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PubMed2004

Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization: initial success and rate of permanent cure.

BACKGROUND AND PURPOSE: Endovascular treatment with cyanoacrylate embolization is an option when complete obliteration of the nidus of an intracranial arteriovenous malformation (AVM) is the goal. Our purpose was to evaluate the rates of initial success and permanent cure of such treatment in a Chinese population. METHODS: Twenty-seven consecutive patients with an intracranial AVM underwent endovascular embolization with cyanoacrylate between June 1995 and May 1997. Twenty-six patients had cerebral AVMs and one had a cerebellar AVM. Curative embolization was attempted in 10 patients in whom 1) the nidus was not larger than 3 cm, 2) the number of feeders did not exceed three, and 3) the nidus was accessible with the tip of the catheter. We used a flow-directed microcatheter and a 20-25% mixture of cyanoacrylate in contrast medium. Long-term outcomes were observed angiographically and clinically. RESULTS: Complete embolization was achieved in six patients. No procedure-related complications occurred during attempted curative embolization. Follow-up angiography performed at 17-32 months showed complete obliteration of the AVM nidus in the six patients after initial embolization. These patients remained asymptomatic 5-7 years after treatment. The rate of permanent cure of the initially complete embolization was 100% (six of six). The success rate of endovascular cure for patients treated with curative intent was 60% (six of 10). The overall cure rate was 22% (six of 27). CONCLUSION: The overall initial cure rate of intracranial AVM with cyanoacrylate embolization was 22%. Initial angiographic evidence of complete embolization indicated permanent cure in these patients.

Adolescent↗
PubMed2004

[Preoperative embolization of metastatic spinal tumors].

The authors reviewed their clinical experience with preoperative embolization of metastatic spinal tumors. Between October 2000 and September 2003, 20 patients (13 men and 7 women; average age 68.3 years, range 44-82 years) underwent 24 spinal operations for 22 spinal metastatic tumors. Nineteen spinal operations (79%) were planned preoperative embolization with polyvinyl alcohol particles. In 3 cases, there was no tumor stain. Fifty percent of the C4-T2 lesions and 76% of the T3-L3 lesions were embolized preoperatively. The level of lesions determined which embolization procedure should be used. With C7-T2 or sacral lesions, feeding arteries were superselectively catheterized, then particles were injected via a microcatheter. With T3-L3 lesions, selective catheterization of the corresponding segmental arteries was performed. Particles were injected via 4 or 5Fr catheters. No complications were encountered during embolization. Embolizing from the origin of the segmental arteries is effective for reducing intraoperative blood loss because feeding vessels in the anterior part of the spinal body are able to be embolized. Preoperative embolization is not a very complicated procedure and careful catheterization can avoid complications. Based on tumor histology, size of the spinal body, depth of the operative field and operative approach, preoperative embolization can be performed with positive results.

Adult↗
PubMed2004

[An experimental study on the repair mechanism after pulmonary embolism].

OBJECTIVE: To study the role of basic fibroblast growth factor (bFGF) and small vascular density in the repair mechanism after pulmonary embolism (PE). METHODS: After peripheral pulmonary arteries had been embolized, 8 dogs were killed 1, 7, 14, and 28 days after embolization. One piece of tissue was taken from the region embolized and unembolized respectively, then HE staining and immunohistochemical staining were performed. The pathological change of the lung, changes of small vascular density and expression of bFGF were observed, and were compared between regions embolized and unembolized at different time points. RESULTS: (1) The course of pathological change during the pulmonary embolism period. (2) The bFGF was increased from 1st day to 14th day after PE (1st day: chi(2) = 44.335, 7th day: chi(2) = 71.911, 14th day: chi(2) = 84.460; P < 0.01), and decreased to normal on 28th day (chi(2) = 2.961, P > 0.05). (3) Small vascular density in embolized region (4.56 +/- 0.50) showed no statistical difference from that of unembolized region (4.11 +/- 0.76) on 1st day (P > 0.05), while it (7th day: 10.17 +/- 1.08, 14th day: 10.54 +/- 0.93, 28th day: 11.47 +/- 1.11) was significantly higher than that of unembolized region (7th day: 6.17 +/- 0.90, 14th day: 7.55 +/- 1.19, 28th day: 7.03 +/- 1.24) after embolized 7, 14, 28 days (P < 0.05). CONCLUSIONS: After PE, with increased expression of bFGF in embolized region, the formation of collateral arteries between pulmonary artery system and bronchial artery system is promoted, and absorption of the transuded blood cells and fluid is accelerated. This mechanism may be important in prevent pulmonary infarction.

