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

This paper is based upon a study of all available records of patients certified as having died in hospital from pemphigus and pemphigoid in England and Wales from 1962 to 1969. The results differ from most published series in that many of the 210 patients died still with extensive skin lesions and with biochemical abnormalities, such as low serum albumin, sodium and chloride, which were secondary to this. Side-effects of treatment, such as diabetes, peptic ulceration, and infections, were also important but the commonest immediate causes of death were respiratory tract infections and pulmonary embolism.
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PMID:The events leading to the death of patients with pemphigus and pemphigoid. 39 Dec 61

Radionuclide imaging of the lungs with 99Tcm-labelled macroaggregates of human serum albumin (99Tcm-MAA) is a safe, reliable and non-invasive method of diagnosing pulmonary embolism. It has been suggested that following intravenous injection of 99Tcm-MAA, arterial oxygen saturation falls significantly. Oxygen saturation was measured in 101 patients who had received an intravenous injection of 99Tcm-MAA prior to a perfusion lung scan. Readings were taken using a pulse oximeter at rest, immediately following injection, 10, 30 and 60 min post-injection. Twenty-five normal volunteers who were not injected acted as controls. Forty patients showed no change in oxygen saturation throughout the study. A fall of 1% was seen in 32 patients and 2-3% in 26 patients. Of the three patients who demonstrated a reduction in saturation of 6, 7 and 13%, two had chronic airways disease and one had left ventricular failure. Twenty out of 25 normal controls showed no change in saturation over the period of observation. Five showed a fluctuation of 1-2% between the measurements. All patients and controls remained asymptomatic with almost all readings returning to the initial values after 1 h. It was the patients with chest or heart disease who showed a fall in saturation. The study shows that the majority of patients undergoing a perfusion scan with 99Tcm-MAA show no significant fall in oxygen saturation. If a fall occurs, it may be related to the underlying disease process rather than to 99Tcm-MAA.
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PMID:Arterial oxygen saturation in patients undergoing perfusion lung scanning with 99Tcm-labelled macroaggregates of human serum albumin. 194 92

Coagulation studies were performed in 16 children with steroid responsive minimal change nephrotic syndrome in order to elucidate the incidence of thromboembolic complications. Fibrinogen and alpha 2-macroglobulin concentrations were inversely correlated with serum albumin concentrations, antithrombin III correlated positively (p less than 0.001). Factor VIII:R:AG concentration was elevated. Coagulation disturbances in children are not less severe than in adults with nephrotic syndrome. Combined scintigraphic pulmonary ventilation and perfusion studies were employed in 26 children to detect noninvasively events of pulmonary embolism, respectively their residual changes. The lung scintigraphic investigation demonstrated a pattern consistent with pulmonary embolism in 7 patients (27.9%), residual changes in 10 (38.5%) and normal findings in 9 (34.9%). The incidence of thromboembolic complications in children with severe nephrotic syndrome is as high as reported for adults. Pulmonary symptoms may well be due to pulmonary embolism.
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PMID:Thromboembolic complications in children with nephrotic syndrome. Risk and incidence. 243 35

Low molecular weight urokinase (LMW-UK) was coupled to the heavy chain of plasmin to make it able to bind to fibrin. The purified conjugate (PHC-UK conjugate), which consisted of equimolar concentrations of each starting material had a molecular weight of 93,600, bound tightly to fibrin-monomer-Sepharose and was not washed off with 1 M NaCl, but was eluted specifically with epsilon-amino caproic acid. The conjugate showed higher fibrinolytic activity than HMW-UK. A control conjugate prepared by coupling human serum albumin to LMW-UK (HSA-UK conjugate) showed the same fibrinolytic activity as HMW-UK. The half-lives of these two conjugates in rabbits were about 3 times that of HMW-UK. In an experimental pulmonary embolism model in rabbits, the PHC-UK conjugate showed about 10 times higher thrombolytic activity than HMW-UK, while the HSA-UK conjugate showed similar thrombolytic activity as HMW-UK, and moreover caused severe systemic fibrinogen breakdown. Thus the significant increase in thrombolytic activity after injection of PHC-UK conjugate into rabbits may be due to its newly acquired fibrin binding activity, and not to increase in its half-life. It is concluded that the PHC-UK conjugate may be useful in treatment of thrombosis.
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PMID:The plasmin heavy chain-urokinase conjugate: a specific thrombolytic agent. 295 92

