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

A new method of producing aerosols (technegas) in which 99Tcm is bound to carbon atoms (99Tcm-C) was evaluated by comparing 99Tcm-C images with those obtained with 81Krm in the same patients. Twenty-five patients with suspected pulmonary embolism (PE) were studied. Immediately after the last 99Tcm-C view, the patients remained in supine position and inhaled 81Krm at tidal volume. Immediately after the 81Krm ventilation views were recorded, 4-7 mCi of MAA were injected IV. The same four views (ant, lop, rop, post) were recorded after inhalation of 99Tcm-C and 81Krm (200 kcounts) and 99Tcm MAA injection (400 kcounts). The mean penetration index of 99Tcm-C (0.91) was lower than that of 81Krm (1.04) (P less than 0.03). The apex to base lung distribution of 99Tcm-C and 81Krm appeared to be similar. The mean heterogeneity of 99Tcm distribution was 23, greater than that of 81Krm (14) (P = 10(-4)). The 99Tcm-C ventilation image quality was considered very good for 16 patients and good for 6 others. Significant foci of high bronchial uptake were infrequent. Interpretation of the examinations performed after inhalation of 99Tcm-C and 81Krm was concordant in all cases. No patient had an 81Krm/99Tcm MAA examination suggestive of PE when 99Tcm-C/99Tcm MAA indicated a low probability of PE, and vice versa. 99Tcm-C aerosols enable good quality ventilation images to be obtained in nearly all cases. Thus 99Tcm-C aerosols could be used in preference to 81Krm in ventilation studies for the diagnosis of PE.
Nucl Med Commun 1990 Sep
PMID:Comparison of technetium-99m aerosol and krypton-81m in ventilation studies for the diagnosis of pulmonary embolism. 217 81

Pulmonary embolism is a common problem in hospitalized patients. Because its initial symptoms may be nonspecific, pulmonary embolism may be difficult to diagnose. A high index of suspicion, together with careful selection of diagnostic tests, is essential. An algorithm for clinical assessment of suspected pulmonary embolism is presented here.
Postgrad Med 1990 Sep 15
PMID:Pulmonary embolism. How to 'nail down' the diagnosis. 220 5

The incidence of deep vein thrombosis in 244 patients who had total knee replacement has been studied. In 120 the prosthesis was cemented and in 124 it was cementless. In all cases the replacement was primary and a porous-coated prosthesis with a porous-coated central tibial stem was used. Deep vein thrombosis was diagnosed by venography, and pulmonary embolism by perfusion scanning. The incidence of deep vein thrombosis in the cementless knees (23.8%) and in the cemented (25%) was approximately the same. The only significant predisposing factors for deep vein thrombosis in both groups were obesity, prolonged postoperative immobilisation, previous venous disease and hyperlipidaemia.
J Bone Joint Surg Br 1990 Sep
PMID:The incidence of deep vein thrombosis after cementless and cemented knee replacement. 221 55

Right heart thrombosis (RHT) was found by 2D-echocardiography in 8 cases. Clinical suspicion of RHT could be documented in only 3 patients, while in the other 5 cases syncope, low output syndrome, essential pulmonary hypertension, cerebral embolism or congestive heart failure was the clinical diagnosis on first presentation. Out of the 4 cases of mobile RHT of extracardiac origin 1 patient had an emergency operation, 2 patients died shortly after the 2D-echo diagnosis before treatment could have been started and 1 patient improved on anticoagulant treatment. RHT of intracardiac origin was due to a central line or a ventriculoatrial shunt in 3 cases and no source could be found in 1 patient. Complete recovery was achieved in 2 cases by medical, in one case by surgical management and in 1 patient medical and surgical treatment resulted in clinical improvement. In conclusion authors 1. consider 2D echocardiography necessary in the clinical setting of acute or chronic pulmonary embolism or "primary" pulmonary hypertension and 2. they recommend emergency operation in case of mobile large RHT detected by 2D-echocardiography.
Orv Hetil 1990 Sep 16
PMID:[Diagnosis and treatment of thromboembolic diseases of the right heart]. 221 28

