Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.展开更多
Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis...Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.展开更多
Lung transplantation(LT)is currently a surgical therapy option for end-stage lung disease.Venous thromboembolism(VTE),which can occur after LT,is associated with significant morbidity and mortality.Because of improved...Lung transplantation(LT)is currently a surgical therapy option for end-stage lung disease.Venous thromboembolism(VTE),which can occur after LT,is associated with significant morbidity and mortality.Because of improved out-comes,increasing numbers of patients are receiving LT as treatment.Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms.These factors contribute to a heightened risk of post-operative VTE.Furthermore,patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT.Bleeding and thromboembolism are common in these patients.Pulmonary embolism(PE)in a freshly transplanted lung can have significant effects leading to morbidity and mortality.PE typically leads to impairment of gas exchange and right ventricular strain.In LT,PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction.This article discussed the incidence,clinical features and diagnosis of VTE after LT.Furthermore,the treatment modalities,complications,and outcomes of VTE were reviewed.展开更多
BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of ...BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery.After the surgery,the patient experienced symptoms including headache,nausea,vomiting,and difficulty breathing,which was followed by neurological symptoms such as slurred speech and left-sided weakness.Comprehensive physical examination and auxiliary investigations,including blood tests,head and neck computed tomography angiography,and cranial magnetic resonance diffusion-weighted imaging,were performed upon admission.The clinical diagnosis was acute cerebral embolism following facial fat filling surgery.Treatment included measures to improve cerebral circulation,dehydration for intracranial pressure reduction,nutritional support,and rehabilitation therapy for left limb function.The patient showed a significant improvement in symptoms after 2 weeks of treatment.She recovered left limb muscle strength to grade 5,had clear speech,and experienced complete relief of headache.CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction.To prevent these complications,plastic surgeons should enhance their professional knowledge and skills.展开更多
BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic thera...BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.展开更多
BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Us...BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.展开更多
BACKGROUND Pulmonary embolism(PE)is a leading cause of cardiovascular mortality.Although anticoagulation is the cornerstone of treatment,aspirin’s potential to modulate thromboinflammation and improve outcomes in non...BACKGROUND Pulmonary embolism(PE)is a leading cause of cardiovascular mortality.Although anticoagulation is the cornerstone of treatment,aspirin’s potential to modulate thromboinflammation and improve outcomes in non-surgical PE patients remains underexplored.AIM To assess whether prehospital aspirin use is associated with improved outcomes in patients hospitalized with acute PE.METHODS We conducted a retrospective case-control study of 323 adult patients admitted with computed tomography-confirmed acute PE from January 2020 to December 2023.Patients were stratified according to documented daily aspirin use for≥7 days prior to hospital admission.Primary outcomes included right ventricular strain,intensive care admission,shock,mechanical ventilation,and in-hospital mortality.Univariate logistic regression was used.A P value<0.05 was considered significant.RESULTS Total of 323 patients,90(27.9%)used aspirin prehospital.Aspirin users were older(74.2±14.3 years vs 66.9±16.7 years,P<0.001)and had more coronary artery disease.Aspirin use was associated with significantly lower rates of right ventricular strain on computed tomography[22.2% vs 34.8%,odds ratio(OR)=0.536,95%confidence interval(CI):0.305-0.944,P=0.029],Intensive care admission(16.7%vs 28.8%,OR=0.496,95% CI:0.266-0.924,P=0.025),shock(2.2%vs 9.9%,OR=0.208,95% CI:0.048-0.899,P=0.021),and in-hospital mortality(3.3% vs 11.6%,OR=0.260,95% CI:0.080-0.889,P=0.022).CONCLUSION Prehospital aspirin use is associated with reduced severity and mortality in acute PE.These findings support a potential protective role for aspirin and warrant validation in prospective,multicenter trials.展开更多
