Cases Of Deep Vein Thrombosis Research Articles

Racial, Biological Sex, and Geographic Disparities of Venous Thromboembolism in the United States, 2016–2019

Venous thromboembolism (VTE) stands as the leading cause of preventable death within hospitals in the United States. While there have been some studies investigating incidence rates of VTE, there has yet to be a large-scale study elucidating disparities in sex, race, income, region, and seasons in patients with VTE. The goal of this study was to report the disparities in race, sex, income, region, and seasons in patients with VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT), in hospitalized patients from 2016-2019. We used the United States National Inpatients Sample database to identify inpatients diagnosed with PE, DVT, and PE & DVT from 2016 to 2019. The inpatient incidence per thousand was calculated for sex and race using the weighted sample model. The regional and monthly incidence of DVT and PE per thousand inpatients and risk of incidence were calculated. Patients' characteristics including hospital type, bed size, median length of stay, median total charges, and mortality were also collected. We examined 455,111 cases of VTE, 177,410 cases of DVT, 189,271 cases of PE, and 88,430 cases of both DVT and PE combined. Over the study period, we observed a statistically significant trend among PE hospitalization incidences. There was a strong and positive correlation between DVT and PE inpatients. Black inpatients had the highest cumulative incidence of hospitalizations in all cohorts with 10.36/1000 in PE, and 9.1/1000 in DVT. Asian and Pacific Islander inpatients had the lowest cumulative incidence with 4.42/1000 in PE and 4.28/1000 in DVT. Females showed the lowest cumulative incidence with 7.47/1000 in PE and 6.53/1000 in DVT. Mountain region was the highest among PE hospitalizations with 9.62/1000. For DVT, Middle Atlantic region was the highest at 8.65/1000. The in-hospital mortality was the highest among the PE hospitalizations with 7.3%. Also, the trend analysis showed significant increases among all groups. Over the study period (2016-2019), we reported the racial, biological sex, and geographical disparities from the National Inpatient Sample database, highlighting that Black inpatients had the highest incidence of PE and DVT, while Asian / Pacific Islander inpatients had the lowest incidence of PE and DVT. Moreover, women had lower incidence compared to men. The observed regional variations indicated that the incidence of PE was highest in the Mountain region, whereas the incidence of DVT was lowest in the Middle Atlantic region. There was an increase in the mortality of inpatients diagnosed with VTE reflecting the growing burden of this condition in the U.S. healthcare system.

DEEP VEIN NET: DEEP VEIN THROMBOSIS IDENTIFICATION VIA SOOTY TERN OPTIMIZED DEEP LEARNING NETWORK

Deep vein thrombosis (DVT) occurs when thrombosis (blood clots) forms in veins far below the skin's surface due to veins or sluggish blood flow injuries. An obstruction in blood flow through a vein could be partially or completely caused by blood clots. DVTs typically occur in the thigh, lower leg, or pelvis, yet can also occur in other body parts, such as the brain, liver, intestines, arm, or kidney. This research proposes a novel Deep Vein Net, integrating deep learning-based dilated CNN and Sooty Tern optimization to detect DVT from CT and MRI images efficiently. The input CT and MRI images are pre-processed to eliminate noise artifacts using the Discrete Wavelet Transform (DWT). Furthermore, the pre-processed images are fed into a Dilated convolutional neural network (Dilated CNN) for feature extraction to extract the most pertinent features. Lastly, the STO algorithm uses the fuzzy Extreme Learning Machine of thrombosis stages normal and DVT to select the best features for additional classification. Metrics like rec, spe, acc, pre, and F1 scores were used to assess the Deep Vein Net's performance. The suggested method achieves a classification accuracy of 99.25 % when identifying DVT cases.

