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

Maternal mortality is examined from June 1980 to December 1986 at Mulago, Nsambyo, Old Kampala, Rubaga, and Mengo Hospitals in Kampala, Uganda. Clinical or immediate causes, direct and indirect, were recorded from case summary forms based on ICD9 definitions of obstetric complications. The nonabortion maternal mortality rate (NAMMR) was 2.65/1000 deliveries (580 deaths); the abortion-related maternal mortality rate (ARMMR) was 3.58/1000 abortions. The hospital maternal mortality rate was 2.0/1000 deliveries. 75% of maternal deaths of women of 28 weeks' gestation or more had delivered outside the hospital. NAMMR doubled between 1980-86, a statistically significant increase. ARMMR increases were almost significant. 75% were direct obstetric and 21% were indirect obstetric causes. 38% had clinical anemia, 29% had some sepsis, 18% had substantial bleeding, and 14% had obstructed labor. Other contributing conditions were pneumonia, ruptured uterus, laparotomy, evacuations and curettage, malaria, preeclampsia, sickle cell anemia, pulmonary embolism, malnutrition, tetanus, meningitis, prolonged labor, and hepatitis. At admission, 48% were in poor condition, 30% in good condition, and 22% in fair condition. 27% had sickle cell anemia, high blood pressure, multiple pregnancy, or malaria at admission. 64% were admitted within 24 hours after delivery, 67% 1-7 days after delivery, and 92% 7-42 days after delivery. Those in good condition were all admitted 7 days postdelivery. 41% of deaths were due to lack of drugs, 7% lack of fluids, 20% with theater problems, 14% with doctor-related factors, and 3% with midwife-related factors. Better information is needed on mortality before delivery, mortality in hospitals vs. outside, and mortality from abortion, and ectopic and hydatidiform molar pregnancies. An explanation given for the increase in maternal mortality is the decline in economic conditions. Abortion complications may be due to the concealment practiced. Causes are consistent with trends from the 1950s, 1960s, and 1970s in Uganda and developing countries in general. Availability and accessibility of gynecological and obstetric services needs great improvement. Training traditional birth attendants and obtaining rural ambulance services are also needed. Health workers lack creativity and imagination for developing country conditions; scarce resources are not the only problem.
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PMID:Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986. 176 15

Over the January 1, 1979 to March 31, 1980 period sterilization-attributable deaths were identified in Dacca and Rajshahi Divisions, Bangladesh. These deaths were identified primarily through government records of compensation to families of deceased sterilization patients. This list was augmented by deaths reported from clinics of the Bangladesh Association for Voluntary Sterilization, detected through a prospective study of sterilization in Bangladesh, and identified by interviews with government family planning officials. A sterilization-associated death was defined as the death of a patient from any cause occurring within 42 days of tubal ligation or vasectomy. Death-to-case rates for vasectomy and tubal ligation were calculated for each month with 95% confidence intervals based on the Poisson distribution. 31 sterilization-associated deaths were identified over the study period. 28 of these were sterilization attributable and 3 were not. The mean age of the 21 women was 30.6 years, and their mean parity was 4.8. The mean age of the 7 vasectomy patients was 37.0 years. Abdominal Pomeroy method of tubal ligation was the only female sterilization technique used. 2 temporal clusters of sterilization attributable deaths occurred during the study. The 1st was a cluster of 5 deaths from tubal ligation performed in June 1979. 3 of these operations took place on June 5, 1979 but in different facilities. 1 factor common to each of these operations was the unseasonably hot weather. The 2nd temporal cluster consisted of 3 deaths after vasectomy in July 1979. 2 men from the same village died from scrotal infections after vasectomy on July 19, 1979 by the same surgeon at a single clinic. A similar death occurred earlier the same month. Another patient of the same surgeon and clinic associated with the deaths after operation on July 19 died from scrotal infection in January 1980. 3 vasectomy deaths related to 1 surgeon in a single remote facility suggests a breach of sterile technique. This could not be confirmed as this clinic physician could not be interviewed. The death-to-case rate for all procedures combined was 21.3 deaths/100,000 procedures, with the rate for vasectomy 1.6 times higher than that for tubal ligation. Anesthesia overdosage was the leading cause of death attributed to tubal ligation with tetanus (24%), intraperitoneal hemorrhage (14%), and infection other than tetanus (5%) as other leading causes. 2 patients (10%) died from pulmonary embolism after tubal ligation; 1 (5%) died from each of the following: anaphylaxis from anti-tetanus serum, heat stroke, small bowel obstruction, and aspiration of vomitus. All 7 men died from scrotal infections after vasectomy. Improvement in anesthesia management and sterile technique can lower the death-to-case rate for contraceptive sterilization in 2 Divisions of Bangladesh.
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PMID:Sterilization-attributable deaths in bangladesh. 612 37

