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Pereira, Daniel José. "Embolia pulmonar experimental = um modelo quase fatal." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309566.
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Orientador: Heitor Moreno Junior<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-19T02:49:22Z (GMT). No. of bitstreams: 1
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Previous issue date: 2011<br>Resumo: Introdução: estudos experimentais de embolia pulmonar (EP) são habitualmente realizados sob ventilação mecânica. Como a maioria dos pacientes com suspeita de EP adentra os Serviços de Emergência em respiração espontânea e em ar ambiente, estudos que medissem as variáveis hemodinâmicas, gasométricas e capnográficas, nestas condições, em muito contribuiriam para compreensão mais específica das alterações cardiopulmonares e gasométricas na fase aguda da doença. Observa-se que faltam na literatura estudos experimentais que avaliem animais em tais condições. Objetivo: o objetivo do presente estudo foi submeter à EP animais sob ventilação espontânea e sem oxigênio suplementar. A EP por coágulos autólogos foi induzida em seis porcos e os registros cardiorrespiratórios e gasométricos foram realizados no pré e pós-EP. O valor da pressão média de artéria pulmonar (PMAP) "quase fatal" foi previamente determinada. Resultados: a presença de choque obstrutivo agudo pôde ser evidenciada pelo aumento da PMAP (de 17,8±3,5 para 41,7±3,3mmHg) (P<0,0001) e pela queda do débito cardíaco (de 4,9±1,0 para 2,7±1,0L/min) (P<0,003). Consequentemente, a presença de acidose metabólica pode ser constatada (de 2,4±0,6 para 5,7±1,8mmol/L) (P<0,0001). Observou-se ainda a presença de hipoxemia (de 73,5±12,7 para 40,3±4,6mmHg) (P<0,0001), porém, a PaCO2 não variou (de 44,9±4,4 para 48,2±6,0mmHg) (NS). Houve expressivos aumentos, tanto para P(a-et)CO2 (de 4,8±2,8 para 37,2±5,8mmHg) quanto para a P(A-a)O2 (de 8,2±8,9 para 37,2±10,3mmHg) (P<0,0001). Como tentativa de compensação à acidose metabólica, evidenciou-se significativo aumento do volume minuto alveolar total (de 4,0±0,9 para 10,6±2,9L/min) (P<0,0001). Conclusão: neste modelo, a PMAP quase fatal foi de 2 a 2,5 vezes a PMAP basal e as variáveis capnográficas, associadas a gasometria arterial e venosa, mostraram-se eficazes em discriminar um quadro obstrutivo agudo<br>Abstract: Introduction: Experimental studies on pulmonary embolism (PE) are usually performed under mechanical ventilation. Most patients with suspicion of PE enter the Emergency Services in spontaneous breathing and environmental air. Thus, under these conditions, measurements of hemodynamic, gasometric and capnographic variables contribute largely to a more specific comprehension of cardiopulmonary and gasometric alterations in the acute phase of the disease. Studies which evaluated animals under conditions are lacking. Objective: This study aimed to submit animals under spontaneous ventilation and without supplemental oxygen to PE. PE was induced in six pigs using autologous blood clots, and cardiorespiratory and gasometric records were performed before and after PE. The values of "near fatal" mean pulmonary arterial pressure (MPAP) were previously determined. Results: The presence of obstructive shock could be evidenced by increased MPAP (from 17.8±3.5 to 41.7±3.3mmHg) (p<0.0001) and decreased cardiac output (from 4.9±1.0 to 2.7±1.0L/min) (p<0.003). Consequently, metabolic acidosis occurred (Lac art)(from 2.4±0.6 to 5.7±1.8mmol/L) (p<0.0001). It was observed hypoxemia (from 73.5±12.7 to 40.3±4.6mmHg) (p<0.0001); however, PaCO2 did not vary (from 44.9±4.4 to 48.2±6.0mmHg) (NS). There were significant increases in both P(a-et)CO2 (from 4.8±2.8 to 37.2±5.8mmHg) and P(A-a)O2 (from 8.2±8.9 to 37.2±10.3mmHg) (p<0.0001). There was also a significant increase in the total alveolar minute volume (from 4.0±0.9 to 10.6±2.9L/min) (p<0.0001). Conclusion: In this model, the near fatal MPAP was from 2 to 2.5 times the basal MPAP; and the capnographic variables, associated with arterial and venous gasometry, showed effective in discriminating an acute obstructive profile<br>Mestrado<br>Farmacologia<br>Mestre em Farmacologia
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Cheriex, Emile C. "Cardiological aspects of pulmonary embolism." Maastricht : Maastricht : Universiteit Maastricht ; University Library, Maastricht University [Host], 1997. http://arno.unimaas.nl/show.cgi?fid=6274.
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Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133529.
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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis<br>Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Karger, 2003. https://tud.qucosa.de/id/qucosa%3A27512.
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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis.<br>Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Commeree, Ashlee N. "Prediction of pulmonary embolism in children." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12077.
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Thesis (M.A.)--Boston University<br>Background: Pulmonary embolism (PE) is a rare condition associated with high morbidity and mortality in children. The diagnosis of PE in children is challenging, considering the often non-specific clinical signs and symptoms associated with this condition. Computed tomography with pulmonary angiography (CTPA) is currently the diagnostic gold standard, but carries the risk of radiation-induced malignancy. For these reasons, the optimal diagnostic management strategy for the care of children with suspected PE in the emergency department (ED) setting is undefined.
Objectives: We sought to describe associated clinical signs and symptoms and developed a clinical decision rule for the evaluation of children with suspected PE in the ED setting. In addition, we evaluated the Modified Wells Criteria and PERC (Pulmonary Embolism Rule-out Criteria) Rule by applying these established adult clinical decision rules against our population of children diagnosed with PE. Methods: We conducted a retrospective cohort study of children less than 21 years of age undergoing diagnostic imaging for evaluation of PE from 2000 to 2012. We included children who received either a CTPA or ventilation-perfusion
(V/Q) scanning for the evaluation of suspected PE. PE was defined by evidence of an occlusion in a pulmonary blood vessel or intermediate to high probability of PE reported in the diagnostic study results of the CTPA or V/Q scan, respectively. We additionally required the use of anticoagulant therapy to establish the diagnosis of PE.
Results: Among 152 patients who presented to an ED setting, the prevalence of PE was 16.4%. The most frequent presenting symptoms in children with PE were chest pain (76%) and shortness of breath (44%), while the most common risk factors were presence of a CVC (16%), prolonged immobility (20%), and recent surgery (24%). The current use of oral contraceptive pill (P value = 0.010), abnormal lung exam (P value = 0.021), and oxygen saturation level (P value = 0.003) were all significant findings that were more likely to be present in patients with PE.
Conclusion: Our results describe a high risk population of children evaluated for PE presenting to an ED setting. We identified several historical, clinical, and physical exam findings that are independently associated with diagnosis of PE, such as current use of OCPs, abnormal lung exam, and oxygen saturation level. Next steps will be to use our descriptive analysis to develop a clinical decision rule for the evaluation and diagnosis of PE in children in an ED setting.
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Fortuna, Geisa Maria Xaud Peixoto. "Participação da metaloproteinase 9 da matriz extracelular nas alterações hemodinamicas apos embolia pulmonar aguda." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310015.
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Orientador: Jose Eduardo Tanus dos Santos<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-10T14:15:06Z (GMT). No. of bitstreams: 1
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Previous issue date: 2007<br>Resumo: Metaloproteinases modulam a contratilidade vascular e podem afetar a hipertensão pulmonar que ocorre na embolia pulmonar induzida (EPA). Nós examinamos os efeitos da administração de doxiciclina ( um inibidor das metaloproteinases) em cães anestesiados e submetidos à EPA. Métodos: 5 cães no grupo sham receberam somente salina. EPA foi induzida por injeção intravenosa de microesferas em quantidade suficiente para aumentar a pressão média arterial pulmonar (PMAP) em 20 mmHg e cães do grupo embolia receberam salina (grupo embolia, N=8) ou doxiciclina (10 mg/Kg, i.v.) 5 ou 30 minutos após EPA (grupos embolia + doxi 5 e embolia + doxi 30, N=9 e 8, respectivamente). Avaliação hemodinâmica foi feita no momento basal e de 5 a 120 minutos após EPA. Zimografia da MMP-2 e da MMP-9 foi feita nas amostras de plasma. Resultado: nenhuma mudança hemodinâmica foi observada no grupo sham. Embolização aumentou a PMAP em 218+/-16% e índice de resistência vascular pulmonar (IRVP) em 289+/-42% no grupo embolia (ambos p<0,05). Doxicilina aumentou o índice cardíaco (IC) em 24+/-5% e reduziu o IRVP em 23+/-4% 120 minutos após EPA no grupo embolia+doxi 30. Em acréscimo, doxi reduziu PMAP e IRVP 30 minutos após EPA com efeito máximo após 120 (25+/-4% de redução na PMAP e 33+/-6% de redução no IRVP, ambos <0,05) no grupo embolia+doxi 5. Os níveis plasmáticos de pró-MMP-9 e MMP-9 elevaram-se somente no grupo embolia e MMP-2 permaneceu inalterada. Conclusão: nosso estudo mostra que doxiciclina atenua a hipertensão pulmonar na EPA induzida e indica que, MMP-9 tem um papel na hipertensão pulmonar da EPA induzida. MMP-9 pode ser um alvo farmacológico na EPA<br>Abstract: Matrix metalloproteinases (MMPs) modulate vascular contractility and may affect acute pulmonary embolism (APE)-induced pulmonary hypertension. We examined the effects of the administration of doxycycline (a MMP inhibitor) following APE in anesthetized dogs. Methods: Sham operated dogs (N=5) received only saline. APE was induced by intravenous injections of microspheres in amounts to increase mean pulmonary artery pressure (MPAP) by 20 mmHg, and embolized dogs received saline (Emb group, N=8), or doxycycline (10 mg/kg, i.v.) 5 or 30 min of APE (Emb + Doxy 5 and Emb + Doxy 30 groups, N=9 and 8, respectively). Hemodynamic evaluation was performed at baseline and 5-120 after APE. Gelatin zymography of MMP-2 and MMP-9 from plasma samples was performed. Results: No significant hemodynamic changes were found in Sham animals. Embolization increased MPAP by 218±16% and the pulmonary vascular resistance index (PVRI) by 289±42% in Emb group (both P<0.05). Doxycyline increased the cardiac index by 24±5% and reduced PVRI by 23±4% 120 min of APE in Doxy 30 + Emb group. In addition, doxycyline reduced MPAP and PVRI 30 min after APE with maximum effects seen 120 min after APE (25 ± 4% decrease in MPAP and 33 ± 6% decrease in PVRI; both P<0.05) in Doxy + 5 group. Plasma pro-MMP-9 and MMP-9 levels increased only in Emb group and MMP-2 remained unaltered. Conclusions: Our study shows that doxycycline attenuates APE-induced pulmonary hypertension, and indicates that MMP-9 has a role in APE-induced pulmonary hypertension. MMP-9 may be a pharmacological target in APE<br>Mestrado<br>Mestre em Farmacologia
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Sanson, Bernd-Jan. "Risks of thrombophilia and diagnostics of pulmonary embolism." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/83894.
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Wong, Christopher Chi-Yuen. "Identifying Novel Predictors of Mortality in Patients Hospitalized with Acute Pulmonary Embolism." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18933.
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Background Acute pulmonary embolism (PE) carries a high burden of mortality and morbidity. PE remains the third leading cause of cardiovascular mortality and carries a substantial economic burden which is driven by the costs of hospitalization. Low-risk PE is safely managed as an outpatient, thus accurate assessment of prognosis is an important part of the management of patients presenting to hospital with PE. Current guidelines recommend the use of clinical risk scores such as the Pulmonary Embolism Severity Index (PESI) or its simplified version (sPESI).There remains scope for refining these risk scores by identifying and incorporating novel predictors of mortality in patients presenting with acute PE. Aims and Methods The aim of this thesis was to identify novel prognostic predictors of mortality by utilizing data from a large contemporary database of patients presenting to a tertiary-referral centre with a primary confirmed diagnosis of PE between 2000 and 2012. Three specific predictors of outcome in patients with acute PE were examined as part of this thesis: 1) the presence of chest pain at presentation with acute PE; 2) the presence of an underlying coagulopathy, indicated by an elevated international normalized ratio (INR), in non-anticoagulated patients presenting with acute PE; and, 3) the administration of a red blood cell (RBC) transfusion during hospital stay in patients admitted to hospital with acute PE. Results In the first part of the thesis examining the prognostic impact of chest pain, 1306 patients were included in the analysis. There were 771 (59%) patients with chest pain at presentation; these patients were younger and had fewer comorbidities compared to patients without chest pain. Multivariable models showed chest pain to be a significant independent predictor of decreased mortality. The addition of chest pain to an established multivariable prognostic model incorporating sPESI led to a significant improvement in net reclassification and reduced the risk of mortality. In the second part of the thesis examining the effect of an elevated admission INR in patients not on anticoagulation, 1039 patients were included in the analysis. There were 94 patients (9%) with an elevated admission INR in the absence of anticoagulant use, and these patients were found to have significantly higher mortality. An elevated admission INR was found to be an independent predictor of mortality; the addition of this variable to a multivariable prognostic model led to significant improvements in both net reclassification and the model’s C statistic. In the third part of the thesis examining the effect of RBC transfusion during the index hospital admission on outcome, 1376 patients were included in the analysis. After adjusting for anaemia and other variables, RBC transfusion independently increased the risk of mortality by three-fold at one month and two-fold at six months. Conclusions Accurate prognostic models can help reduce the frequency of hospitalization in patients with low-risk PE and can better predict outcome consequences of treatment options. We have identified chest pain and elevated baseline INR as two novel and accessible variables that may improve risk stratification on presentation with acute PE. The use of RBC transfusion predicts, and could itself be a cause of increased mortality after acute PE.
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Ebrahimdoost, Yousef. "Computer aided detection of pulmonary embolism (PE) in CTA images." Thesis, Kingston University, 2012. http://eprints.kingston.ac.uk/24027/.
