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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 recently treated three patients showing rather marked complications following sclerosing injections for varicose veins. In the first case, the intra-arterial injection brought about a tissular necrosis in the form of a distal-based triangle. The preservative treatment, undertaken 4 weeks after the injection, did not make it possible to save three toes, that had to be amputated. The second patient was sent to use after an injection in the posterior tibial artery. Acute ischemia was treated on an emergency basis with a lumbar sympathectomy. I believe that the approach we took allowed us to cure the trophic problems and to loose only one small phalanx. The third case reported on concerns a patient brought to us in a state of shock after a massive pulmonary embolism. She had been given a sclerosing injection in a large varicose vein of the leg 48 hours previously. The leg had rapidly increased in volume and was apparently the site of a deep veinous thrombosis.
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PMID:[Complications of sclerotherapy]. 48 71

The purpose of this study was to find out whether acute massive pulmonary embolism can produce myocardial changes visible by light and electron microscopy. Ww therefore produced pulmonary embolism in rats using plastic microspheres (diameter, 15 +/- 5 mu). Two experimental protocols were used: lethal embolism, with a dose of microspheres known to kill in 3 to 15 hours (these rats were killed after 1 hour), and sublethal embolism, with a dose compatible with 100% survival (these rats were killed after 24 hours). In both groups, the left ventricle was normal. The right ventricle showed two tyes of changes: a) A distinctive lesion of the myocytes, more diffuse after lethal enbolism and different from the "zonal lesion" of shock. It consisted primarily in a localized shredding of the myofibrillar system; hence, the name shredding is proposed. Earlier stages of this lesion were represented by focal dissolution of the Z line (Z lysis). The pathogenesis of these lesions appeared to be primarily mechanical. b) Necrosis was already apparent at 1 hour and was more extensive after 24 hours. The pathogensis of the necrotic lesions is best explained by a temporary ischemia followed by delayed reflow; a possible potentiating role of endogenous catecholamines cannot be excluded. Most capilaries in the necrotic foci remained functional; this explains the rapid rate of the healing process of such lesions. A comparison is drawn between the observed foci of necrosis and the human myocardial lesions knowns as "miliary infarcts" and "myocytolysis." It is proposed that a factor common to all three is the preservation of the microcirculatory vessels and that our experimental model helps illuminate the pathogenesis of the human lesions. It is concluded that the right ventricle of acute cor pulmonale may develop cellular changes with a complex pathologenesis (mechanical, ischemic, and possibly hormonal). The nature of the changes found in our model could represent the morphologic substrate of right-sided failure; it can be correlated with the electrocardiographic abnormalities found in the comparable human condition.
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PMID:Ultrastructure of the myocardium after pulmonary embolism. A study in the rat. 67 69

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

Regional lung ischemia was imaged with a rapidly diffusible radioaerosol of pertechnetate. The method is compared with similar techniques using 11C and 15O. The principles involved include (A) the rapid alveolar-capillary diffusion of inhaled radioactive gases (11CO, C15O, and C15O2) and the radioaerosol of 99mTcO4-; (B) the patency of the airways to the ischemic regions; and, most importantly; (C) the much slower tracer removal from lung tissue with a stagnant circulation as opposed to the surrounding normal lung. The 11CO and C15O label the hemoglobin in red blood cells, and the C15O2 labels water in the circulation and in the stagnant ischemic region. The TcO4- probably labels the albumin of the plasma in the embolized regions and in the circulating blood. Experiments involving pulmonary embolism in dogs, proved by pre- and post-mortem angiography and gross post-mortem examination, show that positive ischemic lesions (hot spots) are observed, after TcO4- aerosol and C15O2 gas inhalation, in the embolized region on the same day. Clinical trials with aerosol-inhalation method in suspected pulmonary embolism and now under way.
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PMID:Imaging experimental pulmonary ischemic lesions after inhalation of a diffusible radioaerosol: concise communication. 83 71

In a prospective study, thrombosis of the femoral or popoliteal veins was discovered at operation in nine of eighty-one patients requiring amputation of a lower extremity for arterial insufficiency. One week postoperatively, all nine patients had evidence of pulmonary embolism on the lung scan. Embolization was documented by arteriography in two patients and at autopsy in a third patient. In none of these patients was there clinical evidence of venous thrombosis prior to operation. Two of the subjects with proved thrombosis died during study, a mortality of 22 percent, whereas the mortality for the entire group was 10 percent. It is concluded that the deep venous system of patients requiring amputation for ischemia should be examined carefully at operation. These patients have a high incidence of deep venous thrombosis and the discovery of thrombus at the time of operation places them in a particularly high risk group.
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PMID:Pulmonary embolism associated with surgically proved deep venous thrombosis. 113 May 88

The incidence of postoperative venous thrombosis and pulmonary embolism was assessed in 87 patients undergoing 96 major lower extremity amputations for ischemia. Prospective surveillance for deep leg vein thrombosis was carried out by Doppler ultrasound in 35 patients. There was no instance of major leg vein thrombosis and only one episode of a small non-fatal pulmonary embolus in a patient suffering trauma to the amputation stump after discharge from the hospital. This study suggests that clinically significant venous thromboembolism following current techniques of lower extremity amputation is not as common as previously reported. Doppler ultrasound is the most suitable technique for surveillance of venous thrombosis in these patients.
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PMID:Postoperative deep vein thrombosis in the lower extremity amputee: A prospective study with Doppler ultrasound. 126 98

