Pulmonary Embolism In Women Research Articles

Characteristics of the course acute thromboembolism of the pulmonary artery in women

Abstract. According to modern ideas, men have a more unfavorable course during the hospital period of pulmonary embolism. However, in recent years, works have appeared that have conflicting results regarding the influence of gender differences on mortality in pulmonary embolism, including publications in which a more severe course is observed for women. Aim of the research: determination of gender characteristics of the course of acute pulmonary embolism in women compared to men. Materials and methods. 243 patients with acute pulmonary embolism were examined. All patients underwent a physical examination, clinical and biochemical blood tests, assessed the risk and prognosis according to generally accepted scales, performed an electrocardiographic and X-ray examination, a standard transthoracic echocardiography, an ultrasound Doppler examination of the veins of the lower extremities, and a multispiral computed tomographic angiography of the pulmonary arteries. Statistical processing also included multivariate regression analysis. Results. According to the results of the study, it was found that the average age of women who were hospitalized with acute pulmonary embolism is four years older than that of men. In women, such risk factors for the occurrence of venous thromboembolism as: advanced age, history of venous thromboembolism, diabetes mellitus, and oncological disease were more likely to occur. Heart rate and cholesterol levels at admission were also likely to be higher in women than in men. Prediction of the severity of the course of pulmonary embolism determined by the sPESI scale index showed that high risk occurs probably more often in women. The mortality rate in the female group was also relatively higher than that of the male group. Conclusion. It was established that, despite similar lesions of the pulmonary arteries (localization, distribution and volume), there are gender differences in the prevalence of the leading risk factors for pulmonary embolism. It was found that women have a more severe course of acute pulmonary embolism, which is evidenced by a higher specific weight of high-risk patients, more pronounced saturation disturbances and a higher heart rate. In-hospital mortality in women with pulmonary embolism is higher than in men, both in the group as a whole and among high-risk patients.

Specific aspects of pulmonary embolism in women

This review presents the literature data regarding specific aspects of acute pulmonary embolism (PE) in women. The overall age- and sex-adjusted incidence of PE was found to be higher in men however, the risk in older women exceeded that of age-matched men. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptives, pregnancy and postpartum period, recent surgery, immobilization, trauma, obesity, and heart failure. Women with PE tended to be older, presented more often with dyspnea, hypotension and signs of right ventricular dysfunction and had higher NT-proBNP levels compared to men. When controlled for PE severity, women are less likely to receive reperfusion therapies, such as thrombolysis. More bleeding complications during treatment was reported in women. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. Sex-specific long-term mortality data is limited.

Pulmonary Embolism in Women: A Systematic Review of the Current Literature.

Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women.

Acute Pulmonary Embolism in Women: Focus on Estrogen Therapy as a Predisposing Factor

Acute pulmonary embolism (APE) is a potentially fatal disorder. The literature shows that estrogen therapy is correlated with an increase in mortality and morbidity. Accordingly, the purpose of the present study was to investigate the prevalence and prognostic significance of the recent history of estrogen therapy in women with APE. This study was conducted on female patients admitted to our hospital between January 2008 and January 2016. A total of 276 patients (mean age=62.66±08 y) with confirmed APE were divided into groups with and without recent estrogen therapy. The relationships between estrogen and clinical findings, risk factors, imaging findings, and in-hospital mortality were analyzed. Among the 276 women with APE at presentation, 37 (13.4%) patients had a recent history of estrogen therapy. The estrogen group had a lower frequency of hypertension (21.6% vs49.8%; P< .001), immobilization of at least 3 days (16.2% vs 33.5%; P= .035), and pleural effusion (0% vs16.7%; P= .007) than the group without recent estrogen use. Among the 276 patients, the rate of 1 year’s mortality was 15.8% for the group without recent estrogen therapy. No death occurred in the estrogen group. Older age, tachycardia, tachypnea, malignancy, and lack of obesity were the predictors of 1 year’s mortality. Among the patients with APE in our study, 13.4% had a history of recent estrogen therapy. No death occurred during the 1-year follow-up of these patients.