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Pulmonary embolism (PE) is an obstruction within the pulmonary arterial tree and in the majority of cases arises from a thrombosis that has travelled to the lungs via the venous system. Pulmonary embolism (PE) is a fatal condition which affects all age groups and is the third most common cause of death in the US. Computed tomographic angiography (CTA) imaging has recently emerged as an accurate method in the diagnosis of pulmonary embolism. Each CTA scan contains hundreds of CT images, so the accuracy and efficiency of interpreting such a large image data set is complicated due to various PE look-alikes and human factors such as attention span and eye fatigue. Moreover, manual reading and interpreting a large number of slices is time consuming and it is difficult to find all the pulmonary embolisms (PE) in a data set. Consequently, it is highly desirable to have a computer aided detection (CAD) system to assist radiologists in detecting and characterizing emboli in an accurate, efficient and reproducible manner. A computer aided detection (CAD) system for detection of pulmonary embolism is proposed in CTA images. Our approach is performed in three stages: firstly the pulmonary artery tree is extracted in the region of the lung and heart in order to reduce the search area (PE occurs inside the pulmonary artery) and aims to reduce the false detection rate. The pulmonary artery is separated from the surrounding organs by analyzing the second derivative of the Hessian matrix and then a hybrid method based on region growing and a new customized level set is used to extract the pulmonary artery (PA). In the level set implementation algorithm, a new stopping criterion is applied, a consideration often neglected in many level set implementations. In the second stage, pulmonary embolism candidates are detected inside the segmented pulmonary artery, by an analysis of three dimensional features inside the segmented artery. PE detection in the pulmonary artery is implemented using five detectors. Each detector responds to different properties of PE. In the third stage, filtering is used to exclude false positive detections associated with the partial volume effect on the artery boundary, flow void, lymphoid tissue, noise and motion artifacts. Soft tissue between the bronchial wall and the pulmonary artery is a common cause of false positive detection in CAD systems. A new feature, based on location is used to reduce false positives caused by soft tissue. The method was tested on 55 data scans (20 training data scans and 35 additional data scans for evaluation containing a total of 195 emboli). The system provided a segmentation of the PA up to the 6th division, which includes the sub-segmental level. Resulting performance gave 94% detection sensitivity with an average 4.1 false positive detections per scan. We demonstrated that the proposed CAD system can improve the performance of a radiologist, detecting 19 (11 %) extra PE which were not annotated by the radiologist.
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Bilal, Jawad, Irbaz B. Riaz, Jennifer L. Hill, and Tirdad T. Zangeneh. "Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!" LIPPINCOTT WILLIAMS & WILKINS, 2016. http://hdl.handle.net/10150/620829.
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Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.
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Nilsson, Tage. "Pulmonary embolism : validation of diagnostic imaging methods in the clinical setting /." Stockholm : Karolinska institutets bibl, 2002. http://diss.kib.ki.se/2002/91-7349-346-5.
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Ribeiro, Ary. "Acute and long-term effects of pulmonary embolism on heart function and lung circulation /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3327-8/.
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Rocha, Thalita Leone Alves. "Efeitos da interação da doxiciclina e adrenomedulina na embolia pulmonar aguda em ovinos anestesiados." Botucatu, 2016. http://hdl.handle.net/11449/138011.
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Orientador: Carlos Alan Candido Dias Junior<br>Resumo: As metaloproteinases de matriz extracelular (MMPs) podem limitar a vasodilatação pulmonar e os efeitos inotrópicos positivos promovidos pela adrenomedulina durante a hipertensão pulmonar. O presente estudo teve por objetivo avaliar os efeitos da administração combinada da doxiciclina (inibidor não seletivo das MMPs) e da adrenomedulina sobre as alterações hemodinâmicas observadas durante a embolia pulmonar aguda em ovinos. Alterações hemodinâmicas e respiratórias foram mensuradas em ovinos anestesiados, pré-tratados com doxiciclina (10 mg/kg por via intravenosa), submetidos à EPA induzida pela injeção intravenosa (IV) de microesferas de silicone (500 mg) e posteriormente tratados com solução salina (grupo Dox+PE) ou adrenomedulina (50 ng/kg/min) (grupo Dox+PE+Adm). Os resultados deste estudo foram comparados com grupos históricos recentemente publicados por nosso grupo de pesquisa, realizados sob as mesmas condições experimentais, onde foram utilizados ovinos anestesiados não submetidos a qualquer intervenção (grupo Sham) ou submetidos à EPA e tratados com solução salina (grupo PE) ou com adrenomedulina (50 ng/kg/min) (grupo PE+Adm). Doxiciclina não produziu efeitos adicionais sobre as diminuições significativas no índice de resistência vascular pulmonar e aumento no índice cardíaco (ambos em 25%) observadas com o uso da adrenomedulina (grupo PE+Adm). A administração da adrenomedulina (grupo PE+Adm e Dox+PE+Adm) diminuiu significativamente a pressão arterial média e o índice ... (Resumo completo, clicar acesso eletrônico abaixo)<br>Abstract: Matrix metalloproteinases (MMPs) may limit severely the pulmonary vasodilatory and inotropic effects of adrenomedullin during pulmonary hypertension. Hemodynamic and respiratory changes were measured in anesthetized bovine pre-treated with doxycycline (10 mg/kg intravenously), subjected to APE induced by intravenous injection of silicone microspheres (500 mg) and subsequently treated with physiological saline (Dox+PE group) or adrenomedullin (50 ng / kg / min) (Dox+PE+ Adm group). The results were compared with historical group recently published by our research group, carried out under the same experimental conditions, where anesthetized sheep were used not subjected to any intervention (Sham group) or subjected to APE, and treated with physiological saline (PE group) or with adrenomedullin (50 ng / kg / min) (PE+Adm Group). Doxycycline produced no effect on significant temporal decreases in pulmonary vascular resistance index and increases in cardiac index (both by 25%) observed with adrenomedullin. The administration of adrenomedullin significantly decreased mean arterial pressure and systemic vascular resistance index, leading to a moderate systemic hypotension. Significant decreases in arterial oxygen partial pressure were observed after doxycycline or APE, but these changes were not affected by adrenomedullin. These results demonstrate that the combined administration of doxycycline and adrenomedullin does not provide additional hemodynamic benefits when compared to iso... (Complete abstract click electronic access below)<br>Mestre
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Castañer, González Eva. "Angiotomografía computarizada multidetector (angio-tcmd) en el diagnóstico del tromboembolismo pulmonar agudo y crónico." Doctoral thesis, Universitat Autònoma de Barcelona, 2021. http://hdl.handle.net/10803/671593.
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S'estudia un àmplia sèrie de pacients amb sospita de TEP agut mitjançant angio- TCMD, es va registrar la incidència de TEP agut, TEP crònic, així com la coexistència de tots dos. Es va registrar la mortalitat (7,30,90 dies) i efectes adversos, en el global de pacients inclosos, en els pacients hemodinàmicament estables, en els pacients amb TEP de distribució cavalcada i la seva relació amb els signes de l'angio-TCMD i amb les dades clíniques. Es va analitzar a més la presència d'infarts pulmonars (associats a TEP agut i crònic) així com la incidència de TEP subsegmentario aïllat.<br>Se estudia un amplia serie de pacientes con sospecha de TEP agudo mediante angio- TCMD, se registró la incidencia de TEP agudo, TEP crónico, así como la coexistencia de ambos. Se registró la mortalidad (7,30,90 días) y efectos adversos, en el global de pacientes incluidos, en los pacientes hemodinámicamente estables, en los pacientes con TEP de distribución cabalgada y su relación con los signos de la angio-TCMD y con los datos clínicos. Se analizó además la presencia de infartos pulmonares (asociados a TEP agudo y crónico) así como la incidencia de TEP subsegmentario aislado.<br>Acute pulmonary embolism (PE) is the most severe clinical manifestation of venous thromboembolic disease. We studied a large series of patients with suspected acute PE with multidetector CT angiography, analyzing risk factors associated with morbidity and mortality. We sought to determine the incidence and characteristics of acute and chronic PE in our environment. We included all consecutive patients with suspected acute PE attended at our hospital from August 2006 through February 2017. We recorded the incidence of acute PE, of chronic PE, and of the combined presence of acute and chronic PE on multidetector CT angiography studies. We recorded patients’ comorbidities and predisposing events in the 3 months prior to the episode of PE. We calculated the 7-day, 30-day, and 90-day rates of mortality and adverse events, in the entire cohort, in hemodynamically stable patients, and in patients with saddle PE; moreover, we analyzed the relations between these outcomes and signs on multidetector CT angiography and clinical findings. We analyzed the presence and characteristics of pulmonary infarction associated with acute PE and with chronic PE. We also analyzed the incidence of isolated subsegmental PE. We also evaluated whether there were radiological and/or clinical signs in the initial episode of PE that were associated with a greater risk of posterior episodes of PE.
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Rocha, Thalita Leone Alves [UNESP]. "Efeitos da interação da doxiciclina e adrenomedulina na embolia pulmonar aguda em ovinos anestesiados." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/138011.
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Previous issue date: 2016-02-29<br>Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)<br>As metaloproteinases de matriz extracelular (MMPs) podem limitar a vasodilatação pulmonar e os efeitos inotrópicos positivos promovidos pela adrenomedulina durante a hipertensão pulmonar. O presente estudo teve por objetivo avaliar os efeitos da administração combinada da doxiciclina (inibidor não seletivo das MMPs) e da adrenomedulina sobre as alterações hemodinâmicas observadas durante a embolia pulmonar aguda em ovinos. Alterações hemodinâmicas e respiratórias foram mensuradas em ovinos anestesiados, pré-tratados com doxiciclina (10 mg/kg por via intravenosa), submetidos à EPA induzida pela injeção intravenosa (IV) de microesferas de silicone (500 mg) e posteriormente tratados com solução salina (grupo Dox+PE) ou adrenomedulina (50 ng/kg/min) (grupo Dox+PE+Adm). Os resultados deste estudo foram comparados com grupos históricos recentemente publicados por nosso grupo de pesquisa, realizados sob as mesmas condições experimentais, onde foram utilizados ovinos anestesiados não submetidos a qualquer intervenção (grupo Sham) ou submetidos à EPA e tratados com solução salina (grupo PE) ou com adrenomedulina (50 ng/kg/min) (grupo PE+Adm). Doxiciclina não produziu efeitos adicionais sobre as diminuições significativas no índice de resistência vascular pulmonar e aumento no índice cardíaco (ambos em 25%) observadas com o uso da adrenomedulina (grupo PE+Adm). A administração da adrenomedulina (grupo PE+Adm e Dox+PE+Adm) diminuiu significativamente a pressão arterial média e o índice de resistência vascular sistêmica, levando a uma hipotensão sistêmica moderada. Reduções significativas na pressão parcial de oxigênio arterial foram observadas após a doxiciclina e a EPA, que não foram afetadas pela administração da adrenomedulina. Estes resultados demonstram que a administração combinada da doxiciclina e adrenomedulina não traz benefícios hemodinâmicos adicionais quando comparada ao uso isolado da adrenomedulina, sugerindo que está combinação não se apresenta vantajosa durante a EPA induzida por microesferas.<br>Matrix metalloproteinases (MMPs) may limit severely the pulmonary vasodilatory and inotropic effects of adrenomedullin during pulmonary hypertension. Hemodynamic and respiratory changes were measured in anesthetized bovine pre-treated with doxycycline (10 mg/kg intravenously), subjected to APE induced by intravenous injection of silicone microspheres (500 mg) and subsequently treated with physiological saline (Dox+PE group) or adrenomedullin (50 ng / kg / min) (Dox+PE+ Adm group). The results were compared with historical group recently published by our research group, carried out under the same experimental conditions, where anesthetized sheep were used not subjected to any intervention (Sham group) or subjected to APE, and treated with physiological saline (PE group) or with adrenomedullin (50 ng / kg / min) (PE+Adm Group). Doxycycline produced no effect on significant temporal decreases in pulmonary vascular resistance index and increases in cardiac index (both by 25%) observed with adrenomedullin. The administration of adrenomedullin significantly decreased mean arterial pressure and systemic vascular resistance index, leading to a moderate systemic hypotension. Significant decreases in arterial oxygen partial pressure were observed after doxycycline or APE, but these changes were not affected by adrenomedullin. These results demonstrate that the combined administration of doxycycline and adrenomedullin does not provide additional hemodynamic benefits when compared to isolated use of adrenomedullin, suggesting that this combination does not appear advantageous for the APE-induced microspheres.<br>FAPESP: 2012/12.291-7
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Kay, I. S. "The role of 5-hydroxytryptamine in the responses to embolism of intra-pulmonary C-fibres." Thesis, Liverpool John Moores University, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.379109.
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Moreira, Marcos Mello. "Variaveis capnograficas e d-dimeros em pacientes com suspeita de tromboembolismo pulmonar." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311721.
