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ABSTRACT: Inflammatory myofibroblastic tumor of the trachea is a rare benign tumor of the adult. It is mostly seen before the age of 16. We describe a 20-year-old female patient who presented with stridor. She had a fixed obstruction on spirometry and a thorax computed tomography and bronchoscopy confirmed the presence of tracheal thickening and stenosis below the vocal cords and bronchial wall thickening at the level of carina. Bronchoscopic biopsies confirmed the lesion to be an inflammatory myofibroblastic tumor. After mechanical dilatation and resection by rigid bronchoscopy and corticosteroid therapy, the clinical status of the patient was relieved.
Respiratory care 12/2012; · 2.01 Impact Factor
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ABSTRACT: OBJECTIVE: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. METHODS: Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. RESULTS: The mean of the RV Tei index was 0.46±0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40±20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved. CONCLUSION: RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 09/2012; · 0.44 Impact Factor
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ABSTRACT: To determine predictive fatality criteria based on clinical and laboratory findings on admission to hospital in patients diagnosed with pandemic influenza A (H1N1) virus infection.
The study was conducted at the School of Medicine, Karadeniz Technical University, Trabzon, Turkey. Demographic, clinical, and laboratory data for hospitalized cases with a diagnosis of A (H1N1) virus infection between October 2009 and May 2010 were analyzed retrospectively. Patients were divided into 2 groups: fatal (group I) and non-fatal (group II). The 2 group's demographic, clinical, and laboratory data were compared on admission.
Ten (20%) of the 50 patients included in the study died. The average age of group I was significantly higher than that of the group II. No significant difference was observed between the groups in terms of underlying chronic diseases and pregnancy. Fever, phlegm, shortness of breath, tachypnea, cyanosis were observed at significantly higher levels in group I compared to group II. Serum hemoglobin, glucose, albumin levels, arterial oxygen saturation were significantly lower in group I compared to group II; aspartate transaminase, alanine aminotransferase, C-reactive protein, procalcitonin, blood urea nitrogen levels, time between onset of symptoms and commencement of antiviral treatment were all significantly higher in group I.
This study shows that in addition to demographic characteristics and clinical findings, prognosis of patients with A (H1N1) virus infection can be determined beforehand with various laboratory tests. But these parameters, which can guide the clinician in the prior identification of potentially fatal A (H1N1) cases will contribute to the provision of supporting treatment and, when necessary, intensive care services for such patients.
Saudi medical journal 02/2012; 33(2):146-51. · 0.52 Impact Factor
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ABSTRACT: Risk stratification remains controversial in patients with normotensive pulmonary embolism (PE). The debate has recently focused right ventricular dysfunction detected by echocardiography or spiral computed tomography (CT) and cardiac biomarkers.
The utility of the PaO(2)/PaCO(2) ratio to predict the short-term prognosis of PE is not currently known and that is the aim of the present study.
This study retrospectively enrolled 99 (34 males, 65 females, 67 ± 15 years) consecutive patients with acute PE, diagnosed by spiral chest tomography pulmonary angiography (CTPA). On admission, cardiac troponin T (cTn-T) was measured and on CTPA both right ventricle diameter and left ventricle diameter was calculated (RV/LV ratio). During the first 24 h after admission, all the patients had initial arterial blood gas collected under room air. Receiver-operating characteristic (ROC) analysis was performed to determine the optimal PaO(2)/PaCO(2), RV/LV ratio and cTn-T cutoff level with regard to prognosis.
In-hospital mortality was 12.1% and all-cause 90-day mortality was 15.2%. Ten of 15 patients who died had a PaO(2)/PaCO(2) ≤ 1.8 based on ROC analysis (P < 0.014).The cutoff level of PaO(2)/PaCO(2) ≤ 1.8 had a high negative predictive value of 93% for mortality. Multivariable analysis revealed that PaO(2)/PaCO(2) ≤ 1.8 Hazard Ratio (HR): 16.8 [95% CI: 2.6-108, P < 0.003] was the most significant independent predictor, whereas cTn-T, pO(2) < 60 mmHg and cardiac failure were nonsignificant factors. In addition, PaO(2)/PaCO(2) ≤ 1.8 showed significant survival differences for overall mortality rates in Kaplan-Meier analysis (P < 0.012).
