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

The results of 64 membranes diffusing capacity (Dm) and pulmonary capillary blood volume (Vc) estimations were analysed to assess the clinical significance of these measurements. These estimations were performed on 18 healthy subjects, 19 patients with mitral valvular involvement of rheumatic aetiology, 15 patients with chronic bronchitis and emphysema, 8 patients with chronic bronchitis alone, and 4 patients with pulmonary embolism. It was observed that Dm correlated very well with the pulmonary diffusing capacity (DLCO) measured during the inhalation of room air in all the groups of subjects. In patients with rheumatic heart disease, the DLCO was affected little by even large changes in Vc, whereas it ran closely parallel to the Dm in these subjects. In the past Dm has been considered to be an unreliable estimation, varying greatly as a result of small errors in the measurement of DLCO. This appears to be relatively true only in normal subjects having low Vc/Dm ratio. In a majority of diverse clinical conditions where the Vc/Dm ratio is increased, the Dm becomes a more reliable estimation. In these patients the DLCO itself is a good index of the membrane diffusing capacity.
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PMID:Clinical significance of the measurement of membrane diffusing capacity and pulmonary cappillary blood volume. 116 37

A total of 99 cases of viridans streptococcal endocarditis encountered during the period of 1973 and 1990 at the Veterans General Hospital-Taipei were reviewed to evaluate its prognostic factors. Applying strict clinical and laboratory criteria, 24 cases were categorized as definite, 44 probable, 23 possible and 8 likely. The symptoms were frequently subtle and atypical but initial laboratory tests gave useful indications: 69.1% with leukocytosis, 78% with anemia, 58.5% with elevation of LDH level, 88.9% with elevation of ESR value and 100% with elevation of CRP level. Furthermore, 32.4% of the cases demonstrated proteinuria and 67.4% microscopic hematuria. Seventy-three of the subjects had a history of underlying heart disease, predominantly rheumatic heart disease. Histological examination and echocardiography revealed that 51 patients suffered from vegetative endocarditis, 7 (13.7%) of whom were found to have anatomically confirmed vegetations without initial echocardiographic evidence, Vascular events were seen in 61 cases (61.6%): peripheral stigmata (32 cases), cerebral vascular accidents (17 cases), pulmonary embolism (10 cases) and others (2 cases). The overall mortality rate was 18.2%. Congestive heart failure with embolization was the most common cause of death in this group. The presence of vegetation was not well correlated with embolic events. There was no statistically significant association between the mortality and the following characteristics: age, sex, underlying heart disease, evidence of echocardiographically detected vegetations, major surgical intervention and recurrent cases except for embolic events (p less than 0.01). In conclusion, viridans streptococcal endocarditis complicated embolic events usually presented with a fulminant course and a grave outcome.
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PMID:Overview of viridans streptococcal endocarditis: clinical analysis of 99 cases. 165 35

Published studies encompassing more than 50,000 autopsies were assessed to determine the sensitivity and specificity of clinical diagnostics (the diagnostic process) in persons dying of 1 of 11 specific diseases during the period 1930 through 1977. The accuracy of clinical diagnostics, as reflected in these two determinations, appeared to improve over this period with respect to some of the diseases studied (rheumatic heart disease and leukemia), while for others it worsened (pulmonary tuberculosis, peritonitis, carcinoma of the lung, gastric carcinoma, and carcinoma of the liver and extrahepatic biliary tract) and for a significant number diagnostic accuracy seemed refractory to sustained change (pulmonary embolism, primary cirrhosis of the liver, gastric/peptic ulcer, and acute coronary thrombosis/myocardial infarction). The findings suggest a new way in which the autopsy can be used to monitor clinical diagnostics to identify possible sources of systematic weaknesses and provide data that can be used to approach the difficult subject of necessary fallibility.
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PMID:The sensitivity and specificity of clinical diagnostics during five decades. Toward an understanding of necessary fallibility. 273 31

