Thrombosis Of Lower Limbs Research Articles

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

BackgroundDeep vein thrombosis (DVT) of lower limb is one of the common complications after total hip arthroplasty(THA), we aimed to evaluate the potential risk factors of DVT of lower limb in patients with THA, to provide insights into the management of THA.MethodsPatients who underwent THA in our hospital from January 1, 2017 to November 30, 2020 were included. The personal characteristics and clinical data of DVT and no-DVT patients were compared and analyzed. Logistic regression analyses were perfomed to identify the potential risk factors of DVT in patients with THA.ResultsA total of 182 THA patients were included, the incidence of DVT of lower limb in patients with THA was 19.78 %. There were significant differences in the age, BMI, diabetes, number of replacement, duration of surgery, type of prosthesis and duration of days in bed between DVT and no-DVT patients(all P < 0.05). And there were no significant differences in the gender, hypertension, hyperlipidemia, preoperative D-dimer, type of anesthesia and anticoagulant drugs use(all P > 0.05). Logistic regression analysis indicated that age > 70y(OR4.406, 95 %CI1.744 ~ 6.134), BMI ≥ 28(OR2.275, 95 %CI1.181 ~ 4.531), diabetes(OR3.949, 95 %CI1.284 ~ 5.279), bilateral joint replacements(OR2.272, 95 %CI1.402 ~ 4.423), duration of surgery ≥ 120 min(OR3.081, 95 %CI1.293 ~ 5.308), cemented prosthesis(OR2.435, 95 %CI1.104 ~ 4.315), and duration of days in bed > 3 days(OR1.566, 95 %CI1.182 ~ 1.994) were the risk factors of DVT of lower limb in patients with THA.ConclusionsDVT in the lower limb after THA is common, and its onset is affected by many factors. In clinical work, attention should be paid to identify the risk factors for DVT and targeted interventions are highlighted to prevent the postoperative DVT.

Surviving Complications of Retroperitoneal Fibrosis with Intermittent Relapses over a Period of 20 years: Case report and literature Review

Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease of varied etiology which usually originates around aorta and spreads caudally along Iliac vessels into adjacent retroperitoneum causing ureteral obstruction as the most frequent complication. A 53-year-old male patient presented with complaint of mild pain in both the legs off and on. On investigating further, we found that he had been struggling with intermittent relapses every 3-4 years for last 20 years since he was first diagnosed with Idiopathic Retroperitoneal Fibrosis. He was 33-year-old when he first developed the symptoms of anuria for 48 hours and was diagnosed with Idiopathic retroperitoneal fibrosis. This was followed by atrophy of left kidney and hypertension 6 years later, then hypothyroidism after another 3years and finally involvement of Inferior Vena Cava and acute Deep Vein Thrombosis of lower limbs after another 3-4 years. His deep vein thrombosis was well managed in time. He was put on glucocorticoids everytime he had a relapse and a complication. We did a review of literature to understand recent advances about its pathogenesis, diagnosis, investigations and management. We searched in PubMed using terms like retroperitoneal fibrosis alone and in combination with related terms such as Inferior Vena Cava thrombosis, Deep Vein Thrombosis, Tamoxifen, Methotrexate. This case is unique as it is very rare to find acute Deep Vein Thrombosis in Idiopathic retroperitoneal fibrosis without development of any collaterals when Inferior Vena Cava lumen is compromised to almost complete obstruction. After a follow up of 20 years patient is doing well in terms of physical activity and psychological wellbeing with anti-hypertensives, thyroxine and anti-coagulants. Is the disease-free interval actually free of the disease or it just subsided with immunosuppressants to become active after some time?

The predictive value of dynamic changes of coagulation function for the occurrence and progression of isolated distal deep vein thrombosis of lower limbs in patients with acute brain injury

