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Yolanda C Bryce, Rocio Perez-Johnston, Errol B Bryce, Behrang Homayoon, Ernesto G Santos-Martin
Pulmonary embolus (PE) is the third most common cause of cardiovascular death with more than 600,000 cases occurring in the USA per year. About 45% of patients with acute PE will have acute right ventricular failure, and up to 3.8% of patients will develop chronic thromboembolic pulmonary hypertension (CTEPH) with progressive, severe, chronic heart failure. The right ventricle (RV) is constructed to accommodate a low-resistance afterload. Increases in afterload from acute massive and submassive PE and CTEPH may markedly compromise the RV function leading to hemodynamic collapse and death...
February 13, 2019: Insights Into Imaging
Bedros Taslakian, Clayton Li, Samuel Z Goldhaber, Kathryn Z Mikkelsen, James M Horowitz, Christopher Kabrhel, Geoffrey D Barnes, Akhilesh K Sista
Keywords: pulmonary embolism; submassive; survey.
February 7, 2019: Journal of Clinical Medicine
Alejandro Brañes, Matias Orellana, Rodrigo Muñoz
INTRODUCTION: Venous thromboembolism (VTE) in bariatric surgery is a low incidence disease; however, it is the first cause of morbimortality in this group of patients. PRESENTATION OF THE CASE: We present the case of a female patient with morbid obesity who was readmitted due to an acute submassive bilateral pulmonary embolism (PE) nineteen days after a laparoscopic Roux-en-Y gastric bypass (RYGB). After diagnosis, anticoagulation was initiated, and decision to add mechanical and pharmacological thrombolysis was made with the patient been successfully treated, as shown by normalization of pulmonary hypertension...
January 19, 2019: International Journal of Surgery Case Reports
Emine Argüder, Ebru Parlak, Habibe Hezer, Ayşegül Karalezli, H Canan Hasanoğlu
We present 2 cases of pulmonary thromboembolism (PTE). The first case, a 50-year-old man, was admitted to the emergency department because of sudden onset dyspnea and left side chest pain. He was diagnosed with intermediate-risk (submassive) PTE, and thrombolytic treatment was commenced. The patient fully recovered, but 5 days later, he was diagnosed with a new, high-risk PTE. The second patient, a 23-year-old woman, presented with syncope, dyspnea, and chest pain for 2 days. She was diagnosed with high-risk (massive) PTE...
January 1, 2019: Turkish Thoracic Journal
Jeffrey A Kline, Michael A Puskarich, Alan E Jones, Ronald A Mastouri, Cassandra L Hall, Anthony Perkins, Emily Gundert, Tim Lahm
OBJECTIVE: To test the hypothesis that adjunctive inhaled NO would improve RV function and viability in acute PE. METHODS: This was a randomized, placebo-controlled, double blind trial conducted at four academic hospitals. Eligible patients had acute PE without systemic arterial hypotension but had RV dysfunction and a treatment plan of standard anticoagulation. Subjects received either oxygen plus 50 parts per million nitrogen (placebo) or oxygen plus 50 ppm NO for 24 h...
January 8, 2019: Nitric Oxide: Biology and Chemistry
M R Kuznetsov, I V Reshetov, B B Orlov, A A Khotinsky, A A Atayan, M A Shchedrinа
PURPOSE: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). MATERIAL AND METHODS: We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH...
December 25, 2018: Kardiologiia
R Špunda, M Špaček, R Šachl, L Lambert, S Heller, J Lindner
INTRODUCTION: Pulmonary embolism is a life-threatening condition that causes obstruction of the pulmonary arteries by an embolus, most often originating from the venous system of the lower limbs or pelvic veins. Depending on the extent of the embolism, an acute right-sided heart failure may result, with subsequent death. Paradoxical embolism is a condition in which a venous thrombus is embolized into the systemic circulation arteries by a right-to-left heart shunt. This condition most commonly occurs in the interatrial septum...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Daniel P Rothschild, James A Goldstein, Terry R Bowers
OBJECTIVES: The purpose of the present study is to evaluate the safety and efficacy of "low-dose" systemic thrombolytic therapy (TT) for treatment of patients with intermediate-high risk submassive pulmonary embolism (PE). BACKGROUND: TT is increasingly utilized in acute submassive PE. Strategies for TT include catheter-directed administration as well as traditional IV systemic therapy. Regardless of the route, most studies document the attendant significant bleeding complication rates expected from induction of a systemic lytic state...
December 14, 2018: Catheterization and Cardiovascular Interventions
Julia C Iezzoni
Histochemistry has an important, continuing role in the current assessment of hepatic biopsies and resection specimens. The evaluation of connective tissue elements in the liver can be accomplished with such methods as the Masson trichrome, Snook reticulin, Vierhoff van Gieson, orcein, and Victoria blue stains. The results contribute to the diagnosis of acute and chronic hepatitis, submassive necrosis, venous outflow obstruction, steatohepatitis, and cirrhosis. Fat stains done on frozen sections of liver tissue are routinely performed in the evaluation of donor liver allograft biopsies...
