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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To clarify the epidemiology of pulmonary embolism in adolescents, a retrospective analysis of adolescent admissions to a general hospital over a 15-year period was performed. Eighteen patients had 19 episodes of pulmonary embolism, an incidence of 78 per 100,000 hospitalized adolescents. There were twice as many female as male patients. Common complaints were chest pain, dyspnea, cough, and hemoptysis. Common findings were hypoxemia and deepvein thrombosis. Major risk factors were oral contraceptive use and elective abortion in 75% of female patients and trauma in 67% of male patients. Unlike its effect in adults, pulmonary embolism is rarely fatal in adolescents. Although clinical features in adolescents are similar to those in adults, there is a high incidence of both overdiagnosis and underdiagnosis. The early use of pulmonary arteriography in difficult diagnostic situations is suggested.
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PMID:Pulmonary embolism in adolescents. 371 6

This paper discusses causes, hemodynamics, symptoms, and signs of pulmonary embolism. Severe cases obstruct at least 60 percent of the pulmonary vascular bed. Small or moderate cases may be easily overlooked. Symptoms may be only slight chest pain or dyspnoea, fever, giddiness, or irregular heart beat. In the author's experience with 35 cases of acute massive pulmonary embolism at the Bromptom Hospital oral contraceptives were considered a predisposing factor in 5 cases (14 percent), pregnancy was a possible cause in 2 (6 percent), a recent operation in 24 (68 percent). No other recognized factor was thought to have predisposed more than a single case. Clinical features included cyanosis, collapse, sever chest pain, dyspnoea, sweating, rapid heart rate, falling blood pressure, and occasional coughing up of blood. Electrocardiograms sometimes gave helpful information. Chest x-ray was usually not helpful except to exclude other causes. Heart catheterization and pulmonary arteriography have been done to assess the extent of the embolism. Emergency surgical pulmonary embolectomy is recommended for extreme cases. Fibrinolytic agents such as streptokinase may be adequate for less severe cases who have not had a recent operation of do not suffer from a hemorrhagic disorder.
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PMID:Pulmonary embolism. 535 32

Four cases of paradoxical embolism through a patent foramen ovale associated with massive pulmonary embolism are reported. In two cases, patency of the foramen ovale was demonstrated by a new technique: cross-sectional contrast echocardiography potentiated by coughing. The conventional surgical treatment included arterial embolectomy followed by insertion of a caval filter. Embolism recurred on three occasions under mechanical ventilation prior to insertion of the filter. A new sequence of investigations to facilitate detection of paradoxical embolism in patients with unexplained arterial embolism is suggested: (1) blood gas measurements, which reveal associated pulmonary embolism; (2) cough-potentiated cross-sectional contrast echocardiography, which demonstrates a patent foramen ovale and excludes emboligenic cardiopathies; (3) phlebography and pulmonary angiography which complete the diagnosis. To reduce the risk of recurrent embolism, it is recommended to begin treatment by blocking the vena cava without mechanical ventilation. This can be done by inserting a filter through the jugular vein under local anaesthesia. Arterial embolism can then be treated at lesser risk under mechanical ventilation.
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PMID:[Paradoxical embolism through a patent foramen ovale. 4 cases]. 622 89

Two quadriplegic patients suddenly lost consciousness and were found to have an elevated alveolar-arteriolar oxygen gradient. Their chest x-ray films were normal. Perfusion scintiscans of their lungs showed large areas with markedly reduced or absent perfusion. Ventilation scintiscans demonstrated absent or decreased ventilation to the hypoperfused areas, suggesting mucous plugging. In quadriplegic subjects who have an ineffective cough, acute mucous plugging can produce the sudden onset of hypoxia with essentially normal chest x-ray films, thus mimicking acute pulmonary embolism.
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PMID:Mucous plugging simulating pulmonary embolism in patients with quadriplegia. 669 93

An intensive treatment of patients undergoing thoracic surgery is important, foremost because of the extensity of the surgical procedures and the generally poor condition of the patients. As a first stage of preoperative preparation an evaluation of the functional capacity of the vital organs (heart, lungs and kidneys) is performed, and the most important infection's focci of the oro-pharynx, tracheobronchial tree, urinary tract and skin have to be detected and treated. Respiratory physiotherapy before the surgery improves the ventilatory function, enabling the patient to breath regularly and effectively cough, wherewith a bronchial spasm is prevented and bronchopulmonary infection limited. Before surgery any hypovolaemia, anaemia, hypoproteinemia and dysproteinaemia should also be corrected; in such patients the parenteral alimentation (hyperalimentation) through the central venous catheter, is also important. Immediately following the operation a continuous supervision of vital functions (usually managed by well-experienced surgical nurses) is very essential. Isothermia, isovolemia, a correct oxygenation and analgesia should be maintained permanently. To loose sight of hypoventilation and hypoxia can likely induce respiratory insufficiency. Symptoms indicating tracheal intubation and mechanical ventilation should be watched for and treated at the right moment. Following the surgery, prevention of pulmonary atelectasis and pneumonia, providing an effective thoracic drainage, and respiratory physiotherapy is of utmost importance. The prophylaxis of postoperative pulmonary embolism in particularly jeopardized patients consists in the administration of heparin. Antibiotics in accordance with antibiogram (material: samples taken by a catheter or by bronchoscope from the lung directly).
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PMID:[Intensive care of thoracic surgery patients]. 688 May 35

