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

A 50-year old woman taking oral contraceptives (OC) for the past 3 years without side effects developed an aneurism of the jugular vein. A left thyroid lobectomy was performed and during thyroid exploration, organizing clots were dislodged and resulted in fatal pulmonary embolism. At autopsy, both main pulmonary arteries were plugged with organizing thrombi. A literature search failed to reveal a similar case. A definite relationship exists between OC use and thrombophlebitis. Vessey and Doll reported that a greater than eightfold-risk of thrombophlebitis exists among OC users as compared with nonusers of OC. 46 OC users had been known to develop thromboses in various vessels including cerebral; opthalmic; axillary, and deep leg veins (Luck and Bergin). Warning signals of impeding thrombosis include severe unilateral headache; transient blindness; and/or paresthesias and muscular weakness.
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PMID:Internal jugular vein thrombosis with fatal iatrogenic pulmonary embolism: a case report. 118 59

In a randomized series of patients who underwent gynaecological operations, the prophylactic effect on thrombophlebitis of low dose Heparin was compared to that of oral anti-coagulants. One group (n = 221) received Heparin (Liquemin Roche) subcutaneously in a dosage of 5000 units 2 hours pre-operatively and every 12 hours until the eighth post-operative day. The control group (n = 237) continued to receive the conventional prophylactic medication with Sintrom by mouth from the second post-operative day to complete ambulation keeping the quick test between 20 and 30%. The two groups were more or less identical regarding several risk factors and the following results were obtained: 1. The number of cases of deep thrombophlebitis diagnosed by the I-125-Fibrinogen test was significantly less in the group receiving Heparin than in the group receiving Sintrom. Clinical examination showed the same correlation but only detected 30% of all cases of deep thrombophlebitis. 2. The clinical suspicion of pulmonary embolism was more frequent in the group of patients receiving low dosage Heparin. Most of the symptoms were mild and none of the patients died. 3. During the anti-coagulant treatment the incidence of secondary bleeding was the same in both groups. The prevention of deep thrombophlebitis by low dosage Heparin is a very effective and simple method with few side effects and is superior to the post-operative prophylaxis with oral anti-coagulants.
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PMID:[A comparison of low dose heparin and oral anticoagulants in the prevention ot thrombo-phlebitis following gynaecological operations (author's transl)]. 118 92

The treatment of thrombophlebitis in pregnancy with streptokinase is reviewed. Four personal cases are reported. In 3 cases the streptokinase treatment of thrombosis was carried out in the first trimester of pregnancy. Two pregnancies ended in spontaneous term deliveries of well infants without malformations. In one case the pregnancy ended by a spontaneous abortion two weeks following the treatment of the thrombosis. It is suggested that the abortion was much more likely due to a severe state of shock with pulmonary embolism following laparotomy in early pregnancy. The authors are of the opinion that the thrombolytic therapy with streptokinase should also be carried out in the first trimester of pregnancy to prevent embolization of thrombotic material and to prevent a post-thrombotic syndrome. In each case, streptokinase treatment should be followed up with subcutaneous prophylactic treatment with Heparin until term to prevent recurrent thrombophlebitis in pregnancy. With the onset of labour Heparin medication should be interrupted and the thrombin time should be normal with the beginning of the second stage of labour or the Heparin effect should be neutralized by protamine chloride. At the earliest six hours postpartum, the subcutaneous Heparin prophylaxis can be resumed in order to prevent recurrent thrombo-embolism during the postpartum stay.
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PMID:[The treatment of thrombosis in pregnancy (author's transl)]. 121 58

Popliteal vascular trauma continues to be associated with a relatively high morbidity rate when compared to other major vascular injuries in extremities. There is continuing controversy regarding the management of popliteal venous injuries. The advocates of ligation of injured veins have postulated that there is an increased incidence in thrombophlebitis and pulmonary embolism associated with attempted venous repair. There is a paucity of valid statistics supporting either side of this controversy. Clinical experience documented in the Vietnam Vascular Registry and experimental work at Walter Reed Army Institute of Research have supported our more aggressive approach for venous repair. This study evaluates the management of 110 injured popliteal veins without associated popliteal arterial trauma. Nearly an equal number were ligated and repaired. Thrombophlebitis and pulmonary embolism were not significant complications in this series. The only pulmonary embolus occurred after ligation of an injured popliteal vein. However, there was a significant increase in edema of the involved extremity following ligation, 50.9% compared to 13.2% after repair.
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PMID:The effect of acute popliteal venous interruption. 126 93

