Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.365
Filtrar
1.
Am J Forensic Med Pathol ; 41(1): 42-47, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000221

RESUMO

Myocardial steatosis, also known as lipomatosis cordis, is characterized by adipose tissue within the myocardium without significant fibrosis. Evidence suggests that accumulation of fat can disturb the normal electromechanical physiology of the myocardium. Herein, we discuss the case of a 60-year-old woman with a history of chronic obstructive pulmonary disease who died because of anoxic encephalopathy after a sudden cardiac arrest (SCA). An electrocardiogram showed QRS fragmentation noted as notched R in inferior leads. The autopsy revealed a very small thromboembolus in a distal subsegmental branch of the pulmonary artery, which could not explain the SCA. There was an extensive intramyocardial accumulation of adipose tissue involving the right ventricle and interventricular septum, which split the myocardium into discrete bundles. Arrhythmogenic right ventricular cardiomyopathy was ruled out based on the absence of typical fibrofatty changes. The mechanism of fat replacement was likely secondary to redistribution of visceral fat in the setting of Cushing syndrome. We propose that severe myocardial steatosis can create an anatomic substrate to facilitate the development of SCA. Myocardial steatosis should be reported to identify patients who are at risk for developing cardiovascular events secondary to extreme cardiac adiposity.


Assuntos
Tecido Adiposo/patologia , Morte Súbita Cardíaca , Miocárdio/patologia , Adenoma/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Eletrocardiografia , Feminino , Humanos , Hipertensão , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica , Embolia Pulmonar/patologia
2.
Chemotherapy ; 64(3): 115-118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31610538

RESUMO

Extra-corporeal membrane oxygenation (ECMO) therapy could affect effective drug concentrations via adsorption onto the oxygenator or associated circuit. We describe a case of a 25-year-old female who required a veno-arterial ECMO therapy for refractory cardiac arrest due to massive pulmonary embolism. She had mild renal dysfunction as a result of the cardiac arrest. A total of 2 g of intravenous cefazolin 8-hourly was administered. Pre- and post-oxygenator blood samples were collected at 0, 1, 4, and 8 h post antibiotic administration. Samples were analyzed for total and unbound cefazolin concentrations. Protein binding was ∼60%. Clearance was reduced due to impaired renal function. The pharmacokinetics of cefazolin appear to not be affected by ECMO therapy and dosing adjustment may not be required.


Assuntos
Cefazolina/administração & dosagem , Oxigenação por Membrana Extracorpórea , Adulto , Área Sob a Curva , Cefazolina/sangue , Cefazolina/metabolismo , Feminino , Meia-Vida , Parada Cardíaca/complicações , Parada Cardíaca/diagnóstico , Humanos , Ligação Proteica , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Curva ROC
3.
Biomed Res Int ; 2019: 7846291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531368

RESUMO

Pulmonary embolism (PE) is one of the most common causes of cardiovascular death. The most often PE etiology is a deep vein thrombosis (DVT) of the lower extremities, but embolic material can arise in pelvic or upper extremity veins as well as in right heart chambers. There is growing number of evidences of atrial fibrillation (AF) involvement in PE. The presence of AF in patients with PE may be both the cause and the consequence of PE. The PE association with AF should be considered in patients without confirmed DVT and with history of AF, which itself is associated with prothrombotic state. The valuable diagnostic method is echocardiography that may bring the insight into source of embolic material. Another possible AF and PE association is the AF as a consequence of an abrupt increase in pulmonary vascular resistance due to the occlusion of the pulmonary vessels. Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF. Another important issue is the influence of AF on prognosis in patients with PE. Most investigators demonstrated a negative impact of AF on mortality. The main problem to resolve is whether AF is an independent mortality risk factor or whether it occurs as a result of comorbidities or the severity of a PE episode. Although the pathophysiological basis of this bidirectional relationship exists, many questions are still unresolved and require further studies, including the significance of paroxysmal AF accompanying an acute PE episode, the usefulness of PE risk scales in patients with concomitant AF, and the effect of anticoagulant treatment on PE and AF occurrence. Regardless of the type of AF, clinicians should be alert to the possibility of PE in patients with previous history of AF or presenting with new-onset AF.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/patologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Doença Aguda , Comorbidade , Humanos , Prognóstico , Fatores de Risco , Trombose Venosa/etiologia , Trombose Venosa/patologia
5.
BMC Med Imaging ; 19(1): 65, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412797

RESUMO

BACKGROUND: Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. METHODS: The records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis. RESULTS: Thirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score. CONCLUSIONS: Unenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.


