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

Pulmonary emboli seldom recur, and when recurrence does occur it is not associated with permanent sequelae unless there is progressive pulmonary arterial hypertension. Five patients with clinical and perfusion lung scan evidence of recurrent pulmonary embolism presented with abnormal cardiac rhythms without evidence of progressive pulmonary hypertension. Twenty-four-hour ambulatory electrocardiographic monitoring was valuable in diagnosis and in assessing the effectiveness of treatment. Although palpitation was the main complaint, other symptoms included tiredness, mild exertional dyspnoea, and chest discomfort unrelated to effort. Symptomatic improvement coincided with objective evidence of improvement from repeat lung scans and 24-hour ECG records. Antiarrhythmic agents controlled the arrhythmias but were subsequently withdrawn without the return of symptoms. Four of the five patients continued to take anticoagulants for two years. We believe that these five patients represent a group of patients with recurrent pulmonary emboli and a recognisable clinical picture dominated by arrhythmias unrelated to progressive pulmonary arterial hypertension. Long-term anticoagulant treatment was associated with clinical improvement.
Thorax 1979 Jun
PMID:Recurrent pulmonary thromboembolism presenting with cardiac arrhythmias. 48 14

Paradoxical embolism is an unusual but well recognized complication of venous thromboembolic disease. This case report of a patient with massive pulmonary embolism, who had a paradoxical embolus through a patent foramen ovale, emphasizes that in these circumstances surgical intervention is indicated.
Thorax 1976 Jun
PMID:Paradoxical embolism complicating massive pulmonary embolus. 94 Nov 22

Plasma concentrations of cross linked fibrin degradation products, a marker of intravascular thrombosis and fibrinolysis, were measured in 495 patients with suspected pulmonary embolism referred for ventilation-perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis. Lung scans were described as normal (n = 66) or as showing a low (n = 292), indeterminate (n = 58), or high probability (n = 79) of pulmonary embolism. There was a difference between the mean levels of cross linked fibrin degradation products in each scan category: normal scans, 142 ng/ml; low probability scans, 295 ng/ml; indeterminate probability scans, 510 ng/ml; high probability scans, 952 ng/ml (p less than 0.001). Of the patients with high probability scans, 96% had raised concentrations. Explanations for discrepant low results include incorrect scan diagnosis, delay in blood sampling, and anticoagulation. Of the patients with a low or indeterminate probability of pulmonary embolism, 43% had increased concentrations of cross linked fibrin degradation products that could be attributed in most cases to another illness. Owing to the wide range of values in each lung scan diagnostic category, raised concentrations of these fibrin degradation products cannot be used without reference to the patient's clinical state as a discriminatory test for pulmonary embolism. Further evaluation of the significance of normal concentrations in excluding a diagnosis of pulmonary embolism appears to be warranted.
Thorax 1990 Sep
PMID:Plasma cross linked fibrin degradation products in pulmonary embolism. 221 75

Studies on community acquired pneumonia in the United States in patients over the age of 65 years have shown that Gram negative bacilli account for an appreciable proportion of cases, in addition to usual pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. There have been no reports of community acquired pneumonia in the elderly in the United Kingdom. We undertook such a study to determine the clinical features, aetiology, and outcome. Seventy three patients (38 men) with ages ranging from 65 to 97 (median 79) years were studied prospectively. Pneumonia was defined as an acute lower respiratory tract infection with new, previously unrecorded shadowing on a chest radiograph. Patients with severe chronic illness in whom pneumonia was an expected terminal event were excluded. Nearly all the patients (96%) had respiratory symptoms or signs but many had features that might obscure the true diagnosis of pneumonia. Over half the patients had non-respiratory symptoms and over a third had no systemic signs of infection. A pathogen was identified in 43% of patients, most commonly Streptococcus pneumoniae, Haemophilus influenzae and influenza B virus. Gram negative bacilli were not seen. The mortality rate was high (33%). Early deaths were due to infection whereas later deaths were associated with other factors, such as stroke (two patients) and pulmonary embolism (two patients). Prognostic indicators for mortality were apyrexia, systolic hypotension, increasing hypoxaemia, and new urinary incontinence. As the range of pathogens causing pneumonia was the same in the elderly in this study as in other age groups it is suggested that initial antibiotic treatment for patients in this age group should always cover S pneumoniae and H influenzae.
Thorax 1990 Apr
PMID:A hospital study of community acquired pneumonia in the elderly. 235 52

