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

Though pulmonary embolism (PE) has been thought to be rare, the incidence seems to be increasing recently. During the past 10 years the authors have encountered 5 cases of PE among stroke patients. There were 2 males and 3 females, aged 51 to 71 years (mean age; 63 years). The mean time between admission and onset of PE was 23 days. As to the primary disease to be treated, 5 patients had subarachnoid hemorrhage and one had intracerebral hemorrhage. Generally, PE tends to be overlooked or misdiagnosed because of the fact that stroke patients are often in a state of unconsciousness. In our series, only one patient complained of dyspnea and the other 4 patients due to unexplained sudden tachycardia, tachypnea and hypoxemia were suspected to have PE. Deep venous thrombosis known as the risk factor leading to PE was presented in 3 patients. Especially in one patient, femoral venous catheterization was considered as a risk factor possibly leading to deep venous thrombosis. Regarding the diagnosis of PE, the roles of electrocardiogram and of chest x-ray film were small. In 3 patients, the elevation of the diaphragm was the only abnormal finding on chest X-ray. On the other hand, the lung scintigram with 99mTc-MAA was a useful method for definitive diagnosis of PE. In 3 patients, filling defects were demonstrated on the lung perfusion scintigrams. Consequently, we emphasize that PE must be kept in mind when tachycardia, tachypnea and hypoxemia appear suddenly. Prompt diagnosis and treatment are required.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pulmonary embolism complicated with stroke: analysis of 5 cases]. 189 17

Epidemiologic studies carried out in the UK in the late 1960s and 1970s suggested a strong link between oral contraceptive (OC) use and certain cardiovascular diseases. Most striking was the increased risk (2-4 times) of myocardial infarction in OC users compared to nonusers. OC use was also associated with a greater than average risk of subarachnoid hemorrhage, thrombotic stroke, and fatal pulmonary embolism. It is important, however, to reassess these risks in light of changes that have occurred since these early studies. Most notably, the OCs currently being marketed contain lower estrogen/progestin dosages than earlier formulations and the majority of OC use is concentrated in the under 30 year age group. In fact, preliminary results from a case- control study begun in 1968 suggest that the risk of OC-related myocardial infarction has dropped in recent years as a result of these changes. At present, data have been analyzed for 130 cases 16-39 years of age who died of myocardial infarction and an additional 237 women who died of subarachnoid hemorrhage. 24% of the myocardial infarction cases were OC users at the time of death compared to 19% of matched controls. This produces a relative risk of 1.8 for OC users, which is statistically significant yet lower than that identified in earlier studies. The data confirm that cigarette smoking is another important risk factor for myocardial infarction; the risk increased nearly 12-fold in smokers compared to nonsmokers. The risk of myocardial infarction in women who both smoked and used OCs was increased over 50-fold. The risk of subarachnoid hemorrhage was 1.4 in the current study, which is similar to that found in earlier research; again, the risk was greater among OC users who smoked.
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PMID:An epidemiologic survey of cardiovascular disease in women taking oral contraceptives. 219 99

In neurosurgery, none of the drugs used in other specialties as prophylaxis of thrombo-embolism have found general acceptance. Certain centers reject any drug prophylaxis of thrombo-embolism. Others treat many or--with the exception of subarachnoid hemorrhage--almost all patients according to the Kakkarscheme. Many aim for an individual examination of the risk of early mobilization and, if necessary, combine mechanical and medicinal methods (Tab. 3). No center has published any systematic studies of substantial patient populations. It is not possible to draw any medico-legal conclusions from the neurosurgical literature available. The multitude of diagnostic and therapeutic regimes, sometimes accompanied by contradictory publications, means that even non-neurosurgeons regard neither the diagnosis nor the treatment of thrombo-embolisms as ideal. Even under low-dose heparinization, deep venous thromboses can occur, and it is in principle difficult to refute the contention that this fact changes nothing whatsoever for high-risk patients as far as the incidence of pulmonary embolism ot the occurrence of significant thrombo-embolic events is concerned. Cost calculations have proved that general thrombo-embolism prophylaxis is more expensive than individual thrombosis treatment as necessary (although there are statements to the contrary). It can, however, be stated that additional costs with the aim of improving or maintaining the quality of life would be economically justifiable if a preventive effect were proved. For modern neurosurgery, however, this neither holds true generally nor for a specific subgroup. The state of research would seem to suggest that a prospective, controlled study of neurosurgical patients, primarily in a relatively low-risk group, is necessary, advisable, and justifiable.
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PMID:[Perioperative prevention of thromboembolism in neurosurgery]. 226 2