The effects of peroperative electrical calf muscle stimulation with groups of impulses giving a short lasting tetanus of the calf muscles on postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared with that of dextran 40 given per and postoperatively. The incidence of DVT and PE during the first 4-6 postoperative days was recorded. The diagnosis of DVT was based on the 125I-fibrinogen uptake test and phlebography and of PE on pre- and postoperative perfusion pulmonary scintigram and chest X-ray examination. Both methods reduced the incidence of PE. Calf muscle stimulation reduced the DVT incidence in patients with malignant disease while the reduction in DVT incidence for the whole group only was significant in the stimulation as well as the dextran 40 group. Mean values for preoperatively determined levels of antithrombin III, beta-thromboglobulin, fibrinopeptide A, plasminogen and ability to release fibrinolytic activity during venous stasis did not differ between those patients who developed or those who did not develop postoperative DVT or PE. However, antithrombin III levels below 80 per cent appeared to predispose to postoperative thromboembolism. The two prophylactic methods have similar effects on the incidence of postoperative thromboembolism. The stimulation method has certain advantages due to its safety and simplicity.
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PMID:Prediction and prophylaxis of postoperative thromboembolism--a comparison between peroperative calf muscle stimulation with groups of impulses and dextran 40. 618 44

From 1964 to 1980 a total of 18 patients with tetanus were treated at Tampere Central Hospital, 5 (28%) of whom died. No assurance regarding earlier immunization could be obtained in 15 cases. In 13 cases the site of infection was a small scratch on the finger, the legs or the face. The mean incubation period was 8 days. Ten patients suffered from severe tetanus and 8 from moderate tetanus. Eight patients, of whom 2 died, were treated in an ordinary ward. After the surgical intensive care unit was set up, 10 patients received treatment there. Three died. The mean duration of hospitalization was 27 days and the mean treatment period in the intensive care unit 24 days. Seven patients were asymptomatic when discharged and 6 had minor after-effects. Cardiovascular complications can be prevented by intensive care, but pulmonary embolism remains the commonest cause of death. Special attention should be paid to its prevention.
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PMID:Results of treatment of patients with severe tetanus. A study o 18 cases. 694 10

A study of 165 maternal deaths at the University of Benin Teaching Hospital, Benin City over a 13-year period (from April 1, 1973 to December 31, 1985) is presented. All patients' case files were recovered from the central records library and each case file was carefully analyzed. With a total delivery of 29,324, the maternal mortality rate, inclusive of death from abortion, was 563/100,000 deliveries. There was a general increase in maternal mortality rate with age and this became alarming from 35 years. There was an equally high mortality rate among teenagers, mainly accounted for by illegally induced abortion. Indeed, abortion accounted for 72% of teenage mortality. A statistically significant association between maternal deaths and parity (p, 0.001) was observed. The most important causes of death were hemorrhage with a total of 26 out of 42 deaths, sepsis, and abortion. Other important causes were hypertensive disorders such as eclampsia, liver and respiratory disease, anemia, trophoblastic diseases, caesarean sections, and acute renal failure. Additional causes of maternal deaths include tetanus, sickle-cell disease, anesthetic death, drug reactions, pulmonary embolism, acute pyogenic meningitis, typhoid disease, urinary bladder tumor, acute lymphoblastic leukemia, and carcinoma of the breast thyroid. Factors identified with these deaths included such health services factors as deficient medical treatment of obstetric complications, lack of adequate personnel at primary and secondary health care levels, lack of access to maternal health services, and consequently, lack of prenatal care. Extreme reproductive age, grandmultiparity, and unwanted pregnancies, especially among teenagers, also contributed to maternal deaths. Overhaul of the maternal health care services at national level to include organization of such programs as provision of adequate blood transfusion facilities, prompt treatment of infections, early referrals of patients at risk to secondary and tertiary health centers, intensified family planning programs, and liberalization of abortion laws are recommended in order to reduce the unacceptably high maternal mortality.
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PMID:Maternal mortality at the University of Benin Teaching Hospital Benin City, Nigeria. 1217 71

