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)

In a multicenter, double-blind clinical trial in 1,968 inpatients 1 daily subcutaneous administration of LMW heparin plus 2 placebo injections or 3 x 5,000 IU unfractionated (UF) heparin was given for 10 (8-11) days. The primary end point was the incidence of proximal deep-vein thrombosis or pulmonary embolism. Patients were assessed during the study period for development of proximal deep-vein thrombosis by compression sonography at days 1 and 10 and for pulmonary embolism by scintigraphy in symptomatic patients. Aim of the study was to demonstrate the equivalence of both treatment regimens. A total of 1,968 patients were randomized to receive UF or LMW heparin. Of these, 378 patients were excluded during the study period, so that 780 patients on UF and 810 on LMW heparin were included in the efficacy analysis. Four primary end points were observed with UF and 6 with LMW heparin, demonstrating the equivalence of treatments (p = 0.012). Additionally, pulmonary embolism was suspected as the cause of death in 6 patients who died during the study (3 per treatment group). A higher frequency of death (n = 32) was observed in the LMW-heparin group (p = 0.02) particularly documented in a part of the centers. Safety analysis showed a higher frequency of local pruritus, local erythema and subcutaneous hematoma, a higher increase in plasma levels of triglycerides, total cholesterol, alanine aminotransferase and aspartate aminotransferase, and a decrease of antithrombin III in patients receiving UF heparin. A decrease in platelet count (values ranging between 40,000 and 80,000/microliter) was observed in 4 patients with UF and in none with LMW heparin. No severe thrombocytopenia was observed. Subcutaneous LMW heparin is as effective as UF heparin for prophylaxis of thromboembolism in bedridden, hospitalized medical patients.
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PMID:Subcutaneous low-molecular-weight heparin versus standard heparin and the prevention of thromboembolism in medical inpatients. The Heparin Study in Internal Medicine Group. 873 87

The Norplant contraceptive system consists of 6 silastic capsules 34 mm long by 2.4 mm in diameter each containing 36 mg of levonorgestrel. Norplant provides a constant daily dose of 30 mcg of levonorgestrel beginning 24 hours after insertion and lasting for 5 years. 3 contraceptive effects are provided: the cervical mucus becomes less permeable for sperm, the endometrium atrophies, and ovulation is inhibited in about 50% of cycles. The failure rate is lower than those of pills and IUDs. It is somewhat higher for women weighing over 70 kg than for those weighing less. The safety of Norplant is due to the absence of estrogen. It has no effect on blood pressure, and the risks of ectopic pregnancies or infection at the insertion site are minor. The principal side effect is disturbance of the menstrual cycle, which usually decreases after 3-6 months of use. Other minor effects should not cause termination of the method if the user has been forewarned. Women using Norplant should be followed regularly. Norplant is particularly indicated for women desiring longterm contraception or a very effective method for spacing, postpartum women, and women with contraindications to oral contraceptives and IUDs. Contraindications include pregnancy or suspicion of pregnancy, unexplained vaginal bleeding, liver or cardiovascular disorders, jaundice or pruritus during the last pregnancy, thrombophlebitis or pulmonary embolism, falciform anemia, and breast cancer. Studies are underway to verify that Norplant does not affect lactation. Norplant should be removed immediately if the woman develops migraine headaches or visual problems, signs of thrombophlebitis or hepatic disorders, increased blood pressure, or if she becomes pregnant or must undergo a surgical procedure requiring lengthy bed rest. Norplant should be inserted under scrupulously aseptic conditions during the 1st 7 cycle days under local anesthesia. Large studies in Egypt, Indonesia, Chile and elsewhere have confirmed Norplant's efficacy, lack of harmful lipid effects, and rapid return of fertility after treatment. A 3-year program of clinical trails of Norplant will be conducted in Rwanda with the financial assistance of the UN Fund for Population Activities and the technical assistance of the Population Council, after which Norplant may be added to methods available in all health facilities.
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PMID:[An implantable contraceptive: Norplant]. 1234 82

Living donor liver transplantation has become an alternative therapy for patients with end-stage liver disease. Donors are healthy individuals and donor safety is the primary concern. The objective of this study was to evaluate the anesthetic complications and outcomes for our donor cases; we report one death. The charts of the patients who underwent donor hepatectomy from February 1997 to June 2007 were retrospectively reviewed. Right hepatectomy (resection of segments 5-8) was done in 101 donors, left lobectomy (resection of segments 2-3) in 11 donors, and left hepatectomy (resection of segments 2-4) in one donor. Minor anesthetic complications were shoulder pain, pruritus and urinary retention related to epidural morphine, and major morbidity included central venous catheter-induced thrombosis of the brachial and subclavian vein, neuropraxia, foot drop and prolonged postdural puncture headache. One of 113 donors died from pulmonary embolism on the 11th postoperative day. This procedure has some major risks related to anesthesia and surgery. Although careful attention will lower complication rate, we have to keep in mind that the risks of donor surgery will not be completely eliminated.
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PMID:Anesthesia-related complications in living liver donors: the experience from one center and the reporting of one death. 1882 70

Fondaparinux and enoxaparin are useful for preventing venous thromboembolism after total knee arthroplasty (TKA), but both drugs have associated complications. The purpose of this study was to clarify the risks associated with use of these drugs in Japanese patients who underwent TKA.A total of 575 patients (935 knees) underwent TKA and were retrospectively reviewed; 277 patients (454 knees) were treated with fondaparinux and 298 patients (481 knees) were treated with enoxaparin. The authors investigated the incidences of deep venous thrombosis of the lower limbs and pulmonary embolism to evaluate venous thromboembolism, knee enlargement compared with the preoperative size, incidence of subcutaneous knee hematoma, and other complications. No significant differences were observed between the 2 drugs regarding the incidences of deep venous thrombosis and pulmonary embolism. However, fondaparinux use resulted in knee enlargement (P<.0005) and subcutaneous hematoma of the knee (P=.035) significantly more often than enoxaparin use. Conversely, enoxaparin use significantly caused the elevation of alanine aminotransferase (one of the liver enzymes) at a higher rate than fondaparinux (30.1% vs 8.3%, respectively; P<.0001). However, the increased alanine aminotransferase levels were transient, and no patient exhibited symptoms of abnormal liver function, such as jaundice or cutaneous pruritus.Fondaparinux and enoxaparin were both effective in preventing venous thromboembolism in Japanese patients undergoing elective TKA. However, both drugs had some adverse effects. It is important to be aware of these potential risks when prescribing these drugs.
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PMID:Safety of fondaparinux versus enoxaparin after TKA in Japanese patients. 2359 Jul 81