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

Between 1973 and 1987, 33 patients underwent pulmonary thromboendarterectomy for chronic pulmonary embolism. Twenty-six patients were in Class III of the NYHA Classification, 5 in Class IV with overt right ventricular failure and 2 in Class II. The average pO2 was 60 mmHg under basal conditions without oxygen therapy. The amputation of the pulmonary vascular tree was greater than 50 per cent in all patients. The average systolic pulmonary artery pressure was 70 mmHg. Twenty patients were operated by a lateral thoracotomy without CPB and 6 by sternotomy with CPB under normothermia with or without cardiac fibrillation. The later method avoids having to open the pleura and seemed to give better haemodynamic control. Interruption of the inferior vena cava was systematic in all cases. The global operative mortality was 20 per cent but this seemed to be less in the patients operated by sternotomy under normothermic CPB (no deaths in 6 patients). The authors consider that this technique should be studied in a larger series of patients. Eighteen patients are still being followed up; the clinical and scintigraphic and/or angiographic improvement is clearcut in the majority of cases.
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PMID:[Results of thrombo-endarterectomy of chronic pulmonary embolism]. 210 55

A 79-year-old woman was admitted with general fatigue. Chest roentgenogram showed diffuse reticular shadows and bilateral pleural effusion. Peripheral blood studies revealed an elevation of platelet count (203.3 X 104/mm3). The case was diagnosed as essential thrombocythemia and treated with ACNU. The platelet count decreased. Bilateral pleural effusions increased gradually and their characteristics changed from bloody exudate to transudate. Biopsy of her pleura and thoracoscopy were carried out without significant results. Later, systemic edema, which suggested right heart failure, developed. The diagnosis of pulmonary hypertension and right heart failure was made by echocardiogram and right cardiac catheterization. Because perfusion scan of the lung revealed some perfusion defects, complication of pulmonary embolism was suspected. Bilateral pleural effusion and pulmonary artery pressure decreased with treatment by nifedipine, furosemide and isosorbide dinitrate. This is the first case report of essential thrombocythemia, pulmonary hypertension, right heart failure and bilateral pleural effusion.
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PMID:[A case of essential thrombocythemia with pulmonary hypertension and bilateral pleural effusions]. 221 92

The prognosis of pulmonary embolism depends chiefly on three conditions, the amount of pulmonary arterial obstruction, the cardio-pulmonary state and tolerance and haemostatic factors. Whereas a single, even massive pulmonary embolism as a rule does not lead to chronic morbidity, repeated though minor emboli may be followed by pulmonary hypertension with eventual right heart failure so that the long term prognosis rests upon the probability of further thrombotic events.
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PMID:[Life expectancy after lung embolism]. 229 Dec 70

Twenty six patients with acute (less than 5 days) pulmonary embolism (PE) confirmed by bilateral pulmonary angiography with a Miller index greater than 15 were given tissue plasminogen activator (Alteplase) (rt-PA) intravenously (n = 20) or directly into the pulmonary artery (n = 6). The dosage was 100 mg/7 hours (bolus 10 mg + 40 mg/2 hours + 50 mg/5 hours). Heparin (5000 IV as a bolus and 1000 IV/hour) was associated in all cases. The Miller index decreased from 24 +/- 1 (n = 26) before treatment to 12 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase, and from 25 +/- 0.4 (n = 14) to 22 +/- 0.5 (n = 14) (p less than 0.001) after 50 mg. The mean pulmonary arterial pressures fell from 30 +/- 2 mmHg to 21 +/- 2 mmHg after 50 mg (n = 26) (p less than 0.001) and to 14 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase. A decrease in mean pulmonary artery pressures (-22%, p less than 0.001) and total pulmonary resistances (-29%, p less than 0.001) was obtained after one hour of thrombolysis in 12 monitored patients. There were no fatalities. Severe haemorrhage occurred in 6 cases. Therefore, Alteplase induced a rapid dissolution of recent intrapulmonary thrombi without inacceptable haemorrhagic complications. Its action could be particularly beneficial in patients with right ventricular failure due to life threatening pulmonary embolism.
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PMID:[Tissue plasminogen activator (alteplase) in acute massive pulmonary embolism. A pilot study]. 251 32

Pulmonary embolism can produce severe cardiopulmonary dysfunction characterized by pulmonary artery hypertension, right ventricular failure, and hypoxemia. The search for the source of a pulmonary embolus, by exploration of the veins of the lower limbs and the inferior vena cava should be systematically carried out in all cases of pulmonary embolus which are not immediately life-threatening to the patient. The treatment of deep vein thrombosis associated with pulmonary embolism with thrombolytic agents has been proposed and utilized for approximately 20 years. Although superior results have been claimed with thrombolytic agents, the use of this type of treatment remains limited to massive or sub-massive pulmonary embolism. Fibrinolytic agents with high specificity for fibrin in the thrombi and little systemic activation of the fibrinolytic system have been developed and tested in preliminary clinical trials of patients with acute pulmonary embolism. The largest published experience available has been with recombinant tissue plasminogen activator (rtPA). The acylated streptokinase-plasminogen complex (APSAC) and pro-urokinase also gave promising results. All these agents were accompanied by unexpectedly high incidence of systemic activation of the fibrinolytic system and by hemorrhagic complications with frequencies similar to those that follows the use of first generation products (urokinase and streptokinase). Hence, their superior clinical efficacy must be clearly proven before they are substituted for a more widely available and less expensive drug, such as streptokinase.
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PMID:Pathogenesis and management of acute pulmonary embolism. 251 49