Animals↗
PubMed2005

Selective endovascular treatment of intracranial aneurysms with a liquid embolic: a single-center experience in 39 patients with 41 aneurysms.

BACKGROUND AND PURPOSE: Although embolization with detachable coils is an accepted alternative to surgical clipping, a major long-term problem is aneurysm recanalization due to coil compaction. Liquid embolic agents are a possible alternative as filling material that might decrease the recanalization rate. We evaluated the use of a liquid embolic for endovascular treatment of intracranial aneurysms. METHODS: During 1999-2003, 10 patients with 11 small aneurysms (group 1) and 29 patients with 30 large or giant aneurysms (group 2) were treated with a liquid embolic. Of 32 female and seven male patients, 20 had mass effect and two had subarachnoid hemorrhage; 17 were asymptomatic. All aneurysms were judged unsuitable for regular treatment; selective embolization was performed with a liquid embolic alone or with coils and liquid embolic. Stent placement was performed in 15 cases. Clinical and anatomic outcomes were assessed with the Modified Glasgow Outcome Scale and with angiography at 3, 12, and 24 months. RESULTS: In group 1, good or excellent outcome and complete occlusion were observed in all patients. In group 2, clinical outcome was good or excellent in 26 patients and fair in one, and death occurred in two patients (one procedure related and one disease related). Technical complications occurred in four patients in group 1 (one permanent neurologic deficit) and in four patients in group 2 (one patient died, two remain hemiparetic, one remains asymptomatic). Follow-up images showed two recanalizations in group 1 and nine in group 2. CONCLUSION: Selective embolization with a liquid embolic is useful to treat aneurysms unsuitable for coiling or for patients in whom previous treatment failed. This mostly applies to large and giant aneurysms in which morbidity and mortality rates are better than those associated with surgery, and the recanalization rate is lower than that previously described with coiling.

Adult↗
PubMed2005

[The change of pulmonary surfactant associated protein A in acute pulmonary embolism].

OBJECTIVE: To study the changes of pulmonary surfactant associated protein A (SPA) of lung tissue in acute pulmonary embolism (PE). METHODS: Male SD rats were injected with medical gelfoam microspheres via jugular vein to induce the PE model. Thirty-two rats were randomized into four groups: a control group (n = 8) and three groups of embolism for 24 h (n = 8), 1 week (n = 8) and 2 weeks (n = 8), respectively. The rats were sacrificed at the time of 2 weeks, 24 h, 1 week and 2 weeks. Pulmonary artery pressure, heart rate and respiratory rate were measured by right heart catheterization and artery blood gas was analyzed at the time of sacrifice. Lung tissues were sliced and stained with HE to observe the embolism of pulmonary arteries. RT-PCR and Western blot were used to study the changes of SPA mRNA and SPA protein in lung tissues. RESULTS: In the embolism rats, the pulmonary arterial pressure (mm Hg) increased significantly; the mean pulmonary arterial pressures of the 4 groups were 14.2 +/- 4.1, 26.1 +/- 7.5, 26.1 +/- 6.8 and 29.0 +/- 8.2, respectively (P < 0.05). The heart rate (per/minute) also increased significantly, 415 +/- 15, 451 +/- 35, 463 +/- 29 and 446 +/- 14, respectively in the 4 groups (P < 0.05). The arterial partial pressure of oxygen (mm Hg) decreased significantly, 94.1 +/- 8.8, 80.5 +/- 5.8, 80.4 +/- 13.8 and 73.4 +/- 14.3, respectively in the 4 groups (P < 0.05). After 24 h of embolism, pulmonary arteries were shown to be embolized with gelfoam, and later the gelfoam was resolved at week 2. The expression of SPA mRNA and protein in lung tissues decreased significantly after embolism; the mRNA level was 1.43 +/- 0.51, 0.83 +/- 0.33, 0.91 +/- 0.33 and 0.87 +/- 0.35 respectively in the 4 groups (P < 0.05); the protein level was, 1.00 +/- 0.00, 0.44 +/- 0.18, 0.44 +/- 0.33, and 0.52 +/- 0.32, respectively (P < 0.05). CONCLUSION: The SPA level decreases significantly in acute pulmonary embolism, which may play an important role in hypoxemia in pulmonary embolism.

