scholarly journals Pulmonary embolism in patients with chronic hypoxemia

2010 ◽  
Vol 63 (7-8) ◽  
pp. 492-496 ◽  
Author(s):  
Lidija Ristic ◽  
Milan Rancic ◽  
Tatjana Pejcic
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Predictive Value ◽  
Diagnostic Study ◽  
Diagnostic Strategy ◽  
Radiological Findings ◽  
Group I ◽  
Perfusion Scan ◽  
Group Ii ◽  
Chronic Hypoxemia

Introduction. The aim of this prospective, originally designed, clinical - diagnostic study including 200 chronic hypoxemic patients was to assess the possibility of implementation of noninvasive diagnostic strategy and to investigate the incidence of pulmonary embolism and parameters of diagnostic accuracy of radiological findings according to Shintz criteria, echocardiography, lung perfusion scanning according to PIOPED criteria. Material and methods. The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. Results and conclusion. Out of 200 hypoxemic patients, 49 patients (24.5%) were found to have pulmonary embolism. In the group I of 100 patients (42 women and 58 men) with chronic hypoxemia and secondary erythrocytosis the diagnosis of pulmonary embolism was confirmed in 39%, that being statistically significantly different (p<0.001) from 100 patients (48 women and 52 men) in the group II with chronic hypoxemia without secondary erythrocytosis, where pulmonary embolism was found in 10% of the patients. The predictive value was positive for direct radiological signs in 92.3% of patients in the group I for PTE, for indirect ones in 74.35%, and in the group II it was positive for direct radiological signs in 60% and for indirect ones in 90%. The predictive value of perfusion scan was positive in 59% of the group I and in only 22% of the group II. The predictive value for high pressure in the pulmonary artery was positive in 93.7% of the group I and in 66.6% of the group II. The following were found to be a variable predictor: hypoxemia, enlargement of the pulmonary artery, peripheral oligemia and elevation of diaphragm. Logistic regression according to backward - conditional method showed that the chronic hypoxemic patients with secondary erythrocytosis, who had radiological sign of peripheral oligemia - Westermark sign, had 2.286 times higher probability of having pulmonary embolism than similar patients without this sign.

The Role of a Decision Rule in Symptomatic Pulmonary Embolism Patients with a Non-high Probability Ventilation-perfusion Scan

1997 ◽  
Vol 78 (02) ◽  
pp. 794-798 ◽  
Author(s):  
Bowine C Michel ◽  
Philomeen M M Kuijer ◽  
Joseph McDonnell ◽  
Edwin J R van Beek ◽  
Frans F H Rutten ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Decision Rule ◽  
Predictive Value ◽  
Patient Population ◽  
High Probability ◽  
Characteristic Curve ◽  
Stepwise Logistic Regression ◽  
Pulmonary Angiogram ◽  
Symptomatic Pulmonary Embolism ◽  
Perfusion Scan

Summary Background: In order to improve the use of information contained in the medical history and physical examination in patients with suspected pulmonary embolism and a non-high probability ventilation-perfusion scan, we assessed whether a simple, quantitative decision rule could be derived for the diagnosis or exclusion of pulmonary embolism. Methods: In 140 consecutive symptomatic patients with a non- high probability ventilation-perfusion scan and an interpretable pulmonary angiogram, various clinical and lung scan items were collected prospectively and analyzed by multivariate stepwise logistic regression analysis to identify the most informative combination of items. Results: The prevalence of proven pulmonary embolism in the patient population was 27.1%. A decision rule containing the presence of wheezing, previous deep venous thrombosis, recently developed or worsened cough, body temperature above 37° C and multiple defects on the perfusion scan was constructed. For the rule the area under the Receiver Operating Characteristic curve was larger than that of the prior probability of pulmonary embolism as assessed by the physician at presentation (0.76 versus 0.59; p = 0.0097). At the cut-off point with the maximal positive predictive value 2% of the patients scored positive, at the cut-off point with the maximal negative predictive value pulmonary embolism could be excluded in 16% of the patients. Conclusions: We derived a simple decision rule containing 5 easily interpretable variables for the patient population specified. The optimal use of the rule appears to be in the exclusion of pulmonary embolism. Prospective validation of this rule is indicated to confirm its clinical utility.

