Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1974 to 2005.

BACKGROUND: Pulmonary thromboembolism (PTE) has become a common disease that severely endangers people's health. This study analysed the changes in proportion and mortality of PTE in hospitalized patients to provide data for prevention and management of the disease. METHODS: The data of 763 hospitalized patients with PTE from 1974 to 2005 in Fuwai Hospital were analysed. RESULTS: During the 1970s, 0.27% of patients in a cardiovascular hospital had PTE (< 5 cases per year); while so far this century the proportion is 0.94% (48 to 113 per year). The mortality of hospitalized PTE patients fell from 20.00% in the 1970s to 4.10% this century. Prior to 1990, the mortality of hospitalized PTE patients was 12.50%, and in the years after 1990 only 3.40%. The difference was statistically significant (P < 0.005). People with this disease were mostly between the ages of 30 and 69 years. Men were most susceptible between the ages of 30 and 69 years, while women between the ages of 40 and 69 years. Men contracted PTE 10 years earlier than women. The mortality of male PTE patients was 4.70%, not significantly different from female patients, 5.06% (0.50 < P < 0.75). There were not any significant differences between the mortality of patients in the different age groups overall (< or = 39, 40 - 49, 50 - 59, and > or = 60 years, P > 0.1). More people contracted the disease in winter than in other seasons (P < 0.05). There was no obvious difference between the mortality in different seasons overall (0.75 < P < 0.90). CONCLUSION: PTE is an increasingly significant disease and deserves adequate attention.

[Clinical analysis of 8 cases of paradoxical embolism].

OBJECTIVE: To describe the clinical features of paradoxical embolism and therefore to improve its diagnosis. METHODS: Case analysis and literature review. RESULTS: Eight cases of pulmonary embolism complicated with paradoxical embolism were diagnosed, of whom there were six men and two women (mean age, 47.6 years). Patent foramen ovale with right to left shunt was identified in only 3 cases. Cerebral embolism occurred in three patients, kidney artery embolism in 2 patients, left atrial thrombus in 1 patient, lower limb artery and aortic embolism in 1 patients respectively. The diagnosis of paradoxical embolism can only be confirmed when a venous thrombus was detected lodged at arterial-venous communication; otherwise, paradoxical embolism was considered a clinical diagnosis. Of the 8 cases, 7 were clinically diagnosed, while 1 was confirmed. CONCLUSIONS: Paradoxical embolism is not uncommon. The diagnosis should be considered when venous thromboembolism is complicated with systematic embolism or unknown cause of systematic embolism.

[Vicissitudes of proportion and mortality of patients with pulmonary thromboembolism].

OBJECTIVE: To investigate the vicissitudes of the proportion and the mortality of patients with pulmonary thromboembolism (PTE). METHODS: To analyze respectively the data of 442 patients with PTE admitted to the Fuwai Hospital during the period 1974-2002 were analyzed retrospectively. RESULTS: The numbers of PTE in-patients every year during the 1970s and 48-79 cases in the early 2000s. The hospitalization constituent ratio of PTE was 0.1152% in 1970s and was 0.5866% in early 2000s. The age of onset ranged from 30 to 60. The tide age was from 30 to 60 in the male patients and from 40 to 60 in the female patients. The in-hospital mortality of PTE patients was descending from 20.0% in 1970s to 5.8% in early 2000s. The in-hospital mortality was 12.5% before 1990 and was 4.5% after 1990 (P = 0. 005). The in-hospital mortality rates of the male and female patients were 4.6% and 8.6% respectively (P = 0.09). The in-hospital mortality rates of the patients younger than 70 and elder than 70 were 5.5% and 19.0% respectively (P < 0.05). CONCLUSION: PTE The mortality of PTE, which attacks males more frequently than females, and the proportions of the number of PTE in-patients to the number of the whole in-patients increased and the in-hospital mortality increased during the past 3 decades.

[Pulmonary artery sarcoma misdiagnosed as pulmonary thromboembolism: report of 3 cases and literature review].

OBJECTIVE: To improve the differential diagnosis of pulmonary artery sarcoma from pulmonary embolism. METHOD: Case analysis and literature review. RESULTS: Pulmonary artery sarcoma had similar clinical features as pulmonary thromboembolism. When the radiological features such as unilateral hilar enlargement and massive lumps in main trunk of pulmonary artery were observed and clinical deterioration occurred after thrombolytic and anticoagulant therapy, pulmonary artery sarcoma should be considered seriously in patients with suspected pulmonary thromboembolism. CONCLUSION: Pulmonary artery Sarcoma can be easily misdiagnosed as pulmonary thromboembolism.

[Evaluation of thrombolytic therapy by pulmonary radionuclide perfusion imaging in patients with acute pulmonary thromboembolism].

OBJECTIVE: To assess the change of pulmonary perfusion after thrombolytic therapy in patients with acute pulmonary embolism. METHODS: Eighty patients with acute pulmonary embolism received pulmonary radionuclide perfusion imaging before and after thrombolytic therapy. Percentage of perfusion defect scores (PPDs) was calculated by semiquantitative analysis of pulmonary perfusion imaging before thrombolytic therapy (PPDsD(0)), 1 - 5 days (PPDsD(5)), 6 - 30 days (PPDsD(30)) and 3 months after thrombolytic therapy (PPDsM(3)). RESULTS: The mean PPDsD(0) of the 80 patients was (57.3 +/- 16.4)%. In 64 of the 80 patients, mean PPDsD(0) and PPDsD(5) were (55.5 +/- 16.8)% and (40.0 +/- 18.6)% respectively (P < 0.001). In 30 of these 64 patients, mean PPDsD(0), PPDsD(5) and PPDsD(30) were (57.5 +/- 16.1)%, (39.3 +/- 16.8)% and (29.5 +/- 17.3)% respectively. Differences between these 3 mean PPDs values were highly significant (all P < 0.001). In 11 of the 80 patients, mean PPDsD(30) and PPDsM(3) were (40.9 +/- 18.1)% and (29.1 +/- 27.1)% respectively (P < 0.05). In two groups of patients with the courses of disease in 7 days and in 8 - 14 days respectively, significant differences were found between PPDsD(0) and PPDsD(5) (P < 0.001, P < 0.001 respectively), and between PPDsD(0) and PPDsD(30) (P < 0.001, P < 0.005 respectively). The difference was also significant, although to a lesser degree (P < 0.05) between these values in a group of patients with the course of disease beyond 14 days. CONCLUSION: This study suggests that radionuclide pulmonary perfusion imaging is a reliable method for evaluating the changes of pulmonary perfusion before and after thrombolytic therapy in patients with acute pulmonary embolism.