In a prospective, community-based study of 675 consecutive patients with a first-ever stroke, of whom over 90% had computed tomography (CT) and/or necropsy examinations, 129 deaths occurred within 30 days of the onset of symptoms, a case fatality rate (CFR) of 19%. The 30 day CFR for patients with cerebral infarction was 10% (57 of 545, for primary intracerebral haemorrhage 52% (34 of 66), for subarachnoid haemorrhage 45% (15 of 33) and for those of uncertain pathological type 74% (23 of 31). The CFR for patients who had been functionally dependent pre-stroke was 33% compared with 17% for those who had been independent pre-stroke. The age-adjusted relative risk of death for patients who had been functionally dependent pre-stroke was not significantly greater (1.8, 95% confidence interval 0 to 4.3). There was a significant trend for CFR to increase with age (Chi square for trend = 4.0, p less than 0.05). This relationship was found in those patients who had been functionally independent prestroke (Chi square for trend = 7.9, p less than 0.005) but not in those who had been dependent pre-stroke (Chi square for trend = 0.5, NS). The pattern of increasing CFR with increasing age amongst those who had been independent prestroke was seen particularly in patients with cerebral infarction (Chi square for trend = 8.6, p less than 0.005). The age-adjusted relative risk of death for patients with cerebral infarction who had been functionally dependent pre-stroke was 2.2 (95% confidence interval 1.2 to 4.1). Fifty three percent of all deaths within 30 days of stroke were due to the direct neurological sequelae of the stroke. Patients with primary intracerebral or subarachnoid haemorrhages were significantly more likely to die in this way than those with cerebral infarction (relative risk 4.1; 95% confidence interval 3.4-4.9) and 56% of such deaths occurred within 72 hours of onset. In patients with cerebral infarction, 51% of deaths were due to complications of immobility (for example, pneumonia, pulmonary embolism) and these were more likely to occur after the first week. These findings have implications for clinical practice and the planning of clinical trials.
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PMID:The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project. 226 60

The presence of depression in consecutive admissions with life-threatening illness was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). The 211 patients had one of four conditions, myocardial infarction (N = 100), subarachnoid haemorrhage (N = 41), pulmonary embolism (N = 40), and acute upper gastrointestinal haemorrhage (N = 30). Depression was measured using both the standard MADRS, and a modified version excluding somatic items which might be influenced by the underlying illness. The patients were also assessed for severity of illness and cognitive dysfunction. The results showed that immediately following a life-threatening illness approximately 34% of the patients were depressed, using the modified scale, but that the depressed group did not have a more severe physical illness. However, the depressed patients had a significantly poorer outcome over the 28 days following admission, with 47% of the depressed patients dying or having life-threatening complications, as opposed to 10% of the non-depressed group. This study demonstrates that the psychological state of an individual can affect their individual risk of mortality following physical illness.
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PMID:Depression increases mortality and morbidity in acute life-threatening medical illness. 229 Jan 37

From January 1981 to June 1986 116 patients with anticoagulation-related intracranial haemorrhage were referred to hospital. Seventy six of these haemorrhages were extracerebral, 69 were in the subdural and seven in the subarachnoid space. No epidural haemorrhages were identified. Compared with non-anticoagulation-related haematomas, the risk of haemorrhage was calculated to be increased fourfold in men and thirteenfold in women. An acute subdural haematoma, mostly due to contusion, was more frequently accompanied by an additional intracerebral haematoma than a chronic subdural haematoma. Trauma was a more important factor in acute subdural haematomas than in chronic. Almost half of the patients (48%) had a history of hypertension, more than a third (35%) had heart disease and about one fifth (18%) were diabetic. Headache was the most frequent initial symptom. Later decreased level of consciousness and focal neurological signs exceeded the frequency of headache. Three patients with subarachnoid haemorrhage and nine patients with acute subdural haematomas died, while those with chronic subdural haematomas all survived and had at the most mild, non-disabling sequelae. Myocardial infarction (22%), pulmonary embolism (20%), and arterial disease (20%) were the most frequent reasons for anticoagulant treatment. Critical review based on established criteria for anticoagulation treatment suggests there was no medical reason to treat a third of these patients. The single most useful measure that could be taken to reduce the risk of anticoagulation-induced intracranial haemorrhage would be to identify patients who are being unnecessarily treated and to discontinue anticoagulants.
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PMID:Anticoagulation-related intracranial extracerebral haemorrhage. 276 75