Animals↗
PubMed2005

Failure of the Symbiot PTFE-covered stent to reduce distal embolization during percutaneous coronary intervention in saphenous vein grafts.

OBJECTIVES: To examine the effect of the Symbiot PTFE-covered stent on distal embolization during percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). BACKGROUND: Covered stents are intended to trap friable debris and reduce distal embolization during vein graft PCI, but have consistently failed to improve clinical outcomes in randomized trials. The reasons for this lack of benefit are unclear. METHODS: Thirty patients undergoing SVG PCI, and eligible for a FilterWire distal protection device, were randomized to Symbiot or to a conventional bare-metal stent. Postprocedure, the FilterWire was removed, fixed in formalin, and photographed under high magnification. The primary end-point was embolic debris area, measured by semi-automated edge-detection analysis of digital images. Secondary end points were no-reflow, "Filter no-reflow", and distal embolization. RESULTS: There was no significant difference between the Symbiot and conventional stent groups in embolic debris area (10.5 +/- 7.2 versus 6.6 +/- 7.8 mm2; p = 0.18). No-reflow occurred in 3/14 Symbiot versus 0/16 conventional (p = 0.09), and final TIMI flow was lower in the Symbiot group (2.7 +/- 0.5 versus 3.0 +/- 0.5; p = 0.01). However, there was no difference in the incidence of Filter no-reflow (7/14 versus 7/16; p = NS) or distal embolization (9/14 versus 8/16; p = NS). Distal embolization in the Symbiot group occurred predominantly after postdilatation (7/9; p = 0.05). CONCLUSIONS: The Symbiot PTFE-covered self-expanding stent does not reduce distal embolization compared to a conventional bare metal stent. Distal embolization with the Symbiot occurs almost exclusively after mandatory postdilatation. These findings may explain the failure of the Symbiot, and of covered stents in general, to improve clinical outcomes during vein graft PCI.

Aged↗
PubMed2006

Feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy: a preliminary study.

BACKGROUND: The high operative risk of hepatectomy for specially located intrahepatic stones is still a problem to be solved. This study was undertaken to investigate the feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy. METHODS: Oxybenzene or absolute ethanol plus N-butyl-cyanoacrylate was employed for embolization. The feasibility, effectiveness and mechanism of chemical hepatectomy were preliminarily analyzed histologically or by Fas, TIMP-1, TGF-beta(1), and collagen I. RESULTS: Oxybenzene plus cyanonacrylate can preferably destroy and embolize the intrahepatic biliary duct, leading to the disappearance of hepatocytes in the periphery of embolized lobe and the achievement of effective chemical hepatectomy. The expressions of Fas, TIMP-1 and TGF-beta(1) in oxybenzene embolism group (88.90 +/- 38.10, 619.43 +/- 183.42, 185.22 +/- 70.39) and ethanol embolism group (72.39 +/- 29.51, 407.55 +/- 134.74, 163.56 +/- 51.75) were higher than those of biliary duct-ligated group (26.31 +/- 12.07, 195.31 +/- 107.67, 74.84 +/- 40.73) (P<0.05). The collagen I-positive percentage in the oxybenzene embolism group was also greater than that of the ethanol embolism group (33.97 +/- 12.51% vs. 20.67 +/- 8.09%, P<0.05). CONCLUSION: The effect of chemical hepatectomy may be achieved by chemical bile duct embolization.

Animals↗
PubMed2006

A dilemma: prophylaxis for pulmonary embolism after surgical or invasive interventions for hemodialysis.