Trends in admissions for COVID-19 in the United States between April 2020 and December 2021 and cardiovascular events

IntroductionCoronavirus disease 2019 (COVID-19) can lead to cardiovascular complications. We aimed to understand the trends in admission for COVID-19 and the incidence of various cardiovascular events.Material and methodsThe 2020 and 2021 National Inpatient Sample (NIS) was studied for cases of COVID-19 between April 2020 and December 2021 in the United States. Linear-by-linear association helped us understand the trends of various events.ResultsThe number of cases of COVID-19 was highest in January 2021 (261,469 patients). The incidence of acute pulmonary embolism rose from 2.08% in April 2020 to 4.82% in November 2021, while deep vein thrombosis cases rose from 1.74% in April 2020 to 2.63% in December 2021. The incidence of cardiac arrest varied, with a maximum of 3.00% in August 2021. Similarly, acute ischemic stroke cases experienced their highest incidence in January 2021 (0.91%). The incidence of myocarditis was highest in April and May 2020 (0.42% each). Peak takotsubo cases were seen between October and December 2021. The highest overall all-cause mortality among COVID-19 cases was seen in April 2020 (16.74%).ConclusionsThroughout the 21 months of our analysis, various trends in COVID-19 cases and incidence of cardiac events were noticed. This could relate to the different variants of COVID-19, their direct and indirect impact on coagulation pathways and the myocardial tissues, and the protective roles of the vaccines.

Implementation of the Fast-track Protocol for Total Hip Arthroplasty in a Public Hospital in the State of São Paulo - Brazil.

Objective Evaluate the results of the implementation of the Fast Track Protocol (FTP), a medical practice based on scientific evidence, for elective total hip arthroplasty surgery, mainly comparing the National Average Hospital Admission Rate of 7.1 days. Methods 98 patients who underwent elective total hip arthroplasty surgery via the direct anterior approach, anterolateral approach and posterior approach were included in the FTP from December 2018 to March 2020, being followed up preoperatively, intraoperatively and immediately postoperatively. Results The average length of hospital stay was 2.8 days, being 2.1 days for the direct anterior approach, 3.0 days for the anterolateral access approach and 4.1 days for the posterior access approach. The average surgery time was 90 minutes, 19 (19.39%) of the patients were referred to the ICU in the postoperative period, however, none of them underwent surgery using the direct anterior approach. We had no cases of deep vein thrombosis (DVT), pulmonary embolism (PTE) or neurological injury, 19 (19.39%) patients had postoperative bleeding requiring dressing change, 4 (4.08%) needed blood transfusion, 2 (2.04%) patients had implant instability, 1 (1.02%) patient had a fracture during surgery and 1 (1.02%) patient died of cardiac complications. Conclusion FTP may be a viable alternative to reduce the length of stay and immediate postoperative complications for elective total hip arthroplasty surgery decreasing the length of stay of patients by 2 to 3 times when compared to the national average of 7.1 days.

Comparación de resultados clínicos de enfermedad tromboembólica venosa según manejo ambulatorio versus hospitalario

Objectives. To compare the occurrence of death, bleeding, and recurrence according to inpatient or outpatient management of venous thromboembolic disease (VTE). Materials and methods. Retrospective cohort that included a consecutive sampling of VTE consultations between 2016 and 2019 diagnosed in the Emergency Center of a private hospital in Argentina. Results. There were 1202 cases, 908 with isolated deep vein thrombosis (DVT), 205 with isolated pulmonary embolism (PE), and 89 cases of combined DVT - PE. 66% were women, with a median age of 77 years; 72% of cases were managed on an outpatient basis (n= 862). Comorbidities associated with hospitalization were obesity (p=0.03), chronic obstructive pulmonary disease (COPD) (p=0.01), heart failure (CHF) (p=0.01), chronic renal failure (CKD) (p=0.01), and cancer (p=0.01). At 90 days, the cumulative incidence of bleeding was 2.6% in inpatient compared to 2.9% in outpatient management (p=0.81); recurrence was 0% versus 0.9% (p=0.07), and mortality was 42.9% versus 18.9%, respectively (p=0.01). The HR for 90-day mortality in hospitalized patients adjusted for confounders (sex, age, type of VTE, obesity, CKD, CHF, COPD, and cancer) was 1.99 (95% CI 1.49-2.64; p=0.01). Conclusions. In this elderly, and predominantly female Argentine population, the 90-day mortality in patients hospitalized for VTE was higher than mortality in patients with outpatient management, without differences in recurrence or major bleeding.

