Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The risk of thromboembolic complications in outpatient surgery is regarded as being low. Thromboembolic prophylaxis is seldom administered as a routine. A retrospective study in our outpatient department, based upon patients readmitted for clinical thromboembolism, showed an incidence of deep vein thrombosis of 0.05% (8/1 691) and of pulmonary embolism 0.0006% (1/1 691). None of the patients received prophylaxis for thrombosis, and all operations were performed under regional anaesthesia of the lower extremity. 50% of the operations were performed using a tourniquet. 2/3 of the patients were women and 2/3 were over the age of 50. Operation time was usually 30-45 minutes. Our study indicates that patients undergoing knee arthroscopy, and operations for varicose veins and hallux valgus are at risk of thromboembolism. Prospective studies of these risk groups are necessary to figure out the need for thrombosis prophylaxis.
 ...
PMID:[Thromboembolic complications in ambulatory surgery. A retrospective study of 1691 patients]. 865 54

To optimize pulmonary MR angiography for the noninvasive evaluation of pulmonary vasculature, six healthy volunteers were examined using the fast radiofrequency spoiled gradient echo sequence (Fast SPGR) and standard body coil of a commercial 1.5T MR imaging system. The examinations by 2D Fast SPGR were performed under various TR, flip angles and slice thicknesses within the time of a single breath hold, and those by 3D Fast SPGR were performed under various flip angles and slab thicknesses. The most satisfactory results were obtained by 2D Fast SPGR with the parameters of TR 60 msec, TE 2.1 msec, flip angle 20 degrees slice thickness 10 mm, FOV 30-40 cm, matrix 256 x 192 and NEX1. For 3D Fast SPGR, TR 10 msec, TE 1.9 msec, flip angle 10 degrees, slab thickness 60mm (12 partitions), FOV 30-40 cm, matrix 256 x 128 and NEX1 were best. Concomitant injection of Gd-DTPA provided higher resolution of peripheral vessels. The MIP images showed pulmonary vasculature with resolution of vessels beyond 4 th order branches in 2D Fast SPGR and 5 th order branches in 3D Fast SPGR. 3D Fast SPGR with contrast enhancement was applied to patients with primary lung cancer in the hilum, malignant mediastinal tumor, pulmonary embolism, pulmonary arteriovenous fistula, pulmonary varix, and round atelectasis. Pulmonary MR angiography is considered to be a noninvasive and effective method not only for the evaluation of the tumor invasion to the central pulmonary vessels but also for the demonstration of other pulmonary vascular pathology.
 ...
PMID:[Determination of optimal technical factors for the single breath-hold pulmonary MR angiography and its clinical applications]. 869 68

Pulmonary embolism is the third most common acute cause of death in the United States. There are approximately 500,000 cases annually in this country, leading to death in 50,000. Subjective symptoms and objective findings can oftentimes be confusing and nonspecific. A pulmonary embolism is defined as an occlusion of one or more pulmonary vessels by material that has traveled there from outside of the lung and is usually caused by a dislodged thrombus that originated in the deep veins of the legs or pelvis. Risk factors include older age, prior thromboembolism, immobility, cancer, chronic disease, congestive heart failure, pelvic and lower extremity surgery, varicosities, obesity, and oral contraception. This article will discuss current modalities that are used in the evaluation of deep venous thromboembolism and pulmonary embolism and include ventilation/perfusion scan, ultrasonography, impedance plethysmography, pulmonary angiography, and newer tests including D-dimer assays and spiral computed tomography. Medical management including simple and complex decision making, anticoagulation, and thrombolytic therapy will also be discussed. An ounce of prevention is worth a pound of gold--identification of risk factors and the use of appropriate therapeutic measures can reduce an individual's risk for deep venous thromboembolism and pulmonary embolism.
 ...
PMID:Clinical diagnosis and management of the patient with deep venous thromboembolism and acute pulmonary embolism. 871 Feb 57

During two consecutive study periods (24 months and 16 months), 997 patients (1322 legs) with varicose veins underwent surgical treatment in Huddersfield Royal Infirmary, using a variety of surgical techniques. The average length of stay was 1.5 days, and 95.5% of patients had a hospital stay of less than 2 days. Complications occurred in seven inpatients. A further 16 patients developed complications requiring readmission to hospital (10 minor and intermediate; 6 major). The complication rate appeared to be operator-dependent: an increased complication rate (particularly major complications) occurred after surgery by junior surgeons. Major complications included femoral vein injury (1 patient), postoperative deep venous thrombosis (4 patients), pulmonary embolism (1 patient) and groin lymphatic fistula requiring reoperation (1 patient). Between the first and second study period, a change in policy regarding the type of bandaging used and the use of postoperative antiembolic stockings occurred and appears to have reduced the incidence of thromboembolic complications from 0.7% to 0.2%. Varicose vein surgery is not without major complications though, fortunately, there was no mortality in this series. These complications can be minimised with good surgical technique and better supervision of surgical trainees. Modification of postoperative management can further enhance the safety of this procedure.
 ...
PMID:Morbidity of varicose vein surgery: auditing the benefit of changing clinical practice. 903 5

