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

The authors report 6 cases of acute respiratory failure complicating chronic bronchial and lung disease admitted to hospital with the diagnosis of: heart disease, 3 cases, pulmonary oedema, pulmonary embolism, atrial flutter; status asthmaticus : one case; neuro-psychiatric disease : 2 cases (toxic coma and agitation). The authors emphasize the frequency of chronic bronchial disease and recall the signs of acute decompensation discussing the possible difficulties in diagnosis and the therapeutic implications.
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PMID:[Deceptive and revealing clinical forms of acute respiratory insufficience in chronic bronchopneumopathies]. 19 94

Renal vein thrombosis caused the nephrotic syndrome in a patient with morbid obesity. Pulmonary embolism occurred initially, but not after anticoagulants were administered. Surviving for three years, the patient died of profound uremia and hyperosmolar coma. At autopsy, membranous glomerular changes were found. Conclusive exclusion of renal vein thrombosis in the morbidly obese patient with nephrotic syndrome appears advisable.
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PMID:Thrombosis of the renal veins and vena cava. Occurrence in morbid obesity. 124 31

An 85-year-old female diabetic was admitted in coma, having been on antidiabetic treatment with the biguanide derivative "Silubin retard", 600 mg/d, for one-and-a-half months. The anion deficiency was 57 mmol/l, pH 6.9, suggesting the diagnosis of lactic acidosis in the absence of other causes of metabolic acidosis. Blood lactic acid levels of more than 16.65 mmol/l (150 mg/100 ml) confirmed the diagnosis. Administration of 875 mmol sodium bicarbonate over 12 hours corrected the deficiency. On admission to hospital there had been slight pre-renal failure. Myocardial infarction developed as a result of tissue hypoxia but did not prove clinically important. On the second day there were signs of a compensated disseminated intravascular coagulopathy with upper gastro intestinal haemorrhage. The woman died suddenly 18 days later of pulmonary embolism.
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PMID:[Lactic acidosis after administration of buformine (author's transl)]. 124 7

A previously well 40-year-old woman suddenly collapsed and had to be resuscitated by an emergency physician. Admitted to hospital she remained unconscious and needed artificial respiration. Diagnostic tests failed to find evidence for pulmonary embolism, myocardial infarction or myocarditis. ECG monitoring in the intensive care unit merely revealed occasional unifocal ventricular premature systoles. Echocardiography was within normal limits. She remained in coma without spontaneous respiration. Cranial computed tomography and serial electroencephalograms indicated brain death. Autopsy revealed lipomatous hypertrophy (hamartoma) of the atrial septum with extensive bleeding into it as the most likely cause of (unrecorded) malignant cardiac arrhythmias.
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PMID:[Lipomatous hypertrophy of the atrial septum. Cardiac-induced syncope in hamartoma of the right heart atrium]. 188 55

A consecutive series of 79 patients with Cushing's disease, treated by bilateral adrenalectomy (subtotal, total initially, or total finally) between 1953 and 1980, were studied to determine the survival and mortality rates and causes of death as long as 28 years after surgery. There were three early postoperative deaths, the last in 1974, caused by coma of unknown cause, severe diarrhea, and pulmonary embolism, respectively. The actuarial survival rates at intervals of 1, 2, 3, 5, 10, 15, and 20 years after surgery were approximately 87%, 83%, 82%, 79%, 72%, 68%, and 62%, respectively. These are significantly less than the rates for the general population (p less than 0.001). There were no differences between the sexes or between the types of operation (p greater than 0.05). The commonest causes of death were cardiac or vascular lesions (11 patients) and the local effects of pituitary tumors (four patients). These long-term results of an established method of treatment provide a standard by which other, especially newer, methods may be compared.
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PMID:Survival and causes of death after adrenalectomy for Cushing's disease. 396 25

At present, the Kimray-Greenfield filter appears to be the best intraluminal method for preventing thromboembolism, as it is simple, effective and innocuous. The authors report their experience in the first 22 cases. They were surprised by the frequent problems encountered in installing the filter, especially by the femoral route. Two accidents occurred during the procedure: a filter introduced through the jugular vein migrated as soon as it was released, and a patient developed sudden and irreversible coma during passage of the guiding instrument behind the clavicle. Cavographies performed in 10 patients after one month or more disclosed two thromboses of the inferior vena cava and a tipped-over filter. Eight filters remained permeable. No recurrence of pulmonary embolism was observed.
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PMID:[Prevention of pulmonary embolism by the Kimray-Greenfield filter. 22 cases]. 622 Mar 72

