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PubMedDate not supplied

[Pulmonary embolism--complication of proximal deep venous thrombosis in colorectal cancer. Diagnosis and management].

We present the case of a 57 years old male, without cardiovascular history, with colorectal cancer and proximal deep venous thrombosis, who develops a massive pulmonary embolism. The surgical treatment consists in embolectomy of right ventricle, pulmonary trunk, left and right pulmonary artery. The specifics of the case is discussed: etiology and prevention of pulmonary embolism (caval filter) and treatment: the contraindications of thrombolytic therapy and the indications and perspectives of surgical treatment.

Colorectal Neoplasms↗
PubMed2005

[Interventional neuroradiologic procedures].

Intracranial aneurysms, cervical carotid stenosis and acute cerebral ischemia constitute the three main and more frequent diseases in which the endovascular approach is considered a valuable alternative to the surgical or pharmacologic treatment. With the introduction of balloon assistance techniques, even intracranial large neck aneurysms can be currently suitable to endovascular treatment. Stent angioplasty is widely used in whole Europe in the treatment of cervical carotid artery stenosis. Mechanical endovascular embolectomy techniques are actually available to be used alone or in combination with pharmacologic thrombolysis in the treatment of acute cerebral ischemia. This article discuss on the new technical possibilities concerning the endovascular approach in these aforementioned diseases.

Aneurysm, Ruptured↗
PubMed2005

Major pulmonary embolism treated with a rheolytic thrombectomy catheter.

The current treatment of massive pulmonary embolism (PE) has been either thrombolysis or surgical embolectomy. Recently, percutaneous rheolytic thrombectomy has emerged as an alternative treatment in patients with contraindications to thrombolysis. We describe a 45-year-old woman who developed major PE post-operatively, who was treated successfully with the AngioJet system. The principles of percutaneous rheolytic thrombectomy, its effectiveness and potential complications are discussed.

Angiography↗
PubMed1992

The amount of plasminogen, tissue-type plasminogen activator and plasminogen activator inhibitor type 1 in human thrombi and the relation to ex-vivo lysibility.

Thrombolytic therapy successfully reopens obstructed blood vessels in the majority of cases. However, it is not known why a substantial amount of thrombi are resistant to lysis by a fibrinolytic agent. In vitro studies have demonstrated that tissue-type plasminogen activator (t-PA) and plasminogen incorporated in the clot (during formation) increase lysibility. To test whether lysibility of in vivo formed human thrombi is related to their composition, we studied 25 venous thrombi obtained at autopsy and 21 arterial thrombi obtained during embolectomy. Plasminogen activator inhibitor-1 (PAI-1) antigen was measured in a phosphate-buffered saline (PBS) extract of each thrombus; t-PA antigen and plasminogen antigen were determined in a 6 M urea extract of the thrombus, representing bound proteins. Lysibility was measured as weight reduction during 8 h of incubation in PBS containing streptokinase (SK) 100 U/ml, corrected for spontaneous lysis, reflected by weight loss in PBS without SK. In addition, lysibility in SK was compared with lysibility in urokinase (UK) 100 U/ml and in t-PA 200 U/ml. Spontaneous lysis amounted to 29 +/- 5% (mean +/- SEM) and 33 +/- 5% in venous and arterial thrombi, respectively, and inversely correlated with the PAI-1 content of thrombi (r = -0.43, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1997

Carbon dioxide angioscopy.

Endovascular intervention has become an increasingly more popular method of diagnosing and treating vascular disease. Its expanding scope includes applications ranging from visualization of the peripheral vascular system to coronary artery interventions. This trend is primarily a result of the limitations of angiography, the current imaging standard, when compared to angioscopy. Multiple disease entities, including atherosclerotic plaque, embolic debris, and thrombus, can not be differentiated between based on angiographic appearance. Angioscopy is a more sensitive method of distinguishing between the above disease states by allowing direct visualization of the luminal surface. The significance of this distinction lies in the fact that the treatment options are notably different based upon the diagnosis. Yet another advantage of angioscopy is its therapeutic value in addition to its diagnostic abilities. Directed embolectomy, guide-wire or catheter placement, or pseudointimal resection are all possible through the angioscope at the time of diagnosis.

