WorldWideScience

Sample records for acute pulmonary edema

  1. Unilateral pulmonary edema following acute subglottic edema.

    Science.gov (United States)

    Morisaki, H; Ochiai, R; Takeda, J; Nagano, M

    1990-01-01

    Presented here is a case of unilateral pulmonary edema following acute subglottic edema after removal of an endotracheal tube. A 3-year-old boy, diagnosed as having nondiphtheric croup and pectus excavatum deformity, was scheduled for repair of a cleft lip. No complication occurred during the operation. After removal of the endotracheal tube, he showed dyspnea and cyanosis and was later found to have acute subglottic edema. After reintubation of the trachea, frothy pink fluid was discharged from the tube, and chest roentgenogram showed a right-sided alveolar infiltrate. Many factors may cause unilateral pulmonary edema, but it is suggested that acute subglottic edema and unilateral bronchial fragility strongly affected this episode.

  2. Sympathetic crashing acute pulmonary edema.

    Science.gov (United States)

    Agrawal, Naman; Kumar, Akshay; Aggarwal, Praveen; Jamshed, Nayer

    2016-12-01

    Sympathetic crashing acute pulmonary edema (SCAPE) is the extreme end of the spectrum of acute pulmonary edema. It is important to understand this disease as it is relatively common in the emergency department (ED) and has better outcomes when managed appropriately. The patients have an abrupt redistribution of fluid in the lungs, and when treated promptly and effectively, these patients will rapidly recover. Noninvasive ventilation and intravenous nitrates are the mainstay of treatment which should be started within minutes of the patient's arrival to the ED. Use of morphine and intravenous loop diuretics, although popular, has poor scientific evidence.

  3. Pulmonary edema in acute carbon monoxide poisoning

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Chang, Kee Hyun; Lee, Myung Uk [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1974-10-15

    Acute carbon monoxide poisoning has frequently occurred in Korean, because of the coal briquette being widely used as fuel in Korean residences. Carbon monoxide poisoning has been extensively studied, but it has been sparsely reported that pulmonary edema may develop in acute CO poisoning. We have noticed nine cases of pulmonary edema in acute CO poisoning last year. Other possible causes of pulmonary edema could be exclude in all cases but one. The purpose of this paper is to describe nine cases of pulmonary edema complicated in acute CO poisoning and discuss the pathogenesis and the prognosis.

  4. Clinical Practice Guidelines for Acute Pulmonary Edema.

    Directory of Open Access Journals (Sweden)

    Pablo Rodríguez Díaz

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Acute Pulmonary Edema. It has been defined as an abrupt and severe failure of the left ventricular function which causes pulmonary edema or cardiac origin interfering with the normal oxygen exchange at pulmonary level. This document includes a review and update of the main clinical aspects allowing the early diagnosis and immediate therapeutic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  5. Acute pulmonary edema after near strangulation

    Energy Technology Data Exchange (ETDEWEB)

    Shumaker, D.; Kottamasu, S.; Preston, G.; Treloar, D.

    1988-11-01

    We report a case of acute, noncardiogenic pulmonary edema in an 11 year old boy who suffered strangulation during an altercation. The clinical presentation was characterized by moderate respiratory distress and hemoptysis. Both the radiographic and clinical findings resolved during the three day admission which followed. A review of the literature is presented, and possible pathogenesis is discussed.

  6. An uncommon cause of acute pulmonary edema.

    Science.gov (United States)

    Nepal, Santosh; Giri, Smith; Bhusal, Mohan; Siwakoti, Krishmita; Pathak, Ranjan

    2016-09-01

    Acute cardiogenic pulmonary edema secondary to catecholamine-induced cardiomyopathy is a very uncommon and fatal initial presentation of pheochromocytoma. However, with early clinical suspicion and aggressive management, the condition is reversible. This case report describes a patient who presented with hypertension, dyspnea, and cough with bloody streaks, and who recovered within 48 hours after appropriate treatment.

  7. Acute pulmonary edema after intramyometrial prostodin

    Directory of Open Access Journals (Sweden)

    Neha Baduni

    2011-01-01

    Full Text Available A 25 year old, 68 kg, primigravida, was taken up for emergency caesarean section for meconium stained liquor and fetal distress. She was a known case of pre eclampsia and her blood pressure was controlled on tab methyl dopa. she was administered general anaesthesia. after delivery of baby she went into postpartum hemorrhage which was controlled with intramyometrial prostodin. but immediately after its administration she went into acute pulmonary edema.

  8. [Acute pulmonary edema secondary to acute upper airway obstruction].

    Science.gov (United States)

    Sánchez-Ortega, J L; Carpintero-Moreno, F; Olivares-López, A; Borrás-Rubio, E; Alvarez-López, M J; García-Izquierdo, A

    1992-01-01

    We report a 72 years old woman with mild arterial hypertension and no other pathological history who presented an acute pulmonary edema due to acute obstruction of the upper airway secondary to vocal chord paralysis developing during the immediate postoperative phase of thyroidectomy. The acute pulmonary edema resolved after application of tracheal reintubation, mechanical ventilation controlled with end expiratory positive pressure, diuretics, morphine, and liquid restriction. We discuss the possible etiopathogenic possibilities of this infrequent clinical picture and we suggest that all patients who suffered and acute obstruction of the upper airways require a careful clinical surveillance in order to prevent the development of the pulmonary syndrome.

  9. Glyphosate Poisoning with Acute Pulmonary Edema

    Science.gov (United States)

    Thakur, Darshana Sudip; Khot, Rajashree; Joshi, P. P.; Pandharipande, Madhuri; Nagpure, Keshav

    2014-01-01

    GlySH-surfactant herbicide (GlySH), one of the most commonly used herbicides worldwide, has been considered as minimally toxic to humans. However, clinical toxicologists occasionally encounter cases of severe systemic toxicity. The US Environmental Protection Agency (EPA) states that ‘GlySH’ is of relatively low oral and acute dermal toxicity. It does not have anticholinesterase effect and no organophosphate-like central nervous system (CNS) effects. The clinical features range from skin and throat irritation to hypotension and death. Severe GlySH-surfactant poisoning is manifested by gastroenteritis, respiratory disturbances, altered mental status, hypotension refractory to the treatment, renal failure, and shock.[1] GlySH intoxication has a case fatality rate 3.2–29.3%. Pulmonary toxicity and renal toxicity seem to be responsible for mortality. Metabolic acidosis, abnormal chest X-ray, arrhythmias, and elevated serum creatinine levels are useful prognostic factors for predicting GlySH mortality.[2] There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. We report a case of acute pulmonary edema, which is a rare but severe manifestation of oral GlySH poisoning, where patient survived with aggressive supportive therapy. PMID:25948977

  10. [Acute heart failure: acute cardiogenic pulmonary edema and cardiogenic shock].

    Science.gov (United States)

    Sánchez Marteles, Marta; Urrutia, Agustín

    2014-03-01

    Acute cardiogenic pulmonary edema and cardiogenic shock are two of the main forms of presentation of acute heart failure. Both entities are serious, with high mortality, and require early diagnosis and prompt and aggressive management. Acute pulmonary edema is due to the passage of fluid through the alveolarcapillary membrane and is usually the result of an acute cardiac episode. Correct evaluation and clinical identification of the process is essential in the management of acute pulmonary edema. The initial aim of treatment is to ensure hemodynamic stability and to correct hypoxemia. Other measures that can be used are vasodilators such as nitroglycerin, loop diuretics and, in specific instances, opioids. Cardiogenic shock is characterized by sustained hypoperfusion, pulmonary wedge pressure > 18 mmHg and a cardiac index 30 mmHg) and absent or reduced diuresis (< 0.5 ml/kg/h). The most common cause is left ventricular failure due to acute myocardial infarction. Treatment consists of general measures to reverse acidosis and hypoxemia, as well as the use of vasopressors and inotropic drugs. Early coronary revascularization has been demonstrated to improve survival in shock associated with ischaemic heart disease.

  11. Pulmonary edema

    Science.gov (United States)

    Lung congestion; Lung water; Pulmonary congestion; Heart failure - pulmonary edema ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump efficiently, ...

  12. Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Andrea Fisicaro

    2013-01-01

    Full Text Available Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention.

  13. Acute pulmonary edema secondary to hyperbaric oxygen therapy

    Science.gov (United States)

    Obiagwu, Chukwudi; Paul, Vishesh; Chadha, Sameer; Hollander, Gerald; Shani, Jacob

    2015-01-01

    Hyperbaric oxygen therapy (HBOT) has been shown to be effective in the treatment of diabetic ulcers, air embolism, carbon monoxide poisoning and gas gangrene with minimal adverse effects. Very few cases of HBOT causing acute pulmonary edema (PE) has been described; with a study on dogs suggesting that a complication of this therapy could be PE. We describe the case of an 80-year-old man with a history of stable systolic heart failure and diabetes mellitus presenting with acute PE following treatment with HBOT for diabetic foot. PMID:25988073

  14. Pulmonary Edema

    OpenAIRE

    Tanser, Paul H.

    1981-01-01

    The physician who deals with pulmonary edema from a pathophysiologic basis will seldom make a diagnostic or therapeutic error. Recent additions to preload and afterload therapy have greatly helped in the emergency and ambulatory treatment of pulmonary edema due to left heart failure. Careful follow-up and patient self-monitoring are the most effective means of reducing hospitalization of chronic heart failure patients.

  15. Acute Pulmonary Edema Associated With Propofol: An Unusual Complication

    Science.gov (United States)

    Waheed, Mian Adnan; Oud, Lavi

    2014-01-01

    Propofol is frequently used in the emergency department to provide procedural sedation for patients undergoing various procedures and is considered to be safe when administered by trained personnel. Pulmonary edema after administration of propofol has rarely been reported. We report a case of a 23-year-old healthy male who developed acute cough, hemoptysis and hypoxia following administration of propofol for splinting of a foot fracture. Chest radiography showed bilateral patchy infiltrates. The patient was treated successfully with supportive care. This report emphasizes the importance of this potentially fatal propofol-associated complication and discusses possible underlying mechanisms and related literature. PMID:25493132

  16. Echocardiographic changes during acute pulmonary edema subsequent to scorpion sting

    Directory of Open Access Journals (Sweden)

    K Delma

    2012-01-01

    Full Text Available Acute pulmonary edema (APE occurring after scorpion sting is the leading cause of death of the victims of scorpion envenomation. The APE origin is still questioned by physicians treating these patients. Based on echocardiographic study of 20 patients with severe envenomation treated in Ouargla Hospital resuscitation ward during the last four years, the APE etiology seems more likely cardiogenic, referring to cardiac symptoms confirmed by echocardiography although other mechanisms may also be involved. This hypothesis is further confirmed by the positive response of patients to the administration of dobutamine.

  17. Pharm GKB: Acute bovine pulmonary emphysema AND edema [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym ABPE; Acute bovine pulmonary emphysema and edema;...63 External Vocabularies MeSH: Pneumonia, Atypical Interstitial, of Cattle (D011016) SnoMedCT: Acute bovine ...ia, Atypical Interstitial, of Cattle [Disease/Finding] (N0000010988) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute bovine pulmonary emphysema AND edema ...

  18. Management of acute cardiogenic pulmonary edema: a literature review.

    Science.gov (United States)

    Johnson, Jeremy M

    2009-01-01

    Acute cardiogenic pulmonary edema (CPE) is a pathology frequently seen in patients presenting to emergency departments (EDs) and can usually be attributed to preexisting cardiovascular disease. Heart failure alone accounts for more than 1 million hospital admissions annually and has one of the highest ED morbidity and mortality to date (). Historically, CPE has been managed by the treating clinician in a manner that is based largely on anecdotal evidence. Furosemide (Lasix), morphine, and nitroglycerin have historically been the baseline standard for drug therapy in CPE management. A lack of drastic improvement in the patient's condition over the course of the ED visit may reflect a management style that results in higher morbidity and mortality for CPE patients. Several recent articles provide evidence-based outcomes that suggest changing standard therapy along with the adjunctive use of other medications. These articles also describe treatment modalities that result in a marked improvement in the management of patients with CPE along with decreases in adverse outcomes and hospital length of stay. The goal of this article is to present a summary of the evidence regarding the management of CPE and discuss the implications for current practice.

  19. Delayed Pneumoperitoneum and Acute Pulmonary Edema Secondary to Acute Gastric Dilatation

    Science.gov (United States)

    Ahn, Jae Yun; Kim, Jong Kun

    2015-01-01

    Pneumoperitoneum caused by acute gastric dilatation (AGD) is a very rare complication. We report a case of pneumoperitoneum and acute pulmonary edema caused by AGD in a patient with Parkinson’s disease. A 78-year-old woman presented with pneumonia and AGD. We inserted a nasogastric tube and administered empirical antibiotics. We performed an endoscopy, and perforation or necrosis of the stomach and pyloric stenosis were not observed. Thirty-six hours after admission, the patient suddenly developed dyspnea and shock, and eventually died. We suspected the cause of death was pneumoperitoneum and acute pulmonary edema caused by AGD during the conservative treatment period. Immunocompromised patients with chronic illness require close observation even if they do not show any symptoms suggestive of complications. Even if the initial endoscopic or abdominal radiologic findings do not show gastric necrosis or perforation, follow-up with endoscopy is essential to recognize complications of AGD early. PMID:26668807

  20. Acute Pulmonary Edema in Patients with Cushing’s Syndrome

    OpenAIRE

    Mitra Niafar; Mehrnoush Toufan; Nooshin Milanchian; Farhad Niafar; Kavous Shahsavari Nia

    2015-01-01

    Introduction Dyspnea refers to difficulty in breathing, and short and shallow breaths. This sign is seen in numerous diseases due to pulmonary, cardiac, metabolic and neurological causes. Among cardiac causes, heart failure is considered the main cause of dyspnea. Cardiac failure is a clinical syndrome associated with a set of symptoms (dyspnea, and fatigue) and signs (edema and rales). Common causes of cardiac failure include: myocardial infarction, ischemic heart disease, hypertensi...

  1. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Soldati Gino

    2008-04-01

    Full Text Available Abstract Background Differential diagnosis between acute cardiogenic pulmonary edema (APE and acute lung injury/acute respiratory distress syndrome (ALI/ARDS may often be difficult. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE. Methods Chest sonography was performed on admission to the intensive care unit in 58 consecutive patients affected by ALI/ARDS or by acute pulmonary edema (APE. Results Ultrasound examination was focalised on finding in the two groups the presence of: 1 alveolar-interstitial syndrome (AIS 2 pleural lines abnormalities 3 absence or reduction of "gliding" sign 4 "spared areas" 5 consolidations 6 pleural effusion 7 "lung pulse". AIS was found in 100% of patients with ALI/ARDS and in 100% of patients with APE (p = ns. Pleural line abnormalities were observed in 100% of patients with ALI/ARDS and in 25% of patients with APE (p All signs, except the presence of AIS, presented a statistically significant difference in presentation between the two syndromes resulting specific for the ultrasonographic characterization of ALI/ARDS. Conclusion Pleuroparenchimal patterns in ALI/ARDS do find a characterization through ultrasonographic lung scan. In the critically ill the ultrasound demonstration of a dyshomogeneous AIS with spared areas, pleural line modifications and lung consolidations is strongly predictive, in an early phase, of non-cardiogenic pulmonary edema.

  2. Noninvasive ventilation in patients with acute cardiogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Andrea Bellone

    2013-07-01

    Full Text Available The term noninvasive ventilation (NIV encompasses two different modes of delivering positive airway pressure, namely continuous positive airway pressure (CPAP and bilevel positive airway pressure (bilevel-PAP. The two modes are different since CPAP does not actively assist inspiration whereas bilevel-PAP does. Bilevel-PAP is a type of noninvasive ventilation that helps keep the upper airways of the lungs open by providing a flow of air delivered through a face mask. The air is pressurized by a machine, which delivers it to the face mask through long, plastic hosing. With bilevel-PAP, the doctor prescribes specific alternating pressures: a higher pressure is used to breathe in (inspiratory positive airway pressure and a lower pressure is used to breath out (expiratory positive airway pressure. Noninvasive ventilation has been shown to reduce the rate of tracheal intubation. The main indications are exacerbation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema (ACPE. This last is a common cause of respiratory failure with high incidence and high mortality rate. Clinical findings of ACPE are related to the increased extra-vascular water in the lungs and the resulting reduced lung compliance, increased airway resistance and elevated inspiratory muscle load which generates a depression in pleural pressure. These large pleural pressure swings are responsible for hemodynamic changes by increasing left ventricular afterload, myocardial transmural pressure, and venous return. These alterations can be detrimental to patients with left ventricular systolic dysfunction. Under these circumstances, NIV, either by CPAP or bilevel-PAP, improves vital signs, gas exchange, respiratory mechanics and hemodynamics by reducing left ventricular afterload and preload. In the first randomized study which compared the effectiveness of CPAP plus medical treatment vs medical treatment alone, the CPAP group showed a significant decrease in its

  3. [Non-cardiogenic pulmonary edema, acute respiratory distress syndrome].

    Science.gov (United States)

    Skalická, Hana; Bělohlávek, Jan

    2015-01-01

    Non-cardiogenic pulmonary edema is a clinical syndrome manifested by rapidly progressive respiratory distress leading, without therapy, to severe respiratory insufficiency and subsequent multiorgan failure. The pathophysiological causes are: the change in the pressure gradients in the pulmonary capillaries, the impaired membrane permeability of the alveolocapillary in the lungs, and impaired lymphatic drainage. Unlike in cardiogenic pulmonary edema, cardiac disease is not a cause, and there is no increase in wedge pressure (< 18 mm Hg). The aetiological base is diverse and includes more clinical pathological factors. The diagnosis and evaluation are usually very difficult due to the rapidly deteriorating clinical condition of the patients. A decisive, quick and comprehensive approach, using all available invasive and non-invasive methods is necessary. The basic steps of treatment are: the use of different types of ventilatory support in order to achieve adequate oxygenation, dealing with possible hemodynamic instability, and, when needed, other specific procedures. It is always important to keep in mind that this is a very serious condition with a high mortality rate. And there is a need for fast and efficient access to the best specialized clinic.

  4. Noninvasive mechanical ventilation in chronic obstructive pulmonary disease and in acute cardiogenic pulmonary edema.

    Science.gov (United States)

    Rialp Cervera, G; del Castillo Blanco, A; Pérez Aizcorreta, O; Parra Morais, L

    2014-03-01

    Noninvasive ventilation (NIV) with conventional therapy improves the outcome of patients with acute respiratory failure due to hypercapnic decompensation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPE). This review summarizes the main effects of NIV in these pathologies. In COPD, NIV improves gas exchange and symptoms, reducing the need for endotracheal intubation, hospital mortality and hospital stay compared with conventional oxygen therapy. NIV may also avoid reintubation and may decrease the length of invasive mechanical ventilation. In ACPE, NIV accelerates the remission of symptoms and the normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a trend towards lesser mortality, without increasing the incidence of myocardial infarction. The ventilation modality used in ACPE does not affect the patient prognosis.

  5. Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome

    Science.gov (United States)

    Karamchandani, Kunal; Bortz, Brandon; Vaida, Sonia

    2016-01-01

    Patient: Female, 35 Final Diagnosis: Takotsubo cardiomyopathy Symptoms: Seizures Medication: — Clinical Procedure: Cesarean section Specialty: Critical Care Medicine Objective: Rare co-existance of disease or pathology Background: Acute pulmonary edema in a pregnant patient is associated with significant morbidity and mortality. Takotsubo syndrome, or stress-induced cardiomyopathy, is a rare cause of acute pulmonary edema in a pregnant patient, especially prior to delivery of the fetus. Case Report: We describe a case of a pregnant patient who presented with acute pulmonary edema and eclampsia and was found to have Takotsubo syndrome. To the best of our knowledge, eclampsia as a precipitating factor for Takotsubo syndrome has not been described in literature. Conclusions: Clinicians taking care of pregnant patients should be aware of the potential link between eclampsia and Takotsubo cardiomyopathy. Prompt correction of the precipitating cause along with supportive management as described is the key to a successful outcome. PMID:27658947

  6. Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome.

    Science.gov (United States)

    Karamchandani, Kunal; Bortz, Brandon; Vaida, Sonia

    2016-09-23

    BACKGROUND Acute pulmonary edema in a pregnant patient is associated with significant morbidity and mortality. Takotsubo syndrome, or stress-induced cardiomyopathy, is a rare cause of acute pulmonary edema in a pregnant patient, especially prior to delivery of the fetus. CASE REPORT We describe a case of a pregnant patient who presented with acute pulmonary edema and eclampsia and was found to have Takotsubo syndrome. To the best of our knowledge, eclampsia as a precipitating factor for Takotsubo syndrome has not been described in literature. CONCLUSIONS Clinicians taking care of pregnant patients should be aware of the potential link between eclampsia and Takotsubo cardiomyopathy. Prompt correction of the precipitating cause along with supportive management as described is the key to a successful outcome.

  7. Prevalence of pulmonary edema among the deceased cases with acute Methadone poisoning: A report from Iran

    Science.gov (United States)

    Eizadi-Mood, Nastaran; Naeini, Seyed Amir Hossein Madani; Hedaiaty, Mahrang; Sabzghabaee, Ali Mohammad; Moudi, Maryam

    2016-01-01

    Objective: Methadone poisoning is common in our society, mainly in drug addicts. One of its lethal complications is pulmonary edema. Therefore, we evaluated the prevalence of pulmonary edema in the deceased cases with methadone poisoning and its possible relationship with some medical variables. Methods: In this cross-sectional study which was done in 2014, we have investigated the deceased patients with methadone toxicity who underwent autopsy at Isfahan Forensic Medicine Department (Iran). All variables including age, gender, and autopsy findings were recorded and analyzed. Demographic characteristics and medical complications of the patients were compared between the patients with or without pulmonary edema in the autopsy findings. Findings: There were 64 cases who died with methadone poisoning during the 1-year study period. The average age of cases (±standard deviation) was 32.1 ± 10.29 years, among which 92.2% were male. Based on the autopsy findings, 64.1% were diagnosed with pulmonary edema. There was no statistically significant relationship between pulmonary edema and age, gender, history of addiction, and hepatic or cardiovascular complications. Conclusion: Pulmonary edema is a common finding in deceased methadone poisoning cases and must be considered and ruled out in patients with acute methadone toxicity. PMID:27843967

  8. Epithelial sodium channel is involved in H2S-induced acute pulmonary edema.

    Science.gov (United States)

    Jiang, Lei; Wang, Yixin; Su, Chenglei; Sun, Hao; Zhang, Huazhong; Zhu, Baoli; Zhang, Hengdong; Xiao, Hang; Wang, Jun; Zhang, Jinsong

    2015-01-01

    Acute pulmonary edema is one of the major outcomes of exposure to high levels of hydrogen sulfide (H2S). However, the mechanisms involved in H2S-induced acute pulmonary edema are still poorly understood. Therefore, the present study is designed to evaluate the role of epithelial sodium channel (ENaC) in H2S-induced acute pulmonary edema. The Sprague-Dawley rats were exposed to sublethal concentrations of inhaled H2S, then the pulmonary histological and lung epithelial cell injury were evaluated by hematoxylin-eosin staining and electron microscopy, respectively. In addition to morphological investigation, our results also revealed that H2S exposure significantly decreased the alveolar fluid clearance and increased the lung tissue wet-dry ratio. These changes were demonstrated to be associated with decreased ENaC expression. Furthermore, the extracellular-regulated protein kinases 1/2 pathway was demonstrated to be implicated in H2S-mediated ENaC expression, because PD98059, an ERK1/2 antagonist, significantly mitigated H2S-mediated ENaC down-regulation. Therefore, our results show that ENaC might represent a novel pharmacological target for the treatment of acute pulmonary edema induced by H2S and other hazardous gases.

  9. [Cardiogenic pulmonary edema following β2 agonist infusion for acute, severe asthma].

    Science.gov (United States)

    Bahloul, M; Chaari, A; Dammak, H; Medhioub, F; Abid, L; Chtourou, K; Rekik, N; Chelly, H; Kallel, H; Bouaziz, M

    2015-09-01

    We report the case of a severe acute pulmonary edema secondary to the administration of salbutamol to a patient admitted for severe asthma. The diagnosis of acute pulmonary edema was suspected on the clinical examination, chest radiography, biological (plasmatic Pro-BNP rate) and echocardiographic findings. Rapid improvement under dobutamine and mechanical ventilation argue in favour of cardiogenic pulmonary edema. The young age of our patient, the absence of history of cardiovascular disease and the chronology of this complication onset regarded to salbutamol infusion could suggest β2 agonist involvement in this event. The improvement of cardiac function on echocardiography and the normal results obtained with myocardial perfusion scintigraphy performed 35 days later show the left ventricular reversible dysfunction.

  10. Negative-Pressure Pulmonary Edema.

    Science.gov (United States)

    Bhattacharya, Mallar; Kallet, Richard H; Ware, Lorraine B; Matthay, Michael A

    2016-10-01

    Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.

  11. Acute Pulmonary Edema in Patients with Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Mitra Niafar

    2015-01-01

    Full Text Available IntroductionDyspnea refers to difficulty in breathing, and short and shallow breaths. This sign is seen in numerous diseases due to pulmonary, cardiac, metabolic and neurological causes. Among cardiac causes, heart failure is considered the main cause of dyspnea.Cardiac failure is a clinical syndrome associated with a set of symptoms (dyspnea, and fatigue and signs (edema and rales. Common causes of cardiac failure include: myocardial infarction, ischemic heart disease, hypertension, valvular heart diseases, and cardiomyopathy. Among uncommon causes of heart failure, endocrine disorders such as Cushing’s syndrome can be cited. Cushing’s syndrome can present itself in less common forms such as dyspnea due to heart failure. Cushing’s syndrome’s cardiovascular complications usually occur due to hypertension, end organ damage such as left ventricular heart failure, diastolic and ischemic myocardial heart failure, which are rather seen in chronic cases of the disease and are often irreversible.Transient heart failure in patients with Cushing’s syndrome, due to adrenal adenoma, has been reported in a number of patients. In this case report, a patient is introduced who presented to emergency department with severe dyspnea (FC III, and was ultimately diagnosed with Cushing’s syndrome after work up. Three months after treatment of Cushing’s syndrome, dramatic improvement was observed in this patient’s cardiac function.

  12. Effects of Ischemic Acute Kidney Injury on Lung Water Balance: Nephrogenic Pulmonary Edema?

    Directory of Open Access Journals (Sweden)

    Rajit K. Basu

    2011-01-01

    Full Text Available Pulmonary edema worsens the morbidity and increases the mortality of critically ill patients. Mechanistically, edema formation in the lung is a result of net flow across the alveolar capillary membrane, dependent on the relationship of hydrostatic and oncotic pressures. Traditionally, the contribution of acute kidney injury (AKI to the formation of pulmonary edema has been attributed to bulk fluid accumulation, increasing capillary hydrostatic pressure and the gradient favoring net flow into the alveolar spaces. Recent research has revealed more subtle, and distant, effects of AKI. In this review we discuss the concept of nephrogenic pulmonary edema. Pro-inflammatory gene upregulation, chemokine over-expression, altered biochemical channel function, and apoptotic dysregulation manifest in the lung are now understood as “extra-renal” and pulmonary effects of AKI. AKI should be counted as a disease process that alters the endothelial integrity of the alveolar capillary barrier and has the potential to overpower the ability of the lung to regulate fluid balance. Nephrogenic pulmonary edema, therefore, is the net effect of fluid accumulation in the lung as a result of both the macroscopic and microscopic effects of AKI.