The history and physical examination were assessed in 215 patients with acute pulmonary embolism uncomplicated by preexisting cardiac or pulmonary disease. The patients had been included in the Urokinase Pulmonary Embolism Trial or the Urokinase-Streptokinase Embolism Trial. Presenting syndromes were (1) circulatory collapse with shock (10 percent) or syncope (9 percent); (2) pulmonary infarction with hemoptysis (25 percent) or pleuritic pain and no hemoptysis (41 percent); (3) uncomplicated embolism characterized by dyspnea (12 percent) or nonpleuritic pain usually with tachypnea (3 percent) or deep venous thrombosis with tachypnea (0.5 percent). The most frequent symptoms were dyspnea (84 percent), pleuritic pain (74 percent), apprehension (63 percent) and cough (50 percent). Hemoptysis occurred in only 28 percent. Dyspnea, hemoptysis or pleuritic pain occurred separately or in combination in 94 percent. All three occurred in only 22 percent. The most frequent signs were tachypnea (respiration ate 20/min or more) (85 percent), tachycardia (heart rate 100 beats/min or more) (58 percent), accentuated pulmonary component of the second heart sound (57 percent) and rales (56 percent). Signs of deep venous thrombosis were present in only 41 percent and a pleural friction rub was present in only 18 percent. Either dyspnea or tachypnea occurred in 96 percent. Dyspnea, tachypnea or deep venous thrombosis occurred in 99 percent. As a group, the identified clinical manifestations, although nonspecific, are strongly suggestive of acute pulmonary embolism. Conversely, acute pulmonary embolism was rarely identified in the absence of dyspnea, tachypnea or deep venous thrombosis.
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PMID:History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. 746 69

A 23-year-old man was admitted because of an attack of chest pain and dry cough. Chest roentogenogram showed a solitary pulmonary nodule in the left upper lobe. Chest CT showed a nodule and a small pleural effusion on the same side. Pulmonary thrombosis was diagnosed by pulmonary Ventilation/perfusion scintigraphy and pulmonary arteriography. Deep vein thrombosis was not detected except in a distal pulmonary artery. The solitary nodule disappeared spontaneously without thrombolytic therapy. An anticardiolipin antibody (IgG) test was positive. Primary antiphospholipid syndrome was diagnosed, because of the absence of physical findings suggesting other collagen vascular diseases. Patients with antiphospholipid syndrome have a high frequency of pulmonary complications that include pulmonary hypertension and pulmonary embolism. Most of the patients with pulmonary embolism have deep vein thrombosis, and pulmonary vessel thrombosis as seen in the present case is a rare complication.
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PMID:[A case of pulmonary thrombosis associated with primary antiphospholipid syndrome]. 773 Nov 19

A 39-year-old housewife who underwent intramammary injections of a proprietary silicone fluid mixture showed clinical and novel transbronchial lung biopsy (TBLB) findings. She presented with complaints of progressive dyspnea, dry cough, and pleuritic chest pain 2 days after the last silicone injections. The chest X-ray and CT scan showed diffuse interstitial infiltrates. TBLB demonstrated translucent, presumably silicone globules embolized within the pulmonary capillaries. The documentation of intramammary injections, the clinical and radiographic features of acute pneumonitis, and the histopathologic evidence by TBLB, may support the causal relationship between illicit injections and the silicone embolism. We discuss the pathogenesis and urge that this potentially toxic source of pulmonary embolism be removed.
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PMID:Acute pneumonitis presumed to be silicone embolism. 780 15

The existence of a sheet around a single lumen dialysis catheter tip, which provokes a valve mechanism, is proved by the observation that several times during the replacement procedure of a dialysis catheter, a sheet surrounding the surface of the catheter is removed with the dialysis catheter. This sheet is grey, approximately 1 mm thick and 30 mm long and consists of fibrin and thrombocytes. Bacteriological examinations were always negative. The existence of the sheet in vivo is demonstrated by digitalized angiography during the removal procedure for single lumen dialysis catheters. Rarely, only the sheet is removed with the catheter. It all other instances, the sheet is stripped off and remains in the subcutaneous tunnel or in the vascular bed without causing much clinical discomfort in most patients. Occasionally an episode of cough, dyspnea, hypotension, retrosternal oppression or hemoptae after removing the single lumen dialysis catheter, suggest pulmonary embolism or lung infarction.
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PMID:Fibrin sheet covering subclavian or femoral dialysis catheters. 802 85

Thirty-five patients (10 men and 25 women) with a preoperative diagnosis of cardiac myxoma have undergone cardiac surgery since 1964 at the University of Louvain. The mean age of the patients was 49 (range 20-75) years. The most commonly encountered symptoms were: dyspnoea 49%; thoracic pain 26%; cough and peripheral embolism 17% each; stroke and preoperative atrial fibrillation 14% each; flutter 11%; expectoration, acute pulmonary oedema, syncope and transient ischaemic attack 6% each; and pulmonary embolism 3%. The different locations were: left atrium 66%; right atrium 26%; both atria 3%; right ventricle 3%: and retrohepatic vena cavae 3%. Septal implantation was found in 66%. Histological examination confirmed 28 myxomas but three 'tumours' were thrombi, two haemangiomas, one rhabdomyosarcoma and one liposarcoma. The follow-up has now reached 2829 months with an average of 81 months per patient (range 0-342 months). Three patients died early (9%) and there were four late deaths (11%). No cases were familial. Surgical resection is the correct treatment for cardiac myxomas and gives good long-term results.
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PMID:Cardiac myxoma. 807 15


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