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2.
BMJ Case Rep ; 16(1)2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639199

RESUMO

Pulmonary artery sarcoma is a rare disease with only a handful of cases reported. It is histologically classified as leiomyosarcoma, spindle cell sarcoma, fibrous histiocytoma or undifferentiated sarcoma. The disease is mostly misdiagnosed as pulmonary thromboembolism and carries a grim prognosis with an average survival of only a few months. Misdiagnosis often results in patients being treated inappropriately and diagnosed in later stages of the disease. This delay in diagnosis can be associated with significant mortality in the setting of an already poor prognosis. Early aggressive surgery targeting complete surgical resection is the standard treatment. Chemotherapy and radiation therapy have been tried with variable outcomes. Given the aggressive nature of pulmonary artery sarcoma, regular post-surgery follow-up is indicated.


Assuntos
Leiomiossarcoma , Neoplasias Pulmonares , Embolia Pulmonar , Sarcoma , Neoplasias Vasculares , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Neoplasias Vasculares/patologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/patologia , Sarcoma/patologia , Leiomiossarcoma/patologia , Neoplasias Pulmonares/patologia
3.
Clin Appl Thromb Hemost ; 29: 10760296231151696, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36683414

RESUMO

OBJECTIVE: To investigate the risk factors of pulmonary embolism in patients with lung cancer and develop and validate a novel nomogram scoring system-based prediction model. METHOD: We retrospectively analyzed the clinical data and laboratory characteristics of 900 patients with lung cancer who were treated, including patients with lung cancer without pulmonary embolism (LC) and patients with lung cancer with pulmonary embolism (LC + PE). The patients were randomly divided into derivation and internal validation groups in a 7:3 ratio. Using logistic regression analysis, a diagnostic model of the nomogram scoring system was developed by incorporating selected variables in the derivation group and validated in the internal and external validation groups (n = 108). RESULT: Seven variables (adenocarcinoma, stage III-IV LC, indwelling central venous catheter, chemotherapy, and the levels of serum albumin, hemoglobin, and D-dimer) were identified as valuable parameters for developing the novel nomogram diagnostic model for differentiating patients with LC and LC + PE. The scoring system demonstrated good diagnostic performance in the derivation (area under the curve [AUC]; 95% confidence interval [CI], 0.918; 0.893, 0.943; sensitivity, 88.5%; specificity, 80.5%), internal validation (AUC; 95% CI, 0.921; 0.884, 0.958; sensitivity, 90.5%; specificity, 80.4%), and external validation (AUC; 95% CI, 0.929; 0.875, 0.983; sensitivity; 85.0%; specificity; 87.5%) groups. CONCLUSION: In this study, we constructed and validated a nomogram scoring system based on 7 clinical parameters. The scoring system exhibits good accuracy and discrimination between patients with LC and LC + PE and can effectively predict the risk of PE in patients with LC.


Assuntos
Neoplasias Pulmonares , Embolia Pulmonar , Humanos , Estudos Retrospectivos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Nomogramas , Fatores de Risco
4.
In Vivo ; 37(1): 498-502, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593053

RESUMO

BACKGROUND/AIM: Acute pulmonary embolism during cesarean section is extremely rare and only a limited number of cases have been reported in literature. The aim of this study was to report a case of acute high risk pulmonary embolism during elective cesarean section treated with systemic thrombolysis and discuss the multidisciplinary management in both early recognition and prompt treatment. CASE REPORT: A 39-year-old, G5P2, ASA II parturient presented for repeat cesarean section under general anesthesia. A sudden drop in end-tidal CO2 after placenta delivery combined with significant hemodynamic instability after an uneventful intraoperative course was strongly indicative of pulmonary embolism. Urgent transthoracic ultrasound revealed a sizable thrombus in the inferior vena cava and the right atrium. Thrombolysis was carried out intraoperatively using recombinant tissue plasminogen activator, which was administered under continuous US monitoring until thrombus resolution. This resulted in significant bleeding that was treated in a stepwise manner beginning with implementation of massive transfusion protocol, Bakri balloon placement, and rescue hysterectomy several hours after the event. Follow-up was uneventful and she was discharged on the 12th postoperative day. CONCLUSION: Though pregnancy is one of the major risk factors of the development of venous thromboembolism, acute intraoperative pulmonary embolism is extremely rare. Specific guidelines for the management of such cases are difficult to issue due to the paucity of relevant data. Thus, an individualized approach by a multidisciplinary team for diagnosis and intervention is mandated.


