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

Technetium-99m Pseudogas is an ultrafine near monodisperse aerosol of 0.12-microgram diam particle size. This report describes initial clinical experiences with 27 patients referred for investigation of suspected pulmonary embolism, and in whom Pseudogas ventilation images were compared with a high quality commercial aerosol. An additional group of ten patients with severe COPD was examined in a comparative trial of Pseudogas with 81mKr. Pseudogas was better than a conventional aerosol in reaching a diagnosis of pulmonary embolism using a simple blinded comparison with coded images. In addition, bronchial deposition was minimal unless COPD was severe. Moderately well patients had no difficulty inhaling the necessary activity in one or two breaths, and even severely ill and frail aged persons could accomplish the passive breathing maneuver in less than a minute. Clearance of Pseudogas was directly to the systemic circulation with a half-time of 10 min in normal subjects extending up to 100 min in patients with airways disease.
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PMID:Lung ventilation studies with technetium-99m Pseudogas. 371 96

Diagnostic difficulties occur in pulmonary embolism (PE) during visual analysis of ventilation-perfusion images in matched defects or in chronic obstructive lung disease (COPD). In 44 patients with angiographically confirmed PE and in 40 patients with COPD, the regional ventilation-perfusion ratios (V/Q) were therefore computed using krypton-81m for each perfusion defect, and were displayed in a functional image. In patients with PE and mismatched defects, a high V/Q (1.96) was observed. A V/Q greater than 1.25 was also found in nine of 11 patients having PE and indeterminate studies (studies with perfusion abnormalities matched by radiographic abnormalities). COPD was characterized by matched defects and low V/Q. The percentage of patients correctly classified as having PE or COPD increased from 56% when considering the match or mismatched character to 88% when based on a V/Q of 1.25 in the region of the perfusion defect. This quantitative analysis, therefore, seems useful in classifying patients with scintigraphic suspicion of PE.
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PMID:Computation of ventilation-perfusion ratio with Kr-81m in pulmonary embolism. 623 3

It is often difficult to distinguish pulmonary embolism from worsening underlying disease in the setting of severe chronic obstructive lung disease. We describe three patients with severe COPD and angiographically documented pulmonary embolus to stress that standard clinical and radioisotopic studies were of little value in establishing a diagnosis. All patients had acute increases in alveolar ventilation immediately following the embolus with a reduction in previously elevated levels of PaCO2, as well as hypoxemia. Such changes in arterial blood gases in the patient with severe COPD should suggest pulmonary embolus rather than increased obstruction.
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PMID:Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma. 677 64

Pulmonary nuclear medicine dates back to Knipping and West in the late 1950's but practically starts with the successful production of 131I-MAA by GV Taplin in 1963. Not only is the diagnosis of pulmonary embolism greatly facilitated by using 131I-MAA but also studies of regional lung function have made rapid progress. Radioactive gas and aerosol inhalation have been used to study ventilation distribution in the lungs. Using nuclear medicine technology regional hypoxic vasoconstriction was found to play a great role in regulating regional perfusion distribution in the lungs. Ventilation and perfusion mismatch and match indicate organic lung diseases and pulmonary vascular diseases, respectively. Aerosol deposition patterns in the lungs are helpful in the differential diagnosis of chronic obstructive lung diseases (COPD). Technigas is an ultrafine aerosol which is probably more useful for ventilation studies than conventional aerosols produced by either a jet or an ultrasonic nebulizer. Besides respiratory lung function pulmonary nuclear medicine techniques have made it possible to study nonrespiratory lung function. One is mucociliary clearance mechanisms. They can be studied by using a nonabsorbable aerosol like 99mTc-albumin. Dynamic mucociliary clearance function can be visualized in vivo by radioaerosol inhalation lung cine-scintigraphy. Four abnormal mucociliary transport patterns were discernible in COPD. An objective evaluation of a drug effect on mucociliary transport is feasible. Detailed quantitative analysis of mucociliary clearance is also possible by computer techniques. Pulmonary epithelial permeability is studied following inhalation of 99mTc-DTPA aerosol. Inhaled 99mTc-DTPA disappears from the lungs more rapidly in smokers and patients with interstitial lung diseases. Nuclear medicine has great potential to elucidate other functions of the lung which are still not defined yet by the present knowledge of lung function.
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PMID:[Pulmonary nuclear medicine]. 855 98

