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Lin W, Yao B, He J, Lin S, Wang Y, Chen F, Zhang W, Yang J, Ye Z, Qiu J, Wang Y. The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report. J Med Case Rep 2024; 18:207. [PMID: 38610054 PMCID: PMC11015665 DOI: 10.1186/s13256-024-04516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear. CASE PRESENTATION A 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis. CONCLUSION Standardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.
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Affiliation(s)
- Wujian Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Yao
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiahui He
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Therapy Technology, Lvkang Bomei Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Shuangyan Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Yafei Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fangting Chen
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weichao Zhang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiashu Yang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital, Jinan University, Heyuan, Guangdong, China
| | - Zhihong Ye
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China.
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Tanaka K, Shimizu Y, Kamada H, Aikawa S, Mishima H, Kanamori A, Nishino T, Sakane M, Ochiai N, Yamazaki M. Feasibility and Safety of a Novel Leg Exercise Apparatus for Venous Thromboembolism Prophylaxis after Total Joint Arthroplasty of the Lower Extremities-A Pilot Study. Tomography 2021; 7:734-746. [PMID: 34842826 PMCID: PMC8628884 DOI: 10.3390/tomography7040061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
Venous thromboembolism (VTE) is a severe complication in orthopedic surgeries. Herein, we developed a novel leg exercise apparatus (LEX) to encourage postoperative limb movement in bedridden patients to prevent VTE. We aimed to evaluate its feasibility and safety in individuals at risk of VTE. Twenty patients (four men, 16 women) who underwent total joint arthroplasty in the lower extremity were enrolled in this prospective study. Exercise using the LEX was performed for 5 min at 30 cycles/min, four times/day during postoperative days 1–7. Clinical assessments included the evaluation of vital signs, venous ultrasonography, and blood tests within seven days postoperatively, and adverse events (pulmonary embolism and cerebral hemorrhage) were monitored. Overall, 16/20 (80%) patients completed the 7-day exercise regimen. There were no cases of severe adverse events, changes in vital signs, or lower-extremity deep vein thrombosis in patients who performed exercises with the LEX. Thus, the results of this pilot study show that this novel apparatus may be a safe and feasible tool for VTE prophylaxis after joint arthroplasty of the lower extremities.
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Affiliation(s)
- Kenta Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
- Department of Orthopaedic Surgery, Nogami Hospital, Tozakimachi 6-8, Tsuchiura 300-0031, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan
- Correspondence: ; Tel.: +81-29-853-3219
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
| | - Shizu Aikawa
- Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba 305-8558, Ibaraki, Japan;
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
| | - Tomofumi Nishino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
| | - Masataka Sakane
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
- Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba 305-0854, Ibaraki, Japan
| | - Naoyuki Ochiai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda 278-0005, Chiba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan; (K.T.); (H.K.); (H.M.); (A.K.); (T.N.); (M.S.); (N.O.); (M.Y.)
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Raymundo SRDO, Lobo SMA, Hussain KMK, Hussein KG, Secches IT. What has changed in venous thromboembolism prophylaxis for hospitalized patients over recent decades: review article. J Vasc Bras 2019; 18:e20180021. [PMID: 31191626 PMCID: PMC6542320 DOI: 10.1590/1677-5449.002118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/13/2018] [Indexed: 11/21/2022] Open
Abstract
Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis.
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Affiliation(s)
- Selma Regina de Oliveira Raymundo
- Faculdade Regional de Medicina de São José do Rio Preto - FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.,Hospital Austa, São José do Rio Preto, SP, Brasil
| | - Suzana Margareth Ajeje Lobo
- Faculdade Regional de Medicina de São José do Rio Preto - FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil
| | | | - Kassim Guzzon Hussein
- Faculdade de Medicina em São José do Rio Preto - FACERES, São José do Rio Preto, SP, Brasil
| | - Isabela Tobal Secches
- Faculdade de Medicina em São José do Rio Preto - FACERES, São José do Rio Preto, SP, Brasil
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Pak J, Ikeda M, Uemura M, Miyake M, Nishikawa K, Miyamoto A, Miyazaki M, Hirao M, Nakamori S, Sekimoto M. Risk factors for bleeding in patients receiving fondaparinux after colorectal cancer surgery. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:131-135. [PMID: 31583313 PMCID: PMC6768684 DOI: 10.23922/jarc.2017-022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for bleeding complications in patients who receive Venous thromboembolism (VTE) prophylaxis with fondaparinux (FPX) after colorectal cancer surgery. METHODS Records of 546 patients who underwent VTE prophylaxis with intermittent pneumatic compression and FPX after colorectal cancer surgery between January 2009 and May 2014 were reviewed. Patient characteristics, surgical procedures, and patient laboratory data were examined to identify risk factors for bleeding complications using univariate and multivariate logistic regression. RESULTS We reviewed the records of 324 males and 222 females. Median age and BMI were 68.5 years and 22.7 kg/m2, respectively. The number of laparoscopic surgeries was 366. Median operative time and blood loss were 188.5 min and 20 ml, respectively. The incidence (%) of bleeding events was 5.3%. In univariate analysis, age ≥80 years, BMI ≥25.0 kg/m2, hypertension, and antithrombotic therapy were associated with a significantly higher incidence of bleeding events. Multivariate analysis identified age ≥80 years (odds ratio 5.814; 95% confidence interval 2.502-13.278) as an independent risk factor. CONCLUSION Age ≥80 is a risk factor for bleeding in patients who receive FPX for VTE prophylaxis after colorectal cancer surgery.
