenia in a child [see comments]. J.Pediatr. 121:135- 138, 1992. Keywords : PHLEBITIS; THROMBOCYTOPENIA; CHILD; Adolescence; anastomosis,surgical; Blood Platelets; immunology; CASE REPORT; catheterization,central venous; instrumentation; HEPARIN; adverse effects; HUMAN; isoantibodies; analysis; LEG; blood supply; MALE; Platelet Count; drug effects; SUBCLAVIAN VEIN; chemically induced; THROMBOPHLEBITIS; THROMBOSIS; tricuspid valve; abnormalities; SURGERY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; CENTRAL VENOUS CATHETER; CATHETER; THERAPY; in Notes : We describe a case of thrombocytopenia and deep venous thrombosis in a boy who received heparin to maintain patency of a central venous catheter. Measurement of the release of serotonin labeled with carbon 14 confirmed the presence of heparin-induced thrombocytopenia. Children receiving heparin therapy should be monitored for the possibility of heparin-induced thrombocytopenia. Ref ID : PRANDONI1992 985. Prandoni, P., Lensing, A.W.A., Buller, H.R., Cogo, A., Prins, M.H., Cattelan, A.M., Cuppini, S., Noventa, F., and Ten Cate, J.W. Deep vein thrombosis and the incidence of subsequent symptomatic cancer. N.Engl.J.Med. 327:1128-1133, 1992. Keywords : DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; INCIDENCE; CANCER; DIAGNOSIS; DVT; RISK; RISK FACTORS; vein; in Notes : Prandoni followed 250 patients after a diagnosis of DVT, and confirmed a new diagnosis of cancer within 2 years in 17 percent of those with two episodes of idiopathic DVT, in 8 percent of those with a single episode of idiopathic DVT, but in only 2 percent of those whose DVT was associated with another recognized risk factor. Ref ID : PRATESI1976 986. Pratesi, F. [Nosological classification of phlebopathies of the extremities]. Recenti.Prog.Med. 60:1-12, 1976. Keywords : NASP; AGED; English Abstract; Extremities; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBITIS; Telangiectasis; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; VEINS; Venous Insufficiency; Medline File; classification; ab Notes : TT - Inquadramento nosologico delle flebopatie degli arti AB - [No Abstract Available] UI - 77037757. Ref ID : PRATT1971 987. Pratt, G.H. A technique for operation on the pathologic venous system. Surg.Gynecol.Obstet. 132:1076-1082, 1971. Keywords : TECHNIQUES; PATHOLOGIC; VENOUS; NASP; ANTICOAGULANTS; BANDAGES; FEMALE; HUMAN; Leg Ulcer; Methods; Postoperative Care; Postoperative Complications; PREGNANCY; SAPHENOUS VEIN; Thigh; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; VEINS; Medline File; ab Notes : AB - [No Abstract Available] UI - 71203632. Ref ID : PREDILETTO1990 988. Prediletto, R., Paoletti, P., Fornai, E., Perissinotto, A., Petruzzelli, S., Formichi, B., Ruschi, S., Palla, A., Giannella Neto, A., and Giuntini, C. Natural course of treated pulmonary embolism. Evaluation by perfusion lung scintigraphy, gas exchange, and chest roentgenogram. Chest 97:554-561, 1990. Keywords : EMBOLISM; PERFUSION; LUNG; CHEST; MONITORING; THERAPY; CHEST X-RAY; XRAY; DIAGNOSIS; TREATMENT; ARTERIAL; OXYGEN; GRADIENT; EMBOLIZATION; PULMONARY ARTERY; PULMONARY EMBOLISM; PULMONARY GAS EXCHANGE; CARBON DIOXIDE; COMPARATIVE STUDY; FEMALE; HEPARIN; HUMAN; MALE; MIDDLE AGE; SUPPORT NON U S GOVT; THROMBOLYTIC THERAPY; VENTILATION PERFUSION RATIO; in; abnormalities; Dead; an; ARTERY; Westermark; is Notes : AB-Perfusion lung scintigrams, pulmonary gas exchange data, and chest roentgenograms were obtained in 33 patients during acute embolism and over the following six months in order to assess their clinical usefulness in monitoring the effect of therapy. To this purpose, the measurement of pulmonary gas exchange and the presence of chest x-ray findings were compared with perfusion lung scintigraphic abnormalities both at diagnosis and after 7, 30, and 180 days during treatment. More than 50 percent of the pulmonary arterial tree was obstructed at diagnosis, and a large part of perfusion recovery was complete within the first month. All of the gas exchange parameters were abnormal at diagnosis, and the rate of their improvement was related to that of perfusion recovery. Interestingly, PaO2st (ie, PaO2 corrected for hyperventilation) and VE tended to return to normal during the first month as a consequence of the progressive recovery of perfusion, whereas oxygen and carbon dioxide gradients and physiologic dead space showed the persistence of some abnormalities six months after diagnosis. Significant correlations were observed between the number of ULSs evaluated on the perfusion lung scintigram (and considered an index of the severity of pulmonary embolization) and all of the gas exchange parameters at diagnosis (correlation coefficients averaged from 0.41 to 0.73) and after 7 and 30 days. The enlargement of the right descending pulmonary artery and particularly the "sausage sign and the Westermark sign were significantly associated with a higher degree of gas exchange impairment and with a more severe embolization. In conclusion, this study demonstrates that perfusion lung scintigraphy has a primary role in monitoring the recovery of patients with pulmonary embolism under treatment. Moreover, the chest roentgenogram may help in this purpose. A second major result is that the simple measurement of some gas exchange parameters may allow the assessment of functional recovery of these patients, thus giving additional information about the effect of therapy. Ref ID : PRESTI1990 989. Presti, B., Berthrong, M., and Sherwin, R.M. Chronic thrombosis of major pulmonary arteries. Hum.Pathol. 21:601-606, 1990. Keywords : CHRONIC; THROMBOSIS; PULMONARY ARTERY; Arteries; Hospitals; MASSIVE; AUTOPSY; Pulmonary emboli; EMBOLI; ARTERY; THROMBI; AGE; MALE; CLINICAL FEATURES; DIAGNOSIS; LUNG; THROMBOPHLEBITIS; Arteriosclerosis; ARTERIAL; SURGICAL; INCIDENCE; PATHOGENESIS; POLYCYTHEMIA; PGM-8/94; pathology; co; ab; in; dyspnea; heart; lung diseases; an Notes : CS- Department of Pathology, Penrose Hospital, Colorado Springs, CO 80907 AB- Chronic massive thrombosis of major pulmonary arteries, usually described in 0.1% of autopsies, was found in 68 of 7,753 autopsies (0.9%) in our hospital. For comparison, 201 of the 7, 753 autopsies (2.6%) revealed acute-massive pulmonary emboli. The 68 cases of chronic thromboses by definition had the right, left, or main pulmonary artery occluded or severely stenosed by organized thrombi. The average age was 67; males predominated 3 to 2. Dyspnea and right heart failure were the most common clinical features, though a correct antemortem diagnosis was rare. Severe lung disease was present in 34 cases (50%); one patient (1%) had mitral stenosis. In the remaining patients, clinical thrombophlebitis had been present in 20 cases (29%), and 13 cases (19%) had no recognized related disease. When the lung disease had prominent laterality, thrombi were invariably located on the side of the most serious disease, implying propagation of smaller thrombi in diseased lung retrograde to major arteries. In bilateral lung disease or in patients without lung disease, thromboses were randomly distributed between right or left sides, suggesting an embolic origin. Assessment of the severity of pulmonary arteriosclerosis and distal arterial patency indicated that most patients could have potentially benefited from surgical thromboendarterectomy. The reason for the high incidence of chronic pulmonary artery thrombosis in our autopsy service has not been elucidated. The effects of high altitude may be important in the pathogenesis, although polycythemia was not excessive in our cases. Ref ID : PREWITT1989 990. Prewitt, R.M., Shiffman, F., Greenberg, D., Cook, R., and Ducas, J. Recombinant tissue-type plasminogen activator in canine embolic pulmonary hypertension. Effects of bolus versus short-term administration on dynamics of thrombolysis and on pulmonary vascular pressure-flow characteristics. Circulation 79:929-938, 1989. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; PULMONARY HYPERTENSION; Hypertension; THROMBOLYSIS; CANADA; Injections; rt-PA; LUNG; EMBOLI; PULMONARY ARTERY; ARTERY; Pressure; HEMODYNAMICS; EMBOLIZATION; PULMONARY ARTERY PRESSURE; LYSIS; ANIMAL; Support,Non-U.S.Gov't; Alteplase ,Therapeutic Use ,TU; Hypertension,Pulmonary ,Drug Therapy ,DT; Pulmonary Circulation ,Drug Effects ,DE; Pulmonary Embolism ,Drug Therapy ,DT; Alteplase ,Administration and Dosage ,AD; Blood Pressure; DOGS; Dose-Response Relationship,Drug; Infusions,Intravenous; Pulmonary Artery ,Physiology ,PH; Recombinant Proteins ,Administration and Dosage ,AD Recombinant Proteins ,Therapeutic Use ,TU; TIME FACTORS; VASCULAR RESISTANCE; in; ab; blood; an; is Notes : CS- Department of Medicine, University of Manitoba, Winnipeg, Canada AB- We used a canine model of embolic pulmonary hypertension, induced by injection of autologous radioactive blood clots, to investigate effects of recombinant tissue-type plasminogen activator (rt-PA) on dynamics of thrombolysis and on pulmonary pressure-flow (PQ) characteristics. Over 5 (rt-PA5) or 15 (rt-PA15) minutes, 1 mg/kg rt-PA was infused. Rate and extent of thrombolysis were assessed by counting over both lung fields with a gamma camera. Emboli increased mean pulmonary artery pressure from 14 to 36 mm Hg (p less than 0.005). This change was predominantly due to an increase in the effective outflow pressure (PI) (from 9 to 29 mm Hg, p less than 0.001), obtained by extrapolation from the linear PQ relation. While pulmonary hemodynamics improved with rt-PA5 and rt-PA15, the change was greatest with rt-PA15. For example, the increase in PI that occurred with embolization was abolished with rt-PA15. Also, the decrease in pulmonary artery pressure was greatest with rt-PA15. While not significantly different, extent of total clot lysis tended to be greatest with rt-PA15 (p less than 0.07). Also, while during infusion, the concentration of rt-PA5 was threefold that of rt-PA15, the corresponding rate of thrombolysis was similar with rt-PA5 and rt-PA15. These results indicate that the improvement in pulmonary hemodynamics with rt-PA is primarily explained by a decrease in PI. Furthermore, they suggest an upper limit to the dose-thrombolytic rate relation with rt-PA. Ref ID : PREWITT1990 991. Prewitt, R.M., Hoy, C., Kong, A., Gu, S.A., Greenberg, D., Cook, R., Chan, S.M., and Ducas, J. Thrombolytic therapy in canine pulmonary embolism. Comparative effects of urokinase and recombinant tissue plasminogen activator. Am.Rev.Respir.Dis. 141:290-295, 1990. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PULMONARY EMBOLISM; EMBOLISM; UROKINASE; PLASMINOGEN; PLASMINOGEN ACTIVATOR; CANADA; HEMODYNAMICS; THROMBOEMBOLISM; DOGS; PULMONARY ARTERY; ARTERY; Pressure; CARDIAC; CARDIAC OUTPUT; drugs; THROMBOLYSIS; LUNG; TREATMENT; PULMONARY ARTERY PRESSURE; ANIMAL; COMPARATIVE STUDY; Support,Non- U.S.Gov't; Alteplase ,Therapeutic Use ,TU; Pulmonary Embolism ,Drug Therapy ,DT; Thrombolytic Therapy ,Methods ,MT; Urokinase ,Therapeutic Use ,TU; Alteplase ,Administration and Dosage ,AD; Dose-Response Relationship,Drug; DRUG SCREENING; Hemodynamics ,Drug Effects ,DE Hemodynamics ,Physiology ,PH; Lung ,Drug Effects ,DE Lung ,Physiopathology ,PP; Pulmonary Embolism ,Etiology ,ET Pulmonary Embolism ,Physiopathology ,PP; Recombinant Proteins ,Therapeutic Use ,TU; TIME FACTORS; Urokinase ,Administration and Dosage ,AD; in; ab; blood Notes : CS- Department of Medicine, University of Manitoba, Winnipeg, Canada AB- We compared thrombolytic and pulmonary hemodynamic effects of recombinant tissue plasminogen activator (rtPA) and urokinase (UK) in canine micropulmonary thromboembolism. Dogs were embolized with radioactive autologous blood clot to increase mean pulmonary artery pressure (from 13 to 34 mm Hg, p less than 0.005) and decrease cardiac output (2.5 to 1.6 L min, p less than 0.005). Four groups of six dogs were treated. We employed two doses of UK, 30,000 U/kg (UK30) and 60,000 U/kg (UK60), and two doses of rtPA, 1 mg/kg (rtPA1) and 2 mg/kg (rtPA2). Drugs were infused over 15 min. Rate and extent of pulmonary thrombolysis were assessed by continuously counting over both lung fields with a gamma camera. Compared with treatment with UK, both rtPA regimes significantly increased thrombolysis. Mean total pulmonary thrombolysis was 14 and 23% with UK30 and UK60, respectively, and 35 and 43% with rtPA1 and rtPA2. Corresponding to the increased thrombolysis, pulmonary hemodynamics improved most with rtPA. From 90 min to 3 h, pulmonary artery pressure was significantly lower with both rtPA regimes than with either UK regime. These results indicate, at least in the model employed, that compared with treatment with UK, pulmonary thrombolysis and corresponding hemodynamic improvement are greatest with rtPA. Ref ID : PREWITT1991 992. Prewitt, R.M., Gu, S.A., Greenberg, D., Chan, S.M., Schick, U., La Pointe, H., and Ducas, J. Effects of flow on recombinant tissue plasminogen activator-induced pulmonary thrombolysis. J.Appl.Physiol. 71:1441-1446, 1991. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; THROMBOLYSIS; CANADA; PULMONARY EMBOLISM; EMBOLISM; Injections; CARDIAC; CARDIAC OUTPUT; DOGS; EMBOLI; ARTERIAL; Pressure; Fistula; EMBOLIZATION; THROMBOLYTIC; ANIMAL; Support,Non-U.S.Gov't; Alteplase ,Pharmacology ,PD; Fibrinolytic Agents ,Pharmacology ,PD; Pulmonary Embolism ,Physiopathology ,PP; Thrombosis ,Physiopathology ,PP; Cardiac Output ,Drug Effects ,DE Cardiac Output ,Physiology ,PH; HEMATOCRIT; Hemodynamics ,Drug Effects ,DE; Pulmonary Embolism ,Drug Therapy ,DT; Starch ,Pharmacology ,PD; Technetium Tc 99m Sulfur Colloid ,Diagnostic Use ,DU; Thrombosis ,Drug Therapy ,DT; ab; blood; in; co; an Notes : CS- Department of Medicine, University of Manitoba, Winnipeg, Canada AB- We employed a canine model of pulmonary embolism induced by injection of radioactive blood clots to investigate effects of changes in cardiac output (CO) on recombinant tissue plasminogen activator- (rtPA) induced pulmonary thrombolysis. Rate and extent of thrombolysis were assessed with a gamma camera. Eighteen dogs were studied. Emboli increased mean pulmonary arterial pressure and decreased CO from 2.6 to 1.9 l/min (P less than 0.001). Subsequently, dogs were randomly divided into three groups: group 1 received 0.5 mg/kg of rtPA over 30 min; 30 min before the same dose regimen of rtPA, in the six group 2 dogs, mean CO was increased to approximately 3.25 l/min by opening one systemic arteriovenous fistula; in the six group 3 dogs, before rtPA, mean CO was increased to approximately 4.5 l/min by opening two or three fistulas. After embolization, CO remained low in group 1; the mean 2-h time- averaged CO was 1.8 l/min. CO was much higher in groups 2 and 3 (3.3 and 4.6 l/min, respectively; both P less than 0.001 compared with group 1; and P less than 0.001, group 2 vs. group 3). Compared with group 1, corresponding to the increased flow in groups 2 and 3, rate and extent of pulmonary thrombolysis significantly increased. These results indicate that an increase in flow per se augments rtPA-induced pulmonary thrombolysis. Also, because thrombolysis was similar between groups 2 and 3, these results define an upper limit to the flow-thrombolytic relationship with rtPA. Ref ID : PREWITT1991A 993. Prewitt, R.M., Downes, A.M., Gu, S.A., Chan, S.M., and Ducas, J. Effects of hydralazine and increased cardiac output on recombinant tissue plasminogen activator-induced thrombolysis in canine pulmonary embolism [see comments]. Chest 99:708-714, 1991. Keywords : hydralazine; CARDIAC; CARDIAC OUTPUT; PLASMINOGEN; THROMBOLYSIS; PULMONARY EMBOLISM; EMBOLISM; CANADA; Injections; EMBOLI; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; EMBOLIZATION; DOGS; Fistula; ANIMAL; Alteplase ,Therapeutic Use ,TU; Hydralazine ,Therapeutic Use ,TU; Pulmonary Embolism ,Drug Therapy ,DT; THROMBOLYTIC THERAPY; Alteplase ,Administration and Dosage ,AD; Arteriovenous Shunt,Surgical; Blood Pressure; Cardiac Output ,Drug Effects ,DE Cardiac Output ,Physiology ,PH; FIBRINOLYSIS; Hydralazine ,Administrat ion and Dosage ,AD; Pulmonary Artery ,Physiopathology ,PP; Pulmonary Embolism ,Physiopathology ,PP; RECOMBINANT PROTEINS; Technetium Tc 99m Sulfur Colloid ,Diagnostic Use ,DU; TIME FACTORS; Vascular Resistance ,Drug Effects ,DE Vascular Resistance ,Physiology ,PH; Ventricular Function,Left ,Physiology ,PH; in; ab; blood; an; co Notes : CS- Department of Medicine, University of Manitoba, Winnipeg, Canada AB- We employed a canine model of pulmonary embolism, induced by injection of autologous radiolabelled blood clots, to investigate effects of hydralazine and an increase in cardiac output per se on recombinant tissue plasminogen activator-induced thrombolysis. Emboli increased pulmonary artery pressure (PAP) and decreased CO from 2.7 to 1.8 L/min-1. Following embolization, dogs were randomly divided into three groups. Group 1 received .5 mg/kg of rtPA over 30 minutes. Group 2 received the same dose of rtPA and were pretreated with hydralazine to increase CO approximately 50 percent. In the group 3 dogs, CO was increased by opening a systemic A-V fistula. Following embolization, CO remained low in group 1, the mean 2 h time-averaged CO was 1.9 L/min-1. The CO was 2.9 and 3.1 L/min-1 in groups 2 and 3, respectively. Corresponding to the increased flow in groups 2 and 3, rate and extent of pulmonary thrombolysis significantly increased. These results indicate that an increase in CO augments rtPA-induced pulmonary thrombolysis. Ref ID : PRICE1988 994. Price, C., Jacocks, M.A., and Tytle, T. Thrombolytic therapy in acute arterial thrombosis. Am.J.Surg. 156:488-491, 1988. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; ACEP93; in Ref ID : PRINS1990 995. Prins, M.H. and Hirsh, J. A comparison of general anesthesia and regional anesthesia as a risk factor for deep vein thrombosis following hip surgery: a critical review. Thromb.Haemost. 64(4):497-500, 1990. Keywords : 951217; Regional anesthesia; RISK; RISK FACTORS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; HIP; SURGERY; REVIEW; in; is; INCIDENCE; POSTOPERATIVE; Methods; VENOGRAPHY; PROPHYLAXIS; COMPARATIVE STUDY; TRENDS; anesthesia,conduction; ae; Anesthesia,General; heparin,low- molecular-weight; tu; su; HUMAN; Postoperative Complications; ep; et; pc; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; Medline File; ontario; CANADA Notes : We evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded. In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia Department of Medicine McMaster University Hamilton Ontario Canada. Ref ID : PRINS1991A 996. Prins, M.H. and Hirsh, J. Heparin as an adjunctive treatment after thrombolytic therapy for acute myocardial infarction. Am.J.Cardiol. 67:3A-11A, 1991. Keywords : LMWH; Low-Molecular-Weight-Heparin; HEPARIN; TREATMENT; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; MYOCARDIAL INFARCTION; THROMBOLYSIS; RISK; blood; coronary artery; ARTERY; THROMBIN; FIBRIN; THROMBUS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ANTICOAGULANT; SUBCUTANEOUS; INTRAVENOUS; STREPTOKINASE; MORTALITY; CONTRAST; PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; an; infarction; is; in Notes : The rationale for considering heparin therapy as an adjunct to thrombolytic treatment for patients with acute myocardial infarction is to prevent rethrombosis after successful thrombolysis. The risk of reocclusion is high immediately after thrombolysis because blood flowing through the newly opened coronary artery is exposed to thrombin bound to fibrin in the residual thrombus. Clinical studies of patients with venous thrombosis and acute myocardial infarction indicate that there is a relation between the anticoagulant response to heparin and clinical efficacy and that the concept of a therapeutic heparin level is valid. Subcutaneous doses of approximately 15,000 U twice a day fail to provide an adequate anticoagulant response at 24 hours in the majority of patients, whereas intravenous administration of a bolus of 5,000 U followed by continuous infusion of 30,000 U per 24 hours produces an adequate anticoagulant response at 24 hours in approximately 80% of patients. Studies of patients with myocardial infarction who received streptokinase showed a significant beneficial effect on mortality when 12,500 U of heparin was administered subcutaneously 2 times per day. In contrast, the single largest study evaluating heparin 12,500 U administered subcutaneously 2 times per day as an adjunct to recombinant tissue-type plasminogen activator (rt-PA) treatment did not show a beneficial effect on mortality. However, studies using full-dose intravenous heparin therapy demonstrated that heparin improves patency after coronary thrombolysis with rt-PA.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : PRINS1991B 997. Prins, M.H. and Hirsh, J. A critical review of the evidence supporting a relationship between impaired fibrinolytic activity and venous thromboembolism. Arch.Intern.Med. 151(9):1721-1731, 1991. Keywords : REVIEW; FIBRINOLYTIC; VENOUS; THROMBOEMBOLISM; PLASMINOGEN; PLASMINOGEN ACTIVATOR; analysis; Methods; DIAGNOSIS; THROMBOSIS; RISK; CONTRAST; POSTOPERATIVE; RANDOMIZED; CLINICAL TRIALS; 951217; an; is; in; Blood Coagulation Tests; case-control studies; cohort studies; cross-sectional studies; FIBRINOLYSIS; HUMAN; Postoperative Complications; bl; ep; PROSPECTIVE STUDIES; RISK FACTORS; THROMBOPHLEBITIS; Medline File; ontario Notes : We critically evaluated the evidence for an association between venous thromboembolism and impaired fibrinolytic activity, as determined by global tests of fibrinolytic activity or specific tests for tissue plasminogen activator and plasminogen activator inhibitor. A computer- assisted and manual search was performed to retrieve all articles that reported on fibrinolytic activity and venous thromboembolism. The strength of the evidence for an association was assessed by analysis of the design of individual studies with special attention directed to choice of controls and methods of diagnosis of venous thromboembolism. It is concluded that for patients with symptomatic thrombosis the published evidence does not prove an association between impaired fibrinolytic activity and increased risk of thrombosis. In contrast, for postoperative thrombosis there is good evidence for an association between impaired fibrinolytic activity measured either preoperatively or postoperatively and increased risk of postoperative thrombosis. Whether this association is causal or coincidental is unclear, since randomized clinical trials that used interventions to enhance fibrinolytic activity produced inconsistent results. Ref ID : PRINS1994 998. Prins, M.H., Lensing, A.W., and Hirsh, J. Idiopathic deep venous thrombosis. Is a search for malignant disease justified? Arch.Intern.Med. 154(12):1310-1312, 1994. Keywords : LMWH; Low-Molecular-Weight-Heparin; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; 951217; is; HUMAN; Neoplasms; co; di; RECURRENCE; THROMBOPHLEBITIS; et; Medline File; Health Planning & Administration File; Cancerlit File; EPIDEMIOLOGY; netherlands Ref ID : PRINTEN1978 999. Printen, K.J., Miller, E.V., Mason, E., and Barnes, R.W. Venous thromboembolism im the morbidly obese. Surg.Gynecol.Obstet. 147:63-64, 1978. Keywords : VENOUS; THROMBOEMBOLISM; OBESITY; RISK; DVT; PE; AGE; im; RISK FACTORS; is; an Notes : Obesity, defined as weight greater than 20 percent above ideal weight, has long been accepted as a risk factor for DVT and PE, but the evidence supporting this association has been questioned. When associated factors such as past history, illness, immobility, and age are taken into account it is possible that obesity may not truly be an independent risk factor. Ref ID : PROUNTJOS1991 1000. Prountjos, P., Bastounis, E., Hadjinikolaou, L., Felekuras, E., and Balas, P. Superficial venous thrombosis of the lower extremities co- existing with deep venous thrombosis. A phlebologic study on 57 cases. International Angiology 10:63-65, 1991. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Extremities; NASP; PHLEBOGRAPHY; co Ref ID : QUINN1992 1001. Quinn, D.A., Thompson, B.T., Terrin, M.L., Thrall, J.H., Athanasoulis, C.A., McKusick, K.A., Stein, P.D., and Hales, C.A. A prospective investigation of pulmonary embolism in women and men [see comments]. JAMA 268:1689-1696, 1992. Keywords : PROSPECTIVE; PULMONARY EMBOLISM; EMBOLISM; FREQUENCY; RISK; RISK FACTORS; DIAGNOSIS; VENTILATION/PERFUSION; SCAN; V/Q; V/Q SCAN; diagnostics; PROSPECTIVE STUDIES; AGE; MORTALITY; ORAL CONTRACEPTIVES; SURGERY; EMBOLI; SURGICAL; Pulmonary emboli; in; north carolina; an Notes : OBJECTIVE. The aim of this study was to compare, in women and men suspected of pulmonary embolism, the frequency, risk factors, diagnosis, and presentation of pulmonary embolism as well as the accuracy of the ventilation/perfusion scan (V/Q scan) as a diagnostic tool. DESIGN. Data were collected during a prospective study (the Prospective Investigation of Pulmonary Embolism Diagnosis) to establish the accuracy of the V/Q scan compared with pulmonary angiograms. SETTING. Six tertiary medical centers in Massachusetts, Michigan, Connecticut, Pennsylvania, and North Carolina. PARTICIPANTS. Patients suspected of pulmonary embolism for whom a request was made for a V/Q scan or pulmonary angiogram (496 women and 406 men). RESULTS. Women 50 years old and under had a decreased frequency of pulmonary embolism compared with men of that age (16% vs 32%), but there was no difference in patients over 50 years old (Breslow-Day test, P less than .01). Risk factors for pulmonary embolism, the usefulness of the V/Q scan, and 1- year mortality were not different for women and men. Estrogen use in women was not associated with an increased frequency of pulmonary embolism, except in women using oral contraceptives who had undergone surgery within 3 months; four of five (80%) had emboli compared with four of 28 (14%) age-matched surgical patients not using estrogens (P less than .01). CONCLUSION. Women 50 years old and under (even young women using oral contraceptives) who were suspected of having pulmonary emboli and were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis study had a smaller frequency of pulmonary embolism than men of that age, The risk factors for pulmonary embolism were the same for women and men, except that women using oral contraceptives had an increased risk of pulmonary embolism following surgery. Although the V/Q scan was a useful tool in the preliminary evaluation for pulmonary embolism in these women, a pulmonary angiogram was often needed for accurate diagnosis. Ref ID : QUIROLI1977 1002. Quiroli, A. [Treatment of simple and complicated varices of the lower limbs. Surgical technics used in 600 cases]. Minerva.Chir. 32:1421-1431, 1977. Keywords : VARICES; SURGICAL; Methods; TREATMENT; Extremities; MANAGEMENT; PATHOGENESIS; SURGERY; RECURRENCE; TECHNIQUES; POSTOPERATIVE; INFECTION; Antibiotics; FIBRINOLYTIC; NASP; English Abstract; HUMAN; LEG; Postoperative Complications; SAPHENOUS VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; su; ab; pathology; is; inflammation Notes : TT - La terapia delle varici semplici e complicate degli arti inferiori. Tecniche chirurgiche adottate su 600 casi AB - The methods of treatment used in the cure of simple and complicated lower extremity varices are described. These conditions are found in about 10% of the population throughout the civilised world and their social and economic repercussions are by no means negligible. The lines of surgical management dictated by the latest view of the pathogenesis and physio- pathology of these varices are explained. Treatment is by no means simples or of secondary importance with respect to the surgery of other vascular sectors. Emphasis is placed on the high percentage of recurrences. These are the result of mistakes in surgical technique or inadequate sclerosing management, as shown in the literature. Postoperative cure and the absence of local inflammation or infection come from the employment of non-reabsorbable, inert and very thin threads, rational in addition to the methodical use of widely diffusible antibiotics, fibrinolytics, and modern platelect anti-clumping agents UI -78092748. Ref ID : RAGHAVENDRA1986 1003. Raghavendra, B.N. and et al Deep venous thrombosis: detection by probe compression of veins. J.Ultrasound Med. 5:80, 1986. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; COMPRESSION; VEINS; NASP; vein; bib-4 Ref ID : RAHIMTOOLA1970 1004. Rahimtoola, S.H. Therapeutic defibrination and heparin therapy in the prevention and resolution of experimental venous thrombosis. Circulation. 42:729, 1970. Keywords : VENOUS; THROMBOSIS; SCLEROTHERAPY; DEFIBRINATION; HEPARIN; PREVENTION; RESOLUTION; VENOUS THROMBOSIS; THERAPY; in Ref ID : RAJAN1995 1005. Rajan, R., Gafni, A., Levine, M., Hirsh, J., and Gent, M. Very low-dose warfarin prophylaxis to prevent thromboembolism in women with metastatic breast cancer receiving chemotherapy: an economic evaluation. J.Clin.Oncol. 13(1):42-46, 1995. Keywords : WARFARIN; PROPHYLAXIS; THROMBOEMBOLISM; CANCER; RANDOMIZED; INCIDENCE; VENOUS; BLEEDING; Methods; Hospitals; CANADA; COST; THERAPY; SENSITIVITY; analysis; THROMBOEMBOLIC; 951217; in; an; breast neoplasms; co; dt; FEMALE; health care costs; HUMAN; Support,Non-U.S.Gov't; pc; ad; ec; Medline File; Health Planning & Administration File; Cancerlit File; EPIDEMIOLOGY Notes : PURPOSE: A recent double-blind, randomized trial demonstrated that very low-dose warfarin (VLDW) reduced the incidence of venous thromboembolism (VTE) without increasing the rate of bleeding in women with metastatic breast cancer receiving chemotherapy. We have evaluated the economic impact on the health care system of using VLDW in such patients. METHODS: The records of patients entered onto the trial and a simultaneous, fully allocated, costing model for a tertiary care hospital in Hamilton, Canada were used to determine the difference in costs associated with the care of patients with and without VLDW. RESULTS: The cost of providing VLDW was $ 21,854 (Canadian dollars) per 100 patients. This therapy led to a reduction in costs of $ 24,297 per 100 patients, thus saving the health care system $ 2,443 per 100 patients. In the sensitivity analysis, VLDW prophylaxis still did not increase health care costs unless the cost of VLDW was greatly increased, the cost of treating thromboembolic episodes was markedly reduced, or the incidence of either VTE or bleeding with VLDW was increased above the rates observed in the trial. CONCLUSION: We conclude that for women receiving chemotherapy for metastatic breast cancer, the benefits of VLDW can be realized without increased health care costs. Ref ID : RAKOCZI1978 1006. Rakoczi, I. and et al Prediction of post-operative leg-vein thrombosis in gynecological patients. Lancet 1:509, 1978. Keywords : POSTOPERATIVE; THROMBOSIS; NASP; bib-4; in Ref ID : RAKOV1970 1007. Rakov, P.H. Varicose veins in the aged. Geriatrics. 25:94-97, 1970. Keywords : VARICOSE VEINS; VEINS; AGED; NASP; Cellulitis; Dermatitis; HUMAN; PHLEBITIS; THROMBOPHLEBITIS; Tourniquets; Ulcer; Medline File; varicose; in; ab Notes : AB - [No Abstract Available] UI - 70237246. Ref ID : RAO1990 1008. Rao, M.G. and Rangwala, A.F. Diagnostic yeild from 231 autopsies in a community hospital. American Journal of Clinical Pathology 93(4):486-490, 1990. Keywords : 96-suzy-002; diagnostics; AUTOPSY; in; Hospitals; ADULT; Unexpected; analysis; DIAGNOSIS; EMBOLISM; MISSED DIAGNOSIS Notes : 01-02-96. Abstract : autopsy reports of 231 adult autopies were examined for clinically unexpected diagnoses. Analysis of data showed that 97 of 188 autopsy diagnoses were clinically unexpected. The diagnosis of pummonary embolism was clinically the most frequently missed diagnosis relative to its actual occurrence. Also noted was that the proportion of cases with unexpected diagnoses increased from 1983 to 1987. Ref ID : RASKOB1990 1009. Raskob, G.E. and Hull, R.D. Diagnosis and management of pulmonary thromboembolism. Q.J.Med. 76:787-797, 1990. Keywords : DIAGNOSIS; MANAGEMENT; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM Ref ID : RASKOB1993 1010. Raskob, G.E., Pineo, G.F., and Hull, R.D. Impedance plethysmography and DVT diagnosis [letter; comment]. Ann.Intern.Med. 119:247, 1993. Keywords : IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; DVT; DIAGNOSIS Ref ID : RASKOB1995 1011. Raskob, G.E., Hull, R.D., and Pineo, G.F. Impedance plethysmography for suspected deep-vein thrombosis [letter]. Arch.Intern.Med. 155:773, 776, 1995. Keywords : IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; DEEP VEIN THROMBOSIS; THROMBOSIS Ref ID : REALINI1985 1012. Realini, J.P. and Goldzieher, J.W. Oral contraceptives and cardiovascular disease: A critique of the epidemiologic studies. Am.J.Obstet.Gynecol. 152:729-798, 1985. Keywords : ORAL CONTRACEPTIVES; CARDIOVASCULAR; RISK; DVT; PE; PROSPECTIVE; INCIDENCE; THROMBOSIS; cardiovascular diseases; is; RANDOMIZED; in; cohort studies Notes : Oral contraceptive use raises the risk of DVT and PE, but the magnitude of the risk is difficult to quantify. There are no prospective randomized studies using definitive testing to compare the incidence of DVT or PE in patients with and without oral contraceptives. Case-control and cohort studies based on clinical signs and symptoms of thrombosis suggest a relative risk somewhere between 3 and 12 times as high for patients taking oral contraceptives as for those not taking them. Ref ID : REICHMAN1990 1013. Reichman, R.T., Joyo, C.I., Dembitsky, W.P., Griffith, L.D., Adamson, R.M., Daily, P.O., Overlie, P.A., Smith, S.C.,Jr., and Jaski, B.E. Improved patient survival after cardiac arrest using a cardiopulmonary support system. Ann.Thorac.Surg. 49:101-4; discussion 104-5, 1990. Keywords : SURVIVAL; CARDIAC; Cardiac arrest; CARDIOPULMONARY BYPASS; Nursing; CARDIOVASCULAR; ARTERY; Aorta; Pulmonary emboli; EMBOLI; Angioplasty; MYOCARDIAL INFARCTION; SHOCK; TRAUMA; diagnostics; ANGIOGRAPHY; PULMONARY ANGIOGRAPHY; EARLY; DEATH; MASSIVE; HEMORRHAGE; INJURY; LONG TERM; in; infarction; transplantation; standards; heart Notes : A portable cardiopulmonary bypass system that can be rapidly deployed in a nonsurgical setting using nursing staff was used in 38 patients with cardiovascular collapse refractory to ACLS protocol. Percutaneous or cutdown cannulation sites were: femoral vein-femoral artery (n = 18), right internal jugular vein-femoral artery (n = 2), right atrium-ascending aorta (n = 12), or a combination approach (n = 4). Two patients could not be cannulated. Patient diagnoses were pulmonary emboli (n = 3), failed coronary angioplasty (n = 7), myocardial infarction with cardiogenic shock (n = 5), trauma (n = 7), aortic stenosis (n = 2), postcardiotomy deterioration (n = 10), deterioration after cardiac transplantation (n = 2), cardiomyopathy with shock (n = 1), and ruptured ascending aortic dissection (n = 1). Ninety- five percent of patients (36 of 38) were successfully resuscitated to a stable rhythm. Eight diagnostic procedures (coronary angiography, n = 4; pulmonary angiography, n = 3; and aortography, n = 1) were performed while patients were on cardiopulmonary support. Early deaths resulted from massive hemorrhage (n = 8), inability to cannulate (n = 2), and irreversible myocardial injury (n = 10). Sixty-six percent (24 of 36) of patients successfully cannulated underwent conversion to standard cardiopulmonary bypass with attendant operative procedure or placement of ventricular assist device or total artificial heart. Fifty percent (18 of 36) of patients cannulated were successfully weaned from cardiopulmonary support, and 17% (6/36) are long-term survivors.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : REID1991 1014. Reid, D.B., Reid, A.W., Cuschieri, R.J., Lowe, G.D., and Pollock, J.G. Early experience with intra-arterial thrombolytic therapy for peripheral arterial occlusion. Scott.Med.J. 36:7-9, 1991. Keywords : EARLY; INTRAARTERIAL; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ARTERIAL; OCCLUSION; ACEP-93; ACEP93 Ref ID : REID1994 1015. Reid, T.,3rd and Alving, B.M. Hirulog therapy for heparin- associated thrombocytopenia and deep venous thrombosis [letter; comment]. Am.J.Hematol. 45(4):352-353, 1994. Keywords : 96-suzy-001; THERAPY; Heparin-associated thrombocytopenia; THROMBOCYTOPENIA; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; HEPARIN; adverse effects; HIRUDIN; analogs & derivatives; therapeutic use; HUMAN; peptide fragments; RECOMBINANT PROTEINS; THROMBIN; antagonists & inhibitors; chemically induced; drug therapy; THROMBOPHLEBITIS Ref ID : REIDEL1982 1016. Reidel, M. and et al Longterm followup of patients with pulmonary thromboembolism: late prognosis and evolution of hemodynamic and respiratory data. Chest 81:151, 1982. Keywords : FOLLOWUP; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; LATE; PROGNOSIS; HEMODYNAMICS; CHRONIC; COR PULMONALE; is Notes : Chronic cor pulmonale is often mistaken for another clinical entity. Ref ID : REIS1991 1017. Reis, S.E., Polak, J.F., Hirsch, D.R., Cohn, L.H., Creager, M.A., Donovan, B.C., and Goldhaber, S.Z. Frequency of deep venous thrombosis in asymptomatic patients with coronary artery bypass grafts. Am.Heart J. 122:478-482, 1991. Keywords : PHLEBITIS; FREQUENCY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ASYMPTOMATIC; coronary artery; CORONARY ARTERY BYPASS; ARTERY; bypass graft; AGED; FEMALE; Follow-Up Studies; HUMAN; LEG; blood supply; MALE; Postoperative Complications; EPIDEMIOLOGY; Ultrasonography; PULMONARY EMBOLISM; prevention & control; RISK FACTORS; SAPHENOUS VEIN; transplantation; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; DEEP VEIN THROMBOSIS; vein; DVT; SURGERY; ULTRASOUND; VEINS; Hospitals; Doppler; CALF; THROMBI; Edema; RISK; MALIGNANCY; varicose; VARICOSE VEINS; FOLLOWUP; EMBOLISM; NATURAL HISTORY; PROPHYLAXIS; TREATMENT; in; color; confidence intervals; drainage Notes : The frequency of deep vein thrombosis (DVT) in patients undergoing coronary artery bypass graft (CABG) surgery has not been established. Therefore to estimate the frequency of clinically silent DVT, we performed ultrasound examinations of the leg veins in 29 asymptomatic CABG patients before hospital discharge. We used high- resolution B-mode ultrasonography with color Doppler imaging. Fourteen (48.3%, 95% confidence interval 30.1 to 66.4%) had 20 documented leg vein thromboses, and all but one patient had DVT limited to the calf veins. Of the 20 thrombi 10 (50.0%) were present in the leg ipsilateral and 10 (50.0%) in the leg contralateral to the saphenous vein harvest site. None of the DVTs were suspected clinically. DVT was not associated with any local sign attributed to saphenous vein harvest such as pitting edema, incisional drainage, or local tenderness or with any putative risk factor for DVT such as cigarette use, distant history of malignancy, or varicose veins. Follow-up of these patients 5 to 11 months after CABG surgery showed no clinical evidence of DVT or pulmonary embolism. Our findings indicate that asymptomatic DVT of the calf occurs with surprisingly high frequency, 44.8% after CABG surgery. Future studies in patients undergoing CABG surgery should address the natural history of asymptomatic DVT, determine its clinical importance, and develop optimal strategies for prophylaxis and treatment. Ref ID : REIS1991A 1018. Reis, S.E., Hirsch, D.R., Wilson, M.G., Donovan, B.C., and Goldhaber, S.Z. Program for the prevention of venous thromboembolism in high-risk orthopaedic patients. J.Arthroplasty 6 Suppl:S11-6:S11-6, 1991. Keywords : 951216; PREVENTION; VENOUS; THROMBOEMBOLISM; in; RISK; POSTOPERATIVE; Hospitals; OUTPATIENT; WARFARIN; PROTHROMBIN; PT; PROPHYLAXIS; an; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; DVT; PULMONARY EMBOLISM; EMBOLISM; PE; BLEEDING; COMPLICATIONS; HEMORRHAGE; is; ADULT; AGED; Aged,80 and over; FEMALE; Follow-Up Studies; HUMAN; MALE; MIDDLE AGE; orthopedics; patient discharge; Postoperative Complications; pc; prothrombin time; ra; RISK FACTORS; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; ad; Medline File; Health Planning & Administration File; BRIGHAM; boston Notes : Postoperative orthopaedic patients remain at risk for venous thromboembolism (VTE) after hospital discharge. Therefore, the authors designed and implemented a program for prevention of VTE that included outpatient adjusted-dose warfarin using twice-weekly prothrombin time (PT) determinations, a dedicated telephone line for PT results, and vigilant nurse-physician supervision to administer prophylaxis to 125 postoperative orthopaedic patients against VTE for an average of 31.4 days after discharge. PT was maintained between 13.2 and 18.3 seconds (1.1-1.5 x control) in the average patient. There was a failure rate of 3.2% and 0.8% for clinically suspected and radiologically confirmed deep venous thrombosis (DVT) and pulmonary embolism (PE), respectively. The rate of bleeding complications was 3.2%, but none of these patients required transfusion or hospital readmission for hemorrhage. The authors conclude that the described program for VTE prevention is a safe, effective, and practical program to administer prophylaxis to postoperative orthopaedic patients against clinically evident VTE for the first month after hospital discharge Department of Medicine Brigham and Women's Hospital Boston MA 02115. Ref ID : REMYJARDIN1992 1019. Remy-Jardin, M., Remy, J., Wattinne, L., and Giraud, F. Central pulmonary thromboembolism: Diagnosis with spiral volumetric CT with the single-breath-hold technique -- comparison with pulmonary angiography. Radiology 185:381-387, 1992. Keywords : PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; DIAGNOSIS; CT; TECHNIQUES; ANGIOGRAPHY; SCAN; PULMONARY EMBOLISM; EMBOLISM; EMBOLI; lymph nodes; CT scan Notes : 42 patients had spiral CT and angiography. 23 had normal CT scans and normal angiograms. 19 had pulmonary embolism demonstrated on both studies. 112 emboli were visualized on both studies, but 9 intersegmental lymph nodes were mistaken for emboli on the CT scan. Ref ID : RETTENMAIER1987 1020. Rettenmaier, P.A. Pulmonary venous air embolism in the neonate [letter]. Crit.Care Med. 15:541, 1987. Keywords : 951202; VENOUS; Air; EMBOLISM; HUMAN; Hyperbaric Oxygenation; Infant,Newborn; PULMONARY EMBOLISM; th; Medline File; in Notes : [No Abstract Available]. Ref ID : REUL1974 1021. Reul, G.J. and Beall, A.C. Emergency pulmonary embolectomy for massive pulmonary embolism. Circulation 50:236, 1974. Keywords : EMERGENCY; EMBOLECTOMY; MASSIVE; PULMONARY EMBOLISM; EMBOLISM Ref ID : RICCIARDI1971 1022. Ricciardi, L. [Skin diseases due to chronic venous insufficiency of the lower limbs and their treatment]. Arch.Ital.Dermatol.Venereol.Sessuol. 37:31-37, 1971. Keywords : CHRONIC; CHRONIC VENOUS INSUFFICIENCY; VENOUS; Venous Insufficiency; NASP; Chronic Disease; Drug Combinations; Ergot Alkaloids; HUMAN; LEG; Plants,Medicinal; Rutin; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Dermopatie da insufficienza venosa cronica degli arti inferiori e loro trattamento AB - [No Abstract Available] UI -72178104. Ref ID : RICH1988 1023. Rich, S., Levitsky, S., and Brundage, B.H. Pulmonary hypertension from chronic pulmonary thromboembolism. Ann.Intern.Med. 108:425, 1988. Keywords : PULMONARY HYPERTENSION; CHRONIC; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PULMONARY EMBOLISM; Hypertension Ref ID : RICHARDS1976 1024. Richards, K.L., Armstrong, J.D.,Jr., Tikoff, G., Hershgold, E.J., Booth, J.L., and Rampton, J.B. Noninvasive diagnosis of deep venous thrombosis. Arch.Int.Med. 136:1091-1096, 1976. Keywords : NONINVASIVE; DIAGNOSIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; CLINICAL DIAGNOSIS; PAIN; LEG; is; in Notes : The clinical diagnosis of deep venous system thrombosis is only accurate 50 percent of the time, with as many false positives as negatives, even in the presence of pain, tenderness, and unilateral leg swelling. Ref ID : RICHARDS1985 1025. Richards, S.R., Barrows, H., and O'Shaughnessy, R. Intrapartum pulmonary embolus. A case report. J.Reprod.Med. 30:64-66, 1985. Keywords : EMBOLISM; PREGNANCY; CASE REPORT; Infant; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; RISK; POSTPARTUM; HEMORRHAGE; INDICATIONS; EMBOLECTOMY; VENA CAVAL INTERRUPTION; FEMALE; HUMAN; Labor Complications; Pulmonary Embolism ,Complications ,CO; ADULT; Pulmonary Embolism ,Surgery ,SU; ab; is; in Notes : AB- Intrapartum pulmonary embolus is rare. In a case we encountered, both the mother and infant survived. The peripartum period is a relative contraindication to the use of thrombolytic therapy due to the risk of postpartum hemorrhage. The indications for embolectomy and vena caval interruption are the same as the ones generally accepted. Ref ID : RICHARDSON1937 1026. Richardson, H.F., Coles, B.C., and Hall, G.E. Experimental air embolism. Can.Med.Assoc.J. 36:584, 1937. Keywords : Air; EMBOLISM; NASP; bib-4 Ref ID : RICHAUD1992 1027. Richaud, M., Drobinski, G., Montalescot, G., Salloum, J., Bizec, J.L., and Isnard, R. Diagnosis of pulmonary embolism by transoesophageal echocardiography. Eur.Heart J 13:1000-1001, 1992. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; Echocardiography; SHOCK; VENTILATION; THROMBUS; PULMONARY ARTERY; ARTERY; ANGIOGRAPHY; TREATMENT; AUTOPSY; Died; sdi-11/93; Echocardiogram; in Notes : A 68-year-old woman was admitted for major dyspnoea. A transoesophageal echocardiogram was performed after the occurrence of acute circulatory shock. During the examination, the patient was under mechanical ventilation. We found a thrombus that had almost occluded the right pulmonary artery and which was later confirmed by selective angiography. Despite treatment, the patient died 2 days later; autopsy confirmed the thrombus in the right pulmonary artery. Ref ID : RICHLIE1993 1028. Richlie, D.G. Noninvasive imaging of the lower extremity for deep venous thrombosis. J.Gen.Intern.Med. 8:271-277, 1993. Keywords : NONINVASIVE; Extremities; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; REVIEW; REVIEW ARTICLE Notes : Review Article. Ref ID : RICHLIE1993A 1029. Richlie, D.G. Noninvasive imaging of the lower extremity for deep venous thrombosis. J Gen.Intern.Med 8:271-277, 1993. Keywords : NONINVASIVE; Extremities; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; IPG; ULTRASOUND; TECHNIQUES; Methods; diagnostics; Doppler; CALF; CHRONIC; REVIEW; FREQUENCY; FOLLOW UP STUDIES; sdi-11/93; in; Color-flow Notes : Noninvasive imaging for LE DVT has advanced remarkably in the past decade. Currently, IPG and ultrasound techniques (RTU and DS) have been proven to be quick, accurate, relatively inexpensive, and widely available methods for detecting proximal LE DVT and can be used as the initial diagnostic studies in many settings. Color-flow Doppler ultrasound studies may be more accurate than other ultrasound techniques in diagnosing calf DVT and in differentiating acute from chronic LE DVTs, though this bears further review. Many concerns remain regarding noninvasive LE DVT imaging, including: The accuracy of the above studies in nonreferral centers. The need for and optimal frequency of follow-up studies to detect clots that propagate proximally. The optimal noninvasive techniques for imaging in the setting of recurrent DVT and other specialized settings (e.g., high-risk patients). Ref ID : RICOTTA1991 1030. Ricotta, J. Intra-arterial thrombolysis. A surgical view [comment]. Circulation 83:I120-I121, 1991. Keywords : INTRAARTERIAL; THROMBOLYSIS; SURGICAL; ACEP-93; ACEP93 Ref ID : RICOU1991 1031. Ricou, F., Nicod, P.H., Moser, K.M., and Peterson, K.L. Catheter- based intravascular ultrasound imaging of chronic thromboembolic pulmonary disease. Am J Cardiol. 67:749-752, 1991. Keywords : ULTRASOUND; CHRONIC; THROMBOEMBOLIC; TREATMENT; PULMONARY HYPERTENSION; Hypertension; THROMBOEMBOLI; Extension; THROMBI; SURGERY; ARTERIAL; COMPLEMENT; ANGIOGRAPHY; AGED; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; COMPLICATION; CATHETER; Arteries; PATHOLOGIC; sdi-11/93; Intravascular ultrasound; is; in; standards Notes : Pulmonary thromboendarterectomy is now the treatment of choice for pulmonary hypertension due to chronic pulmonary thromboemboli. A precise assessment of location and extension of these thrombi is important because only proximal chronic pulmonary thromboemboli are accessible to surgery. Because intravascular ultrasound imaging can assess not only arterial luminal size, but also wall thickness, its value as a complement to angiography was assessed in 11 patients aged 35 to 64 years with severe pulmonary hypertension (systolic pulmonary artery pressure, mean +/- standard deviation 70 +/- 19 mm Hg; pulmonary artery resistance, 609 +/- 297 dynes.s.cm-5). Intravascular ultrasound was obtained in 10 of 11 patients and no complication occurred. Intravascular ultrasound identified 10 segments with suspected chronic pulmonary thromboemboli in 7 patients, all confirmed at operation. Nine segments were considered normal, all of which (except 1) were free of chronic pulmonary thromboemboli at operation. Image quality was highly dependent on pulmonary artery size and position of the catheter. Therefore, intravascular ultrasound of pulmonary arteries is feasible and safe in patients with pulmonary hypertension. It may help to assess the location and extension of the pathologic process involving pulmonary arteries. Ref ID : RIDKER1991 1032. Ridker, P.M., Manson, J.E., Buring, J.E., Goldhaber, S.Z., and Hennekens, C.H. The effect of chronic platelet inhibition with low-dose aspirin on atherosclerotic progression and acute thrombosis: clinical evidence from the Physicians' Health Study. Am.Heart J. 122(6):1588- 1592, 1991. Keywords : CHRONIC; PLATELET; INHIBITION; ASPIRIN; Progression; THROMBOSIS; RISK; CARDIOVASCULAR; RANDOMIZED; MALE; MYOCARDIAL INFARCTION; analysis; INCIDENCE; THERAPY; CONTRAST; LONG TERM; DURATION; cardiovascular diseases; in; infarction; an; is; atherosclerosis Notes : AB-Low-dose aspirin has been postulated to decrease risks of cardiovascular disease by affecting atherosclerotic progression as well as acute thrombosis. In the Physicians' Health Study, a randomized double-blind placebo-controlled trial of alternate day aspirin (325 mg), 22,071 apparently healthy male physicians were treated and followed over a period of 5 years for the occurrence of myocardial infarction and of new angina pectoris. In an analysis of the cumulative incidence and cumulative relative risks of these end points, it was found that the full protective effect of aspirin in reducing the risk of myocardial infarction is apparent soon after initiation of therapy and does not change over time. In contrast, long-term aspirin therapy has no apparent role in decreasing the risk of developing future angina pectoris. Taken together, these clinical observations support the hypothesis that the primary effect of prophylactic low-dose aspirin therapy is to inhibit acute thrombosis, but do not support the hypothesis that long-term platelet inhibition for a duration of up to 5 years slows the initiation and progression of atherosclerosis. Ref ID : RIDKER1992A 1033. Ridker, P.M., Vaughan, D.E., Stampfer, M.J., Manson, J.E., Shen, C., Newcomer, L.M., Goldhaber, S.Z., and Hennekens, C.H. Baseline fibrinolytic state and the risk of future venous thrombosis. A prospective study of endogenous tissue-type plasminogen activator and plasminogen activator inhibitor. Circulation 85(5):1822-1827, 1992. Keywords : FIBRINOLYTIC; RISK; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROSPECTIVE; PROSPECTIVE STUDIES; PLASMINOGEN; PLASMINOGEN ACTIVATOR; abnormalities; INHIBITION; FIBRINOLYSIS; RISK FACTORS; THROMBOEMBOLIC; Methods; t-PA; DEEP VENOUS THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; AGE; Vascular Diseases; FOLLOWUP; TRENDS; analysis; CARDIOVASCULAR; CONTRAST; 951216; is; in; an; ADULT; AGED; Aged,80 and over; ALTEPLASE; bl; case-control studies; COMPARATIVE STUDY; HUMAN; MALE; MIDDLE AGE; plasminogen inactivators; et; Support,Non-U.S.Gov't; support,u.s.gov't,non-p.h.s. Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; Medline File; Cardiology; BRIGHAM; Hospitals; multivariate analysis Notes : AN-92240768 AB-BACKGROUND. Although isolated abnormalities of plasminogen activation and inhibition have been reported among selected patients with venous thrombosis, it is unclear whether these deficiencies of fibrinolysis are important risk factors for thromboembolic disease. METHODS AND RESULTS. To evaluate whether baseline levels of endogenous tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) predict the future occurrence of venous thrombosis, levels of these proteins were measured in prospectively collected plasma samples from 55 participants in the Physicians' Health Study who later developed deep venous thrombosis or pulmonary embolism and from an equal number of age- and smoking-matched control subjects who remained free of vascular disease during a mean follow-up period of 60.2 months. Overall, there were no statistically significant differences between case patients and control subjects in baseline levels of PAI-1 (50.5 versus 59.5 ng/ml, p = 0.26), t-PA (13.4 versus 13.3 ng/ml, p = 0.94), or PAI-1:t-PA ratio (6.84 versus 6.58, p = 0.82). No evidence of a threshold effect or trend was seen when these data were analyzed by increasing quartiles of PAI-1 (p = 0.73), t-PA (p = 0.62), or PAI-1:t-PA ratio (p = 0.93). These results were unchanged after multivariate analysis that simultaneously controlled for other baseline cardiovascular risk factors. CONCLUSIONS. In contrast to previous uncontrolled case series and smaller retrospective studies, these prospective data provide strong evidence that baseline fibrinolytic state, as measured by t-PA and PAI-1, does not predict the occurrence of future venous thrombosis. Ref ID : RIDKER1994 1034. Ridker, P.M., Hennekens, C.H., Cerskus, A., and Stampfer, M.J. Plasma concentration of cross-linked fibrin degradation product (D- dimer) and the risk of future myocardial infarction among apparently healthy men. Circulation 90(5):2236-2240, 1994. Keywords : FIBRIN; D-DIMER; RISK; MYOCARDIAL INFARCTION; coronary thrombosis; THROMBOSIS; Methods; MI; AGE; Vascular Diseases; FOLLOWUP; CARDIOVASCULAR; RISK FACTORS; CONTRAST; PLASMINOGEN; PLASMINOGEN ACTIVATOR; FIBRINOLYTIC; ARTERIAL; OCCLUSION; FIBRIN DEGRADATION PRODUCTS; infarction; in; is; an; smoking; confidence intervals; ci; cholesterol Notes : AN-95043173 AB-BACKGROUND--Plasma levels of D-dimer, the primary degradation product of cross-linked fibrin, are elevated in several acute thrombotic disorders. However, whether elevated D-dimer levels among healthy individuals are associated with future coronary thrombosis is unknown. METHODS AND RESULTS--To evaluate whether levels of D-dimer are associated with the occurrence of future myocardial infarction (MI) among apparently healthy men, levels were measured in plasma samples collected at baseline from 296 participants in the Physicians' Health Study who later developed a first MI and from an equal number of age- and smoking status-matched control subjects who remained free of vascular disease during a mean follow-up period of 60.2 months. In univariate analyses, baseline plasma concentrations of D-dimer in the upper ranges of normal were associated with elevated risks of MI. Specifically, the relative risk of future MI for individuals with baseline D-dimer concentration exceeding the 95th percentile of the control distribution was two times higher than that of individuals with lower levels (relative risk [RR], 2.02; 95% confidence interval [CI], 1.04 to 4.02; P = .04). This association persisted in multivariate analyses controlling for nonlipid cardiovascular risk factors (RR, 2.12; 95% CI, 1.05 to 4.28; P = .04) and for lipoprotein(a) (RR, 2.02; 95% CI, 1.04 to 3.94; P = .03). In contrast, this association was attenuated and no longer statistically significant in analyses that controlled for total and high-density lipoprotein cholesterol (RR, 1.74; 95% CI, 0.78 to 3.91; P = .2) or for endogenous tissue-type plasminogen activator and its primary inhibitor, plasminogen activator inhibitor type 1 (RR, 1.58; 95% CI, 0.67 to 3.77; P = .3). CONCLUSIONS--Elevated levels of D-dimer are associated with increased risks of future MI, although they do not appear to be an independent predictor when other risk factors are considered. As the presence of D-dimer in plasma reflects ongoing fibrin degradation, these data support the hypothesis that activation of the endogenous fibrinolytic system occurs many years in advance of coronary arterial occlusion. Ref ID : RIDKER1995 1035. Ridker, P.M., Hennekens, C.H., Lindpaintner, K., Stampfer, M.J., Eisenberg, P.R., and Miletich, J.P. Mutation in the gene coding for coagulation factor V and the risk of myocardial infarction, stroke, and venous thrombosis in apparently healthy men. N.Engl.J.Med. 332(14):912- 917, 1995. Keywords : 951217; in; COAGULATION; FACTOR V; RISK; MYOCARDIAL INFARCTION; infarction; STROKE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; is; PROTEIN C; abnormalities; an; ARTERIAL; ARTERIAL THROMBOSIS; SCREENING; Methods; blood; PULMONARY EMBOLISM; EMBOLISM; FOLLOWUP; Vascular Diseases; PREVALENCE; confidence intervals; AGE Notes : BACKGROUND. A specific point mutation in the gene coding for coagulation factor V is associated with resistance to degradation by activated protein C, a recently described abnormality of coagulation that may be associated with an increased risk of venous thrombosis. Whether this mutation also predisposes patients to arterial thrombosis is unknown, as is the value of screening for the mutation in order to define the risk of venous thrombosis among unselected healthy people. METHODS. Among 14,916 apparently healthy men in the Physicians' Health Study who provided base-line blood samples, 374 had myocardial infarctions, 209 had strokes, and 121 had deep venous thrombosis, pulmonary embolism, or both, during a mean follow-up of 8.6 years. We determined whether a mutation at nucleotide position 1691 of the factor V gene was present or absent in these 704 men and in an equal number of matched participants who remained free of vascular disease. RESULTS. The prevalence of heterozygosity for the mutation among men who had myocardial infarctions (6.1 percent, P = 0.9) or strokes (4.3 percent, P = 0.4) was similar to that among men who remained free of vascular disease (6.0 percent). However, the prevalence of the mutation was significantly higher among men who had venous thrombosis, pulmonary embolism, or both (11.6 percent, P = 0.02). In adjusted analyses, the relative risk of venous thrombosis among men with the mutation was 2.7 (95 percent confidence interval, 1.3 to 5.6; P = 0.008). This increased risk was seen with primary venous thrombosis (relative risk, 3.5; 95 percent confidence interval, 1.5 to 8.4; P = 0.004) but not with secondary venous thrombosis (relative risk, 1.7; 95 percent confidence interval, 0.6 to 5.3; P = 0.3), and it was most apparent among older men. Specifically, the prevalence of the mutation among men over the age of 60 in whom primary venous thrombosis developed was 25.8 percent (relative risk, 7.0; 95 percent confidence interval, 2.6 to 19.1; P < 0.001). CONCLUSIONS. In a large cohort of apparently healthy men, the presence of a specific point mutation in the factor V gene was associated with an increased risk of venous thrombosis, particularly primary venous thrombosis. The presence of the mutation was not associated with an increased risk of myocardial infarction or stroke. This mutation appears to be the most common inherited factor thus far recognized that predisposes patients to venous thrombosis. Ref ID : RIEDEL1980 1036. Riedel, M., Urbanova, D., Ruzbarsky, V., and Widimsky, J. Clinico- -pathologic correlations in pulmonary thromboembolism. Cor.Vasa. 22:176- 184, 1980. Keywords : 951202; in; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; Pulmonary emboli; EMBOLI; PE; AUTOPSY; CAUSE; DEATH; AGE; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; FREQUENCY; FALSE-NEGATIVE; CLINICAL DIAGNOSIS; DIAGNOSIS; LONG TERM; PROGNOSIS; ADULT; AGED; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; di; mo; PA; Medline File; laboratories Notes : Pulmonary emboli (PE) were found in 18.5% of all consecutive autopsies at the Institute for Clinical and Experimental Medicine in Prague. In 11% of autopsies PE was the sole or major contributing cause of death; in 3.4% death occurred in patients who were expected to recover from the original illness. Pulmonary infarct was found in 42.6% of the patients with PE, multiple embolic phenomena of various ages in 43.7%, and venous thrombosis in 55.4% of cases with PE. The frequency of false negative and false positive clinical diagnosis of PE was 66.9% and 41.9%, respectively. PE went undetected in 57.1% of cases where it was directly responsible for death, and in 54.3% of patients with otherwise good long-term prognosis. The main factors responsible for incorrect diagnosis are the time interval from the onset of symptoms, missed clinical diagnosis of venous thrombosis, lack of laboratory examinations or their incorrect interpretation. Ref ID : RIEDEL1981 1037. Riedel, M., Ivaskova, E., and Sajdlova, H. HLA and venous thromboembolism. Tissue Antigens 18:280-281, 1981. Keywords : VENOUS; THROMBOEMBOLISM; INCIDENCE; THROMBOEMBOLIC; HLA; TISSUE ANTIGENS; Antigens Notes : HLA antigens Cw4, Cw5, and Cw6 are associated with a higher incidence of venous thromboembolic disease. Ref ID : RIEDEL1982 1038. Riedel, M. and Stanek, V. Long term follow-up of patients with pulmonary thromboembolism. Chest 81:151-158, 1982. Keywords : LONG TERM; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PULMONARY EMBOLISM; FOLLOWUP Ref ID : RIEDEL1989 1039. Riedel, M. and Rudolph, W. [The diagnosis of lung embolism] Diagnostik der Lungenembolie. Herz. 14:71-81, 1989. Keywords : DIAGNOSIS; LUNG; PULMONARY EMBOLISM; EMBOLISM; MORTALITY; MORBIDITY; THERAPY; ANTICOAGULATION; CLINICAL DIAGNOSIS; vein; THROMBOSIS; THROMBOEMBOLIC; ELECTROCARDIOGRAM; CHEST; CHEST X-RAY; XRAY; Echocardiogram; HEMODYNAMICS; CATHETER; diagnostics; Methods; Echocardiography; CT; MR; THROMBUS; SCANNING; SENSITIVITY; SPECIFICITY; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; MANAGEMENT; ECG; PERFUSION; SCAN; VENTILATION; PROBABILITY; LEG; VEINS; VENOGRAPHY; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; ULTRASOUND; VENOUS; VENOUS THROMBOSIS; PGM-8/94; ab; an; is; dyspnea; laboratories; blood; analysis; in; Segmental Notes : CS- Klinik fur Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munchen AB- An accurate diagnosis of pulmonary embolism is essential to prevent excessive mortality and morbidity from lack of therapy or inappropriate anticoagulation. The clinical diagnosis is highly nonspecific because none of the symptoms or signs of pulmonary embolism is unique and all may be caused by other cardiorespiratory disorders. The diagnosis of pulmonary embolism is unlikely, however, if patients do not have dyspnea, tachypnea, evidence of deep vein thrombosis, or a recognized predisposition to thromboembolic disease. Objective testing is mandatory to either confirm or exclude a diagnosis of pulmonary embolism. The electrocardiogram, chest X-ray and the echocardiogram may assist by excluding other potential diagnoses. Routine laboratory studies and lung function testing including blood gas analysis will not be of much help in the differential diagnosis. The hemodynamic investigation with a floating catheter is of diagnostic value especially in those cases where it is not possible to obtain the definitive diagnosis immediately; this method as well as echocardiography can provide a rough estimate of the degree of pulmonary vascular obstruction and are thus able to guide therapy. Methods such as DSA, CT, MR, SPECT, or radiolabelled thrombus scanning are promising but require more extensive validation before routine use. Lung scanning, with its high sensitivity but low specificity is a very useful procedure but cannot be considered to have diagnostic significance independent of the clinical situation. Pulmonary angiography provides the greatest diagnostic certainty of any test available. Based on current knowledge, a diagnostic approach for the management of clinically suspected pulmonary embolism is proposed. Ventilation-perfusion lung scanning is the appropriate next step after ECG, chest X-ray and echocardiogram. The finding of a normal perfusion scan rules out clinically significant embolism and anticoagulation is withheld. Segmental or lobar perfusion defects with normal ventilation in an appropriate clinical setting is sufficiently indicative of pulmonary embolism to proceed with therapy in patients without contraindications. Ventilation-perfusion scans of low or indeterminate probability for pulmonary embolism neither confirm nor exclude the presence of embolism and pulmonary angiography would then be the definitive procedure. As an alternative approach instrumental examination of the leg veins (with venography, impedance plethysmography, or ultrasound) is proposed (Figure 1). If these tests confirm the presence of deep venous thrombosis, anticoagulation can be commenced without the need to perform pulmonary angiography.(ABSTRACT TRUNCATED AT 400 WORDS). Ref ID : RIJKE1990 1040. Rijke, A.M., Croft, B.Y., Johnson, R.A., de Jongste, A.B., and Camps, J.A. Lymphoscintigraphy and lymphedema of the lower extremities. J.Nucl.Med. 31:990-998, 1990. Keywords : PHLEBITIS; Lymphedema; Extremities; ADULT; AGED; FEMALE; HUMAN; LEG; blood supply; Lymphatic System; physiopathology; radionuclide imaging; ETIOLOGY; MALE; MIDDLE AGE; technetium tc 99m sulfur colloid; diagnostic use; THROMBOPHLEBITIS; COMPLICATIONS; tin; VARICOSE VEINS; FILMS; analysis; QUANTITATIVE; CHRONIC; VENOUS; diagnostics; VENOGRAPHY; in; is Notes : Lymphoscintigraphy, using technetium-99m-labeled sulphur microcolloid, was employed to study the flow and transport of lymph in the lower extremities of 39 consecutive patients in whom lymphedema of one or both legs was suspected clinically. Time-activity curves of four segments of each leg were evaluated for lymph capacity, flow and soft- tissue uptake, and compared with the results from film scintigraphy. Curve analysis provided quantitative evaluation of the extent of hypoplasia or aplasia in primary lymphedema and of lymphatic obstruction in secondary lymphedema, and is particularly suited to assess the involvement of lymphatics in chronic venous disease. Film scintigraphy, on the other hand, is preferable in cases in which the pattern of activity distribution in the affected extremity is diagnostic, such as in dermal back flow, traumatic lymphocele, or megalymphatics. Venography is most informative in cases of suspected underlying venous disease, but the role of lymphangiography, which shows only part of the lymphatic system and requires incision of the edematous tissues, is considered questionable. Ref ID : RIJKEN1980 1041. Rijken, D.C., Wijngaards, G., and Welbergen, J. Relationship between tissue plasminogen activator and the activators in blood and vascular wall. Thromb.Res. 18:815-830, 1980. Keywords : PLASMINOGEN; VASCULAR WALL; PLASMINOGEN ACTIVATOR; TPA; THROMBOLYSIS; in; blood Ref ID : RISIUS1986 1042. Risius, B., Graor, R.A., Geisinger, M.A., Zelch, M.G., Lucas, F.V., Young, J.R., and Grossbard, E.B. Recombinant human tissue-type plasminogen activator for thrombolysis in peripheral arteries and bypass grafts. Radiology. 160:183-188, 1986. Keywords : HUMAN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; THROMBOLYSIS; ACEP93; in; PERIPHERAL ARTERY; Arteries; bypass graft Ref ID : RITTOO1993 1043. Rittoo, D., Sutherland, G.R., Samuel, L., Flapan, A.D., and Shaw, T.R. Role of transesophageal echocardiography in diagnosis and management of central pulmonary artery thromboembolism. Am J Cardiol. 71:1115-1118, 1993. Keywords : DIAGNOSIS; MANAGEMENT; PULMONARY ARTERY; ARTERY; THROMBOEMBOLISM; sdi-11/93; Transesophageal; Echocardiography; in Ref ID : ROBERTS1963 1044. Roberts, G.H. Venous thrombosis in hospital patients: A postmortem study. Scot.Med.J. 8:11, 1963. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; AUTOPSY; EPIDEMIOLOGY; PREVALENCE; POSTMORTEM; in; Hospitals Notes : Autopsy studies reveal evidence of prior venous thrombosis in up to 60 percent of patients. Ref ID : ROBINSON1980 1045. Robinson, W.N. and Roisenberg, I. Venous thromboembolism and the ABO blood groups in a Brazilian population. Hum.Genet. 55:129, 1980. Keywords : VENOUS; THROMBOEMBOLISM; ABO; BLOOD GROUPS; NASP; bib-4; blood; in Ref ID : ROBISON1986 1046. Robison, R.J., Fehrenbacher, J., Brown, J.W., Madura, J.A., and King, H. Emergent pulmonary embolectomy: The treatment for massive pulmonary embolus. Ann.Thorac.Surg. 42:52, 1986. Keywords : EMBOLECTOMY; TREATMENT; MASSIVE; PULMONARY EMBOLISM Ref ID : ROCHA1946 1047. Rocha, E., Silva, M., Andrade, S., and Teixeira, R.M. Fibrinolysis in peptone and anaphylactic shock in dog. Nature. 157:801-802, 1946. Keywords : FIBRINOLYSIS; SHOCK; THROMBOSIS; SCLEROTHERAPY; ANIMAL; PEPTONE; ANAPHYLACTIC; DOG; in Ref ID : RODENHUIS1993 1048. Rodenhuis, S., van't Hek, L.G., Vlasveld, L.T., Kr”ger, R., Dubbelman, R., and van Tol, R.G. Central venous catheter associated thrombosis of major veins: thrombolytic treatment with recombinant tissue plasminogen activator. Thorax. 48:558-559, 1993. Keywords : VENOUS; THROMBOSIS; VEINS; THROMBOLYTIC; TREATMENT; PLASMINOGEN; PLASMINOGEN ACTIVATOR; ACEP93; CENTRAL VENOUS CATHETER; CATHETER Ref ID : ROEBUCK1992 1049. Roebuck, D.J. Duration of anticoagulation for deep-vein thrombosis and pulmonary embolism [letter]. Lancet 340:1296, 1992. Keywords : DURATION; ANTICOAGULATION; DEEP VEIN THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM Ref ID : ROGERS1988 1050. Rogers, J.S., Murgo, A.J., and Fontana, J.A. Chemotherapy for breast cancer decreases plasma protein C and protein S. J.Clin.Oncol. 6:276-281, 1988. Keywords : CANCER; PROTEIN C; PROTEIN S; RISK; DVT; PE; ANTICOAGULANT; ANTITHROMBIN III; 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 act to decrease circulating anticoagulants such as antithrombin III or protein C or S. Ref ID : ROGERS1993 1051. Rogers, F.B., Shackford, S.R., Wilson, J., Ricci, M.A., and Morris, C.S. Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results. J.Trauma. 35:637- 41; discussion 641-2, 1993. Keywords : EMBOLISM; TRAUMA; VENA CAVA; Vena Cava Filters; FILTER; INDICATIONS; PULMONARY EMBOLISM; PE; REVIEW; FATAL; INCIDENCE; INJURY; Spinal cord; FRACTURES; RISK; PROPHYLAXIS; COMPLICATIONS; FOLLOWUP; Extremities; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; in; coma; injuries; is Notes : Pulmonary embolism (PE) remains a significant problem in trauma patients. A 5-year review at this institution revealed 25 PEs (seven fatal) in 2525 admitted trauma patients (1% incidence). Three groups of high-risk patients were identified: (1) those with severe head injury and coma; (2) those with spinal cord injuries with neurologic deficit; and (3) those with pelvic and long bone fractures. The relative risk of PE in these high-risk patients was 21 to 54 times that of the general trauma population. Beginning in July 1991, as prophylaxis against PE, vena cava filters (VCF) were inserted in patients whose injuries placed them in a high-risk group. Thirty-four patients had VCFs inserted percutaneously in the radiology suite without complications. On follow- up examination, 17.6% developed documented lower extremity deep vein thrombosis. There were no PEs. Overall, the incidence of PE in the general trauma population was significantly decreased from 1% to 0.25% (p < 0.05; chi 2). We conclude that insertion of VCFs in high-risk trauma patients is safe and efficacious in decreasing the incidence of PE. Ref ID : ROMANO1993 1052. Romano, A.M., Tomaselli, S., Gualtieri, G., Zoia, M.C., Fanfulla, F., Berrayah, L., and Cerveri, I. Respiratory function in precapillary pulmonary hypertension. Monaldi.Arch.Chest Dis. 48:201-204, 1993. Keywords : PULMONARY HYPERTENSION; Hypertension; Exertion; CHRONIC; THROMBOEMBOLIC; PULMONARY FUNCTION; Retrospective Studies; diagnostics; DIAGNOSIS; ARTERIAL; EXERCISE; LUNG; SHUNT; OXYGEN; CONTRAST; Rest; CHEST; CHEST X-RAY; XRAY; sdi-11/93; in; is; laboratories; physiology; transplantation; blood; Respiratory Function Tests Notes : Since dyspnoea on exertion is very often the first symptom of precapillary pulmonary hypertension (PPH), either from chronic thromboembolic pulmonary hypertension (CTEPH) or from idiopathic pulmonary hypertension (IPH), these patients are often first examined in a pulmonary function laboratory. We carried out a retrospective study (1987-1992) on pulmonary function in 34 patients diagnosed to have PPH by means of specific diagnostic tools, out of 5,467 patients first attending our laboratory. Nine suffered from IPH, 10 from CTEPH and 15 from Eisenmenger physiology. This last group differed from the others, since its diagnosis had been known for a long time and the stage of the disease was more advanced, when pulmonary function tests were performed in our laboratory (with a view to transplantation). Respiratory function, blood gases and arterial oxyhaemoglobin saturation (HbSaO2) during exercise (Bruce protocol), diffusing capacity of the lungs for carbon monoxide (DLCO), shunt fraction (QS%) (approximation obtained from arterial oxygen tension (PaO2) after 100% oxygen breathing) had been evaluated. In the first two groups, in contrast to other reports, we could observe no obstructive defect. Only 20% of the subjects had restrictive defects, however mild. The typical functional picture of these patients revealed normal lung volumes, normal or slightly reduced DLCO, mild hypoxaemia with hypocapnia, severe HbSaO2 drops during exercise, and pathological QS%. We conclude that every time a patient presents with breathlessness at rest or on exercise, a normal chest X- ray and respiratory function tests, pulmonary hypertension must be suspected and subject to specific and invasive tests. More severe functional impairment was observed in the PPH from the Eisenmenger disorder. This might be due to a more advanced stage of this type of hypertension at the time of our observation and/or to the different mechanisms of the diseases themselves. Ref ID : ROSE1990 1053. Rose, S.C., Zwiebel, W.J., Nelson, B.D., Priest, D.L., Knighton, R.A., Brown, J.W., Lawrence, P.F., Stults, B.M., Reading, J.C., and Miller, F.J. Symptomatic lower extremity deep venous thrombosis: accuracy, limitations, and role of color duplex flow imaging in diagnosis [published erratum appears in Radiology 1990 Sep;176(3):879]. Radiology 175:639-644, 1990. Keywords : PHLEBITIS; Extremities; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Duplex; DIAGNOSIS; ADULT; AGED; Aged,80 and over; diagnostic errors; FEMALE; HUMAN; LEG; blood supply; MALE; MIDDLE AGE; PHLEBOGRAPHY; RECURRENCE; Regional Blood Flow; THROMBOPHLEBITIS; radiography; Ultrasonography; PAIN; TECHNIQUES; DVT; CONTRAST; Venogram; VENOGRAPHY; standards; KNEE; CALF; VEINS; THROMBI; color; in; is Notes : Color duplex flow imaging (CDFI) permits pain- and risk-free direct imaging of the deep venous system of the lower extremities. To prospectively ascertain the accuracy and limitations of this technique, CDFI was performed in 75 lower limbs of 69 consecutive patients referred for venographic evaluation of clinically suspected lower extremity deep venous thrombosis (DVT). The CDFI study was obtained within 24 hours of the contrast venogram. Both studies were interpreted without knowledge of the patient's clinical findings or the results of the other test. Contrast venography was regarded as the standard for diagnosis of DVT. Accuracy was 99% for detection of DVT above the knee and 81% below the knee. Sonographic evaluation of the calf veins was technically adequate in 60% of limbs; accuracy was 98% in this group. In the 40% of limbs with technically limited CDFI studies of the calf, accuracy decreased to 57%. Although small nonocclusive thrombi occurred infrequently in this series of symptomatic patients, CDFI missed three of four such thrombi. It is concluded that CDFI, when not technically compromised, is sufficiently accurate to definitively diagnose symptomatic lower extremity DVT. Ref ID : ROSENOW1981 1054. Rosenow, E.C., Osmundson, P.J., and Brown, M.L. Pulmonary embolism. Mayo.Clin.Proc. 56:161-178, 1981. Keywords : PULMONARY EMBOLISM; EMBOLISM Ref ID : ROSOVE1992 1055. Rosove, M.H. and Brewer, P.M. Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann.Intern.Med. 117:303-308, 1992. Keywords : THROMBOSIS; THERAPY; LUPUS; ANTICOAGULANT; THROMBOEMBOLIC; AGE; Syndrome; CHRONIC; VENOUS; ARTERIAL; HEPARIN; WARFARIN; ANTICOAGULATION; FOLLOWUP; FATAL; RECURRENCE; TREATMENT; ASPIRIN; RABBITS; THROMBOPLASTIN; PROTHROMBIN; BLEEDING; DURATION; INR; International normalized ratio; in; ab; Antithrombotic; antibodies; antiphospholipid syndrome; brain; prothrombin time; is Notes : CS- UCLA School of Medicine AB- OBJECTIVE: To determine the clinical course and influence of antithrombotic therapy in patients with lupus anticoagulant or anticardiolipin antibodies, or both, after the first thromboembolic event. DESIGN: Retrospective survey of consecutive patients treated according to their physician's best judgment. SETTING: Secondary and tertiary referral practice. PATIENTS: Seventy patients (48 women [69%]) with a mean age (+/- SD) of 45.5 +/- 17.3 years. The antiphospholipid syndrome was primary in 51 patients (73%) and secondary to systemic lupus erythematosus in 14 patients (20%) and to chronic idiopathic thrombocytopenic purpura in 5 patients (7%). MEASUREMENTS: Site of initial and recurrent thrombotic events (venous or arterial), as well as kind (aspiring, heparin, or warfarin) and intensity of anticoagulation. RESULTS: Total follow-up after the first thrombotic event was 361.0 patient-years (mean [+/- SD], 5.2 +/- 5.6 years per patient). Thirty-seven patients (53%) had 54 recurrent events, with 2 patients experiencing fatal events. Arterial events were followed by arterial events, and venous events by venous events, in 49 of 54 instances (91%). Recurrence rates during "no treatment;" aspirin therapy; or low-, intermediate-, or high-intensity warfarin therapy (international normalized ratios [INRs] less than or equal to 1.9, 2.0 to 2.9, and greater than or equal to 3.0, respectively, or rabbit brain thromboplastin prothrombin time ratios of approximately less than 1.3, 1.3 to 1.5, and greater than 1.5, respectively) were 0.19, 0.32, 0.57, 0.07 (P = 0.12), and 0.00 (P less than 0.001) per patient-year. The follow-up periods for the five types of therapy were 161.2, 37.8, 11.3, 40.9, and 110.2 patient-years, respectively. The highest INR coincident with thrombosis was 2.6. Five warfarin-treated patients had five significant bleeding events (0.031 per patient-year). CONCLUSIONS: Recurrent thrombosis is a potentially serious problem for patients with lupus anticoagulant or anticardiolipin antibodies or both. The site of the first event (arterial or venous) tended to predict the site of subsequent events. Intermediate- to high-intensity warfarin therapy may confer better antithrombotic protection than low- to intermediate- intensity warfarin therapy or aspirin therapy. Further studies are needed to define more precisely the rethrombosis rate and optimal type, intensity, and duration of antithrombotic therapy. Ref ID : ROSTAGNO1991 1056. Rostagno, C., Prisco, D., Abbate, R., and Poggesi, L. Pulmonary hypertension associated with long-standing thrombocytosis. Chest 99:1303-1305, 1991. Keywords : PULMONARY HYPERTENSION; THROMBOCYTOSIS; THROMBOEMBOLIC; PLATELET; THROMBIN; GRADIENT; FIBRINOPEPTIDES; HEPARIN; TREATMENT; HEMODYNAMICS; THERAPY; HYPERTENSION PULMONARY; ADULT; ASPIRIN; BETA THROMBOGLOBULIN; CASE REPORT; FIBRINOPEPTIDES A; HUMAN; MALE; PLATELET ACTIVATION; SPLENECTOMY; THALASSEMIA; THROMBOXANE A2; TIME FACTORS; Hypertension; is; in; FIBRINOPEPTIDE A Notes : AB-A case of thromboembolic pulmonary hypertension associated with long- standing thrombocytosis is presented. In this patient we found a significant local pulmonary platelet activation and thrombin generation as indicated by the existence of a transpulmonary gradient for thromboxane A2, beta thromboglobulin and fibrinopeptide A. Prolonged heparin and acetylsalicylic acid treatment resulted in improvement of clinical and hemodynamic conditions. These findings support the usefulness of anticoagulating and antiaggregating therapy in selected cases of pulmonary hypertension. Ref ID : RUAN1991 1057. Ruan, Y.M. [Clinico-pathological analysis of 100 autopsy cases of massive or submassive pulmonary thrombo-obstruction in cardiovascular and pulmonary diseases]. Chung.Hua.Chieh.Ho.Ho.Hu.Hsi.Tsa.Chih. 14:5-7, 60, 1991. Keywords : 951202; analysis; AUTOPSY; MASSIVE; SUBMASSIVE; in; CARDIOVASCULAR; Segmental; Arteries; LUNG; COMPLICATIONS; THROMBOSIS; EMBOLISM; rheumatic heart disease; heart; heart diseases; COR PULMONALE; infarction; PULMONARY INFARCTION; SUDDEN DEATHS; DEATH; CAUSE; diagnostics; Adolescence; ADULT; AGED; Aged,80 and over; cardiomyopathy,congestive; co; CHILD; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; PULMONARY EMBOLISM; PA; PULMONARY HEART DISEASE; Medline File Notes : A clinico-pathological analysis of 100 autopsy cases of thrombo- obstruction in the segmental and those bigger arteries of the lungs caused by cardiovascular and pulmonary disease was reported. These complications of pulmonary thrombosis and/or embolism were more commonly observed in rheumatic heart disease (29% of the same disease in autopsies), congestive cardiomyopathy (26%) and cor pulmonale (19%). There were 2-4% of the autopsy cases of other cardiovascular and pulmonary diseases. The pulmonary thrombo-obstruction and/or infarction were more frequent in right lower lobes of the lungs and they were often multiple. The pulmonary infarction occurred in 76% of these cases. 35% of 100 cases occurred with sudden death. Only 13% of 100 patients with pulmonary thrombosis and/or embolism were diagnosed before autopsy. The causes of pulmonary thrombo-obstruction and the diagnostic suggestion were discussed in this paper Cardiovascuar Institute Chinese Academy of Medical Science Beijing. Ref ID : RUBENSTEIN1980 1058. Rubenstein, M. and Creger, W.P. Successful streptokinase therapy for catheter-induced subclavian thrombosis. Arch.Intern.Med. 140:1370- 1371, 1980. Keywords : STREPTOKINASE; THERAPY; THROMBOSIS; ACEP93; CATHETER; SUBCLAVIAN Ref ID : RUBINSTEIN1988 1059. Rubinstein, I., Murray, D., and Hoffstein, V. Fatal pulmonary emboli in hospitalized patients. An autopsy study. Arch.Intern.Med. 148:1425-1426, 1988. Keywords : 951202; FATAL; Pulmonary emboli; EMBOLI; in; AUTOPSY; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; st; Hospitals; CAUSE; DEATH; is; LUNG; SCANNING; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; cause of death; hospitalization; HUMAN; ontario; di; PA; Medline File; Health Planning & Administration File; CANADA; an Notes : To determine the accuracy of the antemortem diagnosis of major pulmonary embolism, we reviewed 1276 autopsy reports at St Michael's Hospital, Toronto, from 1980 to 1984. Of 44 patients identified with major pulmonary embolism as the cause of death or a major factor contributing to it, 14 (31.8%) had the diagnosis suspected before death. We could not find any distinctive features separating these patients from those in whom the diagnosis of pulmonary embolism was not suspected before death. We conclude that major pulmonary embolism is still underdiagnosed in hospitalized patients, despite the availability of lung scanning and pulmonary angiography Department of Medicine St Michael's Hospital University of Toronto Ontario Canada. Ref ID : RUCKLEY1987 1060. Ruckley, C.V., Boulton, F.E., and Redhead, D. The treatment of venous thrombosis of the upper and lower limbs with "APSAC" (p- anisoylated streptokinase-plasminogen complex). Eur.J.Vasc.Surg. 1:107- 112, 1987. Keywords : TREATMENT; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ACEP-93; ACEP93 Ref ID : RUIZ1989 1061. Ruiz, M.A., Marugan, I., Estelles, A., Navarro, I., Espana, F., Alberola, V., San Juan, L., Aznar, J., and Garcia-Conde, J. The influence of chemotherapy on the plasmatic coagulation and fibrinolytic system in lung cancer patients. Cancer 63:643-648, 1989. Keywords : COAGULATION; FIBRINOLYTIC; LUNG; CANCER; RISK; DVT; PE; ANTICOAGULANT; ANTITHROMBIN III; PROTEIN C; CAUSE; in; ANTICOAGULANTS; an; is 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 act to decrease circulating anticoagulants such as antithrombin III or protein C or S.{327, 328} Some cause an increase in circulating procoagulants, such as von Willebrand factor.{329} Finally, there is evidence for a chemotherapeutic depression of normal fibrinolytic activity. Ref ID : RUIZ1992 1062. Ruiz, J., Monreal, M., Sala, H., Roncales, J., Fiz, J.A., and Monso, E. Effects of inhaled platelet activating factor on bronchial responsiveness in patients with symptomatic and asymptomatic pulmonary embolism. Chest 102:819-823, 1992. Keywords : PLATELET; ASYMPTOMATIC; PULMONARY EMBOLISM; EMBOLISM; PE; DIAGNOSIS; LUNG; SCAN; Hospitals; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; in; respiratory insufficiency Notes : To determine the possible role of platelet-activating factor (PAF) in pulmonary embolism (PE), the reactivity of the airways to inhaled PAF, using doses ranging from 6.25 to 400 micrograms, was examined in 24 patients with a past episode of PE. Twelve of these patients had experienced acute respiratory insufficiency during the episode (with or without additional symptoms). None of the remaining 12 patients had experienced any respiratory symptoms during the PE episode. Diagnosis was established by means of a ventilation-perfusion lung scan performed when admitted to the hospital because of deep venous thrombosis (DVT) in the lower limbs. Nonspecific bronchial reactivity as measured by the response to bronchoprovocation testing with methacholine showed no significant differences between both groups. PAF caused a dose-dependent bronchoconstriction defined by at least a 35 percent decrease in specific airway conductance (SGaw) in all patients. The average dose of PAF needed to decrease SGaw 35 percent was significantly lower in patients who had had a symptomatic PE than in those with asymptomatic PE (p = 0.011). This finding suggests that patients who suffered from symptomatic PE may present a greater airway reactivity to inhaled PAF. This different behavior might explain the existence of some of the respiratory symptoms of PE, which could be attributed to PAF- related effects. However, additional studies are needed to evaluate the role of PAF in PE. Ref ID : RUPAR1990 1063. Rupar, D.G., Herzog, K.D., Fisher, M.C., and Long, S.S. Prolonged bacteremia with catheter-related central venous thrombosis. Am.J.Dis.Child. 144:879-882, 1990. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ACEP93 Ref ID : RUSSO1993 1064. Russo, R., Marcolongo, R., and Schivazappa, L. [Pulmonary thromboembolism and thrombolytics in pregnancy: a clinical case report and review of the literature] Tromboembolia polmonare e trombolitici in gravidanza: descrizione di un caso clinico e revisione della letteratura. G.Ital.Cardiol. 23:161-164, 1993. Keywords : EMBOLISM; PREGNANCY; THROMBOEMBOLISM; THROMBOLYTIC; CASE REPORT; REVIEW; FEMALE; HUMAN; Heparin ,Administration and Dosage ,AD; Pregnancy Complications,Cardiovascular ,Drug Therapy ,DT; Pulmonary Embolism ,Drug Therapy ,DT; THROMBOLYTIC THERAPY; ADULT; Cesarean Section; Combined Modality Therapy; Emergencies; in; di Notes : CS- Servizio di Prevenzione e Terapia della Trombosi, Universita Degli Studi di Padova. Ref ID : RUTHERFORD1986 1065. Rutherford, S.E. and Phelan, J.P. Thromboembolic disease in pregnancy. Clin.Perinatol. 13:719-739, 1986. Keywords : THROMBOEMBOLIC; PREGNANCY; ANTICOAGULATION; DURATION; in Ref ID : RUTHERFORD1990 1066. Rutherford, J.D. and Braunwald, E. Thrombolytic therapy in acute myocardial infarction. Chest 97(4 Suppl):136S-145S, 1990. Keywords : 96-suzy-001; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; in; MYOCARDIAL INFARCTION; infarction; PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; STREPTOKINASE; MORTALITY; MI; INTRAVENOUS; is; Arteries; UROKINASE; FIBRIN; SPECIFICITY; blood; Blood Viscosity; INCIDENCE; adverse effects; an; RISK; BLEEDING; Punctures; INDICATIONS; CHEST; CHEST PAIN; PAIN; DURATION; TREATMENT; EARLY; AGE; DIAGNOSIS; RANDOMIZED; MANAGEMENT; ALTEPLASE; therapeutic use; FIBRINOLYTIC AGENTS; HUMAN; drug therapy; Methods Notes : Recombinant tissue-type plasminogen activator (rt-PA), streptokinase (SK), and anisoylated plasminogen-streptokinase activator complex (APSAC) have salutary effects on mortality when administered to patients with evolving acute myocardial infarction (MI). Studies suggest that intravenous rt-PA is more effective in reperfusing occluded infarct-related arteries than SK, and the results of ongoing studies directly comparing the influence of SK and rt-PA on mortality are awaited. The clinical role of agents such as APSAC, urokinase, and pro- urokinase, used alone or in combination, remains to be determined. It is evident that a variety of thrombolytic agents will be effective, and variables such as ease of administration, pharmacokinetics, fibrin specificity, effects on blood viscosity, and incidence of adverse effects need to be assessed to determine which agents are the most suitable for clinical use. There is an increased risk of bleeding at vascular puncture sites with all thrombolytic agents. Current indications for thrombolytic therapy include ischemic chest pain of at least 30 min duration that is unrelieved by nitroglycerin and is associated with ST-segment elevations of at least 0.1 mV in two contiguous electrocardiographic leads. Such therapy is usually reserved for patients less than 75 years old who are not at increased risk for bleeding and whose chest pain began less than 4-6 prior to treatment. Trials are under way to determine whether patients with shorter pain duration, transient ST-segment changes (ie, unstable angina patients), chest pain associated with ST-segment depressions or T-wave inversions (ie, non-Q-wave infarction patients), or patients whose pain began more than 4 to 6 h earlier will benefit from early thrombolytic therapy. Other factors such as patient age, the likelihood of the diagnosis of MI, and the estimated risk of bleeding should also be considered. The findings of available major randomized trials indicate that early invasive procedures are generally unnecessary and that meticulous care must be exercised in the selection and management of patients subjected to thrombolytic therapy. Ref ID : RUTHERFORD1991 1067. Rutherford, S.E. and Phelan, J.P. Deep venous thrombosis and pulmonary embolism in pregnancy. Obstet.Gynecol.Clin.North Am. 18:345- 370, 1991. Keywords : EMBOLISM; PREGNANCY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; Hospitals; EARLY; DIAGNOSIS; TREATMENT; PROPHYLAXIS; MATERNAL; THROMBOEMBOLISM; TECHNIQUES; NONINVASIVE; Methods; Doppler; IPG; DVT; ANTICOAGULANT; THERAPY; RISK; RADIOLOGIC; FETAL; HEPARIN; APTT; SUBCUTANEOUS; RECURRENCE; FEMALE; HUMAN; Pregnancy Complications,Cardiovascular; THROMBOPHLEBITIS; Heparin ,Therapeutic Use ,TU; Labor; Pregnancy Complications,Cardiovascular ,Diagnosis ,DI Pregnancy Complications,Cardiovascular ,Epidemiology ,EP Pregnancy Complications,Cardiovascular ,Physiopathology ,PP Pregnancy Complications,Cardiovascular ,Therapy ,TH; Puerperium; Pulmonary Embolism ,Diagnosis ,DI Pulmonary Embolism ,Epidemiology ,EP Pulmonary Embolism ,Physiopathology ,PP Pulmonary Embolism ,Therapy ,TH; RISK FACTORS; THROMBOLYTIC THERAPY; Thrombophlebitis ,Diagnosis ,DI Thrombophlebitis ,Epidemiology ,EP Thrombophlebitis ,Physiopathology ,PP Thrombophlebitis ,Therapy ,TH; in; ab; is; standards Notes : CS- Maternal-Fetal Medicine Program, Evergreen Hospital Medical Center, Kirkland, Washington AB- Early diagnosis, treatment, and appropriate prophylaxis may prevent serious maternal sequelae of thromboembolism. Objective techniques for diagnosis should be used aggressively, using noninvasive methods such as Doppler or IPG when possible for DVT. 125I-fibrinogen should be avoided. The possible consequences of failure to treat or unnecessary use of anticoagulant therapy outweigh risks to the fetus of the appropriate radiologic procedures. Because of its low fetal risk, heparin is the anticoagulant of choice. Measurement of heparin levels by antifactor Xa activity appears to be more sensitive than the current standard, the aPTT, and it is hoped that this will become widely available. Although the risks and benefits of prophylaxis during pregnancy are currently debated, it appears most prudent to use subcutaneous heparin prophylaxis in doses larger than for nonpregnant patients in women at high risk for recurrence. Ref ID : RYAN1974 1068. Ryan, T.J. Diseases of the skin. Management of varicose ulcers and eczema. Brit.Med.J. 1:192-194, 1974. Keywords : Skin; MANAGEMENT; Varicose Ulcer; Ulcer; Eczema; NASP; BANDAGES; Dermatitis,Contact; Edema; Exertion; HUMAN; Ischemia; LEG; OBESITY; Skin Transplantation; Staphylococcal Infections; THROMBOPHLEBITIS; Transplantation,Autologous; VARICOSE VEINS; Medline File; varicose; ab Notes : AB - [No Abstract Available] UI - 74092102. Ref ID : SADICK1991 1069. Sadick, N.S. Sclerotherapy of varicose and telangiectatic leg veins. Minimal sclerosant concentration of hypertonic saline and its relationship to vessel diameter [see comments]. J.Dermatol.Surg.Oncol. 