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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eight patients with pancreatic abscesses secondary to acute necrotizing pancreatitis underwent drainage of their abscesses under laparotomy. Two of them died of acute pulmonary thromboembolism (PTE) within 1 week. Autopsy revealed a large thrombus at the main trunk of the pulmonary artery and in the left common iliac vein. Femoral catheter insertion/indwelling, immobilization, surgery, increased trypsin/kinin/kallikrein, increased endotoxin, and decreased antithrombin-III (AT-III) were present following drainage of the pancreatic abscesses. With respect to the bedside diagnosis of acute PTE, alveolar-arterial oxygen gradients obtained by blood gas analysis and mean pulmonary artery pressure estimated by pulsed Doppler echocardiography are very useful. In terms of the treatment, attention should be paid to the following to prevent deep venous thrombosis: prophylactic administration of low molecular weight heparin and administration of AT-III (AT-III > or = 80%), use of the subclavian vein whenever possible as blood access for apheresis therapy, as short a compression time as possible after removing the blood access catheter (< or =6 h), and application of intermittent pneumatic compression devices or elastic compression stockings on the lower extremities.
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PMID:Postoperative acute pulmonary thromboembolism in patients with acute necrotizing pancreatitis with special reference to apheresis therapy. 1022 70

Balloon valvoplasty was undertaken in 27 patients with tetralogy of Fallot for first-stage palliation. Indications were arterial saturation of oxygen < 80%, hypoxic spells and duct-dependant pulmonary perfusion. The dilation was performed following diagnostic heart catheterization. Saturations improved from 75% +/- 8.5 before valvoplasty to 85% +/- 8.4 after the procedure, and worsened little to 83% +/- 9.6 at follow-up after 3.4 months. The pulmonary valvar orifice was hypoplastic in most patients (Z = -3.3 +/- 1.2), and did not change after the procedure. The cross-sectional area of the pulmonary arteries was diminished initially, reflected by a Nakata index of 186 +/- 95 mm2/m2. After valvoplasty, we found widening of the vessels (Nakata index 225 +/- 100 mm2/m2). At follow-up no further growth of the arteries was observed (Nakata index 209 +/- 109 mm2/m2). The procedure was complicated by hypoxic spells in three patients which were controlled by intravenous propranolol, and deep venous thrombosis in four patients. Our data demonstrate that balloon valvoplasty is feasible for initial palliation in patients with tetralogy of Fallot. It does not, however, produce growth of the pulmonary arteries or of the pulmonary valve.
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PMID:Balloon valvoplasty in infants with tetralogy of Fallot: effects on oxygen saturation and growth of the pulmonary arteries. 1032 34

In recent years, organized basic care and the use of thrombolysis have been significantly effective in improving the acute stroke therapy especially for the ischemic stroke subtype. Combining the efforts for the basic care of stroke patients in the setting of the so-called stroke-units is the goal for a qualified therapy. Main parts in the basic care algorhythm are: optimization of the cerebral perfusion, maintenance of an initial high blood pressure, best oxygen supply, reduction of an increased body temperature and antiinfectious treatment, reduction in the rate of complications (like deep vein thrombosis, pneumonia, falls etc.) and the early physiotherapeutic therapy. Thrombolysis is restricted to selected patients with infarctions of the middle cerebral artery with symptoms starting not longer than three hours before treatment, without hemorrhage in CCT and fulfilling the strict in- and exclusion criteriae established by the recent multicenter trials. The use of rt-PA (0.9 mg/kg body weight) is recommended. Local fibrinolysis is used in patients suffering from basilar artery thrombosis. The use of other recanalizing techniques like PTA or stenting is yet still experimental in acute stroke patients. Neuroprotective agents which were proven in clinical trials are still not available. In recent years therapy with hemodilution was widely used, nowadays the intravenous application of fluids with hemodilutive properties is restricted to patients with reduced cardiac output and macroangiopathy to maintain or to improve cerebral perfusion. Early intravenous anticoagulation with heparin is defined as secondary prevention and not as therapeutical intervention.
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PMID:[Acute therapy of stroke]. 1041 99

