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

We aimed to determine the prevalence of acute pulmonary embolism (APE) in our population and to establish the diagnostic reliability of pulmonary scintigraphy (PS), as well as the influence of the clinical context (CC). During a 2-year prospective study, patients were diagnosed by either pulmonary angiography or normal-perfusion PS. A diagnosis of APE was made in 73 (75%) of a total of 97 patients. In the group of 58 patients diagnosed by ventilation/perfusion (V/Q) PS, 33 were classified as "highly probably" having APE; 32 of these in fact had the syndrome (sensitivity 88%, specificity 94%). Combining the "highly probable" patients with the "highly suspected" patients diagnosed by ventilation/perfusion PS, we obtained a sensitivity of 51% and specificity of 100%. Ventilation scintigrams were unobtainable in 28 older patients with greater dyspnea and tachypnea, who were unable to perform the maneuvers. Of the 21 "highly probable" patients as assessed by PS, 19 were diagnosed as having APE (sensitivity 86%, specificity 85%). Combining the "highly probable" patients with the "highly suspected" group, we obtained a sensitivity of 32% and specificity of 100%. Normal perfusion PS excludes clinically relevant APE. "Intermediate" or "slight" probability PS results, even when combined with CC, have no diagnostic validity.
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PMID:[The gammagraphic diagnosis of acute pulmonary thromboembolism]. 798 44

We present the case of a patient with acute onset of dyspnoea after a long-distance flight. Pulmonary embolism was suspected, but could be excluded by perfusion scintigraphy. The electrocardiogram and chest X-ray were compatible with acute myocardial infarction and pulmonary oedema, but the slightness of the elevation of pulmonary capillary wedge pressure allowed cardiogenic pulmonary oedema to be excluded. The clinical picture was then interpreted as pneumonia with sepsis and hypotension. The rapid and full clinical recovery within 48 h, together with the close temporal relationship of ingestion of hydrochlorothiazide and the onset of symptoms, allowed the diagnosis of drug-induced pulmonary oedema and anaphylactoid hypotension.
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PMID:Pulmonary oedema and hypotension induced by hydrochlorothiazide. 800 Apr 16

The existence of a sheet around a single lumen dialysis catheter tip, which provokes a valve mechanism, is proved by the observation that several times during the replacement procedure of a dialysis catheter, a sheet surrounding the surface of the catheter is removed with the dialysis catheter. This sheet is grey, approximately 1 mm thick and 30 mm long and consists of fibrin and thrombocytes. Bacteriological examinations were always negative. The existence of the sheet in vivo is demonstrated by digitalized angiography during the removal procedure for single lumen dialysis catheters. Rarely, only the sheet is removed with the catheter. It all other instances, the sheet is stripped off and remains in the subcutaneous tunnel or in the vascular bed without causing much clinical discomfort in most patients. Occasionally an episode of cough, dyspnea, hypotension, retrosternal oppression or hemoptae after removing the single lumen dialysis catheter, suggest pulmonary embolism or lung infarction.
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PMID:Fibrin sheet covering subclavian or femoral dialysis catheters. 802 85

Thirty-five patients (10 men and 25 women) with a preoperative diagnosis of cardiac myxoma have undergone cardiac surgery since 1964 at the University of Louvain. The mean age of the patients was 49 (range 20-75) years. The most commonly encountered symptoms were: dyspnoea 49%; thoracic pain 26%; cough and peripheral embolism 17% each; stroke and preoperative atrial fibrillation 14% each; flutter 11%; expectoration, acute pulmonary oedema, syncope and transient ischaemic attack 6% each; and pulmonary embolism 3%. The different locations were: left atrium 66%; right atrium 26%; both atria 3%; right ventricle 3%: and retrohepatic vena cavae 3%. Septal implantation was found in 66%. Histological examination confirmed 28 myxomas but three 'tumours' were thrombi, two haemangiomas, one rhabdomyosarcoma and one liposarcoma. The follow-up has now reached 2829 months with an average of 81 months per patient (range 0-342 months). Three patients died early (9%) and there were four late deaths (11%). No cases were familial. Surgical resection is the correct treatment for cardiac myxomas and gives good long-term results.
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PMID:Cardiac myxoma. 807 15

