Thrombophlebitis Geschichte

The history and historical treatments of deep vein thrombosis

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Deep vein thrombosis DVT is a common disease. However, unlike that of varicose veins, Thrombophlebitis Geschichte, which have been depicted since antiquity in art and literature, its description was more recent in the history of medicine. The number of reported DVT cases steadily increased thereafter, Thrombophlebitis Geschichte, particularly in pregnant and postpartum women.

During the first half of the Thrombophlebitis Geschichte century, well before the discovery of anticoagulants, Thrombophlebitis Geschichte, many therapeutic approaches were used, and arose from the pathologic hypotheses that prevailed at their time, Thrombophlebitis Geschichte. Most of these treatments have now been abandoned, or even forgotten.

We also bring some perspective to historical aspects of this disease and its treatment, notably regarding elastic compression and early mobilization, but also abandoned and complementary treatments. In these times of change Thrombophlebitis Geschichte DVT treatment, mainly marked by the arrival of new oral anticoagulants, efforts of physicians through the ages to treat this common disease provide a beautiful example of the history of knowledge.

This development opens a new era in the management of venous thromboembolic disease [ 2 ]. The developments in DVT treatment and the efforts of physicians through history to treat this common disease provide an illuminating example of the progress of knowledge. It is of interest to look back at the Thrombophlebitis Geschichte of DVT treatment.

Unlike previous reviews, this historical analysis will not focus Krampfadern Strumpfhosen für Männer the gradual improvement in the anticoagulant drugs available. We will not address the treatment of PE, which has its own history and has been reviewed separately, or the history of new oral Thrombophlebitis Geschichte agents, which is just beginning [ 7 ].

Unlike the situation for varicose veins, leg ulcers, or lower limb edema, to which there are extensive references in antique art and literature, the first description of a case truly compatible with a DVT first appears during the Middle Ages [ 8, 9 ].

Raoul's surgeon, Henri de Perche, advised him to wait and see. Unfortunately, the patient's symptoms worsened, Thrombophlebitis Geschichte he developed a leg ulcer. He visited St Eloi's shrine, without any improvement. After additional unsuccessful unspecified treatment attempts, Raoul was advised to visit the tomb of Thrombophlebitis Geschichte Saint Thrombophlebitis Geschichte. He spent several days praying to the saint, and then he decided to collect the dust that he found below the stone that covered the tomb, and he applied it directly to the ulcer.

Thus, this first reported case of effective treatment of DVT might not be the most reproducible, Thrombophlebitis Geschichte. In antiquity, neither famous Greek physicians such as Hippocrates and Oribasius, nor Roman physicians such as Galen or Caelius Aurelianus, reported a case suggesting a diagnosis of DVT; this is also true of the art of ancient Egypt, Persia, and South America.

Nevertheless, Thrombophlebitis Geschichte is likely that this disease is as old as humankind, and it may have affected famous historical figures: Thus, although venous thrombosis is a frequent disease, it appears that no cases clearly compatible with the diagnosis Thrombophlebitis Geschichte DVT were reported before the description of the case of Raoul, Thrombophlebitis Geschichte. Raoul, the first case of deep vein thrombosis [ 9 ], Thrombophlebitis Geschichte.

After this first unquestionable description by Guillaume de Saint Pathus, the number of reported cases of DVT increased rapidly, Thrombophlebitis Geschichte, and the first pathologic hypotheses arose, leading to the first treatment attempts, Thrombophlebitis Geschichte.

Thus, in the late s, breast-feeding was encouraged to prevent DVT [ ]. This technique was used Thrombophlebitis Geschichte treat DVT and many other diseases until the end of the 19th century Thrombophlebitis Geschichte 20, 21 ].

From the 17th century, Thrombophlebitis Geschichte, the humoral theory, Thrombophlebitis Geschichte was previously used to explain DVT pathophysiology, was gradually abandoned. InThrombophlebitis Geschichte, Wiseman suggested that DVT was the consequence of an alteration of Thrombophlebitis Geschichte, and then, inHunter hypothesized that it was an occlusion of the vein by blood clots [ 15 ].

InThrombophlebitis Geschichte, well before Virchow demonstrated the relationship between DVT and fatal PEThrombophlebitis Geschichte, Hunter had performed venous ligations above thromboses, to prevent extension of clots [ 22, 23 ]. In the absence of any other truly effective treatment for preventing fatal PE, this technique became more widely used at the end of the 19th century [ 24 ].

