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

This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease.
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PMID:Epidemiology of venous thromboembolism. 32 79

Using the radiofibrinogen test and perfusion lung scanning (2-phase pharmacoscintigraphy), the incidence of postoperative thrombosis and pulmonary embolism was determined in a group of 362 operated patients. Low-dose heparin administration (twice 5000 IU daily) was given to 162, combined heparin and dihydroergotamine administration (5000 IU heparin and 0.5 mg dihydroergotamine daily) to 150, while 50 patients received no prophylactic treatment. There was a significant decrease in thrombo-embolism in the heparin/DHE group (8.7% deep-vein thrombosis; 2.7% pulmonary embolism) compared with the heparin group (19.8% and 5.5%, respectively) and the control group (30% and 14%, respectively).
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PMID:[Prevention of postoperative thrombo-embolism by heparin/dihydroergotamine (author's transl]. 33

Twelve iatrogene bile duct injuries are reported. Eleven occurred in operations of the bile system, and one in a gastric resection (B II). The injury should be diagnosed immediately, especially by intraoperative cholangiography. Operative treatment is discussed. Eleven patients survived, one died of pulmonary embolism (operative mortality, 8,3%). One patient had to be reoperated because of stenosis of the common bile duct. Choledochoduodenostomy was performed. The follow-up of 11 patients showed good results without any recurrence of jaundice or pain.
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PMID:[Intraoperative biliary tract injuries]. 35 May 17

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

The incidence of pulmonary perfusion defects after routine cardiac catheterization was assessed in 57 patients by comparing ventilation-perfusion lung scans obtained before and 1 day after catheterization. Patients were prospectively randomized to two groups, one in which right heart catheterization was performed using an antecubital venous cutdown procedure and one in which the percutaneous femoral vein approach was used. Seven patients (12 percent) had new postcatheterization perfusion defects consistent with pulmonary emboli. These patients did not differ significantly from patients without new defects in clinical characteristics, duration of catheterization, hemodynamic variables or route of right heart catheterization. The data suggest that pulmonary embolism may be a more common complication of routine cardiac catheterization than previously appreciated.
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PMID:Incidence of new pulmonary perfusion defects after routine cardiac catheterization. 36 48

The frequency of clinical and sub-clinical postoperative pulmonary embolism, demonstrated by combined pulmonary ventilation-perfusion scanning, and the prophylactic effect of low-dose heparin, were assessed in a randomised double-blind study in 43 patients aged over 40 years. Pulmonary embolism was demonstrated using combined ventilation-perfusion scanning in 4 out of 43 patients (9%). The incidence was 1 out of 19 patients in the heparin-treated group and 3 out of 24 patients in the placebo group. This difference was not significant. If post-operative perfusion scanning alone had been utilised for diagnosing pulmonary embolism, the frequency of pulmonary emboli would have been 33%, with 21% in the heparin group and 46% in the placebo group. This difference is not significant. It is concluded that perfusion scanning over-estimates the frequency of post-operative pulmonary embolism. The use of the more specific combined ventilation-perfusion scanning shows that asymptomatic postoperative pulmonary embolism does occur, but that the frequency is considerably lower than indicated by perfusion scanning alone. Combined ventilations-perfusion scanning must be performed in studies assessing the effects of various treatment regimes on the frequency of pulmonary embolism postoperatively. The small number of patients included in the study do not permit any conclusions concerning any prophylactic effect of low-dose heparin against pulmonary embolism.
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PMID:Pulmonary embolism associated with elective surgery, detected by ventilation-perfusion scintigraphy. 37 16

