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

An 86-year-old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal-sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patient's renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.
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PMID:"Spontaneous" atheroembolic disease as a cause of renal failure in the elderly. 46 53

A woman aged 62 developed a septic shock and pulmonary embolism after skin grafting for extensive burns. She was put on anticoagulants. A second shock led to renal insufficiency. Hypercalcaemia developed. A CT scan of the upper abdomen disclosed enlarged adrenal glands. An acute adrenal haemorrhage was suspected. The levels of cortisol were low in the plasma and urine and did not respond to ACTH stimulation. Cortisone replacement therapy improved the condition of the patient and normalized plasma calcium levels. The mechanisms of hypercalcaemia in acute adrenal insufficiency are discussed. Multiple factors have been proposed: haemoconcentration, an increased affinity of plasma proteins for calcium, an increase in the filtrable calcium complexes, and an enhanced calcium mobilization of skeletal origin.
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PMID:Hypercalcaemia in acute adrenal insufficiency. A case report. 216 7

Ninety-one children that were subjected to transabdominal radical nephrectomy are reviewed. The patients' ages ranged from 20 days to 10 years. Forty cases had a right side tumor and 44 a left side tumor; bilateral tumor incidence was 7.70% (7 cases). The tumor weight incidence was 75% for greater than or equal to 500 g and 37.5% for greater than or equal to 1,000 g. Incidence of local extension of the disease was 21.98%. Intraoperative complications were 12 ruptures of the kidney capsule, 1 laceration of the cecum, 1 opening of the pleura, 1 section of the superior mesenteric artery, and 1 section of the right common iliac artery. The mortality rate in unilateral surgery, because of intraoperative massive hemorrhage, was 3/83 (3.61%). One patient with bilateral tumor died because of acute renal insufficiency and sepsis. One patient with caval thrombus which extended up to the right atrium died because of intraoperative massive pulmonary embolism.
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PMID:Transabdominal radical nephrectomy in ninety-one consecutive patients with Wilms' tumor. 216 9

Between 1982 and 1987, 32 patients with severe aortorenal atherosclerosis had simultaneous aortic and bilateral renal revascularization. All patients were hypertensive. Eighteen patients (56%) had renal insufficiency with a mean serum creatinine (SC) of 2.8 mg/dl. Nine patients had an aortic aneurysm; the remaining 23 patients had aortoiliac occlusive disease of varying severity. Aortic reconstruction was done with either a straight (six patients) or bifurcated (26 patients) Dacron graft. Renal revascularization was accomplished with either bypass (60 arteries) or transaortic endarterectomy (four arteries). One patient died of pulmonary embolism (operative mortality rate 3%). Beneficial blood pressure response was achieved in 28 of 31 survivors, (90%). Among the 18 patients with renal insufficiency, mean SC was 2.80 +/- 1.18 mg/dl preoperatively and 1.65 +/- 0.48 mg/dl postoperatively (p less than 0.001). Among eight patients with severe renal dysfunction before surgery (SC greater than 3 mg/dl), mean SC was 3.90 +/- 0.85 mg/dl before and 1.79 +/- 0.69 mg/dl after operation (p less than 0.001). In follow-up extending to 58 months (mean 27.6 months), five late deaths occurred; cumulative survival was 94% at 2 years and 60% at 4 years. There were no instances of worsening hypertension; one patient had deteriorating renal function. These results indicate that severe aortorenal atherosclerosis can be managed with simultaneous aortic reconstruction and bilateral renal revascularization at low operative risk. In addition, there can be high expectation of significant and persisting benefit in both hypertension and renal dysfunction after operation.
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PMID:Simultaneous aortic reconstruction and bilateral renal revascularization. Is this a safe and effective procedure? 274 98

Between 1969 and 1984 a radical prostatectomy was performed in 175 patients for localized carcinoma of the prostate. This corresponds to a percentage of 18,2% of 962 patients with cancer of the prostate admitted to this hospital during the same period of time. The intra- and postoperative complications following radical prostatectomy in this series of 175 patients are analyzed. In 144 patients a retropubic prostatectomy was performed, whereas in 31 patients the perineal approach was utilized. There was a mortality rate of 1.1% (2 patients). Rectal injuries in 7 patients and ureteral transsection in 2 patients accounted for intraoperative complications. In the early postoperative period non-fatal pulmonary embolism occurred in 4 and myocardial infarction in 3 patients. In 3 cases (1,7%) a transitory hemodialysis became necessary because of renal insufficiency. Lymphoceles had to be treated in 22 patients (12,6%) and hematomas in 9 patients (5,1%). Persistent total urinary incontinence was observed in 8 patients (5%) and stress incontinence of varying degree in 25% of cases. The causes of these complications are analyzed and possible ways of preventing and treating them are discussed.
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PMID:[Complications of radical prostatectomy]. 401 40

