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At least 1,297 records · Page 72Linked to original sources
PubMed2003

[Pulmonary thromboembolism after videothoracoscopic excision of a mediastinal tumor; report of a case].

We experienced a case of pulmonary thromboembolism after videothoracoscopic excision of a mediastinal tumor. A 57-year-old woman underwent videothoracoscopic excision of an upper mediastinal tumor, which was pathologically diagnosed as neurilemmoma. On the first postoperative day, she suddenly suffered from fatigue and blood-gas analysis showed hypoxemia. No abnormal shadow was seen on chest X-ray. Lung perfusion scintigram showed multiple embolism. She was treated with anticoagulants and recovered well. We should pay attention to the possibility of pulmonary thromboembolism after video-assisted thoracic surgery as well as thoracotomy, especially when patients have risk factors for pulmonary thromboembolism.

Anticoagulants↗
PubMed2003

[Acute pulmonary thromboembolism--prologue].

For a long time, the studies of acute pulmonary thromboembolism in Japan have been focused on its early diagnosis and the rescue of the patients. However, the recent trends in the trials in the courts or the headlines in the newspapers have indicated that the major public interests are directed to its primary prophylaxis. Thus, the guidelines for the prophylactic strategy of acute pulmonary thromboembolism are needed today. It would be important to know (1) to what extent the thrombotic tendency should be examined, (2) how the patients with the risk could be identified, (3) which prophylactic interventions should be selected, and finally (4) what are the expected cost-benefit effects. An emphasis should be put on that the researches to derive quantitative estimates of the risks of thromboembolism and the studies of the efficacy of each of the prophylactic interventions in Japanese patients would provide the basis of such guidelines.

Acute Disease↗
PubMed2003

[Surgical treatment for acute massive pulmonary thromboembolism].

Acute massive pulmonary thromboembolism is a life threatening disorder that must be treated immediately. We performed emergent pulmonary thrombectomy using cardiopulmonary bypass on 15 patients. The patients were 7 men and 8 women aged 28 to 81 years. Early diagnosis was made by body CT scan and echocardiography. When patient had massive pulmonary thromboembolism, when hemodynamics could not be improved by medical treatment, direct embolectomy was performed immediately. 12 patients developed shock and 8 patients underwent cardiac massage. Among 15 patients, 11 were saved by surgical treatment, while the remaining 4 died of multiple organ failure, cardiac failure and mediastinitis. The lives of patients with acute massive pulmonary thromboembolism can be saved by early detection and emergent thrombectomy using cardiopulmonary bypass.

Acute Disease↗
PubMed2003

New pentasaccharides for the prophylaxis of venous thromboembolism: clinical studies.

Fondaparinux, a selective inhibitor of factor Xa, is the first of a new class of antithrombotic compounds, the synthetic pentasaccharides. Its benefit-to-risk ratio in preventing venous thromboembolism after major orthopedic surgery was investigated in four randomized, double-blind international phase III trials in patients undergoing surgery for hip fracture, elective hip replacement, and major knee surgery. Compared to enoxaparin, fondaparinux administered at a subcutaneous dose of 2.5 mg qd, starting postoperatively, reduced the overall incidence of venous thromboembolism up to day 11 by 55.2% (p < 0.001). The incidence of clinically relevant bleeding was low and did not differ between the two groups. Overall, fondaparinux achieved optimal efficacy and safety when treatment was initiated > or =6 h after the surgical procedure. In a further randomized double-blind trial, 4 weeks of prophylaxis with fondaparinux after hip fracture surgery reduced the risk of venous thromboembolism by 96% as compared to 1 week of prophylaxis, and was well tolerated. Fondaparinux has been recently approved for use in thromboprophylaxis after major orthopedic surgery. The clinical development of fondaparinux in other thromboprophylactic indications is ongoing.

Anticoagulants↗
PubMed2003

[Venous thromboembolism in pregnancy].

Venous thromboembolism has been reported to occur in 1 in 1,000 pregnancies, but is a leading cause of maternal mortality. The challenge is to identify women with risk factors for thromboembolism in pregnancy in order to initiate an appropriate treatment. The objective diagnosis of venous thromboembolism in pregnancy is crucial and have implications not only for management of the pregnancy but also for the choice of contraception and management of future pregnancies. Women with prior venous thrombosis, family history of thrombosis, or additional thrombophilic risks factors have to be evaluated in order to choice the best thromboprophylaxis for pregnancy and puerperium. However recommendations are of low grade (C) and in absence of large prospective studies, the therapeutic strategies are often empiric.

