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

To find out the causes of death with particular reference to venous thromboembolism all patients being operated on for hip fractures who were taking part in a trial of two methods of prophylaxis against thromboembolism were consecutively and prospectively registered. A total of 806 patients were included, 66 of whom died within three months (8%). The necropsy rate was 64%. The patients who died were significantly older than those who did not. Pulmonary emboli were diagnosed in 17 of the 42 necropsies: 3 fatal, 5 contributory, and 9 incidental. The patients with fatal and contributory emboli died a median of 31 days postoperatively. In the 24 patients who did not have necropsies the clinical cause of deaths were cardiac insufficiency (n = 11), pneumonia (n = 8), pulmonary embolism (n = 2), and myocardial infarction, cerebral infarction, and pancreatic cancer (n = 1 each). The incidence of fatal pulmonary embolism therefore varies between a minimum of 0.37% and a theoretical maximum of 3.3%. In conclusion, fatal pulmonary embolism after operations for fractured hips is low where routine thromboprophylaxis is used. Most patients who develop large pulmonary emboli are old but live independently. To study causes of death a high necropsy rate is essential.
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PMID:Pulmonary embolism and mortality in patients with fractured hips--a prospective consecutive series. 168 45

Twelve patients with adenocarcinoma of the pancreas and two patients with carcinoma of the extrahepatic biliary tree received combined therapy with 125I implant, precision high-dose (PHD) photon external beam therapy, and systemic 5-fluorouracil (5-FU). The 125I implant delivered 120 to 210 Gy (median 140 Gy). PHD external beam therapy was given with high-energy photons (10, 15 or 45 meVp) and was initiated 4 to 6 weeks postimplant. A dose of 48.6 to 63 Gy was delivered over 5.5 to 7 weeks in 1.8 Gy increments. Six patients received 5-FU, 500 mg/m2 via weekly intravenous bolus injection. No patient was lost to follow-up (range, 3.5-57 months). Acute postoperative morbidity included pancreatic fistula in two patients and gastrointestinal tract bleeding, pulmonary embolism, and cholangitis in one patient each. No patient died of radiation complications. Median survival of the patients with pancrease cancer was 15 months. One patient is alive at 41 months with hepatic metastasis. Satisfactory palliation was observed in patients with pancreas cancer treated with 125I interstitial implant followed by PHD external beam photon therapy and 5-FU. Patient survival did not seem superior to that of patients treated with PHD external beam therapy +/- chemotherapy, a less morbid procedure. Two cases of bile duct cancer treated in similar fashion are presented.
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PMID:125I interstitial implant, precision high-dose external beam therapy, and 5-FU for unresectable adenocarcinoma of pancreas and extrahepatic biliary tree. 375 65

The true incidence of pulmonary embolism (PE) after general surgery in Japan is unknown. We searched the PubMed and Japana Centra Revuo Medicina 1985-2002 databases, entering "surgery" and "pulmonary embolism" or "thromboembolism", and reviewed the reported incidence of clinical PE associated with general surgery in Japan. The overall incidence of PE after general surgery was 0.33%. Fatal PE was reported in 0.08% of the surgical population and the mortality rate of patients with PE was 31%. The incidence of PE after cancer surgery ranged from 0.57% after colon malignancy to 3.85% after pancreatic cancer surgery, and was significantly higher than that after surgery for noncancerous conditions (0.20%). The incidence of PE after various cancer operations corresponded to a moderate or high risk, as defined by the 6th American College of Chest Physicians consensus recommendations. There was no significant difference in the incidence of PE after laparoscopic and open abdominal surgery. The incidence of PE was four to six times lower in patients who had received mechanical prophylaxis, although the difference was not significant. In conclusion, the incidence of PE in Japanese surgical patients is not as low as previously thought. Perioperative prophylaxis against venous thromboembolism is important, but its benefits need to be confirmed by prospective clinical studies.
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PMID:Current status of pulmonary embolism in general surgery in Japan. 1544 47

Thromboembolic disease is a common complication of pancreatic cancer and is causally associated with the generation of an intrinsic hypercoagulable state. Pancreatic-cancer cells activate platelets and express several procoagulant factors, including tissue factor and thrombin. The activation of coagulation is not simply an epiphenomenon, but might also be related to enhanced tumour growth and angiogenesis. Clinical manifestations of thromboembolic disease in pancreatic cancer include deep venous thrombosis, pulmonary embolism, disseminated intravascular coagulation, portal vein thrombosis, and arterial thromboembolism. Reported incidences of disease range from 17% to 57%. Treatment options include warfarin and low-molecular-weight heparins. Studies over the past decade suggest that long-term use of these heparins in both primary and secondary prevention of venous thromboembolic disease improves outcomes in comparison with warfarin. Further research is needed to understand better the morbidity and mortality associated with this disease in pancreatic cancer and to optimise strategies of prevention and treatment.
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PMID:Pancreatic cancer and thromboembolic disease. 1552 52

