Pulmonary Embolism

Allison, P. R.; Dunnill, M. S.; Marshall, Robert J.

doi:10.1136/thx.15.4.273

Cited by 126 publications

(30 citation statements)

References 4 publications

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“…This time scale matches that seen in the dissolution of emboli studied by pulmonary angiography both in man (Fred et al, 1966) and in dogs (Allison et al, 1960;Dalen et al, 1966).…”

Section: Discussionsupporting

confidence: 81%

Resolution of Pulmonary Embolism

Walker¹,

Jackson²,

Goodwin³

1970

BMJ

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“…This time scale matches that seen in the dissolution of emboli studied by pulmonary angiography both in man (Fred et al, 1966) and in dogs (Allison et al, 1960;Dalen et al, 1966).…”

Section: Discussionsupporting

confidence: 81%

Resolution of Pulmonary Embolism

Walker¹,

Jackson²,

Goodwin³

1970

BMJ

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“…Although Allison, Dunhill and Marshall in 1960 have shown that experimentally produced autologous pulmonary emboli disappear in four weeks, this is not invariably so in clinical practice. Phear's analysis of the long-term follow up of survivors treated medically clearly indicates that rhythm changes, cor pulmonale and respiratory insufficiency occurs in the older age group.…”

Section: Indications For Embolectomymentioning

confidence: 95%

Pulmonary embolism

Paneth

1966

Postgraduate Medical Journal

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CONFIDENCE in modern techniques of post-operative management and the increasing variety and magnitude of surgical interventions has caused an increased incidence of post-operative pulmonary embolism and infarction, but analysis of reported incidence indicates clearly that this is not the only factor; reports from countries devastated by the two world wars shows that the incidence falls significantly during and immediately after such a national disaster. This decrease in incidence can be related directly to the economic status of the population at risk, and is reversed when the nutritional state rises and, in particular, with the rise in the consumption of fats and proteins. There is also suggestive, but not conclusive evidence of a seasonal variation.Morrell, Truelove and Barr (1963) showed that there was a five-fold rise in incidence from 1952 -1961 in two hospitals under review, with a four-fold rise in mortality rate. In patients in medical wards, pulmonary embolism is an appreciable risk over the age of thirty, and the incidence rises sharply over the age of fifty; in surgical wards, the risk is very low below the age of forty, and rises less sharply after the age of fifty. In the two hospitals studied they found that a potentially preventable death occurred once every two weeks. Phear (1960) was able to collect and analyse 168 cases over a three-year period, from one hospital. His conclusions are important and will be referred to again. The EtiologyOf all the factors of etiological significance in thrombo-embolism none appears more important than the limitation of normal activity imposed either by the patient's disease or by the restrictions of out-dated hospital discipline. The reduction of systemic venous flow, together with trauma doubtless forms the broad base upon which all thrombo-embolic phenomena depend. Failure of early post-operative ambulation to control embolism is probably largely due to the failure to recognise pre-operative thromboses. About half the patients who die after a variable period of confinement to bed demonstrate deep venous thromboses unsuspected in life. The majority of emboli originate in the intramuscular veins of the legs, and these veins enlarge with age. The physiological increase in platelet stickiness, which is a normal response to injury, must also be a factor, apart from such obvious ones as haemoconcentration and sludging in the micro-circulation due to dehydration and a reduced cardiac output. The DiagnosisAs long ago as 1934 Churchill stated "the very fact that the event is so unexpected and tragic has coloured the observations with inaccuracies, and it is exceedingly difficult to find an adequate analysis of what really took place." In the major episode signs of infarction are very unusual, occuring only in 10 % of cases, and signs of phlebitis are only found in 15% of cases. It has also been said that in cases operated on for pulmonary embolism the diagnosis has been wrong in more than 60%.

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“…The good recovery of the cases in the clinical group is not remarkable when one considers the experimental (Allison et al, 1960), clinical (Sautter et al, 1964), and necropsy (Orell, 1962) evidence that pulmonary emboli are relatively rapidly absorbed and the pulmonary function soon returns to normal (Marshall et al, 1963). This is borne out by the finding of Duner et al (1960b) that where there is a recovery from the immediate acute episode health some years later is good.…”

Section: Course and Prognosismentioning

confidence: 96%

Massive pulmonary embolism in healthy people.

Fleming¹,

Bailey²

1966

BMJ

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Early Chronic Bronchitis MEDICAL JOURNAL nor therapy had any effect on the rate of decline of F.E.V. or on the volume or purulence of sputum specimens.We wish to record our appreciation to Pfizer Limited for their generous supply of oxytetracycline and indistinguishable dummy tablets, and for their willing cooperation in the analysis of numerous blood and urine samples for oxytetracycline, both before and during the trial ; and to Messrs. Parke Davis and Co. for their supply of chloramphenicol, sulphamethoxypyridazine, and penicillin capsules. Murphy (1963), and by the fact that three of our own severe but fortunately non-fatal cases were also doctors' wives in whom there was considerable delay in diagnosis. This failure is mirrored in a number of otherwise excellent monographs and conference proceedings on the pulmonary circulation, and even one on pulmonary embolic disease, which have nothing whatever to say on fatal pulmonary embolism in healthy persons.The frequency with which we made this clinical diagnosis led us to wonder if there were not a number of such patients who died either before diagnosis was made or before treatment could be effectively instituted (Fleming, 1962). This led to the present study of fatal cases, and of cases diagnosed and treated in life.* Consultant Cardiologist, East Anglian Regional Hospi:al Board and Addenbrooke's Hospital, Cambridge. Of the nine cases of sudden death outside hospital eight were women, and all but one had a recorded complaint of some dyspnoea or chest discomfort preceding death. The 23-year-old patient was five months pregnant, and had been treated for venous thrombosis three and a half weeks previously.In all cases either a large embolus straddled the pulmonary artery bifurcation or both main pulmonary arteries were blocked

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Pulmonary Embolism

Cited by 126 publications

References 4 publications

Resolution of Pulmonary Embolism

Resolution of Pulmonary Embolism

Pulmonary embolism

Massive pulmonary embolism in healthy people.

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