Safety of pregnancy after cerebral venous thrombosis: A case-control study.

Since pregnancy is considered one of the major risk factors of cerebral venous thrombosis (CVT), the safety of pregnancy in women of childbearing age and a previous history of CVT, is concerning in terms of prevention, family planning, and management. This study aims to estimate the prevalence of pregnancies among women of childbearing age with previous CVT, evaluate the pregnancy-associated risk of CVT recurrence, and explore the maternal and fetal outcomes among CVT women in comparison with pregnant women without a history of CVT. A retrospective, case-control study was conducted at the Obstetrics Departments of King Fahad Medical City Hospital, Saudi Arabia. It included all women with a history of CVT diagnosed in the last 5 years (cases), as well as CVT history-free pregnant women (control). The prevalence of pregnancy after CVT was estimated and the prepartum and postpartum parameters of the two groups were compared. Fifty women with CVT and 100 controls were included. Among the 50 CVT cases, 28 (56.0%) have been pregnant. The incidence of pre-eclampsia was significantly more frequent in CVT women (7.1% vs. 0.0%, p = 0.047); however, only one case of deep vein thrombosis (3.6%) was reported in CVT patients versus none in controls (p = 0.219). CVT women delivered at a lower gestational age (mean [SD] = 36.9 [3.5] weeks) compared with controls (38.3 [1.4] weeks) (p = 0.006). No significant differences in other pregnancy or delivery outcomes were observed between the two groups. More than half of women of childbearing age with a history of CVT opt for pregnancy after the CVT episode, with no major additional risk for pre or postpartum complications.

Comparison of clinical outcomes of venous thromboembolic disease between outpatient and inpatient management.

To compare the occurrence of death, bleeding, and recurrence according to inpatient or outpatient management of venous thromboembolic disease (VTE). . Retrospective cohort that included a consecutive sampling of VTE consultations between 2016 and 2019 diagnosed in the Emergency Center of a private hospital in Argentina. There were 1202 cases, 908 with isolated deep vein thrombosis (DVT), 205 with isolated pulmonary embolism (PE), and 89 cases of combined DVT - PE. 66% were women, with a median age of 77 years; 72% of cases were managed on an outpatient basis (n= 862). Comorbidities associated with hospitalization were obesity (p=0.03), chronic obstructive pulmonary disease (COPD) (p=0.01), heart failure (CHF) (p=0.01), chronic renal failure (CKD) (p=0.01), and cancer (p=0.01). At 90 days, the cumulative incidence of bleeding was 2.6% in inpatient compared to 2.9% in outpatient management (p=0.81); recurrence was 0% versus 0.9% (p=0.07), and mortality was 42.9% versus 18.9%, respectively (p=0.01). The HR for 90-day mortality in hospitalized patients adjusted for confounders (sex, age, type of VTE, obesity, CKD, CHF, COPD, and cancer) was 1.99 (95% CI 1.49-2.64; p=0.01). In this elderly, and predominantly female Argentine population, the 90-day mortality in patients hospitalized for VTE was higher than mortality in patients with outpatient management, without differences in recurrence or major bleeding.

A Case Of Deep Vein Thrombosis With Pharmaco-Mechanical Catheter Directed Thrombolysis Therapy

Deep Vein Thrombosis (DVT) is a formation of blood clots condition in deep vein caused by multiple risk factor. The goals of acute phase of DVT management is prevent expansion of thrombus, limiting the progressivenes of leg swelling and also prevent venous dysfunction. In this case report, we present a case of DVT with Pharmaco-mechanical Catheter Directed Thrombolysis therapy which provides satisfactory outcomes during therapy and follow up.

