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1.
Medicine (Baltimore). 2018 Oct;97(40):e12710. doi: 10.1097/MD.0000000000012710.

Curative resolution of chronic thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy in primary antiphospholipid syndrome: A case report.

Author information

1
Department of Rheumatology.
2
Department of Medicine, Peking Union Medical College Hospital.
3
Department of Cardiology.
4
Department of Cardiac Surgery, Fu Wai Hospital, Chinese Academy of Medical Science, Beijing, China.

Abstract

RATIONALE:

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of antiphospholipid syndrome (APS). Once diagnosed, the recommendation for the treatment of CTEPH is long-term anticoagulation and pulmonary thromboendarterectomy (PTE). However, cardiac surgeons apply PTE cautiously for these patients, as there is an increased risk of perioperative complications. Here, we present the curative case of a patient with severe APS-associated CTEPH treated with PTE.

PATIENT CONCERNS:

A 29-year-old man presented with chest pain, decreased exercise capacity, dyspnoea, and haemoptysis.

DIAGNOSES:

He was triple positive for antiphospholipid antibodies. Computed tomography pulmonary angiography revealed multiple, recurrent pulmonary embolisms and complete obstruction of the left pulmonary artery. He was diagnosed with APS and CTEPH.

INTERVENTIONS:

After balancing the risk of thrombosis and haemorrhage, the patient underwent PTE.

OUTCOMES:

The patient experienced symptom relief after PTE, and electrocardiography at a six-month follow-up showed a recovery of cardiac structure and pulmonary arterial pressure.

LESSONS:

After evaluating the thrombosis risk at an experienced treatment centre and the application of standard anticoagulation treatment, PTE may be a curative resolution for APS-associated CTEPH.

PMID:
30290671
DOI:
10.1097/MD.0000000000012710
[Indexed for MEDLINE]
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2.
Medicine (Baltimore). 2018 Sep;97(39):e12546. doi: 10.1097/MD.0000000000012546.

A rare myxoma-like right atrial thrombus causing syncope: A case report.

Author information

1
Department of Respirology.
2
Department of Cardiology, Maoming People's Hospital, Maoming, China.

Abstract

RATIONALE:

Syncope is a complicated clinical condition involving various diseases. Syncope due to myxoma-like right atrial thrombus is rarely seen in patient without structural heart disease.

PATIENT CONCERNS:

A 61-year-old ambulant old male visited our emergency department for sudden syncope.

DIAGNOSES:

After the exclusion of neurological and coronary diseases, a right atrial block mass with a stalk connected to the atrial septum was accidentally found by echocardiography. Pulmonary embolism was subsequently revealed by computed tomographic pulmonary angiography. Atrial myxoma was initially suspected and surgical removal was conducted. Surprisingly, histological examination showed that the pedicled block mass was actually thrombus.

INTERVENTIONS:

The myxoma-like right atrial thrombus and the emboli in the bilateral pulmonary trunks were resected. This patient received anticoagulant treatment with warfarin for 6 months additionally.

OUTCOMES:

The patient was successfully discharged and being continually followed.

CONCLUSION:

This patient had a past medical history of right femoral neck fracture, which might be responsible for the formation of the myxoma-like right atrial thrombus. We should always consider echocardiography examination in syncope patient at risk of thrombus formation.

PMID:
30278549
PMCID:
PMC6181484
DOI:
10.1097/MD.0000000000012546
[Indexed for MEDLINE]
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3.
Medicine (Baltimore). 2018 Sep;97(37):e12169. doi: 10.1097/MD.0000000000012169.

Possibility of venoarterial extracorporeal membranous oxygenator being a bridging therapy for hemodynamic deterioration of pulmonary tumor thrombotic microangiopathy prior to initiating chemotherapy: A case report.

Author information

1
Emergency and Critical Care Center, Mie University Hospital.
2
Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University.
3
Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Abstract

RATIONALE:

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but lethal complication of carcinoma, defined as non-occlusive pulmonary tumor embolism complicated by fibrocellular intimal proliferation of the small pulmonary arteries, with eventual occlusion of the pulmonary arteries. Hemodynamic deterioration caused by this condition leads to high mortality.

PATIENT CONCERNS:

A 46-year-old woman who had undergone radiation therapy for anaplastic oligoastrocytoma and who was taking temozolomide presented with cough and palpitations.

DIAGNOSES:

A 12-lead electrocardiogram showed sinus tachycardia and SIQIII TIII, with negative T in V1-3. Ultrasound cardiography showed a distended right ventricle. Enhanced chest computed tomography showed no significant thrombus in the major pulmonary artery. The patient's condition deteriorated the next morning, with her blood pressure decreasing to 40 mmHg and her SpO2 unmeasurable. She suffered cardiac arrest.

INTERVENTIONS:

We initiated venoarterial extracorporeal membranous oxygenation (VA-ECMO) and her blood pressure increased to 80 mmHg. Her hemodynamic status stabilized and she was weaned off VA-ECMO on intensive care unit (ICU) day 3.

OUTCOMES:

Gastroesophageal endoscopy on ICU day 4 revealed gastric cancer (Borrman type IV), and she arrested again and died on ICU day 5. Autopsy confirmed gastric cancer and PTTM.

