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

10 percent glycerol was given for 6 days to 30 patients who had had acute ischaemic cerebral infarction, and the results were compared with those obtained after treating 31 similar patients with dexamethasone (16 mg. per 24 hours for 6 days). 1 patient treated with glycerol died of haemoglobinuria and acute renal failure. 6 patients treated with dexamethasone died--3 from cerebral oedema and 3 from non-neurological complications (pulmonary embolism, myocardial infarction, and aspiration pneumonia). Improvement was significantly greater in the glycerol group after 8 and 15 days. No improvement was noted using either glycerol or dexamethasone in 7 patients with spontaneous intracerebral haemorrhage.
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PMID:Controlled trial of glycerol versus dexamethasone in the treatment of cerebral oedema in acute cerebral infarction. 4 27

Heparin has been used in clinical practice since 1936 as anticoagulant for: the treatment of thromboembolic disorders, the prevention of deep vein thrombosis and pulmonary embolism and the maintenance of blood fluidity in extracorporal circuits. Its use in these indications has been complicated by an increased risk of hemorrhage such as major bleeding during the treatment of pulmonary embolism and wound hematoma after surgery. Bleeding problems associated with the use of heparin in extracorporal circuits are the following: hemorrhages after cardiopulmonary bypass, serious hemorrhagic complications in patients treated with hemodialysis during acute renal failure and in patients on chronic intermittent hemodialysis and increased occult blood loss from the gastrointestinal tract and from other sites. The precise contribution of the use of heparin to the enhanced bleeding in these conditions has not yet been established. The effects on platelets, coagulation factors and/or fibrinolytic activity by the exposure of blood to foreign surfaces together with uremia present in hemodialysis patients may also contribute to abnormalities in clinical hemostasis. Recently heparin fractions and a heparinoid of low molecular weight (LMW) have been developed because of their potential to diminish the hazard of hemorrhage while retaining their antithrombotic properties. Preliminary reports from pilot studies have confirmed the increased efficacy in preventing deep vein thrombosis (DVT) of some of the new LMW heparin(oid)s; however, improved safety with regard to bleeding still needs to be shown. The use of LMW heparins and of a new LMW heparinoid in acute and chronic hemodialysis has also been shown to be effective.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heparin and its biocompatibility. 243 41

The case histories of the 49 patients who died in a series of 165 patients admitted to the Medical Unit between 1958 and 1984 with polyarteritis nodosa (PAN) were reviewed. The causes of death of the 29 men and 20 women, mean age 51.44 +/- 7.4 years, were classified into 6 groups. Infection accounted for 26.5% (13/49) of deaths, the initial site of infection being pulmonary, complicated by septicaemia in 6 cases. Cardiovascular events were responsible for death in 24.4% (11/49): terminal cardiac failure (4 cases), myocardial infarction (1 case), ventricular tachycardia (1 case), stroke (1 case), pulmonary embolism (2 cases), fulminant hemoptysis (1 case). Gastrointestinal complications were the cause of death in 16.3% (8/49): ischemic necrosis (5 cases), acute pancreatitis (2 cases), oesophageal ulceration (1 case). Renal failure was observed in 10.2% (5/49), all occurring before 1972: acute renal failure (3 cases), chronic renal failure (2 cases). Cancer was the cause of death in 10.2% (5/49): primary bronchial carcinoma (2 cases), laryngeal carcinoma (1 case), carcinoma of the vulva (1 case), bone metastases (1 case). Finally, 14.2% (7/49) could not be classified in the preceding groups. Sudden death occurred in 3 patients, shock in 1 patient, multivisceral PAN in 2 patients and anaphylactic shock in 1 patient. Three of the 12 patients who had post-mortem studies had signs of progressive vasculitis. The results are compared with other reports in the literature and the pathogenic mechanisms are discussed. The infections and cardiovascular deaths occurred early or late and were not related to the state of the activity of the vasculitis. Immunosuppressive treatment seems to play an important role in their pathogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Causes of death in systemic vasculitis of polyarteritis nodosa. Analysis of a series of 165 patients]. 290 28