Use of Eltrombopag for Post-CAR T Cytopenias: A Multi-Institutional Experience

Background: Cytopenias following chimeric antigen receptor T (CAR T) cell therapy are common and can be profound and/or prolonged, leading to increased morbidity and mortality. Supportive care is the mainstay of management but strategies to reduce the duration and severity of cytopenias have yet to be optimized. One such strategy extrapolated from experience in aplastic anemia is the use of thrombopoietin (TPO) receptor agonists, like eltrombopag. Eltrombopag has been used off-label for several years for this indication, however, limited data exists regarding the safety and efficacy of its use after CAR T-cell therapy. Methods: Patients ≥ 18 years of age treated with CAR T-cell therapy for either lymphoma or myeloma at two academic medical centers between January 2018 and January 2023 were included in a retrospective analysis. Use of eltrombopag was initiated at the KUMC for patients who had received CAR T and subsequently had persistent cytopenias at day +30 as evidenced by at least one of four criteria: grade 3 or 4 leukopenia, grade 4 thrombocytopenia, growth factor dependency, or platelet transfusion dependency. Use of eltrombopag was initiated at the MUSC for patients who had received CAR T and had grade 4 thrombocytopenia at day +21 and beyond post-CAR T infusion. Baseline patient and disease characteristics as well as variables describing safety and efficacy of eltrombopag for the treatment of persistent high-grade leukopenia and/or thrombocytopenia beyond day +21 post CAR T infusion were collected and summarized using descriptive statistics. Results: A total of 185 patients were included in this analysis. Of these, 163 (88%) experienced thrombocytopenia or leukopenia at day +30 post-CAR T infusion. A total of 42 patients met institutional criteria for eltrombopag treatment and initiated therapy. Median time to initiation of eltrombopag was 33 days (range 28-50) from infusion, with no significant differences between the two institutions (30 days at KUMC vs 36 days at MUSC, p=0.19). Median duration for the use of eltrombopag was 63 days (range 32-172) and KUMC used eltrombopag for a longer duration than MUSC (108 days vs 32 days, p=0.03). There were no statistically significant differences in bleeding events in the eltrombopag vs non-eltrombopag groups, p=0.053, and no reported cases of deep vein thrombosis or pulmonary embolism (DVT/PE) after initiating eltrombopag. Patients on eltrombopag were more likely to have infections (24 (57%) vs 42 (35%), p<0.01) and admission to intensive care unit (16 (38%) vs 20 (17%), p<0.01) when compared to the non-eltrombopag group. At day +30, 74 (45%) patients in the entire study population had grade 3 or higher leukopenia or thrombocytopenia, with 39 (93%) and 25 (29%) patients in the eltrombopag and non-eltrombopag groups with grade 3 or higher cytopenias, respectively ( p<0.001). By day +90, only 18 (35%) patients in the evaluable population had grade 3 or higher leukopenia or thrombocytopenia, with 12 (50%) and 6 (22%) patients in the eltrombopag and non-eltrombopag groups with grade 3 or higher cytopenias, respectively ( p=0.046). By day +180, all but ten patients in the evaluable population had not recovered to less than a grade 3 cytopenia with no significant difference in cytopenias between the two groups. With a median follow up of 12 months (range 1-34) for the entire patient population, median PFS was lower for the eltrombopag group (13 months) compared to the non-eltrombopag group (16 months, p=0.02). When stratified by disease, this association was observed only for the lymphoma patients, with a median PFS of 8.5 months in the eltrombopag group compared to a median PFS of 17 months in the non-eltrombopag group, p=0.01 (Table 1). Similarly, for the entire patient population, median OS was lower for the eltrombopag group (14 months) compared to the non-eltrombopag group (18 months, p=0.01). When stratified by disease, this association was observed only for the lymphoma patients, with a median OS of 14 months in the eltrombopag group compared to 18 months in the non-eltrombopag group ( p<0.01). Conclusions: In this first of its kind real-world experience, use of eltrombopag for post-CAR T leukopenia and thrombocytopenia was considered effective in recovery of counts and prevention of bleeding in a high-risk patient population. The use of eltrombopag for post-CAR T cytopenias was considered safe without any significant toxicities of thrombosis or myelodysplasia.