Assuntos
Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/patologia , Embolia Pulmonar/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Pan Afr Med J ; 33: 75, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448037

RESUMO

Pulmonary embolism is an acute and severe medical condition. Its clinical characteristics are not pathognomonic and can mimick other medico-surgical emergencies. We report the case of a patient admitted with a clinical manifestation of acute coronary syndrome with electrical changes and elevation in cardiac enzymes without abnormal substrate on the coronarography, enabling diagnosis of pulmonary embolism.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angiografia Coronária/métodos , Embolia Pulmonar/diagnóstico , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Embolia Pulmonar/patologia
7.
J Forensic Leg Med ; 66: 138-143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31302444

RESUMO

Hip arthroplasty (hip replacement) surgery is a very common procedure and is particularly common in elderly individuals, where it is typically performed following traumatic hip fracture. As with any surgical procedure, hip arthroplasties are associated with a certain degree of morbidity and mortality, with many deaths occurring in the post-operative period. As most of these cases result from trauma (fractured hips), they are typically referred for medicolegal death investigation. Occasionally, sudden cardiorespiratory collapse and death occurs during hip arthroplasty surgery. In certain medicolegal jurisdictions, all intra-operative deaths must be investigated. Although many post-operative arthroplasty-related deaths might not require autopsy, those that occur intra-operatively may require autopsy. While clinical decision-making during recent years has resulted in fewer arthroplasty-related deaths, intraoperative deaths may still occur. In this review, the authors present their experience with three intra-operative arthroplasty-related deaths, followed by a discussion related to possible mechanisms involved in the deaths.


Assuntos
Artroplastia de Quadril/efeitos adversos , Morte Súbita/etiologia , Complicações Intraoperatórias , Idoso de 80 Anos ou mais , Cardiomiopatia Dilatada/patologia , Doença da Artéria Coronariana/patologia , Embolia Gordurosa/patologia , Feminino , Parada Cardíaca/etiologia , Fraturas do Quadril/cirurgia , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/patologia
8.
Thromb Res ; 181: 59-63, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352267

RESUMO

BACKGROUND: The Ottawa score was previously developed to predict recurrent venous thromboembolism (VTE) in cancer patients with VTE. The performance of this score in patients with incidental VTE is currently unclear. AIM: To evaluate the performance of the Ottawa risk score in cancer patients with incidental pulmonary embolism included in an international, prospective, observational cohort study. METHODS: The score was used to classify patients as high (≥1), intermediate (0), or low risk (≤-1). The discriminative performance of the score was estimated by calculating the cumulative incidence of recurrent VTE for all groups, the time-dependent c-statistic, and the sub-distribution hazard ratio (SHR), using a competing risk approach. RESULTS: Of the 691 patients for which the Ottawa score could be calculated, 25 (3.6%) had recurrent VTE during 6-month follow-up and 38 (5.5%) during 12-month follow-up. The c-statistics of the continuous score at 6 and 12 months were 0.45 (95% CI, 0.36-0.54) and 0.51 (95% CI, 0.46-0.59), respectively. The 6-month cumulative incidences of recurrent VTE for those at low, intermediate, and high risk were 3.9% (95% CI, 1.5-8.4), 3.6% (95% CI, 1.9-6.2), and 3.6% (95% CI, 1.8-6.5), respectively. A sensitivity analysis restricted to the on-treatment period yielded similar results. None of the Ottawa risk score items were significantly associated with recurrent VTE. CONCLUSION: In cancer patients with incidental pulmonary embolism, the Ottawa risk score has a poor predictive value for recurrent VTE, which does not support the use of the score in this patient population.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/complicações , Embolia Pulmonar/etiologia , Tromboembolia Venosa/etiologia , Idoso , Anticoagulantes/farmacologia , Feminino , Humanos , Masculino , Embolia Pulmonar/patologia , Tromboembolia Venosa/patologia
9.
Tohoku J Exp Med ; 248(2): 137-141, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243182