The PaO(2)/PaCO(2) measurement is a highly useful and practical measurement to predict prognosis in patients with acute PE. Moreover, it appears to be a more accurate predictor than RV/LV ratio and cTn-T levels in patients with normotensive PE.
The Clinical Respiratory Journal 06/2011; 6(2):104-11. · 1.06 Impact Factor
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ABSTRACT: Heparin induced thrombocytopenia is a serious complication of heparin therapy that has a high levels of morbidity and mortality due to thrombotic complications. Heparin induced thrombocytopenia usually develops between days 5 and 14 (inclusive) following initiation of heparin. When heparin induced thrombocytopenia is suspected, heparin should be discontinued and treatment with a direct thrombin inhibitor should be initiated. Heparin induced thrombocytopenia occurs more frequently with unfractionated heparin than with low molecular weight heparin. In this manuscript, we presented a case diagnosis with heparin induced thrombocytopenia who was given low molecular weight heparin for prophylaxis. We tried to make an overview of new treatment choices along with current literature.
Tuberkuloz ve toraks 06/2011; 59(2):178-83.
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ABSTRACT: Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU.
This was a retrospective electronic data review of patients who presented to the emergency department for respiratory reasons between December 2007 and December 2009 and in whom CRP and cTn-T levels were measured. Patients with a diagnosis of pulmonary embolism and acute coronary syndrome were excluded. We recorded demographics, chronic diseases, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), ICU stay, and CRP and cTn-T concentrations.
We included the records of 158 patients. Mean ICU stay was 9.9 days (range 1-65 d), and mean hospital stay was 14.1 days (range 1-72 d). For predicting mortality, receiver operating characteristic analysis gave a CRP cutoff value of ≥ 10 mg/dL, and a CTn-T cutoff value of ≥ 0.01 ng/mL. For CRP the mortality area under the curve was 0.691 (95% CI 0.608-0.775), the sensitivity was 65%, and the specificity was 70%. For cTn-T the mortality area under the curve was 0.733 (95% CI 0.655-0.812), the sensitivity was 78%, and the specificity was 56%. Of the patients who died, 65% had CRP ≥ 10 mg/dL and 78% had cTn-T ≥ 0.01 ng/mL. On multivariable regression analysis, CRP ≥ 10 mg/dL was associated with 6.6-fold higher (95% CI 1.7-21.3) ICU mortality. There was no advantage for models that combined CRP and cTn-T. CRP alone was more valuable in predicting ICU mortality than in combination with troponin or SAPS II.
Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.
Respiratory care 02/2011; 56(7):1002-8. · 2.01 Impact Factor
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ABSTRACT: The aim of this study was to investigate the effect of early or delayed warfarin administration with unfractionated heparin (UFH) on coagulation parameters in pulmonary thromboembolism (PTE).
This study was performed between November 2006 and July 2007. Thirty-three patients with PTE were sequentially slotted to early (n = 16) and delayed (n = 17) warfarin treatment groups. In the early group, both UFH infusion and warfarin were started simultaneously and in the delayed group, warfarin was added (1-3 days later) based on when partial thromboplastin time reached the therapeutic level with UFH. The proteins C and S, D-dimer, hematocrit levels, and platelet counts for all patients were studied prior to treatment and 6, 24, and 48 h after warfarin treatment. In order to determine the overall effect of early and delayed warfarin treatment on clot formation, a thromboelastogram was performed simultaneously.
In both groups, a similar chronological decrease in protein C levels reaching maximum at 24 h with warfarin treatment was observed. However, intragroup or intergroup decreases in protein S levels were not different. On thromboelastogram, INTEM and EXTEM clotting times were significantly prolonged chronologically, but this prolongation was not different between groups.
The suppressor effect of warfarin on proteins C and S in the early period of double anticoagulant treatment did not appear to aggravate the risk of thrombosis in patients with PTE in whom warfarin was started simultaneously with UFH.
Medical Principles and Practice 01/2011; 20(2):181-6. · 0.89 Impact Factor
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ABSTRACT: Despite diagnostic advances, delays in the diagnosis of pulmonary embolism (PE) are common.
