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

An appreciation of the appearances of segmental and lobar defects on a lung scan is important for the diagnosis of pulmonary embolism. The appearances of segmental and lobar ventilation defects of known anatomical location have been examined on 81mKr ventilation scans in normal human subjects, utilizing fibreoptic bronchoscopy to place temporary occlusions under direct vision at the orifices of lobar and segmental bronchi. Scans were obtained in the posterior, posterior-oblique and lateral projections. Anterior views were included if the defects could not be adequately visualized on the other views. The completeness of the occlusion and the site and size of each defect could be confirmed by ventilating the segment itself with 81mKr via the balloon catheter while the occlusion was maintained. Segmental defects located anterior to the hilum of the lung tended to be optimally visualized on the lateral view and defects located posterior to the hilum tended to be optimally visualized on the posterior-oblique view. The size of segmental defects could be underestimated on the lung scan, especially those involving the anterior and lateral basal segments of both lower lobes. Defects involving the medial basal segment of the right lower lobe were undetectable on any view. By implication, the same conclusions apply to 99mTc perfusion scans.
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PMID:The anatomy of radioisotope lung scanning. 156 75

Anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas, masking their notorious association with a high mortality and morbidity rate, failure of total removal, and recurrence. To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. Without total removal, however, recurrence is expected. Recent advances in cranial-base exposure and cavernous sinus surgery have facilitated radical total removal. The author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone. This experience has distinguished three groups (I, II, and III) which influence surgical difficulties, the success of total removal, and outcome. These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels. The presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern. Total removal was impossible in the three patients in Group I, with postoperative death occurring in one patient and hemiplegia in another. Total removal was achieved in 18 of the 19 patients in Group II, with one death from pulmonary embolism. In the two patients in Group III, total removal without complications was easily achieved.
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PMID:Clinoidal meningiomas. 223 Sep 67

Between June 1994 and December 2000, 80 displaced acetabular fractures were treated by open reduction and internal fixation, where possible by a single surgical approach. We report our results in 72 patients (73 fractures) who completed a minimum follow-up of 2 years. The average age of patients was 39.5 years (range 15-76 years). Thirty-four fractures were classified as simple and the remaining 39 were complex fractures. Twenty-four patients were recorded to have posterior dislocation of the hip joint at the time of initial presentation and at surgery eight patients were noted to have varying degrees of damage to the head of the femur. The average time to surgery was 11.7 days (range 1-35 days); 80% of cases were operated within 2 weeks period. The average follow-up was 45.5 months (range 24-96 months). In 67 fractures (92%), only a single approach was used (Anterior Ilioinguinal 26 cases; Posterior Kocker-Lagenbach 41 cases). Five fractures needed an extensile triradiate approach and only one case required a combined anterior and posterior approach. Congruent reduction was achieved in 89% of cases. Main complications included deep infection in two patients (2.7%) and severe degenerative changes in three patients (4.2%). A total of four patients (5.5%) required a total hip replacement. There were no cases of deep vein thrombosis or pulmonary embolism. Heterotopic ossification grade III was seen in three (4.1%) cases and none were grade IV. At the latest follow-up the average Harris hip score was 85 (range 20-100). We conclude that in the majority of cases internal fixation is possible through a single approach provided patients are referred early to a specialist unit. This results in satisfactory outcome with reduced morbidity and complication rate.
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PMID:Operative management of acetabular fractures. A review of 73 fractures. 1582 18

The authors report the case of an 83-year-old woman with refractory sciatica attributable to isthmic spondylolisthesis at L-5. Her symptoms were successfully improved after posterior lumbar interbody fusion (PLIF) at L5-S1; however, notable swelling in her left leg suddenly developed 2 days postoperatively. Anterior migration of a fragment of bone graft was demonstrated on computed tomography scanning, and there was obvious occlusion of the left common iliac vein (CIV) on magnetic resonance venography. Ultrasonography revealed a thrombus in the left CIV at the site of compression. To prevent a pulmonary embolism during manipulation of the affected vein, an inferior vena cava filter was placed just before excision of the migrated bone fragment. The swelling in the patient's leg subsided quickly after the surgery, and she was treated with heparin and warfarin to prevent recurrent deep vein thrombosis (DVT). Six months after the second surgery, complete restoration of blood flow to the left CIV and no recurrence of DVT were demonstrated on magnetic resonance venography. Especially in elderly patients with degenerative disc disease, excessive curettage and impaction of disc materials during the PLIF procedure may cause migration of bone graft fragments. Surgeons should be aware of the possible vascular complications of PLIF.
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PMID:Deep vein thrombosis due to migrated graft bone after posterior lumbosacral interbody fusion. Case report. 1723 90

The purpose of this study was to evaluate the efficacy of thoracoscopic techniques applied for anterior spinal cord decompression and fusion in osteoporotic thoracolumbar vertebral pseudoarthrosis with paralysis that otherwise require open thoracotomy and diaphragm section. Thirteen patients (average age, 65.7 years old) underwent this operation. Unilateral lung ventilation, otherwise bilateral high frequency jet ventilation was applied for general anesthesia. Three ports were routinely prepared through the intercostal spaces. Minimal subperiosteal dissection of the diaphragm was made from its insertion to L1 vertebra by 2 cm. Following corpectomy procedure of collapsed vertebra, spinal cord was decompressed and spinal fusion was performed in either of one or two stages. Spinal cord decompression could be achieved under bright illumination and a magnified view by assistance of endoscope system. Anterior spinal reconstruction could be performed by a titanium mesh cage packed with local bone in 9, or by autogenic iliac strut bone graft in 4 cases. There was no mortality and no major endoscope-related morbidity such as dural tear, spinal cord, lung, or major vascular injury except one case of pulmonary embolism. By avoiding open thoracotomy, thoracoscopic approach resulted in less postoperative wound pain and better respiratory function for such aged high-risk patients.
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PMID:Spinal cord anterior decompression for delayed spinal cord paralysis after osteoporotic vertebral compression fracture: application of thoracoscopic approach. 1868 34