Analysis of factors associated with pulmonary embolism during pregnancy

To investigate risk factors associated with pulmonary embolism in women during pregnancy or peripartum. Information of 7 pregnant women diagnosed pulmonary embolism (PE) were collected from January 2018 to December 2020 in Beijing Friendship Hospital. Four non-PE pregnant women as control group were matched with each patient by age, BMI and pregnancy complications during the same period. Binary logistic regression was used to identify the potential risk factors by the comparison of difference between groups. The laboratory indices, including platelet, hemoglobin, prothrombin time, partially activated prothrombin time, D-dimer, triglyceride, total cholesterol, low density lipoprotein (LDL) and high density lipoproteinage (HDL) showed no significant difference between groups. D-dimer and HDL were found to be associated with PE during pregnancy (P<0.05). D-dimer and HDL might be associated with PE during pregnancy.

673 The Peripartum Risk of Deep Vein Thrombosis and Pulmonary Embolism in Women With Inflammatory Bowel Disease: A Population-Based Cohort Analysis

INTRODUCTION: Population-based adverse outcomes in the peripartum period are limited. Both Inflammatory Bowel Disease (IBD) and pregnancy are known risk factors for venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of our study was to determine whether the odds of VTE are higher in women with Ulcerative Colitis (UC) and Crohn's disease (CD) at the time of delivery, compared to pregnant patients without IBD. METHODS: We performed a population-based retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP)'s Nationwide Inpatient Sample (NIS) between 2005 and 2014. ICD-9-CM diagnosis and procedure codes were used to identify unique obstetric hospitalizations associated with delivery of an infant, and VTE. We created national estimates using appropriate weights for each NIS admission. Multivariable logistic regression was used to evaluate the association of UC and CD with VTE, while adjusting for age, race, smoking, obesity, Charlson Comorbidity Index, chronic steroid use, income, primary insurance, hospital region, and hospital bed size. RESULTS: The cohort comprised of 39.8 million deliveries, including 19,167 in women with UC and 31,083 in women with CD. Table 1 depicts baseline characteristics of the cohort. Overall, IBD patients were more likely to be white, have private insurance, receive care at larger hospitals, have a cesarean section and use chronic steroids compared to non-IBD patients. There were 19 (0.1%) cases of VTE in UC patients, 18 (0.06%) in CD patients versus 11,935 (0.03%) in non-IBD patients. Unadjusted odds ratios [OR] were 4.0 for UC; 95% confidence interval [CI] 1.5-10.5, and 2.5 (95% CI, 0.9-6.8) for CD. After adjusting for confounders, the OR for developing VTE was 1.63 (95% CI 0.41-6.55) among UC patients and 2.11 (95% CI, 0.79-5.64) in CD patients. As seen in Table 2, the following variables were associated independently with an increased risk for VTE: age, higher comorbidity scores, inpatient cesarean delivery, obesity and smoking. CONCLUSION: Our study showed that patients with IBD were not at greater risk for VTE at the time of delivery compared with non-IBD, perhaps due to the lower absolute risk of VTE over time (0.06-0.1% in our study vs 1.5-2.1% in the 2005 NIS database). Improved awareness and practices surrounding DVT prophylaxis may also be contributing. This study was not able to differentiate between active versus quiescent disease.

Correlation of the tamoxifen use with the increased risk of deep vein thrombosis and pulmonary embolism in elderly women with breast cancer: A case-control study.