A 85-year-old woman was admitted to our hospital because of a presumtive diagnosis of pulmonary thromboembolism. The patient presented with a history of progressive dyspnoea and retrosternal pain. 3-4 weeks ago she had noticed a swollen left leg. On examination a 4/6-pansystolic murmur was found. An arterial blood gas analysis showed a reduced oxygen saturation. An electrocardiogram revealed deep S-waves in lead I and pathological Q-waves in lead III. The chest X-ray showed cardiomegaly, a pulmonary nodule and an ill-defined opacity inferioposteriorly. Ventilation-perfusion mismatch was demonstrated by lung ventilation-perfusion scanning. Transthoracic echocardiography showed pulmonary hypertension and tricuspid regurgitation. On the 20th hospital day the patient died from multi organ failure. Pulmonary thromboembolism secondary to deep venous thrombosis of the lower extremities was the most likely diagnosis. In view of the patients' history of night sweat, loss of appetite and weight loss a malignant process had to be taken into consideration. A tumor originating from the right ventricle, the right ventricular outflow tract or the pulmonary artery was compatible with the clinical picture of multiple pulmonary emboli. On autopsy a polymorph cellular sarcoma measuring 6 x 3 x 3 cm was found in the right ventricular outflow tract. Section of the lung revealed a single pulmonary metastasis and multiple thromboemboli of various age. Pulmonary artery sarcomas, as described in our case, are extremely rare. The prognosis is poor and often the diagnosis is only made on autopsy.
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PMID:[A "typical" case of pulmonary embolism]. 1051 85

Pulmonary diseases play a particular role during pregnancy. First, the adaptive hyperventilation of the mother implies sufficient pulmonary reserves, and second, and increasing oxygen consumption of the fetus during pregnancy might be compromised by maternal hypoxemia and could be followed by fetal growth retardation and fetal hypoxemia. Asthma bronchiale is the leading pulmonary disease in pregnancy and is not associated with higher risk for pregnancy and fetus when sufficiently threatened. First line medicaments are beta-2-agonists and steroids. Pneumonia however is a serious menace to the pregnant women, especially when not early diagnosed and correctly treated. Respecting the leading germs, macrolids or wide-spectrum penicillins are used. Tuberculosis has no deleterious effect on pregnancy with early diagnosis and treatment, which follows the usual guidelines during pregnancy with isoniacid, rifampicin and ethambutol. Cystic Fibrosis is not a strict contraindication for a pregnancy, especially for mild clinical forms. However, preconceptional counseling and regular clinical controls before and during pregnancy are indispensible. Deep vein thrombosis and pulmonary embolism are more frequent during pregnancy; the search for risk factors, prophylaxis and treatment are essential to avoid these complications. Heparin is the ideal prophylaxis and treatment in pregnancy, while oral anticoagulants should be avoided because of their effect on the fetus.
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PMID:[Lung diseases in pregnancy]. 1054 31

The accurate detection of pulmonary embolism is possible by means of non-invasive but very expensive ventilation-perfusion lung scanning or invasive and with high rate of complications pulmonary angiography. Thus monitoring of many clinical and biochemical parameters has been recently attempted to increase the probability of correct diagnosis of pulmonary embolism. The alveolar-arterial oxygen gradient is a more sensitive indicator of disturbance in oxygenation than occurrence of hypoxia in gasometry. The aim of our study was to examined the changes of the alveolar-arterial oxygen gradient in patients with pulmonary embolism. The survey was made in 35 patients aged from 41 to 75 with acute pulmonary embolism, of these 17 were men and 18 were women. We excluded patients with coexisting serious heart or lung disease. Pulmonary embolism was diagnosed on the grounds of presence of commonly known risk factors, sudden onset, findings on the chest radiography, hypoxia resistant to oxygen therapy, electrocardiography, echocardiography and catheterization of pulmonary artery using a Swan-Ganz catheter. The alveolar-arterial oxygen gradient was measured in arterial blood samples obtained 15 minutes after 100% oxygen ventilation, using standard formulae. All patients were administered heparin, oxygen and warfarine therapy. The control group consisted of 20 patients, 11 women and 9 men aged from 37 to 74, with deep venous thrombosis without coexisting heart or lung disease. In our study we showed that the alveolar-arterial oxygen gradient is a very useful parameter helping with diagnosis and monitoring efficacy of treatment in patients with pulmonary embolism without coexisting heart or lung diseases.
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PMID:[Alveolar-arterial oxygen gradient in patients with clinical symptoms of pulmonary embolism]. 1059 85

