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

In the absence of malignancy, thrombophlebitis of the lower limb is invariably associated with pre-existent varicose veins. Not until pulmonary embolism was reported to occur in superficial phlebitis did the clinician introduce anticoagulants and/or surgery in the management of this condition. In an effort to reach an effective approach to this problem, 1,000 consecutive cases of varicose veins of the lower limbs were reviewed. Of these patients, 779 were admitted for elective vein ligation and stripping and 221 presented with thrombophlebitis. The latter group was subdivided into four categories according to the mode of management: (1) local heat and anti-inflammatory agents, 60 cases; (2) anticoagulants, 22 cases; (3) phlebotomy, high saphenous ligation and anticoagulation, 4 cases; and (4) ligation and stripping, 135 cases. In category 4 the saphenous is removed in a routine fashion together wih all its tributaries. All perforators are exposed, evacuated of thrombus when present, and ligated subfascially. Thrombi were encountered in one or more perforating veins in 10 patients, but no pulmonary embolism was observed in this group of patients. All instances of documented pulmonary embolism (10 cases) occurred in category 1 with one fatality. The incidence of pulmonary embolism in the elective group of ligation and stripping (without phlebitis) was 0.5%. The data indicate that the surgical approach is safe and preferable to the other modalities for several reasons: (1) It eliminates the varicosities and the phlebitic process simultaneously, (2) a single hospitalization is necessary (cost effectiveness), and (3) no anticoagulants are needed. If, for any reason, surgery cannot be undertaken, then anticoagulants should be employed in an effort to avoid thromboembolism.
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PMID:Superficial thrombophlebitis of lower limbs. 705 11

Based on literature reports suggesting the possible incorporation of Tc-99m sulfur colloid (Tc-SC) into fibrin deposits, this study was undertaken to evaluate the potential of this radiopharmaceutical as an imaging agent in thromboembolic disease. Animal models of deep-vein thrombosis and pulmonary embolism were used. The mean thrombus-to-blood (T/B) uptake ratios were comparable for fresh and older thrombi (up to 72 hr). Thrombus uptake was significantly lower in a group of five control dogs that received pertechnetate instead of Tc-SC. Intravenous heparin administration (5,000 IU) 2 hr before injection of Tc-SC caused a depression in T/B ratios but did not totally block Tc-SC uptake. Gamma imaging with Tc-SC allowed demonstration of deep-vein thrombi, but imaging of pulmonary emboli as areas of increased activity was not satisfactory. This study supports the concept of thrombus detection with radiolabeled particles but not the extension of this principle to the imaging of pulmonary emboli.
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PMID:Experimental evaluation of Tc-99m sulfur colloid as a potential imaging agent in thromboembolic disease: concise communication. 740 Aug 27

Post-operative inferior vena cava (IVC) obstruction is reported as an uncommon complication after orthotopic liver transplantation (OLT). We report 6 cases after 245 OLT's in the period between March '79 and December '92. Compression or torsion of the IVC or a technical problem were underlying causes. Oligo-anuria was observed in almost all patients and was probably caused by renal vein hypertension. Doppler ultrasound has become an important tool for the diagnosis of this complication. Operative treatment was performed in almost all cases in order to correct causative factors. Thrombi above or at the level of the upper anastomosis of the IVC should be removed via the right atrium, during cardio-pulmonary bypass, in order to prevent pulmonary embolism. Thrombi in the IVC caudal to the liver can be removed by cavotomy with high positive end expiratory pressure ventilation.
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PMID:Inferior vena cava obstruction after orthotopic liver transplantation. 813 61

When fast, nondynamic scanning techniques are used in combination with adequate intravenous injection of contrast material, good-quality images of the pulmonary artery (PA) can be obtained with routine computed tomography (CT). The purpose of this study was to evaluate PA filling defects detected on these CT scans. Twenty-two CT scans from 22 patients with PA filling defects were reviewed. A routine scanning technique was used. Thrombus was unilateral in 12 cases and bilateral in 10. All patients but one had a predisposition for pulmonary embolism (PE). However, only five patients underwent CT because there was a strong suspicion for PE. In 17 cases, PE was not the first choice of clinical diagnosis; in 13 cases, thrombus of the PA was not even considered. Diagnosis was confirmed in 11 patients with ventilation-perfusion scanning (n = 7), angiography (n = 3), and surgery (n = 1). In 11 patients, anticoagulation therapy was started without further diagnostic procedures. Diagnosis of thrombus of the PA is possible with routine nondynamic, contrast material-enhanced CT. Because PE is often unsuspected at clinical examination, every contrast-enhanced CT scan of the chest should be evaluated for the presence of filling defects in the PA.
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PMID:Detection of unsuspected central pulmonary embolism with conventional contrast-enhanced CT. 835 60

