HOUSTON, July 20 — One patient in four with superficial vein clots had concomitant deep-vein thrombosis (DVT), most of which were asymptomatic, data from a small clinical study showed.

• Explain to patients that superficial vein clots, which usually are benign, were often accompanied in this study by more serious deep-vein thrombosis.

Although superficial vein thrombosis is not life threatening, the risk of concomitant DVT should not be ignored, Barbara Binder, MD, of the Medical University of Graz in Austria, and colleagues said in the July issue of Archives of Dermatology.

Patients with superficial vein thrombosis should undergo color-coded duplex sonography to rule out DVT, they said.

“We recommend also evaluation of the contralateral leg in cases of superficial vein thrombosis with a substantially elevated D-dimer level and any symptoms of DVT to insure the best medical care and thus hopefully prevent pulmonary embolism or postthrombotic syndrome,” they concluded.

Superficial vein thrombosis develops slowly and usually has a benign course. Although sharing risk factors with more serious forms of venous thromboembolism, superficial vein thrombosis had attracted little research attention until recently, the authors said.

Studies have shown that as many as two-thirds of patients with superficial vein thrombosis have concomitant DVT and as many as a third also have pulmonary emboli, they reported.

Previous studies had focused primarily on DVT in the affected leg. Dr. Binder and colleagues extended the investigation to both lower extremities of patients with superficial vein thrombosis.

The study involved 46 patients with confirmed superficial vein thrombosis. All patients underwent color-coded duplex sonography of both lower extremities. The principal objective was to describe risk factors associated with superficial vein thrombosis and concomitant DVT.

Superficial vein thrombosis was in the great saphenous vein in 10 patients, small saphenous vein in five, and branches in 19. In seven patients the area of involvement extended into the junction with the deep venous system.

The left leg was the affected limb in 54% of cases, the right leg in 44%, and one patient had superficial vein thrombosis in both legs.

Thrombophilic disorders identified in the patients consisted of elevated D-dimer levels (>200 µg/L) in 37 of 46 patients and a heterozygous mutation of factor V Leiden.

Sonography revealed concomitant DVT in 11 patients — eight in the same leg as the superficial vein thrombosis, two in both lower extremities, and one in the contralateral extremity.

Median age of patients with concomitant DVT was 73 compared with 65 in patients who had only superficial vein thrombosis, a difference that did not reach statistical significance. Seven of the 11 patients had no history of thromboembolism.

In all patients with DVT, the superficial vein thrombosis was in the lower leg. In contrast, a third of patients who did not have DVT had superficial vein thrombosis in the thigh.

All patients with DVT had elevated D-dimer levels. The nine patients with normal D-dimer values had superficial vein thrombosis alone.

The investigators found no association between DVT and body mass index, Braden scale, oral contraceptive use, or history of thrombophilic disorders.

“Our study confirms the findings of previous studies and demonstrates that the risk of a concomitant DVT should not be underestimated in patients with SVT,” the authors concluded.

The authors reported no financial disclosures.

Primary source: Archives of Dermatology

Source reference:
Binder B et al. “Association between superficial vein thrombosis and deep vein thrombosis of the lower extremities” Arch Dermatol 2009; 145(7): 753-757.

IntraOp Medical Corporation (OTCBB: IOPM), a provider of Intra-Operative Electron-beam Radiation Therapy (IOERT) solutions for the treatment and eradication of cancer, announced today two new orders for its Mobetron system from its Chinese distribution partner, Hui Long New Technology Co. LTD.

IntraOp’s Mobetron is a mobile technology that delivers IOERT to a tumor site during cancer surgery. The Mobetron enables radiation and surgical oncologists to pinpoint the optimal site for radiation and to deliver an effective dose during the procedure. Since the Mobetron is a mobile, self-shielded device, doctors are able to move the Mobetron among operating rooms (ORs) to treat a greater number of patients more effectively, efficiently and cost-effectively than with a conventional linear accelerator.

This order marks the fifth and sixth Mobetrons sold in China. In the twelve months since installing and utilizing the first device, oncologists in China have had notable success with IOERT, inspiring other centers to follow suit. Earlier this year, IntraOp sold and shipped Mobetrons to two Shanghai medical facilities, where they are currently being installed. This most recent order of two Mobetrons is for hospitals that should be ready for installation early next year. The order reflects Hui Long’s optimism about the near-term opportunities for Mobetron sales in China.

Peter Yu, IntraOp’s Director of Far East Operations, noted, “With the very high patient loads our oncologists experience here in China, IOERT is often the only way to ensure that some patients are getting the radiation therapy treatment they need in a reasonable amount of time. With this order, we will be able to satisfy our customers’ growing demand for a device that will enable them to deliver IOERT in the OR.”

