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

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.
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PMID:[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)]. 69 97

The authors report the clinical history of a 47-year-old patient hospitalised as an emergency with acute respiratory distress complicated by cardiocirculatory arrest. The diagnosis of pulmonary embolism was rapidly suspected and confirmed by emergency pulmonary angiography. A definite diagnosis enabled the early prescription of fibrinolytic treatment in situ. The interest of this case lies essentially in demonstration of the efficacy of fibrinolytic treatment which enabled the rapid restoration of a stable hemodynamic status and normalisation of angiographic appearances within a few days.
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PMID:[Thrombolysis and massive pulmonary embolism: occasionally spectacular results]. 129 89

Conventional thrombolytic therapy with streptokinase (SK) at the standard dose (loading dose, 250,000 IU; maintenance dose, 100,000 IU/h) after recent surgery may provoke a tendency towards severe bleeding secondary to plasminaemia associated with clotting disorders. In contrast, ultrahigh-dose SK therapy regimen (loading dose, 4 million IU; maintenance dose, 1-2 million IU/h) can minimize the risk of bleeding. Since the circulating plasminogen (Plg) can immediately bind to SK to form the so-called SK-Plg activator complex, free plasminogen is no longer available for conversion to systemic plasmin. In a pilot study, greater than 30 patients presenting with acute respiratory distress syndrome (ARDS) received ultrahigh-dose SK therapy following recent surgery. Although the period between surgery and thrombolysis was 2.5 days on average, no major haemorrhages occurred. In addition, a surprisingly high survival of 50% was reported. Although the efficacy of the ultrahigh-dose SK regimen in ARDS has not been definitively confirmed, this regimen is well accepted for the treatment of severe pulmonary embolism after surgery. Another promising indication for the use of this therapy is catheter-induced thrombosis of the major central veins. Additional, albeit rare, situations in which this treatment can be used include intrabronchial administration of thrombolytic agents after blood aspiration or their selective intravenous use following severe venous thrombosis in high-risk patients. This paper demonstrates the feasibility of thrombolytic therapy in these indications and discusses the benefit/risk ratio of the different agents tested.
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PMID:[Fibrinolytic therapy in surgically treated intensive care patients]. 181 12

Suction lipoplasty comprising 3511 procedures in 2009 patients was followed up prospectively for 6 to 12 months over a 5-year period. Eighty-eight percent of the procedures led to patient satisfaction and 3.4 percent led to dissatisfaction. Males were more dissatisfied than females. No mortality, deep thrombosis, pulmonary embolism, hypotension, or respiratory distress (fat emboli syndrome) was registered. Excessive bleeding and complications from anesthesia were the most common general complications. No hematoma, skin slough, or damage to adjacent organs occurred. Hypertrophic scarring and skin problems caused by external factors were the most common local complications. Only one clinical bacterial infection occurred. Three hundred and seventy-nine undesired results were registered by the 6-month follow-up, and 213 revisions because of asymmetry, underresection, or skin problems were performed. A total of 121 procedures unexpectedly required secondary suction, skin excision, or fat grafting. Forty-five sequelae were not corrected by revisions. Medial thigh, buttock, ankle, and facial suction emerged as the most difficult locations with regard to the results and complication rate. The age group 20 to 49 years emerged as the least troublesome.
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PMID:Suction lipoplasty: a report on complications, undesired results, and patient satisfaction based on 3511 procedures. 156 Dec 81

We report the case of an 82-year old male patient without history of chronic obstructive lung disease in whom a sudden respiratory distress syndrome with sibilant rales in both lungs revealed a moderately severe pulmonary embolism, later confirmed by angiography. Bronchospasm occurring in the acute phase of pulmonary embolism may be expressed as acute asthma refractory to bronchodilators. This bronchoconstriction, seldom detectable clinically, seems to be related to regional alveolar hypocapnia in the territories embolized and to platelet-produced mediators, through a vagus nerve-mediated reflex. It must not hide pulmonary embolism, particularly in a suggestive context and when bronchodilators are ineffective.
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PMID:[Bronchospasm disclosing pulmonary embolism]. 207 66

There are occasional reports in the literature concerning the incidence of pulmonary embolism in the postburn population, but reports of burned children are especially rare. The clinical diagnosis of pulmonary embolism is particularly difficult in these populations due to the postburn pulmonary complications of pneumonia, bronchopneumonia, respiratory distress syndrome, and changes incurred through inhalation injury. A retrospective review of all patient deaths occurring at this institution during the past 22 years was performed in order to document the incidence of pulmonary embolism in burned children. Of the 6589 patients admitted during this time, 178 patients died (2.7%) and three (1.7%) deaths were attributable to pulmonary embolism. Two other deaths (1.1%) were associated with deep vein thrombosis. The incidence of pulmonary embolism can then be calculated at 46 per 100,000 admissions in this population of burned children. Burned patients always pose an increased risk for the development of pulmonary embolism. These patients are traumatized, require multiple venous and/or arterial cannulations, undergo multiple surgical procedures, are immobile for prolonged periods, prone to infectious processes and fluid and electrolyte imbalances. Despite all these risk factors, the incidence of pulmonary embolism is less than 2 per cent of all deaths in this postburn paediatric population.
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PMID:Pulmonary embolism in burned children. 262 93