Chronic thromboembolic occlusion of the left pulmonary artery in a 36 year old woman is described, and similar cases reported in the past 15 years are discussed. On review, this disease remains a rare entity. In the majority of cases, the etiology is thrombophlebitis and acute pulmonary embolism. Associated cardiopulmonary disease is uncommon. The most common presenting symptom is unexplained dyspnea, and the majority of patients have past histories of hemoptysis. Acute cardiovascular collapse is distinctly rare. Most physical signs and laboratory tests are normal or nonspecific. The perfusion lung scan, although nonspecific, is the best screening test. Antemortem diagnosis, with rare exception, is established by pulmonary angiography. Eleven patients have been operated on: thromboembolectomy in nine, saphenous vein graft in one and pneumonectomy in one. Operative mortality was 36 per cent (four of 11), definite improvement was seen in 46 per cent (five of 11), and 18 per cent (two of 11) survived the operation with no improvement. The role of medical therapy in this disease is considered.
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PMID:Chronic thromboembolic occlusion of main pulmonary artery or primary branches. Case report and review of the literature. 127 91

A case of unexpected cardiac arrest occurring in a 17-year-old male patient is reported. The patient had been admitted after sustaining hand trauma. A first emergency surgical procedure was carried out, followed about three weeks later by another one. No incidents occurred during or after either of these two operations. A third procedure was required about two months after the accident (free toe graft to the thumb of the left hand). The twelve-hour operation was carried out under general anaesthesia and axillary block. The patient was given intravenous heparin (800 IU.h-1) during the procedure on the arm. The patient recovered quickly, and was extubated before his transfer to the recovery room. Fifteen minutes later, the patient's heart rate decreased to 40 b.min-1, followed by a transient cardiorespiratory arrest. The suspicion of pulmonary embolism was confirmed by pulmonary scintigraphy. Thrombolysis was carried out with 2,000 IU.kg-1.h-1 of urokinase for a 72 h period, combined with continuous heparin administration (16 to 36 x 10(3) IU.day-1). The patient recovered after one week. No thrombophlebitis was found for origin of the emboli. Biological investigations carried out both before and after 10 minutes of anoxia revealed a normal fibrinolytic system, but a deficit in protein C (62% antigen, 64% activity). Two years after the episode of pulmonary embolism, the patient, still taking acenocoumarol, remained free from any sequela. Current perioperative management of patients with a known protein C deficit is discussed.
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PMID:[Disclosure of protein C deficiency with pulmonary embolism followed by cardiac arrest during the recovery period]. 144 21

Oral contraceptive (OC) scares began with the reported deaths of 2 women from pulmonary embolism. Consequently, for the past 30 years OCs have been evaluated for their effects on the cardiovascular system. A critical appraisal is made of epidemiologic and prospective studies of the relationship of OC use to deleterious cardiovascular effects and the experimental evidence of cardiovascular safety. Case control methodology changed the evaluations of the safety of OCs. In 1967, the Royal College of General Practitioners produced case control results which correlated OC use with thrombophlebitis. Reports of Inman and Vessey, and Vessey and Doll, reinforced these results. Computerized multivariate analysis, which would have controlled for confounding factors, was not available. Other documentation of the effects of OC use on ischemic strokes and thromboembolism by Sartwell and Heyman have been criticized by Goldzieher and Associates. Reports in 1970 of a dose-response relationship led to fear of OC use. In 1980, the US Food and Drug Administration concluded that there was such a relationship and prohibited marketing of OCs which contained more than 50 mg of estrogen. Mann and Inman found a relationship with myocardial infarction for women over the age of 40. The result has been to restrict OC use for women smokers over the age of 35 years, in spite of the critiques by Goldzieher and the author. Studies on the frequency of thrombophlebitis and related deaths were published first by Fuertes-de la Haba in 1970 and critiqued by Drill who found no differences in the OC population from the general population. Clifford Kay produced the first large-scale, controlled study in 1974 which showed the risk of thrombotic disease from OC use and smoking, but that research is considered to be flawed due to the lack of control for smoking. As recently as 1989 Vessey analyzed prospectively the risk among family planning clinic users and found no difference between OC users and nonusers. The US Walnut Creek Study found no support for the earlier findings of Vessey nor did the Puget Sound study. The new findings reflect the improved analytical power of multivariate analysis, the reluctance of doctors to prescribe to those with risk factors, and improved diagnostic accuracy.
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PMID:Cardiovascular safety of oral contraceptives: a critical commentary. 168 2