In this study, we aimed to investigate the relationship between delays in the diagnosis of PE and underlying risk factors for PE.
We retrospectively evaluated the records of 408 patients with acute PE. Patients were divided into 2 groups, surgical or medical, based on risk factors leading to the embolism. Analysis involved demographic characteristics of the patients, dates of symptom onset, first medical evaluation, and confirmatory diagnostic tests. Diagnostic delay was described as diagnosis of PE more than 1 week after symptom onset.
The mean time to diagnosis for all patients was 6.95 ± 8.5 days (median, 3 days; range, 0-45 days). Of the total number of patients, 29.6% had presented within the first 24 hours and 72.3% within the first week. The mean time to diagnosis was 4.4 ± 7.6 days (median, 2 days; range, 0-45 days) in the surgical group and 8.0 ± 8.6 days (median, 4 days; range, 0-45 days) in the medical group (P = .000). The mean time to diagnosis in the medical group was approximately 4 times greater than that of the surgical group on univariate analysis. Early or delayed diagnosis had no significant impact on mortality in either group.
Delay in the diagnosis of PE is an important issue, particularly in medical patients. We suggest that a public health and educational initiative is needed to improve efficiency in PE diagnosis.
The American journal of emergency medicine 01/2011; 29(1):26-32. · 1.54 Impact Factor
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ABSTRACT: Influenza pandemics have been observed in several periods throughout history. The first influenza pandemic of the 21st century began in Mexico in 2009 and has spread rapidly all over the world. Swine H1N1 has been officially declared a pandemic by the World Health Organization in June 2009. As has been observed in previous pandemics, pregnant women, adolescents, and immunosuppressed individuals are affected more severely in this pandemic. Despite several reports about the pandemic, there have not been any reports of swine H1N1 infection in individuals who underwent renal transplant. The aim of the current study was to present oseltamivir therapy in a swine H1N1-infected patient who underwent renal transplant 10 months earlier, and was thus under immunosuppressive treatment. To the best of our knowledge, this is the first case report of a swine H1N1 infection in a renal transplant recipient.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 12/2010; 8(4):318-20.
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ABSTRACT: In pulmonary thromboembolism (PE), delay to diagnosis is very common. In this study, we examined the role of patients and the socio-demographic characteristics in delayed diagnosis of PE.
We evaluated 156 PE patients for the dates of symptom onset, the dates of first visit to a health institution and diagnosis, signs and symptoms, and the socio-demographic characteristics. Delays were analyzed using the Mann-Whitney U test, and the predictors were analyzed using logistic regression analysis.
Of the patients, 60.3% visited a health institution within the first day of the symptoms. Mean time from symptoms to the first admission to a health institution (patient delay) was 2.04 ± 3.89 days (median 0 day, range 0-30). Current smoking, a high level of education, and co-morbidity were associated with longer patient delays. The time interval from first symptom to the diagnosis (total delay) was 7.93 ± 10.05 (median 4 days, range 0-45) days. While hypotension, syncope, and previous surgery/trauma were significantly associated with a shorter total delay, a previous visit to any health institution was associated with longer total delay.
In conclusion, although some socio-demographic characteristics of patients such as smoking, educational status, and co-morbid diseases were found to be associated with delayed visit to any health institution, our results showed that physician or health system delays were more prominent in delayed diagnosis of PE.
Upsala journal of medical sciences 11/2010; 116(1):72-6. · 0.73 Impact Factor
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ABSTRACT: Right ventricular dysfunction (RVD) detected by computerized tomography (CT)/echocardiography or elevated biomarkers is associated with a poor prognosis for pulmonary embolism (PE). However, these prognostic factors have not previously been concomitantly elucidated in the same patient group.
This prospective study included 108 consecutive patients with normotensive PE confirmed by CT pulmonary angiography (CTPA). On admission, patient serum NT-proBNP and troponin T (Tn-T) levels were measured, and echocardiography was performed within 24 hours after diagnosis of PE. Receiver operating characteristic (ROC) analysis was performed to determine the optimal echocardiographic end-diastolic diameters of the right ventricle, the ratio of the right ventricle to left ventricle (RV/LV ratio) on CTPA, and NT-proBNP and Tn-T cut-off levels with regard to prognosis.
