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management of pulmonary embolism

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https://www.readbyqxmd.com/read/29222261/symptomatic-subsegmental-pulmonary-embolism-to-treat-or-not-to-treat
#1
REVIEW
Marc Carrier, Fredrikus A Klok
The introduction of computed tomographic pulmonary angiography and its recent increasing availability has led to a significant rise in its use to help clinicians diagnose acute pulmonary embolism (PE). This has led to a significant increase in the incidence of PE diagnoses. Simultaneously, the case fatality rate of acute PE has been decreasing and no significant change in its mortality has been noted, suggesting that the additional PE diagnoses are less severe and these patients might not benefit from anticoagulation therapy...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222260/should-we-diagnose-and-treat-distal-deep-vein-thrombosis
#2
REVIEW
Helia Robert-Ebadi, Marc Righini
Ultrasound series report that isolated distal deep vein thrombosis (DVT), also known as calf DVT, represents up to 50% of all lower-limb DVTs and, therefore, is a frequent medical condition. Unlike proximal DVT and pulmonary embolism, which have been studied extensively and for which management is well standardized, much less is known about the optimal management of isolated calf DVT. Recent data arising from registries and nonrandomized studies have suggested that most distal DVTs do not extend to the proximal veins and have an uneventful follow-up when left untreated...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222259/controversies-in-venous-thromboembolism-to-treat-or-not-to-treat-superficial-vein-thrombosis
#3
REVIEW
Jan Beyer-Westendorf
The management of superficial vein thrombosis (SVT) is poorly defined and remains controversial overall. SVT has long been considered a benign, self-limited disease, but recent studies show that SVT carries a nonnegligible risk for recurrence, deep vein thrombosis, or pulmonary embolism. Current guidelines recommend the use of low-molecular-weight heparin or fondaparinux, but results of several surveys indicate that the majority of patients with SVT receive nonanticoagulant therapy only, which includes compression stockings or bandages, nonsteroidal anti-inflammatory drugs, topical application of heparin gel, or surgical interventions...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29215781/clinical-prediction-rules-for-mortality-in-patients-with-pulmonary-embolism-and-cancer-to-guide-outpatient-management-a-meta-analysis
#4
E Nguyen, J Caranfa, G H Lyman, N M Kuderer, C Stirbis, M Wysocki, C I Coleman, E R Weeda, C G Kohn
BACKGROUND: Cancer treatment is commonly complicated by pulmonary embolism (PE), which remains a leading cause of morbidity and mortality in these patients. Some guidelines recommend the use of clinical prediction rules (CPRs) to help clinicians identify patients at low-risk for mortality to guide care. OBJECTIVE: To determine and compare the accuracy of available CPRs for identifying cancer patients with PE at low-risk for mortality. METHODS: A literature search of Medline and Scopus (01/01/2000-08/01/2017) was performed...
December 7, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29201914/acute-right-ventricular-dysfunction-in-intensive-care-unit
#5
REVIEW
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
https://www.readbyqxmd.com/read/29197610/thromboembolic-risk-of-endovascular-intervention-for-lower-extremity-deep-venous-thrombosis
#6
Philip Lindsey, Angela Echeverria, Mun J Poi, Jesus Matos, Carlos F Bechara, Mathew Cheung, Peter H Lin
INTRODUCTION: This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT) METHODS: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2001 to 2017 were retrospectively analyzed using a prospectively maintained database. Only patients who received an IVC filter were included in the analysis. Trapped intra-filter thrombus was assessed for procedural-related thromboembolism...
November 29, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29196310/endovascular-management-of-a-case-of-spontaneous-retroperitoneal-haematoma-complicated-with-deep-vein-thrombosis-and-pulmonary-embolism
#7
Balbir Singh, Prashant Bharadwaj, Nitin Bajaj, Davinder Chadha
Spontaneous retroperitoneal haematoma (SRH) can be a life-threatening emergency presenting with hypovolaemic shock. SRH has been rarely reported with May-Thurner syndrome (MTS) where it occurs due to rupture of the iliac vein or venous collaterals. We report a case of MTS that presented with deep venous thrombosis of the left lower limb complicated by bilateral pulmonary embolism (PE) and a large pelvic haematoma. The simultaneous occurrence of a large pelvic haematoma and PE offered a therapeutic challenge...
December 1, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29189171/inappropriate-sinus-tachycardia
#8
Mohammed Ruzieh, Abdelmoniem Moustafa, Ebrahim Sabbagh, Ebrahim Sabbagh, Saima Karim
Definition and diagnosis: Inappropriate Sinus Tachycardia (IST) is a clinical syndrome characterized by a sinus heart rate inexplicably higher than one hundred beats per minute at rest that is associated with symptoms like palpitations, dyspnea or dizziness in the absence of primary causes of tachycardia. The diagnosis requires exclusion of other causes of tachycardia including medications/substances (such as anti-cholinergic, beta-blocker withdrawal, caffeine, and alcohol) or medical conditions (such as panic attacks, pulmonary embolism, fever, hyperthyroidism, hypovolemia, anemia, and pain)...