Abstract 4510: Pulmonary Hypertension before Transcatheter Aortic Valve Implantation Is Reversible and Lacks Prognostic Significance

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Abdullah M Al Ali ◽  
Brad Munt ◽  
Lukas Altwegg ◽  
Karin Humphries ◽  
Ronald Carere ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Artery ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Group Iii ◽  
Transcatheter Aortic Valve ◽  
Group I ◽  
Group Ii ◽  
One Year ◽  
Valve Implantation

The prognostic significance of pulmonary hypertension (PH) and the potential for reversibility in the setting of aortic stenosis (AS) have been debated. We examined the clinical correlates and prognostic significance of PH in high risk elderly patients with symptomatic severe AS undergoing transcatheter aortic valve implantation (AVI). AVI was performed in 143 patients. Adequate echocardiographic estimation of baseline pulmonary artery systolic pressure was available in 115 (80%). Patients were divided into 3 groups according to baseline pulmonary artery pressure estimated by transthoracic echocardiogram: I: <30 mmHg, II: 30 –50 mmHg and III: >50 mmHg. Clinical and echocardiographic follow-up was obtained at 1, 6 and 12 months after AVI. Group I consisted of 17 patients (15%), group II 58 patients (50%) and group III 40 patients (35%). At baseline the three groups were similar in terms of age, functional status, presence of severe pulmonary disease, aortic valve area and mean gradient. Patients with severe PH (group III) were more likely to have left ventricular dysfunction (LVEF <50%) than patients with mild to moderate PH (groups I and II) (52% vs. 21%, p=0.002) and had more severe mitral regurgitation (grade ≥ 3 in 68% vs. 41%, p =0.0002). At one month, systolic pulmonary artery pressure fell significantly in group III (11.0 ± 14.3 mmHg, p=0.0008) and this reduction was maintained at 6 months. However, the changes in group I (increase of 7.1 ± 8.7 mmHg, p=0.07) and group II (decrease of 0.9 ± 9.3 mmHg, p=0.53) were not significant. Mortality at one year following AVI was 21%, but was not related to severity of PH. Using group III as a reference, hazard ratios were 0.83 (95% CI: 0.24 –2.9) for group I and 0.88 (95% CI: 0.4 –1.9) for group II. In elderly patients with severe AS treated with transcatheter AVI, severe PH is associated with more depressed left ventricular function and more severe mitral regurgitation. Severe PH is associated with a significant and greater fall in pulmonary pressure following AVI and does not influence one year survival.

scholarly journals Value of ST- Segment Depression with T-Wave Inversion in Lateral Leads I, aVL, V4-V6 in Diagnosing the Left Main or Left Main Equivalent Coronary Artery Disease

2017 ◽  
Vol 9 (2) ◽  
pp. 135-141
Author(s):  
Sambhu Kumar Mallick ◽  
Mahboob Ali ◽  
Amal Kumar Chowdhury
Keyword(s):  
Coronary Artery ◽  
Predictive Value ◽  
Left Main ◽  
Stenotic Lesion ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
Group I ◽  
St Segment ◽  
Group Ii

Background: Critical stenosis in the proximal part of the left anterior descending, severe 3 vessel disease and left main stem stenosis have all been recognized as clinical conditions complicated by a high incidence of large infarction, pump failure, arrhythmias and sudden death in patients with acute coronary syndrome (ACS). As many effective treatment modes are available currently, early recognition of those circumstances is crucial for appropriate management.Methods: this observational study was carried out at the Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka. Patients (30 patients) with NSTEACS having ST-segment depression with T-wave inversion maximally in leads I,avL,V4-V6 were considered as cases (Group I) and those (30 patients) with ST-segment depression without T-wave inversion in lateral leads were controls (Group II). Coronary angiogram (CAG) was done during in-hospital stay.Results: In present study, it was evident that among group I patients, 43.3% had stenotic lesion in left main artery (LM) and 26.67% in LM equivalent coronary artery (LME CA), whereas had no stenotic lesion in LM and 3.33% had LME CA lesion in group II patients. Low cost, widely available ECG criteria is supposed to be useful predictor of left main or left main equivalent coronary artery obstruction (Sensitivity=95%, Specificity= 76%, Positive predictive value= 70.0% and Negative predictive value= 97.0%) and high ST–segment changes score (>18 mm (100%) &/or ³10mm (80%) was an additive predictor of LM or LMECA lesion.Conclusion: Maximum ST- segment depression with T-wave inversion in the lateral leads I, aVL, V4-V6 on admission ECG can predict the critical LM or LMECA obstruction in patients with NSTEACS. It can help to provide prompt and appropriate management earlier to reduce the mortality & morbidity.Cardiovasc. j. 2017; 9(2): 135-141

scholarly journals Serum Asymmetric Dimethylarginine, Nitrate, Vitamin B12, and Homocysteine Levels in Individuals with Pulmonary Embolism

