Acute Pulmonary Embolism: A Challenge for Hemostasiology by N. W. März, M. Nauck, H. Wieland (auth.), Dr. A. Geibel,

By N. W. März, M. Nauck, H. Wieland (auth.), Dr. A. Geibel, Prof. Dr. H. Just, Dr. med. W. Kasper, Dr. S. Konstantinides (eds.)

The price of echocardiography within the diagnostic work-up of sufferers with suspected acute pulmonary embolism.- New advancements within the thrombolytic treatment of venous thrombosis.- Mechanism of blood coagulation. more recent facets of anticoagulant and antithrombotic therapy.- MR-angiography within the analysis of pulmonary embolism.- Scintigraphy-ventilation/perfusion scanning and imaging of the embolus.- medical direction and diagnosis of acute pulmonary embolism.- The molecular mechanisms of inherited thombophilia.

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In regard to arterial events, Norlund et al. found that the C allele of the CIT dimorphism of the thrombomodulin gene at nucleotide 1418, leading to Ala/VaI455 , was associated with premature myocardial infarction [79]. However, Ireland et al. did not find such an 35 36 S. Moll and D. Gulba association in patients with mycocardial infarction [50]. The latter authors also found three different thrombomodulin mutations in five patients of the group of 104 patients with myocardial infarction. Only one of these mutations was present in one patient of their control group [50], suggesting that mutations in the thrombomodulin gene may constitute a risk factor for arterial thrombosis.

One link to the inflammatory system is fibrinogen, which also acts as an acute phase reactant and is a known risk marker for acute atherosclerotic events. , sICAM), interleukins, and other mediators. A second system which constitutes a link between coagulation/fibrinolysis and inflammation is the complement cascade. There are several interactions, including the use of identical inhibitors (C1-esterase inhibitor). Of the various markers of the complement cascade the membrane attack complex (MAC) sensu "lytic complex" or "terminal complex" can be determined as SC5b-9 in plasma.

Lane DA, Mannucci PM, Bauer KA, Betina RM, Bochkov NP, Boulyjenkov V, Chandy M, Dahlback B, Ginter EK, Miletich JP, Rosendaal FR, Seligsohn U (1996) Inherited thrombophilia: Part 1. Thromb Haemost 76: 651-662 66. Le Cam- Duchez V, Gandrille S, Alhenc-Gelas M, Emmerich J, Borg JY, Aiach M (1997) Additional genetic risk factors for thrombosis in 21 families carrying the factor V Arg 506 Gin mutation (abstract). Thromb Haemost: p165; SC-671 67. Levine MN, Hirsh J, Gent M, Turpie AG, Weitz J, Ginsberg J, Geerts W, LeClerc J, Neemeh J, Powers P et al.

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