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P Egermayer

Publications and source records attributed to P Egermayer.

36 records · Page 2Linked to original sources
PubMed1998

Compliance with guidelines for the investigation and management of patients with suspected pulmonary embolism at Christchurch Hospital.

AIMS: (1) To assess the level of compliance of clinicians at Christchurch Hospital with published local guidelines for the diagnostic management of indeterminate lung scans and for the treatment of pulmonary embolism. (2) To evaluate diagnostic outcomes and the methods used to arrive at the diagnosis. METHODS: Retrospective case analysis of 94 consecutive cases of suspected pulmonary embolism referred for a lung scan after August 1993 and a further 70 consecutive cases referred after August 1995. RESULTS: Few clinicians followed the recommendations for the further assessment of indeterminate lung scans. Pulmonary angiography was rarely performed and serial femoral ultrasound was never employed. The majority of patients diagnosed with pulmonary embolism did not have a high probability ventilation/perfusion (VQ) scan or a pulmonary angiogram to support the diagnosis. The use of heparin was overcautious and inconsistent. Major divergences from recommendations were observed in over 50% of cases in which heparin was used to treat pulmonary embolism. CONCLUSIONS: This audit has uncovered a wide diversity of practice in many aspects of the assessment and management of pulmonary embolism and significant deviations from the published guidelines. Underutilisation of objective imaging methods for establishing the diagnosis implies overreliance on clinical impressions, which are known to be unreliable. A review of the guidelines and further educational initiatives are indicated.

Adolescent↗
PubMed1998

Usefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism.

BACKGROUND: A study was undertaken to assess the usefulness of the SimpliRED D-dimer test, arterial oxygen tension, and respiratory rate measurement for excluding pulmonary embolism (PE) and venous thromboembolism (VTE). METHODS: Lung scans were performed in 517 consecutive medical inpatients with suspected acute PE over a one year period. Predetermined end points for objectively diagnosed PE in order of precedence were (1) a post mortem diagnosis, (2) a positive pulmonary angiogram, (3) a high probability ventilation perfusion lung scan when the pretest probability was also high, and (4) the unanimous opinion of an adjudication committee. Deep vein thrombosis (DVT) was diagnosed by standard ultrasound and venography. RESULTS: A total of 40 cases of PE and 37 cases of DVT were objectively diagnosed. The predictive value of a negative SimpliRED test for excluding objectively diagnosed PE was 0.99 (error rate 2/249), that of PaO2 of > or = 80 mm Hg (10.7 kPa) was 0.97 (error rate 5/160), and that of a respiratory rate of < or = 20/min was 0.95 (error rate 14/308). The best combination of findings for excluding PE was a negative SimpliRED test and PaO2 > or = 80 mm Hg, which gave a predictive value of 1.0 (error rate 0/93). The predictive value of a negative SimpliRED test for excluding VTE was 0.98 (error rate 5/249). CONCLUSIONS: All three of these observations are helpful in excluding PE. When any two parameters were normal, PE was very unlikely. In patients with a negative SimpliRED test and PaO2 of > or = 80 mm Hg a lung scan is usually unnecessary. Application of this approach for triage in the preliminary assessment of suspected PE could lead to a reduced rate of false positive diagnoses and considerable resource savings.

Antifibrinolytic Agents↗
PubMed1997

The clinical significance of pulmonary embolism: uncertainties and implications for treatment--a debate.

Pulmonary embolism and deep vein thrombosis are different aspects of a single problem, thromboembolic disease, which is frequently asymptomatic. The incidence and clinical significance of thromboembolic disease is uncertain. The mortality of untreated pulmonary embolism is unknown but may be much lower than is generally thought. Investigation of the lower limbs is desirable in most cases, even when there are no symptoms in the legs, in order to evaluate the prognosis and the need for anticoagulant therapy. Not all cases of pulmonary embolism require treatment. The presence or absence of risk factors may be important in determining the appropriate length of treatment.

Anticoagulants↗
PubMed1982

Perfusion scintigraphy in the diagnosis of pulmonary embolism: a self-assessment quiz.

The authors present ten case reports with lung scintigrams in a format suitable for a self-assessment quiz. The first seven cases include perfusion scintigrams and the final diagnosis was established by postmortem examination. The last three studies include ventilation images (using nebulized Tc-99m tin colloid) and the final diagnosis established by nonradionuclide studies. The authors believe this quiz demonstrates the necessity for ventilation studies when using lung scintigraphy for a positive diagnosis.

Adult↗
PubMed1980

Perfusion scintigraphy in the diagnosis of pulmonary embolism.

This paper reviews 387 patients who had perfusion scintigraphy over a period of two and a half years. Data are presented concerning patients' symptoms and the use of perfusion imaging. Scintigraphy is shown to be subjective and rather unreliable, as practised in this series. Post mortem correlations suggest that used in isolation, perfusion scintigraphy cannot reliably distinguish emboli from other lung diseases. Use of ancillary tests and ventilation scintigraphy is discussed.

Angiography↗
PubMedDate not supplied

The effects of heparin and oral anticoagulants on thrombus propagation and prevention of the postphlebitic syndrome: a critical review of the literature.

Based on a comprehensive literature search, this report aims to examine the effects of heparin and oral anticoagulants on thrombus propagation and prevention of the postphlebitic syndrome. The effects on recurrence of thromboembolic disease have not been addressed. It is concluded that published reports of serial venograms and ultrasound examinations of patients treated with conventional anticoagulant therapy for deep venous thrombosis show either no change or thrombus extension in the first few months in approximately 50% of cases. Approximately two thirds of patients will have damage to the venous valves, leading to incompetence or other hemodynamic changes. More than one third of patients so treated may have oedema, leg pain, or other severe symptoms on long-term follow-up. The consistency with which these outcomes have been observed, particularly in many large, recent, prospective trials, adds to the credibility of these figures. The results of prospective controlled trials have failed uniformly to show any significant local benefits of anticoagulant therapy for deep vein thrombosis compared with other treatments or placebo. There does not seem to be any convincing evidence that heparin exerts a favorable influence on pulmonary embolism in situ or on portal vein thrombosis. Use of anticoagulant therapy to limit thrombus propagation therefore cannot be said to be "evidence based." These generally poor outcomes with regard to postphlebitic complications should lead to an active exploration of alternative methods of management. Substantial uncertainties surrounding many fundamental aspects of the treatment of this disease remain, and further placebo-controlled trials are needed.

Anticoagulants↗