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Murat Altuntaş ◽  
Figen Atalay ◽  
Murat Can ◽  
Remzi Altın ◽  
Meltem Tor
Keyword(s):  
Pulmonary Embolism ◽  
Asymmetric Dimethylarginine ◽  
Therapy Group ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Vitamin B ◽  
Group I ◽  
Thromboembolic Pulmonary Hypertension ◽  
Perfusion Defects ◽  
Group Ii ◽  
Partial Oxygen

We aimed to analyze the pre- and posttreatment serum asymmetric dimethylarginine (ADMA), nitrate (NO3), vitamin B12and homocysteine levels in pulmonary embolism (PTE) patients and to determine the prognostic value of these variables in predicting chronic thromboembolic pulmonary hypertension (CTEPH). This study was conducted in 64 patients. The patients were classified into the two groups: patients with normal pulmonary artery pressure (PAP) (group I) and patients with high PAP with persistent lung perfusion defects or who died at the end of 3 months of therapy (group II). We found statistically significant differences between two groups with respect to the partial oxygen pressure, the oxygen saturation, and the PAP, but there was no difference between the two groups with respect to the pretreatment ADMA, NO3, or homocysteine levels. The vitamin B12levels were higher in group II. The NO3levels increased and the ADMA and vitamin B12levels decreased with treatment in both groups. These results suggest that these parameters are not predictive of the development of CTEPH.

Concomitant Diagnosis of Fibromyalgia and Ankylosing Spondylitis: Relation to Clinical Features and Plasma Pentraxin -3 Level.

2021 ◽  
Vol 17 ◽  
Author(s):  
Eman Baraka ◽  
Mona Balata ◽  
Shereen Ahmed ◽  
Mona El-Blbehisy ◽  
Enas Elattar
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Clinical Features ◽  
Predictive Value ◽  
Disease Duration ◽  
Rapid Screening ◽  
Disease Assessment ◽  
Group I ◽  
Diagnostic Certainty ◽  
Group Ii

Background: Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disease that specifically affects the spine and sacroiliac joint. AS diagnosis is often delayed in the clinical practice and this delay may cause the patients to miss the chance of early treatment. Fibromyalgia (FM) is a frequently encountered clinical syndrome, fibromyalgianess is a term used when patients who are diagnosed with inflammatory arthropathies met the criteria for FM syndrome as shown in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome, and AS. Objectives: We aimed primarily to assess the frequency of concomitant diagnosis FM syndrome in AS patients and to study its impact on clinical disease aspects. Secondary, our aim extended as a preliminary pilot study to assess the PTX-3 as a potential marker for the diagnosis of FM syndrome in AS patients. Methods: Plasma PTX-3 in 61 AS patients was compared to 60 matched controls. FM was diagnosed by FM Rapid Screening Tool. Bath AS disease activity index (BASDAI) and AS disease assessment score using C- reactive protein (ASDAS-CRP), Bath AS functional impairment index (BASFI), Bath AS metrology index (BASMI), AS quality of life (ASQoL) scale, Beck Depression Inventory, and Bath AS Radiology Index (BASRI) were assessed. Results: The patients were categorized into two groups according to the concomitant diagnosis of FM syndrome. Group I included 14 (22.9%) AS patients who fulfilled the clinical diagnosis of FM syndrome. Group II included 47 (77.1%) patients without FM syndrome. AS patients with FM (Group I) had significantly(p<0.001) increased an average of ages, disease duration, diagnostic delay of AS, switching of bDMARDs, morning stiffness duration, ASDAS-CRP, BASFI, ASQoL score, BASDAI (p=0.008), and BDI score (p=0.005) compared to AS patients without FM (Group II). PTX-3 levels were significantly (p<0.001) higher in Group I (p<0.001) (median, 0.23; IQR, 0.15-0.41 ng/ml) than Group II (median, 0.13; IQR, 0.035-0.21ng/ml) which showed no significant differences (p>0.05) compared to the controls. PTX-3 levels had significant positive correlations (p<0.05) with disease duration, BASFI, and ASQOl. Age, female sex, switch of biologic, ASDAS -CRP, and PTX-3 were significant predictors of FM in AS patients. Conclusion: These results indicate that concomitant FM is a significant problem in patients with AS and its presence is associated with higher disease activity, impaired function as well as an overall negative impact on QoL. Easy scanning of suspicious cases of FM with FiRST questionnaire can be done in daily practice. PTX-3 is more or less accurate as the clinical features to improve the diagnostic certainty of FM in the presence of AS with a proven sensitivity of 62.3%, a specificity of 90 %, a positive predictive value of 82.75%, and a negative predictive value of 73.9%.

