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There is more numerous number of patients in the different age rangesubmit to the general physician. They are transfer to the angiologist or to the vascular surgeon then. The oedema of the lower limb is not only an aestehtic problem. It can be very difficult and in the extreme cases can lead to trobles with move, especially in older patients. The causes of the oedema of theb lower limb can be very deiversed, from trivial caused by the injury to the very serious like phlegmasia coerulea dolens.

Venous thromboembolism and associated complications often leading to permanent disability or death are an important problem in modern medicine. Congenital or acquired disorders of the hemostatic system, such as hypercoagulation or thrombophilia, predispose to thrombosis. The aims of the study were as follows: 1. To assess the prevalence of thrombophilia in venous thromboembolism and in healthy subjects by testing resistance to activated protein C and other markers of hemostasis; 2. To screen for factor V Leiden with a PCR-based assay; 3. To evaluate the usefulness of the adopted analytical approach for the detection of thrombophilia in clinical practice. 29 patients (17 females and 12 males) with venous thromboembolism and a history of thrombotic episodes before the age of 40, either idiopathic or associated with protracted immobilization, pregnancy or puerperium, were enrolled in the study. The control group consisted of 25 age-matched healthy subjects (14 females and 11 males) without any history of thrombosis. The following hemostatic parameters were measured: 1. Activated protein C resistance (APC-R); 2. Protein C (PC) and antithrombin III (AT III) activities; 3. Protein S (PS) activity; 4. Fibrinogen (FB) concentration; 5. Euglobin lysis time (ELT); 6. Prothrombin time (PT); 7. Activated partial thromboplastin time (APTT). The presence of Leiden mutation was detected by PCR amplification and digestion of products with Mnl 1 restrictase. The results were tested statistically using: 1. Kolmogorov-Smirnov D test; 2. Student's t-test; 3. linear regression analysis; 4. chi 2 test. The following conclusions were drawn: 1. Prevalence of thrombophilia in patients with venous thromboembolism is 31%, a figure consistent with literature data (no signs of thrombophilia were found in the control group); 2. Resistance to activated protein C is sufficient proof of Leiden mutation provided that APCR index (r) is less than 0.9 (borderline r values (0.9-1.1) require further genetic testing). 3. Methods of diagnosis of thrombophilia used in this study could be applied in routine clinical practice, the most useful ones being resistance to activated protein C, fibrinogen concentration and protein S activity. With this approach the detection of higher risk of thrombotic-embolic episodes, either acquired or inborn, is possible in most cases.

Eleven cases (5 F + 6 M; mean age 48.0 years) of acute noninflammatory renal failure (ANRF) in the course of rhabdomyolysis (RBM) were treated with hemodialysis in years 1995-1999. The causes of RBM were the following: ischemia of lower limbs after vascular operations (4 cases), exhausting exercise with rapid body cooling (3 cases), multiorgan failure after traffic accident, acute myositis (1 case), status epilepticus (1 case), rapid clinical course of viral infection (1 case). It was necessary to perform from 1 to 13 hemodialyses in every patient. In nine cases, complete normalization of renal function during 5 to 30 days of therapy was achieved. Two patients died due to multiorgan complications after vascular operations despite effective dialysis therapy. The following correlation were found: positive between initial values of creatine phosphokinase (CPK) activity and creatinine and uric acid concentrations in the blood and negative correlation between CPK and serum calcium concentrations. The higher initial values of CPK activity were observed the more hemodialysis procedures were necessary and the longer time was needed to normalize renal function. On the base of initial, limited up to now, own results it seems that hemodialysis in ANRF in the course of RBM should be started immediately in cases with high activity of CPK in the blood (above 10,000 U/L).

Switching from heparin to acenocoumarol was complicated by severe retroperitoneal bleeding in a 50-years old patient with massive pulmonary embolism and deep venous thrombosis. The haematomas were evacuated by surgical procedure. Planned insertion of a vena cava filter was abandoned because of a mobile clot in inferior vena cava (IVC) reaching above renal veins as evidenced by spiral computed tomography (SCT). Patient was transferred to the Surgical Department of Medical Academy in Warsaw where thrombectomy was performed. In spite of mechanical and pharmacological methods of venous thrombosis prophylactic, thrombectomy was complicated by massive proximal deep venous thrombosis of right leg and distal part of IVC. Patient was successfully treated with UFH i.v. followed by low molecular weight heparins. No bleeding complications were observed. Screening for thrombophilia and cancer were negative. This case report is an example of difficulties in clinical management in a patient who has both life-threatening thromboembolic disease and bleeding.

Intraluminal caval filter placement can be applied in order to prevent pulmonary embolism. When surgery has to be performed in the patient with proximal deep venous thrombosis anticoagulant therapy should be reduced and filter placement is indicated. Temporary filter appears an interesting option, as it can be removed shortly after surgical intervention, when contraindications to anticoagulation no longer exist. However, obligatory removal of a temporary device in case of suspected filter or vena cava thrombosis emerges as a new clinical problem. We present a ease of 20 year old woman with proximal deep venous thrombosis and high risk of pulmonary embolism in whom temporary vena caval filter with heparin infusion were chosen as a method of perioperative pulmonary embolism prevention.

The aim of the study was to assess effectiveness and safety of the LGM inferior vena cava (IVC) filters in patients with venous thromboembolic disease. In the Department of Internal Medicine of Institute of Tuberculosis and Lung Diseases in Warsaw 79 LGM IVC filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (pe) despite anticoagulation--17 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy--11 pts, contraindications for thrombolytic and/or anticoagulant treatment--5 pts, massive pe--14 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)--30 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery--24 pts. Each filter placement was preceded by cavography. The diagnostic procedures (mainly ultrasonography) were performed after 3-6 and 12 months in the first year then once yearly during follow-up period. Oral anticoagulants (OA) or low-molecular-weight heparins (LMWH) were instituted in the majority of patients. 58 patients are still alive, 21 patients died. Only two non-fatal episodes of recurrent pe were documented. Other complications were rare and insignificant. We have not observed excess rate of recurrent deep venous thrombosis nor thrombosis at the filter site. The LGM IVC filters are effective and safe in such selectively chosen group of patients.

The authors present a case of 75-year old female, who has suffered from venous insufficiency crural ulcerations and lost hope for any relief for 50 years. Hospitalisation for a femur fracture has been a turning point. The patient learnt that modern medicine can treat disease that she suffered from for most of her life.

The paper present a case of 45 years old woman following laparoscopic cholecystectomy (empyema of gall bladder) who died 6 days after operation. The patient were operated 16 years ago account of aortic coarctation. In the post-operative (laparoscopic cholecystectomy) periods cardiovascular and respiratory complications were observed, and cured in intensive Care Department. The case of sudden death was massive pulmonary embolism confirmed by autopsy. The author think, that thrombosis came from venous vessels of pelvic or legs.

In 18 patients with proximal deep venous thrombosis (PDVT) confirmed by phlebography, no symptoms and signs of pulmonary embolism (PE) were observed. All patients were treated with nadroparin. During first 6 days of treatment in all patients perfusion lung scans were performed. 8 patients (44.4%) of all group developed lung scans positive for PE (silent PE). Period of successful treatment of PDVT was 10 days. No evidence of recurrent PE were observed during the period of treatment. We conclude that: 1. Frequency of silent PE in patients with PDVT is very high-lack of symptoms and signs of PE does not exclude the presence of PE in this group of patients. 2. In all patients with PDVT perfusion lung scan should be performed even in cases with no symptoms and signs of PE. 3. Low molecular weight heparins administered subcutaneously are effective in treatment either silent PE or PDVT.

43-year old woman, with considerable overweight had been admitted to Intensive Medical Care Unit with suspicion of pulmonary embolism (PE). The patient had the limb immobilized in gypsum for last several weeks. This episode was tangled with recurrent thrombosis of deep veins in the left limb, treated with heparin and oral anticoagulants irregularly without sufficient control. Taking into consideration the data of anamnesis, clinical picture and the results of ECG, chest X-ray, gasometric and echocardiographic examination we got much closer to the recognition of PE. Our suspicion of PE was confirmed by the result of pulmonary angiography. Indications for thrombolytic treatment (r-tPA) had been established. During the following hours considerable improvement of general state was observed. The therapy was continued with constant drip infusion of heparin. No prolongation of therapeutic PTT was observed. The deficit of AT III was diagnosed. In this situation the patient was given AT III to obtain normalization of its level and therapeutic extension of PTT. Therefore there were settled indications for the operation of uterus with myoma changes. As the rich thrombolytic material in the leg's vein was found the patient was implanted LGM Filter, with excellent prophylactic effect (no PE in perioperative period). The clinical course of our case enabled to present most of diagnostic, therapeutic and preventive methods applied in venous thromboembolism.

