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management of pulmonary embolism

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https://www.readbyqxmd.com/read/29021475/successful-pulmonary-artery-embolization-for-the-management-of-hemoptysis-in-a-patient-with-eisenmenger-syndrome-caused-by-patent-ductus-arteriosus
#1
Naoki Tamada, Kazuhiko Nakayama, Yuto Shinkura, Ken-Ichi Yanaka, Naoto Katayama, Takuya Okada, Masato Yamaguchi, Kensuke Matsumoto, Hidekazu Tanaka, Toshiro Shinke, Noriaki Emoto, Ken-Ichi Hirata
The patient was a 19-year-old woman who was diagnosed with patent ductus arteriosus complicating Eisenmenger syndrome at a previous medical institution. She was referred to our hospital and arranged for lung transplantation. She developed hemoptysis after the introduction of i.v. epoprostenol, which was administered as a bridging treatment while the patient awaited lung transplantation. She continued to suffer from recurrent hemoptysis, even after switching from i.v. epoprostenol to i.v. treprostinil. Angiography of the systemic and pulmonary arteries revealed the vessel responsible for the recurrent hemoptysis and pulmonary artery embolization was successfully performed...
October 11, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29019726/dilemmas-in-the-management-of-venous-thromboembolism-in-older-patients
#2
Musfira Shakeel, Jecko Thachil
Venous thromboembolism most commonly affects older patients. Despite the high incidence in this population, challenges remain in terms of the understanding of its presentation, diagnosis and management. Old age is associated with multi-morbidities which may complicate the diagnosis of venous thromboembolism as signs or symptoms may be attributed to underlying medical conditions. The presence of certain comorbidities (such as congestive cardiac failure and chronic obstructive pulmonary disease) also increases the risk of venous thromboembolism, but could mimic the clinical features of pulmonary embolism...
October 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28993433/management-of-thromboembolism-in-transit-with-pulmonary-embolism
#3
V S Ellensen, S Saeed, T Geisner, R Haaverstad
We present a rare complication of deep venous thrombosis with pulmonary embolism that threatened the patient with systemic embolization. A 36-year-old female was referred to the hospital after five days of progressive shortness of breath and chest pain. Preceding onset of symptoms she had undergone surgery leading to reduced physical activity and had just returned from vacation by a long flight. Investigations with transthoracic and transesophageal echocardiography revealed a thromboembolism-in-transit across a patent foramen ovale...
October 9, 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28985344/point-of-care-testing-in-primary-care-patients-with-acute-cardiopulmonary-symptoms-a-systematic-review
#4
Angel M R Schols, Jacqueline P G Stakenborg, Geert-Jan Dinant, Robert T A Willemsen, Jochen W L Cals
Background: Point-of-care tests (POCT) can assist general practitioners (GPs) in diagnosing and treating patients with acute cardiopulmonary symptoms, but it is currently unknown if POCT impact relevant clinical outcomes in these patients. Objective: To assess whether using POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and impacts clinical management. Methods: We performed a systematic review in four bibliographic databases...
July 23, 2017: Family Practice
https://www.readbyqxmd.com/read/28984372/adverse-maternal-and-birth-outcomes-in-women-admitted-to-hospital-for-hyperemesis-gravidarum-a-population-based-cohort-study
#5
Linda Fiaschi, Catherine Nelson-Piercy, Jack Gibson, Lisa Szatkowski, Laila J Tata
BACKGROUND: Evidence for risks of adverse maternal and birth outcomes in women with hyperemesis gravidarum (HG) is predominantly from small studies, unknown, or conflicting. METHODS: A population-based cohort study using secondary health care records (Hospital Episode Statistics covering all of England from 1997 to 2012) was used to calculate odds ratios (OR) with 99% confidence intervals (CI) for the association between HG hospital admission and adverse outcomes, adjusting for maternal and pregnancy confounders...
October 6, 2017: Paediatric and Perinatal Epidemiology
https://www.readbyqxmd.com/read/28983441/high-value-care-in-the-evaluation-of-stroke
#6
Prakrity Urja, Eric H Nippoldt, Virginia Barak, Carrie Valenta
Value-based care emphasizes achieving the greatest overall health benefit for every dollar spent. We present an interesting case of stroke, which made us consider how frequently health care providers are utilizing value-based care. A 73-year-old Caucasian, who was initially admitted for a hypertensive emergency, was transferred to our facility for worsening slurring of speech and left-sided weakness. The patient had an extensive chronic cerebrovascular disease, including multiple embolic type strokes, mainly in the distribution of the right temporal-occipital cerebral artery and transient ischemic attacks (TIAs)...
