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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two young men presented with prolonged hectic fever and chills followed by chest pain, dyspnea and hemoptysis. The chest films revealed multiple lung infiltrates, and blood cultures yielded Staphylococcus aureus. Echocardiographic examination confirmed the diagnosis of tricuspid valve endocarditis. Multiple punctate lesions in the bilateral inguinal areas and dragon tattoos over the forechest gave rise to the suspicion of drug abuse. After prolonged antimicrobial therapy, bacteremia was eliminated, and elective vegetectomy and valvuloplasty were performed on one of the patients. The other one suffered recurrent episodes of pulmonary embolism. Disappearance of the large vegetation was disclosed by echocardiography. Both of them eventually regained their health with the abstinence of drugs. This report illustrates two typical cases of infective endocarditis in drug addicts.
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PMID:Staphylococcus aureus endocarditis in drug addicts: report of 2 cases. 198 79

Bacteremia is a recognized complication in patients with indwelling central venous catheters. More recently pulmonary embolism in such patients has also been described. Despite abundant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients. This case illustrates such a complication.
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PMID:Septic pulmonary embolism complicating a central venous catheter. 179 59

This retrospective cohort study reviews the incidence of bacteremia in 48 patients undergoing hemodialysis using subclavian vein dialysis catheters (SDC) as temporary vascular access. Twelve (25%) of these patients had catheter-related bacteremia, and the most frequently isolated organisms were coagulase-negative staphylococci. Three patients developed right-sided endocarditis and one of them died due to pulmonary embolism. The presence of possible risk factors for SDC-related bacteremia, including duration of catheterization and number of hemodialysis procedures, were not statistically different when patients with and without bacteremia were compared, with the exception of a significantly lower incidence of bacteremia among those patients receiving antibiotic therapy at the time of catheter insertion. The use of resterilized catheters was not a risk factor. Specific guidelines for SDC insertion and care were established and followed, after which the infection frequency was reduced to 7.5% (1 episode per 45.5 patient-weeks of catheter use) in this high-risk population.
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PMID:High incidence of subclavian dialysis catheter-related bacteremias. 364 90

Twenty patients seen at Boston City Hospital required general or spinal anesthesia for rectal injuries, and 17 required laparotomy. Findings on sigmoidoscopy were falsely negative in 4 of 13 patients examined. Diagnosis was delayed in two patients. Associated injuries occurred in 55 percent, with the lower genitourinary tract being the area most frequently injured. Complications occurred in eight patients (40 percent). Abscess formation and bacteremia were the most common, but iatrogenic complications occurred in four patients. Pulmonary embolism occurred in two patients and was suspected in a third patient. Routine treatment included diverting colostomy with distal irrigation and adequate drainage. Repair of the injury was performed when possible. Two of the 20 patients (10 percent) died, one after a prolonged septic course and one from recurrent pulmonary embolism. Rectal trauma continues to be a challenging injury.
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PMID:Rectal trauma. A retrospective analysis and guidelines for therapy. 685 17

Ninety-four cases of pyelonephritis including 20 who had concurrent bacteremia were treated with cefamandole alone or in combination with either gentamicin or tobramycin. Doses of cefamandole ranged from 1--2 g by intermittent intravenous (VI) infusion every 4 to 8 h; gentamicin and tobramycin doses ranged from 1--1.7 mg/kg every 8 h also by intermittent IV infusion. Duration of therapy ranged from 5 to 23 days (mean 7.3 days). Both single and combination therapy successfully treated acute pyelonephritis and bacteremia in all patients. Seven strains of E. coli and one of Klebsiella pneumoniae responsible for initial infection were resistant to cephalothin but sensitive to cefamandole. Relapse with cefamandole sensitive bacteria occurred in 27% of patients receiving only cefamandole and 8% of those patients receiving combination therapy. Reinfection with cefamandole resistant organisms, predominantly Pseudomonas aeruginosa occurred in five patients. One patient had an intrarenal abscess due to E. coli which was successfully treated with 23 days of cefamandole. One patient died. However, death was due to acute pulmonary embolism, not infection. None of the patients receiving cefamandole plus gentamicin or tobramycin experienced a significant decrease in creatinine clearance during or after therapy. Skin rash, mild thrombophlebitis at the IV site and transient elevation of alkaline phosphatase and SGOT were the only side effects noted.
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PMID:Cefamandole alone and combined with gentamicin or tobramycin in the treatment of acute pyelonephritis. 701 May 44

