Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.
Objective To explore the causal association between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Methods Using the summary statistical data from the FinnGen biological sample library and IEU OpenGWAS database, the relationship between OSA and VTE, including deep vein thrombosis (DVT) and pulmonary embolism, was explored through Mendelian randomization (MR) method, with inverse variance weighted (IVW) as the main analysis method. Results The results of univariate MR analysis using IVW method showed that OSA was associated with VTE and pulmonary embolism (P<0.05), with odds ratios and 95% confidence intervals of 1.204 (1.067, 1.351) and 1.352 (1.179, 1.544), respectively. There was no correlation with DVT (P>0.05). Multivariate MR analysis showed that after adjustment for confounding factors (smoking, diabetes, obesity and cancer), OSA was associated with VTE, DVT and pulmonary embolism (P<0.05), with odds ratios and 95% confidence intervals of 1.168 (1.053, 1.322), 1.247 (1.064, 1.491) and 1.158 (1.021, 1.326), respectively. Conclusion OSA increases the risk of VTE, DVT, and pulmonary embolism.
ObjectiveTo explore the early predictive value of Wells score and D-dimer for acute pulmonary embolism.
MethodsEighty-two cases with acute pulmonary embolism comfirmed by computed tomography pulmonary angiography and (or) lung ventilation/perfusion scan were retrospectively studied from October 2013 to October 2014 in our hospital. Another 82 cases without acute pulmonary embolism in the chest pain center simultaneously were selected as control group. The data on admission were analyzed including Wells score, D-dimer, pH, PCO2, PO2, P(A-a)O2, brain natriuretic peptide, troponin I of two groups of patients. Relevant variables were selected by multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made by sensitivity as the ordinate and 1 minus specificity as abscissa. The area under ROC curve (AUC) for relevant variables was calculated and the variable with higher AUC was selected. The best threshold, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were achieved from the ROC curves.
ResultsThe multivariate logistic regression analysis showed that Wells score (OR=8.114, 95%CI 1.894-34.761, P=0.005) and D-dimer (OR=1.009, 95%CI 1.001-1.017, P=0.021) could predict APE early. The AUC, sensitivity, specificity, PPV, NPV of Wells score for the early prediction of patients with acute pulmonary embolism were 0.990, 50.0%, 100.0%, 100.0%, 66.7%, respectively. The AUC, sensitivity, specificity, PPV, NPV of D-dimer for the early prediction of patients with acute pulmonary embolism were 0.986, 95.1%, 97.6%, 97.5%, 95.2%, respectively.
ConclusionWells score and D-dimer have high predictive value in patients with acute pulmonary embolism, and can be used in preliminary screening of acute pulmonary embolism in the emergency department.
Objective
To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE).
Methods
Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups.
Results
The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05).
Conclusions
IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.
Objective
To explore the clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism.
Methods
The clinical data of patients with Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism admitted to Dongnan Hospital of Xiamen University from January 2012 to January 2017 were retrospectively analyzed.
Results
There were 8 patients who had Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Fever occurred in all patients, respiratory symptoms were noted in 5 patients, abdominal pain occurred in 2 patients, endophthalmitis coexisted in 1 patient, and diabetes mellitus coexisted in 7 patients, with no chest pain or hemoptysis. In biochemical indexes, procalcitonin increased most obviously. Microbiological studies revealed Klebsiella pneumoniae in 8 patients. Chest CT showed peripheral nodules with or without cavities, peripheral wedge-shaped opacities, a feeding vessel sign, pleural effusion, and infiltrative shadow. One patient finally deteriorated to acute respiratory failure, and died due to acute respiratory distress syndrome and/or septic shock. There was one case of spontaneous discharge. A total of 6 patients were improved and cured.
Conclusions
The clinical manifestation of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism is unspecific and misdiagnosis rate is relatively high. The major characteristics of chest CT scan include peripheral nodules with or without cavities, peripheral wedge-shaped opacities and a feeding vessel sign. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and primary disease (liver abscess).