November 29, 2017: Current Cardiology Reviews
https://www.readbyqxmd.com/read/29184692/advanced-duodenal-neoplasia-and-carcinoma-in-familial-adenomatous-polyposis-outcomes-of-surgical-management
#9
Fábio Guilherme Campos, Carlos Augusto Real Martinez, Leonardo Alfonso Bustamante Lopez, Danilo Toshio Kanno, Sérgio Carlos Nahas, Ivan Cecconello
Background: In addition to the presence of neoplasia in the colon and rectum, patients with familial adenomatous polyposis (FAP) may develop numerous polyps and carcinoma within the upper gastrointestinal tract. Methods: The aim of the present paper was to review the incidence advanced duodenal polyposis or cancer and their surgical outcomes. A retrospective review of patients' records from our department was performed. Information was retrieved from a prospective collected data, including clinical (gender, age, family history), endoscopic [association with colorectal cancer (CRC), polyposis severity, age at diagnosis] and surgical management (age, time from the index surgery, type of procedure, morbidity)...
October 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29174781/utilization-of-veno-arterial-extracorporeal-membrane-oxygenation-for-massive-pulmonary-embolism
#10
Chetan Pasrija, Anthony Kronfli, Praveen George, Maxwell Raithel, Francesca Boulos, Daniel L Herr, James S Gammie, Si M Pham, Bartley P Griffith, Zachary N Kon
BACKGROUND: The management of massive pulmonary embolism remains challenging, with a considerable mortality rate. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for massive pulmonary embolism has been reported, its use as salvage therapy has been associated with poor outcomes. We reviewed our experience utilizing an aggressive, protocolized approach of VA-ECMO to triage, optimize, and treat these patients. METHODS: All patients with a massive pulmonary embolism who were placed on VA-ECMO, as an initial intervention determined by protocol, were retrospectively reviewed...
November 23, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29171210/pericardial-esophageal-fistula-complicating-atrial-fibrillation-ablation-successfully-resolved-after-pericardial-drainage-with-conservative-management
#11
Jeong Min Seo, Jong Sung Park, Sang Seok Jeong
A 40-year-old male patient underwent radiofrequency catheter ablation for symptomatic paroxysmal atrial fibrillation (AF). Although pulmonary vein (PV) isolation was successfully completed without acute complications, the patient began complaining of sustained retrosternal pain. Seventeen days after ablation, the patient visited the emergency room with fever and severe chest pain with pericarditis-like features. Chest computed tomography (CT) revealed clustered air bubbles in the pericardial space. Esophagography confirmed leakage of contrast agent into the pericardial space but not into the left atrium...
November 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/29167216/a-rare-case-of-dual-diagnosis-in-a-16-year-old-girl-with-shortness-of-breath
#12
Felicity de Vere, Robyn House, Yunus Gokdogan
Pneumothorax and pulmonary embolism (PE) are two life-threatening causes of shortness of breath in patients presenting to the emergency department. A rare but more serious presentation is that of simultaneous PE and pneumothorax. We present the case of a young patient, with no known comorbidities, who presented with simultaneous submassive PE and pneumothorax. We will review how these two diagnoses may be related, consider the implications of having this dual diagnosis on the patient's management and review the current evidence surrounding thrombolysis in submassive PE...
November 21, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29157526/systemic-thrombolysis-for-pulmonary-embolism-evidence-patient-selection-and-protocols-for-management
#13
REVIEW
Hafeez Ul Hassan Virk, Sanjay Chatterjee, Partha Sardar, Chirag Bavishi, Jay Giri, Saurav Chatterjee
Acute pulmonary embolism presents a clinical challenge for optimal risk stratification. Although associated with significant morbidity and mortality at the population level, the spectrum of presentation in an individual patient varies from mild symptoms to cardiac arrest. Treatment options include anticoagulation, systemic thrombolysis, catheter-based interventions, and surgical embolectomy. In this article, an attempt is made to optimally identify patients who, based on available evidence, may benefit from systemic thrombolytic therapy...
