Venous thrombosis and pulmonary embolism / Michael Hume, Simon Sevitt [and] Duncan P. Thomas.

Format:

• Book

Author/Creator:

• Hume, Michael, 1924-
• Sevitt, Simon, author.
• Thomas, Duncan P., 1929- author.

Language:

English

Subjects (All):

• Thromboembolism.
• Pulmonary Embolism.
• Pulmonary embolism.

Medical Subjects:

• Pulmonary Embolism.
• Thromboembolism.

Physical Description:

xiii, 456 pages : illustrations ; 25 cm

Place of Publication:

Cambridge : Harvard University Press, 1970.

Summary:

This volume, representing the combined efforts of a surgeon, a pathologist, and an internist, is the first comprehensive survey of the subject in many years. Interpreting anatomic, experimental, and clinical data the authors present the subject as a single disease--venous thromboembolism--with pulmonary embolism as its most important complication. Incidence, pathogenesis, clinical manifestations, diagnosis, and management have been dealt with throughout in a way that will acquaint the student with the fundamentals of the disease, the practitioner with current laboratory progress, and the research scientist with the most compelling unsolved problems in clinical management. A significant and lucidly written study, the monograph is thoroughly referenced and illustrated and includes a bibliography at the end of each chapter.

Contents:

• 1 Incidence and Importance of Thromboembolism 1
• Magnitude of the problem 2
• Frequency of deep vein thrombosis 5
• Pulmonary embolism 8
• Is pulmonary embolism increasing? 14
• Geographic and allied factors 17
• Inevitable and potentially preventable deaths 20
• 2 Pathology of Venous Thrombosis 25
• Thrombus growth and evolution 26
• Appearance and structure of thrombi 28
• Histological structure 29
• Platelet aggregates 31
• Valve-cusp thrombi and nidus structure 32
• Location and frequency of thrombi 35
• Frequency of thrombi in leg, thigh, and pelvic veins 37
• Sites of primary thrombosis 39
• Ageing and resolution of thrombi 41
• Leucocytes 41
• Thrombolysis 42
• Red cells and hemosiderin 43
• Platelet phagocytosis and foam cells 44
• Organization and canalization 45
• Mural thrombi 45
• Occlusive thrombi 46
• Source of cells 50
• 3 Predisposing Factors 54
• Sex 55
• ABO blood group 55
• Age 56
• Immobility and bedrest 57
• Age and bedrest combined 59
• Previous thromboembolism 60
• Obesity 60
• Medical and surgical 61
• Heart disease 62
• Cancer 63
• Operation 65
• Trauma 66
• Pulmonary embolism after injury 67
• Paralysis 67
• Tetanus 68
• Pregnancy and the puerperium 69
• Oral contraceptives 71
• Tuberculosis 74
• Ulcerative colitis 75
• Other possible associations 75
• Seasonal variation 75
• Anemia 75
• Polycythemia 76
• Thyroid disease 76
• Idiopathic thrombosis and embolism 76
• 4 Mechanisms of Venous Thrombosis 85
• Vein wall 86
• Venous anatomy 87
• Soleal veins 88
• Gastrocnemius veins 89
• Posterior tibial and peroneal veins 89
• Anterior tibial veins 90
• Popliteal and superficial femoral veins 90
• Common and profunda femoral veins 90
• Iliac veins 91
• Turbulence 92
• Venous stasis 94
• Extreme local stasis 95
• Changes in the blood 96
• 5 Experimental Venous Thrombosis 109
• Coagulation 109
• Hemostasis 111
• Platelet aggregation 112
• Experimental thrombosis 114
• Thrombi in vitro 114
• Thrombi in extracorporeal shunts 115
• Studies in vivo 115
• Serum-induced stasis thrombi 118
• ADP and stasis thrombi 120
• Reactions of the vessel wall to thrombi 121
• 6 A Unified Concept of Pathogenesis 125
• Nidus formation 125
• Stabilization and propagation 128
• Role of fibrinolysis 129
• Retrograde extension 130
• Clotting factors in venous thrombogenesis 130
• Activation at a distance 131
