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Association between pulmonary embolism and occult malignancy
ABSTRACTS
ASSOCIATION BETWEEN PULMONARY EMBOLISM AND OCCULT MALIGNANCY Joel M. Gore. MD, Jonathan S. Pppelbaum, MD, Harry L. Green, MD, Lewis Dexter, MD, FACC, James E. Dalen, MD, FACC, Ullassachusetts Medical School, Worcester, Massachusetts The association between venous thrombosis and cancer was first noted by Trousseau more than a century ago, and has been subsequently confirmed by multiple postmortem studies. Thrombophlebitis migrans, thrombosis involving unusual sites such as the upper extremities, and thrombosis resistant to anticoagulant therapy may precede clinical evidence of malignancy and alert the clinician to suspect occult malignancy. However, no association between pulmonary embolism (PE) and occult malignancy has been established. Therefore, we determined the incidence of cancer before and after the diagnosis of PE was made by pulmonary angiography in 128 patients (pts). The incidence of cancer prior to PE (12%) was essentially the same as in a control group of 128 pts without evidence of PE (10%) by pulmonary angiography. However, within two years following angiography, malignancy was diagnosed in 13 (14.7%) pts with PE as compared to no pts in the control group (p<.OOl). Within six years following angiography, cancer was diagnosed in 19 (21.6%) pts with PE as compared with 2 (2.4%) pts in the control group (p<.OOl). Most of the malignancies that developed in pts with PE were adenocarcinomas involving lung, colon, breast, and female genital tract. These cancers were occult at the time of PE and occurred in pts irrespective of the presence or absence of risk factors for deep venous thrombosis. Conclusion: PE with or without overt DVT is associated with occult malignancy, usually in the form of adenocarcinoma.
WEDNESDAY, APRIL 28, 1982 AM CONGENITAL HEART DISEASE: POSTOPERATIVE UP AND DYSRHYTHMIAS 8:30- 10:00
FOLLOW-
QUANTITATIVE VENTRICULAR ANGICCARDICGRAF'HY DURING TWO STAGE ANATOMICCORRECTIONOF SIMPLETRANSPOSITION OF THE GREAT ARTERIES Peter Lange, i%, Dietrichbnasch,PhD, Erika Stephan,MD, Rosemze Radley-Smith, MD, Ernst Keck. MD, Magdi Yacoub, kD, AlexanderBernhard,.MD, Paul H= Heintzen,MD, FACC. Dept. of Ped. Cardiol.and Cardiovasc.Surgery, Universities of Kiel, Hamburg,and London.
Detailedinformationof ventricular function after the tW stages of anatomic correction [AC) of simple transposition of the great arteriesdoes not exist. 'Rus the resultsof cardiaccatheterization of 7 childrenwere analyzedin whom quantitativeangiocardiographic data were available. The age of the childrenat the time of AC ranged from 13 to 47 months (mean: 26 months). After banding of the pulmonaryarterymaximalpressurein the LV rose to systemicand endsystolic pressure to normal levels. hddiastolic volune and strokevolume of the LV were significantly (pO.O5)altered. Muscle volume / enddiastolicvolune (MVI) of the LV increasedsignificantly (p
Conclusion: Up to 2 l/2 years after two stage anatomic correction of simpletransposition of the great arteries globalmyocardialfunctionof the LV and RV is normal.
IDIOPATHIC PULMONARY HYPERTENSION: THE IMPORTANCE OF A THROMBOEMBOLIC ETIOLOGY Valentin Fuster, MD, FACC; William D. Edwards, MD, FACC, Mayo Clinic, Rochester, Minnesota This study reviews the possible importance and frequency of a thromboembolic etiology in 100 consecutive patients (pts) with pulmonary hypertension (IPH) categorized by clinical and hemodynamic criteria as being idiopathic in type. These pts were all seen atMayoClinic and were followed-up for a median of 12 years (yrs) (range 3-25). Seventy-four pts were female and 26 males, median age being 30 yrs (range 2-70). At diagnostic study, the average pulmonary artery pressure was 96/43 mm Hg and the average total pulmonary vascular resistance was 28 Wood Um2. Within the first 5 yrs of follow-up 75 pts were dead and 25 pts remained alive. The use of anticoagulants (A/C) appeared to show a beneficial trend; that is, longterm A/C were taken by 70% of the 5 yr survivors and by only 19% of the nonsurvivors. Autopsy lung tissue available from 27 of the pts who died revealed that in 76% the predominant lesion was obstruction of the muscular arteries or arterioles by thrombotic material in various stages of organization. In summary, this large and long-term follow-up study on IPH suggests the importance and high frequency of a primary thromboembolic etiology in the pathogenesis of the disease; it may be speculated that because of the high incidence of IPH in young menstruating women, there is the possibility of one of the main etiologies being "microemboli" originating in the pelvic uteritie veins or "in situ" pulmonary thrombus deposition related to the cyclic endocrine changes of these women.
