Deep venous thrombosis in a patient with superficial thrombophlebitis. Apropos of 2 cases]

Many schools refer children who have sustained an injury, directly to the local Accident & Emergency (A&E) department. This prospective study monitored these referrals for one school term (08.01.96-31.03.96). During this time 200 children under the age of 14 years presented from school to the A&E department of the Royal Aberdeen Childrens Hospital (RACH). The majority presented with trivial or mild injuries and 45% of parents felt that attending A&E was inappropriate. Half the accidents happened to unsupervised children. Rural children and children of working parents were less likely to attend A&E. In Grampian Region school referrals to A&E generate a significant workload for the A&E department with resultant cost implications. It would appear that a large number of these attendances are medically unnecessary and result from a desire by the school to avoid any complaint or litigation.     

Ambulatory therapy of acute deep thrombophlebitis

A 53-year-old man developed deep vein thrombosis seven days after arthroscopic meniscectomy. He was successfully treated at home with a low-molecular-weight heparin followed by oral anticoagulation. Today, low-molecular-weight heparins are the initial treatment of choice for acute deep vein thrombosis. Due to the simplicity of administration, they have the potential for allowing home treatment. Several recently published randomised and controlled studies have demonstrated the feasibility, safety and efficacy of home treatment.     

Tuberculous thrombophlebitis of the portal vein

The myelin sheath and axon areas in the sciatic nerve of 20 adult rats were studied using the video-point-counting method (Quantimet). This automatic measurement procedure allows an exact and rapid determination of the above mentioned areas as a result of the differing intensities of the structures. The electron-microscopic pictures are projected at a magnification of 3500 onto the monitor through a lens system from a Vidikon-TV-tube, objective 32 mm. The areas of single nerve cross-sections, myelin sheath areas and total area are then measured. These area values are stated in picture points which can be calculated to absolute values. The statistical evaluation of both parameters shows a linear regression with a correlation coefficient of 0.94. These values are compared with the results obtained using the conventional manual methods of other authors, e.g. determination of lamellae number or myelin sheath thickness as well as axon circumference or axon diameter. The special advantages of this procedure are thereby pointed out.     

Ultrasonographic investigation of the pathogenesis of infusion thrombophlebitis

As shown on cultured striatal neurons recorded in whole-cell configuration, both acetylcholine (in the presence of atropine) and nicotine reduced voltage-dependent outward currents. Although, at early postnatal ages, outward currents in these cells are mainly carried by rapidly and slowly inactivating K+ channels, these inhibitions resulted from a selective and reversible effect on the slowly inactivating K+ conductance (IK+). This action was blocked by the nicotinic antagonist dihydro-beta-erythro?dine and reproduced by nicotinic agonists. When neurons were recorded under current-clamp conditions, nicotine increased reversibly their firing rate generated by step depolarizations. Therefore, in addition to its well documented muscarinic effects, acetylcholine also controls K+ currents in striatal neurons through mechanisms mediated by nicotinic receptors.     

Congenital superficial angiomyxoma

Superficial angiomyxomas are rare, benign, dermal and subcutaneous tumours. We describe a 12-year-old girl who presented with a nodular swelling in the midline of her scalp that had been present since birth. Histological examination revealed an ill-defined myxoid lesion within the dermis, comprising spindle cells, blood vessels and occasional multi-nucleate giant cells. Immunohistochemical staining was negative for S-100, cytokeratin and smooth muscle actin, but focally positive for CD34. Our patient is unusual in that the angiomyxoma was present at birth, which has not previously been described. The importance of screening patients with cutaneous myxomas for cardiac lesions is discussed.     

