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

Thrombosis occurs most often as myocardial infarction, cerebral infarction or venous thromboembolism, ie, deep-vein thrombosis and pulmonary embolism. The incidence of all types of thrombosis is strongly dependent on age. Among young individuals, up to age 40, venous thrombosis is the most common form of thrombosis. The risk factors for arterial and venous thrombosis differ, and among the latter disorders of hemostasis appear to be more prominent. In children venous thrombosis appears almost exclusively in association with venous catheters, with an exception of the renal vein thrombosis of the newborn, which has an unknown etiology. In young adults, the risk factors for venous thrombosis are essentially the same as in older individuals, excepting oral contraceptives, pregnancy and puerperium which are limited to young women. In young women, most venous thrombotic events can be attributed to oral contraceptives. Venous thrombosis is a multicausal disease: more than one risk factor needs to be present before thrombosis occurs. The younger an individual, the more risk factors are required to precipitate thrombosis: in children often three or four, and in young adults often two or more.
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PMID:Thrombosis in the young: epidemiology and risk factors. A focus on venous thrombosis. 919 19

The 78-year-old male underwent coronary angiography because of angina pectoris. He was revealed to have essential thrombocythemia with a platelet count of over 1,000,000/mm3. Essential thrombocythemia belongs to the group of chronic myeloproliferative disorders. It displays both thrombogenic and bleeding tendency due to the increased platelet count, as well as to dysfunction. CABG was performed using the left internal thoracic artery and the right gastroepiploic artery. Hydroxycarbamide was taken to regulate the platelet count before surgery. There was no difficulty with hemostasis during surgery. Warfarin and hydroxycarbamide were used as anticoagulant therapies after surgery. Postoperative CAG demonstrated both grafts to be patients. The patient remained in good condition until he died suddenly on the 159th postoperative day. The cause of death was not clear because no autopsy was carried out. The death may have been associated with a thromboembolism, acute graft thrombosis or cerebral infarction, or pulmonary embolism. This patient did not take antiplatelet drugs because the platelet count and prothrombin time was well controlled. Nonetheless, an antiplatelet agent might reduce the risk of thromboembolism in such patients. It is suggested that meticulous anticoagulation therapy must be important for a patient with essential thrombocythemia, especially in the postoperative period.
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PMID:[A case of coronary artery bypass surgery using left internal thoracic artery and right gastroepiploic artery for a patient with essential thrombocythemia]. 978 79

A 74-year-old woman was admitted because of abdominal pain. A few weeks before this admission she had had a cerebral infarction in the right hemisphere, reflected by a left sided paralysis, dysarthria, depression and a slight cognitive disorder. The night before admission she woke up from a sharp, continuous pain in the right upper abdomen. Physical examination disclosed pain in the right upper abdomen on palpation. Laboratory tests showed a slight elevation of all 'liver' enzymes. A differential diagnosis of cholecystitis or pyelonephritis was made. Additional tests did not confirm either of these diagnoses. Because of immobilisation pulmonary embolism was then suspected. This diagnosis was confirmed by scintigraphy. The patient was treated and made a full recovery. Diagnostic errors can be made by faulty triggering and omitting verification. The diagnostic strategy for pulmonary embolism is a ventilation perfusion scan, which is followed in case of a non high-probability result by pulmonary angiography. It is emphasized that the presentation of pulmonary embolism can be aspecific.
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PMID:[Clinical thinking and decision making in practice. A patient with pain in the upper abdomen]. 1006 38

We systematically screened for the aetiology of thrombophilia in 115 patients with venous, arterial and small vessel thromboses. Forty-one patients (36% of those we examined) suffering from a variety of thromboses, including deep vein thrombosis, pulmonary embolism, arterial occlusion, cerebral infarction, Moyamoya disease and ulcerative colitis, were characterized either with positive lupus anticoagulants or with decreased activities of protein S, protein C, antithrombin III and/or plasminogen. Eight mutation sites were confirmed in 11 thrombotic patients using gene analysis. Decreased protein S activity was found with a high incidence (23 out of 115) in Japanese patients who suffered from not only venous thrombosis but also arterial and small vessel thrombosis. We emphasize here the important role of protein S in the pathogenesis of thrombosis in the Japanese population.
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PMID:Screening for aetiology of thrombophilia: a high prevalence of protein S abnormality. 1045 3

Selective cerebral angiography is currently being performed using transfemoral and transbrachial approaches. However, these techniques require patients to tolerate a prolonged focal compression and sometimes cause serious complications such as pulmonary embolism. The authors describe a technique of transradial approach as a safer selective cerebral angiography. Between July 1997 and November 1998, 70 patients underwent selective cerebral angiography with a transradial approach using a 4-F catheter. The collateral blood supply to the hand from the ulnar artery was confirmed using Allen's test prior to the procedure. To prevent the mechanical spasm of the radial artery, an arterial introducer 20 cm long was used. The radial artery was successfully punctured and cannulated in all patients. Selective catheterization of the intended vessels was obtained in over 98% of the carotid angiography and over 95% of the vertebral angiography. No major vascular complications such as cerebral infarction, upper limb ischemia, significant local hematoma or pseudoaneurysm were experienced. The transradial approach is a less invasive and safer technique for selective cerebral angiography, and could be an alternative to transfemoral and transbrachial approaches.
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PMID:Transradial approach for selective cerebral angiography: technical note. 1104 24

