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1.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(4): 159-162, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184304

RESUMO

La hipertensión pulmonar es una enfermedad compleja, grave y de baja incidencia. Es un estado hemodinámicamente patológico con una presión de arteria pulmonar que supera los 25 mmHg. La presencia de hipertensión pulmonar en el puerperio es poco frecuente y conlleva un alto riesgo para la madre. Se presenta el caso de una mujer de 31 años en puerperio mediato patológico post parto eutócico con datos de bajo gasto cardiaco. El ecocardiograma demostró la presión de la arteria pulmonar que iguala a la sistémica. La angiotomografía helicoidal de tórax descarta tromboembolismo pulmonar, y se realiza diagnóstico de hipertensión de la arteria pulmonar de etiología desconocida


Pulmonary hypertension is a complex, serious and low incidence disease. It is a haemodynamically pathological state with a pulmonary artery pressure that exceeds 25 mmHg. The presence of pulmonary hypertension in the puerperium is rare, and carries a high risk to the mother. The case is presented of a 31 year-old female in the subacute postpartum period of a normal delivery with data of low cardiac output. The echocardiogram showed that the pressure of the pulmonary artery was equal to the systemic. A thoracic helical angio-tomography ruled out pulmonary thromboembolism, making a diagnosis of pulmonary artery hypertension of unknown aetiology


Assuntos
Humanos , Feminino , Adulto , Hipertensão Pulmonar/etiologia , Período Pós-Parto , Embolia Pulmonar/diagnóstico por imagem , Hipertensão/etiologia , Embolia Pulmonar/complicações , Radiografia Torácica/métodos , Débito Cardíaco
2.
Medicine (Baltimore) ; 98(44): e17791, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689854

RESUMO

RATIONALE: Pulmonary embolism (PE) is one of the serious cardiopulmonary diseases that can endanger life. Early diagnosis and timely treatment are key factors to reduce its high mortality rate. Abdominal pain is not currently included in the symptoms of PE in textbooks and guidelines. PATIENT CONCERNS: A 49-year-old man was hospitalized for an exacerbation of right upper quadrant abdominal pain and sudden left upper quadrant pain that lasted for 2 hours. DIAGNOSES: The patient was initially misdiagnosed as cholecystitis and pneumonia, and later was diagnosed as PE by computed tomography pulmonary angiography (CTPA). INTERVENTIONS: The patient received low molecular weight heparin for anticoagulant therapy. OUTCOMES: His abdominal pain disappeared after one week. The patient was later discharged. LESSONS: Sometimes abdominal pain may be the only manifestation of PE. However, most clinicians do not think of the possibility of PE in patients with abdominal pain. This might have contributed greatly to the rate of misdiagnosis of PE in the past. We hope to improve the alertness of the diagnosis of PE in clinical practice. In patients with abdominal pain, the possibility of PE should be considered to avoid mis- or under-diagnosis.


Assuntos
Dor Abdominal/diagnóstico , Embolia Pulmonar/diagnóstico , Dor Abdominal/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações
3.
Int Heart J ; 60(5): 1137-1141, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484878

RESUMO

Current therapeutic methods for chronic thromboembolic pulmonary hypertension (CTEPH) can improve hemodynamic status and are expected to improve prognoses. However, some patients experience dyspnea during effort and continue supplemental oxygenation despite their hemodynamic status being fully improved. Considering the pathogenesis of CTEPH, the dead space and intrapulmonary shunt are assumed to be responsible for hypoxia in CTEPH, but their contributions are unclear. It is also unclear whether they are improved after treatment. The aim of this study was to investigate the implications of the dead space ratio (DSR) and the intrapulmonary shunt ratio (ISR) for hypoxia in CTEPH and treatment for CTEPH.We retrospectively measured the DSR and ISR of 23 consecutive patients with CTEPH. For 11 of these 23 (10 were treated by balloon pulmonary angioplasty, one with riociguat), we also measured these parameters before and after CTEPH treatments. Overall, the DSR and ISR were abnormally elevated (DSR: 0.63 ± 0.06; ISR: 0.20 ± 0.05). After treatment, mean pulmonary artery pressure was improved (from 40.3 ± 8.1 to 25.5 ± 2.7 mmHg). Although atrial oxygen saturation (SaO2), DSR and ISR were improved (SaO2: from 90.2 ± 3.2 to 93.7 ± 1.8%; DSR: from 0.64 ± 0.06 to 0.58 ± 0.05; ISR: from 0.20 ± 0.04 to 0.18 ± 0.02), these improvements were slight compared with that of mean pulmonary artery pressure.The DSR and ISR were abnormally elevated in patients with CTEPH and their improvement by treatment was limited. Only DSR can be a useful marker for normalization of hypoxia in CTEPH.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Pirazóis/uso terapêutico , Pirimidinas/uso terapêutico , Espaço Morto Respiratório/efeitos dos fármacos , Adulto , Idoso , Doença Crônica , Feminino , Hemodinâmica/fisiologia , Hospitais Universitários , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Japão , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Prognóstico , Circulação Pulmonar/fisiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Espaço Morto Respiratório/fisiologia , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento
4.
Isr Med Assoc J ; 21(8): 528-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474014

