Deep vein thrombosis is the formation of a blood clot in a deep vein, most in the legs or pelvis. Symptoms can include pain, swelling and enlarged veins in the affected area, but some DVTs have no symptoms; the most life-threatening concern with DVT is the potential for a clot to detach, travel through the right side of the heart, become stuck in arteries that supply blood to the lungs. This is called pulmonary embolism. Both DVT and PE are considered as part of the same overall disease process, called venous thromboembolism. VTE can occur as an isolated DVT or as PE with or without DVT; the most frequent long-term complication is post-thrombotic syndrome, which can cause pain, swelling, a sensation of heaviness, in severe cases, ulcers. Recurrent VTE occurs in about 30% of those in the 10 years following an inital VTE; the mechanism of clot formation involves some combination of decreased blood flow rate, increased tendency to clot, injury to the blood vessel wall. Risk factors include recent surgery, older age, active cancer, personal history and family history of VTE, injuries, lack of movement, hormonal birth control and the period following birth, antiphospholipid syndrome.
VTE has a strong genetic component, accounting for 50 to 60% of the variability in VTE rates. Genetic factors include non-O blood type, deficiencies of antithrombin, protein C, protein S and the mutations of factor V Leiden and prothrombin G20210A. In total, dozens of genetic risk factors have been identified. People suspected of having a DVT can be assessed using a prediction rule such as the Wells score. A D-dimer test can be used to assist with excluding the diagnosis or to signal a need for further testing. Diagnosis is most confirmed by ultrasound of the suspected veins. An estimated 4–10% of DVTs affect the arms. About 5–11% of people will develop VTE in their lifetime, with VTE becoming much more common with age; when compared to those aged 40 and below, people aged 65 and above are at an approximate 15 times higher risk. However, available data has been dominated by European and North American populations, Asian and Hispanic individuals have a lower VTE risk than whites or blacks. Using blood thinners is the standard treatment, typical medications include rivaroxaban and warfarin.
Beginning warfarin treatment requires an additional a non-oral anticoagulant injections of heparin. Prevention of VTE for the general population includes avoiding obesity and maintaining an active lifestyle. Preventive efforts following low-risk surgery include frequent walking. Riskier surgeries prevent VTE with a blood thinner or aspirin combined with intermittent pneumatic compression. Signs and symptoms of DVT, while variable, include pain or tenderness, warmth, dilation of surface veins, redness or discoloration, cyanosis with fever. Although, some with DVT have no symptoms. Signs and symptoms alone are not sufficiently sensitive or specific to make a diagnosis, but when considered in conjunction with pre-test probability, can help determine the likelihood of DVT. In most suspected cases, DVT is ruled out after evaluation, symptoms are more due to other causes, such as ruptured Baker's cyst, hematoma and chronic venous insufficiency. Other differential diagnoses include tumors, venous or arterial aneurysms, connective tissue disorders.
The three factors of Virchow's triad—venous stasis, hypercoagulability, changes in the endothelial blood vessel lining—contribute to VTE and are used to explain its formation. Venous statsis is the most consequential of these three factors. Other related causes include activation of immune system components, the state of microparticles in the blood, the concentration of oxygen, possible platelet activation. Various risk factors contribute to VTE, including genetic and environmental factors, though many with multiple risk factors never develop it. Acquired risk factors include the strong risk factor of older age, which alters blood composition to favor clotting. Previous VTE unprovoked VTE, is a strong risk factor. Major surgery and trauma increase risk because of tissue factor from outside the vascular system entering the blood. Minor injuries, lower limb amputation, hip fracture, long bone fractures are risks. In orthopedic surgery, venous stasis can be temporarily provoked by a cessation of blood flow as part of the procedure.
Inactivity and immobilization contribute to venous stasis, as with orthopedic casts, sitting, long-haul travel, bed rest, in survivors of acute stroke. Conditions that involve compromised blood flow in the veins are May–Thurner syndrome, where a vein of the pelvis is compressed, venous thoracic outlet syndrome, which includes Paget–Schroetter syndrome, where compression occurs near the base of the neck. Cancer can grow in and around veins, causing venous stasis, can stimulate increased levels of tissue factor. Cancers of the bone, brain and lymphomas are associated with increased VTE risk. Chemotherapy treatment increases risk. Obesity increases the potential of blood to clot, as does pregnancy. In the postpartum, placental tearing releases substances. Oral contraceptives and hormonal replacement therapy increase the risk through a variety of mechanisms, including altered blood coagulation protein levels and reduced fibrinolysis. Family history of VTE is a risk factor for a first VTE. VTE is a disease with strong genetic contributing factors, accounting for 50 to 60% of the variability in VTE rates.
Genetic factors that increase the r
Gmina Mietków is a rural gmina in Wrocław County, Lower Silesian Voivodeship, in south-western Poland. Its seat is the village of Mietków, which lies 32 kilometres south-west of the regional capital Wrocław; the gmina covers an area of 83.3 square kilometres, as of 2006 its total population is 3,876. Gmina Mietków is bordered by the gminas of Kąty Wrocławskie, Kostomłoty, Sobótka and Żarów; the gmina contains the villages of Borzygniew, Chwałów, Dzikowa, Maniów, Maniów Mały, Maniów Wielki, Mietków, Milin, Piława, Stróża, Ujów and Wawrzeńczyce. Polish official population figures 2006
Tenley Nora Molzahn Leopold is a dancer and reality television contestant known from her appearances as a cast member on three ABC reality shows, The Bachelor: On the Wings of Love, Bachelor Pad and Bachelor in Paradise In 2002, Molzahn moved to Los Angeles to audition for Walt Disney Productions. For the next six years, Molzahn danced and performed in Disney in Anaheim and Japan, taking the lead role of Ariel in Tokyo Disney’s ‘Under the Sea’ tour for nine months. Molzahn's work in television began when she was selected as a cast member on ABC's reality show The Bachelor series which first aired on January 4, 2010; the show placed her with twenty-four other women all contending for the affection of pilot Jake Pavelka. She was the last one eliminated by Pavelka. Afterwards, Molzahn joined the cast of Bachelor Pad, the ABC dating-based competition reality TV show in which former contestants from The Bachelor and The Bachelorette compete and play games for a chance at a $250,000 cash prize; the show premiered August 9, 2010 on ABC.
Prior to appearing on The Bachelor, Molzahn had been married to Ryan Natividad. They divorced in 2009. On January 12, 2018, Molzahn became engaged to Taylor Leopold, whom she had been dating for two years, they were married on April 27, 2018