scholarly journals Clinical and laboratory evaluation of premature goat kids with and without antenatal corticotherapy

2022 ◽  
Vol 52 (7) ◽  
Author(s):  
Gabriel Isola Braga ◽  
Jefferson Filgueira Alcindo ◽  
Luis Gustavo Narciso ◽  
Fernanda Bovino ◽  
Thomas Alexander Trein ◽  
...  
Keyword(s):  
Laboratory Evaluation ◽  
Adaptation Period ◽  
Cesarean Sections ◽  
Radiological Findings ◽  
Group Iii ◽  
Ph Values ◽  
Dexamethasone Group ◽  
Group I ◽  
Group Ii ◽  
Gas Measurements

ABSTRACT: This article evaluated the vital parameters, blood gas measurements, cortisol values and radiological findings of goat kids born at term and prematurely during the first 48 hours of life. For this purpose, 24 kids from 24 goats were used and assigned to groups as follows: Group I, eight kids born through cesarean sections performed at 149 days of gestation; Group II, eight kids born through cesarean sections performed at 143 days of gestation; Group III, eight kids born through cesarean sections performed at 143 days of gestation, whose mothers received 20 mg of dexamethasone. Group I had lower heart rate values than the other groups at 60 minutes after birth. In terms of temperature, there was no difference between the groups. The pH values were reduced shortly after birth, rising at 24 and 48 hours in all animals studied. In terms of the cortisol levels, the values increased significantly at birth (M0), with the highest values obtained in animals in group II. These values decreased at 48 hours after birth in the evaluated goats. The animals belonging to group I showed better radiographic aspects, and throughout the 48 hours of evaluation, all newborns exhibited adequate respiratory adaptation. It can be concluded that antenatal dexamethasone administered at 143 days of gestation did not influence neonatal viability, metabolic or radiographic parameters. The metabolic changes found are consistent with the extrauterine adaptation period that animals in this stage of life.

Evaluation of the Learning Curve for Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerves in Thyroid Surgery*

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Krzysztof Pragacz ◽  
Marcin Barczyński
Keyword(s):  
Learning Curve ◽  
Thyroid Surgery ◽  
Predictive Value ◽  
Postoperative Function ◽  
Laryngeal Nerves ◽  
Technical Errors ◽  
Group I ◽  
Group Ii ◽  
Recurrent Laryngeal Nerves ◽  
Neural Monitoring

AbstractIntraoperative neuromonitoring facilitates identification of the recurrent laryngeal nerves (RLN) and allows for predicting their postoperative function. Nevertheless, the outcome of thyroid surgery monitoring is affected by both the experience of the operator and his mastering of the technique.was the assessment of the learning curve for intraoperative RLN neuromonitoring.. The prospective analysis included 100 consecutive thyroid operations performed by a single surgeon during implementation of RLN neuromonitoring in a district surgical ward in Staszów. RLN neuromonitoring was performed in keeping with the recommendations of the International Neural Monitoring Study Group using a C2 NerveMonitor (Inomed, Germany). The outcomes of initial 50 procedures (group I: 08/2012-07/2013) were compared with the results of subsequent 50 operations (group II: 08/2013-07/2014). The evaluation included demographic and intraoperative data along with predictive value of the method and complications.. In group II as compared to group I, a significant reduction of operative time was noted (102.1±19.4 vs 109.9±19; p=0.045), along with an increased percentage of identified RLNs (99% vs 89.2%; p=0.006), a decreased percentage of correction-requiring technical errors (8% vs 24%; p=0.029), an improved negative predictive (99% vs 89.3%; p<0.001) and positive value (75% vs 55.6%; p<0.001), as well as a decreased percentage of RLN injuries (3% vs 14%; p=0.006).. Mastering the technique of intraoperative RLN neuromonitoring in thyroid surgery requires the surgeon to perform independently approximately 50 monitored procedures, what allows for achieving the predictive value of the method that is comparable to outcomes published by referral centers.

