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

Vertebroplasty (VP) is a mini-invasive percutaneous technique for the treatment of symptomatic, vertebral body fracture (VBF) caused by porotic or other diseases and its outcome has now been demonstrated by many trials. Beyond the results of these trials on the efficacy and safety of VP, the real problem for patients with osteoporotic and non-osteoporotic vertebral fractures is the risk of new fractures to adjacent or distant vertebra following VP that is reported to range from 10% to 30%. It is still unclear whether this is related to the natural history of the underlying disease (osteoporotic and non-osteoporotic diseases) or to the treatment, especially when a single vertebral fracture in an osteoporotic patient is highly predictive of future fractures. To prevent new fractures to adjacent or distant vertebra following VP in porotic patients multiple non-pharmacologic interventions are recommended (diet with vitamin D or calcium supplements, smoking cessation, exercise) in addition to a specific medical therapy to block the activation of osteoclast cells responsible for bone resorption, and to re-establish correct bone remodeling. These drugs include anti-catabolic drugs: bisphosphonate, oestrogen hormone, and anabolic drugs: PTH analogues and strontium ranelate. Bisphosphonate are the most commonly used compounds to treat postmenopausal osteoporosis. However, medical treatment appears to be too slow to prevent the natural history of patients with VBF. One session multilevel VP could be performed to prevent vertebral refracture risk in porotic or non-porotic patients with recurrent VBFs also after the first VP even if there is not a true vertebral collapse. Even if there are no limits to how many body levels can be treated in one session, European and American guidelines suggest doing no more than three body levels in the same session to reduce patient discomfort, and to prevent peri-procedural anesthesiologic problems, like uncontrolled fat-embolism, cement leakage, and pulmonary embolism, that could be increased. How many vertebrae could be treated in same session could be analyzed beforehand based on MDCT vertebral morphology and trabecular structure, or on MRI-signal changes. Added to medical therapy, multilevel VP can be performed in selected cases to treat VBF related to osteoporosis, preventing fractures or refracture without any further thrombo-embolic or fat uncontrolled embolism peri or post-procedural complications.
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PMID:Medical therapy and multilevel vertebroplasty in osteoporosis: when and why. 2414 45

Thymic enlargement (TE) in Graves' disease (GD) is often diagnosed incidentally when chest imaging is done for unrelated reasons. This is becoming more common as the frequency of chest imaging increases. There are currently no clear guidelines for managing TE in GD. Subject 1 is a 36-year-old female who presented with weight loss, increased thirst and passage of urine and postural symptoms. Investigations confirmed GD, non-PTH-dependent hypercalcaemia and Addison's disease (AD). CT scans to exclude underlying malignancy showed TE but normal viscera. A diagnosis of hypercalcaemia due to GD and AD was made. Subject 2, a 52-year-old female, was investigated for recurrent chest infections, haemoptysis and weight loss. CT thorax to exclude chest malignancy, showed TE. Planned thoracotomy was postponed when investigations confirmed GD. Subject 3 is a 47-year-old female who presented with breathlessness, chest pain and shakiness. Investigations confirmed T3 toxicosis due to GD. A CT pulmonary angiogram to exclude pulmonary embolism showed TE. The CT appearances in all three subjects were consistent with benign TE. These subjects were given appropriate endocrine treatment only (without biopsy or thymectomy) as CT appearances showed the following appearances of benign TE - arrowhead shape, straight regular margins, absence of calcification and cyst formation and radiodensity equal to surrounding muscle. Furthermore, interval scans confirmed thymic regression of over 60% in 6 months after endocrine control. In subjects with CT appearances consistent with benign TE, a conservative policy with interval CT scans at 6 months after endocrine control will prevent inappropriate surgical intervention. Learning points: Chest imaging is common in modern clinical practice and incidental anterior mediastinal abnormalities are therefore diagnosed frequently. Thymic enlargement (TE) associated with Graves' disease (GD) is occasionally seen in view of the above. There is no validated strategy to manage TE in GD at present. However, CT (or MRI) scan features of the thymus may help characterise benign TE, and such subjects do not require thymic biopsy or surgery at presentation. In them, an expectant 'wait and see' policy is recommended with GD treatment only, as the thymus will show significant regression 6 months after endocrine control.
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PMID:Managing thymic enlargement in Graves' disease. 3070 65