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Pulmonary embolism guide

Melita Kukuljan, Zlatko Kolić, Duje Vukas, David Bonifačić, Kristina Vrbanec
Transthoracic computed tomography-guided core needle biopsy (TTNB) is a well-established method for diagnosing focal pulmonary lesions. However, the dangers associated with this method as well as the significant number of complications caused by it cannot be ignored. Systemic air embolism is a rare but potentially fatal complication that can accompany transthoracic needle biopsies of pulmonary lesions. In this study, we report nonfatal systemic air embolism as a complication of a transthoracic needle core biopsy of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis...
February 2018: Eurasian Journal of Medicine
Ksenija Makar-Aušperger, Kristina Krželj Cand Med, Martina Lovrić Benčić, Matea Radačić Aumiler, Viktorija Erdeljić Turk, Nada Božina
BACKGROUND: Observational studies have indicated potential benefits of CYP2C9 and VKORC1 guided dosing of warfarin but randomized clinical trials have resulted in contradictory findings. One of the reasons for contradiction may be the negligence of possible differences between warfarin indications. This study aims to determine efficacy and safety of genotype- and clinically guided dosing of warfarin in atrial fibrillation (AF), deep-vein thrombosis (DVT), and pulmonary embolism (PE) within the first five days after the introduction of therapy...
February 27, 2018: Therapeutic Drug Monitoring
J Apers, R Wijkmans, E Totte, M Emous
BACKGROUND: Mini gastric bypass (MGB) is a promising and attractive alternative bariatric procedure. In 2011, we introduced MGB in our high-volume bariatric unit. Subsequently, we evaluated short- and midterm results of this procedure. METHODS: A prospective cohort of patients who underwent MGB between 2012 and 2013 was retrospectively evaluated. RESULTS: From 2012 to 2013, primary MGB was performed in 287 patients with a mean BMI of 42 kg/m2 (range 32-76 kg/m2 )...
February 28, 2018: Surgical Endoscopy
Patrick Tivnan, Henny H Billett, Leonard M Freeman, Linda B Haramati
Sickle cell disease, a complex disorder with known pulmonary complications, has the potential to confound the diagnosis of pulmonary embolism. We hypothesized that when the choice of imaging is guided by chest radiographic results, CT pulmonary angiography (CTPA) and Ventilation-Perfusion (V/Q) scintigraphy have comparable diagnostic performance in sickle cell disease. Methods: A retrospective cohort of adults with sickle cell disease who were imaged for suspected pulmonary embolism with either CTPA or V/Q, from 2000-2016, at our institution, was established...
February 1, 2018: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Christopher Czaplicki, Hassan Albadawi, Sasan Partovi, Ripal T Gandhi, Keith Quencer, Amy R Deipolyi, Rahmi Oklu
Venous thrombosis (VT) is a common yet complex clinical condition that has shown minimal alteration in clinical management for decades. It is well known that thrombus evolves structurally over time, with complex changes resulting from the interplay between coagulation factors, cytokines, leukocytes and a myriad of other factors. Our current treatment options are most effective in the acute thrombus, which is composed predominantly of a loose mesh of fibrin and red blood cells (RBCs), making current anticoagulation therapies and thrombolytics quite effective in treatment...
December 2017: Cardiovascular Diagnosis and Therapy
David Lang, Viktoria Reinelt, Andreas Horner, Kaveh Akbari, Franz Fellner, Petra Lichtenberger, Bernd Lamprecht
Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (PCNB) is a common diagnostic procedure and is especially indispensable in thoracic oncology. Complications, such as pulmonary hemorrhage and pneumothorax are frequent, but usually easy to manage. Systemic air embolism is a rare but relevant adverse event and its true incidence is probably underestimated, as not all cases may become clinically apparent. We present a case of systemic air embolism following a core-needle biopsy of a left upper lobe lesion, where immediately after the procedure CT scans documented air in the thoracic aorta and in the left ventricle...