966
March 1982
The American Journal of CARDIOLOGY
LEFT VENTRICULARSIIAPEAND FUNCTIONONE YEAR OR MORE AFTER ANATOMIC CORRECTION OF TRANSPOSITION OF THE GREAT ARTERIES. Magdi Yacoub, M.D.; Frederick Arensman, M.D.; Peter Lange. M.D.: Alexander Bernhard. M.D.: Paul Heintzen, M.D.; Rosema& Radley-Smith, M.D:; Ha&field Hospital, Harefield, England and University of Kiel, West Germany. Twenty children were reinvestigated by cardiac catheterization and angiography one year or more (mean 24 mo.) after anatomic correction of transposition of the great arteries (TGA). The age at operation varied from 2 to 120 months (mean 25 months). The left ventricle was "prepared" by a first stage operation consisting of pulmonary artery banding * systemic to pulmonary artery shunt in the 13 childrenwho had simpleTGA. The remaining patients(Pl'S) had additionallarge VSD in 6 and an aortopulmonary window in 1. At reinvestigation the left ventricular end diastolic pressure (LVEDP) ranged from 4 to 14 (mean8.9). Ejection fraction ranged from 5% to 76% (mean66%). This data correlated well to same day radionuclide gated blood pool studies performed in 6 patients. Frame by frame computer analysis of left ventricular contraction and relaxation by the method of Gibson and Brown was normal in 10, while 5 showed minor abnormalities. Ghan es of shape index derived a6 47f (Cavity area)/perimeter 5 were measured in 16 FTS and showed a mean index of .89 2 0.1 at end diastole and 0.80 i 0.2 at end systole. It is concluded that left ventricular diastolic shape tends to be globular and changes little during systole. Left ventricular function, however, as defined by ejection fraction and LVEDP is normal.
Volume 49
ASSOCIATION BETWEEN PULMONARY EMBOLISM AND OCCULT MALIGNANCY Joel M. Gore. MD, Jonathan S. Pppelbaum, MD, Harry L. Green, MD, Lewis Dexter, MD, FACC, James E. Dalen, MD, FACC, Ullassachusetts Medical School, Worcester, Massachusetts The association between venous thrombosis and cancer was first noted by Trousseau more than a century ago, and has been subsequently confirmed by multiple postmortem studies. Thrombophlebitis migrans, thrombosis involving unusual sites such as the upper extremities, and thrombosis resistant to anticoagulant therapy may precede clinical evidence of malignancy and alert the clinician to suspect occult malignancy. However, no association between pulmonary embolism (PE) and occult malignancy has been established. Therefore, we determined the incidence of cancer before and after the diagnosis of PE was made by pulmonary angiography in 128 patients (pts). The incidence of cancer prior to PE (12%) was essentially the same as in a control group of 128 pts without evidence of PE (10%) by pulmonary angiography. However, within two years following angiography, malignancy was diagnosed in 13 (14.7%) pts with PE as compared to no pts in the control group (p<.OOl). Within six years following angiography, cancer was diagnosed in 19 (21.6%) pts with PE as compared with 2 (2.4%) pts in the control group (p<.OOl). Most of the malignancies that developed in pts with PE were adenocarcinomas involving lung, colon, breast, and female genital tract. These cancers were occult at the time of PE and occurred in pts irrespective of the presence or absence of risk factors for deep venous thrombosis. Conclusion: PE with or without overt DVT is associated with occult malignancy, usually in the form of adenocarcinoma.
WEDNESDAY, APRIL 28, 1982 AM CONGENITAL HEART DISEASE: POSTOPERATIVE UP AND DYSRHYTHMIAS 8:30- 10:00
FOLLOW-
QUANTITATIVE VENTRICULAR ANGICCARDICGRAF'HY DURING TWO STAGE ANATOMICCORRECTIONOF SIMPLETRANSPOSITION OF THE GREAT ARTERIES Peter Lange, i%, Dietrichbnasch,PhD, Erika Stephan,MD, Rosemze Radley-Smith, MD, Ernst Keck. MD, Magdi Yacoub, kD, AlexanderBernhard,.MD, Paul H= Heintzen,MD, FACC. Dept. of Ped. Cardiol.and Cardiovasc.Surgery, Universities of Kiel, Hamburg,and London.