The Relationship of D-dimer Levels and the Incident of Deep Vein Thrombosis in Acute Ischemic Stroke Patients at Haji Adam Malik General Hospital Medan

Background: Deep Vein Thrombosis (DVT) is the formation of a thrombus in deep veins, often observed in stroke patients due to immobilization and infection during hospitalization. High D-dimer levels are associated with DVT in stroke patients. This study aims to evaluate the association between D-dimer levels as a diagnostic tool for DVT in acute ischemic stroke patients. Methods: This cross-sectional, retrospective study was conducted from May to August 2023. The study was carried out on acute ischemic stroke patients at Haji Adam Malik General Hospital, Medan, using consecutive sampling. Doppler ultrasound was used as the gold standard, and D-dimer data were analyzed using the SPSS program, employing the Chi-square test or Fisher's exact test. Results: Of the 49 patients, 35 met the inclusion criteria. Among the patients, 24 (68.6%) were male, 23 (65.7%) were over 50 years old, and 30 (85.7%) had a Body Mass Index (BMI) between 18-24.9. The mean D-dimer value was 2153.43 (±1506.88) ng/mL. All 21 (100%) DVT cases were asymptomatic. According to the Well's score, 15 patients scored 1 (42.8%), 20 patients (57.2%) scored 2, and the probability of DVT is in the moderate range for all 35 patients. The Fisher's Exact Test yielded a p-value of 0.028 (p<0.05). Conclusion: There is a significant relationship between D-dimer levels and the incidence of DVT in patients experiencing acute ischemic stroke. Keywords: Acute Ischemic Stroke, D-dimer, Deep Vein Thrombosis, Doppler Ultrasound

Clinical results of acetabular fracture treatment with hybrid fixation by anterior and posterior approach : Aminimally invasive technique.

Open reduction and internal fixation have been described as the gold standard for the treatment of acetabular fractures, but the high complications of these surgeries have led surgeons to seek less invasive procedures. In recent years, minimally invasive treatment, such as fixation through the skin have been proposed. The aim was to assess acetabular fracture outcomes of combination of posterior approach (Kocher-Langenbeck [KL]) with anterior percutaneous screw fixation (APSF) with minimally invasive surgery (MIS). Between February 2017 and July 2019, 155 patients with acetabular fractures underwent fixation with the KL + APSF approach. For 1 year functional outcomes, radiographic findings, and postoperative complications were evaluated. Of 155 patients with amean age of 40.16 ± 10.32 years, 82patients were male and 73were female. The most common pattern of fracture was both columns (32.9%). The average blood loss was approximately 527 ml. The average operation time was 85 min. The mean length of surgical incision was 113.3 mm. Harris' hip score was excellent in 75.5% of cases. The mean VAS score was approximately 4 and 91.6% of patients returned to pre-trauma activity. In 74.8% of cases, the reduction was anatomical. Complications after surgery were very insignificant and included the following: 2 patients had foot drop within 5 months both patients recovered, 2 patients had femoral nerve palsy and 3 cases of deep vein thrombosis and 1 case of pulmonary thromboembolism were treated. There were four patients with surgical site infections, all of whom recovered and two of the seven patients with osteoarthritis underwent total hip arthroplasty. Combining posterior approach with minimally invasive anterior method in fixation and treatment of acetabular fractures is asafe and reliable method and showed significant functional results with minimal complications.

Thromboembolic Presentations among Patients Hospitalized to the Intensive Care Unit for Coronavirus Disease 2019 (COVID-19) - A Northern Taiwan Single Center Experience.

Coronavirus Disease 2019 (COVID-19) has been associated with a high thromboembolic risk among patients in intensive care units. Asian populations may share a similar thromboembolic risk, but with a higher prevalence of arterial thromboembolism than venous thromboembolism. To clarify this risk in Taiwan, this single-center retrospective study collected 27 consecutive intensive care unit patients with COVID-19 confirmed by polymerase chain reaction, with a median age of 67.6 years (male 81.5%). Twenty-three patients received prophylactic anticoagulation (85.2%), and there were four bleeding events (14.8%). Nine patients had thromboembolism (33.3%), including three with deep vein thrombosis, two with peripheral artery thromboembolism, and four with ischemic stroke. There were no significant clinical differences between the patients with or without thromboembolism. Initial serum ferritin [adjusted odds ratio (OR): 13.19, 95% confidence interval (CI): 1.01-172.07] and peak serum procalcitonin (adjusted OR: 18.93, 95% CI: 1.08-330.91) were associated with a higher risk of thromboembolism. Furthermore, prophylactic anticoagulation (adjusted OR: 0.01, 95% CI: < 0.001-0.55) was associated with a lower risk of thromboembolism. All cases of deep vein thrombosis and one peripheral artery thromboembolism occurred at intravascular catheter locations. No association between thromboembolism and survival was found (age-adjusted hazard ratio: 0.55, 95% CI: 0.10-2.95). In conclusion, the prevalence of COVID-19 thromboembolism among Taiwanese patients in intensive care units was high, even with prophylactic anticoagulation. Serum ferritin and procalcitonin may identify high-risk populations. Prophylactic anticoagulation may reduce the risk of thromboembolism with a manageable bleeding risk. Larger prospective studies are needed to clarify the risk of COVID-19 thromboembolism and its risk factors in the post-Omicron era.

