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

Pulmonary emboli seldom recur, and when recurrence does occur it is not associated with permanent sequelae unless there is progressive pulmonary arterial hypertension. Five patients with clinical and perfusion lung scan evidence of recurrent pulmonary embolism presented with abnormal cardiac rhythms without evidence of progressive pulmonary hypertension. Twenty-four-hour ambulatory electrocardiographic monitoring was valuable in diagnosis and in assessing the effectiveness of treatment. Although palpitation was the main complaint, other symptoms included tiredness, mild exertional dyspnoea, and chest discomfort unrelated to effort. Symptomatic improvement coincided with objective evidence of improvement from repeat lung scans and 24-hour ECG records. Antiarrhythmic agents controlled the arrhythmias but were subsequently withdrawn without the return of symptoms. Four of the five patients continued to take anticoagulants for two years. We believe that these five patients represent a group of patients with recurrent pulmonary emboli and a recognisable clinical picture dominated by arrhythmias unrelated to progressive pulmonary arterial hypertension. Long-term anticoagulant treatment was associated with clinical improvement.
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PMID:Recurrent pulmonary thromboembolism presenting with cardiac arrhythmias. 48 14

A ventilation agent that provides good quality lung images, which is cheap, easy to use and non-toxic, with a low radiation dose, has long been sought. Technegas, an ultrafine aerosol of technetium-99m-labelled carbon, was developed with these qualities in mind. We have studied Technegas in a clinical setting to evaluate some of these qualities. Twenty-five patients referred with a diagnosis of suspected pulmonary embolism were investigated during the same study using both krypton-81 m and Technegas as ventilation agents in conjunction with 99mTc-macroaggregated albumin as a perfusion agent. Technegas provided images which were of satisfactory quality. Images were obtained relatively easily and without discomfort to the patient, and Technegas has the advantage of always being available. A semi-quantitative regional assessment was employed which showed a good correlation (r = 0.499, P less than 0.001) between Technegas and krypton-81 m ventilation. We report on an effect not previously found to be significant, that is lung regions were better ventilated with Technegas than with krypton-81 m. This altered the diagnostic probability rating of pulmonary embolism in a number of patients (n = 3, 12%) compared with krypton-81 m. This effect was also noted in a further 8 patients (32%) without a change in the diagnostic probability. We offer possible explanations for this phenomenon.
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PMID:An evaluation of Technegas as a ventilation agent compared with krypton-81 m in the scintigraphic diagnosis of pulmonary embolism. 838 22

Venous thrombosis and pulmonary embolism are closely related disorders. As many as 70 to 80% of patients with pulmonary embolism have associated proximal deep venous thrombosis. The clinical diagnosis alone of both venous thrombosis and pulmonary embolism is inaccurate because of the insensitivity and nonspecificity of findings, a problem that also occurs with a variety of other disorders. Invasive, objective tests are still the reference standard, but they are not always easy to perform, they cannot be used for a considerable number of very ill patients, and they create some patient discomfort. There is an increasing trend toward using noninvasive methods, either alone or in combination. These methods entail less risk, can be performed more quickly and conveniently, and are usually more cost-effective. Practical approaches to diagnosing venous thrombosis and pulmonary embolism in the clinical setting are discussed.
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PMID:Diagnosis of venous thrombosis and pulmonary embolism. 230 Dec 72