LESSONS:

VA-ECMO rapidly stabilized the hemodynamic status of this patient with PTTM, and may thus be a possible bridging therapy for deterioration of PTTM prior to initiating imatinib.

PMID:
30212945
DOI:
10.1097/MD.0000000000012169
[Indexed for MEDLINE]
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4.
Medicine (Baltimore). 2018 Aug;97(35):e12104. doi: 10.1097/MD.0000000000012104.

Trends in the use of echocardiography in pulmonary embolism.

Author information

1
Department of Cardiology, Lehigh Valley Hospital Network, Allentown, PA.
2
Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Abstract

Pulmonary embolism (PE) is a devastating diagnosis which carries a high mortality risk. Echocardiography is often performed to risk stratify patients diagnosed with PE, and guide management strategies. Trends in the performance of echocardiography among patients with PE and its role in influencing outcomes is unknown.We analyzed the 2005 to 2014 National Inpatient Sample Database to identify patients with primary diagnosis of PE or secondary diagnosis of PE and ≥1 of the following diagnoses: syncope, thrombolysis, acute deep vein thrombosis, acute cardiorespiratory failure, and secondary pulmonary hypertension. Trends in the performance of echocardiography and in-hospital mortality were analyzed. The admissions were divided into 2 groups with echocardiography, and without echocardiography, and 1:2 propensity score matching (PSM) was performed for comparison. The primary end-point was in-hospital mortality. The secondary endpoints were length of stay and total hospitalization costs. Odd ratios (OR) with confidence intervals (CI) were reported.A total of 299,536 unweighted PE cases were studied. Performance of echocardiography among patients with PE patients increased from 3.5% to 5.6%, whereas in-hospital mortality decreased from 4.2% to 3.7% between years 2005 and 2014. Before matching, patients who received an echocardiogram were more likely to be younger, African American, admitted to a large, urban teaching institute, and had higher rates of concurrent acute deep vein thrombosis, and acute respiratory failure. Post-PSM, patients who received echocardiography during hospitalization had lower in-hospital mortality (odds ratio 0.75, 95% confidence intervals (CI) 0.68-0.83; P < 0.001), longer length of stay (median 6 days vs 5 days; P < .001) and higher mean hospitalization costs ($34,379 vs $27,803; P < .001) compared to those without echocardiography.Performance of echocardiography among patients with a PE is increasing and is associated with lower in-hospital mortality.

PMID:
30170434
DOI:
10.1097/MD.0000000000012104
[Indexed for MEDLINE]
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5.
Pan Afr Med J. 2018 May 8;30:14. doi: 10.11604/pamj.2018.30.14.15397. eCollection 2018.

A child with fever, cough and Lancisi's sign.

Author information

1
Anesthesia-Resuscitation Department, Percy Army Training Hospital, Clamart, France.
2
Paris Fire Department, Paris, France.

KEYWORDS:

Lancisi´s sign; endocarditis; septic pulmonary emboli

PMID:
30167042
PMCID:
PMC6110539
DOI:
10.11604/pamj.2018.30.14.15397
[Indexed for MEDLINE]
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6.
Int Heart J. 2018 Sep 26;59(5):1186-1188. doi: 10.1536/ihj.17-660. Epub 2018 Aug 29.

Clinically Worsening Chronic Thromboembolic Pulmonary Hypertension by Riociguat After Balloon Pulmonary Angioplasty.

Author information

1
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
2
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo.
3
Department of Advanced Translational Research and Medicine in Management of Pulmonary Hypertension, Graduate School of Medicine, The University of Tokyo.

Abstract

Riociguat, a soluble guanylate cyclase stimulator, induces pulmonary artery dilatation through blood flow and is effective in treating chronic thromboembolic pulmonary hypertension (CTEPH). There are two types of vasculopathies in CTEPH based upon its location, in other words, proximal or distal to the thrombus-medicated obstruction. Distal vasculopathy is characterized by intrapulmonary shunts due to diminished blood flow. While other therapeutic interventions for CTEPH including pulmonary endarterectomy and balloon pulmonary angioplasty achieve reperfusion to the distal vasculopathy vessels, the effects of riociguat on distal vasculopathy vessels remain undetermined. Herein, we describe a case of a 66-year-old woman who exhibited deterioration of mean pulmonary artery pressure and exercise tolerance after a 4-month treatment with riociguat. She received balloon pulmonary angioplasty prior to riociguat administration. Her lung perfusion scintigraphy and pulmonary angiography findings did not change over the course of treatment. Notably, after the discontinuation of riociguat, her clinical values returned to their levels prior to riociguat administration. Her intrapulmonary shunt ratio followed a similar course as her hemodynamic status. We demonstrate that riociguat can deteriorate hemodynamic status, which may mediate the dilatation of intrapulmonary shunts. We should perform close monitoring of symptoms and hemodynamic status after riociguat administration, especially in patients in whom the reperfused DVs occurred due to invasive treatment.

