scholarly journals Dermo-Hipodermites Bacterianas Agudas Não Necrotizantes: Erisipela e Celulite Infeciosa

2021 ◽  
Vol 34 (3) ◽  
pp. 217
Author(s):  
Maria Alexandra Rodrigues ◽  
Mónica Caetano ◽  
Isabel Amorim ◽  
Manuela Selores
Keyword(s):  
Risk Factors ◽  
Necrotizing Fasciitis ◽  
Lower Limbs ◽  
First Line ◽  
Correct Treatment ◽  
Vein Thrombosis ◽  
Group A ◽  
Low Sensitivity ◽  
Atypical Presentations ◽  
Main Complication

Non-necrotizing acute dermo-hypodermal infections are infectious processes that include erysipela and infectious cellulitis, and are mainly caused by group A β-haemolytic streptococcus. The lower limbs are affected in more than 80% of cases and the risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and in a typical setting we observe an acute inflammatory plaque with fever, lymphangitis, adenopathy and leucocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In case of atypical presentations, erysipela must be distinguished from necrotizing fasciitis and acute vein thrombosis. Flucloxacillin and cefradine remain the first line of treatment. Recurrence is the main complication, so correct treatment of the risk factors is crucial.

Residual Vein Thrombosis Improves Screening for Occult Cancer: Results On 537 Patients with Idiopathic Deep Vein Thrombosis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3999-3999
Author(s):  
Sergio Siragusa ◽  
Alessandra Malato ◽  
Fabio Fulfaro ◽  
Giorgia Saccullo ◽  
Domenica Caramazza ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Early Detection ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Occult Cancer ◽  
Group A ◽  
Group B ◽  
Deep Vein ◽  
Related Mortality

Abstract Abstract 3999 Poster Board III-935 Background Clinical advantage of extensive screening for occult cancer in patients with idiopathic Deep Vein Thrombosis (DVT) is unknown. We have demonstrated that the Residual Vein Thrombosis (RVT)-based screening for occult cancer improves early detection as well as cancer-related mortality (Siragusa S et al. Blood 2007;110(699):OC). Here we report on final analysis of 537 patients over a period of 8 years. Objective of the study We conducted a prospective study evaluating whether a RVT-based screening for cancer is sensitive and influences cancer-related mortality. Study design Prospective with two cohorts of DVT patients: the first cohort was monitored for clinical overt cancer only (Group A), while the second (Group B) received complete screening for occult neoplasm and subsequent surveillance. Materials and methods Consecutive patients with a first episode of DVT who presented RVT after 3 month of anticoagulation and without signs and/or symptoms for overt cancer. Screening for occult cancer was based on: ultrasound and/or CT scan of the abdomen and pelvis, gastroscopy, colonoscopy or sigmoidoscopy, hemoccult, sputum cytology and tumor markers. These tests were extended with mammography and Pap smear for women and ultrasound of the prostate and total specific prostatic antigen (PSA) for men. All investigations had to be completed within four-weeks from the assessment of RVT. All patients were followed-up for at least 2 years. Incidence and cancer-related mortality was compared between the two groups by survival curves (Kaplan-Mayer) and related Breslow test for statistics. Results Over a period of 8 years, 537 patients were included in the analysis: first cohort included 346 patients (Group A), second cohort 191 (Group B). Clinical characteristics between groups were homogenous. During the follow-up, 8.3% of patients developed overt cancer in group A; in group B, 7.8% of patients had diagnosed cancer at the moment of extensive screening while 2 new cases (0.7%) occurred during the follow-up (Table). The sensitivity of this approach was 92.1% (95% confidence intervals 75.2-104.2). Cancer-related mortality was 7.5% in group A and 3.6% in group B (p< 0.001). Conclusions The RVT-based screening for occult cancer is highly effective for improving early detection as well as cancer-related mortality in a cohort of 537 patient with DVT of the lower limbs. Disclosures: Off Label Use: Hydroxyurea use in myelofibrosis.