This report reviews the present status of cardiovascular surgery in West Africa and highlights some of the constraints of development in this field.Rheumatic heart disease is still endemic in the tropics, where it constitutes about 20 percent of all cases of cardiovascular disease (CVD) in Nigeria. Endomyocardial fibrosis is a disease of unknown etiology accounting for 10 to 20 percent of cases. Purulent pericarditis is a common complication of pyomyositis and osteomyelitis found in 5 percent of patients. Chronic constrictive pericarditis is a sequela of infective pericarditis found in 5 percent of all cases of CVD. Calcification is found in 30 percent of cases and pericardiectomy can be performed successfully without cardiopulmonary bypass. Infective endocarditis is equally rare, occurring in 2.5 percent of cases; it is a common source of septic emboli to coronary artery and a very difficult disease to treat in the West African environment.Ischemic heart disease is relatively uncommon, accounting for less than 0.5 percent of patients. The rarity of the disease in black Africans has been attributed to dietary habits and environment rather than to racial and psychosocial factors. Congenital heart disease accounts for 5 percent of all cases of CVD in this review. Ventricular septal defect and patent ductus arteriosus are the most common acyanotic defects, while tetralogy of Fallot and transposition of the great arteries are the most common cyanotic defects.Vascular diseases are uncommon in this series, with traumatic injuries accounting for most of the cases. Abdominal aortic aneurysms, peripheral occlusive vascular disease, and atherosclerotic aortic aneurysms are quite rare. This review further confirms the rarity of deep venous thrombosis and pulmonary embolism in Africans.
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PMID:The status of cardiovascular surgery in West Africa. 331 74

Heart disease is a major cause of death in thal patients after the first decade of life. This study was carried out on autopsy material from 76 patients, six with beta-thal major, 58 with beta-thal/Hb E, and 12 with Hb H disease. Of the 58 patients with beta-thal/Hb E, which form the main group, all but one had cardiac hypertrophy, accompanied by dilatation in 17, five of ten patients with right ventricular and 14 of 25 patients with biventricular hypertrophy had chronic pulmonary thromboembolism. Iron deposition, while present in 18 patients, was very slight. Four patients had fibrinous pericarditis, two with diagnostic rheumatic heart disease; 15 patients had chronic pericarditis, with extensive fibrosis in half the cases. In comparison, the six patients with beta-thal major showed more severe cardiac changes, including more iron deposition. Of the 12 Hb H patients, two died of rheumatic heart disease, one had frank bilateral pulmonary embolism and striking right ventricular hypertrophy, while the remaining nine showed little cardiac pathology.
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PMID:Cardiac pathology in 76 thalassemic patients. 339 May 39

he recent advances in surgical treatment of congenital heart disease, permits the survival of those cases to adult life. Infective endocarditis in the childhood is becoming increasingly important. We studied 32 cases in the pediatric cardiology ward at the INC between 1977 and 1981. There was a male predominance of 62.5%. Rheumatic heart disease (40.7%), congenital heart disease (15.6%) and postoperative cases (43.7%) were the underlying conditions. There was an average time of 43 days delay from the first symptom to diagnosis. Blood cultures were taken in 29 cases (90.6%). Only half of them were positive. Staphylococcus and streptococcus were the commonest isolates. Peripheral and pulmonary embolism (11 cases-34.4%) were the most frequent complications. In those cases with negative blood culture the most successful antibiotic combination was ampicillin or oxacillin plus aminoglucosides (56%). There were 17 deaths (53%).
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PMID:[Infectious endocarditis in children]. 674 35

During 1983-1992 in Turkey, 17 maternal deaths occurred out of 100,531 live births at the Zubeyde Hanim Maternity Hospital in Ankara for a maternal mortality ratio (MMR) of 16.9/100,000 live births. Hemorrhage (41.2%) and pulmonary embolism (35.3%) were the leading causes of maternal death. Cases referred to the hospital after home deliveries accounted for 57% of the hemorrhage-related deaths. Other causes of maternal death were eclampsia (11.7%), puerperal infection (5.9%), and heart failure attributed to rheumatic heart disease (5.9%). The MMR fell over time from 22.6 (1983-1984) to 12.8 (1991-1992). Women younger than 20 and those 35 and older suffered from the highest MMRs. MMR increased with parity (8 for primigravida, 10 for parity 1-2, 27.3 for parity 3-4, and 62.1 for parity =or 5). Cesarean delivery was associated with a higher MMR than vaginal delivery (44.7 vs. 14.1). This association was likely a result of pregnancy complications that led to a cesarean section rather than the cesarean section itself.
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PMID:Maternal mortality in a maternity hospital in Turkey. 766 Jul 64