KEYWORDS:

Distal vasculopathy; Inappropriate vasodilation; Intrapulmonary shunt

PMID:
30158388
DOI:
10.1536/ihj.17-660
[Indexed for MEDLINE]
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7.
Respir Investig. 2018 Sep;56(5):399-404. doi: 10.1016/j.resinv.2018.05.005. Epub 2018 Aug 17.

The sensitivities and prognostic values of the Wells and revised Geneva scores in diagnosis of pulmonary embolism in the Japanese population.

Author information

1
Department of General Internal Medicine, Akashi Medical Center, Japan. Electronic address: maru-tkb@umin.ac.jp.
2
Department of Respiratory Medicine, Akashi Medical Center, Japan.
3
Department of General Internal Medicine, Akashi Medical Center, Japan.

Abstract

OBJECTIVE:

To assess the sensitivities of the Wells score (WS) and the revised Geneva score (RGS) and their prognostic values in the diagnosis of pulmonary embolism (PE) in the Japanese population.

METHODS:

We conducted a retrospective chart review of patients with PE aged 16 years or older who were assessed between December 2008 and August 2014. Patients were divided into the PE unlikely and PE likely groups according to the WS and PE unlikely and PE likely groups according to the RGS. We also described the characteristics and three-month mortality of the patients. Univariate predictors with p < 0.05 were included in the multiple regression model. Fisher׳s exact test and Student׳s t-test were used for categorical and continuous variables, respectively.

RESULTS:

PE was confirmed in 53 patients, and seven (13%) patients died within 3 months. The mean age was 66.0 ± 14.4 years. There were 32 female patients (60.4%). The RGS had a higher sensitivity than the WS (20.8% vs. 15.1%, P <0.01), although both scores had low yields. Mortality rate was significantly higher in patients with syncope than in those without (33.3% vs. 7.3%, respectively; P = 0.039). After age and sex adjustments, the presence of syncope showed a statistically significant association with mortality. The mortality rate did not significantly differ between the two groups categorized according to the WS (17.4% vs. 0%; P = 0.58) and RGS (21.7% vs. 14.3%; P = 1.00).

CONCLUSION:

WS and RGS had low sensitivity in the diagnosis of PE and had limited prognostic values in a Japanese community hospital setting. Promoting awareness about the risk of mortality in patients with PE, especially those with syncope, is necessary.

KEYWORDS:

Clinical Prediction Rules; Japanese; Pulmonary embolism; Syncope

PMID:
30126774
DOI:
10.1016/j.resinv.2018.05.005
[Indexed for MEDLINE]
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8.
Acta Cir Bras. 2018 Jul;33(7):577-587. doi: 10.1590/s0102-865020180070000003.

The effects of inhaled NO on plasma vasoactive factor and CTnI level in rabbits with acute massive pulmonary embolism1.

Author information

1
PhD, Department of Respiratory Medicine, Affiliated Zhou Pu Hospital, Shanghai Health Medical College, China. Conception of the study, technical procedures, manuscript writing, critical revision.
2
Master, Department of Respiratory Medicine, Affiliated Hospital, Hebei University, Baoding, China. Technical procedures, analysis of data, manuscript writing.
3
Bachelor, Department of Respiratory Medicine, Affiliated Hospital, Hebei University, Baoding, China. Technical procedures, chart making.
4
Bachelor´s degree, Department of Neurology, Affiliated Zhou Pu Hospital, Shanghai Health Medical College, China. Acquisition and interpretation of data.

Abstract

PURPOSE:

To investigate changes in the plasma concentrations of cardiac troponin I (CTnI), thromboxane A2 (TXA2), prostaglandin I2 (PGI2) and endothelin-1 (ET-1) in rabbits with massive pulmonary embolism (AMPE) and the impact of nitric oxide inhalation (NOI) on these indices.

METHODS:

A total of 30 Japanese rabbits were used to construct an MPE model and were divided into 3 groups equally (n=10), including an EXP group (undergoing modeling alone), an NOI group (receiving NOI 2 h post-modeling) and a CON group (receiving intravenous physiological saline).

RESULTS:

In the model group, plasma concentration of CTnI peaked at 16 h following modeling (0.46±0.10 µg/ml) and significantly decreased following NOI. Plasma levels of TXB2, PGI2 and ET-1 peaked at 12, 16 and 8 h following modeling, respectively, and significantly decreased at different time points (0, 2, 4, 8, 12, 16, 20 and 24 h) following NOI. A significant correlation was observed between the peak plasma CTnI concentration and peak TXB2, 6-keto prostaglandin F1α and ET-1 concentrations in the model and NOI groups.

CONCLUSION:

Increases in plasma TXA2, PGI2 and ET-1 levels causes myocardial damage in a rabbit model of AMPE; however, NOI effectively down regulates the plasma concentration of these molecules to produce a myocardial-protective effect.

[Indexed for MEDLINE]
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9.
Can Assoc Radiol J. 2018 Aug;69(3):328-337. doi: 10.1016/j.carj.2018.03.005. Epub 2018 Jun 28.

Imaging of Pulmonary Embolus: Thrombotic, Nonthrombotic, and Mimickers.