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Affiliation(s)
- Jongsung Pak
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Masataka Ikeda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Kazuhiro Nishikawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Shoji Nakamori
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
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Northup A, Wilcox S. Thromboprophylaxis Failure in the Adult Medical Inpatient. Am J Med Sci 2017; 354:107-116. [PMID: 28864367 DOI: 10.1016/j.amjms.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 01/12/2023]
Abstract
Venous thromboembolism (VTE), a leading cause of morbidity and mortality among hospitalized patients, is often due to prophylaxis failure rather than omission, but few studies have identified the risk factors for failure. Risk factors for thromboprophylaxis failure include personal or family history of VTE, use of vasopressors or inotropes, increased body mass index, cranial surgery, intensive care patient, leukocytosis, indwelling central venous catheter and admission from a long-term care facility. Identifying patients at risk for thromboprophylaxis failure should prompt close observation during hospitalization for signs of VTE, close observation after discharge and potentially more aggressive prophylaxis strategies, although no specific guidelines exist for medical patients at this time.
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Affiliation(s)
- Amanda Northup
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Susan Wilcox
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina
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The Use of Intermittent Pneumatic Compression in Orthopedic and Neurosurgical Postoperative Patients: A Systematic Review and Meta-analysis. Ann Surg 2016; 263:888-9. [PMID: 26720432 DOI: 10.1097/sla.0000000000001530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to carry out an up-to-date evaluation on the use of compression devices as deep vein thrombosis (DVT) prophylaxis methods in orthopedic and neurological patients. SUMMARY OF BACKGROUND DATA There is an increased risk of DVT with surgery, particularly in patients who are not expected to mobilize soon after their procedures, such as orthopedic and neurosurgical patients. Compression devices are often employed for DVT prophylaxis in these patients. However, the true efficacy of these devices and the standardization of use with these devices are yet to be established. METHODS Medline, CINAHL, Embase, Google Scholar, and the Cochrane library electronic databases were searched to identify randomized controlled trials and observational studies reporting on the use of compression devices for DVT prevention. RESULTS Nine studies were included for review and meta-analysis. Use of an intermittent pneumatic compression device alone is neither superior nor inferior to chemoprophylaxis. CONCLUSIONS In the absence of large randomized multicenter trials comparing the use of intermittent pneumatic compression or chemoprophylaxis alone to a combination of both treatments, the current evidence supports the use of a combined approach in high-risk surgical patients.
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Domeij-Arverud E, Ackermann PW. Deep Venous Thrombosis and Tendon Healing. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 920:221-8. [PMID: 27535264 DOI: 10.1007/978-3-319-33943-6_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tendon metabolism after acute Achilles tendon rupture (ATR) is associated with major complications related to immobilization, which results in reduced circulation, high risk of deep venous thrombosis (DVT), impaired healing and functional deficits.DVT has been demonstrated to occur in up to 50 % of the patients with ATR. Suffering from a DVT during tendon healing has been demonstrated as an independent predictive factor for impaired patient outcome at 1 year after ATR, suggesting that specific interventions are warranted to prevent DVT. Since pharmacological DVT prophylaxis has low or no effect during lower leg immobilization it is speculated whether adjuvant treatment with intermittent pneumatic compression (IPC) applied during lower limb immobilization can reduce the incidence of DVT.IPC, which acts through mechanical, chemical and molecular mechanisms, has been demonstrated to enhance neuro-vascular ingrowth in a tendon repair model and stimulate collagen production leading to improved maximum force during healing.Recently, a prospective randomized trial compared adjuvant IPC applied under an orthosis versus plaster cast only in ATR patients. The study found at 2 weeks post-operatively 21 % DVTs in the IPC-group compared to 37 % in the control group. Patients that received no IPC treatment exhibited an almost threefold increased odds for DVT, independently of age. Furthermore, using microdialysis technique, adjuvant IPC treatment was shown to increase the metabolic healing activity at 2 weeks post-ATR.Tendon healing is impaired by reduced circulation and DVT. The demonstration that adjuvant IPC effectively reduced DVT incidence, and also is capable of enhancing the metabolic response suggests that IPC treatment may not only be a viable means of prophylaxis against DVT, but possibly also a method of promoting healing.