Among 53 patients with hereditary protein C deficiency belonging to 20 families three women were encountered who, aged 27, 34, and 38 respectively, had had cerebral haemorrhagic infarction, probably due to intracranial venous thrombosis. All three had also had venous thrombosis of the leg and pulmonary embolism either before or after their cerebral infarction. One patient sustained cerebral infarction while receiving an oral contraceptive, but infarction in the two others occurred "spontaneously." One patient also had an intraventricular and subarachnoid haemorrhage during the induction phase of coumarin treatment, which was assumed to have resulted from haemorrhagic infarction of the chorioid plexus, analogous to coumarin provoked haemorrhagic skin necrosis in protein C deficiency. Hereditary protein C deficiency should be considered in young patients with acute or subacute cerebral symptoms, especially if they have a family or personal history of venous thromboembolism.
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PMID:Cerebral haemorrhagic infarction in young patients with hereditary protein C deficiency: evidence for "spontaneous" cerebral venous thrombosis. 391 15

The surgical results and long-term outcome in 100 consecutive cases of intracranial aneurysm with a subarachnoid haemorrhage are described. According to the modified Botterell classification of neurological status, 33 patients fell into grade I, 56 into grade II and 11 into grade III at the time of surgery. There were no deaths associated with the surgical procedure. Two patients were worse off immediately after the operation and 4 others developed delayed ischaemic deficits postoperatively owing to cerebrovascular spasm. Four of these 6 patients made a good recovery but the others remained in a vegetative state. One other patient died from a pulmonary embolism on the 9th postoperative day. A group of patients who had grade IV neurological status at some stage before the operation all tolerated surgery well once their condition had stabilized, and stood an even chance of making a full functional recovery by 3-6 months.
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PMID:Intracranial aneurysm with subarachnoid haemorrhage. Surgical results and long-term outcome in 100 cases. 671 2

Cerebral haemorrhage is the main life-threatening complication of oral anticoagulant therapy. In order to identify a means of prevention, the authors undertook a retrospective study of 68 consecutive cases of anticoagulant-related intracerebral haemorrhage. The mortality was 38.5%. The respective frequency of intracerebral haemorrhage, subarachnoid haemorrhage, acute and chronic subdural haematomas was 63.2, 16.2, 10.3 and 10.3%, respectively. On admission, nearly half the patients (53%) had prothrombin ratios inferior to 25%. A predisposing factor was found in 58% of cases: hypertension (30.6%), head injury (14.5%), alcoholism or drug interaction (11.2%), and one case of intracerebral aneurysm. A history of a transient ischaemic attack or of a cerebrovascular accident was found in 10.2% of cases and 11.7% had a previous anticoagulant related extracranial haemorrhage. The initial indications for oral anticoagulation were ischaemic heart disease (32%), atrial fibrillation (20.5%), secondary prevention of venous thromboembolic disease (17.6%) and primary prevention of venous thrombosis (11.7%). The duration of treatment for isolated ischaemic heart disease was over 6 months in all cases: the average duration of treatment was 12.4 months in phlebitis and pulmonary embolism. A critical review of the indications of treatment in the light of recent recommendations showed that if inappropriate indications were rare, the sometimes unnecessary prolongation of treatment was more common. Nearly half of these cases were receiving anticoagulants when the potential benefits were questionable at the time of the haemorrhagic complication. Clinical and biological follow-up is necessary for patients on anticoagulants; minor bleeding complications may be the prelude to major haemorrhage. Biological follow-up is based on control of the international normalised ratio.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The causes of intracranial hemorrhagic complications induced by antivitamins K]. 778 12

The treatment of subarachnoid haemorrhage caused by aneurysm in comatose patients with or without midbrain symptoms is a matter of controversy. The question is, which comatose patients will profit from aneurysm surgery and which will not? In a retrospective study, 573 patients were examined between 1986 and 1992. Of these, 116 were in poor condition (Hunt and Hess Grade IV or V). The following management protocol was used: after computer tomography, a decision was made whether intensive medical treatment was performed or not. The reason for not operating was essentially the severity of the cerebral haemorrhage and poor or absent intracranial filling on angiography. Extracerebral causes were renal failure, sepsis, liver cirrhosis and pulmonary embolism. The direct early aneurysm operation was performed in the clinical deterioration phase in patients with space-occupying haematomas. In dilatation of the ventricle system, external drainage was initially positioned, in the case of bilateral haematocephalus, two-sided drainage was positioned, then intensive medical treatment and angiography were performed. The aneurysm operation was then ruled out if there was no clinical improvement. Aneurysm operation was performed on 57 of the 116 patients; 13 died, 32 showed a good and 12 a poor or fair outcome. 15 patients had mid-brain syndrome, and 5 of them died. Based on our experience, we draw the following conclusion: the Hunt and Hess scale alone is not a sufficient basis for decision taking. Some of the comatose patients, even in mid-brain syndrome, profit from an early operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Modulated surgery in the management of ruptured intracranial aneurysm in poor grade patients. 791 32


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