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Pregnancy and pulmonary embolism

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https://www.readbyqxmd.com/read/28048838/su-f-i-36-in-utero-dose-measurements-within-postmortem-subjects-for-estimating-fetal-doses-in-pregnant-patients-examined-with-pulmonary-embolism-trauma-and-appendicitis-ct
#1
I Lipnharski, N Quails, C Carranza, N Correa, S Bidari, M Bickelhaup, L Rill, M Arreola
PURPOSE: The imaging of pregnant patients is medically necessary in certain clinical situations. The purpose of this work was to directly measure uterine doses in a cadaver scanned with CT protocols commonly performed on pregnant patients in order to estimate fetal dose and assess potential risk. METHOD: One postmortem subject was scanned on a 320-slice CT scanner with standard pulmonary embolism, trauma, and appendicitis protocols. All protocols were performed with the scan parameters and ranges currently used in clinical practice...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28040140/gestational-choriocarcinoma-with-renal-and-pulmonary-metastases-lacking-a-primary-uterine-origin
#2
Hao-Ming Li, Wen-Chien Hou, Yu-Ju Lai, Chien-Chang Kao, Tai-Kuang Chao, Mu-Hsien Yu, Her-Young Su
OBJECTIVE: We describe a case of gestational choriocarcinoma metastasized to the kidney and lung, which presented initially as refractory hematuria after a term pregnancy 5 years earlier. CASE REPORT: A 35-year-old woman, G2P1, with a previous history of full-term pregnancy in 2009, presented to the emergency department complaining of intermittent gross hematuria for 2 months. Abdominal computed tomography showed a suspicious arteriovenous malformation in the right kidney and a thrombus within the right renal vein...
December 2016: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28005587/diagnosis-and-management-of-hellp-syndrome-complicated-by-liver-hematoma
#3
Agnès Ditisheim, Baha M Sibai
Subcapsular liver hematoma is a rare but potentially life-threatening complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. It may present with nonspecific signs and symptoms, none of which are diagnostic, and can mimic pulmonary embolism of cholecystitis. There is no consensus on the management of subcapsular liver hematoma. Unruptured liver hematoma can be conservatively managed. When rupture occurs, surgical, endovascular approaches and, rarely, liver transplantation, may be required...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005272/prophylactic-versus-selective-blood-transfusion-for-sickle-cell-disease-in-pregnancy
#4
REVIEW
Babasola O Okusanya, Olufemi T Oladapo
BACKGROUND: Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies...
22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27975099/paradoxical-bleeding-and-thrombotic-episodes-of-dysprothrombinaemia-due-to-a-homozygous-arg382his-mutation
#5
Qiulan Ding, Likui Yang, Xiaoqing Zhao, Wenman Wu, Xuefeng Wang, Alireza R Rezaie
We have characterised the pathogenic basis of dysprothrombinaemia in a patient exhibiting paradoxical bleeding and thrombotic defects during pregnancy and postpartum. Genetic analysis revealed that the proband is homozygous for the prothrombin Arg382His mutation, possessing only ~1 % clotting activity. The proband experienced severe bleeding episodes during her pregnancy, which required treatment with prothrombin complex concentrates, and then pulmonary embolism and deep-vein thrombosis at 28 days postpartum, which required treatment with LMWH and fresh frozen plasma...
December 15, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27917690/pharmacological-management-of-pulmonary-embolism
#6
Bobby Gouin, Helia Robert-Ebadi, Marc Righini, Marc Blondon
Pulmonary embolism (PE) is a common and potentially severe manifestation of venous thromboembolism. Its management has relied on anticoagulation by vitamin K antagonists (VKA) for the past fifty years. Recently, new alternative drugs have been developed and dramatically modified both the treatment of acute PE and its secondary prevention. Areas covered: This review discusses the contemporary pharmacological treatment for PE, with a focus on anticoagulation options for non-high risk PE. In particular, the advent of direct oral anticoagulants (rivaroxaban, apixaban, edoxaban and dabigatran) and modalities for long-term prevention will be described...