In a series of 250 consecutive open-heart operations, three cases of late cardiac tamponade were noted following the operation. This led the authors to review the literature pertaining to this complication. Ninety-nine cases were collected. The frequency of late tamponade associated with cardiac surgery was 0.62% and was fatal in 16.2% of those cases. The delay before the tamponade appeared varied from 3 days to 3 months (mean 14.5 +/- 7.8 days). The initial clinical picture is insidious and vague, and this constitutes the danger of late cardiac tamponade. The clinical signs are of the respiratory (dyspnea, chest pain), gastrointestinal (anorexia, vomiting) and central nervous (mental confusion, even coma) systems. Pallor with a drop in hematocrit in patients on anticoagulant therapy suggests occult bleeding. A definitive diagnosis depends on catheterization of the right side and on mono- and bidimensional echocardiography. The authors believe that computerized axial tomography represents an interesting noninvasive and reliable examination technique when it can be used during emergency treatment. Pericardial puncture, which is both a diagnostic and therapeutic technique, was useful in one third of the cases; it produced a false-negative result in 12%. The resulting differential diagnoses are pulmonary embolism, myocardial insufficiency and septic shock. Late cardiac tamponade may be produced by one of two mechanisms: hemopericardium due to overdosage of anticoagulants or an exacerbated form of the post-pericardiotomy syndrome. Emergency treatment is always necessary. Pericardiocentesis is a useful diagnostic aid and provides temporary stabilization preoperatively. A wide surgical approach is always indicated. The mortality in untreated patients is 100%. The frequency of immediate relapse or, occasionally, of delayed relapse is estimated to be 11%; relapse may be lethal.
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PMID:[Late tamponade after heart surgery: a dreadful diagnostic pitfall]. 634 35

A 64-year-old woman developed impaired consciousness and vision, sensorimotor paresis, hypothermia, bradycardia, and edema. Symptoms fluctuated with seasonal exacerbations in winter and terminated in coma with respiratory insufficiency at age 69. High CSF protein content and low serum T4 and TSH levels were noted. Treatment with prednisolone and thyroxin considerably improved her consciousness and edema. The patient suddenly expired of pulmonary embolism. Postmortem examination revealed a marked atrophy of pituitary and thyroid glands, while multiple demyelinating plaques were disclosed in the optic tract and cervical cord. A review of the literature indicates that this is the first report of the co-existence of two such disorders.
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PMID:Multiple sclerosis co-existent with myxedema. An autopsy case report. 653 Jun 12

A case of progressive posttraumatic superior sagittal sinus thrombosis is presented, with the complication of pulmonary embolism. A good clinical outcome followed treatment with barbiturate coma.
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PMID:Progressive posttraumatic superior sagittal sinus thrombosis complicated by pulmonary embolism. Case report. 668 14

Aneurysms of the bifurcation of the middle cerebral artery (MCA) can be approached through a small incision in the anterior portion of the superior temporal gyrus. The pterion and the lateral aspect of the lesser wing of the sphenoid bone are removed. The aneurysm is approached, using microsurgical techniques, by following the main divisions of the MCA to the parent trunk and the base of the aneurysm. Once the parent vessel and the origin of the major divisions are clearly identified, it is usually preferable to dissect and mobilize the entire aneurysmal complex to elucidate the anatomy and prepare the neck for clipping. This approach offers the advantages of minimal brain retraction and minimal manipulation of the main trunk and perforators of the MCA. In addition, it allows a more complete exposure of the aneurysmal complex and facilitates dissection behind the aneurysm, which is more difficult when the aneurysm is approached from the front by opening the sylvian fissure medially to laterally. A potential disadvantage of this method is that proximal control is not obtained until the base of the aneurysm is reached, but this has not been a problem in our experience. Other disadvantages are the need for a slightly larger bone flap and the potentially increased risk of epilepsy. This approach is not suitable when the main trunk of the MCA is short and the aneurysm is in front of the insula. It is also not recommended for the rare cases in which the aneurysm points back over the insula. During a 6-year period, this approach was used in 49 of 58 cases of MCA aneurysm. The only deaths in this group occurred in patients who were in deep coma before operation. Two patients were made worse by operative complications, and 2 more worsened as a result of postoperative vasospasm. There was a significant incidence of thrombophlebitis and pulmonary embolism in this series.
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PMID:Superior temporal gyrus approach to middle cerebral artery aneurysms: technique and results. 707 Jun 32


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