August 1, 2017: Curēus
https://www.readbyqxmd.com/read/28971108/hydatid-cyst-of-the-interventricular-septum
#7
Endale Tefera, Joseph Knapp, Michael Teodori
While cardiac involvement is not a common presentation in human echinococcosis, it may lead to life-threatening complications including cyst rupture; anaphylactic shock; tamponade; pulmonary, cerebral or peripheral arterial embolism; acute coronary syndrome; dysrhythmias; infection; ventricular or valvular dysfunction, as well as sudden death. Here we report a 9-year old girl who was diagnosed to have hydatid cyst of the interventricular septum four years after diagnosis and medical treatment of pulmonary hydatidosis...
March 31, 2017: Global Cardiology Science & Practice
https://www.readbyqxmd.com/read/28970039/clinical-conundrums-in-antithrombotic-therapy-management-a-delphi-consensus-panel
#8
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...
September 19, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28964391/-bilateral-proximal-pulmonary-embolism-without-associated-hypoxemia-case-report
#9
M Bahloul, K Chtara, O Turki, M M Kammoun, W Bouaziz, M Bouaziz
INTRODUCTION: Pulmonary embolism is a classic complication in intensive care. It is characterized by hypoxemia secondary to perturbed ventilation/perfusion ratios. We report a case of proximal and bilateral pulmonary embolism that occurred without associated hypoxemia. A spiral computed tomography (CT) scan was performed to explore unexplained fever in a patient with a negative infectious investigation. We discuss the mechanisms underlying the absence of hypoxemia in this patient. CLINICAL CASE: A 43-year-old patient with no significant pathological history was admitted to intensive care for the management of multiple injuries following a road accident...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28964384/prevention-and-treatment-of-cancer-associated-thrombosis-in-france-a-national-survey-among-vascular-disease-and-supportive-care-specialists
#10
I Mahé, F Scotté, J-B Rey, I Elalamy, A Lamblin, D Mayeur, G Pernod
BACKGROUND/AIM: Long-term use of low-molecular-weight heparins (LMWH) for the treatment of cancer-associated thrombosis (CAT) has been well-established. Conversely, the use of thromboprophylaxis in patients with cancer remains controversial in the absence of homogeneous guidelines. Our aim was to assess the awareness of treatment guidelines and the management of patients with CAT in daily clinical practice. METHODS: A national survey based on an open questionnaire developed by a panel of health professionals including specialists in vascular medicine, oncology, supportive care and pharmacy, was proposed on line to 2104 specialists experts in the management of CAT with the objective to collect at least 400 answers...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28957888/usefulness-of-medical-thoracoscopy-in-the-management-of-pleural-effusion-caused-by-chronic-renal-failure
#11
Sara Colella, Federica Fioretti, Chiara Massaccesi, Gian L Primomo, Gianluca Panella, Vittorio D'Emilio, Riccardo Pela
INTRODUCTION: Although pleural effusion (PE) can be caused by several pathologies like congestive heart failure, infections, malignancies, and pulmonary embolism, it is also a common finding in chronic kidney disease (CKD). Diagnostic thoracentesis is of limited value in the differential diagnosis, and the role of more invasive investigations like medical thoracoscopy (MT) is still unclear. AIM: To evaluate the usefulness of MT in unexplained PE in CKD. MATERIALS AND METHODS: In the electronic database of our Institution, we retrospectively searched for patients with CKD who underwent MT for unexplained PE between January 2008 and August 2016...
October 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/28948507/oral-factor-xa-inhibitors-for-the-treatment-of-left-ventricular-thrombus-a-case-series
#12
Keaton S Smetana, Jessie Dunne, Kevin Parrott, George A Davis, Amy C Schmelzer Collier, Mary Covell, Susan Smyth
Left ventricular thrombus (LVT) formation usually necessitates short term anticoagulation for thrombus resolution and to prevent embolic events. Historically, vitamin K antagonist therapy has been the treatment of choice. However, with the advent of direct acting anticoagulants, their role in the management of LVT is not clear. Patients were included if they had received rivaroxaban or apixaban for more than 1 day for LVT documented on imaging. The primary objective was resolution of LVT at 3 months based on assessment by an independent cardiologist review of initial and subsequent imaging results...
September 25, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28941516/continuous-aspiration-mechanical-thrombectomy-for-the-management-of-submassive-pulmonary-embolism-a-single-center-experience
#13
Ramsey Al-Hakim, Alok Bhatt, James F Benenati
The Indigo Mechanical Thrombectomy System (Penumbra, Inc, Alameda, California) was used to treat 6 patients with submassive pulmonary embolism (PE) and a contraindication to thrombolysis. Systolic pulmonary artery pressure (58.2 mm Hg vs 43.0 mm Hg, P < .05), right ventricular/left ventricular ratio (1.7 vs 1.1, P < .05), Miller index (15.0 vs 9.8, P < 0.01), and CT obstructive index (60.4% vs 47.0%, P < .01) were significantly reduced after mechanical thrombectomy. There were no procedural or periprocedural complications...