The association between tamoxifen use and risk of deep vein thrombosis or pulmonary embolism in women with breast cancer has been reported in the Western population. The study aimed to evaluate the association between tamoxifen use and deep vein thrombosis or pulmonary embolism in older women with breast cancer in Taiwan.We conducted a retrospective case–control study using the database of the Taiwan National Health Insurance Program. A total of 281 women subjects with breast cancer aged ≥65 years with newly diagnosed deep vein thrombosis/or pulmonary embolism from 2000 to 2011 were identified as the cases. Additionally, 907 women subjects with breast cancer aged ≥65 years without deep vein thrombosis or pulmonary embolism were randomly selected as the controls. The cases and the controls were matched with age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before index date. Never use of tamoxifen was defined as subjects who never had a prescription for tamoxifen before index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and the 95% confidence interval (CI) of deep vein thrombosis or pulmonary embolism associated with tamoxifen use.After adjustment for confounding variables, the adjusted OR of deep vein thrombosis or pulmonary embolism was 1.95 for subjects with ever use of tamoxifen (95% CI 1.45, 2.62), as compared with never use of tamoxifen. In addition, atrial fibrillation (adjusted OR 3.73, 95% CI 1.89, 7.35) and chronic kidney disease (adjusted OR 1.72, 95% CI 1.06, 2.80) were also associated with deep vein thrombosis or pulmonary embolism.Tamoxifen use is associated with 1.95-fold increased odds of deep vein thrombosis or pulmonary embolism among older women with breast cancer in Taiwan.

Outcome after discontinuing anticoagulant therapy in women with venous thromboembolism during hormonal use

Whether women developing venous thromboembolism (VTE) while using hormonal therapy should be classified as having "unprovoked" or "provoked" VTE is controversial. We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic VTE recurrences after discontinuing anticoagulation in 3 subgroups of women aged ≤50years without cancer, pregnancy or puerperium: (1) those with hormonal therapy and no additional risk factors (hormonal users only); (2) those with unprovoked VTE; and (3) those with additional risk factors, with or without hormonal therapy. As of March 2016, 1513 women had been followed-up for at least one month after discontinuing anticoagulation. Of these, 654 (43%) were hormonal users only, 390 (26%) had unprovoked VTE and 469 (31%) had transient risk factors with or without hormonal therapy. After discontinuing anticoagulation, the rate of VTE recurrences in women with hormonal use only (2.44 per 100 patient-years; 95% CI: 1.53-3.69) was significantly lower than in those with unprovoked VTE (6.03; 95% CI: 3.97-8.77) and similar to those with transient risk factors (2.58; 95% CI: 1.50-4.13). Interestingly, the rate of VTE recurrences presenting as pulmonary embolism in women with hormonal use only (0.55 per 100 patient-years; 95% CI: 0.18-1.29) was similar to those with transient risk factors (0.46; 95% CI: 0.09-1.33) and 4-fold lower than in women with unprovoked VTE (2.23; 95% CI: 1.07-4.10). After discontinuing anticoagulation, the rate of VTE recurrences in hormonal users only was significantly lower than in women with unprovoked VTE and similar to the rate in women with additional risk factors.

Time Spent Sitting and Idiopathic Pulmonary Embolism in Women

ObjectiveTo determine the association between time spent sitting and idiopathic pulmonary embolism in women.DesignProspective cohort study.SettingThe Nurses Health Study during the period from 1988 to 2008.ParticipantsFemale nurses who had completed the 1988 and 1990 biennial questionnaires, provide

Physical inactivity and idiopathic pulmonary embolism in women: prospective study

Physical inactivity and idiopathic pulmonary embolism in women: prospective study

Physical inactivity and idiopathic pulmonary embolism in women: prospective study

Objectives To determine the association between physical inactivity (that is, a sedentary lifestyle) and incident idiopathic pulmonary embolism. Design Prospective cohort study. Setting Nurses’ Health Study. Participants 69 950 female...