  13. Acute cerebral and pulmonary edema induced by hemodialysis in a dog model

    Institute of Scientific and Technical Information of China (English)

    SHI Zhen-wei; WANG Zhi-gang

    2008-01-01

    Background The dialysis disequilibrium syndrome is characterized by neurologic deterioration and cerebral edema which occurs after hemodialysis. The purpose of this study was to investigate the pathogenesis of acute cerebral and pulmonary edema induced by hemodialysis.Methods We evaluated the effects of hemodialysis on the biochemical and hemodynamic parameters of the plasma and cerebrospinal fluid, including the intracranial pressure, dry/wet ratio, and pulmonary edema index, and we also examined the pathological changes of the brain and lung tissue in dogs suffering from uremia.Results Seventy-two hours after bilateral ureteral ligation, 10 uremic dogs were hemodialyzed for 2 hours, yielding a 73.6% and 60.1% decrease in the plasma urea and creatinine, respectively, a decrease in the plasma osmolality from (359±18) mOsm/kgH2O to (304±6) mOsm/kgH2O (P <0.01 ), a decrease in the dry/wet ratio of the lung and brain tissue,and an increase in the hemodynamic parameters (right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure), intracranial pressure, total pulmonary resistance index, and pulmonary edema index. Moreover, the pathological examination revealed lung and brain edema in the dialyzed dogs. This group was compared to 3 control groups: 6 uremic dogs which were sham dialyzed without dialysate so that no fall in the plasma urea occurred, and 12 uremic and 12 nonuremic animals that were not dialyzed.However, the parameters mentioned above were not significantly changed among these 3 control groups.Conclusions The acute brain and lung edema in our model appeared to be primarily due to a large osmotic gradient between the plasma and the brain and lung. This is the "urea reverse effect" which promoted the osmotically-induced lung and brain swelling.

  14. Acute Postpartum Pulmonary Edema in a 32-Year-Old Woman Five Days after Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Masuda Islam Khan

    2013-07-01

    Full Text Available Acute dyspnea after pregnancy is a rare presentation, and a number of important conditions may accompany it. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary edema are some of the potential causes that must be considered. The percentage of pregnancies that are complicated by acute pulmonary edema has been estimated 0.08%. The most common contributing factors include the administration of tocolytic agents, underlying cardiac disease, iatrogenic fluid overload and preeclampsia. Here we report a case of 32- year-old woman of 5th postpartum day following lower uterine cesarean section with acute dyspnea from her first pregnancy who was admitted in coronary care unit with history of one episode of raised blood pressure 160/90 mm Hg and cough on 1st postoperative day. Clinical examination and relevant investigations explored that it was a case of bilateral pulmonary edema. Patient was kept in ventilator and was treated with nitroglycerine (GTN, frusemide and ACE inhibitor. After diuresis, considerable improvement was observed in her respiratory status. From the 4th day, the patient became hemodynamically stable and was weaned off the ventilator. After five days, all the biochemical parameters became normal and she had no dyspnea.

  15. Proceedings of the Workshop on Acute Lung Injury and Pulmonary Edema Held in Aberdeen Proving Ground, Maryland on 4-5 May 1989

    Science.gov (United States)

    1989-11-01

    with side effects, including pulmonary edema . The objective of this study was to determine if the pulmonary edema was cardiogenic or noncardio- genic...Proeedings ~FL gof the .1Workshop on Acute Lung Injury and Pulmonary Edema 4-5 May 1989a Aberdeen Proving Ground, Maryland I7 21 Sponsored by the...TITLE (include Security Classification) (U) Proceedings of the" Workshop on Acute Lung Injury and Pulmonary Edema , May 1989 12. PERSONAL AUTHOR(S) David

  16. Concurrent early-onset peripartum cardiomyopathy in a preeclampsia patient with acute pulmonary edema.

    Science.gov (United States)

    Belen, Erdal; Tipi, Fahri Fatih; Helvaci, Aysen; Bayyigit, Akif

    2015-01-01

    We herein report the case of a preeclampsia patient with comorbid peripartum cardiomyopathy (PPCMP). A 22-year-old woman in the 26th week of gestation was admitted with acute pulmonary edema. Hypertension and proteinuria were detected, and echocardiography showed an ejection fraction of 33%. It is remarkable that PPCMP particularly that associated with preeclampsia was observed in the early gestational period. In conclusion, while dyspnea and pretibial edema are often noted during normal pregnancies, the potential for PPCMP should be considered if these symptoms are excessive and/or comorbid paroxysmal nocturnal dyspnea and orthopnea are present, even in patients with preeclampsia.

  17. Three-view bedside ultrasound for the differentiation of acute respiratory distress syndrome from cardiogenic pulmonary edema.

    Science.gov (United States)

    Mantuani, Daniel; Nagdev, Arun; Stone, Michael

    2012-09-01

    Bedside ultrasound is being increasingly used by emergency physicians (EPs) for the differentiation of acute dyspnea in critically ill patients. Lung ultrasound is emerging as a highly sensitive tool in diagnosing alveolar interstitial edema with the presence of diffuse “B-lines” arising from the pleural line. However, when used independently, lung ultrasound is unable to differentiate between cardiogenic and noncardiogenic causes of pulmonary edema. This case report describes a rapid 3-view or “triple scan” sonographic examination to differentiate acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema.

  18. Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis.

    Science.gov (United States)

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

  19. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    Science.gov (United States)

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative. PMID:25215245

  20. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    Directory of Open Access Journals (Sweden)

    Claire Serena

    2014-01-01

    Full Text Available We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

  1. Pulmonary Edema: Classification, Mechanisms of Development, Diagnosis

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2009-01-01

    Full Text Available Pulmonary edema remains a topical problem of modern reanimatology. In clinical practice, there is a need for continuous monitoring of the content of extravascular water in the lung and the pulmonary vascular permeability index for the timely detection and treatment of pulmonary edema. This literature review considers the minor mechanisms of pulmonary extravas-cular water exchange in health and in different types of pulmonary edema (acute lung injury, pneumonia, sepsis, postoperative period, burns, injuries etc., as well as the most accessible current (irradiation and dilution studies permitting an estimate of the level of pulmonary extravascular water and the pulmonary vascular permeability index in clinical practice. Key words: pulmonary edema, acute lung injury, pulmonary extravascular water, pulmonary vascular permeability index.

  2. Acute pulmonary edema after intravenous administration of nonionic contrast media: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun; Im, Jung Gi; Chung, Jin Wook; Park, Jae Hyung; Han, Man Chung [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-02-01

    We describe high-resolution CT findings of pulmonary edema following the administration of intravenous nonionic contrast media in a patient who had no previous history of cardiovascular disease; areas of ground glass opacity and interlobular septal thickenings which partly disappeared on scans obtained 90 minutes after the initial scans. The proposed mechanisms of pulmonary edema are briefly discussed.

  3. Acute pulmonary edema caused by takotsubo cardiomyopathy in a pregnant woman undergoing transvaginal cervical cerclage

    Science.gov (United States)

    Lee, Jae-Young; Kwon, Hyun-Jung; Park, Sang-Wook; Lee, Yu-Mi

    2017-01-01

    Abstract Background: The physiological changes associated with pregnancy may predispose pregnant women to pulmonary edema. Other known causes of pulmonary edema during pregnancy include tocolytic drugs, preeclampsia, eclampsia, and peripartum cardiomyopathy. Methods: We describe a rare case of pulmonary edema caused by takotsubo cardiomyopathy in a pregnant woman at 14 weeks of gestation who was undergoing emergency transvaginal cervical cerclage. Results: Intraoperative chest radiography revealed severe pulmonary edema and echocardiography indicated moderate left ventricular dysfunction with akinesia of the mid to apical left ventricular wall segment, which is reflective of takotsubo cardiomyopathy. Conclusion: With early detection and appropriate management, the patient was stabilized in a relatively short period of time. Based on her clinical signs and symptoms, we suspect that the pulmonary edema was caused by takotsubo cardiomyopathy. PMID:28072695

  4. Unilateral pulmonary edema: a rare initial presentation of cardiogenic shock due to acute myocardial infarction.

    Science.gov (United States)

    Shin, Jeong Hun; Kim, Seok Hwan; Park, Jinkyu; Lim, Young-Hyo; Park, Hwan-Cheol; Choi, Sung Il; Shin, Jinho; Kim, Kyung-Soo; Kim, Soon-Gil; Hong, Mun K; Lee, Jae Ung

    2012-02-01

    Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

  5. A 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure : A case report

    NARCIS (Netherlands)

    Dieperink, Willem; van der Horst, Iwan C. C.; Nannenberg-Koops, Jaqueline W.; Brouwer, Henk W.; Jaarsma, T.; Nieuwland, Wybe; Zijlstra, Felix; Nijsten, Maarten W. N.

    2007-01-01

    Continuous positive airway pressure (CPAP) is standard treatment for patients with acute cardiogenic pulmonary edema. We describe a patient who had 21 episodes of acute cardiogenic pulmonary edema due to very poor patient compliance. This 64-year old man had end-stage congestive heart failure based

  6. Coexistent transient pulmonary edema and pericardial effusion

    Energy Technology Data Exchange (ETDEWEB)

    Newman, B.; Oh, K.S.; Park, S.C.

    1988-09-01

    Eight (23%) of 35 children with acute pericardial effusions due to infection or juvenile rheumatoid arthritis (JRA) had associated transient pulmonary edema demonstrated on plain chest radiographs. The presence or absence of radiographic pulmonary edema correlated well with clinical and hemodynamic parameters in patients with JRA but not in those with infectious pericarditis. There was no definite relationship between radiographic edema and amount of pericardial fluid as estimated echocardiographically or removed at pericardiocentesis. Rapidity of pericardial fluid accumulation could not be assessed in this study. Children of young age with underlying JRA were the most likely subjects to have radiographic pulmonary edema in conjunction with an acute pericardial effusion.

  7. Novel drugs in the management of acute mountain sickness and high altitude pulmonary edema

    Directory of Open Access Journals (Sweden)

    Sikri G

    2015-12-01

    Full Text Available Gaurav Sikri, Anirban Bhattacharya Department of Physiology, Armed Forces Medical College, Wanowarie, Pune, IndiaWe read with great interest the review article titled “Wilderness medicine at high altitude: recent developments in the field” by Shah et al.1 The authors have comprehensively summarized the recent advances in the field of high altitude medicine relevant to sports and travel medicine. However, Shah et al have described potential drugs for management of high-altitude illnesses, such as acute mountain sickness (AMS, high altitude cerebral edema, and high altitude pulmonary edema (HAPE as one group under the section “Novel drug treatment for AMS”. The pathophysiologies of these two sets of diseases (AMS/high altitude cerebral edema as one and HAPE as another set are different2 and hence it would have been nice to have had the novel drugs described separately to elucidate the therapeutic approach for the two different classes of diseases.View original paper by Shah et al.

  8. Reperfusion pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Klausner, J.M.; Paterson, I.S.; Mannick, J.A.; Valeri, C.R.; Shepro, D.; Hechtman, H.B. (Harvard Medical School, Boston, MA (USA))

    1989-02-17

    Reperfusion following lower-torso ischemia in humans leads to respiratory failure manifest by pulmonary hypertension, hypoxemia, and noncardiogenic pulmonary edema. The mechanism of injury has been studied in the sheep lung lymph preparation, where it has been demonstrated that the reperfusion resulting in pulmonary edema is due to an increase in microvascular permeability of the lung to protein. This respiratory failure caused by reperfusion appears to be an inflammatory reaction associated with intravascular release of the chemoattractants leukotriene B{sub 4} and thromboxane. Histological studies of the lung in experimental animals revealed significant accumulation of neutrophils but not platelets in alveolar capillaries. The authors conclude that thromboxane generated and released from the ischemic tissue is responsible for the transient pulmonary hypertension. Second, it is likely that the chemoattractants are responsible for leukosequestration, and third, neutrophils, oxygen-derived free radicals, and thromboxane moderate the altered lung permeability.

  9. Reexpansion pulmonary edema

    OpenAIRE

    Genofre Eduardo Henrique; Vargas Francisco S.; Teixeira Lisete R.; Vaz Marcelo Alexandre Costa; Marchi Evaldo

    2003-01-01

    Reexpansion pulmonary edema (RPE) is a rare, but frequently lethal, clinical condition. The precise pathophysiologic abnormalities associated with this disorder are still unknown, though decreased pulmonary surfactant levels and a pro-inflammatory status are putative mechanisms. Early diagnosis is crucial, since prognosis depends on early recognition and prompt treatment. Considering the high mortality rates related to RPE, preventive measures are still the best available strategy for patient...

  10. Practical use, effects and complications of prehospital treatment of acute cardiogenic pulmonary edema using the Boussignac CPAP system

    NARCIS (Netherlands)

    E.E. Spijker (Eva Eiske); M. De Bont (Maarten); M. Bax; M. Sandel (Maro)

    2013-01-01

    textabstractBackground: Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a larg

  11. Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia.

    Science.gov (United States)

    Wollina, Uwe; Graf, Andreas; Hanisch, Volkmar

    2015-05-01

    Microcannular liposuction in tumescent anesthesia is the most effective treatment for painful lipedema. Tumescent anesthesia is an established and safe procedure in local analgesia when performed according to guidelines. Major adverse effects are rare. In patients with advanced lipedema, however, the commonly presented comorbidities bear additional risks.We report on post-surgical acute pulmonary edema after tumescent liposuction according to guidelines in a 52-year-old female patient with lipedema of the legs. We discuss in detail possible scenarios that might be involved in such emergency. In the present case the most likely was a retarded community acquired atypical pneumonia with aggravation of pre-existent comorbidities.A combined treatment with intravenous b-lactam antibiosis, positive pressure ventilation, and continuous venovenous hemodialysis and filtration resulted in complete remission in a couple of days. In conclusion, tumescent liposuction of advanced lipedema patients should only be performed in well-trained centers with sufficient infrastructure.

  12. The risk factors and prognostic implication of acute pulmonary edema in resuscitated cardiac arrest patients

    Science.gov (United States)

    Kang, Dae-hyun; Kim, Joonghee; Rhee, Joong Eui; Kim, Taeyun; Kim, Kyuseok; Jo, You Hwan; Lee, Jin Hee; Lee, Jae Hyuk; Kim, Yu Jin; Hwang, Seung Sik

    2015-01-01

    Objective Pulmonary edema is frequently observed after a successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. Currently, its risk factors and prognostic implications are mostly unknown. Methods Adult OHCA patients with a presumed cardiac etiology who achieved sustained return of spontaneous circulation (ROSC) in emergency department were retrospectively analyzed. The patients were grouped according to the severity of consolidation on their initial chest X-ray (group I, no consolidation; group II, patchy consolidations; group III, consolidation involving an entire lobe; group IV, total white-out of any lung). The primary objective was to identify the risk factors of developing severe pulmonary edema (group III or IV). The secondary objective was to evaluate the association between long-term prognosis and the severity of pulmonary edema. Results One hundred and seven patients were included. Total duration of cardiopulmonary resuscitation (CPR) and initial pCO2 level were both independent predictors of developing severe pulmonary edema with their odds ratio (OR) being 1.02 (95% confidence interval [CI], 1.00 to 1.04; per 1 minute) and 1.04 (95% CI, 1.01 to 1.07; per 1 mmHg), respectively. The long term prognosis was significantly poor in patients with severe pulmonary edema with a OR for good outcome (6-month cerebral performance category 1 or 2) being 0.22 (95% CI, 0.06 to 0.79) in group III and 0.16 (95% CI, 0.04 to 0.63) in group IV compared to group I. Conclusion The duration of CPR and initial pCO2 level were both independent predictors for the development of severe pulmonary edema after resuscitation in emergency department. The severity of the pulmonary edema was significantly associated with long-term outcome. PMID:27752581

  13. Pulmonary edema: radiographic differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Soo; Choi, Young Hi; Kim, Seung Cheol; An, Ji Hyun; Lee, Jee Young; Park, Hee Hong [Dankook Univ. College of Medicine, Chonan (Korea, Republic of)

    1997-04-01

    To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema. Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups : group 1 (cardiogenic edema : n = 35), group 2 (renal pulmonary edema : n = 16) and group 3 (permeability edema : n = 26). We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution. In cardiogenic pulmonary edema (n=35), cardiomegaly (n=29), peribronchial cuffing (n=29), inverted pulmonary blood flow distribution (n=21) and basal distribution of edema (n=20) were common. In renal pulmonary edema (n=16), cardiomegaly (n=15), balanced blood flow distribution (n=12), and central (n=9) or basal distribution of edema (n=7) were common. Permeability edema (n=26) showed different findings. Air bronchogram (n=25), normal blood flow distribution (n=14) and peripheral distribution of edema (n=21) were frequent findings, while cardiomegaly (n=7), peribronchial cuffing (n=7) and septal line (n=5) were observed in only a few cases. On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema.

  14. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

    Directory of Open Access Journals (Sweden)

    Ilić Radoje

    2005-01-01

    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  15. Boussignac continuous positive airway pressure for the management of acute cardiogenic pulmonary edema: prospective study with a retrospective control group

    Directory of Open Access Journals (Sweden)

    Aarts Leon PHJ

    2007-12-01

    Full Text Available Abstract Background Continuous positive airway pressure (CPAP treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP system that does not need a mechanical ventilator. Methods BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of Results During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78% were treated at the coronary care unit of which 66 (61% were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47% needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately € 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment. Conclusion At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings.

  16. Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Park Marcelo

    2001-01-01

    Full Text Available OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2, continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05. Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05. CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

  17. Diagnostic utility of C-reactive Protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Murakami Junji

    2011-06-01

    Full Text Available Abstract Introduction Discriminating acute lung injury (ALI or acute respiratory distress syndrome (ARDS from cardiogenic pulmonary edema (CPE using the plasma level of brain natriuretic peptide (BNP alone remains controversial. The aim of this study was to determine the diagnostic utility of combination measurements of BNP and C-reactive protein (CRP in critically ill patients with pulmonary edema. Methods This was a cross-sectional study. BNP and CRP data from 147 patients who presented to the emergency department due to acute respiratory failure with bilateral pulmonary infiltrates were analyzed. Results There were 53 patients with ALI/ARDS, 71 with CPE, and 23 with mixed edema. Median BNP and CRP levels were 202 (interquartile range 95-439 pg/mL and 119 (62-165 mg/L in ALI/ARDS, and 691 (416-1,194 pg/mL (p Conclusions Measurement of CRP is useful as well as that of BNP for distinguishing ALI/ARDS from CPE. Furthermore, a combination of BNP and CRP can provide higher accuracy for the diagnosis.

  18. [Acute Postoperative Negative Pressure Pulmonary Edema Caused by the Compression of Brachiocephalic Artery].

    Science.gov (United States)

    Tagawa, Miki; Iwai, Hidetaka; Fukatsu, Ken; Shimada, Mami; Hirabayashi, Yoshihiro

    2016-06-01

    We report a case of negative-pressure pulmonary edema occurring by tracheal obstruction caused by the brachiocephalic artery. The patient had deformed thorax with cerebral palsy, which deformed thorax placing the brachiocephalic artery high over the trachea, resulting in close and tight contact between the artery and trachea. Additional deformity of the thorax associated with myotonic attacks after general anesthesia might shorten the distance between the sternal notch and the vertebral body, resulting in the tracheal obstruction by the artery.

  19. Pulmonary edema following lumbar puncture

    Directory of Open Access Journals (Sweden)

    Gupta D

    1977-01-01

    Full Text Available In a boy of 17 years with disseminated tuberculosis, sudden onset of pulmonary edema following lumbar puncture is described. Possible pat ho-mechanisms have been discussed. The link bet-ween the lumbar puncture and the development of pulmonary edema is not casual.

  20. Physiological study on CT image analysis of acute pulmonary edema by oleic acid and its application to diagnosis of drowning

    Energy Technology Data Exchange (ETDEWEB)

    Nosaka, Mizuho [Wakayama Medical Coll. (Japan)

    1998-05-01

    Recently, various investigations are carried out about the relationship between the pathophysiological changes and the images of the destructive extent in acute lung injury. In present paper, we examined, in progression time, the pathophysiological and histological changes basing upon pulmonary edema model made by administration of oleic acid to beagle dogs, and simultaneously took images of the lung by employing high-resolution X-ray CT and analyzed them. In pathophysiological and histological investigation, V{sub A}/Q heterogeneity and lung water volume increased, and decrease of PO{sub 2} in arterial blood was observed, and also filling of the alveoli with exudate, edema of the alveolar interstitium, congestion of the alveoli were observed histologically. In image analysis, the findings, that is enough to reflect the pathophysiological and histological changes, were obtained from mean CT value and the distribution of CT value histogram. Moreover, the same examination as in acute pulmonary edema model was carried out in drowning model with seawater. Consequently, it became evident that presuming of pathophysiological changes in drowning was possible from results of X-ray CT image analysis. The results described above seem to indicate that X-ray CT image analysis in acute lung injury can use as an index of the damage degree, and also is available for elucidation of the pathophysiological changes. (author)

  1. Lung clearance of /sup 99m/Tc-DTPA in patients with acute lung injury and pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Coates, G.; O' Brodovich, H.; Dolovich, M.

    1988-07-01

    Several acute and chronic conditions that alter the integrity of the pulmonary epithelium increased the rate of absorption or clearance into the circulation of small solutes deposited in the alveoli. Technetium 99m diethylenetriamine pentaacetic acid can be deposited in the lungs as a submicronic aerosol and its rate of clearance measured with a gamma camera or simple probe. This clearance technique is currently being used to evaluate patients who have developed pulmonary edema and also to detect those patients from a high risk group who are likely to develop adult respiratory distress syndrome (ARDS). Its role in the evaluation of patients with pulmonary edema is still under active investigation. It is clear that a single measurement in patients who smoke is not useful, but repeated measurements may provide important information. The lung clearance measurement is very sensitive to changes in epithelial integrity but is not specific for ARDS. It may be most useful in combination with other predictive tests or when the clearance rate is normal. 54 references.

  2. Acute Idiopathic Scrotal Edema

    Directory of Open Access Journals (Sweden)

    Micheál Breen

    2013-01-01

    Full Text Available We report a case of acute idiopathic scrotal edema (AISE in a 4-year-old boy who presented with acute scrotal pain and erythema. The clinical features, ultrasound appearance, and natural history of this rare diagnosis are reviewed. In this report, we highlight the importance of good ultrasound technique in differentiating the etiology of the acute scrotum and demonstrate the color Doppler “Fountain Sign” that is highly suggestive of AISE.

  3. Inhibition of secretory phospholipase A2 activity attenuates acute cardiogenic pulmonary edema induced by isoproterenol infusion in mice after myocardial infarction.

    Science.gov (United States)

    Kawabata, Kenichi; Fujioka, Daisuke; Kobayashi, Tsuyoshi; Saito, Yukio; Obata, Jun-Ei; Nakamura, Takamitsu; Yano, Toshiaki; Watanabe, Kazuhiro; Watanabe, Yosuke; Mishina, Hideto; Kugiyama, Kiyotaka

    2010-10-01

    Several types of secretory phospholipase A2 (sPLA2) are expressed in lung tissue, yielding various eicosanoids that might cause pulmonary edema. This study examined whether inhibition of sPLA2 activity attenuates acute cardiogenic pulmonary edema in mice. Acute cardiogenic pulmonary edema was induced in C57BL/6J male mice by an increase in heart rate with continuous intravenous infusion of isoproterenol (ISP) (10 mg/kg/h) at 2 weeks after the creation of myocardial infarction by left coronary artery ligation. Just before ISP infusion, a single intraperitoneal injection of 100 mg/kg LY374388, a prodrug of LY329722 that inhibits sPLA2 activity, or vehicle was administered. The ISP infusion after myocardial infarction induced interstitial and alveolar edema on lung histology. Furthermore, it increased the lung-to-body weight ratio, pulmonary vascular permeability evaluated by the Evans blue extravasation method, lung activity of sPLA2, and lung content of thromboxane A2 and leukotriene B4. These changes were significantly attenuated by LY374388 treatment. In Kaplan-Meier analysis, the survival rate during the ISP infusion after myocardial infarction was significantly higher in LY374388- than in vehicle-treated mice. Similar results were obtained with another inhibitor of sPLA2 activity, para-bromophenacyl bromide. In conclusion, inhibition of sPLA2 activity suppressed acute cardiogenic pulmonary edema.