BACKGROUND Air embolism(AE)is a rare but potentially fatal complication of intestinal endoscopy(IE).CASE SUMMARY Herein,we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy(KPE)...BACKGROUND Air embolism(AE)is a rare but potentially fatal complication of intestinal endoscopy(IE).CASE SUMMARY Herein,we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy(KPE)for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site.Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE.The common clinical setting in the five patients,including our case,was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility.We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi—previously opened by KPE for bile drainage—passed through the tiny,microscopic pores of the fenestrated liver sinusoid endothelial cells,and finally entered the bloodstream with ease,resulting in fatal AE.CONCLUSION Meticulous performance of IE,especially on the KPE blind loop,is warranted owing to the risk of AE.展开更多
BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping p...BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping primary symptoms,such as chest tightness and dyspnea.This confluence frequently leads to the misdiagnosis of PE,thus precipitating treatment delays and compromising patient outcomes.Herein,we report the case of a patient with both diseases who under-went surgery and medication therapy.CASE SUMMARY A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD.However,he refused hospitalization.He visited our hospital for the treatment of recurring symptoms.A comprehensive examination after admission revealed elevated D-dimer levels,and computed tomography pulmonary angio-graphy was performed to confirm the diagnosis of PE.The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis.CONCLUSION D-dimer is useful in screening for PE,whereas computed tomography pulmonary angiography is important for diagnosis.For patients with CHD and PE,coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.展开更多
The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 un...The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 underwent CT pulmonary angiography to investigate the risk factors and clinical characteristics of pulmonary embolism(PE)in northern Shaanxi.The patients were divided into a control group(no PE,n=98)and a study group(PE,n=64)based on the presence or absence of PE.Data were collected using a Case Report Form,and statistical analyses were conducted to summarize clinical features and risk factors,followed by three months of targeted therapy.Significant differences were observed between the two groups in clinical manifestations such as pleural pain,dyspnea,and hemoptysis,as well as in past medical histories(including malignant tumor history and right ventricular dysfunction),physical signs like lung rales,and laboratory parameters such as hemoglobin,albumin,white blood cell count,D-dimer,blood oxygen saturation,total cholesterol,triglycerides,and high-density lipoprotein cholesterol(all P<0.05).Multivariate logistic regression analysis identified pleural pain,dyspnea,malignancy,right ventricular dysfunction,lung rales,D-dimer,white blood cell levels,and blood oxygen saturation as risk factors for PE in patients with venous thrombosis.Following targeted therapy,the proportions of patients with pleural pain,dyspnea,and lung rales decreased significantly,with concurrent reductions in right ventricular end-diastolic inner diameter(RVD),D-dimer,and white blood cell levels,and a significant increase in blood oxygen saturation.These findings suggest that early prevention and intervention based on these risk factors can effectively reduce the incidence of PE in northern Shaanxi.展开更多
Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracrani...Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.展开更多
BACKGROUND Cronkhite-Canada syndrome(CCS)is a rare disease,that causes gastrointestinal polyps,ectodermal abnormalities,and gastrointestinal symptoms.CCS is prone to thromboembolism,but clinical workers have not yet e...BACKGROUND Cronkhite-Canada syndrome(CCS)is a rare disease,that causes gastrointestinal polyps,ectodermal abnormalities,and gastrointestinal symptoms.CCS is prone to thromboembolism,but clinical workers have not yet established a clinical consciousness of preventing thromboembolism.The present case illustrates pulmonary embolism(PE)complicated by CCS.CASE SUMMARY A 46-year-old male patient presented with mucus,purulent,and bloody stool.Ectodermal changes included skin pigmentation,alopecia,and nail dystrophy.Colonoscopy revealed the presence of multiple polyps.After a comprehensive evaluation,the patient was diagnosed with CCS.During the disease,he was also diagnosed with pulmonary embolism,Riehl's melanosis,and intestinal flora imbalance.After symptomatic treatment with omeprazole,mesalazine,rivaroxaban,nutritional support,and regulation of intestinal flora,the patient’s symptoms were significantly relieved.CONCLUSION CCS complicated with PE was reported for the first time in China in this study.Despite the fact that CCS is extremely rare,patients with CCS should be classified as a high-risk venous thromboembolism(VTE)population,and emphasis should be placed on venous thromboembolism risk assessment and stratification,deep venous thromboembolism screening,prevention of VTE,and careful long-term follow-up.展开更多
