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

Twenty-two patients from our surgical intensive care ward were, after unsuccessful treatment outside, treated with a combination of antibiotics including 6-[(R)-2-[3-methylsulfonyl-2-oxo-imidazolidine-1-carboxamido]-2-phenyl-acetamido]-penicillanic acid sodium salt (mezlocillin, Baypen) as a beta-lactam antibiotic. The infection was cured in 16 and improved in 2 patients. Three cases of infection with Serratia did not respond to treatment and antibacterial efficacy was unassessable in another case. Four patients died of shock lung (2), pulmonary embolism (1) or Candida-induced septicaemia (1) after cure of the infection. The daily dose of mezlocillin was 3 x 5 g, given as an i.v. short-term infusion. Diarrhoea (1) and petechiae (1) were observed as side effects probably attributable to mezlocillin. In none of the patients was a discontinuation of treatment necessary. Owing to its broad spectrum of action (covering both gram-positive and gram-negative microorganisms and anaerobes) and its consistently strong molar action, mezlocillin is well suited as a beta-lactam combination component for intensive care patients. At the end of this study in vitro resistant strains appeared. Therefore mezlocillin with its very valuable properties should be given only to critically selected cases.
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PMID:[Antibiotic therapy of infections in patients under surgical intensive care, in particular with mezlocillin (author's transl)]. 26 72

A case of antibiotic-induced pseudomembranous colitis is presented. Following resection of a carcinoma of the colon, an 81-year old man was treated with clindamycin for 9 days and with epicillin for another 9 days. One week after discontinuation of antibiotics the patient developed progressively severe diarrhea. Death from central pulmonary embolism ensued 10 days after the onset of diarrhea. Autopsy revealed severe pseudomembranous colitis of the entire large intestine. Pseudomembranous colitis is often observed as a complication after the administration of different antibiotics. The Anglo-American literature contains several recent reports of clindamycin-induced pseudomembranous colitis. The etiopathology of this drug-induced disease is still unclear. A possible interpretation is an antibiotic-induced change in the intestinal flora. Recent observations suggest that toxin-producing clostridia are responsible for the pseudomembranous colitis.
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PMID:[Pseudomembranous colitis caused by antibiotics]. 56 8

A case report of mesenteric venous thrombosis with small bowel infarction in a 38-year-old woman who had been taking oral contraceptives is reported. The patient was admitted complaining of severe abdominal pain and vomiting for 36 hours. On admission, temperature was 37.5 degrees C and pulse 120/minute. Abdominal rigidity and left-sided abdominal tenderness were present. X-ray of the abdomen showed 2 distended loops of small bowel and 3 fluid levels. Serum amylase was normal. White cell count was 10,000/cu mm. There was a history of abdominal pain and diarrhea over a period of several years. For 6 months she had been taking Ovulen (mestranol .1 mg and ethynodiol diacetate .5 mg) for menstrual irregularity. 2 weeks earlier she had suffered an influenzalike illness with pleuristic chest pain, loin pain, urinary frequency, and dysuria. Chest X-ray and intravenous pylography were then reported as normal. At immediate operation, a 15 cm segment of ileum was found to be infarcted. Semipurulent fluid was present in the abdomen and areas of fibrinous peritonitis were observed. The involved segment of ileum was resected. A small thrombus was extracted from a mesenteric vein. Initial postoperative course was good but 3 days after operation chest pain, dyspnea, and giddiness developed and cardiac arrest followed. Resuscitation was successful. Pulmonary angiography then showed thrombi in all branches of the pulmonary artery. After heparin therapy symptoms improved and the patient left the hospital in 2 weeks, her condition being stabilized with warfarin and dipyridamole (Persantin). The diagnosis was confirmed by histological examination. Early recanalization of a mesenteric vein was noted. Other reported cases have shown an average prodromal phase of 4 or 5 days. The long-term diarrhea was considered as not connected with the present illness but the presumed influenza illness 2 weeks earlier may have been due to a pulmonary embolism. Of reported cases, 5 of 13 have died. Early diagnosis, prompt surgery, and heparin therpay are considered important.
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PMID:Mesenteric venous thrombosis associated with oral contraceptives: a case report. 106 70