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Orientadores: Renato Giuseppe Giovanni Terzi, Ilma Aparecida Paschoal<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-12T22:30:15Z (GMT). No. of bitstreams: 1
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Previous issue date: 2009<br>Resumo: Métodos para confirmar o diagnóstico de tromboembolismo pulmonar (TEP) são relativamente invasivos, de alto custo e nem sempre disponíveis. Justifica-se a busca de métodos mais acessíveis, de baixo custo, minimamente invasivos e que possam ser realizados à beira do leito. Foi objetivo deste estudo estabelecer um protocolo de triagem diagnóstica de TEP, minimamente invasivo e de baixo custo, usando para isto a capnografia volumétrica (CV) e o Oímero-O (DO) (ELISA Rápido), para pacientes internados em diferentes unidades de um hospital terciário, atentanto para as possíveis limitações deste protocolo. Foi realizado um estudo prospectivo e observacional com 92 pacientes. Um estudo prévio de CV em 114 voluntários estabeleceu o padrão de normalidade para as variáveis analisadas. No grupo TEP, a CV foi associada à gasometria arterial para cálculo das variáveis do espaço morto e à dosagem do DO. O padrão-ouro para diagnóstico de TEP foi dado pela cintilografia de inalação/perfusão e/ou, tomografia computadorizada helicoidal e/ou, arteriografia pulmonar. Isoladamente, a variável capnográfica que apresentou melhor sensibilidade e especificidade foi a fração tardia do espaço morto alveolar (tO/ate) (91% e 98%, respectivamente). Obteve-se um resultado falso-negativo para o DO e, para a tO/ate, um falso-positivo e três falso-negativos. Quando a tO/ate ,foi associada ao DO, conseguiu-se 100% sensibilidade e 17% de especificidade. Uma outra variável capnográfica importante, por sugerir função pulmonar prévia anormal, e por esta razão, sinalizar uma possível limitação da tO/ate, foi o slope da fase III do capnograma. Por meio dos dados da CV de ambos os grupos (controle e doentes), estabeleceu-se um protocolo que ajuda a direcionar a equipe multiprofissionál quando da suspeita clínica de TEP.<br>Abstract :Background: Tests used to confirm a diagnosis of pulmonary embolism (PE) are relatively invasive, costly and not always available. Minimally invasive methods that are more accessible, less expensive and easily applied should be sought. Objective: To establish a low-cost, minimally invasive, PE diagnostic protocol in hospitalized patients, using capnographic variables and ELlSA D-dimer (DD) to rule out PE. Methods: A prospective observational study was conducted in 92 patients with suspected PE. The values of reference group for volumetric capnography (VCap) were used in order to compare with patterns of patients with PE. The patients were submitted to arterial blood gas analysis (to calculate the dead space variables) and had the DD values determined. The diagnosis was confirmed through ventilation/perfusion scintigraphy, spiral computed tomography, pulmonary arteriogram, or combinations of the three. Results: The capnographic variable that presented the greatest sensitivity and specificity (91 % and 98%, respectively) was the late dead space fraction (fDlate). Our findings include one false-negative DD result, as well as three false-positive and eight false-negative fDlate results. The combination of the fDlate and DD testing presented 100% sensitivity and 17% specificity. Another important capnographic variable, the phase 111 slope, indicated a possible limitation of VCap, since it interferes with the calculation of fDlate. Conclusion: The protocol established could guide multiprofessional teams in the management of clinical suspicion of PE. We were able to determine that the phase 111 slope might interfere with the calculation of fDlate, especially in patients with a history of abnormal lung function. Throught VCap variables (control group and sickness); was possible establishes a protocol that guide the multiprofissional team in cases of PE.<br>Doutorado<br>Pesquisa Experimental<br>Doutor em Cirurgia
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Ferreira, Eleci Vaz. "Diagnóstico alternativo identificado na angiotomografia computadorizada de tórax na suspeita de tromboembolia pulmonar." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/119407.
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Introdução: A angiotomografia computadorizada (angioTC) de tórax é utilizada para diagnosticar tromboembolia pulmonar (TEP). O papel deste exame para estabelecer diagnósticos alternativos, quando negativo para TEP, não é bem conhecido. Objetivos: Estudar a contribuição da angioTC para identificar um diagnóstico alternativo nos casos com angioTC negativa para TEP, assim como determinar a prevalência de TEP e comparar as características clínicas dos pacientes com e sem TEP. Pacientes e Métodos: Estudo transversal, retrospectivo, com 191 pacientes adultos que realizaram angioTC de tórax por suspeita de TEP, no período de setembro de 2009 a maio de 2012. A angioTC e a radiografia de tórax foram revisadas para determinar se os achados poderiam fornecer um diagnóstico alternativo nos casos com angioTC negativa para TEP. Do prontuário eletrônico foram coletados dados relacionados a sintomas, fatores de risco, comorbidades, tempo de internação e mortalidade. Resultados: Dos 191 pacientes incluídos, 128 (67%) eram mulheres. A média de idade foi 59,3 ± 17,1 anos. Em 59,2% a angioTC do tórax foi solicitada no serviço de emergência. A angioTC foi positiva para TEP em 47 pacientes (24,6% dos casos). Achados anormais na angioTC de tórax foram observados em 120 dos 144 pacientes com angioTC negativa para TEP, predominando atelectasia (48,6%), nódulo pulmonar (30,6%), derrame pleural (29,9%) e consolidação (21,5%). Os achados da angioTC foram compatíveis com um diagnóstico alternativo, que explicava os sintomas do paciente, em 39,3% (n=75); esta percentagem reduziu para 20,4% (n=39) quando foram considerados somente os casos sem achados semelhantes na radiografia de tórax. O diagnóstico alternativo mais frequente, identificado somente pela angioTC, foi pneumonia (20 de 39 casos). Não houve diferença nos sintomas, fatores de risco, comorbidades e taxa de óbito intrahospitalar no grupo com angioTC positiva e negativa para TEP. Pacientes com angioTC positiva para TEP tiveram um maior tempo de internação (mediana de 18 dias vs 9,5 dias; p=0,001). Conclusões: A angioTC de tórax foi positiva para TEP em 24,6% dos casos. Não houve diferença significativa nos achados clínicos dos pacientes com angioTC positiva e negativa para TEP, exceto por um tempo de internação maior no grupo com TEP. A angioTC de tórax mostrou achados compatíveis com um diagnóstico alternativo em 39,3% dos pacientes. Entretanto, estes achados não haviam sido detectados na radiografia de tórax em 20,4% dos casos. O diagnóstico alternativo mais frequente foi pneumonia.<br>Introduction: Computed tomography (CT) pulmonary angiography is used to diagnose pulmonary embolism (PE). The role of this test in establishing an alternative diagnosis, when negative for PE, is not well known. Aims: To study the contribution of CT angiography in establishing alternative diagnoses, when the test is negative for PE, as well as to determine the prevalence of PE and compare the clinical characteristics of patients with and without PE. Patients and Methods: Cross-sectional, retrospective study of 191 adult consecutive patients who underwent CT angiography for suspected PE, from September, 2009 to May, 2012. The CT angiographies and chest radiographies were reviewed to determine whether the findings could provide an alternative diagnosis in cases with negative CT angiography for PE. Symptoms, risk factors, comorbidities, length of stay and mortality were collected from the electronic medical record. Results: Of the 191 patients included 128 (67%) were women. The mean age of de patients was 59.3 ± 17.1 years. In 59.2% CT angiography was requested in the emergency room. The CT angiography was positive for PE in 47 patients (24.6% of the total cases). Abnormal findings, observed in 120 of the 144 patients with negative CT angiography for PE, were predominantly atelectasis (48.6%), pulmonary nodules (30.6%), pleural effusion (29.9%) and consolidation (21.5%). CT angiography findings were consistent with a diagnosis that explained the patient's symptoms in 39.3% (n=75). When only those cases without concurrent findings on chest radiography were considered this percentage dropped to 20.4% (n=39). The most common alternative diagnosis, identified only by CT angiography, was pneumonia (20 of 39 cases). There were no differences between the groups with positive and negative CT angiography for PE in terms of symptoms, risk factors, comorbidities, and in-hospital death rate. However, patients with positive CT angiography for PE had a longer hospital stay (median 18 days vs. 9.5 days, p=0.001). Conclusions: CT angiography was positive for PE in 24.6% of cases. There were no significant differences in the clinical findings of patients with positive and negative CT angiography for PE, except for a longer hospital stay in the former group. Chest CT angiography revealed findings consistent with an alternative diagnosis in 39.3 % of the patients. However, these findings were not detected on chest radiography in 20.4 % of the patients. The most common alternative diagnosis was pneumonia.
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Chow, Vincent Yin. "Subclinical Cardiac Dysfunction and Hypercoagulability in survivors of Pulmonary Embolism and in patients with Schizophrenia." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12414.
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Pulmonary embolism (PE) and schizophrenia are common and life threatening conditions with long-term mortality due to cardiovascular and non-cardiovascular causes. In both conditions, the predictors of long-term dysfunction or mortality are poorly studied but both are suspected to have subclinical cardiac dysfunction which has not been defined. The increased risk of thrombosis recurrence in patients with PE, and thrombosis incidence in patients with schizophrenia indicates a shared predisposition to thrombosis in these conditions. This thesis examined cardiac function and global coagulation in: 1)long-term survivors of acute PE and 2)patients with schizophrenia receiving long-term antipsychotic medications including clozapine. Subclinical cardiac dysfunction and global hypercoagulability are common and under-recognised in long-term survivors of PE and in patients with schizophrenia receiving clozapine treatment. In the case of acute PE, we found that the incidence of functional impairment and RV dysfunction is much greater than suspected. Utilising the OHP (Overall Haemostatic Potential) global coagulation assay, we showed a persistent hypercoagulable state amongst long-term survivors of PE. In patients with schizophrenia receiving clozapine treatment, the incidence of subclinical LV cardiomyopathy is much more common than previously recognised. This knowledge will permit easier clinical distinction between mild asymptomatic dysfunction and serious clozapine-induced myocarditis and cardiomyopathy.
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Nasr, Abir. "The prevalence of COPD among patients suspected for pulmonary embolism using V/P SPECT." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50802.
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Rodger, Marc. "A study to develop and validate a clinical prediction rule to exclude pulmonary embolism." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/MQ48177.pdf.
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Smith, Sarah Faith. "Influences on the incidence of clinical deep vein thrombosis and pulmonary embolism in a prospectively collated population of 21,000 neurosurgical inpatients." Thesis, The University of Sydney, 2001. http://hdl.handle.net/2123/818.
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Records of all neurosurgical inpatients admitted to Royal North Shore Hospital since 1976 have been prospectively kept in a relational database. Demographic details, diagnoses, operations and complications have been entered continuously since 1982 by the author of this study. Complications are monitored at monthly review meetings attended by medical staff. The recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE) at these meetings, despite continual improvements in patient care, prompted this study. It aims to use the database to study changes in the incidence of DVT and PE over the previous twenty years; to find what database variables predict these complications; and whether use of mechanical and pharmacological agents has had an impact on DVT and PE rate. Univariate analysis of the incidence of DVT and PE by age, sex, length of stay (LOS), admission month, diagnosis, operation and surgeon over time was run. Any significant variables were then analysed by multivariate logistic regression. The DVT rate was low by world standards, but rose from 0.6% in 1979-83 to 1.2% in 1984-88, then rose exponentially to 3.60% in 1994-98 with a significantly increasing trend over the twenty years (c2 MH =114.20, with IDF, P<0.001). PE rate doubled significantly over the twenty years from 0.6% to 1.2% (c2 MH =17.94 with 1DF, P<0.001). Age, LOS, diagnosis, operation and surgeon were significant predictors of DVT and PE. After adjustment for LOS, time period and age, vascular surgery was found to be the strongest predictor of DVT (OR=2.82, 95% CI: 2.08-3.82, c2 =43.91, P<0.01). Vascular diagnosis was the strongest diagnosis predictor. No effect of sex or month of admission was shown. After adjustment for LOS, time period and age, spinal fusion was the strongest predictor of PE (OR=4.04, 95% CI: 1.81-9.03). Anterior communicating artery aneurysm was the diagnosis most highly associated with PE. The rise in DVT rate may be due to increased complexity of surgical and nursing management, and some screening of patients with the introduction of duplex scanning. The doubling of PE rate is unexplained. The risk of brain or spinal cord haemorrhage makes prophylactic anticoagulation a difficult choice. This study reveals groupings which can be used to determine appropriate prophylaxis. Use of mechanical and pharmaceutical agents is not recorded consistently in the database, but it is known approximately when they were introduced. No impact on the rate of DVT and PE can be demonstrated by these agents. More vigilant and widespread use of mechanical prophylaxis might be just as effective in controlling DVT and PE.
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Smith, Sarah Faith. "Influences on the incidence of clinical deep vein thrombosis and pulmonary embolism in a prospectively collated population of 21,000 neurosurgical inpatients." University of Sydney. Public Health and Community Medicine, 2001. http://hdl.handle.net/2123/818.
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Records of all neurosurgical inpatients admitted to Royal North Shore Hospital since 1976 have been prospectively kept in a relational database. Demographic details, diagnoses, operations and complications have been entered continuously since 1982 by the author of this study. Complications are monitored at monthly review meetings attended by medical staff. The recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE) at these meetings, despite continual improvements in patient care, prompted this study. It aims to use the database to study changes in the incidence of DVT and PE over the previous twenty years; to find what database variables predict these complications; and whether use of mechanical and pharmacological agents has had an impact on DVT and PE rate. Univariate analysis of the incidence of DVT and PE by age, sex, length of stay (LOS), admission month, diagnosis, operation and surgeon over time was run. Any significant variables were then analysed by multivariate logistic regression. The DVT rate was low by world standards, but rose from 0.6% in 1979-83 to 1.2% in 1984-88, then rose exponentially to 3.60% in 1994-98 with a significantly increasing trend over the twenty years (c2 MH =114.20, with IDF, P<0.001). PE rate doubled significantly over the twenty years from 0.6% to 1.2% (c2 MH =17.94 with 1DF, P<0.001). Age, LOS, diagnosis, operation and surgeon were significant predictors of DVT and PE. After adjustment for LOS, time period and age, vascular surgery was found to be the strongest predictor of DVT (OR=2.82, 95% CI: 2.08-3.82, c2 =43.91, P<0.01). Vascular diagnosis was the strongest diagnosis predictor. No effect of sex or month of admission was shown. After adjustment for LOS, time period and age, spinal fusion was the strongest predictor of PE (OR=4.04, 95% CI: 1.81-9.03). Anterior communicating artery aneurysm was the diagnosis most highly associated with PE. The rise in DVT rate may be due to increased complexity of surgical and nursing management, and some screening of patients with the introduction of duplex scanning. The doubling of PE rate is unexplained. The risk of brain or spinal cord haemorrhage makes prophylactic anticoagulation a difficult choice. This study reveals groupings which can be used to determine appropriate prophylaxis. Use of mechanical and pharmaceutical agents is not recorded consistently in the database, but it is known approximately when they were introduced. No impact on the rate of DVT and PE can be demonstrated by these agents. More vigilant and widespread use of mechanical prophylaxis might be just as effective in controlling DVT and PE.
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Ikefuti, Priscilla Venâncio. "Associação entre variáveis meteorológicas, índice climático, fatores socioeconômicos e mortalidade por doenças do aparelho circulatório (acidente vascular cerebral e embolia pulmonar) no município de São Paulo - SP." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/8/8135/tde-13022017-114517/.
