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

A previously reported computer analysis has been used to provide numerical ventilation-perfusion lung scan data, for comparison with tests of airways function and results of arterial blood gas analysis in 11 patients with pulmonary embolism, 18 with asthma, and 37 with chronic obstructive lung disease. In pulmonary embolism an index of underperfusion showed high sensitivity, and an index of ventilation-perfusion mismatching correlated well with severity (hypoxaemia). In asthma an index of underventilation was sensitive and correlated well with severity of airways obstruction. In chronic obstructive lung disease the same index was sensitive but correlated poorly with severity. This was attributed to heterogeneity of the lung disease (airways obstruction plus emphysema) in chronic obstructive lung disease. Ventilation-perfusion mismatching was frequently present in airways disease, and was often of great severity in chronic obstructive lung disease. Discrimination between pulmonary embolism and either type of airways disease was possible by using a combination of underfusion and underventilation indices. The technique offers the prospect of increasing the information derived from lung scans and of automating the reporting of scans.
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PMID:Computer analysis of ventilation-perfusion scans for detection and assessment of lung disease. 389 61

To determine the relative importance of multiple interrelated factors that have been considered to contribute to pulmonary infarction, the authors performed a discriminant analysis on consecutively autopsied patients with pulmonary embolism. From the clinic records of 45 individuals, the authors tabulated the underlying illness, history of valvular or ischemic heart disease, right and left ventricular failure, sepsis, shock, malignancy, premortem functional status, and the clinician's suspicion of pulmonary embolism. At postmortem examination, the authors measured and recorded the extent of emphysema, pneumonia, neoplasia, pulmonary vascular atherosclerosis; thickness and dilatation of both cardiac ventricles; the presence of valvular heart disease; the number, diameter, and amount of occlusion of the pulmonary arteries that contained thromboemboli; the extension of the clot, the size of the infarct; the Reid-Index; and the thickness of pulmonary and bronchial arterial wall. The major determinants of infarction were as follows: poor premortem functional status, the number of lobes having emboli, left ventricular failure, and the presence of lung cancer. The authors then tested the equation generated from these patients on 21 additional patients. The discriminant function correctly classified 81% of first group and predicted the occurrence of infarction in new patients with 70% accuracy. The size of the infarct was most correlated with the use of vasodilators and the embolic burden.
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PMID:Factors associated with pulmonary infarction. A discriminant analysis study. 401 73

Intravenous digital angiography was performed in 92 patients with pulmonary diseases. The examination yielded satisfactory results in 82/92 cases (89%). The most promising fields of application of pulmonary digital angiography are: vascular malformations (3 cases: 3%), pulmonary emphysema (24 cases: 26%) and pulmonary embolism (38 cases: 41%). In tumoral masses (14 cases: 15%) digital angiography showed dislocation of the surrounding pulmonary vessels but failed to demonstrate the intrinsic vascularity of the mass, deriving from the bronchial arteries. In post-lobectomy controls (10 cases: 11%) the examination gave a good demonstration of the absence of vascular supply at the site of the previous surgery. Intravenous digital angiography shows many technical limitations, namely a reduced resolution power and a small field of view; in addition, it requires patient immobility, which results sometimes impossible in critically ill patients. In spite of these inconvenients, however, intravenous digital angiography appears to be an important diagnostic step for the evaluation of pulmonary embolism and vascular malformations: in these conditions, digital angiography can be the procedure of choice.
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PMID:[Intravenous digital angiography of pulmonary circulation]. 408 51

A clinical series of 40 consecutive patients with chronic unilateral hyperlucent lung was analysed. Swyer-James (MacLeod) syndrome turned out to be the most common diagnosis (18 patients, 45%). Other causes were localized emphysema (8 patients, 20%), congenital hypoplastic pulmonary artery (4 patients, 10%), previous massive pulmonary embolism (4 patients, 10%), bronchial carcinoma (3 patients, 7.5%), sequelae of radiation therapy (2 patients, 5%) and benign intrabronchial neoplasm (1 patient, 2.5%). The reduction of pulmonary vasculature was scored (0-9). The most extensive reduction was found in patients with Swyer-James syndrome (mean 5.8), whereas patients with bronchial cancer had the smallest changes (mean 3.0).
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PMID:Chronic unilateral hyperlucent lung. A consecutive series of 40 patients. 621 8

A number of medical disciplines are involved in the diagnosis and therapy of thoracic pain. The origin may be somatic or visceral. Individual diseases are discussed in particular such as myalgia epidemica, intercostal neuralgia, herpes zoster, pleuritis and pneumonia, pulmonary embolism, pneumothorax, mediastinal emphysema, mediastinitis, pulmonary hypertension and the hyperventilation syndrome. Differential diagnosis is also referred to.
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PMID:[Pulmological aspects of diagnosis of thoracic pain (author's transl)]. 677 86

Nuclear medical imaging of the lung after inhalation of Tc-labelled aerosols can be used instead of ventilation scintigraphy with Xe-133 in those cases, where the single-breath-period is essential for diagnosis. Especially for pulmonary embolism aerosols have some advantages compared with Xe-133: Scintigraphic images can be done in several views, aerosols are always available, there is no problem with room-contamination. In patients with obstructive lung disease or emphysema, where the wash-out-period is more essential for diagnosis than the single-breath-period, there is an advantage of xenon to aerosols. Additionally aerosols can be used to study mucociliary function.
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PMID:[Scintigraphic studies of pulmonary ventilation]. 706 91

