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https://www.readbyqxmd.com/read/28644260/intravenous-alteplase-for-acute-stroke-and-pulmonary-embolism-in-a-patient-with-recent-abdominoplasty
#1
Michael E Christiansen, Gyanendra Kumar, Raman C Mahabir, Richard A Helmers, Bernard R Bendok, Cumara B O'Carroll
INTRODUCTION: Major surgery in the past 14 days is a relative contraindication to treatment of acute stroke with intravenous (IV) alteplase. The 2016 American Heart Association/American Stroke Association scientific statement discussing inclusion and exclusion criteria for alteplase in acute stroke allows for provider judgment citing a lack of evidence to support surgery as an absolute contraindication. CASE REPORT: A 59-year-old woman presented with acute left hemiparesis, dysarthria, and acute respiratory failure...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28639114/imaging-guided-chest-biopsies-techniques-and-clinical-results
#2
REVIEW
Michele Anzidei, Andrea Porfiri, Fabrizio Andrani, Michele Di Martino, Luca Saba, Carlo Catalano, Mario Bezzi
BACKGROUND: This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. METHODS: Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive...
June 21, 2017: Insights Into Imaging
https://www.readbyqxmd.com/read/28634174/prognostic-value-of-uric-acid-for-pulmonary-thromboembolism
#3
Savas Ozsu, Arif M Çoşar, Hayriye Bektas Aksoy, Yilmaz Bülbül, Funda Oztuna, S Caner Karahan, Tevfik Ozlu
BACKGROUND: Pulmonary thromboembolism is a serious cardiovascular condition with considerable morbidity and mortality. Clinical studies have indicated that hyperuricemia is an independent risk factor for cardiovascular events. The aim of this study was to investigate possible value of the serum levels of uric acid (UA) in predicting 30-d pulmonary thromboembolism-related mortality. METHODS: Pulmonary thromboembolism was confirmed by computed tomography pulmonary angiography, demographic data, troponin, systolic pressure and pulse on admission, and simplified pulmonary embolism severity index assessment...
June 20, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28628189/-a-statement-the-polish-cardiac-society-working-group-on-pulmonary-circulation-on-screening-for-cteph-patients-after-acute-pulmonary-embolism
#4
Michał Ciurzyński, Marcin Kurzyna, Grzegorz Kopeć, Piotr Błaszczak, Łukasz Chrzanowski, Karol Kamiński, Katarzyna Mizia-Stec, Tatiana Mularek-Kubzdela, Ewa Mroczek, Andrzej Biederman, Piotr Pruszczyk, Adam Torbicki
Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28625110/ultrasound-facilitated-catheter-directed-low-dose-fibrinolysis-in-elderly-patients-with-pulmonary-embolism-a-seattle-ii-sub-analysis
#5
Brett J Carroll, Samuel Z Goldhaber, Ping-Yu Liu, Gregory Piazza
Elderly patients with acute pulmonary embolism (PE) have higher mortality than non-elderly patients, but receive systemic fibrinolysis less frequently. In this sub-analysis of the SEATTLE II trial, we evaluated the efficacy and safety of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with submassive and massive PE. We compared patients ⩾65 years old with those <65 years old. Eligible patients had proximal PE and a right ventricular-to-left ventricular (RV/LV) diameter ratio ⩾0...
June 1, 2017: Vascular Medicine
https://www.readbyqxmd.com/read/28620755/predictive-value-of-mean-platelet-volume-for-pulmonary-embolism-recurrence
#6
Omer Araz, Fadime Sultan Albez, Elif Yilmazel Ucar, Bugra Kerget, Nafiye Yılmaz, Metin Akgun
PURPOSE: Recurrence is a major clinical problem in patients with pulmonary embolism and can affect mortality. The decision to discontinue treatment is important for recurrence and is based on patients' clinical features as well as certain blood parameters. Our aim in this study was to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) have utility as new predictive parameters for recurrence and mortality in pulmonary embolism. MATERIALS AND METHODS: A total of 440 patients with pulmonary embolism underwent computed tomography, Doppler ultrasonography, and echocardiography before and at the conclusion of treatment...
