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

In a prospective study of 50 patients subjected to major abdominal surgery, the frequencies of postoperative deep vein thrombosis and pulmonary embolism were analysed. The patients were randomized to one of two groups receiving either neurolept anaesthesia or neurolept anaesthesia combined with thoracic epidural analgesia. Five patients were excluded. No special anti-thrombotic prophylaxis was administered. Deep vein thrombosis was diagnosed with the 125I-fibrinogen test and pulmonary embolism with pre- and postoperative lung perfusion scintigraphy combined with lung X-ray. Patients with positive scintigraphy were subjected to pulmonary angiography for verification of the diagnosis. Deep vein thrombosis was treated when diagnosed. The frequency of deep vein thrombosis was equal in both groups (38%). No patient with pulmonary embolism was recorded during the first seven days after operation. It is concluded that the addition of thoracic epidural analgesia to neurolept anaesthesia does not alter the postoperative frequency of deep vein thrombosis in patients subjected to major abdominal surgery. Early diagnosis and treatment of postoperative deep vein thrombosis might prevent pulmonary embolism. Problems encountered in the diagnosis of postoperative pulmonary embolism are discussed.
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PMID:Thromboembolic complications after major abdominal surgery: effect of thoracic epidural analgesia. 661 61

Deep vein thrombosis (DVT) is a common condition. Most cases arise as complications during the perioperative period. This can largely be prevented by adequate prophylaxis, principally using low-dose subcutaneous heparin. Only a minority of DVTs produce serious complications, but it is not currently possible to predict the clinical behaviour of any DVT, once formed. For this reason, any identified DVT should be vigorously treated. The mainstay of treatment remains systemic anticoagulation with heparin and then warfarin. Warfarin should be continued for 1 month in postoperative cases and 3 months in spontaneous cases, provided there is no ongoing predisposing factor. Recurrent spontaneous DVT formation is an indication for lifelong anticoagulation. Recent evidence suggests that the subcutaneous route of administration of heparin has advantage over traditional intravenous infusion. Some large DVTs require thrombolysis, and it is now possible to treat the underlying anatomical defects with angioplasty and endovascular stenting, although the long-term outcome of these procedures has not yet been established. For patients with contraindications to the use of anticoagulants, a variety of (temporary and permanent) percutaneously inserted vena caval filters are now available. The principal complications of DVT are pulmonary embolism, which may be fatal, and the development of a postphlebitic leg. The avoidance of these depends on adequate prophylaxis and vigorous treatment of the primary DVT.
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PMID:Deep vein thrombosis. 749 62

Deep vein thrombosis (DVT) of the lower extremity is the major cause of pulmonary embolism and chronic venous obstruction disease of the legs. However, the clinical diagnosis of leg vein thrombosis is notoriously difficult. Venography, using iodine containing contrast materials, has been the most reliable older method for diagnosing thrombosis. It is relatively more invasive, requires exposure to radiation and is not free of risks. Doppler ultrasonography has been shown to be highly sensitive and specific in the diagnosis of obstruction of flow in veins. We present 25 patients studied at Singapore General Hospital (SGH) with Doppler for the presumptive clinical diagnosis of DVT. Thirteen were found to have complete or partial obstruction of leg veins and 12 showed normal veins. These 12 patients were thus spared the risk and expense of long term anticoagulation. In experienced hands, Duplex Doppler ultrasonograph is an excellent diagnostic modality for the diagnosis or exclusion of significant deep vein thrombosis of the legs. It can be carried out safely and reliably in the very sick, in patients with renal failure, diabetics and the pregnant.
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PMID:Diagnosis of deep vein thrombosis by Duplex Doppler ultrasound imaging at the Singapore General Hospital. 757 Jan 37

Deep vein thrombosis (DVT), if not properly treated, may be complicated by pulmonary embolism in about 50% of the cases within 3 months. Therefore, effective prevention of pulmonary embolism relies on three cornerstones: correct prophylaxis, early diagnosis, and correct treatment of DVT. In prophylaxis of DVT, low-dose heparin is effective in preventing postoperatory DVT and pulmonary embolism in medium risk operations, and also in "medical" DVT. In high risk operations and patients, personalized low-dose heparin, oral anticoagulants and especially low-molecular weight heparins have been used. The available controlled trials demonstrate that the low-molecular weight heparins are especially efficacious and also cost-effective in high risk situations as elective hip surgery. Validated techniques for early diagnosis of DVT are phlebography and, in symptomatic proximal DVT, also venous echotomography. Therapy of overt DVT is usually performed with infusional or subcutaneous heparin at therapeutic doses, followed by moderate range oral anticoagulants. In the initial treatment, low-molecular weight heparins at single subcutaneous daily dosing can substitute for standard heparin. Indication to thrombolytic therapy should be restricted to selected cases; thrombectomy has limited application. Caval filters may be useful in strictly selected indications, especially in presence of contraindications or resistance to anticoagulant treatments.
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PMID:[Prevention and treatment of deep venous thrombosis: prevention of pulmonary embolism]. 763 94