Thrombophilia denotes a condition,whether acquired or hereditary,characterized by increased susceptibility to hypercoagulation.[1]This condition was first described in 1965,coinciding with the discovery of an inherite...Thrombophilia denotes a condition,whether acquired or hereditary,characterized by increased susceptibility to hypercoagulation.[1]This condition was first described in 1965,coinciding with the discovery of an inherited predisposition to venous thromboembolism(VTE)in patients deficient in antithrombin III.[2]While arterial and venous thromboses are common in hospitalized patients,acute myocardial infarction(AMI)and pulmonary embolism(PE)stand out as lifethreateningconditions.However,theoccurrenceof AMI complicated by PE is exceedingly rare,especially when considering cases where paradoxical embolism originating from a patent foramen ovale is absent.This report presents a case of AMI complicated with PE.A comprehensive understanding of the pathophysiology of this rare yet critical condition is important for ensuring prompt diagnosis and treatment.展开更多
This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expe...This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).展开更多
Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death...Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.展开更多
BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that...BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.展开更多
BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent for...BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.展开更多
BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE in...BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE include Durant's maneuver,aspiration and removal of air through venous catheters,and hyperbaric oxygen therapy.For critically ill patients,use of cardiotonic drugs and chest compressions remain useful strategies.The wider availability of extracorporeal membrane oxygenation(ECMO)has brought a new option for VAE patients.CASE SUMMARY A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h.One day ago,the patient suffered from abdominal pain,fever,and diarrhea.She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago,accompanied by nausea and vomiting,during which a small amount of gastric contents were discharged.She was immediately sent to a local hospital,where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery.The condition deteriorated despite endotracheal intubation,rehydration,and other treatments,and the patient was then transferred to our hospital.Veno-arterial ECMO was applied in our hospital,and the patient's condition gradually improved.The patient was successfully weaned from ECMO and extubated after two days.CONCLUSION ECMO may be an important treatment for patients with VAE in critical condition.展开更多
Chronic obstructive pulmonary disease(COPD)is one of the most common and important diseases leading to the death of elderly patients in the world at present.It is characterized by continuous airflow restriction and ir...Chronic obstructive pulmonary disease(COPD)is one of the most common and important diseases leading to the death of elderly patients in the world at present.It is characterized by continuous airflow restriction and irreversible chronic airway obstruction,which can easily lead to a variety of complications and accompanying symptoms,greatly affecting the quality of life of individuals and increasing the economic burden of families and society.Pulmonary embolism(PE)is one of the complications of COPD,which can lead to pulmonary blood circulation and respiratory failure,with a high risk of death.However,because its clinical symptoms overlap with the symptoms of acute exacerbation of COPD and lack of specific clinical manifestations and laboratory tests,it is easy to be misdiagnosed and ignored,thus delaying the treatment of patients and affecting the prognosis.This article will elaborate on the clinical diagnosis and treatment of chronic obstructive pulmonary disease combined with pulmonary embolism,providing certain value for early identification of COPD combined with PE patients and the severity of the condition.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is a key procedure for diagnosing and treating biliary and pancreatic disorders.Although effective,it carries risks,including rare but severe complication...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is a key procedure for diagnosing and treating biliary and pancreatic disorders.Although effective,it carries risks,including rare but severe complications such as air embolism.CASE SUMMARY We report a case of a 58-year-old man who developed extensive air embolism during ERCP.He previously underwent a Whipple procedure and experienced a sudden drop in vital signs and loss of consciousness.Immediate intervention with hyperbaric oxygen therapy and supportive care led to gradual recovery.Imaging confirmed widespread air embolism,which resolved with continued treatment.CONCLUSION Air embolism is a rare,critical complication of ERCP,especially in patients with prior surgery such as pancreaticoduodenectomy.Early detection and prompt treatment,including hyperbaric oxygen therapy,are crucial for favorable out-comes.展开更多
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
文摘Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.
