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Hemodynamic effects of inducible nitric oxide synthase inhibition combined with sildenafil during acute pulmonary embolism

DIAS-JUNIOR, Carlos A.; NETO-NEVES, Evandro M.; MONTENEGRO, Marcelo F.; TANUS-SANTOS, Jose E.
Fonte: ACADEMIC PRESS INC ELSEVIER SCIENCE Publicador: ACADEMIC PRESS INC ELSEVIER SCIENCE
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.84%
While endogenous nitric oxide (NO) may be relevant to the beneficial hemodynamic effects produced by sildenafil during acute pulmonary embolism (APE), huge amounts of inducible NO synthase (iNOS)derived NO may contribute to lung injury. We hypothesized that iNOS inhibition with S-methylisothiourea could attenuate APE-induced increases in oxidative stress and pulmonary hypertension and, therefore, could improve the beneficial hemodynamic and antioxidant effects produced by sildenafil during APE. Hemodynamic evaluations were performed in non-embolized dogs treated with saline (n = 4), S-methylisothiourea (0.01 mg/kg followed by 0.5 mg/kg/h, n = 4), sildenafil (0.3 mg/kg, n = 4), or S-methylisothiourea followed by sildenafil (n = 4), and in dogs that received the same drugs and were embolized with silicon microspheres (n = 8 for each group). Plasma nitrite/nitrate (NOx) and thiobarbituric acid reactive substances (TBARS) concentrations were determined by Griess and a fluorometric assay, respectively. APE increased mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance index (PVRI) by 25 +/- 1.7 mm Hg and by 941 +/- 34 dyn s cm(-5) m(-2), respectively. S-methylisothiourea neither attenuated APE-induced pulmonary hypertension...

Tomografia computadorizada multidetectores na avaliação do tromboembolismo pulmonar: uso de reformatações em projeção de intensidade máxima; Multidetector computed tomography in the evaluation of the pulmonary embolism: use of the maximum intensity projection reconstructions

Genu, Ana Maria
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 18/06/2007 PT
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36.84%
INTRODUÇÃO: Os tomógrafos multidetectores (TCMD) aumentaram a sensibilidade na detecção do tromboembolismo pulmonar (TEP). Observa-se, no entanto, um substancial aumento no número de imagens e, conseqüentemente, no tempo de análise pelo radiologista. Uma possível solução, para este problema, é a realização de reconstruções em projeção de intensidade máxima (MIP) que reduz o número de imagens para análise. Existe ainda uma nova modalidade de imagem utilizando reconstrução MIP em planos rotacionais sobre um eixo horizontal ao nível dos hilos pulmonares (reformatação em pás de roda moinho, PRM), que tem demonstrado melhor a continuidade dos ramos arteriais que irradiam dos hilos. No entanto, estudos são necessários para determinar se o uso de reformatações MIP pode reduzir o número de imagens a serem analisadas, sem perda significativa de informações, e se a adição de reformatação PRM pode melhorar o diagnóstico de TEP. OBJETIVOS: Testar a hipótese de que imagens utilizando reconstruções em projeção de intensidade máxima de 2,0 mm e 4,0 mm de espessura, multiplanares, têm o mesmo valor diagnóstico para detecção de TEP nas grandes e pequenas artérias pulmonares, quando comparadas a imagens multiplanares de 1 mm...

Distribuição temporal, fatores de risco e influência prognóstica da embolia em portadores de endocardite infecciosa; Time-related distribution, risk factors and prognostic influence of embolism in patients with infective endocarditis