Simultaneous bilateral total hip arthroplasty (THA) has been performed successfully, with good outcomes and low complication rates reported. Most published studies on the topic used anterolateral or posterior surgical approaches. The anterior approach is performed under live fluoroscopy with the patient supine, obviating the need for patient repositioning during bilateral surgery. The authors report their experience with simultaneous bilateral anterior approach total hip arthroplasty. The authors retrospectively reviewed data for 75 patients (150 hips). Mean follow-up was 26 months (range, 5-60 months). Mean patient age was 59 years and the majority were American Society of Anesthesiology class 2 (range, 1-3). Mean total surgical time was 144 minutes (72 minutes per hip). Mean blood loss was 565 mL. Mean hospital length of stay was 2.75 days (range, 1-4 days). Ninety-six percent of patients were able to ambulate on postoperative day 1. Sixty-eight percent of patients were discharged to home. Mean Harris Hip Score improved from 50 to 97. All patients noted a return to preoperative level of activity or higher. Complications included 1 atraumatic minimally displaced trochanteric fracture occurring 2 weeks postoperatively, 1 pulmonary embolism on postoperative day 3 treated without sequelae, 1 episode of postoperative atrial fibrillation, and 4 minor local wound complications. No readmission, infection, nerve palsy, dislocation, reoperation, or death occurred. Anterior approach THA has the advantage of a single supine position for bilateral simultaneous surgery and the current study supports its use in appropriate patients.
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PMID:Simultaneous Bilateral Anterior Approach Total Hip Arthroplasty. 2618 24

This study reports the surgical and clinical outcomes of spinal tumors managed with total en bloc spondylectomy. The authors searched their prospectively maintained database for patients undergoing total en bloc spondylectomy between 2001 and 2013. Ten patients (9 men, 1 woman; average age, 50.7 years; range, 42-68 years) were identified. The authors obtained demographic information, surgical outcomes (estimated blood loss, complications), and clinical outcomes (recurrence, survival). All patients had pain and were classified as American Spinal Injury Association grade E. The lesions were located in the thoracic (8 patients) and lumbar (2 patients) spine. Anterior column reconstruction was performed with strut allograft (7 patients), mesh cage (2 patients), and polymethyl methacrylate (1 patient). An average of 2.3 (range, 2-4) of 6 portions of the vertebrae were involved, according to the Kostuik classification. Mean estimated blood loss, operative time, and hospital stay were 3.5 L, 500 minutes, and 7.8 days, respectively. Perioperative complications included pleural tear (2 patients) and aortic tear, vena cava tear, retained sponge, pulmonary embolism, urinary tract infection, pneumothorax, anterior column support failure, and prominent instrumentation requiring removal (1 patient each). Postoperatively, all patients remained classified as American Spinal Injury Association grade E. Two patients had recurrence at distant spinal segments, and 1 had a new lesion in the thigh. Five patients had died (mean, 34.5 months after surgery), and 5 were alive a mean of 19.6 months after surgery (range, 6-48 months). Total en bloc spondylectomy is challenging, but in appropriately selected patients, it can be used to treat primary and metastatic spinal lesions.
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PMID:Total En Bloc Spondylectomy for Primary and Metastatic Spine Tumors. 2655 80

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed procedures in the United States. Although complications are rare in ACL surgery, failure to appreciate them can lead to significant patient morbidity in the short and long terms. More common complications in ACL reconstruction include tunnel malposition, infection, tunnel osteolysis, fixation failure, fracture, arthrofibrosis, graft site morbidity, and deep vein thrombosis or pulmonary embolism. Tunnel malposition is the most common technical error in ACL reconstruction leading to failure. Proper planning during the index surgery can help prevent these complications, especially when related to tunnel malposition.
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PMID:Knee Anterior Cruciate Ligament Injuries: Common Problems and Solutions. 2952 27

Anterior cruciate ligament reconstruction (ACL-R) is a common surgical procedure, with good outcome in 75 to 97% of the cases. However, different complications have been described including infection, hemarthrosis, deep vein thrombosis (DVT), and pulmonary embolism (PE) with a rate ranging from 1 to 15%. There are few case reports in the literature describing rare complications after ACL-R and they can be divided into: (1) complications related to the fixation device (rupture, migration); (2) fractures (tibial or femoral side); (3) infections due to uncommon bacteria, mycobacterium, and mycosis; (4) rare vascular injuries; (5) nerve injuries; and (6) other rare complications. In case of fixation device rupture or migration, device removal can be easy but the diagnosis may be challenging. Patellar fracture after ACL-R may be related to harvesting and it is not uncommon. Conversely, femoral or tibial fractures are most frequently due to bone weakness related to bone tunnels. Some rare infections related to uncommon bacteria or mycosis are also described with potentially devastating joint damage. Popliteal artery injuries are uncommon in ACL-R but minor vessels damages are described with possible severe consequences for patients. Injuries to the infrapatellar branch of the saphenous nerve are not uncommon in ACL-R. However, there are few case reports also describing injuries to the saphenous nerve, the common peroneal nerve and the sciatic nerve. The aim of this paper is to review the literature describing uncommon complications after ACL-R, giving some more information about diagnosis and treatment.
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PMID:Uncommon Complications after Anterior Cruciate Ligament Reconstruction. 3058 8