Complication rates in 1,000 consecutive patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer between November 1989 and January 1992 were assessed and compared to complication rates in a historical group of patients operated on by primarily the same surgeons prior to 1987. In the contemporary series, there were no operative deaths, only 22% of patients required blood transfusion, and only six (0.6%) patients suffered rectal injuries. Early complications, including myocardial infarction, pulmonary embolism, bacteremia, and wound infection, occurred in less than 1% of patients. Vesical neck contracture, the most common late complication, developed in 87 patients (8.7%). At 1 year post-surgery, 80% of patients were completely continent, and fewer than 1% were totally incontinent.
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PMID:Morbidity of contemporary radical retropubic prostatectomy for localized prostate cancer. 754

Three weeks following a toothache, a 56-year-old man developed cough, sputum, fever, and pleuritic chest pain. He had mild periodontal disease and his chest radiographs and chest computed tomographic (CT) scans showed multiple pulmonary nodules. The CT scan strongly suggested septic pulmonary embolism. Aspirated pus from one of the nodules yielded pure growth of Streptococcus intermedius. Lesions resolved with antimicrobial therapy. The usual predisposing factors for septic pulmonary embolism were absent, and, the isolation of S intermedius from the pus, the antecedent toothache, and periodontal disease all suggested the gingiva as the source. We hypothesize that periodontal infection led to bacteremia, seeding of the lungs, and multiple anaerobic pulmonary abscesses, akin to reported instances of infective endocarditis from dental foci without any prior dental procedures. To our knowledge, this presentation of septic pulmonary embolism is unprecedented.
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PMID:Septic pulmonary embolism due to periodontal disease. 825 94

In this paper we present a prospective evaluation of 100 patients with Group A Streptococcal (GAS) bacteremia evaluated in our hospital over a 10-year period. Sixty-two patients were intravenous drug users (IVDU); all but 1 of these had an obvious cutaneous portal of entry related to the injection of illicit drugs. Twenty-seven patients had infectious metastasis, and the presence of septic pulmonary embolism was associated with suppurative phlebitis. Four of these patients had endocarditis. In the non-IVDU group, 24 patients had an underlying disease, and 12 were immunosuppressed. In 14 cases the infection was of hospital acquisition; in 35% infection was related to medical manipulations. Comparing the IVDU and non-IVDU groups, GAS bacteremia in IVDU patients is associated with a more benign outcome, a longer time of evolution before diagnosis, and a lower frequency of septic shock and mortality than in non-IVDU patients. Although in the univariate analysis GAS bacteremia was associated with several variables, in the multivariate analysis only the presence of shock and nosocomial acquisition of the infection were independently associated with a fatal outcome. Fifty-two patients were infected with human immunodeficiency virus (HIV); 5 of these were in the non-IVDU group. During the last 5 years of study, GAS bacteremia in our hospital was 39 times more frequent in HIV-infected patients than in patients without HIV. Nine patients presented clinical criteria corresponding to Streptococcal toxic shock syndrome (STSS), although its incidence was lower in the IVDU group. In the non-IVDU group, STSS was more frequent in patients with a necrotizing portal of entry, an age between 20 and 40 years, women, and when the origin of the infection was the skin or soft tissue. Six patients with STSS died, and death was associated with the presence of necrotizing lesions and lower counts of white cells, platelets, or hemoglobin.
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PMID:Group A streptococcal bacteremia. A 10-year prospective study. 927 30

Twenty-one cases of septic pulmonary embolism were selected from a series of 76 patients on chronic haemodialysis diagnosed of S. aureus bacteremia. Ninety percent of patients underwent dialysis through an arteriovenous fistula and 10% by means of a prosthetic access. The most common symptoms were fever (100%), pleuritic pain (66%) and productive cough (55%); twenty-four percent of patients had inflammatory signs at vascular accesses. All patients had some symptoms indicative of pulmonary pathology and all of them had positive blood cultures and findings in the chest X-ray. The clinical course was favourable in 100% of cases. Accesses were lost only in the two cases with prosthetic material. The diagnosis was obtained by chest X-ray and blood cultures. Other more sophisticated tests did not improve the diagnostic yielding.
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PMID:[Septic pulmonary embolism in patients on chronic hemodialysis with Staphylococcus aureus bacteremia]. 1021 94

We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by Staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. Thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula.
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PMID:Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis. 1043 Sep 89


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