Plasma concentrations of cross linked fibrin degradation products, a marker of intravascular thrombosis and fibrinolysis, were measured in 495 patients with suspected pulmonary embolism referred for ventilation-perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis. Lung scans were described as normal (n = 66) or as showing a low (n = 292), indeterminate (n = 58), or high probability (n = 79) of pulmonary embolism. There was a difference between the mean levels of cross linked fibrin degradation products in each scan category: normal scans, 142 ng/ml; low probability scans, 295 ng/ml; indeterminate probability scans, 510 ng/ml; high probability scans, 952 ng/ml (p less than 0.001). Of the patients with high probability scans, 96% had raised concentrations. Explanations for discrepant low results include incorrect scan diagnosis, delay in blood sampling, and anticoagulation. Of the patients with a low or indeterminate probability of pulmonary embolism, 43% had increased concentrations of cross linked fibrin degradation products that could be attributed in most cases to another illness. Owing to the wide range of values in each lung scan diagnostic category, raised concentrations of these fibrin degradation products cannot be used without reference to the patient's clinical state as a discriminatory test for pulmonary embolism. Further evaluation of the significance of normal concentrations in excluding a diagnosis of pulmonary embolism appears to be warranted.
Thorax 1990 Sep
PMID:Plasma cross linked fibrin degradation products in pulmonary embolism. 221 75

We studied the effects of angiotensin II (A-II) antagonist, propranolol and prostaglandin F2 alpha (PGF2 alpha) on arterial hypoxemia after injecting autologous muscle to induce massive pulmonary embolism. Twenty-four anesthetized paralyzed dogs were divided into four groups; control, intravenous A-II antagonist (1-sarcosine, 8-isoleucine A-II) infusion at 5 micrograms.kg-1.min-1, intravenous propranolol injection at 1.5-2.0 mg, and intravenous PGF2 alpha infusion at 1 microgram.kg-1.min-1. With FIO2 of 0.33, the administration of A-II antagonist produced an increase in arterial PO2 from 134 +/- 16 (mean +/- SE) to 155 +/- 11 mmHg during infusion, and to 160 +/- 9 mmHg 30 min after infusion. Simultaneous hemodynamic measurements demonstrated no significant changes in arterial blood pressure and heart rate, but a slight increase in cardiac output was observed. On the other hand, propranolol and PGF2 alpha did not reverse the pulmonary oxygenation. Cardiac output decreased after propranolol, and alveolar dead space and pulmonary artery pressure increased further after PGF2 alpha. We conclude that A-II antagonist may be effective in the treatment of massive pulmonary embolism, possibly by improving the ventilation-perfusion relationship. The exact mechanism of the effect of A-II antagonist has not been clarified.
Masui 1990 Sep
PMID:[The effectiveness of angiotensin II antagonist on experimental pulmonary embolism--comparison of propranolol with prostaglandin F2 alpha]. 224 4

In neurosurgery, none of the drugs used in other specialties as prophylaxis of thrombo-embolism have found general acceptance. Certain centers reject any drug prophylaxis of thrombo-embolism. Others treat many or--with the exception of subarachnoid hemorrhage--almost all patients according to the Kakkarscheme. Many aim for an individual examination of the risk of early mobilization and, if necessary, combine mechanical and medicinal methods (Tab. 3). No center has published any systematic studies of substantial patient populations. It is not possible to draw any medico-legal conclusions from the neurosurgical literature available. The multitude of diagnostic and therapeutic regimes, sometimes accompanied by contradictory publications, means that even non-neurosurgeons regard neither the diagnosis nor the treatment of thrombo-embolisms as ideal. Even under low-dose heparinization, deep venous thromboses can occur, and it is in principle difficult to refute the contention that this fact changes nothing whatsoever for high-risk patients as far as the incidence of pulmonary embolism ot the occurrence of significant thrombo-embolic events is concerned. Cost calculations have proved that general thrombo-embolism prophylaxis is more expensive than individual thrombosis treatment as necessary (although there are statements to the contrary). It can, however, be stated that additional costs with the aim of improving or maintaining the quality of life would be economically justifiable if a preventive effect were proved. For modern neurosurgery, however, this neither holds true generally nor for a specific subgroup. The state of research would seem to suggest that a prospective, controlled study of neurosurgical patients, primarily in a relatively low-risk group, is necessary, advisable, and justifiable.
Neurochirurgia (Stuttg) 1990 Sep
PMID:[Perioperative prevention of thromboembolism in neurosurgery]. 226 2

