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

Hip fracture has repeatedly been associated with increases in the risks of death and pulmonary embolism (PE), but few studies have considered whether other fractures are also associated with these adverse outcomes. The authors estimated the 90-day risks and relative risks of mortality and PE after fractures, and the longer-term relative risks of mortality, for each of ten fracture sites. Using the 5% US standard sample of the Medicare population, we identified 81,181 fractures of the pelvis, patella, and long bones occurring between July 1, 1986, and June 30, 1990, among beneficiaries aged 65 years or older. The fractures were randomly matched by sex, race, and year of birth with a beneficiary who did not suffer that particular fracture, to form ten control cohorts. All patients were followed up until December 31, 1990. The 90-day risk of death was greater than 9% after hip, nonhip femur, and pelvic fractures, with risks relative to their matched control cohorts of 4.7 to 6.7. For white patients with these three fracture types these relative risks decreased substantially with age. White patients who had a hospitalization in the 2 years before hip fracture were more likely to die in the first 90 days than those who had no hospitalization before the hip fracture, but this effect, too, decreased with age. Patients who survived 1 year after most fracture types had no clinically significant excess mortality compared with their surviving controls. For patients with hip, nonhip femur, and pelvis fractures, however, there remained an elevated risk of 1.6 to 1.8, and for patients with proximal humerus fractures the risk ratio was 1.4. All lower-limb fractures carried a higher risk of PE than any upper-limb fracture.
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PMID:Mortality and pulmonary embolism after fracture in the elderly. 1294 31

Hip fracture is a serious and common injury that can lead to permanent disability, pneumonia, pulmonary embolism, and death. Research to help prevent these fractures is essential. Computed tomographic (CT) scan-based finite element (FE) modeling is a tool that can predict proximal femoral fracture loads in vitro. Because this tool might be used in vivo, this study examined whether FE models generated from CT scans in situ and in vitro yield comparable predictions of proximal femoral fracture load. CT scans of the left proximal femur of two human cadavers were obtained in situ and in vitro, and three-dimensional FE models employing nonlinear mechanical properties were generated from each CT scan. The models were evaluated under single-limb stance-type loading by applying displacements incrementally to the femoral head. The FE-predicted fracture load (F(FE)) was the maximum femoral head reaction force. F(FE) for the in situ-derived models for the two subjects were 5.2 and 13.3% greater than for the in vitro-derived models. These results demonstrate that using CT scan data obtained in situ instead of in vitro to generate FE models can lead to substantially different predicted fracture loads. This effect must be considered when using this technology in vivo.
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PMID:Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load. 1451 51

Cardiovascular disease is the major cause of mortality in the industrial world today. We are constantly moving towards new and better ways of fighting this epidemic. Advances have been made in various fields such as patient education, imaging techniques, interventional cardiology, and novel therapeutic agents. In particular, antithrombotics are being studied with great interest and hope. Amid this class of agents, factor Xa inhibitors have already begun to show promising results in trials involving patients with acute coronary syndromes. Whereas DX-9065a is in late stage clinical trials, fondaparinux sodium is available for clinical use. Promising results have been obtained with fondaparinux sodium in patients with coronary artery disease in the PENTUA (Pentasaccharide in Unstable Angina) and PENTALYSE (Pentasaccharide as an Adjunct to Fibrinolysis in ST-Elevation Acute Myocardial Infarction) trials. Besides having a direct effect on the coagulation cascade, they have shown properties that indirectly influence the remodeling of plaques in the coronary circulation. Available evidence on factor Xa inhibitors does not ensure a remedy to acute coronary syndromes but it gives hope of improving current treatments and reducing the morbidity and mortality of cardiovascular disease. The efficacy and tolerability of fondaparinux sodium in the prevention and treatment of deep vein thrombosis (with or without pulmonary embolism) has been established in several large trials such as PENTATHLON (Pentasaccharide in Total Hip Replacement Surgery), PENTAMAKS (Pentasaccharide in Major Knee Surgery), EPHESUS (European Pentasaccharide Hip Elective Surgery), PENTHIFRA (Pentasaccharide in Hip-Fracture Surgery), and PENTHIFRA-Plus. Whereas fondaparinux sodium offers benefits over low molecular weight heparins and unfractionated heparin, the incidence of bleeding complications was greater with fondaparinux sodium than with unfractionated heparin. Treatment with factor VIIa can reverse the anticoagulant effect of fondaparinux sodium and this may be particularly important in patients who need to undergo emergency surgical procedures. Fondaparinux sodium has been recently approved for use, in conjunction with warfarin, in patients with symptomatic deep vein thrombosis or acute pulmonary embolism based on the results of two large trials conducted by the Matisse investigators. In conclusion, these observations strongly suggest the clinical potential of this class of agents in preventing arterial and venous thrombosis.
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PMID:Clinical and experimental experience with factor Xa inhibitors. 1555 23