To examine a possible mechanism which could cause arterial hypoxaemia following pulmonary embolism, we collapsed and did not ventilate one lung in each of eleven dogs, to produce hypoxic pulmonary vasoconstriction. In five dogs (Starch Group), PaO2 fell from 10 to 7.7 kPa (76.6 to 58.4 torr) as shunt fraction (Qs/Qt) rose from 19 to 31 per cent. Mean pulmonary artery pressure (ppa), paCO2 and VD/VT remained constant. Starch emboli (63--74 micron) were taken injected. PPA increased significantly and PaO2 dropped further to 5 kPa (37.8 torr) as Qs/Qt rose to 57 per cent. VD/VT increased and PaCO2 remained constant. Microscopic examination of the lungs showed that three times as many emboli went to the ventilated lung compared to the unventilated lung. Six dogs (Blood Clot Group) received 51Cr labelled autologous blood clot. Changes after emboli in PPA, PaO2, Qs/QT, PaCO2 and VD/VT were similar to the results in the Starch group. 125I serum albumin was then injected and the dogs were sacrificed. The lungs were monogenized separately and the 51Cr and 125I counted. The 51Cr counts indicated 66 per cent of the blood clot emboli went to the ventilated lung. Following embolization, the 125I counts suggested a shift in perfusion to the unventilated lung. We conclude from these results that emboli are preferentially distributed to ventilated lung. After embolization PPA increases. At least in this pulmonary embolism model the increased PPA may overcome hypoxic pulmonary vasoconstriction, redistribute blood to non-ventilated lung and create arterial hypoxaemia.
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PMID:Pulmonary embolism distribution to ventilated and unventilated lungs in the dog: a cause of hypoxaemia. 676 66

Chest X-ray, pulmonary isotopic photoscanning. Doppler sonography of iliac and femoral veins, inferior venacavagram and phlebography of the renal veins have been performed in 26 patients with nephrotic syndrome in order to determine the frequency and localization of thromboses and thromboembolic complications in these patients. 7 of 26 patients (26.9%) exhibited thromboses or thromboembolic complications (2 left sided renal vein thromboses, 1 right sided ileofemoral thrombosis and 1 bilateral ileofemoral thrombosis with occlusion of the vena cava inferior). In one patient renal vein thrombosis caused pulmonary embolism. In 3 other cases with life-threatening severe episodes of pulmonary embolism, the origin of the emboli could not be detected. Serum albumin level was found to be an appropriate parameter to assess the risk of thrombosis development in these patients. In 7 patients with thromboses or thromboembolic complications the serum albumin level was below 2 g/dl, whereas in 19 patients without these complications the serum albumin level was, with one exception, higher than 2 g/dl (1.5 +/- 0.3 g/dl vs. 2.6 +/- 0.5 g/dl; p less than 0.001). The possible pathophysiologic mechanisms for this observation are discussed. Our results help to identify the population of nephrotic patients who are most likely to experience thromboembolic disease. It therefore would be justifiable to carry out a prospective controlled study examining the question, whether this group of patients with benefit from prophylactic anticoagulation.
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PMID:[Incidence and clinical significance of thromboses and thrombo-embolic complications in nephrotic syndrome patients]. 726 57

In order to determine the incidence of postoperative pulmonary complications (POPC) and the value of preoperative spirometry to predict pulmonary complications after upper abdominal surgery, 24 women and 36 men (total 60 patients) were studied prospectively (mean age 48 center dot 3 years). On the day before the operation and for 15 days after the operation, each patient's respiratory status was assessed by clinical examination, chest radiography, spirometry and blood gas analysis, and patients were monitored for pulmonary complications by a chest physician and a surgeon independently. In this study, postoperative pulmonary complications developed in 21 (35%) patients (pneumonia in 10 patients, bronchitis in nine patients, atelectasis in one patient, pulmonary embolism in one patient). Of 31 patients with abnormal preoperative spirometry, 14 (45 center dot 2%) patients showed complications, whereas among 29 patients with normal preoperative spirometry, 7 (24 center dot 1%) patients showed complications (P <0 center dot 05). The incidence of POPC was higher in patients with advanced age, smoking, preoperative abnormal findings obtained from physical examination of the chest, higher ASA class and longer duration of operation. The sensitivity (0 center dot 76) and specificity (0 center dot 79) of abnormal preoperative findings obtained from physical examination to predict POPC were higher than abnormal preoperative spirometry (0 center dot 67 and 0 center dot 56 retrospectively). There was no significant difference between patients with and without pulmonary complications in regard to weight, serum albumin, type of incision, incidence of abnormal preoperative blood gases and duration of postoperative hospital stay. We conclude that POPC is still a serious cause of postoperative morbidity. Multiple risk factors include preoperative abnormal spirometry responsible for development of POPC. If used alone, spirometry has limited clinical value as a screening test to predict POPC after upper abdominal surgery.
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PMID:Value of preoperative spirometry to predict postoperative pulmonary complications. 885 23

