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

The detection of specific hormone receptors in normal and tumor tissue has brought new insight into the mechanisms of action of hormones and anti-hormones. The Swiss Cooperative Cancer Study Group (SAKK) has evaluated the antitumor effect of the new antiestrogenic substance tamoxifen in metastatic breast cancer. 158 postmenopausal patients treated with 20 mg/d tamoxifen by mouth are evaluable at present time. Complete and good partial remissions were achieved in 39 patients (25%) largely with soft tissue but also lung and bone metastases. Tamoxifen was well tolerated and caused few serious complications such as thrombosis/pulmonary embolism and hypercalcemia. These results confirm already published experience with tamoxifen, which may replace the estrogens as the primary endocrine treatment in postmenopausal mammary carcinoma metastasizing to soft tissues, lung and bone.
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PMID:[Antiestrogens: a new endocrine treatment possibility in metastasizing breast neoplasms. Experiences of the Swiss Cooperative Cancer Study Group with tamoxifen]. 69 81

Thrombophlebitis has been associated with virtually all cancers, especially gastrointestinal, urogenital, and lung neoplasms. Although occurring infrequently in cancer patients, thrombophlebitis may appear before the cancer has become symptomatic and may lead to an earlier diagnosis of cancer. The phlebitic syndrome associated with cancer, although not unique, is distinctive. It is often recurrent and migratory, often involves unusual locations, and is often resistant to anticoagulation therapy. Pulmonary emboli are frequent complications. The pathogenesis of phlebitis in cancer patients is not well understood. Evidence suggests that many cancer patients are hypercoagulable, with abnormalities in platelets, coagulation factors, and the fibrinolytic system. These changes may results from the elaboration of thromboplastin-like substances from the cancer tissue.
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PMID:Thrombophlebitis and cancer. A review. 80 83

Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5%) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5%), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5% beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoper treatment appears to be the predominant task in the effort to decrease postoperative mortality.
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PMID:[Analysis of postoperative deaths in colon and rectal cancer (author's transl)]. 84 78

The influence of several diseases and conditions upon the prevalence of pulmonary embolism in autopsies performed over the July 1, 1964 to June 30, 1974 period at the University of Michigan Medical Center (Ann Arbor, Michigan) were analyzed. The prevalence of pulmonary was 12.3% in the 4600 necropsies in this sample. Patients with pulmonary fat emboli or tumor emboli and patients thought to have thrombosis of the pulmonary artery were not designated as having pulmonary thromboembolism. The patients were categorized with regard to heart disease on the basis of both clinical and necropsy findings. The major factors contributing to an increase in risk of development of pulmonary embolism include heart disease, certain types of cancer, obesity, acute paraplegia and accidental and operative trauma. Other risk factors which could not be assessed in this study include a prior history of venous thromboembolism, pregnancy and the puerperium, use of oral contraceptives, ulcerative colitis and Crohn's disease. Age plays a major role in the prevalence of pulmonary embolism. A portion of the effect of age is related to the age distribution of other diseases contributing to an increased risk, yet advanced age alone may have an independent influence. The risk factors defined should be used in a selective program designed to increase the rate of detection of deep venous thrombosis before pulmonary embolism occurs. Alternatively, patients at increased risk should be treated with prophylactic low dosage heparin during hospitalization.
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PMID:Risk factors in pulmonary embolism. 95 58

Since the development of automatic surgical stapling instruments in the Soviet Union in the 1950s and their description in the American literature in 1961, American surgeons have used them for a variety of pulmonary resections. However, there is no account of their use in this country for pneumonectomy by "en masse" stapling of the hilar structures. We have used this whenever it was applicable in 41 consecutive pneumonectomies since 1967. There were 2 postoperative deaths, 1 due to pulmonary embolism and the other to myocardial infarction. There were no complications attributable to the operative technique used. The only empyema developed nine months postoperatively and was not accompanied by bronchial fistula. Cancer-free survival was 43% at two and one-half years and 33% at five years. The technique of en masse stapling of hilar vessels renders pneumonectomy easier, safer, and faster than the technique of individual ligation.
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PMID:Pneumonectomy by "en masse" stapling of hilar vessels. 109 Dec 20

In 112 patients receiving inferior vena caval, serrated, Teflon clips over a 7 year period beginning Jan. 1, 1966, the operative mortality rate was 6 percent (seven patients) and the 1 to 12 month mortality rate was 9 percent (10 patients). Patients with severe heart disease accounted for eight of these 17 deaths. The mortaligy rate was zero in patients who were free of heart disease, malignancy, sepsis, or massive pulmonary embolism. Recurrent pulmonary embolism was suspected, but not lethal, in four patients and was proved in two. Patients who had leg swelling preoperatively were more likely to have swelling postoperatively than those who were initially free of swelling. Postoperative anticoagulation was ineffective in preventing edema and carried the risk of wound hemorrhage. Twelve months after operation, 12 of the 83 patients available for follow-up had severe lower extremity symptoms and 23 had milder, easily controlled edema. Late stasis changes, therefore, appeared at an acceptably low frequency and could reasonably be expected for patients with lower extremity phlebothrombosis. There was no instance of fatal pulmonary embolism in the follow-up period extending from 1 to 6 years.
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PMID:Mortality and morbidity rates after inferior vena caval clipping. 110 11

