Sarcoidosis in a 42 year old AfroCaribbean male who presented with pulmonary embolism: a case report and review of literature.

We present a case of a 42 year old Afro-Caribbean man presenting with pulmonary embolism and gastroesophageal reflux disease, Transbrachial lung biopsy revealed non-caseating granulomata and on the basis of excluding other conditions, the patient was also diagnosed with sarcoidosis. The only identifiable risk factor for his pulmonary embolus was obesity. A literature review is performed of cases with similar presentations. We propose that sarcoidosis may be a contributing factor in enhancing this prothrombotic predisposition

False positive troponin I in a case of metastatic small cell bronchogenic carcinoma complicated by pulmonary thromboembolism

From the search for the ultimate cardiac marker have emerged the cardiac troponin, which have offered high sensitivity and specificity for myocardial damage. Troponin I had arguably been the best of this group, but even this marker is not infallible. We present the case of an elderly women who died shortly after being diagnosed with acute myocardial infarction on the basis of elevated Troponin I. Autopsy revealed a small cell lung cancer complicated by pulmonary thromboembolism. There was no evidence of myocaridal infarction. Explanations for false elevation of serum Troponin I are proposed.(Au)

Electron microscopy of herpes simplex hepatitis with hepatocyte pulmonary embolization in kwashiorkor

We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells. With pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.(AU)

Deep vein thrombosis and pulmonary embolism in the head injured patient - abstract

The true incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the head injury population is not known for sure. Some reports place the incidence of DVT at 40 per cent and fatal PE at greater than 1 per cent in patients with acute head or spinal cord injuries. The records of 736 patients admitted to the Royal Columbian Hospital between January, 1988 and December, 1989 with the diagnosis of head injury were reviewed. An incidence of 0.7 per cent was found for PE and 0.95 per cent (1 per cent) for DVT. All of the patients with PE and most of those with DVT were ill enough to require admission to the ICU or had other significant injuries. The incidence of PE and DVT is surprisingly low. The possible reasons are discussed (AU)

Pulmonary embolism as a cause of death

To investigate the present status of pulmonary embolism as the cause of death in a general hospital population, the author reviewed 610 autopsy reports, and associated hospital records for the period 1985-1989. Pulmonary embolism was the major contributing factor to the cause of death in 61 (10 percent) of the 610 autopsies performed. Of the patients dying from major pulmonary embolism, in only 12 (19.7 percent) was the diagnosis suspected antemortem; and in 44 (72 percent) deep vein thrombosis was detected in the femoralpopliteal vein at autopsy. The mean age of patients dying from major pulmonary embolism was 52.2 years, and 31 (50.8 percent) victims were under the age of 50 years. Fifty-six (92 percent) of patients dying from pulmonary embolism were of African descent while 5 (8 percent) were of East Indian descent. Without autopsies. 49 (80.3 percent) patients dying of pulmonary embolism would have been incorrectly certified and registered in death statistics based on clinical certification only (AU)

Pulmonary embolism revisited: an autopsy based study - abstract

To investigate the present status of pulmonary embolism as the cause of death in an acute tertiary care hospital, 610 of a total 730 autopsies performed over the period 1985 to 1989 were reviewed, together with relevant hospital records. Pulmonary embolism (PE) was the major cause of death in 61 (10 per cent) of cases. In only 12 patients (20 per cent) was the diagnosis suspected before death. Fourty-four (72 per cent) patients had deep vein thrombosis in the femoral-popliteal vein. The mean age was 52.2 years, and 31 (51 per cent) were under 50-years-old. The male : female ratio was 1:1.2. A striking finding was that 56 (92 per cent) patients were of African descent and only 5 (8 per cent) were East Indians. The main underlying conditions were psychiatric in 12 (20 per cent) cases, post-operative and heart disease in 10 each (16 per cent) and pregnancy in 5 (8 per cent) cases. Five of the 61 patients (8 per cent) were on anticoagulant therapy. Without autopsies, 49 (80 per cent) patients who died of PE would have been incorrectly certified as to cause of death (AU)

A mode of clinical presentation of pulmonary thromboembolism (PTE) - abstract

This paper describes observations made initially of five (5) cases of patients with PTE, referred to me in consultation over a period of two years, each with a mistaken referral diagnosis of acute surgical abdomen. The observed clinical features in this group of patients with PTE are: overt abdominal pain, with covert dyspnoea and tachycardia. The observed roentgenographic features in the group are: acutely elevated diaphragm, gas dilated loops of bowel, and fluid blunting of costophrenic angle, with delayed descent of diaphragm and unmasking of pulmonary atelectasis. Theories of causation of observed findings are discussed (AU)

