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

A 32-year-old multiparous woman had progressive swelling of the right arm at 32 weeks' gestation, accompanied by cyanosis and a preserved radial pulse. Phlebography demonstrated a 5-cm thrombus in the axillary vein. No known etiologic factors were found. Intravenous heparin administration resulted in rapid resolution of the clinical findings. Subcutaneous heparin 10,000 U/day was administered for secondary prophylaxis until cesarean at 39 weeks, during which a full dose was administered without complications. Axillary vein thrombosis during pregnancy may be diagnosed by either phlebography or duplex scanning, and preferably should be treated by heparin. Thrombolytic therapy is justified mainly for life-threatening complications such as pulmonary embolism.
Obstet Gynecol 1992 Sep
PMID:Axillary vein thrombosis during pregnancy: a case report. 149 19

This study was designed to identify those total arthroplasty patients at high risk for embolism even while on a proven warfarin prophylactic regimen and to identify the measure of anticoagulation that would be most efficacious in the prevention of pulmonary embolism (PE). A series of 2348 total arthroplasty patients had a preoperative perfusion scan and a postoperative ventilation/perfusion scan. All patients were placed on a low-dose warfarin protocol. Eighty-one patients were identified as having a PE by pulmonary arteriography (incidence of 3.4%). Of these, 89% were asymptomatic and no case was fatal. A control group of 159 patients without PE was used for comparison. Patients older than 65 years of age with a history of genitourinary infection were identified as being at higher risk of PE while on a proven warfarin prophylactic program. These patients may need additional prophylactic measures to reduce the risk of PE. In contrast, patients with a history of phlebitis, PE, obesity, or varicosities were not at excess risk for PE while on warfarin prophylaxis; therefore, no additional prophylactic measures are required. All prothrombin time profiles were within the prophylactic range. Therefore, the actual prothrombin time may not be the critical determinant of the level of anticoagulation or prophylaxis achieved.
Clin Orthop Relat Res 1992 Sep
PMID:Pulmonary embolism in total hip and knee arthroplasty. Risk factors in patients on warfarin prophylaxis and analysis of the prothrombin time as an indicator of warfarin's prophylactic effect. 151 7

The influence of several diseases and clinical conditions on the presence of pulmonary embolism (PE) in a large series of patients with deep venous thrombosis (DVT) in the lower extremities was analyzed prospectively. Lung scan findings from a series of 434 consecutive patients with DVT (with and without symptoms of PE) were studied and then correlated to five clinical variables: age, sex, elapsed time since clinical symptoms had appeared in the leg to diagnosis, degree of proximity of venous thrombus, and the presence or not of several risk factors that could have predisposed to thrombus development. According to scintigraphic findings, 164 patients were considered to have PE (asymptomatic in 76 of them), while 200 patients were classified as having only DVT. Lung scan was considered to be indeterminate for PE in 70 patients, and they were not included in the study. No differences were found in terms of age, sex, interval of time elapsed since onset of symptoms to diagnosis, or in the degree of proximity of the thrombus. However, several differences between groups were found when comparing the presence or absence of several predisposing factors for thrombosis: DVT developing in immobilized patients was associated with a significantly lower incidence of PE as compared with nonimmobilized patients (p = 0.005). Conversely, patients with a history of venous thromboembolism (VTE) had a significantly higher rate of embolism (31/51 vs 133/313; p = 0.01). On logistic regression analysis, a history of VTE showed a statistically significant association with more than a twofold higher risk of having PE for patients with such an antecedent. Our findings suggest that different pathophysiologic pathways could perhaps explain differences in embolic potential.
Chest 1992 Sep
PMID:Deep venous thrombosis and the risk of pulmonary embolism. A systematic study. 151 83

To determine the possible role of platelet-activating factor (PAF) in pulmonary embolism (PE), the reactivity of the airways to inhaled PAF, using doses ranging from 6.25 to 400 micrograms, was examined in 24 patients with a past episode of PE. Twelve of these patients had experienced acute respiratory insufficiency during the episode (with or without additional symptoms). None of the remaining 12 patients had experienced any respiratory symptoms during the PE episode. Diagnosis was established by means of a ventilation-perfusion lung scan performed when admitted to the hospital because of deep venous thrombosis (DVT) in the lower limbs. Nonspecific bronchial reactivity as measured by the response to bronchoprovocation testing with methacholine showed no significant differences between both groups. PAF caused a dose-dependent bronchoconstriction defined by at least a 35 percent decrease in specific airway conductance (SGaw) in all patients. The average dose of PAF needed to decrease SGaw 35 percent was significantly lower in patients who had had a symptomatic PE than in those with asymptomatic PE (p = 0.011). This finding suggests that patients who suffered from symptomatic PE may present a greater airway reactivity to inhaled PAF. This different behavior might explain the existence of some of the respiratory symptoms of PE, which could be attributed to PAF-related effects. However, additional studies are needed to evaluate the role of PAF in PE.
Chest 1992 Sep
PMID:Effects of inhaled platelet activating factor on bronchial responsiveness in patients with symptomatic and asymptomatic pulmonary embolism. 151 9