Postoperative complications observed in 200 patients after pulmonary resection (66 pneumonectomies--30%, 106 lobectomies--53% and 28 wedge resections--17%) are presented. Surgical operations were carried out in 86% of cases for cancer, in 16% for benign lesions. Major complications were: lobar atelectasis, bronchopneumonia, pulmonary embolism, respiratory insufficiency, bronchial fistula, ventricular tachyarrhythmia, altogether they concerned 21% of the cases. Their incidence was not significantly influenced by the extension of resection (the latter, on the contrary, influenced postoperative mortality as much as 4.5% after pneumonectomy, 2.8% after lobectomy and 0% after wedge resection), age of patients under or over 70 years, functional respiratory reserve, or associated cardiovascular diseases. On the contrary, the advanced stage of disease in neoplastic patients was significant for major complications. An adequate monitoring of minor respiratory and cardiac complications is recommended to reduce the incidence of major ones and their control when present. In authors' experience, in fact, postoperative mortality was overall 3% following such behaviour.
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PMID:[The complications of pulmonary resection surgery: the experience of 200 consecutive cases]. 129 61

The autopsy findings and clinical features in 60 patients with fatal pulmonary embolism (PE) in University College Hospital, Ibadan, between 1985 and 1989 are analysed in the current study. Pulmonary embolism occurred in 3,8 pc of all autopsied patients during this period. There was a male to female ratio 1,4 to one and average age was 47 years. Malignant neoplasms, infections and cardiac failure were the leading predisposing factors to PE identified. The ante-mortem clinical features consisted largely of non-specific respiratory symptoms of dyspnoea, cough, chest pain and haemoptysis. Of these patients, 15,6 pc were diagnosed ante-mortem as having PE. Pulmonary infarction occurred in 13,3 pc of the cases and was commoner in females and in patients with underlying cardiac diseases. This study emphasises the need for a high clinical index of suspicion to improve the antemortem diagnosis of this potentially fatal condition and to advocate a greater use of prophylactic anti-coagulant therapy in high risk patients.
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PMID:Pulmonary embolism in Ibadan, Nigeria: five years autopsy report. 130 38

In a double blind, randomized trial the hemorrhagic complications of a reduced dose of low molecular weight heparin (LMWH) (Fragmin, KabiPharmacia) were compared to those of the conventional dose of unfractionated heparin (UH). 2500 anti-XaU of LMWH was given once daily and UH in a dose of 5000 anti-XaU twice daily. During a one year period 141 patients undergoing gynecological surgery were included in this study. The patients were examined clinically for hematomas and for deep venous thrombosis (DVT) on the third and fifth day. Venography was performed when DVT was suspected. No patients developed clinical DVT. One woman in the LMWH group had pulmonary embolism 3 days after the prophylaxis was stopped. Two women in the LMWH group died, one from a stroke on day 2, one from cancer on day 39. There was no significant difference in serious bleeding complications between the two regimens, 20% in the LMWH group and 14% in the UH group. Even with the reduced dose of LMWH the mean plasma concentration of heparin in the LMWH group was higher (mean 0.14 anti-XaU/ml) than in the UH group (0.029 anti-XaU/ml) 3 hours after injection on the 2nd postoperative day. A reduced dose of LMWH (2500 anti XaU once daily) does not cause more bleeding complications than the conventional heparin regimen to prevent thrombosis, as was the case in our previous study with 5000 anti XaU of LMWH once daily.
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PMID:Comparison of low molecular weight heparin vs. unfractionated heparin in gynecological surgery. II: Reduced dose of low molecular weight heparin. 132 46

Between 1985 and 1990, 517 patients were treated for colorectal malignancies at our department of surgery. Nd:YAG laser therapy was used in 37 cases (7.1%). The mean age of these 22 men and 15 women was 71.4 years (range: 22-96 years). One hundred-twenty-nine Nd:YAG laser treatments were performed. Indications for laser treatment were (1) palliative tumor reduction (n = 21), (2) preresectional laser recanalization for obstructing carcinoma (n = 6), and (3) curative treatment (n = 10). Laser related complications included one perforation of the rectum and one rectovaginal fistula. One fatal pulmonary embolism occurred. After palliative treatment, five patients died because of tumor progression (mean survival time: 16 months), two because of other reasons. All patients with obstructing tumors could be recanalized successfully. After curative treatment, eight patients are still alive without tumor recurrence (mean survival time: 25.5 months), and two died of other causes. Palliative Nd:YAG laser treatment of colorectal malignancies is a competitive alternative to conventional surgery. Recanalization of obstructing tumors is an excellent treatment for large bowel obstruction, making one-stage resections possible. Curative treatment should be reserved for special cases only.
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PMID:Nd:YAG laser treatment of colorectal malignancies: an experience of 4 1/2 years. 137 43


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