We studied in humans during total cardio-pulmonary by-pass the effects of positive alveolar pressure on systemic to pulmonary bronchial blood flow. Systemic to pulmonary bronchial blood flow is the entire bronchial blood flow to the lung and was measured as the volume of blood which accumulates in the left heart when there is no pulmonary flow. Systemic to pulmonary bronchial blood flow was vented by gravity via a cannula (18 French) introduced in the upper superior pulmonary vein and advanced into the lower most portion of the left heart. In Group A (10 patients) systemic to pulmonary bronchial blood flow was measured with alveolar pressure constant at 4.0 +/- 0.4 cm H2O for 53.5 +/- 6.2 min (range 25 to 95 min), and ranged between 0.32 and 2.76% of cardiac output (pump flow) remaining constant with time. In Group B (10 patients) systemic to pulmonary bronchial blood flow was measured for 2 periods of 20 min each with alveolar pressure equal 4.1 +/- 0.2 and 14.1 +/- 0.4 cm H2O respectively. The increase of alveolar pressure reduced systemic to pulmonary bronchial blood flow by almost 40%. The reduction of systemic to pulmonary bronchial blood flow we observed may be deleterious for the survival of the lung parenchyma particularly in some circumstances. This is the case of pulmonary embolism, when bronchial blood flow is the major source of blood to the lung parenchyma and serves to prevent pulmonary infarction, or the case of acute respiratory distress syndrome, when pulmonary flow is compromised and systemic to pulmonary bronchial blood flow increases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Positive alveolar pressure reduces bronchial systemic-to-pulmonary blood flow in man]. 267 71

Pulmonary embolism following postoperative deep venous thrombosis is a very serious complication with a high mortality rate. Though this disorder has been thought to be rare in Japanese, its occurrence seems to be increasing recently because of changes in eating habits, increase of average age and the frequent practice of venous catheterization. Two cases of the pulmonary embolism following deep venous thrombosis after surgery are reported, and possible causes of the deep venous thrombosis are discussed. Case 1: A 48 year-old obese female was operated on for a posterior fossa dural arteriovenous malformation. On the 4th postoperative day, she developed a pain and swelling in the left leg and low back pain. On the 18th postoperative day, she fell into a state of shock following the sudden onset of a severe back pain and respiratory distress. After diagnosis of the pulmonary embolism, she was immediately treated with urokinase, warfarin and aspirin. Her obesity was considered to be one of the risk factors of the postoperative deep venous thrombosis. Case 2: A 62 year-old female with a ruptured cerebral aneurysm could not get out of bed because of postoperative mental disturbance. A central venous pressure catheter was inserted into the right femoral vein for two weeks postoperatively. One month after surgery, she complained of swelling and a dull pain in the right leg without cardiorespiratory symptoms. Lung perfusion scintigraphy showed asymptomatic pulmonary embolism. She was treated immediately. Both long bed rest and femoral venous catheterization were considered as risk factors possibly leading to deep venous thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative pulmonary embolism in neurosurgical practice: report of two cases]. 321 Dec 80

Respiratory diseases are the most heavy complications that we can meat in self-poisoning persons. Authors report 15 cases of respiratory complications appeared in 824 self-poisoning cases by drugs. Different factors involved in respiratory diseases origin are analysed but only one appears to be significant: the time between poisoning and admission in intensive care unit. The encountered complications are: acute respiratory distress syndrome, Mendelson syndrome, heavy pulmonary infections, pulmonary embolism. Authors argue about the means of prevention. This seems the fundamental aspect, alone capable to decrease the incidence of very heavy complications responsible of a height mortality range (33%).
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PMID:[Severe respiratory complications in acute voluntary drug poisoning. Apropos of 15 cases in 824 poisoning cases]. 668 85

Quantitative deficiency of surfactant in neonates results in hyaline membrane disease. Although surfactant is also required for normal gas exchange in adults, no disorders have been clearly attributable to a deficient amount of surfactant. Based on studies in our laboratories as well as on information and ideas in the literature, we suggest that a physical alteration in surfactant may lead to, or contribute to, the development of some forms of "adult" respiratory distress syndrome." In particular, we suggest that an altered breathing pattern contributes to the alveolar collapse and liver-like appearance of the lung found in certain clinical entities, i.e., pulmonary embolism and oxygen toxicity. We hypothesize that in these conditions shallow breathing leads to the aggregation of surfactant into a less functional form resulting in increased alveolar surface tension and atelectasis. The increase in surface tension would also contribute to the edema found in these conditions.
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PMID:A hypothesis relating breathing pattern to some forms of the "adult respiratory distress syndrome". 689 77


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