Our purpose was to determine the incidence of deep-vein thrombosis (DVT) in patients who have had early operative fixation of fractures of the lower extremity distal to the hip. There is a high incidence of distal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The incidence of DVT is higher with proximal extremity fractures than with distal extremity fractures. Most clots are occult and do not progress clinically. Given the high incidence of DVT with femoral and tibial plateau fractures, older age, and longer operating times, anticoagulation prophylaxis may be indicated. Ours was a prospective incidence study. All patients who had had early operative fixation of lower-extremity fractures were eligible (n = 176). Seventy-four were excluded based on specific criteria. The remaining 102 patients underwent lower-extremity venography an average of 9 days after operative fixation of their fractures (range 3-22 days). Eight patients had bilateral lower-extremity fractures. The patients were followed clinically for 6 weeks to identify complications related to venous disease. The overall incidence of clinically occult DVT was 28%. Of the represented fractures, 40% were of the femoral shaft (eight of 20), 43% of the tibial plateau (12 of 28), 22% of the tibial shaft (12 of 54), and 12.5% of the tibial plafond (one of eight). Four of the thrombi were proximal to the popliteal fossa. Four of the patients had clinical evidence of pulmonary embolism while in the hospital. One of them had objective confirmation on further testing. No patient had clinical evidence of pulmonary emboli as an outpatient by follow-up criteria. The incidence of DVT has not been determined for patients with early stabilization of lower-extremity fractures. This study suggests a higher DVT incidence in more proximal fractures, but little risk of embolization. Thrombus formation proximal to the popliteal fossa is rare. Older age, longer operating times, and longer times before fracture fixation all correlate with an increased incidence of DVT.
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PMID:Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. 872

Severe hyperhomocysteinemia in its most frequent form, is caused by a homozygous enzymatic deficiency of cystathionine beta-synthase (CBS). A major complication in CBS deficiency is deep venous thrombosis or pulmonary embolism. A recent report by Mandel et al (N Engl J Med 334:763, 1996) postulated factor V Leiden (FVL) to be an absolute prerequisite for the development of thromboembolism in patients with severe hyperhomocysteinemia. We studied 24 patients with homocystinuria caused by homozygous CBS deficiency from 18 unrelated kindreds for FVL and for the 677C-->T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and investigated their possible interaction in the risk of venous thrombosis. Thrombotic complications were diagnosed in six patients, of whom only one was a carrier of FVL. On the contrary, thermolabile MTHFR caused by the 677C-->T mutation, was frequently observed among homocystinuria patients, especially among those with thromboembolic complications: three of six homocystinuria patients who had suffered from a thromboembolic event had thermolabile MTHFR. These data indicate that FVL is not an absolute prerequisite and probably not even a major determinant of venous thrombosis in homocystinuria, but, interestingly, thermolabile MTHFR may constitute a significant risk factor for thromboembolic complications in this inborn error of methionine metabolism.
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PMID:Homozygous cystathionine beta-synthase deficiency, combined with factor V Leiden or thermolabile methylenetetrahydrofolate reductase in the risk of venous thrombosis. 949 Jun 85

The purpose of this article is to report four patients with massive pulmonary embolism treated with percutaneous catheter and guidewire fragmentation and local administration of recombinant tissue plasminogen activator (r-TPA). Four patients with massive pulmonary embolism initially underwent pulmonary angiography. Thrombus fragmentation was performed with both standard angiographic guidewires and catheters followed by local infusion of 41-200 mg of r-TPA. Pulmonary angiography was repeated after treatment. All patients survived with improvement in their clinical status and eventual discharge from hospital. Angiography in all patients post treatment demonstrated improvement in pulmonary perfusion (mean Miller score before treatment 22.5; mean Miller score after treatment 5.75). No patient had a significant complication. Mechanical fragmentation of the thrombus followed by local infusion of r-TPA was an effective treatment for massive pulmonary embolism in these four patients with no significant complications.
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PMID:Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism. 1037

Thrombotic occlusion of the arteries and veins are categorized as acute and chronic presentations. Acute arterial occlusion results in severe ischemia because of poor or no development of the collateral arteries. They should be treated promptly by thrombectomy or thrombolysis. On the other hand, chronic arterial occlusion is preferably treated by bypass surgeries. Although the vascular surgeries in the chronic arterial occlusion have undergone remarkable development in the recent years, the treatment of acute occlusion still lags behind poor with prognosis. The treatment of acute venous occlusion is aimed to prevent postphlebitic syndrome except for the ischemic type such as venous gangrene. The purpose of the treatment of chronic venous occlusion is to assist the pump function of the calf muscles to avoid venous stasis. Pulmonary embolism is the most severe complication and its treatment remains controversial.
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PMID:[Clinical characteristics of thrombotic diseases of arteries and veins]. 1042 43

We examined various nonSTAT commercially available coagulation activation markers in an attempt to help diagnose or exclude the often subtle clinical presentations of proximal deep vein thrombosis (PDVT) and pulmonary embolism (PE). Fifty-five patients presenting to the Emergency Department were completely assessed. Eleven patients were diagnosed with PDVT, six patients were diagnosed with PE, and three patients were diagnosed with both PDVT and PE. Thrombus precursor protein (TpP) excluded the diagnosis in 19 of the 35 patients negative for PDVT and/or PE, D-Dimer in 15 patients, prothrombin fragment 1.2 in 17 patients, and thrombin-antithrombin (TAT) in 14 patients. Both the TpP and TAT enzyme-linked immunosorbent assay (ELISA) tests had 100% sensitivity and negative predictive value for evaluating PDVT and/or PE. The TpP ELISA had the highest specificity (54%) of all four markers studied.
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PMID:The use of thrombus precursor protein, D-dimer, prothrombin fragment 1.2, and thrombin antithrombin in the exclusion of proximal deep vein thrombosis and pulmonary embolism. 1084 25

We present the case of a patient with acute pulmonary embolism and a large right atrial and a smaller pulmonary artery thrombus. Thrombi were successfully treated with intravenous heparin. Echocardiography was used to document the morphological evolution of thrombi and to evaluate the medical treatment.
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PMID:Echocardiography Detects and Demonstrates Disappearance of Right Atrial and Pulmonary Artery Thrombus: Case Report. 1117 72


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