• Venous thrombosis without stasis 132
• Clearance of activated clotting factors 133
• 7 Silent Thrombosis and Unheralded Embolism 135
• Silent thrombosis 136
• Factors influencing silent and clinical thrombosis 137
• Effect of gravity 139
• Unheralded embolism 140
• Frequency of embolism from silent thrombosis 141
• 8 Clinical Features of Venous Thrombosis 144
• Symptoms 144
• Past history 145
• Constitutional signs 146
• Swelling 146
• Local tenderness 148
• Dorsiflexion of the foot 149
• Warm leg 150
• Cuff pain test 151
• Venous claudication 151
• Special forms of thrombosis 152
• Phlegmasia alba dolens 152
• Phlegmasia cerulea dolens 153
• Special points in pathogenesis 154
• Superficial thrombophlebitis 155
• Thrombophlebitis migrans 156
• "False phlebitis" 156
• Arm swelling due to venous obstruction 158
• Mondor's disease 159
• Suppurative thrombophlebitis 160
• Thrombosis of the inferior vena cava 160
• 9 Phlebography and Other Aids to the Diagnosis of Venous Thrombosis 165
• Phlebography 165
• Technique 165
• Indications 168
• Interpretation 170
• Complications 178
• Preferential localization of isotopes in propagating venous thrombosis 178
• Doppler-effect flowmeter 180
• Impedance plethysmography 181
• Venous pressure 181
• Thermography 182
• Blood tests 182
• 10 Statistical Applications to the Study of Venous Thrombosis 186
• Selection of a subset of variables 186
• Discriminant function 189
• 11 Pathology of Pulmonary Embolism 194
• Morbid anatomy 195
• Major emboli 195
• Minor emboli 198
• Secondary thrombosis 200
• Multiplicity and distribution of emboli 200
• Recurrent embolism 201
• Paradoxical embolism 202
• Source of the emboli 204
• Source in clinical thrombosis 206
• Thrombus detachment 206
• Complications 207
• Infarction 208
• Pulmonary edema 211
• Fate of emboli 212
• Thrombolysis 213
• Organization 214
• Atheromatous plaques 215
• Fibrous bands and webs 217
• Sequelae 220
• Bronchopulmonary and other lung anastomoses 220
• Chronic pulmonary hypertension 223
• 12 Pulmonary Microembolism 230
• Arterial microthrombi 230
• Significance and importance 232
• Capillary microthrombi 233
• Hemorrhage and trauma 238
• Burns 239
• Anaphylaxis 240
• Bacterial endotoxin 240
• Pathogenesis of capillary microthrombosis 241
• Significance and importance of capillary microthrombi 245
• Irreversible shock 247
• By-pass surgery and microembolism from transfused blood 247
• 13 Physiological Studies on Pulmonary Embolism 252
• Cardiovascular reactions 253
• Effect of heparin and the role of platelets 256
• Pulmonary function 257
• Pulmonary ventilation and perfusion after embolism 257
• Clinical application 259
• Humoral mechanisms 260
• Physiological effects of pulmonary microembolism 268
• Foreign-body microembolism 269
• Platelet microembolism 270
• Thrombolysis 272
• 14 Clinical Features of Pulmonary Embolism 279
• Massive embolism 279
• Lobar, multiple, and micro-embolism 281
• Symptoms and signs 282
• Dyspnea and tachypnea 282
• Chest pain 282
• Cough, hemoptysis, and chest signs 283
• Cyanosis, tachycardia, fever 283
• Cardiovascular signs 284
• Clinical syndromes of embolism and differential diagnosis 285
• Pneumonic syndrome 285
• Acute hypotension 286
• Acute congestive failure and cor pulmonale 287
• Sudden collapse 287
• Gradual deterioration 287
• Pulmonary infarction 288
• Abcess formation 288
• Embolic detachment 288
• Day of onset of embolism 288
• Embolism in clinical thrombosis 289
• Aids to diagnosis 290
• Electrocardiography 290
• Pulmonary function studies 293
• Enzyme studies 294
• The approach to diagnosis 295
• Major symptoms 296
• Massive embolism 296
• 15 Radiology and Lung Scanning in Diagnosis of Pulmonary Embolism 299