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, which is caused by chronic obstruction of major pulmonary arteries. CTEPH can be cured by pulmonary endarterectomy (PEA). PEA for CTEPH is a challenging procedure, and patient selection and the perioperative management are complex, requiring significant experience. OBJECTIVES: To describe the establishment of a national CTEPH-PEA center in Israel and present results of surgery. METHODS: In this study, we reviewed the outcomes of PEA in a national referral, multi-disciplinary center for CTEPH-PEA. The center was established by collaborating with a high-volume center in Europe. A multidisciplinary team from our hospital (pulmonary hypertension specialist, cardiac surgeon, cardiac anesthesiologist and cardiac surgery intensivist was trained under the guidance of an experienced team from the European center. RESULTS: A total of 38 PEA procedures were performed between 2008 and 2018. We included 28 cases in this analysis for which long-term follow-up data were available. There were two hospital deaths (7%). At follow-up, median New York Heart Association (NYHA) class improved from III to I (P < 0.0001), median systolic pulmonary pressure decreased from 64 mmHg to 26 mmHg (P < 0.0001), and significant improvements were seen in right ventricular function and exercise capacity. CONCLUSIONS: A national center for performance of a rare and complex surgical procedure can be successfully established by collaboration with a high-volume center and by training a dedicated multidisciplinary team.


Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Encaminhamento e Consulta , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
5.
Medicine (Baltimore) ; 98(31): e16740, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374069

RESUMO

RATIONALE: Percutaneous cardiopulmonary support (PCPS) using extracorporeal membrane oxygenation (ECMO) is widely used in the critical patients with cardiopulmonary collapse. It is a representative blood-consuming procedure. In limited situations in which the option of blood transfusion is unavailable, there is no general agreement as to whether ECMO is contraindicated. PATIENT CONCERNS: A 61-year-old male Jehovah Witness with acute respiratory collapse and loss of consciousness was rushed to our emergency room. Throughout his hospital course, the patient's family refused any type of blood transfusion even at the risk of death. DIAGNOSIS: The clinical situations were secondary to a massive pulmonary thromboembolism INTERVENTIONS:: The patient underwent veno-venous ECMO via both femoral veins. The patient was recovered by intensive medical care although the level of hemoglobin (Hb) and hematocrit (Hct) was gradually decreased from 15.8 g/dl and 46.8% to 11.7 g/dl and 36.5%, respectively. OUTCOMES: On hospital day 3, ECMO was successfully removed using a blood-sparing ECMO removal technique involving the recycling of blood within the circuit by continuous saline infusion. There was no significant change in level of Hb/Hct and hemodynamic profile. At 2 days after ECMO removal, the level of Hb/Hct was elevated up to 9.2 g/dl and 30.0%, respectively without any transfusion. LESSONS: Our blood-sparing removal technique of ECMO appears to be feasible and led to no significant adverse impact on hemodynamic status. The technique might be helpful for critical patients who cannot receive blood transfusion due to any cause.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Testemunhas de Jeová , Insuficiência Respiratória/terapia , Procedimentos Médicos e Cirúrgicos de Sangue/métodos , Hematócrito , Hemoglobinas , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Insuficiência Respiratória/etiologia
8.
J Assoc Physicians India ; 67(4): 76-78, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299847