Author information

1
Department of Radiology, University of Montreal, Montreal, Quebec, Canada.
2
Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada.
3
Department of Radiology, University of Montreal, McGill University, Montreal, Quebec, Canada. Electronic address: josephine.pressacco@umontreal.ca.

Abstract

Pulmonary embolism is a common and potentially fatal pathological condition. Imaging plays a crucial role in the diagnosis and differentiation of the causes of pulmonary embolus. Here we present typical imaging findings associated with both thrombotic and nonthrombotic pulmonary emboli, as well as their potential mimickers.

KEYWORDS:

Nonthrombotic pulmonary embolus; Pulmonary embolus; Pulmonary embolus mimickers; Thrombotic pulmonary embolus

PMID:
30078400
DOI:
10.1016/j.carj.2018.03.005
[Indexed for MEDLINE]
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10.
Medicine (Baltimore). 2018 Aug;97(31):e11754. doi: 10.1097/MD.0000000000011754.

Risk factors and treatment of venous thromboembolism in perioperative patients with ovarian cancer in China.

Author information

1
Department of Obstetrics and Gynecology, Shengli Oilfield Central Hospital, Dongying.
2
School of Nursing, Heze Medical College, Heze.
3
Department of Obstetrics and Gynecology, Qilu Hospital.
4
Qilu Medical College, Shandong University, Ji'nan, Shandong, PR China.

Abstract

The aim of this study was to assess the major risk factors for venous thromboembolism (VTE) in Chinese patients with ovarian cancer and to explore optimal methods of prophylaxis and treatment.A retrospective analysis of patients from Qilu Hospital of Shandong University was conducted from January 1, 2014, to January 1, 2017. We analyzed 388 patients who underwent surgery with a final diagnosis of ovarian cancer, of whom 35 developed VTE. Risk factors for preoperative and postoperative VTE were investigated. Preoperative patients with VTE were treated with anticoagulant therapy; chemotherapy with carboplatin paclitaxel was administered for 2 or 3 courses before cytoreductive surgery.Fifteen patients were diagnosed with preoperative VTE and 20 with postoperative VTE. Eight of these 35 patients were also diagnosed with pulmonary embolism (PE), and 1 patient died. Univariate analysis showed differences in age, preoperative D-dimer value, platelet count, preoperative chemotherapy, operative time, and cardiovascular disease according to the presence or absence of VTE. In multivariate analysis, age 55 years and older, tumor diameter greater than 10 cm, preoperative platelet count greater than 300  × 10/L, and a D-dimer value greater than 0.5 μg/mL were independent risk factors for preoperative VTE, whereas a D-dimer value greater than 0.5 μg/mL and surgery time greater than 150 minutes were independent risk factors for postoperative VTE. Four preoperative patients with PE who underwent treatment with anticoagulant therapy and chemotherapy with carboplatin paclitaxel had disappearance of signs of PE and their ascites and mass sizes decreased substantially, leading to subsequent optimal cytoreduction.Preoperative screening and perioperative preventive measures should be taken in gynecological oncology surgery, especially when patients have risk factors identified in this study. For patients with ovarian cancer who have been diagnosed with thrombosis before surgery, adjuvant chemotherapy and anticoagulant drugs can be used to control the progression of thrombosis and cancer.

PMID:
30075594
PMCID:
PMC6081089
DOI:
10.1097/MD.0000000000011754
[Indexed for MEDLINE]
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11.
Tex Heart Inst J. 2018 Jun 1;45(3):182-185. doi: 10.14503/THIJ-17-6316. eCollection 2018 Jun.

Impella RP Support and Catheter-Directed Thrombolysis to Treat Right Ventricular Failure Caused by Pulmonary Embolism in 2 Patients.

Abstract

Right ventricular failure secondary to pulmonary embolism is associated with morbidity and death. The Impella RP System has often been used for percutaneous mechanical circulatory support in patients with right ventricular failure from other causes, including myocardial infarction, cardiac surgery, and left ventricular assist device implantation. We report 2 cases of massive pulmonary embolism in which combined Impella RP use and ultrasound-assisted catheter-directed thrombolysis effectively treated shock caused by right ventricular failure and contributed to successful outcomes. To our knowledge, only one other patient with this indication had been treated with the Impella RP device.

KEYWORDS:

Catheterization, peripheral/instrumentation; combined modality therapy; equipment design; heart-assist devices; pulmonary embolism/complications/therapy; recovery of function; thrombolytic therapy; treatment outcome; ultrasonic therapy/instrumentation; ventricular dysfunction, right/physiopathology/therapy

PMID:
30072860
PMCID:
PMC6059497
DOI:
10.14503/THIJ-17-6316
[Indexed for MEDLINE]
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12.
Pol Merkur Lekarski. 2018 Jun 27;44(264):280-283.

[Zatorowość płucna wysokiego ryzyka powikłana nagłym zatrzymaniem krążenia i udarem mózgu - opis przypadku].

[Article in Polish]

Author information

1
Independent Public Health Care Center Voivodship Emergency Service Station in Bialystok; The Independent Public Health Care Center Provincial Hospital Complex them. Jędrzej Śniadecki in Bialystok, Hospital Emergency Department.
2
Independent Public Health Care Center Voivodship Emergency Service Station in Bialystok.
3
Independent Public Health Care Center. Provincial Integrated Hospital. Jędrzej Śniadecki in Białystok, Department of Anaesthesiology and Intensive Care.
4
Medical University of Bialystok, Department of Emergency Medicine and Disaster.

