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 only effective causal therapy in thromboses of the deep pelvic and femoral veins is fibrinolysis or operative thrombectomy. Concerning the contraindications, fibrinolysis is successful only up to the 5th day. After that time patients with deep vein thrombosis were submitted to thrombectomy and at the same time, to prevent renewed thrombosis secondary to a slowing down of the flow, a peripheral arteriovenous fistula was temporarily positioned. Between 1974 and 1976, 14 patients were treated operatively this way. In 6 cases of pulmonary embolism a vena cava umbrella filter was inserted.
 ...
PMID:[Surgical treatment in deep venous thrombosis of the legs and pelvis (author's transl)]. 87 12

The Doppler Ultrasonic Velocity Detector has been shown to be of significant value in the evaluation of patients with suspected deep venous thrombosis. Our experience in 121 patients demonstrates a false-negative rate of 10% for "minimal" thrombophlebitis and 3.2% for ileofemoral thrombosis when the Doppler was used as a diagnostic aid. Since ileofemoral thrombosis represents the greatest threat to the patient in terms of pulmonary embolism, this appears to be a sensitive and specific technic for the detection of ileofemoral thrombosis.
 ...
PMID:Practical role for ultrasound in diagnosis of deep venous thrombosis of lower extremities. 89 21

Acute deep venous thrombosis of the pelvis and leg are classified according to their mode of origin and development. Because of the low frequency of pulmonary embolism, operation is preferred to thrombolysis. The surgical procedure referred to includes de Weese's caval clip to prevent pulmonary embolism during and after operation. Thrombolysis may be done in cases of deep thrombosis distal to the confluent point or in cases of May's iliac venous "sporn".
 ...
PMID:[Surgical management of deep venous thrombosis (author's transl)]. 91 54

Fibrinogen/fibrin degradation products (FDP/fdp) and soluble fibrin complexes (SFC) were measured serially in 60 patients heparinized for pulmonary embolism or deep venous thrombosis. Eight patients had recurrent thromboembolism. In patients without recurrence, FDP/fdp and SFC tended to normalize within three to five days. In patients with recurrence, results of both tests were significantly higher on admission, and FDP/fdp values were significantly higher throughout ten days of therapy, than in patients without recurrence. The SFC values were not different between the two groups during the first six days of treatment, but again became significantly higher on the seventh day in patients with recurrence. There were no differences in clotting times, heparin dosage, or any other clinical features between patients with and without recurrence. Measurement of FDP/fdp and SFC can help identify patients at risk of recurrent thromboembolism if performed serially during treatment.
 ...
PMID:Tests of fibrin metabolism in recurrent venous thromboembolism. 92 20

Small doses of subcutaneous heparin and infusions of dextran both reduce the incidence of fatal pulmonary embolism after elective general surgery. But both methods have disadvantages. Therefore, the protection against deep vein thrombosis afforded by sulfinpyrazone, a drug which can be taken by mouth as well as by injection, was assessed in a prospective study of 119 patients undergoing elective general or urological surgery. The prophylactic administration of sulfinpyrazone was compared with the effects of small doses of sodium heparin and infusions of dextran-70. The 125I-fibrinogen test was carried out in all patients during their hospitalization. Deep vein thrombosis was diagnosed in 13 of 30 patients (43%) who received sulfinpyrazone, in 9 of 29 (31%) receiving dextran-70 and in 2 of 22 (9%) having subcutaneous heparin. The difference between the sulfinpyrazone and heparin groups was statistically significant (p less than 0.01). Sulfinpyrazone in the dose used in this trial was not effective in reducing the incidence of deep vein thrombosis during elective general surgery.
 ...
PMID:Sulfinpyrazone and postoperative deep vein thrombosis. 92 99

It is reasonable to conclude by considering an approach to the diagnosis and treatment of pulmonary embolism. When the diagnosis is suspect, and in the absence of contraindications, or hemodynamic instability, treatment with heparin may be begun and an arterial blood gas and perfusion lung scan obtained. If the Pao2 and perfusion scan are normal, it is unlikely that significant pulmonary embolism has occurred. The presence of a perfusion scan defect and hypoxemia should suggest that a ventilation scan and/or evaluation for deep vein thrombosis is performed. A ventilation scan which shows absence of ventilation in areas where there is a perfusion defect, or failure to demonstrate deep vein disease, strongly mitigate against the diagnosis of pulmonary embolism. If the diagnosis is in doubt, pulmonary angiography should be performed. If the patient presents in shock, an angiogram should be performed, while heparin is administered and supportive measures are begun. If anticoagulants are contraindicated, or if re-embolization occurs after adequate anticoagulant therapy, consideration should be given to placement of a transcaval umbrella filter.
 ...
PMID:Pulmonary embolism. 92 93