January 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27913507/diagnosis-of-suspected-venous-thromboembolism
#7
Clive Kearon
The primary goal of diagnostic testing for venous thromboembolism (VTE) is to identify all patients who could benefit from anticoagulant therapy. Test results that identify patients as having a ≤2% risk of VTE in the next 3 months are judged to exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Clinical evaluation, with assessment of: (1) clinical pretest probability (CPTP) for VTE; (2) likelihood of important alternative diagnoses; and (3) the probable yield of D-dimer and various imaging tests, guide which tests should be performed...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27878206/new-findings-on-venous-thrombogenesis
#8
James R Byrnes, Alisa S Wolberg
Venous thrombosis (VT) is the third most common cause of cardiovascular death worldwide. Complications from VT and pulmonary embolism are the leading cause of lost disability-adjusted life years. Risks include genetic (e.g., non-O blood group, activated protein C resistance, hyperprothrombinemia) and acquired (e.g., age, surgery, cancer, pregnancy, immobilisation, female hormone use) factors. Pathophysiologic mechanisms that promote VT are incompletely understood, but involve abnormalities in blood coagulability, vessel function, and flow (so-called Virchow's Triad)...
November 23, 2016: Hämostaseologie
https://www.readbyqxmd.com/read/27766527/high-prevalence-of-congenital-thrombophilia-in-patients-with-pregnancy-related-or-idiopathic-venous-thromboembolism-pulmonary-embolism
#9
Makoto Ikejiri, Hideo Wada, Norikazu Yamada, Maki Nakamura, Naoki Fujimoto, Kaname Nakatani, Akimasa Matsuda, Yosihito Ogihara, Takeshi Matsumoto, Yuki Kamimoto, Tomoaki Ikeda, Naoyuki Katayama, Masaaki Ito
Congenital thrombophilia which is characterized by deficiencies in proteins such as antithrombin (AT), protein C (PC) and protein S (PS), is a major cause of venous thromboembolism (VTE). A total of 130 patients with VTE were evaluated for congenital thrombophilia based on the activity of AT, PC, or PS. Fifteen VTE patients with congenital AT deficiency (11.5 %), 16 with congenital PC deficiency (12.3 %) and eight with congenital PS deficiency (6.2 %) were diagnosed using DNA analysis. The frequency of congenital AT deficiency was significantly higher in subjects with pregnancy-related and idiopathic VTE than in those with VTE due to other causes, and congenital PC and PS deficiency were frequently associated with idiopathic VTE...
October 20, 2016: International Journal of Hematology
https://www.readbyqxmd.com/read/27764878/environmental-and-genetic-risk-factors-associated-with-venous-thromboembolism
#10
Marta Crous-Bou, Laura B Harrington, Christopher Kabrhel
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism, and a combination of environmental and genetic risk factors contributes to VTE risk. Within environmental risk factors, some are provoking (e.g., cancer, surgery, trauma or fracture, immobilization, pregnancy and the postpartum period, long-distance travel, hospitalization, catheterization, and acute infection) and others are nonprovoking (e.g., age, sex, race/ethnicity, body mass index and obesity, oral contraceptive or hormone therapy use, corticosteroid use, statin use, diet, physical activity, sedentary time, and air pollution)...
November 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27720446/use-of-clinical-prediction-rules-and-d-dimer-tests-in-the-diagnostic-management-of-pregnant-patients-with-suspected-acute-pulmonary-embolism
#11
REVIEW
L M Van der Pol, A T A Mairuhu, C Tromeur, F Couturaud, M V Huisman, F A Klok
Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy...
September 29, 2016: Blood Reviews
https://www.readbyqxmd.com/read/27673091/poster-335-pulmonary-embolism-and-other-challenges-associated-with-acute-spinal-cord-injury-during-pregnancy
#12
Jack M Smith, William McKinley
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/27644095/optimizing-survival-outcomes-for-adult-patients-with-nontraumatic-cardiac-arrest
#13
Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/27512501/management-of-venous-thromboembolism-secondary-to-ovarian-hyperstimulation-syndrome-a-case-report-documenting-the-first-use-of-a-superior-vena-caval-filter-for-upper-limb-venous-thromboembolism-in-pregnancy-and-the-difficulties-and-complications-relating-to
#14
Nicola Mitchell-Jones, Michael McEwan, Mark Johnson
The management of venous thromboembolism and subsequent pulmonary embolism in pregnancy remains hugely challenging. In this case, we report the first use of a superior vena caval filter in pregnancy as an adjunct to pharmacological anticoagulation. This is the first reported use of a superior vena caval filter in pregnancy. We discuss the complexities of managing thromboembolism in pregnancy and the peri-partum period.