October 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28941051/no-added-value-of-the-age-adjusted-d-dimer-cut-off-to-the-years-algorithm-in-patients-with-suspected-pulmonary-embolism
#14
L M van der Pol, T van der Hulle, Y W Cheung, A T A Mairuhu, C G Schaar, L M Faber, M Ten Wolde, H M A Hofstee, M M C Hovens, M Nijkeuter, R C J van Klink, M J H A Kruip, S Middeldorp, M V Huisman, F A Klok
BACKGROUND: The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50 years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. METHODS: The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, "PE most likely diagnosis") with simultaneous D-dimer testing using a pre-test dependent threshold...
September 22, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28936124/the-risk-of-venous-thromboembolism-associated-with-peripherally-inserted-central-catheters-in-ambulant-cancer-patients
#15
Daniel Jones, Kurt Wismayer, George Bozas, June Palmer, Mandi Elliott, Anthony Maraveyas
BACKGROUND: Deep vein thrombosis (DVT) is a common complication of peripherally inserted central catheters (PICCs). PICCs are increasingly utilised in the management of cancer patients, a group which carries both additional risks for vascular thromboembolism as well as for complex morbidity. We analysed a cohort of cancer patients subjected to PICC insertion in a single cancer centre for the incidence of all-type vascular thromboembolism (VTE) and investigated relative risk factors. METHODS: In this clinical audit, the records of patients referred for PICC insertion in our centre in the period between 1/1/2011 and 1/4/2014 were retrospectively reviewed...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28935434/diagnosis-of-venous-thromboembolism-in-pregnancy
#16
Wee-Shian Chan
The diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) during pregnancy still relies on objective imaging. Ancillary testing such as clinical prediction rules and D-dimer testing may have a role in excluding both DVT and PE in these pregnant patients even as we await results from prospective management studies. The anatomical distribution of DVT in pregnancy differs from those in non-pregnant patient with a greater propensity for proximal iliac vein thrombosis. Using leg ultrasonography with compression maneuvers from the femoral vein to popliteal vein and doppler assessment of the iliac vein in a single examination, appears adequate in most pregnant women with suspected DVT, in excluding DVT...
September 5, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28930804/venous-thromboembolism-in-gynecological-malignancy
#17
Abigail Cohen, Chung Sim Lim, Alun Huw Davies
OBJECTIVE: Venous thromboembolism (VTE) is a recognized complication of gynecological malignancy and represents a leading cause of morbidity and mortality in these patients. The review aimed to discuss the incidence, risk factors, and clinical presentation of VTE before examining the literature on the diagnosis, prevention, and management in the context of uterine, cervical, ovarian, and vulval cancers. METHODS/MATERIALS: A literature search was performed using Ovid Medline and Embase with the following words: "gynecological malignancy," "pelvic tumor," "venous thromboembolism," "deep vein thrombosis" and "pulmonary embolism...
September 19, 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28930373/venous-thromboembolism-in-obese-pregnant-women-approach-to-diagnosis-and-management
#18
Ann Kinga Malinowski, Dorota Bomba-Opoń, Jacqueline Parrish, Urszula Sarzyńska, Dan Farine
Venous thromboembolism (VTE) remains among the leading causes of maternal mortality in the developed world, presenting variably as deep vein thrombosis (DVT), pulmonary embolism (PE) or cerebral vein thrombosis (CVT), among others. Obesity in particular has been recognized as the principal contributing factor to the risk of VTE in pregnancy and with the global increase in the rates of obesity affecting reproductive age women, heightened awareness of the risk and consequences of VTE in this population are vital...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28928561/periprocedural-management-of-vein-of-galen-aneurysmal-malformation-patients-an-11-year-experience
#19
Ajay Prasad Hrishi, Karen Ruby Lionel
CONTEXT: The vein of Galen aneurysmal malformation (VGAM) is a rare arteriovenous malformation where a dilated median prosencephalic vein provides a low-resistance conduit for intracerebral blood flow resulting in high-output cardiac failure, severe pulmonary hypertension, with or without central nervous system symptoms secondary to hydrocephalus, in the neonatal and pediatric population. AIM: This study aims to analysis of the anesthetic management of this unique subset of patients with VGAM...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28925655/pleuritic-chest-pain-sorting-through-the-differential-diagnosis
#20
Brian V Reamy, Pamela M Williams, Michael Ryan Odom
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made...
September 1, 2017: American Family Physician
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