17:65-70, 1991. Keywords : SCLEROTHERAPY; LEG; VEINS; SCLEROSANT; HEPARIN; COMPLICATIONS; VARICOSE VEINS; Sodium Chloride; vein; SCLEROSIS; MORBIDITY; NASP; Adolescence; ADULT; BANDAGES; COMPARATIVE STUDY; Double-Blind Method; FEMALE; Follow-Up Studies; HUMAN; MIDDLE AGE; Saline Solution,Hypertonic; Sclerosing Solutions; Telangiectasis; THROMBOPHLEBITIS; THROMBOSIS; TIME FACTORS; Medline File; Cancerlit File; varicose; ab; telangiectasia; Sodium; in; ad; new york Notes : AB - The author reports the results of a double-blind, paired- comparison study using saline sclerosant plus or minus heparin additive. The study was designed to elucidate the effects of increasing concentrations of hypertonic saline with regard to vessel diameter, clinical efficacy, complications, and discomfort. Six hundred women with bilaterally symmetrical starburst telangiectasias or varicose veins were entered into the study. Sodium chloride 11.7% appeared to be the minimal sclerosant concentration of saline that produced the most effective vein sclerosis of vessels of less than 8 mm in diameter, while producing the least morbidity. The optimal concentration of the sclerosant may vary with the diameter of the vessels under therapeutic consideration AD - Cornell University Medical College AD - New York AD - New York UI - 91123535. Ref ID : SADICK1994 1070. Sadick, N.S. Hyperosmolar Versus Detergent Sclerosing Agents in Sclerotherapy. Effect on Distal Vessel Obliteration. Jrnl of Dermatologic Surgery & Oncology 20(5):313-316, 1994. Keywords : 96-suzy-002; Detergents; SCLEROSING AGENTS; in; SCLEROTHERAPY; ENDOTHELIAL; THROMBOSIS; SCLEROSANTS; POLIDOCANOL; SCLEROSANT; Methods; Sclerosing Solutions; LEG; standards; COMPRESSION; TREATMENT; RESOLUTION; SCLEROSIS Notes : 01-06-96. Abstract : Background. Sclerosing agents produce local endothelial destruction extending to the adventitia of the vessel wall while producing minimal thrombosis formation. They are rapidly inactivated in order to prevent damage far beyond the injected site. It has been stated that detergent sclerosants may have more distal sclerosing capabilities than hyperosmolar sclerosants. Objective. The present study compares the in vivo relative potential of polidocanol (POL.), a detergent sclerosing agent, and hypertonic saline (H.S.), a hyperosmolar sclerosant in their effects on distal vessel obliteration. Method. Symmetrical Class III reticular vessel of 2-3-mm diameter were injected with equal amounts (0.5cc) of sclerosing solutions: 0.5% POL. in the left leg and 23.4% H.S. in the right leg. Distance of vessel sclerosing effect was calibrated from the inferior patellar tendon employing a calibrated measuring window. Standard compression (20-30 mm Hg) was employed for 72 hours after each treatment session. Patients were examined at 2-, 4-, 6- , 8-, 10-, and 16-week intervals for vascular sclerosing resolution effect. Results. The mean distance of vessel sclerosis utilizing 23.4% H.S. was 6.24 cm vs 6.34 cm utilizing 0.5%. Ref ID : SAFAVI1995 1071. Safavi, K. Letter regarding 'Duration of anticoagulant therapy for venous thrombosis'. N.Engl.J.Med. 333(19):1288-1289, 1995. Keywords : LETTER; DURATION; ANTICOAGULANT; THERAPY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; is; an; in; THROMBOEMBOLISM; WARFARIN; drugs; HYPERCOAGULABLE; Vitamin K Notes : There is an abrupt rise in the rate of recurrent venous thromboembolism immediately after the discontinuation of oral warfarin no matter whether the drug is continued for 6 weeks or for 6 months. This may be due to a transient hypercoagulable state caused by the differential recovery of procoagulant and anticoagulant vitamin-K dependent proteins. Ref ID : SAKS1983 1072. Saks, B.J. and Kilby, A.E. Unknown title. Radiology. 149:639-642, 1983. Keywords : THROMBOSIS; SCLEROTHERAPY; PLEURAL EFFUSIONS; SCLEROSANTS; effusion Notes : report of pleural effusions after iv sclerosants. Ref ID : SALKA1993 1073. Salka, S., Saeian, K., and Sagar, K.B. Cerebral thromboembolization after cardioversion of atrial fibrillation in patients without transesophageal echocardiographic findings of left atrial thrombus. Am Heart J 126:722-724, 1993. Keywords : Transesophageal; THROMBUS; sdi-11/93; Cardioversion; Cerebral; Atrial fibrillation; in Ref ID : SALTZMAN1967 1074. Saltzman, H.A. Hyperbaric oxygen. Med.Clin.North Am. 51:1301-1314, 1967. Keywords : 951202; OXYGEN; ACCIDENTS; carbon monoxide poisoning; th; decompression sickness; embolism,air; gas gangrene; HUMAN; Hyperbaric Oxygenation; ae; bl; pd; Respiration; de; Medline File Notes : [No Abstract Available]. Ref ID : SAMKOFF1981 1075. Samkoff, J.S. and Comstock, G.W. Epidemiology of pulmonary embolism: Mortality in a general population. Am.J.Epidemiol. 114:488- 495, 1981. Keywords : EPIDEMIOLOGY; PULMONARY EMBOLISM; EMBOLISM; MORTALITY; AGE; RISK; DVT; PE; in; an; is Notes : 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 : SANDLER1989 1076. Sandler, D.A. and Martin, J.F. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J.R.Soc.Med. 82:203-205, 1989. Keywords : 951202; AUTOPSY; PULMONARY EMBOLISM; EMBOLISM; in; Hospitals; vein; THROMBOSIS; CAUSE; cause of death; DEATH; Retrospective Studies; AGED; CANCER; DEEP VEIN THROMBOSIS; DVT; LEG; Died; SURGERY; SCREENING; ADULT; Aged,80 and over; ANIMAL; chick embryo; FEMALE; HUMAN; MALE; MIDDLE AGE; et; mo; PA; THROMBOPHLEBITIS; co; di; Medline File; Cancerlit File; an Notes : To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388 autopsies performed (10%): 15% of these patients were aged less than 60 years and 68% did not have cancer. Of these patients, 83% had deep-vein thrombosis (DVT) in the legs at autopsy, of whom only 19% had symptoms of DVT before death. Only 3% of patients who had DVT at autopsy had undergone an investigation for such before death. Twenty-four per cent of patients who died from pulmonary embolism had undergone surgery a mean of 6.9 days before. Screening tests for DVT should be applied widely in the hospital population Department of Medicine Royal Hallamshire Hospital Sheffield. Ref ID : SANDRITTER1980 1077. Sandritter, W., Staeudinger, M., and Drexler, H. Autopsy and clinical diagnosis. Pathol.Res.Pract. 168:107-114, 1980. Keywords : 951202; AUTOPSY; CLINICAL DIAGNOSIS; DIAGNOSIS; in; DEATH; CAUSE; cause of death; an; Hospitals; Rest; CIRRHOSIS; Liver; PULMONARY EMBOLISM; EMBOLISM; MYOCARDIAL INFARCTION; infarction; Cerebral; CEREBRAL HEMORRHAGE; HEMORRHAGE; th; Carcinoma; SHOCK; SEPTICEMIA; uremia; di; COMPARATIVE STUDY; diabetes mellitus; diagnostic errors; HUMAN; Liver Cirrhosis; Neoplasms; TIME FACTORS; Medline File Notes : In 1096 cases of death (autopsy rate 63.8%) the accuracy of clinical diagnoses was investigated by comparing clinical diagnoses with recorded autopsy findings. -- In 81.3% of the cases the primary disease had been determined correctly. In more than half of these cases the immediate cause of death or an additional disease contributing to death had not been correctly identified. In 16% of the cases the diagnosis proved to be inadequate. -- In 2.6% of all cases the primary disease, cause of death and accompanying illnesses were misdiagnosed. Most of these patients had stayed in the hospital for a much shorter time than the rest of the patients. -- Among conditions clinically diagnosed as cirrhosis of the liver, pulmonary embolism, myocardial infarction, cerebral hemorrhage, and malignant tumors -- pulmonary embolism was by far the most frequent condition to go unrecognized, i.e. in 50% of th cases in which it was present. Primary liver cell carcinoma proved to be the malignant tumor most frequently not identified by clinical studies. -- Four clinical diagnoses (shock, septicemia, diabetes mellitus and uremia) were often unsupported by morphological findings. Yet there were 13 clinically undiagnosed cases of septicemia in which findings at post mortem examination revealed this condition. These cases also underline the importance of autopsies. Ref ID : SAPIN1966 1078. Sapin, G. A propos dun cas de thrombose profonde sur 300,000 injections sclerosantes (ou soi-disant telles). Phlebologie 19(4):321- 325, 1966. Keywords : PAIN; SCLEROTHERAPY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; INTRAARTERIAL; SCLEROSANT; de; Injections; CASE REPORT; LEG; Foot; Ankle; diagnostics; is; DEEP VENOUS THROMBOSIS; an Notes : Case report of lower leg and foot pain following sclerotherapy of a vessel along the lower inner leg above the ankle. No definitive diagnostic test was performed. It is possible that this represented a case of deep venous thrombosis, but more likely inadvertent intraarterial injection or passage of sclerosant via an arteriovenous malformation. Ref ID : SAPIN1966A 1079. Sapin, G. Apropos of a case of deep thrombosis in 300,000 so- called sclerosing injections. Phlebologie 19(4):301-304, 1966. Keywords : THROMBOSIS; INCIDENCE; SCLEROTHERAPY; in; Injections Ref ID : SASAHARA1973 1080. Sasahara, A.A., Belko, J.S., McIntyre, K.M., Sharma, G.V.R.K., and Morse, R.L. The diagnosis and management of pulmonary embolism: current status. Progr.Nucl.Med. 3:85-110, 1973. Keywords : DIAGNOSIS; MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; NUCLEAR Ref ID : SASAHARA1986 1081. Sasahara, A.A. and Sharma, G.V.R.K. Does thrombolytic therapy alter the prognosis of pulmonary embolism? Haemostasis. 16:Suppl 3, 1986. Keywords : THROMBOLYTIC; THERAPY; PULMONARY EMBOLISM; EMBOLISM; PROGNOSIS; THROMBOLYTIC THERAPY Ref ID : SASAKI1993 1082. Sasaki, Y., Morii, S., Yamashita, T., and Yamamoto, J. Antithrombotic effect of argatroban on the pial vessels of the rat: a study with He-Ne laser-induced thrombus formation. Haemostasis. 23:104- 111, 1993. Keywords : Rats; THROMBUS; THROMBIN; Lasers; TECHNIQUES; THROMBI; INTRAVENOUS; Arterioles; Antithrombotic; sdi-11/93; in; Cerebral; an Notes : The antithrombotic effect of the synthetic thrombin inhibitor (2R,4R)-4-methyl-1-[N2-(3-methyl-1,2,3,4-tetrahydro-8-quinoline-sulfon yl)-L-arginyl]-2-piperidinecarboxylic acid monohydrate (argatroban) was investigated in cerebral vessels of the rat. An occlusive thrombus was formed in pial vessels using a He-Ne laser in a closed cranial window technique. Argatroban retarded the formation of thrombi in a dose- dependent manner. The antithrombotic effect of a single intravenous dose of argatroban at 0.5 mg/kg was diminished after 30 min in arterioles and after 50 min in venules, respectively. The antithrombotic activity was maintained, however, by continuous intravenous infusion (2 mg/kg/h). Ref ID : SASSU1990 1083. Sassu, G.P., Chisholm, C.D., Howell, J.M., and Huang, E. A rare etiology for pulmonary embolism: basilic vein thrombosis. J.Emerg.Med. 8:45-49, 1990. Keywords : ETIOLOGY; PULMONARY EMBOLISM; EMBOLISM; vein; THROMBOSIS; ACEP-93; VEINS; ACEP93 Ref ID : SAUERBRUCH1982 1084. Sauerbruch, T., Weinzierl, M., Dietrich, H.P., Antes, G., Eisenburg, J., and Paumgartner, G. Sclerotherapy of a bleeding duodenal varix. Endoscopy. 14:187-189, 1982. Keywords : SCLEROTHERAPY; BLEEDING; TREATMENT; Hypertension; CIRRHOSIS; CHILD; HEMORRHAGE; SHUNT; ANGIOGRAPHY; THROMBOSIS; vein; SPLENECTOMY; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; MASSIVE; FOLLOWUP; NASP; Splenic Vein; VEINS; ADULT; CASE REPORT; Duodenoscopy; Duodenum; Gastrointestinal Hemorrhage; HUMAN; MALE; Polyethylene Glycols; Sclerosing Solutions; VARICOSE VEINS; Medline File; ab; in; is Notes : AB - A case of successful treatment of a bleeding duodenal varix in a patient with portal hypertension and compensated cryptogenic cirrhosis (Child A) is reported. The 42-year-old man had a history of recurrent gastrointestinal hemorrhage over 14 years. In 1966 he underwent a portocaval shunt operation. Angiography in 1968 revealed a thrombosis of the shunt as well as of the splenic vein. Splenectomy was performed because of hypersplenism. In 1980 bleeding from esophageal varices occurred and was treated by sclerotherapy. Seven weeks after sclerotherapy massive bleeding from a duodenal varix occurred. Sclerotherapy of the duodenal varix via a flexible endoscope proved successful. Since then, during a follow-up period of 15 months, the patient has had no further bleeding episodes UI - 83003546. Ref ID : SAVELEV1980 1085. Savel'ev, V.S. and Konstantinova, G.D. [Surgery of the venous system in the management of patients with postthrombotic syndromes]. Khirurgiia.(Mosk). :44-49, 1980. Keywords : VENOUS; MANAGEMENT; NASP; ADULT; English Abstract; FEMALE; HUMAN; MALE; Postoperative Complications; Syndrome; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; VEINS; Medline File; in; ab Notes : TT - Razobshchenie venoznykh sistem v lechenii bol'nykh posttromboticheskim sindromom AB - [No Abstract Available] UI -81268464. Ref ID : SCALA1992 1086. Scala, P.J., Tubiana, J.M., Le Heuzey, J.Y., Abastado, P.H., Rozensztajn, L., and Valty, J. [Puerperal thrombosis of the right ovarian vein. Clinical and radiological aspects apropos of a case]. Arch.Mal.Coeur.Vaiss. 85:367-371, 1992. Keywords : THROMBOSIS; vein; EMBOLI; CLINICAL FEATURES; CT; SCAN; MAGNETIC RESONANCE; NONINVASIVE; EARLY; DIAGNOSIS; THERAPY; Antibiotics; HEPARIN; sdi-11/93; Puerperal; Ovarian vein; Pulmonary emboli; in; CT scan; magnetic resonance imaging; abnormalities Notes : The authors report the case of puerperal thrombosis of the right ovarian vein complicated by recurrent small pulmonary emboli in a 32 year old woman. The clinical features of this rare condition are reviewed. The echographic, angiographic and CT scan and magnetic resonance imaging abnormalities are described. The authors underline the value of non-invasive radiological investigations for early diagnosis. The patient was rapidly improved by medical therapy with antibiotics and heparin. Ref ID : SCARDIGNO1981 1087. Scardigno, A. and Petruzzellis, V. [PREVENTION OF PATHOLOGIC VEIN DERMATITIS]. Chron.Dermatol. 12:267-275, 1981. Keywords : PATHOLOGIC; vein; Dermatitis; PREVENTION; THERAPY; VARICOSE VEINS; VEINS; THROMBOPHLEBITIS; Skin; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; NASP; HUMAN; Neoplasms; Varicose Ulcer; Cancerlit File; ab; varicose; in; is; ad; di; Italy Notes : TT - LA PREVENZIONE DELLE DERMATITI FLEBOPATICHE AB - Prevention program for pathologic vein dermatitis was analyzed and the following topics were discussed: social and medical aspects, prevention and therapy of varicose veins, acute thrombophlebitis, and prevention of damage in micro vessels associated with damage of tissues, especially skin. Venous thrombosis can be caused by different factors; in 5% of cases it is due to tumors. (12 Refs) AD - Clinica dermosifilopatica IIa AD - Universita degli Studi di Bari AD - Bari AD - Italy UI - 82603099. Ref ID : SCHAFER1985 1088. Schafer, A.I. The hypercoagulable state. Ann.Intern.Med. 102:814- 828, 1985. Keywords : HYPERCOAGULABLE; THROMBOSIS Ref ID : SCHIEBLER1993 1089. Schiebler, M.L., Holland, G.A., Hatabu, H., Listerud, J., Foo, T., Palevsky, H., Edmunds, H., and Gefter, W.B. Suspected pulmonary embolism: prospective evaluation with pulmonary MR angiography. Radiology. 189:125-131, 1993. Keywords : PULMONARY EMBOLISM; EMBOLISM; PROSPECTIVE; MR; ANGIOGRAPHY; TECHNIQUES; Methods; CHRONIC; EMBOLI; Pulse; ARTERIAL; SENSITIVITY; sdi- 11/93; in; Pulmonary emboli Notes : PURPOSE: To prospectively evaluate three magnetic resonance (MR) imaging techniques for detection of pulmonary embolism. MATERIALS AND METHODS: Eighteen patients in whom the presence of acute or chronic pulmonary emboli was suspected underwent examination with the following pulse sequences: cardiac-gated spin echo, cine spatial modulation of magnetization, and two-dimensional time-of-flight pulmonary breath-hold (PBH) MR angiography. Three radiologists independently and blindly reviewed each case and graded a total of 518 arterial segments for each pulse sequence with a continuous scale of 0%-100% for likelihood of pulmonary embolism. RESULTS: The overall sensitivity of PBH MR angiography for detection of acute pulmonary emboli was 0.85; for chronic emboli, which were smaller in anteroposterior (AP) diameter, the overall sensitivity was 0.42. Emboli larger than 1 cm in AP diameter were typically identified with > 75% confidence with all pulse sequences. CONCLUSION: Acute pulmonary emboli greater than 1 cm in AP diameter were as accurately identified on PBH MR angiograms obtained in 15 seconds as they were on MR images obtained with longer pulse sequences not dependent on breath holding. Ref ID : SCHIEFERDECKER1992 1090. Schieferdecker, G. and Bartel, M. [Thrombophlebitis and ulcus cruris caused by primary varicose veins of the lower extremity. Diagnostic and therapeutic consequences for the general practitioner]. Z.Arztl.Fortbild.(Jena) 86:611-615, 1992. Keywords : VEINS; Extremities; NASP; ADULT; Family Practice; FEMALE; HUMAN; MALE; MIDDLE AGE; Plethysmography; THROMBOPHLEBITIS; Ultrasonography; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; diagnostics; ab; ad Notes : TT - Phlebothrombose und Ulcus cruris infolge primarer Stammvarikosis der unteren Extremitat. Diagnostische und therapeutische Konsequenzen fur den Allgemeinmediziner AB - [No Abstract Available] AD - Klinik und Poliklinik fur Chirurgie AD -Medizinischen Fakultat AD - Friedrich-Schiller-Universitat AD -Jena UI - 92343191. Ref ID : SCHIFF1987 1091. Schiff, M.J., Feinberg, A.W., and Naidich, J.B. Noninvasive venous examinations as a screening test for pulmonary embolism. Arch.Int.Med. 147:505, 1987. Keywords : VENOUS; EMBOLISM; PULMONARY EMBOLISM; NONINVASIVE; SCREENING Ref ID : SCHLANGER1986 1092. Schlanger, R.E., Henry, M.L., Sommer, B.G., and Ferguson, R.M. Identification and treatment of cyclosporine-associated allograft thrombosis. Surgery 100:329-333, 1986. Keywords : TREATMENT; THROMBOSIS; ACEP-93; ACEP93 Ref ID : SCHMIDT1992 1093. Schmidt, U., Enderson, B.L., Chen, J.P., and Maull, K.I. D-dimer levels correlate with pathologic thrombosis in trauma patients. J.Trauma. 33:312-9; discussion 319-20, 1992. Keywords : EMBOLISM; TRAUMA; D-DIMER; PATHOLOGIC; THROMBOSIS; PULMONARY EMBOLISM; PE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; DVT; CAUSE; MORBIDITY; MORTALITY; diagnostics; FIBRIN; FIBRIN DEGRADATION PRODUCTS; HYPERCOAGULABILITY; RISK; ADULT; RESPIRATORY DISTRESS; RESPIRATORY DISTRESS SYNDROME; Syndrome; LATE; in; an Notes : Pathologic thrombosis, in the form of pulmonary embolism (PE) and deep venous thrombosis (DVT), causes significant morbidity and mortality in trauma patients and presents a diagnostic and therapeutic challenge because of associated conditions in these patients. This study examines the measurement of D-dimer crosslinked fibrin degradation products (D-dimer XDPs) as an indicator of hypercoagulability that places a trauma patient at risk of developing pathologic thrombosis. The time course of changes in D-dimer values after trauma normally involves an initial increase with a rapid decrease of D-dimer XDP levels to normal. Patients who then demonstrate a second rise in D-dimer values are at risk for pathologic thrombosis. Forty-one trauma patients were studied, in two groups, to evaluate the potential use of D-dimer XDP levels in evaluating the risk of pathologic thrombosis. A secondary increase in D-dimer XDP levels was found to occur in patients with PE, although sepsis and adult respiratory distress syndrome can also cause a late increase. However, D-dimer determinations appear to provide an easy, relatively inexpensive means of evaluating trauma patients for the risk of pathologic thrombosis. Ref ID : SCHNEIDER1967 1094. Schneider, W. and Fischer, H. [Circulatory disorders of the lower limbs: clinical picture and conservative therapy (general summary)]. Asthet.Med.(Berl) 16:35-42, 1967. Keywords : THERAPY; NASP; HUMAN; LEG; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Die Durchblutungsstorungen der unteren Extremitat: Klinisches Bild und konservative Therapie (Ubersichtsreferat) AB -[No Abstract Available] UI - 68358763. Ref ID : SCHNEIDER1974 1095. Schneider, W. and Fischer, H. Histologie des varices sclerosees. Phlebologie 27(4):411-416, 1974. Keywords : VARICES; PATHOLOGIC; SCLEROSANT; ENDOTHELIAL; THROMBUS; ENDOTHELIUM; THROMBOSIS; COLLAGEN; HISTOLOGY; PATHOPHYSIOLOGY; SCLEROTHERAPY; de; VARICOSITIES; Edema; is; in Notes : Pathologic examination of a varicosity 3 hours after the infusion of sclerosant reveals swollen, damaged, and absent endothelial cells, with slight intimal edema. The media and the adventitia are normal. There is minimal thrombus present, and flow is preserved. At 12 hours a fibrin-poor thrombus may be seen within the lumen, closely adherent where the endothelium is absent and less so where the endothelium is merely swollen or is intact. At 24 hours the thrombus is tightly bound to the vessel wall, which is undergoing lamellar disintigration. Erythrocytic infiltration of the intima is observed. A leukocytic infiltration is noted within the adventitia. The media appears normal. Not until the 14th to 18th day does a fully organized clot occupy the lumen of the vessel. The authors hold the stage of thrombosis formation and organisation to be essential. In their view, the thrombus provides the scaffolding which permits histiocytic infiltration, collagen deposition, and replacement of the vessel lumen with connective tissue. Ref ID : SCHRODER1993 1096. Schroder, H.M. and Andreassen, M. Autopsy-verified major pulmonary embolism after hip fracture. Clin.Orthop. :196-203, 1993. Keywords : 951202; PULMONARY EMBOLISM; EMBOLISM; HIP; FRACTURES; Retrospective Studies; AGE; ANTICOAGULATION; Died; hospitalization; in; AUTOPSY; PE; Segmental; Arteries; FREQUENCY; neck; ADULT; AGED; Aged,80 and over; ANTICOAGULANTS; tu; sn; FEMALE; femoral neck fractures; mo; su; hip fractures; HUMAN; MALE; MIDDLE AGE; et; RISK FACTORS; Medline File; an; denmark Notes : This retrospective study included 1812 hip-fracture patients 40 years of age or older who did not receive prophylactic anticoagulation. Two hundred seventy-three patients (15.1%) died within 90 days after hospitalization. In 180 autopsies, 27 cases of major pulmonary embolism (PE), defined as occluding at least one lobar or several segmental arteries, were found. Based on an autopsy frequency of 72%, a rate of 1.4% major PEs during the first 30 days could be estimated. No major PE was found among patients with femoral neck fractures treated conservatively or by internal fixation or among patients younger than 66 years of age University Department of Orthopaedics Aarhus Kommunehospital Denmark. Ref ID : SCHULMAN1984 1097. Schulman, S. and Lockner, D. Local venous infusion of streptokinase in DVT. Thromb.Res. 34:213, 1984. Keywords : VENOUS; STREPTOKINASE; DVT; THERAPY; THROMBUS; VEINS; PULMONARY EMBOLISM; in; LYTIC; is; CATHETER; vein 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 : SCHULMAN1995 1098. Schulman, S., Rhedin, A.S., Lindmarker, P., Carlsson, A., Larfars, G., Nicol, P., Loogna, E., Svensson, E., Ljungberg, B., and Walter, H. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group [see comments]. N.Engl.J.Med. 332(25):1661-1665, 1995. Keywords : 951217; ANTICOAGULANT; THERAPY; VENOUS; THROMBOEMBOLISM; DURATION; ANTICOAGULATION; is; Methods; TREATMENT; in; WARFARIN; CONGENITAL; PROTEIN C; VENOGRAPHY; SCANNING; ANGIOGRAPHY; PULMONARY EMBOLISM; EMBOLISM; RECURRENCE; FOLLOWUP; diagnostics; confidence intervals; odds ratio; MORTALITY; HEMORRHAGE; ANTICOAGULANTS; ad; tu; COMPARATIVE STUDY; FEMALE; Follow-Up Studies; et; HUMAN; MALE; MIDDLE AGE; PROBABILITY; co; dt; mo; Support,Non-U.S.Gov't; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; TREATMENT OUTCOME; Medline File; Health Planning & Administration File; internal medicine; Hospitals; Sweden; International normalized ratio; INR Notes : BACKGROUND. The optimal duration of oral anticoagulant therapy after a first episode of venous thromboembolism is still a matter of debate. METHODS. We performed a multicenter trial comparing six weeks of oral anticoagulant treatment with six months of such therapy in patients who had a first episode of venous thromboembolism. Anticoagulant therapy consisted of warfarin or dicumarol. Of the 902 patients enrolled, 5 were later excluded because they had congenital protein C deficiency; 443 were randomly assigned to receive six weeks of oral anticoagulant therapy with a targeted international normalized ratio (INR) of 2.0 to 2.85, and 454 were randomly assigned to receive six months of such therapy. The initial diagnoses were confirmed by means of venography in cases of deep-vein thromboses (n = 790) and with perfusion-ventilation scanning or angiography in cases of pulmonary embolism (n = 107); recurrences were confirmed in the same way. RESULTS. After two years of follow-up, there had been 123 recurrences of venous thromboembolism that met the diagnostic criteria, 80 in the six-week group (18.1 percent; 95 percent confidence interval, 14.5 to 21.6) and 43 in the six-month group (9.5 percent; 95 percent confidence interval, 6.8 to 12.2). The odds ratio for recurrence in the six-week group was 2.1 (95 percent confidence interval, 1.4 to 3.1). There was no difference in mortality or the rate of major hemorrhage between the six-week and six-month groups. CONCLUSIONS. Six months of prophylactic oral anticoagulation after a first episode of venous thromboembolism led to a lower recurrence rate than did treatment lasting for six weeks. The difference between the two groups occurred between 6 weeks and 6 months after the start of treatment, and the rates of recurrence remained nearly parallel for 1 1/2 years thereafter Department of Internal Medicine Karolinska Hospital Stockholm Sweden. Ref ID : SCHULZEBERGMANN1975 1099. Schulze-Bergmann, G. [Limits of conservative and surgical treatment of the varicose symptom complex]. Z.Hautkr. 50:147-152, 1975. Keywords : SURGICAL; TREATMENT; NASP; Hemangioma; HUMAN; Klippel- Trenaunay Disease; PHLEBOGRAPHY; Postoperative Complications; Purpura,Thrombocytopenic; Sclerosing Solutions; Skin Neoplasms; Syndrome; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - Grenzen der konservativen und chirurgischen Behandlung des varikosen Symptomenkomplexes AB - [No Abstract Available] UI -75180396. Ref ID : SCHWARZ1976 1100. Schwarz, N., Feigl, W., Neuwirth, E., and Holzner, J.H. [Venous thromboses and pulmonary emboli in autopsy material (author's transl)]. Wien.Klin.Wochenschr. 88:423-428, 1976. Keywords : 951202; Pulmonary emboli; EMBOLI; in; AUTOPSY; VENOUS; VEINS; ADULT; CALF; THROMBOSIS; CARDIOVASCULAR; cardiovascular diseases; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; FATAL; CAUSE; INCIDENCE; VENOUS THROMBOSIS; AGE; FEMALE; PROGNOSIS; is; Adolescence; Age Factors; AGED; austria; Body Weight; English Abstract; HUMAN; MALE; MIDDLE AGE; Neoplasms; PA; ep; Sex Factors; THROMBOPHLEBITIS; Medline File Notes : Venous thromboses of the pelvic veins and the veins of the lower limbs were found in 40% of the post mortems carried out on 1350 adults during 1974. The thromboses were bilaterally located in the calf veins in the vast majority of cases. The predominating underlying diseases of patients with thrombosis were malignant neoplasia or cardiovascular diseases. 319 cases (23.5%) showed massive pulmonary embolism. The pulmonary embolism had taken a fulminating fatal course in 7.8% of cases. Thromboses of the lower limb veins seem to have a higher tendency to become mobilized to cause fatal pulmonary embolism than thromboses occurring in other sites. A significantly higher incidence of venous thrombosis, as well as of pulmonary embolism, was found in higher age groups and in female patients; the prognosis is, moreover, grave in these cases. A significant increase in the incidence of venous thromboses and pulmonary embolism-especially those with a rapidly fatal course-has been registered over the past years as compared with previous investigations. Ref ID : SCHWARZ1985 1101. Schwarz, F. Sustained improvement of pulmonary hemodynamics in patients at rest and during exercise after thrombolytic treatment of massive pulmonary embolism. Circulation 71:117, 1985. Keywords : HEMODYNAMICS; EXERCISE; THROMBOLYTIC; TREATMENT; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; in; Rest Ref ID : SCOTT1988 1102. Scott, J.A., Pascuzzi, R.M., Hall, P.V., and Becker, G.J. Treatment of dural sinus thrombosis with local urokinase infusion. Case report. J.Neurosurg. 68:284-287, 1988. Keywords : TREATMENT; THROMBOSIS; UROKINASE; CASE REPORT; ACEP93 Ref ID : SCOTT1990B 1103. Scott, H.J. and Coleridge Smith, P.D. Tissue pressure, posture, and venous ulceration [letter]. Lancet 336:1585, 1990. Keywords : Pressure; Posture; VENOUS; venous ulceration; ULCERATION; NASP; leg ulcer - etiology; thrombophlebitis - complications; venous insufficiency - complications; HUMAN Ref ID : SCURR1985 1104. Scurr, J.H., Coleridge-Smith, P., and Cutting, P. Varicose veins: optimum compression following sclerotherapy. Ann.R.Coll.Surg.Engl. 67:109-111, 1985. Keywords : VARICOSE VEINS; VEINS; COMPRESSION; SCLEROTHERAPY; TECHNIQUES; Pressure; STOCKINGS; COMPLICATIONS; TREATMENT; LEG; INCIDENCE; THROMBOPHLEBITIS; COST; NASP; ADULT; AGED; BANDAGES; CLINICAL TRIALS; Clothing; COMPARATIVE STUDY; FEMALE; HUMAN; MALE; MIDDLE AGE; RANDOM ALLOCATION; Sclerosing Solutions; Medline File; varicose; ab; is; standards; in; Injections; Superficial thrombophlebitis Notes : AB - There is uncertainty regarding the most satisfactory technique of lower limb compression following sclerotherapy for varicose veins. We have compared a standard bandaging technique with a high pressure compression stocking in a randomised trial. Efficacy was judged on the success of injections, complications of the treatment and patient satisfaction. In the stockinged legs 144 of 156 injections were successful, compared with 117 of 147 in the bandaged group (P less than 0.001) (Chi squared). The incidence of superficial thrombophlebitis was also reduced in the stocking group. In addition, the stocking technique costs less in materials than conventional bandaging. We would recommend compression stockings for evaluation in sclerotherapy of varicose veins UI - 85147301. Ref ID : SEABROOK1991 1105. Seabrook, G.R., Mewissen, M.W., Schmitt, D.D., Reifsnyder, T., Bandyk, D.F., Lipchik, E.O., and Towne, J.B. Percutaneous intraarterial thrombolysis in the treatment of thrombosis of lower extremity arterial reconstructions. J.Vasc.Surg. 13:646-651, 1991. Keywords : INTRAARTERIAL; THROMBOLYSIS; TREATMENT; THROMBOSIS; ARTERIAL; ACEP93; in; Extremities Ref ID : SECCIA1991 1106. Seccia, A. and Salgarello, M. Treatment of angiomas with sclerosing injection of hydroxypolyethoxydodecan. Angiology 42:23-29, 1991. Keywords : TREATMENT; Injections; INDICATIONS; VENOUS; SCLEROSING AGENTS; EMBOLIZATION; SURGERY; TECHNIQUES; Methods; SCLEROSIS; Blood Vessels; THERAPY; CAUSE; SURGICAL; BLEEDING; NASP; hemangioma - therapy; polyethylene glycols - therapeutic use; SCLEROTHERAPY; Adolescence; ADULT; CHILD; Extremities; facial neoplasms - therapy; FEMALE; HUMAN; MALE; MIDDLE AGE; mouth neoplasms - therapy; sclerotherapy - adverse effects; sclerotherapy - methods; in; blood; an Notes : The authors discuss the indications for hydroxypolyethoxydodecan in the sclerosing treatment of angiomas, with particular reference to cavernous, venous, and evolutive angiomas (ie, immature angiomas that fail to involute by eight to ten months). Moreover, the sclerosing agent may be employed, in connection with embolization and subsequent surgery, in arteriovenous angiomas with a relevant cutaneous-subcutaneous development. The authors have successfully used the "interstitial? sclerosing technique, according to Andrews' method. This technique involves interstitial injections to obtain the sclerosis of the thin threads of fibrous tissue stroma between the blood vessels. The sclerosing therapy may cause the complete regression of "low flow? angiomas or, at least, a partial reduction that simplifies the ensuing surgical excision. In the case of partial regression of the angioma obtained with the sclerosing therapy, the surgery of the remaining angioma causes a lesser degree of bleeding (especially in areas that do not particularly lend themselves to surgical exploration, ie, the oral cavity); an increased reliability in the radicality of the intervention (due also to the reduced size of the lesion); and better results from an aesthetic-functional point of view. Ref ID : SEIFRIED1991 1107. Seifried, E., Gabelmann, A., Ellbruck, D., and Schmidt, A. [Thrombolytic therapy of pulmonary artery embolism in early pregnancy with recombinant tissue-type plasminogen activator] Thrombolytische Therapie einer Lungenarterienembolie in der Fruhschwangerschaft mit rekombinantem Gewebe-Plasminogen-Aktivator. Geburtshilfe.Frauenheilkd. 51:655-658, 1991. Keywords : EMBOLISM; PREGNANCY; THERAPY; PULMONARY ARTERY; ARTERY; EARLY; PLASMINOGEN; THROMBOLYTIC; TREATMENT; MASSIVE; PULMONARY EMBOLISM; PLASMINOGEN ACTIVATOR; rt-PA; BLEEDING; COMPLICATIONS; THROMBOEMBOLIC; ANTICOAGULATION; Molecular Weight; HEPARIN; CASE REPORT; FEMALE; HUMAN; Alteplase ,Administration and Dosage ,AD; Pregnancy Complications,Hematologic ,Therapy ,TH; Pulmonary Embolism ,Therapy ,TH; ADULT; Combined Modality Therapy; Heparin ,Administration and Dosage ,AD; Heparin,Low-Molecular-Weight ,Administration and Dosage ,AD; Pregnancy Complications,Hematologic ,Blood ,BL; Pregnancy Trimester,First; Pulmonary Embolism ,Blood ,BL; Pulmonary Wedge Pressure ,Drug Effects ,DE; Recombinant Proteins ,Administration and Dosage ,AD; in; ab Notes : CS- Abteilungen Innere Medizin III, Medizinische Universitatsklinik und Poliklinik, Ulm AB- We report on successful thrombolytic treatment of massive pulmonary embolism in a patient in early pregnancy with recombinant tissue-type plasminogen activator (rt- PA). Therapy was started with 20 mg rt-PA intravenously over 20 minutes, followed by two further infusions of 20 mg rt-PA within the next 8 hours. Clinical symptoms and haemodynamic parameters improved 24 hours after initiation of therapy. No bleeding complications were observed and the foetus was not affected. Further thromboembolic episodes could be prevented by anticoagulation with low molecular weight heparin up to full term normal delivery. Ref ID : SERMEUS1992 1108. Sermeus, L., Van Hemelrijck, J., Vandommele, J., and Van Aken, H. Pulmonary embolism confirmed by transoesophageal echocardiography. Anaesthesia. 47:28-29, 1992. Keywords : PULMONARY EMBOLISM; EMBOLISM; Echocardiography; TOURNIQUET; KNEE; DIAGNOSIS; ECG; CARBON DIOXIDE; OXYGEN; Pulse; CARDIOPULMONARY BYPASS; PULMONARY ARTERY; ARTERY; sdi-11/93; an; Pneumatic; in Notes : A 60-year-old patient suffered a pulmonary embolism following the application of an Esmarch and pneumatic tourniquet before arthroscopy of the knee. The diagnosis was suspected because of sudden hypotension, ECG changes, a decrease in end-expiratory carbon dioxide concentration and oxygen desaturation as indicated by pulse oximetry. Before performing a sternotomy and cardiopulmonary bypass for removal of pulmonary artery clots, the diagnosis was confirmed by the demonstration of severe right ventricular strain using transoesophageal echocardiography. Ref ID : SEVITT1959 1109. Sevitt, S. and Gallagher, N.G. Prevention of venous thrombosis and pulmonary embolism in injured patients. Lancet ii:981-989, 1959. Keywords : PREVENTION; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; SURGERY; PE; DEATH; in; 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 : SEYMOUR1992 1110. Seymour, J. Duration of anticoagulation for deep-vein thrombosis and pulmonary embolism [letter]. Lancet 340:1297, 1992. Keywords : ANTICOAGULATION; DEEP VEIN THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; DURATION Ref ID : SHACKFORD1990 1111. Shackford, S.R., Davis, J.W., Hollingsworth-Fridlund, P., Brewer, N.S., Hoyt, D.B., and Mackersie, R.C. Venous thromboembolism in patients with major trauma. Am.J.Surg. 159:365-369, 1990. Keywords : EMBOLISM; TRAUMA; VENOUS; THROMBOEMBOLISM; RISK; RISK FACTORS; INCIDENCE; COMPRESSION; PROPHYLAXIS; ANTICOAGULATION; AGE; regression analysis; ANTICOAGULANT; INJURY; in; is; Pneumatic; analysis; injuries Notes : The risk of venous thromboembolism after trauma is thought to be high, but the specific risk factors and the incidence of venous thromboembolism in the trauma population are poorly defined. Between October 1, 1987, and March 1, 1988, 719 patients were evaluated; 542 had no risk factors and 177 had at least 1 risk factor. No venous thromboembolism occurred in any of the 542 patients without a risk factor, whereas 12 of 177 patients (7%) with at least 1 risk factor had a venous thromboembolism. Pneumatic compression hose was the most common form of prophylaxis used, but it could not be applied to 35% of limbs because of plaster immobilizers, external fixators, complex wounds, or traction. In the high-risk group, 25 patients (14%) received no prophylaxis because of a physical impediment to application of these hose and a contraindication to anticoagulation. Age greater than 45 years was the only risk factor predictive of venous thromboembolism by logistic regression analysis. Patients with more than one risk factor had a significantly higher incidence of venous thromboembolism than those with only one risk factor. We conclude that a selected subgroup of trauma patients appears to be at risk of venous thromboembolism and should receive prophylaxis. Approximately one in seven high-risk patients cannot receive anticoagulant or mechanical prophylaxis because of their injuries. Ref ID : SHALIMOV1981 1112. Shalimov, A.A., Driuk, N.F., Turaev, P.I., Pisklivets, Z.S., and Bul'ba, N.K. [Pathogenesis of trophic disorders and the combined treatment of the postthrombophlebitis syndrome of the legs in the tissue induration and ulceration stage]. Klin.Khir. :1-6, 1981. Keywords : TREATMENT; Syndrome; LEG; ULCERATION; NASP; ADULT; English Abstract; Follow-Up Studies; HUMAN; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Patogenez troficheskikh rasstroistv i kompleksnoe lechenie bol'nykh s tromboflebiticheskim sindromom nizhnikh konechnostei v stadii induratsii i iz"iazvleniia tkanei AB - [No Abstract Available] UI - 82011552. Ref ID : SHARMA1977 1113. Sharma, G.V.R.K. Thrombolytic therapy of deep vein thrombosis. In: Thrombolysis and Urokinase,Anonymous New York:Academic Press, 1977, Keywords : THROMBOLYTIC; THERAPY; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; VENOUS; REFLUX; ANTICOAGULATION; THROMBOLYSIS; UROKINASE; THROMBOLYTIC THERAPY; vein; LYTIC; Plethysmography; in Notes : Lytic therapy can prevent these sequelae: impedence plethysmography shows normal flow patterns without deep venous reflux in 75 percent of patients after lytic therapy but in only 25 percent of patients treated with anticoagulation alone. Ref ID : SHARMA1980 1114. Sharma, G.V.R.K., Burleson, V., and Sasahara, A.A. Effect of thrombolytic therapy on pulmonary capillary blood volume in patients with pulmonary embolism. New.Engl.J.Med. 303:842, 1980. Keywords : THROMBOLYTIC; THERAPY; PULMONARY EMBOLISM; EMBOLISM; PULMONARY CAPILLARY VOLUME; THROMBOLYTIC THERAPY; Capillaries; blood; Blood Volume; in Ref ID : SHARMA1982 1115. Sharma, G.V.R.K., Cella, G., Parisi, A.F., and Sasahara, A.A. Thrombolytic Therapy. The New England Journal of Medicine 306(21):1268- 1276, 1982. Keywords : 96-suzy-002; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY Notes : 01-04-96. Abstract : No abstract available. Ref ID : SHARMA1990 1116. Sharma, G.V.R.K., Folland, E.D., and McIntyre, K.M. Long-term hemodynamic benefit of thrombolytic therapy in pulmonary embolic disease. J.Am.Coll.Cardiol. 15(2):65A, 1990. Keywords : LONG TERM; HEMODYNAMICS; THROMBOLYTIC; THERAPY; PULMONARY EMBOLISM; THROMBOLYTIC THERAPY; in Ref ID : SHARMA1992 1117. Sharma, G.V.R.K. Rationale for aggressive management of pulmonary embolism using thrombolytic agents. In: Latest concepts and management of acute venous thromboembolic disease, edited by Comerota, A.J.Coronado:Abbott Symposium, 1992,p. 20-24. Keywords : MANAGEMENT; PULMONARY EMBOLISM; EMBOLISM; THROMBOLYTIC; VENOUS; THROMBOEMBOLIC Ref ID : SHATTIL1984 1118. Shattil, S. Diagnosis and treatment of recurrent venous thromboembolism. Medical Clinics of North America 68:577-600, 1984. Keywords : DIAGNOSIS; TREATMENT; VENOUS; THROMBOEMBOLISM; NASP Ref ID : SHERRY1969 1119. Sherry, S. Thrombosis, Washington, DC:National Academy of Sciences, 1969. Keywords : THROMBOSIS; THROMBOEMBOLISM; SCLEROTHERAPY; RISK; THROMBOCYTOSIS; ULCERATIVE COLITIS; Carcinoma Notes : Disease entities reported to have increased risk of thromboembolism include homocysteinuria, thrombocytosis, p. vera, ulcerative colitis, carcinoma, and the Shwartzman reaction (immunologic generalized thrombosis). Ref ID : SHEVKUNOV1973 1120. Shevkunov, V.A. [Treatment of varicose veins of the lower extremities with sclerosing solutions under ambulatory care]. Khirurgiia.(Mosk). 49:56-58, 1973. Keywords : VARICOSE VEINS; VEINS; Extremities; Sclerosing Solutions; AMBULATORY; NASP; ADULT; Ambulatory Care; Drug Hypersensitivity; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; varicose; ab Notes : TT - Lechenie varikoznogo rasshireniia ven nizhnikh konechnostei v ambulatornykh usloviiakh AB - [No Abstract Available] UI -74048119. Ref ID : SHIFFMAN1988 1121. Shiffman, F., Ducas, J., Hollett, P., Israels, E., Greenberg, D., Cook, R., and Prewitt, R.M. Treatment of canine embolic pulmonary hypertension with recombinant tissue plasminogen activator. Efficacy of dosing regimes. Circulation 78:214-220, 1988. Keywords : TREATMENT; Hypertension; PLASMINOGEN; PLASMINOGEN ACTIVATOR; CANADA; rt-PA; Sodium; HEPARIN; THROMBOLYSIS; PULMONARY HYPERTENSION; Injections; LUNG; HEMODYNAMICS; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; CONTRAST; LYSIS; DOGS; THERAPY; PULMONARY EMBOLISM; EMBOLISM; ANIMAL; Support,Non-U.S.Gov't; Alteplase ,Administration and Dosage ,AD; Hypertension,Pulmonary ,Drug Therapy ,DT; Pulmonary Embolism ,Drug Therapy ,DT; Drug Administration Schedule; Heparin ,Therapeutic Use ,TU; Hypertension,Pulmonary ,Etiology ,ET; Pulmonary Embolism ,Complications ,CO; TIME FACTORS; ab; in; blood; an Notes : CS- Department of Medicine, University of Manitoba Health Sciences Centre, Winnipeg, Canada AB- We investigated effects of two dosing regimes of recombinant tissue plasminogen activator (rt-PA) and sodium heparin on pulmonary thrombolysis in a canine model of pulmonary hypertension, induced by injection of radioactive blood clots. By continuously counting over both lung fields with a mobile gamma camera, we correlated rate and extent of pulmonary thrombolysis with corresponding pulmonary hemodynamics. Treatment with heparin, over a 3- hour interval, did not result in significant thrombolysis or in a decrease in mean pulmonary artery pressure (PAP). In contrast, rt-PA caused marked pulmonary thrombolysis. While total clot lysis was similar when 1 mg/kg rt-PA was infused over 15 (rt-PA15) or 90 (rt-PA90) minutes (47% and 42%, respectively), rate of lysis during infusion was markedly increased with rt-PA15 (56% vs. 27%/hr, p less than 0.001). Corresponding to the increased rate of thrombolysis with rt-PA15, relative PAP decrease was greater at 15 and 30 minutes. At 4 hours, PAP decreased most with rt-PA90. However, two of the six dogs given rt-PA15 had an increase in PAP and lung radioactivity 1 hour after rt-PA. This was associated with dislodgment of a previously trapped clot. These results suggest that rt-PA may be appropriate therapy for pulmonary embolism and support further studies designed to optimize dosing regimes. Ref ID : SHIONOYA1989 1122. Shionoya, S., Yamada, I., Sakurai, T., Ohta, T., and Matsubara, J. Thrombectomy for acute deep vein thrombosis: prevention of postthrombotic syndrome. J.Cardiovasc.Surg.(Torino). 30:484-489, 1989. Keywords : THROMBECTOMY; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PREVENTION; Syndrome; ACEP-93; VEINS; ACEP93; 96-suzy-002; Extremities; in; INCIDENCE; STASIS; Ulcer; FOLLOWUP; TREATMENT; ULCERATION; THROMBI; LEG; is; EARLY; VENOUS; venous valve; VENOUS VALVES; VENOUS THROMBOSIS Notes : 01-03-96. Abstract : Summary.