Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Treatment with streptokinase or heparin was allocated randomly to 20 patients with major pulmonary embolism verified by angiography. In addition, 4 patients treated with streptokinase and 1 patient treated with heparin were included in the trial prior to the start of treatment. Streptokinase of heparin was given for 72 hours and pulmonary angiography was repeated. The angiographic evidence of thrombolysis was significantly greater (p less than 0.01) in the 14 patients treated with streptokinase than in the 11 treated with heparin. In the heparin group, 1 patient died from massive embolism 15 hours after the start of treatment. In another patient who died 4 weeks later from cerebral glibolastoma, persistent massive embolism contributed to the fatal outcome. In the streptokinase group, 1 patient with a metastatic pulmonary carcinoma died 3 weeks after the start of treatment from gangrene of both legs following thrombotic occlusion of the inferior vena cava. Bleeding was more common after treatment with streptokinase than with heparin, but was not a serious problem in any patient. It is concluded that patients with life-threatening pulmonary embolism should be offered the benefits of streptokinase.
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PMID:A controlled clinical trial of streptokinase and heparin in the treatment of major pulmonary embolism. 35

This is an analysis of 130 cases with embolism of the pulmonary artery with a lethal outcome, which had developed in patients suffering from occlusion of the lower extremities. It is noted that the origin of embolism of the system of the pulmonary artery depends on the severity of ischemia of the tissues of the affected extremity and pointed out that this menacing complication develops both in the stage of ischemia and in the postischemic period. For the prevention of pulmonary embolism in patients with severe ischemia or gangrene of the lower extremities, it is recommended that operative treatment (corrective operations on the arteries or amputation) should be combined with inspection of the major veins.
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PMID:[Pulmonary embolisms as a complication of acute arterial obstruction of the lower extremities]. 69 63

The following complications of pulmonary resection are discussed with reference to their frequency of occurrence, etiology, diagnosis, and treatment: pulmonary insufficiency, arrhythmias, residual intrapleural air spaces, prolonged air leaks, postpneumonectomy empyema, bronchopleural fistula, cardiac herniation, lobar gangrene, esophagopleural fistula, pulmonary embolism, and tumor embolism.
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PMID:Complications of pulmonary resection. 109 96

Sodium warfarin was administered to a 59-year-old woman with congestive cardiac failure and deep vein thrombosis. After 3 days of therapy the nipple and areola of the left breast became inflamed; the entire breast then became necrotic. Gangrene spread and a simple mastectomy was performed. The patient died from pulmonary embolism 1 day after operation. Histologic examination of the breast revealed thrombi in some of the arteries and veins. The etiology of this condition is obscure, and there is no known way of preventing or effectively treating the condition. Simple mastectomy or more conservative local excision recommended.
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PMID:Cutaneous gangrene: a rare complication of coumarin therapy. 124 9

Decisions to resect small aortic aneurysms or employ non-operative treatment for aorto-iliac occlusive disease must depend on current rather than historical surgical results. To assess current morbidity and mortality, we reviewed 200 consecutive aortic resections in two groups of patients treated from 1981 to 1989: those undergoing elective aortofemoral bypass for occlusive disease (AFB, no. 100) or resection of infrarenal abdominal aortic aneurysms (AAA, no. 100). Indications for AFB included claudication (54%), rest pain (32%), and gangrene (13%). AAA size ranged from 3 to 14 cm (mean 6.5 +/- 2.4 cm); 45% presented with abdominal or back pain. Patients undergoing AFB were younger (AFB 61.5 +/- 10 years vs AAA 68.7 +/- 8.9 years) with a higher incidence of some atherosclerotic risk factors, diabetes mellitus 30% vs 10%, tobacco use 77% vs 49%, hyperlipidemia 21% vs 7%; p less than 0.001). Coronary artery disease (CAD) was more prevalent in AAA patients (49% vs 34%; p less than 0.001). Postoperative mortality was not different in occlusive or aneurysmal disease (3% AFB vs 2% AAA), nor was the occurrence of serious complications such as myocardial infarction (2% vs 1%) or pulmonary embolism (2% vs 3%). Improvements in patient selection, perioperative care and surgical technique have lowered the mortality of elective aortic surgery. Given the current standard of care, an aggressive approach to AAA even in high risk patients is appropriate. The low morbidity of AFB for occlusive disease mandates a critical appraisal of less effective nonoperative therapies.
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PMID:Current results of elective aortic reconstruction for aneurysmal and occlusive disease. 221 95

