Emboli embolism

Emboli. Embolic phenomena occur in up to one-third of cases and may result in significant complications. Left-sided endocarditis can result in renal artery emboli causing flank pain with hematuria, splenic artery emboli causing abdominal pain, and cerebral emboli, which may result in hemiplegia or alteration in mental status. Right-sided endocarditis may result in pulmonary emboli, causing pleuritic pain with hemoptysis. 

It is remarkable that most of the data collected from the available SERMs are unanimous in reproducing an estrogen agonistic profile in venous thrombogenesis. The vast clinical experience acquired with tamoxifen confirms an augmented risk for both deep venous thrombosis and pulmonary embolism. This increase, however, did not presuppose increased mortality in the overview of randomized trials of adjuvant tamoxifen for early breast cancer, where the one extra death per 5000 woman-years of tamoxifen attributed to pulmonary embolus was not statistically significant (Early Breast Cancer Trialists Collaborative Group 1998). 

Embolism associated with long flights is generally due to thrombus formation in deep leg veins (deep-vein thrombosis, or DVT). The thrombus may move to the pulmonary circulation, where effects on lung function depend on the extent of the blockage produced. A massive embolus may occlude the main pulmonary artery, resulting in hypotension, shock and possibly death multiple small emboli cause little problem and are lysed by the fibrinolytic system. Sometimes surgical removal of the embolus is necessary, but in Pats/s case clot lysis was successful and she made an uneventful recovery. 

Q6 A thrombus is a blood clot which is fixed to the blood vessel wall. When it detaches and is carried in the blood, it is known as an embolus. Both thrombi and emboli can block blood vessels and deprive tissues of oxygen. In arteries blood clots usually form because the inner surface has been altered by deposition of atheroma. In contrast venous thrombosis results from slow or stagnant blood flow in veins, or defects in mechanisms which normally oppose inappropriate coagulation. Three major risk factors for pulmonary embolism are (i) venous stasis, (ii) hypercoagulability ofblood and (iii) injury to vascular endothelium following trauma or plaque rupture. 

Patients with clinical evidence of pulmonary embolus or suspected embolism who are hemodynamically stable Arterial thromboembolism or patients who are currently receiving dialysis, actively bleeding, have had recent (within 2 weeks) major surgery/trauma, or have other severe uncompensated co-morbid conditions May vary depending on the patient s clinical condition... 

The signs and symptoms are usually insidious in onset and may consist of anorexia, malaise, edema, anasarca, or ascites, and pericardial and pleural effusions may also be present. As a result of a hypercoagulable state, pulmonary embolism may develop, but rarely results in death. " The incidence of renal vein thrombosis varies from 5% to 62%, " and membranous nephropathy should be suspected when there is a sudden onset of hematuria loin pain pulmonary embolus fluctuating or worsening proteinuria or glomerular filtration rate renal tubular acidosis or an increase in leg edema. Hypertension is found in about 30% of patients and is more common in the presence of renal insufficiency or until the disease is advanced. 

Such a cerebral thrombosis is believed to occur as a result of atherosclerotic damage in the arterial wall. Narrowing of the arterial lumen slows the blood flow. The projection of rough-surfaced deposits into what is by then a trickle of blood may serve as a nucleus around which the thrombus will form, thereby completing the occlusion. A variation is the wandering of a blood clot, or embolus, through the vasculature until finally it becomes wedged in a cerebral artery. This is a cerebral embolism. 

Clinical effects produced by thrombi and emboli are (1) no serious effects, the silent thrombus or embolus (2) oedema of a limb, venous thrombus and perivenous lymphangitis (3) post-thrombotic ulceration (4) gangrene of a limb (thrombosis of main artery or embolus from heart or aorta) (5) gangrene of bowel (thrombosis of mesenteric artery or vein, arterial embolism) ... 

The first event that generally occurs after blood contacts a polymer surface is the formation of a protein layer at the blood-polymer interface (1). The formation of this protein layer is followed by the adherence of platelets, fibrin, and possibly leukocytes (2). Further deposition with entrapment of erythrocytes and other formed elements in a fibrin network constitutes thrombus formation. The growth of the thrombus eventually results in partial or total blockage of the lumen unless the thrombus is sheared off or otherwise released from the surface as an embolus (3). Emboli can travel downstream, lodge in vital organs, and cause infarction of tissues. The degree to which the polymer surface promotes thrombus formation and embolization, hemolysis, and protein denaturation determines its usefulness as a biomaterial (4). 

Solvent exchange Describes a specific set of materials that rely upon diffusion of an organic solvent and its replacement by an aqueous one. Practically, this process would be highly inefficient for injection into the blood stream, but can be used peritoneally or subcutaneously, where there is little direat of embolus, and a long time course for diffusion to occur. This technique has been employed with an ethylene vinyl alcohol embolization... 

As is the case with most invasive procedures, deep venous thrombosis and pulmonary embolus represent rare but potential complications of the uterine artery embolization procedure [53]. Patients taking oral contraception are known to be at increased risk for venous thromboembolic disease and there may be a transient hypercoagulability after embolization [92-94],... 

An embolism occurs when a blood clot or thrombus is formed and released in an inflamed vein, associated with pain and swelling, which is called deep vein thrombosis (DVT). The releaised clot, called an embolus, is carried by the bloodsteam and causes an obstruction in a downstream blood vessel or capillary. An embolus can be either part of a thrombus, or an air bubble, piece of fat, bone marrow, or tumor tissue [3]. 

A 36-year-old man had a pulmonary embolus after percutaneous embolization of a varicocele with enbucrilate (Histoacryl ) -I- lipiodol [26 ]. 

Coil embolization is technically easy and successful. Coils should be sized slightly larger than the vessel lumen. Smaller coils or Gelfoam can be used to sandwich or nest between the flanking coils. This will ensure a compact and occlusive embolus. Patients should be observed for splenic infarction, although short gastric or other small collateral vessels can perfuse portions of the spleen distal to the occluded main renal artery. 

Many complications are reported particularly with alcohol embolization, such as pulmonary embolus, cardiovascular collapse, neuropathy, skin blisters, radiculopathy, finger numbness, and focal skin necrosis [23, 24]. Arterial line monitoring and Swan-Ganz catheters are recommended for large AVM embolization [24] (Figs. 23.6a-d, 23.7a-d). 

Cerebral embolism, in which a traveling blood clot, fat, or an embolus of air (a bubble of air) settles in one of the cerebral arteries and chokes off the circulation. 

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