• Radiology in pulmonary embolism 299
• Massive pulmonary embolism 300
• Plain films 300
• Angiography 307
• Emboli in branch arteries 312
• Plain films 312
• Angiography 313
• Small peripheral embolism and chronic pulmonary hypertension 315
• Plain films 315
• Angiography 315
• Pulmonary thrombosis 319
• Veno-occlusive disease 319
• Radioisotope lung scanning 319
• Pulmonary embolism 320
• Branch embolism 323
• Differential diagnosis with angiography and lung scanning 323
• 16 Prevention of Venous Thrombosis and Pulmonary Embolism 328
• Physical activity 329
• Clinical experience 329
• Prophylactic calf muscle contraction during surgery 331
• Elastic compression of the limbs 332
• Anticoagulant prophylaxis 333
• Early trials 333
• Controlled trials 333
• Indications 334
• Trauma 335
• Burns 337
• Orthopedic surgery 337
• Gynecologic surgery 338
• Thoracic cardiac surgery 338
• Abdominal and other surgery 339
• Preoperative institution of prophylaxis 340
• Pregnancy and the puerperium 341
• Medical cases 341
• Short-term heparin prophylaxis 343
• Prophylaxis with dextran 343
• Clinical experience 344
• Dextran and oral anticoagulants 346
• Other agents 346
• Streptokinase 347
• Anti-platelet agents 347
• 17 Medical Treatment 354
• Anticoagulant therapy 354
• Heparin 354
• Administration 357
• Dosage 359
• Duration of therapy for pulmonary embolism 360
• Treatment of venous thrombosis 361
• Oral anticoagulant therapy 362
• Thrombolytic therapy 362
• Experimental thrombolysis 363
• Human studies 364
• Dextran therapy 368
• Therapeutic defibrination 371
• Platelet active agents 372
• Ancillary and supportive
• treatment 373
• Pulmonary embolism 373
• Venous thrombosis 373
• 18 Oral Anticoagulant Therapy 380
• History 380
• Properties of coumarin and indanedione drugs 381
• Pharmacology 383
• Hypoprothrombinemia 384
• Effects on platelets 384
• Other properties 385
• Drugs in common use 386
• Nicoumalone 386
• Sodium warfarin 386
• Phenindione 387
• Dicumoral 388
• Phenprocoumon 388
• Laboratory tests for control of dosage 388
• Prothrombin time (one stage test) 389
• Thromboplastin 393
• Thrombotest 395
• Therapeutic aims and range 397
• Partial thromboplastin time 398
• The balance between antithrombotic action and hemorrhagic complications 399
• Factors influencing therapeutic dosage and response 400
• Effect of certain drugs 401
• Drug resistance 403
• Hemorrhagic complications 403
• Types of hemorrhage 404
• Frequency of hemorrhage 405
• Avoidable hemorrhage 405
• Management of hemorrhage 406
• Contra-indications to anticoagulant therapy 407
• General management 408
• Emotional reactions 409
• Centralized control of therapy 410
• 19 Surgical Management 414
• Phlegmasia alba dolens 414
• Phlegmasia cerulea dolens 418
• Arm vein thrombosis 418
• Superficial thrombophlebitis 419
• Surgery for pulmonary embolism 419
• Suppurative thrombophlebitis with pulmonary embolism 420
• Vein interruption as prophylaxis 421
• Surgery preferred over anticoagulants for the control of overt thrombosis and embolism 422
• Anticoagulants positively contraindicated 422
• Failure of anticoagulants 423
• Choice of ligation site 424
• Caval septation, plication, and clipping 425
• Embolization after ligation 427
• Pulmonary embolectomy 427
• 20 Chronic Venous Insufficiency 438
• Management of chronic venous insufficiency 439
• Local care of venous ulcers 440
• Relief of venous hypertension 440
• Bedrest 440
• Local compression 441
• Interruption of perforating veins 442
• Injection therapy 443
• Cross-over grafts of veins 444
• Lymphedema secondary to venous thrombosis 444
• Surgery 444.

Notes:

• "A Commonwealth Fund book.".
• Includes bibliographies.

ISBN:

0674933206

OCLC:

136256