Intravenous digital subtraction angiography (IVDSA) was performed in 11 patients aged from 23 to 62 yr to visualize vascular disease that required to be treated without delay: 7 were in shock preceded by a cardiac arrest in 5 of them; 4 suffered from acute renal failure, 8 from acute respiratory failure and one from brain death. 5 pulmonary, 2 thoracic aortic, 3 abdominal aortic, 1 right subclavian and 1 renal arterial angiographies were carried out by this method. In all the cases described, we either confirmed the diagnosis (rupture of thoracic aorta, type I aortic dissection, aneurysm of abdominal aorta, complete occlusion of the distal abdominal aorta, pulmonary embolism) or set aside diagnosis (lesion of the subclavian vessels, pulmonary embolism) or visualized the renal vasculature before removing the organ. No incident was observed. Conventional angiography remained a reference method but it presented risks which were not to be neglected in critically ill patients. Despite the theoretical limits set by the technical demands (absolute motionlessness, apnoea) and few other restrictions found in the literature, IVDSA seemed to offer distinct advantages under such conditions. Only requiring an injection using a catheter placed in a peripheral vein, this method was fast, safe and easy; it gave a close enough approach to the diagnosis to be able to help decide on specific treatment or on orientation towards a specific hospital department.
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PMID:[Intravenous digital subtraction angiography in intensive care]. 388 99

From 1957 to 1982, 115 patients underwent radical vulvectomy and bilateral inguinal lymphadenectomy for invasive squamous carcinoma of the vulva. From 1957 to 1971, 57 patients received perioperative prophylactic sodium warfarin (Coumadin) as prophylaxis against pulmonary embolism. From 1971 to 1976, 27 consecutive patients received dextran-40 as prophylaxis for pulmonary embolism and to improve the microcirculation to the inguinal skin flaps. Because of the report that dextran-40 is a cause of acute renal failure, this study was terminated and the subsequent 19 patients were treated with mini-dose heparin because of the reported benefit as prophylaxis against thromboembolic disease. During the 25-year period, 12 patients received no prophylactic anticoagulants. Mini-dose heparin resulted in a significant morbidity not previously reported in patients undergoing inguinal lymphadenectomy: 43% (8/19) of the mini-dose heparin patients, 7% (2/27) of the dextran-40 patients, 0% (0/57) of the sodium warfarin patients, and none of the 12 patients not receiving perioperative prophylaxis developed inguinal lymphocysts (P less than .001). There was no significant difference in the prevention of pulmonary embolism between the mini-dose heparin (0/19), dextran-40 (0/27), and no treatment groups (0/12) as compared to the 5% (3/57) incidence in the sodium warfarin patients (.10 less than P less than .50). The significant relationship between prophylactic heparin and the subsequent development of inguinal lymphocysts and the need to reassess its role in prevention of pulmonary embolism in patients undergoing lymphadenectomy is discussed.
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PMID:Prophylactic anticoagulation as a possible cause of inguinal lymphocyst after radical vulvectomy and inguinal lymphadenectomy. 685 17

Various hemorheological parameters were studied in venous blood samples taken during the initial stages of acute medical emergencies in patients admitted to the Intensive Care Unit. These included more particularly: cerebrovascular accidents, recent acute arterial or venous thrombosis, pulmonary embolism, acute renal failure, pregnancy toxemia and emergencies occurring during pregnancy or in the puerperium, coagulation disorders, gas embolism... The examinations conducted were:--measurement of apparent--blood viscosity (eta a) and plasma viscosity--platelet aggregate fixation after fixing in formalin according to the method described by Wu and Hoak--blood filterability through filters with pores 5 microns in diameter. The principal modifications observed, often correlated were raised blood and plasma viscosity, reduction in the aggregation index, and diminution in filterability. It should be noted that the increase in viscosity, constant in all groups, is significant at low shearing speeds in the thrombosis cases, and that this significance is present in nearly all the pathological groups with high shearing speeds. Variations in the aggregation index are very dispersed and of low significance.
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PMID:[Modifications in hemorheological parameters following acute medical emergencies (author's transl)]. 724 Sep 92

Twenty-two spontaneous aortocaval fistulas between an abdominal aortic aneurysm and the inferior vena cava were surgically treated in 27 years at one surgical unit. The incidence was 5.9% of ruptured abdominal aneurysms; the operative mortality rate of 36.4% compared with an overall mortality rate for ruptured abdominal aortic aneurysms of 34.9%. Among 10 subjects in shock on admission the mortality rate was 50% compared with 25% in non-shocked patients. Of the 22 patients one died at laparotomy from irreversible cardiac arrest; in the other 21 the procedure consisted of endoaneurysmal repair of the fistula which involved replacement of the aneurysm by a Dacron prosthesis after control of venous bleeding was achieved. No occurrence of paradoxical pulmonary embolism was reported. Multiple organ failure caused death in six cases; of these, four died as a result of acute renal failure. Severe preoperative anuric shock was recorded in five instances, with a mortality rate of 80%, compared to 25% for non-shocked subjects. Mortality was not improved by intraoperative autotransfusion; however, the incidence of severe shock was 55.5% in those patients treated by autotransfusion, compared with 38.5% in the standard blood replacement group.
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PMID:Primary aortocaval fistula. 795 56

