Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1991, the U.S. Food and Drug Administration approved Norplant manufactured in Finland for American use. It has had over 500,000 users in almost 50 nations. It is sold as a set of 6 capsules, each containing 36 mg of levonorgestrel, which are implanted subdermally no on the medial upper arm. An American cohort of Norplant users had the following annual Pearl pregnancy rates: (a) 355 women at 1 year, 0; (b) 283 women at 2 years, 2.1; (c) 191 women at 3 years, 3.1; (d) 69 women at 4 years, 0; and (e) 25 women at 5 years, 0. The cumulative continuation rates for 396 American Norplant users were 82% at 1 year, 65% at 2 years, 50% at 3 years, and 44% at 4 years. A 2nd American cohort and groups of Norplant users in Chile, Egypt, and Thailand had higher continuation rates. Among 110 former Norplant users in San Francisco, 61% planned to use it again. The user can conceive in just 1 month after Norplant removal Many women do experience alterations in menstrual patterns, including prolonged bleeding, spotting between periods, and very light or no bleeding. The ectopic pregnancy rate has been 0.28 per 1000 woman-years of Norplant use, an incidence lower than that of ectopic pregnancies in women not using family planning. Norplant is appropriate for many women who want continuous long-term contraception. Definite contraindications to Norplant include: (a) acute liver disease, including benign or malignant tumors; (b) jaundice; (c) undiagnosed vaginal bleeding; (d) a history of thrombophlebitis, pulmonary embolism, or blood clots in the eyes; (e) a history of heart attack, chest pain as a symptom of diagnoses heart disease, or stroke (coronary artery or cerebrovascular disease); (f) possible pregnancy; (g) lactation until at least 6 weeks postpartum; (h) hemorrhagic disorder; (i) anticoagulation therapy; and (j) drugs such as rifampin, barbiturates, phenytoin, carbamazepine, phenylbutazone, and isoniazid, which may interact with the levonorgestrel in Norplant and decrease its effectiveness.
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PMID:Norplant: a welcome new contraceptive. 848 56

Both case-control and cohort studies have consistently documented an association between oral contraceptive (OC) use and venous thromboembolism risk. However, since OC users undergo closer medical surveillance than non-users, these studies are susceptible to detection bias. To overcome this potential source of bias, the present study used a new case-control study design in which 234 women under 40 years of age with suspected deep vein thrombosis or pulmonary embolism recruited from University Hospital in San Antonio, Texas, during 1983-94 underwent contrast venography, pulmonary angiography, or duplex Doppler ultrasound examination. 127 of these women were subsequently excluded from the study because of predispositions to venous thromboembolism. The 9 women whose test results were positive comprised the case group, while the 48 with negative findings served as controls. 7 of the 9 cases and 17 of the 48 controls were current OC users (odds ratio, 6.38; 95% confidence interval, 1.19-34.2). Although documentation of the OC brands women were using was sparse, 12 of the 13 women for whom these data were available were using OCs containing 35 mcg or less of estrogen. The findings of this analysis indicate that the documented association between OC use and venous thromboembolism is not a result of detection bias. The use of women undergoing diagnostic procedures to form both the case and control groups should be replicated in larger populations and diverse settings. The study design could be further strengthened by collecting data on OC use prospectively and uniformly, before women undergo diagnostic procedures.
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PMID:Oral contraceptives and venous thromboembolism: a case-control study designed to minimize detection bias. 929 55

Chronic thromboembolic pulmonary hypertension is a term that has been proposed by Dr. Kenneth Moser to describe a progressively debilitating process that occasionally follows venous thrombosis and pulmonary embolism. In the past, the disease was dramatically underdiagnosed for several reasons: 1) the initial event--deep vein thrombosis or pulmonary embolism--is usually clinically silent; 2) there is a subsequent asymptomatic "honeymoon period" in most patients; 3) there is no clinical description of chronic thromboembolic pulmonary hypertension in most textbooks of medicine and surgery; and 4) until recently, surgical therapy could be performed by only a few surgeons, and with a prohibitive operative mortality. Intensive efforts by physicians at the University of California, San Diego have led to increased recognition of the disease, a better understanding of its pathophysiology, and development of a curative procedure with an acceptable operative mortality. Chronic thromboembolic pulmonary hypertension is truly the "aortic stenosis" of the pulmonary circulation, and the clinical improvement after pulmonary thromboendarterectomy is even more dramatic than that seen after aortic valve replacement.
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PMID:Pulmonary thromboendarterectomy for pulmonary hypertension. 1014 1