文摘Lung transplantation(LT)is currently a surgical therapy option for end-stage lung disease.Venous thromboembolism(VTE),which can occur after LT,is associated with significant morbidity and mortality.Because of improved out-comes,increasing numbers of patients are receiving LT as treatment.Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms.These factors contribute to a heightened risk of post-operative VTE.Furthermore,patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT.Bleeding and thromboembolism are common in these patients.Pulmonary embolism(PE)in a freshly transplanted lung can have significant effects leading to morbidity and mortality.PE typically leads to impairment of gas exchange and right ventricular strain.In LT,PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction.This article discussed the incidence,clinical features and diagnosis of VTE after LT.Furthermore,the treatment modalities,complications,and outcomes of VTE were reviewed.
基金Supported by The National Natural Science Foundation of China,No.82171334The Chongqing Science and Health Joint Medical Research Project,No.2024MSXM155.
文摘BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery.After the surgery,the patient experienced symptoms including headache,nausea,vomiting,and difficulty breathing,which was followed by neurological symptoms such as slurred speech and left-sided weakness.Comprehensive physical examination and auxiliary investigations,including blood tests,head and neck computed tomography angiography,and cranial magnetic resonance diffusion-weighted imaging,were performed upon admission.The clinical diagnosis was acute cerebral embolism following facial fat filling surgery.Treatment included measures to improve cerebral circulation,dehydration for intracranial pressure reduction,nutritional support,and rehabilitation therapy for left limb function.The patient showed a significant improvement in symptoms after 2 weeks of treatment.She recovered left limb muscle strength to grade 5,had clear speech,and experienced complete relief of headache.CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction.To prevent these complications,plastic surgeons should enhance their professional knowledge and skills.
基金Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China,No.WX23B42.
文摘BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.
基金National Natural Science Foundation of China,No.82200686Shaanxi Provincial People's Hospital Incubation Project,No.2022YJY-14.
文摘BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.
文摘BACKGROUND Pulmonary embolism(PE)is a leading cause of cardiovascular mortality.Although anticoagulation is the cornerstone of treatment,aspirin’s potential to modulate thromboinflammation and improve outcomes in non-surgical PE patients remains underexplored.AIM To assess whether prehospital aspirin use is associated with improved outcomes in patients hospitalized with acute PE.METHODS We conducted a retrospective case-control study of 323 adult patients admitted with computed tomography-confirmed acute PE from January 2020 to December 2023.Patients were stratified according to documented daily aspirin use for≥7 days prior to hospital admission.Primary outcomes included right ventricular strain,intensive care admission,shock,mechanical ventilation,and in-hospital mortality.Univariate logistic regression was used.A P value<0.05 was considered significant.RESULTS Total of 323 patients,90(27.9%)used aspirin prehospital.Aspirin users were older(74.2±14.3 years vs 66.9±16.7 years,P<0.001)and had more coronary artery disease.Aspirin use was associated with significantly lower rates of right ventricular strain on computed tomography[22.2% vs 34.8%,odds ratio(OR)=0.536,95%confidence interval(CI):0.305-0.944,P=0.029],Intensive care admission(16.7%vs 28.8%,OR=0.496,95% CI:0.266-0.924,P=0.025),shock(2.2%vs 9.9%,OR=0.208,95% CI:0.048-0.899,P=0.021),and in-hospital mortality(3.3% vs 11.6%,OR=0.260,95% CI:0.080-0.889,P=0.022).CONCLUSION Prehospital aspirin use is associated with reduced severity and mortality in acute PE.These findings support a potential protective role for aspirin and warrant validation in prospective,multicenter trials.
文摘BACKGROUND Air embolism(AE)is a rare but potentially fatal complication of intestinal endoscopy(IE).CASE SUMMARY Herein,we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy(KPE)for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site.Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE.The common clinical setting in the five patients,including our case,was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility.We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi—previously opened by KPE for bile drainage—passed through the tiny,microscopic pores of the fenestrated liver sinusoid endothelial cells,and finally entered the bloodstream with ease,resulting in fatal AE.CONCLUSION Meticulous performance of IE,especially on the KPE blind loop,is warranted owing to the risk of AE.
