The cause of thrombosis is often unknown but is universally ascribed to part of Virchow's triad: stasis, hypercoagulability, and intimal injury. Venous thromboembolic disease is a common and costly medical problem, with iliofemoral deep vein thrombosis (IFDVT) being a less common but often underestimated presentation of this condition. Treatment options for deep vein thrombosis (DVT) have expanded in recent years and now include systemic anticoagulation, thrombolytic therapy, and surgery. Several studies have shown the efficacy of catheter-directed thrombolytic therapy in resolution of IFDVT. There is also growing evidence that early lysis is more likely to preserve valve function leading to a decrease in the incidence of postthrombotic syndrome, which is a known long-term complication of DVT and IFDVT. The following case report describes a patient, without malignancy, who had an atraumatic iliac and femoral DVT and illustrates the diagnostic considerations and therapy of a patient with iliofemoral DVT.
PURPOSE: Body mass index (BMI), since its introduction by Quetlet in 1869, has become a popular method for determining one’s adiposity. It is used a surrogate marker of adiposity. Over the course of last century, similar indices have been proposed. Earlier studies had demonstrated that BMI was most fit for clinical use. However, none of those studies used percent body fat as the gold standard. My previous study evaluated BMI and Corpulence index (CI) against percent body fat as calculated by bioelectrical impedance, and showed that CI is a better predictor of adiposity than is BMI. The purpose of this study is to evaluate Body Mass Index, Corpulence Index, and waist circumference against a gold standard. Percent body mass was measured using a DXA scanner. METHODS: Data from Centers for Disease Control and Prevention (CDC’s) National Health and Nutrition Examination Survey (NHANES) datasets from 2003-2004 (n=7,002) was used for this study. Percent body fat, as calculated by a DXA scanner, and the corresponding height, weight, and waist circumference were used to compare Waist circumference (WC), BMI and CI to percent body fat. Linear correlation was used to assess the relationship between these three markers and percent body fat. The analysis was repeated after the data was broken down by gender and race. Using the ASBP percent body fat guidelines, the diagnostic performance of BMI and CI was evaluated. RESULTS: In the overall analysis, CI had the better R2 value than BMI and WC. After it was broken down my gender. In males, CI’s better correlation was better than both BMI and WC. In females, no statistical significant was noted. After the male dataset was broken down by race, CI also proved to better to have a better correlation with percent body fat in blacks, whites, and Mexican-Americans. However, in Hispanics and other/multi-racial they was no statistically significant difference. Female dataset was broken down by race, and again there was not statistical difference between the measures. CI had a higher sensitivity in both males and females. If females, It also had CONCLUSIONS: CI had a better performance for diagnosing obesity than did BMI or WC.
HISTORY: A 20 yo female collegiate lacrosse goalie presented to the clinic for right elbow pain and popping. Her pain began about 18 months ago when she fell on an outstretched hand during a game, causing a valgus stress at her right elbow. She was treated initially as a UCL sprain with decreased activity, then return to normal participation. She reported intermittent pain since. Her pain was at her right medial elbow (severity of 6/10), worse first thing in the morning. She described popping with flexion and extension and reported dysesthesias in the right 4th and 5th digits with this maneuver. Denied swelling. EXAM: MSK: R Shoulder: Full AROM symmetric with contralateral. R Elbow: Full AROM, pain in deep flexion. No joint effusion. Clicking noted over cubital tunnel. Pain and laxity on valgus stress at 30 and 70 degrees of flexion. Pain with Milking maneuver. No pain at the tricep or with resisted extension. Focal tenderness to palpation at the medial joint line and at the inferior and posterior medial epicondyle. Positive Tinel's. R Wrist: Full AROM symmetric with contralateral. Skin: No ecchymosis or erythema. Neuro: Sensation grossly intact, strength 5/5 symmetric in upper extremities. DIFFERENTIAL: Valgus extension overload syndrome, ulnar neuropathy, ulnar nerve subluxation, UCL sprain/tear, loose body RESULTS: R elbow: X ray 3 view: No fracture or dislocation. MSKUS: Hypoechoic area within the UCL consistent with partial tear. Laxity demonstrated on stress testing. Subluxation of the ulnar nerve demonstrated from within the cubital tunnel riding over the medial epicondyle during flexion. MR arthrogram: Partial-thickness tear (grade 2 sprain) of the UCL at its insertion. A few intact insertional fibers remain. FINAL DIAGNOSIS: Right UCL partial tear and ulnar nerve subluxation TREATMENTS/OUTCOME: We discussed treatment options with patient, with concomitant issues surgical intervention was chosen. Patient underwent a right UCL repair and ulnar nerve subcutaneous transposition without complication. At 5 weeks post op she had full AROM and resolved ulnar dysesthesias. She then underwent a guided physical therapy program and at 3 months after surgery she had full painless ROM and no instability. She was cleared to increased activity as tolerated and allowed to participate in her season starting 4 months post-operative.