Anticoagulants↗
PubMed1992

[Prevention of venous thromboembolism in surgery].

Incidence of postoperative deep venous thrombosis extends from 7% (transurethral prostatectomy) to more than 50% (hip surgery) depending on the magnitude of trauma and due to the corresponding surgical procedure. Although more common with higher age, younger patients suffer from postoperative thromboembolic complications as well. This insight leads to the conclusion that all immobilized adult patients or those needing an operation are to receive thromboembolic prophylaxis should there be no contraindication. As 50% of all postoperative thromboses develop sometime during the operative procedure, thromboembolic prophylaxis has to be effective intraoperatively as well. The first dose must therefore be preoperative. Duration of prophylaxis depends on the ambulation of the individual patient and should be maintained for at least seven days. Physiotherapeutic measures and drug therapy should complement each other. Low molecular heparins have been very successful lately. Their effect on thrombosis in visceral surgery has been equal when compared with unfractioned heparin whereas the effect in hip surgery compared to unfractioned heparin has been even more promising. Due to the longer half-life of low molecular heparin when compared with unfractioned heparin and its better bioavailability, one dose of low molecular heparin a day is sufficient. This is certainly a benefit for the patient and the nursing staff. To our current knowledge the tendency toward bleeding does not differ basically if low molecular heparins or standard heparin is being used. In patients with spinal anaesthesia, as with low molecular heparins, the first dose has to be administered preoperatively. Different ways of application are possible.

Anticoagulants↗
PubMed2004

Venous thromboembolism in oncology.

Thromboembolic events represent well-recognised complications of neoplastic disease contributing, in a significant manner, to the morbidity and mortality from cancer. The close relationship between the activation of blood coagulation and tumor growth is known since 1865, when Armand Trousseau first described the clinical association between primary or idiopathic venous thromboembolism and an underlying occult malignancy. However, only in the last decades significant advances in this field have been achieved, both on the comprehension of the complex interactions between the tumor and the hemostatic system, and on the prophylaxis and therapy of the thromboembolic manifestations in cancer patients.

Anticoagulants↗
PubMed2004

[Pulmonary thromboembolism complicating right subclavian vein obstruction: case report].

We report a case of pulmonary thromboembolism, in which obstruction of the right subclavian vein, also called Paget-von Schroetter syndrome, was detected. The patient was a 39-year-old man (a scaffold constructor). He lost consciousness at work, and was admitted as an emergency case to our hospital. He had noticed gradually worsening dyspnea for 1 month. Chest radiography showed Westmark's sign in the lungs and enlarged hilar vascular markings on both sides. Pulmonary perfusion scintigraphy confirmed multiple flow defects. Upper and lower limb venography disclosed interruption of the right subclavian vein, leading to a diagnosis of pulmonary thromboembolism secondary to upper limb vein thrombosis. In patients who have pulmonary thromboembolism without an apparent underlying disease, the lifestyle and work habits should be considered and the possibility of subclavian vein thrombosis should be kept in mind.

Adult↗
PubMed2004

[Pulmonary artery sarcoma misdiagnosed as pulmonary thromboembolism: report of 3 cases and literature review].

OBJECTIVE: To improve the differential diagnosis of pulmonary artery sarcoma from pulmonary embolism. METHOD: Case analysis and literature review. RESULTS: Pulmonary artery sarcoma had similar clinical features as pulmonary thromboembolism. When the radiological features such as unilateral hilar enlargement and massive lumps in main trunk of pulmonary artery were observed and clinical deterioration occurred after thrombolytic and anticoagulant therapy, pulmonary artery sarcoma should be considered seriously in patients with suspected pulmonary thromboembolism. CONCLUSION: Pulmonary artery Sarcoma can be easily misdiagnosed as pulmonary thromboembolism.

Adult↗
PubMed2004

Rescue in situ thrombolysis for acute coronary thromboembolism in an angiographically normal coronary artery.

