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Pulmonary embolism treatment

Gjam Boon, L F van Dam, F A Klok, M V Huisman
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most frequent cardiovascular disease besides myocardial infarction and stroke. Since DVT may cause life-threatening conditions, treatment should be started as soon as possible. This comprises certain challenges in special populations. Areas covered: In cancer-associated VTE, current treatment is different from non-cancer VTE due to disease-related interventions and higher bleeding risks. In treatment of patients with extensive DVT, the role of catheter-directed thrombolysis has been investigated in two randomised trials but results do not yield a recommendation for standard thrombolysis...
July 17, 2018: Expert Review of Hematology
Jean B Guerrier, Zachary C Dietch, Bruce D Schirmer, Peter T Hallowell
PURPOSE: Laparoscopic sleeve gastrectomy (LSG) has rapidly gained popularity as a single-stage operation for the treatment of morbid obesity, as patients undergoing LSG have been shown to achieve similar weight loss and resolution of obesity-related comorbidities in comparison to those undergoing Roux-en-Y gastric bypass (RYGB), the "gold standard" bariatric operation. Although LSG poses fewer technical challenges than RYGB, little is known about differences in short-term outcomes among patients undergoing LSG and RYGB...
July 16, 2018: Obesity Surgery
Sylvana Ml de Mik, Fabienne E Stubenrouch, Dink A Legemate, Ron Balm, Dirk T Ubbink
Objective To reach consensus on which complications of varicose vein treatments physicians consider major or minor, in order to standardize the informed consent procedure and improve shared decision-making. Methods Using the e-Delphi method, expert physicians from 10 countries were asked to rate complications as "major" or "minor" on a 5-point Likert scale. Reference articles from a Cochrane review on varicose veins were used to compose the list of complications. Results Participating experts reached consensus on 12 major complications: allergic reaction, cellulitis requiring intravenous antibiotics/intensive care, wound infection requiring debridement, hemorrhage requiring blood transfusion/surgical intervention, pulmonary embolism, skin necrosis requiring surgery, arteriovenous fistula requiring repair, deep venous thrombosis, lymphocele, thermal injury, transient ischemic attack/stroke, and permanent discoloration...
January 1, 2018: Phlebology
Jane Liu, Nicholas B Frisch, Nima Mehran, Mossub Qatu, S Trent Guthrie
The purpose of this retrospective cohort study was to evaluate whether there is an increased rate of short-term medical complications following short vs long cephalomedullary nails for the treatment of intertrochanteric hip fractures. A total of 899 patients treated surgically with cephalomedullary nails from January 1, 2005, to September 1, 2014, were included. Patients who received short nails (n=334) were older and had a higher incidence of coronary artery disease and diabetes mellitus compared with patients who received long nails (n=565)...
July 16, 2018: Orthopedics
Dale Ding, Padmini Sekar, Charles J Moomaw, Mary E Comeau, Michael L James, Fernando Testai, Matthew L Flaherty, Anastasia Vashkevich, Bradford B Worrall, Daniel Woo, Jennifer Osborne
BACKGROUND: Patients with spontaneous intracerebral hemorrhage (ICH) are predisposed to venous thromboembolic (VTE) complications, such as deep vein thrombosis and pulmonary embolism. OBJECTIVE: To evaluate, in a multicenter, retrospective cohort study, the rate of VTE complications in ICH patients during acute hospitalization, identify potential risk factors, and assess their association with functional outcome. METHODS: We retrospectively analyzed prospectively collected data from 19 centers and 41 sites that participated in the Ethnic/Racial Variations of Intracerebral Hemorrhage study, from August 2010 to February 2016...
July 13, 2018: Neurosurgery
Mahdi Pishgahi, Toktam Alirezaei, Behzad Hajimoradi, S Mojtaba Nekooghadam, Shima Shahi
In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient's life? Here, we describe three cases of massive PE with absolute contraindication for fibrinolytic therapy who presented to emergency department following dyspnea...