Abstract

The pulmonary embolism is caused by the sudden occlusion or narrowing of the pulmonary artery or its branches through the emboli and it is the third cause of death due to cardiovascular diseases. This disease is characterized by multiple complications, among others, the sudden cardiac arrest or stroke. The success in treatment of pulmonary embolism depends on the early disease diagnosis and a valid therapeutic procedure. The aim of this paper is to discuss the diagnostic and therapeutic procedure in pulmonary embolism, based on the case report of 65-year-old patient with high risk pulmonary embolism complicated with sudden cardiac arrest and stroke. In this paper, the authors prove that proper pre-hospital diagnosis, rapid transport by emergency medical team to appropriate medical center, organization of an emergency department team, a cardiologist and the proper treatment significantly increases the chance of survival and return to full recovery of patients with pulmonary embolism at high risk.

KEYWORDS:

emergency medical team; pulmonary embolism; thrombolytic therapy

PMID:
30057395
[Indexed for MEDLINE]
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13.
Medicine (Baltimore). 2018 Jul;97(29):e11495. doi: 10.1097/MD.0000000000011495.

Nephrotic syndrome with acute pulmonary embolism in young adults: Two case reports.

Author information

1
Department of Cardiology, The First Hospital of Jilin University, Changchun, China.

Abstract

INTRODUCTION:

Pulmonary embolism (PE) is often misdiagnosed, or the diagnosis is delayed because of its diverse clinical manifestations, it may even remain asymptomatic until sudden death. Most risk factors are not associated with young people, and there is a paucity of literature regarding PE in children and young adults.

CASE PRESENTATION:

Patient 1 who died was diagnosed with nephrotic syndrome more than 10 years before. He presented to a clinic with gradually worsening dyspnea, which was initially misdiagnosed as myocarditis. Patient 2 presented with sudden shortness of breath after treatment for nephrotic syndrome. His PE was quickly diagnosed, allowing prompt initiation of anticoagulant therapy. At follow-up 30 days after hospital discharge, his symptoms had disappeared, and his abnormal laboratory results had returned to almost normal.

CONCLUSION:

The diagnosis and treatment of the above 2 patients suggest that the possible occurrence of PE in a young person with nephrotic syndrome should not be ignored. The early diagnosis and delayed diagnosis will have different clinical outcomes.

PMID:
30024529
PMCID:
PMC6086462
DOI:
10.1097/MD.0000000000011495
[Indexed for MEDLINE]
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14.
Respir Investig. 2018 Jul;56(4):332-341. doi: 10.1016/j.resinv.2018.03.004. Epub 2018 Jul 3.

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: A systematic review.

Author information

1
Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: ntanabe@faculty.chiba-u.jp.
2
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kawakami.1650@gmail.com.
3
Division of Cardiology Department of Medicine, Kyorin University Hospital, Mitaka, Japan. Electronic address: tsatoh2008@me.com.
4
Department of Clinical Science, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: matsubara.hiromi@gmail.com.
5
Department of Cardiovascular Medicine, Minami Osaka Hospital, Osaka, Japan. Electronic address: nnakanis@hsp.ncvc.go.jp.
6
Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan. Electronic address: hogino@tokyo-med.ac.jp.
7
Division of Cardiovascular Internal Medicine, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. Electronic address: tamura.u1@gmail.com.
8
First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan. Electronic address: itsujino-circ@umin.net.
9
Department of Clinical Science, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: aiko-oky@umin.ac.jp.
10
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: sakaos@faculty.chiba-u.jp.
11
Department of Rehabilitation, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: marinishi631@gmail.com.
12
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: k-ishida@faculty.chiba-u.jp.
13
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: yichimura@earth.nifty.jp.
14
Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan. Electronic address: dr44da@yahoo.co.jp.
15
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: tatsumi@faculty.chiba-u.jp.

Abstract

BACKGROUND:

Balloon pulmonary angioplasty (BPA) has been performed for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual pulmonary hypertension after pulmonary endarterectomy (PEA). We performed a systematic review to assess the efficacy and safety of BPA, especially compared to medical treatment or PEA.

METHODS:

We reviewed all studies investigating pre- and post-treatment pulmonary hemodynamics, mortality, or complications from three electronic databases (PubMed, Cochrane Library, Japan Medical Abstracts Society) prior to February 2017. From 26 studies retrieved, we selected 13 studies (493 patients): the 10 most recent ones including complete data from each institution, one study of residual pulmonary hypertension, and two studies comparing BPA with medical treatment or PEA.

RESULTS:

No randomized controlled or prospective controlled studies comparing BPA with medical treatment or PEA were reported. The early mortality of BPA ranged from 0% to 14.3%; lung injury occurred in 7.0% to 31.4% (average sessions, 2.5-6.6). Mean pulmonary arterial pressure decreased from 39.4-56 to 20.9-36 mm Hg, and the 6-min walk distance increased from 191-405 to 359-501 m. The 2-year mortality of 80 patients undergoing BPA was significantly lower compared to 68 patients receiving medical treatment (1.3% vs. 13.2%); the risk ratio was 0.14 (95% confidence interval: 0.03-0.76). No significant difference was observed in the 2-year mortality between BPA (n=97) and PEA (n=63) patients.