The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is well documented in patients following cast immobilisation for injuries of lower extremities. There are no generally accepted approaches to preventing this complication and hence there remains substantial practice variation amongst surgeons regarding the use of anticoagulation measures. The present survey was conducted to investigate the current chemothromboprophylaxis practice among UK orthopaedic departments for patients immobilised with plasters for lower extremity injuries and establish any variations in practice. A telephone questionnaire survey was conducted on junior doctors (Senior House Officers and Registrars) in orthopaedic departments of 70 randomly selected hospitals in United Kingdom. This survey assessed the thromboprophylaxis practice for lower limb injuries in plaster casts. Our results show substantial variation amongst British orthopaedic surgeons in the use of chemothromboprophylaxis measures. Sixty-two percent of the departments do not use any DVT prophylaxis in this group of trauma. Furthermore, only 11.4% of the departments performed risk stratification on their patients. Ninety-nine percent of the respondents were unaware of any existing guidelines in this regard. Although the incidence of DVT in patients in plaster for lower extremity injuries is low compared to the Hip/Knee arthroplasty group, this is not insignificant. Both over and under treatment with thromboprophylaxis can have implications in terms of side effects and costs. One possible solution is to use risk stratification to identify individuals who are likely to benefit from prophylaxis. There is a substantial variation and inconsistency in practice among orthopaedic departments in United Kingdom due to a lack of clinical guidelines in this group of trauma and it remains underused even in high-risk group.
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PMID:Thromboprophylaxis following cast immobilisation for lower limb injuries--survey of current practice in United Kingdom. 1676 68

The increasing life expectancies among octogerians ang nanogerians cause increased need for total hip replacement in this age group. The aim of our study was to analyze final results after total hip arthroplasty in patients 75 years of age and older. Clinical and radiological retrospective study was performed on a group of 59 patients (72 hips) in the mean age of 78 years. Minimal follow-up was 3 years. According to Harris Hip Score hip function improved on an average of 47 points and at final follow-up was 86 points. Patients with medical diseases had poorer hip function improvement. Early dislocation was found in 3 patients with was treated conservatively with good result. Almost 1/4 of patients suffered medical postoperative complications: pneumonia (n = 1), urinary tract infection (n = 4), pulmonary embolism (n = 1), acute myocardial infarction (n = 1), postoperative confusion (n = 5) and mild intestinal occlusion (n = 1). Additionally, one patient died for pulmonary embolism. There were no radiological signs of aseptic loosening or need for revision operation. Three fourth of our patients had satisfactory results after total hip replacement, despite relatively high medical (24%) and local complication rate. Aseptic loosening is rear in this age group.
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PMID:[Elective total hip arthroplasty for patients 75 years of age and older]. 1884 21

We report a rare complication during primary total hip arthroplasty. A fatal fat pulmonary embolism immediately followed removal of the femoral head, prior to further preparation of the acetabulum or femoral shaft. Fat embolism syndrome is a well-known complication during total joint arthroplasty, usually attributed to preparation of the femoral shaft, particularly intramedullary reaming and insertion of the prosthesis. These risk factors have previously been identified in the literature. We believe that this case highlights the need for further research to establish the intramedullary pressures during the processes of dislocation and resection of the femoral neck and the attendant risk.
Hip Int
PMID:Fatal fat embolism following femoral head resection in total hip arthroplasty. 1909 14