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Com a transição epidemiológica no Brasil, as doenças crônicas passaram a ser responsáveis pelo maior número de óbitos entre homens e mulheres. Entre os componentes que definem o estado de saúde humana, alguns do contexto geográfico, como clima local e fatores socioeconômicos, parecem influenciar na mortalidade por doenças do aparelho circulatório, tais como no acidente cerebral vascular (AVC) e na embolia pulmonar (EP). O objetivo principal deste trabalho foi verificar a influência do contexto geográfico (variáveis meteorológicas, índice climático e fatores socioeconômicos) na mortalidade por doenças do aparelho circulatório (AVC e EP) no município de São Paulo, no período de 2002 a 2011. Para analisar a associação da mortalidade com as variáveis meteorológicas foi utilizado um modelo linear generalizado empregando-se o método de Poisson e os modelos de lags distribuídos. Espacialmente a associação da mortalidade com as variáveis socioeconômicas foram testadas utilizando-se os modelos de regressão espacial OLS e GWR. Como resultado encontramos que tanto o frio quanto o calor são fatores de risco para todos os tipos de AVC e EP, com risco maior dependendo do tipo em homens e mulheres. Espacialmente os valores mais elevados do risco relativo (RR) da mortalidade por AVC estavam concentrados nas regiões periféricas do municipio de São Paulo, o que coincidiu com as áreas de menor renda per capita e vegetação e maior porcentagem de população preta. Já com relação à distribuição espacial dos altos valores de RR por EP esses estavam presentes principalmente na região central do município. Concluindo, a nossa pesquisa gerou grande quantidade de resultados que mostram que tanto as variáveis ambientais como socioeconômicas têm influência na mortalidade por algumas doenças do aparelho circulatório. Tendo em vista que o atendimento de urgência para os casos de AVC e EP pode evitar óbitos e sequelas graves, a melhor compreensão da importância do contexto geográfico pode permitir o desenvolvimento de sistemas de alertas junto aos serviços de atendimento de urgência e o direcionamento de campanhas para a prevenção dos fatores de risco evitáveis.<br>With the epidemiological transition in Brazil, chronic diseases are now responsible for more deaths among men and women. Among the components that define the state of human health, some geographical context, as local climate and socioeconomic factors appear to influence the mortality from circulatory diseases, such as in stroke and pulmonary embolism (PE). The main objective of this study was to investigate the influence of the geographical context (meteorological variables, climate index and socioeconomic factors) in mortality from cardiovascular diseases (stroke and PE) in São Paulo, between 2002 to 2011. In order to analyze the association of mortality with the meteorological variables we used a generalized linear model using the Poisson distribution and distributed lag non linear models. Spatially the association of mortality with socioeconomic variables were tested using the spatial regression models OLS and GWR. As a result we found that both the cold and the heat are risk factors for all types of stroke and PE with a higher risk depending on the type of men and women. Spatially the highest values of relative risk (RR) for stroke mortality were concentrated in the outskirts of the city of São Paulo, which coincided with areas of lower per capita income and vegetation and higher percentage of black population. In relation to spatial distribution of high values of RR PE by these were present mainly in the inner area. In conclusion, our research has generated a lot of results that show that both environmental and socioeconomic variables influence on mortality from some diseases of the circulatory system. In view of the urgent care for stroke and PE cases can avoid serious sequelae and deaths, a better understanding of the importance of geographic context may allow the development of warning systems at the urgent care services and targeting campaigns for the prevention of avoidable risk factors.
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Lozano, Polo Laura. "Adherència a les guies de pràctica clínica en el diagnòstic d’embolisme pulmonar en un Servei d’Urgències. Impacte clínic d’una intervenció formativa." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665229.
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L’embolisme pulmonar (EP) és una causa freqüent de morbiditat, mortalitat i
hospitalització. Les guies de pràctica clínica (GPC) que combinen l’ús d’escales de
probabilitat clínica (EPC) i una determinació de Dímer-D (DD) per guiar la realització
d’un angio-TC pulmonar, milloren la sensibilitat i especificitat diagnòstica. Malgrat això,
l’adherència a les GPC és baixa. Als serveis d’urgències (SU) s’ha produït un augment
d’atencions en poblacions d’edat avançada. La presentació variable i inespecífica de
l’EP, juntament amb l’associació amb altres patologies en pacients ancians pot
complicar i retardar el diagnòstic. El DD augmenta amb l’edat, condicionant una baixa
especificitat diagnòstica, generant un nou valor de tall del DD ajustat per edat, que es
correspon amb l’edat del pacient multiplicat per 10 en majors de 50 anys. Per això,
garantir un maneig de qualitat i ajustat a les recomanacions de les GPC suposa un repte
organitzatiu als SU.
L’objectiu d’aquest estudi és valorar el canvi en l’adherència a les GPC davant de la
sospita d’EP per part dels professionals sanitaris al SU després d’una intervenció
formativa de millora, valorar la freqüència del diagnòstic d’EP abans i després de la
intervenció, conèixer l’efecte de la utilització del DD ajustat a l’edat i les característiques
dels pacients diagnosticats d’EP.
Es realitzà una primera observació retrospectiva el 2014 de tots els pacients atesos el
2012 amb sospita d’EP al SU. El maig del 2015 es realitzà una intervenció formativa
dirigida a homogeneïtzar i sistematitzar el maneig dels pacients amb sospita d’EP.
Posteriorment es va fer una nova anàlisi retrospectiva observacional de juny a novembre
del 2015 per valorar els canvis després de la intervenció formativa.
Es van incloure 785 pacients amb sospita d’EP al primer període i 256 al segon. L’edat
mitjana dels pacients del primer període va ser de 62.22 anys (18–97; DE 17.65) i de
69.22 anys (25–98; DE 16.27) al segon període. En ambdós períodes més de la meitat
dels pacients inclosos van ser dones. La freqüència de diagnòstic d’EP va ser de 8.3%
al primer període i de 19.5% al segon, amb una mortalitat a 30 dies que disminuí del
12.7% al 6%.
En ambdós períodes, la presentació clínica dels pacients amb sospita clínica d’EP més
joves va ser el dolor pleurític, presentant-se en els més grans, clínica de dispnea,
taquipnea, edemes i sibilants. Ambdues mostres són comparables quant a patologies
associades i factors de risc per presentar EP, sent més freqüents en el grup d’ancians.
L’adherència global a les GPC en l’avaluació de les sospites d’EP al nostre SU abans
de la intervenció formativa, era superior a la descrita a la literatura, variant entre un
39.2% i un 53.2% depenent de l’EPC utilitzada, amb una disminució progressiva i
significativa amb l’augment de l’edat dels pacients. Al segon període, l’adherència varia
de 46.9% a 59.4% en funció de l’escala utilitzada, presentant una tendència a disminuir
amb l’augment de l’edat dels pacients, però sense trobar diferències significatives per
grups d’edat.
La intervenció formativa ha comportat una millora substancial en l’adherència global
(+14.6%) en el diagnòstic d’EP en el SU, sent capaç de corregir l’efecte de l’edat en el
grau d’adherència. La conseqüència de l’increment de l’adherència en totes les edats i
especialment en la població anciana, és un increment important i significatiu de la
sensibilitat diagnòstica i de la freqüència de diagnòstic d’EP després de la intervenció
formativa amb disminució de la mortalitat. El millor acompliment de les GPC ha
comportat també una utilització més raonada de les sol·licituds de DD i angio-TC
pulmonars (millora en l’especificitat) amb els beneficis associats de disminució de riscos
pels pacients i de despesa sanitària.<br>Pulmonary embolism (PE) is a frequent cause of morbidity, mortality and hospitalization
admittance. Clinical practice guidelines (CPG) implementation that use clinical prediction
rules (CPR) and the D-dimer test (DD) to guide the realization of computed tomography
pulmonary angiography (CT_PA) has been useful in improving sensitivity and diagnostic
specificity. In spite of this, adherence to CPGs is low. In ED there are a significant
admission increase in elderly populations. The variable and nonspecific presentation of
PE and the possible association with other diseases can complicate and delay the
diagnosis in this group of patients. The DD increases with patients’ age, conditioning a
low diagnostic specificity, generating an age-adjusted DD cut-off, which corresponds to
the age x10 in patients older than 50 years. To ensure a quality management adjusted
to CPG recommendations we should assumes an ED organization challenge.
The aim of this study was to assess the change in adherence to CPGs on suspicion of
EP of health professionals in ED after a training intervention for improvement, to assess
the frequency of the diagnosis of EP, to know the effect of the age-adjusted DD and
clinical features of patients with PE.
A first retrospective observation was made of all patients admitted in 2012 with suspicion
of PE in ED. In May-2015 a formative intervention was realized directed to homogenize
the handling of the patients with suspicion of PE. Subsequently, a new observational
retrospective analysis was carried out from June to November-2015 to evaluate the
changes after the formative intervention.
We included 785 patients with suspicion of PE in the first period and 256 in the second
one. Mean age in the first period was 62.22 years (18-97, SD 17.65) and 69.22 years
(25-98, SD 16.27) in the second one. In both periods more than half of patients included
were women. The frequency of PE diagnosis was 8.3% in the first period and 19.5% in
the second, with a 30-day mortality rate that dropped from 12.7 to 6%.
In both periods, the clinical presentation of the youngest patients with clinical suspicion
of PE was pleuritic pain, meanwhile in elderly was dyspnea, tachypnea, edema and
rales. Both samples are comparable in terms of associated pathologies and risk factors
for presenting PE, being more frequent in the elderly group.
The adherence to CPG in the evaluation of suspicions of EP in our ED before the
formative intervention was higher than that described in the literature, with a progressive
and significant decrease with age. In the second period, the compliance presenting a
tendency to decrease with the increase of patients’ age, without significant differences
by age groups.
The training intervention carried out has led to a substantial improvement in adherence
(+14.6%) in the diagnosis of PE in ED, being able to correct age effect on the degree of
compliance. After formative intervention, consequence of the adherence increase in all
ages and especially in elderly population, an important and significant increase in
diagnostic sensitivity and PE diagnosis frequency with a decrease in the mortality The
best performance of the CPG has also led to a more reasoned use of the applications of
DD and CT-PA (improvement in specificity) with the associated benefits of decreasing
the risks for patients and healthcare costs.
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Edwards, David. "Pre-Clinical Evaluation of a Novel Radiotracer for the Diagnosis of DVT and Pulmonary Embolism." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7321.
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Sweetland, Sian. "Factors affecting the incidence of pulmonary embolism in a large cohort of women in Scotland." Thesis, University of Oxford, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.504602.
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Nguyen, Doan Trang. "Electrical Impedance Tomography as A Radiation-free Alternative Medical Imaging Modality for Pulmonary Embolism Detection." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13594.
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The diagnosis of Pulmonary Embolism (PE) is an important issue, which currently does not have satisfactory solutions with current imaging modalities such as Computed Tomography Pulmonary Angiogram (CTPA) and Ventilation/Perfusion nuclear scans. Both of these imaging modalities use harmful radiation (X-ray) and CTPA requires the injection of nephrotoxic contrast agents. Furthermore, the patients must be moved to special imaging chambers, which is not optimal for patients who require constant life supporting and/or monitoring devices. A reliable, portable and preferably radiation-free method of imaging would aid significantly in the diagnosis of PE, thus reducing the fatality of this acute condition. Electrical Impedance Tomography (EIT) is a promising medical imaging modality, which typically uses a single ring of external electrodes to image the impedance changes within the body. EIT is portable, non-invasive, radiation free and inexpensive. It can be used for long term monitoring at the bedside with high temporal resolution. Several recent studies showed that pulmonary perfusion could be reliably imaged using EIT with the aid of small bolus of highly conductive fluid (20% NaCl). The presented research explored the application of contrast-enhanced EIT for the evaluation of PE in vivo on a large animal model. The results show that: (1) low concentration saline (3% instead of 20% NaCl) can be effectively utilised as a contrast agent for EIT, (2) perfusion imaging with contrast enhanced EIT during an apnoea with both low and high concentration saline can detect unilateral small segmental PE and (3) with advanced signal processing, perfusion imaging with contrast enhanced EIT without interruption in respiration with low concentration saline can detect unilateral small segmental PE
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Tófano, Viviane Alessandra Capelluppi [UNESP]. "Avaliação clínica e ultrassonografia tardia de pacientes com trombose venosa profunda, portadores de trombofilia." Universidade Estadual Paulista (UNESP), 2008. http://hdl.handle.net/11449/103481.
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tofano_vac_dr_botfm.pdf: 984641 bytes, checksum: d4fcddf13acc4d52c783e4c30966c9b0 (MD5)<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)<br>A trombose venosa profunda (TVP) caracteriza-se pela formação aguda de um trombo no interior das veias profundas. É uma doença de alta incidência e de grande importância clínica e epidemiológica devido à sua morbimortalidade, sendo atualmente, considerada multifatorial. São vários os fatores de risco genéticos e/ou adquiridos relacionados à TVP e a compreensão da interação destes, permite melhor entender esta doença, não só devido aos seus sintomas de fase aguda mas, principalmente, por sua complicação mais temida, a embolia pulmonar e, a longo prazo, a síndrome pós-trombótica (SPT), que apresenta importante morbidade, inclusive com repercussões sócio-econômicas. A avaliação a longo prazo, clínica e ultrassonográfica, de pacientes com diagnóstico de TVP, visando verificar a incidência e gravidade da SPT é necessária para a compreensão da evolução destes pacientes. Desconhecemos a existência de trabalhos em nosso meio, que avaliem a evolução tardia da TVP. Objetivo: Determinar a evolução a longo prazo de pacientes com TVP de membros, portadores de trombofilia e verificar se existem diferenças na evolução de pacientes trombofílicos e não trombofílicos. Método: Num estudo coorte retrospectivo foram avaliados os prontuários de 275 pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp, dos quais foram identificados 60 pacientes trombofílicos, sendo possível contactar 40 deles para consulta, dos quais 39 pacientes aceitaram participar do estudo. Foram selecionados 25 pacientes com diagnóstico de TVP, não trombofílicos, pareados para sexo e idade, para comparação com o grupo trombofílico. Durante a consulta foi preenchido um protocolo que continha as seguintes variáveis: dados demográficos, profissão, antecedentes pessoais e antecedentes obstétricos (se mulher), antecedentes familiares com relação...<br>Deep vein thrombosis (DVT) is characterized by the acute formation of a thrombus in the interior of the deep veins. It is a disease of high incidence and great clinical and epidemiological importance due to its morbimortality, being presently considered multifactorial. The genetic and/or acquired risk factors related to DVT are various and understanding their interaction allows a better comprehension of this illness, due to both symptoms of the acute stage and, mainly, its most feared complication, the pulmonary embolism and, in long term, the post-thrombotic syndrome (PTS), which presents important morbidity, inclusively with social and economical repercussions. The long-term clinical and ultrasound evaluation of patients with DVT diagnosis, aiming to verify the incidence and seriousness of PTS, is necessary to understand the evolution of these patients. We are not aware of the existence of works in our area which evaluate the late evolution of DVT. Objective: To determine the long-term evolution of patients with DVT of limbs, carriers of thrombophilia, and verify the existence of differences in the evolution of thrombophilic and non-thrombophilic patients. Method: In a retrospective cohort study, the medical registers of 275 patients attended at the Clinics Hospital of the School of Medicine of the Paulista State University, in Botucatu, São Paulo, Brazil, were evaluated, from which 60 thrombophilic patients were identified. It was possible to contact 40 of them for appointment, from which 39 patients accepted to participate in the study. 25 non-thrombophilic patients, paired for sex and age, were selected with DVT diagnosis, for comparison with the thrombophilic group. During the appointment, a protocol was filled in, containing the following variables: demographic data, occupation, personal antecedents and obstetric antecedents (if woman), familiar antecedents concerning thrombosis... (Complete abstract click electronic access below)
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Uzuelli, Juliana Alves. "Alterações das concentrações plasmáticas de troponina I e de metaloproteinases 2 e 9 da matriz extracelular após embolia aguda em cães." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/17/17133/tde-17082008-163352/.