Air travel is becoming increasingly more accessible to people both through the availability of cheap flights and because the airlines are now able to cater for individuals of all ages and disabilities. The wide bodies of many new aircraft permit the airlines to have very flexible seating options. Airline operators currently have an important role in determining the comfort and spaciousness of the seating in their aircraft. Passengers who remain seated for the bulk of a flight may risk oedema or deep vein thrombosis. This could be particularly important for larger people in certain economy class seats. The absence of smoking on planes has encouraged designers to cut back on the rate of cabin ventilation and hence introduce filtered recirculated air to the aircraft cabin. In new planes the ventilation rate is under pilot control and savings (economies) can be achieved by using decreased ventilation. A lower ventilation rate may lead to 'less comfortable air quality' in some parts of the plane and an increased risk of possible cross-infection from other passengers on the flight. Technological advances in jet engine design has permitted larger passenger planes to fly longer distances and at greater altitudes than ever before. The higher flying altitude is associated with a lower cabin pressure, which has an important physiological effect on oxygen saturation in the blood of both crew and passengers, particularly for the very young, the elderly and those who are less fit.
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PMID:Comfort and health in commercial aircraft: a literature review. 1132 95

Primary pulmonary hypertension (PPH) is a condition characterized by sustained elevation of pulmonary artery pressure (PAP) without demonstrable cause. The most common symptom at presentation is dyspnea. Other complaints include fatigue, chest pain, syncope, leg edema, and palpitations. Right heart catheterization is diagnostic, showing a mean PAP >25 mmHg at rest and >30 mmHg during exercise, with a normal pulmonary capillary wedge pressure. In the National Institutes of Health-PPH registry, the median survival period was 2.8 years. Treatment is aimed at lowering PAP, increasing cardiac output, and decreasing in situ thrombosis. Vasodilators have been used with some success in the treatment of PPH. They include prostacyclin, calcium-channel blockers, nitric oxide and adenosine. Anticoagulation has also been advised for the prevention of deep vein thrombosis, pulmonary embolism, and in situ thromboses of the lungs. New drug treatments under investigation include L-arginine, plasma endothelin-I, and bosentan. Use of oxygen, digoxin, and diuretics for symptomatic relief have also been recommended. Patients with severe PPH refractory to medical management should be considered for surgery.
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PMID:Primary pulmonary hypertension. 1172 93

We describe the case of 55-year old male with antiphospholipid syndrome (APS) who developed pulmonary hypertension without any thromboembolic episode. Multiple pulmonary perfusion defects suggestive of in situ thrombosis were observed. Hematological findings revealed microangiopathic hemolytic anemia and thrombocytopenia. These findings were improved by anticoagulant therapy. We monitored mean pressure of pulmonary artery (mPAP) and total pulmonary vascular resistance (TPR) before and after using vasodilator agents by Swan-Ganz catheter. mPAP and TPR showed improvement on treatment with oxygen supplementation therapy and Isosorbide administration. Previously 11 cases with APS complicated with pulmonary hypertension were reported. Majority of these patients have had recurrent venous thrombosis, particularly deep vein thrombosis often accompanied by pulmonary thromboembolism (8/11 cases, 72%). However in this case pulmonary hypertension with APS may be induced by in situ thrombosis in pulmonary micro vessels.
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PMID:[A case of primary antiphospholipid syndrome complicated with pulmonary hypertension]. 1172 66

Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to <30%, 30-50%, or >50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (>50% vs. <30%, 6.3 vs. 3.6 kPa, P <.0001). Median plasma DD concentration was 7950 microg/L in patients with >50% perfusion defects compared to 2731 microg/L in those with <30% defects (P = .0001). DD levels above 4000 microg/L were associated to more extensive perfusion defects (>50% vs. <30% defects, OR 30; 95% CI 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (>50% vs. <30% defects, OR 4.5; 95% CI 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.
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PMID:Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. 1181


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