RESUMO

A 21-year old female, recently diagnosed with osteosarcoma of right humerus, presented to the emergency with history of fever, productive cough, chest pain and progressive respiratory distress for six days. Initial investigations suggested pneumonia but she did not respond to parenteral antibiotics. CT pulmonary angiogram revealed bilateral pulmonary artery embolism. Thrombolysis was performed using alteplase, which failed to improve the clinical condition. In view of underlying malignancy, a possibility of tumour-embolism was considered and she was started on chemotherapy for osteosarcoma. There was dramatic improvement in her respiratory symptoms after the first chemotherapy cycle, along with radiological resolution of the embolism. This case highlights the importance of suspecting tumour embolism in a known case of malignancy with respiratory distress.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Osteossarcoma/diagnóstico , Embolia Pulmonar/diagnóstico , Adulto , Angiografia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/tratamento farmacológico , Feminino , Humanos , Osteossarcoma/complicações , Osteossarcoma/tratamento farmacológico , Pneumonia , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Adulto Jovem
9.
Vnitr Lek ; 65(5): 353-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163968

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by a mean pulmonary artery pressure that exceeds 25 mm Hg and is caused by intraluminal thrombi organisation, stenosis and occlusions of pulmonary artery and its branches and peripheral vascular remodelation. It is a chronic complication of acute pulmonary embolism. The obstruction of pulmonary artery branches increases pulmonary vascular resistance (PVR) and this leads to the right ventricular overload and right-sided heart failure. The treatment of choice is surgical pulmonary endarterectomy (PEA), a procedure that is performed in deep hypothermic cardiac arrest. The only center that specializes into the surgical treatment of patients with CTEPH in the Czech Republic is the Complex Cardiovascular Centre at the General Teaching Hospital in Prague. Between years 2004-2017 there were 314 patients opera-ted (including 50 patients from Slovakia, where this treatment is not available). Patients with peripheral type of CTEPH, who are not indicated for operation and also patients with residual pulmonary hypertension after PEA can be indicated for specific vasodilatation therapy. In indicated cases the treatment may involve the balloon angioplasty or lung transplantation.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , República Tcheca , Endarterectomia , Humanos , Hipertensão Pulmonar/cirurgia , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Eslováquia , Resultado do Tratamento
10.
Int Heart J ; 60(4): 924-937, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204374

RESUMO

Our previous studies have revealed that long noncoding RNAs (lncRNAs), microRNAs (miRNAs), and genes were abnormally expressed in the pulmonary artery tissues of the chronic thromboembolic pulmonary hypertension (CTEPH) patients. We aim to establish the CTEPH-related miRNA-gene-lncRNA network for finding the core genes and associated miRNA and lncRNA in CTEPH patients.Firstly, the target genes of differential miRNAs were predicted by searching TargetScan databases, and the predicted target genes were intersected with the mRNAs from the gene chip. Secondly, the intersective genes were analyzed by the Gene Ontology function and Kyoto Encyclopedia of Genes and Genomes pathway software for obtaining differential intersective genes and then establish the miRNA-gene networks. Thirdly, the possible genes regulated by the differential lncRNAs from the gene chip were intersected with the above-screened mRNA to build the lncRNA-mRNA networks. Subsequently, the miRNA-gene-lncRNA networks were constructed according to the two networks above (miRNA-gene networks and lncRNA-mRNA networks). Finally, the core genes of the networks in the experimental group were screened according to Diffk > 0.6 and used to construct the miRNA-core gene-lncRNA networks of CTEPH.The pathway network, miRNA-mRNA network, lncRNA-mRNA networks, and miRNA-gene-lncRNA networks were successfully constructed. The core genes of the miRNA-gene-lncRNA networks (Diffk > 0.6) were the human Beta-type platelet-derived growth factor receptor (PDGFRB) and hypoxia-inducible factor-1a (HIF-1A), the miRNAs-PDGFRB-lncRNAs and miRNAs-HIF1A-lncRNAs networks were constructed. Finally, miRNA-149-5p-PDGFRB-TCONS_l2_00020587-XLOC_l2_010723 and miRNA-338-5p/miRNA-199b-5p-HIF1A- TCONS_l2_00020587-XLOC_l2_010723 were found in the analysis of the network.miRNA-149-5p-PDGFRB-lncRNA CTEPH-associated 1 (CTEPHA1) (TCONS_l2_00020587-XLOC_l2_010723) and miRNA-338-5p/miRNA-199b-5p-HIF1A-lncRNA CTEPHA1 are related to the development of CTEPH.