Optimal reduction in pulmonary vascular resistance caused by chronic pulmonary embolism is obtained by bilateral pulmonary thromboendarterectomy with removal of occlusive material in all bronchopulmonary segmental arteries that are partially or completely obstructed. The most effective way to obtain this goal is the use of median sternotomy with cardiopulmonary bypass, deep hypothermia, and intermittent periods of circulatory arrest. During circulatory arrest, thromboendarterectomy is performed by specially designed dissectors that allow simultaneous dissection and removal of blood from the surgical field. The operative mortality rate for pulmonary thromboendarterectomy at the University of California, San Diego, between 1990 and 1998 was 9.2% in 1,049 patients.
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PMID:The evolution and the current state of the art of pulmonary thromboendarterectomy. 1037 59

Activated protein C resistance (APC-R) is the most common inherited defect of the coagulation system known to date, affecting 3-5% of Americans. It is an autosomal dominant disorder associated with an increased risk of venous thrombosis and is reportedly found in 21% of individuals with deep venous thrombosis. Medical examiners are in a unique position to make the diagnosis since a fatal pulmonary embolism may be the first manifestation of the disorder. This study examines the prevalence of APC-R in individuals who die suddenly of pulmonary embolism to help medical examiners decide if routine testing is indicated. We examined 66 cases of sudden death due to pulmonary embolism seen at the Bexar County Forensic Science Center in San Antonio, Texas, from 1993-1997. The median age was 46 years with a range of 14 to 93 years. Fifty-three percent were Caucasian, 24% were African-American, and 23% were Hispanic. Twenty-seven percent had no known risk factors for pulmonary embolism. Whole blood was tested for the factor V codon 506Q mutation responsible for APC-R using polymerase chain reaction. The prevalence of APC-R was 4.5%, which is similar to the prevalence of APC-R in the general American population. These data imply that individuals with APC-R are not in increased risk for sudden death due to pulmonary embolism, or, conversely, that most fatal pulmonary emboli seen in the medical examiner setting are not induced by APC-R. Routine postmortem testing for the factor V 506Q mutation does not appear indicated at this time, given the low prevalence and high cost of testing.
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PMID:Activated protein C resistance is uncommon in sudden death due to pulmonary embolism. 1058 51

A retrospective cohort study and chart review were performed to estimate the absolute and relative prevalence of the serious diagnoses that might cause a patient to present to the Emergency Department (ED) with a chief complaint of chest pain. In this study, we queried a database of 347,229 complete visits to the San Francisco General Hospital Emergency Department between July 1, 1993 and June 30, 1998 for visits by patients > 35 years old with a chief complaint of chest pain and no history of trauma. Visits for chest pain that resulted in hospitalization were assigned to one of nine diagnostic groups according to final diagnoses as coded in the database. Manual chart review by trained abstractors using explicit criteria was done when group assignment based on coded diagnoses was unclear and in all diagnoses of pulmonary embolism and aortic dissection. Of 8,711 visits (2.5% of all visits) with a chief complaint of non-traumatic chest pain, 3,271 (37.6%) resulted in hospitalization. Of the 3,078 (94.1% of those hospitalized) assigned a final diagnosis, 329 (10.7% of hospitalizations, 3.8% of all visits) had acute myocardial infarction, 693 (22.5%) had either unstable angina or stable coronary artery disease, and 345 (11.2%) had pulmonary causes (mainly bacterial pneumonia) deemed serious enough to require hospitalization. Pulmonary embolism and aortic dissection were diagnosed in only 12 (0.4%) and 8 (0.3%) patients, respectively. In 905 (29.4%) hospitalizations for chest pain, myocardial infarction was "ruled out" and no cardiac ischemia or other serious etiology for the chest pain was diagnosed. Among patients presenting with chest pain, those in older age groups had dramatically increased risk of acute myocardial infarction. Women presenting with chest pain had a lower risk of acute myocardial infarction than men. In conclusion, the prevalence of acute myocardial infarction in the undifferentiated ED patient with a chief complaint of chest pain is only about 4%. An equal number of patients will have a serious pulmonary cause as the etiology of their pain. Pulmonary embolism and aortic dissection are important but extremely rare causes of a chest pain presentation to the ED.
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PMID:Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain. 1624 93