Fabri Junior, José
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 06/12/2002 PT
Relevância na Pesquisa
37%
Os objetivos do estudo foram avaliar as características clínicas das embolias arteriais sistêmicas no curso da endocardite infecciosa, a distribuição temporal, os fatores de risco de embolia e a influência prognóstica da embolia no curso da doença. Foram estudados 629 episódios de endocardite infecciosa. A idade dos pacientes variou de 2 meses a 83 anos (média 37,9 anos; desvio padrão 17,3). Ocorreram 396 (63%) episódios em homens e 233 (47%) em mulheres. Em 538 (85%) episódios, os pacientes eram portadores de doença cardíaca prévia, 272 (43%) com valvopatia, 224 (36%) portadores de prótese valvar cardíaca, 29 (5%) com doença cardíaca congênita, 13 (2%) com outras cardiopatias e 91 (14%) pacientes não apresentavam evidência de cardiopatia prévia. Os agentes etiológicos foram os estreptococos em 297 (47%) pacientes, os enterococos em 51 (8%), os Staphylococcus aureus em 77 (12,6%), os Staphylococcus epidermidis em 56 (9%), as bactérias gram-negativas em 33 (5%), os fungos em nove (1,4%), e outros microorganismos em 27 (4%). Em 79 (13%) pacientes as hemoculturas foram negativas. Os pacientes receberam tratamento clínico em 376 (60%) episódios e cirúrgico em 253 (40%). Para a análise estatística foram utilizados além da estatística descritiva...

Hemodynamic effects of combined sildenafil and L-arginine during acute pulmonary embolism-induced pulmonary hypertension

Souza-Silva, A. R.; Dias-Junior, C. A.; Uzuelli, J. A.; Moreno, H.; Evora, P. R.; Tanus-Santos, J. E.
Fonte: Elsevier B.V. Publicador: Elsevier B.V.
Tipo: Artigo de Revista Científica Formato: 126-131
ENG
Relevância na Pesquisa
37.08%
Sildenafil attenuates acute pulmonary embolism-induced pulmonary hypertension. However, the hemodynamic effects of sildenafil in combination with other vasodilators during acute pulmonary embolism have not been examined yet. In the present study, we examined the hemodynamic effects of combined sildenafil (0.25 mg/kg, i.v.) and L-arginine (100, 200, 500, and 1000 mg/kg/h, i.v.) in an anesthetized dog model of acute pulmonary embolism. Plasma nitrite/nitrate (NOx) and cGMP concentrations were determined using an ozone-based chemiluminescence assay and a commercial enzyme immunoassay, respectively. We found that L-arginine alone did not attenuate acute pulmonary embolism-induced pulmonary hypertension. However, significant decreases in mean pulmonary artery pressure were observed 30, 45, 60, and 75 min after the administration of sildenafil alone or after the combined administration of sildenafil and L-arginine (all P<0.05). No significant differences among groups were observed in the respiratory parameters. While L-arginine significantly increased NOx concentrations, cGMP concentrations increased only when sildenafil was administered (all P<0.05). These results suggest that while sildenafil attenuates acute pulmonary embolism-induced pulmonary hypertension...

Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

Zamproni,Laura Nicoleti; Zétola,Viviane Flumignan; Lange,Marcos Christiano
Fonte: Academia Brasileira de Neurologia - ABNEURO Publicador: Academia Brasileira de Neurologia - ABNEURO
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2012 EN
Relevância na Pesquisa
36.84%
OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.

Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

Mesquita,Cláudio Tinoco; Morandi Júnior,José Laerte Boechat; Perrone,Flávia Teixeira; Oliveira,Cláudia da Silva; Barreira,Lavínia J.; Nascimento,Sônia Santos C. A; Pareto Júnior,Raul Carlos; Mesquita,Evandro Tinoco
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/1999 EN
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36.84%
OBJECTIVE - To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS - Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS - Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION - The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.