CONCLUSIONS:

This systematic review suggests that BPA improves hemodynamics, has acceptable early mortality, and may improve long-term survival compared with medical treatment in inoperable CTEPH patients.

KEYWORDS:

Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Medical treatment; Pulmonary endarterectomy; Pulmonary vasodilator

PMID:
30008295
DOI:
10.1016/j.resinv.2018.03.004
[Indexed for MEDLINE]
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15.
Cochrane Database Syst Rev. 2018 Jul 11;7:CD009447. doi: 10.1002/14651858.CD009447.pub3.

Anticoagulation for perioperative thromboprophylaxis in people with cancer.

Author information

1
Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon, 1107 2020.

Abstract

BACKGROUND:

The choice of the appropriate perioperative thromboprophylaxis for people with cancer depends on the relative benefits and harms of different anticoagulants.

OBJECTIVES:

To systematically review the evidence for the relative efficacy and safety of anticoagulants for perioperative thromboprophylaxis in people with cancer.

SEARCH METHODS:

This update of the systematic review was based on the findings of a comprehensive literature search conducted on 14 June 2018 that included a major electronic search of Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 6), MEDLINE (Ovid), and Embase (Ovid); handsearching of conference proceedings; checking of references of included studies; searching for ongoing studies; and using the 'related citation' feature in PubMed.

SELECTION CRITERIA:

Randomized controlled trials (RCTs) that enrolled people with cancer undergoing a surgical intervention and assessed the effects of low-molecular weight heparin (LMWH) to unfractionated heparin (UFH) or to fondaparinux on mortality, deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding outcomes, and thrombocytopenia.

DATA COLLECTION AND ANALYSIS:

Using a standardized form, we extracted data in duplicate on study design, participants, interventions outcomes of interest, and risk of bias. Outcomes of interest included all-cause mortality, PE, symptomatic venous thromboembolism (VTE), asymptomatic DVT, major bleeding, minor bleeding, postphlebitic syndrome, health related quality of life, and thrombocytopenia. We assessed the certainty of evidence for each outcome using the GRADE approach (GRADE Handbook).

MAIN RESULTS:

Of 7670 identified unique citations, we included 20 RCTs with 9771 randomized people with cancer receiving preoperative prophylactic anticoagulation. We identified seven reports for seven new RCTs for this update.The meta-analyses did not conclusively rule out either a beneficial or harmful effect of LMWH compared with UFH for the following outcomes: mortality (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.63 to 1.07; risk difference (RD) 9 fewer per 1000, 95% CI 19 fewer to 4 more; moderate-certainty evidence), PE (RR 0.49, 95% CI 0.17 to 1.47; RD 3 fewer per 1000, 95% CI 5 fewer to 3 more; moderate-certainty evidence), symptomatic DVT (RR 0.67, 95% CI 0.27 to 1.69; RD 3 fewer per 1000, 95% CI 7 fewer to 7 more; moderate-certainty evidence), asymptomatic DVT (RR 0.86, 95% CI 0.71 to 1.05; RD 11 fewer per 1000, 95% CI 23 fewer to 4 more; low-certainty evidence), major bleeding (RR 1.01, 95% CI 0.69 to 1.48; RD 0 fewer per 1000, 95% CI 10 fewer to 15 more; moderate-certainty evidence), minor bleeding (RR 1.01, 95% CI 0.76 to 1.33; RD 1 more per 1000, 95% CI 34 fewer to 47 more; moderate-certainty evidence), reoperation for bleeding (RR 0.93, 95% CI 0.57 to 1.50; RD 4 fewer per 1000, 95% CI 22 fewer to 26 more; moderate-certainty evidence), intraoperative transfusion (mean difference (MD) -35.36 mL, 95% CI -253.19 to 182.47; low-certainty evidence), postoperative transfusion (MD 190.03 mL, 95% CI -23.65 to 403.72; low-certainty evidence), and thrombocytopenia (RR 3.07, 95% CI 0.32 to 29.33; RD 6 more per 1000, 95% CI 2 fewer to 82 more; moderate-certainty evidence). LMWH was associated with lower incidence of wound hematoma (RR 0.70, 95% CI 0.54 to 0.92; RD 26 fewer per 1000, 95% CI 39 fewer to 7 fewer; moderate-certainty evidence). The meta-analyses found the following additional results: outcomes intraoperative blood loss (MD -6.75 mL, 95% CI -85.49 to 71.99; moderate-certainty evidence); and postoperative drain volume (MD 30.18 mL, 95% CI -36.26 to 96.62; moderate-certainty evidence).In addition, the meta-analyses did not conclusively rule out either a beneficial or harmful effect of LMWH compared with Fondaparinux for the following outcomes: any VTE (DVT or PE, or both; RR 2.51, 95% CI 0.89 to 7.03; RD 57 more per 1000, 95% CI 4 fewer to 228 more; low-certainty evidence), major bleeding (RR 0.74, 95% CI 0.45 to 1.23; RD 8 fewer per 1000, 95% CI 16 fewer to 7 more; low-certainty evidence), minor bleeding (RR 0.83, 95% CI 0.34 to 2.05; RD 8fewer per 1000, 95% CI 33 fewer to 52 more; low-certainty evidence), thrombocytopenia (RR 0.35, 95% CI 0.04 to 3.30; RD 14 fewer per 1000, 95% CI 20 fewer to 48 more; low-certainty evidence), any PE (RR 3.13, 95% CI 0.13 to 74.64; RD 2 more per 1000, 95% CI 1 fewer to 78 more; low-certainty evidence) and postoperative drain volume (MD -20.00 mL, 95% CI -114.34 to 74.34; low-certainty evidence) AUTHORS' CONCLUSIONS: We found no difference between perioperative thromboprophylaxis with LMWH versus UFH and LMWH compared with fondaparinux in their effects on mortality, thromboembolic outcomes, major bleeding, or minor bleeding in people with cancer. There was a lower incidence of wound hematoma with LMWH compared to UFH.