ABO Blood Groups as Risk Factors for Thrombosis

1996 ◽  
Vol 2 (3) ◽  
pp. 196-199 ◽  
Author(s):  
Dayse M. Lourenço ◽  
Fausto Miranda ◽  
Letícia H. C. Lopes
Keyword(s):  
Risk Factors ◽  
Blood Group ◽  
Blood Donors ◽  
Blood Groups ◽  
Abo Blood Groups ◽  
Arterial Embolism ◽  
Fisher Test ◽  
Vein Thrombosis ◽  
Blood Group A ◽  
Group A

To evaluate the relationship between ABO blood group and thrombosis, we studied 127 patients tak ing oral anti-vitamin K drugs for thromboembolism pro phylaxis and compared them with 700 voluntary blood donors. There were 68 patients with venous thrombosis (VT)—68 with deep vein thrombosis and 8 with pulmo nary embolism—and 51 patients with arterial embolism (AE). There were 61 men and 66 women. Mean age at diagnosis was lower for all women, regardless of if they had VT or AE (43 years) than for men (55 years; Kruskal- Wallis test, p < 0.01). There was an imbalance between blood group A and O frequencies in patients with VT versus blood donors, with a higher frequency of blood group A or a lower frequency of blood group O, repre sented by a high A/O ratio. A/O ratio for blood donors was 0.63; it was 1.50 for men (Fisher test, p = 0.028) and 1.44 for women (Fisher test, p = 0.010). Patients with AE showed the same discrepancy, but it was significant for women (A/O = 2.25; Fisher test, p = 0.026) and not for men (A/O = 0.86; Fisher test, p = 0.836), suggesting that men with AE might have other risk factors for thrombo sis. These data are not conclusive about the causes of the association between ABO blood groups and thrombosis, and prospective studies are needed to verify whether blood typing could have a predictive value for prophylatic measures in clinical and surgical patients.

Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: Results from the OPTIMEV study

2009 ◽  
Vol 102 (09) ◽  
pp. 493-500 ◽  
Author(s):  
Marie-Antoinette Sevestre-Pietri ◽  
Jean-Luc Bosson ◽  
Jean-Pieere Laroche ◽  
Marc Righini ◽  
Dominique Brisot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Lower Limbs ◽  
Early Outcome ◽  
Vein Thrombosis ◽  
Recurrent Venous Thromboembolism ◽  
Deep Vein ◽  
Active Cancer

SummaryThere is a lack of consensus on the value of detecting and treating symptomatic isolated distal deep-vein thrombosis (DVT) of the lower limbs. In our study, we compared the risk factors and outcomes in patients with isolated symptomatic distal DVT with those with proximal symptomatic DVT. We analysed the data of patients with objectively confirmed symptomatic isolated DVT enrolled in the national (France), multicenter, prospective OPTIMEV study.This sub-study outcomes were recurrent venous thromboembolism, major bleeding and death at three months. Among the 6141 patients with suspicion of isolated DVT included between November 2004 and January 2006, DVT was confirmed in 1643 patients (26.8%). Isolated distal DVT was more frequent than proximal DVT (56.8% vs. 43.2%, respectively; p=0.01). Isolated distal DVT was significantly more often associated with transient risk factors (recent surgery, recent plaster immobilisation, recent travel), whereas proximal DVT was significantly more associated with more chronic states (active cancer, congestive heart failure or respiratory insufficiency, age >75 years). Most patients (96.8%) with isolated distal DVT received anticoagulant therapies.There was no difference in the percentage of recurrent venous thromboembolism and major bleeding in patients with proximal DVT and isolated distal DVT. However, the mortality rate was significantly higher (p<0.01) in patients with proximal DVT (8.0%) than in those with isolated distal DVT (4.4%). Symptomatic isolated distal DVT differs from symptomatic proximal DVT both in terms of risk factors and clinical outcome. Whether these differences should influence the clinical management of these two events remains to be determined.