RESUMO

Saddle pulmonary embolism (PE) and paradoxical embolism (PDE) are life-threatening disorders carrying a risk of sudden death, and their prompt diagnosis is extremely important. Saddle PE is a radiologic definition and refers to a thrombus that straddles the bifurcation of the pulmonary artery trunk, carrying a risk of sudden hemodynamic collapse. PDE is defined as a systemic arterial embolus due to the passage of a venous thrombus though a right-to-left shunt, such as patent foramen ovale (PFO). We herein present the rare case of asthma exacerbation coincident with saddle PE and PDE. A 69-year-old woman with asthma was suffering from dyspnea, pulse attenuation of the left radial artery and left upper limb pain. An arterial blood gas analysis revealed hypoxemia, and a pulmonary function test demonstrated an obstructive pattern. Enhanced computed tomography (CT) revealed saddle PE, right popliteal venous thrombosis, and left brachial artery occlusion. After the treatment with edoxaban, an anticoagulant, and aspirin, the PE was significantly alleviated, and the brachial artery occlusion was recanalized. Subsequently, the right-to-left shunt through PFO was confirmed, and PDE was suspected of inducting her brachial artery embolism. In the present case, the pulse attenuation of the radial artery and upper limb pain prompted us to consider peripheral vascular disease or coagulation disorders. Physicians should keep in mind that patients with asthma are at considerable risk of PE, and it is important to be aware of possible PFO in patients presenting with the coexistence of PE and systemic arterial embolism.


Assuntos
Asma/complicações , Asma/patologia , Progressão da Doença , Embolia Paradoxal/complicações , Embolia Pulmonar/complicações , Idoso , Asma/diagnóstico por imagem , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Tomografia Computadorizada por Raios X
10.
Pediatr Hematol Oncol ; 36(4): 244-251, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31179809

RESUMO

In the era of neoadjuvant and adjuvant chemotherapy, extrapulmonary involvement by high-grade osteosarcoma (HGOS) is rare. Importantly however, HGOS metastasis in the form of cardiovascular tumor thrombus portends a dismal prognosis. Thus, prompt and accurate identification of tumor thrombus is crucial. We report here two unique cases of recurrent HGOS, presenting as thrombotic events, in order to increase awareness and index of suspicion among practitioners regarding this presentation. Additionally, we review 14 previously reported pediatric cases of cardiovascular metastatic HGOS.


Assuntos
Neoplasias Ósseas , Osteossarcoma , Embolia Pulmonar , Trombose , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/secundário , Humanos , Metástase Neoplásica , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/tratamento farmacológico , Osteossarcoma/patologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Trombose/diagnóstico por imagem , Trombose/patologia
11.
Cardiol Young ; 29(8): 1094-1096, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31241026

RESUMO

Pulmonary embolism is frequently under-recognised in children and, therefore, a high index of suspicion should be exerted on patients with exertional dyspnoea, presyncope/syncope and unexplained cardiopulmonary arrest. We discuss a 10-year-old previously healthy girl who presented with syncope and subsequent cardiac arrest related to massive pulmonary embolism and was salvaged successfully by emergent pulmonary embolectomy.


Assuntos
Parada Cardíaca/etiologia , Embolia Pulmonar/cirurgia , Síncope/etiologia , Criança , Embolectomia , Feminino , Humanos , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Terapia de Salvação , Tomografia Computadorizada por Raios X
12.
J Forensic Sci ; 64(6): 1921-1925, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31116429

RESUMO

Hepatic hemangiomas are usually detected incidentally when investigating for other nonrelated pathologies. When symptomatic, they are usually large and cause symptoms such as abdominal discomfort or other digestive issues. Occasionally, uncommon presentations such as bleeding with coagulopathy (Kasabach-Merritt syndrome) or even fever of unknown origin may occur. As hepatic hemangiomas are benign, they do not result in tumor emboli and pulmonary thromboembolism due to hepatic hemangiomas is extremely rare. This is a case report of a rare case of a female with no known past medical history who presented with sudden death due to pulmonary thromboembolism, possibly as a result of an underlying giant hepatic hemangioma. Incidentally, she also had three other tumors-pancreatic cystic lymphangioma, cerebral capillary telangiectasia, and papillary thyroid carcinoma, and their potential contribution to the cause of death will be discussed.


Assuntos
Morte Súbita/etiologia , Hemangioma/patologia , Neoplasias Hepáticas/patologia , Embolia Pulmonar/patologia , Adulto , Feminino , Humanos
13.
Adv Respir Med ; 87(2): 69-76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038716

RESUMO

INTRODUCTION: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE. MATERIAL AND METHODS: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%. RESULTS: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5-40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (± 0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591-0.858, p = 0.033). CONCLUSION: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism.