Spinal Füzyon Cerrahisinde Venöz Tromboemboli Profilaksisi Uygulamalarının ve Sonuçlarının İncelenmesi: Tek Merkez Deneyimi

Abstract&#x0D; Aim: Venous thromboembolism (VTE) is among the most common causes of preventable hospital-acquired deaths. VTE is known as deep vein thrombosis (DVT) when it occurs in the veins and pulmonary embolism (PE) when it occurs in the lungs and is common in surgery practice. We aimed to determine the frequency of venous thromboembolism (VTE), the factors affecting the development of VTE, and the types and effectiveness of VTE prophylaxis applications in patients who underwent spinal fusion surgery (SFS).&#x0D; Material and Methods: The patients aged over 18 who underwent SFS for spinal fracture or thoracolumbar stenosis in our neurosurgery clinic between June, 2020 and December, 2022 were included. The patients records were evaluated retrospectively. VTE prophylaxis was given according to the Caprini risk score.&#x0D; Results: A total of 137 patients, 85 (62%) of female, with a meanage of 48.6±+8.77 years were included in the study. According to the Caprini risk scores, 90 (65.7%) of the cases were at high risk. VTE was detected in four patients (2.9%) despite prophylaxis (3 cases of DVT and one pulmonary embolism).&#x0D; Conclusions: Although VTE prophylaxis is performed according to Carpini risk score in SFS, it is seen that embolisms cannot be prevented sufficiently. Therefore, studies with a high level of evidence are needed for the use of these algorithms in SFS.

Time-Driven Activity-Based Costing for Capturing the Complexity of Healthcare Processes: The Case of Deep Vein Thrombosis and Leg Ulcers.

Time-driven activity-based costing (TDABC) is suggested to assess costs within the value-based healthcare approach, but there is a paucity of applications in chronic diseases such as deep vein thrombosis (DVT) and leg ulcers. In this context, we applied TDABC in a cost-effectiveness analysis comparing venous stenting to compression ± anticoagulation (standard of care-SOC) from both hospital and societal perspectives in Italy. TDABC was applied to both treatments to assess costs that were included in a cost-effectiveness model. Clinical inputs were retrieved from the literature and integrated with real-world data. The Incremental Cost Utility Ratio (ICUR) of stenting compared to SOC was EUR 10,270/QALY and EUR 8962/QALY for hospital and societal perspectives, respectively. The mean cost per patient for venous stenting of EUR 5082 was higher than the Diagnosis-Related Group (DRG) reimbursement (EUR 4742). For SOC, an ulcer healing in 3 months costs EUR 1892, of which EUR 302 (16%) is borne by the patient versus a reimbursement of EUR 1132. TDABC showed that venous stenting may be cost-effective compared with SOC but that reimbursement rates may not completely cover the real costs, which are partially sustained by the patients. A more efficient policy for covering the real costs may be beneficial for both clinical centers and patients.