2018: Emergency (Tehran, Iran)
Pranav Loyalka, Muhammad Z Ansari, Faisal H Cheema, Charles C Miller, Sudarshan Rajagopal, Keshava Rajagopal
OBJECTIVES: Mortality in acute pulmonary embolism (PE) is believed to be principally due to the subgroup of PEs that are massive. Systemic thrombolysis is the therapeutic mainstay for acute massive PE, despite evidence suggesting limited survival benefits. Both catheter-based therapies (CBT) and surgical pulmonary embolectomy (SE) are well-accepted alternatives to treat acute PE. However, the comparative effectiveness of these approaches is difficult to study. We conducted a systematic review of CBT and SE for acute PE...
June 8, 2018: Journal of Thoracic and Cardiovascular Surgery
Jerry T Dang, Noah Switzer, Megan Delisle, Michael Laffin, Richdeep Gill, Daniel W Birch, Shahzeer Karmali
BACKGROUND: Bariatric surgery is an effective treatment for severe obesity; however, postoperative venous thromboembolism (VTE) remains a leading cause of morbidity and mortality. The objective of this study is to develop a tool to stratify individuals undergoing laparoscopic bariatric surgery according to their 30-day VTE risk. METHODS: This is a retrospective cohort study of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database...
July 12, 2018: Surgical Endoscopy
Paweł Latacz, Marian Simka, Pawel Brzegowy, Wojciech Serednicki, Ewa Konduracka, Wojciech Mrowiecki, Agnieszka Słowik, Bartłomiej Łasocha, Tomasz Mrowiecki, Tadeusz Popiela
Introduction: Intravenous thrombolysis is the treatment of choice in patients presenting with high- and intermediate-risk pulmonary embolism. The role of percutaneous mechanical pulmonary thrombectomy (PMPT) is not fully established, although selected patients can be managed with this method. Aim: This open-label single-centre prospective pilot study was aimed at assessing the feasibility of PMPT for the treatment of severe pulmonary embolism in a Polish hospital...
June 2018: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Matthew S Agam, Michelle A Wedemeyer, Bozena Wrobel, Martin H Weiss, John D Carmichael, Gabriel Zada
OBJECTIVE Pituitary adenomas (PAs) are benign neoplasms that are frequently encountered during workup for endocrinopathy, headache, or visual loss. Transsphenoidal surgery remains the first-line approach for PA resection. The authors retrospectively assessed complication rates associated with transsphenoidal PA resection from an institutional database. METHODS A retrospective analysis of 1153 consecutive transsphenoidal pituitary adenoma resections performed at the Keck Hospital of USC between November 1992 and March 2017 was conducted...
June 1, 2018: Journal of Neurosurgery
Yao-Qian Cao, Li-Xia Dong, Jie Cao
Objective: In most countries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease (COPD), which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism (PE). In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis...
July 20, 2018: Chinese Medical Journal
Huyên-Thu Nguyen Xuan, Deloménie Myriam, Ngo Charlotte, Douard Richard, Bats Anne-Sophie, Timsit Marc Olivier, Méjean Arnaud, Lécuru Fabrice
After concomitant chemo-radiation therapy, 20 to 30% of advanced cervical cancers recur in irradiated territory. Pelvic exenteration remains a therapeutic option for selected patients. However, this procedure remains complex because of tissue fragility after radiotherapy and their associated co-morbidities. Minimally invasive surgery such as robotically assisted laparoscopy may overcome these surgical challenges. The objective of this study was to evaluate the feasibility of pelvic exenteration with robotically assisted laparoscopy...
August 2018: Gynecologic Oncology Reports
Daishi Nonaka, Hiroyuki Takase, Masashi Machii, Kazuto Ohno
RATIONALE: Inferior vena cava (IVC) thrombosis is an under-recognized entity that is associated with a mortality rate approaching twice that of lower extremity deep venous thrombosis (DVT). Thrombolytic therapy not only results in greater lysis, but also results in higher complication rates than anticoagulation alone. Catheter-directed thrombolysis (CDT), which is effective in accomplishing local resolution whilst reducing bleeding complications, has been established as an alternative treatment for patients with extensive DVT...
July 2018: Medicine (Baltimore)
Josipa Unić, Matea Kovačić, Gordana Jakovljević, Ana Tripalo Batoš, Tonći Grmoja, Iva Hojsak
Inflammatory bowel disease (IBD) is a well-recognized risk factor for thrombotic events in adults but data on children are scarce. In the great majority of adult patients, thrombotic events are usually deep vein thrombosis and pulmonary embolism. Other sites such as jugular veins are extremely rare. We present a case of Lemierre syndrome in an adolescent girl with active ulcerative colitis and discuss possible risk factors. This is the first reported case of severe Lemierre syndrome with thrombus extension to cranial veins in a patient with ulcerative colitis...