  4. Levels of interleukin-6, superoxide dismutase and malondialdehyde in the lung tissue of a rat model of hypoxia-induced acute pulmonary edema

    Science.gov (United States)

    GAO, HENGBO; TIAN, YINGPING; WANG, WEI; YAO, DONGQI; ZHENG, TUOKANG; MENG, QINGBING

    2016-01-01

    The present study aimed to investigate the levels of malondialdehyde (MDA), superoxide dismutase (SOD) and interleukin (IL)-6 in the lung tissue of a rat model of acute pulmonary edema induced by acute hypoxia, and its pathophysiological significance. A total of 48 adult Wistar rats were randomly divided into group A, a normal group; group B, a model of acute pulmonary edema induced by hypoxia for 24 h; group C, a model of acute pulmonary edema induced by hypoxia for 48 h; and group D, a model of acute pulmonary edema induced by hypoxia for 72 h. The rats in groups B-D were intraperitoneally injected with 6% ammonium chloride to establish the model of acute pulmonary edema, and were subsequently sacrificed following successful modeling for 24, 48 and 72 h. The plasma of rats was isolated and the lungs of the rats were removed. Subsequently, a 10% lung homogenate was prepared and the contents and the activities of MDA, SOD and IL-6 in the lung tissue and IL-6 in the plasma were detected by enzyme-linked immunosorbent assay. MDA and IL-6 expression levels increased and SOD activity decreased in the lung tissue in group B as compared with group A; however the difference did not reach significance (P>0.05). MDA, IL-6 and SOD levels in the lung tissue of rats were significantly altered following the increased duration of pulmonary edema in groups C and D, as compared group A (P<0.05). The plasma IL-6 levels of the rats in groups B-D significantly increased, as compared with those in group A (P<0.05). In conclusion, the results of the present study demonstrated that the incidence of acute pulmonary edema may be associated with oxidative stress. Furthermore, decreased antioxidant capacity and increased free radical levels may be associated with pulmonary edema, as in the present study the levels of IL-6, SOD and MDA in the lung tissue were observed to be associated with the pathological changes of the disease. PMID:26998026

  5. Edema pulmonar de gran altura HIGH ALTITUDE PULMONARY EDEMA

    Directory of Open Access Journals (Sweden)

    FELIPE UNDURRAGA M

    2003-04-01

    Full Text Available Las enfermedades de altura son de causa cerebral y pulmonar. Las primeras se refieren fundamentalmente al mal agudo de montaña y al edema cerebral de altura y las segundas al edema pulmonar agudo de montaña. Actuales evidencias señalan que el edema cerebral sería un fenómeno universal de los que ascienden a altura y que tres de cada cuatro individuos sanos que se expongan a altura desarrollarán un edema pulmonar agudo de montaña subclínico. La hipoxia de altura es la responsable de estos cuadros y los sujetos susceptibles serían aquellos que genéticamente tienen una respuesta ventilatoria reducida a la hipoxia y una exagerada respuesta vasopresora pulmonar al ejercicio.Se presenta un caso de edema pulmonar agudo de montaña en un deportista previamente sano que participó en una expedición al cerro El Plomo (5.280 msnm en la Cordillera de los Andes central. Posteriormente, se comenta la fisiopatología y tratamiento de esta condiciónHigh altitude diseases are originated from brain and lung. The first are Acute Mountain Sickness and Brain edema and the second is High Altitude Pulmonary Edema (HAPE. Current evidence shows that brain edema is an universal event of the people who are exposed to high altitude. By other hand 3 out of 4 healthy subjects exposed to high altitude will present a subclinical HAPE. Hypoxia of altitude is the responsable for this condition. The susceptible subjects would be those who genetically have a low ventilatory response to hypoxia and an exaggerated increase of vascular pulmonary pressure during exercise. A clinical case of acute pulmonary edema in a young sportman who participated in an expedition to Cerro El Plomo (5.280 m in Chilean Central Andes Mountains is presented. Pathophysiology and treatment of these conditions are discussed

  6. Diagnosis and management of cardiogenic pulmonary edema.

    Science.gov (United States)

    Alwi, Idrus

    2010-07-01

    Acute cardiogenic pulmonary edema (ACPE) is a common cardiogenic emergency with a quite high in-hospital mortality rate. ACPE is defined as pulmonary edema with increased secondary hydrostatic capillary pressure due to elevated pulmonary venous pressure. Increased hydrostatic pressure may result from various causes including excessive administration of intravascular volume, obstruction of pulmonary venous outflow or secondary left ventricular failure due to left ventricular systolic or diastolic dysfunction. ACPE must be distinguished from pulmonary edema associated with injury of alveolar capillary membrane caused by various etiologies, i.e. direct pulmonary injury such as pneumonia and indirect pulmonary injury such as sepsis. Numerous clinical manifestations may differentiate ACPE and Non-ACPE. ACPE usually presents with a history of acute cardiac catastrophe. Physical examination reveals a low-flow state, S3 gallop, jugular venous distention and fine crepitant rales with auscultation. The diagnosis of pulmonary edema is made based on symptoms and clinical signs are found through history taking, physical examination, ECG, chest X-ray, echocardiography and laboratory tests including blood gas analysis and specific biomarkers. Medical treatment of ACPE has 3 main objectives, i.e.: (1) reduced venous return (preload reduction); (2) reduced resistance of systemic vascular (afterload reduction); and (3) inotropic support in some cases. Treatment that can be administered includes: vasodilator when there is normal or high BP, diuretics when there is volume overload or fluid retention, and inotropic drugs when there is hypotension or signs of organ hypoperfusion. Intubation and mechanical ventilation may be necessary to achieve adequate oxygenation.

  7. Reexpansion pulmonary edema following thoracentesis

    Directory of Open Access Journals (Sweden)

    Ansuman Mukhopadhyay

    2016-01-01

    Full Text Available Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and pathogenesis is unknown. An elderly male patient presented to us with right-sided pleural effusion. 2 h after thoracentesis, he felt chest discomfort and increased breathlessness. His chest examination showed right-sided crackles. Chest radiograph showed right-sided heterogeneous opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively along with bilevel positive airway pressure ventilator support. His condition improved gradually and was discharged successfully after 2 days.

  8. Hypertrophic Cardiomyopathy Complicated by Pulmonary Edema in the Postpartum Period

    Directory of Open Access Journals (Sweden)

    Kate Hanneman

    2013-01-01

    Full Text Available We report the case of a 42-year-old patient with hypertrophic cardiomyopathy (HCM who presented to the emergency department with severe shortness of breath one week following uneventful cesarean delivery. Thoracic CT ruled out pulmonary embolus and confirmed pulmonary edema. Asymmetric interventricular septal thickening was clearly identified, demonstrating that the heart may be evaluated even on a non-ECG gated study. Acute pulmonary edema in the postpartum period is an unusual clinical presentation of HCM.

  9. A patient with possible TRALI who developed pulmonary hypertensive crisis and acute pulmonary edema during cardiac surgery.

    Science.gov (United States)

    Kojima, Taiki; Nishisako, Ryo; Sato, Hideo

    2012-06-01

    There are very few case reports of transfusion-related acute lung injury (TRALI) under close hemodynamic monitoring. We encountered a case of possible TRALI during on-pump coronary artery bypass grafting (CABG). A 66-year-old man who had undergone on-pump CABG was administered fresh frozen plasma (FFP). One hour after FFP transfusion, pulmonary hypertensive crisis and subsequent hypoxic decompensation occurred. A second cardiopulmonary bypass (CPB) was needed for circulatory and respiratory deterioration. Extracorporeal life support (ECLS), intraaortic balloon pumping (IABP), and nitric oxide therapy were required after the surgery. Despite the severity of the initial state, his recovery was comparatively smooth. ECLS and IABP were removed on postoperative day (POD)1; the patient was extubated and discharged from the ICU on POD7 and POD12, respectively. The diagnosis of TRALI was confirmed by human leukocyte antigen antibody detection in the administered FFP. In addition, lymphocytic immunofluorescence test showed that a cross-match of the plasma from the pooled FFP against the recipient leukocytes was positive. The clinical course of the pulmonary artery hypertension was followed by a decrease in dynamic lung compliance. The mechanism of this phenomenon is unclear. However, it might suggest the possibility of vasoconstriction or obstruction of the peripheral pulmonary artery preceding lung damage, as in the case in animal models reported previously.

  10. Influenza leaves a TRAIL to pulmonary edema.

    Science.gov (United States)

    Brauer, Rena; Chen, Peter

    2016-04-01

    Influenza infection can cause acute respiratory distress syndrome (ARDS), leading to poor disease outcome with high mortality. One of the driving features in the pathogenesis of ARDS is the accumulation of fluid in the alveoli, which causes severe pulmonary edema and impaired oxygen uptake. In this issue of the JCI, Peteranderl and colleagues define a paracrine communication between macrophages and type II alveolar epithelial cells during influenza infection where IFNα induces macrophage secretion of TRAIL that causes endocytosis of Na,K-ATPase by the alveolar epithelium. This reduction of Na,K-ATPase expression decreases alveolar fluid clearance, which in turn leads to pulmonary edema. Inhibition of the TRAIL signaling pathway has been shown to improve lung injury after influenza infection, and future studies will be needed to determine if blocking this pathway is a viable option in the treatment of ARDS.

  11. Protective effect of phenylethanoid glycosides extracted from Phlomis younghusbandii on acute high altitude pulmonary edema in rats

    Directory of Open Access Journals (Sweden)

    Fei LUAN

    2015-10-01

    Full Text Available Objective To investigate the protective effect of phenylethanoid glycosides (PhGCs extracted from Phlomis younghusbandiion acute high altitude pulmonary edema (HAPE in rats. Methods Seventy male Wistar rats were randomly divided into 7 groups (10 each: normoxia control group (NG, distilled water, normoxia+PhGCs group (NG+PhGCs, 400mg/ kg, hypoxia model group (HG, distilled water, dexamethasone (Dex, 4mg/kg, and three groups of PhGCs in high (PhGCs-H, 400mg/kg, middle (PhGCs-M, 200mg/kg and low (PhGCs-L, 50mg/kg dosage. PhGCs extracted from Phlomis younghusbandiiwere administered prophylactically to rats for 3 days, and HAPE was induced by the hypobaric hypoxia exposure for 72 hours in an animal decompression chamber with the chamber pressure of 267mmHg to simulate an altitude of 8000m. The water content of rat lung tissue was determined with wet/dry specific gravity method, and histopathologic changes were observed with HE staining. The enzymatic activities of SOD and GSH, and the contents of MDA in lung tissue were determined with spectrophotometry, and the contents of IL-1β, TNF-α in serum and lung tissue were determined with ELISA. Results Compared with NG group, no obvious difference was found in the water content of rat lung tissue in NG+PhGCs group, but the water content increased obviously in HG group (P<0.05. Compared with NG group, lung tissue congestion and edema were found in HG group, with a heavy inflammatory cell infiltration, widening of alveolar interval, and thickening of alveolar wall were found. The enzymatic activities of SOD and GSH were notablely depressed, and the contents of MDA in lung tissue, and the contents of IL-1β and TNF-α in serum and lung tissue remarkably increased (P<0.05. Compared with HG group, the water content of rat lung tissue in each PhGCs group decreased obviously. Inflammatory cells infiltration, widening of alveolar interval, and thickening of alveolar wall, the enzymatic activity of SOD and

  12. 全麻期间并发急性肺水肿(附5例报告)%Acute pulmonary edema during general anesthasia.

    Institute of Scientific and Technical Information of China (English)

    黄冰; 何并文; 赖恩华; 王建荔; 温文钊

    2001-01-01

    目的 探讨全麻期间急性肺水肿的发病、诊断、治疗和预后。方法 临床资料的回顾性分析。结果 全身麻醉期间发生急性肺水肿5例,发病机理可能为心源性肺水肿、负压性肺水肿和通透性肺水肿。预防及处理意见是:①严格控制输血输液量;②有胸水的病人在抽胸水时,首次量应控制在800ml左右;③胸科手术中,特别是双侧开胸手术者,避免单肺通气或对肺组织挤压、牵拉时间过长。结论 急性肺水肿是全身麻醉的严重并发症,须及时诊断和治疗%Objective To study the clinical feature,diagnosis,treatment andprognosis of acute pulmonary edema during general anesthasia.Methods The clinical material are retrospectively analysed.Results 5 cases Acute pulmonary edema are onset during general anesthasia.The provocation must possible was cardiogenic pulmonary edema,negative-pressure pulmonary edema and permeability pulmonary edema.The opinion of prevention and treatment was:①To control both transfusion volume of fluid and blood;②When you drew pleural fluid,for the patients with pleural fluid,the first volume have to control in 800 ml;③In thoracic surgery particular in both chest,you have to avoid one lung ventilation to much time and crushed or drag the lung tissues to much.Conclusion Acute pulmonary edema was the severity complication during general anesthasia.We have to diagnosis and treatment in time.

  13. Immersion Pulmonary Edema in Female Triathletes

    Directory of Open Access Journals (Sweden)

    Eric A. Carter

    2011-01-01

    Full Text Available Pulmonary edema has been reported in SCUBA divers, apnea divers, and long-distance swimmers however, no instances of pulmonary edema in triathletes exist in the scientific literature. Pulmonary edema may cause seizures and loss of consciousness which in a water environment may become life threatening. This paper describes pulmonary edema in three female triathletes. Signs and symptoms including cough, fatigue, dyspnea, haemoptysis, and rales may occur within minutes of immersion. Contributing factors include hemodynamic changes due to water immersion, cold exposure, and exertion which elevate cardiac output, causing pulmonary capillary stress failure, resulting in extravasation of fluid into the airspace of the lung. Previous history is a major risk factor. Treatment involves immediate removal from immersion and in more serious cases, hospitalization, and oxygen administration. Immersion pulmonary edema is a critical environmental illness of which triathletes, race organizers, and medical staff, should be made aware.

  14. Acidemia in severe acute cardiogenic pulmonary edema treated with noninvasive pressure support ventilation: a single-center experience.

    Science.gov (United States)

    Lazzeri, Chiara; Gensini, Gian F; Picariello, Claudio; Attanà, Paola; Mattesini, Alessio; Chiostri, Marco; Valente, Serafina

    2015-09-01

    In clinical practice, acidotic patients with acute cardiogenic pulmonary edema (ACPE) are commonly considered more severe in comparison with nonacidotic patients, and data on the outcome of these patients treated with noninvasive pressure support ventilation (NIV) are lacking.The present investigation was aimed at assessing whether acidosis on admission (pH < 7.35) was associated with adverse outcome in 65 consecutive patients with ACPE treated with NIV and admitted to our Intensive Cardiac Care Unit (ICCU).In our population, 28 patients were acidotic (28 of 65, 43.1%), whereas 41 patients were not (37 of 65, 56.9%). According to the Repeated Measures General Linear Model, pCO2 values significantly changed throughout the 2-h NIV treatment (P = 0.019) in both groups (P = 0001). In acidotic patients, pCO2 significantly decreased (51.9 ± 15.3 → 47.0 ± 12.8 → 44.8 ± 12.7), whereas they increased in the nonacidotic subgroup (36.8 ± 6.5 → 36.9 ± 7.2 → 37.6 ± 6.4). No difference was observed in intubation rate between acidotic (eight patients, 28.6%) and nonacidotic patients (12 patients, 32.4%) (P = 0.738). In-ICCU mortality rate did not differ between (13 patients, 35.1%) and nonacidotic patients (nine patients, 32.1%) (P = 0.801).Our data strongly suggest that in patients with severe ACPE treated with NIV, the presence of acidosis is not associated with adverse outcomes (early mortality and intubation rates) in these patients.

  15. Diagnosis, prevention and management of postoperative pulmonary edema.

    Science.gov (United States)

    Bajwa, Sj Singh; Kulshrestha, A

    2012-07-01

    Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

  16. Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema Uso da ventilação não invasiva no tratamento de pacientes com edema agudo de pulmão cardiogênico

    Directory of Open Access Journals (Sweden)

    Marcelo Park

    2006-06-01

    Full Text Available Current literature was searched by using the MEDLINE database to find consistent evidence regarding the use of noninvasive mechanical ventilation in patients with acute cardiogenic pulmonary edema. 18 studies demonstrating that noninvasive ventilation applied by continuous positive airway pressure (CPAP or bilevel positive airway pressure (bilevel-PAP is safe, and that the two approaches have similar effects and are effective in preventing endotracheal intubation in patients with respiratory distress of cardiac origin, were found. The results support the concept that positive intrathoracic positive pressure must be seen as a nonpharmacological form of treatment of acute pulmonary edema rather than only a supportive measure.Pesquisamos a literatura atual usando a base de dados MEDLINE para encontrar evidências consistentes sobre o uso da ventilação não invasiva em pacientes com edema agudo de pulmão cardiogênico. Foram encontrados 18 estudos demonstrando que a ventilação não invasiva aplicada por CPAP ou bilevel-PAP é segura, tem efeitos similares e é efetiva em reduzir a necessidade de intubação traqueal em pacientes com desconforto respiratório de origem cardíaca. Os resultados reforçam o conceito que a pressão positiva intratorácica deve ser considerada um forma não farmacológica de tratamento do edema agudo de pulmão cardiogênico e não simplesmente uma medida de suporte.

  17. Neurogenic pulmonary edema due to delayed radiation necrosis

    Directory of Open Access Journals (Sweden)

    Mani R

    2005-01-01

    Full Text Available Neurogenic pulmonary edema is oftten missed in the ICU setting as it is mistaken for pneumonia or ARDS. The case presented here illustrates how a high index of suspicion in the appropriate setting can lead to the diagnosis. The patient in this report developed acute-on-chronic cerebral edema due to radiation necrosis following gamma-knife radiation therapy for cerebral arteriovenous malformation.

  18. Mitral Valve Regurgitation Causing Right Upper Lobe Pulmonary Edema

    OpenAIRE

    Young, Andrew L.; Langston, Charles S.; Schiffman, Robert L.; Shortsleeve, Michael J.

    2001-01-01

    When radiography is performed in patients with mitral regurgitation, cardiogenic pulmonary edema is a typical finding; however, asymmetric pulmonary edema has also been reported. We describe the case of a patient in whom mitral valve regurgitation caused isolated pulmonary edema in the right upper lung. We include a discussion of pulmonary edema in conjunction with mitral regurgitation.

  19. Our patients followed up with a diagnosis of neurogenic pulmonary edema

    Science.gov (United States)

    Sarı, Mehmet Yusuf; Yıldızdaş, Rıza Dinçer; Yükselmiş, Ufuk; Horoz, Özden Ögür

    2015-01-01

    Neurogenic pulmonary edema is a clinical situation which developes as a result of central nervous system injury. It is rare in the childhood. Neurogenic pulmonary edema is a clinical diagnosis. Although the pathogenesis is not elucidated well, there is increase in pulmonary interstitial and alveolar fluid. The main principle in treatment of neurogenic pulmonary edema is supportive treatment and decreasing intracranial pressure as in acute respiratory distress syndrome. In this article, clinical properties of our two patients diagnosed with neurogenic pulmonary edema developed as a result of central nervous system injury are presented. PMID:26884694

  20. Our patients followed up with a diagnosis of neurogenic pulmonary edema.

    Science.gov (United States)

    Sarı, Mehmet Yusuf; Yıldızdaş, Rıza Dinçer; Yükselmiş, Ufuk; Horoz, Özden Ögür

    2015-12-01

    Neurogenic pulmonary edema is a clinical situation which developes as a result of central nervous system injury. It is rare in the childhood. Neurogenic pulmonary edema is a clinical diagnosis. Although the pathogenesis is not elucidated well, there is increase in pulmonary interstitial and alveolar fluid. The main principle in treatment of neurogenic pulmonary edema is supportive treatment and decreasing intracranial pressure as in acute respiratory distress syndrome. In this article, clinical properties of our two patients diagnosed with neurogenic pulmonary edema developed as a result of central nervous system injury are presented.

  1. Neurogenic Pulmonary Edema (A Case Report

    Directory of Open Access Journals (Sweden)

    Funda Gümüş

    2012-08-01

    Full Text Available Neurogenic pulmonary edema is a life threatening complication of severe central nervous system injury. The most common cause of neurogenic pulmonary edema is subarachnoid hemorrhage followed by head trauma and epilepsy. The rare causes are cervical spine trauma, multiplesclerosis, cerebellar hemorrhage and intracranial tumors. Neurogenic pulmonary edema is characterized by an increase in extravascular lung water in patients who have sustained a sudden change in neurologic condition. The exact pathophysiology is unclear but it probably involves an adrenergic response to the central nervous system injury which leads to increased catecholamine, pulmonary hydrostatic pressure and increased lung capillary permeability. The presenting symptoms are nonspecific and often include dyspnea, tachypnea, tachycardia, hypoxemia, pinkfroty secretion, bilateral pulmonary infiltrates and crackles. These symptoms start within minutes or hours and resolves 48-72 hours that typically for neurogenic pulmonary edema. Basic principles of treatment, surgical decompression, reduce intracranial pressure, controlled ventilation with suplemental oxygen, positive end expiratory pressure and diuresis. We report a case with neurogenic pulmonary edema that occured after head trauma. (Journal of the Turkish Society Intensive Care 2012; 10: 59-62

  2. Neurogenic pulmonary edema: successful treatment with IV phentolamine.

    Science.gov (United States)

    Davison, Danielle L; Chawla, Lakhmir S; Selassie, Leelie; Tevar, Rahul; Junker, Christopher; Seneff, Michael G

    2012-03-01

    Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant CNS insult. The cause is believed to be a surge of catecholamines that results in cardiopulmonary dysfunction. Although there are myriad case reports describing CNS events that are associated with this syndrome, few studies have identified specific treatment modalities. We present a case of NPE caused by an intracranial hemorrhage from a ruptured arteriovenous malformation. We uniquely document a rise and fall of serum catecholamine levels correlating with disease activity and a dramatic clinical response to IV phentolamine.

  3. Negative pressure pulmonary edema following choking on a cookie.

    Science.gov (United States)

    Toukan, Yazeed; Gur, Michal; Bentur, Lea

    2016-07-01

    A 12-year-old boy developed severe acute respiratory distress during a school break requiring resuscitative measures. The episode started shortly after a short choking episode with a cookie. History, physical examination, laboratory results, chest X-ray, and clinical course supported the diagnosis of negative pressure pulmonary edema (NPPE). NPPE occurring outside a hospital setting, especially following a short episode of choking on a cookie, is rarely reported in children. Understanding the pathophysiological mechanisms contributing to pulmonary edema can help in distinguishing NPPE from other causes of fulminant respiratory distress, and especially from other causes of noncardiogenic pulmonary edema. Pediatr Pulmonol. 2016;51:E25-E27. © 2016 Wiley Periodicals, Inc.

  4. Triazolam, obesity and non cardiac pulmonary edema

    Directory of Open Access Journals (Sweden)

    Fabio Di Stefano

    2012-12-01

    Full Text Available Introduction Triazolam belongs to the group of benzodiazepines and may have side effects on the respiratory system which include not only respiratory depression, but also transient benign non cardiac pulmonary edema.Case report A 52 year old obese woman developed pulmonary edema after she was taking triazolam for almost two weeks without any other medications. All possible cardiogenic and non cardiogenic causes were excluded. The condition was severe enough to require non invasive ventilation.Discussion This case differs from the other report of triazolam associated non cardiac pulmonary edema for its severity requiring non invasive ventilation. The pathogenetic mechanism is unknown. Despite the lack of objective evidence to explain pulmonary venous hypertensive changes in our case, we want to advice that triazolam should be used with caution in obese patients, as obesity might aggravate this described drug adverse reaction.

  5. Severe Tumor Lysis Syndrome and Acute Pulmonary Edema Requiring Extracorporeal Membrane Oxygenation Following Initiation of Chemotherapy for Metastatic Alveolar Rhabdomyosarcoma.

    Science.gov (United States)

    Sanford, Ethan; Wolbrink, Traci; Mack, Jennifer; Rowe, R Grant

    2016-05-01

    We present an 8-year-old male with metastatic alveolar rhabdomyosarcoma (ARMS) who developed precipitous cardiopulmonary collapse with severe tumor lysis syndrome (TLS) 48 hr after initiation of chemotherapy. Despite no detectable pulmonary metastases, acute hypoxemic respiratory failure developed, requiring extracorporeal membrane oxygenation (ECMO). Although TLS has been reported in disseminated ARMS, this singular case of life-threatening respiratory deterioration developing after initiation of chemotherapy presented unique therapeutic dilemmas. We review the clinical aspects of this case, including possible mechanisms of respiratory failure, and discuss the role of ECMO utilization in pediatric oncology.

  6. Interstitial Pulmonary Edema Following Bromocarbamide Intoxication

    Science.gov (United States)

    Sugihara, H.; Hagedorn, M.; Bōttcher, D.; Neuhof, H.; Mittermayer, Ch.

    1974-01-01

    Bromocarbamides are sleep-inducing drugs which can lead, in man, to intoxication and death due to respiratory failure. To prove whether hemodynamic factors or the changed endothelial permeability induce pulmonary edema, animal experiments were performed. The fine structural changes in pulmonary edema in rabbits were observed at 60, 90 and 120 minutes after oral administration. The major findings were a) large blebs between capillary endothelium and alveolar epithelium and b) interstitial edema of the vessel wall. The bleb contents were much less electron dense than the blood contents in the capillary. Colloidal carbon did not enter the bleb or the edematous interstitial tissue. Exogenous peroxidase uptake in pinocytotie vesicles increased in pathologic cases. The hemodynamic measurements in animal receiving artificial respiration which maintained the blood pO2 at a steady state showed similar blebs in the pulmonary vessels, indicating that anoxia is not the major cause of the vascular lesion. Moreover, pulmonary arterial pressure and pulmonary vascular resistance could be held in the normal range in artificially respirated animals under bromocarbamide intoxication. Thus, hemodynamic factors are not likely to play a pathogenetic role in bringing about pulmonary edema. The chief, early factor is the increased endothelial permeability due to increased cytoplasmic transport. From this a practical suggestion for treating patients with bromocarbamide intoxication is derived: the usual fluid replacement in shock patients should be handled with great care to avoid fluid overload of the lung. ImagesFig 1Fig 2Fig 3Fig 4Fig 5Fig 6 PMID:4835993

  7. Reexpansion pulmonary edema- A case report

    Directory of Open Access Journals (Sweden)

    Janmeja A

    2007-01-01

    Full Text Available A middle aged male presented to us with right side pneumothorax. Two hours after insertion of intercostals tube he felt discomfort and increased breathlessness. His chest examination showed crepitations. Chest radiograph showed partial expansion of right lung with opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively and improved with complete resolution on chest radiograph. Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and patho-genesis is unclear.

  8. Edema pulmonar pós-pneumonectomia Postpneumonectomy pulmonary edema

    Directory of Open Access Journals (Sweden)

    Marcos Naoyuki Samano

    2005-02-01

    Full Text Available A pneumonectomia, embora seja tecnicamente simples, está associada a alta incidência de complicações (cerca de 60%. As complicações respiratórias correspondem a aproximadamente 15% deste total. A mortalidade global dessa cirurgia é de 8,6%, mas em presença de complicações respiratórias, a taxa de mortalidade chega a 30%. O edema pulmonar pós-pneumonectomia é uma complicação rara (3% a 5%, mas muito grave, sendo fatal na maioria dos casos. Foi descrito pela primeira vez há pouco mais de vinte anos mas, apesar da gravidade alarmante, pouco sabemos acerca de sua fisiopatologia, embora muitas hipóteses tenham sido levantadas. Uma vez instalado, nenhuma medida é comprovadamente eficaz no seu tratamento. Vários fatores de risco estão associados ao aparecimento do edema pulmonar pós-pneumonectomia, dentre os quais a sobrecarga hídrica, que foi o primeiro fator evitado. Entretanto, muitos trabalhos mostram não haver relação direta entre o volume recebido e o desenvolvimento do edema. A prevenção é a melhor forma de evitá-lo e deve ser realizada de maneira multifatorial, envolvendo toda a equipe médica, desde o momento da anestesia até os cuidados cirúrgicos e na terapia intensiva. No entanto, tão importante quanto a prevenção, é a suspeita clínica precoce, identificando os pacientes em risco para essa grave complicação.Although pneumonectomy is a technically simple procedure, it has been associated with a high (60% incidence of complications. Respiratory complications account for approximately 15% of such complications. Worldwide, the mortality rate among patients subjected to pneumonectomy is 8.6%. However, the rate among patients developing respiratory complications is 30%. Although postpneumonectomy pulmonary edema is rare (occurring in 3% to 5% of cases, it is a serious complication and is almost always fatal. It was first described twenty years ago and, despite these alarming statistics, little is known

  9. 急性心源性肺水肿应用呼吸机的抢救效果%Rescue effect of ventilator on acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    马爱华

    2016-01-01

    Objective To investigate the effect of ventilator on acute cardiogenic pulmonary edema.Methods From December 2012 to June 2014, 64 patients with cardiogenic pulmonary edema were selected, ventilator was used in its rescue, combined with psychological nursing, postural care and respiratory management, observed the illness closely, prevented to dealing with complications.Results Breathing machine for 2 to 5 days, the condition of 60 patients were improved, 2 cases were replaced by the use of the face mask for tracheal intubation, while 2 cases of elderly patients with pulmonary infection due to poor drainage.Conclusions The rescue process in mind when hypoxemia in patients with pulmonary edema, early ventilator significantly improved therapeutic effect, but a series of patient care is to ensure the key to ventilator therapy.%目的 探讨急性心源性肺水肿应用呼吸机的抢救效果.方法 选取2012年12月至2014年6月心源性肺水肿患者64例,在其抢救过程中使用呼吸机,配合心理护理、体位护理以及呼吸道管理等,密切观察病情,预防和处理并发症.结果 呼吸机治疗2~5d,病情好转60例.2例因不配合使用面罩改为气管插管,2例高龄患者因排痰较差肺部感染改为气管插管辅助通气.结论 在心源性肺水肿患者抢救过程中出现低氧血症时,尽早使用呼吸机可提高治疗效果,而对患者的一系列护理则是保证呼吸机治疗的关键.