The objectives of this study were to determine if diagnostic certainty on angiography correlates with scintigraphic probability for the diagnosis of pulmonary embolism. From a total of 160 consecutive patients who underwent both nuclear imaging and invasive selective pulmonary angiography, we reviewed the xenon-133 ventilation images in 2 posterior oblique views and the Tc-99m macroaggregated serum albumin perfusion scans and angiograms of 40 patients (15 men, 25 women; average age 57 years) who were discharged from the hospital on anticoagulants with a diagnosis of pulmonary embolism. The angiograms were reviewed and the diagnosis of embolism was considered certain in the presence of an intraluminal filling defect, a trailing embolus, or a branch occlusion equal to or larger than a segmental branch (n=29; 73%), and uncertain when the studies were reinterpreted as either equivocal or negative or in the presence of a single, small subsegmental filling defect of questionable clinical significance. The ventilation-perfusion scans were read as high (n=18; 45%), intermediate (n=10; 25%), or low (n=12; 30%) probability. The proportion of patients with diagnostic certainty on angiography in the high-, intermediate-, and low-probability scintigraphic subgroups was, respectively, 100% (18 of 18), 70% (7 of 10), and 33% (4 of 12) (P=0.004). In patients diagnosed with pulmonary embolism based on selective angiography, a lower probability of pulmonary embolism on ventilation-perfusion scintigraphy correlates with a lesser degree of diagnostic certainty on angiography and a higher incidence of single subsegmental emboli.
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PMID:Scintigraphic probability and angiographic diagnostic certainty in acute pulmonary embolism. 1457 4

It has long been recognized that nephrotic syndrome is associated with an increased risk for thromboembolic complications, including deep venous thrombosis, renal vein thrombosis, and pulmonary embolism. This risk varies with the nature of the underlying disease and seems to be greatest for membranous nephropathy. Other factors, including the level of serum albumin, previous thromboembolic episodes, and a genetically determined predisposition to thrombosis, may also be involved. Prevention of thromboembolic events with oral anticoagulants in nephrotic syndrome requires a careful case-by-case analysis of the risks for thromboembolic events balanced by the risks for anticoagulant induced bleeding. Markov-based decision analysis using literature-based assumptions regarding these risks has suggested that prophylactic anticoagulants may be indicated in certain circumstances. Such decisions need to take into account the nature of the underlying disease, the severity of the nephrotic syndrome (as assessed by serum albumin concentration), preexisting thrombophilic states, and the overall likelihood of serious bleeding events consequent to oral anticoagulation (as assessed by the international normalized ratio for prothrombin time). The optimal duration of prophylactic anticoagulation is unknown but very likely extends to the duration of the nephrotic state per se.
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PMID:Prophylactic anticoagulation in nephrotic syndrome: a clinical conundrum. 1759 72

Thrombus (blood clot) is implicated in a number of life threatening diseases, e.g., heart attack, stroke, pulmonary embolism. EP-2104R is an MRI contrast agent designed to detect thrombus by binding to the protein fibrin, present in all thrombi. EP-2104R comprises an 11 amino acid peptide derivatized with 2 GdDOTA-like moieties at both the C- and N-terminus of the peptide (4 Gd in total). EP-2104R was synthesized by a mixture of solid phase and solution techniques. The La(III) analogue was characterized by and 1D and 2D NMR spectroscopy and was found to have the expected structure. EP-2104R was found to be significantly more inert to Gd(III) loss than commercial contrast agents. At the most extreme conditions tested (pH 3, 60 degrees C, 96 hrs), less than 10% of Gd was removed from EP-2104R by a challenge with a DTPA based ligand, while the commercial contrast agents equilibrated within minutes to hours. EP-2104R binds equally to two sites on human fibrin (Kd = 1.7 +/- 0.5 microM) and has a similar affinity to mouse, rat, rabbit, pig, and dog fibrin. EP-2104R has excellent specificity for fibrin over fibrinogen (over 100-fold) and for fibrin over serum albumin (over 1000-fold). The relaxivity of EP-2104R bound to fibrin at 37 degrees C and 1.4 T was 71.4 mM(-1) s(-1) per molecule of EP-2104R (17.4 per Gd), about 25 times higher than that of GdDOTA measured under the same conditions. Strong fibrin binding, fibrin selectivity, and high molecular relaxivity enable EP-2104R to detect blood clots in vivo.
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PMID:EP-2104R: a fibrin-specific gadolinium-Based MRI contrast agent for detection of thrombus. 1839 3


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