Pulmonary embolism (PE) is one of the increasing diseases in Japan, which is aggravated rapidly and early diagnosis is necessary to improve its prognosis. We experienced three cases of successful surgical salvage. It is emphasized that the Doppler ultrasonic echocardiography plays important part in diagnosing PE early and noninvasively. Namely, it shows a appearance of acute cor pulmonale, and is usually able to guess the pulmonary artery pressure by using the simplified formula of Bernoulli's equation. We believe that the surgical pulmonary embolectomy under the cardiopulmonary bypass should be immediately considered in case of unsatisfactory conservative thrombolytic therapy.
Kyobu Geka 1992 Sep
PMID:[Report of three cases of emergency surgical salvage for acute pulmonary embolism]. 151 2

The purpose of this study was to determine the effect of anticoagulation on the incidence of thrombotic propagation and pulmonary embolism in patients with calf vein thrombosis after total hip or total knee arthroplasty. Patients undergoing arthroplasties had prospective surveillance for postoperative deep vein thrombosis by both bilateral contrast venography and venous duplex scanning. Calf vein thrombosis was documented by venography in 42 patients (50 limbs), including 29 of 253 patients undergoing total hip arthroplasty (11.4%) and 13 of 99 patients undergoing total knee arthroplasty (13%). Of patients on whom follow-up duplex scans were performed, heparin followed by warfarin anticoagulation was used in 11 (13 limbs) and withheld in 21 (25 limbs). Propagation of thrombosis to the popliteal or superficial femoral vein or both was detected by serial duplex scanning in 3 of 13 treated limbs (23%) and 2 of 25 untreated limbs (8%), (p = 0.43). All thrombus propagations were detected within 2 weeks of the operative procedure. There were no pulmonary emboli or deaths. Propagation of asymptomatic calf vein thrombosis after arthroplasty was not influenced by anticoagulation, suggesting that postoperative calf vein thrombosis need not be routinely treated. Serial venous duplex scanning is useful to identify the occasional patient in whom thrombotic propagation requiring anticoagulation develops.
J Vasc Surg 1992 Sep
PMID:Is anticoagulation indicated for asymptomatic postoperative calf vein thrombosis? 152 45

We have reviewed the results of 19 ankle arthrodeses in 18 patients by a new technique of posterior internal compression. Sixteen of the ankles fused at a mean time of 14 weeks and the other three after reoperation. Complications included one case each of infection, Sudeck's atrophy and non-fatal pulmonary embolism. Clinical assessment using Mazur's ankle score showed excellent or good results in nine ankles and three painfree ankles in patients who were wheelchair-bound for other reasons. The mean position of fusion was in 1.7 degrees equinus and 0.8 degrees varus, and the mean range of midtarsal movements was 15.8 degrees. Twelve patients showed radiographic signs of talonavicular or subtalar osteoarthritis.
J Bone Joint Surg Br 1992 Sep
PMID:Posterior internal compression arthrodesis of the ankle. 152 28

Heparin-associated thrombocytopenia (HAT) is a rarely described adverse reaction of systemic administration of heparin that may be complicated by thrombosis, embolism and bleeding. Unfractionated heparin as well as low molecular weight heparin may provoke HAT. A case of HAT complicated by thrombosis and pulmonary embolism is described that came about during preventive postoperative anticoagulation with the low molecular weight heparin enoxaparin. Pathogenesis, diagnosis, prophylaxis and therapy of HAT are discussed.
Chirurg 1991 Sep
PMID:[Heparin-associated thrombocytopenia, thrombosis and embolism. Side effects of thromboembolism prevention with low molecular weight heparin enoxaparin?]. 166 Aug 3

DVT is a fairly frequent event and often fails to be recognised. Its main complication, pulmonary embolism, is the third cause of death in Italy with more than 70,000 deaths per annum. In the presence of infra- and suprarenal floating thrombi, cases in which the application of neither intraluminal nor extraluminal filters is indicated, the treatment of choice is thrombectomy with direct surgical access to the cava. Personal experience of 11 patients operated in the past 16 months with excellent surgical success is analysed. The indications and surgical techniques adopted are described.
Minerva Chir 1991 Sep 30
PMID:[Thrombectomy of the infra- and suprarenal cava to prevent pulmonary embolism in the presence of deep venous thrombosis. Personal experience with 11 surgically-treated cases]. 175 92

The incidence of pulmonary embolism was retrospectively studied in a University Chest Institute and its affiliated hospital in Sendai, Japan, whose annual numbers of discharged patients from chest medical wards and lung operations as a whole are about 600 and 400, respectively. Before 1975 there was no documented patient with pulmonary embolism. Since then 70 patients had been clinically suspected of having pulmonary embolism and 31 of the 70 were diagnosed as having pulmonary embolism; 15 without and 16 with surgical operations in the immediate past. Fourteen of the 31 patients required combined perfusion and aerosol inhalation lung imaging for diagnosis. Twelve postoperative patients could be diagnosed as pulmonary embolism by comparing postoperative perfusion lung images taken at the time of suspicion with preoperative perfusion counterparts. Although it is said to be rising, the incidence of pulmonary embolism in a chest hospital still seems to remain low compared with that in western countries. For postoperative patients, comparison with preoperative studies was found very useful in diagnosing postoperative pulmonary embolism. The importance of preoperative perfusion lung imaging cannot be overstressed not only as a preoperative lung function test but as a baseline study to be compared with postoperative perfusion images when pulmonary embolism is clinically suspected in postoperative patients.
Ann Nucl Med 1991 Sep
PMID:Incidence of pulmonary embolism in a chest hospital in Japan and importance of preoperative perfusion lung imaging in the diagnosis of postoperative pulmonary embolism. 176 44


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