  10. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Keerthi Chigurupati

    2015-01-01

    Full Text Available We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.

  11. Pulmonary edema following transcatheter closure of atrial septal defect

    Science.gov (United States)

    Chigurupati, Keerthi; Reshmi, Liza Jose; Gadhinglajkar, Shrinivas; Venkateshwaran, S.; Sreedhar, Rupa

    2015-01-01

    We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation. PMID:26139760

  12. 产科发生急性肺水肿的相关因素分析%Analysis of related factors of acute pulmonary edema in obstetrics

    Institute of Scientific and Technical Information of China (English)

    周紫琼

    2016-01-01

    Objective To analyze the related factors of acute pulmonary edema( APE)in obstet-rics. Methods From January 2005 to June 2015 ,the clinical data of 1 575 cases of maternal were se-lected,according to different conditions,the patients were divided into APE group( n =75 )and non APE group( n=1 500 ). The factors of acute pulmonary edema were analyzed by using two Logistic re-gression analysis. Results By single factor and multi factor analysis,maternal twin pregnancy/ multiple pregnancy,pregnancy induced hypertension,peripar cardiomyopathy,organic heart disease,pulmonary infection,severe preeclampsia,chorioamnionitis,excessive fatigue,safety of the treatment of premature delivery and infusion of excess or over speed were the risks of APE ( P ﹤ 0. 05 ). Conclusions Focus on monitoring the heart and lung function,it is not over exertion,timely ending pregnancy,be careful expansion,it should strictly control the application of security,strengthening the management of transfusion is the fundamental measure to prevent the occurrence of APE.%目的:分析产科发生急性肺水肿( APE)的相关因素。方法选取2005年1月至2015年6月收治的产妇1575例,根据病情不同分为APE组(n=75)和非APE组(n=1500)。应用二分类Logistic回归分析方法对产科发生急性肺水肿相关因素进行分析。结果经单因素及多因素分析,产妇的双胎妊娠/多胎妊娠、妊娠高血压性心脏病、围生期心肌病、器质性心脏病、肺部感染、重度子痫前期、绒毛膜羊膜炎、过度疲劳、安宝治疗早产及输液过量或过速均是发生APE的独立危险因素(P﹤0.05)。结论重点监测心肺功能,勿过度劳累,适时终止妊娠,慎扩容,严格控制安宝应用,加强输液管理,是预防产科发生APE的根本措施。

  13. Cerebral edema associated with acute hepatic failure.

    Directory of Open Access Journals (Sweden)

    Fujiwara,Masachika

    1985-02-01

    Full Text Available The clinicopathological findings of cerebral edema were investigated in patients with acute hepatic failure autopsied at Okayama University Hospital between 1970 and 1980 retrospectively. Nine (64% of 14 hepatic failure cases were found to have cerebral edema during a post-mortem examination of the brain. Clinical features of the patients with cerebral edema were not significantly different from those of the patients without cerebral edema. However, general convulsions were observed more frequently in patients later found to have cerebral edema. Moreover, the length of time from deep coma to death was much shorter in the brain edema cases with cerebral herniation than without herniation.

  14. Noninvasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema%无创正压通气治疗急性心源性肺水肿疗效观察

    Institute of Scientific and Technical Information of China (English)

    关晶; 李建民

    2012-01-01

    目的:观察无创正压通气(noninvasive positive pressure ventilation,NPPV)治疗急性心源性肺水肿的疗效.方法:对急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV,2小时后观察心率和动脉血气分析的指标变化情况.结果:急性心源性肺水肿患者使用无创正压通气后,心率及动脉血气分析指标均较使用前有显著改善.结论:对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著.%Objective To observe the curative effect of noninvasive positive pressure ventilation (NPPV) in treatment of acute cardiogenic pulmonary edema. Methods patients with acute respiratory failure due to acute cardiogenic pulmonary edema were treated by NPPV. The variation of heart rate and the blood gas analysis were observed. Compared before treatment and 2 hours after treatment. Results The symptoms of the patients were significantly alleviated including heart rate and the blood gas analysis. Conclusion NPPV has therapeutic advantages and significant effect in treatment of acute respiratory failure due to acute cardiogenic pulmonary edema.

  15. Agents Which Mediate Pulmonary Edema

    Science.gov (United States)

    1990-12-01

    directly the effect of mediators in the lavage on pulmonary vascular endothelium using endothelial cell line methods, as well as isolated perfused lungs...inte;wvention and/or protection from pathological chang6s. 8 1 MATERIALS AND METHODS Bronchoalveolar Lavage: The lavage procedure was performed through...have changed our 14 I technique to the following: 1 ) animals are lightly anesthetized with 30 mg/kg sodium arnytal and a #7.5 - 8 F polyvinyl

  16. Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema

    Directory of Open Access Journals (Sweden)

    Dragoumanis Christos K

    2010-05-01

    Full Text Available Abstract Background Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE and right ventricular (RV systolic (Sm and diastolic (Em & Am tissue Doppler imaging (TDI velocities are related with duration of weaning in mechanically ventilated patients with acute respiratory failure due to acute pulmonary edema (APE. Methods Detailed quantification of left and right ventricular systolic and diastolic function was performed at admission to the Intensive Care Unit by Doppler echocardiography, in a cohort of 32 mechanically ventilated patients with APE. TAPSE and RV TDI velocities were compared between patients with and without prolonged weaning (≥ or Results Patients with prolonged weaning (n = 12 had decreased TAPSE (14.59 ± 1.56 vs 19.13 ± 2.59 mm, Sm (8.68 ± 0.94 vs 11.62 ± 1.77 cm/sec and Em/Am ratio (0.98 ± 0.80 vs 2.62 ± 0.67, p 2 = 0.53, beta slope = 0.76, p 2 = 0.52, beta = 0.75, p 2 = 0.57, beta = 0.32, p Conclusions We suggest that in mechanically ventilated patients with APE, low TAPSE and RV TDI velocities upon admission are associated with delayed liberation from mechanical ventilation, probably due to more severe LV heart failure.

  17. The protective effect of Rhodiala on the acute pulmonary edema in rat%红景天口服液对大鼠急性肺水肿的保护作用

    Institute of Scientific and Technical Information of China (English)

    李巧云; 李霞

    2001-01-01

    目的:通过大鼠急性肺水肿试验,了解红景天口服液有无抗急性肺水肿、降低肺动脉压的作用。方法:SD大鼠麻醉后,分离股动脉、颈动脉并分别插管,由示波器监测,记录正常血压、肺动脉压和造成急性肺水肿模型前、后各项指标的变化。结果:红景天口服液对急性肺水肿大鼠有明显的降低肺动脉压、减少肺含水量、维持大鼠正常血压、延长大鼠的生存时间等作用。结论:红景天口服液对急性肺水肿大鼠有明显的保护效果。%Objective: To observe effect of Rhodiala anti-acuta pulmonary edema and reduce pulmonary hypertension by test of acute pulmorarry edema in rats. Method: Femoral arteria artery and arteria carotis communis is detached, inserted plastic tube, normal blood pressure and plumonary artery pressure of rats are record by oseillograph keep watch on. Results: Rhodiala could obviously reduce the pulmonary artery pressure, pulmonary water content and maintain the normal blood pressure, prolong the survival time of rats of the acute pulmonary edema. Conclusion: Rhodiala has obvious protective effect for the acute pulmonary edema induced by Ad in rats.

  18. The evolution of scuba divers pulmonary edema.

    Science.gov (United States)

    Edmonds, Carl

    2016-01-01

    The evolution of scuba divers pulmonary edema is described. When discovered in 1981, it was believed to be a cold-induced response in a submerged, otherwise healthy, scuba diver. The clinical features are described and discussed, as are the demographics. An alleged prevalence of 1.1% was complicated by problematic statistics and an apparent increase in reported cases. Recurrences both while diving and swimming or snorkeling were common. More recent case reports and surveys are described, identifying predisposing factors and associations, including cardiac pathology. Stress cardiomyopathies, reversible myocardial disorder or Takotsubo cardiomyopathy, may complicate the presentation, especially in older females. Relevant cardiac investigations and autopsy findings are reviewed. Disease severity and potential lethality of scuba divers pulmonary edema became more apparent early this century, and these influence our current recommendations to survivors. First aid and treatment are also discussed.

  19. Postobstructive pulmonary edema after biopsy of a nasopharyngeal mass

    Science.gov (United States)

    Mehta, Keyur Kamlesh; Ahmad, Sabina Qureshi; Shah, Vikas; Lee, Haesoon

    2015-01-01

    We describe a case of 17 year-old male with a nasopharyngeal rhabdomyosarcoma who developed postobstructive pulmonary edema (POPE) after removing the endotracheal tube following biopsy. He developed muffled voice, rhinorrhea, dysphagia, odynophagia, and difficulty breathing through nose and weight loss of 20 pounds in the preceding 2 months. A nasopharyngoscopy revealed a fleshy nasopharyngeal mass compressing the soft and hard palate. Head and neck MRI revealed a large mass in the nasopharynx extending into the bilateral choana and oropharynx. Biopsy of the mass was taken under general anesthesia with endotracheal intubation. Immediately after extubation he developed oxygen desaturation, which did not improve with bag mask ventilation with 100% of oxygen, but improved after a dose of succinylcholine. He was re-intubated and pink, frothy fluid was suctioned from the endotracheal tube. Chest radiograph (CXR) was suggestive of an acute pulmonary edema. He improved with mechanical ventilation and intravenous furosemide. His pulmonary edema resolved over the next 24 h. POPE is a rare but serious complication associated with upper airway obstruction. The pathophysiology of POPE involves hemodynamic changes occurring in the lung and the heart during forceful inspiration against a closed airway due to an acute or chronic airway obstruction. This case illustrates the importance of considering the development of POPE with general anesthesia, laryngospasm and removal of endotracheal tube to make prompt diagnosis and to initiate appropriate management. PMID:26744691

  20. Postobstructive pulmonary edema after biopsy of a nasopharyngeal mass

    Directory of Open Access Journals (Sweden)

    Keyur Kamlesh Mehta

    2015-01-01

    Full Text Available We describe a case of 17 year-old male with a nasopharyngeal rhabdomyosarcoma who developed postobstructive pulmonary edema (POPE after removing the endotracheal tube following biopsy. He developed muffled voice, rhinorrhea, dysphagia, odynophagia, and difficulty breathing through nose and weight loss of 20 pounds in the preceding 2 months. A nasopharyngoscopy revealed a fleshy nasopharyngeal mass compressing the soft and hard palate. Head and neck MRI revealed a large mass in the nasopharynx extending into the bilateral choana and oropharynx. Biopsy of the mass was taken under general anesthesia with endotracheal intubation. Immediately after extubation he developed oxygen desaturation, which did not improve with bag mask ventilation with 100% of oxygen, but improved after a dose of succinylcholine. He was re-intubated and pink, frothy fluid was suctioned from the endotracheal tube. Chest radiograph (CXR was suggestive of an acute pulmonary edema. He improved with mechanical ventilation and intravenous furosemide. His pulmonary edema resolved over the next 24 h. POPE is a rare but serious complication associated with upper airway obstruction. The pathophysiology of POPE involves hemodynamic changes occurring in the lung and the heart during forceful inspiration against a closed airway due to an acute or chronic airway obstruction. This case illustrates the importance of considering the development of POPE with general anesthesia, laryngospasm and removal of endotracheal tube to make prompt diagnosis and to initiate appropriate management.

  1. The clinical application of pulmonary vascular permeability index on differential diagnosis of acute pulmonary edema%肺血管通透性指数对急性肺水肿鉴别诊断价值初探

    Institute of Scientific and Technical Information of China (English)

    杨从山; 谢剑锋; 莫敏; 刘松桥; 黄英姿; 邱海波; 杨毅

    2011-01-01

    目的 探讨肺血管通透性指数(PVPI)在急性肺水肿鉴别诊断中的价值.方法 选2004年5月至2008年9月收住东南大学附属中大医院重症医学科,留置脉搏指示连续心排血量(PiCCO)导管,氧合指数[PaO2/吸入氧浓度(FiO2)]<300 mm Hg(1 mm Hg=0.133 kPa)且血管外肺水指数(EVLWI)≥7 ml/kg的急性肺水肿患者,分为急性肺损伤(ALI)组和心源性肺水肿组,观察PVPI、胸腔内血容量指数(ITBVI)、肺血容量(PBV)、血管外肺水(EVLW)/胸腔内血容量(ITBV)在2组中的变化与差异.结果 (1)34例患者纳入研究,其中ALI 22例,心源性肺水肿12例;(2)ALI组PVPI为2.7±1.4,心源性肺水肿组为1.9±0.6,2组比较,P<0.05.EVLWI、ITBVI在2组间差异无统计学意义(P>0.05);(3)PVPI与EVLWI呈正相关(r=0.762,P=0.000),与PaO2/FiO2呈负相关(r=-0.478,P=0.012);(4)纳入患者中肺内原因ARDS 8例,肺外原因ARDS 5例,肺外原因ARDS患者PVPI、EVLW/ITBV和EVLWI显著高于肺内原因ARDS患者.结论 PVPI有助于对重症患者肺水肿类型的鉴别.%Objective To assess the value of pulmonary vascular permeability index in differentiating acute lung injury (ALI) from cardiac pulmonary edema. Methods Critically ill patients with acute pulmonary edema were included from May, 2004 to September, 2008. Patients were divided into two groups, the ALI group and the cardiac pulmonary edema group (C group). Pulmonary vascular permeability index (PVPI) , intrathoracic blood volume (ITBVI) were determined by pulse indicator continuous cardiac output(PiCCO) system. Results ( 1 ) Thirty-four patients were enrolled, 22 cases in ALI group and 12 cases in C group. (2) The PVPI in patients of ALI group (2.7 ± 1.4) was higher than that of C group (1.9 ±0.6 ;P<0.05). EVLWI and ITBVI did not have the significant difference between the two groups (P >0. 05). (3) PVPI was positively correlated with EVLWI(r = 0. 762) , negatively correlated with PaO2/ FiO2(r= -0.478). (4)ARDS was diagnosed

  2. Radiological diagnosis of pulmonary edema in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Tret' yakov, A.E. (Tsentral' naya Klinicheskaya Bol' nitsa, Moscow (USSR))

    Pulmonary edema has been revealed in 132 patients (51.6 %) during radiologic examination of 256 patients with chronic renal failure. The performance of anterio-posterior chest radiographs was in most cases necessary and quite sufficient for making diagnostic conclusions. Follow up study of patients with pulmonary edema and analysis of radiologic picture of the alterations permitted physicians to distinguish approximately 3 stages of the process development, which transit from one into another. Stage 1 involves early disorders and prodromes of pulmonary edema; Stage 2 interstitial lung edema; Stage 3 alveolar edema. The circulation enforcement of the upper lobar vessels has been the main feature of stage 1. Radiogramometry provided additional information for the pulmonary edema diagnosis. For instance, cardioradiometric data are useful for pulmonary edema diagnosis and evidence in favour of its close connection with heart disorders.

  3. Subclinical high altitude pulmonary edema:A clinical observation of 12 cases in Yushu

    Institute of Scientific and Technical Information of China (English)

    Li Shuzhi; Zheng Bihai; Wu Tianyi; Chen Huixing; Zhang Ming

    2013-01-01

    During the Yushu Earthquake on April 14,2010,a high incidence of acute high altitude illness was observed in the mountain rescuers,and 0.73 % of these patients suffered from high altitude pulmonary edema,of which 12 patients developed subclinical pulmonary edema and concomitantly contracted acute mountain sickness.Symptoms and signs were atypically high heart rate with high respiratory rate,striking cyanosis,and significantly low oxygen saturation,whereas no moist rates were heard on auscultation,and Chest X-ray showed peripheral with a patchy distribution of mottled infiltrations in one or both lung fields.We believe that subclinical high altitude pulmonary edema is an earliest stage of pulmonary edema at high altitude.The possible pathogenesis and the diagnosis were discussed.

  4. Pulmonary Edema and Myocarditis Developing Due to Scorpion Stings

    Directory of Open Access Journals (Sweden)

    Sevdegul Karadas

    2015-11-01

    Full Text Available Although most of the scorpion stings are harmless, deadly species of scorpions may cause multiorgan failure, neurotoxicity, cardiotoxicity, and pulmonary edema. The cases should be observed in the emergency department against the possibility of development of systemic effects. Fatal complications, in particular such as pulmonary edema, and myocarditis should be considered. In this study, a case of myocarditis and pulmonary edema was detected on the patient who had applied to the emergency department due to a scorpion sting is presented.

  5. Edema agudo pulmonar associado à obstrução das vias aéreas: relato de caso Edema agudo pulmonar asociado a la obstrucción de las vías aéreas: relato de caso Acute pulmonary edema associated with obstruction of the airways: case report

    Directory of Open Access Journals (Sweden)

    Flora Margarida Barra Bisinotto

    2008-04-01

    developed acute pulmonary edema after extubation. CASE REPORT: A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatment consisted of elevation of the head, administration of oxygen via a face mask, furosemide and fluid restriction. Chest X-ray was compatible with acute pulmonary edema and normal cardiac area. Electrocardiogram (ECG, echocardiogram and cardiac enzymes were normal. The condition of the patient improved and she was discharged from the hospital the following day, asymptomatic. CONCLUSIONS: Acute pulmonary edema associated with obstruction of the upper airways can aggravate surgical procedures with low morbidity, affecting mainly young patients. Early treatment should be instituted because it has a fast evolution and, in most cases, resolves without lasting damages.

  6. Pulmonary tissue volume in dogs during pulmonary edema.

    Science.gov (United States)

    Peterson, B T; Petrini, M F; Hyde, R W; Schreiner, B F

    1978-05-01

    Pulmonary tissue volume (Vt) and pulmonary capillary blood flow (Qc) were measured in anesthetized dogs by analyzing end-expiratory concentrations of dimethyl ether (DME), acetylene (C2H2), and sulfur hexafluoride during a 30-s rebreathing maneuver. Vt was compared to the postmortem lung weight of control dogs and dogs with hemodynamic and nonhemodynamic (alloxan) pulmonary edema. Qc was compared to the cardiac output measured by dye dilution. A 100-ml increase in alveolar volume (VA) in the range of 1-2 liters resulted in a 9 +/- 3 ml increase in Vt. Vt measured at a VA of 1.9 liters measures 114 +/- 18% of the postmortem lung weight in 20 control dogs and in 6 dogs with moderate edema (lung weight smae mean values of Vt, but the reproducibility of a series of 3-7 measurements was greater with DME (coefficient of variation was 5% with DME and 8% C2H2). Qc measured 96 +/ 15% of the cardiac output during the rebreathing maneuver, but the maneuver caused a 4-40% fall in the cardiac output. These data show that Vt determined by rebreathing DME is between 86% and 135% of the lung weight in dogs with pulmonary edema until the lung weight is greater than 250% of the predicted value.

  7. Smoke aldehyde component influences pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Hales, C.A.; Musto, S.W.; Janssens, S.; Jung, W.; Quinn, D.A.; Witten, M. (Department of Medicine (Pulmonary/Critical Care Unit), Massachusetts General Hospital, Boston (United States))

    1992-02-01

    The pulmonary edema of smoke inhalation is caused by the toxins of smoke and not the heat. We investigated the potential of smoke consisting of carbon in combination with either acrolein or formaldehyde (both common components of smoke) to cause pulmonary edema in anesthetized sheep. Seven animals received acrolein smoke, seven animals received a low-dose formaldehyde smoke, and five animals received a high-dose formaldehyde smoke. Pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac output were not affected by smoke in any group. Peak airway pressure increased after acrolein (14 +/- 1 to 21 +/- 2 mmHg; P less than 0.05) and after low- and high-dose formaldehyde (14 +/- 1 to 21 +/- 1 and 20 +/- 1 mmHg, respectively; both P less than 0.05). The partial pressure of O2 in arterial blood fell sharply after acrolein (219 +/- 29 to 86 +/- 9 (SE) Torr; P less than 0.05) but not after formaldehyde. Only acrolein resulted in a rise in lung lymph flow (6.5 +/- 2.2 to 17.9 +/- 2.6 ml/h; P less than 0.05). Lung lymph-to-plasma protein ratio was unchanged for all three groups, but clearance of lymph protein was increased after acrolein. After acrolein, the blood-free extravascular lung water-to-lung dry weight ratio was elevated (P less than 0.05) compared with both low- and high-dose formaldehyde groups (4.8 +/- 0.4 to 3.3 +/- 0.2 and 3.6 +/- 0.2, respectively). Lymph clearance (ng/h) of thromboxane B2, leukotriene B4, and the sulfidopeptide leukotrienes was elevated after acrolein but not formaldehyde.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Histoplasmosis - acute (primary) pulmonary

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000098.htm Histoplasmosis - acute (primary) pulmonary To use the sharing features on this page, please enable JavaScript. Acute pulmonary histoplasmosis is a respiratory infection that is caused by ...

  9. Negative Pressure Pulmonary Edema After Extubation in Appendectomy: Case Report

    Directory of Open Access Journals (Sweden)

    Tarik Purtuloglu

    2016-01-01

    Full Text Available Negative pressure pulmonary edema (NPPE is a rare complication that can occur after acute upper airway obstruction or secondary to relax chronic upper airway obstruction and a life-threatening fatal condition. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglottitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors. Supportive therapy is usually the only treatment. The fundamental principle of treatment is early diagnosis and to provide adequate oxygenation. Application of positive airway pressure is often provided with CPAP in most of patients, but sometimes re-intubation and mechanical ventilation may be required.

  10. Effect of zinc on acute pulmonary edema and changes of essential metal contents produced by nitrogen dioxide exposure to mice

    Energy Technology Data Exchange (ETDEWEB)

    Yamane, Y.; Mimura, S.; Sakai, K.; Yamane, Y. (Chiba Univ., Chiba (Japan). Faculty of Pharmaceutical Sciences); Ito, M. (Chiba Prefectural Government, Chiba (Japan))

    1992-01-10

    This is a report on the protective effect of zinc (Zn) pretreatment of mice against lung edema caused by high-level, short-term NO{sub 2} exposure. There were significant increases of Fe content at 15ppm NO{sub 2}, Ca at 25ppm NO{sub 2}, Ca and Cu at 35ppm NO{sub 2}, and Ca and Zn at 40 and 50ppm NO{sub 2}. Zn pretreatment inhibited significantly the augmentation of Fe at 15ppm NO{sub 2}, that of Cu at 35ppm NO{sub 2}, and that of Ca at 25 to 50ppm NO{sub 2} exposure. The Ca content in serum at 25 to 50ppm NO{sub 2} exposure showed a significant decrease, and the decrease was significantly suppressed by Zn pretreatment. The ratio of Ca content in serum to that in lung was also decreased significantly at 25 to 50ppm NO{sub 2} exposure, and the decrease of the ratio was significantly suppressed by Zn pretreatment. Zn seems to depress the influx of serum Ca to lung caused by NO{sub 2} exposure. 26 refs., 4 tabs.

  11. New Compton densitometer for measuring pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Loo, B.W.; Goulding, F.S.; Simon, D.S.

    1985-10-01

    Pulmonary edema is the pathological increase of extravascular lung water found most often in patients with congestive heart failure and other critically ill patients who suffer from intravenous fluid overload. A non-invasive lung density monitor that is accurate, easily portable, safe and inexpensive is needed for clinical evaluation of pulmonary edema. Other researchers who have employed Compton scattering techniques generally used systems of extended size and detectors with poor energy resolution. This has resulted in significant systematic biases from multiply-scattered photons and larger errors in counting statistics at a given radiation dose to the patient. We are proposing a patented approach in which only backscattered photons are measured with a high-resolution HPGe detector in a compact system geometry. By proper design and a unique data extraction scheme, effects of the variable chest wall on lung density measurements are minimized. Preliminary test results indicate that with a radioactive source of under 30 GBq, it should be possible to make an accurate lung density measurement in one minute, with a risk of radiation exposure to the patient a thousand times smaller than that from a typical chest x-ray. The ability to make safe, frequent lung density measurements could be very helpful for monitoring the course of P.E. at the hospital bedside or outpatient clinics, and for evaluating the efficacy of therapy in clinical research. 6 refs., 5 figs.

  12. Pulmonary tissue volume in dogs during pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, B.T.; Petrini, M.F.; Hyde, R.W.; Schreiner, B.F.

    1978-01-01

    Pulmonary tissue volume (Vt) and pulmonary capillary blood flow (Qc) were measured in anesthetized dogs by analyzing end-expiratory concentrations of dimethyl ether (DME), acetylene (C/sub 2/H/sub 2/), and sulfur hexafluoride during a 30-s rebreathing maneuver. Vt was compared to the postmortem lung weight of control dogs and dogs with hemodynamic and nonhemodynamic (alloxan) pulmonary edema. Qc was compared to the cardiac output measured by dye dilution. A 100 ml increase in alveolar volume (Va) in the range of 1 to 2 liters resulted in a 9 +- 3 ml increase in Vt. Vt measured at a Va of 1.9 liters measures 114 +- 18% of the postmortem lung weight in 20 control dogs and in 6 dogs with moderate edema (lung weight <250% of predicted). Vt measured only 53 +- 14% of the lung weight in 11 dogs with more severe edema. DME and C/sub 2/H/sub 2/ gave the same mean values of Vt, but the reproducibility of a series of 3 to 7 measurements was greater with DME (coefficient of variation was 5% with DME and 8% C/sub 2/H/sub 2/). Qc measured 96 +- 15% of the cardiac output during the rebreathing maneuver, but the maneuver caused a 4 to 40% fall in the cardiac output. These data show that Vt determined by rebreathing DME is between 86% and 135% of the lung weight in dogs with pulmonary edema until the lung weight is greater than 250% of the predicted value.

