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