Peripheral arterial embolism. Report of hospitalized cases

Pereira Barretto,Antonio Carlos; Nobre,Moacyr Roberto Cuce; Mansur,Alfredo José; Scipioni,Aírton; Ramires,José Antonio Franchini
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2000 EN
Relevância na Pesquisa
37.08%
OBJECTIVE: We analyzed the frequency of peripheral embolisms, the underlying heart disease,triggering factors, the sites of the emboli, and evolution of the patients. METHODS: We analyzed 29 cases of peripheral arterial embolism out of a total of 20,211 hospitalizations in a cardiology center in the city of São Paulo. The age was 51.89±18.66 years, and 15 were males. RESULTS: Embolism in the right lower limb occurred in 18 patients (62.0%),in the left lower 11(37.9%) and right upper 3 (10.3%) limbs, and in the left arm (1). Four patients had embolism in two limbs. The heart disease, mitral valvar heart disease (9 patients - 31.0%); infective endocarditis (7- 24.1%); dilated cardiomyopathy (6 - 20.6%); ischemic coronary heart disease (6 patients - 20.6%); and one patient with cor pulmonale. Atrial fibrillation was observed in 20 patients (68.9%), chronic in 12 patients (41.3% ) and acute in 8 (27.5%). All patients with mitral valvar heart disease had atrial fibrillation, chronic in 8 patients (88.8%); patients with cardiomyopathy and coronary heart disease, 4 in each group had atrial fibrillation, acute in 60% of the patients.Patients with infective endocarditis, 3 had staphylococcus and 2 Gram-negative bacteria. In the follow-up...

Fat embolism in liposuction and intramuscular grafts in rabbits

Felzemburgh,Victor Araujo; Barbosa,Rafaela Cavalcante das Neves; Nunes,Victor Luiz Correia; Campos,José Humberto Oliveira
Fonte: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia Publicador: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2012 EN
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PURPOSE: To evaluate the effects of fat embolism in organs such as lung and liver. METHODS: Twenty rabbits underwent autologous intramuscular fat grafting in the right thigh after liposuction. The groups were determined according to the postoperative day that occurred in euthanasia: 60, 90 and 120 day. Then, lung and liver were excised and sent to the histopathology laboratory for analysis in search of late injury secondary to a prior event of fat embolism in the tissues. RESULTS: The results showed a change in the macroscopic sample with discoloration of the liver tissue heterogeneously. There were no changes consistent with embolic effect under the microscope. CONCLUSION: The option of performing a technique of fat grafting with a less traumatic surgical procedure can be considered protective against embolic events, with no impact to late embolic events on the tissues.

Endovascular management of massive pulmonary embolism with clot fragmentation and suction

Belczak,Sergio Quilici; Sincos,Igor Rafael; Aun,Ricardo; Lederman,Alex; Mioto Neto,Boulanger; Saliture,Fernando; Lobato,Manoel
Fonte: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Publicador: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2013 EN
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Massive pulmonary embolism with right ventricular dysfunction may be treated with thrombolysis, embolectomy, or percutaneous mechanical thrombectomy. This study describes our experience with two patients that had massive pulmonary embolism and were treated with percutaneous mechanical thrombectomy and reports on the mid-term results of this procedure. A 28-year-old man and a 70-year-old woman were diagnosed with deep venous thrombosis and massive pulmonary embolism. They first had lower limb edema followed by sudden onset of dyspnea. Their physical examination revealed edema, tachypnea, chest discomfort and jugular turgescence. Both needed to receive oxygen using a nasal cannula. Doppler ultrasound, echocardiography, and computed tomography angiography were used to establish the diagnoses. Patients underwent percutaneous mechanical thrombectomy using the Aspirex® system (Straub Medical), and their clinical condition and imaging study findings improved substantially. At mid-term follow-up, patient conditions were improving satisfactorily.

Pulmonary embolism and stroke associated with mechanical thrombectomy

Bastianetto,Paulo; Pinto,Daniel Mendes
Fonte: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Publicador: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2014 EN
Relevância na Pesquisa
36.93%
Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy.

Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study

Carvalho Bricola,Solange Aparecida Petilo; Paiva,Edison Ferreira; Lichtenstein,Arnaldo; Gianini,Reinaldo José; Duarte,Jurandir Godoy; Shinjo,Samuel Katsuyuki; Eluf-Neto,Jose; Arruda Martins,Milton
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2013 EN
Relevância na Pesquisa
37.14%
OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days)...

