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

We report the results of a detailed examination of clinical events associated with the antiphospholipid antibody (aPL) syndrome in 96 consecutive patients with systemic lupus erythematosus (SLE) who underwent renal transplantation between January 1, 1984, and September 1, 1996. Because of the retrospective nature of our study, we developed strict definitions of clinical events considered to be associated with the aPL syndrome. We reviewed all available hospital, clinic, and outside records of the patients with SLE who underwent transplantation at our center during this time period and noted the results of three standard serological tests for aPLs, when available. Mean follow-up of the 96 patients was 62.6 months. Eighty-five of the 96 patients (88.5%) had at least one test for aPLs performed, and 25 patients (29.4%) had at least one abnormal test result. Among these 25 patients, 15 patients (60%) had clinical events associated with aPL syndrome. Ten patients (10.4%) either died of the aPL syndrome or had an aPL-associated clinical event within 3 months of transplantation. Other morbidity from the aPL syndrome in these 15 patients included: thrombotic arteriolar microangiopathy (2 patients), stroke (4 patients), ocular ischemia (7 patients), deep vein thrombosis or pulmonary embolism (6 patients), renal artery or vein thrombosis (4 patients), peripheral ischemia (1 patient), and fetal wastage (3 patients). By comparison, among the 60 patients with normal aPL test results, only 5 patients had clinical events compatible with the aPL syndrome (P < 0.0001 by chi-squared test). aPLs may be associated with significant morbidity and mortality in patients with SLE undergoing renal transplantation. This study is the first attempt to quantify the impact of aPLs on renal transplantation in a large population of patients with SLE. Further investigation of aPLs in SLE patients with end-stage renal disease is required to clarify the risks, benefits, and optimal clinical management of renal transplantation for these patients.
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PMID:Antiphospholipid antibody syndrome in renal transplantation: occurrence of clinical events in 96 consecutive patients with systemic lupus erythematosus. 1058 13

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

A 57-year-old female patient with known cardiac disease developed a 4 to 6 week history of diarrhea, followed by onset of orthopnea and subsequent right-sided cardiac failure. On hospital admission she was found to have pure tricuspid regurgitation, without evidence of cardiac ischemia, pulmonary embolism, bacterial endocarditis or pericardial disease. A 24-hour urine collection for 5-HIAA was elevated, and a subsequent octreotide scan documented abnormal uptake in the pelvic cul-de-sac. Bilateral ovarian masses were found at laparotomy, which on pathological examination were found to be a benign left ovarian cystic teratoma, and a right carcinoid tumor of the ovary. This patient presented with systemic complaints of diarrhea, and orthopnea and right sided heart failure that on evaluation were ultimately found to be due to a unilateral primary carcinoid tumor of the ovary, which accounts for less than 0.1% of all ovarian carcinomas, and only 5% of all carcinoids. Treatment of this malignant carcinoid syndrome presentation consisted of debulking of the tumor and continuation of her diuretics and digoxin. Diarrhea and orthopnea ceased within 2 weeks after her oophorectomy. On evaluation 6 weeks and 6 months postoperatively, her cardiac function was stable, though unchanged. 5-HIAA levels were within normal limits, demonstrating the curative function of surgery in patients with unilateral ovarian carcinoid without evidence of metastases, as well as preserved cardiac function in otherwise stable patients.
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PMID:A case of diarrhea and orthopnea in a 57-year-old female. 1106 Oct 23

In general, massive pulmonary embolism induces severe right ventricular overload, but pathological changes in the right ventricle due to pulmonary embolism is rarely seen. In this report, we describe two autopsy cases of massive pulmonary embolism without pre-existing cardiopulmonary disease. Both cases were accompanied by myocarditis-like changes in the right ventricle and infiltration of a number of polymorphonuclear neutrophils and mononuclear cells into the dilated right ventricular wall. Transmural or subendocardial coagulation necrosis was not apparent. Almost all of the mononuclear cells were immunohistochemically revealed to be CD68-positive macrophages. We speculated that these findings resulted from ischemia due to massive pulmonary embolism.
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PMID:Two cases of right ventricular ischemic injury due to massive pulmonary embolism. 1118 71