IntraOp CEO John Powers added, “This order represents our fifth and sixth Mobetron sale in China in just 18 months. This adoption rate demonstrates China’s willingness to leap frog old technologies, while quickly adopting and standardizing on new technologies proven to provide superior outcomes. We are incredibly optimistic about this adoption rate and the Mobetron’s potential to benefit cancer patients.”

Source
IntraOp Medical Corporation

SAN FRANCISCO, July 21 — For patients with a history of colorectal adenoma, combining the results of prior colonoscopies may help determine the right screening interval for subsequent surveillance, researchers found.

For patients with a clean bill of health on their first post-adenoma colonoscopy, the results of the prior colonoscopy predicted likelihood of high-risk findings on the third examination, Douglas J. Robertson, MD, MPH, of the VA Medical Center in White River Junction, Vt., and colleagues reported.

Thus, considering the baseline exam might help identify low-risk patients who could go longer between colonoscopies, they wrote in the July 21 issue of the Annals of Internal Medicine.

After adenoma is found on colonoscopy, the American Cancer Society and U.S. Multisociety Task Force on Colorectal Cancer recommend surveillance at five- to 10-year intervals for low-risk cases and three-year intervals for high-risk cases.

• Explain to interested patients that the study supported a longer interval between colonoscopy surveillance for patients with consistently low risk findings after discovery of adenoma.
• Note that the study did not randomize patients to screening intervals.

For more guidance in selecting an interval, the researchers analyzed findings from the Aspirin/Folate Polyp Prevention Study, originally designed as a randomized clinical trial for adenoma prevention.

The analysis included 564 patients who had two surveillance colonoscopies after a baseline colonoscopy that showed a first occurrence of adenoma, but not cancer.

At the third colonoscopy, 10.3% of participants had high-risk findings with detection of at least one advanced adenoma, or cancer, or multiple adenomas of any size — the same definition used in current adenoma surveillance guidelines.

As might be expected, findings between the two surveillance colonoscopies were linked.

Patients with high-risk findings on the second colonoscopy were an absolute 11.4% more likely to have high-risk results on the third as well than were those who had no adenomas on the second (19.0% versus 7.7%, P=0.002).

Inclusion of results of the first colonoscopy added predictive ability when the second examination revealed no adenomas.

Even if the second colonoscopy showed no adenomas, if the first showed high-risk adenoma then high-risk results on the third colonoscopy were more likely than if the first exam showed low-risk adenoma (12.3% versus 4.9%, P=0.015).

But if the second colonoscopy showed low-risk adenoma, then adding in the results of the first had little impact on predicting risk on the third colonoscopy (13.6% if high risk initially versus 9.5% if low risk initially, P=0.43).

Likewise, if the second colonoscopy showed high-risk adenoma, considering the results of the baseline colonoscopy did not add significantly to value in predicting results of the third (18.2% if high-risk initially versus 20.0% if not high-risk initially, P=0.78).

The multivariate analysis mirrored these findings.

Among those with initial low-risk findings and no adenoma on the second exam, the researchers estimated a number needed to screen of 20.4 to detect one high-risk case on their third colonoscopy.

By comparison, the number needed to screen was only 5.5 among those with high-risk findings on both first and second examinations.

Thus, the three-year surveillance interval recommended for high-risk adenoma patients is likely appropriate, regardless of a prior colonoscopy done with the intent to clear the colon of adenoma, the researchers said.

But for low-risk adenoma patients free of adenoma on their next exam — the largest patient group — these results suggest choosing a 10-year rather than five-year screening interval, the researchers noted.

The risk for this group “resembles that of a screening population with negative results on a prior examination, for whom a 10-year interval examination is recommended,” they wrote.

They cautioned that the study was limited by the three- to five-year surveillance intervals prevailing as practice norms at the time, “so we cannot know what percentage of participants would have had clinically significant findings at a five- or 10-year surveillance examination.”

But it may be the best evidence available, they noted.

Also, timing of follow-up was not entirely uniform, and the risk profile of the patients included in the trial may not match that of a more general population, Dr. Robertson’s group added.

The parent study was supported by a grant from the National Institutes of Health. Dr. Robertson’s work was supported by a VA Health Services Research & Development Career Development Award. The researchers reported no conflicts of interest.

Primary source: Annals of Internal Medicine

Source reference:

Robertson DJ, et al “Using the Results of a Baseline and a Surveillance Colonoscopy to Predict Recurrent Adenomas With High-Risk Characteristics” Ann Intern Med 2009; 151: 103-109.