Objective To analyze the clinical features of rickettsial infection complicated with pulmonary embolism and to improve clinicians’ knowledge of rickettsial infection complicated by thromboembolism events. Methods We retrospectively analyzed the clinical data of a patient with pulmonary thromboembolism complicated by Rickettsial felis infection and conducted a review of the relevant literature. The search terms "Rickettsia/Scrub typhus, thrombosis" or "Rickettsia/ Scrub typhus, embolism" were used to search the Wanfang ,VIP ,Chinese National Knowledge Infrastructure and PubMed databases from January 1985 to May 2023, respectively. Results The 81-year-old male patient was admitted to the hospital on June 1, 2021 due to "dizziness, sore throat for 11 days, fever for 7 days, and shortness of breath for 3 days". Physical examination revealed a eschar-like rash behind the left ear, venous thrombosis in both lower limbs was detected by color ultrasound, computed tomographic pulmonary angiography indicated multiple pulmonary embolism in both lungs, and positive rickettsiae on peripheral blood next-generation sequencing, confirming the diagnosis of Rickettsial felis infection complicated by venous thromboembolism (VTE) in both lower limbs and pulmonary embolism. Twenty manuscripts, including 20 cases, were retrieved from databases. Among them, Rickettsial felis infection combined with thromboembolism event was not found. With the addition of our case, a total of 21 cases were analyzed in detail. Six of the 21 cases were complicated with VTE, 10 with pulmonary embolism, 5 with intracranial venous thrombosis, 6 with thrombosis at other sites (jugular venous thrombosis, mesenteric thrombosis, aortic thrombosis, etc), and 8 of which had concurrently involved systemic thrombosis. Of the 4 deaths, 2 cases had mesenteric embolism, 1 case had cerebral infarction, and 1 case had systemic multiple thrombus. Conclusions Rickettsial infection symptoms and signs are often atypical, can be complicated with lower limb VTE or pulmonary embolism. Early identification, diagnosis and treatment are very important, especially for patients with dyspnea, chest pain and other related symptoms.
Objective To explore the clinical value of Wells score combined with thromboelastography (TEG) in rapid prediction of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 130 AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine of Guangxi University of Science and Technology from January 2022 to March 2023 were selected as the study subjects. According to results of digital subtraction angiography (DSA) of the pulmonary artery, the patients were divided into a PE group (n=37) and a non-PE group (n=93). Both groups underwent Wells score analysis combined with TEG. Thromboelastographic parameters were comparing between the two groups, including Wells score, reaction time (R time), reaction time (K time), coagulation index (CI), and maximum amplitude (MA). The diagnostic value of different prediction models to diagnose AECOPD with PE was compared, including Wells score, thromboelogram and Wells score combined with TEG. Results The Wells score of the patients in the PE group was significantly higher than that in the non-PE group, and R time of the patients in the PE group was significantly lower than that in the non-PE group. The K time, CI, MA and other parameter levels of the patients in the PE group were significantly higher than those in the non-PE group (all P<0.05). The sensitivity, specificity, and area under ROC curve of the combination of Wells score and TEG prediction model in diagnosing AECOPD complicated with PE were greater than those of the Wells score alone prediction model (P<0.05). Conclusion The combination of Wells score and TEG has significant clinical value in quickly predicting AECOPD complicated with PE, and is worthy of clinical application and promotion.