Venous thromboembolism (VTE) incidence and risk factors in patients (pts) with non-small cell lung cancer (NSCLC) receiving front-line therapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19293-e19293
Author(s):  
Jai Narendra Patel ◽  
Myra M. Robinson ◽  
Hailey Hill ◽  
Lauren Lu ◽  
Daniel Slaughter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Checkpoint Inhibitors ◽  
Competing Risk ◽  
Tumor Type ◽  
First Line ◽  
Treatment Groups ◽  
Vein Thrombosis ◽  
Diagnosis Codes ◽  
Treatment Type

e19293 Background: VTE incidence varies based on factors such as tumor type, stage, and treatment. There is limited data on VTE incidence and risk factors in NSCLC pts receiving first-line therapies, including immune checkpoint inhibitors (ICIs) and targeted therapies (TTs). Methods: This is a single institution retrospective cohort study of adult NSCLC pts who received first-line treatment between July 2003 and July 2019. Treatments included chemotherapy (chemo) (platinums, taxanes, pemetrexed, gemcitabine, etoposide, bevacizumab), ICI (pembrolizumab, nivolumab, atezolizumab, durvalumab), chemo + ICI, or TT (erlotinib, gefitinib, afatinib, osimertinib, crizotinib, alectinib, ceritinib). Diagnosis codes (ICD 9/10 codes) confirmed VTE (deep vein thrombosis and/or pulmonary embolism) and presence of risk factors which are summarized in Table. Landmark VTE incidence was estimated from cumulative incidence curves for time to VTE, death as a competing risk. Time to VTE distributions were compared between groups with Gray’s tests. Univariable and multivariable competing risk analyses identified risk factors for time to VTE. Results: In 1,618 evaluable pts, the median age was 66 years, 53% were male, 79% White, 18% Black, 58% had adenocarcinoma, 32% squamous cell carcinoma, and 47% metastatic disease. 1178 received chemo, 172 ICIs, 157 chemo + ICI, and 111 TTs. 6-month VTE rates per arm were 5.3%, 7.0%, 7.2%, and 12.0% and 12-month rates were 8.9%, 8.1%, 11.7%, and 13.3%, respectively. Cumulative incidence of VTE was not significantly different between treatment groups (p = .27). Univariable and multivariable analyses are summarized in the Table below. Conclusions: Treatment type was not associated with VTE risk in first-line NSCLC, but rates were numerically highest in pts receiving TTs. Khorana risk score was significantly associated with VTE risk and may identify those likely to benefit from thromboprophylaxis. [Table: see text]

D-dimer and residual vein obstruction as risk factors for recurrence during and after anticoagulation withdrawal in patients with a first episode of provoked deep-vein thrombosis

2011 ◽  
Vol 105 (05) ◽  
pp. 837-845 ◽  
Author(s):  
Cristina Legnani ◽  
Michela Cini ◽  
Giuliana Guazzaloca ◽  
Gualtiero Palareti ◽  
Benilde Cosmi
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Recurrence Risk ◽  
Lower Limbs ◽  
University Hospital ◽  
First Episode ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Residual Vein Obstruction ◽  
D Dimer

SummaryD-dimer and residual venous obstruction (RVO) have been separately shown to be risk factors for recurrent venous thromboembolism (VTE) after a first episode of unprovoked proximal deep-vein thrombosis (DVT). It was the objective of this study to assess the predictive value of D-dimer and residual vein obstruction (RVO), alone and in combination, for recurrence after provoked DVT of the lower limbs. A total of 296 consecutive patients with a first episode of symptomatic provoked proximal DVT were evaluated at a university hospital in Bologna, Italy. On the day of anticoagulation withdrawal (T0), RVO was determined by compression ultrasonography. D-dimer levels (cut-off: 500 ng/ml) were measured at T0 and after 30 ±10 days (T1). The main outcome was recurrent VTE during a two-year follow-up. D-dimer was abnormal in 11.6% (32/276) and 31% (85/276) of subjects at T0 and at T1, respectively. RVO was present in 44.8% (132/294) of patients. Recurrence rate was 5.1% (15/296; 95% confidence interval [CI]: 3–8%; 3% patient-years; 95% CI: 2–5 %). An abnormal D-dimer either at T0 or at T1 was associated with an adjusted hazard ratio (HR) for recurrence of 4.2 (95% CI:1.2–14.2; p=0.02) and 3.8 (95%CI: 1.2–12.1; p=0.02), respectively, when compared with normal D-dimer. The HR for recurrence associated with RVO was not significant, and RVO did not increase the recurrence risk associated with an abnormal D-dimer either at T0 or T1. In conclusion, an abnormal D-dimer during vitamin K antagonist (VKA) treatment or at one month after VKA withdrawal is a risk factor for recurrence in patients with provoked DVT, while RVO at the time of anticoagulation withdrawal is not.