Pulmonary embolism is the fourth leading cause of pleural effusion. The possibility of pulmonary embolus should be evaluated for all patients who have undiagnosed pleural effusion. The mechanism of pleural effusion caused by pulmonary embolus is usually increased interstitial fluid in the lungs as a result of ischemia or the release of vasoactive cytokines. Approximately 75% of patients with pulmonary emboli and pleural effusion have pleuritic chest pain. The most common cause of pleuritic chest pain and pleural effusion in patients under 40 years old is pulmonary emboli. Pleural effusion resulting from a pulmonary embolus usually occupies less than one-third of the hemithorax. Dyspnea is frequently out of proportion to the size of the pleural effusion. Pleural fluid caused by pulmonary emboli is usually exudative but is occasionally transudative. d-Dimer testing is a good screen for pulmonary emboli. If d-dimer results are positive, then a spiral computed tomograph should be obtained to confirm the diagnosis. Low-molecular-weight-heparin has become the initial treatment of choice for patients with pulmonary emboli and pleural effusion.
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PMID:Pleural effusion due to pulmonary emboli. 1147 Sep 74

An 86-year-old-woman presented with apical ballooning left ventricular dysfunction associated with therapy for acute pulmonary thromboembolism. She was referred to our hospital for advanced treatment for her shock state due to acute pulmonary embolism with normal left ventricular(LV) function. Her condition was stabilized using a percutaneous cardiopulmonary support system. Suction embolectomy was successfully carried out after pulmonary arteriography. After the therapy, echocardiography revealed apical ballooning and hyperkinesis of the base(LV ejection fraction = 28%), although coronary arteriography showed no fixed stenosis. LV wall motion significantly improved on day 3(LV ejection fraction = 45%). Pulmonary embolism relapsed on day 5 in spite of anticoagulation treatment. She died of multiple organ failure on day 9. Autopsy findings indicated no sign of myocardial infarction or myocarditis, patchy appearance of myocardial contraction band necrosis and few migrated lymphocytes. The mechanism for the flow mis-matched LV dysfunction remains unknown. The probable explanations include non-ischemic stress such as catecholamine or neurogenic stress, and possibly ischemic stress or ischemia/reperfusion injury.
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PMID:[Apical ballooning by transient left ventricular dysfunction (so-called "ampulla" cardiomyopathy) associated with therapy for acute pulmonary thromboembolism: a case report]. 1149 35

The authors present their results of the treatment of diabetic foot critical ischemia by means of surgical revascularisation together with minor amputation or debridement. They discuss the causes of higher amputations and re-amputations in revascularised ischemic diabetic lower limbs and presents patency rates in different types of peripheral arterial bypasses. The authors evaluated 81 diabetic feet with chronic critical ischemia, where they performed 50 arterial bypass procedures in the 50 limbs (13 femoropopliteal, 13 femorodistal, 19 pedal bypasses and 5 aorto/ilicofemoral or extraanatomical bypasses). 41 minor amputations or debridements (82%), 6 minor re-amputations (12%) was performed in the group of 50 revascularised limbs. The primary patency rates, secondary patency rates and limb salvage was achieved 92%, 92% and 92% in femoropopliteal bypass, 91%, 91% and 92% in femorodistal bypass, 78%, 83% and 84% in pedal bypass, respectively. The average follow-up time was 11.4 months. 6 minor re-amputations (12%) and 5 high amputations was necessary to perform in the group of 50 revascularised lower limbs. The main cause of re-amputation and high amputation was continuing ischemia. 30 day mortality rate was 0%, 30 day morbidity rate was 8% (myocardial infarction and pulmonary embolism).
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PMID:[Surgical treatment of ischemia in the diabetic foot syndrome]. 1179 84

Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting.First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access.In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is preferred because it is noninvasive, does not require contrast agent, carries no exposure to ionizing radiation, and is highly accurate and reproducible. Apart from catheter-directed thrombolysis, mechanical thrombectomy has proven to be a quick and safe treatment modality by enabling the recanalization of thrombotic occlusions in conjunction with minimal invasiveness and a low bleeding risk. Mechanical thrombectomy devices should only be used in conjunction with a temporary cava filter.Contrast-enhanced CT is at present considered the examination of choice for acute mesenteric vein occlusion which has mortality rates as high as 80%. Patients with proven acute mesenteric venous occlusion and contraindications to surgical therapy and no identified bleeding disposition without looming bowel ischemia or infarction are possible contenders to the less invasive percutaneous approach either by (in)direct thrombolysis or mechanical means. Ultrasonography is the primary imaging modality for the diagnosis of upper extremity thrombosis. Computed tomography and MRI are in addition helpful in diagnosing central chest vein occlusions. The interventionalist is rarely involved in the treatment of this entity. Catheter-directed thrombolysis is known to improve lysis rates. Together with balloon angioplasty good results have been obtained. If stenosis or thrombus remains after thrombolysis and angioplasty, stent placement should follow. Within the first two weeks, thrombosed dural sinus and cerebral venous vessels are typically hyperdense on CT compared with brain parenchyma; after the course of 2 weeks, the thrombus will become isodense. In MRI an axial fluid-attenuated inversion recovery sequence, an axial diffusion-weighted MRI, coronal T1-weighted spin-echo and T2-weighted turbo-spin-echo sequences, a coronal gradient-echo and a 3D phase-contrast venous angiogram should be performed. Local thrombolysis is needed only when patients have an exacerbation of clinical symptoms or imaging signs of worsening disease despite sufficient anticoagulation therapy. Acute occlusions of dialysialysis grafts and fistulae are a frequently encountered complication. Among the various methods described for acute occlusion screening, ultrasonography and MRI have been proven to be accurate and noninvasive; however, if immediate treatment can be anticipated, imaging should be performed directly by digital subtraction angiography before the percutaneous intervention. Initial percutaneous thrombectomy is very effective with success rates and patency rates comparable to those of surgical thrombectomy. A short thrombosis can be treated with balloon angioplasty alone, whereas an extensive thrombosis requires a combination of mechanical devices and/or thrombolytic agents with adjunctive balloon angioplasty.
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PMID:Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion. 1238 51

Pulmonary embolism (PE) and associated acute peripheral ischemia suggest the diagnosis of paradoxic embolism. The most common intracardiac defect associated with paradoxic emboli is a patent foramen ovale (PFO). Therapeutic options include anticoagulation, thrombolysis, inferior vena cava (IVC) filtration, and closure of the intracardiac defect. The authors discuss the diagnosis and treatment of a young female athlete who presented with massive PE complicated by a paradoxic embolus to the right subclavian artery. Systemic and catheter-directed thrombolysis, IVC filtration, and percutaneous closure of a PFO were performed in an effort to return the patient to the level of competitiveness she desired.
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PMID:Temporary IVC filtration before patent foramen ovale closure in a patient with paradoxic embolism. 1284 4

During this year, cellular therapy with bone mononuclear cells of critical leg ischemia was demonstrated to be a new therapeutic approach in critical leg ischemia. This treatment, as well as gene therapy, is an important step forward in this pathology when there is no other therapeutic option. In venous thromboembolism, the usefulness of fibrinolytic therapy in severe pulmonary embolism associated with right ventricular dysfunction or pulmonary-artery hypertension was demonstrated. Fondaparinux appears also to be a promising agent for prophylaxis of deep vein thrombosis. Finally, the publication of the WHI trial (Women Health Initiative) confirms the absence of any benefit of hormone replacement therapy in primary cardiovascular prevention.
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PMID:[The best of vascular medicine in 2002]. 1261 66


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