-Ninety-six limbs of 89 patients with acute deep vein thrombosis of the lower extremity were followed for 1 to 18 years. In the thrombectomy group (43 limbs), the cumulative incidence of pigmentation at the 15th year was 15%, but no stasis ulcers occurred throughout the follow-up period. In the conservative treatment group (53 limbs), the cumulative incidence of pigmentation at the 15 year was 41%, and that of stasis ulceration was 27%. Fogarty thrombectomy restricted below the pelvic vein spur and removal of thrombi in the leg vein by manual milking is sufficient to relieve early morrbidity, preserve venous valve function, and promote intrapelvic collateral circulation. Preservation of venous valves in the femoropopliteal region is a key to the prevention of postthrombotic syndrome. Thrombectomy within 5 days of the onset of symptoms is recommended for patients with iliofermoropopliteal venous thrombosis. Ref ID : SHISHIDO1994 1123. Shishido, M., Ohtsuki, Y., Ichiki, H., and Nishitani, K. [A case of idiopathic pulmonary fibrosis associated with bilateral pulmonary arterial thrombosis found at autopsy]. Nippon.Kyobu.Shikkan.Gakkai.Zasshi. 32:1026-1031, 1994. Keywords : 951202; Fibrosis; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; Hospitals; Exertion; CHEST; radiography; drugs; RECURRENCE; Pulse; THERAPY; TREATMENT; RESPIRATORY DISTRESS; an; Atrial fibrillation; Died; AUTOPSY; THROMBI; in; PULMONARY ARTERY; Arteries; THROMBUS; HISTOLOGICAL; LUNG; PNEUMONIA; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; AGED; CASE REPORT; English Abstract; fatal outcome; FEMALE; HUMAN; PULMONARY EMBOLISM; co; PA; pulmonary fibrosis; Medline File; dyspnea; laboratories; japan Notes : A 73-year-old woman admitted to the hospital with dyspnea on exertion. Chest radiography revealed a diffuse interstitial shadow; PaO2 was 72 Torr, and PaCO2 was 41 Torr. Laboratory examination results were compatible with idiopathic pulmonary fibrosis (IPF). Prednisolone relieved the dyspnea, but tapering of the drug led to a recurrence of this symptom. Pulse therapy was started and azathioprine was added to the corticosteroid. Over the course of 6 months of treatment, the patient's respiratory function remained fairly stable. Then respiratory distress was induced by an attack of atrial fibrillation, with relief provided by anti-arrhythmic drugs and large doses of corticosteroids. The patient died suddenly 3 weeks later. An autopsy revealed large thrombi in both pulmonary arteries with 90% stenosis. Parts of the thrombi were organized, which suggests that 2-3 weeks had elapsed since initial thrombus formation. Histological examination of lung tissue showed usual interstitial pneumonia. Pulmonary thromboembolism should be considered in patients with IPF if respiratory distress suddenly and unexpectedly worsens Department of Internal Medicine Niihama Prefectural Hospital Ehime Japan. Ref ID : SHOULER1989 1124. Shouler, P.J. and Runchman, P.C. Varicose veins: optimum compression after surgery and sclerotherapy [see comments]. Ann.R.Coll.Surg.Engl. 71:402-404, 1989. Keywords : VARICOSE VEINS; VEINS; COMPRESSION; SURGERY; SCLEROTHERAPY; STOCKINGS; SURGICAL; TREATMENT; vein; THROMBOPHLEBITIS; BANDAGES; LEG; Hospitals; NASP; ADULT; AGED; CLINICAL TRIALS; FEMALE; HUMAN; MALE; MIDDLE AGE; Postoperative Period; Medline File; varicose; ab; graduated compression stockings; in; Ankle; varicose vein; vein surgery; is; ad Notes : AB - Graduated compression stockings are used in both surgical and non- surgical treatment of varicose veins. In a trial of high versus low compression stockings (40 mmHg vs 15 mmHg at ankle) after varicose vein surgery, both were equally effective in controlling bruising and thrombophlebitis, but low compression stockings proved to be more comfortable. In a further trial after sclerotherapy, high compression stockings alone produced comparable results to Elastocrepe bandages with stockings. It is concluded that after varicose vein surgery low compression stockings provide adequate support for the leg and that after sclerotherapy, bandaging is not required if a high compression stocking is used AD - Department of Surgery AD - Royal Naval Hospital AD - Gosport AD - Hants UI - 90103397. Ref ID : SHUMATE1995 1125. Shumate, M.J. Heparin-induced thrombocytopenia [letter]. N.Engl.J.Med. 333(15):1006; discussion 100, 1995. Keywords : 96-suzy-001; THROMBOCYTOPENIA; HEPARIN; therapeutic use; heparin,low-molecular-weight; immunology; HUMAN; igg; analysis; THROMBOSIS; prevention & control Ref ID : SHVEDOV1974 1126. Shvedov, N.I. [Post-thrombophlebitic syndrome (literature review)]. Khirurgiia.(Mosk). :132-141, 1974. Keywords : Syndrome; NASP; Blood Flow Velocity; Capillaries; Edema; HEMODYNAMICS; HUMAN; LEG; Manometry; Microcirculation; PHLEBOGRAPHY; Plethysmography,Impedance; Posture; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; VEINS; Venous Insufficiency; Medline File; ab Notes : TT - Posttromboflebiticheskii sindrom (obzor literatury) AB -[No Abstract Available] UI - 75136490. Ref ID : SIE1985 1127. Sie, P., DuPouy, D., Pichon, J., and Boneu, B. Constitutional heparin co-factor II deficiency associated with recurrent thrombosis. Lancet ii:414-416, 1985. Keywords : HEPARIN; THROMBOSIS; HEPARIN COFACTOR II; HYPERCOAGULABLE Ref ID : SIGEL1974 1128. Sigel, B., Ipsen, J., and Felix, W.R. The epidemiology of lower extremity deep venous thrombosis in surgical patients. Ann.Surg. 179:278-290, 1974. Keywords : EPIDEMIOLOGY; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SURGICAL; VARICOSITIES; RISK; DVT; AGE; VARICOSE VEINS; Extremities; DEEP VENOUS THROMBOSIS; in; is; an; RISK FACTORS Notes : It is widely believed, although unproven, that superficial varicosities are an independent risk factor for DVT. Kakkar and Nicolaides have both found that patients below age 60 with varicosities were 3 times more likely to have DVT when compared with those who had no varicosities. This finding has been disputed by Sigal, who found no such association. Ref ID : SIGG1950 1129. Sigg, K. Zur behandlung der varizen der phlebitis und ihrer komplikationen. Dermatologica 100:315-320, 1950. Keywords : PHLEBITIS; INCIDENCE; THROMBOSIS; SCLEROTHERAPY Ref ID : SIGG1970 1130. Sigg, K. [Conservative treatment of venous diseases in the leg]. Med.Klin. 65:972-977, 1970. Keywords : TREATMENT; VENOUS; NASP; ADULT; AGED; ANTICOAGULANTS; BANDAGES; Cortisone; Eczema; FEMALE; HUMAN; Injections,Intravenous; LEG; Leg Ulcer; Lymphedema; MALE; Methods; MIDDLE AGE; Sclerosing Solutions; Skin; Skin Transplantation; THROMBOPHLEBITIS; Transplantation,Homologous; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; in; ab Notes : TT - Konservative Behandlung venoser Beinerkrankungen AB - [No Abstract Available] UI - 71190854. Ref ID : SILVER1971 1131. Silver, D., Gleysteen, J.J., Rhodes, G.R., Georgiade, N.G., and Anlyan, W.G. Surgical treatment of the refractory postphlebitic ulcer. Arch.Surg. 103:554-560, 1971. Keywords : SURGICAL; TREATMENT; POSTPHLEBITIC; Ulcer; NASP; Adolescence; ADULT; Age Factors; AGED; Evaluation Studies; FEMALE; Follow-Up Studies; HUMAN; MALE; Methods; MIDDLE AGE; PHLEBITIS; PHLEBOGRAPHY; Postoperative Complications; PREGNANCY; RECURRENCE; THROMBOPHLEBITIS; TIME FACTORS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Venous Pressure; Medline File; ab Notes : AB - [No Abstract Available] UI - 72033426. Ref ID : SIMMONS1973 1132. Simmons, A.V., Sheppard, M.A., and Cox, A.F. Deep venous thrombosis after myocardial infarction. Predisposing factors. Brit.Heart J. 35:623-625, 1973. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MYOCARDIAL INFARCTION; DVT; PE; BEDREST; MI; ANTICOAGULATION; INCIDENCE; infarction; heart; 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 : SIMON1973 1133. Simon, M. Plain film and angiographic aspects of pulmonary embolism. In: Pulmonary Thromboembolism, edited by Moser, K.M. and Stein, M.Chicago:Year Book Medical Publishers, 1973, Keywords : PULMONARY EMBOLISM; EMBOLISM; ANGIOGRAPHY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; FILMS Ref ID : SIMONS1993 1134. Simons, G.R., Piwnica-Worms, D.R., and Goldhaber, S.Z. Ovarian vein thrombosis. Am.Heart J. 126(3 Pt 1):641-647, 1993. Keywords : 951216; Ovarian vein; vein; THROMBOSIS; REVIEW; CT; SCANNING; MRI; ULTRASOUND; in; POSTPARTUM; ASYMPTOMATIC; an; Carcinoma; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; ADULT; CASE REPORT; Diagnosis,Differential; FEMALE; HUMAN; magnetic resonance imaging; MIDDLE AGE; Ovary; bs; PHLEBOGRAPHY; PREGNANCY; Pregnancy Complications,Cardiovascular; di; Puerperal Disorders; Support,Non- U.S.Gov't; tomography,x-ray computed; VEINS; PA; Medline File; Cancerlit File; BRIGHAM; Hospitals; boston Notes : We report five cases of OVT and review the literature on this disease. Among our patients OVT was not suspected clinically and was diagnosed by CT scanning or MRI. Ultrasound imaging, utilized in three cases, failed to detect OVT. Although this disease usually occurs after delivery, in two cases it was diagnosed before delivery. Of the two postpartum cases, one had a typical presentation and the other was asymptomatic. The final case was diagnosed incidentally 5 months after removal of an ovarian carcinoma. Our experience suggests that this disease may be underdiagnosed. More widespread use of CT scanning and MRI may lead to more frequent diagnosis of OVT. The role that clinically silent OVT may play in peripartum pulmonary embolism should be clarified Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115. Ref ID : SIMONS1995 1135. Simons, G.R., Skibo, L.K., Polak, J.F., Creager, M.A., Klapec-Fay, J.M., and Goldhaber, S.Z. Utility of leg ultrasonography in suspected symptomatic isolated calf deep venous thrombosis. Am.J.Med. 99(1):43-47, 1995. Keywords : 951216; LEG; Ultrasonography; in; CALF; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; Duplex; Methods; CONTRAST; VENOGRAPHY; ULTRASOUND; an; vein; VEINS; FALSE-NEGATIVE; COMPRESSION; ADULT; AGED; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBOGRAPHY; predictive value of tests; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; ra; us; Medline File; BRIGHAM; Hospitals; boston Notes : PURPOSE: To evaluate the utility of duplex ultrasonography in patients with suspected symptomatic, isolated calf deep venous thrombosis. PATIENTS AND METHODS: Thirty patients with clinically suspected isolated calf deep venous thrombosis were examined with both duplex ultrasonography and contrast venography and the results were compared. RESULTS: Venography detected 7 cases of isolated calf deep venous thrombosis, all of which were also detected by ultrasonography. Ultrasound identified an additional 3 cases of soleal vein thrombosis, but venography did not visualize these veins. Of the 20 negative ultrasound studies, 11 were technically inadequate; however, no false- negative ultrasound studies were noted. CONCLUSIONS: Compression ultrasonography may be reliable for the evaluation of patients with suspected symptomatic infrapopliteal deep venous thrombosis. Its apparent superiority to contrast venography in visualizing muscular calf veins warrants further study; however, the high rate of technical inadequacy in ultrasound studies observed here, if confirmed in larger studies, may limit the usefulness of ultrasound in this setting Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts 02115 USA. Ref ID : SINGER1987 1136. Singer, I., Hutchins, G.M., Mirowski, M., Mower, M.M., Veltri, E.P., Guarnieri, T., Griffith, L.S., Watkins, L., Juanteguy, J., and Fisher, S. Pathologic findings related to the lead system and repeated defibrillations in patients with the automatic implantable cardioverter- defibrillator. J.Am.Coll.Cardiol. 10:382-388, 1987. Keywords : 951202; PATHOLOGIC; in; AUTOPSY; myocardium; LONG TERM; Died; VENTRICULAR FIBRILLATION; CAUSE; Fibrosis; THROMBUS; VENA CAVA; ASYMPTOMATIC; Pulmonary emboli; EMBOLI; vein; Necrosis; INJURY; ADULT; AGED; ELECTRIC COUNTERSHOCK; ae; is; FEMALE; HUMAN; implants,artificial; MALE; MIDDLE AGE; PA; pericarditis; et; PULMONARY EMBOLISM; Support,U.S.Gov't,P.H.S. THROMBOSIS; TIME FACTORS; vena cava,superior; Medline File; electrodes Notes : The purpose of the present study was to examine at autopsy the effect of multiple defibrillations on the myocardium and the pathologic consequences of short- and long-term placement of the intravascular and interpericardial leads of the automatic implantable cardioverter- defibrillator. Twenty-five patients were examined at autopsy; 8 of them underwent lead implantation only and 17 received both leads and the automatic implantable cardioverter-defibrillator. Twelve patients (48%) died of ventricular tachycardia or ventricular fibrillation; seven (28%) died of other causes. Acute pericarditis occurred in all patients, resulting in a localized, progressive fibrosis around the apical patch lead without giving rise to pericardial restriction. Thrombus formation was associated with the superior vena cava spring electrode in four patients (17%) and the right ventricular rate- sensing electrode in one patient (4%). Asymptomatic pulmonary emboli occurred in two patients (8%). In one patient who underwent defibrillation 59 times, superior vena cava changes consisted of vein wall destruction, fibrosis and thrombus formation. Pathologic changes under the apical patch related to defibrillation were observed in seven patients; two of these had fewer than 5 defibrillations, one had 8 defibrillations and four had 21 to 74 defibrillations. These changes consisted of contraction band necrosis in four patients, vacuolar cytoplasmic clearing and loss of myocytes confined to the myocardium under the patch electrode in five patients who had multiple defibrillations. The observed pathologic changes were estimated to affect less than 2% of the total myocardial mass. Thus, the automatic implantable cardioverter-defibrillator lead system and multiple defibrillations result in localized myocardial injury confined to the tissue under the patch electrode.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : SISTO1992 1137. Sisto, D., Hoffman, D., Camacho, M., Fernandes, S., Maldarelli, W., and Lee, S. Massive intraoperative pulmonary embolism. Chest 102:307-308, 1992. Keywords : MASSIVE; PULMONARY EMBOLISM; EMBOLISM; INTRAVENOUS; HEPARIN; MYOCARDIAL INFARCTION; MANAGEMENT; DIAGNOSIS; VENOUS; CORONARY ARTERY BYPASS; INTRAOPERATIVE COMPLICATIONS; AGED; CASE REPORT; HUMAN; MALE; Intraoperative; is; in; intravenous heparin; an; infarction; Angioplasty Notes : AB-Intraoperative massive pulmonary embolism is extremely rare. We describe such a case in a patient treated for a prolonged period preoperatively with intravenous heparin after an acute myocardial infarction and unsuccessful attempt at angioplasty, emphasizing that the problem should be borne in mind to facilitate expeditious and appropriate management. A clue to the diagnosis is interruption of venous return that is not due to a kink in the cannulae. Ref ID : SKOLNIK1990 1138. Skolnik, N.S. Venous thromboembolism [letter; comment]. Am.Rev.Respir.Dis. 141:1603-1604, 1990. Keywords : PHLEBITIS; VENOUS; THROMBOEMBOLISM; AGED; HEPARIN; therapeutic use; HUMAN; LEG; blood supply; THROMBOPHLEBITIS Ref ID : SKRIPNICHENKO1976 1139. Skripnichenko, D.F. and Podoprigora, A.P. [Surgical treatment of superficial varicose veins complicated by trophic ulcers and thrombophlebitis]. Klin.Khir. :34-37, 1976. Keywords : TREATMENT; VARICOSE VEINS; VEINS; Ulcer; NASP; Adolescence; ADULT; CASE REPORT; FEMALE; HUMAN; MALE; MIDDLE AGE; Preoperative Care; THROMBOPHLEBITIS; Varicose Ulcer; Medline File; varicose; ab Notes : TT - Khirurgicheskoe lechenie varikoznogo rasshireniia poverkhnostnykh ven nizhnikh konechnostei, oslozhnennogo troficheskimi iazvami i tromboflebitom AB - [No Abstract Available] UI - 77122053. Ref ID : SLAGLE1986 1140. Slagle, D.C. and Gates, R.H.,Jr. Unusual case of central vein thrombosis and sepsis. Am.J.Med. 81:351-354, 1986. Keywords : vein; THROMBOSIS; ACEP93; VEINS Ref ID : SMITH1948 1141. Smith, L. and Johnson, M.A. Incidence of pulmonary embolism after venous sclerosing therapy. Minn.Med. 31:270, 1948. Keywords : INCIDENCE; PULMONARY EMBOLISM; EMBOLISM; VENOUS; THERAPY; NASP; bib-4 Ref ID : SMITH1965 1142. Smith, G.T., Dexter, L., and Dammin, G.J. Postmortem quantitative studies in pulmonary embolism. In: Pulmonary Embolic Diseases, edited by Sasahara, A.A. and Stein, M.New York:Grune and Stratton, 1965, Keywords : POSTMORTEM; QUANTITATIVE; PULMONARY EMBOLISM; EMBOLISM; in Ref ID : SMITH1991 1143. Smith, P.K., Miller, D.A., Lail, S., and Mehta, A.V. Urokinase treatment of neonatal aortoiliac thrombosis caused by umbilical artery catheterization: a case report. J.Vasc.Surg. 14:684-687, 1991. Keywords : UROKINASE; TREATMENT; THROMBOSIS; CASE REPORT; ACEP93; ARTERY; Catheterization Ref ID : SMITH1991A 1144. Smith, R.R. and Hutchins, G.M. Fatal fecal embolization [letter; comment]. Arch.Pathol.Lab.Med. 115:862, 1991. Keywords : PHLEBITIS; FATAL; EMBOLIZATION; ADULT; CASE REPORT; feces; Fistula; COMPLICATIONS; HUMAN; MALE; PULMONARY EMBOLISM; ETIOLOGY; MORTALITY; VEINS Ref ID : SMITH1994 1145. Smith, L.L., Iber, C., and Sirr, S. Pulmonary embolism: confirmation with venous duplex US as adjunct to lung scanning. Radiology 191:143-147, 1994. Keywords : PHLEBITIS; PULMONARY EMBOLISM; EMBOLISM; VENOUS; Duplex; LUNG; SCANNING; Adolescence; ADULT; AGED; Aged,80 and over; FEMALE; HUMAN; LEG; blood supply; radionuclide imaging; Ultrasonography; MALE; MIDDLE AGE; COMPLICATIONS; Retrospective Studies; THROMBOPHLEBITIS; PREVALENCE; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; RADIONUCLIDE; PE; ANTICOAGULANT; THERAPY; Methods; SCAN; PROBABILITY; Doppler; us; in; is Notes : PURPOSE: To assess the prevalence of deep venous thrombosis with venous duplex ultrasonography (US) in patients who underwent radionuclide lung scanning for evaluation of clinically suspected pulmonary embolism (PE) and to assess the clinical usefulness of this type of US in the selection of patients for anticoagulant therapy. MATERIALS AND METHODS: Two hundred eighty-five lung scan and duplex US examinations in 267 consecutive patients seen between January 1987 and June 1990 with clinical evidence of PE (151 men and 134 women, aged 17- 98 years [mean, 57 years]) were retrospectively reviewed. Lung scans were divided into four groups: normal, depicting up to 30% probability of PE, indeterminate or intermediate probability of PE, and greater than 90% probability of PE. RESULTS: Thrombotic disease was confirmed with US in seven (21%) of 33 patients with normal lung scans and in 64 (25%) of 252 patients with abnormal lung scans. CONCLUSION: Venous duplex Doppler US is a useful adjunct to lung scanning in patients with signs and/or symptoms of PE. Ref ID : SNELL1927 1146. Snell, A.M. The relation of obesity to fatal postoperative pulmonary embolism. Arch.Surg. 12:237, 1927. Keywords : FATAL; POSTOPERATIVE; PULMONARY EMBOLISM; EMBOLISM; RISK; DVT; PE; AGE; OBESITY; RISK FACTORS; is; an Notes : Obesity, defined as weight greater than 20 percent above ideal weight, has long been accepted as a risk factor for DVT and PE, but the evidence supporting this association has been questioned. When associated factors such as past history, illness, immobility, and age are taken into account it is possible that obesity may not truly be an independent risk factor. Ref ID : SOLIS1993 1147. Solis, M.M., Ranval, T.J., Thompson, B.W., and Eidt, J.F. Results of venous thrombectomy in the treatment of deep vein thrombosis. Surg.Gynecol.Obstet. 177:633-639, 1993. Keywords : PHLEBITIS; VENOUS; THROMBECTOMY; TREATMENT; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; Femoral Vein; SURGERY; HUMAN; Iliac Vein; inflammation; Ischemia; prevention & control; LEG; blood supply; PAIN; POSTPHLEBITIC SYNDROME; PULMONARY EMBOLISM; THROMBOPHLEBITIS; COMPLICATIONS; Vascular Patency; UNITED STATES; analysis; THROMBUS; DIAGNOSIS; VENOGRAPHY; Duplex; Doppler; VENOUS THROMBOSIS; AGE; in; is Notes : Despite the infrequent use in the United States, venous thrombectomy seems to have a beneficial effect in carefully selected patients with acute iliofemoral thrombosis. The final decision to proceed with venous thrombectomy should be based on a balanced analysis of two factors--the characteristics of the thrombus and the characteristics of the patient. First, the diagnosis of acute deep vein thrombosis must be unequivocally established preoperatively. Accurate anatomic localization is usually achieved with venography, but duplex Doppler examination may be sufficient in selected instances. Second, the distribution of thromboses should be determined. Venous thrombectomy should be considered only in instances of deep vein thrombosis involving the iliofemoral venous segment. Thrombectomy for venous thrombosis below the inguinal ligament has not been consistently beneficial. Third, the age of the thrombus should be estimated. This can usually be accomplished though a careful analysis of the clinical history, but may be corroborated by duplex Doppler or venographic features of the thrombus. Venous thrombectomy should rarely be attempted if the age of the thrombus is thought to be greater than 72 hours. Unfortunately, in many instances the clinical history substantially underestimates the actual age of the underlying thrombus. Fourth, patient characteristics must be assessed preoperatively. While venous thrombectomy can usually be accomplished using local anesthesia, substantial shifts in fluid and acid base balance may be poorly tolerated by elderly, frail patients. In the setting of widespread metastatic disease, rethrombosis rates may be too high to justify thrombectomy in some patients.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : SOLOMON1987 1148. Solomon, D.D., Arnold, W.L., Martin, N.D., and Lentz, D.J. An in- vivo method for the evaluation of catheter thrombogenicity. J.Biomed.Mater.Res. 21:43-57, 1987. Keywords : CATHETER; ACEP93; THROMBOGENICITY; PLATELETS; an; Methods Ref ID : SOSKOLNE1990 1149. Soskolne, C.L., Wong, A.W., and Lilienfeld, D.E. Trends in pulmonary embolism death rates for Canada and the United States, 1962 - 1987. Can.Med.Assoc.J. 142:321, 1990. Keywords : PULMONARY EMBOLISM; EMBOLISM; DEATH; UNITED STATES; CANADA; TRENDS; in Ref ID : SPAET1966 1150. Spaet, T.H. and Erichson, R.B. The vascular wall in the pathogenesis of thrombosis. Thromb.Diath.Haemorrh. Suppl 21:175, 1966. Keywords : THROMBOSIS; SCLEROTHERAPY; VASCULAR WALL; PATHOGENESIS; in Ref ID : SPANNAGEL1993 1151. Spannagel, U. and Kujath, P. Low molecular weight heparin for the prevention of thromboembolism in outpatients immobilized by plaster cast. Semin.Thromb.Hemost. 19 Suppl 1:131-141, 1993. Keywords : Low molecular weight heparin; Molecular Weight; HEPARIN; PREVENTION; THROMBOEMBOLISM; OUTPATIENT; RANDOMIZED; PROSPECTIVE; INCIDENCE; THROMBOSIS; PROPHYLAXIS; INJURY; RISK; THROMBUS; Immobilization; TREATMENT; COMPRESSION; ULTRASOUND; PHLEBOGRAPHY; RISK FACTORS; AGE; OBESITY; varicose; VARICOSE VEINS; VEINS; FRACTURES; DVT; CONTRAST; Important article; Immobilized; Cast; sdi-11/93; in; an; LMWH; is; injuries Notes : In an open, randomized, prospective, interindividual trial, the incidence of thrombosis with (n = 126) and without (n = 127) LMWH prophylaxis once a day was determined in 253 outpatients immobilized in a plaster cast due to an injury of the lower limb. Furthermore, the influence of possible risk factors on the thrombus formation was determined. The histories of the patients were comparable. The average period of plaster cast immobilization was 15.7 days and did not differ between treatment groups. Thrombosis was diagnosed by compression ultrasound; patients with positive findings were investigated by means of ascending phlebography. There were 21 cases of thrombosis in the group without prophylaxis (16.5%) and only six cases of thrombosis (4.8%) with LMWH. This difference is statistically significant (2p < 0.01). Crucial risk factors were age over 30 years, obesity, varicose veins, and fractures. Patients without prophylaxis who had fractures developed DVT in 29% in contrast to 11.3% in patients with soft-tissue injuries. This study shows that LMWH prophylaxis should be mandatory for plaster cast immobilized patients regardless of preexisting risk factors for thromboembolism. Ref ID : SPARTERA1979 1152. Spartera, C., Santoro, P., Frezzotti, A., Marciani, A., and Ricci, G. [Clinical evaluation of a new drug in phlebology]. Clin.Ter. 88:139- 147, 1979. Keywords : NASP; ADULT; AGED; Bioflavonoids; Diosmin; DRUG EVALUATION; English Abstract; FEMALE; HUMAN; MALE; MIDDLE AGE; PHLEBITIS; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Venous Insufficiency; Medline File; drugs; in; di; ab Notes : TT - Valutazione clinica di un nuovo farmaco in flebologia AB - [No Abstract Available] UI - 79147700. Ref ID : SPERRY1990 1153. Sperry, K.L., Key, C.R., and Anderson, R.E. Toward a population- based assessment of death due to pulmonary embolism in New Mexico. Hum.Pathol. 21:159-165, 1990. Keywords : 951202; DEATH; PULMONARY EMBOLISM; EMBOLISM; in; PE; death certificates; FREQUENCY; diagnostics; is; Died; RISK; RISK FACTORS; Hospitals; MALE; AGE; SURGICAL; Immobilization; TRAUMA; Adolescence; ADULT; AGED; AUTOPSY; cause of death; FEMALE; HUMAN; MIDDLE AGE; new mexico; ep; population surveillance; PA; Medline File; Health Planning & Administration File; pathology Notes : During a 5-year period (1981 through 1985), 586 of 46,512 (1.26%) deaths in New Mexico had pulmonary embolism (PE) listed on the death certificate. The frequency of death due to PE was mentioned more frequently in the autopsied than in the non-autopsied component of the study (2.4% v 1.1%). This observation, together with published data on the accuracy of clinical diagnostics among persons dying with autopsy- documented PE, suggests that the frequency of death due to this disease is considerably higher than previously thought. Among autopsied persons who died of PE, risk factors and associated diseases are not appreciably different for those who die in or out of the hospital. Important associations with respect to persons dying of PE include male gender, advanced age, serious medical or surgical disease, immobilization, and trauma Department of Pathology University of New Mexico School of Medicine Albuquerque 87131. Ref ID : SPIES1986 1154. Spies, W.G. and Burstein, S.P. Ventilation-perfusion scintigraphy in suspected pulmonary embolism: Correlation with pulmonary angiography and refinement of criteria for interpretation. Radiology 159:383, 1986. Keywords : PULMONARY EMBOLISM; EMBOLISM; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; SENSITIVITY; SPECIFICITY; FALSE-NEGATIVE; in Notes : False-Negative rates for pulmonary angiography. Ref ID : SPITTELL1992 1155. Spittell, P.C. and Hayes, D.L. Venous complications after insertion of a transvenous pacemaker. Mayo.Clin.Proc. 67:258-265, 1992. Keywords : VENOUS; COMPLICATIONS; CARDIOVASCULAR; INCIDENCE; CLINICAL FEATURES; TREATMENT; DIAGNOSIS; VENOUS THROMBOSIS; THROMBOSIS; EARLY; LATE; CHRONIC; DEEP VENOUS THROMBOSIS; ASYMPTOMATIC; FOLLOWUP; THERAPY; MONITORING; MORBIDITY; MORTALITY; VENOGRAPHY; MANAGEMENT; ANTICOAGULATION; THROMBOLYTIC; THROMBOLYTIC THERAPY; SURGICAL; DURATION; Pacemaker; internal medicine; ab; diagnostics; in; an; Collateral Circulation; VENOUS OBSTRUCTION; Venous Pressure; Pressure; is; OCCLUSION Notes : CS- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905 AB- We reviewed the incidence, clinical features, current diagnostic evaluations, and treatments of venous complications that can occur after implantation of a transvenous pacemaker. Of the approximately 80 published articles on the potential venous complications after implantation of a permanent transvenous pacemaker, we selected 63 that addressed the clinical features, diagnosis, and treatment of pacemaker lead-induced venous thrombosis, which occurs in approximately 30 to 45% of patients early or late after implantation of a transvenous pacemaker. Most patients with chronic deep venous thrombosis remain asymptomatic because of the development of an adequate venous collateral circulation. Clinical features of pacemaker lead-induced deep venous thrombosis, although rare, are easily recognized. They should be sought routinely during follow-up of all patients with transvenous pacemaker leads because venous obstruction can interfere with intravenously administered therapy, monitoring of central venous pressure, and revision of a pacemaker lead. Acute deep venous thrombosis is likely to be symptomatic. Early recognition and treatment of acute deep venous thrombosis may help to decrease the potential morbidity and mortality. The definitive diagnosis of pacemaker lead- induced venous thrombosis necessitates contrast-enhanced or digital subtraction venography. Management includes anticoagulation, thrombolytic therapy, surgical intervention, and, recently, percutaneous transluminal balloon venoplasty and depends on the duration, extent, and site of venous occlusion as well as the accompanying symptoms. Ref ID : SPRITZER1988 1156. Spritzer, C.E., Sussman, S.K., Blinder, R.A., Saeed, M., and Herfkens, R.J. Deep venous thrombosis evaluation with limited-flip- angle, gradient-refocused MR imaging: preliminary experience. Radiology. 166:371-375, 1988. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MR; Extremities; VENOGRAPHY; GRADIENT; MAGNETIC RESONANCE; THROMBOSED; THROMBI; THROMBUS; Femoral Vein; VEINS; CALF; Popliteal Vein; Pulse; NONINVASIVE; sdi-11/93; in Notes : Sixteen patients (17 lower extremities) were prospectively examined with venography and limited-flip-angle, gradient-refocused magnetic resonance (MR) imaging for the presence or absence of deep venous thrombosis. Thrombosed vessels showed decreased-to-absent signal intensity, while patent vessels had high signal intensity. In 16 of 17 extremities, MR images allowed accurate detection and localization of the thrombi found with venography. In the remaining extremity, MR imaging allowed correct identification of thrombus in the iliac and femoral veins but incorrectly demonstrated clot in the calf and popliteal veins. MR imaging with limited-flip-angle, gradient-refocused pulse sequences appears to be a sensitive, noninvasive means of detecting deep venous thrombosis. Ref ID : SPRITZER1990 1157. Spritzer, C.E., Sostman, H.D., Wilkes, D.C., and Coleman, R.E. Deep venous thrombosis: experience with gradient-echo MR imaging in 66 patients. Radiology. 177:235-241, 1990. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MR; Medical Records; DVT; MAGNETIC RESONANCE; Venogram; FOLLOWUP; VENOGRAPHY; SENSITIVITY; SPECIFICITY; EMBOLI; AUTOPSY; PULMONARY EMBOLISM; EMBOLISM; CAUSE; DEATH; NONINVASIVE; sdi-11/93; in; Pulmonary emboli; Died; cause of death; is; an Notes : The medical records of 66 patients who underwent evaluation for possible deep venous thrombosis (DVT) by means of gradient-echo (GRE) magnetic resonance (MR) imaging were reviewed. Confirmatory venograms were obtained in 26 patients; in the other 40, the accuracy of GRE MR imaging was assessed by means of clinical follow-up, which ranged from 1 to 23 months (mean, 7.7 months). Findings in GRE MR images were negative in 42 patients (64%) and positive in 24 patients (36%). In patients who underwent confirmatory venography, the sensitivity of GRE MR imaging was 100% and the specificity was 92.9%. No patient with a negative GRE MR study developed DVT or pulmonary emboli during the follow-up period. Although seven patients in this group died, the single autopsy showed no evidence of pulmonary embolism, and no clinical evidence existed to suggest that pulmonary embolism was the cause of death in any of the other six patients. It is concluded that GRE MR imaging is an accurate, noninvasive means of detecting DVT. Ref ID : SPRITZER1990A 1158. Spritzer, C.E., Sostman, H.D., Wilkes, D.C., and Coleman, R.E. Deep venous thrombosis: experience with gradient-echo MR imaging in 66 patients. Radiology 177:235-241, 1990. Keywords : PHLEBITIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MR; Adolescence; ADULT; AGED; Aged,80 and over; FEMALE; HUMAN; LEG; blood supply; magnetic resonance imaging; Methods; MALE; MIDDLE AGE; PHLEBOGRAPHY; THROMBOPHLEBITIS; DIAGNOSIS; radiography; Medical Records; DVT; MAGNETIC RESONANCE; Venogram; FOLLOWUP; VENOGRAPHY; SENSITIVITY; SPECIFICITY; Pulmonary emboli; EMBOLI; Died; AUTOPSY; PULMONARY EMBOLISM; EMBOLISM; CAUSE; DEATH; NONINVASIVE; in; cause of death; is; an Notes : The medical records of 66 patients who underwent evaluation for possible deep venous thrombosis (DVT) by means of gradient-echo (GRE) magnetic resonance (MR) imaging were reviewed. Confirmatory venograms were obtained in 26 patients; in the other 40, the accuracy of GRE MR imaging was assessed by means of clinical follow-up, which ranged from 1 to 23 months (mean, 7.7 months). Findings in GRE MR images were negative in 42 patients (64%) and positive in 24 patients (36%). In patients who underwent confirmatory venography, the sensitivity of GRE MR imaging was 100% and the specificity was 92.9%. No patient with a negative GRE MR study developed DVT or pulmonary emboli during the follow-up period. Although seven patients in this group died, the single autopsy showed no evidence of pulmonary embolism, and no clinical evidence existed to suggest that pulmonary embolism was the cause of death in any of the other six patients. It is concluded that GRE MR imaging is an accurate, noninvasive means of detecting DVT. Ref ID : SPRITZER1993 1159. Spritzer, C.E., Norconk, J.J.J., Sostman, H.D., and Coleman, R.E. Detection of deep venous thrombosis by magnetic resonance imaging. Chest 104:54-60, 1993. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MAGNETIC RESONANCE; GRADIENT; DEEP VENOUS THROMBOSIS; REVIEW; PROSPECTIVE; FOLLOWUP; VENOGRAPHY; ULTRASOUND; Thigh; VEINS; SENSITIVITY; SPECIFICITY; sdi- 11/93; magnetic resonance imaging; in; is Notes : OBJECTIVE: To determine the accuracy of gradient recalled echo magnetic resonance imaging in assessing deep venous thrombosis. DESIGN: This is a retrospective review of a prospective clinical experience in 216 consecutive patients studied using gradient recalled echo magnetic resonance imaging. Sixteen patients were unavailable for follow-up and 1 study was technically suboptimal, leaving 199 studies as the basis of this report. RESULTS: In 79 cases with confirmatory venography (n = 54), ultrasound (n = 16, thigh veins only), or computed tomography (n = 9, pelvic veins only), magnetic resonance imaging was 97 percent sensitive, 95 percent specific, and 96 percent accurate. Including cases that were normal by magnetic resonance imaging, not anticoagulated, and with uneventful follow-up as true normal cases, the corresponding sensitivity, specificity, and accuracy of magnetic resonance imaging were as follows: 97 percent, 98 percent, and 97 percent. CONCLUSION: Magnetic resonance imaging, using gradient recalled echo acquisitions, is capable of accurately diagnosing acute deep venous thrombosis. Ref ID : SRIVASTAVA1963 1160. Srivastava, G.N., Roy, A.K., Chakravarti, R.N., and Zaidi, S.H. Induction of blood hypercoagulability and thrombosis in rats by systemic factors. Indian.J.Med.Res. 51:661, 1963. Keywords : HYPERCOAGULABILITY; THROMBOSIS; THROMBUS; INJURY; SCLEROTHERAPY; LIPEMIC SERUM; blood; in; Rats Notes : The presence of lipemic serum greatly increases the speed and extent of thrombus formation in response to vascular injury. Ref ID : STAAL1987 1161. Staal, M.J., Meihuizen-de Regt, M.J., and Hess, J. Sudden death in hydrocephalic spina bifida aperta patients. Pediatr.Neurosci. 13:13-18, 1987. Keywords : 951202; SUDDEN DEATHS; DEATH; in; drainage; Died; CAUSE; cause of death; SHUNT; PULMONARY EMBOLISM; EMBOLISM; THROMBOEMBOLIC; COMPLICATIONS; CASE REPORT; PREVENTION; Adolescence; AUTOPSY; cerebrospinal fluid shunts; mo; CHILD; Child,Preschool; Death,Sudden; et; FEMALE; HUMAN; hydrocephalus; co; MALE; meningomyelocele; Medline File; Hospitals; netherlands Notes : Twelve patients of 146 hydrocephalic spina bifida aperta patients, treated with a ventricular drainage system, died suddenly. In 7 of them the cause of death was most probably related to the use of a ventriculovascular shunt, causing pulmonary embolism. Thromboembolic complications were not seen in the 26 hydrocephalic spina bifida patients treated with a ventriculoperitoneal shunt. In 4 other patients shunt malfunction was considered as the cause of sudden death. The case reports of these 11 patients are presented. Pathophysiological mechanisms are discussed and measures for prevention of these two potentially lethal complications are described Department of Neurosurgery University Hospital Groningen The Netherlands. Ref ID : STALLMAN1993 1162. Stallman, J.S., Aisen, P.S., and Aisen, M.L. Pulmonary embolism presenting as fever in spinal cord injury patients: report of two cases and review of the literature. J Am Paraplegia.Soc. 16:157-159, 1993. Keywords : PULMONARY EMBOLISM; EMBOLISM; FEVER; INJURY; REVIEW; FATAL; COMPLICATION; Pulmonary emboli; EMBOLI; SCANNING; diagnostics; THROMBOEMBOLIC; sdi-11/93; Spinal cord; Unexplained fever; in; spinal cord injuries; is Notes : Pulmonary embolism is a common, sometimes fatal complication of spinal cord injury. We describe two quadriplegic patients who developed unexplained fever as the sole presenting sign of multiple pulmonary emboli during the subacute phase following injury. These cases and a review of the literature suggest that ventilation-perfusion scanning should be considered in the diagnostic evaluation of fever in patients with recent spinal cord injury even in the absence of other clinical signs of thromboembolic disease. Ref ID : STALPORT1969 1163. Stalport, J. and Letawe, P. [Surgical aspects of thrombosis in the lower extremities]. Acta Chir.Belg. 68:529-539, 1969. Keywords : THROMBOSIS; NASP; Edema; English Abstract; Fatigue; Femoral Vein; Follow-Up Studies; HUMAN; Ligation; PAIN; Postoperative Complications; SAPHENOUS VEIN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; de; ab Notes : TT - Aspects chirurgicaux de la thrombose des membres inferieurs AB - [No Abstract Available] UI - 71231495. Ref ID : STAMATAKIS1977 1164. Stamatakis, J.D., Kakkar, V.V., Sagar, S., Lawrence, D., Nairn, D., and Bentley, P.G. Femoral vein thrombosis and total hip replacement. Brit.Med.J. 2:223-225, 1977. Keywords : VEINS; THROMBOSIS; THROMBI; VENOUS; ENDOTHELIAL; INJURY; POSTOPERATIVE; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; HIP REPLACEMENT; HIP; Femoral Vein; vein; in; STASIS; is Notes : Deep vein thrombi may occur in the setting of venous endothelial injury, even if mild. Most cases of postoperative deep venous thrombosis are believed to start in the area of the valve cusps, where stasis is at its maximum. Ref ID : STAUBESAND1991 1165. Staubesand, J. and Seydewitz, V. [An ultrastructural study of sclerosed varices]. Phlebologie. 44:16-22; discussion 33-6, 1991. Keywords : VARICES; TREATMENT; Injections; ELECTRON MICROSCOPY; ANIMAL; HUMAN; Air; TECHNIQUES; vein; RABBITS; COMPRESSION; PLATELETS; VEINS; ENDOTHELIUM; THROMBUS; FIBRIN; Methods; VARICOSITIES; RECURRENCE; Femoral Artery; ARTERY; INTRAARTERIAL; ARTERIAL; BLOOD FLOW; NASP; Benzyl Alcohols; Blood Vessels; Drug Combinations; English Abstract; FEMALE; Iodides; Microscopy,Electron; MIDDLE AGE; Polyethylene Glycols; Rats; Sclerosing Solutions; SCLEROTHERAPY; Sodium; THROMBOSIS; VARICOSE VEINS; Medline File; EPITHELIUM; de; ab; in; an; blood; is; Necrosis; ad Notes : TT - Etudes ultra-structurelles des varices sclerosees AB - The authors describe the results of treatment by sclerosing injections, seen by electron microscopy, in an animal experiment and using human material from a volunteer. The air block technique was used to study the action of ethoxysclerol and of variglobane on the marginal vein of the rabbit ear up to 60 minutes after injection of the compound and subsequent compression. During this time a pseudo- epithelium developed, consisting of platelets in segments of veins of which the endothelium was damaged by the sclerosing compound. The thrombus which formed subsequently consisted of blood cells, cell debris and fibrin filaments. It is possible by powerful local compression, using the Winner method (1974), to prevent the appearance of a thrombus, in particular in reticular varicosities, which enables the avoidance of recurrences by recanalisation of the thrombus. Various animal experiments were used to study the action of different paravascular administrations of sclerosing compounds on the wall of the rat femoral artery and vein. Following paravascular administration, small doses of compound at low concentration already caused considerable lesions of the walls of the vessels concerned and of nerve myelin fibres. The intra-arterial injection of sclerosing compounds caused very severs local lesions of the arterial wall and embolisation of terminal vessels by dispersal of cell debris into peripheral blood flow. This caused necrosis in the corresponding regions supplied AD - Anatomisches Institut AD - Freiburg/Breisgau UI -92052551. Ref ID : STEGMANN1974 1166. Stegmann, W. [Importance in the treatment of the "leg disease" by bandages]. Z.Hautkr. 49:997-1002, 1974. Keywords : TREATMENT; LEG; NASP; BANDAGES; Elasticity; HUMAN; Nylons; Rubber; THROMBOPHLEBITIS; TIME FACTORS; Varicose Ulcer; VARICOSE VEINS; Zinc; Medline File; in; ab Notes : TT - Die Bedeutung der Verbandbehandlung bei "Beinleiden" AB - [No Abstract Available] UI - 75104718. Ref ID : STEGMANN1980 1167. Stegmann, W. [Clinic and therapy of peripheral venous diseases (author's transl)]. Offentl.Gesundheitswes. 42:724-732, 1980. Keywords : THERAPY; VENOUS; NASP; English Abstract; FEMALE; HUMAN; MALE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; ab Notes : TT - Klinik und Therapie der venosen Durchblutungsstorungen AB - [No Abstract Available] UI - 81099804. Ref ID : STEIN1975 1168. Stein, P.D. The electrocardiogram in acute pulmonary embolism. Prog.Cardiovasc.Dis. 17:247, 1975. Keywords : ELECTROCARDIOGRAM; PULMONARY EMBOLISM; EMBOLISM; in Ref ID : STEIN1990 1169. Stein, P.D., Sabbah, H.N., Basha, M.A., Popovich, J.,Jr., Kensey, K.R., and Nash, J.E. Mechanical disruption of pulmonary emboli in dogs with a flexible rotating-tip catheter (Kensey catheter). Chest 98:994- 998, 1990. Keywords : EMBOLI; DOGS; CATHETER; PULMONARY EMBOLISM; EMBOLISM; Injections; CONTRAST; vein; OCCLUSION; PULMONARY ARTERY; Arteries; PERFUSION; Pulmonary emboli; in; blood; jugular veins Notes : Pulmonary embolism was induced in 11 dogs by the injection of three- to four-day-old allogeneic blood clots. The clots were made radiopaque by soaking them in contrast material. The resulting clots were firm, 3 to 4 cm long, and 1 cm in diameter. Injection of the clots into the external jugular vein consistently produced occlusion of at least one of the lobar pulmonary arteries. In every instance in which the tip of the catheter could be positioned at the clot embolus (six dogs), the clots were readily fragmented with a number 8 French (2.67 mm OD) flexible rotating tip catheter (Kensey catheter) activated at 80, 000 rpm. Overall perfusion was shown by posttreatment angiograms to be markedly improved. These studies show that catheter-tip fragmentation of pulmonary emboli with a Kensey catheter has excellent potential for therapeutic application in patients with pulmonary embolism. Ref ID : STEIN1991 1170. Stein, P.D., Terrin, M.L., Hales, C.A., Palevsky, H.I., Saltzman, H.A., Thompson, B.T., and Weg, J.G. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease [see comments]. Chest 100:598-603, 1991. Keywords : PULMONARY EMBOLISM; EMBOLISM; CARDIAC; Physical Examination; CHEST; CHEST RADIOGRAPH; ELECTROCARDIOGRAM; PE; PLEURITIC; PAIN; partial pressure; Pressure; OXYGEN; ARTERIAL; Air; GRADIENT; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; diagnostics; laboratories; in; blood; dyspnea; abnormalities; st; is Notes : The history, physical examination, chest radiograph, electrocardiogram and blood gases were evaluated in patients with suspected acute pulmonary embolism (PE) and no history or evidence of pre-existing cardiac or pulmonary disease. The investigation focused upon patients with no previous cardiac or pulmonary disease in order to evaluate the clinical characteristics that were due only to PE. Acute PE was present in 117 patients and PE was excluded in 248 patients. Among the patients with PE, dyspnea or tachypnea (greater than or equal to 20/min) was present in 105 of 117 (90 percent). Dyspnea, hemoptysis, or pleuritic pain was present in 107 of 117 (91 percent). The partial pressure of oxygen in arterial blood on room air was less than 80 mm Hg in 65 of 88 (74 percent). The alveolar-arterial oxygen gradient was greater than 20 mm Hg in 76 of 88 (86 percent). The chest radiograph was abnormal in 98 of 117 (84 percent). Atelectasis and/or pulmonary parenchymal abnormalities were most common, 79 of 117 (68 percent). Nonspecific ST segment or T wave change was the most common electrocardiographic abnormality, in 44 of 89 (49 percent). Dyspnea, tachypnea, or signs of deep venous thrombosis was present in 107 of 117 (91 percent). Dyspnea or tachypnea or pleuritic pain was present in 113 of 117 (97 percent). Dyspnea or tachypnea or pleuritic pain was present in 113 of 117 (97 percent). Dyspnea or tachypnea or pleuritic pain or atelectasis or a parenchymal abnormality on the chest radiograph was present in 115 of 117 (98 percent). In conclusion, among the patients with pulmonary embolism that were identified, only a small percentage did not have these important manifestations or combinations of manifestations. Clinical evaluation, though nonspecific, is of considerable value in the selection of patients in whom there is a need for further diagnostic studies. Ref ID : STEIN1991A 1171. Stein, P.D., Saltzman, H.A., and Weg, J.G. Clinical characteristics of patients with acute pulmonary embolism. Am.J.Cardiol. 68:1723-1724, 1991. Keywords : PULMONARY EMBOLISM; EMBOLISM Ref ID : STEIN1991B 1172. Stein, P.D., Alavi, A., Gottschalk, A., Hales, C.A., Saltzman, H.A., Vreim, C.E., and Weg, J.G. Usefulness of noninvasive diagnostic tools for diagnosis of acute pulmonary embolism in patients with a normal chest radiograph. Am.J.Cardiol. 