June 15, 2017: Lung
https://www.readbyqxmd.com/read/28612276/clinical-risk-stratification-of-acute-pulmonary-embolism-comparing-the-usefulness-of-cta-obstruction-score-and-pulmonary-perfusion-defect-score-with-dual-energy-ct
#7
Wei-Fang Kong, Yu-Ting Wang, Long-Lin Yin, Hong Pu, Ke-Yan Tao
To compare the ability of CT angiography (CTA) obstruction score and perfusion defect score on dual energy CT perfusion imaging (DEPI) for clinical risk stratification of patients with acute pulmonary embolism (PE). 55 patients diagnosed as acute PE either by CTA or DEPI were retrospectively enrolled. Patients were grouped into high-, intermediate-, and low-risk groups in accordance to the renewed guidelines of 2014. Consistency between DEPI and CTA in diagnosis of PE were assessed. Correlations between CT parameters and right-to-left ventricular (RV/LV) diameter ratio were evaluated...
June 13, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28611162/a-large-chronic-pericardial-effusion-in-an-ultramarathon-runner-with-anti-ccp-positive-rheumatoid-arthritis
#8
Thomas J McClelland, Rose Penfold, Stefan Kluzek, Navraj S Nagra
Pericardial effusions arise as an extra-articular manifestation of rheumatoid arthritis (RA). Pericardial effusions are often asymptomatic, particularly in the early phase, but patients are at risk of cardiac tamponade as the effusion progresses. We discuss the case of a 40-year-old male ultramarathon runner with RA who presented with mild pleuritic chest pain and exertional dyspnoea after a recent long-haul flight. Despite a relative tachycardia, his observations were otherwise unremarkable. His blood tests revealed a C-reactive protein (CRP) of 86 mg/L and an anti-cyclic citrullinated peptide (anti-CCP) titre of 360 units/mL...
June 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28611051/sulfhaemoglobinaemia-caused-by-ferrous-sulfate
#9
Laith Derbas, Mohamed Warsame, Mohannad Abu Omar, Yousaf Zafar, Gregory Howell
A 78-year-old man was referred from his primary care clinic to the emergency department due to bluish discolouration of his lips and decreased oxygen saturation on pulse oximetry. The patient was asymptomatic. Physical exam was normal except for lip cyanosis. A CT pulmonary angiogram was negative for pulmonary embolism. Arterial blood gas (ABG) analysis with co-oximetry showed low oxyhaemoglobin, normal partial pressure of oxygen and methaemoglobinaemia, but an unexplained 'gap' in total haemoglobin saturation...
June 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28607332/massive-ischemic-stroke-due-to-pulmonary-barotrauma-and-cerebral-artery-air-embolism-during-commercial-air-travel
#10
Sara Farshchi Zarabi, Matteo Parotto, Rita Katznelson, James Downar
BACKGROUND Air embolism into the systemic arterial circulation secondary to pulmonary barotrauma has rarely been reported. Herein, we report the clinical course of an extremely rare presentation of cerebral air embolism likely due to ruptured pulmonary bullae during commercial air travel. CASE REPORT A 65-year-old man suddenly became unconscious during an airplane descent. Upon landing, he was immediately transferred to the nearest emergency department where he was intubated for airway protection. His head CT angiogram showed multiple air pockets in the right parietal lobe suspicious for multiple air emboli...