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Affiliation(s)
- Erica Domeij-Arverud
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
- Department of Orthopedic Surgery, Danderyd Hospital, Stockholm, SE-17176, Sweden.
| | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden
- Department of Orthopedic Surgery, Karolinska University Hospital, SE-17176, Stockholm, Sweden
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Ackermann PW, Hart DA. Influence of Comorbidities: Neuropathy, Vasculopathy, and Diabetes on Healing Response Quality. Adv Wound Care (New Rochelle) 2013; 2:410-421. [PMID: 24688829 DOI: 10.1089/wound.2012.0437] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Indexed: 12/13/2022] Open
Abstract
SIGNIFICANCE Prolonged and nonhealing connective tissue injuries are often seen associated with common diseases, such as metabolic disorders, obesity, hypertension, arteriosclerosis, neuropathy, and diabetes mellitus and these influences result in considerable burden on society via the health care system, the economy, and quality of life for patients. RECENT ADVANCES Emerging findings have established important new links in our understanding of effective connective tissue healing. Thereby, the function of the nervous system, vascular supply, and metabolic state of the patient can be directly linked to the quality of the connective tissue healing process. CRITICAL ISSUES As some of these conditions are also more common in individuals as they age, and aging can also impact healing effectiveness, such complications will have an emerging significant impact as the demographics of many societies change with expanding percentages of the populations >60-65 years of age. FUTURE DIRECTIONS Comorbidities have to be early identified in patients with acute wounds or planned surgery. Necessary interactions between physicians with different subspecialties have to be initiated to optimize wound healing potentials.
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Affiliation(s)
- Paul W. Ackermann
- Section of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - David A. Hart
- Department of Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
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Malafaia O, Montagnini AL, Luchese A, Accetta AC, Zilberstein B, Malheiros CA, Jacob CE, Quireze-Junior C, Bresciani CJC, Kruel CDP, Cecconello I, Sad EF, Ohana JAL, Aguilar-Nascimento JED, Manso JEF, Ribas-Filho JM, Santo MA, Andreollo NA, Torres OJM, Herman P, Cuenca RM, Sallum RAA, Bernardo WM. Thromboembolism prevention in surgery of digestive cancer. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:216-23. [PMID: 23411918 DOI: 10.1590/s0102-67202012000400002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/10/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. AIM To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. METHODS The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength. RESULTS A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A, 130 B, 1 C and 0 D. CONCLUSION It was possible to prepare safe recommendations as guidance for thromboembolism prophylaxis in operations on the digestive tract malignancies, addressing the most frequent topics of everyday work of digestive and general surgeons.
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Affiliation(s)
- Osvaldo Malafaia
- Colégio Brasileiro de Cirurgia Digestiva, São Paulo, SP, Brazil.
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Henke PK, Arya S, Pannucci C, Kubus J, Hendren S, Engelsbe M, Campbell D. Procedure-specific venous thromboembolism prophylaxis: a paradigm from colectomy surgery. Surgery 2012; 152:528-34; discussion 534-6. [PMID: 23021132 DOI: 10.1016/j.surg.2012.07.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/10/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colectomy patients are at high-risk for venous thromboembolism (VTE), but associated risk factors and best prophylaxis in this defined population are only generalized. METHODS Fifteen hospitals prospectively collected pre-, peri-, and postoperative variables related to VTE and prophylaxis, in addition to the variables defined by the National Surgical Quality Improvement Program between 2008 and 2009 concerning open and laparoscopic colectomy patients with 30-day outcomes. Symptomatic VTE was the primary outcome, and risk factors were tested for association with VTE using multiple logistic regression. RESULTS The cohort included 3,464 patients with a mean age of 65; 53% were female. Overall, the 30d incidence of VTE was 2.2%. VTE prophylaxis included sequential compression devices (SCDs, 11%) alone; pharmacologic prophylaxis alone (15%); and both SCDs and pharmacologic prophylaxis (combined prophylaxis, 74%). VTE was associated with each additional year of age (OR, 1.05; 95% CI 1.02-1.06, P < .001); increased body mass index (OR 1.03; CI 1.01-1.05; P = .02); preoperative anemia (OR 2.4; CI 1.2-4.8; P = .011); contaminated wound (OR 3.4; CI 1.6-7.3; P < .01); postoperative surgical site infection (OR 2.5; CI 1.2-5.2; P < .011); and postoperative sepsis/pneumonia (OR 3.6;CI 1.9-6.7; P < .01). Postoperative factors alone accounted for 32% of VTE risk. When controlling for all other factors, only combination prophylaxis was protective against VTE (OR 0.48; CI 0.27-0.9; P = .02). Operative time, presence of disseminated malignancy, anastomotic leak, transfusion, urinary tract infection, and laparoscopic procedure were not significantly associated with VTE. Propensity matching showed that unfractionated heparin was equivalent to low molecular weight heparin, and the transfusion rate was not increased with pharmacologic prophylaxis compared to SCDs alone. CONCLUSION Regardless of preoperative factors, VTE prophylaxis using a combination of SCDs and chemoprophylaxis was associated with significant reduction in VTE and should be standard care for patients after colectomy.