To analyze risk factors for the occurrence and progression of isolated distal deep vein thrombosis (IDDVT) of lower limbs, and to explore the predictive value of dynamic changes of coagulation index D-dimer on the occurrence and progression of IDDVT in acute brain injury (ABI) patients during perioperative period. A retrospective case-control study was conducted. Perioperative ABI patients admitted to department of neurocritical care unit (NCCU) of the First Affiliated Hospital of University of Science and Technology of China from September 2019 to May 2020 were enrolled. Patients' baseline characteristics, disease characteristics, treatment approaches, outcomes and coagulation function index at 1, 2-4, 5-7 and > 7 days post operation were analyzed between patients with IDDVT and patients with progressive IDDVT. Risk factors for IDDVT occurrence and progression were identified by multivariate Logistic regression. Receiver operating characteristic curve (ROC curve) were drawn to assess the predictive value of coagulation indexes for IDDVT occurrence and progression. A total of 164 ABI patients were enrolled. Most of the patients were elderly [age was 60 (51, 69) years], male [99 cases (60.4%)], and severe cases [Glasgow coma score (GCS) at admission was 6 (5, 8)]. The rates of IDDVT occurrence and progression were 61.6% (101 cases) and 16.8% (17 cases), respectively, the rate of proximal deep venous thrombosis (DVT) was 12.8% (21 cases). Compared with the IDDVT group (101 patients), patients without IDDVT group were younger (years: 55±13 vs. 62±13), length of intensive care unit (ICU) stay were shorter (days: 12±6 vs. 15±7), body mass index (BMI) and GCS at admission were higher [59 patients, BMI (kg/m2): 23±5 vs. 19±8, GCS scores: 7±2 vs. 6±2], the differences were statistically significant (all P < 0.05). Compared with patients with IDDVT progression group, male patients were fewer [61.9% (52/84) vs. 88.2% (15/17)], the proportion of transfusion of red blood cell and anticoagulant therapy were lower [8.3% (7/84) vs. 29.4% (5/17) and 47.6% (40/84) vs. 94.1% (16/17)], the proportion of cerebral herniation was higher [42.9% (38/84) vs. 11.8% (2/17)] in patients without IDDVT progressive group. All of the differences were statistically significant (all P < 0.05). D-dimer were increased in two groups of whether IDDVT occurrence or not over time. D-dimer peaked on 5-7 days after surgery in IDDVT occurrence group, and then decreased. D-dimer peaked at > 7 days after surgery in patients without IDDVT. With time, D-dimer were increased in groups of whether IDDVT progression or not, both peaked at 5-7 days postoperation, and then decreased. Compared with non-IDDVTgroup, D-dimer was significantly increased in IDDVT group from 2-4 days after surgery [mg/L: 4.1 (2.3, 8.0) vs. 2.4 (1.7, 3.4), P < 0.05], and lasted until 5-7 days [mg/L: 5.5 (3.3, 11.4) vs. 3.9 (2.6, 5.8), P < 0.05]. Compared with IDDVT group, D-dimer was significantly increased in IDDVT progressive group from 2-4 days [mg/L: 11.2 (4.7, 20.0) vs. 3.7 (2.1, 6.8), P < 0.05], and lasted until 7 days [mg/L: 11.0 (3.0, 18.9) vs. 4.1 (2.6, 6.5), P < 0.05]. Multivariate Logistic regression analysis showed that age > 60 years [odds ratio (OR) = 3.43, 95% confidence interval (95%CI) was 1.69-6.96, P = 0.001], GCS score at admission > 8 (OR = 0.35, 95%CI was 0.17-0.76, P = 0.008), length of ICU stay > 13 days (OR = 2.25, 95%CI was 1.08-4.70, P = 0.031) were risk factors for IDDVT. Gender (OR = 0.19, 95%CI was 0.02-0.71, P = 0.019), transfusion of red blood cell (OR = 6.50, 95%CI was 1.33-31.94, P = 0.021), cerebral herniation (OR = 0.18, 95%CI was 0.37-0.90, P = 0.036) were risk factors for IDDVT profression. ROC curve analysis showed that age and D-dimer at 5-7 days were predicators of IDDVT [the area under curve ROC (AUC) were 0.68 and 0.72, 95%CI were 0.60-0.75 and 0.64-0.80, both P value were 0.000 1]. When the cut-off value of age was 60 years old and the D-dimer was 5.4 mg/L, the sensitivity were 60.6% and 54.4%, specificity were 71.2% and 80.9%, respectively, positive predictive value were 78.7%, 84.5%, negative predictive value were 51.2%, 48.1%, respectively. The elevation of D-dimer to 3.9 times at days 5-7 compared with day 1 of NCCU stay was a predicator of IDDVT progression (AUC = 0.81, 95%CI was 0.71-0.88, P = 0.000 1). The sensitivity, specificity, positive predictive value and negative predictive value were 76.5%, 74.6%, 41.9% and 93.0%, respectively. IDDVT occurrence and progressiveare common in severe ABI patients during perioperative period. The dynamic change of D-dimer, especially at days 5-7, is a valuable predictor of IDDVT progressionin ABI patients, which is helpful for guiding implementation of deep vein ultrasound of lower limb.

Screening for venous thromboembolism in patients with COVID-19

Pulmonary thromboembolism and deep venous thrombosis occur frequently in hospitalised patients with COVID-19, the prevalence increases on the intensive care unit (ICU) and is very high in patients on extracorporeal membrane oxygenation (ECMO). We undertook a literature review to assess the usefulness of screening for peripheral venous thrombosis or pulmonary thrombosis in patients admitted with COVID-19. Outside of the ICU setting, D-dimer elevation on presentation or marked increase from baseline should alert the need for doppler ultrasound scan of the lower limbs. In the ICU setting, consideration should be given to routine screening with doppler ultrasound, given the high prevalence of thrombosis in this cohort despite standard anticoagulant thromboprophylaxis. However, absence of lower limb thrombosis on ultrasound does not exclude pulmonary venous thrombosis. Screening with CT pulmonary angiography (CTPA) is not justified in patients on the general wards, unless there are clinical features and/or marked elevations in markers of COVID-19-associated coagulopathy. However, the risk of pulmonary embolism or pulmonary thrombosis in ICU patients is very high, especially in patients on ECMO, where studies that employed routine screening for thrombosis with CT scanning have uncovered up to 100% incidence of pulmonary thrombosis despite standard anticoagulant thromboprophylaxis. Therefore, in patients at low bleeding risk and high clinical suspicion of venous thromboembolism, therapeutic anticoagulation should be considered even before screening, Our review highlights the need for increased vigilance for VTE, with a low threshold for doppler ultrasound and CTPA in high risk in-patient cohorts, where clinical features and D-dimer levels may not accurately reflect the occurrence of pulmonary thromboembolism.

Post-acute conditions of patients with COVID-19 not requiring hospital admission

Post-acute conditions of patients with COVID-19 not requiring hospital admission

An Examination System to Detect Deep Vein Thrombosis of a Lower Limb Using Light Reflection Rheography.

Deep vein thrombosis (DVT) of lower limbs can easily arise from prolonged sitting or standing. Elders and pregnant women are most likely to have this disease. When the embolus of DVT comes to pass the lung, it will become a life-threatening disease. Thus, for DVT disease, early detection and the early treatment are needed. The goal of this study was to develop an examination system to be used at non-medical places to detect the DVT of lower limbs with light reflection rheography (LRR). Consisting of a wearable device and a mobile application (APP), the system is operated in a wireless manner to control the actions of sensors and display and store the LRR signals on the APP. Then, the recorded LRR signals are processed to find the parameters of DVT examination. Twenty subjects were recruited to perform experiments. The veins of lower limbs were occluded by pressuring the cuff up to 100 mmHg and 150 mmHg to simulate the slight and serious DVT scenarios, respectively. Six characteristic parameters were defined to classify whether there was positive or negative DVT using the receiver operating characteristic curves, including the slopes of emptying and refilling curves in the LRR signal, and the changes of venous pump volume. Under the slight DVT scenario (0 mmHg vs. 100 mmHg), the first three parameters, m10, m40, and m50, had accuracies of 72%, 69%, and 69%, respectively. Under the serious DVT scenario (0 mmHg vs. 150 mmHg), m10, m40, and m50 achieved accuracies of 73%, 76%, and 73%, respectively. The experimental results show that this proposed examination system may be practical as an auxiliary tool to screen DVT in homecare settings.

Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA). Results were analysed using SPSS version 23. Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.