Prospective Study of BMI and the Risk of Pulmonary Embolism in Women

Pulmonary embolism (PE) is common and associated with significant morbidity and mortality. An association between obesity and PE has been suggested, but the nature of the association has not been well defined. We performed a prospective cohort study of 87,226 women in the Nurses' Health Study (1984-2002) to define the association between BMI and the risk of incident PE. Primary exposure was BMI (<22.5, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, and >or=35.0 kg/m(2)). Primary outcome was idiopathic PE (medical record confirmed cases of PE not associated with prior surgery, trauma, or malignancy). Secondary analysis of nonidiopathic PE was also performed. Multivariable Cox proportional hazards models were controlled for age, physical activity, caloric intake, smoking, pack-years, race, spouse's educational attainment, parity, menopause, nonaspirin nonsteroidal anti-inflammatory drugs, warfarin, multivitamin supplements, hypertension, coronary heart disease, and rheumatological disease. There were 157 incident idiopathic PE and 338 nonidiopathic PE. There was a strong positive association between BMI, the risk of idiopathic PE (relative risk (RR) = 1.08 (95% confidence interval (CI), 1.06-1.10) per 1 kg/m(2) increase in BMI, P < 0.001) and nonidiopathic PE (RR = 1.08 (95% CI, 1.07-1.10), P < 0.001). The association was linear, and apparent even with modest increases in BMI (22.5-25 kg/m(2)). The risk increased nearly sixfold among subjects with BMI >or=35 kg/m(2), and was present in multiple subgroups. Increasing BMI has a strong, linear association with the development of PE in women. Clinicians should consider BMI when assessing the risk of PE in their patients.

Editorial comment

Today’s bariatric surgeons finds themselves faced with an ever-increasing set of decision points in the treatment of the morbidly obese patient, from the preoperative evaluation to the postoperative and longer term care. The prevention of potentially life-threatening venous thromboembolic complications remains one of the key considerations for this clearly at-risk population [ [1] Goldhaber S.Z. Grodstein F. Stampfer M.J. et al. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997; 277: 642-645 Crossref PubMed Google Scholar ]; however, we currently lack the quantity and quality of data to make truly evidence-based decisions. The available data for bariatric patients have been plagued by a lack of standardized dosing regimens, timing of administration, length and intensity of follow-up, and definitions of venous thromboembolic events. A casual review of the plethora of algorithms and published recommendations for deep venous thrombosis (DVT) prophylaxis emphasizes the need for clarity and consensus if we are to achieve widespread improvement in both process and outcomes for our patients. Efficacy of prophylactic inferior vena cava filter placement in bariatric surgerySurgery for Obesity and Related DiseasesVol. 3Issue 6PreviewTo determine whether prophylactic placement of an inferior vena cava (IVC) filter in bariatric patients deemed to be at high risk is effective in reducing their risk of pulmonary embolism. The study was performed at a bariatric center in a community hospital. Full-Text PDF

Are Some Types of Hormone Therapy Safer Than Others?

Despite great strides in hormone therapy (HT) research, clinical trial data on the benefit-to-risk profile of different formulations, doses, and routes administration of HT remain lacking. Most of the large-scale clinical trials1–3 have tested oral conjugated equine estrogens with or without medroxyprogesterone acetate, and data on nonoral routes and different types and doses of estrogens and progestogens have been limited. The evidence is mounting that route of delivery and possibly type and dose of HT are important factors, particularly for venous thromboembolism (VTE). Results of clinical trials4,5 and observational studies6 have been concordant in demonstrating an increased risk of VTE with oral exogenous HT. Recent studies suggest that VTE risk may be lower with transdermal than oral estrogen7 and with estrogen alone than with combined therapy.4 However, in the absence of rigorous evidence from large-scale clinical trials on differential effects by hormone formulation or route of delivery, should these findings influence clinical practice? Article p 840 The Estrogen and Thromboembolism Risk (ESTHER) study,7 published in the current issue of Circulation , adds important, relevant data to bolster the case that HT type and route of delivery do indeed make a difference. This well-designed, French, multicenter case-control study of VTE enrolled 271 consecutive cases of VTE in women (age, 45 to 70 years) and matched them to hospital and community controls. Current HT use was present in 46% of the VTE cases compared with 37% of controls. Oral HT users had 4-fold-increased odds of VTE; however, there was no increased risk among transdermal hormone users (odds ratio, 0.9). Previous randomized trials have suggested that the risk of VTE may …