  13. Clinical efficacy observation of noninvasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema%无创正压通气治疗急性心源性肺水肿的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈占伟

    2014-01-01

    目的:观察无创正压通气( NPPV)治疗急性心源性肺水肿的临床疗效。方法对48例急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV,观察治疗期间心率和经皮血氧饱和度的变化,比较治疗前及治疗后2 h血气情况。结果急性心源性肺水肿患者治疗后2h缺氧症状得到明显改善,心悸、呼吸困难及紫绀明显好转,心功能评级明显降低(P﹤0.01)。结论对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著,具有良好的临床实用价值,值得推广。%Objective To observe the clinical effect of noninvasive positive pressure ventilation( NPPV)on acute cardiogenic pulmonary edema. Methods Forty-eight patients with acute respiratory failure due to acute cardiogenic pulmonary edema were treated by NPPV. The variation of heart rate and percutaneous oxygen saturation were observed. The blood gas analysis was com-pared before treatment and 2 hours after treatment. Results The symptoms of the patients were significantly alleviated including hypoxia,heart palpitations,breathing difficulties and cyanosis,and the NYHA decreased significantly( P﹤0. 01 ). Conclusion NPPV has therapeutic advantages and significant effect in the treatment of acute respiratory failure due to acute cardiogenic pul-monary edema. It is of certain clinical value and is worth popularizing.

  14. An orally active TRPV4 channel blocker prevents and resolves pulmonary edema induced by heart failure.

    Science.gov (United States)

    Thorneloe, Kevin S; Cheung, Mui; Bao, Weike; Alsaid, Hasan; Lenhard, Stephen; Jian, Ming-Yuan; Costell, Melissa; Maniscalco-Hauk, Kristeen; Krawiec, John A; Olzinski, Alan; Gordon, Earl; Lozinskaya, Irina; Elefante, Lou; Qin, Pu; Matasic, Daniel S; James, Chris; Tunstead, James; Donovan, Brian; Kallal, Lorena; Waszkiewicz, Anna; Vaidya, Kalindi; Davenport, Elizabeth A; Larkin, Jonathan; Burgert, Mark; Casillas, Linda N; Marquis, Robert W; Ye, Guosen; Eidam, Hilary S; Goodman, Krista B; Toomey, John R; Roethke, Theresa J; Jucker, Beat M; Schnackenberg, Christine G; Townsley, Mary I; Lepore, John J; Willette, Robert N

    2012-11-01

    Pulmonary edema resulting from high pulmonary venous pressure (PVP) is a major cause of morbidity and mortality in heart failure (HF) patients, but current treatment options demonstrate substantial limitations. Recent evidence from rodent lungs suggests that PVP-induced edema is driven by activation of pulmonary capillary endothelial transient receptor potential vanilloid 4 (TRPV4) channels. To examine the therapeutic potential of this mechanism, we evaluated TRPV4 expression in human congestive HF lungs and developed small-molecule TRPV4 channel blockers for testing in animal models of HF. TRPV4 immunolabeling of human lung sections demonstrated expression of TRPV4 in the pulmonary vasculature that was enhanced in sections from HF patients compared to controls. GSK2193874 was identified as a selective, orally active TRPV4 blocker that inhibits Ca(2+) influx through recombinant TRPV4 channels and native endothelial TRPV4 currents. In isolated rodent and canine lungs, TRPV4 blockade prevented the increased vascular permeability and resultant pulmonary edema associated with elevated PVP. Furthermore, in both acute and chronic HF models, GSK2193874 pretreatment inhibited the formation of pulmonary edema and enhanced arterial oxygenation. Finally, GSK2193874 treatment resolved pulmonary edema already established by myocardial infarction in mice. These findings identify a crucial role for TRPV4 in the formation of HF-induced pulmonary edema and suggest that TRPV4 blockade is a potential therapeutic strategy for HF patients.

  15. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Singhi Anil

    2010-01-01

    Full Text Available Pulmonary edema after device closure of atrial septal defect (ASD is a rare complication. We present illustrative images of a case of pulmonary edema after device closure of ASD in a 53 year old adult. Older patients undergoing ASD closure can benefit from their left atrial and left ventricular end diastolic pressures measurement before and after temporary balloon occlusion of ASD.

  16. Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction?

    Directory of Open Access Journals (Sweden)

    Asaad Akbar Khan

    2015-01-01

    Full Text Available Flash pulmonary edema is characteristically sudden in onset with rapid resolution once appropriate therapy has been instituted (Messerli et al., 2011. Acute increase of left ventricular (LV end diastolic pressure is the usual cause of sudden decompensated cardiac failure in this patient population. Presence of bilateral renal artery stenosis or unilateral stenosis in combination with a single functional kidney in the susceptible cohort is usually blamed for this condition. We describe a patient who presented with flash pulmonary edema in the setting of normal coronary arteries. Our case is distinct as our patient developed flash pulmonary edema secondary to unilateral renal artery stenosis in the presence of bilateral functioning kidneys. Percutaneous stent implantation in the affected renal artery resulted in rapid resolution of pulmonary edema.

  17. Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction?

    Science.gov (United States)

    Khan, Asaad Akbar; McFadden, Eugene Patrick

    2015-01-01

    Flash pulmonary edema is characteristically sudden in onset with rapid resolution once appropriate therapy has been instituted (Messerli et al., 2011). Acute increase of left ventricular (LV) end diastolic pressure is the usual cause of sudden decompensated cardiac failure in this patient population. Presence of bilateral renal artery stenosis or unilateral stenosis in combination with a single functional kidney in the susceptible cohort is usually blamed for this condition. We describe a patient who presented with flash pulmonary edema in the setting of normal coronary arteries. Our case is distinct as our patient developed flash pulmonary edema secondary to unilateral renal artery stenosis in the presence of bilateral functioning kidneys. Percutaneous stent implantation in the affected renal artery resulted in rapid resolution of pulmonary edema. PMID:25793128

  18. 神经源性肺水肿%Neurogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    孙若鹏; 赵翠芬

    2008-01-01

    @@ Neurogenic pulmonary edema (NPE) is a type of pulmonary edema that occurs secondary to central nervous sytem (CNS) damage, namely centrogenic pulmonary edema or cerebrogenic pulmonary edema[1,2] NPE is clinically characterized by acute dyspnea and progressive hypoxemia, while tachycardia, hypertension and tachypnea are only nonspecific symptoms in early phase. Early diagnosis of NPE is difficult since chest X-ray shows no remarkable sign or only increased hazy lung markings in early stage[3]. Diagnosis can be made definitely in the late stage of NPE according to the following manifestation : paleness, clamminess, feeling of impending death, rales, frothy pink sputum, hypoxemia and bilateral widespread infiltration on chest roentgenography. However, successful rescue rate is very low and mortality rate could reach as high as 90% at this stage[4-6].

  19. Edema pulmonar de gran altura HIGH ALTITUDE PULMONARY EDEMA

    OpenAIRE

    FELIPE UNDURRAGA M.; ALVARO UNDURRAGA P

    2003-01-01

    Las enfermedades de altura son de causa cerebral y pulmonar. Las primeras se refieren fundamentalmente al mal agudo de montaña y al edema cerebral de altura y las segundas al edema pulmonar agudo de montaña. Actuales evidencias señalan que el edema cerebral sería un fenómeno universal de los que ascienden a altura y que tres de cada cuatro individuos sanos que se expongan a altura desarrollarán un edema pulmonar agudo de montaña subclínico. La hipoxia de altura es la responsable de estos cuad...

  20. Noncardiac Pulmonary Edema induced by Sitagliptin Treatment

    Science.gov (United States)

    Belice, Tahir; Yuce, Suleyman; Kizilkaya, Bayram; Kurt, Aysel; Cure, Erkan

    2014-01-01

    A 74-year-old male patient with type 2 diabetes mellitus admitted to the emergency department with the complaints of progressive breathlessness, dry cough, and swollen lower extremities. Our patient had type 2 diabetes mellitus and hypertension for 3 years. His HbA1c was not within the target range so sitagliptin was added to on-going therapy. After 1 week of starting sitagliptin therapy, even though the patient had not heart failure he applied to the emergency department with a complaint of dyspnea. The cardiovascular safety and efficacy of many anti-hyperglycemic agents such as sitagliptin, saxagliptin are unclear. Our case has shown that dipeptidyl peptidase 4 inhibitors may cause pulmonary edema. Hence, it should be used with cautious, especially in patients with heart failure. PMID:25657966

  1. Serotonin syndrome presenting as pulmonary edema

    Directory of Open Access Journals (Sweden)

    Nilima Deepak Shah

    2016-01-01

    Full Text Available Serotonin syndrome (SS is a potentially life-threatening condition resulting from excessive central and peripheral serotonergic activity. Clinically, it is a triad of mental-status changes, neuromuscular abnormalities, and autonomic disturbances. It can be caused by intentional self-poisoning, overdose, or inadvertent drug interactions. We report the case of a 58-year-old male with type 2 diabetes mellitus and obsessive compulsive disorder who developed pulmonary edema as a possible complication of SS. SS was caused by a combination of three specific serotonin re-uptake inhibitors (fluoxetine, fluvoxamine, and sertraline, linezolid, and fentanyl. The hospital course was further complicated by difficult weaning from the ventilator. SS was identified and successfully treated with cyproheptadine and lorazepam. The case highlights the importance of effective consultation-liaison and prompt recognition of SS as the presentation may be complex in the presence of co-morbid medical illness.

  2. Serotonin syndrome presenting as pulmonary edema

    Science.gov (United States)

    Shah, Nilima Deepak; Jain, Ajay B.

    2016-01-01

    Serotonin syndrome (SS) is a potentially life-threatening condition resulting from excessive central and peripheral serotonergic activity. Clinically, it is a triad of mental-status changes, neuromuscular abnormalities, and autonomic disturbances. It can be caused by intentional self-poisoning, overdose, or inadvertent drug interactions. We report the case of a 58-year-old male with type 2 diabetes mellitus and obsessive compulsive disorder who developed pulmonary edema as a possible complication of SS. SS was caused by a combination of three specific serotonin re-uptake inhibitors (fluoxetine, fluvoxamine, and sertraline), linezolid, and fentanyl. The hospital course was further complicated by difficult weaning from the ventilator. SS was identified and successfully treated with cyproheptadine and lorazepam. The case highlights the importance of effective consultation-liaison and prompt recognition of SS as the presentation may be complex in the presence of co-morbid medical illness. PMID:26997733

  3. Unilateral pulmonary edema after laparoscopic nephrectomy

    Directory of Open Access Journals (Sweden)

    Shreepathi Krishna Achar

    2011-01-01

    Full Text Available Unilateral-dependent pulmonary edema though reported in laparoscopic donor nephrectomies, has not been reported after laparoscopic non-donor nephrectomies. A 75-kg, 61-year-old man, a diagnosed case of right renal cell carcinoma was scheduled for laparoscopic nephrectomy. After establishing general anesthesia, the patient was positioned in the left-sided modified kidney (flank position. During the 5.75-hour procedure, he was hemodynamically stable except for a transient drop in blood pressure immediately after positioning. Intra-abdominal pressure was maintained less than 15 mmHg throughout the procedure. Blood loss was approximately 50 mL and urine output was 100 mL in the first hour followed by a total of 20 mL in the next 4.75 hours. Total fluid received during the procedure included 1.5 L of Ringer′s lactate and 1.0 L of 6% hydroxyethyl starch. After an uneventful procedure he developed respiratory distress in the postoperative period with a radiological evidence of dependent lung edema. Clinical and radiological improvement followed noninvasive ventilation, intravenous diuretics and oxygen therapy.

  4. Neurogenic Pulmonary Edema in Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Saracen, A; Kotwica, Z; Woźniak-Kosek, A; Kasprzak, P

    2016-01-01

    Neurogenic pulmonary edema (NPE) is observed in cerebral injuries and has an impact on treatment results, being a predictor of fatal prognosis. In this study we retrospectively reviewed medical records of 250 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) for the frequency and treatment results of NPE. The following factors were taken under consideration: clinical status, aneurysm location, presence of NPE, intracranial pressure (ICP), and mortality. All patients had plain- and angio-computer tomography performed. NPE developed most frequently in case of the aneurysm located in the anterior communicating artery. The patients with grades I-III of SAH, according to the World Federation of Neurosurgeons staging, were immediately operated on, while those with poor grades IV and V had only an ICP sensor's implantation procedure performed. A hundred and eighty five patients (74.4 %) were admitted with grades I to III and 32 patients (12.8 %) were with grade IV and V each. NPE was not observed in SAH patients with grade I to III, but it developed in nine patients with grade IV and 11 patients with grade V. Of the 20 patients with NPE, 19 died. Of the 44 poor grade patients (grades IV-V) without NPE, 20 died. All poor grade patients had elevated ICP in a range of 24-56 mmHg. The patients with NPE had a greater ICP than those without NPE. Gender and age had no influence on the occurrence of NPE. We conclude that the development of neurogenic pulmonary edema in SAH patients with poor grades is a fatal prognostic as it about doubles the death rate to almost hundred percent.

  5. [Cardiogenic and non cardiogenic pulmonary edema: pathomechanisms and causes].

    Science.gov (United States)

    Glaus, T; Schellenberg, S; Lang, J

    2010-07-01

    The development of pulmonary edema is divided in cardiogenic and non-cardiogenic. Cardiogenic edema pathogenically is caused by elevated hydrostatic pressure in the pulmonary capillaries due to left sided congestive heart failure. Non-cardiogenic pulmonary edema is categorized depending on the underlying pathogenesis in low-alveolar pressure, elevated permeability or neurogenic edema. Some important examples of causes are upper airway obstruction like in laryngeal paralysis or strangulation for low alveolar pressure, leptospirosis and ARDS for elevated permeability, and epilepsy, brain trauma and electrocution for neurogenic edema. The differentiation between cardiogenic versus non-cardiogenic genesis is not always straightforward, but most relevant, because treatment markedly differs between the two. Of further importance is the identification of the specific underlying cause in non-cardiogenic edema, not only for therapeutic but particularly for prognostic reasons. Depending on the cause the prognosis ranges from very poor to good chance of complete recovery.

  6. Profiling of ARDS Pulmonary Edema Fluid Identifies a Metabolically Distinct Subset.

    Science.gov (United States)

    Rogers, Angela J; Contrepois, Kevin; Wu, Manhong; Zheng, Ming; Peltz, Gary; Ware, Lorraine B; Matthay, Michael A

    2017-03-03

    There is considerable biologic and physiologic heterogeneity among patients who meet standard clinical criteria for acute respiratory distress syndrome (ARDS). In this study, we tested the hypothesis that there exists a sub-group of ARDS patients who exhibit a metabolically distinct profile. We examined undiluted pulmonary edema fluid obtained at the time of endotracheal intubation from 16 clinically phenotyped ARDS patients and 13 control patients with hydrostatic pulmonary edema. Non-targeted metabolic profiling was carried out on the undiluted edema fluid. Univariate and multivariate statistical analyses including principal components analysis (PCA) and partial least squares discriminant analysis (PLSDA) were conducted to find discriminant metabolites. 760 unique metabolites were identified in the pulmonary edema fluid of these 29 patients. We found that a subset of ARDS patients (6/16, 38%) presented a distinct metabolic profile with the overrepresentation of 235 metabolites compared to edema fluid from the other 10 ARDS patients, whose edema fluid metabolic profile was indistinguishable from those of the 13 control patients with hydrostatic edema. This "high metabolite" endotype was characterized by higher concentrations of metabolites belonging to all of the main metabolic classes including lipids, amino acids, and carbohydrates. This distinct group with high metabolite levels in the edema fluid was also associated with a higher mortality rate. Thus, metabolic profiling of the edema fluid of ARDS patients supports the hypothesis that there is considerable biologic heterogeneity among ARDS patients who meet standard clinical and physiologic criteria for ARDS.

  7. 急性脑损伤继发神经源性肺水肿%Neurogenic pulmonary edema secondary to acute central nervous system injury

    Institute of Scientific and Technical Information of China (English)

    梁锦泉; 冯子泽

    2013-01-01

    Objective To explore the pathogenesis and summarize the clinical characteristic and treatment experience of neurogenic pulmonary edema (NPE) secondary to acute central nervous system injury. Methods The data of 18 cases of NPE were retrospectively analyzed by reviewing medical literature. Results The age ranged from 19 to 69. The patients became acutely dyspneic, tachypneic and hypoxic following neurologic injury. Pink, frothy sputum was seen and bilateral crackles and rales were appreciated on auscultation. Chest X-ray or CT revealed diffuse bilateral pulmonary infiltrates. Eventually, they were cured by mechanical ventilation and other combined treatment. According to glasgow prognosis score, 13 cases of them got good recovery, 3 cases got moderate disability, 2 cases got severe disability. Conclusion NPE is characterized by the development of respiratory failure soon after neurologic injury. The primary therapy is to control the development of the damage to central nervous system, break the vicious circle, and apply mechanical ventilation, vascular active drugs and sedatives. After weaning, sputum suction via fiberoptic bronchoscopy shall be administered until the symptoms are relieved.%目的探讨脑损伤继发神经源性肺水肿的发病机制,总结其临床特点和救治经验。方法整理近年来18例急性脑损伤继发神经源性肺水肿病例的临床资料,并结合文献分析。结果患者19~69岁,均在急性脑损伤后出现呼吸困难,咳粉红色泡沫痰,血氧饱和度下降,双肺满布湿啰音,胸部CT/DR提示双肺弥漫性渗出性病变,最终经机械通气等综合处理后治愈。根据格拉斯哥预后评分(glasgow prognosis score,GOS),恢复良好(5分)13例,轻残(4分)3例,重残(3分)2例。结论急性脑损伤继发神经源性肺水肿的临床特点是均有急性脑损害的基础,短期内出现呼吸衰竭,基本救治方法是控制脑损伤的进展,打断

  8. Exercise-Induced Pulmonary Edema in a Triathlon

    Science.gov (United States)

    Yamanashi, Hirotomo; Koyamatsu, Jun; Nobuyoshi, Masaharu; Murase, Kunihiko; Maeda, Takahiro

    2015-01-01

    Introduction. Family physicians have more opportunities to attend athletic competitions as medical staff at first-aid centers because of the increasing popularity of endurance sports. Case. A 38-year-old man who participated in a triathlon race experienced difficulty in breathing after swimming and was moved to a first-aid center. His initial oxygen saturation was 82% and a thoracic computed tomography scan showed bilateral ground glass opacity in the peripheral lungs. His diagnosis was noncardiogenic pulmonary edema associated with exercise or swimming: exercise-induced pulmonary edema (EIPE) or swimming-induced pulmonary edema (SIPE). Treatment with furosemide and corticosteroid relieved his symptoms of pulmonary edema. Discussion. Noncardiogenic pulmonary edema associated with endurance sports is not common, but knowledge about EIPE/SIPE or neurogenic pulmonary edema associated with hyponatremia, which is called Ayus-Arieff syndrome, is crucial. Knowledge and caution for possible risk factors, such as exposure to cold water or overhydration, are essential for both medical staff and endurance athletes. Conclusion. To determine the presence of pulmonary edema associated with strenuous exercise, oxygen saturation should be used as a screening tool at a first-aid center. To avoid risks for EIPE/SIPE, knowledge about these diseases is essential for medical staff and for athletes who perform extreme exercise. PMID:26229538

  9. Exercise-Induced Pulmonary Edema in a Triathlon

    Directory of Open Access Journals (Sweden)

    Hirotomo Yamanashi

    2015-01-01

    Full Text Available Introduction. Family physicians have more opportunities to attend athletic competitions as medical staff at first-aid centers because of the increasing popularity of endurance sports. Case. A 38-year-old man who participated in a triathlon race experienced difficulty in breathing after swimming and was moved to a first-aid center. His initial oxygen saturation was 82% and a thoracic computed tomography scan showed bilateral ground glass opacity in the peripheral lungs. His diagnosis was noncardiogenic pulmonary edema associated with exercise or swimming: exercise-induced pulmonary edema (EIPE or swimming-induced pulmonary edema (SIPE. Treatment with furosemide and corticosteroid relieved his symptoms of pulmonary edema. Discussion. Noncardiogenic pulmonary edema associated with endurance sports is not common, but knowledge about EIPE/SIPE or neurogenic pulmonary edema associated with hyponatremia, which is called Ayus-Arieff syndrome, is crucial. Knowledge and caution for possible risk factors, such as exposure to cold water or overhydration, are essential for both medical staff and endurance athletes. Conclusion. To determine the presence of pulmonary edema associated with strenuous exercise, oxygen saturation should be used as a screening tool at a first-aid center. To avoid risks for EIPE/SIPE, knowledge about these diseases is essential for medical staff and for athletes who perform extreme exercise.

  10. Exercise-Induced Pulmonary Edema in a Triathlon.

    Science.gov (United States)

    Yamanashi, Hirotomo; Koyamatsu, Jun; Nobuyoshi, Masaharu; Murase, Kunihiko; Maeda, Takahiro

    2015-01-01

    Introduction. Family physicians have more opportunities to attend athletic competitions as medical staff at first-aid centers because of the increasing popularity of endurance sports. Case. A 38-year-old man who participated in a triathlon race experienced difficulty in breathing after swimming and was moved to a first-aid center. His initial oxygen saturation was 82% and a thoracic computed tomography scan showed bilateral ground glass opacity in the peripheral lungs. His diagnosis was noncardiogenic pulmonary edema associated with exercise or swimming: exercise-induced pulmonary edema (EIPE) or swimming-induced pulmonary edema (SIPE). Treatment with furosemide and corticosteroid relieved his symptoms of pulmonary edema. Discussion. Noncardiogenic pulmonary edema associated with endurance sports is not common, but knowledge about EIPE/SIPE or neurogenic pulmonary edema associated with hyponatremia, which is called Ayus-Arieff syndrome, is crucial. Knowledge and caution for possible risk factors, such as exposure to cold water or overhydration, are essential for both medical staff and endurance athletes. Conclusion. To determine the presence of pulmonary edema associated with strenuous exercise, oxygen saturation should be used as a screening tool at a first-aid center. To avoid risks for EIPE/SIPE, knowledge about these diseases is essential for medical staff and for athletes who perform extreme exercise.

  11. Negative pressure pulmonary edema after nasal fracture reduction in an obese female patient: a case report

    Science.gov (United States)

    Choi, Eunkyung; Yi, Junggu; Jeon, Younghoon

    2015-01-01

    Postoperative negative pressure pulmonary edema (NPPE) is a rare, but well-known life-threatening complication of acute upper airway obstruction (UAO) which develops after general anesthesia. The pronounced inspiratory efforts following UAO lead to excessive negative inspiratory pressure, which may cause acute pulmonary edema. Early recognition and prompt treatment of NPPE is necessary to prevent patient morbidity and mortality. In addition, the physician should carefully manage the patient who has risk factors of UAO to prevent this situation. We experienced a case of NPPE following laryngospasm after tracheal extubation in an obese patient who underwent open reduction of orbital wall and nasal bone surgery. PMID:26316826

  12. ECG Changes in 8-Year-Old Boy with Pulmonary Edema after Head Injury

    Directory of Open Access Journals (Sweden)

    Bojko Bjelakovic

    2006-01-01

    Full Text Available This is a case story of an 8-year-old boy with no prior history of cardiac disease who developed acute pulmonary edema with ECG changes similar to transmural myocardial infarction after basilar skull fracture. Biochemical evaluation showed elevated total creatine kinase activity –1,350 U/L with 12% MB isoenzyme fraction. The brain scan on admission showed cerebral edema with ethmoidal sinuses hemorrhage. Neurogenic pulmonary edema following CNS damage is an extremely rare entity in the pediatric population and there are few reports. There are many proposed mechanisms and explanations of its origin. Based on previous reports and experimental studies, the cause of “neurogenic” pulmonary edema may be of cardiac as well as of noncardiac origin.

  13. Vasogenic edema characterizes pediatric acute disseminated encephalomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Zuccoli, Giulio; Panigrahy, Ashok; Sreedher, Gayathri; Bailey, Ariel [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Section of Neuroradiology, Pittsburgh, PA (United States); Laney, Ernest John [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Section of Neuroradiology, Pittsburgh, PA (United States); Rush University Medical Center, Department of Diagnostic Radiology, Chicago, IL (United States); La Colla, Luca [University of Parma, Department of Anesthesiology, Parma (Italy); UPMC Shadyside Hospital, Department of Emergency Medicine, Pittsburgh, PA (United States); Alper, Gulay [Children' s Hospital of Pittsburgh of UPMC, Department of Pediatric Neurology, Neuroimmunology Clinic, Pittsburgh, PA (United States)

    2014-08-15

    MR imaging criteria for diagnosing acute disseminated encephalomyelitis (ADEM) have not been clearly established. Due to the wide spectrum of differential considerations, new imaging features allowing early and accurate diagnosis for ADEM are needed. We hypothesized that ADEM lesions would be characterized by vasogenic edema due to the potential reversibility of the disease. Sixteen patients who met the diagnostic criteria for ADEM proposed by the International Pediatric Multiple Sclerosis Study Group (IPMSSG) and had complete MR imaging studies performed at our institution during the acute phase of the disease were identified retrospectively and evaluated by experienced pediatric neuroradiologists. Vasogenic edema was demonstrated on diffusion-weighted imaging (DWI) and corresponding apparent diffusion coefficient (ADC) maps in 12 out of 16 patients; cytotoxic edema was identified in two patients while the other two patients displayed no changes on DWI/ADC. ADC values for lesions and normal-appearing brain tissue were 1.39 ± 0.45 x 10{sup -3} and 0.81 ± 0.09 x 10{sup -3} mm/s{sup 2}, respectively (p = 0.002). When considering a cutoff of 5 days between acute and subacute disease, no difference between ADC values in acute vs. subacute phase was depicted. However, we found a significant correlation and an inverse and significant relationship between time and ADC value. We propose that vasogenic edema is a reliable diagnostic sign of acute neuroinflammation in ADEM. (orig.)