Prostaglandin D2 (PGD2) produced by platelets can inhibit aggregation via activation of platelet adenylate cyclase. PGD2 activation of platelet cyclase in platelet membrane fractions was studied in 20 consecutive patients hospitalized with acute deep-vein thrombosis and/or pulmonary embolism. In nine patients, PGD2-stimulated enzyme activity was decreased at all concentrations of PGD2 studied. This altered enzyme sensitivity was specific for PGD2 as basal enzyme activity, and prostaglandin E1, prostaglandin I2, and sodium fluoride stimulated adenylate cyclase was normal. The effect of PGD2 on platelet aggregation and 14C-serotonin release was also studied in one patient where a four-fold higher concentration of PGD2 was required to inhibit collagen-induced 14C-serotonin release. Binding studies using [3H]PGD2 as a radioligand indicated that this patient's platelets bound 10 fmole PGD2/10(8) platelets compared to 30 fmole/10(8) platelets in a normal control. Five patients had follow-up studies between 2 and 7 mo after their acute thrombotic event, and PGD2-stimulated adenylate cyclase activity returned towards normal in four. Since PGD2 is synthesized in platelets at concentrations sufficient to inhibit aggregation and activate adenylate cyclase, diminished platelet sensitivity to this prostaglandin could result in "hyperactivity" and contribute to the thrombosis observed in these patients.
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PMID:Diminished platelet adenylate cyclase activation by prostaglandin D2 in acute thrombosis. 38 Jun 88

The efficacy of low-dose subcutaneous heparin (5000 IU eight-hourly) is being studied in a single-centre, prospective randomised trial of patients aged over 40 submitted to major elective intra-abdominal surgery. The trial end-points are the objectively defined incidence and extent of deep vein thrombosis (as seen on uptake of 125I-labelled fibrinogen, Doppler ultrasonography, and bilateral ascending phlebography) and non-fatal pulmonary embolus (as measured by preoperative spirometry and preoperative and postoperative chest radiography and perfusion lung scanning performed on a routine, unselected basis). An interim analysis of the first 200 patients indicates that low-dose heparin significantly reduces the incidence of calf-vein thrombosis but does not reduce the incidence of proximal segment thrombosis or non-fatal pulmonary embolism. Thus the routine use of low-dose heparin prophylaxis in all major surgical procedures in patients aged over 40 may not be advisable.
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PMID:Failure of low-dose heparin to prevent significant thromboembolic complications in high-risk surgical patients: interim report of prospective trial. Groote Schuur Hospital Thromboembolus Study Group. 38 Jul 42

Heparin is an anticoagulant drug which is used for the prophylaxis and treatment of venous thromboembolism and for the treatment of some cases of arterial thromboembolism. Venous thromboembolism is the commonest preventable cause of death in hospitalized patients, and the best approach to reduce its morbidity and mortality is the use of safe, effective, prophylaxis in patients at high risk. The use of low doses of heparin given s.c. (5000 units, 8 hourly)) has been shown in prospective clinical trials to be effective prophylaxis against venous thrombosis and nonfatal and fatal pulmonary embolism in patients undergoing general abdominothoracic surgery, without producing dangerous bleeding. Low-dose heparin, however, is not totally effective in patients undergoing hip surgery and suprapubic prostatectomy. The lack of benefit in these patients may be related to the intensity of the provocation to thrombosis. The use of heparin in large doses to treat thrombosis is associated with hemorrhagic complications in up to 30% of patients. There is evidence that continuous i.v. heparin is associated with fewer hemorrhagic complications than intermittent i.v. heparin, but the frequency is not related to the dose or to the use of laboratory monitoring. Hemorrhagic complications occur more frequently in elderly patients and in females and is more common following surgical operations. The frequency of recurrent venous thromboembolism is low in patients on therapeutic doses of heparin, and there is no difference in the frequency of recurrence in patients receiving heparin by continuous i.v. or intermittent i.v. administration.
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PMID:Prophylaxis and therapy of venous thromboembolism. 38 Sep 2

Two patients with multiple myeloma are described in whom an unusual complication developed: pleural effusion containing myeloma cells. There are 7 previously reported cases of myeloma in the English literature with this type of effusion. Pleural effusion in myeloma may be due to plasma cell infiltration of the pleura, congestive heart failure, pulmonary embolism, nephrotic syndrome, and second neoplasms. In view of these multiple etiologies, diagnostic thoracentesis should be performed in order to treat the effusion appropriately.
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PMID:Pleural effusion in multiple myeloma. 38 71


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