The records of 6 patients undergoing pulmonary embolectomy for massive pulmonary embolism (MPE) at Kurume University Hospital during 17 years were reviewed to determine the management of surgery. The patients consisted of 2 men and 4 women. The patients' ages ranged from 29 to 68 years (mean age, 49.3 years). The records showed that one patient died of brain death after operation and the others survived. All the patients complained of chest pain, anterior chest discomfort and dyspnea. Sudden syncope was observed in 2 patients. Artificial mechanical ventilation was performed preoperatively on 3 patients. Right ventricular load was demonstrated on electrocardiograms and ultrasonograms. Pulmonary angiograms were attempted on two patients and one of them had cardiac arrest during this examination. MPE was suspected by perfusion defect of 50% to 80% of pulmonary vasculature demonstrated on lung perfusion scintigram in 4 patients. Open pulmonary embolectomy with cardiopulmonary bypass (CPB) was performed on all patients using crystalloid cardioplegia and topical cooling. Intraoperative pulmonary angiograms were performed in 4 patients to prevent residual thromboemboli. Since most thromboemboli originate below the level of the vena cava, acute double ligation of the vena cava just below the renal vein was performed to control recurrent embolism. Oral anticoagulant, warfarin, was administered for 3 months after embolectomy as prophylaxis against postoperative recurrent embolism. It is our opinion that an aggressive attitude toward pulmonary embolectomy on CPB is necessary to save lives of MPE patients. This surgical procedure is very easy and safe.
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PMID:[Surgical treatment of massive pulmonary embolism--the time of the operation and its effectiveness]. 237 90

A 78-year-old woman, suffering from acute massive pulmonary embolism, was successfully treated with transvenous pulmonary embolectomy by catheter. This patient had been suffering from oppressive chest sensations during exercise, and diagnosed and treated as angina pectoris at a nearby clinic. She consulted our hospital complaining that her chest pains were increasing in frequency. She was admitted to our hospital on July 7, 1988, for coronary angiography (CAG), which she underwent on July 8 by the right femoral approach. After the CAG, she was ordered to rest in bed overnight, with the right inguinal region compressed. 18 hours later, the compression was removed and she was allowed to walk. Soon after she walked to the toilet, she complained of chest discomfort and fell into shock (systolic blood pressure was 60 mmHg). An ECG examination showed a right bundle branch block and an inverted T wave in lead V1-3. An echocardiography showed normal contraction of the left ventricle, but an enlargement of the right ventricle and a flattened interventricular septum. An analysis of arterial blood gas showed hypoxia (Pao2 52.5 mmHg, Paco2, 30.9 mmHg). Acute pulmonary embolism was suspected. 240,000 units of urokinase were administered intravenously, and pulmonary angiography was performed immediately. It revealed that the bilateral pulmonary arteries were almost completely obstructed. Although 720,000 units of urokinase were infused into the pulmonary artery, the obstruction did not improve. At that time, we performed a transvenous pulmonary embolectomy. We used a Judkins R 4 guiding catheter for PTCA made by USCI. The catheter was inserted into the pulmonary artery and clots were aspirated with a syringe.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of acute massive pulmonary embolism successfully treated with transvenous pulmonary embolectomy by catheter]. 261 14

To evaluate the long-term effects of "conservative" management (heparin initially then Coumadin for 3 months) on patients with axillary vein thrombosis, the authors studied 20 patients (average age 44 years) who presented at the Wellesley Hospital in Toronto between 1975 and 1984. The diagnosis of axillary vein thrombosis was made from history, findings on physical examination and Doppler studies. In 12 patients, the diagnosis was confirmed by venography. Three patients subsequently underwent a first-rib resection for thoracic outlet syndrome. The average follow-up was 42 months. The cause of the thrombosis in 3 patients was an intravenous-line catheter, in 7 it was effort thrombosis and in 10 the cause was unknown. Two patients had had a previous deep venous thrombosis in the lower limb. Results of conservative treatment showed that only five patients had residual minimal swelling and two had minor discomfort. These symptoms did not interfere with either leisure or work activities in any of the patients. Fifteen patients were asymptomatic. One patient had nonfatal pulmonary embolism. The conservative management of axillary vein thrombosis is safe, effective, relatively inexpensive and gives excellent long-term results. The prognosis is good, irrespective of the cause of the thrombosis and, in view of this, a more aggressive approach, using either streptokinase therapy or thrombectomy, does not appear to be justified.
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PMID:Consequences of "conservative" conventional management of axillary vein thrombosis. 358 Sep 73