Septic embolism in the intensive care unit

Stawicki, Stanislaw P.; Firstenberg, Michael S.; Lyaker, Michael R.; Russell, Sarah B.; Evans, David C.; Bergese, Sergio D.; Papadimos, Thomas J.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
36.93%
Septic embolism encompasses a wide range of presentations and clinical considerations. From asymptomatic, incidental finding on advanced imaging to devastating cardiovascular or cerebral events, this important clinico-pathologic entity continues to affect critically ill patients. Septic emboli are challenging because they represent two insults—the early embolic/ischemic insult due to vascular occlusion and the infectious insult from a deep-seated nidus of infection frequently not amenable to adequate source control. Mycotic aneurysms and intravascular or end-organ abscesses can occur. The diagnosis of septic embolism should be considered in any patient with certain risk factors including bacterial endocarditis or infected intravascular devices. Treatment consists of long-term antibiotics and source control when possible. This manuscript provides a much-needed synopsis of the different forms and clinical presentations of septic embolism, basic diagnostic considerations, general clinical approaches, and an overview of potential complications.

Water transport, embolism recovery and water storage in trees

Wheeler, James K
Fonte: Harvard University Publicador: Harvard University
Tipo: Thesis or Dissertation
EN_US
Relevância na Pesquisa
36.93%
The ability to maintain hydraulic continuity in the xylem is essential to supply leaves with the water that must be exchanged for carbon dioxide. The metastable nature of xylem sap causes this system to be inherently vulnerable to failure by rapid vaporization within the conduits. Much of the recent work on hydraulic architecture and cavitation has pursued the elusive mechanism behind apparent hydraulic recovery concurrent with tension in the bulk of the xylem, referred to as "novel refilling". An investigation into the dynamics of this behavior (Chapter 3) revealed two key artifacts that can produce the appearance of novel refilling when in fact no embolism (and therefore, no recovery) has occurred. A further implication of these artifacts is that plant xylem may be more robust against embolism than previously expected. In the absence of novel refilling, it becomes much harder to reconcile the extreme vulnerability reported for ring porous species. Studies of Robinia pseudoacacia (Chapter 4) address whether the artifacts illuminated in chapter 3 provide insight into the ongoing debate about the cavitation resistance of long-vesseled species and whether it is possible to accurately assess cavitation resistance in these species using the centrifuge method. Root pressure...

Crisis management during anaesthesia: embolism

Williamson, J.; Helps, S.; Westhorpe, R.; Mackay, P.
Fonte: British Med Journal Publ Group Publicador: British Med Journal Publ Group
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
Relevância na Pesquisa
37.12%
Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK" supplemented by a specific sub-algorithm for embolism, in the management of embolism occurring in association with anaesthesia. Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. Results: Among the first 4000 incidents reported to AIMS, 38 reports of embolism were found. A sudden fall in end-tidal carbon dioxide and oxygen saturation were the cardinal signs of embolism, each occurring in about two thirds of cases, with hypotension and electrocardiographic changes each occurring in about one third of cases. Conclusion: The potential value of an explicit structured approach to the diagnosis and management of embolism was assessed in the light of AIMS reports. It was considered that, correctly applied, it potentially would have led to earlier recognition of the problem and/or better management in over 40% of cases.; J A Williamson, S C Helps, R N Westhorpe, P Mackay; © 2005 BMJ Publishing Group Ltd.

A comparison of water stress-induced xylem embolism in two grapevine cultivars, Chardonnay and Grenache, and the role of aquaporins.

