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  • ISSN: 2378-9344
    Volume 8, Issue 3
    Research Article
    M. Birgitte Visch*, Lars L.F.G. Valke, Germa Hazelaar, Marcel M.C. Hovens
    Introduction: In patients presenting with pulmonary embolism (PE), a concomitant deep venous thrombosis (DVT) is relatively common even without clinical symptoms of DVT.
    Objectives: To determine the percentage of PE patients with concomitant DVT and to identify risk factors that increases the likelihood of (asymptomatic) DVT.
    Patients and methods: Patients with acute PE at Rijnstate Hospital (Arnhem, the Netherlands) were retrospectively analysed after evaluation with whole leg duplex ultrasound. Patients with confirmed DVT were treated with compression therapy and compression stockings. To determine risk factors for concomitant DVT in PE patients, we performed a multivariate analysis.
    Results: An ultrasound was performed in 505 patients. Concomitant DVT was diagnosed in 299 patients (59.2%), of which 195 (65.2%) had limited DVT and 101 (33.8%) had extended DVT. Clinical complaints and edema were present in 40.5% and 40.4% of patients with DVT respectively. DVT was significantly more often diagnosed in patients with central PE and clinical manifestations (92.9%; 95%-confidence interval 84.1-97.6). Clinical complaints (multivariate odds ratio 12.3) and central PE (multivariate odds ratio 8.0) were found to be the strongest predicting factors for concomitant DVT in patients with PE. Adversely, no characteristics could be identified that could safely exclude DVT.
    Conclusion: Concomitant DVT is common in PE patients, even without the presence of clinical symptoms. Since DVT cannot be excluded based on clinical characteristics alone, a duplex ultrasound should be performed in all PE patients to ensure adequate DVT treatment and to prevent long-term complications such as PTS.
    Essentials: Pulmonary embolism (PE) patients have a high chance of concomitant deep venous thrombosis (DVT).
    The incidence of, clinical manifestations of and risk factors for DVT were determined in PE patients.
    DVT was seen more often in patients with central PE and clinical manifestations.
    Risk factors that can safely exclude DVT could not be identified.
    Case Report
    Tomonari Suetsugu, Yoshihiro Tanaka*, Yuta Sato, Ritsuki Takaha, Masahiro Fukada, Itaru Yasufuku, Naoki Okumura, Nobuhisa Matsuhashi, Takao Takahashi and Kazuhiro Yoshida
    A 72-year-old woman with early gastric cancer and D-dimer elevation had deep venous thrombosis (DVT) in her soleus, posterior tibial, and sural veins, but no pulmonary thromboembolism (PTE) or proximal lower limb vein thrombosis. Because of anemia and her subacute phase DVT, anticoagulant therapy was not administered preoperatively. She underwent robotic distal gastrectomy with D2 lymphadenectomy and Billroth I reconstruction without intraoperative complications. Her platelets decreased from 263,000/μL to 76,000/μL on postoperative day (POD) 1. Because of potential postoperative bleeding following initiation of anticoagulant therapy under her low platelet count, anticoagulant therapy was postponed until platelets recovered. On POD 3, D-dimer and soluble fibrin monomer complex levels respectively rose to 91.6 μg/mL and 64.2 μg/mL. She complained of respiratory distress. Saturation of percutaneous oxygen was about 95% on O2 at 4 L/min, indicating poor oxygenation. Contrast-enhanced CT showed PTE in her right upper and peripheral left pulmonary arteries. After oral rivaroxaban 30 mg/day was started, respiratory distress gradually improved, and O2 administration became unnecessary with no decrease in platelets or bleeding. She was discharged 17 days postoperatively without complications. It should be recognized that even subacute lower limb-only DVT can result in symptomatic postoperative PE.
    Girardi Luka*
    A 64 y/o female patient was referred to our clinic for a vascular check because of blue left index finger since three weeks. She had been experiencing the Raynaud-phenomenon on her fingers for thirty years, but it was not limiting her daily routine; a single workup many years earlier reportedly did not reveal a cause. Otherwise, she was treated for arterial hypertension, hyperlipidaemia and depression. Her medication consisted of a statin, blood pressure lowering medication and antidepressants. She was a non-smoker and had no allergies.
    Ihnatovich I* and Ihnatovich K
    The traditional definition of tissue ischemia - a decreased level of oxygen deliverability by the bloodstream that results in cell hypoxia. Anatomical and functional obstruction of blood flow is the basis of tissue hypoperfusion. Arterial, venous, and functional disturbances in blood circulation lead to acute intestinal ischemia.
    Review Article
    Klas Norrby*
    Mast cells (MCs) have a unique role among the innate immune cells because of their unique and extensive mediator profile and their ability to interact with the vasculature. The physiological role of MCs is unclear. We argue that MCs exist in all species with a circulatory system due to the basic triad tissue response that they are able to produce under physiological and pathological conditions alike: extracellular matrix degradation and tissue remodeling, de novo cell proliferation, and de novo angiogenesis.
    MC-activation occurs not only in life-saving reactions such as inflammation and wound healing but in implantation, the decidua, the placenta, the pregnant uterus, and the fetus too. In fact, MC-activation is essential for successful pregnancy, and helpful for the survival of the newborn up to reproductive age (owing to beneficial actions of the MCs in inflammation and wound healing), and essential as for reproductive capability in adulthood.
    The fact that MCs since more than 500 million years are preserved in all species that have a circulatory system, i.e., the vertebrates, suggests that the life-saving and life-promoting MC-mediated response of tissue remodeling, changing the functional capabilities of the tissue, cell proliferation, and angiogenesis could be MCs’ purpose. The MCs’ action in the pregnant uterus could, hypothetically, be their physiological role.
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