Gender Differences in the Treatment for Acute Myocardial Infarction

Accumulating evidence over the last several decades regarding the treatment and outcomes for coronary artery disease reveals disparities that have a clear relationship to gender. It had previously been thought that these differences were related to gender bias in physicians’ approach to treatment; thus, the term Yentl syndrome was coined in 1991.1 As the volume of literature expanded and clinical studies included more women, it became clear that outcomes after treatment for coronary artery disease, particularly acute myocardial infarction, were different for women compared with men. Women have a well-documented higher mortality after acute myocardial infarction.2 Much of this disparity has been attributed to differences in age and attendant comorbidities. Female patients with coronary artery disease typically are older, have a higher prevalence of risk factors, and have a lower functional status than their male counterparts.3,4 Additionally, women appear to be at higher risk than men when diabetes, hypertriglyceridemia, and metabolic syndrome are present. The underuse of revascularization procedures in women has been suggested as an explanation, but it has not been uniformly demonstrated to explain increases in mortality. Some studies have suggested a link to less aggressive hospital care of female patients, including the underuse of revascularization, as an explanation for their increased mortality.5 Other studies have indicated age and comorbidity as the primary factors leading to mortality differences.6 Still other studies suggest no evidence of undertreatment.7,8 Article p 833 Gender differences in the clinical outcome of patients with acute myocardial infarction may be explained in part by the female status. Several conditions found only in women hint at differences in the pathophysiology of ischemic vascular disease between the sexes. Such female-specific conditions include early menopause, gestational diabetes, peripartum vascular dissection, preeclampsia and eclampsia, polycystic ovarian syndrome, low-birth-weight children, and hypothalamic hypoestrogenemia. Several …

Building Research Programs in Diagnostic Radiology Part I. Framing the Issues

HomeRadiologyVol. 241, No. 3 PreviousNext Reviews and CommentaryPerspectivesBuilding Research Programs in Diagnostic Radiology Part I. Framing the IssuesJames H. ThrallJames H. ThrallAuthor Affiliations1From the Department of Radiology, Massachusetts General Hospital, MZ-FND 216, Box 9657, 14 Fruit St, Boston, MA 02114. Received August 21, 2006; final version accepted August 25.Address correspondence to the author (e-mail: [email protected]).James H. ThrallPublished Online:Dec 1 2006https://doi.org/10.1148/radiol.2413061449MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Alderson PO, Bresolin LB, Becker GJ, et al. Enhancing research in academic radiology departments: recommendations of the 2003 Consensus Conference. Radiology 2004;232:405–408. Link, Google Scholar2 Hendee WR, Chien S, Maynard CD, Dean DJ. The National Institute of Biomedical Imaging and Bioengineering: history, status, and potential impact. Radiology 2002;222:12–18. Link, Google Scholar3 National