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At least 685 records · Page 38Linked to original sources
PubMed1995

[Percutaneous transthoracic needle aspiration biopsy. Diagnostic yield after negative fiberoptic bronchoscopy in patients with peripheral pulmonary infiltrations].

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB performed over a five-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytological classification of the tumour type in 72.2% (39 of 54 patients). Five of the 54 patients (9.3%) presented with small cell anaplastic bronchogenic carcinoma, diagnosed by TNB, and were treated with chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, three benign tumour, two infection, and three sequelae after pulmonary infarction. The remaining 22 patients with undiagnosed lesions were followed long term, five showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable in the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore a definitive benign diagnosis was not made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral, malignant pulmonary lesions.

Adult↗
PubMed1988

Acute right ventricular infarction secondary to massive pulmonary embolism.

Isolated right ventricular infarction has been found in cases of right ventricular hypertrophy, but there are no reports on right ventricular infarction secondary to massive pulmonary embolism. Six autopsied patients with massive pulmonary embolism and pure right ventricular infarction, suspected to be secondary to the embolism, were selected from a population of 216 autopsies. Pulmonary embolism was the suspected diagnosis in five cases due to typical clinical, electrocardiographic and haemodynamic data. Right ventricular infarction was a post-mortem finding, not previously diagnosed. In every case the thickness of the right ventricular myocardium was normal. The necrosis of the right ventricle was transmural in four cases and subendocardial in two and the entire right ventricular wall (anterolateral as well as posterior) was involved. No mural thrombi were present and in no case did the necrosis involve the left ventricle. In one case the coronary arteries were normal, in the other five significant lesions of the right or left coronary arteries were observed. These lesions may have been, in part, responsible for the necrosis of the right ventricle when the massive pulmonary embolism was added. We conclude that right ventricular infarction may be secondary to pulmonary hypertension in the setting of massive pulmonary embolism, even in the absence of right ventricular hypertrophy and with normal or stenotic coronary arteries.

Aged↗
PubMed1979

[Mural thromboses of the right heart. Clinico-pathological study].

39 instances of mural thrombosis of the right side of the heart were observed among 2000 cases of post-mortem examinations. The right atrium was the most frequent site of thrombosis; the right ventricle was involved in 8 cases. The relationships between right sided thrombosis and rhythm disturbances, myocardial or valvular disease, myocardial infarction, pulmonary disease, neoplasm, sepsis and disturbance of coagulation are discussed. The high incidence of pulmonary embolism and their relationship with thrombosis of the right side of the heart are emphasized.

Adult↗
PubMed2005

Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism.

BACKGROUND: Patients with acute pulmonary embolism (APE) present with a broad spectrum of prognoses. Computed tomographic pulmonary angiography (CTPA) has progressively been established as a first line test in the APE diagnostic algorithm, but estimation of short term prognosis by this method remains to be explored. METHODS: Eighty two patients admitted with APE were divided into three groups according to their clinical presentation: pulmonary infarction (n = 21), prominent dyspnoea (n = 29), and circulatory failure (n = 32). CTPA studies included assessment of both pulmonary obstruction index and right heart overload. Haemodynamic evaluation was based on systolic aortic blood pressure, heart rate, and systolic pulmonary arterial pressure obtained non-invasively by echocardiography at the time of diagnosis of pulmonary embolism. RESULTS: The mortality rate was 0%, 13.8% and 25% in the three groups, respectively. Neither the pulmonary obstruction index nor the pulmonary artery pressure could predict patient outcome. In contrast, a significant correlation with mortality was found using the systolic blood pressure (p<0.001) and heart rate (p<0.05), as well as from imaging parameters including right to left ventricle minor axis ratio (p<0.005), proximal superior vena cava diameter (p<0.001), azygos vein diameter (p<0.001), and presence of contrast regurgitation into the inferior vena cava (p = 0.001). Analysis from logistic regression aimed at testing for mortality prediction revealed true reclassification of 89% using radiological variables. CONCLUSION: These results suggest that CTPA quantification of right ventricular strain is an accurate predictor of in-hospital death related to pulmonary embolism.

Acute Disease↗
PubMed2000

[Intralobar sequestration of the lung in an adult (type 1 of pryce). Treatment by coil embolization].

A 34 year old patient presented with recurrent hemoptysis. A chest radiograph was normal. Helical CT angiogram of the chest with tridimensional reconstructions demonstrated an intralobar pulmonary vascular sequestration Pryce I-type of the right lower lobe. The angiography confirmed the diagnosis showing a large feeding artery arising from the coeliac trunk. An embolization of the feeding artery using metallic coils was performed. Transient pulmonary infarction occurred immediately after treatment. At two years follow-up, the patient remains asymptomatic. Percutaneous embolization of this rare pulmonary vascular malformation is an alternative to surgical treatment.

Adult↗
PubMed1998

[Role of cardiac first aid in a level-II Emergency Department].

We report our experience in the organization and management of a Cardiac First Aid Unit (CFAU) which was developed according to the guidelines of the National Hospital Cardiologists Association as a part of a General Emergency Department. The CFAU is a 24 hour service directed by a Senior Cardiologist. The medical facilities are two monitored beds for short-term observation (cardio-pulmonary resuscitation instruments, echocardiograph, endoesophageal pacing for overdrive). The main goals of CFAU are the treatment of cardiac emergencies (acute myocardial infarction, pulmonary oedema, threatening arrhythmias, etc.) and the screening of patients presenting with chest pain or symptoms suggesting cardio-vascular involvement. In one year, there were 1700 admissions to the CFAU (3.7% of the total Medical Emergencies). The frequency of hospital admissions was 81% and coronary heart disease accounted for 38.3%. A sample of 100 consecutive patients with acute myocardial infarction admitted in the period October-November 1996 was examined to explore the impact of a CFAU on in-hospital delay in the application of thrombolysis. Thirty-nine patients were treated with thrombolysis, 15 in CFAU and 24 in Coronary Care Unit (CCU). The mean in-hospital delay to thrombolysis was 30 +/- 14 minutes for those treated in CFAU and 55 +/- 12 minutes for those treated in CCU (p < 0.0004). In a second sample of 100 consecutive patients with undetermined chest pain, by means of our protocol of short observation we identified 22 cases of acute myocardial infarction (AMI), 8 cases of angina pectoris, 18 various cardiac causes, 30 non-cardiac causes, 22 absent disease. ECG was obtained in all 100 pts, cardiac enzymes in 74, echocardiogram and chest X-ray in 48, ST monitoring in 26. In no case was diagnosed AMI after discharge. Cardiac First Aid Unit, as designed in our Hospital, suits the needs of a level II Emergency Department. It is a useful tool to shorten in-hospital delay to thrombolysis and to screen chest pain with nearly complete safety.

Adult↗
PubMed1984

The complications of therapeutic plasma exchange.

We reviewed a series of 181 patients who were treated with therapeutic plasma exchange ( TPE ) a total of 1,389 times. Complications were associated with 22 (1.6%) of the procedures and involved 20 (11%) of the patients. Six of the complications were of a technical nature and did not affect the medical conditions of the patients. 8 patients developed the following serious medical problems: unexplained death during the post- TPE period, myocardial infarction, pulmonary embolus, loss of consciousness, myocardial ischemia, cerebral ischemia and chest pain. Although these problems were temporally associated with TPE none of them could be attributed to the TPE with certainty. The remaining eight medical complications were of a less serious nature.

Adolescent↗
PubMed1976

Morphological basis of radiological band shadows on chest radiographs.

Lungs of unselected cadavers were fixed at necropsy using a formalin vapour technique. "Band shadows" were identified in the excised lungs and these were correlated with in vivo radiographs and with the morphological changes in the lung. Persistent shadows were produced by pulmonary infarction, subsegmental atelectasis, and septal fibrosis singly and in combination. Potentially transient shadows were seen in association with atelectasis and pulmonary oedema.

Adult↗
PubMed1995

Diagnostic yield of transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in 103 patients with peripheral circumscribed pulmonary lesions.

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy (FOB) in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB over a 5-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytologic classification of the tumor type in 72.2% (39 of the 54 patients). Five of the 54 patients (9.3%) presented with small-cell anaplastic bronchogenic carcinoma, diagnosed at TNB, and were referred to chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, 3 benign tumor, 2 infection, and 3 sequelae after pulmonary infarction. The remaining 22 undiagnosed patients were followed up over a long period of time, 5 showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable for the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore no definitive benign diagnosis was made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral localized malignant pulmonary lesions.