Shelden, Megan Cherie
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2008
Relevância na Pesquisa
37.05%
Aquaporins (AQP) are membrane bound proteins that facilitate the movement of water and other small neutral solutes across cellular membranes. Plant aquaporins belong to a large family of highly conserved proteins called the Membrane Intrinsic Protein (MIP) superfamily. In many plant species the expression of aquaporin genes and their regulation has been linked to water stress. Grapevines respond to water stress with a variety of physiological mechanisms, including the susceptibility to xylem embolism. The formation of embolised vessels can lead to a reduction in hydraulic conductivity of the xylem. Recently, it has been hypothesised that aquaporins may contribute to the water movement required for embolism recovery of xylem vessels thus restoring the hydraulic pathway. Molecular and physiological techniques have been combined to study the putative role of plasma membrane and tonoplast membrane aquaporins in response to water stress induced xylem embolism in two cultivars of grapevine (Vitis vinifera cv. Chardonnay and Grenache). Water-stress induced cavitation was measured in the stems and petioles of pot grown grapevines of a drought tolerant (Grenache) and a drought sensitive variety (Chardonnay) by the detection of ultrasonic acoustic emissions (UAEs) over both a drying and diurnal cycle. Vulnerability curves were generated by correlating the UAEs with the leaf water potential (ψL). Varietal differences in cavitation vulnerability and hydraulic properties were observed. Grenache was more susceptible to water-stress induced xylem embolism than Chardonnay...

Lungenemboliediagnostik in der Mehrzeilen-Spiral-CT; Diagnosis of pulmonary embolism with multislice spiral CT

Haas, Anja Marisa
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
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37%
Die Lungenembolie (LAE) ist der dritthäufigste akute kardiovaskuläre Notfall. Es gibt viele unterschiedliche Wege der Diagnostik dieser ernsten Erkrankung. Die Computertomographie (CT) ist dabei als Methode der Wahl bis zur Ebene der Segmentarterien und Subsegmentarterien etabliert. 77 Patienten (34 Frauen, 43 Männer) im Alter von gemittelt 60,6 Jahren mit klinischem Verdacht auf akute Lungenembolie wurden der Spiral-CT Diagnostik zugeführt. Die Untersuchungen wurden mit einer Kollimation von 1 und 2,5 mm und einem Pitch von 2-8 durchgeführt (Kollimation 5 mm bei Venen der unteren Extremitäten). Der Thorax wurde während einer Atemanhalteperiode in 10 Sekunden untersucht. Die Scanführung verlief vom Unterrand der rechten Arteria pulmonalis bis zum Aortenbogen in caudo-cranialer Richtung, anschließend der gesamte Thorax in cranio-caudaler und abschließend das Abdomen und Becken in cranio-caudaler Richtung bis unter das Leistenband. Röhrenstrom und –spannung wurden individuell an den Habitus des Patienten angepasst (140 kV und 130-160 mA). Die Kontrastierung der Gefäße erfolgte mit hoher Konzentration und geringer Flußrate durch automatisches Bolustracking. Bei den 35 Patienten mit Lungenembolie konnten bei der Untersuchung mit der Spirale 1:1...

Tromboembolismo Pulmonar no Doente Oncológico em Ambulatório; Pulmonary Embolism in Ambulatory Oncologic Patients

Silva, Patrícia; Serviço de Onco-Hematologia. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.; Rosales, Maria; Serviço de Imuno-Hemoterapia. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.; Milheiro, Maria Joã
Fonte: Ordem dos Médicos Publicador: Ordem dos Médicos
Tipo: info:eu-repo/semantics/article; article; info:eu-repo/semantics/publishedVersion Formato: application/pdf; application/pdf
Publicado em 31/08/2015 POR; ENG
Relevância na Pesquisa
37.05%
Introdução: A associação entre a doença oncológica e a doença tromboembólica venosa é conhecida. O doente oncológico apresenta um risco de evento trombótico seis a sete vezes superior à população em geral. O tromboembolismo pulmonar é uma importante causa de morbilidade e mortalidade neste grupo de doentes, encontrando-se a sua prevalência subestimada.Material e Métodos: Estudo retrospetivo de todos os episódios de tromboembolismo pulmonar referenciados num período de cinco anos. Selecionaram-se os doentes oncológicos em regime de ambulatório, tendo sido revistos os dados demográficos, fatores de risco, presença de sintomatologia ao diagnóstico, estratificação de risco de doença tromboembólica venosa pelo modelo de Khorana, probabilidade de mortalidade aos 30 dias e sobrevivência global. O trabalho elaborado está de acordo com a declaração de Helsínquia.Resultados: Avaliaram-se 186 doentes, 55,9% do sexo feminino, mediana de idade de 64 anos. As neoplasias mais prevalentes foram a colo-rectal (24,2%) e a pulmonar (17,7%), sendo que a maioria apresentava metástases (66,1%) ou realizaram quimioterapia (69,4%). O tromboembolismo pulmonar foi um achado imagiológico em 69,4%, sendo que nenhum dado clínico analisado no nosso estudo mostrou ter significado estatístico na apresentação de tromboembolismo pulmonar com sintomatologia clínica evidente. Observou-se uma mortalidade aos 30 dias resultante do tromboembolismo pulmonar de 7...

