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

Our experience with 101 consecutive T.H.A.'s in 91 patients was examined in an attempt to identify preoperative risk factors for postoperative medical complications, especially pulmonary embolism and thrombophlebitis. Six per cent of patients developed postoperative clinical thrombophlebitis, and 8% a pulmonary embolism. Advancing age and previous venous thrombosis served as predictors for pulmonary embolism and thrombophlebitis, respectively (p less than 0.01), but obesity, venous varicosities, diabetes mellitus, cigarette smoking, previous pulmonary embolism, and length of surgery did not, for either. Fifty per cent of the patients with preoperative abnormal kidney function developed some form of medical complication postoperatively, a significant increase in risk (p less than 0.05) over patients with normal kidney function. We were unable to identify an increase in postoperative atelectasis or pneumonia associated with smoking or obesity in these patients. No consistent decrease in post-operative medical morbidity could be assigned to preoperative medical consultations, suggesting that we have not yet identified all significant risk factors. A thorough preoperative preparation and improvement in intra- and postoperative techniques and management may account for differences found in this study from traditionally held risk factors.
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PMID:Risk factor assessment in 101 total hip arthroplasties: a medical perspective. 47 24

The authors recently treated three patients showing rather marked complications following sclerosing injections for varicose veins. In the first case, the intra-arterial injection brought about a tissular necrosis in the form of a distal-based triangle. The preservative treatment, undertaken 4 weeks after the injection, did not make it possible to save three toes, that had to be amputated. The second patient was sent to use after an injection in the posterior tibial artery. Acute ischemia was treated on an emergency basis with a lumbar sympathectomy. I believe that the approach we took allowed us to cure the trophic problems and to loose only one small phalanx. The third case reported on concerns a patient brought to us in a state of shock after a massive pulmonary embolism. She had been given a sclerosing injection in a large varicose vein of the leg 48 hours previously. The leg had rapidly increased in volume and was apparently the site of a deep veinous thrombosis.
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PMID:[Complications of sclerotherapy]. 48 71

To refine 1974 results on venous thrombosis and oral contraceptives (OCs) from a prospective study begun in 1968 comparing 23,000 women using OCs with 23,000 controls, women with known preexisting conditions relevant to thrombosis were excluded. Rates in each contraceptive category (users, ex-users, and controls) were indirectly standardized for age, parity, cigarette consumption, and social class. The relative risk (users to nonusers) of deep vein thrombosis was 4.17; for superficial vein thrombosis, it was 2.41. For other thrombosis and pulmonary embolism, trends were similar but the differences were not significant. Rates of ex-users did not differ significantly from the controls, implying no persistent risk after OC use ends. Superficial thrombosis correlated significantly with age, parity, and estrogen dose and progesterone content of OCs, but deep vein thrombosis did not. The risk of superficial thrombosis was significantly increased in users and nonusers with severe varicose veins, and increased with the severity; no significant relationship was found with deep vein thrombosis.
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PMID:Oral contraceptives, venous thrombosis, and varicose veins. Royal College of General Practitioners' Oral Contraception Study. 70 53

The prevalence and sociomedical importance of peripheral venous diseases and peripheral venous disorders are discussed on the basis of a prospective epidemiologic field study (Basle Study) among 4529 apparently healthy workers and clerks of the Basle pharmaceutical industry. Prevalence: Pulmonary embolism was reported in 2% phlebitis in 10%. Varicose veins were present in 56% and signs of chronic venous insufficiency in 16%, respectively. Reticular and hyphen web varices predominated. Stem varicose veins were found in 15%. The sociomedical importance of varicose veins is evaluated according to the rates of complication and treatment. A medically significant varicosity was present in 12% of this working population. Three percent presented severe alterations that already had caused complications and 9% presented changes indicating.
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PMID:[Overview: varicosis (author's transl)]. 73 18

Scientific knowledge is reliable because it has been built on accurate measurements. Clinical knowledge is not. The science of biometry was started in 1835 by the Belgian astronomer Adolphe Quetelet. In the last fifty years a precise set of rules have been invented for this science. The method is suitable for a wide range of problems in clinical medicine and as the result of its application in recent years a firm foundation has been laid upon which scientific clinical knowledge can be built. Surge-ns, particularly, have been slow to apply biometrical methods to their clinical problems; but a start has now been made. The outcome of a particular type of treatment is determined by a complex set of inter-acting factors. The basis of the appropriate biometrical method is the elimination of all bias in favour of one of the rival techniques being compared. If this precaution is taken the observed results of the trial can be fitted onto Quetelet's distribution graph, and the probability of the observed difference in the results being due to chance, and nothing else, can be measured mathematically. The accuracy of this measurement deteriorates the greater are the number of the patients who can not be found and examined at the end of the trial. To make this point two trials conducted by the author are used. In the trial designed to discover if postoperative deep vein thrombosis and pulmonary embolism could be prevented by electrically stimulating the patients legs during the operation there was no difficulty. All the patients were examined at the end of the trial, because it ended before any of the patients left the hospital. The trial to discover if the primary treatment of varicose veins ought to be by Fegan's sclerotherapy or by operation was the exact opposite. At the end of the first year of the two year trial 15% of the patients could not be traced. The results in these patients, therefore, was unknown. Because of this, elaborate mathematical calculations had to be made to try and reach a reliable conclusion to the trial. The loss of patients before the end of the trial is a very serious practical difficulty which besets all long-term clinical trials.
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PMID:Clinical trials in surgery. 79 Aug 78