Standard chest radiographs have been shown to be insensitive for the diagnosis of morphologic abnormalities of airways. Computed tomography is the most sensitive and specific investigation to diagnose emphysema. However, as emphysema may be missed on computed tomography, this investigation cannot be used to definitely rule out the diagnosis. Computed tomography may contribute to the investigation of bronchiolitis, and it is now considered as the gold standard for establishing the diagnosis of bronchiectasis. Imaging may contribute to identify complications such as bronchopulmonary infection, pulmonary hypertension, pneumothorax, cancer of the lung, compressive bullae, and pulmonary embolism.
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PMID:[Imaging of COPD]. 765 67

"At first glance the lungs may seem uncomplicated, but many wise men have gone astray in their labyrinths." These words were written by Dr. A.A. Liebow, a famous pathologist, in a foreword to the first edition of Pathology of the Lung by H. Spencer. This same thought can also be applied to the field of medicolegal autopsies. 1. The gross appearance of the lungs in medicolegal autopsies Plucks consisting of the lungs, neck organs, the esophagus and the aorta were removed from human cadavers and after taking photos of the frontal and rear view, the lungs were carefully examined to reveal whether the lung shows characteristic morphological changes depending on causes of death. Based on their appearance, the lungs were classified into the 3 following types: a collapsed, a non-collapsed and an inflated type, each of these types reflecting the probable cause of death. The collapsed type of lung was seen in cases of death from exanguination, and the lung falling into shrinkage due to traumatic pneumo- and/or hemo-thorax was also classified into the collapsed type. The non-collapsed type of lung was seen in cases whose lungs were thermo-coagulated and in a case of death from a pulmonary embolism. Also, the deflating lungs of drowning victims before falling into collapse, were classified into a non-collapsed type. The inflated type of lung consisted of lungs that showed ballooning soon after death by drowning, and lungs that had inflated due to emphysema or edema from various causes. This lung study has reconfirmed that the lungs show hypostatic changes more clearly than any other organs of the body, and in the absence of skin color changes reflecting hypostasis, the settling of the blood in the lung could be detected in most cases. 2. Early histopathological lung changes induced by shock One hundred and thirty medicolegal cases were reviewed to detect early histopathological changes of the lung induced by shock. In many cases of death from various causes, pulmonary edema and hemorrhage were noted, but the incidence of such changes did not reveal any significant differences among the causes of death. When death had resulted from a hemorrhage or occurred during a state of shock, megakaryocytes in the pulmonary vessels tended to increase. However, if death from such causes had occurred shortly after the event, no increase in megakaryocytes was noted.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Some findings of the lung in medicolegal autopsy cases]. 786 36

The immediate effects and long-term results are reported of thoracoscopic pleurodesis in 225 patients (158 men, 67 women) treated for persistent or recurrent spontaneous pneumothorax. The procedure was performed by combined local and neurolept analgesia with direct visual exploration of the pleural space through a rigid thoracoscope. The technique included electrocoagulation of small pleural blebs, followed by regional application of fibrin and insufflation of talc powder. The main indications were a first event which persisted more than 7 days despite chest-tube suction drainage in 27% (n = 61) or a recurrent event in 73% (n = 164). The procedure provided primary success in 96.4% of the patients. Only 8 patients (3.6%) required surgical intervention including parietal pleurectomy. Perioperative complications were pharmacologically induced respiratory failure (n = 5), generalized subcutaneous emphysema (n = 8), bleeding by cutting adhesions (n = 5) and Horner's syndrome (n = 2). However, no fatal complications occurred which could be ascribed to the procedure and all patients were discharged from the hospital after an average of 12.3 days except one who died of pulmonary embolism 5 days after thoracoscopy. Long-term follow-up over a mean period of 4.1 years revealed an ipsilateral recurrence rate of 10.2% (n = 24), 16% of the patients complained of sporadic pains at the site of insertion, 51% still had diffuse thoracic pains and 2.4% reported occasional attacks of dyspnea. Spirometric lung function tests showed normal values in 89%. The immediate and longterm results show thoracoscopic pleurodesis with fibrin and talcum to be a safe and effective method for treatment of patients with persistent or recurrent pneumothorax.
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PMID:[Thoracoscopic pleurodesis in spontaneous pneumothorax]. 811 43

Single-lung transplantation has been successfully performed in patients with pulmonary fibrosis and emphysema. In contrast, patients with end-stage pulmonary hypertension (either primary or secondary to Eisenmenger's syndrome) have conventionally been offered heart-lung transplantation. The rationale underlying this approach is that chronic pulmonary hypertension results in irreversible right ventricular dilatation and failure. Recovery of the right ventricle has previously been reported after thromboendarterectomy for chronic large-vessel pulmonary embolism, correction of atrial septal defect or mitral valve replacement. The evolution of right ventricular morphology and function after lung transplantation has not been previously described. This study examines the reversibility of right ventricle dysfunction following normalization of pulmonary artery pressure after single-lung transplantation in 4 patients with pulmonary hypertension. Cardiac function was assessed using electrocardiography, echocardiography and radionuclide angiography. Pulmonary hemodynamic measurements, including pulmonary artery pressure and pulmonary vascular resistance, decreased in all patients after single-lung transplantation. Electrocardiographic changes observed were leftward shift in the QRS axis, and a decrease in P-wave amplitude and in right ventricular force. Echocardiographic examination revealed decreased right atrial, right ventricular and tricuspid valve annular dimensions, normalization of septal motion, and decreased tricuspid regurgitation. Thus, improved pulmonary hemodynamics after single-lung transplantation for pulmonary vascular disease results in reversal of right heart dilatation and dysfunction, and improved myocardial performance. The extent of right ventricular dysfunction beyond which recovery is unlikely to occur has yet to be determined.
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PMID:Recovery of the right ventricle after single-lung transplantation in pulmonary hypertension. 814 Oct 91


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