摘要:目的:探討腹腔鏡膽囊切除術(laparoscopic cholecystectomy, LC)后發生嚴重并發癥的原因、治療措施和經驗教訓。方法:分析 2007 年 8 月至2009 年 4月期間華西醫院膽道外科收治的LC術后發生嚴重并發癥的7例患者的臨床資料。結果:2例繼發性膽總管結石合并化膿性膽管炎患者,采用內鏡下十二指腸乳頭切開(endoscopic sphincterotomy, EST)取出結石;3例膽道損傷患者,均進行肝門膽管成形和肝總管空腸吻合術;1例絞窄性腸梗阻患者,切除壞死空腸管后,行空腸對端吻合術;以上6例患者均順利出院,隨訪8～20個月,均生活良好。1例患者LC術后發生肺動脈栓塞,積極搶救后因呼吸衰竭而死亡。結論:術中仔細輕柔的操作以及辯清肝總管、膽總管與膽囊管的三者關系是預防LC術后發生嚴重并發癥的關鍵。合理可行的治療措施是提高發生并發癥的患者生活質量的保障。LC術時,膽道外科醫生思想上要高度重視,不可盲目追求速度,必要時及時中轉開腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
Objective To investigate the risk factors, clinical characteristics and prognostic factors of venous thrombosis (and pulmonary embolism) in patients with idiopathic hypereosinophilia (IHE) so as to provide a theoretical basis for clinical prevention of venous thrombosis and improve prognosis.Methods Thirty-nine patients with IHE admitted to West China Hospital of Sichuan University from January 2010 to January 2022 were collected in this retrospective case-control study to explore the risk factors of venous thrombosis (including pulmonary embolism) and thrombosis recurrence after treatment. Results There were 17 (43.5%) patients combined with venous thrombosis of 39 patients with IHE. In the patients with vascular involvement, pulmonary embolism was the initial expression of IHE accounted for 29% (5/17). patients of IHE with pulmonary embolism were younger [44 (24.5 - 51.0) vs. 56 (46.3 - 67.8) year, P=0.035] and had higher peak absolute eosinophil counts [11.7 (7.2 - 26.5)×109/L vs. 3.8 (2.9 - 6.7)×109/L, P=0.020] than those without pulmonary embolism. After a mean follow-up of 13 months (2 - 21 months), thrombosis recurred in 35.3% (6/17) of patients. Persistent increasing in eosinophils (>0.5×109/L) was an independent risk factor for thrombus recurrence (odds ratio 13.33, 95% confidential interval 1.069 - 166.374). Conclusions Thrombosis is a common vascular impaired complication in IHE , and increased eosinophilia is a risk factor for thrombosis and thrombus recurrence after therapy. Controlling and monitoring the eosinophilic cell levels in patients with IHE may avoid severe comorbidities.
ObjectivesTo evaluate the effects of Pulmonary Embolism Response Team (PERT) on treatment strategies and long-term prognosis in patients with acute pulmonary embolism before and after the implementation of the first PERT in China. Methods The official start of PERT (July 2017) was took as the cut-off point, all APE patients who attended Beijing Anzhen Hospital of Capital Medical University one year before and after this cut-off time were included through the hospital electronic medical record system. The APE patients who received traditional treatment from July 5, 2016 to July 4, 2017 were recruited in the control group (Pre-PERT group), and the APE patients who received PERT mode treatment from July 5, 2017 to July 4, 2018 were recruited as the intervention group (Post-PERT group). Treatment methods during hospitalization were compared between the two groups. The patients were followed up for one year after discharge to evaluate their anticoagulant therapy, follow-up compliance and long-term prognosis. Results A total of 108 cases in the Pre-PERT group and 102 cases in the Post-PERT group were included. There was no significant statistical difference between the two groups in age and gender (both P>0.05). Anticoagulation therapy (87.3% vs. 81.5%, P=0.251), catheter-directed treatment (3.9% vs. 2.8%, P=0.644), inferior vena cava filters (1.0% vs. 1.9%, P=1.000), surgical embolectomy (2.0% vs. 0.9%, P=0.613), systemic thrombolysis (3.9% vs. 4.6%, P=0.582) were performed in both groups with no significant differences between the two groups. The use rate of rivaroxaban in the Post-PERT group was higher than that in the Pre-PERT group at one year of discharge, and the use rate of warfarin was lower than that of the Pre-PERT group (54.5% vs. 32.5%; 43.6% vs. 59.0%, P=0.043). The anticoagulation time of the Post-PERT group was longer than that of the Pre-PERT group (11.9 months vs. 10.3 months, P<0.001). The all-cause mortality within one year, hemorrhagic events and the rate of rehospitalization due to pulmonary embolism were not significantly different between the two groups, (10.4% vs. 8.6%), (14.3% vs. 14.8%), and (1.3% vs. 2.5%, χ2=3.453, P=0.485), respectively. Conclusions APE treatment was still dominated by anticoagulation and conventional treatment at the early stage of PERT implementation, and advanced treatment (catheter-directed treatment and surgical embolectomy) is improved, it showed an expanding trend after only one year of implementation although there was no statistical difference. At follow-up, there is no increase in one-year all-cause mortality and bleeding events with a slight increase in advanced treatment after PERT implementation.
