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Background: Epidemiologic studies on deep-vein thrombosis (DVT) have been mainly confined to the inpatient population. The aim of this study was to investigate the association between DVT and acquired risk factors in a large cohort of outpatients with clinically suspected DVT. Methods: Consecutive outpatients with clinically suspected DVT were enrolled in the study. Before objective testing, all patients were interviewed by a trained physician for the presence of risk factors for DVT development. Subsequently, the presence or absence of DVT was assessed with venography. Results: Approximately 50% of cases of DVT were considered to be secondary to a major risk factor (immobilization, trauma, and/or recent surgery). Among additional risk factors, only increased age (over 60 years), male gender, malignant neoplasm, heart failure, systemic lupus erythematosus, and arteriopathy were independently associated with the risk of acute DVT. Conclusion: Major risk factors for venous thromboembolism are a common cause of DVT among symptomatic outpatients; therefore, the usefulness of extending DVT prophylaxis in the outpatient setting should be tested. The role of additional risk factors in the development of DVT needs to be established by properly designed studies.

* Background.--Serial testing with impedance plethysmography or compression ultrasonography has been demonstrated to be feasible and accurate for the detection of deep vein thrombosis (DVT) in symptomatic outpatients, and these techniques are replacing contrast venography in this patient category. Limited data, however, are available on the clinical utility of these noninvasive tests in symptomatic hospitalized patients. The objectives of our study were to determine the feasibility of ascending contrast venography and to evaluate the accuracy of these two noninvasive methods for the detection of DVT in symptomatic hospitalized patients. Methods.--A prospective, 'blind' comparison of impedance plethysmography and compression ultrasonography with ascending contrast venography was performed in consecutive hospitalized patients with clinically suspected DVT of the leg. Results.--Of the 127 potentially eligible patients, 44 had to be excluded; 25 of these could not undergo venography (feasibility of venography, 80.3%). The sensitivity, specificity, and positive and negative predictive values of impedance plethysmography for proximal DVT were 96%, 83%, 82%, and 97%, respectively. For compression ultrasonography, these measures for proximal DVT were 97%, 86%, 87%, and 97%, respectively. The overall prevalence of DVT was 53%, of which 85% was located proximally. Conclusions.--Contrast venography cannot be performed in about 20% of consecutive symptomatic patients. Both impedance plethysmography and compression ultrasonography are feasible and valid alternatives to contrast venography in the diagnostic treatment of these patients. (Arch Intern Med. 1992;152:1901-1903)

Deep-vein thrombosis (DVT) of the legs occurs when blood clots form in the veins of the legs. Preoperative diagnosis is required to locate and characterize these clots. This is usually done using venography, a technique for X-raying veins. Venography requires the injection of a contrast material to help visualize the clot. These contrast materials can cause side effects, including the development of blood clots in the veins. There are two main types of contrast materials, high-osmolar and low-osmolar. Studies have shown that the high-osmolar materials are more likely to cause side effects. This study examined the use of the low-osmolar, nonionic material, iohexol, to evaluate its effectiveness and to determine the amount and kinds of side effects it produced. Venography using iohexol was performed on 463 patients. They were subsequently examined for side effects. Eighty-three patients reported minor side effects including pain in the foot, nausea, dizziness, edema (accumulation of fluids in tissues), and itching. Two patients suffered serious side effects (bronchospasm, a spasm of the airways). A subset of 41 patients were examined for fibrinogen uptake as an indicator of blood clot formation. Although 10 of these patients tested positive, further examination showed that only one patient had formed new clots. The results reported here were comparable to those of previous studies showing a low incidence of blood clot formation when low-osmolar materials were used, and the incidence of new blood clots was much lower than has been reported with high-osmolar contrast agents. Iohexol was associated with less discomfort than many of the other materials used. These results indicate that iohexol is a safe and effective contrast material for use in venography. (Consumer Summary produced by Reliance Medical Information, Inc.)

The development of engineered tissues represents a new therapeutic possibility in the treatment of chronic ulcers of the lower limbs in a diabetic patient. In our experience this tissue consists [...]

Background: Diabetic foot infection (DFI) is a serious, difficult-to-treat infection, especially when caused by methicillin-resistant Staphylococcus aureus(MRSA). Vancomycin has been the standard treatment for MRSA infection, but lower response rates in MRSA skin infections have been reported. This analysis assessed the outcome and safety of daptomycin therapy in patients with a DFI caused by MRSA.Methods: Using the Cubicin Outcomes Registry and Experience and the European Cubicin Outcomes Registry and Experience (2006–2009), 79 patients with MRSA DFI were identified and included in this analysis.Results: In the 74 evaluable patients, daptomycin was administered at a median dose of 4.8 mg/kg primarily every 24 hours (85.1) and for a median of 15.0 days. Overall, 77.0 of the patients (57 of 74) received initial therapy with activity against MRSA; however, of patients receiving daptomycin as second-line therapy (n 31), only 45.2 were treated with an antibiotic agent active against MRSA. The overall clinical success and treatment failure rates were 89.2 and 10.8, respectively. Success with daptomycin therapy was higher in patients who had surgery and in those whose initial therapy was daptomycin. Eleven patients had 14 adverse events, two of which were possibly related to daptomycin use and led to discontinuation.Conclusions: In a large real-world cohort of patients with MRSA DFI, daptomycin therapy was shown to be generally well tolerated and effective. The use of an anti-MRSA antibiotic agent should be considered when implementing first-line antibiotic drug therapy for DFI in countries where MRSA is common to avoid inappropriate empirical treatment and potential negative effects on outcomes.

Deep-vein thrombosis of the lower extremity is a frequent disorder associated with morbidity and mortality due to pulmonary embolism and the postthrombotic syndrome. It was not until the introduction of contrast venography that the inaccuracy of the clinical diagnosis became apparent. Since then, management decisions have usually been based on objective diagnostic test. Venography is generally considered the reference method for the diagnosis of deep-vein thrombosis, but it is invasive and associated with serious side effects. Several noninvasive or less invasive objective diagnostic methods have been developed. These diagnostic methods are distinctly different in technology and consequently in their ability to demonstrate or refute deep-vein thrombosis. In this review, a critical analysis is provided on the accurary of the current noninvasive diagnostic approaches to venous thrombosis in patients with a first episode of clinically suspected deep-vein thrombosis. Results of studies were considered only when their methodology fulfilled the essential criteria for evaluation of a diagnostic test.