Cancer Institute. American College of Radiology Imaging Network Web site. http://www.imaging.cancer.gov/clinicaltrials/acrin/. Accessed August 6, 2006. Google Scholar4 Brainard J. What the NIH bought with double the money. The Chronicle of Higher Education 2004;50(22):A17. http://www.chronicle.com/free/v50/i22/22a01701.htm. Accessed May 29, 2006. Google Scholar5 Dunnick NR. Report of the 2002 Intersociety Commission Meeting: radiology 2002—today's research is tomorrows practice. AJR Am J Roentgenol 2003;180:925–928. Crossref, Medline, Google Scholar6 West Coast Clinical Trials. Glossary. http://www.wcctrials.com/glossary.htm. Accessed June 5, 2006. Google Scholar7 NIH Director's Panel on Clinical Research. Report to the Advisory Committee to the NIH Director. http://www.nih.gov/news/crp/97report/index.htm. Accessed June 5, 2006. Google Scholar8 RSNA Department of Research. Educational courses. http://www.rsna.org/Research/educational_courses.cfm. Accessed May 29, 2006. Google Scholar9 Quinn DA, Thompson BT, Terrin MT, et al. A prospective investigation of pulmonary embolism in women and men. JAMA 1992;268:1689–1696. Crossref, Medline, Google ScholarArticle HistoryPublished in print: 2006 FiguresReferencesRelatedDetailsCited ByAcademic Radiology, Vol. 27, No. 9Canadian Association of Radiologists Journal, Vol. 69, No. 3Canadian Association of Radiologists Journal, Vol. 67, No. 2Research in Radiology10 July 2013QuIRI (quality improvement and research in imaging) program: a means to promote and coordinate research and quality-improvement activities in radiology1 February 2011 | Pediatric Radiology, Vol. 41, No. 4Pediatric Radiology, Vol. 40, No. 4Journal of the American College of Radiology, Vol. 7, No. 9Pediatric Radiology, Vol. 39, No. 4Turf Wars in Radiology: What Must Academic Radiology Do?Journal of the American College of Radiology, Vol. 4, No. 9American Journal of Roentgenology, Vol. 189, No. 4Recommended Articles Trends and Developments Shaping the Future of Diagnostic Medical Imaging: 2015 Annual Oration in Diagnostic RadiologyRadiology2016Volume: 279Issue: 3pp. 660-666Customer Service in Radiology: Satisfying Your Patients and ReferrersRadioGraphics2018Volume: 38Issue: 6pp. 1872-1887A Roadmap for Foundational Research on Artificial Intelligence in Medical Imaging: From the 2018 NIH/RSNA/ACR/The Academy WorkshopRadiology2019Volume: 291Issue: 3pp. 781-791In Vivo PET Assay of Tumor Glutamine Flux and Metabolism: In-Human Trial of 18F-(2S,4R)-4-FluoroglutamineRadiology2018Volume: 287Issue: 2pp. 667-675MRI in Patients with Cardiac Implantable Electronic DevicesRadiology2018Volume: 289Issue: 2pp. 281-292See More RSNA Education Exhibits Pandemic Preparedness: Streamlining the Breast Imaging Patient Care and Teaching Experience During COVID-19Digital Posters2020'Imaging' the Current State of Patient Experience and Imagining the Future StateDigital Posters2018Imaging Biomarkers in Targeted Therapies: From Quantitative Imaging to RadiomicsDigital Posters2019 RSNA Case Collection PyknodysostosisRSNA Case Collection2020Osteomyelitis with sequestrumRSNA Case Collection2021Chronic recurrent multifocal osteomyelitis RSNA Case Collection2022 Vol. 241, No. 3 Metrics Altmetric Score PDF download