Assuntos
Índices de Eritrócitos/fisiologia , Ventrículos do Coração/fisiopatologia , Embolia Pulmonar/sangue , Embolia Pulmonar/mortalidade , Doença Aguda , Biomarcadores/sangue , Ecocardiografia , Feminino , Humanos , Masculino , Prognóstico , Embolia Pulmonar/patologia , Fatores de Risco
14.
Int J Clin Oncol ; 24(10): 1273-1283, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31073813

RESUMO

BACKGROUND: This study aimed to examine the clinical significance and risk factors of thromboembolic events (TEEs) in patients with ovarian carcinoma. METHODS: Patients with ovarian carcinoma treated at our hospital between 2000 and 2017 were identified. The risk factors of TEEs, including venous TEEs and arterial TEEs, and the association between TEEs and prognosis were investigated. Patients with TEEs were classified into two groups: those with severe TEEs, defined as patients who required urgent treatment for deep vein thrombosis, massive pulmonary embolism, acute myocardial infarction, and symptomatic cerebral infarction, and those with mild TEEs. The risk factors of severe TEEs and the association between severe TEEs and prognosis were investigated. RESULTS: A total of 369 patients were enrolled. Among them, 53 patients (14.4%) were complicated with TEEs. Clear cell carcinoma (CCC) was a greater risk factor of TEEs than serous carcinoma (hazard ratio [HR] = 2.81, p = 0.03). In multivariate analysis for survival, TEEs were a prognostic factor of poor progression-free survival (PFS; HR = 2.90, p < 0.01) and overall survival (OS; HR = 2.89, p < 0.01). Among 53 patients with TEEs, 17 (32.1%) developed severe TEEs. CCC was strongly associated with severe TEEs (HR = 42.6, p = 0.02). Multivariate analysis for survival demonstrated that severe TEEs were a risk factor of worse PFS (HR = 4.34, p < 0.01) and OS (HR = 3.30, p = 0.03). CONCLUSION: TEEs induced poor prognosis and was associated with CCC. A standard treatment for CCC should be included in the strategy of TEEs.


Assuntos
Adenocarcinoma de Células Claras/mortalidade , Cistadenocarcinoma Seroso/mortalidade , Procedimentos Cirúrgicos de Citorredução/mortalidade , Neoplasias Ovarianas/mortalidade , Embolia Pulmonar/mortalidade , Trombose Venosa/mortalidade , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/cirurgia , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/cirurgia , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Prognóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Fatores de Risco , Taxa de Sobrevida , Trombose Venosa/etiologia , Trombose Venosa/patologia
15.
J Thorac Cardiovasc Surg ; 158(2): 604-614.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31084984

RESUMO

OBJECTIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by one or more of the following features: intraluminal thrombus organization, fibrous stenosis, and complete obliteration of major pulmonary arteries, amenable to significant improvement by pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty, and medical treatments with vasodilators. Because treatment practices and outcomes differ in Europe versus Japan, we hypothesized that population-based characteristics of pulmonary vascular phenotypes may exist in Austria compared with Japan. The objectives of this study were to analyze clinical characteristics, hemodynamics, and PEA specimens in consecutive patients with CTEPH undergoing PEA in Austria and Japan. METHODS: Clinical features, hemodynamics, and PEA specimens were collected and analyzed in patients with CTEPH undergoing PEA, and clinical features and hemodynamics were collected and analyzed in patients with not-operated CTEPH and in patients with nonthromboembolic pulmonary arterial hypertension. RESULTS: Apart from key differences between Austrian and Japanese patients regarding body size, lung function vital capacity, cardiac output, and serum high-density lipoprotein levels, Austrian patients were more likely to be obese, have greater hematocrits and greater white blood cells counts, greater C-reactive protein levels, and significantly elevated serum myeloperoxidase levels compared with Japanese patients with CTEPH. Analysis of PEA specimens demonstrated more proximal thrombus and more fresh red thrombus components in Austrian patients. CONCLUSIONS: This study documents an inflammatory thrombotic phenotype in Austrian compared with Japanese patients with CTEPH that may be a determinant of differential treatment outcomes.


Assuntos
Hipertensão Pulmonar/etiologia , Embolia Pulmonar/complicações , Adulto , Idoso , Áustria , Doença Crônica , Endarterectomia , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/patologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Japão , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/patologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/cirurgia
17.
J Foot Ankle Surg ; 58(4): 792-794, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31010772

RESUMO

Venous thromboembolism is a condition that includes both deep vein thrombosis and pulmonary thromboembolism. Pulmonary thromboembolism is a condition that is familiar to forensic pathologists for its common cause of sudden unexpected death. Fatal pulmonary thromboembolism following deep vein thrombosis has been previously reported as a consequence of major ankle injury but not following minor ankle injury. Here, I report the case of sudden unexpected death in a 54-year-old female without known underlying risk factors for venous thromboembolism, except for a history of minor injury at her left ankle, which possibly caused local vascular wall damage with subsequent deep vein thrombosis and eventual massive pulmonary thromboembolism.


