January 27, 2012

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Authored By: Behnood Bikdeli, MD^1,2 and Babak Sharif-Kashani, MD¹
In this article, we review the general perspective of venous thromboembolism from Iran, mainly focusing on the trends from the National Research Institute of Tuberculosis and Lung Disease (NRITLD), a WHO-collaborating university hospital in Tehran, Iran.

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Authored by Paul D. Stein, M.D Department of Internal Medicine and Research and Advanced Studies Program, Michigan State and Fadi Matta, MD University College of Osteopathic Medicine, East Lansing, Michigan

ABSTRACT

Background: Methods for preventing venous stasis include graduated compression stockings and ankle exercise in the form of repetitive dorsiflexion and plantar flexion. We measured the effects of graduated compression stockings and ankle exercise on venous blood velocity.

Methods: Time averaged peak blood velocity in the popliteal vein of 25 men aged 23-39 years was measured while supine and sitting, at rest and with ankle exercise, with and without graduated compression stockings.

Results: Popliteal vein blood velocity was lower when sitting than when lying supine. Blood velocity increased with ankle exercise. Graduated compression stockings had no effect at rest and stockings did not augment blood velocity with ankle exercise.

Conclusion: Ankle exercise may be useful for decreasing venous stasis. In healthy young men, graduated compression stockings had no effect, but these data on compression stockings may not apply to hospitalized patients, many of whom have venous insufficiency.

Occult cancers are frequent in patients with unprovoked venous thromboembolism (VTE) and approximately 10% of patients with unprovoked VTE will be diagnosed with cancer within one year of their thrombotic event. A “limited” occult cancer screening (medical history taking, physical examination, routine laboratory blood tests and a chest-X ray) detects a large proportion of these occult malignancies. A more extensive occult cancer screening strategy (computed tomography, ultrasound, tumor markers, etc) seems to increase the number of cancers detected. However, current evidence does not support improvements in malignancy-related mortality, morbidity or quality of life with an extensive cancer screening strategy. Further clinical trials are required to assess the risks and benefits of a comprehensive screening program in patients with unprovoked VTE.

ABSTRACT:

Background: Despite the global efforts to control tuberculosis, it remains a common, life-threatening infectious disease. Tuberculosis can lead to hypercoagulability, increased venous stasis, and endothelial dysfunction, thus increasing the susceptibility to venous thromboembolism (VTE). However, few studies have assessed the epidemiology of the association between tuberculosis and VTE. We recently completed a study to address this coexistence.

Three factors influence the occurrence of thrombosis: blood stasis, endothelial injury and thrombophilia (The Virchow triangle). Thrombophilia is an inherited or acquired predisposition, detected by a set of laboratory tests, which increases the risk for venous thromboembolism (DVT or PE) or pregnancy complications, like: preeclampsia, intra-uterine fetal death, intra-uterine growth restriction and placental abruption [1,2]. Acquired or secondary thrombophilia includes: active cancer, certain chemotherapies, nephrotic syndrome, disseminated intravascular coagulation (DIC), thrombosis thrombocytopenic purisra (TTP), pregnancy and some inflammatory or autoimmune diseases.
The pain initially felt like it was coming from my calf, then behind my knee, and as time passed it seemed to travel down my leg. In my ignorance, I thought the pain was working itself down and out, so it must be improving.

Chronic Venous Insufficiency (CVI) is a common medical condition but often overlooked by the medical community. Manifestations of CVI are a result of longstanding venous hypertension due to chronic venous obstruction or venous valvular reflux. Most patients present with symptoms of leg heaviness, aching, cramps, itching, tingling, restless leg, swelling, fatigue, pruritus and skin changes. Skin changes in the extremities range from dilated veins (small reticular veins, teleangiectases and varicose veins) to edema, hyperpigmentation, fibrosis and ulceration. Complications include cellulitis and venous ulcers. Treatment is aimed at reducing venous pooling, either with conservative measures initially, or with endovascular interventions if disabling symptoms persist. Compression therapy using short-stretch bandages and then graded compression garments are the mainstay of therapy. Skin and wound care is of paramount importance in preventing more serious complications.