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O diagnóstico da tromboembolia pulmonar aguda (EPA) e a avaliação da gravidade desta condição é desafiador. Enquanto as concentrações de troponina I cardíaca (TI) já estão bem estabelecidas quanto ao risco de estratificação, não há estudos prévios que tenham examinado se há alguma relação linear entre as concentrações de TI cardíaca e a gravidade da EPA. Além disso, as metaloproteinases (MMPs) da matriz extracelular estão envolvidas na fisiopatologia da EPA. Entretanto, é desconhecido se o aumento da atividade gelatinolítica das MMPs após a EPA reflete a gravidade desta condição. Nós examinamos se as concentrações circulantes destes biomarcadores aumentam em proporção à gravidade da EPA experimental induzida em cães anestesiados. A EPA foi induzida com coágulos de sangue autólogo (salina, 1, 3 ou 5 mL/Kg) injetados no átrio direito. As avaliações hemodinâmicas foram realizadas no momento basal e 120 minutos após a EPA. Da mesma forma, foram realizadas as quantificações de troponina I no soro e a zimografia das MMPs 2 e 9 no plasma. Nossos resultados sugerem não haver aumento significativo da atividade gelatinolítica da pró-MMP-2 no plasma após a EPA, enquanto que a atividade da pró-MMP-9 aumenta em 80% apenas no grupo que recebeu 5 mL/Kg de coágulos. A TI cardíaca no soro e a atividade da pró-MMP-9 no plasma tiveram uma correlação positiva com o índice de resistência vascular pulmonar (p=0,007 e rs=0,833 para a TI, e p=0,034 e rs=0,684 para a pró-MMP-9) e com a pressão média na artéria pulmonar (p=0,005 e rs=0,610 para a TI, e p=0,022 e rs=0,720 para a pró-MMP-9). Concluímos que a TI cardíaca e a pró-MMP-9 circulantes aumentam em proporção à gravidade da EPA, embora o aumento da pró-MMP-9 não seja muito evidente em graus menos severos da EPA. Estes achados podem ser relevantes para a clínica da EPA.<br>Making the diagnosis of acute pulmonary thromboembolism (APT) and assessing its severity is very challenging. While cardiac troponin I (CTI) levels are promising in risk stratification, no previous study has examined whether there is a linear relation between CTI levels and the severity of APT. Moreover, matrix metalloproteinases (MMPs) are involved in the pathophysiology of APT. However, it is unknown whether the increases in MMP levels after APT reflect the severity of this condition. We examined whether the circulating levels of these biomarkers increase in proportion to the severity of experimental APT induced in anesthetized dogs. APT was induced with autologous blood clots (saline, 1, 3, or 5 mL/kg) injected into the right atrium. Hemodynamic evaluations were carried out for 120 min. Gelatin zymography of MMP-2 and MMP-9 from plasma samples were performed and serum CTI levels were determined at baseline and 120 min after APT. Our results sugest that while no significant increases in pro-MMP-2 levels were found after APT, pro-MMP-9 levels increased by 80% only after 5 mL/kg of clot embolization. Serum CTI and plasma pro-MMP-9 levels correlated positively with pulmonary vascular resistance (p=0.007 and rs=0.833 for troponin I, and p=0.034 and rs=0.684 for pro-MMP-9) and with pulmonary artery pressure (p=0.005 and rs=0.610 for troponin I, and p=0.022 and rs=0.720 for pro-MMP-9). We conclude that circulating CTI and pro-MMP-9 increase in proportion to the severity of APT, although the increases in plasma pro-MMP-9 are less clear with less severe APT. These findings may be relevant for clinical APT.
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Chaves, Marcus Silvane Sanchez. "Angio-TC no diagnóstico do tromboembolismo pulmonar : grau de concordância em sua interpretação entre emergencistas, residentes de radiologia e radiologistas em 123 casos suspeitos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/104560.
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Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição.<br>Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.
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Hayashino, Yasuaki. "Ventilation-perfusion scanning and helical CT in suspected pulmonary embolism : meta-analysis of diagnostic test performance." Kyoto University, 2006. http://hdl.handle.net/2433/143811.
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Planquette, Benjamin. "Séquelles perfusionnelles après une embolie pulmonaire : pronostic, prédiction et mécanismes physiopathologiques." Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCB254/document.
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Au décours d'une première embolie pulmonaire (EP), certains patients présentent un syndrome post EP : un tiers des patients ont une obstruction persistante de la vascularisation pulmonaire, associée à la persistance d'une dyspnée et une limitation des performances à l'effort. Certains patients présenteront une récidive d'EP ou, plus rarement, une hypertension pulmonaire, dont les séquelles perfusionnelles sont un critère diagnostique indispensable. Le rôle et la physiopathologie des séquelles perfusionnelles au cours du syndrome post EP est incomprise. Ce travail a mis en évidence l'existence d'un risque majoré de récidive d'EP (odds ratio 1,9) chez les patients présentant des séquelles perfusionnelles >10% à la vascularisation pulmonaire. L'analyse des propriétés fonctionnelles du fibrinogène purifié à partir du plasma de patients suivis pour une première EP améliore la prédiction de séquelles perfusionnelles confirmant le rôle clé de celui-ci dans la physiopathologie de la maladie. Ainsi, une forte proportion de chaine Bβ porteuse d'un seul résidu acide sialique majore le risque de séquelles. L'étude des cellules endothéliales circulantes à la phase aigüe et après une EP montre que les patients qui développeront des séquelles mobilisent peu de cellules endothéliales, témoignant d'une forte altération des processus de réparation de l'endothélium pulmonaire. L'interaction de la fibrine avec les progéniteurs endothéliaux dans cette anomalie de la régulation est possible : les progéniteurs expriment le récepteur VLDLr dont l'épitope β15-42 de la fibrine est un ligand impliqué dans la régulation du cycle cellulaire et l'inhibition de l'angiogenèse<br>Pulmonary vascular sequels after pulmonary embolism: prognosis, prediction and physiopathologyAbstract: Post Pulmonary Embolism (PE) syndrome is not rare after PE: one third of the patients presents residual pulmonary vascular obstruction (RPVO) traducing sequels associated with increased dyspnea and impaired exercise capacity. Some of these patients will suffer PE recurrence or, more rarely, chronic thromboembolic pulmonary hypertension, whose one the diagnosis criteria is persistent perfusion defect. Prognosis value and mechanisms underlying vascular sequels are still unclear. The present work shows that RPVO > 10% after a first PE is associated with an increased risk for venous thromboembolism recurrence (odds ratio 1.9). Secondly, fibrinogen properties were investigated in PE patients. Patients with RPVO >10% presented more monosialiated Bβchain form. Prediction models for RPVO that include fibrinogen analysis were more accurate than those without fibrinogen data; This results highlights the key role of fibrin in the pathophysiology of chronic venous thromboembolism. Interestingly, the present work shows that patient who will present RPVO had an impaired endothelial cells mobilization. Compared to patients without RPVO, patients with RPVO had lower circulating endothelial cells at the acute phase of PE. This endothelial dysfunction is probably triggered by endothelial progenitors that expressed the very low density lipoprotein receptor (VLDLr), implicated in the inhibition of angiogenesis and able to bind the β15-42 N terminal sequence of the fibrin Bβ chain
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Ярмолюк, А. О., та Ю. А. Вікторова. "Визначення D-димеру для діагностики тромбоемболії легеневої артерії". Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47685.
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Актуальність. Тромбоемболія легеневої артерії (ТЕЛА) – одне з найпоширеніших ускладнень багатьох захворювань, що представляє загрозу для життя людини. Відомо, що серед пацієнтів терапевтичного профілю найчастіше ТЕЛА виникає при інсульті (65%), інфаркті міокарда (ІМ) (22%), а також у людей похилого віку (9%). Це призводить до розвитку гіпертензії малого кола кровообігу та легеневого серця.
Мета. Визначити перспективу застосування D-димеру для діагностики ТЕЛА.
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Ghaye, Benoît. "La Maladie thromboembolique pulmonaire aigue: diagnostic et pronostic par tomodensitométrie hélicoïdale." Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209051.
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L’acquisition par MDCT et la reconstruction en coupes épaisses de 1.25 mm permettent l’analyse des artères pulmonaires jusqu’à leur 5ème ordre. L’angiographie thoracique par TDM permet de proposer des critères pronostiques de survie des patients atteints d’EP sévère. Le VD/VGd et le diamètre de la veine azygos en sont les meilleurs prédicteurs. En tenant compte de Dmax, de tmax, de l’homogénéité de l’opacification vasculaire et de la différence minimale nécessaire, le délai optimal pour l’acquisition de la vénographie par TDM se situe entre 210 et 240 sec. pour les veines infrapoplitées et entre 180 et 300 sec. pour les veines supra-poplitées. Pour une vénographie par TDM en mode séquentiel, une acquisition caudo-craniale débutant 210 sec. après l’injection du produit de contraste iodé pourrait permettre la détection optimale des caillots. En mode hélicoïdal, le sens de l’acquisition n’est pas déterminant. Malgré la possible amélioration de la détection des caillots artériels pulmonaires par MDCT, cette technique n’a pas permis de déceler plus d’EP sans TVP que le SDCT. En revanche, puisque le MDCT a permis de détecter plus de TVP sans EP que le SDCT, la vénographie par TDM en MDCT apporte une valeur ajoutée au SDCT. Par ailleurs, en MDCT, la vénographie par TDM diminue de 29% la proportion d’examens indéterminés obtenus par la seule réalisation de l’angiographie thoracique par TDM. Que ce soit en SDCT ou en MDCT, cette étude suggère l’utilité de combiner les deux examens. Chez les patients suspects d’EP, la vénographie par TDM doit s’étendre des mollets aux crêtes iliaques. Bien qu’une EP existe chez une majorité de patients atteints de TVP et vice versa, la charge en caillots dans un compartiment n’indique pas nécessairement la charge en caillots dans l’autre.<br>Doctorat en Sciences médicales<br>info:eu-repo/semantics/nonPublished
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Tromeur, Cécile. "Etude des facteurs de risque cliniques de maladie veineuse thromboembolique chez les femmes : implication sur la réduction des risques liées à la stratégie diagnostique de l'embolie pulmonaire chez les femmes enceintes." Thesis, Brest, 2018. http://www.theses.fr/2018BRES0021/document.
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Introduction: La stratégie diagnostique de l’EP au cours de la grossesse est incertaine du fait du manque d’études solides d’un point de vue méthodologique, et du risque lié à l’irradiation des examens diagnostiques (angioscanner thoracique et scintigraphie pulmonaire). L’enjeu est donc de valider des stratégies performantes d’une part, et d’identifier des marqueurs cliniques permettant de réduire le recours aux examens irradiants d’autre part. Notre premier objectif a été d’identifier les pièges au cours de la stratégie diagnostique de l’EP (baisse de la performance du dosage des D‐dimères, des scores de probabilité clinique et de l’imagerie) au cours de la grossesse. Le deuxième objectif a été de comparer les performances diagnostiques et les risques des deux examens d’imagerie de référence que constituent la scintigraphie pulmonaire et l’angioscanner thoracique. Le troisième objectif a été de valider une stratégie diagnostique permettant une réduction du recours aux examens irradiants (ajustement du taux de D-dimères sur la probabilité clinique). Le dernier objectif a été de mettre en place un programme de recherche centré sur le poids des antécédents familiaux de MVTE, paramètre lui aussi susceptible de réduire le recours aux examens paracliniques. Conclusion : Au terme de ces analyses, nous avons développé un programme de validation d’une stratégie diagnostique de l’EP chez la femme enceinte ; en outre, l’identification d’un ajustement du taux de D‐dimères sur la probabilité clinique ainsi que, en termes de perspective, sur les antécédents familiaux de MVTE a le potentiel de conduire à des stratégies diagnostiques moins irradiantes et plus performantes chez les femmes enceintes ayant une suspicion d’EP<br>Introduction : The diagnostic strategy for PE during pregnancy is uncertain due to the lack of high quality studies and the risk of radiation exposure with computed tomography pulmonary angiography (CTPA) and ventilationperfusion (V-Q) lung scan. The challenge is to validate diagnostic strategies, and to identify predictive factors to reduce the number of additional imaging tests with radiation exposure.First, we aim to identify pitfalls during the diagnostic strategy of PE (the D-dimer assay threshold, clinical probability scores, imaging) during pregnancy. Second, our objective was to compare the diagnostic efficiency of CTPA and (V-Q) lung scan during pregnancy.Third, our objective was to validate a diagnostic strategy wich reduces the number of imaging tests (adjustment of the D-dimer level on the clinical probability). Finally, the last objective was to set up a research program focused on the weight of the family history of MVTE, that may also reduce the need of additional tests. Conclusion : We identified an ongoing validation protocol with a new diagnostic algorithm in pregnant patients withPE suspicion ; Furthermore, identifying a D-dimer level adjustement as well as a family history of VTE can lead tomore effective diagnostic stragegies with less radiation exposure for pregnant women with suspected PE
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Johnson, Patrick Connor. "Coronary Artery Calcification Is Often Unreported in CT Pulmonary Angiograms in Patients With Suspected Pulmonary Embolism: An Opportunity to Improve Diagnosis of Acute Coronary Syndrome." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295864.