Assuntos
Traumatismos do Tornozelo/complicações , Morte Súbita/etiologia , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Autopsia , Evolução Fatal , Feminino , Veia Femoral/lesões , Veia Femoral/patologia , Humanos , Perna (Membro)/irrigação sanguínea , Pulmão/patologia , Pessoa de Meia-Idade , Embolia Pulmonar/patologia , Trombose Venosa/patologia
18.
Dis Markers ; 2019: 2324515, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30992732

RESUMO

Objective: To investigate the value of the PTX-3 test in evaluating the prognosis of acute pulmonary embolism (APE). Method: 117 APE patients were selected and divided into two groups according to plasma PTX-3 levels, including the group in which PTX - 3 ≥ 3.0 ng/mL (n = 42) and the group in which PTX - 3 < 3.0 ng/mL (n = 75). Patients were stratified into high-risk, medium-risk, and low-risk groups according to the Wells scores, and the PTX-3 levels were compared among the groups. Patients had been followed-up as well. Results: According to the Wells scores, 11 patients were classified as high-risk (9.4%) and 68 were medium-risk (58.1%), while 38 were low-risk (32.5%). The PTX-3 levels in different risk groups were statistically different (all P < 0.05). During the follow-up period, 6 deaths occurred in the group with elevated PTX-3 (≥3.0 ng/mL), while 2 deaths occurred in the group with nonelevated PTX-3 (<3.0 ng/mL). The difference between the two groups was statistically significant (P < 0.01). 13 patients were hospitalized due to recurrent pulmonary embolism, of which 12 were in the group with elevated PTX-3 (≥3.0 ng/mL), while 1 patient was in the group with nonelevated PTX-3 (<3.0 ng/mL). The difference was statistically significant (P < 0.01). Conclusion: The plasma PTX-3 level in APE patients is correlated with PE risk stratification. There is a significant correlation between PTX-3 levels and PE-related cardiac deaths, as well as the prognosis of recurrent PE. PTX-3 can be used as a clinical indicator of PE prognosis.


Assuntos
Proteína C-Reativa/análise , Embolia Pulmonar/sangue , Componente Amiloide P Sérico/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/patologia
19.
BMJ Case Rep ; 12(4)2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31028051

RESUMO

A 51-year-old man presented acutely with recurrent bouts of coughing associated with transient and brief loss of consciousness consistent with cough syncope, mild stridor and a recent history of a respiratory tract infection. A chest X-ray demonstrated tracheal narrowing. His D-dimer was negative. A non-contrast CT scan of the chest demonstrated a large retrosternal goitre causing tracheal compression, and further investigation with a contrast-enhanced CT scan of the neck and chest demonstrated an incidental finding of a large pulmonary embolus (PE). The full extent of the PE was determined through performing a CT pulmonary angiography. Doppler ultrasound demonstrated a left leg deep vein thrombosis as the primary cause of the PE. His cough syncope improved in response to anticoagulation treatment, to the point where he could be safely discharged home. He had a further significant improvement in symptoms following an elective hemithyroidectomy for retrosternal goitre.


Assuntos
Angiografia por Tomografia Computadorizada , Tosse/fisiopatologia , Bócio Subesternal/fisiopatologia , Embolia Pulmonar/fisiopatologia , Síncope/fisiopatologia , Doenças da Traqueia/fisiopatologia , Anticoagulantes/uso terapêutico , Tosse/complicações , Bócio Subesternal/complicações , Bócio Subesternal/cirurgia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Síncope/etiologia , Tireoidectomia , Doenças da Traqueia/complicações , Doenças da Traqueia/cirurgia , Resultado do Tratamento
20.
J Forensic Leg Med ; 63: 48-51, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30861473

RESUMO

Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized light.


Assuntos
Cimentos para Ossos/efeitos adversos , Morte Súbita/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Átrios do Coração/lesões , Embolia Pulmonar/patologia , Vertebroplastia/efeitos adversos , Idoso , Feminino , Corpos Estranhos/patologia , Patologia Legal , Fraturas por Compressão/cirurgia , Átrios do Coração/patologia , Humanos , Fraturas por Osteoporose/cirurgia , Polimetil Metacrilato/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA