• Journal of Korean Critical Care Nursing
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• v.4 no.1
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• pp.75-87
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• 2011

Purpose: This study was done to investigate the DVT-related knowledge and compliance of hospital nurses. Methods: A survey questionnaire was administrated to a convenience sample of 367 nurses working at 3 university hospitals and 4 general hospitals located in Busan. Results: The mean score of DVT-related knowledge was $16.86{\pm}$3.40$ points out of 26, with a percentage of correct answers of 64.8%. The mean score of DVT-related compliance was $21.40{\pm}6.42$ points out of 32. There was a significant correlation between hospital nurses' DVTrelated knowledge and compliance (r=.309, p=.000). The factors for predicting hospital nurses' DVT-related compliance included knowledge of treatment and care areas, the subcategories of DVT knowledge (${\beta}$=.214), knowledge of the area of risk factors (${\beta}$=.105), whether to perform DVT prevention and treatment based on protocols (${\beta}$=.193), the existence of DVT protocols (${\beta}$=.168) and the degree of interest in DVT (${\beta}$=.102) and the total explanatory power of these was 21.3%. Conclusion: To improve compliance on preventing DVT effectively, it is necessary to improve nurses' DVT-related knowledge and interest in DVT through appropriate education. And, it is necessary to develop standardized protocols and guidelines.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.742-746
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• 1993

Recent literature reveals that pulmonary embolism secondary of pulmonary tumor embolism are dyspnea, hemoptysis, pulmonary hypertension, and circulatory collapse. We experienced a case of pulmonary embolism secondary to hepatocelluar cancer in 53-year-old man. From 2 months before admission, he began to experience cough and mild shortness of breath. Within a few days these symptoms progressed to near total incapacity. Pulmonary embolism was confirmed by angiography and the diagnosis of hepatocellular cancer was estabillished by abdomen CT and $\alpha$-FP(21,000 ng/ml). There was no evidence of intravascular cogulation elsewhere in deep vein of the extremities or risk factors of deep vein thrombosis. Thus we consider that pulmonary embolism in this patients is related to hepatocellular cancer rather than deep vein thrombosis. Therefore we report the first case which hepatocellular cancer initially presented as pulmonary embolism in Korean literature.

• Journal of Hospice and Palliative Care
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• v.8 no.1
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• pp.57-64
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• 2005

Cyclooxygenase-2 (COX-2) selective inhibitors were specifically developed to reduce the risks of gastrointestinal bleeding associated with other NSAID drugs. However, the APPROVe (Adenomatous Polyp Prevention on VIOXX) trials revealed that rofecoxib sometimes exerts prothrombotic effects. Meanwhile, cancer patients, who also carry a risk of thrombosis due to a variety of mechanisms, are often treated with COX-2 selective inhibitors, due to their relative gastrointestinal safety. This report concerns the case of a 46-year old woman with advanced cervical cancer, who had been treated with opioids and a COX-2 selective inhibitor (celecoxib) for 2 months, for the relief of pain associated with her cancer. The patient was admitted due to swelling of the left leg, which was also accompanied by pain. A computerized tomography scan revealed deep vein thrombosis occurring in multiple veins of both legs. After the administration of low-molecular weight heparin and oral warfarin, the patient's symptoms were relieved initially. However, her prothrombin time was found to be prolonged, necessitating the discontinuation of anticoagulation therapy. The patient's dyspnea worsened, ultimately resulting in her death. In conclusion, the administration of cox-2 selective inhibitors should be carefully considered in patients with a number of different risk factors, and assessed on a case-by-case basis.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.22 no.3
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• pp.249-257
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• 2015

Purpose: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. Methods: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. Results: The mean age was 57.5 (${\pm}15.7$) and 61.4 % were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. Conclusion: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1358-1361
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• 1992

During the past 4 years, 18 cases of deep vein thrombosis were treated. Diagnosis was based on clinical symptoms, phlebography and vascular Doppler examination. Etiologic factors were mainly trauma, operation and immobilization of the lower extremities. Seven patients were treated surgically and eleven patients medically. The indications for surgical thrombectomy included phlegmasia cerulea dolens [N=6], and phlemasia cerulea dolens with focal venous gangrene[N=1]. The comparative analysis of each treatment methods was done after a mean observation period of 6 months. Good clincal results were observation in 4 patents in surgically treated [57.1%], and 4 in conservative management group[36.3%]. There were no mortality in the both surgical and medically treated group but one patient with phlegmasia cerulea dolens and focal venous gangrene was dischared in moribund state at the third postoperation day due to sepsis and multiorgan failure. We believe that aggressive early surgical thrombectomy should be stronly considered for patients of phlegmasia cerulea dolena.