We determined retrospectively the postoperative mortality and fatal pulmonary embolism (PE) rates in 1275 consecutive primary total hip replacements (THR) in the six-week period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%. The death rate from PE was 0.16% (CI 0.04%-0.57%) and the all-cause mortality rate was 0.47% (CI 0.22%-1.02%). All deaths were within the first 10 days during the initial hospitalisation. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 1.08 (CI 0.4-2.36). We observed a lower mortality in females (SMR=0.58; CI 0.07-2.09) but a higher mortality in males (SMR=1.91; CI 0.52-4.9) during the first 42 postoperative days compared to the general population. Fatal PE after THR without routine chemical thromboprophylaxis is uncommon. The death rate in patients undergoing THR appears to be similar to that in the general population.
Hip Int
PMID:Fatal pulmonary embolism, death rates and standardised mortality ratios after primary total hip replacement in a joint replacement centre. 1919 46

In order to prevent fatal pulmonary embolism, TED stockings, foot pumps and early mobilisation on the second post-operative day are used at our centre. Only patients deemed to be high risk (previous DVT/PE or obese) are given clexane as inpatients and warfarin for six weeks post-op. From the hospital database 1137 primary total hip replacements and 1017 primary total knee re-placements were identified and the figures were confirmed with the theatre implant order books. The cause of death for those patients on the database, now deceased, was obtained from the coroner. Where a postmortem had not been performed the patient was assumed to have died of a PE. Within three months of surgery, a fatal PE rate of 0.09% (95% CI 0.00-0.26%) following hip replacement and 0.20% (95% CI 0.00-0.46%) after knee replacement was found. Thirty-four patients had been discharged on warfarin according to the pharmacy records. We would therefore not recommend the routine use of chemical thromboprophylaxis following joint replacement.
Hip Int
PMID:Fatal pulmonary embolism following hip and knee replacement. A study of 2153 cases using routine mechanical prophylaxis and selective chemoprophylaxis. 1921 78

Dislocation after total hip arthroplasty (THA) remains a problem despite many advances in technique and prosthetic design over the 5 decades since the introduction of total joint replacement. This article reports the short-term results (1 year of follow-up) of THA in 235 patients who received a large, anatomically sized femoral head (BFH Technology; Wright Medical Technology, Inc, Arlington, Tennessee) with modular necks for hip stability. The prosthesis allows a 6-mm differential between the size of the acetabular component and femoral head size. Patients also received a Conserve monoblock acetabular cup and a Profemur femoral stem (Wright Medical Technology, Inc) implanted without cement. Postoperative clinical evaluations included measurements of Harris Hip Scores and range of motion, along with assessments of pain and function and radiological evaluations. There were no complications (deep venous thrombosis, pulmonary embolism, infection, reoperations) and no dislocations. All clinical evaluations showed statistically significant improvement (P<.001) at 1-year follow-up, and radiographic evaluation has shown no evidence of osteolysis or implant loosening. This study indicates that using a large femoral head may reduce the incidence of dislocation and may enable early return to activities postoperatively. Future evaluations of this patient group will elicit longer-term follow-up data.
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PMID:Hip stability in primary total hip arthroplasty using an anatomically sized femoral head. 1963 54

We compared the results of 1-stage uncemented bilateral total hip arthroplasty (THA) performed in 49 patients (98 hips) with those of 2-stage uncemented bilateral THA performed during the same hospital stay in 40 patients (80 hips). There was no significant difference in mean Harris Hip Score preoperatively and at final follow-up between the 2 groups. Radiographic evaluation of patients in the 1-stage group revealed the acetabular component was stable in 95 hips and possibly unstable in 3. The femoral component was bone-ingrown in 91 hips and stable fibrous in 7. In the 2-stage group, the acetabular component was stable in 77 hips and possibly unstable in 3. The femoral component was bone-ingrown in 71 hips and stable fibrous in 9. In both groups, no patients exhibited clear signs of loosening, migration or osteolysis.In the 1-stage group, postoperative dislocation occurred in 2 hips and 1 patient had developed deep venous thrombosis and pulmonary embolism. In the 2-stage group, no complications were observed. The incidence of complications was not significantly different between the 2 groups.There was no significant difference in the total blood loss and mean hemoglobin level preoperatively and at discharge between the 2 groups. However, in the 1-stage group, operative time, intraoperative blood loss, procedure cost, and hospital stay were significantly reduced compared with the 2-stage group. Therefore, 1-stage bilateral THA is a safe and effective option for patients with significant arthritic disease of both hips.
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PMID:One- versus two-stage bilateral total hip arthroplasty. 2070 12


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