  14. Regional pulmonary edema caused by acute mitral insufficiency after rupture of chordae tendinae with prolaps of the posterior mitral valve; Regionales Lungenoedem bei akuter Mitralinsuffizienz nach Chordae-tendineae-Abriss mit Prolaps des posterioren Mitralsegels

    Energy Technology Data Exchange (ETDEWEB)

    Mauser, M.; Wiedemer, B.; Fleischmann, D. [Klinikum Lahr (Germany). Medizinische Klinik; Billmann, P. [Klinikum Lahr (Germany). Inst. fuer Radiologie; Ennker, J. [Herzzentrum Lahr/Baden (Germany). Abt. fuer Herzchirurgie

    2003-07-01

    An unilateral or predominantly lobar pulmonary edema is an unusual clinical or radiological finding, often misdiagnosed as one of the more common causes of focal lung disease. We report 2 cases of a regional pulmonary edema caused by the acute onset of a severe mitral insufficiency after the rupture of chordae tendinae resulting in a prolaps of the posterior mitral leaflet. In both cases the regional pulmonary edema was initially misdiagnosed as a pneumonic infiltration, which delayed the cardiological diagnostical procedures and the surgical intervention. The mechanism of the regional edema is an excentric regurgitation jet into the left atrium, which is usually directed to the orifice of the right upper lobe pulmonary vein which increases the hydrostatic vascular pressure in the corresponding lung segment. For the confirmation of the diagnosis, transesophageal echogradiographye is helpful in documenting the direction of the regurgitant flow and detecting differential gradients between the right and left pulmonary venous systems. The pulmonary infiltrations, which persisted for several weeks, dissappeared within a few days after surgical mitral-valve-reconstruction in both cases. (orig.) [German] Ein einseitiges oder ueberwiegend lobaeres Lungenoedem ist ein seltener klinischer und radiologischer Befund, der haeufig initial zur Fehldiagnose einer weitaus haeufigeren fokaleren Lungenerkrankung fuehrt. Wir berichten ueber 2 Faelle, bei denen nach Auftreten einer akuten Mitralinsuffizienz auf dem Boden eines Sehnenfadenabrisses am posterioren Mitralsegel ein regionales Lungenoedem zunaechst als pneumonisches Infiltrat fehlgedeutet wurde, was die weitere kardiologische Diagnostik und chirurgische Therapie verzoegerte. Wie in den wenigen in der Literatur beschriebenen Faellen findet sich hierbei ein exzentrischer Regurgitationsjet in den linken Vorhof, der ueblicherweise auf die Einmuendung der rechten oberen Pulmonalvene gerichtet ist und in dem dazugehoerigen

  15. Unilateral pulmonary edema during laparoscopic resection of adrenal tumor

    Science.gov (United States)

    Prakash, Smita; Nayar, Pavan; Virmani, Pooja; Bansal, Shipra; Pawar, Mridula

    2015-01-01

    Despite technological, therapeutic and diagnostic advancements, surgical intervention in pheochromocytoma may result in a life-threatening situation. We report a patient who developed unilateral pulmonary edema during laparoscopic resection of adrenal tumor. PMID:26330724

  16. Unilateral pulmonary edema during laparoscopic resection of adrenal tumor

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2015-01-01

    Full Text Available Despite technological, therapeutic and diagnostic advancements, surgical intervention in pheochromocytoma may result in a life-threatening situation. We report a patient who developed unilateral pulmonary edema during laparoscopic resection of adrenal tumor.

  17. Swimming-induced immersion pulmonary edema while snorkeling can be rapidly life-threatening: case reports.

    Science.gov (United States)

    Cochard, G; Henckes, A; Deslandes, S; Noël-Savina, E; Bedossa, M; Gladu, G; Ozier, Y

    2013-01-01

    It is well known that immersion pulmonary edema can be life-threatening for divers using a self-contained underwater breathing apparatus (scuba). Swimming-induced pulmonary edema in otherwise healthy individuals is not an object of dispute but its real severity is not well known and is probably underestimated. We report two cases of life-threatening acute respiratory distress while swimming and snorkeling, one of which is well documented for swimming-induced pulmonary edema. The interest of these case reports lies in the suddenness of these life-threatening events. Such accidents can mimic a loss of consciousness due to cardiac dysrhythmia and lead to drowning. In the case of swimming-induced pulmonary edema, the prognosis is far better than for a cardiac disorder, but it is also dependent on the efficiency of the supervision. Swimmers, divers, race organizers and supervising physicians should be given knowledge of this pathology and its potentially acute occurrence. Adequate organizational dispositions are mandatory to prevent swimming-induced pulmonary edema-related deaths.

  18. Preventive treatment of alveolar pulmonary edema of cardiogenic origin

    Institute of Scientific and Technical Information of China (English)

    Gideon Charach; Michael Shochat; Alexander Rabinovich; Oded Ayzenberg; Jacob George; Lior Charach; Pavel Rabinovich

    2012-01-01

    Objective To evaluate the efficacy of preventive treatment (PT) on alveolar pulmonary edema (APE) of cardiogenic origin using a monitor based on principles of internal thoracic impedance (ITI) measurements. Methods We conducted blinded clinical trials on patients with ST-elevation myocardial infarction (STEMI) and monitored whether the condition would progress to APE. ITI was measured noninvasively by the Edema Guard Monitor (EGM, model RS-207) every 30 min. The measurement threshold for the diagnosis of APE was fixed at > 12% decrease in ITI from baseline as described in our methodology. The patients were divided into one group that received standard treatment after the appearance of clinical signs of APE without considering the prediction of APE by EGM devise (Group 1), and another group of asymptomatic patients in whom development of APE was predicted by using only EGM measurements (Group 2). The latter participants' PT consisted of furosemide, intravenous nitroglycerine and supplemental oxygen. Results One-hundred and fifty patients with acute STEMI were enrolled into this study. Group 1 included 100 patients (53% males, age 64.1 ± 12.6 years). Treatment was started after the clinical appearance of overt signs of APE. Group 2 included 50 patients (54% males, age 65.2 ± 11.9 years) who received PT based on EGM measurements. Group 2 had significantly fewer cases of APE (n = 4, 8%) than Group 1 (n = 100, 100%) (P > 0.001). While APE was lethal in six (6%) Group 1 patients, PT resulted in prompt resolution of APE in all four (8%) Group 2 patients. Conclusion ITI is a useful modality for early diagnosis and PT of pulmonary edema of cardiogenic origin.

  19. Diagnosis and quantitative estimation of pulmonary congestion or edema by pulmonary CT numbers

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Shiro; Nakamoto, Takaaki

    1987-12-01

    Pulmonary computed tomography (CT) was performed in 25 patients with left heart failure and 10 healthy persons to diagnose pulmonary congestion or edema associated with left heart failure. In an analysis of histogram for pulmonary CT numbers obtained from CT scans, CT numbers indicating pulmonary edema were defined as -650 to -750 H.U. This allowed pulmonary edema to be quantitatively estimated early when abnormal findings were not available on chest X-ray film or pulmonary circulation studies. Histograms for CT numbers could be displayed by colors on CT scans. (Namekawa, K.).

  20. Effect of adjuvant treatment of noninvasive positive pressure ventilation in patients with acute cardiogenic pulmonary edema%无创正压机械通气辅助治疗急性心源性肺水肿的效果

    Institute of Scientific and Technical Information of China (English)

    方凯; 王晓玲; 柳月珍; 皮铎波; 吴峰; 王贞

    2012-01-01

    Objectives To evaluate the effect of adjuvant treatment of noninvasive positive pressure ventilation in patients with acute cardiogenic pulmonary edema. Methods Twenty seven patients with acute cardiogenic pulmonary edema were given noninvasive positive pressure ventilation via face mask after hypoxia cannot be corrected by high-flow oxygen and conventional drug treatment. Clinical symptom, heart rate, breathing, arterial oxygen saturation and changes of arterial blood gas analysis were observed before and after the use of noninvasive positive pressure ventilation. Results Clinical symptoms and signs were obviously improved, oxygen partial pressure significantly increased [(90.08±15.39) mm Hgvs. (53.12±17.65) mm Hg, P<0.05], partial pressure of carbon dioxide significantly declined [(14.52±20.52) mm Hg vs. (55.47±23.82) mm Hg, P<0.05] in 20 cases (74.07%) out of the 27 patients with acute cardiogenic pulmonary edema after application of noninvasive positive pressure ventilation via face mask. Seven (25.93%) cases treated by orotracheal intubation and mechanical ventilation when noninvasive positive pressure ventilation failed. There were 2 dead cases. Conclusions Application of noninvasive positive pressure ventilation can significantly improve symptoms, signs and blood gas analysis results in patients with acute cardiogenic pulmonary edema. It can be used as one of the safe, rapid and effective adjuvant means of treatment on acute cardiogenic pulmonary edema.%目的 评价无创正压机械通气辅助治疗急性心源性肺水肿的疗效.方法 选择27例急性心源性肺水肿患者,在高流量吸氧及常规药物治疗不能纠正缺氧时,经面罩给予无创正压通气,观察使用无创正压机械通气治疗前、治疗后其临床症状、心率、呼吸、血氧饱和度和动脉血气分析的变化.结果 经面罩无创正压通气治疗后,27例患者中20例(74.07%)临床症状、体征明显改善,血气分析中氧气分压明显升

  1. Neurogenic pulmonary edema in head injuries: analysis of 5 cases

    Institute of Scientific and Technical Information of China (English)

    QIN Shi-qiang; SUN Wei; WANG Han-bin; ZHANG Qing-lin

    2005-01-01

    Objective: To review the pathophysiology and study the diagnosis and clinical management of neurogenic pulmonary edema (NPE). Methods: The data of 5 patients who developed NPE after head injury treated in our hospital form December 1995 to May 2003 were collected and analyzed.Results: The patients developed dyspnea and respiratory failure 2-8 hours after neurologic event. Four of the 5 patients presented with pink frothy sputum. Chest radiography showed bilateral diffuse infiltrations in all the 5 patients. After supportive measures such as oxygen support and pharmacologic therapy, 4 patients recovered in 72 hours and one patient died. Conclusions: The pathophysiologic mechanisms of NPE is unclear. In acute respiratory failure following head injury, NPE must be given much attention and timely and effective measures should be taken.

  2. [Nursing assessment and management of patients with cardiogenic pulmonary edema].

    Science.gov (United States)

    Wang, Yu-Jyuan; Liao, Chieh-Yin; Kao, Chi-Wen

    2012-02-01

    Cardiogenic pulmonary edema (CPE) is a clinical health problem that induces impaired gas exchange, dyspnea and hypoxia. This serious condition results in acute respiratory failure and high mortality rate. This article suggests an effective approach to CPE patient clinical symptom assessment and management. In accordance with evidence-based methods, we searched Cochrane, CINAHL and ScienceDirect and identified four Oxford Ia or Ib reports that employed a randomized controlled trial, systematic review and meta-analysis. Results suggest that prompt application of a non-invasive positive ventilator, especially continuous positive or bi-level positive airway pressure, can help patients reduce intubation risks, ICU stay days, and mortality rates. The authors hope to see more clinical trials on this topic to support evidence-based clinical nursing care.

  3. Lung ultrasound for monitoring cardiogenic pulmonary edema.

    Science.gov (United States)

    Cortellaro, Francesca; Ceriani, Elisa; Spinelli, Monica; Campanella, Carlo; Bossi, Ilaria; Coen, Daniele; Casazza, Giovanni; Cogliati, Chiara

    2016-07-29

    Several studies address the accuracy of lung ultrasound (LUS) in the diagnosis of cardiogenic pulmonary edema (CPE) evaluating the interstitial syndrome, which is characterized by multiple and diffuse vertical artifacts (B-lines), and correlates with extravascular lung water. We studied the potential role of LUS in monitoring CPE response to therapy, by evaluating the clearance of interstitial syndrome within the first 24 h after Emergency Department (ED) admission. LUS was performed at arrival (T0), after 3 (T3) and 24 (T24) hours. Eleven regions were evaluated in the antero-lateral chest; the B-lines burden was estimated in each region (0 = no B-lines, 1 = multiple B-lines, 2 = confluent B-lines/white lung) and a mean score (B-Score, range 0-2) was calculated. Patients received conventional CPE treatment. Blood chemistry, vital signs, blood gas analysis, diuresis at T0, T3, T24 were also recorded. A complete echocardiography was obtained during hospitalization. Forty-one patients were enrolled. Respiratory and hemodynamic parameters improved in all patients between T0 and T3 and between T3 and T24. Mean B-score significantly decreased at T3 (from 1.59 ± 0.40 to 0.73 ± 0.44, P < 0.001) and between T3 and T 24 (from 0.73 ± 0.44 to 0.38 ± 0.33, P < 0.001). B-score was higher in the lower pulmonary regions at any time. At final evaluation (T24) 75 % of apical and only 38 % of basal regions were cleared. LUS allows one to assess the clearance of interstitial syndrome and its distribution in the early hours of treatment of CPE, thus representing a possible tool to guide therapy titration.

  4. 无创机械通气治疗急性心源性肺水肿临床研究%Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    李强; 罗柳苏

    2010-01-01

    Objective To asses the efficacy of noninvasive nasal mask bi-level positive airway pressure (BiPAP) ventilation in acute cardiogenic pulmonary edema Methods 45patients with acute cardiogenic pulmonary edema hospitalized from October 2008 to May 2010 were randonly assigned to receive conventional medical treatment (21 patients,control group) or noninvasive nasal mask bi-level positive airway pressure (BiPAP) ventilation in addition to the conventional therapy (24 patients,study group). The symptoms,signs,and the findings of blood gas analysis were noted. Results One hour after therapy,HR,RR,SpO2.and PaO2 were improved significantly in the study group; SBP and PH were returned to normal; the symptoms and signs were improved,with significant differences as compared with the control group. (P<0.05). Conclusions Noninvasive ventilation is a safe,effective method in the treatment of acute cardiogenic pulmonary edema with acute respiratory failure. It improves cardiac function and is worth popularizing.%目的 评价BiPAP无创机械通气治疗急性心源性肺水肿病例的临床价值.方法 将兴宁市人民医院2008年10月-2010年5月收治的急性心源性肺水肿患者45例随机分为两组,对照组21例常规药物治疗,治疗组24例在常规药物治疗的基础上,应用BiPAP呼吸机面作者单位:514500 兴宁市人民医院心血管内科罩辅助通气,观察其前后症状、体征及动脉血气分析结果.结果 治疗组患者1h后呼吸、心率明显减慢SpO2、PaO2均明显改善,SBP和pH恢复正常,临床症状体征明显改善,与对照组比较差异有显著性(P<0.05).结论 无创机械通气治疗急性心源性肺水肿安全有效能迅速纠正缺氧、改善心功能,值得临床推广.

  5. Ipsilateral reexpansion pulmonary edema after drainage of a spontaneous pneumothorax: a case report

    Directory of Open Access Journals (Sweden)

    Conen Anna

    2007-09-01

    Full Text Available Abstract We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. The patient received supplemental oxygen via a non-rebreather face mask to compensate for hypoxemia. 24 hours after the acute event, the patient recovered completely without residual hypoxemia. Reexpansion pulmonary edema after the insertion of a thoracic drainage for pneumothorax or pleural effusion is a rare complication with a high mortality rate up to 20%. It should be considered in case of hypoxemia following the insertion of a chest tube. The exact pathophysiology leading to this complication is not known. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to the insertion of chest tubes. Treatment is supportive.

  6. Platelet-rich plasma extract prevents pulmonary edema through angiopoietin-Tie2 signaling.

    Science.gov (United States)

    Mammoto, Tadanori; Jiang, Amanda; Jiang, Elisabeth; Mammoto, Akiko

    2015-01-01

    Increased vascular permeability contributes to life-threatening pathological conditions, such as acute respiratory distress syndrome. Current treatments for sepsis-induced pulmonary edema rely on low-tidal volume mechanical ventilation, fluid management, and pharmacological use of a single angiogenic or chemical factor with antipermeability activity. However, it is becoming clear that a combination of multiple angiogenic/chemical factors rather than a single factor is required for maintaining stable and functional blood vessels. We have demonstrated that mouse platelet-rich plasma (PRP) extract contains abundant angiopoietin (Ang) 1 and multiple other factors (e.g., platelet-derived growth factor), which potentially stabilize vascular integrity. Here, we show that PRP extract increases tyrosine phosphorylation levels of Tunica internal endothelial cell kinase (Tie2) and attenuates disruption of cell-cell junctional integrity induced by inflammatory cytokine in cultured human microvascular endothelial cells. Systemic injection of PRP extract also increases Tie2 phosphorylation in mouse lung and prevents endotoxin-induced pulmonary edema and the consequent decreases in lung compliance and exercise intolerance resulting from endotoxin challenge. Soluble Tie2 receptor, which inhibits Ang-Tie2 signaling, suppresses the ability of PRP extract to inhibit pulmonary edema in mouse lung. These results suggest that PRP extract prevents endotoxin-induced pulmonary edema mainly through Ang-Tie2 signaling, and PRP extract could be a potential therapeutic strategy for sepsis-induced pulmonary edema and various lung diseases caused by abnormal vascular permeability.

  7. Edema pulmonar neurogênico: relato de dois casos Neurogenic pulmonary edema: report of two cases

    Directory of Open Access Journals (Sweden)

    Desanka Dragosavac

    1997-06-01

    Full Text Available O edema pulmonar neurogênico é rara e grave complicação de pacientes com traumatismo craniencefálico (TCE. Pode ocorrer também em outras patologias do sistema nervoso central, tais como acidentes vasculares cerebrais (AVC, tumores ou após crises epilépticas, entre outras. Foram avaliados 36 casos com TCE grave e quatro pacientes com AVC, internados na UTI geral, no período de janeiro a setembro 1995. Nesse intervalo de tempo foram diagnosticados dois casos de edema pulmonar neurogênico, um ocorrendo em paciente com TCE grave e outro em paciente com AVC hemorrágico. O diagnóstico foi estabelecido pelo rápido desenvolvimento de edema pulmonar, com hipoxemia grave, queda da complacência pulmonar e infiltrados difusos bilaterais sem história prévia de aspiração traqueal ou outro fator de risco para o desenvolvimento de síndrome de angústia respiratória aguda. No primeiro paciente com trauma craniencefálico, o edema neurogênico foi diagnosticado na internação, uma hora após o trauma, com concomitante reação inflamatória grave e boa evolução em três dias. O outro caso, com AVC hemorrágico, desenvolveu edema neurogênico no quarto dia após drenagem de hematoma intraparenquimatoso, evoluindo para o óbito.Neurogenic pulmonary edema is a rare and serious complication in patients with head injury. It also may develop after a variety of cerebral insults such as subarachnoid hemorrhage, brain tumors and after epileptic seizures. Thirty six patients with severe head injury and four patients with cerebrovascular insults treated in Intensive Care Unit of HC-UNICAMP from January to September 1995 were evaluated. In this period there were two patients with neurogenic pulmonary edema, one with head injury and other with intracerebral hemorrhage. Diagnosis was made by rapid onset of pulmonary edema, severe hypoxemia, decrease of pulmonary complacence and diffuse pulmonary infiltrations, without previous history of tracheal

  8. Synthetic smoke with acrolein but not HCl produces pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Hales, C.A.; Barkin, P.W.; Jung, W.; Trautman, E.; Lamborghini, D.; Herrig, N.; Burke, J.

    1988-03-01

    The chemical toxins in smoke and not the heat are responsible for the pulmonary edema of smoke inhalation. We developed a synthetic smoke composed of carbon particles (mean diameter of 4.3 microns) to which toxins known to be in smoke, such as HCl or acrolein, could be added one at a time. We delivered synthetic smoke to dogs for 10 min and monitored extravascular lung water (EVLW) accumulation thereafter with a double-indicator thermodilution technique. Final EVLW correlated highly with gravimetric values (r = 0.93, P less than 0.01). HCl in concentrations of 0.1-6 N when added to heated carbon (120 degrees C) and cooled to 39 degrees C produced airway damage but no pulmonary edema. Acrolein, in contrast, produced airway damage but also pulmonary edema, whereas capillary wedge pressures remained stable. Low-dose acrolein smoke (less than 200 ppm) produced edema in two of five animals with a 2- to 4-h delay. Intermediate-dose acrolein smoke (200-300 ppm) always produced edema at an average of 147 +/- 57 min after smoke, whereas high-dose acrolein (greater than 300 ppm) produced edema at 65 +/- 16 min after smoke. Thus acrolein but not HCl, when presented as a synthetic smoke, produced a delayed-onset, noncardiogenic, and peribronchiolar edema in a roughly dose-dependent fashion.

  9. 机械通气治疗重症心源性肺水肿40例临床分析%Clinical Analysis of 40 Patients with Severe Acute Cardiogenic Pulmonary Edema Treated by Mechanical Ventilation

    Institute of Scientific and Technical Information of China (English)

    陆逢时; 骆斯敏; 金同新

    2015-01-01

    Objective:To summarize the clinical efficacy of patients with severe acute cardiogenic pulmonary edema treated by mechanical ventilation. Methods:The clinical data of 40 patients with severe acute cardiogenic pulmonary edema treated by mechanical ventilation were retrospectively analyzed from Jan 2010 to Dec 2014. Results:The condition improved rate of the patients was 87.5% (35/40), with an average recovery time of (7.5 ±0.9) h. 4 cases died, the cause of death were all a large area of myocardial infarction complicated with cardiogenic shock. The pH,PaO2,SaO2 of patients were significantly increased after treatment (P<0.05). While PaCO2, heart rate, respiratory rate, systolic pressure, diastolic pressure were decreased significantly,all P<0.05. Conclusion:Mechanical ventilation contributes to the improvement of hypoxia symptoms of patients with severe acute cardiogenic pulmonary edema and improve their cardiac function.%目的:总结机械通气治疗重症心源性肺水肿的临床疗效。方法:回顾性分析2010年1月至2014年12月我科收治的机械通气治疗的重症心源性肺水肿患者40例的临床资料。结果:患者病情好转率87.5%(35/40),平均好转时间(7.5±0.9)h;死亡4例,死于大面积心梗合并心源性休克;治疗后患者pH、PaO2、SaO2均有明显上升,PaCO2、心率、呼吸频率、收缩压、舒张压均明显下降,P均<0.05。结论:机械通气治疗有助于改善重症心源性肺水肿患者低氧症状、改善其心功能。

  10. CT findings of pulmonary edema: comparison of various causes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyae Young; Im, Jung Gi; Goo, Jin Mo [Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Jae Kyo [Yeungnam University College of Medicine, Taegu (Korea, Republic of); Song, Jae Woo [Seoul City Boramae Hospital, Seoul (Korea, Republic of)

    1999-02-01

    To access the CT findings of pulmonary edema and to compare them, according to the cause. CT findings (thin section, 20 ; thick section, 16) of pulmonary edema in 36 patients [cardiac disease (group 1, n=20), renal disease (group 2, n=13), ARDS (group 3, n=3)] were analyzed and compared. There were 21 men and 15 women ranging in age from 27 to 77 years. Distribution (even, central, or peripheral) and patterns of pulmonary edema were compared between the three groups. The distribution of edema, appearing as consolidation or ground-glass opacity, was even in 75% (n=15) of group 1, even in 46% (n=6) and central in 38% (n=5) of group 2, and peripherally predominant in 100% (n=3) of group 3. Interlobular septal thickening was seen in 80% (n=16), 69% (n=9), and 0% of group 1, 2 and 3, respectively. Centrilobular ground-glass opacity was noted in six patients. In spite of various findings and considerable overlapping of the findings of pulmonary edema, the distribution and pattern of edema differed according to the cause, and this can be helpful for differential diagnosis.

  11. High altitude pulmonary edema among "Amarnath Yatris"

    Directory of Open Access Journals (Sweden)

    Parvaiz A Koul

    2013-01-01

    Full Text Available Background: Annual pilgrimage (Yatra to the cave shrine of Shri Amarnath Ji′ is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common. Materials and Methods: More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft. The clinical features and the response to treatment were recorded. Results: Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41 had presented with acute onset breathlessness of 1-4 days (median 1.9 d starting within 12-24 h of a rapid ascent; accompanied by cough (68%, headache (8%, dizziness and nausea (65%. Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea ( n = 31, tachycardia ( n = 23, bilateral chest rales ( n = 29, cyanosis ( n = 22 and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation ( n = 3. Three patients died due to multiorgan dysfunction. Conclusions: Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.

  12. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: short review of the pathophysiology and diagnostic approach.

    Science.gov (United States)

    Manne, Janaki R; Kasirye, Yusuf; Epperla, Narendranath; Garcia-Montilla, Romel J

    2012-08-01

    Acute pulmonary edema complicating electroconvulsive therapy is an extremely uncommon event that has rarely been described in the literature. Different theories, including one suggesting a cardiogenic component, have been proposed to explain its genesis. The present report describes a classic presentation of this condition with review of its potential mechanisms and diagnostic approach. After successful completion of a session of electroconvulsive therapy, a 42-year-old woman with major depressive disorder developed acute systemic high blood pressure, shortness of breath, and hemoptysis. A chest radiograph demonstrated diffuse bilateral pulmonary infiltrates. Initially cardiogenic pulmonary edema was presumed, but an extensive diagnostic work-up demonstrated normal systolic and diastolic left ventricular function, and with only supportive measures, a complete clinical and radiographic recovery was achieved within 48 hours. The present case does not support any cardiogenic mechanism in the genesis of this condition.

  13. 无创正压通气在急性心源性肺水肿中的应用进展%Application progress of nonivasive positive pressure ventilation in acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    竺文静; 朱蕾

    2010-01-01

    急性心源性肺水肿的发病率和病死率皆较高.对严重持续低氧血症或呼吸窘迫进行性加重的患者及早进行无创正压通气治疗有独到的优势,较单纯药物治疗更快地缓解症状、改善氧合、降低气管插管率,并且可能改善患者的预后.%Acute cardiogenie pulmonary edema is a disease with high morbidity and mortality. Noninvasive positive pressure ventilation has been proved specific advantage for patients suffering severe continuous hypoxemia or progressive respiratory failure. Compared with single medication, noninvasive positive pressure ventilation can relieve symptom,improve oxygenation, decrease tracheal intubation more quickly,and probably improve patients' prognosis.