Adult↗
PubMed1991

[Pathological and etiological studies on cerebral infarction in the vertebrobasilar arterial system].

25 cases of cerebral infarcts in vertebrobasilar arterial system are reported. Those were divided into 4 groups: 1. Embolism (10), the causes were NBTE, pulmonary infarct, rheumatic or congenital heart disease, coronary artery disease, respectively, and 2 unknown. 2. Thrombosis (5), the causes were arteriosclerosis, vascular malformations in the basal part of cerebrum. 3. Inflammatory infarcts (3), those were verified from tuberculosis, syphilis and aspergillosis respectively. 4. Lacunar infarcts (7), the causes were considered from hypertension. Pathologically, it was noticed that the location of embolism often situated at the terminal of basilar artery, and that if the embolism was completely obliterated, often a hemorrhagic infarction would follow. But the thrombosis in basilar artery, even the lumen was completely obliterated, any infarct would not follow, if the related collateral circulation was satisfactory. Clinically, the embolism in basilar artery often showed sudden onset, and that the symptoms of brain stem would aggravate quickly, but the thrombosis in basilar artery, if the collateral circulation was satisfactory, and symptom of brain stem might not follow.

Adult↗
PubMed1990

[Behçet's disease. 316 cases].

The authors have reviewed the records of 316 patients with Behcet's disease diagnosed between 1981 and 1989 in the Internal Medicine Department of Casablanca's University Hospital, Morocco. Males aged between 20 and 40 years (78 percent) were most frequently affected (71 percent of the cases). All patients presented with muco-cutaneous lesions, including aphthous stomatitis (100 percent) and genital ulcers (85 percent). Skin hyperirritability was present in 77 percent. Ocular lesions were frequent (72 percent) and led to blindness in 88 patients. Articular manifestations occupied third rank in our series, with 60 percent of the cases. Three patients showed polyarthritis deformans, with destructive lesions in two cases and associated with Sjögren's syndrome in one case. Thrombophlebitis was present in 69 patients (superior vena cava thrombosis in 8 patients and Budd-Chiari syndrome in one), and it was complicated by pulmonary infarction in 6 cases. Other vascular lesions included middle cerebral artery thrombosis (1 case), cerebral arterial aneurysm (1 case) and pulmonary arterial aneurysm (1 case). Neurological manifestations were present in 50 patients (16 percent), in 13 of them related to mild intracranial hypertension. Ulcerative colitis was diagnosed in 2 cases and proteinuria in 4 others, with a nephrotic syndrome in 2 cases.

Adolescent↗
PubMed1991

Pleuropulmonary complications of endoscopic variceal sclerotherapy.

The most common pulmonary complication of EVS is pleural effusion. The most clinically significant pulmonary complication of EVS is delayed perforation with formation of esophagopleural or esophagobronchial fistula. Pneumonia, empyema, pulmonary infarction, and atelectasis can also occur. Endoscopic variceal sclerotherapy probably does not cause ARDS, but that issue remains unsettled. Transient relative pulmonary hypertension during EVS is probably of no clinical significance, but caution is urged when sclerosing varices in a patient with borderline right heart function.

Esophageal and Gastric Varices↗
PubMed1992

The predictability of matched ventilation perfusion scan in pulmonary embolism.

In retrospect, we reviewed 17 cases of proven pulmonary emboli at Taichung VGH. These patients were then divided into two groups, the matched and the mismatched V/Q scan. Patients with lung consolidation, along with their chest films, were studied and characterized. In the matched V/Q group (5 cases), perfusion defects were comparable with lung consolidation in both size and location. In the V/Q mismatched group, perfusion defects were larger than lung consolidation (either single or multiple foci). A matched V/Q scan in patients with a pulmonary embolism, may result from lung consolidation induced by a pulmonary infarction, localized edema, or hemorrhage. A matched V/Q scan with localized lung consolidation in a suspicious case could not rule out pulmonary embolism, and further evaluation is mandatory.

Aged↗
PubMed2004

[A case of pulmonary embolic metastasis of choriocarcinoma presenting with multiple pulmonary infiltrative shadows].

