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

We examined the effects of cyclooxygenase inhibitors on pulmonary hemodynamics and gas exchange after experimental acute pulmonary embolism in 12 intact anesthetized dogs. Pulmonary hemodynamics were evaluated by pulmonary arterial pressure (Ppa)/cardiac output (Q) plots before and 60 min after autologous blood clot embolization and again 30 min after cyclooxygenase inhibition, either by acetylsalicylic acid (ASA, n = 6) or by indomethacin (INDO, n = 6). Gas exchange was assessed using the multiple inert gas elimination technique, at a constant intermediate Q, under each of these experimental conditions. Embolization increased Ppa at all levels of Q studied (p less than 0.001), increased true shunt (p less than 0.05), and shifted perfusion (Q) and ventilation (VA) distributions to lower and higher VA/Q (p less than 0.05), respectively. ASA and INDO further shifted Ppa/Q plots toward higher pressures (p less than 0.05). Concomitantly, the physiologic dead space increased after INDO (p less than 0.001), and the proportion of lung units with a high VA/Q increased and the inert gas dead space decreased after both ASA (p less than 0.05) and INDO (p less than 0.05). We conclude that, in experimental pulmonary embolism, structurally different cyclooxygenase inhibitors aggravate pulmonary hypertension and deteriorate gas exchange by an altered distribution of VA/Q essentially to lung units with a higher than normal VA/Q. These findings may be explained by changes in the distributions of both VA and of Q as a consequence of cyclooxygenase inhibition-associated increases in both bronchial and vascular tone in embolized lung regions.
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PMID:Cyclooxygenase inhibition aggravates pulmonary hypertension and deteriorates gas exchange in canine pulmonary embolism. 155 6

This is a prospective study of aspirin prophylaxis and thromboembolism surveillance in 159 patients having total hip arthroplasty by one surgeon at one institution. All patients had preoperative venous Doppler examination of the lower extremities and a ventilation-perfusion lung scan. Aspirin (650 mg) was given the night prior to surgery and continued at that dose twice per day. Venous Doppler examination was performed 10-14 days after operation. Asymptomatic pulmonary embolism was treated with oral anticoagulation only. There was a 12.6% incidence of pulmonary embolism, but only 1.9% of all patients developed a symptomatic pulmonary embolus. No patient had a fatal pulmonary embolus. No patient had a clinically evident deep vein thrombosis, and venous Doppler examination detected only nine patients with deep vein thrombosis (5.7%). The venous Doppler examination could not predict which patients would develop a pulmonary embolism. The authors could not determine a group of patients at high risk for the development of pulmonary embolism. There was no correlation between well-established "risk factors" and the development of pulmonary embolism. There was no correlation between the use of cemented or uncemented components and the development of pulmonary embolism. There were few complications of this prophylactic regimen of aspirin and surveillance. The authors believe this may be an acceptable prophylactic regimen for patients having total hip arthroplasty. However, the value of venous Doppler examination in the detection of deep vein thrombosis following total hip arthroplasty is uncertain.
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PMID:Aspirin prophylaxis and surveillance of pulmonary embolism and deep vein thrombosis in total hip arthroplasty. 219 14

The decision to operate on a patient older than 70 years for an intracranial meningioma is always difficult. Therefore a series of meningiomas treated surgically in 30 cases older than 70 years has been reconsidered and studied according to the following parameters: Karnofsky's rating scale, physiological status of the patient (A.S.A. criteria), perifocal oedema and mass effect. The locations of the meningiomas were: convexity 13, parasagittal 6, falx 2, pterion (sphenoid ridge) 5, orbito-cranial 3, jugum sphenoidale 1, tentorium (occipital) 1. Postoperative survival at day 30 shows a mortality rate of 23% which increases to 37% at day 90 including causes like decubitus ulcers and 3 cases of fatal pulmonary embolism. In a comparable series of 31 cases from 60 to 70 years, mortality rate was only 16% at day 90. Two parameters seem essential for quantifying surgical risk: clinical status, oedema and mass effect, evaluated by CT scan. The best conditions seem combined when Karnofsky rating scale is higher than or equal to 50 with no or only limited perifocal hypodensity and without mass effect. Although meningiomas may remain dormant for many years or can be kept under control medically for some time, their development is unpredictable. We think therefore that a reasonable surgical risk can be taken on patients with good physical status and favourable parameters at the time of diagnosis, particularly if the meningioma is located at the convexity where the risk of recurrence is minimal. On the other hand, patients with unfavourable parameters are not recommended for surgery.
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PMID:Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. 335 58