Lung perfusion scintigraphy can make arterial embolic obstruction visible because the uptake of microspheres labelled with 99mTc is lower than normal in the corresponding lobes, segments or subsegments. The sensitivity for pulmonary embolism is high (up to 98%). The specificity of a positive finding increases with additional investigations: infiltrative and space occupying lesions can be seen on the chest X-ray, and broncho-obstructive diseases with concomitant perfusion defects can be identified with the help of ventilation scintigraphy using 133Xe. In view of its high sensitivity and specificity, its low cost, low risk with practically no discomfort for the patient, and standardized techniques not dependent on the skill of the examiner, lung scintigraphy can replace pulmonary angiography in nearly all circumstances. It should be noted, however, that late sequelae--after thrombolysis and recanalization have taken place and when atelectases or pneumonia may dominate--may blur the scintigraphy findings. Thus, patients must be sent for lung scintigraphy as soon as suspicion of pulmonary embolism arises.
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PMID:[Nuclear medical diagnosis of pulmonary embolism]. 652 99

The clinical diagnosis of acute deep vein thrombosis (DVT) is but 50% accurate when compared to the results of contrast venography. This clinical inaccuracy had led to the dependence of the physician upon laboratory diagnosis. Whereas contrast venography is the gold standard of diagnosis, its expense, special equipment, personnel, and discomfort make it unsuitable for evaluating large numbers of patients. For this reason, numerous noninvasive tests utilizing plethysmographic and Doppler techniques have been developed to evaluate patients with suspected venous disease, and when expertly performed have a degree of accuracy of approximately 90%. This degree of accuracy coincides with the experience of our peripheral vascular laboratory using the Doppler venous examination. Based on these statistics, our current practice is to evaluate patients suspected of having DVT with a Doppler venous examination (Figure 1). If the test is abnormal or equivocal, contrast venography is usually obtained and anticoagulation recommended. Contrariwise, if the Doppler venous examination is normal, venography is not obtained, and anticoagulation treatment is not recommended. This practice should reduce the number of venograms in a patient population that is not at an increased risk of pulmonary embolism or repeated deep venous thrombosis. To evaluate the validity and safety of this practice, one hundred eighty-six patients with normal Doppler venous examinations in whom contrast venography was not obtained were evaluated and form the basis of this report.
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PMID:The normal Doppler venous examination. 683 18

Pulmonary embolism is a rare problem in the pediatric age group. As in adults, symptoms include tachypnea, chest discomfort, and hypoxia, but the index of suspicion in making this diagnosis in children is low. This report confirms the usefulness of two-dimensional and Doppler echocardiography in the diagnosis of pulmonary embolism, regardless of patient age. Causes of hypercoagulable states in children are also briefly discussed.
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PMID:Echocardiographic diagnosis of pulmonary embolism in childhood. 771 Jul 42

The Greenfield vena cava filter is an established therapeutic option in the prevention of pulmonary embolism. The development of a 12 French modified titanium Greenfield filter (TGF) has made it possible to insert the filter percutaneously and to have a low complication rate. We report our initial experience with percutaneous insertion of the 12-French titanium Greenfield vena cava filter for 6 patients who all had major extensive deep venous thrombosis (DVT) and contraindications to anticoagulation. The inferior vena cava (IVC) filters were inserted in all the 6 patients via the internal jugular route without difficulty. There was no bruising, haematoma or bleeding complications despite the use of the 12 French system. The IVC filter was opened without cross-snaring of the filter legs in all 6 patients. This was confirmed with cranio-caudal, left anterior oblique and right anterior oblique views of the deployed filter. There was however some asymmetry of the filter leg positions but it did not cause any significant angulation of the filter in relation to the IVC. The IVC filters were firmly secured with no filter migration immediately post-procedure. The 12-French titanium Greenfield vena cava filter was safely deployed percutaneously with no complications in our small series of patients. With the use of titanium in the design of Greenfield filter, the clinical effectiveness and performance is maintained while providing for easier insertion and reduction of patient discomfort.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The new titanium Greenfield vena cava filter: initial experience and review. 776 90


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