AIM: This study was designed to investigate if it needs to do prophylaxis for pulmonary embolism in the patients treated with different kinds of dialysis or not, and if it is, to find a proper method for prophylaxis. METHODS: Ten numbers of patients with central venous catheters (CVC group), 13 numbers of patients with arteriovenous fistula (AVF group) were enrolled in this study. Eleven patients treated with peritoneal dialysis (PD group) were utilized as a control group. Clinical and laboratory examinations to exclude pulmonary embolism were carried out in both AVF and PD groups at the onset and after three months. Same examinations were performed in CVC group at the onset and after 3 weeks (mean: 21 days). Examinations to exclude pulmonary embolism consist of medical history, clinical examinations, d-dimer measures, chest x-ray, respiratory function tests, blood gas analyses, ventilation-perfusion scintigraphies. RESULTS: Neither clinical nor laboratory findings in any stages reflected any suspicion for pulmonary embolism. None of the patients in any groups was admitted with pulmonary embolism in any period of follow-up. There was not any statistically difference between the outcomes of all first examinations and of all second ones (P>0.005). Neither obvious nor subclinical pulmonary embolism was detected in any case. None of the patients had deep venous thrombosis in any stage of follow-up. CONCLUSIONS: Conventional techniques of haemodialysis do not lead to pulmonary embolism unless deep venous thrombosis due to any intervention occurs in the patients. Thus, prophylactic anticoagulant usage to prevent pulmonary embolism is not necessary in haemodialysis patients. To shorten the length of stay of central venous catheters is the most important factors for pulmonary embolism prophylaxis in haemodialysis patients.

Adult↗
PubMed1989

[Hepatic artery embolization for primary hepatic carcinoma].

Twenty patients with primary hepatic carcinoma (PHC) treated by hepatic arterial embolization in our department from Dec. 1986 to Mar. 1987 are reported. There were 15 males and 5 females. The ages ranged from 34 to 75 years with an average of 50.7. Preoperative diagnosis and localization of the tumor were done by AFP, B-us, CT and angiography (right lobe 15 cases, left lobe 1 case, both lobes 4 cases). Celiac and superior mesenteric angiography was carried out by femoral artery approach and then highly selective hepatic catheterization was utilized for hepatic arterial embolization. Antitumor agent (5-Fu, adriamycin), iophendylate and foamy gel sponge were used for peripheral and proximal embolization. Manifestations were improved in most of the patients after embolization, such as relief of abdominal pain, improvement of appetite, decrease of tumor size. Total necrosis of the tumor was found in 2 patients who underwent surgery 1 month after embolization. The side effects of the posthepatic embolization such as, nausea, vomiting, abdominal pain and fever could be relieved by symptomatic treatment. No severe complications, such as gangrene of the gall bladder, hepatic failure, liver abscess, intestinal necrosis or pulmonary embolization were found except 3 patients who died of renal failure after the procedure. The liver dys-function returned to normal within 2 weeks. Hepatic arterial embolization provides an alternative treatment for the patients with PHC who has compensated liver function without severe systemic diseases, especially renal endocrine problems and severe portal hypertension. They should have patent portal system as proved by angiography. The authors considered that this therapeutic embolization with hepatic chemotherapy infusion is safe and effective in the management of PHC. It may increase the resectability and provide palliative means for the advanced and terminal cases.

Adult↗
PubMed1989

[Management of bleeding esophageal varices--efficacy of emergency embolization therapy].

To increase durability for long term control of bleeding, additional treatment has to be performed. Since Oct. 1979, various embolizations that is percutaneous transhepatic obliteration (PTO), splenic artery embolization (SAE) and left gastric artery embolization (LGE) were introduced as conservative treatments, and have been used singly or concomitantly. Embolization has been employed in order to avoid the high risk of emergency operation. Complete hemostasis and prolonged efficacy could be obtained by introducing various embolizations. No emergency operation has been performed since all of these embolizations were introduced in Jan. 1983. The rates of hemostasis (100%), one month survival (90%), 1 year incidence of rebleeding (6.7%), 1 year survival (75.5%) and 3 year survival (62.5%) of emergency cases which received combined embolizations were better than the results of the cases which received emergency operation or endoscopic sclerotherapy alone. Moreover, the patients with gastric varices, including bleeding gastric varices treated with various combined embolizations, showed results of diminished varices in 78.9% of the patients. Thus to increase durability for long term control of bleeding, embolization should be combined according to the patient's hemodynamics, which may result in its extended application.