A case of 72 years old man, diabetic, suffering from phlegmonous cellulitis with orbital veins and sinus cavernous thrombophlebitis as a nasal vestibule furuncle complication is presented. Apart from the application of antibiotics and surgical procedure, the patient was treated from beginning with thrombolytics specimen, fraxiparine. The methods of treatment of cavernous sinus thrombosis with thrombolytic specimens evoke in the literature controversial opinions. In the author's opinion the early application of fraxiparine in presented case could be regarded as responsible for stopping the process orbital veins and sinus cavernous thrombosis and even causing it to recess. The complete cure without complications (e.g. blindness) is attributed by the authors to the anticoagulation treatment. The authors also stress that fraxiparine may by used for treatment of cavernous sinus thrombophlebitis even when the surgical procedure is planned.

Among the risk factors of venous thromboembolism malignant neoplasms play a very important role. 43-years old man with adenocarcinoma of the lung, neoplasmatic cardiac tamponade and recurrent deep venous thrombosis has been presented. The pitfalls in diagnosis and particularly in treatment of venous thromboembolism in cancer-patients have been discussed.

A decreased plasma antithrombin III activity has been noted in 12 out of 20 patients. In 2 patients it was most probably congenital defect, whereas in the remaining 10 patients--acquired. The observed disorders in the activity of antithrombin III with particular reference to anticoagulant therapy have been discussed.

The study was carried out of 53 patients with acute myocardial infarction receiving no anticoagulant treatment. Changes were traced in certain indices of the blood clotting system and fibrinolysis in plasma in the first 14 days of the disease, with particular attention given to patients in whom during the hospitalization signs of deep vein thrombosis in the lower extremities appeared or a positive result was obtained of the test with 125I-fibrinogen. In a group of 9 patients with deep vein thrombosis developing during the observation, on the first day of myocardial infarction shortening of the kaolin-cephalin clotting time and considerable rise of the level of fibrinogen-fibrin (FDP) degradation products were noted in serum, and on the 14th day raised fibrinogen level and reduced exogenous fibrinolytic activity of the plasma were noted. Increased level of fibrinogen and FDP and exogenous and endogenous plasma fibrinolytic activity observed on the 7th day of the disease were not related to the development of thrombotic complications. The thrombin clotting time, platelet count, factor X level, protein C concentration and antithrombin III activity in the plasma were not significantly changed during myocardial infarction. The obtained results suggest a limited usefulness of the basic tests of the clotting and fibrinolytic systems for early diagnosis of deep vein thrombosis in acute myocardial infarction.

In 49 patients with insulin-resistant diabetes, with ischaemia of the lower extremities blood viscosity was measured at low coagulation rates and plasma viscosity was determined also. Moreover plasma measurements were done of total lipids, alpha-, pre-beta-, and beta lipoproteins, triglycerides, total cholesterol, free fatty acids, and, besides that, the hematocrit was measured. Immediately after blood sampling for rheological and biochemical investigations the distance of intermittent claudication was measured. A rather considerable increase of blood and plasma viscosity was noted in the patients in comparison with controls, other findings included disturbances of lipid metabolism, increased fibrinogen level, and a negative correlation between the distance of intermittent claudication and blood and plasma viscosity.

A 38-year-old male patient was admitted to a neurosurgical hospital department because of hemiparesis and speech disturbances which had developed during an acute febrile disease. In view of supposed brain tumour the patient had been given prior to admission to the neurosurgical department high doses of dehydrating agents which resulted in high grade dehydration of the patient. During 10 days it was possible to achieve compensation of water and electrolyte disturbances and simultaneously hemiparesis regressed and function of speech improved. Angiography ruled out presence of brain tumour. The patient had no neurological disturbances during follow-up examination 6 months after discharge from the hospital. In the case the cerebral distrubances were due probably to venous thrombosis and intensive dehydrating therapy had contributed considerably to the severe condition of the patient.

In the reported case eye fundus changes and symptoms suggested initially increased intracranial pressure. The cause of choked disc was recognized relatively late, after phlebography. Thrombosis of the upper ophthalmic vein causes papilloedema with or without haemorrhages on the disc and around it. Vision may be normal or slightly impaired. There are no inflammatory changes in the orbital soft tissues or exophthalmos. Fundus changes are not different from those caused by raised intracranial pressure.