July 2018: Pediatric Gastroenterology, Hepatology & Nutrition
Pierluca Torcia, Silvia Squarza, Umberto G Rossi, Paolo Rigamonti, Lorenzo Carlo Pescatori, Giovanni Damiani, Maurizio Cariati
A 79-year-old man, suffering from atrial fibrillation and on anticoagulation therapy, was admitted at the emergency department of our institution because of a worsening respiratory insufficiency. After a diagnostic work-up, he was found to suffer from pneumonia, and antibiotic therapy was settled. He was kept under observation for his pulmonary conditions but, within a week, he developed a spontaneous iliopsoas hematoma, due to a sudden dysregulation of anticoagulation therapy subsequent to new in-hospital treatments...
2018: Case Reports in Radiology
Gabriella De Rosa, Maria Pia De Carolis, Alessia Tempera, Alessandro Pedicelli, Massimo Rollo, Tony Christian Morena, Ersilia Luca, Daniele De Luca, Giorgio Conti, Marco Piastra
BACKGROUND:  Neonatal presentation of vein of Galen aneurysmal malformations (VGAMs) complicated by cardiac failure and pulmonary hypertension is frequently associated with a poor prognosis. Interventional neuroradiology with embolization can offer a chance for survival, although neurological damage can represent a limitation. OBJECTIVE:  This article determines if aggressive intensive care and drug management of cardiac failure before urgent embolization can influence morbidity and mortality...
July 10, 2018: American Journal of Perinatology
J Ramos Aranda, C Ramírez Cerda, S Cohen Mussali, J Valdés Flores
Introduction: Inferior vena cava agenesis (IVCA) is one of the many anomalies of this vessel. It is one of the most uncommon anomalies, with an estimated prevalence of 0.0005-1% in the general population. Around 5% of the patients younger than 30 years with a diagnosis of deep vein thrombosis (DVT) have a total or segmental IVCA. Report: Here two unique cases of young and previously healthy male patients are reported: one with bilateral lower extremity DVT, the second with lower extremity DVT and pulmonary embolism...
2018: EJVES Short Reports
Takehiko Oami, Taku Oshima, Reiko Oku, Kazuya Nakanishi
Background: Thrombolysis for pulmonary embolism and targeted temperature management for cardiac arrest are controversial treatments in pregnancy. Case: A 37-year-old woman at 23 weeks gestation presented with persistent dyspnea. She experienced cardiac arrest soon after arrival at the emergency room. Massive right ventricular dilatation on echocardiography during the transient return of spontaneous circulation suggested pulmonary embolism. We administered recombinant tissue plasminogen activator for suspected pulmonary embolism to successfully resuscitate the patient experiencing refractory cardiac arrest despite heparin infusion...
July 2018: Acute Medicine & Surgery
Nilofar Sarvaiya, Yevgeniya Lapitskaya, Lorena Dima, Peter Manu
BACKGROUND: Recent epidemiological studies have identified an excess of pulmonary embolism (PE) cases in patients treated with antipsychotic drugs. The findings are particularly relevant for patients treated with clozapine, which has many potentially life-threatening adverse drug effects. Among these adverse drug effects are myocarditis and agranulocytosis that have early onset and are dose independent, but also seizures and myocardial repolarization delay, which are dose dependent and may occur at any time...
July 2018: American Journal of Therapeutics
Hicaz Zencirkıran Agus, Begum Uygur, Arda Guler, Gokhan Demirci, Ali K Kalkan, Mustafa Yildiz
: Pulmonary embolism is a life-threatening disease which represents with high mortality and morbidity. Systemic fibrinolysis is the first-line recommended therapy in hemodynamically instable patients with massive pulmonary embolism. Systemic fibrinolytic treatment remains controversial for pulmonary embolism after surgery due to high risk of hemorrhage. Herein, we report a 49-year-old man with massive pulmonary embolism after meniscus surgery, successfully treated with low-dose prolonged infusion of tissue type plasminogen activator...
July 4, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
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