1/16. Clinicopathologic review of pulmonary silicone embolism with special emphasis on the resultant histologic diversity in the lung--a review of five cases.It is known that the subcutaneous injection of silicone can lead to severe pulmonary complications, followed in some patients by respiratory failure. Currently, silicone is being increasingly applied in the field of plastic surgery and, unfortunately, the illicit injection of silicone fluid by uncertified practitioners is not uncommon in korea. We offer a critical pathologic review of 5 cases of pulmonary silicone embolism following illegal injection to the vaginal wall, four of which were fatal and came to legal autopsy. Our findings again confirm that subcutaneously injected silicone can gain access to the pulmonary vascular tree and cause pulmonary embolism. The histologic changes observed in the lung are variable and include four patterns i.e., the mere presence of silicone emboli, congestion and hemorrhage, acute pneumonitis, and diffuse alveolar damage despite the severe critical course in all cases. We were unable to find any histologic pattern that correlates well with the clinical course. Apart from producing emboli in the pulmonary vessels, subcutaneous injection of silicone can obviously cause serious pulmonary disease due to its ability to induce acute to induce acute pneumonitis and even possibly acute respiratory distress syndrome.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/16. The role of Bayesian Networks in the diagnosis of pulmonary embolism.pulmonary embolism (PE) is a life-threatening condition and, despite advances in diagnostic technology, it remains an elusive diagnosis. The rich variety of possible clinical presentations make it particularly difficult to represent the diagnostic process as a 'decision tree'. However, Bayesian networks offer the opportunity of a compact representation of the domain underlying the decision process: once the network portrays the natural history of the disease, the utility of investigations can be quantitatively evaluated. We developed a network for the diagnosis of PE, including 72 variables to represent both the risk factors and the pathophysiological consequences of the disease. Its structure has been specified by discussing which causal relationships explain the manifestations of the disease. The quantitative measures of associations were retrieved from the medical literature, through a critical review of available studies and agreement on the assumptions made to cope with the lack of published information. Six examples are presented to illustrate the appropriateness of 'entropy reduction' as a measure of the utility of investigation, once the set of examinations to be evaluated is bounded on the grounds of their cost and the patient's current risk. The network, which has been given the acronym 'BayPAD' (Bayesian network for pulmonary embolism Assisted diagnosis), appears to be able to detect which observations make others irrelevant, so that decisions can be tailored to single cases.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/16. Transcatheter embolization of a high-flow renal arteriovenous fistula with use of a constrained wallstent to prevent coil migration.Transcatheter embolization of large, high-flow arteriovenous (AV) fistulas carries a significant risk for migration of embolic material through the fistula and into the venous outflow and subsequently into the pulmonary arterial tree. Several strategies have been described to address this risk, including the use of Amplatz "spider" devices, covered stents, and "stop-flow" techniques employing occlusive balloons. This article describes a high-flow renal AV fistula after nephrectomy embolized with use of a constrained Wallstent deployed within the fistula to prevent coil migration. This method allowed for complete occlusion of a large, high-flow fistula by transcatheter embolization with minimal risk of pulmonary embolization.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/16. Intraoperative fiberoptic angioscopy to evaluate the completeness of pulmonary embolectomy.Intraoperative angioscopy was performed in three patients who underwent pulmonary embolectomy for massive pulmonary embolism. angioscopy followed conventional techniques such as extracting the clot by a gallstone forceps, using a Fogarty catheter in the pulmonary tree or squeezing of the lungs. The rationale for angioscopy was to assess the result of these usual "blind" techniques. In two patients residual thrombus was detected and removed under direct visual control. Our initial experience suggests that intraoperative angioscopy appears to be useful in the detection of residual thrombus material, especially in the asanguinous, arrested heart. The small size of the angioscope allows easily access to the secondary, and up to the tertiary pulmonary branches. Clots can be visualized and extracted under direct visual control.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/16. Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism.We present a 30-year-old man with pulmonary hypertension after pulmonary embolism. Pulmonary angiography showed multiple stenoses in the pulmonary vascular tree. We treated four of these stenoses by balloon angioplasty in three sessions. pulmonary artery pressure was reduced from 90/25 mm Hg (mean 46) to 78/13 mm Hg (mean 35) with concomitant increase of aortic pressure from 105/60 mm Hg (mean 75) to 134/68 mm Hg (mean 90). Pulmonary perfusion scintigraphy showed increase of perfusion in the treated segments. Two procedures were followed by transient segmental pulmonary edema, but no other complications were noted. We conclude that balloon angioplasty is a promising method of lowering pulmonary artery pressure and improving pulmonary perfusion in suitable cases of pulmonary hypertension secondary to pulmonary embolism.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/16. Cardiopulmonary thrombosis complicating peritoneovenous shunting: a case report and review of the literature.Peritoneovenous shunting has been successfully employed for several years in the treatment of severe ascites resistant to medical therapy. Many short and long term complications of this procedure have been documented, including thrombotic events and consumptive coagulopathy. Reported below is the finding of a single, continuous thrombus extending from the right atrium to the distal pulmonary arterial tree, a novel complication of peritoneovenous shunting with multiple possible causes.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/16. Needle emboli to lung following intravenous drug abuse.Presented is the case of a 36-year-old man using central venous sites for injection of street drugs. X-ray study revealed numerous retained subcutaneous needles as well as a needle that had embolized to the lung periphery. This represents, to the best of our knowledge, a previously unreported complication of central venous injection of street drugs.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
8/16. Echocardiographic detection of right atrial thromboembolism.Deep venous thrombosis may result in the clinical syndrome of pulmonary embolus. In rare instances, embolization has occurred, not directly to the pulmonary arterial tree, but to the right atrium or right ventricle. We report herein two cases of right atrial thromboembolization detected by two-dimensional echocardiography, and we review recently reported similar cases. The echocardiographic appearance of right-sided cardiac thromboembolism may be unique and allow precise noninvasive diagnosis. mortality was five of five in patients receiving no specific therapy, four of eight in medically treated patients, and one of seven in surgically treated patients. From this review, it appears that there is a high mortality associated with this entity, which may be improved by rapid recognition and institution of specific therapy with anticoagulants, thrombolytic agents, or surgery. In select patients with low surgical risk, prompt exploration and removal of the mass may be indicated.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/16. Pulmonary embolus: detection and follow-up using magnetic resonance.magnetic resonance imaging (MRI) of an angiographically confirmed pulmonary embolus was performed. The thrombus appeared as an intense intraluminal signal within the left descending pulmonary artery; this signal was absent on repeat examination after clot lysis. Because MR will not image flowing blood, it provides a potential method of non-invasive identification of stationary emboli within the pulmonary vascular tree.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/16. bile pulmonary embolism: report of a case and a review of the literature.bile emboli were found at autopsy in the small pulmonary arteries of a 68-year-old man with a past history of polyposis coli who had required percutaneous transhepatic drainage of his biliary tree because of an obstructing ampullary carcinoma. A communication between the biliary tract and a hepatic vein was shown to be due to the catheter. Eight previously reported cases of bile pulmonary emboli have been found. All but one had a clear history of hepatic trauma or intrahepatic abscess. bile pulmonary embolism is a rare, occasionally fatal, complication of fistulous communication between the biliary tree and the hepatic venous system.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
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