67:1117-1120, 1991. Keywords : NONINVASIVE; diagnostics; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; CHEST; CHEST RADIOGRAPH; PE; partial pressure; Pressure; OXYGEN; ARTERIAL; PROBABILITY; VENTILATION/PERFUSION; SCAN; in; blood; dyspnea; is Notes : The value of bedside examination and noninvasive tests in the diagnosis of acute pulmonary embolism (PE) among patients with a normal chest radiograph was investigated. Normal chest radiographs were present in 20 of 260 patients (8%) with acute PE and in 113 of 642 (18%) with suspected acute PE, in whom the diagnosis was excluded. A partial pressure of oxygen in arterial blood less than or equal to 70 mm Hg in a dyspneic patient with a normal chest radiograph was more often seen among patients with PE (9 of 17, 53%) than among patients in whom PE was excluded (18 of 93, 19%; p less than 0.01). However, no combinations of blood gases, signs and symptoms were strictly diagnostic. High probability ventilation/perfusion scans among patients with a normal chest radiograph were indicative of PE in only 6 of 9 patients (67%). Among patients with low-probability ventilation/perfusion scans, 8 of 47 (17%) had PE. This study showed that the combination of dyspnea and hypoxia in a patient with a normal chest radiograph is a useful clue to the diagnosis of PE. Although intuition suggested that ventilation/perfusion scans would yield better results in patients with a normal chest radiograph, the ability to diagnose PE by ventilation/perfusion scans in this subset of patients was not enhanced, except by a reduction of the percentage of patients with intermediate probability scans. Ref ID : STEIN1991C 1173. Stein, P.D., Coleman, R.E., Gottschalk, A., Saltzman, H.A., Terrin, M.L., and Weg, J.G. Diagnostic utility of ventilation/perfusion lung scans in acute pulmonary embolism is not diminished by pre-existing cardiac or pulmonary disease. Chest 100:604-606, 1991. Keywords : diagnostics; VENTILATION/PERFUSION; LUNG; SCAN; PULMONARY EMBOLISM; EMBOLISM; CARDIAC; V/Q; DIAGNOSIS; PE; V/Q SCAN; PREDICTIVE VALUE; PROBABILITY; SENSITIVITY; SPECIFICITY; in; is Notes : The purpose of this study was to assess the impact of prior cardiac or pulmonary disease upon the utility of ventilation/perfusion (V/Q) scans in the diagnosis of acute pulmonary embolism (PE). Ventilation/perfusion scans were evaluated among 365 patients with no prior cardiac or pulmonary disease and compared to V/Q scans in 526 patients with prior cardiac or pulmonary disease. Among patients with no prior cardiac or pulmonary disease, PE was present in 117 and PE was excluded in 248. Among patients with prior cardiac or pulmonary disease, PE was present in 140 and excluded in 386. The positive predictive value for PE of high probability V/Q scans among patients with prior cardiac or pulmonary disease, 55 of 66 (83 percent), was not significantly lower than among patients without prior cardiac or pulmonary disease, 50 of 54 (93 percent) (NS). The positive predictive value of low probability V/Q scans was similar with prior cardiac or pulmonary disease, 25 of 182 (14 percent), and without prior cardiac or pulmonary disease, 17 of 113 (15 percent) (NS), as was the predictive value of near normal/normal V/Q scans, 2 of 51 (4 percent), vs 3 of 79 (4 percent) (NS). The sensitivity of high probability V/Q scans, with pre-existing cardiac or pulmonary disease and without, 55 of 140 (39 percent) vs 50 of 117 (43 percent), did not differ significantly. The specificity of high probability V/Q scans with prior cardiac or pulmonary disease and without, 375 of 386 (97 percent) vs 244 of 248 (98 percent) was also similar (NS). In conclusion, the diagnostic utility of V/Q scans for acute PE was not impaired by the presence of pre-existing cardiac or pulmonary disease. Fewer patients, however, with no prior cardiac or pulmonary disease, had intermediate (indeterminate) V/Q scans. Ref ID : STEIN1991D 1174. Stein, P.D., Gottschalk, A., Saltzman, H.A., and Terrin, M.L. Diagnosis of acute pulmonary embolism in the elderly. J.Am.Coll.Cardiol. 18:1452-1457, 1991. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; diagnostics; Syndrome; PLEURITIC; PAIN; FREQUENCY; THROMBOPHLEBITIS; COMPLICATIONS; ANGIOGRAPHY; PULMONARY ANGIOGRAPHY; in; dyspnea; Unexpected; abnormalities; Respiration Notes : The diagnostic features of acute pulmonary embolism among 72 patients greater than or equal to 70 years old were evaluated and compared with characteristics of pulmonary embolism among 144 patients 40 to 69 years and 44 patients less than 40 years old. Syndromes characterized by either 1) pleuritic pain or hemoptysis, 2) isolated dyspnea, or 3) circulatory collapse were observed with comparable frequency among patients greater than or equal to 70 years old and younger patients. One of these presenting syndromes occurred in 64 (89%) of the 72 patients greater than or equal to 70 years old. Those who did not show these syndromes were identified on the basis of unexpected radiographic abnormalities, which may have been accompanied by tachypnea or a history of thrombophlebitis. Among the 72 patients greater than or equal to 70 years with pulmonary embolism, dyspnea or tachypnea (respirations greater than or equal to 20/min) occurred in 66 (92%), dyspnea or tachypnea or pleuritic pain in 68 (94%) and dyspnea or tachypnea or radiographic evidence of atelectasis or a parenchymal abnormality in 72 (100%). Complications of angiography were evaluated among patients with and without pulmonary embolism. Major complications of pulmonary angiography among patients greater than or equal to 70 years old (2 [1%] of 200) were not more frequent than among younger patients (6 [1.1%] of 562) (p = NS). However, renal failure (major or minor) was more frequent in patients greater than or equal to 70 years old than in younger patients (6 [3%] of 200 versus 4 [0.7%] of 562) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : STEIN1992 1175. Stein, P.D., Athanasoulis, C., Alavi, A., Greenspan, R.H., Hales, C.A., Saltzman, H.A., Vreim, C.E., Terrin, M.L., and Weg, J.G. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 85:462-468, 1992. Keywords : COMPLICATIONS; VALIDITY; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PULMONARY EMBOLISM; EMBOLISM; PROSPECTIVE; DIAGNOSIS; PIOPED; VENTILATION/PERFUSION; SCAN; PE; RISK; diagnostics; Methods; DEATH; FATAL; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; CONTRAST; FREQUENCY; DIALYSIS; COMPLICATION; CONSENSUS; AGE; PA; FALSE- NEGATIVE; THROMBOEMBOLISM; AUTOPSY; in; intensive care; intensive care units; an; is Notes : BACKGROUND. The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) addressed the value of ventilation/perfusion scans in acute pulmonary embolism (PE). The present study evaluates the risks and diagnostic validity of pulmonary angiography in 1,111 patients who underwent angiography in PIOPED. METHODS AND RESULTS. Complications were death in five (0.5%), major nonfatal complications in nine (1%), and less significant or minor in 60 (5%). More fatal or major nonfatal complications occurred in patients from the medical intensive care unit than elsewhere: five of 122 (4%) versus nine of 989 (1%) (p less than 0.02). Pulmonary artery pressure, volume of contrast material, and presence of PE did not significantly affect the frequency of complications. Renal dysfunction, either major (requiring dialysis) or less severe, occurred in 13 of 1, 111 (1%). Patients who developed renal dysfunction after angiography were older than those who did not have renal dysfunction: 74 +/- 13 years versus 57 +/- 17 years (p less than 0.001). Angiograms were nondiagnostic in 35 of 1,111 (3%), and studies were incomplete in 12 of 1,111 (1%), usually because of a complication. Surveillance after negative angiograms showed PE in four of 675 (0.6%). Angiograms, interpreted on the basis of consensus readings, resulted in an unchallenged diagnosis in 96%. CONCLUSIONS. The risks of pulmonary angiography were sufficiently low to justify it as a diagnostic tool in the appropriate clinical setting. Clinical judgment is probably the most important consideration in the assessment of risk. Abstract : Craig's Notes:1,111 patients in the PIOPED study underwent angiography. Major complications occured in 9 patients (1%) and minor complications occurred in 60 (5%). Five patients had a major complication followed by death (0.5%), but two of these deaths occurred many hours after angiography, and all of these patients were very ill and were hemodynamically unstable prior to the initiation of angiography. The risk of complications was not related to age, sex, volume of contrast, mean PA pressures, nor the presence or absence of PE. Readers agreed that a positive angiogram was positive 98% of the time when the defect was lobar, but only 66% of the time when the embolus was subsegmental. Readers agreed that a negative angiogram was negative only 81% of the time, and this agreement dropped to 54% when the angiogram was of poor quality. Individual readers were uncertain of the diagnosis in 8% of patients. 1% of the studies could not be completed for technical or patient-care reasons, and 3% were inadequate. The final concensus reading of negative angiogram was judged to be a false-negative in 4 cases (1%) in which thromboembolism was proven at autopsy within 6 days of the angiogram. Ref ID : STEIN1992A 1176. Stein, P.D., Terrin, M.L., Gottschalk, A., Alavi, A., and Henry, J.W. Value of ventilation/perfusion scans versus perfusion scans alone in acute pulmonary embolism. Am.J.Cardiol. 69:1239-1241, 1992. Keywords : VENTILATION/PERFUSION; SCAN; PERFUSION; PULMONARY EMBOLISM; EMBOLISM; in Ref ID : STEIN1992B 1177. Stein, P.D., Athanasoulis, C., Greenspan, R.H., and Henry, J.W. Relation of plain chest radiographic findings to pulmonary arterial pressure and arterial blood oxygen levels in patients with acute pulmonary embolism. Am.J.Cardiol. 69:394-396, 1992. Keywords : CHEST; ARTERIAL; Pressure; OXYGEN; PULMONARY EMBOLISM; EMBOLISM; CHEST RADIOGRAPH; PE; CARDIAC; partial pressure; ALVEOLAR; GRADIENT; PULMONARY ARTERY; ARTERY; PLEURAL EFFUSION; effusion; PULMONARY HYPERTENSION; Hypertension; HEMORRHAGE; blood; in; abnormalities; infarction; is Notes : Abnormalities of the plain chest radiograph of 123 patients with acute pulmonary embolism (PE) and no prior cardiac or pulmonary disease were related to the pulmonary arterial mean pressure, the partial pressure of oxygen in arterial blood, and the alveolar-arterial oxygen gradient. Patients with either a prominent central pulmonary artery or cardiomegaly had higher pulmonary arterial mean pressures than did patients with atelectasis, a pulmonary parenchymal abnormality or pleural effusion (p less than 0.001). These radiographic findings give clues to the severity of pulmonary hypertension in acute PE and suggest that pulmonary infarction or hemorrhage is associated with less severe PE. Ref ID : STEIN1993 1178. Stein, P.D., Henry, J.W., and Gottschalk, A. The addition of clinical assessment to stratification according to prior cardiopulmonary disease further optimizes the interpretation of ventilation/perfusion lung scans in pulmonary embolism. Chest 104:1472-1476, 1993. Keywords : VENTILATION/PERFUSION; LUNG; SCAN; PULMONARY EMBOLISM; EMBOLISM; PREDICTIVE VALUE; PE; diagnostics; PROBABILITY; in; Segmental; an Notes : The purpose of this investigation was to test the hypothesis that prior clinical assessment among patients stratified according to the presence or absence of prior cardiopulmonary disease enhances the accuracy of the predictive value of pulmonary embolism (PE) in the various categories. Diagnostic evaluation was made on the cumulative spectrum of mismatched defects, rather than a probability based on a preassigned number of mismatched segmental equivalent defects or mismatched vascular defects. Families of curves were derived that allowed an accurate assessment of the predictive value for each category of patients. The families of curves were comparable, irrespective of whether ventilation/perfusion scans were assessed on the basis of mismatched segmental equivalent defects or mismatched vascular defects, although the latter eliminated the necessity of estimating whether segmental defects were large or moderate in size. Clinical assessment was shown to prominently affect the predictive value of PE. Prior clinical assessment among patients stratified according to prior cardiopulmonary disease enhanced the accuracy of the predictive value of PE in the various groups of patients. Ref ID : STEIN1993A 1179. Stein, P.D., Henry, J.W., and Gottschalk, A. Mismatched vascular defects. An easy alternative to mismatched segmental equivalent defects for the interpretation of ventilation/perfusion lung scans in pulmonary embolism. Chest 104:1468-1471, 1993. Keywords : VENTILATION/PERFUSION; LUNG; SCAN; PULMONARY EMBOLISM; EMBOLISM; V/Q; PE; PROSPECTIVE; DIAGNOSIS; PIOPED; PREDICTIVE VALUE; diagnostics; V/Q SCAN; an; Segmental; in; is Notes : The purpose of this investigation was to test the hypothesis that ventilation/perfusion (V/Q) lung scans in patients with suspected acute pulmonary embolism (PE) can be evaluated on the basis of the total number of mismatched vascular defects, irrespective of whether such defects are moderate or large size segmental defects. Lung scan data from the national collaborative study of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were assessed in 383 patients with acute PE and 681 patients in whom suspected PE was excluded. The predictive value of the cumulative number of mismatched moderate size segmental defects (irrespective of the number of mismatched large segmental defects) was nearly the same as that of mismatched large segmental defects (irrespective of the number of mismatched moderate size segmental defects). This suggests that the diagnostic value of mismatched moderate size segmental defects is the same as mismatched large segmental defects. Lung scans evaluated on the basis of the number of mismatched vascular defects (moderate and/or large segmental defects) were compared with V/Q scans evaluated on the basis of the number of mismatched segmental equivalents. The maximum likelihood estimates of the areas under the receiver operating characteristic (ROC) curves for the number of mismatched vascular defects and for mismatched segmental equivalents were similar (0.8512 vs 0.8530) (NS). Stratification according to the presence or absence of prior cardiopulmonary disease permitted a more accurate assessment of both clinical groups. Evaluation of V/Q scans by vascular defects and by segmental equivalents showed similar areas under the ROC curves. In conclusion, the number of mismatched vascular defects is as powerful for the assessment of V/Q scans as the number of mismatched segmental equivalents. The number of mismatched vascular defects, however, is easier to interpret, and permits a more objective evaluation. Ref ID : STEIN1993B 1180. Stein, P.D., Gottschalk, A., Henry, J.W., and Shivkumar, K. Stratification of patients according to prior cardiopulmonary disease and probability assessment based on the number of mismatched segmental equivalent perfusion defects. Approaches to strengthen the diagnostic value of ventilation/perfusion lung scans in acute pulmonary embolism. Chest 104:1461-1467, 1993. Keywords : PROBABILITY; PERFUSION; diagnostics; VENTILATION/PERFUSION; LUNG; SCAN; PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; PE; PROSPECTIVE; PIOPED; PREDICTIVE VALUE; SPECIFICITY; Segmental; in; is; an Notes : A categorical diagnosis of "high probability" or "intermediate probability" encompasses a spectrum of diagnostic probabilities of pulmonary embolism (PE) that is not communicated to the referring physician. The diagnostic value of ventilation/perfusion lung scans, in the present investigation, was strengthened by use of a table to determine the likelihood of PE in individual patients on the basis of the observed number of mismatched segmental equivalent perfusion defects. In addition, we tested the hypothesis that stratification of patients according to the presence or absence of prior cardiopulmonary disease may enhance the ventilation/perfusion scan assessment of the probability of PE among both of these clinical categories of patients. Data were derived from the collaborative study of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Ventilation/perfusion lung scans were evaluated in 378 patients with acute PE and 672 patients in whom suspected PE was excluded. Among patients with no prior cardiopulmonary disease, > or = 1.0 mismatched segmental equivalents was indicative of PE in 102 of 118 (86 percent) vs 113 of 155 (73 percent) among patients with prior cardiopulmonary disease (p < 0.02). Among patients with prior cardiopulmonary disease, > or = 2 mismatched segmental equivalents were required to indicate > or = 80 percent probability of PE. Stratification on the basis of the presence or absence of prior cardiopulmonary disease, therefore, enhanced the ability of ventilation/perfusion scan readers to assign an accurate positive predictive value and specificity to individual patients based on the observed number of mismatched segmental equivalent defects. Among patients with no prior cardiopulmonary disease, fewer mismatched segmental equivalent defects were required to indicate a high probability of PE than were required by PIOPED criteria. The findings from some of these patients, by PIOPED criteria, would have indicated intermediate probability. Some indeterminate probability readings, therefore, will be eliminated among patients stratified with no prior cardiopulmonary disease. Ref ID : STEIN1993C 1181. Stein, P.D., Hull, R.D., Saltzman, H.A., and Pineo, G. Strategy for diagnosis of patients with suspected acute pulmonary embolism. Chest 103:1553-1559, 1993. Keywords : DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; MANAGEMENT; PE; PROSPECTIVE; diagnostics; RECOMMENDATIONS; Methods; REVIEW; RISK; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; PIOPED; PROBABILITY; VENTILATION/PERFUSION; V/Q; SCAN; V/Q SCAN; TREATMENT; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; in; algorithms; an; is Notes : STUDY PROTOCOL: Two separate groups of clinical investigators have provided new information and divergent approaches to the management of acute pulmonary embolism (PE). In this position paper, investigators from both groups (Prospective Investigation of Pulmonary Embolism Diagnosis [PIOPED] and Canadian study groups) have utilized the combined scientific database in order to rationalize seemingly polarized diagnostic recommendations into a single practical algorithm. METHODS: An in-depth review established the relative risks of deep venous thrombosis (DVT) and the related accuracy of diagnostic tests. In PIOPED, 640 of 887 patients at risk for PE had either an intermediate probability ventilation/perfusion (V/Q) scan or a V/Q scan probability that was discordant with the prior estimate of probability by clinical assessment. The risk of PE in these patients was 16 to 88 percent (average, 34 percent). In this group, we calculated the probability of PE assuming that tests for DVT had been performed and that 50 percent of patients with PE have detectable proximal DVT. By calculation, 108 in 640 patients of whom the diagnosis of PE was uncertain, would have shown proximal DVT. In 239 of these 640 patients, tests for DVT would have been negative and the risks of PE in these patients is calculated to be less than 10 percent. RESULTS: Therefore, we calculate that in 347 of 640 patients, confident recommendations for treatment or no treatment could have been given without pulmonary angiography. Accordingly, in the PIOPED study group of 887 patients, the need for pulmonary angiography would have been reduced from 640 (72 percent) to 293 patients (33 percent). CONCLUSION: In conclusion, a diagnostic strategy that includes the clinical evaluation, V/Q scan, and evaluation for DVT would decrease the number of patients who require pulmonary angiography from 72 to 33 percent. Ref ID : STEIN1994 1182. Stein, P.D., Hull, R.D., and Raskob, G. Risks for major bleeding from thrombolytic therapy in patients with acute pulmonary embolism. Consideration of noninvasive management. Ann.Intern.Med. 121:313-317, 1994. Keywords : RISK; BLEEDING; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; PULMONARY EMBOLISM; EMBOLISM; NONINVASIVE; MANAGEMENT; LUNG; SCAN; Methods; DIAGNOSIS; COMPLICATIONS; MYOCARDIAL INFARCTION; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PLASMINOGEN; PLASMINOGEN ACTIVATOR; TPA; HEMORRHAGE; PREVALENCE; diagnostics; in; analysis; infarction; an; ci; is Notes : OBJECTIVE: To assess the relative risks for bleeding with thrombolytic therapy in patients who are managed using pulmonary angiograms compared with those managed using noninvasive tests, primarily the ventilation-perfusion lung scan. DESIGN: A decision analysis based on data from other studies. METHODS: The risk for major bleeding in patients with pulmonary embolism who receive thrombolytic therapy after a noninvasive diagnosis was assessed from complications of thrombolytic therapy in patients with myocardial infarction, assuming that the same risk ratio for major bleeding when comparing an invasive with a noninvasive approach applied to patients with pulmonary embolism. The risk ratio was 3.3 (95% CI, 1.5 to 9.8) for major bleeding in patients with myocardial infarction. One or more major complications of pulmonary angiography occurred in 1.3% of patients (CI, 0.6% to 1.9%). RESULTS: The average reported risk was 14% (18 of 129 patients) (CI, 7.9% to 20.1%) for major bleeding in patients who had pulmonary angiography before receiving tissue plasminogen activator (tPA). The estimated risk was 4.2% (estimated CI, 1.4% to 9.3%) for major bleeding with tPA after a noninvasive diagnosis of pulmonary embolism. Assuming a risk of 1.3% for major complications from pulmonary angiography, a risk for major hemorrhage of 14.0% for an invasive diagnosis, and a risk of 4.2% for a noninvasive diagnosis, fewer complications would occur with noninvasive management if the prevalence of pulmonary embolism exceeded 21%. CONCLUSION: Among patients with suspected pulmonary embolism who are candidates for thrombolytic therapy, it is safer to use noninvasive diagnostic tests in many patients. Ref ID : STEIN1994A 1183. Stein, P.D. and Gottschalk, A. Critical review of ventilation/perfusion lung scans in acute pulmonary embolism. Prog.Cardiovasc.Dis. 37:13-24, 1994. Keywords : REVIEW; VENTILATION/PERFUSION; LUNG; SCAN; PULMONARY EMBOLISM; EMBOLISM; in Ref ID : STEIN1994B 1184. Stein, P.D. and Hull, R.D. Relative risks of anticoagulant treatment of acute pulmonary embolism based on an angiographic diagnosis vs a ventilation/perfusion scan diagnosis. Chest 106:727-730, 1994. Keywords : RISK; ANTICOAGULANT; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; VENTILATION/PERFUSION; SCAN; Antithrombotic; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; PE; THERAPY; V/Q; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; COMPLICATIONS; BLEEDING; HEPARIN; WARFARIN; PROBABILITY; V/Q SCAN; LEG; VEINS; an; in; International normalized ratio Notes : The purpose of this investigation was to assess the relative risks of antithrombotic treatment following pulmonary angiography vs no angiography in patients with acute pulmonary embolism (PE). Comparisons of risks of diagnosis and therapy were made among patients treated on the basis of a pulmonary angiographic diagnosis vs patients treated on the basis of a ventilation/perfusion (V/Q) scan combined with clinical assessment in the presence of a single negative test for deep venous thrombosis. Calculations of risks assumed major complications of pulmonary angiography equal to 1.3 percent, major bleeding with heparin equal to 4.9 percent (1.1 percent among patients with a low risk of bleeding and 10.8 percent among patients with a high risk of bleeding), and major bleeding with warfarin (international normalized ratio 2 to 3) equal to 1.7 percent. Among patients with a risk of major bleeding from heparin followed by warfarin of 6.6 percent, if the estimated probability of PE was greater than about 80 percent, fewer major complications of diagnosis and treatment would occur if treatment was initiated on the basis of the V/Q scan. If the probability of PE in such patients was less than 80 percent, fewer major complications of diagnosis and treatment would occur if the diagnosis was established by pulmonary angiography. Among patients with a high (12.5 percent) risk of major bleeding, it was shown to be safer to treat on the basis of an angiographic diagnosis if the estimated probability of PE was less than 90 percent. If the patients, however, were at low (2.8 percent) risk of major bleeding, fewer major complications would occur if angiography was reserved for patients with an estimated risk of PE less than about 50 percent. Serial studies of the leg veins may eliminate the need for angiography in such patients. Ref ID : STEIN1995 1185. Stein, P.D., Goldhaber, S.Z., and Henry, J.W. Alveolar-arterial oxygen gradient in the assessment of acute pulmonary embolism [see comments]. Chest 107(1):139-143, 1995. Keywords : 951216; OXYGEN; GRADIENT; in; PULMONARY EMBOLISM; EMBOLISM; is; DIAGNOSIS; PE; PROSPECTIVE; PIOPED; Methods; ANGIOGRAPHY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; A-a GRADIENT; AGE; ACUTE DISEASE; ADULT; AGED; Aged,80 and over; HUMAN; MIDDLE AGE; PROSPECTIVE STUDIES; PULMONARY ARTERY; ra; co; di; PULMONARY GAS EXCHANGE; Medline File; Health Planning & Administration File; heart; aa Notes : PURPOSE: The purpose of this investigation is to evaluate the utility of the alveolar-arterial (A-a) oxygen gradient in the diagnosis of acute pulmonary embolism (PE) among patients who participated in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIO-PED). METHODS: Pulmonary embolism was diagnosed (n = 280) or excluded (n = 499) by angiography in all patients. Patients were then categorized as (1) the entire cohort, (2) no prior cardiopulmonary disease and no prior PE, and (3) no prior PE or deep venous thrombosis. Normal values of the A-a gradient were defined in three ways: (1) values < or = 20 mm Hg; (2) values < or = age/4 + 4; and (3) values based on age from the literature. RESULTS: When a normal A-a gradient was defined as < or = 20 mmHg, 11 to 14% of patients with PE in the three categories of patients had a normal A-a gradient. When the equation age/4 + 4 was used, 8% to 10% of patients with PE in the three categories of patients had a normal A-a gradient. With age-related values from the literature, 20 to 23% of patients with PE in the three categories of patients had a normal A-a gradient. The A-a gradient was normal in comparable percentages of patients who did not have PE. CONCLUSION: Normal values of the A-a gradient did not exclude the diagnosis of acute PE Henry Ford Heart and Vascular Institute Detroit Mich 48202-2691. Ref ID : STEMMER1971 1186. Stemmer, R. [Cicatrization of leg ulcers of venous origin]. Bull.Soc.Sci.Med.Grand.Duche.Luxemb. 108:109-113, 1971. Keywords : LEG; Leg Ulcer; Ulcer; VENOUS; NASP; Cicatrix; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; de; ab Notes : TT - La cicatrisation des ulceres de jambe d'orgine veineuse AB -[No Abstract Available] UI - 71182813. Ref ID : STEPHEN1995 1187. Stephen, J.M. and Feied, C.F. Venous thrombosis. Postgraduate Medicine 97(1):36-47, 1995. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS Ref ID : STEVENSON1976 1188. Stevenson, I.M., Seddon, J.A., and Parry, E.W. The occurrence of deep venous thrombosis following compression sclerotherapy. Angiology 27:311-321, 1976. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SCLEROTHERAPY; SCLEROSANT; DEEP VENOUS THROMBOSIS; EXERCISE; VEINS; TREATMENT; DEEP VEIN THROMBOSIS; COMPRESSION; in; CONTRAST; vein Notes : The authors carried out a radiographic investigation in 13 patients to determine whether injected sclerosant flows into the deep venous system via incompetent perforators and to look for radiographic evidence of deep venous thrombosis following compression sclerotherapy. It was found that even with exercise, radiographic contrast material injected into a superficial perforating vessel remained for a long time confined to the incompetent superficial venous segment and the adjacent superficial veins. There was no radiographic evidence of post-treatment deep vein thrombosis in any case. Ref ID : STEVENSON1976A 1189. Stevenson, I.M., Seddon, J.A., and Parry, E.W. The occurrence of deep venous thrombosis following compression sclerotherapy. Angiology. 27:311-321, 1976. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; COMPRESSION; SCLEROTHERAPY; NASP; Contrast Media; HUMAN; Injections,Intravenous; MIDDLE AGE; PHLEBOGRAPHY; Pressure; Sclerosing Solutions; Support,Non- U.S.Gov't; THROMBOPHLEBITIS; VARICOSE VEINS; Medline File; ab Notes : AB - [No Abstract Available] UI - 87182500. Ref ID : STEWARD1988 1190. Steward, A. and Mayne, E.E. Rapid Resolution of subclavian vein thrombosis by tissue plasminogen activator. Lancet ii:890-? 1988. Keywords : RESOLUTION; vein; THROMBOSIS; PLASMINOGEN; PLASMINOGEN ACTIVATOR; VEINS; SUBCLAVIAN; SUBCLAVIAN VEIN Ref ID : STEWART1987 1191. Stewart, S., Cianciotta, D., Alexson, C., and Manning, J. The long-term risk of warfarin sodium therapy and the incidence of thromboembolism in children after prosthetic cardiac valve replacement. J.Thorac.Cardiovasc.Surg. 93:551-554, 1987. Keywords : LONG TERM; RISK; WARFARIN; THERAPY; INCIDENCE; THROMBOEMBOLISM; CARDIAC; ANTICOAGULATION; DURATION; Sodium; in Ref ID : STODDARD1993 1192. Stoddard, G.J. and Davis, H.T. Development of thrombophlebitis in peripheral veins with Vialon and PTFE-Teflon cannulas: a double-blind, randomised, controlled trial [letter]. Ann.R.Coll.Surg.Engl. 75:296-299, 1993. Keywords : THROMBOPHLEBITIS; VEINS; sdi-11/93; Superficial thrombophlebitis; Vialon; PTFE; Teflon; Catheters; in Ref ID : STOLLBERGER1993 1193. Stollberger, C., Slany, J., Schuster, I., Leitner, H., Winkler, W.B., and Karnik, R. The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism [published erratum appears in Ann Intern Med 1994 Feb 15;120(4):347]. Ann.Intern.Med. 119:461-465, 1993. Keywords : PHLEBITIS; PREVALENCE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; EMBOLISM; ADULT; AGED; Aged,80 and over; Cerebrovascular Disorders; COMPLICATIONS; Echocardiography; Methods; Esophagus; FEMALE; heart septal defects,atrial; DIAGNOSIS; HUMAN; Ischemia; LEG; blood supply; MALE; MIDDLE AGE; PHLEBOGRAPHY; THROMBOPHLEBITIS; radiography; CONTRAST; Transesophageal; Foramen ovale; STROKE; Hospitals; CALF; Popliteal Vein; VEINS; THROMBOEMBOLISM; OCCULT; vein; in; laboratories; is Notes : OBJECTIVE: To determine the prevalence of venous thrombosis in patients with suspected paradoxical embolism. DESIGN: Observational study. PATIENTS: Two hundred sixty-four patients with clinically suspected embolic events underwent contrast transesophageal echocardiographic evaluation. Forty-nine patients (24 women, 25 men) had a patent foramen ovale. Forty-one patients had acute stroke, and 8 had acute limb ischemia. SETTING: Echocardiography laboratory of a community hospital. MEASUREMENTS: The presence of a patent foramen ovale was assessed by transesophageal contrast echocardiography. Forty-two patients had venographic evaluation of the lower-extremity venous system. RESULTS: Venous thrombosis was clinically suspected in 6 patients and documented in 24 of the 42 patients with patent foramen ovale who underwent venographic study (57%; 95% Cl, 41% to 72%). Venous thrombosis was confined to calf or popliteal veins in 15 cases. Fifteen of 17 patients who had venographic evaluation within 7 days of the index event had thrombosis compared with 9 of 25 patients who had later evaluations (P = 0.001). More patients with venous thrombosis than without venous thrombosis had a history of previous thromboembolism (13 of 24 compared with 1 of 18 [corrected], respectively; P = 0.001). CONCLUSION: When a patent foramen ovale is detected in a patient with embolism, occult leg vein thrombosis is frequently present. Ref ID : STOLTENBERG1987 1194. Stoltenberg, P.H., Goodale, R.L., and Silvis, S.E. Portal vein thrombosis following combined endoscopic variceal sclerosis and vasopressin therapy for bleeding varices. Am.J.Gastroenterol. 82(12):1297-1300, 1987. Keywords : VEINS; THROMBOSIS; THERAPY; BLEEDING; VARICES; PORTAL VEIN; PORTAL VEIN THROMBOSIS; SCLEROSIS; VASOPRESSIN; vein Ref ID : STRUP1993 1195. Strup, S.E., Gudziak, M., Mulholland, S.G., and Gomella, L.G. The effect of intermittent pneumatic compression devices on intraoperative blood loss during radical prostatectomy and radical cystectomy. J Urol. 150:1176-1178, 1993. Keywords : COMPRESSION; Intraoperative; Methods; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PROPHYLAXIS; FIBRINOLYSIS; SURGERY; MALE; FEMALE; Extremities; sdi-11/93; Intermittent pneumatic compression; Prostatectomy; Blood loss; Pneumatic; blood; in; sex Notes : Intermittent pneumatic compression devices are a widely used, effective and presumed risk-free method of deep venous thrombosis prophylaxis, presumably by increasing peak venous blood velocity, and stimulating local and systemic fibrinolysis. We investigated whether intermittent pneumatic compression devices had any effect on intraoperative blood loss or transfusion during radical pelvic urological surgery. To our knowledge no previous study has addressed these issues. Records were reviewed for patients undergoing radical retropubic prostatectomy or radical cystectomy with diversion from 1985 to 1990. A total of 91 cases was reviewed: 38 radical retropubic prostatectomies and 53 radical cystectomies with diversion (34 male and 19 female patients). There were 59 patients with intermittent pneumatic compression devices (29 radical retropubic prostatectomies and 30 radical cystectomies with diversion) and 32 without intermittent pneumatic compression devices (9 radical retropubic prostatectomies and 23 radical cystectomies with diversion). Intraoperative blood loss and transfusions were calculated for each group with and without intermittent pneumatic compression devices. No clinically apparent lower extremity deep venous thrombosis or pulmonary embolus was diagnosed in any patient. For the group with intermittent pneumatic compression devices mean intraoperative blood loss was 2,541 ml. (range 700 to 8,850) versus 1,807 ml. (range 450 to 5,100) without a device, for a statistically significant difference of 734 ml. (p = 0.005). When 5 patients with excessive intraoperative blood loss (more than 5, 000 ml.) were excluded the statistically significant difference was maintained. When comparing radical retropubic prostatectomy and radical cystectomy with diversion, with and without intermittent pneumatic compression devices, blood loss was greater for the group with a device for each procedure. Differences in intraoperative blood loss were independent of sex or tumor stage. Intraoperative transfusions were increased by approximately 0.6 units per patient with the device. Our study suggests that intermittent pneumatic compression devices may increase blood loss during a radical pelvic operation. Ref ID : SUAREZ1989 1196. Suarez, C.R., Ow, E.P., Lambert, G.H., Anderson, C.L., and Purewal, N.S. Urokinase therapy for a central venous catheter thrombus. Am.J.Hematol. 31:269-272, 1989. Keywords : UROKINASE; THERAPY; VENOUS; CATHETER; THROMBUS; ACEP93; CENTRAL VENOUS CATHETER Ref ID : SULLIVAN1988 1197. Sullivan, K.L., Minken, S.L., and White, R.I.,Jr. Treatment of a case of thromboembolism resulting from thoracic outlet syndrome with intra-arterial urokinase infusion. J.Vasc.Surg. 7:568-571, 1988. Keywords : TREATMENT; THROMBOEMBOLISM; Syndrome; INTRAARTERIAL; UROKINASE; ACEP93 Ref ID : SULLIVAN1991 1198. Sullivan, K.L., Gardiner, G.A.J., Kandarpa, K., Bonn, J., Shapiro, M.J., Carabasi, R.A., Smullens, S., and Levin, D.C. Efficacy of thrombolysis in infrainguinal bypass grafts. Circulation 83:I99-105, 1991. Keywords : THROMBOLYSIS; ACEP93; in; bypass graft Ref ID : SUMNER1979 1199. Sumner, D.S. and Lambeth, A. Reliability of Doppler ultrasound om the diagnosis of acute venous thrombosis both above and below the knee. Am.J.Surg. 138:205, 1979. Keywords : Doppler; ULTRASOUND; DIAGNOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; KNEE; PULMONARY EMBOLISM; CALF Ref ID : SUYAMA1994 1200. Suyama, N., Mashimoto, H., Araki, J., Asai, S., Ikeno, Y., and Ikeda, T. [An autopsy case of urinary bladder carcinoma with pulmonary infarction and subacute cor pulmonale caused by tumor embolization]. Nippon.Kyobu.Shikkan.Gakkai.Zasshi. 32:491-496, 1994. Keywords : 951202; AUTOPSY; Carcinoma; PULMONARY INFARCTION; infarction; COR PULMONALE; EMBOLISM; is; an; Tumor emboli; EMBOLI; PULMONARY ARTERY; Arteries; CHEST; CHEST X-RAY; XRAY; RADIATION; THERAPY; Urine; Died; in; RESPIRATORY DISTRESS; POSTMORTEM; effusion; heart; LUNG; Liver; EMBOLIZATION; CAUSE; blood; SWAN-GANZ; Catheters; DIAGNOSIS; AGED; Aged,80 and over; bladder neoplasms; PA; carcinoma,transitional cell; CASE REPORT; English Abstract; fatal outcome; HUMAN; MALE; neoplasm circulating cells; PULMONARY EMBOLISM; et; PULMONARY HEART DISEASE; Medline File; Cancerlit File; internal medicine; Hospitals; japan Notes : Pulmonary tumor embolism is a common finding at autopsy but is difficult to diagnose clinically antemortem. We report an autopsy case of urinary bladder carcinoma associated with tumor emboli of the pulmonary arteries and subsequent pulmonary infarctions. An eighty- six- year-old man with bloody sputum showed multiple infiltrates on chest X- ray and multiple pleural based parenchymal lesions with truncated apex on computed tomography. The patient had a history of radiation therapy against urinary bladder carcinoma two years earlier. Transitional type carcinoma cells were identified from a urine sample obtained on admission. Three weeks later, the patient developed subacute cor pulmonale and died in severe respiratory distress. Postmortem examination revealed primary carcinoma of the urinary bladder. Multiple tumor emboli of pulmonary arteries and subsequent pulmonary infarctions were visible microscopically. There was a large amount of effusion in both the pleural and the abdominal space. The heart contained focal scarring and mild right ventricular hypertrophy and there was congestion of the lungs, liver, kidneys and spleen. Pulmonary tumor embolization may present at any stage of the patient's illness but rarely causes subsequent pulmonary infarctions. Cytologic examination of blood samples obtained from Swan-Ganz catheters may be useful in the diagnosis of tumor embolization Department of Internal Medicine Sasebo City General Hospital Nagasaki Japan. Ref ID : SUZUKI1992 1201. Suzuki, N., Nakao, A., Nonami, T., and Takagi, H. Experimental study on the effects of sclerosants for esophageal varices on blood coagulation, fibrinolysis and systemic hemodynamics. Gastroenterologia.Japonica. 27(3):309-316, 1992. Keywords : SCLEROSANTS; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; COAGULATION; FIBRINOLYSIS; PROTHROMBIN; FIBRINOGEN; PLATELET; ARTERIAL; THROMBOSIS; SCLEROTHERAPY; HEMODYNAMICS; SODIUM TETRADECYL SULFATE; ETHANOLAMINE OLEATE; ABSOLUTE ETHANOL; POLIDOCANOL; PT; APTT; THROMBOPLASTIN; blood; BLOOD COAGULATION; Sodium; st; et; prothrombin time; partial thromboplastin time; Plasmin; an; in; Platelet Count; pulmonary vascular resistance; VASCULAR RESISTANCE; Pressure; is Notes : Sodium tetradecyl sulfate (STS), ethanolamine oleate (EO), absolute ethanol (ET), and, to a lesser extent, polidocanol (PO) have all been shown to prolong the prothrombin time (PT) and the activated partial thromboplastin time (APTT), while decreasing fibrinogen and alpha-2 plasmin inhibitor (PI) activity. All of these agents are capable of producing an acute drop in the circulating platelet count, and STS has also been shown to decrease levels of antithrombin III. Pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP) both undergo a marked increase lasting 30 minutes after STS administration, with lesser transient increases seen after infusion of EO and ET. PO produced minimal changes in PVR and PAP. The mechanism for these effects is not known. Ref ID : SVENDSEN1989 1202. Svendsen, E. and Karwinski, B. Prevalence of pulmonary embolism at necropsy in patients with cancer. J.Clin.Pathol. 42:805-809, 1989. Keywords : 951202; PREVALENCE; PULMONARY EMBOLISM; EMBOLISM; in; CANCER; Died; DEATH; Stomach; INCIDENCE; VENOUS; CALF; CALF VEIN THROMBOSIS; vein; THROMBOSIS; is; RISK; RISK FACTORS; Adolescence; ADULT; AGED; Aged,80 and over; AUTOPSY; CHILD; Child,Preschool; FEMALE; HUMAN; Infant; Length of Stay; MIDDLE AGE; Neoplasms; co; mo; th; ovarian neoplasms; palliative treatment; ep; et; Medline File; Health Planning & Administration File; Cancerlit File; pathology; Norway; bile; drainage; an Notes : The series studied comprised 6197 patients who had died of or who had cancer at death and represents all patients with cancer from 21,530 necropsies performed at this department from 1960-84. Pulmonary embolism was significantly more common among cancer patients than in those with non-neoplastic diseases. Among those palliatively treated, patients with ovarian cancer, cancer of the extrahepatic bile duct system, and cancer of the stomach had the highest prevalence of pulmonary embolism (34.6%, 31.7%, and 15.2%, respectively). Necropsy patients with cancer of the oesophagus and larynx, together with leukaemia, myelomatosis, and malignant lymphoma had the lowest prevalence (0-5.6%). Palliatively treated cancers in organs of the peritoneal cavity had a significantly higher incidence than all other cancers combined. Cancer of the peritoneal cavity may impede venous drainage from the lower limbs and thus be an important factor in the onset of deep calf vein thrombosis and pulmonary embolism. It is concluded that cancer represents an increased risk factor for onset of pulmonary embolism, in particular in patients with ovarian cancer and cancer of the extrahepatic bile duct system Department of Pathology University of Bergen Norway. Ref ID : SVENDSEN1991 1203. Svendsen, E., Karwinski, B., and Aardal, N.P. Frequency of pulmonary embolism in patients with circulatory disturbances of the lower limb or intestine. An autopsy study. Pathol.Res.Pract. 187:267- 270, 1991. Keywords : 951202; FREQUENCY; PULMONARY EMBOLISM; EMBOLISM; in; intestines; an; AUTOPSY; DURATION; Hospitals; DEATH; SURGERY; CAUSE; cause of death; is; Arterial Occlusive Diseases; co; GANGRENE; HUMAN; bs; LEG; ep; et; Medline File; pathology; Norway Notes : The frequency of pulmonary embolism in patients with circulatory disturbances in the lower limbs (CDLL) or intestine (CDI) were investigated in an autopsy series. Pulmonary embolism was seen more frequently in patients with CDLL than in patients with CDI. This difference was maintained irrespective of duration of last admission. Patients with CDLL had pulmonary embolism in 36% of the cases when they stayed in the hospital for more than 5 days prior to death, versus 12% in CDI patients. Pulmonary embolism occurred with approximately equal frequency in all age-groups. Surgery had little influence on the occurrence of pulmonary embolism in patients with CDLL. In 85% of the CDLL cases, pulmonary embolism (n = 81) was considered the immediate cause of death at autopsy. The awareness of this life-threatening disease is poor as only 12% had been diagnosed prior to death Department of Pathology Gade Institute University of Bergen Norway. Ref ID : SVENSSON1994 1204. Svensson, P.J. and Dahlback, B. Resistance to activated protein C as a basis for venous thrombosis. N.Engl.J.Med. 330:517-522, 1994. Keywords : PROTEIN C; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; FAMILIAL; ANTICOAGULANT; THROMBOEMBOLIC; FACTOR V; HEMATOLOGIC DEFECT; PROTEIN C RESISTANCE; in; is; abnormalities Notes : A newly discovered familial defect in the anticoagulant properties of unactivated factor V is the single most common hematologic defect responsible for venous thromboembolic disease. The defect is believed to be present in 33 percent of patients with recurrent venous thrombosis (more than 10 times more common than any other hematologic abnormality in this patient population). Ref ID : SVENSSON1994A 1205. Svensson, P.J. and Dahlback, B. Resistance to activated protein C as a basis for venous thrombosis [see comments]. N.Engl.J.Med. 330(8):517-522, 1994. Keywords : 96-suzy-001; PROTEIN C; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; in; an; ANTICOAGULANT; Methods; PREVALENCE; partial thromboplastin time; THROMBOPLASTIN; SURVIVAL; Adolescence; ADULT; AGED; BLOOD COAGULATION; FACTOR V; metabolism; FEMALE; HUMAN; MALE; MIDDLE AGE; deficiency; PROTEIN S; Support,Non-U.S.Gov't; THROMBOEMBOLISM; blood; genetics; THROMBOPHLEBITIS Notes : BACKGROUND. In three families with various forms of venous thrombosis, we observed an apparently inherited poor response to the anticoagulant activated protein C (APC). The condition was due to a deficiency in a previously unrecognized anticoagulant factor that functioned as a cofactor to activated protein C. METHODS. We conducted the present study to determine the prevalence of resistance to APC in patients with venous thrombosis. We compared 104 consecutive patients with venous thrombosis confirmed by objective tests with 130 controls. In addition, 211 members of 34 families of persons with resistance to APC were studied. The anticoagulant response to APC was measured with a modified version of the activated partial-thromboplastin time test; the results were expressed as APC ratios. RESULTS. Forty-five percent of patients had a family history of thrombosis. A significant (P < 0.001) difference in APC ratios was observed between the controls and the patients with thrombosis. For 33 percent of patients, the APC ratio was below the 5th percentile of the control values, although the results of the family studies suggested that the prevalence of APC resistance may be even higher (approximately 40 percent) in the patients with thrombosis. The inherited nature of the defect was confirmed in a majority of cases, and the family studies suggested the mode of inheritance to be autosomal dominant. The thrombosis-free survival of APC-resistant family members was significantly less than that of non- APC-resistant family members. CONCLUSIONS. There was a high prevalence of APC resistance among young persons with a history of venous thrombosis, and this resistance appeared to be inherited as an autosomal dominant trait. Ref ID : SWAN1984 1206. Swan, K.W. and Black, P.M. Deep vein thrombosis and pulmonary emboli in neurosurgical patients: A review. J.Neurosurg. 