Chronic intravenous toxicity studies in monkeys were carried out with 3-[(2,3-cyclopenteno-1-pyridinium)-methyl]-7-[2-syn-methoximino - 2-(2-aminothiazol-4-yl)-acetamido]-ceph-3-em-4-carboxylate (cefpirome, HR 810; CAS 84957-29-9) a new cephalosporin derivative. In a 90-day study in rhesus monkeys (4 males/4 females per group) dosages of 0, 50, 160 and 500 mg/kg/day were administered. In a 6-month study 5 groups of 6 male and 6 female cynomolgus monkeys received NaCl-solution (0.9%), the vehicle, and 50, 200 or 800/400 mg/kg/d (the highest dosage had to be lowered after the first week due to acute drug intolerance). For clarification of the dose relationship to the findings in the 800/400 mg/kg group, a supplementary 6-month study with 500 mg/kg cefpirome including a vehicle control was also performed. 50 mg cefpirome/kg/d was well tolerated; so too were 160 and 200 mg/kg apart from a slight beta 2-microglobulinuria and/or enzymuria. Almost exclusively at the high dosages retching and vomiting, and exclusively at the high dosages diarrhea, inappetence and physical weakness were sporadically seen in the first phase of the studies. 500 and 400 mg/kg led to increasing signs of discrete renal tubular changes (enzymuria, beta 2-microglobulinuria, cylindruria and minimal histological changes in 2 animals of the 400 mg/kg group). In one rhesus monkey (500 mg/kg) and two cynomolgus monkeys (800 mg/kg) severe kidney damage had developed within the first week. In all dosage groups of the 90-day study special histological methods revealed a dose-dependent increase and enlargement of lysosomes in the epithelia of the proximal renal tubules. Increased cytolysis was, however, not observed. In all the studies there was a dose-dependent increase in the kidney weights of the intermediate and highest dosage groups. The females of the 400 mg/kg group showed slight anemia accompanied by a slight increase in the reticulocyte count. One animal of this group died prematurely probably due to pulmonary embolism. The signs of slight renal impairment including lysosome enlargement, and the slight anemia proved to be reversible.
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PMID:Chronic intravenous toxicity of the new antibiotic cefpirome in monkeys. 198 10

A 56-year-old woman was admitted to the Emergency Department for profuse diarrhoea, associated with hypokaliemia and dehydration. A subclavian venous catheter was inserted after she had a cardiac arrest. Six days later, the subclavian and innominate veins were thrombosed. Prophylactic low molecular weight heparin was then replaced by sodium heparinate. The patient's platelet count decreased to 65 G.1-1. It was nevertheless decided to remove her villous tumour. After the operation, the patient became shocked, with worsening thrombocytopaenia (15 G.1-1). She was unresponsive to fluid replacement. Transoesophageal echocardiography (TEE) was carried out, as pulmonary arterial catheterization was considered too dangerous. A "white" thromboembolus was discovered in the right pulmonary artery. Embolectomy was successfully performed without extracorporeal circulation. Flow was completely restored in the main pulmonary artery, but only partially in the right branch. Oral anticoagulation was started postoperatively. It is concluded that TEE might be a very helpful technique to promptly diagnose acute pulmonary embolism; moreover, it could be an alternative to pulmonary angiography, especially in patients in a poor state.
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PMID:[Diagnosis of severe pulmonary embolism by transesophageal echocardiography]. 227 21

We describe the case of pulmonary embolism from metallic mercury after an deliberate intravenous injection in a drug addict. Metallic mercury embolisation is extremely rare and it is very important to remark the role of elementary mercury in chronic poisoning. In most reported cases, including our patient, the clinical pathologic manifestations are not so important. The reported symptoms are chest pain, tachypnea, gastrointestinal-tract disorder and one case of bloody diarrhea. Intravenous injection causes a local endothelial damage. After embolization the mercury may remain within the pulmonary interstitium and the alveoli, where may develop in sterile abscesses and granulomatous foreign body reactions. The mercury may remain localized as a depot of elemental mercury or may be oxidized to the soluble mercuric ion and may be distributed to other body tissues and may produce chronic poisoning. This toxicity causes damages, particularly to the kidneys (glomerular-nephritis), but does not cause changes in renal function (follow-up 10 years).
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PMID:[A case of embolism caused by metallic mercury in a drug addict]. 248 39