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Objective: In patients with suspected pulmonary thromboembolism (PTE), coronary artery calcification (CAC) can be an incidental finding in CT pulmonary angiograms. We evaluated the frequency of unreported CAC and its association with diagnosis of acute coronary syndrome (ACS).
Methods: The data of 469 consecutive patients who were referred to the emergency radiology department for CT pulmonary angiography because of suspicion for PTE were reviewed. Radiology reports were rechecked, and positive CAC findings were recorded. All CT pulmonary angiograms were re-evaluated by one radiologist, and CAC findings were recorded. The rate of ACS and PTE as final diagnosis for that hospital admission was calculated. The association between CAC and ACS diagnosis was assessed in different subgroups of patients.
Results: About 11.1% of patients had PTE and 43.8% had CAC. CAC was significantly higher in patients with ACS diagnosis than those without (56.2% vs. 40.4%; OR = 1.9). There was a strong positive association (OR = 3.5) between CAC and ACS in younger patients (age ≤ 45 in men, age ≤ 55 in women); those without PTE (OR = 2.15); and those without cardiometabolic risk-factors (OR = 3.8). CAC was unreported in 45% of patients with positive CAC (n = 98). ACS was the final diagnosis in 31.6% of patients with unreported CAC. There was a significant association between CAC and ACS in patients with unreported CAC (OR = 2.18). This association was more prominent in the above subgroups.
Conclusions: CAC is often unreported in CT pulmonary angiograms. CAC is a significant predictor of ACS, particularly in younger patients and those without PTE and cardiometabolic risk-factors. Especially in these sub-groups, radiologists should assess CAC findings.
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Sobieraj, Diana M., Craig I. Coleman, Vinay Pasupuleti, Abhishek Deshpande, Roop Kaw, and Adrian V. Hernández. "Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis." Elsevier B.V, 2015. http://hdl.handle.net/10757/346496.
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Diana.sobieraj@hhchealth.org<br>Objective To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA). Methods A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, through September 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals. Results Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. Conclusion Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options. Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.<br>Revisión por pares
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Tófano, Viviane Alessandra Capelluppi. "Avaliação clínica e ultrassonografia tardia de pacientes com trombose venosa profunda, portadores de trombofilia /." Botucatu : [s.n.], 2008. http://hdl.handle.net/11449/103481.
Full textAbstract:
Orientador: Francisco Humberto de Abreu Maffei<br>Banca: Hamilton Almeida Rollo<br>Banca: Adilson F. Paschôa<br>Banca: Newton Key Hokama<br>Banca: Cyrillo C. Filho<br>Resumo: A trombose venosa profunda (TVP) caracteriza-se pela formação aguda de um trombo no interior das veias profundas. É uma doença de alta incidência e de grande importância clínica e epidemiológica devido à sua morbimortalidade, sendo atualmente, considerada multifatorial. São vários os fatores de risco genéticos e/ou adquiridos relacionados à TVP e a compreensão da interação destes, permite melhor entender esta doença, não só devido aos seus sintomas de fase aguda mas, principalmente, por sua complicação mais temida, a embolia pulmonar e, a longo prazo, a síndrome pós-trombótica (SPT), que apresenta importante morbidade, inclusive com repercussões sócio-econômicas. A avaliação a longo prazo, clínica e ultrassonográfica, de pacientes com diagnóstico de TVP, visando verificar a incidência e gravidade da SPT é necessária para a compreensão da evolução destes pacientes. Desconhecemos a existência de trabalhos em nosso meio, que avaliem a evolução tardia da TVP. Objetivo: Determinar a evolução a longo prazo de pacientes com TVP de membros, portadores de trombofilia e verificar se existem diferenças na evolução de pacientes trombofílicos e não trombofílicos. Método: Num estudo coorte retrospectivo foram avaliados os prontuários de 275 pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu-Unesp, dos quais foram identificados 60 pacientes trombofílicos, sendo possível contactar 40 deles para consulta, dos quais 39 pacientes aceitaram participar do estudo. Foram selecionados 25 pacientes com diagnóstico de TVP, não trombofílicos, pareados para sexo e idade, para comparação com o grupo trombofílico. Durante a consulta foi preenchido um protocolo que continha as seguintes variáveis: dados demográficos, profissão, antecedentes pessoais e antecedentes obstétricos (se mulher), antecedentes familiares com relação... (Resumo completo, clicar acesso eletrônico abaixo)<br>Abstract: Deep vein thrombosis (DVT) is characterized by the acute formation of a thrombus in the interior of the deep veins. It is a disease of high incidence and great clinical and epidemiological importance due to its morbimortality, being presently considered multifactorial. The genetic and/or acquired risk factors related to DVT are various and understanding their interaction allows a better comprehension of this illness, due to both symptoms of the acute stage and, mainly, its most feared complication, the pulmonary embolism and, in long term, the post-thrombotic syndrome (PTS), which presents important morbidity, inclusively with social and economical repercussions. The long-term clinical and ultrasound evaluation of patients with DVT diagnosis, aiming to verify the incidence and seriousness of PTS, is necessary to understand the evolution of these patients. We are not aware of the existence of works in our area which evaluate the late evolution of DVT. Objective: To determine the long-term evolution of patients with DVT of limbs, carriers of thrombophilia, and verify the existence of differences in the evolution of thrombophilic and non-thrombophilic patients. Method: In a retrospective cohort study, the medical registers of 275 patients attended at the Clinics Hospital of the School of Medicine of the Paulista State University, in Botucatu, São Paulo, Brazil, were evaluated, from which 60 thrombophilic patients were identified. It was possible to contact 40 of them for appointment, from which 39 patients accepted to participate in the study. 25 non-thrombophilic patients, paired for sex and age, were selected with DVT diagnosis, for comparison with the thrombophilic group. During the appointment, a protocol was filled in, containing the following variables: demographic data, occupation, personal antecedents and obstetric antecedents (if woman), familiar antecedents concerning thrombosis... (Complete abstract click electronic access below)<br>Doutor
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Scudeller, Paula Gobi. "Avaliação do impacto de mudanças técnicas introduzidas na operação de tromboendarterectomia pulmonar ao longo de 10 anos: estudo retrospectivo no InCor-HCFMUSP." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-12092018-101725/.
Full textAbstract:
INTRODUÇÃO: A hipertensão pulmonar tromboembólica crônica (HPTEC) é uma doença vascular pulmonar progressiva, cuja incidência varia de 0,56% a 3,2% em indivíduos com embolia pulmonar aguda (EPA) recorrente. Apesar do avanço nas opções de tratamento para HPTEC, a tromboendarterectomia pulmonar (TEAP) continua sendo padrão ouro, levando a melhora hemodinâmica e aumento da sobrevida. OBJETIVOS: Avaliar o impacto que mudanças técnicas intraoperatórias implementadas tiveram na evolução dos pacientes submetidos à TEAP em relação à morbimortalidade imediata e tardia, e também sobre o desenvolvimento do ato operatório. MÉTODOS: Estudo retrospectivo em portadores de HPTEC, submetidos à TEAP, no período de janeiro/2007 a maio/2016, divididos em 3 grupos, de acordo com intervenções implementadas. A 1ª intervenção consistiu em mudanças na circulação extracorpórea (CEC) e no tempo de parada circulatória total (PCT), e a 2ª intervenção incluiu alterações na CEC, técnicas anestésica e cirúrgica. A avaliação dos dados incluiu análise univariada para associações entre intervenções com variáveis de morbimortalidade e técnica operatória. O modelo de regressão multivariado foi aplicado para validar se as melhorias resultaram das intervenções implementadas. A análise de sobrevida foi feita por Kaplan-Meier. RESULTADOS: Foram avaliados 102 indivíduos, 62,8% mulheres, idade média de 49,1±14,8 anos, 65,7% estavam em classe funcional III-IV (NYHA). A avaliação hemodinâmica demonstrou hipertensão pulmonar importante, com valores médios elevados de pressão média na artéria pulmonar (PmAP; G1=52,9±14,45mmHg; G2=53,2±12,4mmHg; G3=53,3±12,5mmHg, p=0,992) e resistência vascular pulmonar (RVP; G1=828,4±295,13 dynas.s.cm-5; G2=838,9±428,4 dynas.s.cm-5; G3=969±417,3 dynas.s.cm-5, p=0,313). Os pacientes submetidos à TEAP mostraram aumento do tempo total de CEC entre os grupos (G1=192,3±39,4min; G2=251,7±33,4min; G3=298,2±40,2min, p < 0,001), como resultado da padronização dos tempos de esfriamento (G1=47,9±18,5min; G2=66,9±5,9min; G3=70,6±3,7min, p < 0,001), aquecimento (G1=66,8±17,7min; G2=87,2±8,1min; G3=107,7±23,5min, p < 0,001) e reperfusão (G1=25,5±7,6min; G2=20,7±8,4 min; G3=18,6±9,4min, p=0,007). A diminuição do número de operações com mais de 2 PCT (G1= 89%; G2= 60%; G3: 55%, p=0,002) foi decorrente do aumento da duração média de cada PCT (G1=15,5±2,9min; G2=17,8±1,7min; G3=19,2±2,0min, p < 0,001). Complicações pós-operatórias foram observadas em 88,5% dos pacientes, havendo redução significativa das complicações cirúrgicas (p=0,035), infecciosas (p=0,017) e neurológicas com sintomas permanentes (p=0,048) na comparação entre os 3 grupos. No seguimento após a alta, 85% estavam em classe funcional I-II (NYHA), sem melhora hemodinâmica significativa entre os grupos. Após a análise multivariada, o G3 apresentou 4,7 menos chances de complicação cirúrgica que G1 (p=0,034) e tempo de aquecimento menor que 83 minutos aumentou 4 vezes a chance de complicação infecciosa (p=0,002). A redução da mortalidade hospitalar e da sobrevida não foi significativa entre os grupos. CONCLUSÕES: Em relação à morbimortalidade imediata e tardia, o impacto das intervenções foi evidenciado pela redução das complicações neurológicas com sintomas permanentes, complicações cirúrgicas e infecciosas. Em relação ao ato operatório, o impacto foi evidenciado pelo aumento dos tempos totais de CEC, de esfriamento, de aquecimento, tempo médio das PCT, redução nos números de PCT e no tempo total de reperfusão<br>INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease which incidence varies from 0.56% to 3.2% in individuals with recurrent acute pulmonary embolism (APE). Despite advances in treatment options for CTEPH, pulmonary endarterectomy (PE) remains a gold standard, leading to hemodynamic improvement and increased survival. OBJECTIVES: Evaluate the impact of intraoperative technical changes on the evolution of patients submitted to PE related to immediate and late morbimortality, as well as on the development of the operative procedure. METHODS: Retrospective study of patients with CTEPH, submitted to PE, between January 2007 and May 2016, divided into 3 groups, according to the implemented interventions. The first intervention consisted of changes in cardiopulmonary bypass (CPB) and total circulatory arrest time (CAT), and the second intervention included changes in CPB, anaesthetic and surgical techniques. The data analysis included a univariate analysis for associations between interventions with morbidity variables and operative technique. The multivariate regression model was applied to validate whether the improvements resulted from the interventions implemented. Survival analysis was performed using Kaplan-Meier. RESULTS: We evaluated 102 individuals, 62.8% were women, mean age was 49.1 ± 14.8 years, and 65.7% were in functional class III-IV (NYHA). The hemodynamic evaluation showed significant pulmonary hypertension, with mean values of mean pulmonary artery pressure (mPAP, G1 = 52.9 ± 14.45 mmHg, G2 = 53.2 ± 12.4 mmHg, G3 = 53.3 ± 12.5 mmHg, p = 0.992) and pulmonary vascular resistance (PVR, G1 = 828.4 ± 295.13 dynas.s.cm-5, G2 = 838.9 ± 428.4 dynas.s.cm-5, G3 = 969 ± 417.3 dynas.s.cm-5, p = 0.313). The patients submitted to PE showed an increase in the total CPB time between the groups (G1 = 192.3 ± 39.4min, G2 = 251.7 ± 33.4min, G3 = 298.2 ± 40.2min, p < 0.001), as a result of the standardization of cooling times (G1 = 47.9 ± 18.5min, G2 = 66.9 ± 5.9min, G3 = 70.6 ± 3.7min, p < 0.001), heating (G1 = 66.8 ± 17.7min, G2 = 87.2 ± 8.1min, G3 = 107.7 ± 23.5min, p < 0.001) and reperfusion (G1 = 25.5 ± 7.6min, G2 = 20.7 ± 8.4 min, G3 = 18.6 ± 9.4min, p = 0.007). The decrease in the number of operations with more than 2 CAT (G1 = 89%, G2 = 60%, G3: 55%, p = 0.002) was due to the increase in the average duration of each CAT (G1 = 15.5 ± 2, 9min, G2 = 17.8 ± 1.7min, G3 = 19.2 ± 2.0min, p < 0.001). Postoperative complications were observed in 88.5% of the patients, with a significant reduction in surgical (p = 0.035), infectious (p = 0.017) and neurological complications with permanent symptoms (p = 0.048) in the comparison between the three groups. In the post-discharge follow-up, 85% were in functional class I-II (NYHA), with no significant hemodynamic improvement between groups. After the multivariate analysis, G3 presented 4.7 less chance of surgical complication than G1 (p = 0.034) and warming time less than 83 minutes increased 4 times the chance of infectious complication (p = 0.002). The reduction in hospital mortality and survival was not significant between the groups. CONCLUSIONS: Regarding immediate and late morbimortality, the impact of interventions was evidenced by the reduction of neurological complications with permanent symptoms, surgical and infectious complications. Regarding the operative event, the impact was evidenced by the increase in total CPB, cooling, heating, mean CAT time, CAT reduction and total reperfusion time
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Golfam, Mohammad. "Optimization of Lung Scintigraphy in Pregnant Women at The Ottawa Hospital." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35961.