A 34-year-old woman visited our hospital complaining of dry cough. Chest radiography and computed tomography showed bilateral multiple infiltrative shadows over the lung field. After an initial diagnosis of pneumonia, antibiotics were administered, but the therapy failed to improve the symptoms and abnormalities observed on the chest radiograph. The patient was then admitted to our hospital. The bronchoalveolar lavage fluid (BALF) was slightly bloody, but we were not able to make any specific findings in BALF. In order to confirm the pathological diagnosis, video-assisted thoracoscopic lung biopsy was performed aiming at the right middle and lower lobes. There were bleeding pulmonary infarctions in a biopsy specimen from the right middle lobe. Atypical cells positive for human chorionic gonadotropin (hCG) proliferated in the pulmonary arteries, and so a diagnosis of pulmonary embolic metastasis of choriocarcinoma was made. After the diagnosis, it became clear that urine and serum hCG values were very high. The patient has since received systemic chemotherapy in the gynecology unit at our hospital. Pulmonary embolic metastasis of choriocarcinoma diagnosed by video-assisted thoracoscopic lung biopsy has never been reported in the literature. However, early hCG measurement may have detected this syndrome in the earlier stages, and pulmonary metastasis of choriocarcinoma should be considered in the differential diagnosis of women with past pregnancy presenting with intractable multiple pulmonary shadows.

Adult↗
PubMed2003

Weekly paclitaxel plus estramustine combination therapy in hormone-refractory prostate cancer: a pilot study.

BACKGROUND: Paclitaxel used in combination with estramustine has been shown to exert synergistic cytotoxicity in patients with hormone-refractory prostate cancer (HRPC). There have been few reports of this therapy in an Asian male population. METHODS: Nine patients with progressive metastatic HRPC completed at least one cycle of combination therapy employing weekly paclitaxel plus estramustine. Paclitaxel was given weekly for 3 weeks as a 2-h intravenous infusion at a dose of 100 mg/infusion. The cycle was repeated every 4 weeks. A dose of 280 mg of oral estramustine was administrated twice daily for 21 days from the first day of each cycle. Both efficacy and toxicity were recorded. RESULTS: Grade 1 sensory neuropathy was seen in three patients (33%) and grade 4 thrombopenia/anemia was seen in one patient (11%). Performance status improved in three of seven patients (43%), while six patients (67%) showed a 50% or greater decline in prostate-specific antigen levels. Two of these patients experienced significant improvement in bone pain. One patient died of cardiac infarction during this trial and another died of disseminated intravascular coagulopathy subsequent to gastrointestinal bleeding. An additional patient suffered non-fatal pulmonary infarction. The one-year median survival rate was 22.2% and the overall survival period was 36 weeks. CONCLUSION: Although weekly paclitaxel plus estramustine may pose a significant risk, this combination may have a beneficial effect on the quality of life HRPC patients. A well-designed phase I-II trial in an Asian male population is highly recommended.

Adenocarcinoma↗
PubMed1999

[A case of preoperatively diagnosed primary pulmonary leiomyosarcoma].

A 29-year-old woman had been suffering from right back pain for 3 months. Chronic pulmonary thromboembolism was suspected and she was referred to our hospital. She presented with no risk factors for thromboembolism, and during the previous 6 months had lost 4 kg in body weight. Chest radiography showed nodular shadows in the lower field of the right lung. Contrast-enhanced computed tomography demonstrated a filling defect in the right pulmonary artery and nodular lesions in the lower field of the right lung, which were considered to be signs of pulmonary infarction. Absence of perfusion into the right lung was demonstrated by a perfusion scan. Right heart catheterization showed normal pressure in the pulmonary arteries, and pulmonary angiography showed an abrupt cutoff of the right pulmonary artery, which was similar to the finding of pulmonary thromboembolism. A transvenous catheter suction biopsy was performed in the right pulmonary artery and the histopathologic findings yielded a diagnosis of leiomyosarcoma. The patient underwent surgical resection under total cardiopulmonary bypass. A large tumor completely filled the right main pulmonary artery and invaded the posterior wall of the pulmonary trunk close to the left main pulmonary artery. Primary pulmonary leiomyosarcoma is a rare tumor and its prognosis is very poor. Radical surgical resection is the only effective treatment, but early diagnosis is very difficult. Transvenous catheter suction biopsy is a useful procedure for the early diagnosis of pulmonary artery sarcoma.

Adult↗