phenprocoumon and Pain

Neonatal renal vein thrombosis is a recognised cause of renal and inferior caval vein atresia (IVCA). However, the long-term impact of the condition is underrecognized with a high burden of morbidity for the patient, especially in adulthood. IVCA has been shown to be an independent risk factor for deep venous thrombosis (DVT) with a high risk of recurrence. The acronym KILT for kidney and inferior vena cava anomaly with leg thrombosis summarizes the pathological situation.. We present the case of a 40-year-old patient with pain in the right lower limb resulting from acute thrombophlebitis. No risk factors could be identified. His history was remarkable with two episodes of deep venous thrombosis first of the left, then the right leg 22 years earlier; at that time also, no risk factor was identified. Because of the idiopathic character of that thrombosis, the patient remained on long-term anticoagulation with phenprocoumon. The present thrombophlebitis occurred while the INR was not therapeutic in the preceding weeks. A CT with contrast showed atresia of the inferior vena cava and of the right kidney, and presence of numerous collaterals. A thorough medical history revealed a renal vein thrombosis as a neonate. Anticoagulation was intensified, and stent placement became necessary after a further 2 years.. KILT syndrome is a rare but underrecognized condition. Complications may arise in young adulthood only, and it is of prime importance to instruct parents of the pediatric patient of the possible consequences of renal vein thrombosis and to assure guidance from the treating physicians throughout adulthood. Diagnosis of IVCA is by CT with contrast or by MRI, and lifelong anticoagulation may be necessary. Since the KILT syndrome is widely underdiagnosed, we challenge the clinicians to keep it in mind when confronted with thrombophlebitis or thrombosis of the young, male and with no other identifiable risk factors for deep vein thrombosis.

Topics: Abbreviations as Topic; Adult; Anticoagulants; Follow-Up Studies; Humans; Infant, Newborn; Kidney; Leg; Male; Pain; Phenprocoumon; Renal Veins; Syndrome; Thrombophlebitis; Time Factors; Tomography, X-Ray Computed; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis

The effect of Arwin on peripheral arterial occlusive disease has been studied in two multicentre trials. In the first, in cases of severe peripheral arterial circulatory disorders of the lower extremities with permanent rest pain (stages III and III + IV according to Fontaine) Arwin had a better intravenous therapeutic effect than anticoagulant treatment. A further trial was done to investigate whether subcutaneous administration of Arwin would have an effect superior to classical conservative therapy with vasodilator drugs in this type of disease. The results were assessed by sequential analysis. Arwin was again shown to be a much better treatment. Problems of medical documentation and statistics are discussed in relation to the value of sequential analysis.

Topics: Ancrod; Arterial Occlusive Diseases; Blood Viscosity; Clinical Trials as Topic; Depression, Chemical; Drug Evaluation; Endopeptidases; Female; Fibrinogen; Heparin; Humans; Infusions, Parenteral; Injections, Subcutaneous; Male; Nicotinyl Alcohol; Pain; Phenprocoumon

Spontaneous internal carotid artery dissection (sICAD) occurs annually in 2.5 to 3 per 100,000 presenting with signs of ischemic events in the majority of cases. In contrast, lower cranial nerve palsy due to peripheral nerve affection is seldom the presenting clinical sign. In symptomatic cases (>90%), sICAD is most commonly accompanied by local pain. We report a case of a 49-year old woman with a left sICAD presenting with isolated ipsilateral hypoglossal palsy as the sole clinical sign. Compared to other cases, local pain was absent and other cranial nerves were not affected. Further, sICAD could not be detected in repeated Doppler-/Duplex-sonography, but magnetic resonance imaging and MR-angiography only.

Topics: Aged; Anticoagulants; Carotid Artery, Internal, Dissection; Cranial Nerve Diseases; Female; Humans; Hypoglossal Nerve Diseases; Pain; Paralysis; Phenprocoumon; Tongue Diseases

Topics: Administration, Oral; Aged; Diagnosis, Differential; Hematoma; Heparin, Low-Molecular-Weight; Humans; Inflammation; Male; Pain; Phenprocoumon; Popliteal Cyst; Rupture, Spontaneous; Thrombophlebitis; Ultrasonography, Doppler, Duplex; Venous Thrombosis