The incidence of deep venous thrombosis or pulmonary embolism after lung or heart-lung transplantation has not been well defined. Pulmonary embolism may be of particular concern in the postoperative period owing to an inadequately developed or absent collateral bronchial circulation and potential risk of pulmonary infarction. Fourteen (12.1%) of 116 patients undergoing either lung (n = 87) or heart-lung (n = 29) transplantation developed thromboembolic complications 10 days to 36 months after operation. Deep vein thrombosis developed in nine patients, including three with upper body thrombosis related to indwelling central venous catheters. Seven patients (6%) had pulmonary embolism, and three of them died. Resolution of pulmonary embolism was successfully accomplished by selective pulmonary artery infusion of urokinase in three patients without complications. Our experience indicates that deep vein thrombosis and pulmonary embolism are significant problems after lung transplantation. Mortality is high in those patients in whom pulmonary embolism develops. Therefore, a comprehensive prevention protocol is warranted.
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PMID:Deep venous thrombosis and pulmonary embolism after lung transplantation. 763 73

Deep vein thrombosis with consecutive pulmonary embolism is one of the most important complications for trauma patients. At the University Hospital of Mainz, Department of Traumatology, colour duplex ultrasound is used as screening method in trauma patients. Fractures of thoracic and lumbal spinal bones, pelvis, hip and lower extremities, endoprosthesis of hip and knee joints and longer immobilisation are considered as special risk for the genesis of deep vein thrombosis. Out of 326 patients investigated with colour duplex ultrasound, 24 patients suffered from unknown deep vein thrombosis, 8 developing pulmonary embolism. We recommend colour duplex sonography on day 10, after the third week, and after longer immobilisation. Colour duplex sonography provides an easy performable and noninvasive method for screening evaluation of deep vein thrombosis in trauma patients.
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PMID:[Color-coded duplex ultrasound as a screening method in trauma surgery]. 763 25

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) is a major source of mortality and morbidity in stroke patients. This study was designed to determine the effectiveness of different prophylactic treatments in the prevention of DVT after a stroke in patients undergoing rehabilitation. An additional objective was the identification of risk factors for DVT in stroke in patients during rehabilitation. Three hundred and sixty patients, over a 3-year period, were randomly assigned to one of four groups: adjusted dose heparin, intermittent pneumatic compression (IPC), functional electrical stimulation (FES), or control. There was no significant difference in the development of DVT by treatment group. Patients with DVT on admission (prevalent, n = 61) were compared with the study patients (n = 360). Time interval (from stroke to admission) and lactic dehydrogenase (LDH) concentration were significant risk factors, as well as predictors, for development of DVT (p < .000). These results suggest that the longer a patient remains without DVT prophylaxis after a stroke, the greater the risk of developing DVT and this supports early prophylaxis before rehabilitation.
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PMID:Deep vein thrombosis: prevention in stroke patients during rehabilitation. 771 32

A 23-year-old man was admitted because of an attack of chest pain and dry cough. Chest roentogenogram showed a solitary pulmonary nodule in the left upper lobe. Chest CT showed a nodule and a small pleural effusion on the same side. Pulmonary thrombosis was diagnosed by pulmonary Ventilation/perfusion scintigraphy and pulmonary arteriography. Deep vein thrombosis was not detected except in a distal pulmonary artery. The solitary nodule disappeared spontaneously without thrombolytic therapy. An anticardiolipin antibody (IgG) test was positive. Primary antiphospholipid syndrome was diagnosed, because of the absence of physical findings suggesting other collagen vascular diseases. Patients with antiphospholipid syndrome have a high frequency of pulmonary complications that include pulmonary hypertension and pulmonary embolism. Most of the patients with pulmonary embolism have deep vein thrombosis, and pulmonary vessel thrombosis as seen in the present case is a rare complication.
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PMID:[A case of pulmonary thrombosis associated with primary antiphospholipid syndrome]. 773 Nov 19

Deep vein thrombosis (DVT) is a common complication in patients undergoing elective hip surgery. Because of the associated risk of pulmonary embolism, prophylaxis with standard (unfractionated) heparin is becoming increasingly important. Recent clinical trials have shown a low molecular weight form of heparin, enoxaparin, to be more effective than standard heparin in preventing DVT, but the new drug is also more expensive. Data on clinical effectiveness and cost were combined in an economic evaluation of the two regimens. It was found that prophylaxis with enoxaparin would be expected to lead to a net saving of 20 pounds per patient. The economic results are sensitive to the costs of enoxaparin, the costs of drug administration and the probability of false clinical diagnosis of DVT or pulmonary embolism.
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PMID:Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery. 782 28

Deep vein thrombosis (DVT) and pulmonary embolism are serious complications following hip and knee replacement surgery. Both surgical procedures have significantly high postoperative rates of DVT. In total hip replacement, the rate of proximal thrombi tends to be higher. However, total knee replacement produces a high rate of calf thrombi and a higher overall rate of thrombosis. In a search for innovative ways to reduce the risk of thrombosis, three types of anesthesia were examined: general anesthesia, epidural anesthesia, and hypotensive epidural anesthesia in which a controlled hypotension is provided. The hypotension commonly exists with epidural anesthesia also, unless blood pressure is maintained with an agent such as ephedrine. When blood pressure is allowed to drop in a controlled fashion, hypotensive anesthesia is effected.
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PMID:Effects of epidural anesthesia on incidence of venous thromboembolism following joint replacement. 793 84


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