Obesity, edema in the legs before surgery, a history of deep venous thrombosis, varicose veins, and a diagnosis of osteoarthrosis were associated with an increased risk for postoperative thromboembolism. Selective administration of anticoagulants to high risk but not to low risk patients should result in a reduction in total mortality following surgery. It is therefore suggested that when deciding whether prophylactic anticoagulants should be administered to a patient, consideration should be given to that patient's likelihood of developing fatal pulmonary embolism if the anticoagulant is not given, compared to the potential reduction in his risk for fatal pulmonary embolism and the increase in risk for fatal bleeding complications if the anticoagulant is used.
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PMID:Prediction of thromboembolism following total hip replacement. 126 Nov 18

The chief venous diseases which may have notable or costly economic consequences are, on the one hand, varicose veins and phlebitis (superficial and deep) with their sequelae of chronic venous insufficiency and of ulcers, and, on the other hand, pulmonary embolism and its prevention. The incidence of the former is higher and treatment is very costly. The cost of leg ulcers only in Britain is estimated at 600 million pounds per year. Pulmonary emboli have notable economic consequence because of the cost of preventive and essential measures against such events, which are often fatal.
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PMID:[The socioeconomic impact of venous pathology in Great Britain]. 130 18

This study was designed to identify those total arthroplasty patients at high risk for embolism even while on a proven warfarin prophylactic regimen and to identify the measure of anticoagulation that would be most efficacious in the prevention of pulmonary embolism (PE). A series of 2348 total arthroplasty patients had a preoperative perfusion scan and a postoperative ventilation/perfusion scan. All patients were placed on a low-dose warfarin protocol. Eighty-one patients were identified as having a PE by pulmonary arteriography (incidence of 3.4%). Of these, 89% were asymptomatic and no case was fatal. A control group of 159 patients without PE was used for comparison. Patients older than 65 years of age with a history of genitourinary infection were identified as being at higher risk of PE while on a proven warfarin prophylactic program. These patients may need additional prophylactic measures to reduce the risk of PE. In contrast, patients with a history of phlebitis, PE, obesity, or varicosities were not at excess risk for PE while on warfarin prophylaxis; therefore, no additional prophylactic measures are required. All prothrombin time profiles were within the prophylactic range. Therefore, the actual prothrombin time may not be the critical determinant of the level of anticoagulation or prophylaxis achieved.
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PMID:Pulmonary embolism in total hip and knee arthroplasty. Risk factors in patients on warfarin prophylaxis and analysis of the prothrombin time as an indicator of warfarin's prophylactic effect. 151 7

We report about a 66-years-old obese and diabetic female patient, treated with anti-inflammatories for osteoarthritis of the hip and operated for varices of the lower limbs by a bilateral stripping of the internal saphenous veins, who presented with a mortal necrotizing fasciitis during the postoperative period. Necrotizing fasciitis is a severe, infrequent disease jeopardizing the vital prognosis, in which an appropriate and early treatment (medical, using antibiotics, and surgical by extensive debridement) can prevent a fatal outcome. The most often involved germs are streptococci (45%). The association of anaerobic and aerobic germs sometimes causes mixed cellulitis. The vital prognosis is always threatened by postoperative fasciitis. The mortality rate ranges from 50 to 75%, the main causes of death being a septic shock or pulmonary embolism. The functional prognosis of the surviving patients depends on the extent and quality of surgery.
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PMID:[Necrotizing fasciitis: a medical and surgical emergency. Apropos of a case]. 163 89

The introduction of the stab-incision--phlebectomy (Muller's technique)--has opened a large field for ambulatory surgery. This is specially true when phlebectomy is combined with a saphena-femoral or saphena-popliteal ligature. In a series of 1825 operations including 1592 incompetent saphenous veins 1216 (67%) were performed under local anesthesia. Radical surgery of incompetent short saphenous veins as well as of minor forms of varicose long saphenous veins is feasible in local anesthesia. Regional or general anesthesia (609 operations) are still recommended for stripping procedures in advanced long saphenous varices. In most cases phlebectomy of varices (553) provides a better cosmetic result than sclerotherapy, the latter being the treatment of choice for small veins and telangiectasias. Ambulatory surgery and sclerotherapy are cost-effective and low-risk treatments. No deep vent thrombosis or pulmonary embolism was observed in this group, whereas 1 DVT and 2 PE occurred in the 609 operations performed under general anesthesia.
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PMID:[Indications for and results of ambulatory varices therapy]. 178 Jul 98


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