Assuntos
Hipertensão Pulmonar/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , MicroRNAs/genética , Proteínas Proto-Oncogênicas c-sis/genética , Embolia Pulmonar/complicações , Doença Crônica , Perfilação da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , MicroRNAs/metabolismo , Proteínas Proto-Oncogênicas c-sis/metabolismo , Embolia Pulmonar/genética , Embolia Pulmonar/metabolismo
11.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 302-309, May-June 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1002221

RESUMO

This paper is about the Guideline for Ventilation / Perfusion Scintigraphy. It has been developed by the Brazilian Society of Nuclear Medicine to be a best practices guide used in Nuclear Medicine. Its function is to be an educational tool to help the Nuclear Medicine Services in Brazil to guarantee a quality care to the patients


Assuntos
Humanos , Masculino , Feminino , Relação Ventilação-Perfusão , Guias como Assunto/normas , Artéria Pulmonar/patologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Cintilografia/métodos , Medicina Nuclear/normas
13.
Radiol Clin North Am ; 57(4): 787-794, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076032

RESUMO

Cardiovascular injuries represent the second most common cause of death among trauma victims in the United States. Motor vehicle collisions account for more than 80% of all blunt thoracic trauma. Given the nonspecific nature and variable severity of presenting symptoms, such as chest pain and shortness of breath, as well as confounding and overlapping clinical presentations in the setting of additional injuries, diagnosis of cardiovascular injuries can be challenging. This article reviews the clinical entities of acute aortic syndrome and pulmonary embolism, their imaging findings, and diagnostic challenges.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Úlcera/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Aneurisma Dissecante/complicações , Aorta/diagnóstico por imagem , Aorta/lesões , Angiografia por Tomografia Computadorizada/métodos , Emergências , Hematoma/complicações , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/lesões , Embolia Pulmonar/complicações , Síndrome , Úlcera/complicações
14.
Am J Ther ; 26(3): e301-e307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31082863

RESUMO

BACKGROUND: Syncope represents a common condition among the general population. It is also a frequent complaint of patients in the emergency department (ED). Pulmonary embolism (PE) considers a differential diagnosis, particularly in a case of syncope without chest pain. STUDY QUESTION: What is the prevalence of PE among patients who presented an episode of syncope to the ED and among those hospitalized for syncope in a tertiary care hospital? STUDY DESIGN: From January 2012 to December 2017, we conducted a prospective observational study among adult patients presenting themselves to the ED consecutively or admitted for syncope. MEASURES AND OUTCOMES: Syncope and PE were defined by professional guidelines. PE was ruled out in patients who had a low pretest clinical probability, as per Wells score and a negative D-dimer assay. In other patients, computed tomography pulmonary angiography was performed. RESULTS: Seventeen thousand eight-two patients (mean age 71.3 ± 13.24 years) visited the ED for syncope. PE was detected in 45 patients (mean age 65.75 ± 9.45 years): 4 with low risk, 26 with intermediate risk, and 15 with high risk. The prevalence of PE in those hospitalized with syncope was 11.47%, which is 45 of 392 (confidence interval 95% 8.48-15.04), and was 2.52%, 45 of 1782 (confidence interval 95% 1.8-3.3), in patients presenting with syncope to the ED. The location of the embolus was bilateral in 24 patients (53.33%), in a main pulmonary artery in 10 (22.22%), in a lobar artery in 10 (22.22%), and in a segmental artery in 1 (2.22%). CONCLUSIONS: The occurrence of syncope, if not explained otherwise, should alert one to consider PE as a differential diagnosis. PE rate, presenting as syncope, is the highest in patients with large thrombi, which is responsible for bilateral or proximal obstruction in a main or lobar pulmonary artery.