Assuntos
Embolia Pulmonar , Trombose , Gravidez , Humanos , Feminino , Adulto , Cesárea/efeitos adversos , Ativador de Plasminogênio Tecidual , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Histerectomia/efeitos adversos , Trombose/cirurgia , Terapia Trombolítica/efeitos adversos , Período Pós-Parto
6.
Rev. clín. esp. (Ed. impr.) ; 223(1): 40-49, ene. 2023.
Artigo em Espanhol | IBECS | ID: ibc-214308

RESUMO

Antecedentes y objetivo Las escalas de predicción clínica para embolia de pulmón (EP) determinan la probabilidad pretest y valoran la necesidad de las pruebas para estos pacientes. La infección por coronavirus se asocia a un mayor riesgo de EP, aumentando su gravedad y confiriendo un peor pronóstico. La patogénesis de la EP parece ser diferente en pacientes con y sin infección por SARS-CoV-2. Esta revisión sistemática pretende conocer, revisando la bibliografía disponible, la utilidad de los modelos predictivos desarrollados para EP en pacientes con COVID-19. Métodos Se realizó una búsqueda bibliográfica en las bases de datos de PubMed, Scopus y EMBASE, incluyendo todos los estudios que comunican datos relacionados con la aplicación de escalas de predicción clínica para EP en pacientes con COVID-19. La calidad de los estudios se evaluó con la escala Newcastle-Ottawa para estudios no aleatorizados. Resultados Se incluyeron 13 estudios de cohortes que evaluaron cinco modelos predictivos (escala de Wells, puntuación de Ginebra, algoritmo YEARS y las reglas de decisión clínica PERC y PEGeD). Las diversas escalas se aplicaron en 1.187 pacientes con COVID-19. En general, los modelos tuvieron una capacidad predictiva limitada. La escala de Wells de dos categorías con probabilidad clínica baja (o improbable) en combinación con un dímero D<3.000ng/mL o con una ecografía pulmonar a pie de cama normal mostraron una adecuada correlación para excluir la EP. Conclusión Nuestra revisión sistemática sugiere que las escalas de predicción disponibles para EP desarrolladas en población general no son aplicables a los pacientes con COVID-19, por lo que, de momento, no se recomienda su uso en la práctica clínica como única herramienta de cribado diagnóstico. Se necesitan nuevas escalas de probabilidad clínica para EP validadas en estos pacientes (AU)


Background and objective Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. Method A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Results Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. Conclusions Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed (AU)


Assuntos
Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/virologia , Infecções por Coronavirus/complicações , Pandemias , Valor Preditivo dos Testes
9.
Blood Coagul Fibrinolysis ; 34(1): 40-46, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36598377

RESUMO

Ultrasound-assisted catheter directed thrombolysis (US-CDT) is frequently used for the treatment of pulmonary embolism. Due to the variety of thrombolytic and anticoagulant dosing utilized in practice, patients with pulmonary embolism who undergo US-CDT may be at an increased risk of bleeding. The primary objective of this study was to determine factors associated with major bleeding occurring with US-CDT. Secondary outcomes included in-hospital mortality and ventilator-free days. This multicentre retrospective cohort study evaluated inpatients diagnosed with pulmonary embolism and treated with US-CDT and systemic anticoagulation. A total of 173 patients were included. Most patients receiving US-CDT had a submassive pulmonary embolism with a median Pulmonary Embolism Severity Index (PESI) score of 85. Major bleeding events occurred in 37 of the 173 patients (21%). In-hospital mortality occurred in four (11%) of the patients who experienced major bleeding and three (2%) patients who did not experience major bleeding (P = 0.04). Factors associated with a higher risk of major bleeding included female sex and anticoagulation strategy. The odds of major bleeding were 3.3 times higher for women than for men (odds ratio = 3.32, 95% confidence interval 1.29-8.54). In addition, for each second increase in goal aPTT the odds of major bleeding increased by 5% (odds ratio = 1.05, 95% confidence interval 1.02-1.09). In patients with pulmonary embolism treated with US-CDT, major bleeding may be underestimated. In this analysis, major bleeding was associated with female sex and higher goal aPTT levels. In addition, bleeding with US-CDT was associated with a higher risk of in-hospital mortality.