Prevention of deep venous thrombosis is fundamental in the prevention of pulmonary embolism. Deep venous thrombosis is common after all surgical procedures, but the frequency differs, as does the effectiveness of various methods of prevention. Low-dose heparin, low molecular weight heparin, graduated compression elastic stockings, intermittent pneumatic compression, and oral anticoagulants have a role in the prevention of deep venous thrombosis, depending on the risks of deep venous thrombosis and their demonstrated effectiveness (or lack of effectiveness) in the particular circumstance. The optimal method of prophylaxis is specific to the predisposing condition. Heparin continues to be a mainstay of anticoagulant therapy. Major bleeding is rare in patients treated with low doses of heparin to prevent deep venous thrombosis. With therapeutic doses, however, major bleeding occurs in about 5% of patients. The optimal dose of warfarin and the method of evaluating the anticoagulant effect of warfarin have undergone modifications in recent years. It is now recognized that the prothrombin time ratio depends on the activity of the thromboplastin used for measuring the prothrombin time. An International Normalized Ratio, which relates to a standardized thromboplastin, has been developed, thus avoiding differences of the prothrombin time ratio that occur from batch to batch of thromboplastin reagent from the same manufacturer and that occur with different thromboplastin reagents from different animal sources and different manufacturers. The bedside diagnosis of pulmonary embolism is useful in helping a physician determine the extent to which diagnostic tests should be pursued. A sound bedside impression also contributes strongly to the formulation of a noninvasive diagnosis of pulmonary embolism. The clinical manifestations of pulmonary embolism form a recognizable constellation of findings that often lead to a correct diagnosis or exclusion of pulmonary embolism. Important clues to the diagnosis of pulmonary embolism relate to the initial syndrome. The presentation of pulmonary embolism is most often in the form of the pulmonary hemorrhage-pulmonary infarction syndrome. The next most common presentation is unexplained dyspnea, unaccompanied by pulmonary hemorrhage or infarction. Least common, but most severe, is the syndrome of circulatory collapse. Immobilization, usually caused by surgery, is the most frequent predisposing factor. Most patients with clinically recognizable pulmonary embolism have dyspnea or tachypnea. Dyspnea or tachypnea or pleuritic pain occurs in nearly all patients who have clinically apparent pulmonary embolism (97%). Ordinary tests such as the electrocardiogram and chest radiograph are helpful if the physician is attentive to nonspecific abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acute pulmonary embolism. 807

The immediate effects and long-term results are reported of thoracoscopic pleurodesis in 225 patients (158 men, 67 women) treated for persistent or recurrent spontaneous pneumothorax. The procedure was performed by combined local and neurolept analgesia with direct visual exploration of the pleural space through a rigid thoracoscope. The technique included electrocoagulation of small pleural blebs, followed by regional application of fibrin and insufflation of talc powder. The main indications were a first event which persisted more than 7 days despite chest-tube suction drainage in 27% (n = 61) or a recurrent event in 73% (n = 164). The procedure provided primary success in 96.4% of the patients. Only 8 patients (3.6%) required surgical intervention including parietal pleurectomy. Perioperative complications were pharmacologically induced respiratory failure (n = 5), generalized subcutaneous emphysema (n = 8), bleeding by cutting adhesions (n = 5) and Horner's syndrome (n = 2). However, no fatal complications occurred which could be ascribed to the procedure and all patients were discharged from the hospital after an average of 12.3 days except one who died of pulmonary embolism 5 days after thoracoscopy. Long-term follow-up over a mean period of 4.1 years revealed an ipsilateral recurrence rate of 10.2% (n = 24), 16% of the patients complained of sporadic pains at the site of insertion, 51% still had diffuse thoracic pains and 2.4% reported occasional attacks of dyspnea. Spirometric lung function tests showed normal values in 89%. The immediate and longterm results show thoracoscopic pleurodesis with fibrin and talcum to be a safe and effective method for treatment of patients with persistent or recurrent pneumothorax.
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PMID:[Thoracoscopic pleurodesis in spontaneous pneumothorax]. 811 43