scholarly journals Management of a case of thromboembolism post spine surgery: a case report

2021 ◽  
Vol 9 (10) ◽  
pp. 3194
Author(s):  
Manoj K. S. Tomer ◽  
Kalpana Shah ◽  
Shilpa Bhojraj ◽  
Pinki Devi
Keyword(s):  
Spine Surgery ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Surgery Patient ◽  
Patients At Risk ◽  
Low Sensitivity

Postoperative deep vein thrombosis (DVT) of lower limbs is often asymptomatic. In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative venous thromboembolism (VTE). Routine screening for asymptomatic DVT of the lower limbs has a low sensitivity and is quite impractical. For these reasons, routine and systematic prophylaxis in patients at risk, is the strategy of choice to reduce the burden of VTE after surgery. If used appropriately such prophylaxis is cost effective since it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Here we report the post-operative course of a spine surgery patient, presenting with DVT in calf veins, which lodged into pulmonary artery and was managed successfully with low molecular weight heparin (LMWH), embolectomy, inferior vena cava (IVC) filter, and dabigatran.

scholarly journals Septic Arthritis of the Knee and Necrotizing Fasciitis in a Young Immunocompetent Adult: A Case Report

2018 ◽  
Vol 3 (2) ◽  
pp. 56
Author(s):  
Hayatul Najaa Miptah ◽  
Siti Fatimah Badlishah-Sham ◽  
Selvyn LLyod ◽  
Anis Safura Ramli
Keyword(s):  
Risk Factors ◽  
Knee Joint ◽  
Septic Arthritis ◽  
Necrotizing Fasciitis ◽  
Knee Pain ◽  
Group A Streptococcus ◽  
Immunocompetent Adult ◽  
Group A ◽  
Left Calf ◽  
Underlying Risk

Septic arthritis is uncommon in immunocompetent young adults. It typically presents in individuals with underlying risk factors. Isolation of Group A Streptococcus (GAS) as the causative agent of septic arthritis is usually associated with autoimmune diseases, chronic skin infections or trauma. Here we report a case of a young lady who is immunocompetent without any prior history of trauma, who presented with an abrupt onset of left knee pain and swelling to the emergency department. An initial diagnosis of acute gout was made and she was treated with non-steroidal anti-inflammatory drug (NSAID). She presented again two days later to a primary care clinic with worsening knee pain and severe left calf pain. A clinical diagnosis of septic arthritis was suspected and the patient was urgently referred to the Orthopaedic team. Synovial fluid from the knee joint aspiration showed growth of GAS. A diagnosis of necrotizing fasciitis was also made as the culture taken from the left calf during incision and drainage (I&D) procedure showed a mixed growth. She eventually underwent surgical debridement twice, together with the administration of several courses of intravenous antibiotics leading to her full recovery after 45 days. This case demonstrates the challenge in making a prompt diagnosis of septic arthritis and probable Type II necrotizing fasciitis in an immunocompetent adult without underlying risk factors. Any delay in diagnosis and treatment would have increased the risk of damage to her knee joint and this may be fatal even in a previously healthy young adult. KEYWORDS: septic arthritis, immunocompetent, Group A streptococcus, necrotizing fasciitis

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