  14. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso Edema pulmonar asimétrico por presión negativa pós-obstrucción aguda de vía aérea superior: relato de caso Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report

    Directory of Open Access Journals (Sweden)

    Aldo José Peixoto

    2002-06-01

    ventilatorio con PEEP o CPAP, no necesitando de cualquier otra terapia. El pronóstico es bueno, con mejoría en la mayoría de los casos en las primeras 24 horas.BACKGROUND AND OBJECTIVES: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, though infrequently diagnosed and reported. This report aimed at presenting a case of upper airway obstruction negative pressure pulmonary edema following acute upper airway obstruction characterized by pulmonary edema asymmetry, being more prominent in the right lung. CASE REPORT: A 4-year-old boy, 17 kg, phisical status ASA I submitted to combined tonsillectomy, adenoidectomy and turbinate cauterization under general anesthesia with sevoflurane/nitrous oxide/O2. Surgery duration was 90 minutes without complications. During anesthetic recovery and spontaneously breathing, patient reacted to tracheal tube, which was removed. Following, ventilatory efforts resulted in chest wall retraction without apparent air movement, being impossible to ventilate him with facial mask. Symptoms evolved to severe hypoxemia (50% SpO2 requiring reintubation. At this point, it was observed that the lung was stiffer and there were bilateral rales characterizing pulmonary edema. A chest X-ray showed diffuse bilateral infiltrates, right upper lobe atelectasis and marked pulmonary edema asymmetry (right greater than left. Patient was mechanically ventilated with PEEP for 20 hours when he was extubated. There was a progressive pulmonary edema improvement and patient was discharged 48 hours later. CONCLUSIONS: Negative pressure pulmonary edema (NPPE is a rare event with high morbidity risk. It is often not diagnosed and requires from the anesthesiologist an updated knowledge and adequate management. It is usually bilateral, rarely unilateral, and exceptionally asymmetric as in this case. Most cases are treated by mechanical ventilation with PEEP or CPAP without any other therapy. The prognosis is favorable, with most

  15. The treatment application of acute cardiogenic pulmonary edema with BiPAP noninvasive positive air pressure ventilation%BiPAP无创通气在急性心源性肺水肿救治中的应用

    Institute of Scientific and Technical Information of China (English)

    黄玉蓉; 王晓园; 张海涛; 李玮; 白会云

    2012-01-01

    目的 探讨双水平正压无创机械通气在救治急性心源性肺水肿患者中的疗效.方法 将我科收治的59例急性心源性肺水肿患者随机分为两组:在常规利尿、扩血管、强心和镇静治疗的基础上,治疗组26例经BiPAP无创通气治疗;而对照组33例则给予高浓度面罩吸氧,观察两组治疗前后心率、呼吸频率、血气分析指标及临床征象的变化,评价治疗效果.结果 治疗组无创正压通气2 h后患者心率(HR)、呼吸频率(RR)明显减慢(P<0.05),收缩压(ABP)及舒张压(DBP)明显下降(P<0.01),血氧饱和度(SaO2)明显升高(P<0.01).结论 BiPAP无创通气治疗急性心源性肺水肿起效快,能明显改善低氧血症,是抢救急性心源性肺水肿的重要方法之一,值得临床推广.%Objective To evaluate the effects of BiPAP noninvasive positive ah- pressure ventilation on acute cardiogenic pulmo nary edema. Methods Fifty-nine patients with acute cardiogenic pulmonary edema were randomly divided into two groups: 26 patients in treatment group received BiPAP, while 33 patients in control groups had high concentration oxygen mask. All the patients received conven tional treatments including diuresis, cardiac stimulant, and sedation. Results Two hours after BiPAP, the patients' heart rate and breathing rate slowed down obviously ( P<0.05 ), and their systolic pressure and diastolic pressure declined dearly ( P <0. 01 ). Be sides , the oxygen saturation of blood rose obviously ( P < 0. 01 ). Conclusion BiPAP noninvasive positive air pressure ventilation can im prove meionectic blood better and take into effect quickly. Therefore it is an important means to rescue acute pulmonary edema and wouth to popularize.

  16. Current status of research in terbutaline for the control of pulmonary edema after acute lung injury%特布他林防治急性肺损伤后肺水肿的研究现状

    Institute of Scientific and Technical Information of China (English)

    陶军; 杨天德

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with disruption of the alveolo-capillary barrier, which results in edema fluid accumulation and impaired gas exchange. Despite nearly 30 years of research,no specific pharmacological therapy has yet proven to be efficacious in manipulating the pathophysiological processes. Several in vitro and in vivo animal or human studies suggest a potential role for β2 agonists in the treatment of ALI/ARDS. Terbutaline has been shown to reduce pulmonary neutrophil sequestration and activation, decrease pulmonary microvascular permeability, accelerate alveolar fluid clearance, thus attenuating pulmonary edema and improving gas exchange. However, further work with large animals and patients is needed to confirm these findings and to determine the physiological benefits of the terbutaline effect and the doseresponse relationship.%急性肺损伤(acute lung inury,ALI)后渗透性肺水肿是导致损伤后呼吸功能衰竭的主要病理基础,其发生机制错综复杂,至今仍无完善的治疗方案.研究结果显示,β2-受体激动剂特布他林在一定程度上恢复或改善了肺微血管内皮、肺泡上皮的通透性,对肺泡Ⅱ型细胞的钠-钾-ATP酶和上皮细胞的肺泡侧钠通道活性均有上调作用,增强肺泡液体清除功能,对肺损伤后肺水肿具有良好的防治作用,是一种有前景的治疗措施.但是其临床效果尚需要进一步证实,而且其给药途径及药物用量有待进一步的临床实验研究.

  17. Accuracy of point-of-care lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs and cats with acute dyspnea.

    Science.gov (United States)

    Ward, Jessica L; Lisciandro, Gregory R; Keene, Bruce W; Tou, Sandra P; DeFrancesco, Teresa C

    2017-03-15

    OBJECTIVE To determine the accuracy of a point-of-care lung ultrasonography (LUS) protocol designed to diagnose cardiogenic pulmonary edema (CPE) in dyspneic dogs and cats. DESIGN Diagnostic test evaluation. ANIMALS 76 dogs and 24 cats evaluated for dyspnea. PROCEDURES Dogs and cats were evaluated by LUS; B lines were counted at 4 anatomic sites on each hemithorax. A site was scored as positive when > 3 B lines were identified. Animals with ≥ 2 positive sites identified on each hemithorax were considered positive for CPE. Medical records were evaluated to obtain a final diagnosis (reference standard) for calculation of the sensitivity and specificity of LUS and thoracic radiography for the diagnosis of CPE. RESULTS Dogs and cats with a final diagnosis of CPE had a higher number of positive LUS sites than did those with noncardiac causes of dyspnea. Overall sensitivity and specificity of LUS for the diagnosis of CPE were 84% and 74%, respectively, and these values were similar to those of thoracic radiography (85% and 87%, respectively). Use of LUS generally led to the misdiagnosis of CPE (ie, a false-positive result) in animals with diffuse interstitial or alveolar disease. Interobserver agreement on LUS results was high (κ > 0.85). CONCLUSIONS AND CLINICAL RELEVANCE LUS was useful for predicting CPE as the cause of dyspnea in dogs and cats, although this technique could not be used to differentiate CPE from other causes of diffuse interstitial or alveolar disease. Point-of-care LUS has promise as a diagnostic tool for dyspneic dogs and cats.

  18. Acute edema blisters in a hereditary angioedema cutaneous attack.

    Science.gov (United States)

    Fernández Romero, D; Di Marco, P; Malbrán, A

    2008-01-01

    Hereditary angioedema is a rare autosomal dominant disease characterized by recurrent episodes of acute edema affecting the skin and the respiratory and digestive tracts. Acute edema blisters or hydro-static bullae develop after rapid accumulation of interstitial fluid usually associated to cardiac insufficiency. Lesions contain sterile fluid and break up easily resolving without scars. Blisters disappear when fluid accumulation resolves. We describe a patient developing recurrent acute edema blisters as a consequence of cutaneous hereditary angioedema attacks.

  19. Dichotomal role of TNF in experimental pulmonary edema reabsorption

    NARCIS (Netherlands)

    Braun, C; Hamacher, J; Morel, DR; Wendel, A; Lucas, R

    2005-01-01

    Distinct from its receptor binding sites, TNF carries a lectin-like domain, situated at the tip of the molecule, which specifically binds oligosaccharides, such as NN'-diacetylchitobiose. In view of the apparently conflicting data concerning TNF actions in pulmonary edema, we investigated the contri

  20. POST OBSTRUCTIVE PULMONARY EDEMA AFTER ATTEMPTED NYLON ROPE SUICIDAL HANGING

    Directory of Open Access Journals (Sweden)

    Rakesh

    2015-06-01

    Full Text Available Survival after nylon rope suicidal hanging is a rare occurance . We describe here a patient who attempted suicide by nylon rope hanging and developed post obstructive pulmonary edema was managed successfully . Patient recovered completely with ventilatory support in next 60 hours without any neurological deficit.This case highlights an unusual complication of hanging and its recovery.

  1. 无创机械通气抢救急性心源性肺水肿40例分析%Analysis of noninvasive mechanical ventilation in acute cardiogenic pulmonary edema rescue of 40 cases

    Institute of Scientific and Technical Information of China (English)

    刘宏营

    2011-01-01

    目的 探讨无创机械通气在心源性肺水肿急救治疗中的临床作用,并观察其疗效.方法 对收治的40例心源性肺水肿,在常规治疗基础上加用无创机械通气,观察临床疗效及血气变化.结果 采用紧闭面罩双相气道正压通气前后患者心率、呼吸频率、平均动脉压、SpO、PaO均有明显变化,PaCO无明显变化.结论 在常规强心、利尿、扩张血管等基础治疗同时,加用无创双水平正压机械通气治疗急性肺水肿,可迅速纠正缺氧、改善病情、提高抢救成功率,减少气管插管及气管切开率,降低死亡率.%Objective To investigate and observe the effect of non - invasive mechanical ventilation in the treatment of pulmonary edema.Methods Totally 40 patients in our hospital with cardiogenic pulmonary edema, in the conventional treatment based on the use of noninvasive mechanical ventilation, observe clinical effect and blood gas changes.Results Before and after closed mask bilevel positive airway pressure ventilation in patients the heart rate, respiratory rate, mean arterial pressure,SpO2, PaO2 changed significantly, PaCO2 did not change.Conclusions In normal cardiac, diuretic,while expanding treatment and other infrastructure management, plus non- invasive bi -level positive pressure ventilation treatment of acut.

  2. Beta-adrenergic agonist therapy accelerates the resolution of hydrostatic pulmonary edema in sheep and rats.

    Science.gov (United States)

    Frank, J A; Wang, Y; Osorio, O; Matthay, M A

    2000-10-01

    To determine whether beta-adrenergic agonist therapy increases alveolar liquid clearance during the resolution phase of hydrostatic pulmonary edema, we studied alveolar and lung liquid clearance in two animal models of hydrostatic pulmonary edema. Hydrostatic pulmonary edema was induced in sheep by acutely elevating left atrial pressure to 25 cmH(2)O and instilling 6 ml/kg body wt isotonic 5% albumin (prepared from bovine albumin) in normal saline into the distal air spaces of each lung. After 1 h, sheep were treated with a nebulized beta-agonist (salmeterol) or nebulized saline (controls), and left atrial pressure was then returned to normal. beta-Agonist therapy resulted in a 60% increase in alveolar liquid clearance over 3 h (P Ringer lactate). beta-Agonist therapy resulted in a significant decrease in excess lung water (P < 0.01) and significant improvement in arterial blood gases by 2 h (P < 0.03). These preclinical experimental studies support the need for controlled clinical trials to determine whether beta-adrenergic agonist therapy would be of value in accelerating the resolution of hydrostatic pulmonary edema in patients.

  3. Clinical observation on noninvasive positive pressure ventilation in treatment of acute cardiogenic pulmonary edema%无创正压通气治疗急性心源性肺水肿的临床观察

    Institute of Scientific and Technical Information of China (English)

    周永明; 李文强

    2012-01-01

    Objective: To evaluate the effect of noninvasive positive pressure ventilation ( NIPPV) via face mask in treatment of acute cardiogenic pulmonary edema (ACPE). Methods: Fifty-four adult patients with severe acute respiratory failure resulted from cardiogenic pulmonary edema received NIPPV based on conventional treatments consisting of oxygen, nitrates,and diuretics. Patients'arterial blood gas analysis, Borg dyspnea score,vital signs,and requirement for endotracheal intubation (ETI) were observed before and after treatments. Results: Patients'blood pH,PaCO2 ,PaO2 ,SaO2 ,Borg score and respiratory rate were improved significantly after treatment with NIPPV for 60 minutes than those before treatment ( P < 0.05). The symptoms were improved in 49 patients (90.7% ) ,5 patients complicated with severe chronic obstructive pulmonary disease (COPD) and required ETI. No complication occurred in patients with NIPPV. Conclusion; NIPPV can improve hypoxemia rapidly. It is an effective treatment for ACPE and may help to avoid ETI.%目的:评估经面罩压力支持非侵入性正压通气(NIPPV)对急性心源性肺水肿(ACPE)患者的疗效.方法:54例急诊就诊、ACPE所致急性呼吸衰竭需要气管插管的成年患者,除了常规给予持续氧疗、硝酸酯类药物和利尿剂,还应用NIPPV治疗.观察治疗前、后患者动脉血气分析、Borg呼吸困难评分、生命体征和是否需要气管内插管.结果:54例患者NIPPV治疗60 min后的血pH、PaCO2、PaO2、SaO2、Borg评分、呼吸频率较治疗前明显改善(均P <0.05).49例患者(90.7%)症状改善后,停止应用NIPPV,5例合并严重慢性阻塞性肺病(COPD)患者需要气管内插管.NIPPV治疗患者无并发症出现.结论:NIPPV能迅速改善ACPE患者低氧血症,使其避免了气管插管,是抢救ACPE的一种安全有效的方法.

  4. Non-invasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema Application%无创机械通气在治疗急性心源性肺水肿中的应用研究

    Institute of Scientific and Technical Information of China (English)

    陈培莉

    2010-01-01

    目的 探讨无创机械通气(NMV)治疗急性心源性肺水肿(ACPE)的临床应用价值.方法 对80例各种原因所致的急性肺水肿患者随机分为NMV治疗组39例和对照组41例,对照组常规药物治疗加鼻导管高流量吸氧,NMV治疗组在常规药物治疗的基础上给予压力支持通气(PSV)加呼吸末正压(PEEP)通气模式,分别监测治疗前及治疗后的临床表现、动脉血气分析、血氧饱和度、呼吸频率、心率、血压等变化.结果 治疗组治疗后,39例患者均于30 min内症状缓解,除3例较重患者需辅助通气2 h才能撤机外,其他均于1 h内撤机.撤机后能平卧呼吸,面色恢复正常、大汗消失、口唇无青紫、泡沫样痰消失、双肺啰音明显减少甚至消失.两组临床各项指标比较差异均具有统计学意义(P<0.05).结论 在常规强心、利尿、扩管等基础治疗同时,加用无创双水平正压机械通气治疗急性肺水肿,可迅速纠正缺氧、改善病情、提高抢救成功率,减少气管插管及气管切开率,降低死亡率.%Objective To investigate the non-invasive mechanical ventilation (NMV) treatment of acute cardiogenic pulmonary edema (ACPE) for clinical application.Methods 80 patients with different causes of acute pulmonary edema were randomly divided into NMV treatment group and control group 39 cases,41 cases of conventional therapy control group,high-flow oxygen by nasal catheter,NMV in the conventional treatment group,drug treatment basis for pressure support ventilation (PSV) plus PEEP (PEEP) ventilation node,were monitored before treatment and after treatment of clinical manifestations,blood gas analysis,oxygen saturation,respiratory rate,heart rate,blood pressure changes.Results After treatment,39 patients were in remission within 30 min,in addition to three cases of heavy patients can be assisted ventilation weaning 2 h,the other are at weaning within 1 h.Supine position after weaning can breathe

  5. Proanthocyanidin to prevent formation of the reexpansion pulmonary edema

    Directory of Open Access Journals (Sweden)

    Akay Cemal

    2009-07-01

    Full Text Available Abstract Background We aimed to investigate the preventive effect of Proanthocyanidine (PC in the prevention of RPE formation. Methods Subjects were divided into four groups each containing 10 rats. In the Control Group (CG: RPE wasn't performed. Then subjects were followed up for three days and they were sacrificed after the follow up period. Samplings were made from tissues for measurement of biochemical and histopathologic parameters. In the Second Group (PCG: The same protocol as CG was applied, except the administration of PC to the subjects. In the third RPE Group (RPEG: Again the same protocol as CG was applied, but as a difference, RPE was performed. In the Treatment Group (TG: The same protocol as RPEG was applied except the administration of PC to the subjects. Results In RPEG group, the most important histopathological finding was severe pulmonary edema with alveolar damage and acute inflammatory cells. These findings were less in the TG group. RPE caused increased MDA levels, and decreased GPx, SOD and CAT activity significantly in lung tissue. Conclusion PC decreased MDA levels. Oxidative stress plays an important role in pathophysiology of RPE and PC treatment was shown to be useful to prevent formation of RPE.

  6. Observation on BiPAP in treatment of acute cardiogenic pulmonary edema%BiPAP呼吸机治疗急性心源性肺水肿的疗效观察

    Institute of Scientific and Technical Information of China (English)

    黄小芬; 吴晓秋; 农祯瑞

    2015-01-01

    Objective To investigate the clinical effect of BiPAP ventilator in the treatment of acute cardiogenic pulmonary edema. Methods Thehospital in recent years to 60 cases of acute cardiogenic pulmonaryedema patients were divided into treatment group and control grouprandomly, 30 cases in each group. Using the conventional therapy for the treatment of the patients in the control group, the treatment groupbesides the conventional therapy, also needs to use the BiPAP ventilatortreatment, after the treatment were observed and compared to the treatment group and the control efifcacy, groups of patients with clinicalsymptoms and improve. Results Compared with the control group, the clinical therapeutic effect of the treatment group patients, heart rate,respiratory frequency to improve the situation is more ideal, and arterial blood gas outcome effect is more ideal, with signiifcant difference between the two groups (P<0.05). Conclusion Using BiPAP ventilator intreatment of patients with acute cardiogenic pulmonary edema, can obtain good therapeutic effect, less adverse reaction, and has widely application value.%目的:探讨BiPAP呼吸机治疗急性心源性肺水肿(ACPE)的疗效。方法按照随机原则将本院近年来收治的60例ACPE患者分为治疗组和对照组,各30例。采用常规治疗法给予对照组患者进行治疗,治疗组除了采用常规治疗法外,还需要采用BiPAP呼吸机进行治疗,治疗结束后,对治疗组和对照组患者的疗效、临床症状改善情况进行观察和比较。结果相较于对照组,治疗组患者的疗效,心率、呼吸频率改善情况更加理想,且动脉血气转归效果也更加理想,两组间差异有统计学意义(P<0.05)。结论采用BiPAP呼吸机对ACPE患者进行治疗,可以取得不错的疗效,不良反应少,具有广泛应用的价值。

  7. Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients.

    LENUS (Irish Health Repository)

    Dolan, Niamh

    2009-11-01

    We report two cases of non-cardiogenic pulmonary edema as a complication of basiliximab induction therapy in young pediatric renal transplant patients identified following a retrospective review of all pediatric renal transplant cases performed in the National Paediatric Transplant Centre, Childrens University Hospital, Temple Street, Dublin, Ireland. Twenty-eight renal transplantations, of which five were living-related (LRD) and 23 were from deceased donors (DD), were performed in 28 children between 2003 and 2006. In six cases, transplantations were pre-emptive. Immunosuppression was induced pre-operatively using a combination of basiliximab, tacrolimus and methylprednisolone in all patients. Basiliximab induction was initiated 2 h prior to surgery in all cases and, in 26 patients, basiliximab was re-administered on post-operative day 4. Two patients, one LRD and one DD, aged 6 and 11 years, respectively, developed acute non-cardiogenic pulmonary edema within 36 h of surgery. Renal dysplasia was identified as the primary etiological factor for renal failure in both cases. Both children required assisted ventilation for between 4 and 6 days. While both grafts had primary function, the DD transplant patient subsequently developed acute tubular necrosis and was eventually lost within 3 weeks due to thrombotic microangiopathy and severe acute antibody-mediated rejection despite adequate immunosuppression. Non-cardiogenic pulmonary edema is a potentially devastating post-operative complication of basiliximab induction therapy in young pediatric patients following renal transplantation. Early recognition and appropriate supportive therapy is vital for patient and, where possible, graft survival.

  8. Thallium scintigraphy in experimental toxic pulmonary edema: relationship to extravascular pulmonary fluid. [Dogs

    Energy Technology Data Exchange (ETDEWEB)

    Slutsky, R.A.; Higgins, C.B.

    1984-05-01

    Pulmonary fluid volumes (PBV = lung blood volume; EVLW = extravascular lung water) were examined to define the effects of oleic acid injury and then to examine the relationship between edema formation and accumulation of pulmonary thallium. In six dogs, pulmonary fluid compartments were monitored during the induction of pulmonary injury by oleic acid (0.15 cc/kg i.v.). By 30 min after the injection, EVLW had doubled; it continued to increase slowly for 180 min, whereas PBV declined. In six anesthetized dogs, similar measurements were made in an identical preparation and pulmonary fluid volumes were compared with pulmonary counts derived from sequential thallium scintigrams obtained after the injection of oleic acid. Measures of EVLW and PBV were obtained sequentially along with thallium scintigrams. The authors conclude that sequential thallium scintigrams provide useful information about the degree of change of EVLW over time in a model of noncardiogenic pulmonary edema.

  9. Inhibition of chlorine-induced pulmonary inflammation and edema by mometasone and budesonide

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Jing; Mo, Yiqun; Schlueter, Connie F.; Hoyle, Gary W., E-mail: Gary.Hoyle@louisville.edu

    2013-10-15

    Chlorine gas is a widely used industrial compound that is highly toxic by inhalation and is considered a chemical threat agent. Inhalation of high levels of chlorine results in acute lung injury characterized by pneumonitis, pulmonary edema, and decrements in lung function. Because inflammatory processes can promote damage in the injured lung, anti-inflammatory therapy may be of potential benefit for treating chemical-induced acute lung injury. We previously developed a chlorine inhalation model in which mice develop epithelial injury, neutrophilic inflammation, pulmonary edema, and impaired pulmonary function. This model was used to evaluate nine corticosteroids for the ability to inhibit chlorine-induced neutrophilic inflammation. Two of the most potent corticosteroids in this assay, mometasone and budesonide, were investigated further. Mometasone or budesonide administered intraperitoneally 1 h after chlorine inhalation caused a dose-dependent inhibition of neutrophil influx in lung tissue sections and in the number of neutrophils in lung lavage fluid. Budesonide, but not mometasone, reduced the levels of the neutrophil attractant CXCL1 in lavage fluid 6 h after exposure. Mometasone or budesonide also significantly inhibited pulmonary edema assessed 1 day after chlorine exposure. Chlorine inhalation resulted in airway hyperreactivity to inhaled methacholine, but neither mometasone nor budesonide significantly affected this parameter. The results suggest that mometasone and budesonide may represent potential treatments for chemical-induced lung injury. - Highlights: • Chlorine causes lung injury when inhaled and is considered a chemical threat agent. • Corticosteroids may inhibit lung injury through their anti-inflammatory actions. • Corticosteroids inhibited chlorine-induced pneumonitis and pulmonary edema. • Mometasone and budesonide are potential rescue treatments for chlorine lung injury.

  10. Cerebellar infarct with neurogenic pulmonary edema following viper bite

    Directory of Open Access Journals (Sweden)

    Salil Gupta

    2012-01-01

    Full Text Available Russell′s viper (Daboia russelli bites are well known to cause bleeding complications. However, thrombotic complications are rare. We present the case details of a female who was bitten by a Russell′s viper (Daboia russelli in her village. She then developed features of envenomation in the form of hemorrhagic episodes. She received 27 vials of polyvalent anti-snake venom to which the hemorrhagic complications responded. After about 48 h of the bite she developed features of cerebellar infarct along with pulmonary edema which was in all probability neurogenic in origin. She was managed with mechanical ventilation and extra ventricular drainage with good recovery. We discuss the likely pathogenesis of the infarct and pulmonary edema occurring in a patient with viper bite and other features of envenomation.

  11. Aripiprazole induced non-cardiogenic pulmonary edema: a case report.

    Science.gov (United States)

    Cetin, Mustafa; Celik, Mustafa; Cakıcı, Musa; Polat, Mustafa; Suner, Arif

    2014-01-01

    Aripiprazole is a second-generation antipsychotic drug with partial dopamine agonistic activity. Although the adverse cardiovascular effects of both typical and atypical antipsychotics are well known, similar data on aripiprazole, which was recently introduced, are scarce. Herein we report a 35-year-old female that presented to our emergency department with non-cardiogenic pulmonary edema. Chest X-ray and thoracic CT showed pulmonary edema and bilateral pleural effusion. Anamnesis showed that she had been taking sertraline 200 mg d-1 for obsessive-compulsive disorder for a long time and that aripiprazole10 mg d-1 was added for augmentation 2 months prior to presentation. We think that the CYP 2D6 inhibitor sertraline might have played a role in increasing the plasma concentration and toxicity of aripiprazole in the presented patient.

  12. Positional shifting of HRCT findings in patients with pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Sun; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Seo, Heung Suk; Lee, Seung Rho; Hahm, Chang Kok [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-03-01

    To assess the value of positional shifting to a gravity-dependent area, as revealed by HRCT, in differentiating pulmonary edema (PE) from other conditions. Sixteen consecutive patients in whom plain radiographs suggested the presence of pulmonary edema but the clinical findings were indefinite underwent HRCT of the lung. For initial scanning they were in the supine position, and then in the prone position. Findings of ground-glass opacity, interlobular septal thickening and peribronchovascular interistitial thickening were analyzed in terms of the presence and degree of shifting to a gravity-dependent area, a grade of high, intermediate or low being assigned. PE was diagnosed in 8 of 16 cases, the remainder being designated as non-pulmonary edema (NPE). Ground-glass opacity was observed in all 16, while the degree of positional shifting was found to be high in ten (PE:NPE=6:4), intermediate in four (PE:NPE=2:2), and low in two (PE:NPE=0:2). There was no significant difference between the two groups ({rho} > 0.05). Interlobular septal thickening was observed in all but two NPE cases; the degree of shifting was high in six (PE:NPE=6:0), intermediate in one (PE), and low in seven (PE:NPE=1:6). Shifting was significantly more prominent in PE than in NPE case ({rho} <0.05). Peribronchovascular interstitial thickening was positive in all PE cases and one NPE case, with no positional shifting. Positional shifting of interlobular septal thickening to a gravity-dependent area, as demonstrated by HRCT, is the most specific indicator of pulmonary edema.

  13. Negative pressure pulmonary edema after nasal fracture reduction in an obese female patient: a case report

    Directory of Open Access Journals (Sweden)

    Choi EK

    2015-08-01

    Full Text Available Eunkyung Choi,1 Junggu Yi,1 Younghoon Jeon,2 1Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; 2Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea Abstract: Postoperative negative pressure pulmonary edema (NPPE is a rare, but well-known life-threatening complication of acute upper airway obstruction (UAO which develops after general anesthesia. The pronounced inspiratory efforts following UAO lead to excessive negative inspiratory pressure, which may cause acute pulmonary edema. Early recognition and prompt treatment of NPPE is necessary to prevent patient morbidity and mortality. In addition, the physician should carefully manage the patient who has risk factors of UAO to prevent this situation. We experienced a case of NPPE following laryngospasm after tracheal extubation in an obese patient who underwent open reduction of orbital wall and nasal bone surgery. Keywords: airway obstruction, negative pressure pulmonary edema, laryngospasm, nasal surgery, obese

  14. Negative pressure pulmonary edema revisited: Pathophysiology and review of management

    Directory of Open Access Journals (Sweden)

    Balu Bhaskar

    2011-01-01

    Full Text Available Negative pressure pulmonary edema (NPPE is a dangerous and potentially fatal condition with a multifactorial pathogenesis. Frequently, NPPE is a manifestation of upper airway obstruction, the large negative intrathoracic pressure generated by forced inspiration against an obstructed airway is thought to be the principal mechanism involved. This negative pressure leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. The early detection of the signs of this syndrome is vital to the treatment and to patient outcome. The purpose of this review is to highlight the available literature on NPPE, while probing the pathophysiological mechanisms relevant in both the development of this condition and that involved in its resolution.