The risk of early recurrence of pulmonary embolism in patients with venous thromboembolic disease treated by anticoagulants is not well established. To determine the risk linked to contemporary proximal deep venous thrombosis, a prospective study was organised to give clinical and scintigraphic surveillance to 50 patients with angiographically proved pulmonary embolism plus phlebographically proved proximal deep vein thrombosis during the first 15 days of anticoagulant treatment. Perfusion lung scans were performed initially and on days 3, 7, and 15. Only two patients had a recurrence of pulmonary embolism during this period; both episodes were revealed by new symptoms, and one recurrence was fatal. The systematic performance of angiography in four patients found to have new scintigraphic defects led to the diagnosis of "spurious scintigraphic recurrence" in three of them. It is concluded that (a) adjusted anticoagulant treatment showed an effectiveness of 96% for preventing early recurrence of pulmonary embolism in this group of supposed high risk patients, and (b) in patients with recent pulmonary embolism new defects on systematic perfusion lung scans are not specific indicators of recurrent pulmonary embolism.
Thorax 1987 Jul
PMID:Recurrence of pulmonary embolism during anticoagulant treatment: a prospective study. 343 91

A previously reported computer analysis has been used to provide numerical ventilation-perfusion lung scan data, for comparison with tests of airways function and results of arterial blood gas analysis in 11 patients with pulmonary embolism, 18 with asthma, and 37 with chronic obstructive lung disease. In pulmonary embolism an index of underperfusion showed high sensitivity, and an index of ventilation-perfusion mismatching correlated well with severity (hypoxaemia). In asthma an index of underventilation was sensitive and correlated well with severity of airways obstruction. In chronic obstructive lung disease the same index was sensitive but correlated poorly with severity. This was attributed to heterogeneity of the lung disease (airways obstruction plus emphysema) in chronic obstructive lung disease. Ventilation-perfusion mismatching was frequently present in airways disease, and was often of great severity in chronic obstructive lung disease. Discrimination between pulmonary embolism and either type of airways disease was possible by using a combination of underfusion and underventilation indices. The technique offers the prospect of increasing the information derived from lung scans and of automating the reporting of scans.
Thorax 1985 Jul
PMID:Computer analysis of ventilation-perfusion scans for detection and assessment of lung disease. 389 61

Seven members of a family affected by hereditary antithrombin III deficiency were identified. The disorder was associated with recurrent spontaneous episodes of phlebitis, deep venous thrombosis, and pulmonary embolism in middle age. Danazol, a 17-alkyl derivative of ethinyl testosterone, which has been used to treat other antiprotease deficiency states, was assessed in the management of two men with antithrombin deficiency. In a dose of 600 mg a day danazol appeared to correct the antithrombin deficiency. This drug may provide a useful adjunct to anticoagulant treatment, particularly before surgery.
Thorax 1985 Sep
PMID:Effect of danazol on the biochemical abnormality of inherited antithrombin III deficiency. 406 Jan 4

The presence or absence of venous thrombosis was determined in 29 patients with an acute exacerbation of chronic obstructive lung disease by the technique of autologous platelet labelling with indium-111. Deep venous thrombosis was diagnosed in 13 patients and in nine of these patients thrombosis was located proximal to the knee--that is, in areas associated with an appreciable risk of pulmonary embolism. One patient died; pulmonary emboli were found at postmortem examination. The incidence of venous thrombosis seen in this study is high enough to suggest that these patients may benefit from prophylactic antithrombotic treatment.
Thorax 1983 Aug
PMID:Frequency of venous thrombosis in patients with an exacerbation of chronic obstructive lung disease. 661 52

Major pulmonary embolism occurring insidiously over several weeks (subacute massive pulmonary embolism) has a high mortality and may not respond well to standard anticoagulant or thrombolytic treatment. A priming dose of plasminogen was used to enhance thrombolysis produced by a streptokinase infusion in five consecutive patients with subacute massive pulmonary embolism. In each patient a dramatic clinical improvement occurred with a substantial increase in pulmonary blood flow. All five patients survived to leave hospital. Malignant disease was the underlying cause of embolism in three patients, two of whom died of their malignant disease in the six months after treatment of their pulmonary embolism. The third patient with malignant disease had a choriocarcinoma; at least some of the pulmonary obstruction may have been tumour tissue but this obstruction was dramatically cleared by the treatment. The use of a combination of plasminogen with streptokinase should be considered in severely ill patients with subacute massive pulmonary embolism, particularly if other treatment, including streptokinase alone, has failed.
Thorax 1983 Dec
PMID:Subacute massive pulmonary embolism treated with plasminogen and streptokinase. 666 49

To assess the diagnostic value of measuring free plasma deoxyribonucleic acid (DNA) in patients suspected of having pulmonary embolism, we prospectively assayed the plasma of 40 consecutive patients who underwent pulmonary angiography for the presence of free plasma DNA. Fifteen of them had angiographic evidence of pulmonary embolism. Of these 15 only two (13%) had a positive result in the test for free double-stranded plasma DNA. We concluded that measuring free double-stranded plasma DNA is of no value in the diagnosis of pulmonary embolism.
Thorax 1983 Mar
PMID:Plasma DNA in the diagnosis of pulmonary embolism. 685 86


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