Orthopaedic surgeons may be confronted with a variety of medical problems that demand recognition and treatment. These may range in severity from a mild case of rheumatoid arthritis to a life-threatening pulmonary embolism. Rhabdomyolysis is a serious problem that must be recognized early to avoid grave renal consequences. This disorder is characterized by significant muscle injury giving rise to nephrotoxic breakdown products in the bloodstream. As many as 33% of these patients will suffer acute renal failure. Many orthopaedic patients may be at high risk for rhabdomyolysis, and the orthopaedic surgeon should be familiar with its diagnosis and treatment.
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PMID:Rhabdomyolysis. A primer for the orthopaedist. 815 50

Myxedema coma is characterized by severe lack of thyroid hormones, unconsciousness and serious restriction of vital functions. The mortality rate still ranges between 50 and 80%. In patients with inapparent hypothyroidism myxedema coma occasionally follows surgery, anesthesia or severe infection. A case of myxedema coma following surgery is reported. CASE REPORT. A 46-year-old woman was anesthesized for hip replacement. The intraoperative cardiovascular situation was characterized by hypotension and tachycardia. On the first postoperative day, unexpectedly a cardiac arrest occurred. Resuscitation with high doses of epinephrine was successful. There was no evidence of myocardial infarction, hypoxia and pulmonary embolism as causative factors for cardiac arrest. A pulmonary artery catheter was inserted and showed low cardiac output. Catecholamines and intravascular fluids were administered without hemodynamic improvement. In the next 5 days pneumonia was followed by ARDS and acute renal failure. After successful treatment of these complications the patient remained in deep coma. An intracerebral disease could be excluded by computerized tomography. Evaluation showed low thyroid hormones (T3; T4) and elevated TSH. The diagnosis of a myxedema coma was assumed. After failure of oral therapy with L-thyroxine (0.025-0.05 mg/day) for 10 days, intravenous therapy with 0.5 mg L-thyroxine was performed. Thirty-six hours later the patient regained consciousness, without cardiac complications. The patient progressed uneventfully under oral therapy with 0.1 mg L-thyroxine and was discharged from the hospital 6 weeks later. DISCUSSION. Pathophysiology and symptomatology of a case of postoperative myxedema coma are described (Tables 1-4). In this patient, the following symptoms occurred: low thyroid hormones (T3; T4), elevated TSH, deep coma, decreased ventilatory response to CO2, diminished myocardial contractility under catecholamine stimulation, impaired renal water excretion. After failure of oral substitution of L-thyroxine, intravenous therapy had to be performed in spite of the high risk of further cardiac complications in this patient. This led to complete recovery with normal neuropsychological and cardiopulmonary parameters. CONCLUSION. Myxedema coma is a rare complication in postoperative care, but in cases of inexplicable unconsciousness thyroid failure should be excluded. If myxedema coma is evident, intravenous therapy with L-thyroxine should be performed under the conditions of extended monitoring.
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PMID:[Myxedema coma as a rare postoperative complication]. 848 Sep 6

Although rare, exertional collapse and sudden death are the most serious potential complications of sickle cell trait. Studies suggest that this condition may occur in susceptible persons when poor physical conditioning, dehydration, heat stress or hypoxic states precipitate sickling of the abnormal erythrocytes. Sickling leads to endothelial damage, which can cause vasoconstriction, disseminated intravascular coagulation and local tissue damage. Cardiac effects include acute ischemia and arrhythmias. Muscle damage results in acute compartment syndromes and release of myoglobin into the circulation. Acute renal failure is possible. Diagnosis is based on a high index of suspicion, and characteristic presentation and laboratory findings, including myoglobinuria, hyperkalemia, hypocalcemia, hyperphosphatemia and elevated creatine kinase levels. The differential diagnosis includes pulmonary embolism, acute cardiac events, anaphylaxis and heat stroke. Management is based on stabilization, rehydration, and the treatment and prevention of complications.
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PMID:Exertional collapse and sudden death associated with sickle cell trait. 904 99


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