PMID:
29993117
DOI:
10.1002/14651858.CD009447.pub3
[Indexed for MEDLINE]
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16.
Am Surg. 2018 Jun 1;84(6):909-915.

Primary Pulmonary Thrombus in Combat Casualties: Is Treatment Necessary?

Abstract

The objective of this study was to describe the natural history of primary pulmonary thrombus (PPT) in combat casualties. This was a retrospective study of casualties treated at a major military treatment facility from 2010 to 2012. Patients with a downrange chest CT were included. CTs were reviewed by two independent, blinded radiologists to confirm PPT on initial imaging. Follow-up CTs, if obtained, were also independently reviewed to determine the extent of clot burden. Two hundred and forty-nine casualties with a downrange, acceptable quality chest CT were included. 9 per cent (23/249) of patients sustained PPT. Thirty nine per cent (9/23) were initially treated with therapeutic anticoagulation (AC). Conversely, 61 per cent (14/23) arrived to our military treatment facility without AC. Seven arriving without AC-developed pulmonary symptoms during their hospitalization and had interval chest CTs. Of those, three had no evidence of pulmonary thrombus. The other four had subsegmental filling defects and three were started AC whereas one had an IVC (Inferior Vena Cava) filter inserted. In total, 11/23 (48%) PPT patients were managed without AC and discharged without complications. This is the first study attempting to look at PPT natural history. There were no adverse sequelae from managing PPT without AC. Further studies are warranted to further characterize PPT.

PMID:
29981623
[Indexed for MEDLINE]
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17.
Indian Heart J. 2018 May - Jun;70(3):427-429. doi: 10.1016/j.ihj.2017.08.002. Epub 2017 Aug 18.

Profile of pulmonary embolism in service personnel posted at high altitude area.

Author information

1
Department of Pulmonary Medicine, Indian Spinal Injuries Centre, Army Hospital (Research & Referral), New Delhi 110010, India.
2
Departments of Oncology, Army Hospital (Research & Referral), New Delhi 110010, India.
3
Departments of Medicine, Army Hospital (Research & Referral), New Delhi 110010, India.
4
Departments of Cardiology, Army Hospital (Research & Referral), New Delhi 110010, India.
5
Departments of Endocrinology, Army Hospital (Research & Referral), New Delhi 110010, India. Electronic address: hariendo@rediffmail.com.

Abstract

BACKGROUND:

We evaluated the clinical presentation and risk factors of pulmonary embolism (PE) in soldiers posted at high altitude areas (HAA).

METHODS:

We conducted a retrospective analysis of all cases of PE presented to us between March 2011 and Aug 2014. The patients were serving at an altitude between 10,000 and 22,000ft above sea level and PE was diagnosed using the pulmonary CT angiography. Screening for the deep vein thrombosis (DVT) and procoagulant conditions was done at presentation and after six months of treatment. The patients were managed as per the American College of Cardiology (ACC) guidelines and descriptive statistics were used to present the data.

RESULTS:

The patients (53 males) had a mean age of 33±4.2 year and were serving at a mean altitude of 12,176±448 feet (ranged between 10,000 and 20,500) at the onset of symptoms. Dyspnea (79%) and tachycardia (68%) were the commonest symptom and sign, respectively. D dimer was positive in 96.2% of the cases while nonspecific T inversion in the ECG was seen in 54.7% of the patients. Procoagulant work up revealed a hereditary thrombophilic condition in 9 out of 53 patients. A total of 44 cases were idiopathic and DVT of lower limb veins was seen in 2 patients. There was no mortality in our case series.

CONCLUSION:

PE is a common complication of HAA and hereditary thrombophilia contributes in a minority of the patients. Further studies are needed to ascertain the risk factors of PE at HAA.

KEYWORDS:

Cold; High altitude; Pulmonary embolism; Soldiers; Thrombophilia

PMID:
29961462
PMCID:
PMC6034107
[Available on 2019-05-01]
DOI:
10.1016/j.ihj.2017.08.002
[Indexed for MEDLINE]
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18.
Bone Joint J. 2018 Jul;100-B(7):938-944. doi: 10.1302/0301-620X.100B7.BJJ-2017-1239.R4.