The ligation could be performed at the femoral, common femoral, iliac and inferior vena Entzündung von Krampfadern Beine IVC levels in cases of proximal thromboses, and more rarely in cases of distal thromboses, although this latter therapeutic intervention remained controversial [ 25, 26 ].

This surgical treatment was still widely used until the midth century in association with, or instead of, anticoagulants [ 7, 27 ]. For fear of Varizen Ton, ist migration, strict bed rest was prescribed, and constituted, at least from the Krampfadern der Speiseröhre Code in ICD 10 of the 19th century, the cornerstone of DVT treatment.

Thus, in cases of DVT, the patient's lower limbs were set in iron splints to prevent any movement Fig. Special, Thrombophlebitis Geschichte, orthopedic beds were also used to favor venous return Fig. Devices used to favor strict immobilization for cases of deep vein thrombosis France, early 20th century [ 28 ], Thrombophlebitis Geschichte. B Reclining iron bed.

This was consistent with the observation that DVT is, in many cases, associated with fever, and Thrombophlebitis Geschichte occurred postpartum, after — septic — surgical procedures, or during bed rest for an infectious disease. Consequently, the treatments prescribed involved anti-inflammatory medication was trophischen Geschwüren an den Bein Foto Symptome the prevention and treatment of infection [ 20, 29 ], Thrombophlebitis Geschichte.

Bloodletting, sometimes via application of leeches, which was popular in these times, was thought to be one of the most effective methods to relieve lower limb congestion and to treat inflammation [ Thrombophlebitis Geschichte, 32 Thrombophlebitis Geschichte. Apart from bloodletting, Thrombophlebitis Geschichte, other therapeutic options consisted of: These therapeutic attitudes, based on the theory of inflammation and infection, started to become obsolete in the early Thrombophlebitis Geschichte. Overall, Einfluss auf den Organismus Varizen to the s, before the introduction of anticoagulants, the most common treatment for DVT mainly relied on: Because major risk factors for DVT had already been identified, most currently used thromboprophylactic measures were already known and applied in hospitalized cases.

For example, Wright describes prophylactic measures such as early ambulation, elastic compression, and avoidance of dehydration and of tightly applied adhesive strapping [ 22 ]. By the middle of the 19th century, the major pathologic mechanisms of venous thrombosis had been discovered. They Thrombophlebitis Geschichte first summarized in the famous Virchow's triadtheorized by Andral in and which Virchow probably never described [ 36 ]. However, Thrombophlebitis Geschichte, it was only towards the s that a consensus appeared regarding the three factors contributing to thrombosis: During this period, a number of therapeutic breakthroughs, most of them discovered by accident, revolutionized DVT treatment.

The first isolated anticoagulant was hirudin, obtained in by Haycraft [ 32 ]. It was extracted from the saliva of leeches, Thrombophlebitis Geschichte. However, it could not be used as a potent anticoagulant agent until its production by genetic engineering in Thus, the first anticoagulant that could be effectively used for the treatment of DVT was heparin.

It was discovered in by McLean, at that time a medical student, while he was studying the procoagulant properties of crude ether and alcohol extracts of the brain, liver and heart under the supervision of Howell [ 37 ]. McLean noticed that these extracts, and more Thrombophlebitis Geschichte heparphosphatide, became anticoagulant agents after long-term exposure to air [ 37 ].

Four years later, he discovered true heparin, a water-soluble mucopolysaccharide from dog liver. A dispute over Thrombophlebitis Geschichte paternity of the Thrombophlebitis Geschichte started between the two scientists. However, this dispute might well have been vain, as it emerged later that the anticoagulant isolated years earlier in by Doyon after peptone shock was, in fact, heparin [ 3 ], Thrombophlebitis Geschichte.

InThrombophlebitis Geschichte, Charles and Scott succeeded in producing pure crystalline heparin, allowing its use in humans, which began in [ 38 ]. The severity of DVT and the absence of convincing effective treatment were probably the main reasons Lyapko Applikator für Krampfadern the rapid spread of this innovative drug. As was the case for Thrombophlebitis Geschichte modern anticoagulants, the first indication for heparin was thromboprophylaxis in surgical patients: Despite the absence of randomized placebo-controlled trials, the effectiveness of heparin was almost immediately considered to be unquestionable: Therefore, in the early s, heparin was already widely used, when available.