We describe a patient with a severe, neoplastic pulmonary embolism due to primary cancer of the pancreas. The 40-year-old male was admitted to the haematology department with an initial diagnosis of lymphoma. Transthoracic echocardiography showed a mass in the right atrium. Transoesophageal echocardiography was performed and revealed two moving tumours: the first in the extend of the vena cava superior and the second one in the tricuspid valve annulus. After bronchoscopy the patient's haemodynamic condition deteriorated and was followed by cardiac arrest. Post-mortem examination showed extensive tumour emboli in the left pulmonary artery as well as pancreatic cancer at an advanced stage.
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PMID:[Severe nonthrombotic pulmonary embolism due to primary cancer of the pancreas--a case report]. 1743 57

Venous thromboembolism is a common complication in patients with cancer and an important cause of morbidity and mortality. Idiopathic thrombosis, migratory or recurrent thrombophlebitis may be the first manifestation of an occult malignancy. While deep venous thrombosis and pulmonary embolism are the most common thrombotic conditions in patients with malignant disease, tumor thrombus may be seen in inferior vena cava, mainly in patients with renal cell carcinoma, hepatocellular carcinoma, testicular tumors or adrenal carcinoma. Although pancreatic cancer is one of the cancers that are most strongly associated with thrombotic complications along with cancers of ovary and brain, there has been no report about presence of thrombus in the inferior vena cava in pancreatic cancer. We report a female patient with pancreatic cancer associated with tumor thrombus extending from the inferior vena cava to the right atrium.
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PMID:Inferior vena caval tumor thrombus extending into the right atrium in a patient with pancreatic cancer. 1748 76

In the presented case of a 60-year-old man, deep vein thrombosis and pulmonary embolism symptoms preceded pancreatic cancer diagnosis. An unexpected echocardiographic finding was a longitudinal mass attached to the tricuspid valve, and extending to the pulmonary artery - suggestive of a thrombus (as confirmed further autopsy), probably embolic in origin. This uncommon situation might be due to nonbacterial thrombotic endocarditis, which involved all, but mainly tricuspid and aortic valves. During heparin therapy the patient's haemodynamic status was stable until systemic emboli occurred with multifocal ischaemic stroke that was the cause of death.
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PMID:[Uncommon presentation of venous thromboembolism and fatal systemic emboli in a patient with nonbacterial thrombotic endocarditis due to pancreatic cancer]. 2080 1

This paper is an updated review of a classical clinical subject: the association between deep vein thrombosis and pancreatic cancer. Recent epidemiological data support the empirical observation of Trousseau that digestive cancer may induce deep vein thrombosis. Pancreatic cancer is among the most common malignancies associated with thrombosis, due to the fact that cancer may induce the activation of the coagulation. There are genetic factors linked to this association. Cancer patients carrying the factor V Leiden mutation and the prothrombin 20210A mutation have increased risk to develop thrombosis. Reciprocally, it has been speculated that deep vein thrombosis or pulmonary embolism could represent a warning sign for a latent cancer. The practical question about this association is: shall we recommend searching for pancreatic and other cancers in all patients with thrombosis? Present data show that the strategy to look for such malignancies in patients with thrombosis on a routine base is not cost-effective. Oncological screening should be limited to patients at risk to develop cancer. Patients with pancreatic cancer, as with other visceral cancers, should be submitted to a prophylactic strategy to prevent thrombosis: therapy with low-molecular-weight heparin for several weeks was beneficial in several trials.
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PMID:Thrombotic complications of pancreatic cancer: classical knowledge revisited. 2081 11

The influence of the site of cancer on outcome in cancer women with venous thromboembolism (VTE) is poorly understood. Reliable information on its influence might facilitate better use of prevention strategies. We assessed the 30-day outcome in all women with active cancer in the RIETE Registry, trying to identify if differences exist according to the tumor site. Up to May 2010, 2474 women with cancer and acute VTE had been enrolled. The most common sites were the breast (26%), colon (13%), uterus (9.3%), and haematologic (8.6%) cancers. During the 30-day study period, 329 (13%) patients died. Of them, 71 (2.9%) died of pulmonary embolism (PE), 22 (0.9%) died of bleeding. Fatal PE was more common in women with breast, colorectal, lung or pancreatic cancer (59% of the fatal PEs). Fatal bleeding was more frequent in women with colorectal, haematologic, ovarian cancer or carcinoma of unknown origin (55% of fatal bleedings).
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PMID:Thirty-day mortality rate in women with cancer and venous thromboembolism. Findings from the RIETE Registry. 2126 24

We present a case of early onset pancreatic cancer related extra-axial brain metastases. A 46-year-old Caucasian non-Jewish nonobese male with a history of PC diagnosed 3 months ago with metastases to the liver, omentum, malignant ascites, and a history of a pulmonary embolism was admitted to the hospital because of a new onset headache, nausea, and vomiting which started 2 days prior to the encounter. Brain MRI was ordered, which showed acute bihemispheric subdural hematomas and left hemispheric extra-axial heterogeneously enhancing lesions consisting with metastatic disease. The patient was started on ondansentron, metoclopramide, and dexamethasone. The cranial irradiation was started, and the patient's headache and nausea significantly improved. There are only 9 published reports of extra-axial brain metastases related to the pancreatic cancer, whereas our paper is the first such case reported on a patient with epidural metastases and early onset pancreatic cancer.
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PMID:Epidural brain metastases in a patient with early onset pancreatic cancer: a case report and literature review. 2311 7


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