Journal Article↗
PubMed1992

[A surgically treated case of acute pulmonary embolism owing to deep vein thrombosis of the leg mainly caused by uterine myoma].

A 49-year-old woman with deep vein thrombosis of the left leg suddenly complained of slight dyspnea during her hospitalization. Enhanced chest CT and pulmonary arterial DSA revealed pulmonary emboli, while phlebography of the left leg and lower abdominal CT showed a uterine myoma compressing the left external iliac vein, which was regarded as a chief cause of deep vein thrombosis of the left leg. The patient became dyspneic severely with a rapid increase of pulmonary arterial pressure and a decrease of arterial oxygen pressure. Therefore, pulmonary embolectomy and deep vein thrombectomy of the left leg and pelvis was performed using a cardiopulmonary bypass. Hysterectomy was also performed after weaning the bypass. The postoperative course was uneventful without recurrence of pulmonary embolism. This was a very rare case of pulmonary embolism, because, as far as we investigated, no literature has reported deep vein thrombosis of the leg caused by uterine myoma. We emphasize the availability of the enhanced CT for diagnosis of pulmonary embolism.

Acute Disease↗
PubMed1992

Saddle embolism of aorta.

Aortic saddle embolus is a rare but serious form of arterial embolisation in patients with myocardial infarction. Four patients with aortic saddle embolism with peripheral propagation of the clott are reported. Two patients had suffered an attack of acute anterior myocardial infarction (one and four weeks respectively) prior to the embolic episode. One patient had a transmural myocardial infarct five years ago, and the 4th patient had dilated cardiomyopathy. The onset was sudden, marked by pain, parasthesias, pallor, pulselessness in three patients, and gradual in one. Two of the three patients (both females) in whom clott migration occured in only one limb developed below-knee gangrene of the affected side. In one patient (a young male) clott migration occurred in both popliteal arteries and the limbs were spared from developing gangrene although he continues to have leg angina. One patient presented with intermittent calf claudication only. All our patients reported late due to which none could be subjected to embolectomy.

Adult↗
PubMedDate not supplied

Use of Amplatzer duct occluder to close severely hypertensive ducts: utility of transient balloon occlusion.

BACKGROUND: The dividing line between a patent ductus arteriosus with severe but reversible pulmonary artery hypertension and an Eisenmenger duct remains elusive. Increasing experience with the Amplatzer duct occluder has made non-surgical closure of even large patent ductus arteriosus simple and safe. However, data on the use of this device in severly hypertensive ducti is sparse. METHODS AND RESULTS: There were six patients (2 males, 4 females), wherein transient ductal occlusion was done with an embolectomy balloon catheter. The post-occlusion hemodynamics along with overall clinical and hemodynamic assessment was used to decide the likelihood of benefit of closure and the choice of the device. In four of six patients of patent ductus arteriosus with severe pulmonary artery hypertension (pulmonary vascular resistance index> 8.0 U/m2) the duct was successfully closed using the Amplatzer duct occluder, while in two an Amplatzer ventricular septal defect occluder was used. CONCLUSIONS: Transient balloon occlusion is quite helpful for assessing patients with patent ductus arteriosus with severe pulmonary hypertension, and short-term non-invasive follow-up has shown this strategy to be safe and useful.

Adult↗
PubMed1992

[Transesophageal echography and peripheral arterial embolism. A new etiologic approach. Apropos of 87 cases].