The objectives of this study are to determine the trend of maternal mortality at the University of Ilorin Teaching Hospital, to identify the causes of death, and to identify ways of minimizing the frequency of preventable deaths. Analysis of 75 cases of maternal deaths seen over 3 1/2 years (January 1983-June 1986) was conducted. During this period, there were 26,905 births, giving a maternal mortality rate of 279/100,000. 84% of the deaths were due to direct causes while the remaining 16% were classified under the indirect and pregnancy related categories. The main direct causes of death include hemorrhage (35.6%), septicemia (24.7%), and anemia (13.7%). Other direct obstetric causes include eclampsia, anesthetic death, hemoglobinopathy, and ruptured uterus. The most important indirect causes were native drug intoxication (6.8%), fulminant hepatitis (5.5%), and pulmonary embolism (2.7%). The maternal mortality was highest in the age ranges 25-29 years (31.5%). Median age and parity were 27 years and 4.5 respectively. While the maternal mortality rate of 2.8/1000 is an improvement over the previous years' (1972-1982) record of 4.3/1000, it is still unacceptable. The majority of these deaths could have been prevented if delivery had occurred in a well equipped hospital where blood transfusion and surgical facilities are available, if sterile manipulations for pregnant women had been employed, if appropriate antenatal care was available, and if specialist anesthetist services were accessible. Recommendations to reduce the maternal mortality rate include improved education and training of traditional birth attendants, improved immunization of women against tetanus, and increased community involvement through education. Furthermore, policy makers must set new priorities such as encouraging greater investment in improving clinics and hospital facilities, improving access to contraception, increasing awareness of the magnitude of the problem and encouraging community leadership and action.
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PMID:Maternal mortality at Ilorin, Nigeria. 1217 82

53 of 3100 abortions at Bombay hospital were septic abortions, giving an incidence of 1.7%. Various factors of possible etiological significance were analyzed, including age, parity, marital status, duration of gestation, and the mode of interference leading to sepsis. 36 of 53 patients were aged 20-30 years, but other age groups were represented. In the present study, gravidity was not relevant, for all gravidity groups, from primipara to grand multipara 5 and above, had patients suffering septic abortions. 9 patients were married and gave a history of interference; in all, 38 patients were married, 22 were unmarried, and 4 were widows. 23 patients gave a definite mode of interference, and the most common method was interference with a stick. 43% mortality occurred in patients giving a history of interference, and 36% mortality occurred in others. Vaginal and cervical cultures revealed (16 cases studied) 5 cases of CL. tetani, 1 case of E. coli, and 10 patients showing strepto-, staphylo-, pneumococcal infections. In this series, 21 of 53 patients died: 8 of tetanus, 3 or renal failure, 4 of septicemia, 2 of hemorrhagic diathesis, and 3 of endotoxic shock. 1 patient had acute bacterial endocarditis and pulmonary embolism at sutopsy. It is this article's contention that the main cause of sepsis is using an instrument to induce abortion during an unwanted pregnancy; hence, a plea is made for more liberalized abortion legislation.
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PMID:Septic abortion. 1226 87

A study of maternal deaths due to septic abortion from 1973-77 in India found the incidence of septic abortion to be 6.6% of all spontaneous abortion in the L.N.J.P. Hospital. The total maternal deaths were 81 and deaths due to septic abortion were 17. The death rate due to septic abortions remained constant during the 5-year period. The majority of cases were married and belonged to the urban population. Of a total 6418 medically terminated pregnancies, 190 were septic abortions. The causes of death were generalised peritonitis (4); septicaemia (4); uraemia (2); endotoxic shock (2); uterine perforation with peritonitis (2); pelvic abcess and pulmonary embolism (1); and tetanus (2). In view of the high number of septic abortion deaths, medically terminated pregnancy services should be reapprised. Preventive contraception would alleviate most of the potential dangers of septic abortion.
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PMID:Septic abortions: 5 years review. 1233 18

Due to a high mortality rate, headshot injuries pose serious diagnostic and clinical problems. In this work, we wanted to describe four atypical headshot injuries. The first patient with a headshot injury using a nail gun mishap; the second one after a headshot injury, as a result of attempted murder (the bullet came to a parasagittal halt in the left parietal area); the third victim, after a suicide attempt (the bullet was removed from clivus area, below the pituitary gland); in the case of the fourth patient, after shooting himself with a self-constructed weapon in the chin, the metal body was surgically removed - a bearing pellet from the corpus callosum. Males dominate among victims of headshot injuries. Alcohol is one of the elements that facilitate suicidal behaviour. Anti-spasm, antibacterial, anti-tetanus prophylaxes are incredibly important. In some cases, the metallic body does not have to be removed from the brain. Pulmonary embolism can be a cause of death after 7 days from injury.
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PMID:[Treatment methods of atypical gunshot wounds to the head--case reports]. 2723 64

Tetanus is a disease characterized by spastic paralysis and spasms. It is a serious pathology that requires treatment in the ICU. Mortality rate is primarily due to neurodegenerative and infectious complications. Thromboembolic complications are rare. To the best of our knowledge, pulmonary embolism has never occorred and been confirmed in patients with generalized tetanus. Our study reports the case of a patient with generalized tetanus complicated by fibrin, cruoric pulmonary embolism.
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PMID:[A rare complication of generalized tetanus: pulmonary embolism]. 2829 34


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