June 2016: Obstetric Medicine
https://www.readbyqxmd.com/read/27441306/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital
#15
Elizabeth Janette Hamilton, Alistair Quentin Green, Jennifer Ann Cook, Henry Nash
This was a retrospective review of five years' data relating to patients referred to the Acute Medical Unit (AMU) of a large teaching hospital with suspected Pulmonary Embolism (PE) during pregnancy or 6 weeks postpartum. During this period, 210 patients in this group underwent half-dose perfusion scanning as investigation for possible PE and were managed via our ambulatory pathway. Pulmonary embolism was diagnosed in 5.2% of patients compared to 18% of non-pregnant patients identified in a previous audit. Half-dose Q scanning enabled exclusion of PE in almost 90% of patients without the need for further imaging...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27412479/microparticles-reveal-cell-activation-during-ivf-a-possible-early-marker-of-a-prothrombotic-state-during-the-first-trimester
#16
Nina Olausson, Fariborz Mobarrez, Håkan Wallen, Eli Westerlund, Outi Hovatta, Peter Henriksson
Cell-derived microparticles (MPs) are known to be elevated in a number of diseases related to arterial and venous thromboembolism (VTE), such as acute myocardial infarction, VTE (deep-vein thrombosis and pulmonary embolism) and peripheral arterial disease. IVF-associated pregnancies have previously been shown to be associated with an increased incidence of VTE, mechanisms behind being unknown and sparsely studied. Our objective was to assess cell activation during IVF through analysis of MP levels and phenotype following ovarian stimulation...
August 30, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27396794/the-direct-factor-xa-inhibitor-rivaroxaban-passes-into-human-breast-milk
#17
Martin H J Wiesen, Cornelia Blaich, Carsten Müller, Thomas Streichert, Roman Pfister, Guido Michels
Thromboembolic disorders frequently require antithrombotic treatment during pregnancy and lactation. Vitamin K antagonists and heparins are the treatment options of choice in breastfeeding women. Factors including the route of administration, discomfort during treatment, and fetal and neonatal safety affect women's choices about anticoagulant therapy. Direct-acting oral anticoagulants (DOACs) have emerged as alternatives to these agents and may offer advantages compared with vitamin K antagonists. As breastfeeding women were excluded from clinical trials evaluating DOACs, no safety and efficacy data are available for these special patients and, crucially, estimates for infant exposure are lacking...
July 2016: Chest
https://www.readbyqxmd.com/read/27365558/preoperative-emboli-in-a-pregnant-woman-with-myxoma
#18
Freidoun Sabzi, Reza Faraji
The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism...
July 2016: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/27349162/the-diagnostic-role-of-ventilation-perfusion-scans-versus-computed-tomography-pulmonary-angiography-in-obstetric-patients-investigated-for-pulmonary-embolism-at-wellington-hospital-from-2010-to-2012
#19
Sally Easther, Fali Langdana, Richard Beasley, Dushyant Maharaj, James Entwisle, Peter Abels
AIM: To develop best practice clinical guidelines for the use of ventilation/perfusion (V/Q) scanning and computed tomography perfusion angiography (CTPA) in pregnancy and the postpartum period. METHOD: Retrospective analysis of the clinical findings and radiologic investigation for pulmonary embolism (PE) in obstetric women at Wellington Hospital from 2010 to 2012. RESULTS: Fifty-four women were investigated for PE with a V/Q scan or CTPA, including 29 antenatal women and 25 postnatal women...
April 22, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27334082/-a-pregnant-patient-with-spontaneous-haemothorax-hereditary-haemorrhagic-telangiectasia-in-pregnancy
#20
S M Mourad, R Mies, T Frenzel, S Willems, E van der Heijden, L J Schultze Kool
BACKGROUND: The incidence of hereditary haemorrhagic telangiectasia (HHT - Osler-Weber-Rendu disease) in the Netherlands is 1:5000 but approximately 1:1300 in people from the Antilles. The disease is characterised by the development of telangiectasia and arteriovenous malformations (AVMs) that may result in serious morbidity and mortality. CASE DESCRIPTION: A 31-year-old primigravid patient consulted her general practitioner at 31 1/7 weeks gestational age with dyspnoea...
2016: Nederlands Tijdschrift Voor Geneeskunde
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