Venous thromboembolism in hospital emergency room. A retrospective study on climatic effect

Several cardiovascular conditions exhibit seasonality in frequency and mortality, but little is known about the seasonality of Venous ThromboEmbolism (VTE), a very relevant medical condition, and seasonal influences are still conflicting. Patients having co-morbidities, individual suffered from dyspnea, swelling, edema of lower limb, pain (chest, lower limbs) are admitted frequently to the hospital emergency room (HER), particularly. Both mark a potential risk for VTE, that can be increased also by seasonality. A four years retrospective analysis (2016–2019) was carried out in individuals and patients admitted to the HER of the Hospital of Catania (a Mediterranean city of Sicily, Italy) to evaluate the VTE frequency and its seasonal differences, common symptoms, potential usage of some common laboratory tests. Dyspnea, swelling, edema of lower limb and pain (chest, lower limbs) were considered to suspect pulmonary embolism (PE) or for deep vein thrombosis of lower limb (DVT). Platelet count, platelet volume, fibrinogen, C-reactive protein, and D-dimer were considered. VTE frequency per year was 2.9/10,000 (2016), 4.9/10,000 (2017) 3.6/10,000 (2018), and 5.1/10,000 (2019) respectively. Dyspnea was highly frequent for PE, edema and lower limb pain were frequent in DVT patients. Fibrinogen, C reactive protein, and D-dimer values were found raised in all the VTE patients. Platelet volume was found higher in DVT than PE VTE events that occurred in warm periods were modestly greater (57 VTE: 38 DVT, 19 PE) compared to cold months (52 VTE: 34 DVT, 18 PE). Our results could be explained by the increased sweating due to the high temperatures, which in turn, can affect both on plasma concentration and on hematocrit value coupled to the reduction in atmospheric pressure determining both a hyper-coagulative condition. Climate seasonal characteristics, and environmental conditions in Catania city (Sicily) may be as reasonable items in expecting on different VTE rates in warm period compared to cold. This study highlights no specific symptoms, and confirms the common lab tests for individuals and patients admitted to HER as simple and helpful tools in initiating none or mini-invasive diagnostic strategy for the VTE. Finally, the climate/seasonality coupled with latitude can have a direct influence on the incidence of DVT.

A Case of Enlarged Iliopsoas Bursa Compressed Femoral Vein with Groin Pain

Background: Iliopsoas bursal cystic lesion (IBCL), a rare disease on groin area, posing a significant threat to the lower limb thrombosis, but it is easy to misdiagnose or missed diagnose. Doppler ultrasonography (DU) with certain advantages could be used to detect the enlarged iliopsoas bursa (EIB) and compression of lower extremity vein. Case presentation: A 60-year-old man was admitted to our department complaining of pain and swelling in his right groin area for 3 weeks. DU demonstrated that there was a well-defined, echo-free, cystic mass in the right inguinal region, which severely compressed the common femoral vein (CFV), and the blood flow velocity was extremely slow. Then, surgery was performed to exclude the lesion, consequently, corresponding signs and symptoms had resolved completely. Histopathological results suggested the mass is an iliopsoas bursa filled with mucinous materials. After that, DU was displayed again and the results suggested that the EIB has almost been excised and there was a slight echogenic structure in the deep layer communicating to the hip joint space. Conclusion: Although, IBCL is rare and easy to misdiagnose and missed diagnose, the DU with certain advantages could be used to diagnose effectively this disease and guide the clinical prevention and intervention of thromboembolic events.

Unprovoked internal jugular vein thrombosis: a case report and literature review

BackgroundManaging thrombosis in rare sites is challenging. Existing studies and guidelines provide detailed explanations on how to overcome lower-limb thromboses and pulmonary embolisms, but few studies have examined thrombosis in rare sites. Lack of data makes clinical practice heterogeneous. Recommendations for diagnosing, treating, and following-up internal jugular vein thrombosis are not clearly defined and mostly based on adapted guidelines for lower-limb thrombosis.Case presentationA 52-year-old Caucasian woman came to the Emergency Department with chest, neck, and left arm pain. Computed tomography imagery showed a left internal jugular vein thrombosis. An extensive workup revealed a heterozygous factor V Leiden gene. Therapy was initiated with intravenous unfractionated heparin, then switched to oral acenocoumarol, which resolved the symptoms. Based on this case presentation and a literature review, we summarize the causes, treatment options, and prognosis of unprovoked internal jugular vein thrombosis.ConclusionsManaging internal jugular vein thrombosis lacks scientific data from large randomized clinical trials, partly because such thromboses are rare. Our literature review suggested that clinical treatments for internal jugular vein thrombosis often followed recommendations for treating lower-limb thrombosis. Future specific studies are required to guide clinicians on the modalities of diagnosis, screening for thrombophilia or oncologic disease, treatment duration, and follow-up.