January 23, 2018: Wiener Klinische Wochenschrift
Nick van Es, Martha Louzada, Marc Carrier, Vicky Tagalakis, Peter L Gross, Sudeep Shivakumar, Marc A Rodger, Philip S Wells
BACKGROUND: The risk of recurrent venous thromboembolism (VTE) in cancer patients despite anticoagulant therapy is high. Clinical factors and pro-coagulant markers may identify high-risk patients and guide decisions about intensifying anticoagulation therapy. AIMS: To evaluate whether serial measurements of pro-coagulant markers can identify patients at high risk of recurrent VTE. METHODS: In this multicenter, prospective cohort study, patients with active cancer and acute deep vein thrombosis or pulmonary embolism were enrolled...
January 9, 2018: Thrombosis Research
Ji Ung Park, Han Sol Bae, Seung Mi Lee, Jaehoon Bae, Jeong Woo Park
RATIONALE: To report the distant migration of a subdermal contraceptive implant and to suggest that C arm-guided technique is one of the feasible options for removal of the device migrated to the axilla. PATIENT CONCERNS: A 41-year-old multipara with tingling sensation in the left axilla was referred for removal of an Implanon NXT which could not be palpated by physical examination or detected by ultrasound scanning. Finally, the device was detected by computed tomography and found migrating to the left axilla...
December 2017: Medicine (Baltimore)
Y S Sun, I T Sun, H K Wang, A H Yang, C Y Tsai, C J Huang, D F Huang, C C Lai
Objective The objective of this paper is to identify the risk of complications of real-time ultrasound-guided renal biopsy in adult and pediatric patients with systemic lupus erythematosus (SLE). Materials and methods This retrospective study examined outcomes of 296 renal biopsy procedures in 275 SLE patients. Imaging-confirmed symptomatic hematoma was regarded as a major complication when intervention (blood transfusion, angiographic embolization, or surgery) was required or as a minor complication otherwise...
January 1, 2018: Lupus
Lucas Fiore, Nathan Elie Frenk, Guilherme Lopes Pinheiro Martins, Publio Cesar Cavalcante Viana, Marcos Roberto de Menezes
CT-guided percutaneous biopsy is a resourceful and widely used tool to evaluate pulmonary nodules that frequently avoids costly and unnecessary surgeries. Severe complications occur in less than 1% of cases and include gas embolism, which is rarely documented. We report a case of gas embolism after transthoracic biopsies and discuss the pathophysiology and the benefits of early diagnosis and proper management.
June 2017: Journal of Radiology Case Reports
O A Zeleznik, E M Poole, S Lindstrom, P Kraft, A Van Hylckama Vlieg, J A Lasky-Su, L B Harrington, K Hagan, J Kim, B A Parry, N Giordano, C Kabrhel
BACKGROUND: Patients with acute pulmonary embolism (PE) exhibit wide variation in clinical presentation and outcomes. Our understanding of the pathophysiologic mechanisms differentiating low-risk and high-risk PE is limited, so current risk-stratification efforts often fail to predict clinical deterioration and are insufficient to guide management. OBJECTIVES: To improve our understanding of the physiology differentiating low-risk from high-risk PE, we conducted the first-ever high-throughput metabolomics analysis (843 named metabolites) comparing PE patients across risk strata within a nested case-control study...
December 29, 2017: Journal of Thrombosis and Haemostasis: JTH
Tony Wan, Marc Rodger, Wanzhen Zeng, Philippe Robin, Marc Righini, Michael J Kovacs, Melanie Tan, Marc Carrier, Susan R Kahn, Philip S Wells, David R Anderson, Isabelle Chagnon, Susan Solymoss, Mark Crowther, Richard H White, Linda Vickars, Sadri Bazarjani, Grégoire Le Gal
BACKGROUND: The optimal duration of oral anticoagulant therapy after a first, unprovoked venous thromboembolism is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. Risk stratification tools may assist in decision making. OBJECTIVES: We sought to determine the relationship between residual pulmonary embolism assessed by baseline ventilation-perfusion scan after completion of 5-7months of oral anticoagulant therapy and the risk of recurrent venous thromboembolism in patients with the first episode of unprovoked pulmonary embolism...
February 2018: Thrombosis Research
E Nguyen, J T Caranfa, G H Lyman, N M Kuderer, C Stirbis, M Wysocki, C I Coleman, E R Weeda, C G Kohn
Essentials Clinical prediction rules (CPRs) can stratify patients with pulmonary embolism (PE) and cancer. A meta-analysis was done to assess prognostic accuracy in CPRs for mortality in these patients. Eight studies evaluating ten CPRs were included in this study. CPRs should continue to be used with other patient factors for mortality risk stratification. SUMMARY: Background Cancer treatment is commonly complicated by pulmonary embolism (PE), which remains a leading cause of morbidity and mortality in these patients...