Wells' prediction rules for pulmonary embolism: valid in all clinical subgroups?

Sharif-Kashani, B.; Bikdeli, B.; Ehteshami-Afshar, S.; Chitsazan, M.; Behzadnia, N.; Chitsaz, E.; Kermani-Randjbar, S.; Saliminejad, L.; Masjedi, M.R.; Bikdeli, B.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
37.25%
Pulmonary embolism is major cause of hospital death. Clinical prediction rules such as Wells’ prediction rules can help in selection of at-risk patients who need further testing for pulmonary embolism. We evaluated the usefulness of such criteria for detection of patients with diagnosed pulmonary embolism. Patients enrolled in National Research Institute of Tuberculosis and Lung Disease (NRITLD) deep venous thrombosis (DVT) registry were evaluated and those with objective data about presence or absence of pulmonary embolism were selected for this study. Diagnosis of pulmonary embolism was based on computed tomography pulmonary angiography (CTPA). We calculated the embolic burden in those with CTPA-confirmed pulmonary embolism. Eighty-six patients entered the study (58 males, 28 females, mean age = 54.39 ± 1.74 years). Fifty-four cases had coexisting pulmonary embolism (embolic burden score: 10.77 ± 1.181). Embolic burden score was correlated to presence of massive pulmonary embolism (Pearson rho: 0.43, P = 0.002). There was no association between Wells’ pulmonary embolism score and the occurrence of pulmonary embolism (Spearman's rho: 0.085, P = 0.51). Dividing the patients into two, or three, risk groups according to Wells’ model did not reveal an association with occurrence of pulmonary embolism either (P = 0.99 and P = 0.261...

Totally implantable catheter embolism: two related cases

Ribeiro,Rodrigo Chaves; Monteiro,Áurea Cristina Ferreira; Menezes,Quirino Cavalcante; Schettini,Sérgio Tomaz; Vianna,Sonia Maria Rossi
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2008 EN
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CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath®) are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

Deep venous thrombosis and pulmonary embolism in psychiatric settings

Van Neste,Els G.; Verbruggen,Ward; Leysen,Mark
Fonte: The European Journal of Psychiatry Publicador: The European Journal of Psychiatry
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/03/2009 ENG
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Background and objectives: Deep venous thrombosis and pulmonary embolism are serious, possibly life-threatening events which are often ignored in psychiatric settings. This article investigates which psychiatric patients are at increased risk of developing a venous thromboembolism. To our knowledge we are the first to perform a literature review of clinical studies relating venous thrombosis and pulmonary embolism to psychotropic drugs and mental disorders. Methods: A Medline search for English studies using the appropriate search terms was performed. In addition, cross references of the relevant articles` literature references were considered. We withheld 12 observational studies, 29 case-reports and one review-article. Results: We found evidence that low potency antipsychotic drugs like chlorpromazine and thioridazine, and clozapine for treatment of resistant schizophrenia have an increased risk of venous thromboembolism. There is no evidence that antidepressants, benzodiazepines or mood stabilizers have a similar effect. Also psychiatric conditions like physical restraint, catatonia and neuroleptic malignant syndrome are related to a higher incidence of deep venous thrombosis. Conclusions: Limitations of the studies and hypotheses about underlying biological mechanisms are reviewed. The rationale for prophylactic measures is discussed and recommendations to prevent deep venous thrombosis and pulmonary embolism are given.