Detailedinformationof ventricular function after the tW stages of anatomic correction [AC) of simple transposition of the great arteriesdoes not exist. 'Rus the resultsof cardiaccatheterization of 7 childrenwere analyzedin whom quantitativeangiocardiographic data were available. The age of the childrenat the time of AC ranged from 13 to 47 months (mean: 26 months). After banding of the pulmonaryarterymaximalpressurein the LV rose to systemicand endsystolic pressure to normal levels. hddiastolic volune and strokevolume of the LV were significantly (p
Conclusion: Up to 2 l/2 years after two stage anatomic correction of simpletransposition of the great arteries globalmyocardialfunctionof the LV and RV is normal.
IDIOPATHIC PULMONARY HYPERTENSION: THE IMPORTANCE OF A THROMBOEMBOLIC ETIOLOGY Valentin Fuster, MD, FACC; William D. Edwards, MD, FACC, Mayo Clinic, Rochester, Minnesota This study reviews the possible importance and frequency of a thromboembolic etiology in 100 consecutive patients (pts) with pulmonary hypertension (IPH) categorized by clinical and hemodynamic criteria as being idiopathic in type. These pts were all seen atMayoClinic and were followed-up for a median of 12 years (yrs) (range 3-25). Seventy-four pts were female and 26 males, median age being 30 yrs (range 2-70). At diagnostic study, the average pulmonary artery pressure was 96/43 mm Hg and the average total pulmonary vascular resistance was 28 Wood Um2. Within the first 5 yrs of follow-up 75 pts were dead and 25 pts remained alive. The use of anticoagulants (A/C) appeared to show a beneficial trend; that is, longterm A/C were taken by 70% of the 5 yr survivors and by only 19% of the nonsurvivors. Autopsy lung tissue available from 27 of the pts who died revealed that in 76% the predominant lesion was obstruction of the muscular arteries or arterioles by thrombotic material in various stages of organization. In summary, this large and long-term follow-up study on IPH suggests the importance and high frequency of a primary thromboembolic etiology in the pathogenesis of the disease; it may be speculated that because of the high incidence of IPH in young menstruating women, there is the possibility of one of the main etiologies being "microemboli" originating in the pelvic uteritie veins or "in situ" pulmonary thrombus deposition related to the cyclic endocrine changes of these women.
966
March 1982
The American Journal of CARDIOLOGY
LEFT VENTRICULARSIIAPEAND FUNCTIONONE YEAR OR MORE AFTER ANATOMIC CORRECTION OF TRANSPOSITION OF THE GREAT ARTERIES. Magdi Yacoub, M.D.; Frederick Arensman, M.D.; Peter Lange. M.D.: Alexander Bernhard. M.D.: Paul Heintzen, M.D.; Rosema& Radley-Smith, M.D:; Ha&field Hospital, Harefield, England and University of Kiel, West Germany. Twenty children were reinvestigated by cardiac catheterization and angiography one year or more (mean 24 mo.) after anatomic correction of transposition of the great arteries (TGA). The age at operation varied from 2 to 120 months (mean 25 months). The left ventricle was "prepared" by a first stage operation consisting of pulmonary artery banding * systemic to pulmonary artery shunt in the 13 childrenwho had simpleTGA. The remaining patients(Pl'S) had additionallarge VSD in 6 and an aortopulmonary window in 1. At reinvestigation the left ventricular end diastolic pressure (LVEDP) ranged from 4 to 14 (mean8.9). Ejection fraction ranged from 5% to 76% (mean66%). This data correlated well to same day radionuclide gated blood pool studies performed in 6 patients. Frame by frame computer analysis of left ventricular contraction and relaxation by the method of Gibson and Brown was normal in 10, while 5 showed minor abnormalities. Ghan es of shape index derived a6 47f (Cavity area)/perimeter 5 were measured in 16 FTS and showed a mean index of .89 2 0.1 at end diastole and 0.80 i 0.2 at end systole. It is concluded that left ventricular diastolic shape tends to be globular and changes little during systole. Left ventricular function, however, as defined by ejection fraction and LVEDP is normal.
Volume 49