The authors report two cases of hepatotoxicity induced by low molecular weight heparin. A 26-year-old woman and a 33-year-old man were treated with low molecular weight heparin for pulmonary embolism and cerebral infarction, respectively. They both developed derangement in liver function tests a few days after commencement of the low molecular weight heparin. The derangement in liver function tests was associated with a decreased serum complement 3 activity. Their liver functions recovered over a period of 2 to 3 months after low molecular weight heparin was stopped. Liver biopsy in the woman demonstrated balloon degeneration with scattered foci of hepatocytic necrosis, suggesting a complement-mediated hepatocellular damage.
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PMID:Low molecular weight heparin-induced liver toxicity. 1140 39

We studied a nationwide Swedish cohort with 654,957 women who had 1,003,489 deliveries from 1987 through September 1995 to assess late pregnancy and puerperal risks of circulatory diseases. We used standardized incidence rate ratios to calculate relative risks [with 95% confidence intervals (CIs)]. Compared with unexposed (nonpregnant and early pregnant) women, relative risks of venous thrombosis and pulmonary embolism during the third trimester were 6.7 (95% CI = 5.7--7.8) and 2.7 (95% CI = 1.7--4.2), respectively. Around delivery (from 2 days before to 1 day after delivery), the relative risks of all assessed circulatory diseases were dramatically increased: venous thrombosis, 115.1 (95% CI = 96.4--137.0); pulmonary embolism, 80.7 (95% CI = 53.9--117.9); subarachnoid hemorrhage, 46.9 (95% CI = 19.3--98.4); intracerebral hemorrhage, 95.0 (95% CI = 42.1--194.8); cerebral infarction, 33.8 (95% CI = 10.5--84.0); and myocardial infarction, 27.0 (95% CI = 0.6--180.0). During the rest of the first 6 weeks postpartum, the risks declined but were still substantially increased for all diseases, with the exception of subarachnoid hemorrhage. The results suggest that the increased risk for circulatory diseases related to pregnancy is mainly confined to a few days around delivery.
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PMID:Increased risks of circulatory diseases in late pregnancy and puerperium. 1141 82

The patient was a 69-year-old man with a 3-year history of diabetes mellitus accompanied by cerebral infarction and arteriosclerosis obliterans of the lower extremities. After squatting to clean a car, the patient began to experience dyspnea. A blood gas analysis was performed upon admission, and the patient's PaCO2 and PaO2 levels were found to be low. Examination of a blood sample revealed elevated FDP, FDP-D dimer and platelet factor 4 levels. A perfusion lung scan showed multiple defects in both lungs, but no abnormal findings were detected on a ventilation scan. A pulmonary angiogram showed an interrupted blood flow in branches A9 + 10 of the left pulmonary artery. Accordingly, a pulmonary embolism was diagnosed. Squatting may have caused a partial obstruction of the venous return from the lower extremities by compression of the inguinal region and may have been a predisposing cause of the thrombosis. To our knowledge, such cases of pulmonary embolism triggered by the act of squatting are very rare.
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PMID:[A case of acute pulmonary embolism associated with squatting]. 1151 Jan 1

A 76-yr-old male presented for leg amputation above the knee. The patient complained of dyspnea due to pulmonary embolism occurring 3 weeks before operation. In addition, the patient could not report paresthesias because he had suffered from a cerebral infarction. Anesthesia was performed with combined block of femoral, sciatic, obturator nerves and the lateral cutaneous nerve of the thigh. The nerves were anesthetized with 0.75% ropivacaine solution 31 ml by use of an electrical nerve stimulator and an insulated needle. Nerve stimulation technique is the best choice for patients who are unable to report paresthesias reliably.
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PMID:[Combined block of femoral, sciatic, obturator nerves and lateral cutaneous nerve block with ropivacaine for leg amputation above the knee]. 1238 94

A 60 year-old female complained with abdominal distension for one month. Stage IIIc, grade 2 clear cell carcinoma of the ovary was diagnosed after laparotomy. Weekly paclitaxel combined with carboplatin as adjuvant chemotherapy was given after optimal cytoreductive surgery. An acute cerebral infarction after first chemotherapy cycle was developed. The patient presented with dyspnoea after the third chemotherapy cycle and the symptom could be relieved at rest. Such symptom worsened and relieved alternatively for 3 days. A sudden dyspnoea occurred to the patient again when she got up one night, and died of respiratory and circulatory failure on the way to the hospital. Autopsy revealed ovarian clear cell carcinoma with metastasis to the whole pelvic and abdominal cavity and massive pulmonary arterial embolism (the length of embolus is 20 cm) with cerebral infarction. A conclusive remarks was made during the conference that patients who underwent operation and chemotherapy were at high risk for venous thrombosis (VT) and pulmonary embolism (PE). It was important to analyze a patient's individual risk for VT and PE. Appropriate thrombosis prophylaxis ought to be considered highly for high risk patients.
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PMID:[Clinicopathological conference: an advanced ovarian carcinoma patient suddenly died of pulmonary embolism]. 1297 96


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