This prospective study (September 1989 to November 1990) was undertaken to evaluate the utility of transesophageal echocardiography in acute peripheral ischaemic syndromes. After embolectomy or thrombolysis, 87 patients with an average age of 69.7 years underwent not only the usual investigations (conventional echocardiography, abdominal ultrasonography and Holter monitoring) but also transesophageal echocardiography within 2 days of the ischaemic events (lower limb 84%, multiple embolism 11%, recurrent embolism 13%). Atrial fibrillation was documented in 44 patients (50.5%), 19 patients had chronic arterial disease (22%), 8 patients had valvular heart disease (9%) and 2 patients had a blood disorder (2%). Transthoracic echocardiography only demonstrated one left ventricular apical thrombus whereas transesophageal echocardiography showed residual thrombus in 22 patients (25%) mainly in the left auricle but also in the descending thoracic aorta (8 patients) as a mobile, pediculated thrombus or lining an aortic aneurysm, thereby opening up new therapeutic possibilities. In addition, double aortic dissection was diagnosed in a patient who was not echogenic, isolated spontaneous contrast in 20 patients (23%) and other abnormalities in 7 patients (8%). Statistical analysis showed a significant relationship between the presence of thrombus and/or spontaneous contrast in the left atrium and/or left auricle and the size of the left atrium (Fisher test - p = 0.0073), and the presence of a supraventricular arrhythmia (chi 2 test).

Adult↗
PubMed1991

Human endothelial cells are stimulated and vascular smooth muscle cells are inhibited in their proliferation and migration by heparins.

The actions of two natural heparins and a semi synthetic low molecular weight heparin with low anticoagulant activity have been studied on the migration and proliferation of human vascular endothelial and vascular smooth muscle cells in vitro. In a migration assay non irradiated confluent cultures of endothelial cells and smooth muscle cells were "wounded" with a sharp razor blade in such a way, that the migration of individual cells from the wound edge into a region void of cells could be measured. The maximum distance migrated (perpendicularly to the wound edge) three days after wounding, was taken as an index for migratory activity. All tested heparins reduced migration of vascular smooth muscle cells and enhanced migration of vascular endothelial cells in a concentration dependent manner. Cell proliferation was studied in clone culture. All heparins tested were found to inhibit smooth muscle cell growth. The number of clones, as well as the size of single clones, were smaller with increasing concentrations of natural and low molecular weight heparin. The endothelial cells, however, exhibited contrary responses; with increasing concentrations of heparin, the cloning efficiency and the cell number of individual endothelial cell clones increased. This opposite effects of natural heparins and low molecular weight heparin could be of importance in preventing secondary stenosing intimal proliferations after angioplasty, bypass operation and embolectomy or even atherogenesis. Since the low molecular weight heparin has only a low anticoagulatory activity, it may be more appropriate than natural heparins for long term therapy to prevent artery stenoses caused by intimal SMC proliferation.

Cell Division↗
PubMed1991

Alpha 1-receptor antagonists urapidil and prazosin inhibit neointima formation in rat carotid artery induced by balloon catheter injury.

Sympathetic nerves and catecholamines seem to have a trophic influence on vascular smooth muscle cells in vivo. We therefore tested whether alpha 1-antagonists would inhibit proliferation in arterial smooth muscle in vivo. Smooth muscle cells were stimulated to form a neointima in rat carotid arteries after deendothelialization by means of a 2F embolectomy catheter. The development of intimal lesions was determined 14 days after injury. The size of the neointima was measured using two parameters. Intimal DNA content was estimated from 5-mm segments of carotid arteries after DNA extraction and staining with Hoechst-stain. The size of the neointima was determined morphometrically as intimal area in histological cross-sections. Prazosin and urapidil were given orally once per day. Urapidil-treated rats showed significant inhibition of neointima formation for both parameters in a dose-dependent fashion. For prazosin a significant reduction could only be observed if DNA content was considered.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Combined thrombolysis and inferior vena caval interruption as a therapeutic approach to massive and submassive pulmonary embolism.

