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Mahjoubi MF, Rezgui B, Mabrouk A, Essid N, Jedidi L, Ben Moussa M. Spontaneous gas gangrene of the lower limb in a patient with rectal cancer: A fatal diagnostic pitfall. Clin Case Rep 2022; 10:e6311. [PMID: 36177081 PMCID: PMC9474909 DOI: 10.1002/ccr3.6311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/11/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Spontaneous gas gangrene of lower limb is rare. It may complicate digestive cancer or neutropenia. We report a case of spontaneous gas gangrene of the lower limb complicating a rectal cancer, initially diagnosed as deep vein thrombosis. The diagnostic delay was fatal.
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Affiliation(s)
- Mohamed Farès Mahjoubi
- Department of Surgery ACharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Bochra Rezgui
- Department of Surgery ACharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Aymen Mabrouk
- Department of Surgery ACharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Nada Essid
- Department of Surgery ACharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Laila Jedidi
- Department of Surgery ACharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of SousseUniversity of SousseSousseTunisia
| | - Mounir Ben Moussa
- Department of Surgery ACharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
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Salvi A, Nitti C, Fabbri A, Groff P, Ruggiero EG, Agnelli G. Diagnosis and Treatment of Deep Vein Thrombosis in the Emergency Department: Results of an Italian Nominal Group Technique Study. Clin Appl Thromb Hemost 2021; 26:1076029620959720. [PMID: 33112649 PMCID: PMC7791439 DOI: 10.1177/1076029620959720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Early diagnosis and treatment of deep vein thrombosis (DVT) is a main issue in
the Emergency setting. With the aim of assisting clinicians in the diagnosis and
the subsequent management of DVT in the Emergency Departments, a Nominal Group
Technique (NGT) study was conducted. A panel of 5 Italian experts developed 21
consensus statements based on available evidence and their clinical experience.
The agreed consensus statements may assist clinicians in applying the results of
clinical studies and clinical experience to routine care settings, providing
guidance on all aspects of the risk assessment, prophylaxis, early diagnosis and
appropriate treatment of DVT in the EDs.
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Affiliation(s)
- Aldo Salvi
- Emergency Department, 18494"Ospedali Riuniti Ancona", Ancona, Italy
| | - Cinzia Nitti
- Emergency Department, 18494"Ospedali Riuniti Ancona", Ancona, Italy
| | - Andrea Fabbri
- Emergency Department, "Presidio ospedaliero Morgagni-Pierantoni", Forlì, Italy
| | - Paolo Groff
- Emergency Department, 18633"Azienda ospedaliera di Perugia", Perugia, Italy
| | | | - Giancarlo Agnelli
- Internal and Vascular Medicine-Stroke Unit, 9309University of Perugia, Perugia, Italy
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Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2020; 61:9-82. [PMID: 33334670 DOI: 10.1016/j.ejvs.2020.09.023] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Riporto VA, Lefebvre T, Bertoletti L, Martinez M. Follow-up of guidelines and impact on the management of suspected deep vein thrombosis in emergency departments. JOURNAL DE MEDECINE VASCULAIRE 2020; 45:326-333. [PMID: 33248535 DOI: 10.1016/j.jdmv.2020.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Abstract
AIMS To evaluate the implementation of the European Society of Cardiology (ESC) guidelines concerning the diagnostic management of deep vein thrombosis (DVT) in emergency departments (ED); and to estimate the additional financial cost and the increase in the time spent in the ED if the guidelines are not followed. PATIENTS AND METHODS Retrospective, bi-centric study including all patients directly admitted or referred to the ED for a suspected isolated DVT, between April 1, 2019, and July 30, 2019. The diagnostic management was compared to the 2017 ESC's guidelines. RESULTS 107 patients were included, 13 had DVT (12%) and three had superficial venous thrombosis (3%). A total of 26 patients (24%) had a diagnostic management according to guidelines. In 72 patients (67%), no assessment of clinical probability score was found. Among the 35 patients in whom a clinical probability score was calculated, 5 patients had an unnecessary D-dimer assay and 2 patients had unjustified imaging. The median time spent in the ED was 185minutes when the recommendations were followed, and 250minutes when they were not (P=0.317). The total estimated additional cost was €232.20. CONCLUSION The rate of adherence to the guidelines is low, mainly due to the absence of calculation of a clinical probability. This leads, in addition to the risk of diagnostic error, to an increase in the time spent in the EDs and inappropriate use of the technical platform, resulting in additional costs of care.