Assuntos
Embolia Pulmonar , Terapia Trombolítica , Masculino , Humanos , Feminino , Terapia Trombolítica/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Embolia Pulmonar/complicações , Fibrinolíticos/uso terapêutico , Hemorragia/induzido quimicamente , Cateteres , Anticoagulantes/uso terapêutico
10.
BMC Genomics ; 24(1): 10, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624378

RESUMO

BACKGROUND: Pulmonary embolism (PE) is a severe disease that usually originates from deep vein thrombosis (DVT) of the lower extremities. This study set out to investigate the changes in the transcriptome of the pulmonary artery (PA) in the course of the PE in the porcine model. METHODS: The study was performed on 11 male pigs: a thrombus was formed in each right femoral vein in six animals, and then was released to induce PE, the remaining five animals served as a control group. In the experimental animals total RNA was isolated from the PA where the blood clot lodged, and in the control group, from the corresponding PA segments. High-throughput RNA sequencing was used to analyse the global changes in the transcriptome of PA with induced PE (PA-E). RESULTS: Applied multistep bioinformatics revealed 473 differentially expressed genes (DEGs): 198 upregulated and 275 downregulated. Functional Gene Ontology annotated 347 DEGs into 27 biological processes, 324 to the 11 cellular components and 346 to the 2 molecular functions categories. In the signaling pathway analysis, KEGG 'protein processing in endoplasmic reticulum' was identified for the mRNAs modulated during PE. The same KEGG pathway was also exposed by 8 differentially alternative splicing genes. Within single nucleotide variants, the 61 allele-specific expression variants were localised in the vicinity of the genes that belong to the cellular components of the 'endoplasmic reticulum'. The discovered allele-specific genes were also classified as signatures of the cardiovascular system. CONCLUSIONS: The findings of this research provide the first thorough investigation of the changes in the gene expression profile of PA affected by an embolus. Evidence from this study suggests that the disturbed homeostasis in the biosynthesis of proteins in the endoplasmic reticulum plays a major role in the pathogenesis of PE.


Assuntos
Embolia Pulmonar , Transcriptoma , Masculino , Animais , Suínos , Artéria Pulmonar/metabolismo , Perfilação da Expressão Gênica , Embolia Pulmonar/genética , Embolia Pulmonar/metabolismo , Transdução de Sinais
12.
Praxis (Bern 1994) ; 112(1): 28-35, 2023 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-36597683

RESUMO

Pulmonary Endarterectomy and Treatment for Chronic Thromboembolic Pulmonary Hypertension Abstract. Chronic thromboembolic pulmonary hypertension is a relatively rare disease which mostly evolves as a complication of acute pulmonary embolism resulting from the fibrotic organization of residual thrombotic material despite adequate anticoagulation leading to precapillary pulmonary hypertension and persistence of its symptoms. The elevated pulmonary vascular resistance leads to right ventricular heart failure, its symptoms and reduced prognosis. The therapy of choice is the pulmonary endarterectomy, which leads to a reduction of symptoms, optimization of the hemodynamics and improved prognosis. Misdiagnosis and delayed referral often lead to disease progression along with poor surgical outcome. In case of more distal, surgically non-accessible disease, treatment consists of balloon pulmonary angioplasty and pulmonary vasodilator drugs.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Artéria Pulmonar , Doença Crônica , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Endarterectomia/efeitos adversos , Endarterectomia/métodos
13.
Eur Rev Med Pharmacol Sci ; 27(1): 159-165, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36647864

RESUMO

OBJECTIVE: This study investigates characteristics and predictors of mortality among elderly patients with acute pulmonary embolism (APE). PATIENTS AND METHODS: Data on patients with the diagnosis of APE at the first admission to two centers between January 2012 and March 2022 were screened retrospectively. Patients aged 65 years and older were categorized as the elderly group while patients between 18 and 64 years of age constituted the non-elderly group. RESULTS: Among the 361 enrolled patients, the average age in the non-elderly group was 51.0 (18.0-64.0) years and the average age in the elderly group was 76 (65.0-92) years. While male patients were the majority in the non-elderly group, there was a higher proportion of female patients in the elderly group (p=0.001). In multivariate regression analysis, the independent risk factors of mortality among elderly patients were oxygen saturation [odds ratio (OR): 1.163, 95% confidence interval (CI): 1.613-9.476; p=0.044], C-reactive protein (CRP) (OR: 1.133, 95% CI: 1.041-1.234; p=0.004), simplified Pulmonary Embolism Severity Index (sPESI) score (OR: 3.910, 95% CI: 1.613-9.476; p=0.003), absence of deep vein thrombosis (OR: 12.88, 95% CI: 1.321-125.739; p=0.028), and leukocyte count (OR: 2.591, 95% CI: 1.015-6.617; p=0.047). In ROC analysis, the cut-off values for mortality prediction were ≥7.7 mg/dL for CRP, >0.125 ng/mL for troponin, and ≥2 for the sPESI score. CONCLUSIONS: If CRP of ≥7.7, troponin of >0.125, and sPESI score of ≥2 are present in elderly patients with APE, extra attention should be paid to the risk of mortality and the utmost care should be taken in planning the monitoring of these patients.