A case of deep vein thrombosis of a 42 years old male patient healed successfully using Yoga Prana Vidya (YPV) healing protocols

Introduction: Deep vein thrombosis (DVT) is a medical condition leading to pulmonary embolism in most cases. DVT occurs usually in lower limb venous system. Studies in India found that DVT is as prevalent as it exists in the West. Anti-coagulation is the common treatment modality. This paper presents a case of DVT of a 42 years old male patient who was successfully healed using Yoga Prana vidya (YPV) healing protocols as complementary medicine. Method: This is a case study method going through patient’s medical reports, YPV healer’s records and patient feedback. YPV intervention consisted of self-practice modules of physical exercises, Rhythmic Yogic breathing and Forgiveness Sadhana. Additionally, the YPV healer conducted healing sessions. Results: Within 5 weeks of healing, all symptoms of DVT disappeared. The patient was able to recover from fear of the disease completely. The patient continued practicing Rhythmic Yogic Breathing and Forgiveness Sadhana regularly to maintain wellness with self-care. He resumed working from office as usual. Conclusion: Yoga Prana Vidya System is an integrated and versatile system of treatment and healing which has treated the DVT condition as a complementary medicine with speedy recovery in this case. Further research is recommended using appropriate sample and methodology. It will be beneficial to train the frontline health care workers such as doctors and nurses in the application of YPV techniques as complementary to their individual specialties.

Suburothelial hemorrhage masquerading as renal neoplasms: a case report of antopol Goldman lesion

Renal cell carcinoma (RCC), which accounts for 2-3% of all adult malignancies, is one of the most lethal urologic cancers. They are sporadic in the majority of cases with 4-6% being familial. They are adenocarcinomas arising from renal tubular epithelial cells. They can present with symptoms of loin pain, palpable mass and haematuria. Another rare presentation is spontaneous perirenal haemorrhage which can be seen in up to 50% of these patients. These patients are also predisposed to increased risk of deep vein thrombosis (DVT) due to prevailing pro-thrombogenic state. Management requires radical nephrectomy for localised disease, targeted therapy and cytoreductive nephrectomy for metastatic RCC. Our patient is adult female who was referred to surgical OPD given her history of gross haematuria and right flank pain for 6 days. She is a known case of DVT on treatment with Warfarin for 4 years. A diagnosis of renal malignancy was made, contrast CT was suggestive of solid mass lesion of the upper pole of calyx likely transitional cell carcinoma (TCC)/papillary RCC. She underwent an urgent radical nephrectomy which showed a hard 5×5 cm lump in the upper pole of the kidney, revealing a clot on the cut section. Post-op HPE showed a large subcapsular hematoma in the upper pole with microscopy showing large areas of haemorrhage surrounded by chronic inflammatory infiltrate, likely Antopol Goldman lesion notorious for its similarity to renal malignancy.

Deep Vein Thrombosis Following Prolonged Prone Position Maintenance after Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: We report a rare case of deep vein thrombosis and pulmonary embolism that occurred following 2 weeks in the prone position after a trans pars plana vitrectomy with gas tamponade to treat rhegmatogenous retinal detachment.Case Summary: A 49-year-old man without a remarkable medical history visited our clinic complaining of gradual vision loss on the inferior side of the left eye. In fundus examinations, rhegmatogenous retinal detachment involving the macula with multiple tears was noted. After trans pars plana vitrectomy with gas tamponade, the patient was encouraged to maintain a prone position for retinal reattachment. However, after 2 weeks in the prone position, he complained of right calf pain and swelling. The department of cardiovascular surgery was consulted immediately and deep vein thrombosis and pulmonary embolism were diagnosed. After deep vein thrombectomy and anticoagulation therapy, the lower extremity symptoms improved and the patient was stable during follow-up with a well attached retina.Conclusions: When prolonged prone positioning after retina surgery is necessary, careful monitoring for the possibility of deep vein thrombosis and pulmonary embolism is required, especially in high-risk patients.