Deep Venous Thrombosis of Lower Limbs: Prevalence, Risk Factors and Treatment in Semi-Urban Areas in Senegal

Context and Objectives: Deep vein thrombosis (DVT) is a potentially serious affection because it can be complicated by life-threatening pulmonary embolism. Epidemiological data are scarce in Africa. The objective of this work was to describe the prevalence, risk factors and treatment of deep venous thrombosis (DVT) in Ziguinchor. Methodology: This was a retrospective study carried out at the Ziguinchor Peace Hospital from January 1, 2016 to June 30, 2020. We included in the study all patients of both sexes, aged at least 18 years and hospitalized with DVT of the lower limb confirmed by venous Doppler ultrasound. Results: A total of 64 patients were hospitalized for DVT of the lower limbs during the study, for a hospital prevalence of 3.9%. The average age of the patients was 53 years (±17.6). A female predominance was noted with an M/F sex ratio of 0.7. The main risk factors found were the age ≥ 60 years (36%) and infectious pathologies (17%). Clinical signs were dominated by lower limb pain (93.8%) and lower limb edema (92%). The lower limbs’ venous Doppler ultrasound showed a predominance of thrombosis in the left lower limb (56%). The femoral vein was the most affected in 90% of cases. The patients had all benefited from an anticoagulant treatment mainly by a low molecular weight heparin relayed from the 1st day by an antivitamin K that was acenocoumarol in 97% of the cases. The average length of hospitalization was 10 days. The complications found were pulmonary embolism (8%) and accident with anticoagulants (3%). Hospital mortality was 6%. The average cost of care was 164.000 CFA francs. Conclusion: DVT is a multifactorial pathology; its treatment requires the control of risk factors. In our study, it was more frequent in the elderly.

Systematic duplex ultrasound screening in conventional units for COVID-19 patients with follow-up of 5 days

ObjectiveCOVID-19 patients may develop coagulopathy, which is associated with poor prognosis and high risk of thrombosis. The main objective of this work was to evaluate the prevalence of deep venous thrombosis of lower limbs (DVT) through ultrasonography in patients infected with COVID-19 admitted to conventional units at our hospital with 5 days of monitoring. The secondary objective was to determine if D-dimer levels, body mass index, and C-reactive protein were associated with DVT. MethodsA total of 72 patients, with a mean age of 65 ± 12.3 years, infected with COVID-19 were admitted to three conventional units at our institution; 28 patients were women. A COVID-19 diagnosis was made by a transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest computer tomography without iodine contrast media. Demographics, comorbidities, and laboratory parameters were collected. A preventive anticoagulation treatment was established on admission with low-molecular-weight heparin. A complete venous duplex ultrasound (DU) test of lower limbs was performed on day (D) 0 and D5. A pulmonary computer tomography angiogram with iodine contrast media was required when pulmonary embolism was suspected. ResultsOn D0, the DU showed acute DVT in seven patients (9.75%). A pulmonary computer tomography angiogram was performed in 12 patients (16.65%), 3 (25%) of whom had an acute pulmonary embolism. On D0, acute DVT was not significantly associated with C-reactive protein (mean 101 ± 98.6 in the group without DVT vs 67.6 ± 58.4 mg/L, P = .43) or body mass index (27.7 ± 5.04 vs 28.1 ± 2.65 kg/m2, P = .54). However, we found a significant association between acute DVT and D-dimer levels (1536 ± 2347 vs 9652 ± 10,205 ng/mL, P < .01). Among the patients included on D0, only 32 had a DU on D5. Forty of them (55.55%) were not examined for the following reasons: 7 (9.7%) were previously diagnosed with venous thromboembolism on D0 and therefore were excluded on D5, 8 (11%) were transferred to the intensive care unit, 10 (14%) were discharged from the hospital, 5 (7%) died, and 10 (13.9%) were excluded because of technical issues. On D5, five (15.6%) patients had acute DVT in addition to those found on D0; three were distal and two proximal despite preventive anticoagulation with low-molecular-weight heparin. ConclusionsHospitalized non-intensive care unit patients with COVID-19 pneumonia have a high frequency of venous thrombotic events justifying screening with DU.