Assuntos
Embolia Pulmonar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Doença Aguda , Proteína C-Reativa , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Medição de Risco , Curva ROC , Índice de Gravidade de Doença , Troponina
14.
Sci Rep ; 13(1): 967, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653367

RESUMO

Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model's backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.


Assuntos
Embolia Pulmonar , Trombose Venosa , Humanos , Inteligência Artificial , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/complicações , Embolia Pulmonar/etiologia , Angiografia/efeitos adversos , Extremidade Inferior
15.
BMC Pulm Med ; 23(1): 25, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653788

RESUMO

BACKGROUND: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.


Assuntos
COVID-19 , Embolia Pulmonar , Humanos , Mortalidade Hospitalar , COVID-19/complicações , Estudos Retrospectivos , Embolia Pulmonar/complicações , Artéria Pulmonar , Medição de Risco
16.
Inn Med (Heidelb) ; 64(1): 40-49, 2023 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-36625924

RESUMO

Pulmonary embolism is a frequent cardiovascular disease which in recent years has shown a reduction in the mortality but an increase in the incidence. Due to the optimization of clinical probability scores and the interpretation of the D­dimer test, unnecessary examinations using computed tomography with respect to the exclusion of an acute pulmonary embolism can be avoided, also in pregnant women. The evaluation of the right ventricle contributes to a risk-adapted treatment. Treatment consists of anticoagulation, alone or in combination with reperfusion treatment, such as systemic thrombolysis and also catheter-assisted or surgical treatment. In addition to acute treatment of pulmonary embolisms, an adequate aftercare is important, particularly for the early detection of long-term sequelae. This review article summarizes the current recommendations of international guidelines for patients with pulmonary embolism, accompanied by clinical case examples and a critical discussion.


Assuntos
Embolia Pulmonar , Terapia Trombolítica , Gravidez , Humanos , Feminino , Terapia Trombolítica/métodos , Embolia Pulmonar/diagnóstico , Cateteres , Doença Aguda , Progressão da Doença
17.
J Cardiothorac Surg ; 18(1): 42, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36658637

RESUMO

Pulmonary artery thrombosis in-situ is a term used to describe a pulmonary embolism occurs in the absence of deep vein thrombosis in the lower extremities. Most cases occur in a patient who had a recent traumatic injury to the chest. Other risk factors include the presence of hypercoagulable conditions, including inflammatory state, hypoxia and vascular endothelial injury. Although it has been discussed extensively in the acute COVID-19 disease, pulmonary artery thrombosis in-situ that occur in the setting of Post-Acute COVID-19 syndrome is not commonly reported and poorly understood.


Assuntos
COVID-19 , Embolia Pulmonar , Trombose Venosa , Humanos , Artéria Pulmonar , COVID-19/complicações , Trombose Venosa/etiologia , Embolia Pulmonar/etiologia
18.
J Biomed Opt ; 28(1): 015001, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36688229

RESUMO

Significance: In recent years, the incidence rate of pulmonary embolism (PE) has increased dramatically. Currently, the correct diagnosis rate of PE in China is relatively low, and the diagnosis error rate and missed diagnosis rate were as high as about 80%. The most standard method of PE detection is pulmonary artery digital subtraction angiography (DSA), but pulmonary artery DSA is an invasive examination, and patients can have certain risks and discomfort. Noninvasive monitoring of PE remains challenging in cardiovascular medicine. Aim: We attempt to study the light propagation in human thoracic tissues and explore the possibility of near-infrared spectroscopy (NIRS) in noninvasive detection of PE. Approach: In this study, by utilizing the Monte Carlo simulation method for voxelized media and the Visible Chinese Human dataset, we quantified and visualized the photon migration in human thoracic region. The influence of the development (three levels) of PE on the light migration was observed. Results: Results showed that around 4.6% light fluence was absorbed by the pulmonary tissue. The maximum signal sensitivity distribution reached 0.073% at the 2.8- to 3.1-cm light source-detector separation. The normalized light intensity was significantly different among different PE levels and formed a linear relationship ( r 2 = 0.998 , p < 10 - 5 ). Conclusions: The study found that photons could reach the pulmonary artery tissue, the light intensity was linearly related to the degrees of embolism, PE could be quantitatively diagnosed by NIRS. Meanwhile, the optimized distance in between the light source and detector, 2.8 to 3.1 cm, was recommended to be used in future potential noninvasive optical diagnosis of PE.


Assuntos
Embolia Pulmonar , Humanos , Método de Monte Carlo , Embolia Pulmonar/diagnóstico por imagem , Artéria Pulmonar , Espectroscopia de Luz Próxima ao Infravermelho/métodos
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