Outcomes of dedicated iliac venous stents during pregnancy and postpartum

ObjectiveThe aim of this study was to assess the performance of dedicated iliac venous stents during subsequent pregnancy and postpartum, including stent patency and stent integrity, as well as incidence of venous thromboembolism and bleeding complications. MethodsThis study included retrospective analysis of prospectively collected data of patients attending a private vascular practice. Women of child-bearing age who had received dedicated iliac venous stents were included in a surveillance program and then, for any subsequent pregnancies, followed the same pregnancy care protocol. This included an antithrombotic regime of 100 mg aspirin daily until gestation week 36, and subcutaneous enoxaparin at a dose dependent on risk of thrombosis: low-risk patients, those stented for non-thrombotic iliac vein lesion, received a prophylactic dose of 40 mg/day from the third trimester; high-risk patients, those stented for thrombotic indication, received a therapeutic dose of 1.5 mg/kg/day from the first trimester. All women underwent follow-up with duplex ultrasound assessment of stent patency during pregnancy and at 6 weeks postpartum. ResultsData was analyzed for a total of 10 women and 13 post-stent pregnancies. Stents were placed for non-thrombotic iliac vein lesions in seven patients, and for post-thrombotic stenoses in three patients. All stents were dedicated venous stents, and four crossed the inguinal ligament. All stents remained patent during pregnancy, at 6 weeks postpartum, and latest follow-up (median time post-stent, 60 months). There were no cases of deep vein thrombosis or pulmonary embolism, and no bleeding complications. There was only one reintervention case due to in-stent thrombus, and one case of asymptomatic stent compression. ConclusionsDedicated venous stents performed well through pregnancy and post-partum. A protocol including the use of low dose antiplatelets in combination with anticoagulation at either a prophylactic or therapeutic dose depending on the patient’s risk profile appears safe and effective.

Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique.

To describe our surgical technique and report the oncological outcomes and complication rates using a fascial-sparing radical inguinal lymphadenectomy (RILND) technique for penile cancer patients with cN+ disease in the inguinal lymph nodes. Over a 10-year period, 660 fascial-sparing RILND procedures were performed in 421 patients across two specialist penile cancer centres. The technique used a subinguinal incision with an ellipse of skin excised over any palpable nodes. Identification and preservation of the Scarpa's and Camper's fascia was the first step. All superficial inguinal nodes were removed en bloc under this fascial layer with preservation of the subcutaneous veins and fascia lata. The saphenous vein was spared where possible. Patient characteristics, oncologic outcomes and perioperative morbidity were retrospectively collected and analysed. Kaplan-Meier curves estimated the cancer-specific survival (CSS) functions after the procedure. Median (interquartile range, IQR) follow-up was 28 (14-90) months. A median (IQR) number of 8.0 (6.5-10.5) nodes were removed per groin. A total of 153 postoperative complications (36.1%) occurred, including 50 conservatively managed wound infections (11.9%), 21 cases of deep wound dehiscence (5.0%), 104 cases of lymphoedema (24.7%), 3 cases of deep vein thrombosis (0.7%), 1 case of pulmonary embolism (0.2%), and 1 case of postoperative sepsis (0.2%). The 3-year CSS was 86% (95%Confidence Interval [95% CI] 77-96), 83% (95% CI 72-92), 58% (95% CI 51-66), respectively, for the pN1, pN2 and pN3 patients (p < 0.001), compared to a 3-year CSS of 87% (95% CI 84-95) for the pN0 patients. Fascial-sparing RILND offers excellent oncological outcomes whilst decreasing the morbidity rates. Patients with more advanced nodal involvement had poorer survival rates, emphasizing the need for adjuvant chemo-radiotherapy.

“A RETROSPECTIVE STUDY OF SURGICAL EMERGENCIES DURING COVID 19 PANDEMIC DUE TO THROMBOTIC COMPLICATIONS IN SVS INSTITUTE”

Background: To know the incidence of thrombotic events leading to surgical emergencies in covid patients in SVS Medical college and hospital, during covid pandemic. A structured retrospective study was conducted during rst and se Methods: cond wave of pandemic in our institute. Data of the patients who presented to the casualty with surgical emergencies such as acute bowel ischemia, acute ischemia limb ,Deep vein thrombosis, Portal vein thrombosis, was collected and diagnosis was established by consecutive analysis of all investigations performed. Results: Of all the abdominal emergencies eight cases, one case of bilateral lower limb ischemia, one case of unilateral upper limb ischemia, ten cases of Deep vein thrombosis were found to be positive for covid 19. Conclusion: The incidence of surgical emergencies during covid 19 pandemic due to thrombotic complications in our institute over a period of 2yrs is 3.83%