Coronary thromboembolism in an angiographically normal coronary artery is extremely uncommon. There are few instances where normal coronary arteries have been documented just prior to an episode of acute thromboembolic insult. We now report such a case of acute coronary thromboembolism in a patient with widely patent coronary vessels documented just prior to the event during preoperative screening angiogram with successful in situ revascularization.

Atrial Fibrillation↗
PubMed2004

[Thromboembolic and inflammatory complications of knee joint alloplasty with cemented endoprostheses].

In the presented paper the authors evaluate the long-term results of treatment for inflammatory and thromboembolic complications in knee joint alloplasty with cemented endoprostheses. The clinical material spanning the years 1998-2003 are 15 patients with analysed complications, it determine 9% of all operated. They have evaluated achieved results using the HSS knee rating scale in their own modification. As far as the authors are concerned, venographic examination is a prerequisite for appropriate care of the patients following knee joint alloplasty who might have deep venous thrombosis. It is necessary to provide similar treatment when developing infections are suspected in the perioperative period and in cases of late infections. Consequently, antibiotic therapy and a possible quick bacteriological checkup for healing a postoperative wound is a prerequisite for successful treatment. Achieved results induce statement, that thromboembolic and inflammatory complications caused at most operated chronic vein insufficiency, deficit of range of motion at operated joint and gait insufficiency. Thromboembolic complications was always related with inflammation of knee joint alloplasty in our own material.

Aged↗
PubMed2005

[Pulmonary embolectomy for acute massive pulmonary thromboembolism].

Acute pulmonary thromboembolism is a frequently lethal and acute-onset in-hospital complication after surgery. Absolute indications for surgical embolectomy are acute massive pulmonary embolism with deep shock, refractory circulatory collapse, and continuous hypoxemia. Although thrombolytic therapy is indicated for patients with pulmonary thromboembolism with right ventricular overload, it is contraindicated for patients after major surgery or with stroke due to the high risk of rebleeding. Therefore surgical embolectomy should be considered in those patients. Pulmonary embolectomy relieves the right ventricular overload, and immediate restoration of right ventricular function contributes to the recovery of hemodynamics. A recent study revealed improved outcome for massive pulmonary embolism with early diagnosis with multidetector-row computed tomography, risk stratification using echocardiography, and surgical embolectomy. Surgical pulmonary thromboembolectomy should be considered for critically ill patients with massive pulmonary thromboembolism.

Acute Disease↗
PubMedDate not supplied

[Thromboembolic chronic pulmonary hypertension--a fake primary pulmonary hypertension--case report].

Chronic pulmonary hypertension (CPHT) is on the third place of causes leading to cardiovascular morbidity and mortality in patients over fifty. Two of the rare causes of CPHT (< or = 7%) are: chronic thromboembolic hypertension and primary one; these two diseases resemble in many situations and, consequently, the diagnosis is frequently difficult (especially when risk factors for recurrent pulmonary thromboembolism are not present). Our case presentation is just such a situation; only pulmonary perfusion scintigraphy allowed us to make the right diagnosis--chronic thromboembolic pulmonary hypertension--in an "apparently clear" primary pulmonary hypertension.

Acenocoumarol↗
PubMed2005

[Prevention and treatment of perioperative pulmonary thromboembolism].

Surgical interventions, as well as many related diagnostic and therapeutic procedures, are associated with pulmonary thromboembolism promotion. Venous thromboembolism is the most frequent preventable cause of death in the postoperative period. In the United States of America its prevalence is of 600,000 cases per year, being responsible for 5% to 10% of all in-hospital deaths. The authors presents a review of risk factors, diagnostic tools, and prophylactic and therapeutic measures for pulmonary thromboembolism during the perioperative period.

Humans↗
PubMed2005

Thromboendarterectomy for chronic pulmonary thromboembolism.

OBJECTIVE: To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. METHODS: The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterectomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. RESULTS: Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. CONCLUSION: Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.

Adult↗
PubMed2005

Pulmonary artery sarcoma misdiagnosed as chronic thromboembolic pulmonary hypertension.

Pulmonary artery sarcomas are rare neoplasms of the pulmonary artery that are often confused with chronic thromboembolic disease, as both diseases have similar presentations. In patients with presumed chronic thromboembolic pulmonary hypertension, certain clinical and imaging characteristics may suggest the alternative diagnosis of pulmonary artery sarcoma. In this article we present a case of a man initially diagnosed with chronic thromboembolic pulmonary hypertension, but who was later found to have pulmonary artery sarcoma. We review the distinguishing characteristics of the two diseases and discuss possible treatment strategies.

