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

Two new cases of popliteal venous aneurysm are reported and added to the 22 other cases of popliteal venous aneurysm available for review. Both patients were first seen with acute pulmonary embolism and were treated with thrombolytic therapy followed by anticoagulation. Each had recurrent venous thromboembolism before discovery of the popliteal venous aneurysm. One popliteal venous aneurysm was diagnosed with phlebography and the second with venous duplex imaging, confirmed with phlebography. Both were surgically corrected with tangential aneurysmectomy and lateral venorrhaphy. Twenty-four cases of popliteal venous aneurysm are now available for review. Seventy-one percent (17 of 24) presented with pulmonary embolism, 88% (21 of 24) were saccular, and 96% (23 of 24) were located in the proximal popliteal vein. All but two were diagnosed by ascending phlebography. Three patients received no treatment: in two of these the outcome was not documented and the third had occasional pain. Two patients received anticoagulation without subsequent operative repair and both died of recurrent pulmonary emboli. Operative correction resulted in a 75% patency rate with 21% complications, most of which were related to postoperative anticoagulation. No patient who was operated on had subsequent pulmonary embolism, and there were no operative deaths. We suggest that all patients who have pulmonary embolism have lower-extremity venous duplex imaging. All popliteal venous aneurysms should be surgically repaired, inasmuch as nonoperative therapy results in recurrent thromboembolism and an unacceptably high mortality rate. Tangential aneurysmectomy with lateral venorrhaphy is the recommended procedure.
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PMID:Popliteal venous aneurysm: report of two cases and review of the world literature. 841 79

Deep vein thrombosis (DVT) is a ubiquitous process that in the acute setting can lead to pulmonary embolism. Chronically, permanent changes that develop within the venous system following an episode of DVT can produce the postphlebitic syndrome, which is associated with pain, swelling, and ulceration. The postphlebitis syndrome can often mimic acute DVT or coexist with it. The clinical evaluation of DVT is ineffective and necessitates a reliable noninvasive diagnostic technique. Compression ultrasound (US) has proved to be the diagnostic method of choice for detection of extremity clot. Femoral and popliteal veins are routinely evaluated for acute clot, but uncertainty exists concerning the need to evaluate the calf veins similarly. US also can be used to diagnose chronic venous changes, which are indicated by the presence of incompetent valves and retrograde blood flow. Upper-extremity venous thrombosis, often induced by indwelling catheters, can also be diagnosed with US.
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PMID:Venous thromboembolic disease: the role of US. 843 Jan 64

The present article analyzes the indications for sphincterotomy in the Surgical Department of the University of Murcia, postoperative morbidity and mortality and the long term clinical situation of the patient after a follow-up period averaging 5.8 years. During a ten year period, a total of 2,610 patients underwent operation for biliary lithiasis, with exploratory choledochotomy indicated in 591 (22.6 percent). Surgical exploration of the bile duct finished with sphincterotomy in 135 (22.9 percent); 52 percent of these patients were less than 60 years old. The most frequent preoperative diagnosis was choledocholithiasis (33.3 percent) and cholelithiasis with crises of acute pancreatitis (30.3 percent). If we divide the ten years of the study into two five year periods, we noted a statistically significant decrease (p < 0.001) in the percentage of sphincterotomies compared with the number of choledochotomies performed during the second period. The rate of intra-abdominal complications was 5.1 percent; four intra-abdominal abscesses, one hemorrhaging at the level of the sphincterotomy and two instances of postoperative pancreatitis. Mortality in the series was 1.4 percent (two patients)--one with postoperative pancreatitis that developed torpidly and one with pulmonary embolism. Six years after the operation, 72.9 percent of the patients are still asymptomatic and the remaining patients have some type of symptoms--15.8 percent presented with dyspeptic syndrome; 2.0 percent had crises of colicky pain, and 5.9 percent required hospital admission for cholangitis. All of the patients with symptoms underwent endoscopy and ultrasonographic exploration of the bile duct. There were no pathologic findings in the biliary tree of patients who had dyspeptic syndrome or colicky pain, and all of the patients with cholangitis had a papillary stenosis and required endoscopic sphincterotomy or reoperation.
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PMID:Long term results of surgical sphincterotomy in the treatment of choledocholithiasis. 843 96

Acute arterial occlusions of the extremities present with the classical five P's: pain, pallor, pulselessness, paresthesia, paresis. Loss of sensitivity and motility are symptoms of the most severe grade of ischemia. The occlusions are due to embolism in about 70% of subjects and to local thrombosis in 30%. These patients have to be treated immediately with heparin. In the mildest forms, deobliteration is desirable, but in the more severe cases rapid restoration of flow not only saves limbs but also life. Deobliteration may be performed surgically or by means of catheters (local thrombolysis or thrombus aspiration) if available. Deep vein thrombosis, the other kind of emergency situation, requires immediate anticoagulation as soon as pulmonary embolism is suspected. It should be initiated by heparin and followed by oral anticoagulation. In patients presenting without pulmonary embolism but a swollen leg, ruptured Baker cysts or muscle hematomas should be ruled out before anticoagulation is started. Systemic thrombolysis or surgical thrombectomy is reserved for young patients with acute isolated thromboses. Thrombectomy must also be kept in reserve for the most severe form of deep venous thromboses, the phlegmasia cerulea dolens. In thrombophlebitis, no anticoagulation is indicated except in bedridden patients. The others must remain mobile and may be treated by systemic and local antiinflammatory drugs, incision of thrombosed varices, and bandages.
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PMID:[Emergencies in angiology]. 849 73