From January 1973 through December 1979, 131 patients underwent proximal gastric vagotomy (PGV) for duodenal ulcer. There were 78 men and 53 women, whose age ranged from 19 to 73 years, with a mean age of 45 years. One hospital death occurred as a result of pulmonary embolism (0.7% mortality). There were 12 late deaths unrelated to ulcer disease, and each of the 12 patients was graded Visick I or II prior to death. Nine patients were lost to follow-up. This report is an analysis of the remaining 109 patients followed from 6 to 13 years. One hundred two patients (93.5%) underwent PGV for intractability. Seven patients (6.5%) who underwent PGV in selective circumstances for either acute perforation (3 patients), bleeding (1 patient), and moderate outlet obstruction (3 patients) are included. Follow-up results reveal that 52 patients (47%) are graded Visick I, 40 patients (36%) Visick II, five patients (5%) Visick III, and 12 patients (12%) Visick IV. Mild diarrhea occurred in 2.8% and mild dumping in 1.9%, and no reflux gastritis or esophagitis was noted. Recurrent ulceration took place in 10 patients, and seven subsequently required reoperation. Two additional patients had the antral pump mechanism denervated and later required antrectomy. PGV has yielded satisfactory results over a 6-13 year follow-up when operation was done for intractability. The low incidence of unpleasant long-term side effects is an appealing feature of the operation. A recurrent ulcer rate of 9.2% (10 patients) has, however, been of major concern. Those with a prime interest in gastric surgery are urged to continue the use of PGV in cases of intractability. Another 10 years of clinical investigative work will no doubt be necessary to determine the ultimate rate of recurrent ulceration.
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PMID:Proximal gastric vagotomy. Follow-up of 109 patients for 6-13 years. 374 Oct 1

A consecutive series of 79 patients with Cushing's disease, treated by bilateral adrenalectomy (subtotal, total initially, or total finally) between 1953 and 1980, were studied to determine the survival and mortality rates and causes of death as long as 28 years after surgery. There were three early postoperative deaths, the last in 1974, caused by coma of unknown cause, severe diarrhea, and pulmonary embolism, respectively. The actuarial survival rates at intervals of 1, 2, 3, 5, 10, 15, and 20 years after surgery were approximately 87%, 83%, 82%, 79%, 72%, 68%, and 62%, respectively. These are significantly less than the rates for the general population (p less than 0.001). There were no differences between the sexes or between the types of operation (p greater than 0.05). The commonest causes of death were cardiac or vascular lesions (11 patients) and the local effects of pituitary tumors (four patients). These long-term results of an established method of treatment provide a standard by which other, especially newer, methods may be compared.
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PMID:Survival and causes of death after adrenalectomy for Cushing's disease. 396 25

A 27-year-old male commercial diver developed massive mesenteric venous thrombosis following a dive. Symptoms at presentation included abdominal pain and diarrhea. A severe upper gastrointestinal bleed developed. Exploratory laparotomy demonstrated 130 cm of infarcted small bowel. The pathophysiologic events in decompression sickness predispose to vascular obstruction and venous infarction. This patient had a past history of possible thrombophlebitis and pulmonary embolism associated with diving but no identifiable coagulopathy.
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PMID:Mesenteric venous thrombosis as sole complication of decompression sickness. 669 39

Between October 1967 and November 1977, the jejunoileal bypass was performed on 177 patients for morbid exogenous obesity. The female--male ratio was 9:1. The mean follow-up period was 3.4 years and their ages ranged from 15 to 58 years. Eighty-five per cent of this patient population base were between the ages of 21 and 49 years, and in 83% the onset of obesity was in childhood. Four parameters were used to assess the effectiveness of this procedure: 1) the ponderal index, 2) the per cent of ideal weight, 3) complications, and 4) diarrhea. Using the ponderal index, 38% of the results were excellent, 20% satisfactory, and 25% poor. When the per cent of ideal weight was used, the results were 24, 27 and 32% respectively. For complications, the results were 55, 23 and 5% and with diarrhea, 53, 22 and 8%. A summary of these mean values was 42.5, 23 and 17.5% for excellent, satisfactory and poor results. There were four deaths in this series, occurring 2--16 months postoperatively, due to sepsis, pulmonary embolism, drug overdose, and liver failure. Of the 28 patients (17%) requiring revision, eight were revised for inadequate weight loss, four for excessive weight loss, 15 for uncontrollable diarrhea, and 11 for metabolic electrolyte problems. In 14% the revision was required for multiple indications. A review of 100 of these patients to determine their response to the procedure revealed that 91% were able to recommend the procedure to other patients and intrepreted their results as being excellent in 51%, good in 36% and fair in 11%. Continued use of this procedure should be deferred pending much needed investigation of the associated complications.
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PMID:Jejunoileal bypass. Long-term results. 740 62


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