2127 patients with operations of the stomach, colon, lungs, vascular system, and amputations were analysed with regard to postoperative mortality and age. There was a striking relationship between age and risk in each group of diseases. The perioperative mortality rate rose from 2.3% in the age group under 50 years to 8.5% in patients between 51 and 70 years of age, and to 18.6% in patients older than 71 years. There was no sex related difference. The causes of death in 219 cases were exactly analysed. Cardiac insufficiency, myocardial infarction, cachexia in malignancies, pulmonary embolism, and renal insufficiency were the main lethal complications in elderly patients.
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PMID:[Surgery of elderly patients--evaluation of perioperative mortality]. 686 49

Between 1985 and 1992, 9 patients (6 men and 3 women), 50-76 years old (mean age 63.6), underwent radical nephrectomy and removal of the tumor thrombus for the treatment of renal cell carcinoma extending into the vena cava at the Department of Urology, Hiroshima University Hospital. Seven tumors were located in the right kidney and two in the left kidney. Three tumor thrombi extended into the vena cava within 2 cm (level 1 according to the Novick's classification), 2 extended into the infrahepatic vena cava (level 2), 2 extended into the suprahepatic vena cava (level 3), and other 2 extended into the right atrium (level 4). Two patients had distant metastases preoperatively. The tumor thrombi at the level 1 were removed by venacavotomy with a short duration of surgery and a small amount of blood loss, while in those at the level of 2 or 3, both the duration of surgery and the amount of blood loss increased because the mobilization of the liver needed to remove the thrombi. For removing tumor thrombi at the level 4, cardiopulmonary bypass and deep hypothermic circulatory arrest were applied, resulting in longer duration of surgery but less amounts of blood loss than those at the level 2 or 3. Postoperatively, 2 patients had a renal insufficiency and another 2 had a liver dysfunction. One operative death occurred in this series because of pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgical treatment of renal cell carcinoma with extension into the vena cava]. 817 74

The authors report two cases of puerperal right ovarian vein thrombophlebitis (POVT) with floating thrombus in the inferior vena cava (IVC). The originality of this report lies in the first line surgical treatment approach. POVT is recognized as presenting usually within the first week post-partum after about 0.05% of deliveries. The syndrome consists of lower abdominal or flank pain, unexplained fever and a tender abdominal mass. Abdominal or pelvic findings are often scanty. In some cases, the thrombus may extend to the inferior vena cava, leading to the risk of pulmonary embolism or low grade renal insufficiency. Diagnosis has been difficult in the past. Since acute appendicitis is the commonest differential diagnosis, laparotomy is frequent. CT scan provides a readily available, accurate, non invasive technique for the diagnosis of POVT. Criteria are: enlargement of the vein, a low density lumen within the vessel wall and a sharply defined vessel wall enhanced by contrast media. The treatment of POVT is initially medical. Antibiotics should be given to cover the commonest infecting organisms. Heparin should also be prescribed at therapeutic IV doses to be followed by oral anticoagulants for at least six weeks. Surgery is usually only recommended when the patient remains symptomatic despite proper medical management, develops clinical, scan or arteriographic evidence of pulmonary embolism, or cannot be anticoagulated. The recommended surgical technique is to clamp the anastomosis of the ovarian vein with the vena cava.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Thrombophlebitis of the ovarian vein. New therapeutic approach]. 824 95

NONINVASIVE PROCEDURE: Helical CT angiography is a noninvasive procedure whose only relative contraindications are renal insufficiency and iodine allergy. MASSIVE PULMONARY EMBOLISM: If a massive pulmonary embolism is suspected, helical CT angiography is the examination of choice because of its high accuracy in detecting proximal thrombi and its safety profile. NON-MASSIVE PULMONARY EMBOLISM: If a non massive pulmonary embolism is suspected, helical CT angiography, because of its high specificity, can be the first examination instead of scintigraphy. If a thrombus is depicted by CT, the diagnosis of pulmonary embolism is confirmed and treatment is started. If no thrombus is visualized by CT, pulmonary embolism can be ruled out in most cases. In case of doubt, another noninvasive procedure should be performed. Angiography should be the exception and seldom is needed.
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PMID:[Pulmonary embolism. The role of computed tomography angiography]. 976 92

As a result of numerous clinical trials and meta-analyses supporting the superior efficacy and relative safety of low-molecular-weight heparins (LMWHs) compared with unfractionated heparin (UFH), LMWHs are emerging as the antithrombotic agents of choice for the prevention and treatment of deep vein thrombosis and pulmonary embolism. In addition, data indicate that enoxaparin given with low-dosage aspirin is more effective than UFH in treating acute coronary syndromes. Anti-Xa activity can be used as a biologic marker of LMWH activity. Because of the more predictable anticoagulant response to subcutaneous administration of LMWHs compared with UFH, routine monitoring of anti-Xa activity in clinically stable adults with uncomplicated disease is not recommended. Because the optimal dosage of LMWHs has not been established for patients with renal insufficiency or extremes of body weight, during pregnancy, or for children, anti-Xa activity monitoring may be warranted in these subsets.
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PMID:Dosing and monitoring of low-molecular-weight heparins in special populations. 1121 59


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