61:1055-1062, 1984. Keywords : DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; EMBOLI; TRAUMA; DEFIBRINATION; DIC; DVT; POSTOPERATIVE; vein; Pulmonary emboli; in; REVIEW 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 : SWARCZINSKI1991 1207. Swarczinski, C. and Dijkers, M. The value of serial leg measurements for monitoring deep vein thrombosis in spinal cord injury. J.Neurosci.Nurs. 23:306-314, 1991. Keywords : PHLEBITIS; LEG; MONITORING; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; Spinal cord; INJURY; Adolescence; ADULT; AGED; anthropometry; Methods; FEMALE; FIBRINOGEN; chemistry; HUMAN; iodine radioisotopes; diagnostic use; Length of Stay; statistics & numerical data; MALE; MIDDLE AGE; nursing assessment; standards; nursing evaluation research; spinal cord injuries; COMPLICATIONS; Support,Non- U.S.Gov't; support,u.s.gov't,non-p.h.s. THROMBOPHLEBITIS; DIAGNOSIS; ETIOLOGY; Nursing; DVT; COMPLICATION; CLINICAL DIAGNOSIS; SPECIFICITY; SENSITIVITY; intensive care; CALF; Thigh; Atrophy; in; is; an; intensive care units; decision making Notes : Deep vein thrombosis (DVT) is a common complication of spinal cord injury (SCI). Many specialized SCI nursing units use serial leg measurements to establish clinical diagnosis of DVT, in spite of extensive studies showing that clinical signs and symptoms of DVT have a specificity and sensitivity hardly better than chance. For 30 patients who spent 920 days in an SCI intensive care unit, we collected daily serial calf and thigh measurements and the results of radiofibrinogen uptake test (RFUT) performed about every third day. Three criteria for clinical diagnosis of DVT found in the literature were used: an increase from baseline, an increase from the previous day or a right-left difference of a specific minimal size. The cut-off points for minimal size used were also those suggested by the literature: over .5 inch, over 1 cm, or 1.2 cm and over for women, 1.5 cm and over for men. We found such changes or differences correlated weakly or not at all with RFUT results, and symptomatic increases or differences occurred very frequently. Major factors presumably underlying the variability of measurements and their lack of sensitivity and specificity are: premorbid leg asymmetry; atrophy of the legs after SCI; true changes in circumference due to factors other than DVT; and lack of measurement reliability. It was concluded taking serial leg measurements is of no value in the SCI population. For those reluctant to abandon tradition, suggestions are provided for improving the quality of measurements and related decision making. Further research is needed. Ref ID : SWIERZEWSKI1993 1208. Swierzewski, S.J.,3d, Denil, J., and Ohl, D.A. The management of penile Mondor's phlebitis: superficial dorsal penile vein thrombosis [see comments]. J.Urol. 150:77-78, 1993. Keywords : PHLEBITIS; MANAGEMENT; vein; THROMBOSIS; ADULT; CASE REPORT; coitus; HUMAN; MALE; penis; blood supply; DIAGNOSIS; ETIOLOGY; THERAPY; VEINS; AGE; MEDICATIONS; drugs; RESOLUTION; FOLLOWUP; Anti-Inflammatory Agents; in; sexual; is Notes : Superficial dorsal penile vein thrombosis was diagnosed 8 times in 7 patients between 19 and 40 years old (mean age 27 years). All patients related the onset of the thrombosis to vigorous sexual intercourse. No other etiological medications, drugs or constricting devices were implicated. Three patients were treated acutely with anti- inflammatory medications, while 4 were managed expectantly. The mean interval to resolution of symptoms was 7 weeks. Followup ranged from 3 to 30 months (mean 11) at which time all patients noticed normal erectile function. Only 1 patient had recurrent thrombosis 3 months after the initial episode, again related to intercourse. We conclude that this is a benign self-limited condition. Anti-inflammatory agents are useful for acute discomfort but they do not affect the rate of resolution. Ref ID : SWINTON1968 1209. Swinton, N.W., Edgett, J.W., and Hall, R.J. Primary subclavian vein thromboses. Circulation 38:737-745, 1968. Keywords : SUBCLAVIAN; SUBCLAVIAN VEIN; vein; VEINS; THROMBOSIS; PULMONARY EMBOLISM Ref ID : SYMINGTON1977 1210. Symington, I.S. and Stack, B.H. Pulmonary thromboembolism after travel. Br.J.Dis.Chest 71:138, 1977. Keywords : PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; NASP; bib-4 Ref ID : SZUCS1971 1211. Szucs, M.M., Brooks, H.L., Grossman, W., Banas, J.S.,Jr., Meister, S.G., Dexter, L., and Dalen, J.E. Diagnostic sensitivity of laboratory findings in acute pulmonary thromboembolism. Ann.Intern.Med. 74:161, 1971. Keywords : SENSITIVITY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PE; PULMONARY INFARCTION; WBC; diagnostics; laboratories; in; is; infarction Notes : Leukocytosis is common in PE. The average WBC count is 11,000, and WBC counts of 20,000 may be seen in patients with pulmonary infarction. Ref ID : TAGNON1946 1212. Tagnon, H.J., Levenson, S.M., Davidson, C.S., and Taylor, F.H.L. The occurrence of fibrinolysis in shock, with observations on the prothrombin time and the plasma fibrinogen during haemorrhagic shock. Amer.J.Med.Sci. 211:88-96, 1946. Keywords : FIBRINOLYSIS; THROMBOSIS; SCLEROTHERAPY; SHOCK; PROTHROMBIN; FIBRINOGEN; in; prothrombin time Ref ID : TAKADA1991 1213. Takada, K., Matsumoto, A., Miyoshi, H., and Oshiba, S. Changes in thrombin-antithrombin III complex after endoscopic injection sclerotherapy. Am.J.Gastroenterol. 86(1):123-124, 1991. Keywords : SCLEROTHERAPY; THROMBIN; ETHANOLAMINE OLEATE; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; THROMBUS; SCLEROSANT; ANTITHROMBIN III; in; Injections Notes : Thrombin antithrombin III complex (TAT) rises significantly after injection of 2ml or more of ethanolamine oleate into esophageal varices, most likely reflecting thrombus formation. This change did not occur after injection of smaller amounts of sclerosant. Ref ID : TALBOT1970 1214. Talbot, S. and et al ABO blood groups and venous thromboembolic disease. Lancet 1:1257, 1970. Keywords : ABO; BLOOD GROUPS; VENOUS; THROMBOEMBOLIC; NASP; bib-4; blood Ref ID : TALBOT1986 1215. Talbot, R.W., Hepell, J., Dozois, R.R., and Beart, R.W. Vascular complications of inflammatory bowel disease. Mayo.Clin.Proc. 61:140-145, 1986. Keywords : COMPLICATIONS; RISK; DVT; PE; FIBRINOGEN; FACTOR VIII; PLATELET; ANTITHROMBIN III; ULCERATIVE COLITIS; CROHN'S DISEASE; INFLAMMATORY BOWEL; 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 : TAMM1974 1216. Tamm, D., Uhlenbruch, K., and Maass, D. [Bilateral Paget-v- Schrotter syndrome. Hormonal contraception and the risk of thrombosis--a case report (author's transl)]. Dtsch.Med.Wochenschr. 99:836-838, 1974. Keywords : Syndrome; RISK; CASE REPORT; NASP; ADULT; Axillary Vein; Contraceptives,Oral; English Abstract; FEMALE; FIBRINOLYSIS; HUMAN; Intermittent Claudication; PHLEBOGRAPHY; STREPTOKINASE; THROMBOPHLEBITIS; TIME FACTORS; Varicose Ulcer; VARICOSE VEINS; Medline File; de; ab Notes : TT - Doppelseitiges Paget-v.-Schrotter-Syndrom. Kasuistischer Beitrag zum Problem des Thromboserisikos bei hormoneller Kontrazeption AB - [No Abstract Available] UI - 74164523. Ref ID : TAUBMAN1986 1217. Taubman, L.B. and Silverstone, F.A. Autopsy proven pulmonary embolism among the institutionalized elderly. J.Am.Geriatr.Soc. 34:752- 756, 1986. Keywords : 951202; AUTOPSY; PULMONARY EMBOLISM; EMBOLISM; is; in; AGE; CHEST; CHEST PAIN; PAIN; PHLEBITIS; MALIGNANCY; SURGERY; LONG TERM; DIAGNOSIS; REVIEW; INCIDENCE; Nursing; nursing homes; diagnostics; Methods; POSTMORTEM; AGED; FEMALE; homes for the aged; HUMAN; MALE; Medical Records; new york; di; ep; PA; Medline File; Health Planning & Administration File; dyspnea Notes : The presentation of pulmonary embolism is variable in the elderly as in any age group. Common symptoms such as chest pain, dyspnea, and hemoptysis may be absent. Furthermore, precursors such as phlebitis, malignancy, and recent surgery often may be absent as well. Our intent was to examine the occurrence in a long-term care institution of pulmonary embolism at autopsy and the extent of missed antemortem diagnosis of this condition, and to compare patients with and without pulmonary embolism by chart and autopsy review. The incidence of pulmonary embolism in our study of elderly patients during a six-year period in a teaching nursing home was 12.8%. Although our series is small, consisting of 47 autopsies, our results are in accord with reports from other patient sites. Few autopsies are performed on nursing home patients and even fewer have been studied with regard to the occurrence and characteristics of pulmonary embolism in this population. The diagnosis remains difficult and uncertain, especially so in the elderly, because of the variability of presentation and association, the lesser pursuit of aggressive or invasive diagnostic methods, and the paucity of postmortem documentation. Ref ID : TAVEL1995 1218. Tavel, M.E., Goldhaber, S.Z., and Moser, K.M. Rapidly progressing dyspnea associated with a mass in the right side of the heart. Chest 107(3):866-868, 1995. Keywords : 951216; in; heart; AGED; ANTICOAGULANTS; tu; CASE REPORT; coronary thrombosis; di; pp; th; us; Diagnosis,Differential; disease progression; dyspnea; et; fatal outcome; Heart Atrium; heart neoplasms; HUMAN; MALE; THROMBOLYTIC THERAPY; Vena Cava Filters; Medline File; Cancerlit File; boston Notes : [No Abstract Available] Department of Medicine Harvard Medical School Boston MA. Ref ID : TCHENG1995 1219. Tcheng, J.E. Enhancing safety and outcomes with the newer antithrombotic and antiplatelet agents. Am.Heart J. 130(3 Pt 2):673-679, 1995. Keywords : 96-suzy-001; Safety; OUTCOME; Antithrombotic; RISK; COMPLICATIONS; LONG TERM; in; CLINICAL TRIALS; HEPARIN; THROMBIN; HIRUDIN; partial thromboplastin time; THROMBOPLASTIN; BLEEDING; PLATELET; Glycoproteins; CLINICAL TRIAL; an; Heparin dose; MANAGEMENT; light; drugs; Cardiology; antibodies,monoclonal; adverse effects; PHARMACOLOGY; FIBRINOLYTIC AGENTS; HUMAN; immunoglobulins,fab; peptides; platelet aggregation inhibitors Notes : Novel antithrombotic and antiplatelet agents may help reduce the short-term risk of ischemic complications and the long-term risk of restenosis in patients undergoing coronary revascularization procedures. Recent clinical trials suggest that, compared with heparin, direct thrombin inhibitors (such as hirudin and hirulog) offer a predictable dose-response effect on the activated partial thromboplastin time without a concomitant increase in bleeding. Among the newer antiplatelet agents, the platelet integrin glycoprotein IIb/IIIa inhibitors (including c7E3 Fab and Integrelin) have generated the greatest interest. Clinical trial data have shown that c7E3 Fab (administered in conjunction with heparin) significantly reduces ischemic events and improves clinical outcomes. In phase II trials, Integrelin has also shown similar effects. The primary limitations have been an increase in heparin-associated bleeding, which suggests that the safety profile may be enhanced by careful adjustment of the heparin dose implementation of other patient management guidelines. The safety and efficacy data obtained in future trials should shed more light on the appropriate roles of these drugs in interventional cardiology. Ref ID : TEIGEN1993 1220. Teigen, C.L., Maus, T.P., Sheedy, P.F., Johnson, C.M., Stanson, A.W., and Welch, T.J. Pulmoary embolism: Diagnosis with electron-beam CT. Radiology 188:839-845, 1993. Keywords : EMBOLISM; DIAGNOSIS; CHEST; ANGIOGRAPHY; SCAN; FALSE- NEGATIVE; THROMBUS; CT; CT scan; in Notes : 25 patients had combined chest CT and angiography. Compared to angiography, CT scans produced 19 true positives, 4 true negatives, one false negative, and one false positive. In patients with a true-positive CT scan, 17 zones of thrombus were visualized by CT but were not visible on angiography, while 18 zones were visualized by angiography but not by CT. Ref ID : TENCATE1993 1221. Ten Cate, J.W. Thrombolytic treatment of pulmonary embolism. Lancet 341:1315-1316, 1993. Keywords : PHLEBITIS; THROMBOLYTIC; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; HUMAN; LEG; blood supply; drug therapy; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS Ref ID : TERADA1990 1222. Terada, T., Nakanuma, Y., Yonejima, M., Yokoyama, H., and Koike, N. Portal, mesenteric, and splenic venous thrombosis after endoscopic injection sclerotherapy. J.Clin.Gastroenterol. 12(2):238-239, 1990. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; SCLEROTHERAPY; ESOPHAGEAL; ESOPHAGEAL VARICES; VARICES; FATAL; Injections Notes : The authors report a twelfth case of fatal portal venous thrombosis following injection sclerotherapy of esophageal varices. Ref ID : TERRIN1989 1223. Terrin, M., Goldhaber, S.Z., and Thompson, B. Selection of patients with acute pulmonary embolism for thrombolytic therapy: the Thrombolysis In Pulmnonary Embolism (TIPE) patient survey Selection of patients with acute pulmonary embolism for thrombolytic therapy. Thrombolysis in pulmonary embolism (TIPE) patient survey. The TIPE Investigators. Chest 95(5 Suppl):279S-281S, 1989. Keywords : PULMONARY EMBOLISM; EMBOLISM; THROMBOLYTIC; THERAPY; THROMBOLYSIS; 951216; THROMBOLYTIC THERAPY; in; UNITED STATES; PROBABILITY; LUNG; SCAN; CLINICAL TRIAL; TREATMENT; RISK; blood; Blood loss; BLEEDING; is; DIAGNOSIS; RANDOMIZED; ALTEPLASE; tu; COMPARATIVE STUDY; Data Collection; FIBRINOLYTIC AGENTS; HUMAN; MULTICENTER STUDIES; dt; RECOMBINANT PROTEINS; RISK FACTORS; Support,Non-U.S.Gov't; Medline File; maryland Notes : During a recent one-year period, 44 clinical centers in the United States saw 2,539 patients with diagnoses of pulmonary embolism as supported by high probability lung scans and/or positive pulmonary angiograms. In developing proposals for a clinical trial of Thrombolysis in Pulmonary Embolism (TIPE), investigators in the 44 clinical centers reviewed the 2,539 patients' medical charts for contraindications to thrombolytic therapy. Overall, 1,345 (53.5%) patients surveyed in the TIPE clinical centers would have been acceptable for treatment with thrombolytic therapy, a proportion higher than generally anticipated. Risks of major blood loss were the most frequent contraindications to thrombolytic therapy and were found in 838 (33.3%) patients. Risks to the CNS were found to contraindicate thrombolytic therapy in 453 (17.9%) patients. Risks of bleeding into special compartments were found to contraindicate thrombolytic therapy in 76 (3.0%) patients. Pulmonary embolism is underdiagnosed in most clinical settings, and even more patients than found in the TIPE survey could benefit from appropriate diagnosis and treatment. The question remains as to whether pulmonary embolism patients will benefit from thrombolytic therapy. Only a randomized clinical trial will provide a satisfactory answer Maryland Medical Research Institute Baltimore 21210. Ref ID : THAMES1977 1224. Thames, M.D., Alpert, J.S., and Dalen, J.E. Syncope in patients with pulmonary embolism. JAMA 238:2509, 1977. Keywords : PULMONARY EMBOLISM; EMBOLISM; SYNCOPE; in Ref ID : THANDROYEN1994 1225. Thandroyen, F.T., Phillips, M.D., D'Souza, D., and Buja, L.M. A 24-year-old man with extensive lower limb edema and acute arterial occlusion [clinical conference]. Circulation 90:2115-2123, 1994. Keywords : PHLEBITIS; Edema; ARTERIAL; OCCLUSION; ACUTE DISEASE; ADULT; Arterial Occlusive Diseases; COMPLICATIONS; Blood Coagulation Disorders; CASE REPORT; HUMAN; LEG; MALE; protein-losing enteropathies; THROMBOPHLEBITIS; THROMBOSIS Ref ID : THATCHER1986 1226. Thatcher, B.S., Sivak, M.V.,Jr., Ferguson, D.R., and Petras, R.E. Mesenteric venous thrombosis as a possible complication of endoscopic sclerotherapy: A report of two cases. Am.J.Gastroenterol. 81(2):126-129, 1986. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; COMPLICATION; SCLEROTHERAPY; COMPLICATIONS Ref ID : THERIAULT1990 1227. Theriault, R.L. and Buzdar, A.U. Acute superior vena caval thrombosis after central venous catheter removal: successful treatment with thrombolytic therapy. Med.Pediatr.Oncol. 18:77-80, 1990. Keywords : THROMBOSIS; CENTRAL VENOUS CATHETER; VENOUS; CATHETER; TREATMENT; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; ACEP-93; ACEP93 Ref ID : THIBAULT1995 1228. Thibault, G.E. CLINICAL PROBLEM SOLVING Studying the Classic. Multiple Pulmonary Emboli. The New England Journal of Medicine 333(10):648-652, 1995. Keywords : 96-suzy-002; Pulmonary emboli; EMBOLI; in Notes : 01-03-96. Abstract : [ABSTRACT NOT IN ARTICLE]. Ref ID : THIBAULT1995A 1229. Thibault, G.E. Clinical Problem-Solving: Multiple Pulmonary Emboli. To the Editor. The New England Journal of Medicine 332(26):1792, 1995. Keywords : 96-suzy-002; Pulmonary emboli; EMBOLI Notes : 01-05-96. Ref ID : THOMAS1978 1230. Thomas, M.L. and O'Dwyer, J.A. A phlebographic study of the incidence and significance of venous thrombosis in the foot. Am.J.Roentgenol. 130:751-754, 1978. Keywords : INCIDENCE; VENOUS; THROMBOSIS; Foot; NASP; VENOUS THROMBOSIS; in Ref ID : THOMAS1985 1231. Thomas, D.P. Venous thrombogenesis. Annu.Rev.Med. 36:39, 1985. Keywords : VENOUS; THROMBOGENESIS; CAUSE; ETIOLOGY; VIRCHOW Notes : What are the fundamental causes of thrombogenesis? Ref ID : THUNE1972 1232. Thune, P. Plethysmographic recordings of skin pulses. V. Piezoelectric and photoelectric measurements in venous leg ulcers. Acta Derm.Venereol.(Stockh) 52:24-30, 1972. Keywords : Skin; Pulse; VENOUS; LEG; Leg Ulcer; Ulcer; NASP; ADULT; AGED; Arteriosclerosis; HEMODYNAMICS; HUMAN; Methods; MIDDLE AGE; Photometry; Plethysmography; Regional Blood Flow; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : AB - [No Abstract Available] UI - 72137725. Ref ID : THURLBECK1981 1233. Thurlbeck, W.M. Accuracy of clinical diagnosis in a Canadian teaching hospital. Can.Med.Assoc.J. 125:443-447, 1981. Keywords : 951202; CLINICAL DIAGNOSIS; DIAGNOSIS; in; Hospitals; AUTOPSY; CAUSE; cause of death; DEATH; MANAGEMENT; OUTCOME; LUNG; lung diseases; PULMONARY EMBOLISM; EMBOLISM; PNEUMONIA; british columbia; Chronic Disease; COMPARATIVE STUDY; diagnostic errors; HUMAN; PA; di; Medline File Notes : Two hundred autopsies were investigated to determine the correlation between the clinical and pathological diagnoses in three categories-- major underlying disease, cause of death and significant incidental pulmonary findings. There was concurrence in diagnosis of the major underlying disease in 76% of cases, with 12% of disagreements being considered minor and 12% major. In only three cases might different management have affected the outcome had the correct diagnosis of the major underlying disease been made during life. There was concurrence of the diagnosis of the cause of death (which was often different from the underlying disease) in 64% of cases, and in 10% of cases the outcome might have been different had the clinical diagnosis been accurate. The clinical opinion that lung disease was the cause of death was confirmed at autopsy in 54% of cases, and 45% of the pulmonary causes of death as determined at autopsy had been recognized clinically. Major incidental pulmonary findings diagnosed clinically were confirmed in 76% of cases, and major pulmonary findings diagnosed at autopsy had been recognized clinically in 83%. The major sources of these discrepancies were pulmonary embolism and pneumonia. If autopsies are to play a role in patient management, clinicians will have to be made aware of discrepancies between clinical and autopsy diagnosis. The real test of efficacy would be modification of patient management for the good. Ref ID : THURSTON1973 1234. Thurston, O.G. and Williams, H.T. Chronic venous insufficiency of the lower extremity. Pathogenesis and surgical treatment. Arch.Surg. 106:537-539, 1973. Keywords : CHRONIC; CHRONIC VENOUS INSUFFICIENCY; VENOUS; Venous Insufficiency; PATHOGENESIS; SURGICAL; TREATMENT; NASP; ADULT; AGED; FEMALE; Femoral Vein; HUMAN; Iliac Vein; LEG; Ligation; MALE; MIDDLE AGE; Postoperative Complications; PULMONARY EMBOLISM; Surgical Wound Infection; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; Extremities; ab Notes : AB - [No Abstract Available] UI - 73154856. Ref ID : TOPOL1992 1235. Topol, E.J. and Califf, R.M. Thrombolytic therapy for elderly patients. N.Engl.J.Med. 327:45-47, 1992. Keywords : THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; TPA; HEMORRHAGE; CEREBRAL HEMORRHAGE; in; an; Cerebral Notes : A weight-adjusted dose of TPA did not result in an excess of cerebral hemorrhage in elderly patients. Ref ID : TOTH1972 1236. Toth, L.M. and Van Der Molen, H.R. Les complications thromboemboliques apres traitement sclerosant de varices. Phlebologie 25(4):425-430, 1972. Keywords : COMPLICATIONS; SCLEROSANT; VARICES; VEINS; THROMBOSIS; EMBOLISM; DEATH; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; PULMONARY EMBOLISM; SURGICAL; TREATMENT; VARICOSE VEINS; VENOUS; SURGERY; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; SCLEROTHERAPY; DIAGNOSIS; RISK; MORTALITY; EMBOLI; de; in; vein; varicose; France; CONTRAST; AMBULATORY; is Notes : In 1962 the French Society of Phlebology reported in its Expansion Scientifique that of the previous 87,685 patients treated surgically for varices, there had been 256 cases of proven deep vein thrombosis, 100 cases of pulmonary embolism, and 13 to 18 deaths due to pulmonary thromboembolism. This represents a mortality from pulmonary embolism of 0.02 percent in patients undergoing surgical treatment for varicose veins in France. Toth compares these figures with those for Holland: of 20,041 patients undergoing superficial venous surgery there were 7 deaths due to pulmonary embolism. If the likelihood of death from pulmonary embolism were the same in the two settings, one could extrapolate backwards to suggest that there had been approximately 35 pulmonary emboli and approximately 85 cases of deep venous thrombosis in this patient population. In contrast, Toth states that of 18,000 patients treated with ambulatory sclerotherapy for varicose veins there were only two proven cases of pulmonary thromboembolism and two more in which the diagnosis was likely but had not been proven. There were no deaths in this patient population. He concludes that even if pulmonary thromboembolism were caused by sclerotherapy, the risk is many times less than that associated with a surgical approach to the same problem. Ref ID : TOTH1972A 1237. Toth, L.M. and Van Der Molen, H.R. [Thromboembolic complications after sclerosing treatment of varicose veins]. Phlebologie. 25(4):425- 430, 1972. Keywords : 96-suzy-001; COMPLICATIONS; TREATMENT; varicose; English Abstract; FEMALE; HUMAN; MIDDLE AGE; Postoperative Complications; PULMONARY EMBOLISM; chemically induced; MORTALITY; Sclerosing Solutions; adverse effects; surgery,operative; THROMBOEMBOLISM; DIAGNOSIS; VARICOSE VEINS; SURGERY Ref ID : TOTTEN1965 1238. Totten, H.P. The surgical treatment of acute ascending superficial thrombophlebitis. Angiology 16:37, 1965. Keywords : SURGICAL; TREATMENT; THROMBOPHLEBITIS; NASP; bib-4; Superficial thrombophlebitis Ref ID : TOTTEN1967 1239. Totten, H.P. Superficial thrombophlebitis: observations on diagnosis and treatment. Geriatrics 22:151, 1967. Keywords : THROMBOPHLEBITIS; DIAGNOSIS; TREATMENT; NASP; bib-4; Superficial thrombophlebitis Ref ID : TOURNAY1962 1240. Tournay, R. Crossectomie et stripping. In: La sclerose des varices, edited by Tournay, R.Paris:Expansion scientifique Francais, 1962,p. 60 Keywords : VARICES; VEINS; THROMBOSIS; EMBOLISM; DEATH; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; MORTALITY; PULMONARY EMBOLISM; SURGICAL; TREATMENT; VARICOSE VEINS; SCLEROSE; et; de; in; vein; varicose; France Notes : In 1962 the French Society of Phlebology reported in its Expansion Scientifique that of the previous 87,685 patients treated surgically for varices, there had been 256 cases of proven deep vein thrombosis, 100 cases of pulmonary embolism, and 13 to 18 deaths due to pulmonary thromboembolism. This represents a mortality from pulmonary embolism of 0.02 percent in patients undergoing surgical treatment for varicose veins in France. Ref ID : TOW1967 1241. Tow, D.E. and Wagner, H.N.,Jr. Recovery of pulmonary arterial blood flow in patients with pulmonary embolism. N.Engl.J.Med. 276:1053, 1967. Keywords : ARTERIAL; PULMONARY EMBOLISM; EMBOLISM; PULMONARY ARTERIAL BLOOD FLOW; blood; BLOOD FLOW; in Ref ID : TRAN1985 1242. Tran, T.H., Marbet, G.A., and Duckert, F. Association of hereditary heparin cofactor II deficiency with thrombosis. Lancet ii:413-414, 1985. Keywords : HEREDITARY; HEPARIN; HEPARIN COFACTOR II; THROMBOSIS Ref ID : TRETBAR1970 1243. Tretbar, L.L. and Pattisson, P.H. Injection-compression treatment of varicose veins. Am.J.Surg. 120:539-541, 1970. Keywords : TREATMENT; VARICOSE VEINS; VEINS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; TOURNIQUET; varicose Notes : Venous thrombosis reported due to tourniquet effect from improper bandaging. Ref ID : TSCHIRHART1988 1244. Tschirhart, J.M. and Rao, M.K. Mechanism and management of persistent withdrawal occlusion. Am.Surg. 54:326-328, 1988. Keywords : MANAGEMENT; ACEP93; CATHETER; FIBRIN SLEEVE; UROKINASE; THROMBOLYSIS; CENTRAL VENOUS CATHETER; OCCLUSION Ref ID : TSCHIRKOV1978 1245. Tschirkov, A., Krause, F., and Elert, O. Surgical management of massive pulmonary embolism. J.Thoracic.Cardiovasc.Surg. 75:730-733, 1978. Keywords : SURGICAL; MANAGEMENT; MASSIVE; PULMONARY EMBOLISM; EMBOLISM Ref ID : TURPIE1990 1246. Turpie, A.G., Levine, M.N., Hirsh, J., Ginsberg, J.S., Cruickshank, M., Jay, R., and Gent, M. Tissue plasminogen activator (rt- PA) vs heparin in deep vein thrombosis. Results of a randomized trial. Chest 97(4 Suppl):172S-175S, 1990. Keywords : PLASMINOGEN; PLASMINOGEN ACTIVATOR; rt-PA; HEPARIN; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; TREATMENT; LYSIS; THROMBUS; FIBRINOGEN; LONG TERM; FOLLOWUP; POSTPHLEBITIC; POSTPHLEBITIC SYNDROME; Syndrome; ALTEPLASE; THROMBOLYTIC THERAPY; THROMBOPHLEBITIS; COMPARATIVE STUDY; DOUBLE BLIND METHOD; FOLLOW UP STUDIES; HUMAN; RANDOMIZED CONTROLLED TRIALS; SUPPORT NON U S GOVT; CLINICAL TRIALS; 951217; in; vein; RANDOMIZED; PLACEBOS; an; tu; Double-Blind Method; Follow-Up Studies; Support,Non-U.S.Gov't; dt; Medline File; CANADA Notes : AB-We performed a randomized trial comparing two dosing regimens of recombinant tissue plasminogen activator (rt-PA) plus heparin vs heparin alone in the treatment of acute proximal deep vein thrombosis in 83 patients. Of 12 patients who received 0.5 mg/kg rt-PA plus heparin over 4 h, seven (58 percent) had greater than 50 percent lysis of the thrombus, compared with none of 12 who received placebo plus heparin (p = 0.002). Of 28 patients who received 0.5 mg/kg rt-PA over 8 h, repeated in 24 h, six (21 percent) had greater than 50 percent lysis, compared with two (7 percent) of 30 patients who received placebo plus heparin (p = 0.11). The 4-h infusion of rt-PA produced a 40 percent reduction and the 8-h infusion an 11 percent reduction in plasma fibrinogen concentration. At long-term follow-up, three (25 percent) of 12 patients in whom greater than 50 percent lysis was achieved had symptoms of the postphlebitic syndrome, compared with 19 (56 percent) of 34 patients in whom lysis was less than 50 percent (p = 0.07). Ref ID : TURPIE1993 1247. Turpie, A.G., Gent, M., Laupacis, A., Latour, Y., Gunstensen, J., Basile, F., Klimek, M., and Hirsh, J. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement [see comments]. N.Engl.J.Med. 329:524-529, 1993. Keywords : ASPIRIN; PLACEBOS; WARFARIN; EMBOLISM; COMPLICATION; Safety; Methods; RANDOMIZED; TREATMENT; Atrial fibrillation; THROMBOEMBOLISM; DEATH; CAUSE; RISK; HEMORRHAGE; BLEEDING; THERAPY; MORTALITY; in; an; International normalized ratio; heart; confidence intervals Notes : BACKGROUND. Despite the use of warfarin, major systemic embolism remains an important complication in patients with heart-valve replacement. Although the addition of antiplatelet agents has the potential to reduce this complication, their efficacy and safety when given in combination with warfarin are uncertain. METHODS. In a randomized, double-blind, placebo-controlled trial, we assessed the efficacy and safety of adding aspirin (100 mg per day) to warfarin treatment (target international normalized ratio, 3.0 to 4.5) in 370 patients with mechanical heart valves or with tissue valves plus atrial fibrillation or a history of thromboembolism. RESULTS. A total of 186 patients were randomly assigned to aspirin and 184 to placebo, and they were followed for up to 4 years (average, 2.5). Major systemic embolism or death from vascular causes occurred in 6 aspirin-treated patients (1.9 percent per year) and 24 placebo-treated patients (8.5 percent per year) (risk reduction with aspirin, 77 percent; 95 percent confidence interval, 44 to 91 percent; P < 0.001). Major systemic embolism, nonfatal intracranial hemorrhage, or death from hemorrhage or vascular causes occurred in 12 patients assigned to aspirin (3.9 percent per year) and 28 patients assigned to placebo (9.9 percent per year) (risk reduction, 61 per cent; 95 percent confidence interval, 24 to 80 percent; P = 0.005); major systemic embolism or death from any cause occurred in 13 patients (4.2 percent) and 33 patients (11.7 percent), respectively (risk reduction, 65 percent; 95 percent confidence interval, 33 to 82 percent; P < 0.001); and death from all causes occurred in 9 patients (2.8 percent) and 22 patients (7.4 percent), respectively (risk reduction, 63 percent; 95 percent confidence interval, 19 to 83 percent; P = 0.01). Bleeding occurred in 71 patients in the aspirin group (35.0 percent), as compared with 49 patients in the placebo group (22.0 percent) (increase in risk, 55 percent; 95 percent confidence interval, 8 to 124 percent; P = 0.02); major bleeding occurred in 24 and 19 patients, respectively (increase in risk, 27 percent; 95 percent confidence interval, -30 to 132 percent; P = 0.43). CONCLUSIONS. In patients with mechanical heart valves and high-risk patients with prosthetic tissue valves, the addition of aspirin to warfarin therapy reduced mortality, particularly mortality from vascular causes, together with major systemic embolism. Although there was some increase in bleeding, the risk of the combined treatment was more than offset by the considerable benefit. Ref ID : UPET1973 1248. UPET The Urokinase Pulmonary Embolism Trial: A national cooperative study. Circulation 47 (Supp II):1-108, 1973. Keywords : UROKINASE; PULMONARY EMBOLISM; EMBOLISM; UPET Ref ID : USPENSKII1975 1249. Uspenskii, L.V., Kurguzov, O.P., and Tsallagov, B.A. [Treatment of trophic ulcers in patients with varicose veins and post- thrombophlebitic syndrome]. Klin.Khir. :39-43, 1975. Keywords : Ulcer; VARICOSE VEINS; VEINS; NASP; ADULT; AGED; Boric Acids; Drug Combinations; Erythromycin Ethylsuccinate; FEMALE; HUMAN; MALE; MIDDLE AGE; Naphthalenes; Syndrome; THROMBOPHLEBITIS; Trypsin; Varicose Ulcer; Zinc; Medline File; in; varicose; ab Notes : TT - Lechenie troficheskikh iazv u bol'nykh s varikoznym rasshireniem ven i posttromboflebiticheskim sindromom AB - [No Abstract Available] UI - 76123790. Ref ID : USPET1974 1250. USPET Urokinase Streptokinase Pulmonary Embolism Trial: Phase II results. JAMA 229:1606-1613, 1974. Keywords : UROKINASE; STREPTOKINASE; PULMONARY EMBOLISM; EMBOLISM Ref ID : VALERIO1981 1251. Valerio, D., Hussey, J.K., and Smith, F.W. Central vein thrombosis associated with intravenous feeding. A prospective study. Parenter.Enteral Nutr. 5:240-242, 1981. Keywords : vein; THROMBOSIS; INTRAVENOUS; PROSPECTIVE; PROSPECTIVE STUDIES; VENOUS THROMBOSIS; TPN Ref ID : VANBEMMELEN1991 1252. van Bemmelen, P.S., Bedford, G., Beach, K., and Strandness, D.E.,Jr. Status of the valves in the superficial and deep venous system in chronic venous disease. Surgery 109:730-734, 1991. Keywords : VENOUS; CHRONIC; VENOUS VALVES; VEINS; ULCERATION; Ulcer; VENOUS THROMBOSIS; THROMBOSIS; Ankle; Skin; DEEP VEIN THROMBOSIS; vein; varicose; VARICOSE VEINS; Ultrasonics; Duplex; REFLUX; Femoral Vein; NASP; femoral vein - physiopathology; saphenous vein - physiopathology; thrombophlebitis - physiopathology; thrombosis - physiopathology; varicose veins - physiopathology; Age Factors; Chronic Disease; COMPARATIVE STUDY; HUMAN; MIDDLE AGE; skin ulcer - etiology; skin ulcer - physiopathology; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. thrombophlebitis - complications; thrombosis - complications; varicose veins - complications; PHLEBITIS; physiopathology; SAPHENOUS VEIN; Skin Ulcer; ETIOLOGY; THROMBOPHLEBITIS; COMPLICATIONS; Single segment; in; an Notes : The relationship between the functional status of the venous valves in the superficial and deep veins and ulceration was evaluated in 42 patients. Twenty-five patients had ulcers, 12 of these patients had a history of previous deep venous thrombosis and 13 of these patients denied such an event. Seventeen patients had normal ankle skin, 10 of these patients had a documented history of deep vein thrombosis and seven of these patients had varicose veins only. An ultrasonic duplex scanner was used to document the presence of reflux in all segments of the superficial and deep system. In the entire group of 25 limbs with ulceration, valvular incompetence was noted in 22 limbs at levels involving segments that communicated with the ulcer-bearing area. Of the 17 limbs with normal ankle skin, in only two instances was a single segment of posterior tibial vein in midcalf found to be incompetent. For those patients with normal ankle skin and a history of varicose veins, the deep veins below the common femoral vein level were always competent. Ref ID : VANDERMOLEN1982 1253. Van Der Molen, H.R. The choice of compressive methods in phlebology. Phlebologie. 35:73-99, 1982. Keywords : Methods; BANDAGES; ARTERIAL; LEG; Pressure; Foot; Extension; COMPRESSION; NASP; Clothing; HUMAN; Lymphedema; Posture; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Venous Pressure; Medline File; in; ab; an; blood; is Notes : AB - A very simple experiment shows the difference between an elastic and a rigid bandage. The experiment consists of placing the sheath of a tensiometer (for the measurement of arterial tension) on the lower third of the leg and then of raising the pressure to 80 mmHg (between the systolic and diastolic pressure. The foot must be placed in a hanging position (slight extension) and raised in dorsiflexion. It can be seen that the compression achieved using the rigid sheath (canvas) rises to double the pressure at its lowest. After several moments of this sort the pressure drops because the blood, lymph, and interstitial liquid are expelled from this segment of the member. The pressure differential is therefore 6-7 cmHg. And this is the differential required to eliminate oedema UI - 82174926. Ref ID : VANDERMOLEN1989 1254. Van Der Molen, H.R. Le risque de throbose profonde lors des injections intra-variqueuses pourquoi est-il quasi inexistant? Phlebologie 42(1):137-139, 1989. Keywords : SCLEROSANT; THROMBUS; INJURY; VEINS; CAUSE; VARICES; VENOUS; PLATELET; PLATELET AGGREGATION; SCLEROSANTS; POLIDOCANOL; THROMBOSIS; SCLEROTHERAPY; RISK; DVT; ENDOTHELIAL; THROMBOGENESIS; de; Injections; is; in; blood; STASIS Notes : Argument #1 is that the sclerosant itself is non thrombogenic -- any thrombus is secondary only to endothelial injury. The sclerosant used is diluted in whatever blood remains within the superficial veins, but is still strong enough to cause endothelial injury within those veins. Relative stasis within varices also helps to prolong the contact time of the sclerosant, producing a greater endothelial injury. By the time the sclerosant makes its way back into the deep circulation it has been so much diluted with blood that it is no longer capable of producing any detectable endothelial injury. Relatively rapid laminar flow within the deep veins prevents prolonged exposures, further reducing the likelihood of deep venous endothelial injury. Argument #2 is that in the absence of endothelial injury platelet aggregation, the first step in thrombogenesis, is actually inhibited by low concentrations (up to 0.8 mg sclerosant per cc of platelet-rich plasma, or up to .08 percent weight/volume) of the sclerosants Trombovar, Variglobin, Polidocanol, and Sclerovein. Ref ID : VANETTI1971 1255. Vanetti, A., Tessler, L., Slama, R., and Mathey, J. Embolies pulmonaires recidivantes a la fin d'un traitement sclerosant de varices chez une femme enceinte, traitees avec succes par embolectomie pulmonaire sous circulation extra-corporelle. Phlebologie 24(3):201-209, 1971. Keywords : SCLEROSANT; VARICES; PREGNANT; SCLEROTHERAPY; PAIN; TREATMENT; CAUSE; CHEST; CHEST X-RAY; XRAY; ANGIOGRAPHY; DIAGNOSIS; MASSIVE; PULMONARY EMBOLISM; EMBOLISM; PREGNANCY; CHILD; EMBOLECTOMY; CARDIOPULMONARY BYPASS; ELECTROCARDIOGRAM; AXIS; PULMONARY ANGIOGRAPHY; CLINICAL DIAGNOSIS; de; et; Edema; dyspnea; Hospitals; an; Ligation Notes : Vanetti et al. have described a case of a five month pregnant woman who underwent sclerotherapy because of pain, tremendous edema and functional impairment associated with large varices and unresponsive to conservative treatment. Sclerotherapy proceeded without any unusual occurrences, until three days after treatment when the patient developed a transient attack of dyspnea. On the seventh day post treatment she developed another attack of dyspnea, this time so prolonged and severe as to cause her presentation to the hospital. A chest x-ray revealed Westermark's sign, and the electrocardiogram showed a right axis deviation along with an S1 Q3 pattern suggestive of pulmonary strain. Pulmonary angiography confirmed the clinical diagnosis of massive pulmonary embolism, and the patient underwent successful pulmonary embolectomy and vena caval ligation under cardiopulmonary bypass. The remainder of the pregnancy was uneventful and a healthy full-term child was delivered transvaginally. Ref ID : VATHESATOGKIT1989 1256. Vathesatogkit, P., Saenghirunvattana, S., and Nitiyanant, P. Autopsy proven cases of pulmonary thromboembolism: 18-year study at Ramathibodi Hospital. J.Med.Assoc.Thai. 72:271-274, 1989. Keywords : 951202; AUTOPSY; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; Hospitals; PULMONARY EMBOLISM; EMBOLISM; in; an; INCIDENCE; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; CAUSE; ADULT; AGED; CHILD; FEMALE; HUMAN; MALE; MIDDLE AGE; di; Retrospective Studies; thailand; Medline File Notes : Twelve cases of pulmonary embolism were found among 4,896 autopsies during 18 years in Ramathibodi hospital. This gives an incidence of 0.24 per 100 necropsies. Deep vein thrombosis occurred in two of the twelve cases and was not the main cause of pulmonary embolism in this series. Ref ID : VAUGHAN1987 1257. Vaughan, D.E., Goldhaber, S.Z., Kim, J., and Loscalzo, J. Recombinant tissue plasminogen activator in patients with pulmonary embolism: correlation of fibrinolytic specificity and efficacy. Circulation 75(6):1200-1203, 1987. Keywords : 951216; PLASMINOGEN; PLASMINOGEN ACTIVATOR; in; PULMONARY EMBOLISM; EMBOLISM; FIBRINOLYTIC; SPECIFICITY; blood; HUMAN; rt-PA; FIBRINOLYSIS; INTRAVENOUS; FIBRINOGEN; FIBRIN; FIBRIN DEGRADATION PRODUCTS; TREATMENT; PULMONARY ARTERY; ARTERY; THROMBUS; UROKINASE; THROMBOLYSIS; is; ADULT; AGED; Aged,80 and over; ALTEPLASE; tu; COMPARATIVE STUDY; DRUG EVALUATION; FEMALE; Fibrin Fibrinogen Degradation Products; an; FIBRINOLYTIC AGENTS; MALE; MIDDLE AGE; polymers; bl; dt; RECOMBINANT PROTEINS; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. Medline File; Health Planning & Administration File Notes : Blood samples from 24 patients who received recombinant human tissue- type plasminogen activator (rt-PA) for angiographically documented acute pulmonary embolism were examined to identify and quantify fibrinolysis. Before and after the intravenous administration of 50 mg rt-PA over a 2 hr period, levels of total fibrinogen, fibrin(ogen) degradation products (FDP), and cross-linked fibrin degradation products (XDP) were measured in each patient. Elevated levels of XDP were found in all patients before treatment (mean 2.0 micrograms/ml, normal less than 0.2 microgram/ml), and these increased 12-fold with treatment. Fibrinogen levels fell 30% and FDP levels increased 24- fold for the entire group of patients. Over this 2 hr period, 10 of 24 patients (responders) demonstrated 25% or greater improvement in the extent of pulmonary artery thrombus as quantified by Urokinase Pulmonary Embolism Trial score, and these patients were found to have a significantly lower XDP/FDP ratio after rt-PA (p less than .04) than those patients who failed to respond. These data suggest that the intravenous administration of pharmacologic doses of rt-PA in patients with pulmonary embolism produces both fibrinolysis and fibrinogenolysis, successful thrombolysis in these patients is associated with a preponderance of fibrinogenolysis over fibrinolysis, the XDP/FDP ratio is a useful indicator of fibrinolytic specificity, and in patients with acute pulmonary embolism the endogenous fibrinolytic pathways are activated, albeit ineffectively, as indicated by the increased circulating XDP levels seen in all 24 patients before the administration of rt-PA. Ref ID : VEA1985 1258. Vea, H.W., Sirotta, P.S., and Nelp, W.B. Ventilation-perfusion scanning for pulmonary embolism: refinement of predictive value through Bayesian analysis. AJR 145(5):967-972, 1985. Keywords : SCANNING; PULMONARY EMBOLISM; EMBOLISM; PREDICTIVE VALUE; analysis; DIAGNOSIS; PE; PERFUSION; VENTILATION; diagnostics; PROBABILITY; is; PREVALENCE; an; in; PROSPECTIVE; PROSPECTIVE STUDIES; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; CHEST; SENSITIVITY; sensitivity and specificity; SPECIFICITY; NUCLEAR; Segmental; Bayes; V/Q Notes : The diagnosis of pulmonary embolism (PE) by pulmonary perfusion and ventilation scintigraphy presents problems common to all imperfect diagnostic tests. Bayesian analysis indicates that the posttest probability of PE is a function of the prevalence (or pretest probability) of PE as well as the scintigraphic findings. The authors propose that Bayesian analysis allows an explicit refinement in communicating the implications of scintigraphic findings to referring clinicians. Recent data reported from a prospective study of ventilation-perfusion scanning compared with pulmonary angiography in patients suspected of PE were reviewed. Using the reported scintigraphic and chest radiographic findings, the sensitivity and specificity of each of the various test result combinations for angiographically proven PE were derived. The overall prevalence of PE was estimated to be 20% in patients suspected of PE who were referred for nuclear imaging. A Bayesian analysis was then performed for each category of test result to estimate the posttest probability of PE for different prevalence estimates. If a perfusion study alone is done which shows segmental or larger defects without corresponding chest radiographic changes, the sensitivity for PE is 80%, and the specificity is 86%. With a 20% prevalence of PE, the posttest probability of PE is 58%. The use of ventilation imaging improves the predictive power of the test by its effect on specificity. When a ventilation image shows preserved (mismatched) ventilation in concert with the above findings, the sensitivity for PE is 75%, and the specificity increases to 95%. For these findings the posttest probability increases to 79%, and for a prevalence of 50%, the posttest probability of PE is 94%. Ref ID : VERHAEGHE1987 1259. Verhaeghe, R., Wilms, G., and Vermylen, J. Local low-dose thrombolysis in arterial disease of the limbs. Semin.Thromb.Hemost. 13:206-211, 1987. Keywords : THROMBOLYSIS; ARTERIAL; ACEP93; in Ref ID : VERSCHAKELEN1993 1260. Verschakelen, J.A., Vanwijck, E., Bogaert, J., and Baert, A.L. Detection of unsuspected central pulmonary embolism with conventional contrast-enhanced CT. Radiology 188:847-850, 1993. Keywords : PULMONARY EMBOLISM; EMBOLISM; CT; CHEST; SCAN; ARTERIAL; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; DIAGNOSIS; RISK; RISK FACTORS; DVT; PE; CT scan; in Notes : Twenty-two chest CT scans with pulmonary arterial filling defects were reviewed. Pulmonary thromboembolism had been clinically highly suspected in only five of these patients. Pulmonary thromboembolism had not been part of the clinical differential diagnosis in 13 of the cases, despite the fact that all but one of the patients had obvious risk factors for DVT and PE. Ref ID : VESSEY1978 1261. Vessey, M.P. and Mann, J.I. Female sex hormones and thrombosis. Br.Med.Bull. 34:157-162, 1978. Keywords : FEMALE; Hormones; THROMBOSIS; NASP; sex Ref ID : VIN1990 1262. Vin, F.P. [Verification of the efficacy of sclerosing treatments in phlebology]. Phlebologie. 43:673-680, 1990. Keywords : TREATMENT; SCLEROSANTS; NASP; ADULT; AGED; FEMALE; Fibrosis; HUMAN; MALE; MIDDLE AGE; RECURRENCE; SAPHENOUS VEIN; SCLEROTHERAPY; THROMBOSIS; VARICOSE VEINS; Medline File; in; de; en; ab; ad Notes : TT - Controle d'efficacite des traitements sclerosants en phlebologie AB - [No Abstract Available] AD - Hopital de Bon Secours AD - Paris UI - 91239659. Ref ID : VINITSKI1993 1263. Vinitski, S., Thakur, M.L., Consigny, P.M., Mitchell, D.G., Mohamed, F.B., and Ortega, H.V. Use of Ferrum in MRI of lung parenchyma and pulmonary embolism. Magn.Reson.Imaging. 