A mysterious hemorrhagic disease decimated cattle in the area, ruining numerous farmers [ 4, 43 ]. InSchoefield, a Canadian veterinary pathologist, showed that the disease was caused by spoiled sweet clover [ 3 ]. It could Thrombophlebitis Geschichte prevented by withdrawal of the spoiled clover from food, Thrombophlebitis Geschichte, and could be treated by blood transfusion, Thrombophlebitis Geschichte.

Two years later, dicoumarol was used for the first time to treat DVTs [ 44 ]. The proliferation of rats was a public health concern; rodent behavior, and particularly their habit of eating small pieces of foodstuff and the presence of tasters among them, made eradication Thrombophlebitis Geschichte fast-acting poisons poorly effective.

Link decided to test the anticoagulant power of all coumarins that had been synthesized in his laboratory between and to develop the optimal rodenticide. Here started the story of warfarin, initially launched in as the Thrombophlebitis Geschichte rat poison and considered to be too toxic for human use Fig. This opened the way to its commercialization as a therapeutic agent in [ 3 ].

Physicians quickly realized that the two drugs were complementary: Warfarin, Thrombophlebitis Geschichte, its discoverer, and its Thrombophlebitis Geschichte indication warfarin, discovered by Link, was initially launched in as the ideal rodenticide, and was considered to be too toxic for human use [ 43 ].

The most important advances in the field of DVT therapeutic management occurred during the first half of the 20th century, Thrombophlebitis Geschichte. However, numerous other therapeutic options, sometimes surprising, were tried during this period and later abandoned because of insufficient efficacy: This last technique, developed by Debakey inwas used during the s.

The underlying pathophysiologic rationale for the use of lumbar sympathic block was based on images of venographic series, which suggested that DVT was accompanied by severe vasospasm [ 22, 25 ].

Another debated issue, Thrombophlebitis Geschichte, which arose around the s, concerned whether or not patients should be mobilized during the acute phase of DVT [ 22, 34 ]. This question was resolved only subsequently, half a century later, thanks to the development of low molecular weight heparin LMWH.

This has dramatically modified DVT presentation and management. Indeed, thanks to venography, which, although developed by Berberich and Hirsch inhas been widely used only since the s after the standardization of the procedure, physicians no longer treat clinically suspected DVT but objectively confirmed DVT [ 5, 45 ].

DVT is also treated earlier, and is even diagnosed and treated while clinically asymptomatic. From a therapeutic point of view, this period has seen the simplification of anticoagulant treatment and the end of the bed-rest dogma, which allowed the emergence of home treatment and the development of complementary treatments to decrease both mortality in high-risk patients and the burden of long-term sequelae.

This attitude was based on pathophysiologic data. The duration of bed rest was also based on more Thrombophlebitis Geschichte considerations: However, prolonged immobilization was often associated with serious adverse consequences, including ankle or knee ankylosis, Thrombophlebitis Geschichte, and amyotrophia [ 29, 30, 46 ].

In Thrombophlebitis Geschichte s, a growing number of authors started to raise serious doubts about this management, and pleaded in favor of early ambulation and the use of compression stockings to fix the thrombus in place [ 22, 34 ]. However, in the absence of clear evidence of its harmlessness, most physicians remained reluctant to recommend immediate mobilization, for fear of Thrombophlebitis Geschichte migration.

In addition, the need to administer continuous intravenous infusions of heparin was a major impediment to early ambulation. The most significant Thrombophlebitis Geschichte in the simplification of anticoagulant treatment was the development of LMWH, which, in most cases, does not require monitoring. InLevine demonstrated that LMWH given Thrombophlebitis Geschichte home was as safe and effective as unfractionated heparin administered in the hospital to treat proximal DVT [ 49 ].

In the same Thrombophlebitis Geschichte, Partsch's small randomized trial provided evidence that, relative to bed rest, early ambulation with compression stockings improved pain and counteracted swelling without increasing the risk of PE [ 50 ]. These studies were rapidly followed by widespread implementation of early ambulation with compression stockings in outpatient settings, which has now become the Thrombophlebitis Geschichte and, indeed, recommended management [ 1, 55 ].

Thus, DVT became an ambulatory disease. The era of novel anticoagulants could start.

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Medicinal leeches

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