BACKGROUND: Massive and a submassive pulmonary embolism (PE) is a life-threatening emergency. This condition is usually treated urgently with measures to attain hemodynamic stability and anticoagulation. In selected subjects, thrombolysis, inferior vena caval interruption and embolectomy have been used. We report a consecutive case series of subjects with massive and submassive pulmonary embolism treated with both inferior vena caval interruption and thrombolysis. METHODS: Chart review of consecutive cases of massive and submassive pulmonary embolism treated with both inferior vena cava filter placement and thrombolysis. Hospital course was reviewed and subjects were followed up six months after the acute event. Complications as a result of therapy were documented. RESULTS: Sixteen subjects were identified. Ten (62.5%) subjects were categorized as submassive and six subjects (37.5%) were categorized as massive. There was no attributable mortality to PE or its treatment. Minor bleeding was seen in the majority of subjects (75 %) but major bleeding was seen in only one (6.25%) subject. Other complications were not encountered. No recurrent thromboembolic events were clinically evident during a six-month follow-up period. CONCLUSIONS: The combination of inferior vena caval interruption and thrombolysis seems safe and effective for the treatment of PE. This modality was not associated with mortality in any of our patients. The only complication encountered was bleeding primarily at the sites of vascular access. We conclude that combined vena caval interruption and thrombolysis is a safe means of treating potentially life-threatening pulmonary embolism.

Aged↗
PubMed2006

Complications relating to intravenous buprenorphine abuse: a single institution case series.

INTRODUCTION: We present a retrospective descriptive study of cases admitted to Tan Tock Seng Hospital from March 2005 to October 2005 with complications of Subutex abuse. CLINICAL PICTURE: A total of 8 patients were studied. Of the 8, 7 were male and one was female. Their complications consist of the following: arterial pseudoaneurysm (2), arterial pseudoaneurysm with infective venous thrombus (1), infective venous thrombus (1), venous thrombus (2), end arterial spasms (1) and sympathetic dystrophy (1). TREATMENT: For the patient who presented with buprenorphine-associated neuropathy, non-operative treatment with analgesics was given. Conservative medical therapy involving deep venous thrombosis treatment was instituted for the patient with deep venous thrombosis. Repair, restorative bypass and embolectomy surgery were performed for patients who had severe embolic/thrombotic complications. One of the patients who received the above surgery required amputation of his lower limb. OUTCOME: Of the 8 patients, 4 were treated medically, 3 required surgery and 1 required amputation. Their recoveries were uneventful. Of the 8, 1 absconded and was not followed up with. CONCLUSION: Parenteral injection of buprenorphine can cause a wide range of vascular complications from simple vascular irritation to severe infective thrombosis and pseudoaneurysms requiring limb amputations. Non-sterile preparation of an injected substance or non-sterile injection sites and the repeated punctures of major vessels are possible culprits in those who are seen to have acute infection of injection sites.

Abscess↗
PubMedDate not supplied

[Friedrich Trendelenburg (1844 - 1924)--life and work].

LIFE: Friedrich Trendelenburg was born on 24th of May, 1844 in Berlin, where he completed his early education. When he was 17 years old, he went to Glasgow where he met Allen Thompson and Joseph Lister, who introduced him with the world of medicine. After his return to Berlin, he entered medical studies, which he finished at the age of 22. Ludwig Traube and Bernhard von Langenbeck had the greatest influence on his professional career. Just like his teacher Langenbeck, he helped in creating many great surgeons, among them the most famous were Willy Meyer and Martin Kirschner. CONTRIBUTIONS: Friedrich Trendelenburg is best remembered for the Trendelenburg position in which the patient is placed on a bed for diagnostic and therapeutic procedures. He was the first one who performed endotracheal anesthesia, the first one who proposed pulmonary embolectomy and successfully performed ligation of the great saphenous vein for the treatment of varicose veins. Urology was also a field of his interest, where he did a great tribute. He died in 1924, when he was 80 years old.

General Surgery↗
PubMed2006

[The role of polymorphonuclear cells in lung ischemia-reperfusion injury in a canine model of pulmonary thromboembolism].