Assuntos
Embolia Pulmonar/epidemiologia , Síncope/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Fatores de Risco , Síncope/terapia , Adulto Jovem
15.
A A Pract ; 12(9): 305-307, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048599

RESUMO

We report a 31-year-old woman with sickle beta thalassemia zero who presented at 21 weeks gestational age with multiple bilateral pulmonary emboli and no hemodynamic instability. Acquired antithrombin deficiency was suspected due to a refractory response to therapeutic anticoagulation with enoxaparin, unfractionated heparin, and fondaparinux, and a reduced antithrombin antigen level. At 26 4/7 weeks, she developed signs concerning for increased pulmonary clot burden. To avoid the use of alternative anticoagulants that may cross the placenta and impact the fetus, a planned cesarean delivery was performed without complication at 27 weeks gestation. Both mother and child experienced successful long-term outcomes.


Assuntos
Anemia Falciforme/complicações , Resistência a Medicamentos , Embolia Pulmonar/complicações , Trombofilia/complicações , Adulto , Cesárea , Gerenciamento Clínico , Feminino , Heparina/administração & dosagem , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Segundo Trimestre da Gravidez
16.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 302-309, may.-june. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1006185

RESUMO

This paper is about the Guideline for Ventilation / Perfusion Scintigraphy. It has been developed by the Brazilian Society of Nuclear Medicine to be a best practices guide used in Nuclear Medicine. Its function is to be an educational tool to help the Nuclear Medicine Services in Brazil to guarantee a quality care to the patients


Assuntos
Humanos , Masculino , Feminino , Relação Ventilação-Perfusão , Guias como Assunto/normas , Artéria Pulmonar/patologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Cintilografia/métodos , Medicina Nuclear/normas
18.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948387

RESUMO

This is a case of a 68-year-old man with Parkinson's disease who was admitted in the psychiatry floor for new-onset aggressive behaviour and hallucinations. On the third day of hospitalisation, he suddenly developed dyspnoea followed by an ECG showing atrial fibrillation with rapid ventricular response. A few seconds later, he went into cardiac arrest; he was resuscitated after multiple rounds of Advanced Cardiovascular Life Support. A transthoracic echo showed hypokinetic and enlarged right ventricle. A CT Chest showed a saddle embolus. Patient was provided with systemic thrombolysis, which led to an improvement in his haemodynamic status. Interestingly, his psychotic symptoms also improved. In this paper, we present and review how pulmonary embolism can be associated with acute psychosis.


Assuntos
Alucinações/etiologia , Parada Cardíaca/etiologia , Doença de Parkinson/psicologia , Transtornos Psicóticos/etiologia , Embolia Pulmonar/psicologia , Idoso , Humanos , Masculino , Doença de Parkinson/complicações , Embolia Pulmonar/complicações
19.
Artigo em Alemão | MEDLINE | ID: mdl-30978752

RESUMO

A 46-year-old woman on oral contraceptives developed an intrahepatic hematoma due to a benign hepatic tumor. As an incidental finding, a computed tomography showed a pulmonary embolism. Unfractionated heparin was given in a prophylactic dosing in an attempt to balance the risk of further intrahepatic bleeding with that of thrombosis. Ten days later, the patient developed a second pulmonary embolism along with acute right heart failure requiring cardiopulmonary resuscitation. As a sufficient circulation and oxygenation could not be reestablished, a veno-arterial extracorporeal membrane oxygenation (ECMO) was installed. An ELISA-Test, detecting PF4-Heparin associated antibodies, resulted in a positive result for a type II heparin induced thrombocytopenia even in the absence of thrombocytopenia. After hemodynamic and pulmonary stabilization, six days after ECMO-support the cannula was scheduled to be removed. On removal of the venous cannula the patient developed another massive pulmonary embolism with cardiac arrest which led to immediate reinstallation of va-ECMO. Under therapeutic anticoagulation using argatroban the ECMO support continued until the patient was on day 17 successfully weaned.


Assuntos
Anticoncepcionais Orais , Oxigenação por Membrana Extracorpórea , Embolia Pulmonar , Trombocitopenia , Anticoagulantes/efeitos adversos , Anticoncepcionais Orais/efeitos adversos , Feminino , Hematoma , Heparina/efeitos adversos , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Trombocitopenia/complicações
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