基金Supported by the National Natural Science Foundation of China,No.82200981Natural Science Foundation of Shandong Province,No.ZR2022QH358and Special Funds of Taishan Scholars Project of Shandong Province,No.tsqn202312384.
文摘BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping primary symptoms,such as chest tightness and dyspnea.This confluence frequently leads to the misdiagnosis of PE,thus precipitating treatment delays and compromising patient outcomes.Herein,we report the case of a patient with both diseases who under-went surgery and medication therapy.CASE SUMMARY A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD.However,he refused hospitalization.He visited our hospital for the treatment of recurring symptoms.A comprehensive examination after admission revealed elevated D-dimer levels,and computed tomography pulmonary angio-graphy was performed to confirm the diagnosis of PE.The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis.CONCLUSION D-dimer is useful in screening for PE,whereas computed tomography pulmonary angiography is important for diagnosis.For patients with CHD and PE,coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.
文摘The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 underwent CT pulmonary angiography to investigate the risk factors and clinical characteristics of pulmonary embolism(PE)in northern Shaanxi.The patients were divided into a control group(no PE,n=98)and a study group(PE,n=64)based on the presence or absence of PE.Data were collected using a Case Report Form,and statistical analyses were conducted to summarize clinical features and risk factors,followed by three months of targeted therapy.Significant differences were observed between the two groups in clinical manifestations such as pleural pain,dyspnea,and hemoptysis,as well as in past medical histories(including malignant tumor history and right ventricular dysfunction),physical signs like lung rales,and laboratory parameters such as hemoglobin,albumin,white blood cell count,D-dimer,blood oxygen saturation,total cholesterol,triglycerides,and high-density lipoprotein cholesterol(all P<0.05).Multivariate logistic regression analysis identified pleural pain,dyspnea,malignancy,right ventricular dysfunction,lung rales,D-dimer,white blood cell levels,and blood oxygen saturation as risk factors for PE in patients with venous thrombosis.Following targeted therapy,the proportions of patients with pleural pain,dyspnea,and lung rales decreased significantly,with concurrent reductions in right ventricular end-diastolic inner diameter(RVD),D-dimer,and white blood cell levels,and a significant increase in blood oxygen saturation.These findings suggest that early prevention and intervention based on these risk factors can effectively reduce the incidence of PE in northern Shaanxi.
文摘Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.
文摘BACKGROUND Cronkhite-Canada syndrome(CCS)is a rare disease,that causes gastrointestinal polyps,ectodermal abnormalities,and gastrointestinal symptoms.CCS is prone to thromboembolism,but clinical workers have not yet established a clinical consciousness of preventing thromboembolism.The present case illustrates pulmonary embolism(PE)complicated by CCS.CASE SUMMARY A 46-year-old male patient presented with mucus,purulent,and bloody stool.Ectodermal changes included skin pigmentation,alopecia,and nail dystrophy.Colonoscopy revealed the presence of multiple polyps.After a comprehensive evaluation,the patient was diagnosed with CCS.During the disease,he was also diagnosed with pulmonary embolism,Riehl's melanosis,and intestinal flora imbalance.After symptomatic treatment with omeprazole,mesalazine,rivaroxaban,nutritional support,and regulation of intestinal flora,the patient’s symptoms were significantly relieved.CONCLUSION CCS complicated with PE was reported for the first time in China in this study.Despite the fact that CCS is extremely rare,patients with CCS should be classified as a high-risk venous thromboembolism(VTE)population,and emphasis should be placed on venous thromboembolism risk assessment and stratification,deep venous thromboembolism screening,prevention of VTE,and careful long-term follow-up.