OBJECTIVE: To explore the effects of polymorphonuclear cells (PMN) on lung ischemia-reperfusion (I/R) injury in a canine model of pulmonary thromboembolism. METHODS: Fifteen dogs were divided into three groups: a sham group (n = 5), an ischemia group (n = 5) and a reperfusion group (n = 5). PMN in the whole blood were isolated with density gradient centrifugation. Apoptosis rates of the PMN was measured through flow cytometer after the cells were labeled by Annexin V-FITC before embolectomy and at 2, 4, 6 h after the operation. The myeloperoxidase (MPO) concentrations in lung homogenates were measured by ELISA. Alveolar PMN in the reperfusion lobar were observed by optical microscopy. The lung ultrastructure was studied by transmission electron microscopy. RESULTS: Alveolar PMN infiltration and the concentrations of MPO in the reperfusion group were significantly higher than those in the ischemia group (PMN (31 +/- 11) vs (8 +/- 4)/ten high power fields, MPO (11.7 +/- 1.6) vs (9.1 +/- 0.5) microg/L, P < 0.05). In the reperfusion group, abundant inflammatory cell infiltration was observed, predominantly with PMN in the alveoli. Apoptosis rates of the blood PMN at 6 h after reperfusion were much lower than before reperfusion (3.0 +/- 2.5)% vs (7.4 +/- 4.5)%, P < 0.05). At 4 and 6 h after operation, the PMN apoptosis rates in the reperfusion group were significantly lower than the ischemia group (4 h: (4.8 +/- 2.6)% vs (9.3 +/- 2.0)%, 6 h: (3.0 +/- 2.5)% vs (8.0 +/- 1.6)%, P < 0.05). PMN attaching firmly to the alveolar septum were observed by electron microscope. CONCLUSION: PMN with enhanced activities and decreased apoptosis rate, are involved in the cellular mechanisms of the lung I/R injury in this model of pulmonary thromboembolism.

Alveolar Epithelial Cells↗
PubMed2006

[Acute popliteal arterial occlusion during extracorporeal circulation].

A 79-year-old man underwent aortic arch replacement for thoracic aortic aneurysm. He had a history of smoking, coronary stenting for ischemic heart disease and replacement with artificial blood vessel for abdominal aortic aneurysm. Anesthesia was induced and maintained with midazolam, fentanyl, sevoflurane, and vecuronium. A 20 gage catheter was placed in the right radial artery and a 22 gage catheter in the left posterior tibial artery. Total circulatory arrest under profound hypothermia and retrograde cerebral perfusion were performed using extracorporeal circulation. After finishing anastomosis with artificial blood vessel, he was weaned from extracorporeal circulation. The pressure in the left posterior tibial artery was maintained at 15 mmHg, although the blood pressure in the right radial artery increased gradually. Then, the pressure in the left femoral artery in the operative field was the same as the pressure in the right radial artery. Therefore, we suspected the arterial line occlusion of the left posterior tibial artery. After the operation, we found the left leg and foot pale and cold with no pulsation on the left popliteal, dorsal pedis, and posterior tibial arteries. Further, acute left popliteal arterial occlusion was assessed by means of Doppler and left lower extremity angiography. We immediately performed the balloon-catheter embolectomy. However, as he developed compartment syndrome on the left lower limb due to reperfusion injury postoperatively, fascitomy was performed. On the 58th postoperative day, he was discharged from our hospital. Measurement by Doppler is useful for the early diagnosis of the lower leg arterial occlusion.

Aged↗
PubMed2006

Percutaneous thrombectomy for pulmonary embolism.

The current treatment of massive pulmonary embolism (PE) has been either thrombolysis or surgical embolectomy. Percutaneous rheolytic thrombectomy, however, has emerged as an alternative treatment in patients with contraindications to thrombolysis. This case illustrates the usefulness of the AngioJet(R) thrombectomy catheter in patients with contraindications to thrombolytics. Three-dimensional computed tomography imaging demonstrated the effectiveness of treatment in this patient with massive PE.

Aged↗

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