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== '''[[Spanish missions in California]]''' ==
== '''[[Pulmonary embolism]]''' ==
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The '''Spanish missions in California''' comprise a series of twenty-one religious outposts and associated support facilities established by [[Spain|Spaniards]] of the Franciscan Order between 1769 and 1823, in order to spread the [[Catholic]] faith among the local Native American populations. The missions represented the first major effort by [[Europe]]ans to colonize the Pacific Coast region, and gave Spain a valuable toehold in the frontier land. The settlers introduced European livestock, fruits, vegetables, and industry into the region. European contact was a momentous event, which profoundly affected California's native peoples.<ref>Paddison, p. xiv: "''These missionaries, along with the soldiers, merchants, and settlers who emigrated to California before 1848, brought terrible changes to its Indian population''."</ref> In the end, the mission system failed in its objective to convert, educate, and "civilize" the indigenous population in order to transform the California natives into Spanish colonial citizens. <!-- need to better develop this thought train; architecture, literature, other -->Today, the missions are among the state's oldest structures and the most-visited historic monuments.<ref>California Missions Foundation</ref>
'''Pulmonary embolism''' (PE) is form of [[embolism and thromboembolism]] in which a blockage of the [[pulmonary artery]] (or one of its branches), usually when a [[deep vein thrombosis]] (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs.<ref name="pmid18322285">{{cite journal |author=Tapson VF |title=Acute pulmonary embolism |journal=N. Engl. J. Med. |volume=358 |issue=10 |pages=1037–52 |year=2008 |month=March |pmid=18322285 |doi=10.1056/NEJMra072753 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18322285&promo=ONFLNS19 |issn=}}</ref> This process is termed ''thromboembolism''.
 
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===Precontact===
===Pathophysiology===
The current prevailing theory postulates that Paleo-Indians entered the Americas in successive waves from [[Asia]] via a land bridge called "Beringia" that connected eastern [[Siberia]] with present-day [[Alaska]] (when sea levels were significantly lower, due to widespread glaciation) between about 15,000 to 35,000 years ago.<ref>Leffingwell, p. 9</ref> The remains of Arlington Springs Man on Santa Rosa Island are among the traces of a very early habitation in California, dated to the last ice age (Wisconsin glaciation) about 13,000 years ago.<ref>Jones and Klar 2007, p. 53: "''Understanding how and when humans first settled California is intimately linked to the initial colonization of the Americas''."</ref><ref>Oakley, p. 1172</ref> The first humans are therefore thought to have made their homes among the southern valleys of California's coastal mountain ranges some 10,000 to 12,000 years ago; the earliest of these people are known only from archaeological evidence.<ref>Paddison, p. 333: The first undisputable archaeological evidence of human presence in California dates back to ''circa'' 8,000 BCE.</ref><ref>Jones and Klar 2005, pp. 369-400: Recent research suggests that the Chumash may have been visited by Polynesians between 400 and 800 CE, nearly 1,000 years before Columbus reached [[North America]]. Although the concept was generally rejected for decades and remains controversial, studies published in peer-reviewed journals have given the idea greater plausibility.</ref> Over the course of thousands of years, California's diverse group of first settlers (later known as "Indians") evolved into hundreds of separate tribal groups, with an equally diverse range of languages, religions, dress, and other customs.<ref>Margolin, pp. 2-6</ref>  
The development of thrombosis is classically due to a group of causes named [[Virchow's triad]] (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is present.
 
* ''Alterations in blood flow'': immobilization (after surgery, [[Physical trauma|injury]] or [[Economy class syndrome|long-distance air travel]]), [[pregnancy]] (also procoagulant), [[obesity]] (also procoagulant)
''[[Spanish missions in California|.... (read more)]]''
* ''Factors in the vessel wall'': of limited direct relevance in VTE
* ''Factors affecting the properties of the blood'' (procoagulant state):
** [[Estrogen]]-containing [[hormonal contraception]]
** Genetic thrombophilia ([[factor V Leiden]], [[protein C deficiency]], [[protein S deficiency]], [[antithrombin]] deficiency, [[hyperhomocysteinemia]] and [[plasminogen]]/[[fibrinolysis]] disorders). The role of [[prothrombin]] mutation G20210A, is  unclear.<ref name="pmid19531787">{{cite journal |author=Segal JB, Brotman DJ, Necochea AJ, ''et al.'' |title=Predictive value of factor V Leiden and prothrombin G20210A in adults with venous thromboembolism and in family members of those with a mutation: a systematic review |journal=JAMA |volume=301 |issue=23 |pages=2472–85 |year=2009 |month=June |pmid=19531787 |doi=10.1001/jama.2009.853 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19531787 |issn=}}</ref>
** Acquired thrombophilia (malignancy, [[antiphospholipid syndrome]], [[nephrotic syndrome]], [[paroxysmal nocturnal hemoglobinuria]])
===Diagnosis===
The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation ([[shortness of breath]], [[chest pain]]) cannot be definitively differentiated from other causes of chest pain and shortness of breath.<ref name="pmid14657070">{{cite journal |author=Chunilal SD, Eikelboom JW, Attia J, ''et al'' |title=Does this patient have pulmonary embolism? |journal=JAMA |volume=290 |issue=21 |pages=2849–58 |year=2003 |pmid=14657070 |doi=10.1001/jama.290.21.2849 |issn=}}</ref> Patients can present with atypical syndromes such as unexplained exacerbations of chronic obstructive pulmonary disease.<ref name="pmid16549851">{{cite journal |author=Tillie-Leblond I, Marquette CH, Perez T, ''et al'' |title=Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors |journal=Ann. Intern. Med. |volume=144 |issue=6 |pages=390–6 |year=2006 |month=March |pmid=16549851 |doi= |url= |issn=}}</ref>
''[[Pulmonary embolism|.... (read more)]]''


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Revision as of 06:57, 6 October 2012

Pulmonary embolism

Pulmonary embolism (PE) is form of embolism and thromboembolism in which a blockage of the pulmonary artery (or one of its branches), usually when a deep vein thrombosis (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs.[1] This process is termed thromboembolism.

Pathophysiology

The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is present.

Diagnosis

The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath.[3] Patients can present with atypical syndromes such as unexplained exacerbations of chronic obstructive pulmonary disease.[4] .... (read more)

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