The authors report 23 cases of heparin-induced thrombocytopenia with vascular complications. The clinical presentation consisted of arterial ischaemia in 16 cases, hemiplegia in 1 case, 4 cases of blue thrombophlebitis, 1 case of bilateral thrombophlebitis, 1 case of pulmonary embolism. The vascular surgeon faced with such emergency complications must be aware of the difficulties of clinical (atypical forms) and laboratory diagnosis (unreliability of platelet aggregability tests). Arterial occlusions are generally accessible to treatment with a Fogarty catheter during an operation performed without the use of heparin. The excessively frequent delay in diagnosis explains the severity of these complications and 2 deaths, 1 case of paraplegia, 4 cases of amputation secondary to arterial occlusion, 4 cases of severe postphlebitis disease, including 2 cases requiring transmetatarsal amputation and one case of pulmonary sequelae after pulmonary embolism were observed in our series of 23 patients. The diagnosis of heparin-induced thrombocytopenia requires immediate discontinuation of heparin therapy. Replacement by low molecular weight heparin is not devoid or risks and can only be considered with a negative platelet aggregability test (in the presence of low molecular weight heparin). As these test can be rarely performed as an emergency procedure, the use of rapid-acting oral anticoagulants appears to be the most reliable solution. The place of platelet antiaggregants and partial interruption of the inferior vena cava is discussed.
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PMID:[Heparin-induced thrombocytopenia. Practical management of vascular complications]. 176 34

Four cases of pulmonary embolism (PE) secondary to puerperal ovarian vein thrombophlebitis (POVT) were treated surgically during the first semester 1990. Clinical features are described in detail. The diagnosis was made by echotomography in three cases, but the crucial examination was contrast phlebocavography in all the subjects. Ovarian vein ligation, caval thrombectomy and inferior vena cava interruption by DeWeese clip positioning was the operation performed in any cases. Postoperative courses were always uneventful and three to six months follow-up was available. The extensive practice of echotomography during the first week of puerperium could demonstrate that POVT is more frequent than previously thought.
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PMID:Pulmonary embolism secondary to puerperal ovarian vein thrombophlebitis. 177 Oct 99

In five meticulously controlled investigations, the question of whether deep thrombophlebitis and pulmonary embolism may be signs of occult cancer was raised. One investigation was considered to be of doubtful value on account of selection. In two other investigations, an increased risk for cases of cancer was found among patients under the age of 50 years in whom suspicion of thrombophlebitis was confirmed and among patients with verified suspicion of pulmonary embolism. Two investigations reveal that the risk of cancer is particularly great if no risk factor for deep thrombophlebitis (so-called idiopathic deep thrombophlebitis) was found. In one of these investigations, problems concerning blinding were, however, present and the possible solution is not commented upon. On the present basis, arguments exist for a paraclinical investigation of patients with idiopathic deep thrombophlebitis or with pulmonary embolism. Investigation is probably only necessary in other patients with deep thrombophlebitis if symptoms suggestive of cancer are present and patients under the age of 50 years should be offered outpatient control in view of the possibility of cancer.
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PMID:[Deep-vein thrombophlebitis and pulmonary embolism as a sign of malignant disease]. 180 82


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