Embolization, Therapeutic↗
PubMed1989

[The diagnosis of lung embolism].

An accurate diagnosis of pulmonary embolism is essential to prevent excessive mortality and morbidity from lack of therapy or inappropriate anticoagulation. The clinical diagnosis is highly nonspecific because none of the symptoms or signs of pulmonary embolism is unique and all may be caused by other cardiorespiratory disorders. The diagnosis of pulmonary embolism is unlikely, however, if patients do not have dyspnea, tachypnea, evidence of deep vein thrombosis, or a recognized predisposition to thromboembolic disease. Objective testing is mandatory to either confirm or exclude a diagnosis of pulmonary embolism. The electrocardiogram, chest X-ray and the echocardiogram may assist by excluding other potential diagnoses. Routine laboratory studies and lung function testing including blood gas analysis will not be of much help in the differential diagnosis. The hemodynamic investigation with a floating catheter is of diagnostic value especially in those cases where it is not possible to obtain the definitive diagnosis immediately; this method as well as echocardiography can provide a rough estimate of the degree of pulmonary vascular obstruction and are thus able to guide therapy. Methods such as DSA, CT, MR, SPECT, or radiolabelled thrombus scanning are promising but require more extensive validation before routine use. Lung scanning, with its high sensitivity but low specificity is a very useful procedure but cannot be considered to have diagnostic significance independent of the clinical situation. Pulmonary angiography provides the greatest diagnostic certainty of any test available. Based on current knowledge, a diagnostic approach for the management of clinically suspected pulmonary embolism is proposed. Ventilation-perfusion lung scanning is the appropriate next step after ECG, chest X-ray and echocardiogram. The finding of a normal perfusion scan rules out clinically significant embolism and anticoagulation is withheld. Segmental or lobar perfusion defects with normal ventilation in an appropriate clinical setting is sufficiently indicative of pulmonary embolism to proceed with therapy in patients without contraindications. Ventilation-perfusion scans of low or indeterminate probability for pulmonary embolism neither confirm nor exclude the presence of embolism and pulmonary angiography would then be the definitive procedure. As an alternative approach instrumental examination of the leg veins (with venography, impedance plethysmography, or ultrasound) is proposed (Figure 1). If these tests confirm the presence of deep venous thrombosis, anticoagulation can be commenced without the need to perform pulmonary angiography.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiac Catheterization↗
PubMed1989

[Diagnosis of cardiac causes of cerebral embolism: a contribution to 2D echocardiography and long-term ECG].

Certain cardiac diseases are regarded as potential sources of embolic strokes. Due to the high risk of recurrent brain embolism diagnosis of a potential cardiac source implies therapeutic consequences in most cases. The contribution of 2D-echocardiography and of ECG Holter monitoring to the detection of possible cardiac sources of cerebral embolism is not yet fully established. We therefore performed 2D-echocardiography and 24-h Holter monitoring in 135 consecutive patients with regional cerebral ischemia. In 17 (12.6%) out of the 135 patients a potential cardiac source of cerebral embolism was found, four of them presented with two cardiac disorders compatible with a cardiac source of embolism. In 10 patients a cardiac disease as potential source of cerebral embolism was already detected during routine examination. 2D-echocardiography disclosed no cardiac embolic source, which was not suspected before but confirmed the diagnosis in five cases. Holter monitoring identified 16 cases with arrhythmias, which may cause systemic embolism. Among these cases seven were not detected during the routine examinations, all of them suffered from intermittent atrial fibrillation. It is concluded that Holter monitoring contributes more than 2D-echocardiography to disclose hitherto unsuspected potential cardiogenic sources of brain embolism.

Adult↗
PubMed1987

[Outcome of patients in metastatic renal cell carcinoma with or without embolization].

Nineteen cases of metastatic renal cell carcinoma were embolized (embolization group) and 18 cases were not (non-embolization group). The median survival time after nephrectomy for the 14 cases in the embolization group, 23 months, was more favorable than the 11 months obtained for the 13 cases in the non-embolization group. In the case of one organ metastasis, the median survival time was 33 months for 9 cases in the embolization group and 11 months for 10 cases in the non-embolization group, with a remarkable difference in survival time between the two groups. Therefore, the survival rate can be improved by performing nephrectomy after embolization in the case of single organ metastasis. On the other hand, in the case of multiple organ metastasis prolongation of survival time cannot be expected even when embolization is performed with or without nephrectomy.