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Affiliation(s)
- V-A Riporto
- Pôle Urgences, centre hospitalier du Forez, BP 219, 42605 Montbrison, France
| | - T Lefebvre
- Réseau d'urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - L Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne; inserm, UMR1059, Université Jean Monnet; inserm, CIC-1408, CHU de Saint-Etienne; INNOVTE, CHU de Saint-Étienne, 42055 Saint-Etienne, France
| | - M Martinez
- Pôle Urgences, centre hospitalier du Forez, BP 219, 42605 Montbrison, France; Réseau d'urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France.
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Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases. Diagnostics (Basel) 2020; 10:diagnostics10060355. [PMID: 32485855 PMCID: PMC7344462 DOI: 10.3390/diagnostics10060355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. METHODS An observational study with retrospective data analysis. MATERIALS Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. RESULTS In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen's kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. CONCLUSIONS TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
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Prospective study comparing the rate of deep venous thrombosis of complete and incomplete lower extremity venous duplex ultrasound examinations. J Vasc Surg Venous Lymphat Disord 2019; 7:882-888. [DOI: 10.1016/j.jvsv.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/25/2019] [Indexed: 02/06/2023]
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Ng AH, Gupta E, Bianty J, Williams JL, Bruera E. Calf measurements screening for deep vein thrombosis in acute inpatient cancer rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Cancer patients have a fourfold increase in the frequency of thrombosis and it is a common cause of death. The purpose of this study was to review the impact of calf measurements during initial admission to an inpatient rehabilitation unit to detect deep vein thrombosis. Methods: During inpatient admission to a rehabilitation unit, calf measurement assessments were performed by nursing staff. The nurses were instructed to notify clinicians for an order for a venous Doppler ultrasound if the difference between the two calves was greater than 3 cm. Findings: A total of 374 patients were admitted to the inpatient cancer rehabilitation unit over 12 months. Only six patients (2%) did not have their calves measured, with a 98% compliance of measurement. Only two patients (0.5%) had a difference in calf measurement and clinical exam significant to warrant a venous Doppler ultrasound. Both cases were negative for thrombosis. Venous Doppler ultrasounds were performed in 63 (17%) patients before admission to the rehabilitation unit. During the rehabilitation stay, venous Doppler ultrasounds were performed on 44 (12%) patients, with 10 (3%) patients identified with having deep vein thrombosis. Conclusions: This study suggests that calf measurements at admission to a rehabilitation unit were unable to detect deep vein thrombosis in this cancer population. Venous Doppler ultrasounds were ordered and identified additional patients who had deep vein thrombosis.
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Affiliation(s)
- Amy H Ng
- Assistant Professor, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Ekta Gupta
- Assistant Professor, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Josephine Bianty
- Coordinator, Clinical Care, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Janet L Williams
- Manager, Clinical Data Management Systems, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Eduardo Bruera
- Chair, Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Martinez M, Duchenne J, Bobbia X, Brunet S, Fournier P, Miroux P, Perrier C, Pès P, Chauvin A, Claret PG. Deuxième niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
La Société française de médecine d’urgence a élaboré en 2016 des recommandations formalisées d’experts définissant le premier niveau de compétence en échographie clinique en médecine d’urgence. Ce niveau est maintenant complété par un deuxième niveau correspondant à une pratique plus avancée utilisant des techniques non envisagées dans le premier niveau comme l’utilisation du Doppler et nécessitant aussi une pratique et une formation plus poussées. Des champs déjà présents dans le premier référentiel sont complétés, et de nouveaux champs sont envisagés. La méthodologie utilisée est issue de la méthode « Recommandations par consensus formalisé » publiée par la Haute Autorité de santé et de la méthode Delphi pour quantifier l’accord professionnel. Ce choix a été fait devant l’insuffisance de littérature de fort niveau de preuve dans certaines thématiques et de l’existence de controverses. Ce document présente les items jugés appropriés et inappropriés par les cotateurs. Ces recommandations définissent un deuxième niveau de compétence en ECMU.
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