June 13, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28603413/identifying-the-heterogeneity-of-copd-by-v-p-spect-a-new-tool-for-improving-the-diagnosis-of-parenchymal-defects-and-grading-the-severity-of-small-airways-disease
#11
M Bajc, Y Chen, J Wang, X Y Li, W M Shen, C Z Wang, H Huang, A Lindqvist, X Y He
INTRODUCTION: Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. METHODS: 94 COPD patients (aged 43-86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I-IV) were examined with V/P SPECT and spirometry...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28596928/pulmonary-embolism-due-to-inferior-vena-cava-compression-by-a-retroperitoneal-hematoma-after-endovascular-repair-of-a-ruptured-abdominal-aortic-aneurysm
#12
Kota Shukuzawa, Naoki Toya, Yasutake Momokawa, Soichiro Fukushima, Tadashi Akiba, Takao Ohki
We report a case of a patient with a residual hematoma compressing the inferior vena cava after endovascular aneurysm repair (EVAR), which led to a pulmonary embolism (PE). A 65-year-old man underwent emergent EVAR for a ruptured aortic aneurysm in the right retroperitoneal region. He developed sudden chest pain at midnight of the fifth day after EVAR, and computed tomography demonstrated a massive PE. He subsequently went into cardiopulmonary arrest. This case suggested that abdominal complications due to a residual hematoma, including deep vein thrombosis and PE, should be considered in addition to compartment syndrome...
2017: Case Reports in Vascular Medicine
https://www.readbyqxmd.com/read/28596513/bidirectional-pull-back-technique-for-retrieval-of-strut-embedded-cylinder-shaped-filters-in-inferior-vena-cava
#13
Xiaolong Du, Chenglong Li, Aimin Qian, Yeqing Zhang, Wendong Li, Huiying Yu, Xiaoqiang Li, Lingshang Kong
BACKGROUND IVC filters have been widely accepted as an effective method to prevent pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). However, the placement of IVC filters is associated with significant complications and filter retrieval can be challenging when the filter struts are embedded into the caval wall. MATERIAL AND METHODS Over 26 months, we reviewed the safety and efficacy of the bidirectional pull-back technique for removing strut-embedded IVC filters in 15 consecutive patients...
June 9, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28594950/association-between-computed-tomography-obstruction-index-and-mortality-in-elderly-patients-with-acute-pulmonary-embolism-a-prospective-validation-study
#14
Marie Méan, Tobias Tritschler, Andreas Limacher, Stéphane Breault, Nicolas Rodondi, Drahomir Aujesky, Salah D Qanadli
INTRODUCTION: Computed tomography pulmonary angiography (CTPA) has not only become the method of choice for diagnosing acute pulmonary embolism (PE), it also allows for risk stratification of patients with PE. To date, no study has specifically examined the predictive value of CTPA findings to assess short-term prognosis in elderly patients with acute PE who are particularly vulnerable to adverse outcomes. METHODS: We studied 291 patients aged ≥65 years with acute symptomatic PE in a prospective multicenter cohort...
2017: PloS One
https://www.readbyqxmd.com/read/28593162/extravascular-migration-of-a-fractured-inferior-vena-cava-filter-strut
#15
Jung Hyeon Lim, Weon Yong Lee, Yong Joon Ra, Jae Han Jeong, Bong Suk Park, Ho Hyun Ko
A 20-year-old man presented with a femur fracture and epidural hemorrhage (EDH) following a fall. One month after fracture surgery, swelling developed in both legs, and he was diagnosed as having a deep-vein thrombosis and pulmonary embolism. A retrievable inferior vena cava filter (IVCF) was inserted, because EDH is a contraindication to anticoagulants. Four months later, he complained of abdominal pain, and a computed tomography scan showed a fractured IVCF strut. After percutaneous removal failed 3 times, the IVCF was surgically removed by orthopedists using a portable image intensifier without cardiopulmonary bypass...