October 16, 2018: Seminars in Diagnostic Pathology
Elizabeth Murphy, Ahmed Lababidi, Renuka Reddy, Taaha Mendha, David Lebowitz
A pulmonary embolism (PE) is an acute life-threatening respiratory event that results in upwards of 200,000 deaths per year in the United States. While anticoagulation is currently the standard of treatment for PEs, there is increasing evidence to suggest that in certain cases anticoagulation in combination with thrombolytic therapy may improve patient outcomes and reduce mortality. This article aims to compare the effects of combined intervention with thrombolytic therapy and anticoagulation to the effects of anticoagulation alone in patients with submassive PEs in terms of various outcome measures, including but not limited to: mortality, hemodynamic status, length of hospital stay, and safety...
June 15, 2018: Curēus
Charles Hennemeyer, Abdul Khan, Hugh McGregor, Cheyenne Moffett, Gregory Woodhead
BACKGROUND: Catheter directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. METHODS: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over two years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8) or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone...
October 24, 2018: American Journal of Medicine
Luis Alberto Martínez Insfran, Felipe Alconchel Gago, Pascual Parrilla Paricio
Orlistat is an intestinal lipase inhibitor drug that is recommended in obese patients along with a hypocaloric diet. Although the most frequent secondary effect is steatorrhea, fulminant liver failure has also been associated with this drug, which has required liver transplantation in 3 patients. We present the case of a 42-year-old obese male.
October 16, 2018: Revista Española de Enfermedades Digestivas
Jay N Lozier, Jason M Elinoff, Anthony F Suffredini, Douglas R Rosing, Stanislav Sidenko, Richard M Sherry, Adam R Metwalli, Vandana Sachdev, Robert L Danner, Richard Chang
: Guidelines-recommend thrombolytic therapy for pulmonary embolism in patients with severe hemodynamic compromise and low risk of bleeding. Thrombolytics in submassive pulmonary embolism have an unfavorable risk/benefit ratio and remain controversial. Based on our experience with extensive, lower extremity thrombi, nine patients with symptomatic, submassive pulmonary embolisms (five medical, four surgical) were treated with low-dose alteplase (<10 mg/day, infused over 6 h per treatment). Alteplase was delivered by pulse spray and/or directed or undirected central venous catheters depending on clot size and location...
December 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Aditya Jandial, Kundan Mishra, Susheel Kumar, Pankaj Malhotra
No abstract text is available yet for this article.
October 8, 2018: QJM: Monthly Journal of the Association of Physicians
Oscar M P Jolobe
No abstract text is available yet for this article.
October 8, 2018: QJM: Monthly Journal of the Association of Physicians
Michael R Kendall, Stuart Swadron, Leonardo C Clavijo, Anilkumar K Mehra, Antotreas Hindoyan, Ray V Matthews, David M Shavelle
BACKGROUND: Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage, and consideration for reperfusion therapy. Use of an existing ST-segment elevation myocardial infarction (STEMI) team and activation protocol may be an effective means to care for these patients. OBJECTIVE: The objective of this analysis was to evaluate a pilot study using the STEMI team and a dedicated PE protocol for treatment of patients with massive and submassive PE...
October 2018: Journal of Invasive Cardiology
Muhammad Saad, Danial H Shaikh, Nikhitha Mantri, Ahmed Alemam, Aiyi Zhang, Muhammad Adrish
Background: Fever is considered as a presenting symptom of pulmonary embolism (PE). We aim to evaluate the association between PE and fever, its clinical characteristics, outcomes and role in prognosis. Methods: A retrospective chart review of patients who were hospitalised with the diagnosis of acute PE was conducted. Patients in whom underlying fever could also be attributable to an underlying infection were also excluded. Results: A total of 241 patients met the study criteria...
2018: BMJ Open Respiratory Research
Rachel Rosovsky, Yuchiao Chang, Kenneth Rosenfield, Richard Channick, Michael R Jaff, Ido Weinberg, Thoralf Sundt, Alison Witkin, Josanna Rodriguez-Lopez, Blair A Parry, Savannah Harshbarger, Praveen Hariharan, Christopher Kabrhel
Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients with life-threatening PE. We sought to determine how the creation of PERT affects treatment and outcomes of patients with serious PE. A pre- and post-intervention study was performed using an interrupted time series design, to compare patients with PE before (2006-2012) and after (2012-2016) implementation of PERT at a university hospital. T-tests, Chi square tests and logistic regression were used to compare outcomes, and multivariable regression were used to adjust for differences in PE severity...
September 21, 2018: Journal of Thrombosis and Thrombolysis
Daniel P Rothschild, James A Goldstein
No abstract text is available yet for this article.
August 1, 2018: Catheterization and Cardiovascular Interventions
Barbara L LeVarge, Cameron D Wright, Josanna M Rodriguez-Lopez
Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. When thrombus is proximal, embolectomy can rapidly restore cardiac function. Chronic thromboembolic pulmonary hypertension is a more complex disease that requires skilled, careful dissection of the arterial wall, including vascular intima...
September 2018: Clinics in Chest Medicine
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