All-cause 30-day mortality was 13% and PE-related mortality was 5.6%. RVD was defined as a right/left ventricular dimension ratio≥1.1 on CTPA and RV>30 mm on echocardiography by ROC analysis. A cut-off level of NT-proBNP≤90 pmol/ml had a high positive predictive value of 98% for survival, whereas NT-proBNP>300 and Tn-T≥0.027 had a negative predictive value, for all-cause deaths, of 95% and 96%, respectively. PE mortality in patients with NT-proBNP>300 and Tn-T≥0.027 reached 64%. In univariable analysis, the combination of Tn-T≥0.027 ng/ml with a echocardiographic RVD were the most significant predictors of overall mortality and PE-related death [HR: 14 (95% CI: 4.6-42,) and HR: 37.6 (95% CI: 4.4-324)], respectively. In multivariable Cox's regression analysis, NT-proBNP>300 and Tn-T≥0.027 HR: 26.5 (95% CI: 4.1-169.9, p<0.001) were the best combination to predict all-cause of mortality.
The combination of NT-proBNP and Tn-T clearly appears to be a better risk stratification predictor than biomarkers plus RVD on CT/ echocardiography in patients with normotensive PE.
Thrombosis Research 10/2010; 126(6):486-92. · 2.44 Impact Factor
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Journal of Emergency Medicine 09/2010; 42(4):460-1. · 1.31 Impact Factor
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ABSTRACT: To investigate possible relationship between the D-dimer and ischemia-modified albumin (IMA) levels and radiological imaging-based severity scores in pulmonary embolism (PE) based on two different radiological characteristics; the pulmonary arterial obstruction index (PAOI) and the right ventricle/left ventricle (RV/LV) ratio.
In this prospective cohort study, forty-seven patients presenting to the emergency department and definitively diagnosed with PE using spiral computerized tomography (CT) were initially enrolled in the study. Levels of IMA and D-dimer were assessed colorimetrical and immuno-turbidimetric methods, respectively. The PAOI and RV/LV ratios were calculated from CT images. The levels of biochemical parameters between the groups were compared with use of Mann-Whitney U and Kruskal-Wallis tests and relationship between the radiological scores were assessed using the Spearman correlation test.
Analysis of the calculated PAOI and RV/LV ratio revealed a significant correlation between them (r=0.36, p=0.023). D-dimer levels differed considerably among the mild (=40%), moderate (40%-60%) and severe (60%) groups constituted on the basis of PAOI (p=0.039). This difference stemmed from those in D-dimer levels in the mild group, PAOI =40 % and the severe group, PAOI 60% (p=0.02; Z= -2.328). In addition, D-dimer levels and PAOI revealed a positive correlation, but no similar correlation was determined between D-dimer levels and RV/LV. There were no significant correlations between IMA and D-dimer levels, PAOI and RV/LV ratios.
In the biochemical determination of severity of PE based on radiological characteristics, D-dimer may be a more relevant marker than IMA, which has been proposed as a new marker.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 08/2010; 10(4):346-52. · 0.44 Impact Factor
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ABSTRACT: Atelectasis was reported as a favorable prognostic sign of pulmonary carcinoma; however, the underlying mechanism in those patients is not known. In this study, we aimed to investigate prospectively the potential impact of atelectasis and/or obstructive pneumonitis (AO) on survival and the relation between atelectasis and some laboratory blood parameters. The study was conducted on 87 advanced stage non-small cell lung cancer (NSCLC) patients. Clinical and laboratory parameters of patients at first presentation were recorded, and patients were divided into two groups according to the presence of AO in thorax computed tomography (CT). Survival was calculated using Kaplan-Meier and univariate Cox's regression analyses. Laboratory parameters that might be related with prolonged survival in atelectasis were compared using chi-square, Student's t, and Mann-Whitney U tests. Of the patients, 54% had stage IV disease, and AO was detected in 48.3% of all cases. Overall median survival was 13.2 months for all cases, 10.9 months for patients without AO, and 13.9 months for patients with AO (P=0.067). Survival was significantly longer in stage III patients with AO (14.5 months versus 9.2 months, P=0.032), but not in stage IV patients. Patients with AO in stage III had significantly lower platelet counts (P=0.032) and blood sedimentation rates than did those with no AO (P=0.045). We concluded that atelectasis and/or obstructive pneumonitis was associated with prolonged survival in locally advanced NSCLC. There was also a clear association between atelectasis and/or obstructive pneumonitis and platelets and blood sedimentation rate.
