[ XXXX --a diagnostic and therapeutic challenge].

@entity1 @entity5 @entity1524 @entity49 @entity1150 @entity887 @entity1031 @entity954 @entity715 @entity1211
PURPOSE: @entity49 and @entity887 has been the target of intensive investigation in recent years. The growing importance of mortality and morbidity due to @entity1211 led to new diagnostic and therapeutic tools. The clinical diagnosis may be misleading and both false-negative and false-positive diagnoses are common, when only clinical signs and symptoms are considered. METHODS: A major problem in the care of the @entity1 is to establish the correct diagnosis. Studies show, that only Venography or Duplexsonography can clearify diagnosis. Risk factors for @entity1211 , propability calculations and consensus recommendations for diagnosis and therapy are presented. RESULTS: Diagnosis. Diagnosis of @entity1150 must be established by Duplexultrasound and/or venography. Special situations may need further investigation by CT-scan or NMR-tomography. No single clinical sign or combination of signs give enough sensitivity and specificity. In @entity1 with @entity1031 without clear etiology, @entity49 , @entity5 , compression syndroms, vascultides and other conditions have to be excluded. THERAPY: Heparins are the standard-therapy. Low-molecular weight heparins may have some benefits over standard heparins in terms of side effects and handling. @entity1524 therapy can be started immediately, if no invasive procedures are necessary and have to be continued for 4-12 months, in recurred events and/or @entity49 even life-long. Thrombolysis is restricted to very few @entity1 ( @entity1 under the age of 50 with large @entity715 not older than 3-7 days and no contraindications). @entity954 is even more restricted. Compression therapy should be obligatory in all @entity1 with @entity1031 . CONCLUSIONS: @entity1031 is mainly a diagnostic challenge. The immediate start of the appropriate treatment may reduce @entity887 and @entity715 formation, induce recanalisation and prevent post-thrombotic syndrom.