February 2018: Journal of Thrombosis and Haemostasis: JTH
Babatunde Olaiya, Charles A Gilliland, Seth D Force, Felix G Fernandez, Manu S Sancheti, William C Small
PURPOSE: In this study, we describe our experience of lesion marking with fiducial markers (FM) and microcoils (MC) facilitating same-day surgical wedge resection, including success rates, pathology outcomes, and complications. We also explored patient/nodular characteristics associated with developing complications. MATERIALS AND METHODS: An IRB-approved single-institutional retrospective study of 136 patients who had 148 pulmonary nodules was conducted. All patients had CT-guided pulmonary nodule labeling with either FM (121) or MC (15) patients with plan for same-day fluoroscopic-guided wedge resection...
November 6, 2017: Current Problems in Diagnostic Radiology
Juan C Grignola, Enric Domingo
The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients...
2017: BioMed Research International
Svetlana Kvint, James Schuster, Monisha A Kumar
Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient's exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years...
November 2017: Neurosurgical Focus
Liliana Villari, Roberta Pancani, Ferruccio Aquilini, Letizia Marconi, Laura Carrozzi, Antonio Palla, Alessandro Celi
The optimal duration of anticoagulant therapy after a first episode of unprovoked pulmonary thromboembolism is not fully defined. The identification of patients more prone to recurrence would be useful in this context but is currently relatively unreliable. Perfusion lung scan (PLS) is an established approach for the follow-up of patients with pulmonary embolism to identify recurrences and to help in the diagnosis of chronic thromboembolic pulmonary hypertension. The aim of the study was to investigate the potential role of residual perfusion defects at follow-up perfusion scans in predicting pulmonary embolism recurrences...
October 25, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Kaiwen Sun, Rishi Batra, Nicholas W Markin, Melissa Suh, Iraklis I Pipinos, Ellen K Roberts, Jason N Mactaggart, B Timothy Baxter
Obstruction of the superior vena cava (SVC) is an uncommon, but potentially life-threatening condition due to likely development of edema in the head and neck and potential respiratory compromise. Less than half of those affected by SVC syndrome survive more than a year. Obstruction can be from neoplasms or secondary to benign disease. Treatment for most cases of symptomatic SVC syndrome involves placement of a stent to relieve the stenosis. Serious complications such as stent migration, pulmonary embolism, and cardiac tamponade can occur in 5% to 10% of cases, and inadequate imaging of the SVC-atrial junction by fluoroscopy contributes to these problems...
November 2017: Vascular and Endovascular Surgery
Paolo Colonna, Felicita Andreotti, Walter Ageno, Vittorio Pengo, Niccolò Marchionni
BACKGROUND: Anticoagulants are recommended for the prevention of stroke/systemic embolism for most patients with atrial fibrillation (AF) and for the treatment of patients with venous thromboembolism (VTE). Regulatory-driven randomized trials, however, typically exclude extreme patient scenarios involving, for instance, severe bleeding, ischaemic risk, frailty or renal impairment, despite their common occurrence in clinical practice. Uncertainty in the management of such cases leads to a high degree of variability in therapeutic approaches...
December 15, 2017: International Journal of Cardiology
Nicole M Kuderer, Marek S Poniewierski, Eva Culakova, Gary H Lyman, Alok A Khorana, Ingrid Pabinger, Giancarlo Agnelli, Howard A Liebman, Eric Vicaut, Guy Meyer, Frances A Shepherd
BACKGROUND: Patients with lung cancer are known to be at increased risk for venous thromboembolism (VTE). Venous thromboembolism is associated with increased risk for early mortality. However, there have been no studies performing a comprehensive assessment of risk factors for VTE or early mortality in lung cancer patients undergoing systemic chemotherapy in a global real-world setting. MATERIALS AND METHODS: CANTARISK is a prospective, global, noninterventional cohort study including patients with lung cancer initiating a new cancer therapy...
February 2018: Oncologist
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