June 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28589462/discharge-or-admit-emergency-department-management-of-incidental-pulmonary-embolism-in-patients-with-cancer-a-retrospective-study
#16
Srinivas R Banala, Sai-Ching Jim Yeung, Terry W Rice, Cielito C Reyes-Gibby, Carol C Wu, Knox H Todd, W Frank Peacock, Kumar Alagappan
BACKGROUND: Hospitalization and early anticoagulation therapy remain standard care for patients who present to the emergency department (ED) with pulmonary embolism (PE). For PEs discovered incidentally, however, optimal therapeutic strategies are less clear-and all the more so when the patient has cancer, which is associated with a hypercoagulable state that exacerbates the threat of PE. METHODS: We conducted a retrospective review of a historical cohort of patients with cancer and incidental PE who were referred for assessment to the ED in an institution whose standard of care is outpatient treatment of selected patients and use of low-molecular-weight heparin for anticoagulation...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28580152/brugada-phenocopy-in-a-patient-with-acute-pulmonary-embolism-presenting-with-recurrent-syncope
#17
Nixiao Zhang, Tong Liu, Gary Tse, Shuyu Yu, Huaying Fu, Gang Xu, Changyu Zhou, Chengzong Zhang, Guangping Li
Brugada phenocopy (BrP) refers to a group of clinical conditions that have etiologies distinct from Brugada syndrome (BrS). Although both demonstrate features of ST-segment elevation in the right precordial leads on the electrocardiogram (ECG), one must be distinguished from the other as their treatment options are different. We report a male patient who presented with recurrent syncope with a Brugada and a S1Q3T3 pattern on the ECG. Acute pulmonary embolism (APE) complicated by BrS was suspected. Twenty-four hours Holter monitoring did not demonstrate any evidence of ventricular arrhythmias...
May 2017: Oxford Medical Case Reports
https://www.readbyqxmd.com/read/28577412/postmortem-computed-tomography-evaluation-of-fatal-gas-embolism-due-to-connection-of-an-intravenous-cannula-to-an-oxygen-supply
#18
Yoichiro Takahashi, Rie Sano, Akiyuki Yasuda, Eri Kuboya, Keiko Takahashi, Rieko Kubo, Yoshihiko Kominato, Hiroyuki Takei, Susumu Kobayashi, Takehiro Shimada, Sachiko Awata, Hiroyuki Tokue, Satoshi Hirasawa
An 84-year-old man who had suffered from chronic obstructive pulmonary disease accompanied by moderate pneumonia as well as gastric cancer with liver metastasis was found dead by a nurse, who noticed that the patient's intravenous catheter in the left forearm had been erroneously connected to an oxygen supply in his hospital room, leading to infusion of oxygen into a vein. Postmortem CT scanning demonstrated multiple accumulations of gas in the pulmonary artery, the right atrium and ventricle, as well as the left subclavian and brachiocephalic veins, corresponding to the route that the infused gas would have taken to the heart and pulmonary artery...
May 26, 2017: Legal Medicine
https://www.readbyqxmd.com/read/28574672/safety-of-multidetector-computed-tomography-pulmonary-angiography-to-exclude-pulmonary-embolism-in-patients-with-a-likely-pretest-clinical-probability
#19
Helia Robert-Ebadi, Frédéric Glauser, Benjamin Planquette, Thomas Moumneh, Grégoire Le Gal, Marc Righini
BACKGROUND: In patients with suspected pulmonary embolism (PE) classified as having a likely or high pre-test clinical probability, the necessity of performing additional testing after a negative multidetector computed tomography pulmonary angiography (CTPA) remains a matter of debate. OBJECTIVES: The aim of this study was to assess the safety of excluding PE by CTPA without additional imaging in patients with a likely pre-test probability of PE. PATIENTS/METHODS: We retrospectively analysed patients included in two multicentre management outcome studies that assessed diagnostic algorithms for PE diagnosis...
June 2, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28573824/bone-cement-cardiac-and-pulmonary-embolism
#20
Tomás F Cianciulli, Diego E Mc Loughlin, Luis A Morita, María C Saccheri, Jorge A Lax
This case describes a complication of bone cement use. A 65-year-old male patient with back spine trauma caused by a fall, underwent a percutaneous vertebroplasty. Five years later, he consulted for palpitations, and the electrocardiogram showed supraventricular arrhythmia. A transthoracic two-dimensional echocardiography showed a hyperechogenic linear structure of 7 cm length, running from the lateral wall of the right ventricle to the right atrium through the tricuspid valve. This foreign body, which was suspicious for bone cement embolism, appeared rigid and was attached at the lateral wall of the right ventricle, with its proximal end free in the right atrium...
June 1, 2017: Echocardiography
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