Venous thromboembolic disease (VTED) is the most common and potentially the most serious immediate postoperative complication of hip surgery. Prophylaxis of VTED remains controversial and its practice is widely variable. Since the last survey of VTED prophylaxis as practiced by American orthopedists, published in 1974, the literature has expanded tremendously and the number of orthopedists has doubled. The authors surveyed 10% of American orthopedists and the chiefs of training programs and/or major teaching hospitals to assess current practices. The average practicing orthopedist responding was 44-years-old and had performed 17.6 total hip arthroplasties and treated operatively 30.6 hip fractures per year during the last five years. The average responding chief surgeon, was 49 years old and had performed 49 total hip arthroplasties and treated operatively 20.5 hip fractures per year during the last five years. Most surgeons use pharmacologic prophylaxis or external pneumatic compression for total hip arthroplasty patients (84.4%) and hip fracture patients (74%). Warfarin has been tried and abandoned by 50% of all respondents, largely because of bleeding complications. Aspirin was the most popular agent. However, more than 25% of the respondents stated that at least one of their patients who had elective total hip arthroplasties had died of pulmonary embolism during the last five years.
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PMID:Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery. 365 74

A retrospective study was made to evaluate the effects of two preventive measures on deep venous thrombosis. The first group consists of 147 patients operated upon for biliary tract disease and 118 operative at the hip. The prophylactic measures consisted of dextran and ASA. The second group comprises 52 patients who underwent biliary tract surgery and 40 a hip intervention. During the operation they were submitted to a moderate normovolemic hemodilution (Hemat. 27%) only. During the postoperative period this group received no other prophylactic measures or therapy except for routine physical therapy. This study suggests that moderate normovolemic hemodilution is the best prophylaxis for deep venous thrombosis. Indeed, in the first group 10% of those operated upon for biliary tract disease developed a deep venous thrombosis as detected by the fibrinogen-I 25 test and phlebography (0,68% massive lethal pulmonary embolism). The incidence was 37,2% after hip surgery (1,6% massive lethal pulmonary embolism). Of those operated with moderate normovolemic hemodilution no deep venous thrombosis was detected in the biliary surgery group and only 10% in the hip surgery group. None of them died of a pulmonary embolus. The mechanisms by which normovolemic moderate hemodilution prevents the development of deep venous thrombosis are discussed.
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PMID:[Dextran and hemodilution in the prevention of postoperative venous thrombo-embolism (author's transl)]. 616 3

The effectiveness of low-dose heparin has been compared with other methods of thrombo-embolism prophylaxis, on the basis of 892 gynaecological operations. No case of acute venous thrombosis or lethal pulmonary embolism was established in the Infukoll-M-40 group. No effective prophylaxis against thrombo-embolism was obtainable from acetylsalicylic acid (Micristin). More postoperative bleeding was recorded from the low-dose heparin group. Two far-reaching thromboses and three cases of lethal pulmonary embolism occurred in the wake of low-dose heparin prophylaxis. The most favourable effect, in terms of preventing postoperative leg thrombosis and pulmonary embolism, was recorded from low-molecular dextran (Infukoll M 40). Anaphylactoid reactions, such as bronchospasm, flush, urticaria, and hypotension, were not observed. A therapy standard for gynaecological operations is recommended, with reference being made to the authors' own findings.
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PMID:["Low-dose heparin" and other methods to prevent thrombo-embolism in gynaecological surgery (author's transl)]. 616 67

Four drugs that inhibit platelet function have been evaluated for their antithrombotic effects in humans. These are aspirin, dipyridamole, hydroxychloroquine and sulphinpyrazone. Aspirin has been shown to reduce the number of transient ischemic attacks (TIA), stroke and death in patients with multiple TIA. The reduction in TIA was greatest in males who were normotensive and when there was an angiographically demonstrated lesion in the carotid artery that accounted for the symptoms. Aspirin reduced venous thrombosis and non-fatal and fatal pulmonary embolism in patients after surgery for fractured hip and after elective hip replacement. There is evidence that the prophylactic effect of aspirin may be greater in male patients. Aspirin reduced the frequency of arteriovenous shunt thrombosis. Aspirin abolished symptoms in patients with peripheral ischemia associated with thrombocytosis and spontaneous platelet aggregation. There is no conclusive evidence at the present time that aspirin is effective in patients with coronary artery artery disease. Dipyridamole in combination with oral anticoagulants is effective in reducing the frequency of systemic embolism in patients with prosthetic heart valve replacement but is ineffective in patients with transient cerebral ischemic attacks or for the prevention of venous thromboembolism. Hydroxychloroquine was effective in reducing postoperative venous thrombosis in patients undergoing general abdominothoracic surgery but the evidence that it was effective in patients undergoing orthopaedic surgery is inconclusive. Sulphinpyrazone may be effective in reducing the frequency of sudden cardiac deaths in patients in the first year after myocardial infarction when it is started within 25 to 35 days after the infarction. Sulphinpyrazone reduced the incidence of arteriovenous shunt thrombosis in patients undergoing chronic hemodialysis and in combination with anticoagulants, it reduced the frequency of recurrent venous thrombosis. There have been no large scale trials of platelet suppressant drugs in clinical cancer and successful treatment of thromboembolic disorders cannot be used to predict success in the treatment of malignant disease.
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PMID:Antithrombotic effects of drugs which suppress platelet function: their potential in prevention growth of tumour cells. 705 Oct 35