11:499-508, 1993. Keywords : MRI; LUNG; PULMONARY EMBOLISM; EMBOLISM; PE; Iron; CONTRAST; RABBITS; COAGULATION; vein; MR; Injections; HUMAN; sdi-11/93; in; blood; jugular veins; ge; is Notes : MRI of lung parenchyma and pulmonary embolism (PE) remains challenging. "Ferrum," a ferric hydroxide sucrose complex used clinically for iron deficiency anemia for more than 40 years, was investigated as a negative MRI contrast agent in five rabbits bearing experimental PE as well as in five normal volunteers. Clots were prepared by spontaneous coagulation of 0.1 ml In-111 labeled autologous red blood cells and introduced through the jugular vein. Scintigraphic imaging permitted anatomical localization of PE in vivo and thereby served as a control for MR imaging. MRI was performed on a 1.5 T GE Signa scanner before and after induction of PE, and before and after the injection of Ferrum. T1-weighted images were obtained continuously for up to 90 min using varying doses of Ferrum. In five normal human volunteers, a single dose of 100 mg each was administered. T1-and T2- weighted spin-echo and gradient-echo images of lung parenchyma were repeatedly obtained before and after agent administration. In rabbit, Ferrum remained in circulation for several hours where it shortened both T1 and T2 of blood, improving the contrast between PE and lung parenchyma (i.e., intravascular compartment). A dose of 3 mg/kg was enough to increase the contrast-to-noise ratio (CNR) between PE and lung parenchyma by almost three fold, substantially improving lesion detectability. CNR increased up to five-fold when the dose was increased up to 20 mg/kg at which point CNR reached a plateau. In humans, T2- weighted spin-echo sequence appeared to be most sensitive to changes in signal-to-noise ratio (SNR) of normal lung parenchyma. Within 60 min after injection of 100 mg of iron, SNR dropped by 34% (p < .025). However, 24 hr later, SNR returned to almost normal. Ferrum increased the contrast between PE and lung parenchyma in the rabbit and decreased the parenchymal SNR in humans in nontoxic doses. These results suggest that Ferrum is worthy of further investigation of PE imaging in humans. Ref ID : VISELLI1993 1264. Viselli, A.L., Feuer, G.A., and Granai, C.O. Lower limb ischemic venous thrombosis in patients with advanced ovarian carcinoma. Gynecol.Oncol. 49:262-265, 1993. Keywords : PHLEBITIS; VENOUS; THROMBOSIS; Carcinoma; CASE REPORT; FEMALE; HUMAN; Ischemia; ETIOLOGY; LEG; blood supply; MIDDLE AGE; ovarian neoplasms; COMPLICATIONS; radiotherapy; THROMBOPHLEBITIS; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; CANCER; GANGRENE; Extremities; STASIS; COMPRESSION; HEPARIN; THERAPY; Progression; RADIATION; EARLY; TREATMENT; Methods; in; is Notes : Three cases of lower limb, deep venous thrombosis that progressed to ischemia in patients with advanced ovarian cancer are reported. One patient developed frank gangrene of the extremity. Venous stasis, secondary to venous compression from metastatic disease, was the predisposing factor in all cases. Heparin therapy was uniformly unsuccessful in halting progression of thrombosis. Ischemic thrombosis originating from extrinsic venous compression is unlikely to respond to conventional therapy alone. Local external radiation to metastatic sites, given early and possibly in conjunction with conventional treatment methods, may achieve a clinical response by causing a reduction in tumor size and thus relief of venous compression. Ref ID : VIX1983 1265. Vix, V.A. The usefulness of chest radiographs obtained after a demonstrated perfusion scan defect in the diagnosis of pulmonary embolism. Clin.Nucl.Med. 11:577, 1983. Keywords : CHEST; CHEST RADIOGRAPH; PERFUSION; SCAN; DIAGNOSIS; PULMONARY EMBOLISM; EMBOLISM; in Ref ID : VOIGT1975 1266. Voigt, H., Hackel, F., and Wiemers, U. [Assessment of the functional capacity in the patients with venous diseases]. Z.Gesamte.Inn.Med. 30:230-233, 1975. Keywords : VENOUS; ACUTE DISEASE; VEINS; CAUSE; Hospitals; TREATMENT; CHRONIC; CHRONIC VENOUS INSUFFICIENCY; Venous Insufficiency; PAIN; Skin; Chronic Disease; Methods; Venous Pressure; Pressure; PHLEBOGRAPHY; NASP; English Abstract; HUMAN; LEG; MALE; Plethysmography,Impedance; Sex Factors; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; in; ab; is Notes : TT - Beurteilung der Leistungsfahigkeit Venenkranker AB - Acute diseases of the veins, in most cases thromboses, cause inability to work in almost all cases; in profound phlebothromboses hospital treatment is indicated. In the chronic venous insufficiency the functional capacity can be decreased especially bey pains, inclination to swelling and changes of the skin (congestive dermatoses, ulcera). Eventual basic diseases and concomitant diseases render the judgment difficult. Experienced treatment under active collaboration of the patient may improve the functional capacity in most cases. The daily load of the patient by profession and so on, and the often changing course of chronic diseases of the veins must be taken into consideration in the estimation. On the basis of a stage-plan proposed by Kornotzki and coworders the evidence of selected phlebological methods (anamnesis, state, tourniquet-tests, measurement of the venous pressure, functional phlebography) is discussed. It is particularly referred to plethysmographic functional tests of the veins UI - 76107150. Ref ID : VOLLMAR1970 1267. Vollmar, J. [Surgery in post-thrombotic syndrome]. Dtsch.Med.J. 21:466-472, 1970. Keywords : POST-THROMBOTIC; NASP; Blood Vessel Prosthesis; Blood Vessels; FEMALE; HUMAN; LEG; MIDDLE AGE; Sympathectomy; THROMBOSIS; Transplantation,Autologous; Varicose Ulcer; VARICOSE VEINS; Medline File; in; de; ab Notes : TT - Chirurgie des postthrombotischen Syndroms AB - [No Abstract Available] UI - 72070615. Ref ID : VUKOV1991 1268. Vukov, L.F., Berquist, T.H., and King, B.F. Magnetic resonance imaging for calf deep venous thrombophlebitis. Ann.Emerg Med 20:497-499, 1991. Keywords : MAGNETIC RESONANCE; CALF; VENOUS; THROMBOPHLEBITIS; MRI; VENOGRAPHY; DVT; ADULT; SCAN; EMERGENCY; Hospitals; Venogram; Thigh; DIAGNOSIS; sdi-11/93; magnetic resonance imaging; an; abnormalities; hi; standards Notes : STUDY OBJECTIVE: To compare magnetic resonance imaging (MRI) of the calf with venography for patients with suspected calf deep venous thrombophlebitis (DVT). DESIGN: Ten consecutive adult patients with suspected calf DVT received venography and, within 48 hours, MRI scans. The tests were reviewed blindly by two radiologists, and results of the tests were compared. SETTING: The emergency department of a large teaching hospital with an annual census of 60,000 patients. MAIN RESULTS: All patients with negative venograms had no suggestion of DVT on MRI scan. Two of these patients had other significant demonstrable abnormalities. Four of the five patients with positive venograms had positive calf MRI scans. One patient with a venogram that was difficult to interpret had no DVT on MRI. A thigh DVT was seen on his venogram and was suggested by MRI findings. CONCLUSION: MRI may replace ascending venography as the standard for diagnosis of calf DVT. Ref ID : WAGNER1993 1269. Wagner, U., Bittinger, A., von Wichert, P., and Barth, P.J. Pulmonary arteritis with pulmonary arterial thrombosis and recurrent endopulmonary embolization. Clin.Investig. 71:559-563, 1993. Keywords : Arteritis; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; EMBOLIZATION; THROMBOPHLEBITIS; LEG; CHRONIC; Extremities; CONTRAST; VENOGRAPHY; VENOUS; VENOUS THROMBOSIS; Pelvis; INTRAVENOUS; HEPARIN; Died; OCCLUSION; THROMBI; Superficial thrombophlebitis; sdi-11/93; in; an; is Notes : A 41-year-old woman underwent medical examination for superficial thrombophlebitis of both lower legs. Incidentally a chronic myelogenous leukemia was diagnosed and chemotherapeutically treated. Three weeks after the first attendance the patient again suffered superficial thrombophlebitides of all extremities. Clinically she exhibited symptoms of recurrent mild pulmonary embolization. Contrast venography revealed no signs of deep venous thrombosis of legs, pelvis, or cava inferior. Despite continuous full-dose intravenous heparin administration the patient died, with signs of fulminant pulmonary embolization. Surprisingly, necropsy revealed a complete thrombotic occlusion of the pulmonary arterial system caused by pulmonary arteritis with signs of recurrent pulmonary embolization from a parietal truncus pulmonalis thrombosis. In addition, an appositional growth of parietal thrombi central from peripheral arterial ramifications had occurred. Simultaneously, superficial thrombophlebitis of all extremities was observed without any additional signs of general vasculitis. There was no strong evidence for a causal relationship between the chronic myelogenous leukemia and pulmonary arteritis nor for any other underlying systemic disorder. Therefore we consider the pulmonary arteritis a possibly primary one. This very rare disease is discussed with respect to the literature. Ref ID : WAKEFIELD1993 1270. Wakefield, T.W. and Greenfield, L.J. Diagnostic approaches and surgical treatment of deep venous thrombosis and pulmonary embolism. Hematology/Oncology Clinics of North America 7:1251-1267, 1993. Keywords : diagnostics; SURGICAL; TREATMENT; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; PULMONARY EMBOLISM; EMBOLISM; REVIEW Ref ID : WALLOIS1969 1271. Wallois, P. and Griton, P. [On some conclusions of a survey of phlebologists about vascular diseases of the legs in patients under 18]. Phlebologie. 22:249-253, 1969. Keywords : Vascular Diseases; LEG; NASP; Adolescence; Age Factors; Child,Preschool; Hemangioma; HUMAN; Leg Injuries; Lymphatic System; Puberty; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vasomotor System; Medline File; in; de; an; ab Notes : TT - Quelques conclusions de l'enquete faite aupres de phlebologues au sujet des affections vasculaires des membres inferieurs chez les moins de 18 ans AB - [No Abstract Available] UI - 70056399. Ref ID : WALLOIS1971 1272. Wallois, P. Les incidents et accidents au cours du traitement sclerosant des varices at leur prevention. Phlebologie 24(3):217-224, 1971. Keywords : INCIDENTS; ACCIDENTS; SCLEROSANT; VARICES; PREVENTION; INTRAARTERIAL; COMPLICATION; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; TECHNIQUES; et; du; de; Injections; Femoral Artery; ARTERY; Arteries; in; LEG; vein; is Notes : Intraarterial injection most commonly involves either the femoral artery at the level of the inguinal crease or small end-arteries in the popliteal crease or the posterior tibial artery in the lower medial leg. Careful attention to technique can prevent this complication. Deep vein thrombosis is rare but has been known to occur. Ref ID : WALLOIS1984 1273. Wallois, P. La Sclerotherapie dans la maladie post-phlebitique. Phlebologie 37(4):469-477, 1984. Keywords : SCLEROTHERAPY; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; THROMBOPHLEBITIS; VARICES; PHLEBITIS; POST PHLEBITIC SYNDROME; us; hi; an; Superficial thrombophlebitis Notes : M. Wallois, following the French tradition, advises us according to his experience and that of his colleagues, without reference to any published data. He advises that sclerotherapy should be avoided for 8 to 12 months following an acute deep venous thrombosis and a slightly shorter time following a superficial thrombophlebitis. He emphasizes that the superficial varices which are often seen following a deep phlebitis are only a small part of the disease process. Ref ID : WALLOIS1984A 1274. Wallois, P. [Sclerotherapy in postphlebitic disease]. Phlebologie. 37:469-477, 1984. Keywords : POSTPHLEBITIC; SCLEROTHERAPY; POSTPHLEBITIC SYNDROME; Syndrome; VENOUS; SCLEROSING AGENTS; vein; NASP; VEINS; English Abstract; HUMAN; Sclerosing Solutions; THROMBOPHLEBITIS; VARICOSE VEINS; Medline File; in; ab Notes : TT - La sclerotherapie dans la maladie post-phlebitique AB - Sclerotherapy can be used for the postphlebitic syndrome as long as two important precautions are observed. First, the inflammatory phase must be resolved, usually taking one year for thromboplhebitis of the deep venous system and six months for that of the superficial venous system. Secondly, always begin progressively with small, doses, after having initially tested the effect of the sclerosing agent on a secondary vein UI -85088830. Ref ID : WALLOIS1985 1275. Wallois, P. Incidents et accidents de la sclerose. In: La sclerose des varices, edited by Tournay, R.Paris:Expansion Scientifique Francais, 1985,p. 297-319. Keywords : THROMBOSIS; SCLEROTHERAPY; INCIDENTS; ACCIDENTS; SCLEROSE; VARICES; et; de Ref ID : WALSH1974 1276. Walsh, J.J., Bonnar, J., and Wright, F.W. A study of pulmonary embolism and deep leg vein thrombosis after major gynaecological surgery using labelled fibrinogen-phlebography and lung scanning. J.Obstet.Gynaecol.Br.Commw. 81:311-316, 1974. Keywords : PULMONARY EMBOLISM; EMBOLISM; LEG; VEINS; THROMBOSIS; SURGERY; FIBRINOGEN; LUNG; SCANNING; THROMBOEMBOLISM; PHLEBITIS; vein; PHLEBOGRAPHY; PULMONARY THROMBOEMBOLISM Notes : More than two-thirds of patients with proven pulmonary thromboembolism lack any clinically evident phlebitis. Ref ID : WALSH1977 1277. Walsh, P.N., Murphy, S., and Barry, W.E. The role of platelets in the pathogenesis of thrombosis and hemorrhage in patients with thrombosis. Thromb.Haemost. 38:1085-1096, 1977. Keywords : PLATELETS; PATHOGENESIS; THROMBOSIS; HEMORRHAGE; RISK; PLATELET; BLEEDING; THROMBOCYTOSIS; in; Platelet Count; an 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 : WARKENTIN1995 1278. Warkentin, T.E., Levine, M.N., Hirsh, J., Horsewood, P., Roberts, R.S., Gent, M., and Kelton, J.G. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin [see comments]. N.Engl.J.Med. 332:1330-1335, 1995. Keywords : THROMBOCYTOPENIA; Molecular Weight; HEPARIN; antibodies; THERAPY; FREQUENCY; RISK; Methods; PLATELET; Platelet Count; RANDOMIZED; CLINICAL TRIAL; PROPHYLAXIS; HIP; SURGERY; Low-molecular-weight heparin; VENOUS; ARTERIAL; in; is; odds ratio; confidence intervals; 96-suzy-001; igg; COMPARATIVE STUDY; Double-Blind Method; enoxaparin; therapeutic use; FEMALE; adverse effects; immunology; HUMAN; analysis; Postoperative Complications; prevention & control; RISK FACTORS; Support,Non- U.S.Gov't; chemically induced; COMPLICATIONS; THROMBOPHLEBITIS; TREATMENT OUTCOME Notes : BACKGROUND. Heparin-induced thrombocytopenia, defined by the presence of heparin-dependent IgG antibodies, typically occurs five or more days after the start of heparin therapy and can be complicated by thrombotic events. The frequency of heparin-induced thrombocytopenia and of heparin-dependent IgG antibodies, as well as the relative risk of each in patients given low-molecular-weight heparin, is unknown. METHODS. We obtained daily platelet counts in 665 patients in a randomized, double-blind clinical trial comparing unfractionated heparin with low-molecular-weight heparin as prophylaxis after hip surgery. Heparin-induced thrombocytopenia was defined as a decrease in the platelet count below 150,000 per cubic millimeter that began five or more days after the start of heparin therapy, and a positive test for heparin-dependent IgG antibodies. We also tested a representative subgroup of 387 patients for heparin-dependent IgG antibodies regardless of their platelet counts. RESULTS. Heparin-induced thrombocytopenia occurred in 9 of 332 patients who received unfractionated heparin and in none of 333 patients who received low-molecular-weight heparin (2.7 percent vs. 0 percent; P = 0.0018). Eight of the 9 patients with heparin-induced thrombocytopenia also had one or more thrombotic events (venous in 7 and arterial in 1), as compared with 117 of 656 patients without heparin-induced thrombocytopenia (88.9 percent vs. 17.8 percent; odds ratio, 36.9; 95 percent confidence interval, 4.8 to 1638; P < 0.001). In the subgroup of 387 patients, the frequency of heparin- dependent IgG antibodies was higher among patients who received unfractionated heparin (7.8 percent, vs. 2.2 percent among patients who received low-molecular-weight heparin; P = 0.02). CONCLUSIONS. Heparin- induced thrombocytopenia, associated thrombotic events, and heparin- dependent IgG antibodies are more common in patients treated with unfractionated heparin than in those treated with low-molecular-weight heparin. Ref ID : WARLOW1972 1279. Warlow, C., Ogston, D., and Douglas, A.S. Venous thrombosis following strokes. Lancet i:1305-1306, 1972. Keywords : VENOUS; VENOUS THROMBOSIS; THROMBOSIS; LEG; FIBRINOGEN; SCANNING; DVT; STROKE; HEMIPARESIS; CVA; PARALYSED; Immobilization; is; in Notes : Further evidence of the importance of immobilization is shown by a study of stroke patients with a single paretic leg: fibrinogen scanning detected DVT in 60 percent of the paralysed legs but in only 7 percent of the nonparalysed ones. Ref ID : WARNER1993 1280. Warner, M.A., Shields, S.E., and Chute, C.G. Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia. JAMA 270:1437-1441, 1993. Keywords : MORBIDITY; MORTALITY; AMBULATORY; Ambulatory Surgery; SURGERY; INCIDENCE; PROSPECTIVE; OUTCOME; SURGICAL; Ambulatory Care; AGED; Anesthetics; MYOCARDIAL INFARCTION; PULMONARY EMBOLISM; EMBOLISM; RESPIRATORY FAILURE; Died; ACCIDENTS; COMPLICATION; sdi-11/93; infarction; in Notes : OBJECTIVE--To determine the incidence and time sequence of mortality and major morbidity after ambulatory surgery. DESIGN-- Prospective outcome survey of patients at 16 to 72 hours and 30 days after their surgical procedures. SETTING--A tertiary care rural referral center providing ambulatory care. PATIENTS--A total of 38,598 patients aged 18 years and older undergoing 45, 090 consecutive ambulatory procedures and anesthetics. Contact rates for 72 hours and 30 days were 99.94% and 95.9%, respectively. MAIN OUTCOME MEASURES--Mortality and major morbidity incidences, including myocardial infarction, central nervous system deficit, pulmonary embolism, and respiratory failure. RESULTS--Thirty-three patients either experienced major morbidity or died (1:1366 [proportional risk]). Four patients died (1:11,273), two of myocardial infarction and two in automobile accidents. No patient died of a medical complication within 1 week of surgery. Of the 31 patients who developed a major morbidity (1:1455), 14 (45%) had myocardial infarction (1: 3220), seven (23%) had a central nervous system deficit (1:6441), five (16%) had pulmonary embolism (1:9018), and five (16%) had respiratory failure (1:9018). Four events (13%) occurred within 8 hours of surgery (1:11,273), 15 (48%) in the next 40 hours (1: 3006), and 12 (39%) in the next 28 days (1:3758). CONCLUSION--In this ambulatory surgical population, more than one third of major morbidity occurred 48 hours or later after surgery. Overall morbidity and mortality rates, however, were very low. Ref ID : WASSELLE1993 1281. Wasselle, J.A. and Bandyk, D.F. Intraoperative thrombolysis in peripheral arterial occlusion. Can.J Surg. 36:354-358, 1993. Keywords : Intraoperative; THROMBOLYSIS; ARTERIAL; OCCLUSION; THROMBOEMBOLIC; PERIPHERAL ARTERY; Arteries; MORBIDITY; MORTALITY; SURGICAL; THERAPY; Ischemia; THROMBECTOMY; CATHETER; TECHNIQUES; THROMBUS; INJURY; THROMBOLYTIC; THROMBOLYTIC THERAPY; Safety; REVIEW; sdi-11/93; in; standards; is; an; laboratories Notes : Thromboembolic occlusion of peripheral arteries continues to be associated with significant morbidity, mortality and loss of limbs. Surgical intervention with prompt revascularization by clot extraction, alone or in combination with arterial bypass, remains the standard therapy for critical ischemia with imminent tissue loss. Mechanical thrombectomy using a balloon catheter has been the preferred technique for distal embolus or thrombus extraction. Unfortunately, complete thrombectomy is rare, and the procedure is associated with arterial wall injury. Intraoperative thrombolytic therapy is an attractive adjunct to catheter thrombectomy alone and is appropriate in the care of a significant number of patients with acute limb ischemia. Its safety and efficacy have been confirmed in the laboratory and in a limited number of patients. The authors review experimental and clinical data and report their experience with 19 patients. Ref ID : WATTS1990 1282. Watts, R.A. and Bretland, P.M. Necrotizing fasciitis mimicking a ruptured popliteal cyst. J.R.Soc.Med. 83:52-53, 1990. Keywords : PHLEBITIS; popliteal cyst; ADULT; CASE REPORT; Diagnosis,Differential; fasciitis; DIAGNOSIS; pathology; FEMALE; HUMAN; LEG; Necrosis; rupture,spontaneous; synovial cyst; THROMBOPHLEBITIS; Ultrasonography Ref ID : WEINMANN1994 1283. Weinmann, E.E. and Salzman, E.W. Deep-Vein Thrombosis. The New England Journal of Medicine 331(24):1630-1641, 1994. Keywords : 96-suzy-002; DEEP VEIN THROMBOSIS; THROMBOSIS; PHLEBOGRAPHY; FRACTURES; Tibia; PREVALENCE; VENOUS; THROMBOEMBOLISM; in; injuries; Methods; DIAGNOSIS; NATURAL HISTORY; PREVENTION; TREATMENT Notes : 01-03-96. Abstract : Credit for fundamental studies leading to our current understanding of deep-vein thrombosis should be given to Bauer, who used phlebography to diagnose deep-vein thrombosis complicating fractures of the tibia, and to Sevitt and Gallagher for their autopsy-based studies of the prevalence of venous thromboembolism in patients with other injuries. The development of objective methods for the diagnosis of deep-vein thrombosis has facilitated the investigation of its natural history and has provided a rational basis for its prevention and treatment. Ref ID : WEINMANN1995 1284. Weinmann, E.E. and Salzman, E.W. Deep-Vein Thrombosis. Correspondence. The New England Journal of Medicine 332(21):1447, 1995. Keywords : 96-suzy-002; DEEP VEIN THROMBOSIS; THROMBOSIS Notes : 01-05-96. Ref ID : WEISS1992B 1285. Weiss, L.D. and Van Meter, K.W. The applications of hyperbaric oxygen therapy in emergency medicine [see comments]. Am.J.Emerg.Med. 10:558-568, 1992. Keywords : 951202; OXYGEN; THERAPY; EMERGENCY; EMERGENCY MEDICINE; Burns; th; carbon monoxide poisoning; decompression sickness; embolism,air; gas gangrene; HUMAN; Hyperbaric Oxygenation; ae; CT; is; RISK; Medline File; in Notes : [No Abstract Available] Department of Emergency and Hyperbaric Medicine Jo Ellen Smith Medical Center Louisiana State University New Orleans 70131. Ref ID : WEITGASSER1968 1286. Weitgasser, H. [New possibilities in the management of venous perfusion disorders]. Z.Haut.Geschlechtskr. 43:153-158, 1968. Keywords : MANAGEMENT; VENOUS; PERFUSION; NASP; CLINICAL TRIALS; Ergoloid Mesylates; FEMALE; HUMAN; MALE; PLACEBOS; Plants,Medicinal; Rutin; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; in; ab Notes : TT - Neue Moglichkeiten in der Behandlung venoser Durchblutungsstorungen AB - [No Abstract Available] UI - 68360462. Ref ID : WEITZ1991 1287. Weitz, J.I., Kuint, J., Leslie, B., and Hirsh, J. Standard and low molecular weight heparin have no effect on tissue plasminogen activator induced plasma clot lysis or fibrinogenolysis. Thromb.Haemost. 65(5):541-544, 1991. Keywords : 951217; standards; Molecular Weight; HEPARIN; PLASMINOGEN; PLASMINOGEN ACTIVATOR; LYSIS; is; an; t-PA; in; HUMAN; FIBRIN; THROMBOLYSIS; THROMBOLYTIC; PA; ALTEPLASE; pd; drug interactions; FIBRINOGEN; me; heparin,low-molecular-weight; iodine radioisotopes; du; radioimmunoassay; Support,Non-U.S.Gov't; THROMBOSIS; dt; Medline File; CANADA Notes : Although heparin is often given as an adjunct to tissue plasminogen activator (t-PA), the effect of heparin on t-PA induced fibrin(ogen)olysis is controversial. To address this controversy, we examined the effects of standard and low molecular weight heparin (enoxaparine) on both t-PA induced clot lysis and t-PA mediated fibrinogenolysis in a human plasma system. Accordingly, 125I-labeled fibrin clots were incubated in t-PA containing citrated plasma in the presence or absence of these glycosaminoglycans, and the extent of thrombolysis was determined by measuring residual radioactivity of the clots, while B beta 1-42 levels were used as a specific index of fibrinogenolysis. Over a wide range of t-PA concentrations (0.1 to 1.6 micrograms/ml), neither heparin nor enoxaparine influences either t-PA induced clot lysis or t-PA mediated B beta 1-42 generation. These findings suggest that either agent could be used as an adjunct to t-PA without compromising either the thrombolytic potential of t- PA or its clot-selectivity Department of Medicine McMaster University Hamilton Ont Canada. Ref ID : WEITZ1992 1288. Weitz, J.I. and Hirsh, J. Antithrombins: their potential as antithrombotic agents. Annu.Rev.Med. 43:9-16, 1992. Keywords : LMWH; Low-Molecular-Weight-Heparin; Antithrombotic; INHIBITION; THROMBIN; PREVENTION; TREATMENT; HEPARIN; ANTICOAGULANT; is; an; in Notes : The inhibition of thrombin is the key to the prevention and treatment of thrombotic disorders. Although heparin is an extremely effective anticoagulant, it has certain limitations that are not shared by newer thrombin inhibitors. As a result, these novel inhibitors may have advantages over heparin in certain clinical settings. Ref ID : WEITZ1993 1289. Weitz, J.I., Leslie, B., Hirsh, J., and Klement, P. Alpha 2- antiplasmin supplementation inhibits tissue plasminogen activator- induced fibrinogenolysis and bleeding with little effect on thrombolysis. J.Clin.Invest. 91:1343-1350, 1993. Keywords : PLASMINOGEN; BLEEDING; THROMBOLYSIS; PLASMINOGEN ACTIVATOR; t-PA; CAUSE; FIBRINOGEN; HEMORRHAGE; Plasmin; INHIBITION; HUMAN; RABBITS; ANTIPLASMIN; HAT; LYSIS; vein; THROMBI; RANDOMIZED; blood; Blood loss; analysis; ANIMAL; THROMBIN; HEMOSTATIC; Safety; is; in; plasminogen activators Notes : Tissue plasminogen activator (t-PA) causes fibrinogen proteolysis when alpha 2-antiplasmin levels fall, and this may contribute to t-PA-induced hemorrhage. Because clot-bound plasmin is protected from alpha 2-antiplasmin inhibition, we tested the possibility that alpha 2-antiplasmin supplementation would block t-PA-induced fibrinogenolysis and bleeding without affecting thrombolysis. When added to human or rabbit plasma, alpha 2-antiplasmin inhibits t-PA-induced fibrinogenolysis, but hat little effect on the lysis of 125I-fibrin clots. To examine its effect in vivo, rabbits with preformed 125I- labeled-jugular vein thrombi were randomized to receive t-PA, t-PA and alpha 2-antiplasmin, or saline. alpha 2-Antiplasmin infusion produced a modest decrease in t-PA-induced thrombolysis (from 40.2% to 30.1%, P = 0.12), but reduced fibrinogen consumption from 87% to 27% (P = 0.0001), and decreased blood loss from standardized ear incisions from 5,594 to 656 microliter (P < 0.0001). We hypothesize that alpha 2-antiplasmin limits t-PA-induced hemorrhage by inhibiting fibrinogenolysis and subsequent fragment X formation because (a) SDS-PAGE and immunoblot analysis indicate less fragment X formation in alpha 2-antiplasmin treated animals, and (b) when added to a solution of fibrinogen and plasminogen clotted with thrombin in the presence of t-PA, fragment X shortens the lysis time in a concentration-dependent fashion. These findings suggest that fragment X incorporation into hemostatic plugs contributes to t-PA-induced bleeding. By blocking t-PA-mediated fibrinogenolysis, alpha 2-antiplasmin supplementation may improve the safety of fibrin-specific plasminogen activators. Ref ID : WEITZ1993A 1290. Weitz, J. and Hirsh, J. New anticoagulant strategies. J.Lab.Clin.Med. 122:364-373, 1993. Keywords : ANTICOAGULANT; standards; HEPARIN; Antithrombotic; LMWH; North America; THROMBIN; PREVENTION; VENOUS; THROMBOEMBOLIC; TREATMENT; VENOUS THROMBOSIS; THROMBOSIS; THERAPY; THROMBOLYSIS; Angioplasty; ARTERIAL; ARTERIAL THROMBOSIS; HIRUDIN; in; is; an Notes : The limitations of standard heparin have prompted the development of a variety of newer antithrombotic agents. In fact, a LMWH preparation has recently been approved for clinical use in North America. Of these novel preparations, LMWH, the direct thrombin inhibitors, and inhibitors of GPIIb-IIIa have been used clinically and are in advanced stages of evaluation. Not only is LMWH effective in the prevention of venous thromboembolic disease in high-risk patients, but its more predictable dose response makes it an ideal candidate for the treatment of venous thrombosis. Further studies are needed to determine whether LMWH is superior to standard heparin as adjunctive therapy in patients undergoing coronary thrombolysis or angioplasty. Particularly promising in the setting of arterial thrombosis are hirudin, hirulog, and 7E3. With the encouraging results reported to date, it is likely that these agents will soon find their way into the treatment armamentarium of arterial thrombosis. Ref ID : WELLMAN1986 1291. Wellman, H.N. Pulmonary thromboembolism: Current status report on the role of nuclear medicine. Seminars.in.Nuclear.Med.XVI. 4:236, 1986. Keywords : PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; NUCLEAR; PULMONARY EMBOLISM Ref ID : WELLS1994A 1292. Wells, P.S., Lensing, A.W., and Hirsh, J. Graduated compression stockings in the prevention of postoperative venous thromboembolism. A meta-analysis [see comments]. Arch.Intern.Med. 154(1):67-72, 1994. Keywords : LMWH; Low-Molecular-Weight-Heparin; graduated compression stockings; COMPRESSION; STOCKINGS; PREVENTION; POSTOPERATIVE; VENOUS; THROMBOEMBOLISM; META ANALYSIS; PROPHYLAXIS; Methods; REVIEW; analysis; SELECT; RISK; VENOUS THROMBOSIS; THROMBOSIS; Orthopedic; SURGERY; 951217; in; is; an; odds ratio; confidence intervals; BANDAGES; HUMAN; Postoperative Complications; pc; Support,Non-U.S.Gov't; et; Medline File; ontario; Hospitals Notes : BACKGROUND: The effectiveness of graduated compression stockings in prophylaxis of postoperative venous thromboembolism is unclear to many physicians. Surveys show there is considerable variability in their use and their perceived effectiveness. We undertook to establish, by a systematic overview of the literature, the effectiveness of graduated compression stockings in the prophylactic setting of postoperative venous thromboembolism. METHODS: Studies published between 1966 and June 1992 were identified through the languages, through reviews of Current Contents, and including references cited in identified articles. Articles were selected for initial analysis if they assessed the use of graduated compression stockings for the prophylaxis of venous thromboembolism, and if the stocking group was compared with an untreated or unconfounded control group. Criteria were established a priori, to select only studies with sound methods. On the basis of these criteria, 12 studies were identified for the combined analysis. Each eligible study was independently analyzed for the risk of development of deep venous thrombosis in the control and stocking groups, and this was expressed as an odds ratio. Odds ratios were combined across studies by means of the Mantel-Haenszel chi 2 procedure. The data were analyzed separately for orthopedic surgery because of its high risk for venous thromboembolism. RESULTS: Eleven of the 12 studies were in moderate-risk surgery (abdominal, gynecologic, and neurosurgery); the summary odds ratio was 0.28, which translates into a risk reduction of 68% (95% confidence interval, 53% to 73%), which is statistically significant (P < .0001). In the one study in orthopedic surgery that was eligible for inclusion, the odds ratio was 0.50 (95% confidence interval, 0.19 to 1.29; P = .17). CONCLUSIONS: The use of graduated compression stockings for prophylaxis of venous thromboembolism after moderate-risk surgery results in a significant risk reduction. It is unknown whether the use of graduated compression stockings in combination with other forms of prophylaxis results in further risk reduction. The efficacy of graduated compression stockings in orthopedic surgery has been assessed by only one study that used sound methods, hence no definitive conclusions can be made in these high-risk patients. Ref ID : WELLS1995 1293. Wells, P.S., Lensing, A.W., Davidson, B.L., Prins, M.H., and Hirsh, J. Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. A meta- analysis. Ann.Intern.Med. 122(1):47-53, 1995. Keywords : LMWH; Low-Molecular-Weight-Heparin; ULTRASOUND; DIAGNOSIS; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; ASYMPTOMATIC; Orthopedic; SURGERY; META ANALYSIS; SCREENING; Duplex; color; Doppler; standards; CONTRAST; VENOGRAPHY; EARLY; diagnostics; PROSPECTIVE; Ultrasonography; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; THROMBI; 951217; in; ci; AGED; Aged,80 and over; COMPARATIVE STUDY; HUMAN; MIDDLE AGE; orthopedics; Postoperative Complications; us; predictive value of tests; sensitivity and specificity; Support,Non- U.S.Gov't; THROMBOPHLEBITIS; et; mt; Medline File; Hospitals; ontario; CANADA Notes : OBJECTIVE: To evaluate, by meta-analysis, the accuracy of ultrasound screening for deep venous thrombosis in patients after orthopedic surgery. DATA SOURCES: The MEDLINE database from January 1982 to October 1993. Bibliographies of retrieved articles and recent journal publications were searched independently and using Current Contents. STUDY SELECTION: All articles evaluating the use of venous ultrasound imaging (B-mode, duplex, and color Doppler) compared with standard contrast venography for detecting deep venous thrombosis. We excluded abstracts, early reports of studies later reported in full, and studies in which venography was not done in all patients. Seventeen of 30 identified studies were eligible. DATA EXTRACTION: Eligible articles were reviewed for the presence of three key criteria necessary for evaluating the accuracy of the diagnostic tests: 1) previously established objective criteria for venography and ultrasound, 2) independent blinded comparisons of venography and ultrasound, and 3) prospective evaluations of consecutive patients. Studies including all three key criteria were defined as level 1 (minimized bias) studies; otherwise, they were defined as level 2 studies. DATA SYNTHESIS: In level 1 studies, ultrasonography had a sensitivity of 62% (95 of 153; 95% CI, 54% to 70%), a specificity of 97% (CI, 96% to 98%), and a positive predictive value of 66% (95 of 144; CI, 58% to 74%) for detecting proximal thrombi. For level 2 studies, the sensitivity was 95% (CI, 87% to 99%), the specificity was 100% (CI, 99% to 100%), and the positive predictive value was 100% (CI, 94% to 100%). Differences between level 1 and level 2 studies appeared to be related to bias in study design. CONCLUSIONS: Venous ultrasound imaging has only moderate sensitivity and a moderate positive predictive value when used to screen for deep venous thrombosis in patients after orthopedic surgery; thus, ultrasound imaging may have limitations as a screening test. Ref ID : WELLS1995A 1294. Wells, P.S., Brill-Edwards, P., Stevens, P., Panju, A., Patel, A., Douketis, J., Massicotte, M.P., Hirsh, J., Weitz, J.I., and Kearon, C. A novel and rapid whole-blood assay for D-dimer in patients with clinically suspected deep vein thrombosis. Circulation 91(8):2184-2187, 1995. Keywords : D-DIMER; vein; THROMBOSIS; blood; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; IPG; PROSPECTIVE; cohort studies; DVT; Methods; CONTRAST; VENOGRAPHY; VEINS; CALF; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; sensitivity and specificity; MANAGEMENT; 951217; in; an; is; agglutination tests; FEMALE; Fibrin Fibrinogen Degradation Products; HUMAN; LEG; bs; MALE; MIDDLE AGE; PHLEBOGRAPHY; mt; Plethysmography,Impedance; predictive value of tests; PROSPECTIVE STUDIES; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; bl; di; ep; Medline File; CANADA Notes : BACKGROUND: The clinical utility of using a novel whole blood assay for D-dimer (SimpliRED), alone or in combination with impedance plethysmography (IPG), was investigated in a two-center, prospective cohort study of 214 consecutive patients with clinically suspected deep vein thrombosis (DVT). METHODS AND RESULTS: All patients underwent the SimpliRED D-dimer assay, contrast venography, and IPG. According to the results of venography, 43 patients had proximal DVT (popliteal and/or more proximal veins), 10 had isolated calf DVT, and 161 had DVT ruled out. The D-dimer had a sensitivity of 93% for proximal DVT and of 70% for calf DVT, an overall specificity of 77%, and a negative predictive value of 98% for proximal DVT. The sensitivity and specificity of IPG for proximal DVT were 67% and 96%, respectively. When analyzed in combination with the IPG results, it was determined that (1) the combination of a negative D-dimer and a normal IPG had a negative predictive value of 97% for all DVT and of 99% for proximal DVT and occurred in 58% of patients (likelihood ratio, 0.1) and (2) the combination of a positive D-dimer and an abnormal IPG had a positive predictive value of 93% for any DVT and of 90% for proximal DVT and occurred in 14% of patients (likelihood ratio, 42.6). When the D-dimer and IPG results were discordant, it was not possible to exclude or diagnose DVT reliably; discordant results occurred in 28% of patients. CONCLUSIONS: The SimpliRED D-dimer assay, which can be performed and interpreted at the bedside within 5 minutes, has great potential in patients with clinically suspected DVT, especially for ruling out DVT, and is complementary to IPG. The assay should be evaluated in large clinical management studies. Ref ID : WELLS1995B 1295. Wells, P.S., Hirsh, J., Anderson, D.R., Lensing, A.W., Foster, G., Kearon, C., Weitz, J., D'Ovidio, R., Cogo, A., and Prandoni, P. Accuracy of clinical assessment of deep-vein thrombosis. Lancet 345:1326-1330, 1995. Keywords : DEEP VEIN THROMBOSIS; THROMBOSIS; CLINICAL DIAGNOSIS; DIAGNOSIS; OUTPATIENT; vein; PROBABILITY; VENOUS; Ultrasonography; diagnostics; VENOGRAPHY; PREVALENCE; PREDICTIVE VALUE; ULTRASOUND; is; in; an; ci Notes : The clinical diagnosis of deep-vein thrombosis is generally thought to be unreliable. From experience, we hypothesised that this widely held view might be incorrect. We developed a clinical model and prospectively tested its ability in three tertiary care centres to stratify symptomatic outpatients with suspected deep-vein thrombosis into groups with high, moderate, or low probability groups of deep-vein thrombosis. We evaluated our clinical model in combination with venous ultrasonography to determine the potential for an improved and simplified diagnostic approach in patients with suspected deep-vein thrombosis. All patients were clinically assessed to determine the probability for deep-vein thrombosis before they had ultrasonography and venography. All tests were performed and interpreted by independent observers. In 529 patients, the clinical model predicted prevalence of deep-vein thrombosis in the three categories: 85% in the high pretest probability category, 33% in the moderate, and 5% in the low category. There was no statistical difference in the performance of the model in the three centres. The model demonstrated excellent interobserver reliability (Kappa = 0.85). There were important differences with ultrasonography between the high and low pretest probability groups for both positive predictive values (100% (95% CI, 94-100%) vs (63% [35- 85%], respectively). Thus, use of the clinical model combined with ultrasonography would decrease the number of false positive and negative diagnosis if venography were done when the ultrasound result and pretest probability were discordant. The diagnostic process could be simplified by excluding those patients with low pretest probability and normal ultrasound results from serial testing. Ref ID : WELLS1995C 1296. Wells, P.S., Hirsh, J., Anderson, D.R., Lensing, A.W., Foster, G., Kearon, C., Weitz, J., D'Ovidio, R., Cogo, A., and Prandoni, P. Accuracy of clinical assessment of deep-vein thrombosis [published erratum appears in Lancet 1995 Aug 19;346(8973):516] [see comments]. Lancet 345(8961):1326-1330, 1995. Keywords : 951217; DEEP VEIN THROMBOSIS; THROMBOSIS; in; CLINICAL DIAGNOSIS; DIAGNOSIS; is; OUTPATIENT; vein; PROBABILITY; VENOUS; Ultrasonography; an; diagnostics; VENOGRAPHY; PREVALENCE; PREDICTIVE VALUE; ci; ULTRASOUND; decision trees; Femoral Vein; ra; us; fibula; bs; Follow-Up Studies; HUMAN; Iliac Vein; observer variation; PHLEBOGRAPHY; pilot projects; Popliteal Vein; predictive value of tests; PROSPECTIVE STUDIES; Reproducibility of Results; RISK FACTORS; sensitivity and specificity; Support,Non-U.S.Gov't; THROMBOPHLEBITIS; di; Tibia; Medline File; Health Planning & Administration File; Hospitals; ontario; CANADA Notes : The clinical diagnosis of deep-vein thrombosis is generally thought to be unreliable. From experience, we hypothesised that this widely held view might be incorrect. We developed a clinical model and prospectively tested its ability in three tertiary care centres to stratify symptomatic outpatients with suspected deep-vein thrombosis into groups with high, moderate, or low probability groups of deep- vein thrombosis. We evaluated our clinical model in combination with venous ultrasonography to determine the potential for an improved and simplified diagnostic approach in patients with suspected deep-vein thrombosis. All patients were clinically assessed to determine the probability for deep-vein thrombosis before they had ultrasonography and venography. All tests were performed and interpreted by independent observers. In 529 patients, the clinical model predicted prevalence of deep-vein thrombosis in the three categories: 85% in the high pretest probability category, 33% in the moderate, and 5% in the low category. There was no statistical difference in the performance of the model in the three centres. The model demonstrated excellent interobserver reliability (Kappa = 0.85). There were important differences with ultrasonography between the high and low pretest probability groups for both positive predictive values (100% (95% CI, 94-100%) vs (63% [35- 85%], respectively). Thus, use of the clinical model combined with ultrasonography would decrease the number of false positive and negative diagnosis if venography were done when the ultrasound result and pretest probability were discordant. The diagnostic process could be simplified by excluding those patients with low pretest probability and normal ultrasound results from serial testing Ottawa Civic Hospital Ontario Canada. Ref ID : WENGER1972 1297. Wenger, N.K., Stein, P.D., and Willis, P.W. Massive acute pulmonary embolism: The deceivingly non-specific manifestations. JAMA 220:843-845, 1972. Keywords : MASSIVE; PULMONARY EMBOLISM; EMBOLISM; PE; CHEST; CHEST PAIN; PAIN; THROMBOSIS; PHLEBITIS; CHEST X-RAY; XRAY; DIAGNOSIS; Important article; PLEURITIC; Syndrome; UPET; in; dyspnea Notes : Of 160 UPET patients with acute PE, 90 had massive PE, but even in this critically ill subgroup of patients the clinical signs and symptoms were vague and nonspecific. Only 62% had pleuritic chest pain. Only 17% had a pleural rub. 27% had hemoptysis. 58% had no evidence of thrombosis or phlebitis. The most common presenting syndrome was sudden unexplained dyspnea. Often, there was little else in the history, physical exam, or chest x-ray to suggest a diagnosis. Ref ID : WENNER1981 1298. Wenner, L. [Are endovaricose accumulation of hematogenous substances normal in sclerotherapy?]. Vasa. 10:174-176, 1981. Keywords : NASP; English Abstract; HUMAN; Sclerosing Solutions; THROMBOPHLEBITIS; VARICOSE VEINS; Medline File; in; ab Notes : TT - Sind endovarikose hamatische Ansammlungen eine Normalerscheinung bei Sklerotherapie? AB - [No Abstract Available] UI - 81228122. Ref ID : WERIER1991 1299. Werier, J., Ducas, J., Gu, S., Chan, S.M., and Prewitt, R.M. Effect of low-molecular-weight heparin on recombinant tissue plasminogen activator-induced thrombolysis in canine pulmonary embolism. Chest 100:464-469, 1991. Keywords : Low-molecular-weight heparin; HEPARIN; PLASMINOGEN; THROMBOLYSIS; PULMONARY EMBOLISM; EMBOLISM; CANADA; PLASMINOGEN ACTIVATOR; EMBOLIZATION; DOGS; RANDOMIZED; Molecular Weight; CONTRAST; ANIMAL; Support,Non-U.S.Gov't; Alteplase ,Therapeutic Use ,TU; Heparin,Low-Molecular-Weight ,Therapeutic Use ,TU; Pulmonary Embolism ,Drug Therapy ,DT; THROMBOLYTIC THERAPY; Alteplase ,Administration and Dosage ,AD Alteplase ,Pharmacology ,PD; Atrial Function,Right; Blood Pressure ,Physiology ,PH; Cardiac Output ,Physiology ,PH; Dose-Response Relationship,Drug; Drug Synergism; Heparin,Low-Molecular-Weight ,Administration and Dosage ,AD Heparin,Low-Molecular-Weight ,Pharmacology ,PD; Infusions,Intravenous; Injections,Intravenous; Pulmonary Artery ,Physiopathology ,PP; Pulmonary Embolism ,Physiopathology ,PP; RECOMBINANT PROTEINS; regression analysis; TIME FACTORS; in; ab; blood; is; an Notes : CS- Department of Medicine, University of Manitoba, Winnipeg, Canada AB- We employed a canine model of pulmonary embolism induced by radioactive blood clots to determine if low-molecular-weight heparin augments recombinant tissue plasminogen activator (rtPA)-induced thrombolysis. Following embolization, dogs were randomized: group 1 dogs received heparin; group 2 dogs received low-molecular-weight heparin; group 3 dogs received 1.5 mg/kg of rtPA over 45 minutes; group 4 dogs received rtPA 3 mg/kg over 45 minutes; and group 5 dogs received 1.5 mg/kg of rtPA plus low-molecular-weight heparin. Over three hours, little thrombolysis occurred in groups 1 and 2. In contrast, significant thrombolysis occurred in groups 3 to 5, 46 percent, 49 percent, and 46 percent, respectively (all p less than 0.01 compared with groups 1 and 2). We conclude that there is an upper limit to the dose-thrombolytic rate relationship with rtPA, and that low-molecular-weight heparin does not augment rtPA-induced thrombolysis. Ref ID : WESSEL1986 1300. Wessel, D.L., Keane, J.F., Fellows, K.E., Robichaud, H., and Lock, J.E. Fibrinolytic therapy for femoral arterial thrombosis after cardiac catheterization in infants and children. Am.J.Cardiol. 