The maternal mortality ratio in New York City during the 3-year period of 1981-1983 was 36.1 deaths per 100,000 live births. Eight (7%) of 120 deaths occurred more than 42 days after termination of the pregnancy. Eighteen (15%) of the cases involved white, non-Hispanic women, 66 (55%) were black, and 32 (27%) were Hispanic. Fifty-seven deaths were associated with cesarean delivery, although most of these could not be attributed to the mode of delivery. Sixty-six (55%) of the deaths were classified as direct maternal deaths. The age ranged from 16-44 years, with 83 (69%) of the women aged 20-34, 11 (9%) 19 or less, and 26 (22%) aged 35 or older. Increasing age and parity were associated with greater maternal mortality ratios. The leading causes of pregnancy-associated mortality were found to be ectopic pregnancy, pulmonary embolism, anesthetic complications, amniotic fluid embolism, intracranial hemorrhage, hypertensive diseases of pregnancy, infection, and cardiac disease. Abortion-related mortality was about nine times less than the maternal mortality ratio, and the cesarean death-to-case rates could be considered roughly comparable to overall maternal mortality.
Obstet Gynecol 1990 Sep
PMID:Maternal mortality in New York City, 1981-1983. 238 7

Primary venous aneurysms are infrequently noted and rarely have clinical significance. An important exception, however, is an aneurysm of the popliteal vein that is known to be a source for pulmonary emboli. We present the case of a previously healthy 57-year-old man with recurrent episodes of occult pulmonary embolism. Initial diagnostic investigations were compatible with multiple pulmonary emboli, but no source was identified. Subsequently, an indium 111-labeled platelet scan confirmed a site of active thrombus formation in the right lower extremity above the knee. Magnetic resonance imaging defined a saccular aneurysm of the popliteal vein, which was confirmed by contrast venography. Thereafter, the patient had resection of the venous aneurysm and tangential venorrhaphy. After operation duplex scanning confirmed patency of the venous repair. This is the eleventh report in the English-language literature of pulmonary emboli suspected of having originated from a popliteal venous aneurysm.
J Vasc Surg 1990 Sep
PMID:Primary popliteal venous aneurysm with recurrent pulmonary emboli. 188 Aug 52

Coagulation studies were performed in 16 children with steroid responsive minimal change nephrotic syndrome in order to elucidate the incidence of thromboembolic complications. Fibrinogen and alpha 2-macroglobulin concentrations were inversely correlated with serum albumin concentrations, antithrombin III correlated positively (p less than 0.001). Factor VIII:R:AG concentration was elevated. Coagulation disturbances in children are not less severe than in adults with nephrotic syndrome. Combined scintigraphic pulmonary ventilation and perfusion studies were employed in 26 children to detect noninvasively events of pulmonary embolism, respectively their residual changes. The lung scintigraphic investigation demonstrated a pattern consistent with pulmonary embolism in 7 patients (27.9%), residual changes in 10 (38.5%) and normal findings in 9 (34.9%). The incidence of thromboembolic complications in children with severe nephrotic syndrome is as high as reported for adults. Pulmonary symptoms may well be due to pulmonary embolism.
Acta Paediatr Scand 1986 Sep
PMID:Thromboembolic complications in children with nephrotic syndrome. Risk and incidence. 243 35


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