Obstetrician-gynecologists reviewed patient records of women delivering during January 1986-December 1992 to determine the maternal mortality rate and trends and the causes of maternal deaths in the maternity ward at the National University of Singapore. There were 26,173 deliveries and 9 maternal deaths (a maternal mortality rate of 22.9/100,000). The causes of maternal deaths were pulmonary embolism (underlying condition, systemic lupus erythematosus [SLE]), hemorrhage from multiple sites (thrombotic thrombocytopenia), acute exacerbation of SLE with interstitial pneumonitis, pulmonary fibrosis (systemic sclerosis), fulminant hepatitis (prior hepatitis and liver disease), and cerebral embolism (rheumatic heart disease with mitral valve replacement). There were also three incidental maternal deaths bringing the maternal mortality rate up to 34.4/1000. The incidental causes of death included septicemia from perforated peptic ulcer (uncontrolled thyrotoxicosis), multiple metastases from lung cancer, and suicide (family dispute over adoption of newborn). A cesarean section preceded 4 (44%) of the 9 maternal deaths. Two of these deaths were incidental maternal deaths. Cesarean section was related to two of the remaining six (33%) deaths. These findings show that traditional direct causes of maternal death (hemorrhage, sepsis, embolism, or hypertension) were not responsible for the maternal deaths at this tertiary facility. Instead, the women tended to have medical conditions that placed them at high risk of death regardless of pregnancy status.
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PMID:Maternal mortality: evolving trends. 781 Nov 98

When atrial fibrillation (AF) complicates rheumatic heart disease, the risk of stroke is 17 times that of patients in sinus rhythm and full anticoagulation is mandatory. Non-rheumatic AF carries a lower risk--5% per annum, a 5-fold increase. Four major trials (SPAF, AFASAK, BAATAF, CAFA) have lately examined thromboembolic prophylaxis in this group of patients. These randomized prospective open studies showed a 56-86% reduction in stroke and systemic embolism in patients receiving full anticoagulation compared with placebo. In older people, the BAATAF trial of low-dose warfarin (INR = 1.5-2.7) showed an 86% reduction in stroke and a significant reduction in mortality. In all 4 studies the incidence of hemorrhagic complication was very low (0.5%). In SPAF trial, aspirin, 325 mg/day was found to be effective, but this was not the case in AFASAK, which used 75 mg/day and had an older population. In a double-blind randomized trial indobufene, 100 mg bid, was found effective in the 67% reduction of stroke, systemic and pulmonary embolism in patients with various cardiac diseases in AF or in sinus rhythm. Consequently, a reasonable policy would be to give full or low-dose anticoagulation to those patients with chronic AF who have structural heart disease or are over 65 years old; to consider low-dose anticoagulation or aspirin or indobufene in younger patients with chronic lone AF; and to give indobufene or aspirin or nothing to those with episodes of paroxysmal AF lasting hours only. In borderline cases, the use of transesophageal echocardiography to exclude left atrial thrombus and spontaneous echo contrast may aid decision-making.
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PMID:[Atrial fibrillation: embolic risk and prevention]. 802 31

The frequency of pulmonary embolism in patients with myocardial infarction (MI) and chronic rheumatic heart disease (RHE) has been investigated in an autopsy series. The series comprised 21530 hospital autopsies from 1960 to 1984. Altogether 5351 patients with MI and 289 patients with RHE as underlying death cause were selected for this study. Patients with RHE or old myocardial infarction (OMI) had a significantly higher frequency of pulmonary embolism than patients with acute myocardial infarction (AMI) or acute and old myocardial infarction combined (AOMI). This was true irrespective of duration of stay in the hospital during last admission. The frequency of pulmonary embolism decreased in patients with OMI or RHE from 1960 to 1984 suggestive of better therapy of chronic heart failure. A similar trend was seen in patients with AMI during a period with consistent anticoagulation treatment.
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PMID:Pulmonary embolism and heart disease. An autopsy study. 830 25


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