This article reviews the distinguishing features of epidemiology and clinical medicine and their interdependence in clinical epidemiology as applied to vascular disease. Selected literature is reviewed to emphasize the principles of clinical epidemiology for five vascular disorders: abdominal aortic aneurysms, lower extremity peripheral arterial occlusive disease, cerebrovascular disease, deep vein thrombosis and pulmonary embolism, and varicose veins. These vascular disorders are prevalent and pose significant risks for death and disability. Many have risk factors that can be controlled. All can be treated by vascular surgery, but outcomes including functional health and well-being may fall short of that which is implied in our traditional surgical literature. Appropriate allocation of resources to detect and treat vascular disease demands that clinicians not only assume responsibility for the care of individual patients but also develop a working knowledge of the clinical epidemiology of vascular health and disease and its management within populations.
 ...
PMID:Vascular holism: the epidemiology of vascular disease. 874 37

With regard to deep vein thrombosis, superficial thrombophlebitis of lower limbs have a reputation of mildness disease that the experience gained from widely used duplex scanning in their evaluation comes to question. Short superficial thrombophlebitis on non-varicose veins often remain a symptom belonging to or revealing a systemic disease. Superficial thrombophlebitis on varicose veins are of two kinds: short superficial thrombophlebitis remain a common complication of varicose phlebectasia but they must be differenciated from extensive saphenous thrombophlebitis. The first ones are of local symptomatic treatment and of varicose vein surgery. The last ones are associated--with deep vein thrombosis in 10 to 30% of case (either by extension from the saphenous to the deep veins, either without anatomical link), with clinical pulmonary embolism in 5% of cases, and with a cancer in about 10% of cases. Numerous superificial venous thrombosis occur without inflammatory signs and the clinical diagnosis of extensive superficial venous thrombosis is as difficult as the one of deep vein thrombosis. So the diagnosis, the treatment, the etiological investigation of extensive superficial venous thrombosis are in fact not very different from those of deep vein thrombosis.
 ...
PMID:[Superficial venous thrombosis of the lower limbs]. 876 76

Studies conducted in the first three decades after discovery of a link between venous thromboembolism and oral contraceptive users showed a relative risk of first thrombosis during oral contraceptive use of 2.9 (95% CI 0.5-17). In recent studies in which the sub-50 micrograms ethinyl estrodiol containing pills were investigated comparing current users with non-users, the RR is 3.8 for non-fatal deep VTE and 2.7 for superficial VTE, deep VTE and pulmonary embolism (PE) together and 2.1 for fatal VT and PE together. The association is attributed to the estrogenic component and not related to duration of pill use. The risk disappears once the pill has been stopped, and it is not elevated among past users. Smoking does not appear to be risk factor for VTE; obesity and varicose veins are, at the most, weak risk factors. Since a causal relationship between OC use and VTE is tempting, clues for unraveling the mechanism were sought in the hemostatic system. Studies of the coagulation system found changes in the activation of coagulation and fibrinolytic compartments, but within the normal range. An epidemiologic study showed that the risk of VTE among women using OCs is 30-fold increased by the presence of a mutation of factor V, called Factor V Leiden (5% prevalence in the Caucasian population). Selective screening for the mutated factor V should be limited to women with a personal or family history of VTE. Four epidemiologic studies showed a two-fold increase in risk of VTE with the use of OCs containing third-generation progestins (gestodene and desogestrel), relative to second-generations products (levonorgestrel). Biases cannot devaluate the conclusion that the increased risk of VTE in especially first-time and younger users of third-generation OCs is highly likely. The clinical consequence is therefore that second-generation OCs are the first choice in prescription to first-time users.
 ...
PMID:Oral contraceptives and thrombotic disease: risk of venous thromboembolism. 919 74