The diagnosis of pulmonary embolism remains enigmatic. Points to look for are: (1) Ninety percent or more of patients with pulmonary embolism have known predisposing factors. (2) Eighty percent or more complain of dyspnea and exhibit hyperpnea (eg, respiratory rate > 20 breaths per minute). (3) Chest roentgenogram abnormalities occur in more than 80% of patients. (4) Seventy percent to 90% of patients complain of chest pain. (5) Either the pCO2 is low or the alveolar-arterial oxygen gradient is high in more than 95% of cases. (6) Twenty percent of patients have normal pO2. (7) Anxiety is present more often than not, and, if present, is no reason to dismiss the cause as "hyperventilation syndrome." Pulmonary arteriography is the "gold standard" for diagnosis, although the combination of ventilation/perfusion scan and noninvasive leg vein studies may decrease its use. An experimental test, the immunosorbent plasma D-dimer assay, seems a promising future screening tool if its reportedly high sensitivity is confirmed. Transthoracic or esophageal echocardiology, if immediately available, may have a place in assessing patients who present with cardiovascular collapse. Early and adequate heparinization coupled with the use of intravenous heparin protocols should lower future mortality rates. Food and Drug Administration approval of low-molecular-weight heparin and heparinoids may revolutionize the management of routine thromboembolism, as these substances are easier to use and less hazardous. A recent British study showed no advantage to anticoagulation beyond 4 weeks for patients with perioperative thrombophlebitis and no other risk factors. In selected cases, thrombolytic therapy, vena caval filters, and invasive embolectomy have been shown to decrease both short- and long-term mortality.
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PMID:Recent developments in the diagnosis, treatment, and prevention of pulmonary embolism. 811 86

Two patients with advanced hepatocellular carcinoma presented severe exertional dyspnea because of extension of a tumor into the right side of the heart. Removable of the tumor thrombus by open-heart surgery ameliorated the symptoms in each case, but their subsequent courses differed considerably. One patient survived for as long as 8 months thanks to successive multi-disciplinary treatments, whereas the other patient died suddenly 1 month after the surgery. The first patient's hepatocellular carcinoma was more differentiated, and the dyspnea was caused by a low cardiac output due to the intracardiac tumor mass, not by pulmonary embolism as in the second patient's case. We conclude that successive multidisciplinary treatments to control the growth of hepatocellular carcinoma is the most important approach and is indispensable for improving the prognosis.
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PMID:Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries. 813 87

We studied 196 patients with suspicion of pulmonary embolism (PE) to evaluate the role of clinical pattern, with special reference to gender and age, in raising the suspicion. Results are that clinical and instrumental patterns, although not specific for PE, may show highly frequent symptoms and signs such as dyspnea (52%), chest pain (60%), enlargement of descending pulmonary artery (49%), diaphragmatic elevation (41%), enlargement of azygos vein (46%) and hypoxia (mean value 68 +/- 13 mm Hg) that allow to suspect PE in most patients and, therefore, to recruit more patients for diagnosis. Moreover, this study shows that gender and age may only partially influence the possibility of raising the suspicion of PE. Indeed, only hemoptysis is significantly (p < 0.02) more frequent in males; only pleuritic chest pain is significantly (p < 0.02) more frequent in youngs; few instrumental findings, such as 'sausage-like' descending pulmonary artery (p < 0.001), enlargement of cardiac shadow (p < 0.01), and hypoxia (p > 0.03) are significantly more frequent in elderly patients. Finally, a characteristic clinical and instrumental pattern of PE may allow to select a subset of patients at higher risk; in fact, previous PE, prolonged immobilization (p < 0.01) and thrombophlebitis (p < 0.001), sudden dyspnea and cough (p < 0.05), 'sausage-like' descending pulmonary artery (p < 0.001), diaphragm elevation (p < 0.02), enlargement of heart shadow, pulmonary infarction and Westermark sign (p < 0.001), S-T segment depression (p < 0.001), and hypoxia (p < 0.001) are findings significantly more frequent in patients with confirmed PE.
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PMID:Gender, age and clinical signs in patients suspected of pulmonary embolism. 817 65

A 73-year-old man presented to our hospital complaining of dysuria and nocturia. The examination revealed prostatic cancer. Metastatic cancer was not revealed by the examination. He underwent total prostatectomy and iliac lymphadenectomy. Pathological examination of the surgical specimen revealed moderately differentiated adenocarcinoma of the prostate with right iliac lymph node metastasis. On the 33rd postoperative day, he suddenly developed chest pain, dyspnea, tachycardia, and tachypnea. Arterial PO2 was 62 mmHg, and chest X-ray showed right ventricular hypertrophy. Pulmonary perfusion scan revealed multiple cold areas throughout both lung fields. The diagnosis was pulmonary embolism and anti-coagulant therapy was immediately successful in resolving his symptoms. We suggest that pulmonary embolism should be considered as one of the postoperative complications of urological operations.
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PMID:[A case of pulmonary embolism following total prostatectomy]. 817 46


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