Full textAbstract:
INTRODUCTION: Pulmonary embolism (PE) is a major cause of mortality during
pregnancy. It is estimated that about 20% of maternal deaths in north america are due to PE. A lung V/Q study in a standard (non-gravid) patient typically consists of a low dosage ventilation study followed by a higher dosage perfusion study. In some centers however, perfusion-only imaging, without accompanying ventilation imaging has been employed. In this method, a several-fold lower dose of radioactivity is used. Perfusion-only imaging has multiple advantages. In addition to reduction of radiation dose to the mother and the fetus, there is decreased cost to the health-care system as well as improved patient convenience and shortened hospital workflow.
OBJECTIVES: The present study aimed at assessing the negative predictive value (among other diagnostic accuracy measures) of perfusion-only imaging in a large group of pregnant patients with suspected pulmonary embolism.
METHODS: This study was a retrospective cohort study of the entire pregnant patients with suspected PE who underwent V/Q scan at The Ottawa Hospital and their V/Q scans were available in the PACS system. After acquiring REB approval, a comprehensive search in the PACS (Picture Archiving and Communication System) was conducted to find pregnant patients who were assessed for PE in our division since 2004 (the earliest date the V/Q images were available in our system). A statistical consultation was made before the initiation of data collection and at the time of data analysis. All patients who met the inclusion criteria were included. Initially a nuclear medicine resident with 2 years of experience read all the perfusion- only images. The PISAPED criteria were used for image interpretation. Then the results were compared against the reports made by nuclear medicine staffs that were available to us in our electronic system and a final interpretation was made after such comparison. The follow-up clinical notes were used as the gold standard to make a final diagnosis of PE. Finally, diagnostic accuracy measures were calculated.
RESULTS: A total of 364 patients were included. Mean maternal age at the time of lung V/Q scan was 30.3 years-old (SD=5.8) ranging from 16 to 51 years-old. From a total of 362 lung perfusion scans, 316/362 (87.3%) scans interpreted as normal,
17/362 (4.7%) scans were interpreted as high probability and 29/362 (8.0%) scans were interpreted as non-diagnostic. Pulmonary embolism was diagnosed in a total of
15 patients directly after performing lung scan. None of the patients with normal perfusion-only scans were diagnosed later with PE, proving a negative predictive value of 100%. The sensitivity and specificity of perfusion-only imaging after including the non-diagnostic studies were 100% (100% to 100%) and 99.1% (88.1% to 94.1%), respectively with a negative predictive value of 100% (100% to 100%) and a positive predictive value of 32.6% (19.1% to 46.2%).
Conclusion: The results of the current study show that perfusion-only imaging has a very high negative predictive value for PE in pregnant population and therefore can exclude PE with a very high degree of accuracy.
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Kaw, Roop, Vinay Pasupuleti, D. Wayne Overby, et al. "Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis." Elsevier B.V, 2014. http://hdl.handle.net/10757/320268.
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Background: Pulmonary embolism (PE) accounts for almost 40% of perioperative deaths after bariatric surgery. Placement of prophylactic inferior vena cava (IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate postoperative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28, 2013. Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity, and Sidik-Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks (RR) and 95% Confidence Intervals (CI). Results: Seven observational studies were identified (n=102,767), with weighted average incidences of DVT (0.9%), PE (1.6%), and mortality (1.0%) for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR 2.81, 95%CI 1.33-5.97, p=0.007; and RR 3.27, 95% CI 0.78-13.64, p=0.1, respectively); there was no difference in the risk of PE (RR 1.02, 95%CI 0.31-3.77, p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery is associated with higher risk of postoperative DVT and mortality. A similar risk of PE in patients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline. Randomized trials are needed before IVC placement can be recommended.<br>Revisión por pares
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Genu, Ana Maria. "Tomografia computadorizada multidetectores na avaliação do tromboembolismo pulmonar: uso de reformatações em projeção de intensidade máxima." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-20082007-104638/.
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INTRODUÇÃO: Os tomógrafos multidetectores (TCMD) aumentaram a sensibilidade na detecção do tromboembolismo pulmonar (TEP). Observa-se, no entanto, um substancial aumento no número de imagens e, conseqüentemente, no tempo de análise pelo radiologista. Uma possível solução, para este problema, é a realização de reconstruções em projeção de intensidade máxima (MIP) que reduz o número de imagens para análise. Existe ainda uma nova modalidade de imagem utilizando reconstrução MIP em planos rotacionais sobre um eixo horizontal ao nível dos hilos pulmonares (reformatação em pás de roda moinho, PRM), que tem demonstrado melhor a continuidade dos ramos arteriais que irradiam dos hilos. No entanto, estudos são necessários para determinar se o uso de reformatações MIP pode reduzir o número de imagens a serem analisadas, sem perda significativa de informações, e se a adição de reformatação PRM pode melhorar o diagnóstico de TEP. OBJETIVOS: Testar a hipótese de que imagens utilizando reconstruções em projeção de intensidade máxima de 2,0 mm e 4,0 mm de espessura, multiplanares, têm o mesmo valor diagnóstico para detecção de TEP nas grandes e pequenas artérias pulmonares, quando comparadas a imagens multiplanares de 1 mm, realizadas em TCMD de 10 e 16 fileiras de detectores. Avaliar se há influência no valor diagnóstico de TEP o acréscimo de reformatações PRM, nas imagens reconstruídas em MIP de 2 mm. CASUÍSTICA E MÉTODOS: Cinqüenta pacientes com suspeita diagnóstica de TEP (30 com TEP positivo e 20 com TEP negativo, detectados no exame tomográfico), realizaram tomografia computadorizada do tórax para avaliação das artérias pulmonares em TCMD com 16 e 10 fileiras de detectores (120 kV, 200 mAs e 1 mm de colimação). Cada exame foi reconstruído em 4 tipos de séries de imagens multiplanares: imagens multiplanares (MPR) de 1 mm e 3 tipos de reconstrução MIP, com espessuras de 2 mm, 4 mm e 2 mm acrescidas de reformatação PRM. Dois observadores avaliaram, independentemente, em estação de trabalho, a presença ou ausência de êmbolos nas artérias principais, lobares, segmentares e subsegmentares dos 50 pacientes em cada uma das reconstruções MIP, as quais foram comparadas usando-se a reformatação MPR de 1 mm como padrão de referência. RESULTADOS: As reconstruções MIP de 2 mm tiveram melhor acurácia, estatisticamente significativa, em relação a MIP de 4 mm, com valores de sensibilidade 100,0 e 100.0 para as artérias principais e lobares; 92,6 e 85,5 para as segmentares e 94,3 e 86,8 para as subsegmentares. Utilizando as imagens multiplanares de 1 mm como referência padrão. Todos pacientes com TEP foram detectados com imagens em MIP de 2 mm. Dois pacientes com TEP não foram diagnosticados com imagens em MIP de 4 mm. Não houve diferença estatisticamente significativa entre a reformatação MIP de 2 mm e 2 mm + PRM na detecção de êmbolos. CONCLUSÃO: Com um número de imagens equivalente a metade da reconstrução MPR de 1 mm, a reconstrução em MIP de 2 mm conseguiu detectar todos os pacientes com TEP positivo que foram diagnosticados pelas imagens multiplanares de 1 mm, com sensibilidade de 100,0 e 100,0 nas artérias principais e lobares, de 92,6 e 85,5 para as artérias segmentares e 94,3 e 86,8 para as artérias subsegmentares. O acréscimo de reformatações PRM às imagens em MIP de 2 mm não aumentou a acurácia na detecção de êmbolos, mas melhorou a visualização da continuidade dos êmbolos, principalmente, nas artérias centrais.<br>INTRODUCTION: Multidetector computed tomography (MDCT) has been making possible the increase of the sensibility in the detection of the pulmonary embolism (PE). It is observed, however, that there is a substantial increase in the number of images and, consequently, in the time of analysis for the radiologist. A possible solution to this problem is accomplishing a maximum intensity projection reconstruction (MIP) that reduces the number of images for analysis. Still, there is a new image modality using MIP reconstructions in rotational plans that pivot on a central horizontal axis between the lung hila (paddlewheel reformations, PDW). It provides a continuous display of branching arteries that radiate from both hila. However, studies are necessary to determine if the use of multiplan MIP reformation can reduce the number of images to be analyzed, without significant loss of information; and, if the addition of PDW reformation can improve the diagnosis of PE. OBJECTIVE: To test the hypothesis that images using maximum intensity projection reconstructions of 2,0 mm and 4,0 mm of thickness, multiplan, have the same diagnosis value for detection of pulmonary embolism in the big and small pulmonary arteries, when compared to multiplan images of 1 mm collimation, accomplished in 16 and 10 slice MDTC; and to evaluate if there is influence on the diagnosis value of PE the increment of PDW reformation, in the images rebuilt in MIP of 2 mm. CASUISTIC AND METHODS: Fifty patients suspected of having an acute PE (30 with positive PE and 20 with negative PE, detected during the tomography exam) accomplished computerized tomography of the thorax for evaluation of the pulmonary arteries by 16 and 10 slice MDTC (120 kV, 200 mAs and 1 mm collimation). Four kind of images series (1 mm thick multiplan images and 3 kinds of reconstructed images using the MIP tecnhnique with slab thicknesses of 2 mm, 4 mm and 2 mm added of PDW reformation) were obtained from each exam. Two observers independently evaluated, in work station, the presence or absence of emboli in the main and lobar, segmental and subsegmental arteries in the 50 patients in each one of the reconstructions in MIP, which they were compared using the reformation of 1 mm of thickness as reference pattern. RESULTS: The reconstructions in MIP of 2 mm had better accuracy than MIP of 4 mm, statistically significant with values of sensibility 100,0 and 100,0 for the main and lobar pulmonary arteries; 92,6 and 85,5 for the segmental and 94,3 and 86,8 for the subsegmental. The images in MPR of 1 mm were used as a reference pattern. All patients with PE were detected with images in MIP of 2 mm; two patients with PE were not diagnosed with images in MIP of 4 mm. There was not difference statisticament significant among reformation in MIP of 2 mm and 2 mm plus PDW in the detection of emboli. CONCLUSION: Reconstruction in MIP of 2 mm reduced the number of images for the half and it detected all patients with positive PE that were diagnosed by the multiplans images of 1 mm, with sensibility of 100,0 and 100,0 in the main and lobar arteries, of 92,6 and 85,5 and 79,2 for the segmental arteries and 94,3 and 86,8 for the subsegmental arteries. The increment of PDW reformation to the images in MIP of 2 mm didn\'t increase the accuracy in the detection of emboli, but it improved the visualization of the continuity of the emboli, mainly, in the central arteries.
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Al-Dosari, Sultan Aeyd Rashed. "Diagnostic Value of Multi-Slice CT Pulmonary Angiography in the Diagnosis of Pulmonary Embolism: An Investigation of Optimal Scanning Protocols in Terms of Image Quality, Contrast and Radiation Doses." Thesis, Curtin University, 2018. http://hdl.handle.net/20.500.11937/75226.
Full textAbstract:
This thesis investigates the feasibility of low-dose multi-slice CT pulmonary angiography in the diagnosis of pulmonary embolism based on experiments on a 3D printed realistic pulmonary artery model and patient data analysis. The research findings show that significant dose reductions in radiation dose and contrast medium have been achieved using low-dose CT pulmonary angiography protocols without affecting diagnostic image quality.
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Lee, Jung-Ah. "A review of the management of patients at risk for or diagnosed with venous thromboembolism (VTE) at an academic medical center, and the cost-effectiveness of diagnostic strategies for VTE /." Thesis, Connect to this title online; UW restricted, 2008. http://hdl.handle.net/1773/7224.
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Ngoya, Patrick Sitati. "Pulmonary embolism diagnosis : a clinical comparison between conventional planar and SPECT V/Q imaging using Krypton 81m – with CTPA as the gold standard." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4358.
Full textAbstract:
Thesis (MScMedSC (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2010.<br>ENGLISH ABSTRACT: Single photon emission computed tomography (SPECT) with a superior contrast
resolution has been shown to be more sensitive and specific with a lower nondiagnostic
rate than planar imaging in many nuclear medicine studies but it is still not
being routinely implemented in V/Q studies at many centres including Tygerberg
Hospital. There are many studies on V/Q SPECT using Technegas as a ventilation
agent but very limited studies available on 81m Kr gas.
Aim: To clinically compare conventional planar and SPECT V/Q imaging using 81mKr
gas in the diagnosis of pulmonary embolism, with CTPA as the gold standard.
Patients and Methods: All patients referred with clinical suspicion of pulmonary
embolism were assessed. The inclusion criteria were normal chest radiograph,
normal renal function and no contrast allergy. Exclusion criteria were age below 18
years old, pregnancy, abnormal chest radiograph, abnormal serum creatinine/urea
levels and unstable patients. A Well’s score was assigned to each enrolled patient.
Perfusion scintigraphy was performed after intravenous injection 125 MBq of 99mTc
MAA. Ventilation scintigraphy was performed with 81mKr gas. On a dual head
camera, SPECT was done before planar acquisition, while perfusion was done
before ventilation imaging in the same position. Planar V/Q images consisted of 6
standard views. All V/Q SPECT images were reconstructed using ordered-subset
expectation-maximization (OSEM) algorithm and a post-reconstruction 3D
Butterworth filters were applied. V/Q Planar and V/Q SPECT images were later
evaluated and reviewed separately and reported based on recent EANM guidelines
blinded to the CTPA results.
All patients underwent multi-slice CTPA examinations on a 40-detector row scanner.
The images were later assessed and reported blinded to the V/Q results.
Statistical analysis was done using the Fisher exact test for comparison of
categorical variables and the one-way ANOVA for continuous variables (p<0.05 was significant). Results: A total of 104 consecutive patients were referred with clinical suspicion of
pulmonary embolism. Seventy-nine patients were excluded from this study mostly
due to abnormal serum creatinine/urea levels. Only 25 patients were included in this
study, with a mean age of 48 ± 19 years, and 64% being females. When compared
to CTPA as gold standard, the prevalence of PE was 16% [5% – 37% at 95% CI],
sensitivity 75% [21% – 99% at 95% CI], specificity 90% [68% – 98% at 95% CI],
positive predictive value 60% [17% – 93% at 95% CI], negative predictive value 95%
[73% – 100% at 95% CI] and diagnostic accuracy 88% [69% – 97%at 95% CI] for
both V/Q Planar and SPECT. V/Q Planar showed a lower reader confidence i.e.
could only clearly resolve 72% of cases compared to V/Q SPECT, which could
precisely interpret all cases, showed more and better delineated mismatch vs match
and segmental vs non-segmental defects. All patients who were scored as PE
unlikely on Wells’ score (4) had PE ruled out on CTPA (p=0.04581) as well as 89%
of patients on V/Q SPECT and V/Q Planar.