Most patients with lupus anticoagulant (LA) activity have coincident antibodies to a group of negatively charged phospholipids, and its is suggested that LA and anticardiolipin tests detect antibodies with overlapping specificities. Some discordance between the two assays has been described, however. One patient presenting with severe thrombotic disease (recurrent deep vein thrombosis, pulmonary embolism, inferior venocaval obstruction, myocardial infarction, and digital gangrene) showed strong LA activity in February 1987. An enzyme linked immunosorbent assay (ELISA) showed no binding to the negatively charged phospholipids cardiolipin, phosphatidylserine, and phosphatidic acid, but binding to zwitterionic phosphatidylethanolamine (PE) was demonstrated. Inhibition studies and affinity purification confirmed this finding. Interestingly, the serum did not bind to the kaolin cephalin clotting time reagent when used as antigen in an ELISA. The pathogenic significance of anti-PE antibodies and their relation to LA remains to be clarified. Further studies of the occurrence of anti-PE antibodies in patients with LA activity who have negative anticardiolipin tests are suggested.
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PMID:Antibody to phosphatidylethanolamine in a patient with lupus anticoagulant and thrombosis. 249 57

Unsuccessfully treated iliofemoral venous thrombosis can result in pulmonary embolism, phlegmasia cerulea dolens, and post-thrombotic syndrome. Phlegmasia cerulea dolens is characterized by tense swelling of the lower extremity with tenderness of the thigh over the femoral vein, mottling of the limb, and absent distal pulses. Without treatment, phlegmasia cerulea dolens can progress to cause venous gangrene and ultimate limb loss. In the reported case, phlegmasia cerulea dolens developed in a middle-aged woman with metastatic thyroid carcinoma following Greenfield filter placement via the femoral vein after heparinization for deep-vein thrombophlebitis had failed.
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PMID:Phlegmasia cerulea dolens as a complication of percutaneous insertion of a vena caval filter. 292 Nov 23

Defiency of protein C has been reported to be associated with recurrent thrombosis and pulmonary embolism, disseminated intravascular coagulation, and coumarin-induced skin necrosis and peripheral gangrene. That all of these serious and eventually lethal complications of protein C deficiency, including embolic myocardial infarction, may occur in the same person is the subject of this case report and description of pathological findings.
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PMID:Recurrent thromboembolism, disseminated intravascular coagulation, and coumarin-induced skin necrosis associated with protein C deficiency. 342 32

The authors present a retrospective analysis of the management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients at the Massachusetts General Hospital from January, 1978, through June, 1982. There were 44 cases of DVT and 13 cases of PE. Management modalities included observation only, femoral vein ligation, inferior vena cava clipping, transvenous placement of an inferior vena cava filter or umbrella, and anticoagulation therapy. Six (75%) of eight patients with symptomatic DVT who were managed by observation alone had subsequent pulmonary emboli, and three (38%) died. Femoral vein ligation was followed by PE in one of four cases and led to significant leg swelling in two others. Neither observation alone nor femoral vein ligation can be recommended as routine management options. Partial inferior vena cava interruption with a De Weese clip, Kim-Ray Greenfield filter, or Mobin-Uddin umbrella all successfully prevented pulmonary emboli. The major problem associated with these methods was leg edema, which occurred in 47% of patients with clip placement, 25% with filter placement, and 21% with a Mobin-Uddin umbrella. Anticoagulation therapy was associated with a complication rate of 29% and a mortality rate of 15%. Fatal PE and paradoxical hypercoagulability with gangrene of a lower extremity were the causes of death. In one patient, hemorrhage into a glioblastoma occurred following discontinuation of anticoagulation therapy when the coagulation parameters were normal. The authors conclude that: 1) management with observation alone of patients with symptomatic DVT places the patient at risk for the development of life-threatening pulmonary emboli; 2) the safety and timing of therapeutic anticoagulation in postoperative neurosurgical patients or patients with tumors is unclear; and 3) partial interruption of the inferior vena cava with a transvenous filter successfully prevents PE and may represent a safer alternative to anticoagulation therapy.
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PMID:Management of symptomatic deep venous thrombosis and pulmonary embolism on a neurosurgical service. 395 Jul 40

Ten personal cases of necrotizing cellulitis and fasciitis are reported. The lower limbs were the most common site of infection. Two patients had involvement of the whole of the leg and died of septic shock. Two other patients died of pulmonary embolism. Bacteriological investigations showed multiple infection to be the rule; gangrene due to streptococcal infection alone was only observed in 3 cases, staphylococcus alone in 1 case and serratia alone in 1 case. Surgery was performed within 48 hours of admission under antibiotic cover in all but two cases. The authors emphasize the need for adequate anticoagulation to prevent multiple venous thrombosis in the infected subcutaneous tissues and to avoid the risk of fatal pulmonary embolism.
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PMID:[Necrotizing cellulitis and fasciitis of infectious origin. Review of 10 personal cases and the literature]. 409 58


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