Maternal mortality in Jamaica

A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive disease of pregnancy (10 percent), pulmonary embolus (8 percent), and sepsis (8 percent). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.(AU)

Maternal mortality in Jamaica: a confidential enquiry into all maternal deaths in Jamaica 1981 to 1983

This paper presents an analysis and confidential enquiry into all maternal deaths occurring in Jamaica during the years 1981 to 1983. Details were obtained of all maternal deaths, irrespective of whether they occurred in hospitals or at home, during this three year period. Anonymous case summaries were prepared for all maternal deaths. These case summaries contained general characterisitics of the women, e.g. age and parity, details of the health care (if any) they had received and specific circumstances surrounding their deaths. Each case summary was independently assessed by two practicising Jamaican obstetricians from a panel of seven. They were specifically asked to comment as to whether there were any avoidable factors present in each death which, in their opinion and given their knowledge of current generally accepted standards of satisfactory medical care in Jamaica, may have increased the likelihood of death. Such departures from accepted standards include failure of patients to utilize or cooperate with services, as well as failure to provide or offer adequate care (AU)

Cardiac and pulmonary fat embolectomy for suspected fat embolus

There is no specific treatment of fat embolism, whether the embolism is predominantly cerebral, pulmonary, renal or mesenteric. A 46-year old man had fractured his right femur for the third time in December 1971. Seventy hours later he developed the cardiovascular, respiratory, and cerebral manifestations of post-traumatic fat embolism. His chest radiograph at the onset of symptoms was consistent with fat embolism. He underwent cardiac and pulmonary embelectomy on 7 December 1971 and made a most dramatic recovery. His haemobronchorrhoea, dyspnoea, tachypnoea, hyperpyrexia, and profound shock disappeared at the end of the operation. His only post-operative cerebral disturbance was mild disorientation. The pathophysiological changes accompanying fat embolism are due to toxic vasculitis and fat macroglobule aggregations blockading the pulmonary arterioles and capillaries. The blockading concept is the basis for cardiac and pulmonary fat embelectomy. Only a larger series emboding a multicentre trial will show whether or not cardiopulmonary fat embelectomy is a specific treatment of massive fat embolism. The purpose of this paper is to report on the technique and result of embelectomy for a suspected fat embolus following fracture of the femur (Summary)

Sub-aortic septal perforation associated with pulmonary and systemic embolism

The fourth case of septal perforation, in a 92 year old woman is reported. Interesting clinical and autopsy findings were the high diastolic and systolic murmurs. Paradoxic embolism or shorn dumb-bell clot caused her systemic and pulmonary embolism. Diagnosis is difficult, as Leatham's (1883) classic acquired VSD description does not hold (Summary)

Causes of death in tetanus: a clinical study of 55 patients - abstract

Since January 1965, 55 patients have been treated in the recovery and intensive therapy unit of U.H.W.I. 12 deaths have occurred - mortality rate 21.8 percent. Based on experience gained in this series and using illustrative rate 21.8 percent. Based on experience gained in this series and using illustative case reports certain aspects regarding causes of death and their prevention are discussed. Deaths in early tetanus almost invariably are related to severe anoxia or possibly due to an increased susceptibility to lesser degrees of anoxia. There have been no early deaths in patients managed in this unit but reference is made to other, essentially preventable, deaths occurring prior to admission. The life threatening complications encountered later in the disease are more varied and have included severe respiratory depression, anoxia and acidosis, exhaustion, hyperpyrexia, infection, pulmonary emboli and iatrogenic difficulties associated with tracheostomy and mechanical ventilation. The necessity for intensive therapy facilities in severe tetanus is emphasized. It is possible that many deaths in this group are also preventable. In 3 patients measurements have been made of ventilatory, acid base and oxygen transport parameters at intervals during their illness. Results are given and significance discussed. In conclusion the precipitating causes of death in this series are clinically obvious even if the exact mechanisms are not clear. We have seen little evidence of the previously described syndrome of fulminating intoxication with myocardial or brain stem involvement. We agree with others who state that the successful outcome in a previously health patient who develops tetanus should rarely be in doubt providing the patient has received ideal treatment based on the well- recognized principles of intensive therapy(AU)

Some aspects of the pathology of pulmonary embolism

Approximately 96 patients have died as a result of pulmonary embolism at U.H.W.I. since its opening. In at least half of these the embolism was a terminal complication of a fatal disease, usually neoplasm. In the remainder, death was unexpected. The features of both groups were examined and compared with findings elsewhere in the world. Pulmonary emboli were found in 2.4 percent of all autopsies here and there appears to be an increasing incidence of this disease. The veins of the legs and pelvis were the commonest source of emboli but in a large number of patients the primary source was undetermined. In many instances, chronic changes were found suggesting long standing or repeated embolization (AU)