Adult↗
PubMed1982

[Embolization of benign non tumoral diseases of the kidney (author's transl)].

The material includes 11 traumatic lesions of the kidney after needle biopsy, one hemangioma of the kidney with arteriovenous fistula and 4 renal exclusions for malignant hypertension. In traumatic lesions of the kidney after needle biopsy, embolization was followed by 90,9 p. cent excellent, permanent results without any marked loss of renal parenchyma and with simple post-operative follow-up. A hemangioma with congenital arteriovenous fistula required complex embolization owing to multiple pedicles and caused devascularisation of part of the lower pole of the kidney. The clinical result was satisfactory, but an arteriographic control carried out as a routine 3 months later after the embolization showed the development of newly formed vessels around the renal pelvis. However, no relapse of the hematuria occurred after a follow-up of 2 years. During the same period, spontaneous disappearance of 3 hemangiomas of the kidney sent up for embolization was noted, which led us to treat only hemangiomas which bled and prefer embolization in order to keep the kidney intact. In malignant hypertension, embolization proved efficacious and lasting in one case of small unilateral kidney. Carried out in two stages in one case of chronic nephritis with small kidneys, it proved efficacious on one side, insufficient on the other and had to be followed by nephrectomy. Finally, embolization of a remaining kidney due to chronic glomerulonephritis, technically incomplete, was followed by an uncontrollable attack of hypertension with later death of the patient. The blood supply of the kidney must thus be interrupted completely and embolization should not be undertaken unless it appears technically possible. The degree of pain following embolization suggests the possibility of peridural anesthesia.

Adult↗
PubMed1984

[Studies on experimental miliary pulmonary embolism with special reference to the mechanism of initial elevation in pulmonary arterial pressure. Significance of myogenic factor].

It is generally accepted that a vasoconstrictive mechanism participates in transient pulmonary hypertension observed in miliary embolism, in addition to the mechanical blockade of pulmonary vascular tree. For the explanation, some neural and humoral factors, especially those released from adhesion-aggregation process of platelets, have been emphasized. In our previous reports, we have stressed the importance of some local vascular factors in this vasoconstrictive mechanism. Present study was undertaken to elucidate those local factors extensively. Miliary pulmonary embolism in the isolated perfused canine lung lobe was produced by injecting lycopodium spore suspension in saline, in which hepalinized autologous blood and three different artificial solutions were employed as the perfusate. Although each perfusate made a slight difference in perfusing condition, probably owing to its viscosity and oncotic pressure, all preparations showed definite response to embolization. After each embolization, pulmonary inflow pressure was raised rapidly and reached to a maximal level after 30-60 sec., then fell gradually. Repeated embolization at an interval of 6 min., before pulmonary inflow pressure returned to the control level, produced a cumulative effect. There was no significant difference between perfusations with autologous blood and artificial perfusates at the first and the second embolizations, but it was more distinct in those with autologous blood at the third and the fourth embolizations. The results have showed that the initial pulmonary pressure elevation in miliary embolism is observed apparently even under the bloodless and denervated conditions. It was concluded that "Myogenic Factor" (existing locally in the pulmonary arterial and arteriolar endothelium-smooth muscle) must play a very important role as to initial elevation in pulmonary arterial pressure induced by miliary embolizations. Further advanced studies on the myogenic factor is expected.

Animals↗
PubMed1995

Fatal pulmonary embolism in the catatonic syndrome: two case reports and a literature review.