Self-Assessment MCQ Questions Vol.1 No.2

(A Evans &amp; M Taylor) · Diabetic Ketoacidosis 1. Only occurs in patients with a history of Insulin-treated Diabetes 2. Can be precipitated by Acute Pancreatitis 3. The diagnosis is excluded by a blood glucose less than 14 mmol/l 4. Has a higher mortality than Hyper-Osmolar Non-Ketotic coma 5. Patients with newly diagnosed Diabetes Mellitus rarely present with Diabetic Ketoacidosis · The Sliding Scale Insulin Regimen 6. 50 units of isophane insulin should be mixed in 50 mls of N/Saline and commenced at 6 units/hour 7. If there is a delay in commencing the intravenous sliding scale 10 units of soluble insulin should be given sub-cutaneously 8. Blood glucose falls of greater than 5 mmol/hour should be avoided 9. When the blood glucose falls to less than 5 mmol/l then the insulin infusion should be stopped 10. If the blood glucose remains above 20mmol/l additional bolus injections of insulin should be administered · Cerebral oedema in DKA 11. Is more common in children than adults 12. Typically occurs 4-12 hours after the start of treatment 13. If suspected clinically a CT scan should be performed prior to treatment with mannitol 14. Should be treated with mannitol 0.5g/kg 15. Intubation and hyperventilation may be required (AP Williams, T Krishna &amp; AJ Frew) · The following statements are true of Anaphylaxis 16. Anaphylaxis results from generation of specific IgG antibody directed against an allergen 17. Biphasic reactions affect fewer than 5% of patients 18. Intravenous adrenaline is the treatment of choice 19. Bronchodilators such as salbutamol may be useful 20. Intravenous hydrocortisone will provide rapid relief from symptoms (G R Jones) · Regarding the antibiotic treatment of cellulitis 21. Aspiration of the lesion yields a pathogen in over 80% of cases 22. Cellulitis resulting from a bite injury may be due to an unusual pathogen 23. Oral agents may be as effective as vancomycin in treating MRSA cellulitis 24. 80% of patients are suitable for outpatient intravenous antibiotic therapy 25. Combination of gentamicin with penicillin enhances streptococcal killing (S Fletcher) · Indicators of life threatening asthma requiring immediate ICU admission are 26. PEFR &lt; 200 l/min 27. Cyanosis despite high inspired FiO2 28. Generalized audible inspiratory and expiratory wheeze 29. Hypertension and tachycardia 30. Altered level of consciousness or confusion · CPAP and Non Invasive Ventilation 31. Has no place in the management of the asthmatic patient 32. May reduce the inspiratory work of breathing 33. May reduce air trapping 34. CPAP &gt; 10 cm/H2O is most beneficial 35. Can be usefully combined with a heliumoxygen mix · Mechanical ventilation of asthmatic patients is 36. A straightforward therapeutic manoeuvre 37. Intubation is associated with severe acute complications 38. Requires a careful balancing act between high inspiratory flow and prolonged expiratory time 39. May not aim for normocapnoea 40. Is well tolerated (C Borland) · Pulmonary embolism 41. Is associated with a mortality of less than 5% 42. Is the most frequent cause of maternal death 43. Nowadays is rarely an unsuspected post mortem finding 44. Is found in a minority of patients undergoing perfusion lung scanning 45. Is usually due to genetic factors · For pulmonary embolism in women 46. The pill is a major risk factor 47. Warfarin may be safely given in pregnancy provided control is optimum 48. Warfarin may be safely given during breast feeding 49. Thrombolysis is indicated for massive post partum pulmonary embolism 50. Spiral CT is the imaging method of choice in pregnancy · In treatment of pulmonary embolism 51. Low molecular weight heparin is no more effective than unfractionated heparin 52. Warfarin can be started at diagnosis 53. Thrombolysis has not been shown to reduce mortality in hypotensive patients 54. Alteplase is preferred to streptokinase or urokinase 55. Inferior vena caval filters double the risk of deep vein thrombosis (P J Francis &amp; B Edmunds) · Regarding direct ophthalmoscopy 56. The macula is located temporal to the optic disc 57. Blurring of the temporal margin of the optic disc can be a normal finding 58. To examine the red reflex, the patient is instructed to fixate over the examiner’s shoulder 59. Myopic examiners should set the dial on the ophthalmoscope on a minus lens (unless wearing their glasses) 60. Viewing the fundus of a myopic patient is challenging because the image is magnified · Regarding papilloedema 61. Visual loss occurs early in the disease 62. Unilateral swelling of the ONH excludes the diagnosis 63. Spontaneous venous pulsation will be absent 64. The presence of spontaneous venous pulsation excludes the diagnosis 65. The optic nerve head (ONH) swells because axoplasmic flow is interrupted

Modifiable Risk Factors for Pulmonary Embolism

To the Editor. —Dr Goldhaber and colleagues have published a worthy study1looking at risk factors associated with pulmonary embolism in women. It is certainly useful, though not surprising, to hear that it confirmed that obesity, cigarette smoking, and hypertension portend an increased risk for thromboembolic events. My comment, however, pertains to wording used in the closing sentence of the article's abstract, which states that not only are the above variables correlated with pulmonary embolism, but that control of these risk factors will decrease the risk of same. There is, in fact, no evidence in the study presented that control of obesity, smoking, or hypertension will reduce the risk of pulmonary embolism, only that there exists a positive association. In counseling patients about control of these adverse behaviors and conditions, clinicians tend to infer that risk factor modification will lead to reduction in the incidence of pulmonary embolism (as

Prospective Study of Exogenous Hormones and Risk of Pulmonary Embolism in Women

Grodstein, Francine; Stampfer, Meir J.; Goldhaber, Samuel Z.; Manson, JoAnn E.; Colditz, Graham A.; Speizer, Frank E.; Willet, Walter C.; Hennekens, Charles H. Author Information

A prospective study of risk factors for pulmonary embolism in women

A prospective study of risk factors for pulmonary embolism in women