1/97. Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited.The computed tomographic (CT) pulmonary angiogram appearances of acute right ventricular dysfunction due to massive pulmonary embolus in a patient are described. Abnormal findings comprised right ventricular dilatation, interventricular septal shift, and compression of the left ventricle. These changes resolved following thrombolysis. Use of CT pulmonary angiography to diagnose pulmonary emboli is increasing. Secondary cardiac effects are established diagnostic features shown by echocardiography. These have not been previously described but are important to recognise as they may carry important prognostic and therapeutic implications.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/97. Postoperative acute pulmonary thromboembolism in patients with acute necrotizing pancreatitis with special reference to apheresis therapy.Eight patients with pancreatic abscesses secondary to acute necrotizing pancreatitis underwent drainage of their abscesses under laparotomy. Two of them died of acute pulmonary thromboembolism (PTE) within 1 week. autopsy revealed a large thrombus at the main trunk of the pulmonary artery and in the left common iliac vein. Femoral catheter insertion/indwelling, immobilization, surgery, increased trypsin/kinin/kallikrein, increased endotoxin, and decreased antithrombin-III (AT-III) were present following drainage of the pancreatic abscesses. With respect to the bedside diagnosis of acute PTE, alveolar-arterial oxygen gradients obtained by blood gas analysis and mean pulmonary artery pressure estimated by pulsed Doppler echocardiography are very useful. In terms of the treatment, attention should be paid to the following to prevent deep venous thrombosis: prophylactic administration of low molecular weight heparin and administration of AT-III (AT-III > or = 80%), use of the subclavian vein whenever possible as blood access for apheresis therapy, as short a compression time as possible after removing the blood access catheter (< or =6 h), and application of intermittent pneumatic compression devices or elastic compression stockings on the lower extremities.- - - - - - - - - - ranking = 3keywords = compression (Clic here for more details about this article) |
3/97. Acute massive pulmonary embolism following high ligation combined with compression sclerotherapy for varicose veins report of a case.A case of acute pulmonary embolism following high ligation and compression sclerotherapy for varicose veins is reported. A 54-year-old women developed superficial varicosities and stasis pigmentation on her left leg 1 year prior to her first visit to hospital. No deep vein thrombosis was detected by ascending phlebography performed 3 months prior to operation. High ligation combined with compression sclerotherapy was performed for the varicose veins. One day after treatment, the patient complained of chest pain and discomfort, and then collapsed. perfusion scintigraphy revealed multiple embolisms in the bilateral lungs. The patient recovered after aggressive anticoagulant and thrombolytic therapy. Although pulmonary embolism is a rare complication of sclerotherapy, it is potentially one of the most serious.- - - - - - - - - - ranking = 6keywords = compression (Clic here for more details about this article) |
4/97. Lower limb exsanguination and embolism.We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.- - - - - - - - - - ranking = 2.5875900728932keywords = fracture, compression (Clic here for more details about this article) |
5/97. Pulmonary fat embolism: a complication of fracture.Medical personnel must be aware of the possibility of fat embolism as a complicating factor of fractures. Ambulance, emergency room, orthopedic, and intensive-care personnel may frequently be involved in the care of these patients. Fat embolism should be suspected any time a patient exhibits bizarre mental, pulmonary, or circulatory symptoms following a fracture. Prevention may be achieved by as near immobilization of a fracture as possible. When fat embolism does occur, the course of the illness may or may not be complex. The treatment is supportive and the patient should be made as comfortable as possible.- - - - - - - - - - ranking = 11.113130510252keywords = fracture (Clic here for more details about this article) |
6/97. Retrieval of an IV catheter fragment from the pulmonary artery 11 years after embolization.The use of a peripherally inserted central catheter (PICC) is occasionally complicated by intravascular fracture and central embolization of the catheter fragment. We present a patient in whom a PICC fragment was retrieved from the pulmonary artery 11 years after embolization following its incidental detection. Despite a history of IV drug abuse and mitral regurgitation, this patient remained asymptomatic and without complications. The catheter fragment was retrieved since the patient was believed to be at risk for endocarditis. This may be the longest duration reported of an embolized catheter fragment that was successfully removed. As the natural history of asymptomatic-retained central venous foreign bodies remains unclear, the decision to remove them should be individualized. In selected cases, these foreign bodies may be retrieved without complications even several years after embolization.- - - - - - - - - - ranking = 1.5875900728932keywords = fracture (Clic here for more details about this article) |
7/97. Intravascular migration of fractured sternal wire presenting with hemoptysis.We present a rare complication of median sternotomy in which a segment of fractured sternal wire punctured the heart, embolized to the right lung, and eroded into a bronchus causing massive hemoptysis. It was safely removed through a median sternotomy. Sternal wire fracture or migration is diagnosed easily on chest roentgenograms, but frequently goes unnoticed. Sternal wire failure can be managed nonoperatively; however, repair is indicated if fractured wires are displaced or potentially migratory.- - - - - - - - - - ranking = 11.113130510252keywords = fracture (Clic here for more details about this article) |
8/97. Near-fatal pulmonary embolism.A case of a 79-year-old female admitted to the hospital with a hip fracture and suffering a near-fatal embolism, is presented. The article then reviews the epidemiology of deep venous thrombosis and pulmonary embolism in the setting of hip fracture and orthopedic surgery and outlines the diagnostic approach to a critically ill patient with pulmonary embolism. The use of thrombolysis as an adjunct to usual heparin therapy is examined, as are the potential benefits versus the absolute risks of thrombolysis. Finally, practical recommendations outlining a reasonable approach to this group of patients, based on available evidence, are proposed.- - - - - - - - - - ranking = 3.1751801457864keywords = fracture (Clic here for more details about this article) |
9/97. pulmonary embolism following operative treatment of ankle fractures: a report of three cases and review of the literature.The risks of thromboembolism following operative treatment of ankle fractures are deep vein thrombosis (DVT) and pulmonary embolism (PE). These are potentially life-threatening complications. Many orthopedic surgeons fail to appreciate the potential complications of thromboembolic events because of their rare and delayed occurrence in foot and ankle operations. The purpose of this report is to describe the potential for DVT and PE following ankle operations. We present three cases in which patients who underwent operative treatment of ankle fractures subsequently developed PE. We also review the literature on the prevalence of thrombosis, risk factors, methods of prophylaxis, and use of prophylaxis in surgical procedures of the lower extremity.- - - - - - - - - - ranking = 9.5255404373592keywords = fracture (Clic here for more details about this article) |
10/97. Protected iliofemoral venous thrombectomy in a pregnant woman with pulmonary embolism and ischemic venous thrombosis.Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity The cause was determined to be a severe protein s deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
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