文摘Thrombophilia denotes a condition,whether acquired or hereditary,characterized by increased susceptibility to hypercoagulation.[1]This condition was first described in 1965,coinciding with the discovery of an inherited predisposition to venous thromboembolism(VTE)in patients deficient in antithrombin III.[2]While arterial and venous thromboses are common in hospitalized patients,acute myocardial infarction(AMI)and pulmonary embolism(PE)stand out as lifethreateningconditions.However,theoccurrenceof AMI complicated by PE is exceedingly rare,especially when considering cases where paradoxical embolism originating from a patent foramen ovale is absent.This report presents a case of AMI complicated with PE.A comprehensive understanding of the pathophysiology of this rare yet critical condition is important for ensuring prompt diagnosis and treatment.
文摘This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).
文摘Venous thromboembolism(VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism(PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.
基金Supported by Tianjin Health Science and Technology Project,No.ZC20147.
文摘BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.
基金Supported by Natural Science Foundation of Guangdong Province,No.2021A1515011267and Guangzhou Municipal Science and Technology Bureau,No.2023A03J0984.
文摘BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.
基金Construction and Application of Management Program for Prevention and Treatment of Inpatients with Venous Thromboembolism,No.WFWSJK-2022-111and Shandong Provincial Medical and Health Science and Technology Development Program,No.202103050856.
文摘BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE include Durant's maneuver,aspiration and removal of air through venous catheters,and hyperbaric oxygen therapy.For critically ill patients,use of cardiotonic drugs and chest compressions remain useful strategies.The wider availability of extracorporeal membrane oxygenation(ECMO)has brought a new option for VAE patients.CASE SUMMARY A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h.One day ago,the patient suffered from abdominal pain,fever,and diarrhea.She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago,accompanied by nausea and vomiting,during which a small amount of gastric contents were discharged.She was immediately sent to a local hospital,where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery.The condition deteriorated despite endotracheal intubation,rehydration,and other treatments,and the patient was then transferred to our hospital.Veno-arterial ECMO was applied in our hospital,and the patient's condition gradually improved.The patient was successfully weaned from ECMO and extubated after two days.CONCLUSION ECMO may be an important treatment for patients with VAE in critical condition.
基金National Key Research and Development Program(No.2022YFC2305004)Key Research and Development Project of Hainan Province(No.ZDYF2020223)+2 种基金Key Science and Technology Project of Hainan Province(No.ZDKJ2021036)International Science and Technology Cooperation Project of Hainan Provincial Key Research and Development Program(No.GHYF2022011)National Natural Science Foundation of China(No.82260001,82160012)。
文摘Chronic obstructive pulmonary disease(COPD)is one of the most common and important diseases leading to the death of elderly patients in the world at present.It is characterized by continuous airflow restriction and irreversible chronic airway obstruction,which can easily lead to a variety of complications and accompanying symptoms,greatly affecting the quality of life of individuals and increasing the economic burden of families and society.Pulmonary embolism(PE)is one of the complications of COPD,which can lead to pulmonary blood circulation and respiratory failure,with a high risk of death.However,because its clinical symptoms overlap with the symptoms of acute exacerbation of COPD and lack of specific clinical manifestations and laboratory tests,it is easy to be misdiagnosed and ignored,thus delaying the treatment of patients and affecting the prognosis.This article will elaborate on the clinical diagnosis and treatment of chronic obstructive pulmonary disease combined with pulmonary embolism,providing certain value for early identification of COPD combined with PE patients and the severity of the condition.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is a key procedure for diagnosing and treating biliary and pancreatic disorders.Although effective,it carries risks,including rare but severe complications such as air embolism.CASE SUMMARY We report a case of a 58-year-old man who developed extensive air embolism during ERCP.He previously underwent a Whipple procedure and experienced a sudden drop in vital signs and loss of consciousness.Immediate intervention with hyperbaric oxygen therapy and supportive care led to gradual recovery.Imaging confirmed widespread air embolism,which resolved with continued treatment.CONCLUSION Air embolism is a rare,critical complication of ERCP,especially in patients with prior surgery such as pancreaticoduodenectomy.Early detection and prompt treatment,including hyperbaric oxygen therapy,are crucial for favorable out-comes.