A 58 year old woman was admitted to this hospital because of retrosternal pain followed by dyspnea which developed a few hours prior to admission, and two week history of progressive intolerance of physical effort. Echocardiography was done which revealed enlarged cavity of the right atrium (59 x 54 mm) and right ventricle (46 mm) of the heart. (Scintigraphy showed numerous triangular lung zones of sharply decreased or completely absent perfusion. After the diagnosis of recurrent pulmonary embolism, the patient was treated with intravenous heparin at a dosage of 25000 a day for 10 days. Dyspnea settled within 48 hours of starting heparin, analysis of arterial blood gases became normal and the general condition of the patient improved. A repeated echocardigram showed a significantly reduced dilatation of the right atrium from 59 x 45 mm to 47 x 43 mm and decreased pulmonary hypertension from 110 mmHg, on admission, to 65 mmHg.
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PMID:[Echocardiography in the diagnosis and therapy of pulmonary embolism]. 864 77

The purpose of this study was to determine if any differences existed in the early complication rate, short term clinical outcome, and total length of hospital stay between patients who had bilateral total hip arthroplasty performed under a single anesthetic (during 1 patient visit to the operating room) and patients who had the procedure performed under 2 anesthetics (during 2 patient visits to the operating room). Patients operated on bilaterally were divided into 3 groups: Group A (1 stage procedure)--hips that were operated on simultaneously (128 hips); Group B (2 stage procedure)--surgeries performed less than 6 weeks apart (126 hips); and Group C (2 stage procedure)--surgeries performed between 6 weeks and 6 months apart (256 hips). All patients were evaluated after an average followup of 1.5 years. There were no differences in operative, early local, or general complications among the 3 groups. In particular, no higher incidence of pulmonary embolism or deep vein thrombosis was found in the 1 stage group. Preoperatively, very stiff hips (total range of motion < 50 degrees) gained significantly more motion in the 1 stage group than in the 2 stage groups, whereas hips with better preoperative motion (total range of motion > 50 degrees) improved the most in Group B, without a significant difference occurring between Groups A and C. The degree of pain reduction was the same in all groups, but patients in the 1 stage group had a significantly better capacity for walking after their procedure. Average total hospital stay was 5 to 6 days less for the patients in Group A than those in the other groups, which, combined with using the operating room only once, resulted in a reduction of overall hospital costs by more than 30% when using the 1 stage procedure.
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PMID:Bilateral total hip arthroplasty: one stage versus two stage procedure. 865 43

The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
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PMID:Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia. 873 85

Pulmonary embolism has protean manifestations. This report describes a 20-year-old woman without risk factors with pulmonary embolism presenting as abdominal pain. Previous cases and potential etiologies of pain are reviewed.
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PMID:Pulmonary embolism presenting as acute abdominal pain. 888 8

Between January 1991 and June 1995 we have operated on 19 patients (9 male, 10 female) with 22 skeletal metastases of the lower limb (19 femora, 3 tibiae) using a static interlocking nail. Closed intramedullary nailing without resection of the metastasis has been established as our standard procedure. We have stabilized 15 patients with advanced osteolysis and seven pathological fractures. Sixteen patients underwent postoperative local radiation therapy with 40 Gy. As intraoperative complications we have observed one fracture of an osteolysis and one death due to fat embolism. Postoperatively there were observed one seroma, one haematoma and one patient with non fatal pulmonary embolism following DVT. Two patients died within the first 30 postoperative days because of tumor progression. All patients surviving longer than 30 days could be mobilized under full weight-bearing. Morphine like analgetics for metastasis related pain were no longer needed. A secondary instability has not been observed within a mean survival time of 199 days (811 longest follow up). Closed intramedullary nailing in combination with postoperative local radiation therapy seems to be an appropriate and technically non demanding procedure to stabilize skeletal metastases of the lower limb in patients with a short or medium-term expectation of life.
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PMID:[Surgical management of bone metastases of the lower extremity with AO interlocking nail]. 902 56

Percutaneous vertebroplasty is a technique of interventional radiology, which allows to fulfill pathologic vertebral body with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in some diseases involving the vertebra. Main indications are spine angiomas, metastases and osteoporosis. The vertebroplasty is realised under neuroleptanalgesia for cervical spine antero lateral way is used. For thoracic or lumbar vertebra, the way of approach is usually transpedicular; but in some cases, this approach is not possible: osteolysis of the pedicle, surgical osteosynthesis; in such cases, a postero lateral approach is realized. Technical incidents are not rare, but are usually asymptomatic. More frequent are venous filling with cement; the veins involved can be intra spinal (vertebral plexus) or paraspinal. Instead of this frequency pulmonary embolism in direct relation with the vertebroplasty where not reported. Extravasation in intervertebral disk or soft tissue can also be observed. This last incident can be in relation with the way of the needle or with a cortical rupture. Local complications are rare: rate of neurological deficit or infection is under 0.5%. Radicular pain is observed in 3.7% of cases. These complications are in close relation with the radiological involvement of the vertebra: cortical disruption, heterogeneous Lysis of the vertebral body. The frequency of complications is 1.3% in osteoporosis, 2.5% in spine angiomas and 10% in metastatic disease. Indications concern lesion involving the vertebral body: symptomatic spine angiomas; painful osteoporotic fractures after medical treatment or in patients with a high risk of decubitus complications; in metastatic disease, vertebroplasty is a way to consolidate the vertebral body and release pain. It can be usefull in recurrent pain after chemotherapy and/or radiotherapy, and also in unstable vertebra to obtain a stabilization before radiotherapic or chemotherapic treatment isolated or in combination with surgical osteosynthesis.
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PMID:[Percutaneous vertebral surgery. Technics and indications]. 930 44


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