58:347-351, 1986. Keywords : FIBRINOLYTIC; THERAPY; ARTERIAL; ARTERIAL THROMBOSIS; THROMBOSIS; CARDIAC; ACEP93; Catheterization; in; Infant Ref ID : WESTABY1984 1301. Westaby, D., Melia, W.M., Macdougall, B.R., Hegarty, J.E., and Williams, R. Injection sclerotherapy for oesophageal varices: a prospective randomised trial of different treatment schedules. Gut 25:129-132, 1984. Keywords : Injections; SCLEROTHERAPY; VARICES; PROSPECTIVE; TREATMENT; COMPLICATIONS; CIRRHOSIS; PORTAL VEIN; PORTAL VEIN THROMBOSIS; vein; THROMBOSIS; FREQUENCY; BLEEDING; ULCERATION; Endoscopy; PAIN; LONG TERM; NASP; VEINS; CLINICAL TRIALS; Drug Administration Schedule; Esophageal and Gastric Varices; FEMALE; Gastrointestinal Hemorrhage; HUMAN; MALE; MIDDLE AGE; PROSPECTIVE STUDIES; RANDOM ALLOCATION; Sclerosing Solutions; Varicose Ulcer; Medline File; ab; in Notes : AB - A prospective randomised study to compare the efficacy and complications of injection sclerotherapy carried out at intervals of one week and three weeks up to the time obliteration of varices was achieved, was undertaken in 55 patients (48 cirrhosis, six portal vein thrombosis, one nodular regenerative hyperplasia). The number of courses of injection required for obliteration of the varices was not different in the two groups and despite a shorter time scale for obliteration in the weekly treated patients the frequency with which further episodes of bleeding occurred before that was not significantly less. Mucosal ulceration during the period required for obliteration was observed at endoscopy more frequently in the weekly treated patients but was not associated with a greater frequency of postinjection pain, dysphagia or of long term stricture formation UI - 84109602. Ref ID : WHEELER1982 1302. Wheeler, H.B., Anderson, F.A.J., and Cardulla, P.A. Suspected deep venous thrombosis: management by impedance plethysmography. Arch.Surg. 117:1206, 1982. Keywords : DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; MANAGEMENT; IMPEDANCE PLETHYSMOGRAPHY; PULMONARY EMBOLISM; Plethysmography Ref ID : WHEELER1985 1303. Wheeler, H.B. Diagnosis of deep vein thrombosis. Review of clinical evaluation and impedance plethysmography. Am.J.Surg. 150(4A):7- 13, 1985. Keywords : 96-suzy-001; DIAGNOSIS; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; REVIEW; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; DVT; MANAGEMENT; in; RISK; RISK FACTORS; is; Physical Examination; INCIDENCE; NONINVASIVE; SENSITIVITY; sensitivity and specificity; SPECIFICITY; Venogram; Methods; VENOUS; venous outflow; CALF; OCCLUSION; Thigh; COMPUTER; analysis; computers; Cost-Benefit Analysis; HUMAN; LEG; blood supply; PAIN; Plethysmography,Impedance; Postoperative Complications; Regional Blood Flow; THROMBOPHLEBITIS; Venous Insufficiency Notes : This article has briefly reviewed the diagnosis of DVT by clinical evaluation and by impedance plethysmography. Clinical evaluation alone cannot be relied on for patient management, but when carefully performed, it remains useful in determining the need for additional testing. The medical history, especially the detection of risk factors for DVT, is as important as the physical examination. In 1,464 patients suspected of DVT, the incidence of this disease by impedance plethysmography was only 11 percent when there were no major risk factors present but increased to 50 percent when three risk factors were present. Impedance plethysmography is a widely used noninvasive test for the diagnosis of DVT. It has a sensitivity and specificity of 94 percent based on correlation with 2,561 venograms. The method is based on quantitation of the venous outflow from the calf after temporary venous occlusion in the thigh. It is particularly helpful in ruling out DVT in patients with suspicious signs or symptoms. Recent improvements in methods, including computer-assisted data analysis, appear likely to further extend its usefulness. Ref ID : WHEELER1988 1304. Wheeler, A.P., Jaquiss, R.D., and Newman, J.H. Physician practices in the treatment of pulmonary embolism and deep venous thrombosis. Arch.Intern.Med. 148:1321-1325, 1988. Keywords : PHYSICIAN PRACTICES; TREATMENT; PULMONARY EMBOLISM; EMBOLISM; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; HEPARIN; Sodium; ANTICOAGULATION; COMPLICATIONS; DIAGNOSIS; THROMBOPLASTIN; THERAPY; in; ab; partial thromboplastin time; laboratories; kinetics Notes : CS- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn AB- To quantify physician practices in the care of patients with presumed pulmonary embolism or deep venous thrombosis, we analyzed heparin sodium orders, the intensity of anticoagulation, and complications in 65 patients with the diagnosis of deep venous thrombosis or pulmonary embolism. All patients were given heparin, for a mean (+/- SEM) period of 8.8 +/- 0.4 days. A high percentage of patients (60%) did not have a single partial thromboplastin time (PTT) greater than 1.5 times control within the first 24 hours of heparin therapy. Not until day 8 were 90% of PTTs in therapeutic range. We identified five common practices that led to delays in achieving a PTT greater than 1.5 times the laboratory control: (1) failure to start heparin therapy at the time of initial clinical suspicion, (2) choice of a heparin sodium bolus (mean, 5861 +/- 365 U) and continuous infusion (1026 +/- 148 U/h) insufficient to elevate the PTT to greater than 1.5 times control, (3) delay in obtaining the first PTT (mean, 11.7 +/- 1 h after start of heparin therapy), (4) insufficient heparin dosing in response to a low PTT, and (5) excessive and prolonged reductions in heparin therapy in response to a PTT greater than three times control, leading to subtherapeutic levels in 56% of subsequent PTTs. We think that poor understanding of heparin kinetics, overcautious behavior of physicians, and high heparin requirements in this selected population account for the findings. Ref ID : WHEELER1994 1305. Wheeler, H.B., Hirsh, J., Wells, P., and Anderson, F.A.,Jr. Diagnostic tests for deep vein thrombosis. Clinical usefulness depends on probability of disease. Arch.Intern.Med. 154(17):1921-1928, 1994. Keywords : LMWH; Low-Molecular-Weight-Heparin; diagnostics; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; PROBABILITY; REVIEW; DIAGNOSIS; DVT; PREDICTIVE VALUE; MANAGEMENT; NONINVASIVE; Ultrasonography; IMPEDANCE PLETHYSMOGRAPHY; Plethysmography; IPG; VENOGRAPHY; COST; THROMBUS; standards; SENSITIVITY; OUTCOME; 951217; in; an; is; bias (epidemiology); Cost-Benefit Analysis; HUMAN; PHLEBOGRAPHY; ec; Physical Examination; Plethysmography,Impedance; predictive value of tests; PULMONARY EMBOLISM; di; sensitivity and specificity; THROMBOPHLEBITIS; ep; ultrasonography,interventional; Medline File; Health Planning & Administration File; SURGERY Notes : We review the general principles that govern the clinical utility of diagnostic tests, particularly with respect to the diagnosis of deep vein thrombosis (DVT). We stress the importance of clinical probability of disease, which strongly influences the positive predictive value (true-positive rate) and negative predictive value (true-negative rate) of all diagnostic tests. In selecting a diagnostic procedure for DVT, the physician must first consider the clinical probability of disease and then the local accuracy of the test employed and its cost-effectiveness. In 75% to 80% of patients suspected to have DVT, clinical management can be based on the results of noninvasive tests, such as ultrasonography or impedance plethysmography (IPG), rather than venography. Ultrasonography has clear advantages over venography with respect to cost and patient comfort, and it defines the anatomic extent of the thrombus. It should be considered the new diagnostic standard for symptomatic DVT. Despite recent reports of lower sensitivity than previously reported, IPG remains an acceptable alternative to ultrasonography for symptomatic DVT in selected patients. Even if the recently reported lower sensitivity proves to be accurate, the probability of adverse clinical outcomes as a result of overlooked disease is still extremely low in patients with a low probability of DVT. The negative predictive value of IPG under these circumstances approaches 99%. Impedance plethysmography is also useful in patients with a high probability of DVT, in whom the positive predictive value may be as high as 97%. When the findings of IPG (or ultrasonography) are at variance with a strong clinical impression, venography should be considered, especially when there is a high clinical probability of disease and a negative noninvasive test result. Ref ID : WHEELWRIGHT1993 1306. Wheelwright, E.F., Byrick, R.J., Wigglesworth, D.F., Kay, J.C., Wong, P.Y., Mullen, J.B., and Waddell, J.P. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J Bone.Joint.Surg.Br. 75:715-723, 1993. Keywords : CARDIAC; CARDIAC OUTPUT; EMBOLISM; SUDDEN DEATHS; DEATH; DOGS; PULMONARY ARTERY; PULMONARY ARTERY PRESSURE; ARTERY; Pressure; VASCULAR RESISTANCE; RECOMMENDATIONS; PREVENTION; MANAGEMENT; sdi-11/93; Fat embolism; Orthopedic; an; is; joints; in; vasodilation Notes : An episode of hypotension is common during cemented joint replacement, and has been associated with circulatory collapse and sudden death. We studied the mechanism of hypotension in two groups of six dogs after simulated bilateral cemented arthroplasty. In one group, with no lavage, the insertion of cement and prosthesis was followed by severe hypotension, elevated pulmonary artery pressure, decreased systemic vascular resistance and a 21% reduction in cardiac output. In the other group, pulsatile intramedullary lavage was performed before the simulated arthroplasties. Hypotension was less, and although systemic vascular resistance decreased, the cardiac output did not change. The severity of the hypotension, the decrease in cardiac output and an increase in prostaglandin metabolites were related to the magnitude of pulmonary fat embolism. Pulsatile lavage prevents much of this fat embolism, and hence the decrease in cardiac output. The relatively mild hypotension after lavage was secondary to transient vasodilation, which may accentuate the hypotension caused by the decreased cardiac output due to a large embolic fat load. We make recommendations for the prevention and management of hypotension during cemented arthroplasty. Ref ID : WHITE1987 1307. White, R.D., Winkler, M.L., and Higgins, C.B. MR imaging of pulmonary arterial hypertension and pulmonary emboli. AJR. 149:15, 1987. Keywords : ARTERIAL; EMBOLI; PULMONARY EMBOLISM; MR; PULMONARY ARTERIAL HYPERTENSION; Hypertension; Pulmonary emboli Ref ID : WIDMER1985 1308. Widmer, L.K., Zemp, E., and Widmer, M.R. Late results in deep vein thrombosis of the lower extremity. Vasa 14:264, 1985. Keywords : LATE; DEEP VEIN THROMBOSIS; VEINS; THROMBOSIS; PULMONARY EMBOLISM; in; vein; Extremities Ref ID : WIEDMANN1966 1309. Wiedmann, A. [The varicose symptom complex. Report on the literature of 1964]. Hautarzt. 17:385-391, 1966. Keywords : NASP; HUMAN; Leg Ulcer; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - Der varicose Symptomenkomplex. Bericht uber die Literatur des Jahres 1964 AB - [No Abstract Available] UI - 68282431. Ref ID : WIEDMANN1969 1310. Wiedmann, A. [The varicose symptom complex. Report of the literature of 1966]. Zentralbl.Phlebol. 8:35-55, 1969. Keywords : NASP; Blood Circulation; Eczema; HUMAN; Leg Ulcer; THROMBOSIS; Varicose Ulcer; VARICOSE VEINS; Medline File; varicose; de; ab Notes : TT - Der varikose Symptomenkomplex. Bericht uber die Literatur des Jahres 1966 AB - [No Abstract Available] UI - 69168500. Ref ID : WIENER1985 1311. Wiener, C.P. Diagnosis and management of thromboembolic disease during pregnancy. Clin.Obstet.Gynecol. 28:107, 1985. Keywords : DIAGNOSIS; MANAGEMENT; THROMBOEMBOLIC; PREGNANCY; PULMONARY EMBOLISM Ref ID : WILLIAMS1984 1312. Williams, R.A. and Wilson, S.E. Sclerosant treatment of varicose veins and deep vein thrombosis. Arch.Surg. 119:1283-1285, 1984. Keywords : SCLEROSANT; TREATMENT; VARICOSE VEINS; VEINS; DEEP VEIN THROMBOSIS; THROMBOSIS; SCLEROTHERAPY; THROMBUS; VENOUS; IMPEDANCE PLETHYSMOGRAPHY; IPG; Doppler; ULTRASOUND; varicose; vein; Plethysmography; in; an; Injections; COMPRESSION; Progression Notes : Impedance plethysmography (IPG) and bidirectional continuous- wave doppler ultrasound were used in an effort to assess whether injection compression sclerotherapy would result in progression of thrombus from the superficial into the deep veins. No evidence of altered deep venous flow was found after treatment. Ref ID : WILLIAMSON1990 1313. Williamson, M., Thomas, S., Edwards, A., Johnson, R., Riggs, J., and Lewis, M.H. Graduated compression stockings in the prevention of post-operative deep vein thrombosis: a comparative study of pressure profiles and patient compliance. Phlebologie 5:135-139, 1990. Keywords : graduated compression stockings; COMPRESSION; STOCKINGS; PREVENTION; DEEP VEIN THROMBOSIS; vein; THROMBOSIS; COMPARATIVE STUDY; Pressure; NASP; postoperative deep vein thrombosis; in; patient compliance Ref ID : WILSON1994 1314. Wilson, M.G., Pei, L.F., Malone, K.M., Polak, J.F., Creager, M.A., and Goldhaber, S.Z. Fixed low-dose versus adjusted higher-dose warfarin following orthopedic surgery. A randomized prospective trial. J.Arthroplasty 9(2):127-130, 1994. Keywords : 951216; WARFARIN; Orthopedic; SURGERY; RANDOMIZED; PROSPECTIVE; RISK; VENOUS; THROMBOEMBOLISM; ANTICOAGULATION; PROPHYLAXIS; Hospitals; an; LEG; DEEP VENOUS THROMBOSIS; VENOUS THROMBOSIS; THROMBOSIS; standards; TREATMENT; ULTRASOUND; ASYMPTOMATIC; in; BLEEDING; COMPLICATIONS; THROMBOEMBOLIC; PREVENTION; COMPARATIVE STUDY; FEMALE; Follow-Up Studies; hip fractures; su; hip prosthesis; HUMAN; knee prosthesis; MALE; MIDDLE AGE; Postoperative Complications; ep; pc; PROSPECTIVE STUDIES; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. THROMBOPHLEBITIS; TIME FACTORS; ad; tu; Medline File; BRIGHAM; boston Notes : Orthopedic patients are at a high risk for developing venous thromboembolism, yet only a fraction of eligible patients receive anticoagulation prophylaxis after hospital discharge. This pilot study compared the efficacy of a fixed 2 mg/d dose of warfarin versus an adjusted higher dose of warfarin for 1 month after discharge to prevent the development of proximal leg deep venous thrombosis among recently discharged orthopedic patients. After standard inhospital treatment with adjusted higher-dose warfarin and a predischarge leg ultrasound to exclude deep venous thrombosis, 96 orthopedic patients were randomized just prior to discharge to either fixed low-dose (n = 49) or adjusted higher-dose warfarin (n = 47). At the 6-week follow- up evaluation, ultrasonographically confirmed, asymptomatic, proximal leg deep venous thrombosis occurred in two patients (4%). Both patients were randomized to the fixed low-dose group, although one remained on adjusted higher- dose warfarin throughout the trial. No patient in either group developed major bleeding complications. Further studies should be undertaken to further test fixed low-dose warfarin for venous thromboembolic prevention in high-risk orthopedic patients Department of Orthopedic Surgery Brigham and Women's Hospital Harvard Medical School Boston Massachusetts. Ref ID : WIMAN1984 1315. Wiman, B., Csemiczky, G., Marsk, L., and Robbe, H. The fast inhibitor of tissue plasminogen activator in plasma during pregnancy. Thromb.Haemost. 52:124-126, 1984. Keywords : PLASMINOGEN; PREGNANCY; TPA; THROMBOSIS; PLASMINOGEN ACTIVATOR; in Ref ID : WINCHELL1994 1316. Winchell, R.J., Hoyt, D.B., Walsh, J.C., Simons, R.K., and Eastman, A.B. Risk factors associated with pulmonary embolism despite routine prophylaxis: implications for improved protection. J.Trauma. 37:600-606, 1994. Keywords : EMBOLISM; TRAUMA; RISK; RISK FACTORS; PULMONARY EMBOLISM; PROPHYLAXIS; PE; CAUSE; MORBIDITY; MORTALITY; REVIEW; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; FILTER; Vena caval filter; INJURY; in; an; analysis; is Notes : Despite prophylaxis, pulmonary embolism (PE) remains a major cause of posttraumatic morbidity and mortality in high-risk patients. We studied injury-related risk factors associated with the occurrence of PE despite routine prophylaxis. A review of 9721 trauma patients discharged from January 1, 1985 through December 31, 1992, identified 36 patients (0.4%) who suffered clinically evident PE despite a policy of routine prophylaxis against deep venous thrombosis that included use of prophylactic inferior vena caval filters. (Twenty-nine patients had an inferior vena caval filter placed for prophylaxis against PE.) A detailed analysis of injury-related risk factors was performed. Four high-risk patterns of injury were identified, representing common combinations of significant risk factors. These patient groups have an absolute risk of PE despite prophylaxis ranging from 1.5% to 3.8%. The relative risk is approximately ten times that of control patients. Identification of appropriate high-risk groups is necessary to allow optimization of prophylactic measures, including placement of inferior vena caval filter. Ref ID : WINDENBANK1974 1317. Windenbank, W.J., Boyd, G., and Moran, F. Pulmonary thromboembolism presenting as cardiac emergencies. Scot.Med.J. 19:221, 1974. Keywords : PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; CARDIAC; EMERGENCY; PULMONARY EMBOLISM; Emergencies Ref ID : WINSTONE1982 1318. Winstone, N. What are the results of high ligation followed by sclerotherapy? Phlebologie. 35:299-307, 1982. Keywords : Ligation; SCLEROTHERAPY; LATE; COMPRESSION; SURGICAL; REFLUX; VARICOSE VEINS; VEINS; SURGERY; Hospitals; TREATMENT; VENOUS; NASP; HUMAN; Postoperative Complications; PROGNOSIS; Sclerosing Solutions; THROMBOPHLEBITIS; Venous Insufficiency; Medline File; ab; in; varicose; st Notes : AB - In the late 1960's, many surgeons in the United Kingdom became enthusiastic sclerotherapists as a result of the work and publications of Professor George Fegan a few years earlier. This resulted in many centres using compression sclerotherapy alone for all types of varicose veins--some centres virtually abandoned the surgical approach even in the presence of sapheno-femoral and/or sapheno- popliteal reflux. Although initial results seemed remarkable, it gradually became clear that after a few years, recurrent varicose veins were prevalent particularly in those patients who had initially demonstrated reflux. The magnitude of the problem only became fully defined with the publication of the 6 year results of the random trial, "Surgery versus Sclerotherapy" from John Hobbs at St. Mary's Hospital, London. (John Hobbs - The treatment of venous disorders. Edinburgh, R. & R. Clark Ltd, 1977) UI - 82174913. Ref ID : WINTHROP1984 1319. Winthrop, A.L. and Wesson, D.E. Urokinase in the treatment of occluded central venous catheters in children. J.Pediatr.Surg. 19:536- 538, 1984. Keywords : UROKINASE; TREATMENT; VENOUS; CATHETER; CHILD; THROMBOSIS; THROMBOLYSIS; ACEP93; in; Catheters Ref ID : WISSNIOWSKI1974 1320. Wissniowski, T. and Harlin-Wissniowski, A. [Conservative and surgical measures in phlebologic consulatation. Report on the potassium- neutral venous diuretic Dehydro-sanol-tri]. Fortschr.Med. 92:1132-1137, 1974. Keywords : SURGICAL; VENOUS; NASP; ADULT; AGED; Ambulatory Care; Bioflavonoids; Blood Pressure; Body Weight; Chronic Disease; CLINICAL TRIALS; Diuretics; Diuretics,Thiazide; Drug Combinations; DRUG EVALUATION; Drug Tolerance; Eating Disorders; FEMALE; Headache; Hesperidin; HUMAN; Lymphedema; MALE; MIDDLE AGE; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Venous Insufficiency; Medline File; Health Planning & Administration File; in; ab Notes : TT - Konservative und chirurgische Massnahmen in einer phlebologischen Sprechstunde Erfahrungsbericht uber das kaliumneutrale Venodiuretikum dehydro sanol tri AB - [No Abstract Available] UI - 75132208. Ref ID : WITTLICH1992 1321. Wittlich, N., Erbel, R., Eichler, A., Schuster, S., Jakob, H., Iversen, S., Oelert, H., and Meyer, J. Detection of central pulmonary artery thromboemboli by transesophageal echocardiography in patients with severe pulmonary embolism. J Am Soc.Echocardiogr. 5:515-524, 1992. Keywords : PULMONARY ARTERY; ARTERY; THROMBOEMBOLI; Transesophageal; Echocardiography; PULMONARY EMBOLISM; EMBOLISM; CONTRAST; INCIDENCE; DIAGNOSIS; Methods; THROMBUS; SENSITIVITY; SPECIFICITY; diagnostics; sdi-11/93; in; is; an Notes : Transthoracic echocardiography generally provides only indirect signs of pulmonary embolism. In contrast, with transesophageal echocardiography the thromboembolus itself can be visualized in the central parts of the pulmonary artery. The aims of our study were to evaluate, first, the incidence of central pulmonary artery thromboemboli in patients with severe pulmonary embolism, and second, the accuracy of the echocardiographic diagnosis. Our study group comprised 60 patients with proved severe pulmonary embolism. All patients were examined by transthoracic and transesophageal echocardiography. The echocardiographic findings concerning the absence or presence of central pulmonary artery thromboemboli were compared with the results of different reference methods. Central pulmonary thromboemboli were found in 35 patients (58.3%) by echocardiography. Two types of thrombus were differentiated. Type A is a long, highly mobile thrombus, and type B is an immobile wall-adherent thrombus. In comparison with the reference methods, we determined a sensitivity of 96.7% and a specificity of 88% for the echocardiographic detection of central pulmonary artery thromboemboli in patients with severe pulmonary embolism. Transesophageal echocardiography seems to be a useful method for the diagnosis of severe pulmonary embolism. In our series, central pulmonary artery thromboemboli were present in more than half of the patients. In these cases, transesophageal echocardiography can clarify the diagnosis within a few minutes without further invasive diagnostic procedures. Ref ID : WOLFE1993 1322. Wolfe, M.W., Skibo, L.K., and Goldhaber, S.Z. Pulmonary embolic disease: diagnosis, pathophysiologic aspects, and treatment with thrombolytic therapy. Curr.Probl.Cardiol. 18(10):587-633, 1993. Keywords : 951216; DIAGNOSIS; TREATMENT; THROMBOLYTIC; THROMBOLYTIC THERAPY; THERAPY; AGED; blood gas analysis; CASE REPORT; clinical protocols; Echocardiography; ELECTROCARDIOGRAPHY; FEMALE; HEMODYNAMICS; de; HUMAN; PULMONARY EMBOLISM; bl; di; pp; th; ae; mt; Vena Cava Filters; Medline File; BRIGHAM; Hospitals; boston Notes : [No Abstract Available] Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts. Ref ID : WOLFE1994 1323. Wolfe, M.W., Lee, R.T., Feldstein, M.L., Parker, J.A., Come, P.C., and Goldhaber, S.Z. Prognostic significance of right ventricular hypokinesis and perfusion lung scan defects in pulmonary embolism. Am.Heart J. 127(5):1371-1375, 1994. Keywords : 951216; PERFUSION; LUNG; SCAN; in; PULMONARY EMBOLISM; EMBOLISM; Echocardiography; PE; analysis; SENSITIVITY; RISK; chi-square distribution; COMPARATIVE STUDY; mt; sn; false positive reactions; HUMAN; bs; us; PROGNOSIS; ep; pp; RANDOM ALLOCATION; roc curve; thorax; TIME FACTORS; ventricular function,right; ph; Medline File; BRIGHAM; Hospitals; boston Notes : We studied the relation between right ventricular (RV) hypokinesis on echocardiography and defects on the initial perfusion lung scan among 90 hemodynamically stable patients with pulmonary embolism (PE). Of the 90, 38 had qualitative evidence of RV hypokinesis, with a mean RV end-diastolic area significantly larger than those with normal RV wall motion (40.0 +/- 10.2 cm2 vs 20.1 +/- 6.4 cm2; p < 0.001). The degree of the perfusion defect was greater in those patients with baseline RV hypokinesis (54% +/- 16% of the lung nonperfused) than in those patients with normal RV wall motion at baseline (30% +/- 18% nonperfused lung; p < 0.001). Receiver operating characteristic curve analysis showed that a perfusion lung scan defect score of 0.3 (i.e., 30% of the lung nonperfused) had a 92% sensitivity for predicting RV hypokinesis and carried a relative risk for observing RV hypokinesis of 6.8 times greater than among those patients with a perfusion scan score of < 0.3. Considering that all patients with recurrent symptomatic PE were in the subgroup with RV hypokinesis (13% vs 0% for those with normal RV wall motion; p = 0.01), a strategy of performing echocardiography in those patients with a perfusion scan defect score of > or = 0.3 appears to identify patients at increased risk for recurrent PE Department of Medicine Brigham and Women's Hospital Boston MA 02115. Ref ID : WONG1993 1324. Wong, C. and Bracker, M. Coagulopathy presenting as calf pain in a racquetball player. J.Fam.Pract. 37:390-393, 1993. Keywords : PHLEBITIS; COAGULOPATHY; CALF; PAIN; ADULT; Blood Coagulation Disorders; COMPLICATIONS; DIAGNOSIS; CASE REPORT; Diagnosis,Differential; HUMAN; LEG; Leg Injuries; MALE; ETIOLOGY; racquet sports; injuries; THROMBOPHLEBITIS; INJURY; TREATMENT; CAUSE; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; EXERCISE; HEREDITARY; HYPERCOAGULABLE; in Notes : Most cases of lower leg pain in athletes result from musculoskeletal injury. Occasionally these patients do not respond to treatment in a timely fashion. This should alert the clinician to rethink the original diagnosis and consider more unusual causes of leg pain. Deep venous thrombosis must be considered in a young athletic person experiencing unexplained persistent calf pain after exercise. Further investigation may be necessary to rule out a hereditary or acquired hypercoagulable state. Ref ID : WORSLEY1993 1325. Worsley, D.F., Alavi, A., Aronchick, J.M., Chen, J.T., Greenspan, R.H., and Ravin, C.E. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology. 189:133-136, 1993. Keywords : CHEST; PULMONARY EMBOLISM; EMBOLISM; PIOPED; SENSITIVITY; SPECIFICITY; PREDICTIVE VALUE; PE; Methods; CHEST RADIOGRAPH; PREVALENCE; PULMONARY ARTERY; ARTERY; PLEURAL EFFUSION; SCAN; Westermark; Hampton's hump; effusion; sdi-11/93; in; is; Mimic Notes : PURPOSE: To determine the sensitivity, specificity, and positive and negative predictive values of chest radiographic findings in patients suspected of having acute pulmonary embolism (PE). MATERIALS AND METHODS: Chest radiographs of 1,063 patients with suspected PE were reviewed. PE was confirmed angiographically in 383 patients and excluded in 680 patients. RESULTS: The chest radiograph was interpreted as normal in only 12% of patients with PE. The most common chest radiographic finding in patients with PE was atelectasis and/or parenchymal areas of increased opacity; however, the prevalence was not significantly different from that in patients without PE. Oligemia (the Westermark sign), prominent central pulmonary artery (the Fleischner sign), pleural-based area of increased opacity (the Hampton hump), vascular redistribution, pleural effusion, elevated diaphragm, and enlarged hilum were also poor predictors of PE. CONCLUSION: Although chest radiographs are essential in the investigation of suspected PE, their main value is to exclude diagnoses that clinically mimic PE and to aid in the interpretation of the ventilation-perfusion scan. Ref ID : WORSLEY1993A 1326. Worsley, D.F., Kim, C.K., Alavi, A., and Palevsky, H.I. Detailed analysis of patients with matched ventilation-perfusion defects and chest radiographic opacities. J.Nucl.Med. 34:1851-1853, 1993. Keywords : CHEST; PROSPECTIVE; PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; PIOPED; PREVALENCE; PE; V/Q; diagnostics; V/Q SCAN; SCAN; CHEST RADIOGRAPH; LUNG; PROBABILITY; analysis; in; abnormalities; an Notes : We performed a retrospective evaluation of the data obtained from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study to determine the prevalence and distribution of pulmonary embolism (PE) in patients with matching ventilation-perfusion (V/Q) defects and chest radiographic opacities (triple matches). From the 1,487 patients in whom diagnostic V/Q scans were obtained, 247 (17%) patients were recorded as having matching V/Q defects and chest radiograph opacities in at least one lung zone. Diagnostic angiograms were available for 275 lung zones (233 patients) which demonstrated matching V/Q defects and chest radiograph opacities. The overall prevalence of PE in all lung zones with triple matches was 26%. The prevalences of PE in the upper, middle and lower lung zones were 11%, 12% and 33%, respectively. Pulmonary embolism was significantly more common in lower lung zone triple matches compared with the upper and middle lung zone triple matches (p < 0.005). There was no correlation between the size of the V/Q and chest radiographic abnormalities and the prevalence of PE. We conclude that in patients with matching V/Q defects and chest radiographic opacities isolated to the upper and middle zones the V/Q scan can be interpreted as representing a low probability of PE. Similar findings in the lower lung zones represent an intermediate probability of PE. The application of this modification to V/Q scan interpretation criteria will aid in reducing the number of intermediate V/Q lung scan interpretations. Ref ID : WORSLEY1993B 1327. Worsley, D.F., Alavi, A., and Palevsky, H.I. Role of radionuclide imaging in patients with suspected pulmonary embolism. Radiol.Clin.North Am. 31:849-858, 1993. Keywords : RADIONUCLIDE; PULMONARY EMBOLISM; EMBOLISM; DIAGNOSIS; VENTILATION/PERFUSION; V/Q; LUNG; SCAN; NONINVASIVE; TECHNIQUES; MANAGEMENT; diagnostics; SCANNING; VENOUS; Extremities; radionuclide imaging; in Notes : The accurate diagnosis of acute pulmonary embolism often represents a challenge to clinicians. The ventilation/perfusion (V/Q) lung scan provides a safe, noninvasive technique, which has been widely used in the diagnosis of pulmonary embolism. Although some controversy still exists in the management of patients with suspected pulmonary embolism, diagnostic strategies for investigating patients have incorporated V/Q scanning, noninvasive venous studies of the lower extremities and clinical assessment of the likelihood of pulmonary embolism. The combination of these strategies will provide acceptable diagnostic accuracy for evaluating patients with suspected pulmonary embolism in the majority of cases. Ref ID : WORSLEY1994 1328. Worsley, D.F., Palevsky, H.I., and Alavi, A. Ventilation-perfusion lung scanning in the evaluation of pulmonary hypertension. J.Nucl.Med. 35:793-796, 1994. Keywords : LUNG; SCANNING; PULMONARY HYPERTENSION; Hypertension; SENSITIVITY; SPECIFICITY; V/Q; CHRONIC; THROMBOEMBOLIC; CAUSE; Methods; SCAN; V/Q SCAN; PROBABILITY; DIAGNOSIS; PULMONARY ANGIOGRAPHY; ANGIOGRAPHY; SURGICAL; THROMBOEMBOLISM; diagnostics; in; ph; an Notes : The objective of this study was to define the sensitivity, specificity and accuracy of ventilation-perfusion (V/Q) lung scanning in distinguishing chronic thromboembolic pulmonary hypertension (PHT) from other nonembolic causes of PHT. METHODS: The V/Q lung scans from 75 patients in whom a confirmed cause of PHT was established were retrospectively reviewed. Twenty-five patients (33%) had chronic thromboembolic PHT, whereas 35 patients (47%) and 15 patients (20%) suffered from primary PHT and secondary nonthromboembolic PHT, respectively. RESULTS: A high-probability V/Q scan interpretation had a sensitivity of 96% and a specificity of 94% for detecting patients with thromboembolic PHT. The combination of high- and intermediate- probability V/Q scan interpretations had a sensitivity of 100% for detecting patients with thromboembolic PH; however, the specificity decreased to 86%. Of the 35 patients with primary PHT, all but one patient had low-probability V/Q scan interpretations. CONCLUSION: In this series, a low-probability V/Q scan interpretation effectively excluded the diagnosis of chronic thromboembolic PHT. In patients with an intermediate- or high-probability V/Q scan interpretation, pulmonary angiography was required to confirm the diagnosis of chronic thromboembolic PHT and determine whether surgical intervention was indicated. The V/Q lung scan appears to be a highly sensitive test for chronic thromboembolism in the diagnostic evaluation of patients with PHT. However, its role needs to be defined further by application to a prospectively recruited cohort of patients with PHT. Ref ID : WOZASEK1994 1329. Wozasek, G.E., Thurnher, M., Redl, H., and Schlag, G. Pulmonary reaction during intramedullary fracture management in traumatic shock: an experimental study. J.Trauma. 37:249-254, 1994. Keywords : EMBOLISM; TRAUMA; FRACTURES; MANAGEMENT; SHOCK; CAUSE; EMBOLIZATION; Methods; LUNG; CHRONIC; Fistula; ANIMAL; Tibia; Pressure; HEMORRHAGIC; INJURY; in; an; is; multiple trauma; instrumentation Notes : Immediate nailing of shaft fractures in severely injured patients causes fat embolization. This method therefore is considered potentially dangerous, since fat intravasation in association with multiple trauma and subsequent endotoxemia might lead to pulmonary dysfunction. We therefore studied the pathophysiologic events of intramedullary nailing in the lungs of sheep with chronic instrumentation including lung lymph fistula. In the 7 animals in group I closed nailing of the intact tibia and femur was performed. Group II (n = 7) animals sustained hypovolemic shock and retransfusion prior to nailing, while group III (n = 11) animals were treated like those in group II and further challenged on the following two days with endotoxin. Group III was compared with group IV (n = 6), in which endotoxin was given only once without additional trauma. Nailing in group I led to a significant increase of the MPAP from 10.8 to 13.8 mm Hg postoperatively (p < 0.05), but no increase in lung permeability. Only additional hypovolemia, retransfusion and nailing as performed in groups II and III showed significant increase of the lymph flow (QI) from 4.4 mL/h to 12.4 mL/h and the protein clearance (Pclear) from 3 to 6.3. A significant difference of the pulmonary permeability between group I and II was only observed postoperatively. There was no difference in the lung response between group III and IV. This ovine study corroborates that although nailing causes a moderate increase in pulmonary pressure, it does not lead to increased lung permeability. Only additional hemorrhagic shock, even when adequately resuscitated, leads to lung disturbance postoperatively. The subsequent endotoxin challenge does not aggravate lung injury. Ref ID : WRIGHT1942 1330. Wright, H.P. Changes in the adhesiveness of blood platelets following parturition and surgical operations. J.Path.Bact. 54:461-468, 1942. Keywords : THROMBOSIS; SCLEROTHERAPY; PLATELET ADHESION; PARTURITION; SURGICAL OPERATIONS; PLATELETS; SURGICAL; in; blood; Blood Platelets Ref ID : WU1993 1331. Wu, J.J., MacFall, J.R., Sostman, H.D., and Hedlund, L.W. Clot- blood contrast in fast gradient-echo magnetic resonance imaging. Invest.Radiol. 28:586-593, 1993. Keywords : CONTRAST; MAGNETIC RESONANCE; MRI; Pulse; IN VITRO; HUMAN; DEEP VENOUS THROMBOSIS; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DVT; Methods; sdi-11/93; in; magnetic resonance imaging; blood; an; Immobilized; is Notes : RATIONALE AND OBJECTIVES. Contrast between clot and blood in magnetic resonance imaging (MRI) at 1.5T using fast gradient-echo pulse sequences (fast GRE), with 8 ms < TR < 20 mseconds was studied both in vitro and in clinical human deep venous thrombosis (DVT) to assess whether good contrast could be obtained at such short repetition times and at clinically relevant flow rates. METHODS. In vitro studies used an apparatus that contained flowing MnCl2[aq] (water adjusted with manganese chloride to have T1, T2 similar to blood) and an immobilized clot (T1, T2 similar to those in DVT) for flow velocities between 0 and 16.5 cm/sec. Seven patients with DVT were imaged with the fast GRE sequences to observe the clot-blood contrast in vivo. RESULTS. Peak contrast-to-noise ratio (CNR) was achieved using flip angles between 20 degrees and 40 degrees (increasing with flow velocity) with or without radiofrequency "spoiling," consistent with a natural spoiling effect of flow. The CNR between MnCI2[aq] and clot decreased less than 10% as TR was reduced 56% from 18 mseconds to 8 mseconds (30 degrees flip angle). In four patients with nonocclusive DVT, fast GRE imaging provided good contrast while in occlusive cases (three patients) the contrast was not as good as conventional GRE sequences with longer TR values (TR = 33 mseconds). CONCLUSION. A fast GRE sequence with TR = 8 mseconds, TE = 3 mseconds, and a flip angle = 40 degrees is a promising approach to speeding up the detection of nonocclusive clinical DVT. Ref ID : WU1993A 1332. Wu, G., Li, F., Li, P., and Ruan, C. Detection of plasma alpha- granule membrane protein GMP-140 using radiolabeled monoclonal antibodies in thrombotic diseases. Haemostasis. 23:121-128, 1993. Keywords : PLATELET; PLATELET ACTIVATION; ENDOTHELIUM; PATHOGENESIS; MYOCARDIAL INFARCTION; CEREBRAL THROMBOSIS; THROMBOSIS; CARDIOPULMONARY BYPASS; Platelet Count; Early detection; sdi-11/93; antibodies; in; is; an; radioimmunoassay; infarction; Cerebral Notes : There is an assumption that platelet activation and endothelium damage play a critical role in the pathogenesis of thrombotic disorders. A radioimmunoassay based on using two monoclonal antibodies (MAbs) to different epitopes of alpha-granule membrane protein (GMP-140) was used to determine whether plasma GMP-140 can be detected in patients suffering from acute myocardial infarction (AMI) or cerebral thrombosis and in patients during cardiopulmonary bypass (CPB). MAb SZ-51 was used as a solid phase, and 125I-labeled MAb S12 was used as a fluid phase. The assay is so sensitive that it can detect as little as 1 ng/ml of purified GMP-140. The intra- and interassay coefficients of variation were 4.2% (n = 5) and 7.1% (n = 8), respectively. The concentration of plasma GMP-140 was found to be 10.0 +/- 4.5 ng/ml (mean +/- SD, n = 20) in normal subjects. Ten patients undergoing CPB demonstrated a transient increase in the concentration of plasma GMP-140, especially at 2 h after CPB, and the plasma GMP-140 level was inversely correlated with the decreased platelet counts during bypass (r = -0.81, p < 0.01). It was found that the concentration of plasma GMP-140 increased significantly after AMI. Plasma GMP-140 reached the peak within 3 days and changed with the process of AMI (n = 16) patients. The concentration of plasma GMP-140 increased significantly in patients with cerebral thrombosis in the acute phase but not after relief.(ABSTRACT TRUNCATED AT 250 WORDS). Ref ID : WUPPERMANN1975 1333. Wuppermann, T. and Haas, K.H. The effect of the sclerosing agent Hydroxypolyaetoxydodecan on the coagulation potentials: in vitro investigations. Vasa 4(1):45-53, 1975. Keywords : SCLEROSING AGENTS; COAGULATION; SCLEROSANTS; PLATELETS; VEINS; THROMBOSIS; SCLEROTHERAPY; HYDROXYPOLYAETOXYDODECAN; SCLEROSANT; THROMBUS; in; IN VITRO; varicose Notes : It was concluded that at least in vitro, this sclerosant acts upon intrinsic and extrinsic systems as well as upon platelets to inhibit thrombus formation and propagation, and that this effect may slow or prevent the propagation of thrombus from peripheral varicoses into the deep veins. Ref ID : YAMAMOTO1992 1334. Yamamoto, H., Wakiya, I., Matsueda, K., Yokoi, T., Ariyoshi, M., Shimamura, J., Doi, I., Yano, K., and Ogasawara, K. [Treatment of cardial varicose bleeding by trans-ileocolic vein obliteration combined with endoscopic injection sclerotherapy]. Nippon.Shokakibyo.Gakkai.Zasshi. 89:9-16, 1992. Keywords : BLEEDING; vein; Injections; VARICES; SHUNT; Extension; ESOPHAGEAL; ESOPHAGEAL VARICES; BLOOD FLOW; SCLEROSING AGENTS; TREATMENT; HEMOSTASIS; HEMOSTATIC; Hospitals; NASP; VEINS; AGED; Cardia; CASE REPORT; Combined Modality Therapy; Embolization,Therapeutic; English Abstract; Esophageal and Gastric Varices; FEMALE; Gastrointestinal Hemorrhage; Gastroscopy; HUMAN; Injections,Intravenous; MALE; MIDDLE AGE; SCLEROTHERAPY; Stomach; Medline File; varicose; ab; in; an; blood; ad Notes : AB - In the past 4 years, 11 patients with cardial varix bleeding were experienced. The cardial varices were of 2 types, nodular and serpentine. The nodular varices were caused by gastro-renal shunt and the site of bleeding often existed on the posterior wall. The serpentine cardial varices were an extension of esophageal varices, and the site of bleeding was often on the lesser curvature. The nodular varices had an abundant blood flow. When EIS was performed to these varices independently, the time of contact with the sclerosing agent was so short that no therapeutic effect was obtained. For the purpose of decreasing the blood flow in these varices, TIO was performed first and then EIS was used in the treatment of four cases of nodular varix bleeding. Hemostasis was obtained in two of the four cases with TIO alone, and after the addition of EIS a good hemostatic and varix- reducing effect was noted in all four cases AD - Department of Internal Medicine AD - Kurashiki Central Hospital UI - 92219490. Ref ID : YEE1993 1335. Yee, L.L., Williams, G.P., Gaither, N.S., and Zurcher, R.P. Diagnosis of acute intraoperative pulmonary thromboembolism by transesophageal echocardiography. Am Heart J 125:262-263, 1993. Keywords : DIAGNOSIS; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; Transesophageal; Echocardiography; sdi-11/93; Intraoperative Ref ID : YOUNG1971 1336. Young, J.R. Peripheral venous diseases. J.Maine.Med.Assoc. 62:226- 227, 1971. Keywords : VENOUS; NASP; HUMAN; THROMBOPHLEBITIS; Varicose Ulcer; VARICOSE VEINS; Vascular Diseases; Medline File; ab Notes : AB - [No Abstract Available] UI - 72015137. Ref ID : YUCEL1991 1337. Yucel, E.K., Fisher, J.S., Egglin, T.K., Geller, S.C., and Waltman, A.C. Isolated calf venous thrombosis: diagnosis with compression US. Radiology 179:443-446, 1991. Keywords : PHLEBITIS; CALF; VENOUS; VENOUS THROMBOSIS; THROMBOSIS; DIAGNOSIS; COMPRESSION; ACUTE DISEASE; ADULT; AGED; Aged,80 and over; FEMALE; HUMAN; LEG; blood supply; MALE; Methods; MIDDLE AGE; PHLEBOGRAPHY; PROSPECTIVE STUDIES; THROMBOPHLEBITIS; radiography; Ultrasonography; ULTRASOUND; Popliteal Vein; VEINS; CALF VEIN THROMBOSIS; vein; PROSPECTIVE; Sonography; VENOGRAPHY; SENSITIVITY; FALSE-NEGATIVE; THROMBI; Venogram; SPECIFICITY; SCREENING; us; is; an; in Notes : Compression ultrasound (US) is an excellent means of evaluating the femoral and popliteal veins but is generally regarded as inadequate for the diagnosis of calf vein thrombosis. This prospective study evaluated compression sonography of the calf veins in 45 symptomatic patients with normal femoral and popliteal veins. All patients underwent correlative venography. Compression US enabled identification of 15 of 17 patients with calf vein thrombosis (sensitivity, 88%). The two false- negative results were in patients with small isolated thrombi. Compression US results were true-negative in 26 of 27 patients with normal venograms (specificity, 96%). If these results can be duplicated by other investigators in larger series of patients, compression US will be an adequate screening modality for calf vein thrombosis. Ref ID : YUTANI1993 1338. Yutani, C., Imakita, M., Ishibashi-Ueda, H., Katsuragi, M., Yoshioka, T., and Kunieda, T. Pulmonary hypertension due to tumor emboli: a report of three autopsy cases with morphological correlations to radiological findings. Acta Pathol.Jpn. 43:135-141, 1993. Keywords : 951202; PULMONARY HYPERTENSION; Hypertension; Tumor emboli; EMBOLI; AUTOPSY; LUNG; CLINICAL DIAGNOSIS; DIAGNOSIS; PULMONARY THROMBOEMBOLISM; THROMBOEMBOLISM; SURGICAL; EMBOLECTOMY; CANCER; EMBOLISM; is; PERIPHERAL ARTERY; Arteries; Segmental; ADULT; CASE REPORT; chondrosarcoma; co; PA; ra; choriocarcinoma; FEMALE; HUMAN; hypertension,pulmonary; et; lung neoplasms; MIDDLE AGE; PULMONARY ARTERY; PULMONARY EMBOLISM; Support,Non-U.S.Gov't; Medline File; Cancerlit File; pathology; CARDIOVASCULAR; japan Notes : Three cases of pulmonary hypertension caused by tumor emboli to the lungs are described. Two of the three cases had a clinical diagnosis of pulmonary thromboembolism until surgical embolectomy, and the other had a diagnosis of primary pulmonary hypertension. Autopsy disclosed chondrosarcoma, choriocarcinoma and gastric cancer as the primary tumors, respectively. Pulmonary vascular obstruction due to tumor embolism leading to pulmonary hypertension is a previously rare clinical entity, and obstructed pulmonary vessels are believed to tend to be small vessels. We compared the autopsy and radiological findings and concluded that pulmonary tumor embolism involved not only the small peripheral arteries but also the segmental and/or lobar arteries Department of Pathology National Cardiovascular Center Osaka Japan. Ref ID : ZEIT1985 1339. Zeit, R.M. and Cope, C. Failed hemodialysis shunts: one year of experience with aggressive treatment. Radiology 154:353-356, 1985. Keywords : SHUNT; TREATMENT; DIALYSIS SHUNT; THROMBOSIS; STREPTOKINASE; hemodialysis Ref ID : ZEIT1986 1340. Zeit, R.M. Arterial and venous embolization: declotting of dialysis shunts by direct injection of streptokinase. Radiology. 159:639-641, 1986. Keywords : ARTERIAL; VENOUS; EMBOLIZATION; SHUNT; STREPTOKINASE; ACEP93; DIALYSIS; DIALYSIS SHUNT; Injections Ref ID : ZEKERT1975 1341. Zekert, F. Thrombosen, embolen, und aggregationshemmer in der chirugie, Stuttgart:F. K. Schattauer, 1975. Keywords : SURGERY; PE; DEATH; THROMBOSIS; EMBOLISM; in; Orthopedic Notes : 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 : ZOLLINGER1962 1342. Zollinger, R.W., Williams, R.D., and Briggs, D.O. Problems in the diagnosis and treatment of thrombophlebitis. Arch.Surg. 85:18, 1962. Keywords : DIAGNOSIS; TREATMENT; THROMBOPHLEBITIS; NASP; bib-4; in Ref ID : ZOLLINGER1967 1343. Zollinger, R.W. Superficial thrombophlebitis. Surg.Gynecol.Obstet. 124:1077, 1967. Keywords : THROMBOPHLEBITIS; NASP; bib-4; Superficial thrombophlebitis