The influence of several diseases and conditions upon the prevalence of pulmonary embolism in autopsies performed over the July 1, 1964 to June 30, 1974 period at the University of Michigan Medical Center (Ann Arbor, Michigan) were analyzed. The prevalence of pulmonary was 12.3% in the 4600 necropsies in this sample. Patients with pulmonary fat emboli or tumor emboli and patients thought to have thrombosis of the pulmonary artery were not designated as having pulmonary thromboembolism. The patients were categorized with regard to heart disease on the basis of both clinical and necropsy findings. The major factors contributing to an increase in risk of development of pulmonary embolism include heart disease, certain types of cancer, obesity, acute paraplegia and accidental and operative trauma. Other risk factors which could not be assessed in this study include a prior history of venous thromboembolism, pregnancy and the puerperium, use of oral contraceptives, ulcerative colitis and Crohn's disease. Age plays a major role in the prevalence of pulmonary embolism. A portion of the effect of age is related to the age distribution of other diseases contributing to an increased risk, yet advanced age alone may have an independent influence. The risk factors defined should be used in a selective program designed to increase the rate of detection of deep venous thrombosis before pulmonary embolism occurs. Alternatively, patients at increased risk should be treated with prophylactic low dosage heparin during hospitalization.
 ...
PMID:Risk factors in pulmonary embolism. 95 58

The natural history diagnosis and immediate treatment of patients suffering from pulmonary embolism has been discussed. Anaesthetists should use their influence to bring about a high standard of prophylactic care against deep venous thrombosis and consequently of pulmonary embolism. They are likely to be involved in the resuscitation and treatment in intensive care units of those cases who suffer from major symptoms and massive emboli and some of them will rarely be involved in anaesthetising for pulmonary embolectomy aided by cardiopulmonary by-pass and, less rarely, for IVC ligation or plication and venous disobliteration. Anticoagulant drugs appear to limit the mortality of pulmonary embolism to 5%. The mortality of IVC ligation or plication varies in different reports from 2 to 50%; it should therefore be reserved for the special indications which have been discussed. There is also an incidence of recurrent pulmonary embolism after IVC ligation and plication and leg troubles from stasis in about 30% of cases. Streptokinase is usually indicated in the immediate treatment of major pulmonary emboli which cause shock and severe distress with an immediate threat to life. In hospitals having access to cardiopulmonary by-pass, pulmonary embolectomy has a small role to play in major emboli with cardiovascular collapse, if surgery can start within 2 hours and pulmonary angiography is available. Cardiopulmonary by-pass on its own may be life-saving in supporting the circulation while the clot fragments. If cardiac arrest occurs, external cardiac massage should be undertaken as it is sometimes successful and disseminates and fragments the clot in the pulmonary artery.
 ...
PMID:Pulmonary embolism. Prophylaxis diagnosis and treatment. 97 May 90

In a prospective study fo the incidence of deep-vein thrombosis in thirty patients undergoing total knee replacement, all patients had clinical examinations and 125I fibrinogen scanning, while those suspected of having deep venous thrombosis also had confirmatory venography. Sixteen (53 per cent) of the thirty patients had thromboembolic disease; nine had thrombi only in the limb operated on; four had bilateral deep venous thrombi; and three had pulmonary embolism. In nine patients who took aspirin regularly the incidence of thromboembolism was 11 per cent, while in the eight who did not take aspirin or any other antiplatelet drug the incidence was 88 per cent, a difference which was highly significant (p = 0.003).
 ...
PMID:Thromboembolic disease in patients undergoing total knee replacement. 97 23

The standard low dose of heparin for the prevention of deep venous thrombosis in patients who are operated upon is 5,000 units administered subcutaneously two hours before operation and at eight or 12 hourly intervals for the next seven days. Heparin in low doses can at present be recommended as an effective agent in the prevention of deep venous thrombosis in patients over the age of 40 years who are undergoing a major abdominothoracic or gynecologic operation. There is reasonable evidence that heparin in low doses also offers a satisfactory protection against fatal pulmonary embolism for patients at high risk after general abdominothoracic operations. The evidence of the effectiveness of low doses of heparin in the prevention of deep venous thrombosis is less well established in other patients and particularly those at high risk, as after urologic and hip operations. This important distinction is to be made in terms of the population at risk and the efficacy of heparin in low doses. Considering the evidence so far available, it appears that the postoperative state in which dextran has been shown to reduce the incidence of phlebographically confirmed deep venous thrombosis most convincingly is after orthopedic operations. Major orthopedic operations are precisely the type in which the superiority of heparin in low doses is controversial. Unless proved otherwise, dextran 70 in an infusion of 500 to 1,000 milliliters of a 6 per cent solution started before operation and 500 milliliters the following and next three alternate days may be the agent of choice in preventing deep venous thrombosis in major orthopedic operations. Using this scheme, the prophylaxis of postoperative deep venous thrombosis appears equally effective with dextran 70 as with oral anticoagulants. Whether the protection offered by dextran 70 will also prevent fatal and nonfatal pulmonary embolism is still an open question. Low doses of heparin and dextran do not expose patients to serious risks of bleeding after operation, and with the recommended doses of the latter drug, other untoward effects are rare. At the doses recommended, neither of these two drugs requires laboratory monitoring.
 ...
PMID:The prevention of postoperative deep vein thrombosis and pulmonary embolism with low dose subcutaneous heparin and dextran. 99 22


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