Measuring of the rate of radioactivity decrease of inhaled 99mTc-DTPA aerosol may detect disorders of alveocapillary membrane integrity. The study included 21 patients (11 non-smokers and 10 smokers) suffering from different pulmonary diseases (pulmonary embolism - PE; chronic obstructive pulmonary disease - COPD; pneumonia - PN; occupational diseases - OD) in order to detect disorders of pulmonary epithelial permeability (PEP) and 2 healthy individuals (non-smokers) with normal findings (NF). DTPA was labelled using the standard procedure with 1480 MBq 99mTc in 1 ml of physiologic saline. Patients with nasal obstruction inhaled aerosol for 2.5 min. particle size 0.8 micron produced in a nebulizer connected to O2. After that gamma scintillation camera and computer were used for data acquiring in dynamic mode. After that ventilation and perfusion scintigraphy of the lungs was performed in four standard projections. Data processing was conducted with ROI drawing after both lungs on the added image. Clearance value was expressed in T1/2 (min), while the curves had monoexponential shape in all patients. In the non-smoking group mean clearance value for both lungs in patients suffering from PE, COPD and PN did not differ from NF. Clearance in the part of the lungs affected with disease (pneumonia, embolism) was faster than in healthy pulmonary tissue. In sick smokers, however, mean pulmonary clearance value was higher than in non-smokers, irrespective of the type of disease. Pulmonary clearance in individuals suffering from occupational diseases was also accelerated, irrespective of the fact whether the patients smoked or not.
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PMID:Application of 99mTc-DTPA aerosol in evaluation of pulmonary epithelial permeability. 856 98

The epidemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculotic drugs led to a renaissance of surgical procedure such as plombage thoracoplasty, initiated in 1891 by Tuffier. Especially in Germany the insertion of paraffin and polyethylene was used in order to achieve an extrapleural pneumothorax in order to collapse the tuberculous cavities in the upper lobes. Due to a high rate of early complications and the assumed cancerogenicity, in a considerable number of cases the material was removed soon after its deployment. In some cases with the filling remaining in place, 30-40 years later infections and/or neoplasms occurred. From 1985 to 1996 in two centers of thoracic surgery 13 patients underwent procedures for removal of filling material. The patients suffered from infections (n = 11), malignant lymphoma associated with infection of the plombage (n = 1) and bronchial carcinoma (n = 1). Technically, we performed the thoracoplasty described by Schede (n = 9). Schede's thoracoplasty in combination with a muscle flap repair (n = 1) or partial resection of the thoracic wall (n = 1), an empyemectomy (n = 1), and an en-bloc pleuropneumonectomy (n = 1). All patients suffered from multiple underlying diseases (COPD, coronary heart disease, diabetes mellitus). However, apart from beside two procedure related deaths (pulmonary embolism n = 1, pneumonia complicated by multi-organ failure n = 1) no other major complications were observed. The plombage material in the case of malignant lymphoma is probably carcinogenic in relation to the time of exposure and should be removed in all cases.
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PMID:[Delayed complications after extrapleural pneumonolysis for lung tuberculosis]. 941 Jun 83