A percentage ranging from 0.1 to 4.0 of patients recovering from acute pulmonary embolism develop chronic thromboembolic pulmonary hypertension (CTEPH). Without intervention, CTEPH is a progressive and lethal disease for which there is no effective medical therapy. Pulmonary endarterectomy (PEA) is the treatment of choice. Lung transplantation is indicated only in few cases when PEA is not feasible. Since 1994 at the IRCCS San Matteo Hospital - University of Pavia (Italy), 134 PEAs have been performed. Preoperatively, NYHA class distribution was respectively 3-II, 56-III, and 75-IV; mean pulmonary artery pressure and pulmonary vascular resistances were 47 +/- 13 mmHg and 1149 +/- 535 dynes*s*cm(-5) respectively. The overall operative mortality has been 9.7% (4.5% in 2004). Survival at 3-month, 1-year, and 3-year follow-up was 89.5 +/- 2.6, 87.8 +/- 2.9, and 83.3 +/- 3.5% respectively; this last rate was unchanged up to 10 years. After PEA, mean pulmonary artery pressure and pulmonary vascular resistances were 25 +/- 9 mmHg and 322 +/- 229 dynes*s*cm(-5) respectively and these results were stable over time. At the 3-year follow-up, 94% of patients were in NYHA class I or II and the only therapy is anticoagulation.
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PMID:Pulmonary endarterectomy: the treatment of choice for chronic thromboembolic pulmonary hypertension. 1627 Apr 81

Pulmonary embolism is a common and sometimes devastating disease caused by many factors, most commonly deep venous thrombosis. Treatment is typically systemic anticoagulation depending on patient clinical presentation. For patients with life threatening pulmonary embolism, IV tPA (Activase, Genentech, South San Francisco, CA) is the most common medication given emergently at the time of presentation. Computed tomography angiography (CTA) of the chest has advanced the diagnosis and potential treatment options for patients with life threatening pulmonary embolism. Combination percutaneous transcatheter directed pharmacological and mechanical thrombolysis has become extremely useful in these difficult cases.
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PMID:Bilateral EKOS EndoWave catheter thrombolysis of acute bilateral pulmonary embolism in a hemodynamically unstable patient. 2037 46

Pulmonary thromboendarterectomy (PTE), also referred to as pulmonary endarterectomy, is the definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH). The true incidence of CTEPH is unknown and difficult to ascertain; however, most experts agree that approximately 4% to 5% of all patients who have an acute episode of pulmonary embolism (PE) will continue to develop CTEPH. Based on an incidence rate of about 0.1% for acute PE, this translates into a CTEPH incidence of approximately 10,000 to 15,000 annually in the United States alone. Furthermore, there are patients with CTEPH who have no history of prior PE or deep vein thrombosis, adding to the estimated number. Despite these facts, the disease remains significantly underdiagnosed, and currently there are only about 300 PTEs performed nationwide, the majority of which are done at the University of California, San Diego (UCSD) Health System. The technical aspects of the procedure can be somewhat challenging and require meticulous and complete dissection of the entire pulmonary vascular tree, with the patient under profound hypothermic circulatory arrest. However, the determination of true CTEPH patients and those who would benefit from surgery can also be challenging and relies heavily on the experience of the CTEPH team. In this article, we will highlight some key points about the disease and describe the surgical techniques of PTE.
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PMID:Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension: Pulmonary Thromboendarterectomy. 2828 96

Venous thromboembolism (VTE) is a potentially life-threatening condition that includes both deep vein thrombosis (DVT) and pulmonary embolism. We sought to improve detection and reporting of children with a new diagnosis of VTE by applying natural language processing (NLP) tools to radiologists' reports. We validated an NLP tool, Reveal NLP (Health Fidelity Inc, San Mateo, CA) and inference rules engine's performance in identifying reports with deep venous thrombosis using a curated set of ultrasound reports. We then configured the NLP tool to scan all available radiology reports on a daily basis for studies that met criteria for VTE between July 1, 2015, and March 31, 2016. The NLP tool and inference rules engine correctly identified 140 out of 144 reports with positive DVT findings and 98 out of 106 negative reports in the validation set. The tool's sensitivity was 97.2% (95% CI 93-99.2%), specificity was 92.5% (95% CI 85.7-96.7%). Subsequently, the NLP tool and inference rules engine processed 6373 radiology reports from 3371 hospital encounters. The NLP tool and inference rules engine identified 178 positive reports and 3193 negative reports with a sensitivity of 82.9% (95% CI 74.8-89.2) and specificity of 97.5% (95% CI 96.9-98). The system functions well as a safety net to screen patients for HA-VTE on a daily basis and offers value as an automated, redundant system. To our knowledge, this is the first pediatric study to apply NLP technology in a prospective manner for HA-VTE identification.
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PMID:The use of natural language processing on pediatric diagnostic radiology reports in the electronic health record to identify deep venous thrombosis in children. 2881 63


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