Actinic superficial folliculitis

BACKGROUND: The maze operation is effective for the restoration of sinus rhythm; however, restoration of atrial mechanical function has not been demonstrated in all patients. METHODS: Maze operations were performed in 32 patients (13 men, 19 women; mean age 47.1 +/- 9.0 years) combined with valvular surgery (n = 25), coronary artery bypass graft (CABG) (n = 3), and others (n = 4). At 1 week, 3 months, 6 months, and 1 year after the operation, prospective serial Doppler echocardiographic examination was carried out to determine the presence of atrial mechanical function. RESULTS: Sinus rhythm was restored and maintained during the follow-up period in 26 (81%) patients; in 22 patients this was due solely to the operation, whereas in four patients an antiarrhythmic agent was needed to maintain sinus rhythm. Another four patients showed paroxysmal atrial fibrillation (AF) despite treatment with an antiarrhythmic agent. Right atrial mechanical function was restored in all 30 patients with sinus rhythm or paroxysmal AF; in 19 (63%) of these, left atrial mechanical function was restored. In patients with restored left atrial mechanical function, peak A velocity (A) and A/E ratio (A/E) of mitral inflow were significantly lower than in the 16 postoperative control patients (A: 0.46 +/- 0.14 m/sec vs 0. 75 +/- 0.29 m/sec, p < 0.01; A/E: 0.40 vs 0.80, p < 0.01). In patients with left atrial mechanical function, the duration of AF was significantly shorter than in patients without left atrial mechanical function (1.9 +/- 2.9 years vs 7.1 +/- 3.0 years, p < 0. 01), but there were no significant differences in left atrial size and volume. CONCLUSIONS: The maze operation could be safely added to standard open heart surgery for the correction of underlying structural heart disease. The rate of conversion to sinus rhythm resulting solely from the operation might be lower than the rates previously reported with only the duration of AF adversely affecting the restoration of left atrial mechanical function. Considering the fact that not all patients converted to sinus rhythm show atrial mechanical function, the role of the maze operation in the prevention of systemic embolism, with subsequent improvement in survival, requires further study.     

Complications of thoracoscopy

BACKGROUND: The revolution in video technology has led to the acceptance of thoracoscopy as an important tool in thoracic surgery. METHODS: A review of all patients undergoing thoracoscopy at the University of Maryland between November 1991 and March 1995 was performed to identify the incidence of intraoperative and postoperative complications. In addition, the role of computed tomography for predicting intraoperative complications was analyzed. RESULTS: Three hundred forty-eight procedures were performed in 321 patients. Twenty-seven patients required conversion to thoracotomy for various indications. In 12 patients further resection was required after frozen section diagnosis confirmed lung carcinoma. Six patients were opened due to adhesions. Two patients were opened due to inability to find the lesion (this represents 1.6% of all solitary pulmonary nodules). Three cases were converted to thoracotomy for lesions that were too large to remove (representing 2.5% of all solitary pulmonary nodules resected). Two patients required conversion to thoracotomy because of inability to obtain one-lung ventilation. One case required a limited thoracotomy for a lost needle used for needle localization of a solitary intraparenchymal nodule, and 1 patient had emergent exploration for bleeding. Early postoperative complications developed in 10 patients. There were two explorations in the immediate postoperative period for bleeding. Prolonged air leak occurred in 3 patients, empyema in 2, and recurrent pneumothorax, pulmonary edema, and pneumonia in 1 patient each. Computed tomography failed to diagnose adhesions in the majority of patients requiring conversion to thoracotomy. CONCLUSIONS: Thoracoscopy is a safe and effective procedure with low intraoperative and postoperative complication rates.     

Complications of blepharoplasty

Although blepharoplasty is a technically straightforward procedure, many postoperative complications may occur. Some of the untoward effects may be only a transient nuisance for the patient, such as mild ocular dryness, whereas other sequelae can lead to severe visual loss. An extensive review of the prevention, diagnosis, and management of complications associated with blepharoplasty is presented.     

Complications of rhytidectomy

In a recent study of rhytidectomy patients, the most common complications were hematoma, inflammation, crusting, hypertrophic scars, hair loss, and changes in ear lobe appearance. The nurse's role in early detection and prevention cannot be overlooked. This article will review these complications and less common ones, emphasizing the known etiologies, signs and symptoms, and the nurse's role in assessment and intervention.     

The ultrasonic diagnosis of acute thrombophlebitis of the vena saphena magna

A total of 321 patients with suspected acute thrombophlebitis were examined. There were 92 men (30%) and 229 women (70%). For control 15 patients without lower limb vein abnormalities and 19 ones with uncomplicated varicose disease were examined. Ultrasonic examinations using Ultramark-8 (Medata, Sweden) device were carried out in all the patients. Of the 313 cases (in 8 patients the diagnosis of acute thrombophlebitis was not confirmed by ultrasonic examination) ultrasonography results were erroneous in only 6 cases when assessing the proximal borderline of the great subcutaneous femoral vein thrombosis. Hence, the accuracy of duplex scanning in assessment of the proximal border of thrombosis in acute thrombophlebitis was 98.6% in our study. Ultrasonic angio-scanning in patients with superficial thrombophlebitis give reliable and valuable information about the presence, type, and extension of the pathologic process. This helps to optimally solve the therapeutic policy problems and adequately plan surgical intervention.