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

The aim of the study was to evaluate if D-dimer and thrombin-antithrombin III complex determinations in patients with clinically suspected pulmonary embolism create a discrimination between patients to be further investigated with lung scanning and those who should be investigated for other diseases mimicking pulmonary embolism. The Data-Fi Dimertest Latex Assay, MAbCO Dimertest EIA, and TAT EIA were performed in 100 consecutive patients (26 percent outpatients) who were sent to our institution for lung scanning by their attending physicians because of clinically suspected pulmonary embolism. The D-dimer Latex Assay was positive (greater than 500 ng/ml) in 12 (48.0 percent) of 25 patients with high probability of pulmonary embolism and in one (11.1 percent) of nine with intermediate probability, respectively. Only one patient (1.5 percent) with a normal scan had a positive latex assay, presumably due to inapparent bleeding after a computed tomographic (CT)-guided liver biopsy. Referring to 120 ng/ml as upper limit of normal (mean +/- 2 SD of healthy controls), the D-dimer enzyme immunoassay (EIA) was positive in 21 (84.0 percent) of 25 patients with high probability, in six (66.7 percent) of nine patients with intermediate probability, and in 40 (60.6 percent) of 66 patients with normal/low probability of pulmonary embolism, respectively. The TAT EIA was positive (greater than mean +/- 2 SD of healthy controls = 3.53 ng/ml) in 18 (72.0 percent) of 25 patients with high probability, in five (55.6 percent) of nine patients with intermediate probability and in 16 (24.2 percent) of 66 patients with normal/low probability of pulmonary embolism. A normal result in one of these hemostaseologic tests did not predict a low probability of pulmonary embolism after lung scanning. Thus, it is not justified to exclude patients with clinically suspected pulmonary embolism from further investigation by lung scanning because of a normal result in one of these tests.
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PMID:Pulmonary embolism. Efficacy of D-dimer and thrombin-antithrombin III complex determinations as screening tests before lung scanning. 195 91

This is a case report on a course of gemini-pregnancy complicated by gestosis, recurrent submassive pulmonary embolism and discordant growth of the hypotrophic twins. It is concluded from this report that: 1. the AT-III-deficiency in gestosis can be caused by loss and consumption; 2. due to decrease below a critical AT-III-level the coagulation-fibrinolysis system tends to decompensate, reflected in a disseminated intravascular coagulation and/or a pulmonary embolism. The tendency consists particularly in immobilisation and stasis; 3. the daily determination of AT III, better of TAT-complex and D-dimer, the daily clinical examination regarding signs of thrombosis and in cases of heparinization the measurement of PTT several times daily, are necessary to avoid or recognise disorders, of the coagulation-fibrinolysis-system at an early stage. 4. The increased consumption in coagulation systems can be avoided by AT-III substitution and correct heparinisation. 5. In cases of risk of pulmonary embolisation in pregnancy a cava filter should be temporarily implanted. The filter must be changed every 3 days, if it is required for a longer period. 6. In high-risk pregnancy the check for factors of thrombophilia is a basic diagnostic procedure.
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PMID:[Gestosis, thrombophilia and pulmonary embolism in a primipara with twin pregnancy]. 848 92

Seventy-eight patients having elective total hip replacement were randomised into 3 groups A) control; B) low molecular weight heparin: (enoxaparin 40 mg once daily) and C) enoxaparin (40 mg once daily) plus graduated elastic compression (TEDR stockings) for 8-12 days. All patients had a preoperative perfusion lung scan and chest X-Ray and a postoperative perfusion/ventilation scan together with bilateral ascending venography on days 8-12. A blood sample was taken preoperatively, on the 1st, 3rd and 5th postoperative day and at the end of the study. The control group received placebo injections. The venograms and V/Q scans were reported blindly by an independent panel of three and one radiologists respectively. An independent panel of assessors stopped entry in the control group when a total of 45 patients were admitted according to Ethics Committee directives. The study continued with groups B and C. The incidence of DVT (including isolated asymptomatic calf thrombi) was as follows: Group A (n = 14) 93%; Group B (n = 32) 38%; Group C (n = 32) 25% (chi 2; p < 0.001 for group A versus B or C). The incidence of proximal DVT was: Group A 57%; group B 28%; group C 13% (chi 2; p = 0.057 for group A versus B and p < 0.005 for group A versus C). The incidence of silent pulmonary embolism (PE) (new defect on V/Q scan) was 28% (8 out of 29) in patients with and 5% (2 out of 43) in patients without DVT (chi 2; p < 0.02). The combination of high TAT and low anti-Xa activity on the 1st postoperative day identified a high risk group of patients who had a 56% incidence of proximal DVT on the 8th to 12th postoperative day. Further studies are needed to confirm the suggested increased efficacy in prophylaxis by the combination of LMWH and GEC as compared with LMWH alone.
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PMID:Deep venous thrombosis prophylaxis with low molecular weight heparin and elastic compression in patients having total hip replacement. A randomised controlled trial. 880 42

Nuclear medicine procedures and mainly perfusion lung scanning (often associated with ventilation lung scanning), after thirty years still play a major role in the diagnosis of pulmonary embolism. International study groups with accurate statistical methods have shown their efficacy in the diagnosis and follow-up, in reducing the clinical uncertainty, in directing the therapy and in lowering health care costs. The major limitation of nuclear medicine procedures lies in the high percentage of patients for whom intermediate or indeterminate probability is reported. However this percentage is steadily decreasing based on: patient clinical preselection; improved procedures and especially an extensive use of D-SPET with a three-head gamma camera; the combination with other advanced diagnostic imaging procedures (HRCT, fast-CT, MRI); suitable diagnostic algorithms for nuclear medicine procedures which should consider laboratory data (D-dimer, TAT) and the study of deep vein thrombosis; the use of artificial intelligence; the introduction of radiopharmaceuticals which enable direct scanning of the intravasal embolus (as P180 polypeptide) in combination with perfusion scanning which shows the hemodynamic alterations.
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PMID:The role of nuclear medicine in pulmonary embolism. 906 56

Deep vein thrombosis (DVT) is reported in up to 40% of trauma patients. The individual risk is nearly unpredictable. A daily single dose of a low molecular weight heparin (LMWH) was administered as prophylaxis to 518 trauma patients who were examined preoperatively and up to 10 days postoperatively in a prospective study. They were divided into two groups: group I comprised surgery of the hip and femur as well as total knee replacement and group II knee and lower leg surgery. Thrombin-antithrombin complex and D-dimer were analyzed. A second daily dose of LMWH was added if D-dimer exceeded the cutoff. If ultrasound was suspicious for DVT venography was added. Deep vein thrombosis was seen in five cases (group I=4, group II=1), without pulmonary embolism. TAT and D-dimer were significantly higher in group I than in group II ( p<0.005). One hundred patients, 79 of them belonging to group I, were treated with a second dose of LMWH. The daily cutoff had the highest sensitivity and specificity for day 4. Due to individual monitoring of coagulation markers, the risk for thromboembolism compared to actual data in the literature seems to be reduced.
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PMID:[Prevention of thromboembolism in trauma surgery by dose adjustment of low molecular weight heparin depending on levels of TAT and D-dimer]. 1472 38