Emergency pulmonary embolectomy was performed successfully on a patient in her second trimester of pregnancy. The patient had severe right ventricular failure due to obstruction of 85% of the pulmonary arterial circulation. Three months after embolectomy she was delivered of a normal infant. The problem of significant but misinterpreted or overlooked clinical and electrocardiographic signs of pulmonary embolism is discussed. Thrombolytic therapy during pregnancy imposes considerable risk of bleeding with deleterious effects on both mother and fetus. In our opinion, emergency embolectomy during extracorporeal circulation is the best treatment in case of massive emboli during pregnancy.
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PMID:Emergency embolectomy in a patient with massive pulmonary embolism during second trimester pregnancy. 261 11

The various forms of bronchoplastic and angioplastic procedures are the best means of avoiding pneumonectomy. Essential indications are limited respiratory reserve and central site of a malignancy. In a retrospective study 248 broncho- and angioplastic operations carried out in the years 1973 to 1983 were analyzed. Reference date for the analysis of survival was January 1986. In consequence the minimum period of follow-up was two years. For all patients (n = 248) the 5-year-survival was 22% with a 30-day-lethality of 13%. The 5-year-survival of all bronchial sleeve resections operated radically (stage I and II of the TNM-classification) (n = 44) was 42% with a 30-day-lethality of 7%. The 5-year-survival of all bronchoplastic operations of stage I and II (n = 88) was 38% with a 30-day-lethality of 14%. Improved suture material and surgical techniques caused a reduction of operative lethality from 23% to 8% during the described period. In the first thirty postoperative days the following complications caused death: Hemoptysis (n = 5), insufficiency of the anastomosis (n = 3), right heart failure (n = 5), pulmonary embolism (n = 4) and sepsis (n = 1).
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PMID:[Bronchoplastic and angioplastic operations in bronchial carcinoma]. 282 31

Drugs with pharmacological activity limited to the pulmonary circulation are not at present available. Serotonin antagonists, specific thromboxane A2 inhibitors and prostacyclin may offer new possibilities for the treatment of certain forms of pulmonary arterial hypertension (PAH), but their clinical efficacy remains to be evaluated. Vasodilators simultaneously influence the pulmonary and systemic vascular resistances, and their overall hemodynamic effects in patients with PAH are therefore unpredictable. Therapeutic trials with such drugs should be closely monitored to avoid serious adverse reactions. Oral administration of beta-adrenergic agents, such as salbutamol or terbutaline, is preferable to digoxin in the treatment of patients with right ventricular failure due to chronic obstructive bronchitis. Right ventricular failure following massive pulmonary embolism may be aggravated by reduced blood flow through the right coronary artery. Increase of aortic perfusion pressure (e.g. noradrenaline) should be considered as a therapeutic measure in patients with arterial hypotension.
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PMID:[Pharmacology of the pulmonary circulation]. 286 81

Pulmonary lymphangitic carcinomatosis is a rare form of metastatic cervical cancer. A patient with persistent squamous cell carcinoma of the cervix presented with symptoms suggestive of pulmonary embolism and right heart failure. Pulmonary lymphangitic spread of the cancer was found postmortem. The pathogenesis of pulmonary lymphangitis carcinomatosis is reviewed and diagnostic evaluation discussed.
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PMID:Pulmonary lymphangitic carcinomatosis secondary to cervical carcinoma: a case report. 291 Jul 89

Clinical and echocardiographic data of 11 patients with tricuspid valve endocarditis (TE) were analysed to determine diagnostic criteria and to study the outcome of this condition. The study population comprised 6 men and 5 women (average age 38.4 +/- 18 years). TE was the only lesion in 9 cases; there was 1 case of associated pulmonary and aortic valve endocarditis, and in the other patient mitral and aortic valve endocarditis was also present. Five patients were heroin addicts. In 5 cases, the causative organism was Staphylococcus aureus. The clinical presentation was usually atypical with a systolic murmur rarely characteristic in 9 patients and signs of right ventricular failure in only 3 patients. On the other hand, 8 patients had one or more episodes of acute pneumonia or typical pulmonary embolism. The diagnosis was established by echocardiography which demonstrated the valvular vegetations. The outcome was favourable in 10 patients, only one of whom required surgical intervention. Two dimensional echocardiography provided valuable information about the evolution of the valvular vegetations, frequently showing regression after medical therapy.
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PMID:[Tricuspid endocarditis. Value of echocardiography. Developmental data. Apropos of 11 cases]. 308 18


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