Upsala journal of medical sciences 08/2010; 115(3):176-80. · 0.73 Impact Factor
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ABSTRACT: This cross-sectional study was intended to investigate the etiology of community-acquired pneumonia (CAP) in adult patients receiving no prior antibiotic therapy. Etiological agents were identified in 137 (62.8%) of 218 patients, the most frequent being Streptococcus pneumoniae (14.7%), Mycoplasma pneumoniae (13.8%) and respiratory syncytial virus (10.1%). A single pathogen was detected in 50.9% of cases and mixed pathogens in 11.9%. Typical pathogens were determined in 35.8% of cases, atypical pathogens in 20.2% and viral pathogens in 20.6%. Chronic obstructive pulmonary disease was a common (42.7%) comorbidity. S. pneumoniae was the most common pathogen in adult patients with CAP. Atypical pathogens were more common in patients < 65 years old, M. pneumoniae being the most common in this age group. Our results suggest that initial empiric antibiotic treatment in patients with CAP should cover S. pneumoniae and M. pneumoniae in Turkey.
Tuberkuloz ve toraks 01/2010; 58(2):119-27.
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ABSTRACT: To prospectively determine whether the diffusion-weighted magnetic resonance imaging is useful to distinguish between malignant and benign mediastinal lymph nodes.
Thirty-five patients (14 women, 21 men; mean age 52 years) with 91 lymph nodes in the mediastinum detected by computed tomography underwent 1.5 Tesla (T) diffusion-weighted MR imaging before mediastinoscopy (n = 29) and mediastinotomy (n = 6). Diffusion-weighted MR images were acquired with a b factor of 50, and 400 s/mm(2) using single-shot echo-planar sequence.
Of the 35 patients, 18 had diagnosis of malignant tumor. Of the 18 patients with tumor, 8 had nonsmall cell carcinoma, and 10 had small cell carcinoma. Ninety-one mediastinal lymph nodes were detected in the 35 untreated patients: 19 were pathologically diagnosed as metastatic lymph nodes, and 72 lymph nodes were diagnosed as nonmetastatic lymph nodes, including 50 sarcoidosis, 14 reactive lymphoid hyperplasia, and 8 necrotizing granulamatous lymphadenitis. The apparent diffusion coefficient (ADC) was significantly lower in metastatic lymph nodes (1.012 +/- 0.025 x 10(-3) mm(2)/s; P < 0.0005) than in benign lymph nodes (1.511 +/- 0.075 x 10(-3) mm(2)/s). On the ADC map, malignant nodes showed hyperintense (n = 2, 10.52%), hypointense (n = 14, 73.68%), and mixed intensity (n = 3; 15.78%), whereas benign nodes showed hyperintense (n = 57; 79.16%), hypointense (n = 3; 41.6%), isointense (n = 6; 8.33%), and mixed intensity (n = 6; 8.33%).
Diffusion-weighted MR with ADC value and signal intensity can be useful in differentiation of malignant and benign mediastinal lymph nodes.
Journal of Magnetic Resonance Imaging 08/2009; 30(2):292-7. · 2.70 Impact Factor
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ABSTRACT: The objectives of this study were to determine the levels of lifetime cigarette use, daily use, and current use among young people (aged 15-19 years) and to examine the risk factors contributing to regular smoking.
The number of students was determined proportionately to the numbers of students in all the high schools in the province of Trabzon in Turkey. The data were gathered using the questionnaire method. A total of 4666 students participated in the study. The chi-square test and logistic regression analysis were used in data analysis.
