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

To determine if the addition of potassium enhances the myocardial protective effect of intracoronary perfusion hypothermia during aortic cross-clamping, 50 patients undergoing aortocoronary bypass grafting were studied in a randomized, prospective, double-blind fashion. Twenty-six patients received a cold crystalloid solution infused with a handheld syringe into the root of the cross-clamped aorta every 20 minutes, and 24 patients received the same solution but with 25 mEq/L of potassium chloride added, infused in a similar manner. Both groups were analyzed by mortality, rate of perioperative myocardial infarction (electrocardiographic changes, MB-CPK enzyme release, and preoperative and postoperative gated cardiac blood pool scans), intraoperative hemodynamic changes, intraoperative lactate determinations, postoperative arrhythmias, and requirement for pressor or intraaortic balloon pump support. One patient in the potassium cardioplegia group died (massive pulmonary embolism), and none in the hypothermic perfusion group died. Possible perioperative myocardial infarction was diagnosed by more than one marker in 4 of 26 patients in the hypothermic perfusion group and 5 of 24 patients in the potassium group (p = 0.61). There were no differences between the two groups in terms of hemodynamic changes, lactate production, postoperative arrhythmias, or the need for postoperative hemodynamic support. This study in human beings could not demonstrate a specific protective effect of potassium, beyond that afforded by myocardial perfusion hypothermia and wash-out. The data suggest that myocardial hypothermia, achieved through cold intracoronary arterial perfusion, may be the most important beneficial component of so-called cardioplegia for attaining effective intraoperative myocardial preservation in human beings.
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PMID:Hypothermic ischemic arrest versus hypothermic potassium cardioplegia in human beings. 704 99

The real place of isotopic imaging in intensive care patients remains still unclear. This review aimed to consider the indications of isotopic imaging for improved diagnosis and therapy and to specify its place among the other techniques of exploration. Pulmonary perfusion and ventilation scintigraphies are valuable for the diagnosis of pulmonary embolism (PE). A "high probability" scintigraphy of the lungs ascertains the diagnosis of PE and allows to start a specific treatment without requiring a pulmonary angiography. This is not the case in the presence of a history of previous PE or if the arguments for a PE are only weak. A normal lung scintigraphy eliminates the diagnosis of a clinically significant PE all the more as an exploration of good quality of the lower limb veins remains negative. In the opposite a "non diagnostic" scintigraphy justifies a pulmonary angiography in intensive care patients. The diagnosis of myocardial contusion is made uneasy as the clinical symptoms, the ECG, the cardiac enzymes and the chest X-ray are only of limited value. Isotopic explorations of the heart could provide additional valuable data or be an alternative for 2 D echocardiography. The comparison of CPK-MB concentrations with a myocardial scintigraphy using thallium 201 is given as being very reliable, with positive and negative predictive values higher than 80%. An exploration restricted to the cardiac ejection fractions is only of limited value. In the future, an improvement will perhaps be obtained with tracers such as MIBI labelled with technetium 99m, which allow the simultaneous assessment of myocardial perfusion and the ventricular ejection fractions as well. The localisation of centres of infection, especially when intra-abdominal, remains difficult in intensive care patients. Isotopic imaging, especially the scintigraphies with labelled polynuclears, could allow in combination with conventional imaging techniques (computed tomography and 2 D echocardiography) to prevent from errors in diagnosis. An array of arguments is essential for ascertaining the presence of an abscess. Scintigraphies with leucocytes labelled with indium 111 or technetium 99m are qualified as having a sensitivity and a specificity greater than 90%. The conventional techniques of measurement of the cerebral blood flow (CBF) using xenon 133 require a special equipment or are invasive. Other cerebral tracers, such as cyclic amines (HMPAO) labelled with technetium 99m and administrable by i.v. route, allow the use of a standard tomo-gamma camera, and could be of help in various pathological conditions.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Role of isotopic imaging in intensive care]. 799 43

A 61-year-old Caucasian was admitted to Department of Chest Diseases and Tuberculosis, Medical University of Bialystok, Poland for progressive muscle weakness and weight loss. Eighteen months prior to admission, the patient had been diagnosed with pulmonary embolism. At that point he was started on Enoxaparin QD. Past medical history was unremarkable. In the interim, the patient developed fever, myalgia and progressive dyspnea. Physical examination on admission revealed a rash on his upper torso and back, and the extensor surfaces of all four extremities. Laboratory values included CPK 8229, MB fraction 219, LDH 981. Chest X-ray and CT scan revealed bilateral patchy consolidations and ground-glass opacities. EMG was consistent with myositis. The patient was started on solumedrol 40 mg i.v., b.i.d., and then switched to prednisone 40 mg b.i.d. His symptoms and muscle strength improved remarkably. The patient was discharged with prednisone with an outpatient follow up.
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PMID:Dermatomyositis masquerading as pulmonary embolism. 2015 49