This trial represents the Egyptian experience in cyanoacrylate injection for hemostasis of bleeding gastric varices. One hundred patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis were included. All patients presented with bleeding from gastric varices either fundal (80 patients) or inferior extension of esophageal varices (20 patients) were enrolled. Injection therapy was administered as the first active measure. No tamponade or drugs were used. Cyanoacrylate was mixed with lipid and injected through a hand-made probe. A mean of 3 (range 1-9) ampoules of cyanoacrylate were used per injection session. Bleeding stopped at the end of all sessions. Ten patients (12.5%) with fundal varices had rebleeding during the first 24 hours. Reinjection could control bleeding in 6 patients with a total success rate of 95%. Four patients were managed surgically. Fatal pulmonary embolism developed in one patient (1.25%) with fundal varix. Five more patients (6.25%) died from bleeding-related liver failure. In conclusion, injection of cyanoacrylate is highly satisfactory in controlling bleeding from both types of gastric varices.
 ...
PMID:Endoscopic control of gastric variceal bleeding with butyl cyanoacrylate in patients with schistosomiasis. 925 78

Acute superficial thrombophlebitis of the lower extremities is one of the most common vascular diseases affecting the population. Although it is generally considered as a benign disease, it can be extended to the deep venous system and pulmonary embolism. We examined 50 patients (22 males and 28 females), mean age 52.5 years. These patients were surgically treated due to acute superficial thrombophlebitis of the lower limbs that affected great saphenous vein above the knee. The diagnosis was made by palpable subcutaneous cords in the course of great saphenous vein or its tributaries in association with tenderness, erythema and oedema. Of these 50 patients, 26 were examined by duplex ultrasonography before the operation. In 20 patients duplex scanning confirmed that the process was greater than we supposed after clinical examination (77%) and in 6 patients there were no differences (23%) (Figures 1 and 2). The operation included crossectomy, ligation and resection of the proximal part of the great saphenous vein. Intraoperative findings in 38 patients showed that the level of the phlebitic process was higher than the clinical level (76%). There was no difference in 12 patients (24%). Deep vein thrombosis and pulmonary embolism were noted in 14 patients (28%) (Tables 1 and 2). Both complications were found in two patients, and 12 had one of these complications. Generally, there were 12 patients with deep venous thrombosis and 4 patients with pulmonary embolism. Only in one patient deep venous thrombosis appeared postoperatively, while all other complications occurred before surgical intervention (Scheme 1 and Table 3). The most common risk factor was the presence of varicose veins (86%). Obesity, age over 60 years, cigarette smoking are listed in decreasing order of frequency. Patients under 60 years were more likely to have complications while older patients usually followed a benign clinical course (Tables 4 and 5). There was no intrahospital mortality. Average hospitalization was 5.7 days. It was 4 days in patients without complications. After thes urgent operation that practically removed the risk of potentially fatal consequences, the patients were dismissed from hospital. New hospitalization was recommended after two weeks when the second act of surgical treatment was performed. It included stripping of the great saphenous vein and extirpation of varicose veins in the area without acute inflammation. The findings of this study confirm the general opinion that acute superficial thrombophlebitis is a very common vascular disease with usually "benign" clinical course. In its ascending form that affects the great saphenous vein above the knee it can be associated with deep venous thrombosis and pulmonary embolism. The level of phlebitic process is usually much higher than can be palpated clinically. Duplex scanning was a highly reliable, precise, fast non-invasive diagnostic method that is necessary in examining, following and making decision for operative treatment of acute superficial thrombophlebitis. If suspected complications an urgent surgical intervention should be performed. It is short and efficient, contributing to the fast recovery of the patients and their return to normal activities.
 ...
PMID:[Acute superficial thrombophlebitis--modern diagnosis and therapy]. 934 Jul 96

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are less common after knee arthroscopy than after elective hip and knee arthroplasties. There is no consensus on the optimal prophylaxis. In this prospective cohort study, we used ultrasound, phlebography and lung scan pre- and postoperatively to assess the incidence of thromboembolic complications in 101 consecutive patients who underwent knee arthroscopy. Preoperatively, patients were screened for typical risk factors for DVT such as age, obesity, varicose veins, contraceptive pills and nicotine abuse. All patients received a once-daily injection of 5000 IU of low molecular weight heparin, at least 12 hours prior to surgery. 5 weeks after surgery, the same screening tests were repeated. In 12 of the 101 patients either DVT or PE was diagnosed. DVT occurred in 8 cases, 4 of which were silent and 4 symptomatic. The number of PEs was 9, 8 silent and 1 symptomatic. We found no correlation between DVT or PE and individual clinical risk factors, but there was a tendency towards the development of DVT and PE, with a higher number of risk factors. We found no correlation between DVT and intraoperative risk factors such as use of a tourniquet, type of anesthesia or duration of surgery. The relatively high rate of thromboembolic events after knee arthroscopy in our study suggests the need of all patients for routine use of thromboprophylaxis, probably in a higher dose than given.
 ...
PMID:Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patients. 993 Jan 21


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>