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Immuno-Pathologic Basis of COVID-19 and the Management of Mild and Moderate Cases
Published in Srijan Goswami, Chiranjeeb Dey, COVID-19 and SARS-CoV-2, 2022
Debdeep Dasgupta, Srijan Goswami, Chiranjeeb Dey
The blockage may limit or stop blood flow. A clot that adheres to a vessel wall is called a thrombus, whereas an intravascular clot that floats in the blood is termed an embolus. Thus, a detached thrombus becomes an embolus. Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs (Cecil et al., 2012; Kumar et al., 2014; Hall, 2015; McPhee et al., 2021).
Haematological disorders
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Further medical or surgical interventions may be necessary in life-threatening pulmonary embolism. Thrombolytic therapy (‘clot busting’ drugs such as streptokinase) may be used, but this is not common in pregnancy except in a life-threatening situation, due to the risk of major haemorrhage and fetal loss79,80. Inferior vena cava filters, which work by intercepting emboli travelling to the pulmonary vasculature, may be used in cases of confirmed recurrent VTE despite anticoagulation62,59. Pulmonary embolectomy, which requires major cardiothoracic surgery, is rarely used and only as a life-saving measure80.
Thromboembolic Disease in the Obstetric Patient: Evaluation, Diagnosis, and Treatment
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Therapy for a pulmonary embolus involves both cardiovascular support and anticoagulation. The latter is necessary to prevent recurrent embolus. Whether or not heparin actually speeds resolution is unclear. An intravenous loading dose of heparin (110 to 120 U/kg) is followed by a continuous infusion adequate to maintain the PTT at twice normal. The subcutaneous route is avoided initially because of the time required to achieve anticoagulation (2 to 4 h). The patient who reembolizes despite adequate anticoagulation should be considered for surgical interruption of the vena cava distal to the renal veins. If the location of the thrombus is unknown, the left ovarian vein must also be ligated. Caval ligation should be undertaken only after careful consideration, since long-term sequelae are not uncommon.27 If the embolus occurs antepartum, the patient is anticoagulated until delivery. If the embolus occurs postpartum, warfarin can be begun after adequate anticoagulation has been achieved with heparin. The protime is maintained at twice the control. While its ease of administration is an advantage, the incidence of all bleeding complications in patients receiving warfarin remains in excess of 30%.28 Heparin may be utilized postpartum, but the unknown incidence of osteoporosis and lack of prospective studies should be considered. Regardless of the agent selected, some form of anticoagulation should be continued at least 3 months from the acute event, or 6 weeks postpartum.
Filler-induced non-thrombotic pulmonary embolism after genital aesthetic injection
Published in Journal of Cosmetic and Laser Therapy, 2022
Regarding the clinical manifestations, the main presenting symptoms were dyspnea (n = 10) and chest pain (n = 4) (Figure 2). Three patients presented the symptoms during the operation, five presented the symptoms during the operation within 12 hours post-operation, three presented 12–24 hours post-operation, and two patients presented more than 24 hours post-operation (Figure 3). The onset of one male patient’s embolism was unknown. The diagnostic examinations of pulmonary embolism mainly were arterial blood gas analysis (ABG) and imaging examinations, including X-ray (n = 1), chest computer tomography (n = 3), and computer tomography pulmonary angiography (CTPA) (n = 4). To confirm the emboli, six patients received autopsy, and three patients received biopsies.
Intermediate risk pulmonary embolism concomitant with or without lung cancer: a wide spectrum of features
Published in Clinical and Experimental Hypertension, 2022
Yu-Jia Jin, Yi-Fan Jin, Xin-Yun Zhu, Bei-Lei Zhang, Cheng Chen
Table 1 summarizes the demographic characteristics and risk stratification of the study population. This study included 22 patients in the LC (male/female: 16/6) and 92 patients in the non-LC group (56/36). The median LC group age was 66 years (58–72), and this was 67 years for the non-LC group (58–77). Smoking history was the following: there were 22 ever smokers in the non-LC group and 13 ever smokers in the LC group, which showed significant difference between these two groups (p < 0.05). Concerning the medical history, the two groups had similar percentages of diabetes (3/22 vs. 11/92), hypertension (9/22 vs. 53/92), COPD (1/22 vs. 13/92) and tuberculosis (2/22 vs. 6/92, p > 0.05). According to the 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism (6), most pulmonary embolism patients with lung cancer were stratified as intermediate-risk (n = 19), followed by low-risk (n = 3) and high-risk (n = 0), and in the non-LC group, the most common risk level was again intermediate-risk (n = 71), with low-risk (n = 18) and high-risk (n = 3) following. In addition, at the diagnosis of PE, in the LC group, 7 patients (31.8%) were naïve therapy, 2 patients (9.1%) post-operative recurrence, 11 patients post (50.0%) chemotherapy, and 2 patients (9.1%) received targeted therapy. Among the 114 patients with pulmonary embolism, 90 intermediate-risk patients were enrolled for further investigation.
Cyclin-dependent kinase inhibition and its intersection with immunotherapy in breast cancer: more than CDK4/6 inhibition
Published in Expert Opinion on Investigational Drugs, 2022
Xianan Guo, Huihui Chen, Yunxiang Zhou, Lu Shen, Shijie Wu, Yiding Chen
Cardiotoxicities related to anticancer drugs have always been adverse effects requiring attention. QTc prolongation is a noteworthy adverse effect of ribociclib. In the MONALEESA-2 trial, 11 patients (3.3%) in the ribociclib plus letrozole group experienced QTc prolongation (>480 ms) [123]. To prevent long QT syndrome, the baseline QT interval prior to therapy initiation should be <450 ms, and patients who are at high risk of developing a prolonged QT interval should not receive ribociclib [124,125]. Hypertension is among the most common grade 3/4 adverse events in patients treated with ribociclib [126]. A small number of patients treated with CDK4/6 inhibitors, including palbociclib [68], ribociclib [123] and abemaciclib [67], reportedly suffered from thromboembolic events. Therefore, patients should be carefully monitored for typical symptoms of pulmonary embolism, including dyspnea, chest pain, and hemoptysis.