CT pulmonary angiography in lower limb arthroplasty.

Author information

1
Musgrave Park Hospital, Belfast, UK.
2
Musgrave Park Hospital, Belfast, Co. Antrim, UK.
3
Ulster Hospital, Dundonald, Belfast, UK.

Abstract

Aims:

The aims of this study were to determine the indications and frequency of ordering a CT pulmonary angiography (CTPA) following primary arthroplasty of the hip and knee, and to determine the number of positive scans in these patients, the location of emboli and the outcome for patients undergoing CTPA.

Patients and Methods:

We analyzed the use of CTPA, as an inpatient and up to 90 days as an outpatient, in a cohort of patients and reviewed the medical records and imaging for each patient undergoing CTPA.

Results:

Out of 11 249 patients, scans were requested in 229 (2.04%) and 86 (38%) were positive. No patient undergoing CTPA died within 90 days. The rate of mortality from pulmonary embolism (PE) overall was 0.08%. CTPA was performed twice as often following total knee arthroplasty (TKA) compared with total hip arthroplasty (THA), and when performed was twice as likely to be positive. Hypoxia was the main indication for a scan, being the indication in 149 scans (65%); and in 23% (11 of 47), the PE was peripheral and unilateral. Three patients suffered complications resulting from therapeutic anticoagulation for possible PE, two of whom had a negative CTPA.

Conclusion:

CTPA is more likely to be performed following TKA compared with THA. Hypoxia was the main presenting feature of PE. A quarter of PEs which were diagnosed were unilateral and peripheral. Further study may indicate which patients who have a PE after lower limb arthroplasty require treatment, and which can avoid the complications associated with anticoagulation. Cite this article: Bone Joint J 2018;100-B:938-44.

KEYWORDS:

Arthroplasty; Aspirin; CT pulmonary angiography; Prophylaxis; Pulmonary embolism

[Indexed for MEDLINE]
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19.
Ann Hematol. 2018 Oct;97(10):1961-1973. doi: 10.1007/s00277-018-3388-4. Epub 2018 Jun 13.

Allogeneic hematopoietic cell transplantation in patients with GATA2 deficiency-a case report and comprehensive review of the literature.

Author information

1
Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
2
Center of Laboratory Medicine, University Hospital, Inselspital Bern, CH-3010, Bern, Switzerland.
3
Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
4
Department of Pathology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
5
Department of Medical Oncology, University Hospital, Inselspital Bern, CH-3010, Bern, Switzerland.
6
Pediatric Immunology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
7
Department of Internal Medicine, Division of Medical Oncology and Hematology, City Hospital Triemli, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland.
8
Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. AntoniaMaria.Mueller@usz.ch.

Abstract

Recently, an immunodeficiency syndrome caused by guanine-adenine-thymine-adenine 2 (GATA2) deficiency has been described. The syndrome is characterized by (i) typical onset in early adulthood, (ii) profound peripheral blood cytopenias of monocytes, B lymphocytes, and NK cells, (iii) distinct susceptibility to disseminated non-tuberculous mycobacterial (NTM) and other opportunistic infections (particularly human papillomavirus), and (iv) a high risk of developing hematologic malignancies (myelodysplastic syndromes (MDS); acute myeloid leukemias (AML)). Considerable clinical heterogeneity exists among patients with GATA2 deficiency, but once infectious symptoms occur or MDS/AML arises, survival declines significantly. Allogeneic hematopoietic cell transplantation (HCT) currently provides the only curative treatment option for both MDS/AML and dysfunctional immunity with life-threatening opportunistic infections. Strategies regarding timing of allogeneic HCT, antimicrobial prophylaxis and treatment, intensity of the preparative regimen, and optimal donor and graft source have not been clearly defined due to the rarity of the disease. Here, we provide a comprehensive analysis of the available literature and published case reports on the use of allogeneic HCT in patients with GATA2 deficiency. In addition, a case of a young woman with GATA2 deficiency, who developed an immune reconstitution inflammatory syndrome in her mycobacterial skin lesions post allogeneic HCT is presented and illustrates distinct problems encountered in this disease context.

KEYWORDS:

Allogeneic hematopoietic cell transplantation; GATA2 deficiency; Immune reconstitution inflammatory syndrome; Myelodysplastic syndrome

PMID:
29947977
DOI:
10.1007/s00277-018-3388-4
[Indexed for MEDLINE]
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20.
Thromb Res. 2018 Aug;168:78-79. doi: 10.1016/j.thromres.2018.06.012. Epub 2018 Jun 15.

Electrocardiographic changes in pulmonary embolism: Each lead could be a clue in solving the puzzle.

Author information

1
Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy. Electronic address: risca88@live.it.

KEYWORDS:

Electrocardiogram; Myocardial ischemia; Prognosis; Pulmonary embolism; Ventricular repolarization

PMID:
29933149
DOI:
10.1016/j.thromres.2018.06.012
[Indexed for MEDLINE]
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