The aim of this study is to present a relatively rare case of paradoxical arterial embolism, found in a patient who was sent to us for serious pulmonary embolism. Taking into account that the foramen ovale, despite being functionally competent, remains anatomically patent in 30% of the adult population, we cannot neglect the possibility of a paradoxical embolism, in the presence of a sudden embolic limb ischemia unless heart pathology or aortic lesions can be held responsible. Furthermore it must not be forgotten that deep venous thrombosis in the lower limbs or in the pelvic plexus may go unobserved on a purely clinical evaluation.
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PMID:[Arterial embolism, venous thrombosis, pulmonary embolism: a suggestive triad]. 148 Feb 99

Electromechanical dissociation (EMD) is a condition of cardiac arrest occurring despite the persistence of apparently effective cardiac electric activity. Secondary EMDs are consequence of catastrophic circulatory failure (i.e. great vessel rupture, massive pulmonary embolism, cardiac tamponade), resulting in sudden and critical changes in hemodynamic load. Primary EMDs, on the other hand, occur in presence of intact circulatory system; they are known to be associated with global cardiac ischemia and contraction failure; however, the exact pathophysiologic change, triggering the onset of primary EMD, is still unknown. The current hypothesis of electromechanical uncoupling (a supposed derangement of excitation and contraction linking) has not been demonstrated. On the contrary, in a previous series of 22 2D-echocardiographic evaluations of patients with EMD, wall and valvular motion was visible in the majority of cases. In our Coronary Care Unit we had the opportunity to perform 2D and color-Doppler echocardiogram in 2 patients, developing primary EMD just while the examination was in course; we subsequently completed the examinations in the short pauses of cardio pulmonary resuscitation. Both patients died and necropsy showed in both cases recent large myocardial infarction, without hemopericardium. The analysis of the echocardiograms emphasized the presence of a residual cardiac mechanical activity: minimal segmental wall motion of left ventricle (LV); residual mitral valve motion, but no visible closure; diastolic low-velocity orthograde transmitralic flow; systolic regurgitant flow from LV to left atrium. On the other hand, we didn't observe any systolic flow directed to the LV outflow tract and to the aorta.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Color-Doppler echocardiography in electromechanical dissociation. Study of 2 cases]. 150 65

Two patients showed hypoxia and brain swelling during craniotomy under the diagnosis of ruptured cerebral aneurysm. It was not possible to continue the operation due to brain swelling. Postoperatively, they were diagnosed as pulmonary embolism by Tc-scintigraphy. Re-operation was carried out after the improvement of the condition and fortunately they were discharged with minor neurological complications. According to the references, cerebral blood flow increases with PaO2 of less than 50 mmHg, but it is possible that brain swelling may occur with PaO2 of about 60 mmHg in the presence of brain ischemia. These cases suggest that, during the craniotomy, operation should be stopped when good operative field is not obtained because of brain swelling, and that a better outcome can be anticipated when re-operation is scheduled after an improvement of the condition.
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PMID:[Anesthesia for patients with a cerebral aneurysm who showed hypoxemia during surgery]. 154 92

In 1983, a previously healthy 21-year old mother came to University Hospital in Dijon, France feeling weak and had a severe frontal headache with vomiting. Clinical and biochemical tests were normal. She smoked 20 cigarettes/day and used a high dosed combined oral contraceptive (OC) (ethinyl estradiol and cyproterone acetate). 15 days later, the headache returned and she could not understand spoken words and the bilateral section of the brain had slowed. Yet her mental status was normal as were cerebrospinal fluid and cerebral computerized tomography tests. The antiherpes virus drug, vidabarine, did not alleviate symptoms. At least 1 month later, a severe left pulmonary embolism caused acute right heart failure. She also had a prethrombotic left iliac vein, so physicians began heparin therapy, adding nifedipine and buflomedil to control the spasms in the right internal iliac artery and both external iliac arteries. Acute ischemia of the lower limbs eased within a week but sensory disorders remained for 2 months. Satisfactory collaterality transpired due to a blocked left external iliac artery and left iliac vein. The following signs and symptoms indicated her condition to be homocystinuria: blond hair with deep blue eyes, macrocytic anemia, factor VII deficit (51%), strong positive Brandt's reaction, cystine homocystine in the plasma, and presence of homocystine, cystathionine, and methionine in the urine. Physicians took her off the OC and discharged her on vitamin B6/day, folic acid/day, betaine citrate/day, and the anticoagulant Coumadin. A subsequent check of her 19-year old sister found she had it too. They assessed the patient's condition yearly. In 1988, her left leg developed edema and she limped when not using elastic stockings. Effects of iliac vein phlebitis were evident. She no longer suffered from headaches. Since plasma methionine was within the normal range and homocystine no longer was present in plasma and urine, the physicians halted the anticoagulant therapy. In conclusion, the OC precipitated this partial form of homocystinuria.
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PMID:Vascular manifestations in homocystinuria. 161 Jun 63


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