Treatment of Severe Pulmonary Embolism by Urokinase and Lysyl-Plasminogen

1979 ◽  
Author(s):  
H. Sors ◽  
A. Venet ◽  
P. Reynaud ◽  
D. Safran ◽  
P. Cornu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Arterial Pressure ◽  
Pulmonary Emboli ◽  
Thrombolytic Treatment ◽  
Mean Pulmonary Arterial Pressure ◽  
Group I ◽  
Pulmonary Arterial ◽  
Group Ii ◽  
Vascular Obstruction ◽  
The Uk

The effects of the heparin (H)-Urokinase (UK) treatment on pulmonary emboli (PE) are limited by the rapid disappearance of the plasminogen (Pig) contained in the clots. Two groups of patients with recent PE (less than 8 days) of equal severity (as judged by angiography) have been studied: Group I (15 patients) treated by H(500 IU/kg/24h) and UK (i.v. bolus 15,000 u. CTA/kg/20min) and Group II (15 patients) receiving H and a sequential treatment with a bolus of UK followed by Lysyl-Plg infusion (300 UI/kg/6h), then by a 2nd bolus of UK and finally by a Pig loading. Angiography and catheterization were performed before and 24 hours after the treatment. The vascular obstruction (VO%) was appreciated by the UPET method. In Group II, the values before treatment were : VO 57±11% ; mean pulmonary arterial pressure (PAP) : 30±5 torrs ; cardiac index (CI) ; 2.0±0.6 I/min/m2 ; pulmonary arterial resistances (PAR) 8.4±2.7 torrs/I/min/m2 ; PaO2 : 56±7 tors. The UK + Pig treatment elicited significant changes : 50% decrease in VO and PAR, 33% decrease in PAP and 30% increase in PaO2 and CI in 24 hours. One month later, hemodynamic was normal and the residual VO was less than 15%. In Croup I the initial hemodynamic values were similar but the 24 hours decrease in VO, PAP and FAR were respectively of 30, 22 and 29%, differing significantly of the Group II (F test). After one month, the residual VO was 25%. These observations suggest that Lys-Plg loading increases significantly the efficacy of thrombolytic treatment of massive and recent PE.

scholarly journals Prediction of oesophageal varices in cirrhotic patients by measuring liver stiffness with fibroscan

2016 ◽  
Vol 6 (2) ◽  
pp. 85 ◽  
Author(s):  
Shahinul Alam ◽  
Ahmed Lutful Moben ◽  
A.K.M. Kborshed Alam
Keyword(s):  
Predictive Value ◽  
Liver Stiffness ◽  
Oesophageal Varices ◽  
Cross Sectional ◽  
Group Iii ◽  
Group I ◽  
Grade Ii ◽  
Cirrhotic Patients ◽  
Group Ii ◽  
Sensitivity Specificity

<p><strong>Background:</strong> Repeated endoscopy is required to detect &amp; follow up of esophageal varices (OV) in cirrhotic patients. <strong></strong></p><p><strong>Objective:</strong> For discomfort and unwillingness lo do the endoscopy directed us to evaluate liver stiffness measurement (LSM) for lhe prediclion ofO V. <strong></strong></p><p><strong>Methods:</strong> A cross sectional observational study was conducted between July 2010 to July 2011. A total of 50 patients with cirrhosis were divided into three groups. Group-I patients had no varix (n=4), group-II had Grade-I OV (n=23) and group-UI had Grade-II/III OV (n=23 ) at endoscopy. Liver stiffness was measured by fibroscan &amp; data was analyzed by SPSS.</p><p><strong>Results:</strong> Mean age were 35.20 ± 11.36 years with highest frequency 19 (38 %) in 21-30 years age group. Etiologies were different with leading causes includes HBV (76%) followed by HCV (6%), alcohol (2%) and 14% were unknown. Liver stiffness did not significantly differ from group-I &amp; group-II, but was signifi­cantly higher in group III than group-II &amp; group I. Liver stiffness was nol accurate in the prediction of grade-I oesophageal variees [Arca under the curve (AUC)] = 23.6%. Liver stiffness at a cut off value 32.52 kPa with sensitivity, specificity, positive predictive value, negative predictive value, accuracy respectively 82.6%, 77.8 %, 76 %, 84%, 80% can predict the Grade-II-Ill oesophageal varices (AUROC = 85.2%). <strong></strong></p><p><strong>Conclusion:</strong> Liver stiffness may be suitable for prediction of Grade-II-III oesophageal varices, not for the screening of the presence of oesophageal varices.</p>

Sign in / Sign up

Export Citation Format

Share Document