Cardiovascular findings in classic homocystinuria

Objectivedescribe cardiovascular findings from echocardiograms and electrocardiograms in patients with Classic Homocystinuria Methodsthis retrospective exploratory study evaluated fourteen subjects with Classic Homocystinuria (median age = 27.3 years; male n = 8, B6-non-responsive n = 9 patients), recruited by convenience sampling from patients seen Hospital de Clínicas de Porto Alegre (Brazil), between January 1997 and July 2020. Data on clinical findings, echocardiogram and electrocardiogram were retrieved from medical records. ResultsEight patients presented some abnormalities on echocardiogram (n = 6) or electrocardiogram (n = 5). The most frequent finding was mild tricuspid regurgitation (n = 3), followed by mitral valve prolapse, mild mitral regurgitation, enlarged left atrium and aortic valve sclerosis (n = 2 patients each). Aortic root ectasia was found in one patient. Venous thrombosis was reported in six patients: deep vein thrombosis of lower limbs (n = 3), ischaemic stroke (n = 1), cerebral venous sinus thrombosis (n = 1) and pulmonary vein thrombosis (n = 1). Conclusionmild valvulopathies seen to be common in patients with Classic Homocystinuria, but more studies regarding echocardiogram and electrocardiogram in this population are needed to draw absolute conclusions.

Clinical effect of titanium cable assisted fixation combined with lengthened Gamma nail in the treatment of subtrochanteric fracture of femur

To investigate the clinical effect of titanium cable assisted fixation combined with lengthened Gamma nail in the treatment of subtrochanteric fracture of femur. From January 2010 to January 2018, 45 patients with long subtrochanteric fractures were retrospectively analyzed, and they were divided into two groups according to the operation plan. There were 24 cases of titanium cable assisted fixation combined with lengthened Gamma nail (observation group), including 14 males and 10 females, with an age of (54.2±12.8) years; 21 patients (control group) were treated with simple lengthened Gamma nail (control group), including 12 males and 9 females, with an age of (51.4±15.9) years. The operation time, intraoperative blood loss, hospital stay, hemoglobin decrease and fracture healing time were observed and recorded in the two groups. Harris hip function score was used to evaluate the postoperative curative effect, and the occurrence of complications was observed. All patients were followed up for 14 to 36 months. There was significant difference in operation time, intraoperative blood loss, hospital stay between two groups(P<0.05). Three months after operation, the fracture healing rate of the observation group was 79.1%(19 / 24), which was higher than that of the control group 52.4%(11 / 21)(P<0.05). There was no significant difference in Harris hip function score 1 year after operation and fracture healing rate at 6 and 12 months after operation between the two groups (P>0.05). There were no complications such as deep infection, fracture of internal fixation and deep vein thrombosis of lower limbs in the two groups, and delayed healing occurred in 1 case in the control group. Lengthened Gamma nail fixation is reliable in the treatment of subtrochanteric fracture. Limited incision titanium cable assisted fixation can improve the reduction rate and fixation strength of long segment fracture, which is conducive to early functional exercise.

Dectin-1 and TIM3 Expression in Deep Vein Thrombosis of Lower Limbs (DVTLL).

The pathophysiological mechanisms of venous thromboembolism are venous stasis, endothelial damage, and hypercoagulability, while less attention has been given to the role of both innate and native immunity. In this paper, we investigate the involvement of the activated immune system detected through some indicators such as TIM3 and Dectin-1 expressed by T lymphocytes. TIM3 and Dectin-1, two surface molecules that regulate the fine-tuning of innate and adaptive immune responses, were evaluated in patients affected by deep vein thrombosis of lower limbs (DVTLL). CD3+, CD4+ and CD8+ T lymphocytes obtained from patients affected by DVTLL were analysed using fluorescence-conjugated antibodies for TIM3 and Dectin-1 by an imaging flow cytometer. DVTLL patients showed a higher number of CD4+ and CD8+ T lymphocytes. TIM3 expression in T lymphocytes was very low in both DVTLL patients and controls. On the contrary, an increase in Dectin-1+ cells among CD4+ and CD8+ T lymphocytes from DVTLL patients was observed. Dectin-1 is known to play a role in inflammation and immunity and our result suggests its potential involvement in thrombotic venous disease.

Calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach

To explore the effectiveness of the calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach. Between January 2015 and December 2017, 18 patients with acetabular fracture involving quadrilateral surface were treated with the calcaneal plate bridge reconstruction plate via the modified Stoppa approach. There were 12 males and 6 females. The age ranged from 28 to 63 years (mean, 39 years). The cause of injury was traffic accident in 13 cases and falling from height in 5 cases. According to the Letournel-Judet classification, there were 10 cases of anterior and posterior column fractures, 6 cases of T-shaped fractures, and 2 cases of anterior column and posterior semi-transevere fractures. The interval from injury to operation was 6 to 24 days (mean, 8.6 days). The reduction quality was assessed by postoperative X-ray film and CT according to the criteria proposed by Matta. The hip joint function was assessed by the modified Merled'Aubigné-Postel score. The operation time was 120-240 minutes (mean, 165 minutes) and the intraoperative blood loss was 600-1 400 mL (mean, 850 mL). All patients were followed up 18-30 months (mean, 24.5 months). There were 2 cases of the fat liquefaction of abdominal incisions, 3 cases of intraoperative injury of lateral femoral cutaneous nerve, 1 case of lower limb thrombosis, and 1 case of abdominal pain and hematuria due to intraoperative accidental bladder injury. According to the criteria proposed by Matta, the reduction quality rated as anatomic reduction in 12 cases, satisfactory reduction in 5 cases, and unsatisfied reduction in 1 case, and the satisfaction rate was 94.4%. All fractures healed with the healing time of 3-5 months (mean, 3.4 months). During follow-up, no internal fixator loosening, breakage, or fracture displacement occurred. At last follow-up, according to modified Merled'Aubigné-Postel score, hip joint functions rated as excellent in 11 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 83.3%. Application of calcaneal plate bridge reconstruction plate via the modified Stoppa approach for the acetabular fracture involving the quadrilateral surface can obtain satisfactory effectiveness.

Drug Utilization Study on Oral Contraceptives provided from Social Security, Buenos Aires-Argentina: Risk and cost analysis according to the type of combination used

Oral contraceptive pill is the most prescribed option to avoid birth-rate around the world. It is a combination of estrogens/progestin. Unfortunately, new combinations raise the risk of thrombosis. To determine the prescription profile and the incidence of thrombotic events associated to oral contraceptive use, we developed the present study. Method: It is a drug utilization study among beneficiaries of Buenos Aires Social Security Organization. Variables studied were age, sex, combination consumed, doses, co-morbidities, thrombotic events.Results: 69,653 women were enrolled in the study. 66,043 of them (94.84%) used new progestogen generation combination (desogestrel, gestodene, drospirenone,) while 3610 (5.18%) used either levonorgestrel or norgestrel as progestin. The number of thrombotic events (either depth vein thrombosis of lower limbs, thromboembolism or arterial thrombosis) was 77 (75 with new progestin and 2 using 1st/2nd generation options). Adjusting these values to 100,000 users; the occurrence of thrombotic events were doubled with new generation progestins when compared to older options. The price of the new generation combinations were 10.2 times more expensive that the safer ones. Conclusion: Among the beneficiaries of Buenos Aires State Social Security, the users of oral contraceptives with new generation progestin denote a greater risk of thrombotic events when compared with users of levonorgestrel or norgestrel. Public reproductive health policies that provide contraceptives to the population are crucial in guaranteeing rights such as avoiding unwanted pregnancies and reproductive planning. However, the combinations provided should not expose population to additional and unnecessary risks.&#x0D; Keywords: oral contraceptives, thrombosis, progestin, risk, public health

Deep Vein Thrombosis in the Uninjured Limb in Patients with Lower Extremity Fractures: A Retrospective Study.

Objective This study is aimed at investigating the incidence of deep vein thrombosis (DVT) in the uninjured limb during hospitalization and 1 month after surgery in patients with lower extremity fractures. Methods We collected the clinical data of patients with lower extremity fractures in Xi'an Honghui Hospital. Doppler ultrasonography was used to diagnose DVT. According to the results of ultrasonography, the patients were divided into two groups: uninjured limb with DVT group and uninjured limb without DVT group. Results A total of 494 patients who met all inclusion criteria were included in this study. The incidence rate of DVT in the uninjured limb was 19.84% and 18.83% during hospitalization and 1 month after surgery, respectively. Age (OR = 1.035, 95% CI: 1.013–1.059; P = 0.002) and D-dimer level 1 day after surgery (OR = 1.065, 95% CI: 1.030–1.102; P < 0.001) were independent risk factors for DVT during hospitalization. Similarly, age (OR = 1.045, 95% CI: 1.021–1.070; P < 0.001) and D-dimer level 1 day after surgery (OR = 1.048, 95% CI: 1.014–1.083; P = 0.006) were independent risk factors for DVT 1 month after surgery. During hospitalization and 1 month after surgery, 15.79% and 12.35% of patients had double lower limb thrombosis and 4.04% and 6.48% of patients had DVT in the uninjured limb only, respectively. Conclusion The actual incidence of DVT in the uninjured limb in patients with lower extremity fractures cannot be ignored despite the use of anticoagulants for prevention or treatment during hospitalization. We should also be aware of DVT in the uninjured limb while focusing on DVT in the injured limb.