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Affiliation(s)
- Peter K Henke
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Arverud E, Azevedo J, Labruto F, Ackermann PW. Adjuvant compression therapy in orthopaedic surgery—an evidence-based review. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12570-012-0151-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bhagya Rao B, Kalayarasan R, Kate V, Ananthakrishnan N. Venous Thromboembolism in Cancer Patients Undergoing Major Abdominal Surgery: Prevention and Management. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/783214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer is an important risk factor for venous thrombosis. Venous thromboembolism is one of the most common complications of cancer and the second leading cause of death in these patients. Recent research has given insight into mechanism and various risk factors in cancer patients which predispose to thromboembolism. The purpose of this review is to summarize the current knowledge on the prophylaxis, diagnosis, and management of venous thromboembolism in these patients.
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Affiliation(s)
- Bhavana Bhagya Rao
- Department of Gastroenterology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - R. Kalayarasan
- Department of Surgical Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Vikram Kate
- Department of General and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - N. Ananthakrishnan
- Department of Surgery, Mahatma Gandhi Medical College & Research Institute, Pondicherry 607402, India
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Hacker RI, Ritter G, Nelson C, Knobel D, Gupta R, Hopkins K, Marini CP, Barrera R. Subcutaneous heparin does not increase postoperative complications in neurosurgical patients: An institutional experience. J Crit Care 2012; 27:250-4. [DOI: 10.1016/j.jcrc.2011.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/10/2011] [Accepted: 09/23/2011] [Indexed: 10/14/2022]
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Hogg K, Carrier M. Prevention and treatment of venous thromboembolism in patients with cancer. Ther Adv Hematol 2012; 3:45-58. [PMID: 23556111 PMCID: PMC3573425 DOI: 10.1177/2040620711422590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Venous thromboembolism (VTE) is the second leading cause of death and a major cause of morbidity in patients with cancer. Pharmacologic thromboprophylaxis is recommended in all hospitalized cancer patients without contraindications to anticoagulants. The role of thromboprophylaxis in outpatients undergoing chemotherapy is less certain because of the diversity of the tumor types and their associated risks of VTE and bleeding. Thromboprophylaxis should only be considered in patients at high risk for VTE. Cancer patients with a newly diagnosed VTE should be preferably treated with low-molecular-weight heparin for a minimum of 3-6 months. Treatment duration should be individualized based on the clinical status and stage of the cancer, the risk of recurrent VTE, the risk of bleeding, and personal preference of the patient. Further research is required to assess the role of the new oral anticoagulants (direct Xa and thrombin inhibitors) for this high-risk population.
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Ng TM, Tsai F, Khatri N, Barakat MN, Elkayam U. Venous Thromboembolism in Hospitalized Patients With Heart Failure. Circ Heart Fail 2010; 3:165-73. [DOI: 10.1161/circheartfailure.109.892349] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Tien M.H. Ng
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Fausan Tsai
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Nudrat Khatri
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Mohamad N. Barakat
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Uri Elkayam
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
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Abstract
Prevention of venous thromboembolism (VTE) remains the number one preventable cause of death in hospitalized patients. The pathogenesis of thrombosis involves the triad of venous stasis, dilatation of the leg veins, and changes in coagulability of the blood. These changes can be modified by the use of intermittent pneumatic compression devices (IPC) and, to a much lesser extent, by graduated compression hose (GCS). Studies have shown the effectiveness of GCS in preventing deep vein thrombosis (DVT) compared to placebo, but there is no evidence that they reduce the incidence of pulmonary emboli (PE). No venographic data are available regarding the efficacy of GCS; however, IPC have shown excellent efficacy in several venographic studies over the past 25 years. Mechanical methods are important to use in situations where the risk of bleeding exists, thereby making the use of anticoagulants hazardous. One of the key uses for mechanical methods is in combination with anticoagulants in patients at the highest risk of developing VTE. Chest consensus guidelines assigns a 2A recommendation for the use of combination prophylaxis in the highest risk patients. Unfortunately, studies to show which type of leg compression device is optimal for DVT prevention are not available, so individual preference, ease of use, and company support are the determining factors at the present time. Finally, compliance using these devices is a major problem, and until systems have been developed to easily monitor and ensure compliance, these methods will enjoy only limited use.
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Current World Literature. Curr Opin Pulm Med 2009; 15:521-7. [DOI: 10.1097/mcp.0b013e3283304c7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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