BACKGROUND: Catatonia is associated with excess early mortality when it is unrecognized or inadequately treated. The characteristics of the lethal catatonia subtype are now well described, but the excess mortality of the remaining patients with catatonic syndrome, particularly from pulmonary embolism, appears to be inadequately recognized. The fatal risk of the catatonic syndrome is reviewed. METHOD: Two new case reports of sudden death from pulmonary embolism in catatonic syndrome are presented. The world literature on morbidity, mortality, and pulmonary embolism in catatonia was reviewed by a search of MEDLINE and PsychInfo from 1966 to the present. Additional older references were discovered by screening bibliographies from articles produced by the searches. RESULTS: Twenty cases of autopsy-confirmed pulmonary embolism were found in patients with catatonic syndrome. Catatonic patients were more likely to die of pulmonary embolism and die earlier than patients with other types of schizophrenia. Death from pulmonary embolism did not occur until after the second week of catatonic symptoms and often occurred without warning. CONCLUSION: Risk of a fatal pulmonary embolism is inherent in persistent catatonic symptoms and may explain the observed excess early mortality. Prompt resolution of the catatonic syndrome with benzodiazepines, barbiturates, or electroconvulsive therapy is the best way to reduce risk of pulmonary embolism. The prophylactic value of physical therapy or anticoagulation merits further investigation. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of acute pulmonary embolism warrants early and vigorous intervention in catatonic patients.

Adult↗
PubMed1994

Selective vascular embolization in benign gynecologic conditions.

Eight patients with benign obstetric and gynecologic conditions required embolization. There was a total of 11 embolizations, and embolizing agents were chosen depending on the abnormality requiring embolization. Gelfoam, Ivalon and alcohol were used to treat vascular malformations. Ovarian veins were embolized with coils. Postoperative bleeding was managed with Gelfoam, coils and/or Ivalon. Four patients had bleeding after hysterectomy or vaginal suspension. One patient had postdelivery bleeding. All the bleeding was controlled after embolization. A uterine arteriovenous malformation was managed with embolization, allowing the patient to carry her next pregnancy to term. The symptoms of a vulvar hemangioma and ovarian syndrome were controlled with vascular embolization. Morbidity was minimal. Embolization is the primary treatment of choice in obstetric and gynecologic patients with postoperative bleeding or symptomatic vascular malformation.

Angiography↗
PubMed1994

Acute pulmonary embolism.

Prevention of deep venous thrombosis is fundamental in the prevention of pulmonary embolism. Deep venous thrombosis is common after all surgical procedures, but the frequency differs, as does the effectiveness of various methods of prevention. Low-dose heparin, low molecular weight heparin, graduated compression elastic stockings, intermittent pneumatic compression, and oral anticoagulants have a role in the prevention of deep venous thrombosis, depending on the risks of deep venous thrombosis and their demonstrated effectiveness (or lack of effectiveness) in the particular circumstance. The optimal method of prophylaxis is specific to the predisposing condition. Heparin continues to be a mainstay of anticoagulant therapy. Major bleeding is rare in patients treated with low doses of heparin to prevent deep venous thrombosis. With therapeutic doses, however, major bleeding occurs in about 5% of patients. The optimal dose of warfarin and the method of evaluating the anticoagulant effect of warfarin have undergone modifications in recent years. It is now recognized that the prothrombin time ratio depends on the activity of the thromboplastin used for measuring the prothrombin time. An International Normalized Ratio, which relates to a standardized thromboplastin, has been developed, thus avoiding differences of the prothrombin time ratio that occur from batch to batch of thromboplastin reagent from the same manufacturer and that occur with different thromboplastin reagents from different animal sources and different manufacturers. The bedside diagnosis of pulmonary embolism is useful in helping a physician determine the extent to which diagnostic tests should be pursued. A sound bedside impression also contributes strongly to the formulation of a noninvasive diagnosis of pulmonary embolism. The clinical manifestations of pulmonary embolism form a recognizable constellation of findings that often lead to a correct diagnosis or exclusion of pulmonary embolism. Important clues to the diagnosis of pulmonary embolism relate to the initial syndrome. The presentation of pulmonary embolism is most often in the form of the pulmonary hemorrhage-pulmonary infarction syndrome. The next most common presentation is unexplained dyspnea, unaccompanied by pulmonary hemorrhage or infarction. Least common, but most severe, is the syndrome of circulatory collapse. Immobilization, usually caused by surgery, is the most frequent predisposing factor. Most patients with clinically recognizable pulmonary embolism have dyspnea or tachypnea. Dyspnea or tachypnea or pleuritic pain occurs in nearly all patients who have clinically apparent pulmonary embolism (97%). Ordinary tests such as the electrocardiogram and chest radiograph are helpful if the physician is attentive to nonspecific abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