Of the 4666 students who took part in the study, the level of lifetime cigarette use was 38.2% (n = 1796), that of lifetime daily cigarette use was 10.5% (n = 491), and that of current cigarette use was 9.5% (n = 447). Male students (P < .0005), those whose mothers were smokers (P < .0005), those whose fathers smoked (P = .005), those whose siblings smoked (P<.0005), those whose friends smoked (P < .0005), those whose teachers smoked (P = .001), and low achievers in school (P < .0005) stated that they significantly smoked on a more regular basis. According to the results of the logistic regression analysis, the following risk factors were statistically significant: male students smoked 3.02 times (95% CI 2.20-4.16) more than females, those whose mothers were smokers smoked 1.57 times (95% CI 1.09-2.28) more than those whose mothers were not, those whose friends were smokers smoked 2.42 times (95% CI 1.73-3.39) more than those whose friends were non-smokers, poor achievers in school smoked 2.62 times (95% CI 1.97-3.49) more than high achievers, and those without poor grades smoked 1.75 times more (95% CI 1.23-2.40), the risk rising 1.06 times (95% CI 1.01-1.11) with earlier age at first experimentation. The risk of daily cigarette use was observed to decline by 0.91 times (95% CI 0.84-0.98) with increasing numbers of siblings.
Effective smoking prevention programs should take into account the dominant influence of peer groups in the onset and continuation of smoking.
Journal of School Health 03/2009; 79(3):93-7. · 1.34 Impact Factor
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Wilderness and Environmental Medicine 01/2009; 20(4):391-2. · 0.94 Impact Factor
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ABSTRACT: In recent years, circannual variations in incidence and mortality for venous thromboembolic disease have been demonstrated, with a peak in winter. However, several investigators have observed no seasonal variation in these diseases. The aim of our study was to investigate whether a seasonal variation, in terms of atmospheric pressure, humidity, and temperature, exists for pulmonary thromboembolism.
We retrospectively included 206 patients with a diagnosis of pulmonary embolism (PE) between 1 June 2001 and 31 May 2006.
The highest number of cases in the 5 years concerned occurred in May (29 cases). Although PE occurred most commonly in the spring (72 cases) and autumn (51 cases), the difference was statistically significant (P = .003). There were no case correlations with months and pressure, temperature, or humidity. However, there was a statistically significant positive correlation between case incidence and atmospheric pressure (r = 0.53, P < .0005) and humidity (r = 0.57, P < .0005). In terms of risk factors, seasonal distribution was not statistically significant as regards cases of embolism occurring for surgical or nonsurgical reasons (r = 0.588).
In terms of the relationship between seasons and embolism cases, despite the determination of an insignificant positive correlation, a statistically significant positive correlation was determined between air pressure and humidity and case incidence. There is now a need for further wide-ranging prospective studies including various hematological parameters to clarify the correlation between PE and air pressure.
The American journal of emergency medicine 11/2008; 26(9):1035-41. · 1.54 Impact Factor
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ABSTRACT: Although pulmonary thromboembolism is usually considered as an acute illness, delayed presentations are fairly common.
The purpose of this study was to investigate delays to presentation/diagnosis and their likely correlation with patients' clinical and radiographic findings in pulmonary thromboembolism.
All cases of pulmonary embolism diagnosed in our hospital between March 2002 and May 2006 were reviewed for the date of symptom onset, the dates of presentation and diagnosis, clinical findings, localization of embolism in pulmonary vascular tree and pleuropulmonary changes arising secondary to thrombotic occlusion. The parameters related to presentation delays were analyzed using a Mann-Whitney U test and logistic regression analysis.
Of the 178 patients enrolled, 30.4% presented to hospital 1 week after the start of their symptoms and there was an average of 8.4 +/- 11.4 days' (median 4 days, range 0-75) delay to presentation. The delay from presentation to diagnosis was 0.9 +/- 1.9 days (median 0, range 0-16). Patients with hypotension, respiratory rate >20 and atelectasis in spiral CT presented earlier. However, no correlation was found between delays and the level of thromboembolic occlusion in pulmonary artery.
Pulmonary thromboembolism should be considered not only in an acute setting, but also in patients with prolonged respiratory symptoms, since there was a significant delay to presentation amongst our patients. The presence of hypotension and a high respiratory frequency was clearly associated with early presentation.
Respiration 10/2008; 78(1):36-41. · 2.26 Impact Factor