Treatment of spine metastases by open decompression, microwave ablation combined with open vertebroplasty and pedicle screw rod system

To evaluate the preliminary clinical effective of open decompression, microwave ablation combined with open vertebroplasty and pedicle screw rod system in the treatment of spine metastases. The clinical data of 12 patients with spine metastases were retrospectively analyzed, they were treated with open decompression, microwave ablation combined with open vertebroplasty and pedicle screw rod system between January 2014 and January 2016. Six males and 6 females were included, aged from 30 to 75 years old with an average of 55.6 years. There were 5 cases with spine metastases from lung cancer, 2 from breast cancer, 2 from thyroid cancer, 2 from renal cancer and 1 from liver cancer. Sevencases were thoracic metastases and 5 cases were lumbar metastases. Tomita score were mainly arranging from 3 to 6 points. According to ASIA neurologic grading system, 3 patients were grade C, 1 was grade D, 8 were grade E. Preoperative VAS score was 8.3±0.4. VAS was used to evaluate the clinical effect at 1, 3, 6 months after operation and final follow-up. All operations were successful and the amount of blood loss during surgery was 500 to 2 050 ml (average of 850 ml), operation time was 3.5 to 5.5 h (average of 4.5 h). There was no nerve root injury during surgery. Cerebrospinal fluid leakage occurred in 3 cases after surgery, which were healed after conservative treatment. Superficial infection of the incision occurred in 2 cases, which were healed after dressing change. There was one case of pulmonary infection. No deep infection, lower limb thrombosis or other complications were found. All 12 patients were followed up for 9 -40 months with an average of 28.6 months. The clinical symptoms of all patients were significantly improved, and the motor function of the lower limbs was recovered to varying degrees. According to ASIA grade, 2 cases of grade C were improved to grade B;1 case of grade C did not recover significantly;1 case of grade D was improved to grade E. One patient died of primary liver cancer 10 months after surgery. Local tumor recurrence occurred in 1 patient during follow up period. The VAS scores were 2.7±0.6, 2.5±0.4, 2.6±0.5, and 2.5±0.5 at 1, 3, 6 months after surgery and at final follow-up, which were significantly improved compared with the score before surgery(P<0.05). Open decompression, microwave ablation combined with open vertebroplasty and pedicle screw rod system in the treatment of spine metastases show some effects, with less intraoperative blood loss, shorter operation time, significant postoperative pain relief, and low tumor recurrence rate.

Analysis of perioperative complications of laparoscopic radical cystectomy for bladder cancer

Objective To evaluate operation process and perioperative complications of patients who underwent laparoscopic radical cystectomy ( LRC) . Methods The clinical data of 104 cases of LRC from December 2016 to December 2018 were reviewed retrospectively. Perioperative complications, the operative time, blood loss and postoperative hospital stay were analyzed. Perioperative complications were defined as complications occurring within 30 days of surgery. Results The mean operation time was 327 minutes, the mean blood loss was 478 mL, The number of patients with transfusin was 16 cases(15.4%), the mean transfusion volume was 415 mL, and the average postoperative hospital stay was 17.9 d. For urinary diversion, ileal conduits were constructed in 68 patients, ureterocutaneostomies in 36 patients. A total of 49 patients ( 47.1% ) developed at least one perioperative complication, which included ileus, urinary tract infections, deep venous thrombosis of the lower limbs, pneumonia, etc. Conclusions Morbidity of perioperative complications following LRC is still high. The most frequent complications are ileus and urinary tract infections. Preventive measures should be taken to prevent serious complications. And we should choose an appropriate surgical procedure according to the patient's condition. Key words: Urinary Bladder Neoplasms; Cystectomy; Laparoscopy