Aged↗
PubMed2006

[Effects of different durations of thromboembolism on blood gases, hemodynamics, pulmonary arteriography and thrombo-pathology in a canine model with selective embolization of pulmonary lobar arteries].

OBJECTIVE: To investigate the effects of different durations of thromboembolism on blood gases, hemodynamic parameters, pulmonary arteriography and thrombo-pathology in an animal model mimicking chronic pulmonary thromboembolism (PTE). METHODS: Sixteen dogs were embolized with five thrombi developed by autologous blood into the left lower pulmonary artery (n = 15) and the right lower pulmonary artery (n = 1, used to confirm the available method of selective embolization). The 15 dogs were divided into three groups: sham group (n = 5), one-week group (n = 5) and two-week group (n = 5) according to the different durations of embolization. Swan-Ganz catheter was used to guide a plastic duct, through which the thrombi were injected selectively into the left or right lower pulmonary artery by X-ray fluoroscopy. Local pulmonary arteriography of lower pulmonary arteries was taken. Blood pressure (BP), and blood gases were measured. Central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arteriole wedge pressure (PAWP), and cardiac output (CO) were recorded, and pulmonary vascular resistance (PVR) was calculated. Each dog underwent muscular injection with tranexamic acid for one or two weeks to prevent thrombolysis. The lower lung lobe was dissected to confirm the thromboembolism after one or two weeks. The lung sections were stained with phosphotungstic acid hematoxylin (PTAH) to observe thromboemboli with optical microscopy. RESULTS: In the PTE group, PaO(2)/FiO(2), MPAP and PVR changed significantly as compared to baseline values (P < 0.05) after one hour of embolization, with MPAP increasing from (15 +/- 3) mm Hg to (21 +/- 4) mm Hg, PVR increasing from (178 +/- 114) mm Hg.s/L to (404 +/- 260) mm Hg.s/L, and PaO(2)/FiO(2) decreasing from (508 +/- 58) mm Hg to (395 +/- 100) mm Hg; these parameters returned to the baseline values one or two weeks later. After embolization, pulmonary arteriography demonstrated lower lobar artery cut-off perfusion defects. One week later, pulmonary arteriography demonstrated irregularities and stiffness of the arterial wall, enlarged proximal part of lower pulmonary artery and cut-off perfusion defects. Poor filling at embolus site was evident after embolization for two weeks. In the 1-week PTE group, organized tissue covered with the blue-purple fibrin nest was observed in the thrombus with PTAH stain. In the two-week group, the well organized thrombi were partially recanalized and surrounded and invaded by hyperplastic tissues from pulmonary artery wall. CONCLUSIONS: A canine model mimicking chronic PTE can be established by the use of fibrinolytic inhibitor tranexamic acid. Different manifestations on pulmonary arteriography and varied degree of organization of thrombi are evident at different times after embolization.

Angiography↗
PubMed2006

Submassive acute pulmonary thromboembolism with normal D-dimer. A case report.

Pulmonary thromboembolism is a relatively common disease in an Emergency Department. Diagnosis, often difficult, is based on careful evaluation of risk factors, clinical examination, radiological and laboratory investigations. Plasma D-dimer, a degradation product of cross-linked fibrin with low specificity and very high sensibility, is considered extremely useful as screening to rule out a pulmonary thromboembolism. We report the case of a 74 year old woman who presented in the Emergency Department suffering from the sudden onset of dyspnea 4 hours before. Plasma D-dimer (automated latex-enhanced turbidimetric test) was normal (253 ng/mL; normal value: 278 ng/mL), but spiral CT angiography showed a sub-massive thromboembolism of the principal branch of the right pulmonary artery, also involving the middle and the inferior lobar branches. A cardiac echo-color-Doppler demonstrated an enlargement of the right cardiac section with telediastolic pressure in the pulmonary artery of 74 mmHg (normal value 4-12 mmHg). A second measurement of plasma D-dimer, 12 hours later, remained in the normal range (274 ng/mL) and only after four days was there a significant increase (1017 ng/mL). The authors, taking the case as a starting point, stigmatize the difficulties that such diagnosis involves, despite indications of guidelines.

Acute Disease↗