Death due to pulmonary embolism caused by thrombosis formation along a pacing wire has been reported in patients with antibradycardia pacemakers. The purpose of this prospective and randomized study was to evaluate the effects of prophylactically assigned aspirin (100 mg per day) or phenprocoumon (a coumarin derivative) on the incidence of right-sided thromboembolic complications associated with transvenous defibrillation leads. Multiplane transoesophageal echocardiography and pulmonary scintigraphy were performed in 62 consecutive patients immediately and 6 +/- 2 months after transvenous defibrillator implantation. Aspirin or phenprocoumon was administered to the patients in a randomized and parallel manner. By means of multiplane transoesophageal echocardiography and pulmonary scintigraphy no thromboembolic events were observed immediately after transvenous defibrillator implantation. After 6 +/- 2 months, however, multiplane transoesophageal echocardiography disclosed thrombi on the transvenous leads in 13 of 62 patients (21%) despite antithrombotic therapy. At the same time, pulmonary scintigraphy did not reveal any defects compatible with pulmonary embolism. Although thrombi occurred in only four patients treated with phenprocoumon, but in nine patients receiving aspirin, this difference was statistically insignificant. Other variables associated with the occurrence of thrombosis formation were not identified. One fatal intracranial haemorrhage occurred in the phenprocoumon group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Randomized comparison of aspirin and phenprocoumon for prevention of right-sided thromboembolic complications associated with transvenous defibrillation leads. 749 16

Carotid endarterectomy (TEA) has proven to be beneficial for symptomatic patients. Anticoagulation (AC) and antiplatelet therapy (ASA) have been shown to prolong life following vascular surgery in patients with occlusive arterial disease (PAOD). To determine whether ASA or AC prolong life after TEA, retrospective analysis was undertaken, since cerebral haemorrhage is associated with the use of both drugs, especially AC. Between 1979-1986, 328 patients with stenotic lesions of the carotid bifurcation were operated upon electively. Patient survival and causes of death were the primary end points of the analysis. Recent data were obtained from the Austrian Central Bureau of Statistics. Cumulative survival rates were calculated by Kaplan-Meier estimation and differences determined by Breslow and Mantel tests. 36 patients were on AC, 157 on ASA and 135 remained without medication (0-group). Since the common risk factors in PAOD were unevenly distributed between groups, a stepwise Cox regression model was applied which revealed age (p < 0.01), cardiac pathology (p < 0.01) and diabetes (p < 0.05) as relevant for survival. Therefore, ASA patients and 0-group patients were selected and matched, employing the aforementioned prognostic criteria, and compared to the patients on long-term AC for various indications (vein bypass surgery, myocardial infarction, pulmonary embolism; i.e. data-matching). The median postoperative survival was 7.72 years for ASA and 8.48 years for AC, compared to 6.07 years for the 0-group (p = 0.0095 Breslow, p = 0.477 Mantel). There was no significant difference between AC and ASA treated patients. Irrespective of medication, the causes of death were well balanced, and no higher incidence of intracerebral haemorrhage was detected.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Anticoagulants, antiaggregants or nothing following carotid endarterectomy? 835 90

We randomised 250 patients undergoing unilateral, elective hip arthroplasty for osteoarthritis to receive either a cemented or a non-cemented Mallory Head prosthesis. Aspirin was used as prophylaxis against thromboembolism during the first half of the study and adjusted-dose warfarin during the second half. Postoperatively, all patients were asked to have bilateral venography and 80% agreed. All were evaluated clinically for pulmonary embolism. There was no difference in the frequency of deep-venous thrombosis between the two groups (50% cemented nu 47% non-cemented, p = 0.73; 95% CI of the difference -13.6% to 19.3%). Three of the 64 patients (5%) in whom venography had demonstrated isolated distal thrombi developed pulmonary emboli.
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PMID:The frequency of venous thrombosis in cemented and non-cemented hip arthroplasty. 866 26


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