January 2018: Interventional Cardiology Clinics
https://www.readbyqxmd.com/read/29155385/local-low-dose-urokinase-thrombolysis-for-the-management-of-hemodynamically-stable-pulmonary-embolism-with-right-ventricular-dysfunction
#14
Sara Alcántara Carmona, Marina Pérez Redondo, Luis Nombela Franco, Rocío González Costero, Bárbara Balandín Moreno, Miguel Valdivia de la Fuente, Santiago Méndez Alonso, Agustín García Suárez, Ana Royuela
AIMS: To evaluate the effectiveness of local low-dose urokinase thrombolysis (LLDUT) in hemodynamically stable pulmonary embolism with right ventricular dysfunction (RVD). METHODS AND RESULTS: Prospective study. LLDUT with a 200,000 IU bolus followed by a 100,000 IU/h infusion. Treatment duration was determined through radiological control performed 48-72h into treatment. Follow-up echocardiogram was performed within seven days after LLDUT completion. Evolution of thrombus burden, pulmonary artery pressures (PAP) and RVD were studied, and hemorrhagic complications and mortality were recorded...
November 21, 2017: EuroIntervention
https://www.readbyqxmd.com/read/29145233/prospective-evaluation-of-the-feasibility-safety-and-efficacy-of-cocoon-duct-occluder-for-transcatheter-closure-of-large-patent-ductus-arteriosus-a-single-center-study-with-short-and-medium-term-follow-up-results
#15
Santosh Kumar Sinha, Mahmadula Razi, Rama Niwas Pandey, Prakash Kumar, Vinay Krishna, Mukesh Jitendra Jha, Vikas Mishra, Mohammad Asif, Nasar Abdali, Pradyot Tewari, Ramesh Thakur, Umeshwar Pandey, Chandra Mohan Varma
OBJECTIVE: To evaluate the feasibility, safety, and efficacy of a novel Cocoon Duct Occluder device for the transcatheter closure (TCC) of large patent ductus arteriosus (PDA). METHODS: In this prospective, non-randomized study, consecutive patients with large PDA (narrowest diameter: ≥3.5/4.0 mm in symptomatic/asymptomatic patients, respectively), who underwent TCC with Cocoon Duct Occluder at our institute between November, 2012 and June, 2016 were examined...
November 2017: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29143501/-the-place-of-balloon-pulmonary-angioplasty-in-the-management-of-chronic-thromboembolic-pulmonary-hypertension
#16
Aileen Kharat, Béatrice Duxbury, Anne-Lise Hachull, Stéphane Noble, Hélène Bouvaist, Paola M Soccal, Frédéric Lador
Chronic thromboembolic pulmonary hypertension (CTEPH) is uncommon. Its diagnosis should not be delayed as its prognosis is poor if not treated. In most cases, an acute pulmonary embolism is found in the medical history of the patient. Once suspected, a specific work-up should be performed in a pulmonary hypertension (PH) center. The ventilation/perfusion scan has a central role in this workup but the emergence of non invasive imaging technologies provides morphological and functional information which take part in the therapeutic decision making, such as operability...
November 15, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29142484/contemporary-management-of-pulmonary-arteriovenous-malformations
#17
REVIEW
Nicholas Rauh, John Gurley, Sibu Saha
Pulmonary arteriovenous malformations (PAVMs) are atypical vascular structures involving a direct connection between the pulmonary arterial and venous circulations. While PAVMs are a relatively uncommon disorder, unmanaged cases are at risk for the development of serious complications including embolization and infection. Since their first description in 1897, PAVMs have been identified and treated in a variety of ways. Advancements in diagnostic methods and operative techniques have allowed for more effective treatment of the disease...
December 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/29141890/british-thoracic-society-clinical-statement-on-pulmonary-arteriovenous-malformations
#18
Claire L Shovlin, Robin Condliffe, James W Donaldson, David G Kiely, Stephen J Wort
Pulmonary arteriovenous malformations (PAVMs) are structurally abnormal vascular communications that provide a continuous right-to-left shunt between pulmonary arteries and veins. Their importance stems from the risks they pose (>1 in 4 patients will have a paradoxical embolic stroke, abscess or myocardial infarction while life-threatening haemorrhage affects 1 in 100 women in pregnancy), opportunities for risk prevention, surprisingly high prevalence and under-appreciation, thus representing a challenging condition for practising healthcare professionals...
December 2017: Thorax
https://www.readbyqxmd.com/read/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#19
Cristian Toarta, Muhammad Mukarram, Kirtana Arcot, Soo-Min Kim, Sarah Gaudet, Marco L A Sivilotti, Brian H Rowe, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians' confidence in assigning the etiology were collected...
November 14, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29132697/treatment-of-postsurgical-chylothorax
#20
Janani S Reisenauer, Carlos A Puig, Chris J Reisenauer, Mark S Allen, Emily Bendel, Stephen D Cassivi, Francis C Nichols, Rob K Shen, Dennis A Wigle, Shanda H Blackmon
BACKGROUND: Postoperative chylothorax can be managed by any or all of observation, parenteral nutrition, surgical duct ligation, pleurodesis, or thoracic duct embolization. The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic duct embolization). METHODS: A prospectively maintained database at a single institution was used to identify and review patients with postoperative chylothorax from 2008 to 2015...
November 11, 2017: Annals of Thoracic Surgery
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