Diagnosing pulmonary embolism (PE) we can use many investigations. We are presenting analysis of pulmonary artery investigations performed using spiral CT during 18 months in the J. Jonston hospital in Lubin. There were 38 PE cases diagnosed. They were complicating following states: surgical intervention, lower limbs profound thrombophlebitis, COPD, chronic circulatory insufficiency, neoplastic disease, oral contraceptive drugs and unknown. PE affected 0.1% surgical departments patients (that means 0.2% subjected to operation), and 0.4% internal diseases departments patients. 16 cases, i.e. 42% were connected with operative procedures. The largest group of internal medicine departments patients with PE were those suffering from severe chronic airway obstruction (9 cases per 27), chronic circulatory insufficiency (3 per 27), lower limbs profound thrombophlebitis (4 per 27). This data shows, as important problem is PE differential diagnostics of patients suffering from severe internal diseases especially and an important role of spiral computer tomography in it.
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PMID:[Diagnosis of pulmonary embolism in the age of spiral computed tomography ]. 1236 63

COPD is often accompanied with acute symptoms exacerbations. Patients in Ist stage: slide grade of COPD and IInd stage: middle grade of COPD suffer exacerbations accompanied with increased dyspnoea often together with increased cough and increased production of sputum. Patients in IIIrd stage (serious) and IVth stage (very serious) experience during exacerbations development of respiration insufficiency or its worsening and thus are usually treated in hospital. The most frequent causes of exacerbations are tracheobronchial tree infections and air pollution. The cause of approximately one third of serious exacerbations is not disclosed. Conditions which can resemble acute exacerbation are pneumonia, congestive heart failure, pneumothorax, pleural exudation, pulmonary embolism, and arrhythmia. Exacerbation treatment is symptomatic. Obstruction symptoms are treated with bronchodilatants and corticosteroids administration, hypoxemia with oxygen administration and signs of bacterial infection with antibiotics.
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PMID:[Treatment principle of the chronic obstructive pulmonary disease (COPD) exacerbation]. 1558 Sep 1

Dyspnea is an alarming symptom for both the patient and the emergency physician. There are many causes of dyspnea, some of which are life-threatening, especially in the elderly patient. In addition to the usual cardiac and pulmonary causes such as congestive heart failure, asthma exacerbation, COPD, pneumonia, and pulmonary embolism, there are less common causes of dyspnea, which if not diagnosed and managed expeditiously may have dire consequences for both the patient and physician. We present a case of an elderly patient with a life-threatening unusual cause of acute shortness of breath, a diaphragmatic hernia with sepsis.
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PMID:An unusual cause of dyspnea. 1679 52

The introduction and acceptance of a standard definition for exacerbations of COPD can be helpful in prompt diagnosis and management of these events. The latest GOLD executive committee recognised this necessity and it has now included a definition of exacerbation in the guidelines for COPD which is an important step forward in the management of the disease. This definition is pragmatic and compromises the different approaches for exacerbation. However, the inclusion of the "healthcare utilisation" approach (".. may warrant a change in regular medication") in the definition may introduce in the diagnosis of exacerbation factors related to the access to health care services which may not be related to the underlying pathophysiological process which characterizes exacerbations. It should be also noted that the aetiology of COPD exacerbations has not yet been included in the current definition. In this respect, the definition does not acknowledge the fact that many patients with COPD may suffer from additional conditions (i.e. congestive cardiac failure or pulmonary embolism) that can masquerade as exacerbations but they should not be considered as causes of them. The authors therefore suggest that an inclusion of the etiologic factors of COPD exacerbations in the definition. Moreover, COPD exacerbations are characterized by increased airway and systemic inflammation and significant deterioration in lung function. These fundamental aspects should be accounted in diagnosis/definition of exacerbations. This could be done by the introduction of a "laboratory" marker in the diagnosis of these acute events. The authors acknowledge that the use of a test or a biomarker in the diagnosis of exacerbations meets certain difficulties related to performing lung function tests or to sampling during exacerbations. However, the introduction of a test that reflects airway or systemic inflammation in the diagnosis of exacerbations might be another step forward in the management of COPD.
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PMID:COPD exacerbation: lost in translation. 1917 1


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