Conclusion: Based on this study, V/Q Planar and V/Q SPECT have a similar
diagnostic performance in patients with a normal or near normal chest X-rays.<br>AFRIKAANSE OPSOMMING: Enkelfoton emissie rekenaartomografie (EFERT) met beter kontrasresolusie is
bewys om meer sensitief en spesifiek met ‘n laer nie-diagnostiese opbrengs as
planare beelding in verskeie kerngeneeskunde ondersoeke te wees. In Tygerberg
Hospitaal, soos in verskeie ander sentra, word dit egter steeds nie roetineweg vir
ventilasie-perfusiestudies (V/Q) geïmplementeer nie. Daar is verskeie EFERT V/Q
studies met Technegas as ventilasie agens, maar beperkte studies met 81m Kr gas
beskikbaar.
Doel: Om konvensionele planare en EFERT V/Q beelding vir die diagnose van
pulmonale embolisme met mekaar te vergelyk, met rekenaartomografie pulmonale
angiografie (RTPA) as goue standaard.
Pasiënte en Metodes: Alle pasiënte wat met ‘n kliniese vermoede van pulmonale
embolisme verwys is, is geevalueer. Die insluitingskriteria was ’n normale borskas Xstraal,
normale nierfunksie en geen kontrasallergie nie. Uitsluitingskriteria was
pasiënte jonger as 18 jaar, swanger pasiënte, abnormale borskas X-straal,
abnormale serum kreatinien / ureumvlakke en onstabiele pasiënte. ’n Wells telling is
vir elke pasiënt wat in die studie ingesluit is, bepaal.
Perfusiebeelding is uitgevoer na die intraveneuse toediening van 125 MBq 99mTc
MAA. Ventilasiestudies is gedoen met 81mKr gas. Die V/Q EFERT studies is voor die
planare beelding met ’n dubbelkop gammakamera uitgevoer. Perfusiebeelding is
voor die ventilasie in dieselfde posisie verkry. V/Q planare beelding het bestaan uit 6
standaard beelde. Alle V/Q EFERT is met “ordered-subset expectationmaximization”
(OSEM) algoritmes verwerk, en post-rekonstruksie 3D Butterworth
filters is toegepas. V/Q planare en V/Q EFERT beelding is later afsonderlik en
sonder RTPA inligting volgens onlangse EANM riglyne evalueer en gerapporteer.
‘n Veelsnit RTPA met ‘n 40 snit skandeerder is op alle pasiënte uitgevoer. Die
beelde is later beoordeel en gerapporteer sonder inagneming van die V/Q
beeldingsresultate
Statistiese verwerking is gedoen met die Fisher presisietoets vir vergelyking van
kategoriese veranderlikes en die eenrigting ANOVA vir kontinue veranderlikes
(p<0.05 is statisties betekenisvol). Resultate: ‘n Totaal van 104 opeenvolgende pasiënte met ‘n kliniese vermoede van
pulmonale embolisme is verwys. Nege-en-sewentig pasiënte is uitgesluit, in die
meeste gevalle as gevolg van abnormale serum kreatinienvlakke. Slegs 25 pasiënte
is ingesluit, met ’n gemiddelde ouderdom van 48 ± 19 jaar, en 64% vroue. In
vergelyking met RTPA as goudstandaard, was die prevalensie van PE 16% [5% –
37% met 95% VI], sensitiwiteit 75% [21% – 99% met 95% VI], spesifisiteit 90% [68%
– 98% met 95% VI], positiewe voorspellingswaarde 60% [17% – 93% met 95% VI],
negatiewe voorspellingswaarde 95% [73% – 100% met 95% VI] en diagnostiese
akkuraatheid van 88% [69% – 97% met 95% VI] vir beide planare en EFERT V/Q
beelde. V/Q planare beelde het ‘n laer lesersvertroue getoon, nl. dat slegs 72% van
gevalle opgelos kon word relatief tot V/Q EFERT beelde, wat in alle gevalle presies
geïnterpreteer kon word, met meer en beter omskrewe nie-ooreenstemmende
teenoor ooreenstemmende en segmentele teenoor nie-segmentele defekte. In alle
pasiënte met ‘n Wells puntetelling van 4 is PE met die RTPA uitgeskakel
(p=0.04581), terwyl dit in 89% van pasiënte met V/Q EFERT en planare beelde
uitgeskakel is.
Gevolgtrekking: Gebaseer op hierdie studie het V/Q planare en EFERT beelding ‘n
ooreenstemmende diagnostiese prestasie in pasiënte met ’n normale of naby
normale borskas X-straal.
47
Bulajic, Bojana. "Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29664.
Full textAbstract:
Introduction: The diagnosis of Pulmonary Embolism (PE) is challenging to make and is often missed in the Emergency Centre. The true incidence of PE in South Africa is unknown. The diagnostic work-up of PE has been improved by the use of Clinical decision rules (CDRs) and CT Pulmonary Angiography (CTPA) in high-income countries. Currently used CDRs have not been validated in the South African environment, where HIV and TB are highly prevalent. Both conditions are known to induce a hyper-coagulable state. Methods: This study was a retrospective chart review of patients with suspected PE that had CTPAs performed from October 2013 to October 2015 at Mitchell’s Plain Hospital in South Africa. Data was collected on demographics, presenting symptoms and signs, vitals, bedside investigations, HIV and TB status, use of CDRs and CTPA result. A Revised Geneva Score was calculated retrospectively and compared to the CTPA result. Results: The median age of patients with confirmed PE was 45 years and 68% were female. The CTPA yield for PE in our study population was 32%. The most common presenting complaint was dyspnoea (83%), followed by cough and chest pain. 29% of patients also had clinical features of DVT. No sign or symptom was seen to be markedly different in those with confirmed PE compared to those without. Among patients with confirmed PE, 37% were HIV positive and 52% had current TB. The retrospective revised Geneva Scores compared poorly with the CTPA results. Discussion: PE remains a diagnostic challenge. Worldwide, the use of CDRs has shown to improve the utilization of CTPA. In our study, the retrospectively calculated CDR was not predictive of PE in a population with a high prevalence of HIV and TB. Emergency physicians should be cautious when making a clinical probability assessment of PE in this setting. However, further studies are needed to determine whether HIV and TB could be independent risk factors for PE.
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Viana, Vitor Ramos Borges. "Trombose venosa profunda e tromboembolismo pulmonar no pós-operatório de cirurgia de revascularização miocárdica: pesquisa diagnóstica independente de suspeita clínica." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-02022016-161807/.
Full textAbstract:
Introdução: O termo tromboembolismo venoso (TEV) engloba trombose venosa profunda (TVP) e/ou tromboembolismo pulmonar (TEP). TEV tem sido considerado incomum após cirurgia de revascularização miocárdica (CRM), e Diretrizes recomendam profilaxia mecânica para todos os pacientes e acrescentar profilaxia com heparina apenas se o tempo de internação hospitalar for prolongado por complicações não hemorrágicas (Grau 2C). Objetivo: Pesquisar o diagnóstico de TEV no pós-operatório de CRM, independente de suspeita clínica, e analisar se os resultados podem contribuir para melhor definição das características clínicas de TEV após CRM. Métodos: Em estudo observacional, prospectivo, unicêntrico, 100 pacientes com doença arterial coronariana crônica realizaram tomografia computadorizada da artéria pulmonar (multidetectores-64) e ultrassonografia compressiva dos membros inferiores após CRM eletiva. Pacientes com alto risco para TEV foram excluídos. Resultados: Por livre escolha dos cirurgiões, 83 cirurgias foram realizadas com circulação extracorpórea e 17 sem extracorpórea. Em média, tomografia e ultrassonografia foram realizadas 7 ± 3 dias após a cirurgia. TEP isolada foi observada em 13/100 (13%), TEP e TVP simultâneos em 8/100 (8%), e TVP isolada em 4/100 (4%) pacientes, totalizando 25/100 (25%) TEVs. Entre as 21 TEPs, 3/21 (14%) envolveram artérias subsegmentares, 15/21 (71%) artérias segmentares, 1/21 (5%) artéria lobar e 2/21 (10%) artérias pulmonares centrais (tronco da artéria pulmonar e/ou seus ramos principais). Das 12 TVPs, todas foram distais (abaixo da veia poplítea) e 2/12 (17%) foram também proximais; 5/12 (42%) foram unilaterais, das quais 3/5 (60%) acometeram a perna contralateral à safenectomia. Nenhum TEV causou instabilidade hemodinâmica e nenhum deles foi clinicamente suspeitado. Conclusões: TEV é frequente e subdiagnosticado após CRM, talvez porque a maioria tenha localização distal e porque os procedimentos habituais desta cirurgia dificultam a suspeita diagnóstica. Os resultados enfatizam a recomendação de recentes Diretrizes que sugerem profilaxia mecânica para todos os pacientes, e ressaltam a necessidade de estudos randomizados para avaliar a relação de benefícios e os riscos de profilaxia farmacológica<br>Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Currently, VTE has been considered uncommon after coronary artery bypass grafting (CABG) and Guidelines suggest mechanical prophylaxis and adding prophylactic heparin if hospital course is prolonged by nonhemorrhagic complications (Grade2C). Objective: To search VTE after CABG, independent of clinical suspicion, and to analyze whether the results can aid in better defining the clinical characteristics of VTE after CABG. Methods: In a prospective, observational, single-center study, 100 patients with coronary artery disease underwent computed tomographic pulmonary angiography (multidetector-64) and lower-extremity venous compressive ultrasound after elective CABG. Patients at high risk for VTE were excluded. Results: At the discretion of surgeons, 83 surgeries were on-pump and 17 off-pump. On average, tomography and ultrasound were performed 7 ± 3 days after CABG. Isolated PE was observed in 13/100 (13%) patients, simultaneous PE and DVT in 8/100 (8%), and isolated DVT in 4/100 (4%), totaling 25/100 (25%) VTEs. Of the PEs 3/21 (14%) involved subsegmental, 15/21 (71%) segmental, 1/21 (5%) lobar and 2/21 (10%) central pulmonary arteries. Of the 12 DVTs all were distal (below the popliteal vein) and 2/12 (17%) were also proximal; 5/12 (42%) were unilateral, of which 3/5 (60%) on the contralateral vein saphenous harvested leg. No VTE caused hemodynamic instability and none was clinically suspected. Conclusions: VTE is frequent and underdiagnosed perhaps because the majority is distally localized and because the ordinary procedures of GABG conceal the diagnostic suspicion. The results emphasize the current guidelines\' recommendation suggesting mechanical prophylaxis for all patients and highlight the necessity of randomized studies to assess the risk/benefit ratio of pharmacological prophylaxis
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Stevenson, David. "Estimation of the time-varying elastance of the left and right ventricles." Thesis, University of Canterbury. Mechanical Engineering, 2013. http://hdl.handle.net/10092/8794.
Full textAbstract:
The intensive care unit treats the most critically ill patients in the hospital, and as such the clinical staff in the intensive care unit have to deal with complex, time-sensitive and life-critical situations. Commonly, patients present with multiple organ dysfunctions, require breathing and cardiovascular support, which make diagnosis and treatment even more challenging. As a result, clinical staff are faced with processing large quantities of often confusing information, and have to rely on experience and trial and error. This occurs despite the wealth of cardiovascular metrics that are available to the clinician.
Computer models of the cardiovascular system can help enormously in an intensive care setting, as they can take the monitored data, and aggregate it in such a way as to present a clear and understandable picture of the cardiovascular system. With additional help that such systems can provide, diagnosis can be more accurate and arrived at faster, alone with better optimised treatment that can start sooner, all of which results in decreased mortality, length of stay and cost.
This thesis presents a model of the cardiovascular system, which mimics a specific patient’s cardiovascular state, based on only metrics that are commonly measured in an intensive care setting. This intentional limitation gives rise to additional complexities and challenges in identifying the model, but do not stand in the way of achieving a model that can represent and track all the important cardiovascular dynamics of a specific patient. One important complication that comes from limiting the data set is need for an estimation for the ventricular time-varying elastance waveform. This waveform is central to the dynamics of the cardiovascular model and is far too invasive to measure in an intensive care setting.
This thesis thus goes on to present a method in which the value-normalised ventricular time-varying elastance is estimated from only metrics which are commonly available in an intensive care setting. Both the left and the right ventricular time-varying elastance are estimated with good accuracy, capturing both the shape and timing through the progress of pulmonary embolism and septic shock. For pulmonary embolism, with the algorithm built from septic shock data, a time-varying elastance waveform with median error of 1.26% and 2.52% results for the left and right ventricles respectively. For septic shock, with the algorithm built from pulmonary embolism data, a time-varying elastance waveform with median error of 2.54% and 2.90% results for the left and right ventricles respectively. These results give confidence that the method will generalise to a wider set of cardiovascular dysfunctions.
Furthermore, once the ventricular time-varying elastance is known, or estimated to a adequate degree of accuracy, the time-varying elastance can be used in its own right to access valuable information about the state of the cardiovascular system. Due to the centrality and energetic nature of the time-varying elastance waveform, much of the state of the cardiovascular system can be found within the waveform itself. In this manner this thesis presents three important metrics which can help a clinician distinguish between, and track the progress of, the cardiovascular dysfunctions of pulmonary embolism and septic shock, from estimations based of the monitored pressure waveforms. With these three metrics, a clinician can increase or decrease their probabilistic measure of pulmonary embolism and septic shock.
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Ярмолюк, А. О., та Ю. А. Вікторова. "Визначення D-димеру для діагностики тромбоемболії легеневої артерії". Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47691.
Full textAbstract:
Актуальність. Тромбоемболія легеневої артерії (ТЕЛА) – одне з найпоширеніших
ускладнень багатьох захворювань, що представляє загрозу для життя людини. Відомо, що серед пацієнтів терапевтичного профілю найчастіше ТЕЛА виникає при інсульті (65%), інфаркті міокарда (ІМ) (22%), а також у людей похилого віку (9%). Це призводить до розвитку гіпертензії малого кола кровообігу та легеневого серця.
Мета. Визначити перспективу застосування D-димеру для діагностики ТЕЛА.