• Journal of Yeungnam Medical Science
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• v.33 no.2
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• pp.166-169
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• 2016

Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and self-expanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.941-946
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• 1995

The association between hypercoagulability and malignant disease was first described by Armand Trousseau in 1865. According to Trousseau, the thrombophlebitis was usually/migratory and recurrent and involved both venous and arterial system. Thrombosis remains the hallmark of Trousseau's syndrome, although a wide variety of coagulation disorders including disseminated intravascular coagulation(DIC), pulmonary embolism, thrombotic endocarditis, and bleeding have been associated with the syndrome. Since then, abnormalities of the coagulation system have been repeatedly demonstrated in patients with cancer. Pancreatic carcinoma is thought to carry the highest risk of Trousseau's syndrome although the number of cases of Trousseau's syndrome is actually higher in patients with lung cancer because of the greater prevalence of this tumor. We report a thirty-five year old male patient with Trousseau's syndrome associated with lung cancer initially presenting deep vein thrombosis.

• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.231-237
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• 2017

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are conditions with significant morbidity and mortality. Proximal DVT has a significant association with PE and possible fatal outcomes. Traditionally, PE is subdivided into symptomatic PE and asymptomatic PE, which have different treatments, preventions and prognoses. The growing utilization of computed tomography pulmonary angiography has led to increased detection of PE in DVT patients. This study examined the clinical characteristics and compared symptomatic PE and asymptomatic PE following proximal DVT. Methods: The medical records of 258 DVT inpatients from July, 2012 to June, 2015 were reviewed retrospectively. After excluding the patients who did not performed PE evaluation and were not diagnosed with PE, 95 patients diagnosed with PE following proximal DVT were enrolled in this study. They were divided into the symptomatic PE group and asymptomatic PE group. Results: The body weight, body mass index, thrombus size, thrombus length and location were similar in the two groups. The symptomatic PE following proximal DVT group showed an older age, higher incidence of emergency department access (85.0% vs. 38.7%, p<0.001) and preceding infection (25.0% vs. 1.3%, p<0.001) as well as a higher incidence of immobilization (45.0% vs 13.3%, p=0.016). In the multivariate logistic regression study, preceding infection and emergency department access showed significant association with symptomatic PE. Conclusion: In proximal DVT inpatients, symptomatic PE was associated with emergency department access and preceding infection. The possibility of a symptomatic PE event should be considered in proximal DVT patients, especially those who were admitted through the emergency department and had preceding infection.

• Tuberculosis and Respiratory Diseases
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• v.81 no.1
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• pp.49-58
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• 2018

Background: Information regarding the incidence and risk factors for deep vein thrombosis (DVT) detected by follow-up computed tomographic (CT) venography after pulmonary embolism (PE) is sparse. The aim of the present study was to identify the predictors of DVT in follow-up CT images, and to elucidate their clinical significance. Methods: Patients with PE were classified into the following three cohorts based on the time of indirect CT venography follow-up: within 1 month, 1 to 3 months, and 3 to 9 months after the initial CT scan. Each cohort was subdivided into patients with or without DVT detected by follow-up CT. Clinical variables were compared between the two groups. Results: Follow-up CT revealed DVT in 61% of patients with PE within 1 month, in 15% of patients with PE at 1 to 3 months, and in 9% of patients with PE at 3 to 9 months after the initial CT scan. Right ventricular (RV) dilation on the initial CT (odds ratio [OR], 8.30; 95% confidence interval [CI], 1.89-36.40; p=0.005) and proximal DVT at the initial presentation (OR, 6.93; 95% CI, 1.90-25.20; p=0.003) were found to independently predict DVT in follow-up CT images within 1 month, proximal DVT at the initial presentation was found to independently predict DVT in follow-up CT images at 1 to 3 months (OR, 6.69; 95% CI, 1.53-29.23; p=0.012), and central PE was found to independently predict DVT in follow-up CT images at 3 to 9 months (OR, 4.25; 95% CI, 1.22-4.83; p=0.023) after the initial CT scan. Furthermore, the detection of DVT by follow-up CT independently predicted the recurrence of venous thromboembolism (VTE) (OR, 4.67; 95% CI, 2.24-9.74; p<0.001). Conclusion: Three months after PE, DVT was not detected by follow-up CT in most patients with PE. RV dilation on the initial CT, central PE, and proximal DVT at the initial presentation were found to predict DVT on follow-up CT, which might predict VTE recurrence.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.677-683
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• 2009

May-Thurner syndrome is a deep vein thrombosis of the ilio-femoral vein due to compression of the left common iliac vein by the overlying right common iliac artery. Although, catheter directed thrombectomy (CDT) and thrombolysis with stent insertion has become the standard treatment method for acute or subacute May-Thurner syndrome, because of technical feasibility and lower recurrence rate, however, sometimes this methods make fatal complications. Furthermore, there are few reports on optimal treatment strategies for patients in a chronic state of May-Thurner syndrome. We now present two cases of chronic (> 1 month since onset of symptoms) May-Thurner syndrome treated by surgical thrombectomy and femoral arteriovenous shunt with simultaneous stent insertion after failed endovascular treatment. This technique may provide a significant benefit for patients who are not suitable for conventional endovascular treatment.