  15. Methylprednisolone therapy in acute hemorrhagic edema of infancy

    DEFF Research Database (Denmark)

    Risikesan, Jeyanthini; Koppelhus, Uffe; Steiniche, Torben;

    2014-01-01

    We present a case of an 18-month-old boy who showed severe clinical signs indicative of acute hemorrhagic edema of infancy (AHEI) with painful purpuric skin affection primarily of the face and marked edema of the ears. The histological findings were diagnostic for leukocytoclastic vasculitis...

  16. Clinical feature of severe hand, foot and mouth disease with acute pulmonary edema in pediatric patients%危重型手足口病合并急性肺水肿患儿的临床特点

    Institute of Scientific and Technical Information of China (English)

    周立新; 李轶男; 麦志广; 强新华; 汪首振; 誉铁鸥; 方滨; 温伟标

    2015-01-01

    ObjectiveTo explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema.Methods A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment.Results Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa·s·L-1·m-2):148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8,P< 0.05 orP< 0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2

  17. Pulmonary Edema Assessed by Ultrasound: Impact in Cardiology and Intensive Care Practice.

    Science.gov (United States)

    Blanco, Pablo A; Cianciulli, Tomás F

    2016-05-01

    Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring.

  18. An index of pulmonary edema measured with emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ahluwalia, B.D.; Brownell, G.L.; Hales, C.A.; Kazemi, H.

    1981-10-01

    Positron camera and short-lived biological isotopes are used to obtain transverse sections of lung volume, blood volume, and total lung water of dog lungs to assess the degree of pulmonary edema in normal and edematous dogs. At equilibration with specific isotope, 30 equally spaced angular profiles of the distribution are collected to obtain transverse section images. Emission computed number is obtained in the lung and heart areas for the images obtained with an intravascular marker (11CO) and intra- and extravascular marker (C15O2). The emission computed number ratio of lung to heart for C15O2 images is an index that is related to degree of edema. Emission computed number related to extravascular water can be obtained from normalized (C15O2--11CO) scintigrams. The technique is noninvasive.

  19. Acute hemorrhagic edema of infancy-a rare entity

    Directory of Open Access Journals (Sweden)

    Saurabh R Jindal

    2013-01-01

    Full Text Available A patient presenting with fever and purpura often presents a diagnostic challenge for the dermatologist. Acute hemorrhagic edema of infancy (AHEI is a rare acute cutaneous leukocytoclastic vasculitic syndrome of infants leading to this presentation. We present an 18-month-old girl with AHEI who presented with fever, edema, and purpuric lesions involving the face, ears and extremities with uneventful complete recovery.

  20. Pulmonary Embolism Masquerading as High Altitude Pulmonary Edema at High Altitude.

    Science.gov (United States)

    Pandey, Prativa; Lohani, Benu; Murphy, Holly

    2016-12-01

    Pandey, Prativa, Benu Lohani, and Holly Murphy. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. High Alt Med Biol. 17:353-358, 2016.-Pulmonary embolism (PE) at high altitude is a rare entity that can masquerade as or occur in conjunction with high altitude pulmonary edema (HAPE) and can complicate the diagnosis and management. When HAPE cases do not improve rapidly with descent, other diagnoses, including PE, ought to be considered. From 2013 to 2015, we identified eight cases of PE among 303 patients with initial diagnosis of HAPE. Upon further evaluation, five had deep vein thrombosis (DVT). One woman had a contraceptive ring and seven patients had no known thrombotic risks. PE can coexist with or mimic HAPE and should be considered in patients presenting with shortness of breath from high altitude regardless of thrombotic risk.

  1. Negative Pressure Pulmonary Edema Associated with Anterior Cervical Spine Surgery

    Science.gov (United States)

    Yoneda, Masana; Tanaka, Yasuhito

    2014-01-01

    We report a very rare case of negative pressure pulmonary edema (NPPE) that occurred immediately after anterior cervical discectomy and fusion (ACDF). The patient was a 25-year-old man who sustained a facet fracture-dislocation of C5 during a traffic accident. After ACDF, he developed NPPE and needed mechanical ventilation. Fortunately, he recovered fully within 24 hours. NPPE is a rare postoperative complication that may occur after cervical spine surgery. The aims of this report are to present information regarding the diagnosis and emergent treatment of NPPE, and to review the previous literature regarding this serious complication. PMID:25558327

  2. Is High Altitude Pulmonary Edema Relevant to Hawai‘i?

    Science.gov (United States)

    2014-01-01

    High altitude clinical syndromes have been described in the medical literature but may be under recognized in the state of Hawai‘i. As tourism increases, high altitude injuries may follow given the easy access to high altitude attractions. Visitors and clinicians should be aware of the dangers associated with the rapid ascent to high altitudes in the perceived comfort of a vehicle. This paper will review the basic pathophysiology, prevention, and treatment of the most serious of the high altitude clinical syndromes, high altitude pulmonary edema. PMID:25478294

  3. Unusual ventilation perfusion scintigram in a case of immunologic pulmonary edema clinically simulating pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Campeau, R.J.; Faust, J.M.; Ahmad, S.

    1987-11-01

    A case of immunologic pulmonary edema secondary to hydrochlorothiazide allergy developed in a 55-year-old woman that clinically simulated pulmonary embolism. The patient had abnormal washin images with normal washout images on an Xe-133 ventilation study. On the perfusion study, large bilateral central and posterior perfusion defects were present that showed an unusual mirror image pattern on the lateral and posterior oblique views. Resolution of radiographic and scintigraphic abnormalities occurred over a 3-day period in conjunction with corticosteroid therapy.

  4. 急救中早期比例辅助通气治疗急性心源性肺水肿的临床效果分析%Early application of assisted ventilation in acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    王元华

    2016-01-01

    目的:探讨急救中早期比例辅助通气治疗急性心源性肺水肿的临床效果。方法:收集2012年5月-2014年5月于我院接受治疗的急性心源性肺水肿患者90例,根据治疗方法分为三组,其中常规治疗患者共27例,作为对照组;常规治疗联合早期比例辅助通气治疗患者31例,作为A组;常规治疗联合双水平正压通气治疗患者32例,作为B组。比较三组患者治疗前后的临床效果。结果:三组患者治疗后PaO2、PaCO2、 SpO2、pH值、呼吸频率、心率明显优于治疗前(P<0.05),且A组、B组患者的PaO2、PaCO2、 SpO2、pH值、呼吸频率、心率优于对照组(P<0.05)。A组患者的舒适度为(3.51±0.55),低于B组的(4.58±0.39)(P<0.05)。A组患者的气压峰值为(10.78±1.12)cm H2O,低于B组的(14.54±1.92)cm H2O(P<0.05)。结论:急救中早期比例辅助通气治疗急性心源性肺水肿的临床效果良好,可改善患者症状,值得临床推广及应用。%Objective: To investigate cffcacy of assisted ventilation on acute cardiogenic pulmonary edema. Methods: 90 patients were divided into three groups; 27 patients were treated by conventional therapy, as the control group; 31 patients received conventional therapy combined with early proportional assist ventilation, as the group A; conventional therapy combined with BiPAP therapy in 32 patients, as the group B. Results: After treatment, PaO2, PaCO2, SpO2, pH value, respiratory rate, heart rate were signiifcantly better than before treatment (P<0.05), and the patients, PaO2, PaCO2, SpO2, pH value, respiratory rate, heart rate in the group A and group B were better than the control group (P<0.05). Conclusion: Clinical effects of assisted ventilation on acute cardiogenic pulmonary edema is good, can improve symptoms, and is worthy of promotion and application.

  5. Ataxia, acute mountain sickness, and high altitude cerebral edema

    Institute of Scientific and Technical Information of China (English)

    Wu Tianyi; Ma Siqing; Bian Huiping; Zhang Minming

    2013-01-01

    Previous investigations suggest that ataxia is common and often one of the most reliable warning signs of high altitude cerebral edema(HACE).The aim of this study was to investigate the diagnostic role of ataxia in acute mountain sickness (AMS) and HACE among mountain rescuers on the quake areas,and in approaching the relation between AMS and HACE.After the earthquake on April 14,2010,approximately 24080 lowland rescuers were rapidly transported from sea level or lowlands to the mountainous rescue sites at 3750 ~ 4568 m,and extremely hardly worked for an emergency treatment after arrival.Assessments of acute altitude illness on the quake areas were using the Lake Louise Scoring System.73 % of the rescuers were found to be developed AMS.The incidence of high altitude pulmonary edema(HAPE) and HACE was 0.73 % and 0.26 %,respectively,on the second to third day at altitude.Ataxia sign was measured by simple tests of coordination including a modified Romberg test.The clinical features of 62 patients with HACE were analyzed.It was found that the most frequent,serious neurological symptoms and signs were altered mental status(50/62,80.6 %)and truncal ataxia (47/62,75.8 %).Mental status change was rated slightly higher than ataxia,but ataxia occurred earlier than mental status change and other symptoms.The earliest sign of ataxia was a vague unsteadiness of gait,which may be present alone in association with or without AMS.Advanced ataxia was correlated with the AMS scores,but mild ataxia did not correlate with AMS scores at altitudes of 3750~4568 m.Of them,14 patients were further examined by computerized tomographic scanning of the brain and cerebral magnetic resonance imagines were examined in another 15 cases.These imaging studies indicated that the presence of the cerebral edema was in 97 % of cases who were clinically diagnosed as HACE (28/29).Ataxia seems to be a reliable sign of advanced AMS or HACE,so does altered mental status.

  6. Neurogenic pulmonary edema after rupture of intracranial aneurysm during endovascular coiling

    Directory of Open Access Journals (Sweden)

    Ashish Bindra

    2011-01-01

    Full Text Available Neurogenic pulmonary edema (NPE is a well-known entity, occurs after acute severe insult to the central nervous system. It has been described in relation to different clinical scenario. However, NPE has rarely been mentioned after endovascular coiling of intracranial aneurysms. Here, we report the clinical course of a patient who developed NPE after aneurysmal rupture during endovascular surgery. There was significant cardiovascular instability possibly from stimulation of hypothalamus adjacent to the site of aneurysm. This case highlights the predisposition of minimally invasive procedures like endovascular coiling to life-threatening complications such as NPE.

  7. Edema pulmonar por presión negativa: a propósito de 3 casos Negative pressure pulmonary edema: 3 cases report

    Directory of Open Access Journals (Sweden)

    J. R. Ortiz-Gómez

    2006-08-01

    Full Text Available El edema agudo pulmonar por presión negativa es una complicación descrita desde 1977 tras la obstrucción de la vía aérea respiratoria, tanto en niños como en adultos. Aunque su etiopatogenia es multifactorial, destaca especialmente la excesiva presión intratorácica negativa causada por la inspiración forzada espontánea de un paciente con la glotis cerrada, que resulta en trasudación de líquido de los capilares pulmonares hacia el espacio alveolointersticial. El edema pulmonar resultante puede aparecer en pocos minutos tras la obstrucción de la vía aérea o de forma diferida al cabo de varias horas. Este cuadro clínico es potencialmente grave, pero habitualmente responde bien al tratamiento con oxigenoterapia, ventilación mecánica a presión positiva y diuréticos. Es importante el diagnóstico de sospecha para adecuar el tratamiento con presteza. Presentamos nuestra experiencia en 3 casos clínicos con edema agudo pulmonar por presión negativa.Negative pressure pulmonary edema is a complication, described since 1977, caused by upper airway obstruction in both children and adults. Although its aetiopathogeny is multifactorial, especially outstanding is excessive negative intrathoracic pressure caused by the forced spontaneous inspiration of a patient against a closed glottis, that causes high arteriole and capillary fluid pressures that favor transudation into the alveolar space The resulting pulmonary edema can appear a few minutes after the obstruction of the airway or in a deferred way after several hours. The clinical manifestations are potentially serious, but normally respond well to treatment with supplemental oxygen, positive pressure mechanical ventilation and diuretics. Diagnostic suspicion is important for acting promptly. We report three clinical cases with acute negative pressure pulmonary edema.

  8. Experimental drug intervention study on dinitrogen tetroxide inhalation induced acute pulmonary edema in mice%四氧化二氮吸入中毒致小鼠急性肺水肿药物干预实验研究

    Institute of Scientific and Technical Information of China (English)

    李建忠; 刘志国; 常李荣; 司少艳; 化楠; 陈阿鑫

    2015-01-01

    Objective To establish the mice model of acute pulmonary edema and investigate the therapeutic effect of the compound ami-no acids and vitamin B6. Methods Ten ICR mice(23˜25 g)were randomly divided into control group,poisoned group,and treatment group (n=8). The mice in poisoned group and treatment group were put in the 120 L exposed cabinet to establish N2O4 inhalation induced acute pulmo-nary edema model. Blood was obtained 48 h after the exposure. The mice in treatment group received composite amino acids and vitamin B6 for the treatment. ANP,SP-D,TGF-β1 and TNF-αwere detected by ELISA. Results There were significant differences in ANP,SP-D,TGF-β1 and TNF-α levels between poisoned group and control group( P <0. 05),and there were significant differences in ANP,SP-D and TNF-α levels between the treatment group and the poisoned group( P <0. 05). Conclusion N2 O4 inhalation poisoning can lead to pulmonary ede-ma. Mornitoring the changes of serum ANP,SP-D,TGF-β1 and TNF-αis of clinical significance for the study of the mechanism of N2 O4 in-halation poisoning. The treatment of composite amino acids in combination with vitamin B6 can significantly improve serum ANP,SP-D and TNF-α levels in N2 O4 inhalation poisoning animal. The study has certain reference value for the treatment of patients with this type of poisoning.%目的制作四氧化二氮( N2 O4)吸入中毒致小鼠肺水肿动物模型,应用复合氨基酸加维生素B6予以救治,研究药物干预效果。方法实验动物为ICR小鼠,体重23˜25 g,随机分为对照组、中毒组和治疗组三组( n=8)。将动物置于120 L染毒柜制作N2 O4吸入中毒致肺损伤动物模型,于48 h采用眼球摘除法取血,分离血清-70℃保存,酶联免疫分析(ELISA)法测定心钠素(ANP)和肺表面活性物质相关蛋白D(SP-D)、转化生长因子β1(TGF-β1)、肿瘤坏死因子-α(TNF-α)含量。结果中毒组与

  9. Takotsubo Cardiomyopathy in the Setting of Immersion Pulmonary Edema: Case Series

    Science.gov (United States)

    Sorrentino, Dante; Azuma, Steven

    2015-01-01

    Immersion Pulmonary Edema is a unique medical condition being increasingly described in the medical literature as sudden-onset pulmonary edema in the setting of scuba diving and or swimming. Case reports have associated immersion pulmonary edema with cardiac dysfunction, but there are no known case reports describing submersion pulmonary edema resulting in Takotsubo cardiomyopathy. We report on three patients with unique presentations of immersion pulmonary edema with associated Takotsubo cardiomyopathy. All three cases occurred in O‘ahu, Hawai‘i and were seen by the same cardiologist within a span of seven years. Each patient was scuba diving with sudden dyspnea with pulmonary edema on chest X-ray. Cardiac catheterization revealed no significant epicardial stenosis. Wall motion abnormalities resolved. EKG's showed typical evolution of symmetric T wave inversion. Immersion pulmonary edema and Takotsubo cardiomyopathy may occur together and may be more common than initially thought. Dyspnea has been long known to be stressful as in “waterboarding.” Stressful events are known to trigger Takotsubo cardiomyopathy. Takotsubo cardiomyopathy should be considered as a possible complication of immersion pulmonary edema and EKG's, troponins, echocardiogram and in the appropriate situation cardiac catheterization should be considered.

  10. Hemorrhagic Lacrimation and Epistaxis in Acute Hemorrhagic Edema of Infancy

    Directory of Open Access Journals (Sweden)

    Shireen Mreish

    2016-01-01

    Full Text Available Acute hemorrhagic edema of infancy is an uncommon benign cutaneous vasculitis. Despite its worrisome presentation, it carries good prognosis with rarely reported systemic involvement. Management of these cases has been an area of debate with majority of physicians adopting conservative modalities. We report a case that presented with classic triad of rash, low grade fever, and peripheral edema along with two rarely reported manifestations in literature: hemorrhagic lacrimation and epistaxis.

  11. Morphine blocks the Mesobuthus tamulus venom-induced augmentation of phenyldiguanide reflex and pulmonary edema in anesthetized rats

    Directory of Open Access Journals (Sweden)

    Aparna Akella

    2016-01-01

    Conclusion: The results reveal that morphine prevents the MBT venom-induced augmentation of PDG reflex response and pulmonary edema. Thus, morphine can be useful in scorpion envenomation syndrome associated with pulmonary edema.

  12. Fluid distribution in progressive pulmonary edema: a low-temperature scanning-electron-microscopy study

    Energy Technology Data Exchange (ETDEWEB)

    Hook, G.R.

    1981-06-01

    High pressure pulmonary edema is a common medical disorder caused by venous hypertension following left ventricular heart failure. Abnormal fluid accumulation in the alveolar air spaces results in a life-threatening loss of respiratory function. The primary component of the fluid is water and therefore the study of water distribution in the alveolus can provide insight into high pressure pulmonary edema pathology. The new method of freeze-fracture, low temperature SEM has been developed and applied to the study of pulmonary edema. This method combines freeze-fracture sample preservation with SEM observation and retains pulmonary fluids in the frozen hydrated state for direct three-dimensional SEM imaging of alveoli. Quantitative measurements of alveolar structures resulting from high-pressure pulmonary edema were made from SEM micrographs. From these measurements a model for alveolar fluid distribution resulting from progressive high pressure edema was made.

  13. Transthoracic lung ultrasound in normal dogs and dogs with cardiogenic pulmonary edema: a pilot study.

    Science.gov (United States)

    Rademacher, Nathalie; Pariaut, Romain; Pate, Julie; Saelinger, Carley; Kearney, Michael T; Gaschen, Lorrie

    2014-01-01

    Pulmonary edema is the most common complication of left-sided heart failure in dogs and early detection is important for effective clinical management. In people, pulmonary edema is commonly diagnosed based on transthoracic ultrasonography and detection of B line artifacts (vertical, narrow-based, well-defined hyperechoic rays arising from the pleural surface). The purpose of this study was to determine whether B line artifacts could also be useful diagnostic predictors for cardiogenic pulmonary edema in dogs. Thirty-one normal dogs and nine dogs with cardiogenic pulmonary edema were prospectively recruited. For each dog, presence or absence of cardiogenic pulmonary edema was based on physical examination, heartworm testing, thoracic radiographs, and echocardiography. A single observer performed transthoracic ultrasonography in all dogs and recorded video clips and still images for each of four quadrants in each hemithorax. Distribution, sonographic characteristics, and number of B lines per thoracic quadrant were determined and compared between groups. B lines were detected in 31% of normal dogs (mean 0.9 ± 0.3 SD per dog) and 100% of dogs with cardiogenic pulmonary edema (mean 6.2 ± 3.8 SD per dog). Artifacts were more numerous and widely distributed in dogs with congestive heart failure (P edema on radiographs. Findings from the current study supported the use of thoracic ultrasonography and detection of B lines as techniques for diagnosing cardiogenic pulmonary edema in dogs.

  14. Asymmetric pulmonary edema after scorpion sting: a case report Edema pulmonar assimétrico após picada de escorpião: relato de caso

    Directory of Open Access Journals (Sweden)

    Ebrahim Razi

    2008-12-01

    Full Text Available A 12-year-old boy was referred with acute asymmetric pulmonary edema (APE four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.Menino de 12 anos foi internado no Pronto Socorro, com edema pulmonar assimétrico agudo (APE, quatro horas após picada de escorpião. À admissão, as principais manifestações clínicas foram: dispnéa, taquipnéa e taquicardia. Raio X do pulmão revelou APE predominantemente no hemitórax direito. O paciente foi tratado com oxigênio, frusemida intravenosa e digoxina e teve alta no sexto dia de internação, em boas condições. Este relato de caso enfatiza a ocorrência de edema pulmonar assimétrico algumas horas após a picada.

  15. In the Absence of the Effect of Nursing Intervention on Invasive Ventilation in the Treatment of Acute Cardiogenic Pulmonary Edema%急性心源性肺水肿在无创呼吸机治疗中的护理干预及效果

    Institute of Scientific and Technical Information of China (English)

    努日古力·阿布都瓦依提; 余世勤

    2014-01-01

    Objective:To investigate the nursing methods and curative effect of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema.Method:60 cases of patients with acute cardiogenic pulmonary edema were treated in author’s hospital,early application of noninvasive ventilator,and nursing intervention measures professional,observation and nursing effect of patients.Result:This group of 60 cases of patients wereimproved,no complications, satisfactory effect.Conclusion:Early application of noninvasive ventilator in the treatment of patients with acute cardiogenic pulmonary edema ventilation,can effectively improve the hypoxemia;at the same time,effective intervention measures to become an important guarantee for noninvasive ventilator therapy.%目的:探讨无创呼吸机治疗急性心源性肺水肿的护理干预方法及疗效。方法:选取笔者所在医院收治的60例急性心源性肺水肿患者,早期均应用无创呼吸机治疗,并配合专业的护理干预措施,观察患者护理效果。结果:本组60例患者病情均好转,无并发症发生,取得满意疗效。结论:早期应用无创呼吸机对急性心源性肺水肿患者通气治疗,能够有效改善患者的低氧血症;同时有效的护理干预措施成为无创呼吸机治疗的重要保证。

  16. Neuroleptic malignant syndrome presenting as pulmonary edema and severe bronchorrhea.

    Science.gov (United States)

    Patel, U; Agrawal, M; Krishnan, P; Niranjan, S

    2002-04-01

    Neuroleptic malignant syndrome is a rare (incidence, 0.02%-3.2%) but dangerous complication following the use of neuroleptic drugs. When not promptly recognized, this disease carries a high mortality (10%-20%) and morbidity rate. We report an unusual case of neuroleptic malignant syndrome that presented predominantly with autonomic instability in the form of recurrent episodes of respiratory distress. The respiratory distress was initially caused by pulmonary edema and later was caused by severe bronchorrhea. We propose that aspiration pneumonia resulting in respiratory failure, the leading cause of death in neuroleptic malignant syndrome, may be a result of a combination of altered mental status and bronchorrhea. This has therapeutic implications because early institution of bromocriptine/dantrolene can prevent aspiration pneumonia and, hence, mortality from respiratory failure.

  17. Pulmonary edema of environmental origin--newer concepts

    Energy Technology Data Exchange (ETDEWEB)

    Cordasco, E.M.; Demeter, S.R.; Kester, L.; Cordasco, M.A.; Lammert, G.; Beerel, F.

    1986-06-01

    Pulmonary edema of non-cardiac origin is usually an urgent clinical problem, which has recently increased in frequency throughout the world in the past few years. This is partly due to sociological factors and to pre-eminent advances in industrial technology. Recent severe massive toxic gas explosions have had national and worldwide implications. Therefore, urgent and appropriate therapy is of utmost importance in most of these patients. The use of high flow oxygen with Constant Positive Pressure Breathing are the main inhalational therapeutic approaches. Newer modalities of treatment include: (1) earlier Fiberoptic bronchoscopy in those individuals afflicted with aspiration problems and (2) certain specific chemical blocking agents for the management of phosgene intoxication and hydrogen sulfide toxicity. Preventive environmental measures are also important.

  18. A rare cause of pulmonary edema in the postoperative period

    Directory of Open Access Journals (Sweden)

    Kshitij Chatterjee

    2017-01-01

    Full Text Available With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.

  19. A Rare Cause of Pulmonary Edema in the Postoperative Period.

    Science.gov (United States)

    Chatterjee, Kshitij; Mittadodla, Penchala S; Colaco, Clinton; Jagana, Rajani

    2017-02-01

    With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS) is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.

  20. Ibuprofen prevents synthetic smoke-induced pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Shinozawa, Y.; Hales, C.; Jung, W.; Burke, J.

    1986-12-01

    Multiple potentially injurious agents are present in smoke but the importance of each of these agents in producing lung injury as well as the mechanisms by which the lung injury is produced are unknown. In order to study smoke inhalation injury, we developed a synthetic smoke composed of a carrier of hot carbon particles of known size to which a single known common toxic agent in smoke, in this case HCI, could be added. We then exposed rats to the smoke, assayed their blood for the metabolites of thromboxane and prostacyclin, and intervened shortly after smoke with the cyclooxygenase inhibitors indomethacin or ibuprofen to see if the resulting lung injury could be prevented. Smoke exposure produced mild pulmonary edema after 6 h with a wet-to-dry weight ratio of 5.6 +/- 0.2 SEM (n = 11) compared with the non-smoke-exposed control animals with a wet-to-dry weight ratio of 4.3 +/- 0.2 (n = 12), p less than 0.001. Thromboxane B, and 6-keto-prostaglandin F1 alpha rose to 1660 +/- 250 pg/ml (p less than 0.01) and to 600 +/- 100 pg/ml (p greater than 0.1), respectively, in the smoke-injured animals compared with 770 +/- 150 pg/ml and 400 +/- 100 pg/ml in the non-smoke-exposed control animals. Indomethacin (n = 11) blocked the increase in both thromboxane and prostacyclin metabolites but failed to prevent lung edema.

  1. Computerized lung sound analysis following clinical improvement of pulmonary edema due to congestive heart failure exacerbations

    Institute of Scientific and Technical Information of China (English)

    WANG Zhen; XIONG Ying-xia

    2010-01-01

    Background Although acute congestive heart failure (CHF) patients typically present with abnormal auscultatory findings on lung examination, lung sounds are not normally subjected to rigorous analysis. The goals of this study were to use a computerized analytic acoustic tool to evaluate lung sound patterns in CHF patients during acute exacerbation and after clinical improvement and to compare CHF profiles with those of normal individuals.Methods Lung sounds throughout the respiratory cycle was captured using a computerized acoustic-based imaging technique. Thirty-two consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created, geographical area of the images and lung sound patterns were quantitatively analyzed.Results The geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were (67.9±4.7) and (60.3±3.5) kilo-pixels, respectively (P <0.05). In CHF patients without and with radiographically evident pulmonary edema (REPE), after clinical improvement the geographical area of vibration energy image of lung sound increased to (74.5±4.4) and (73.9±3.9) kilo-pixels (P <0.05), respectively. Vibration energy decreased in CHF patients with REPE following clinical improvement by an average of (85±19)% (P <0.01). Conclusions With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image. Lung sound analysis may be useful to track in acute CHF exacerbations.

  2. Postobstructive Pulmonary Edema following Tonsillectomy/Adenoidectomy in a 2-Year-Old with Poland-Moebius Syndrome

    Directory of Open Access Journals (Sweden)

    Tanisha Powell

    2016-01-01

    Full Text Available A 2-year-old male with Poland-Moebius syndrome was transferred from a local hospital to the Pediatric ICU at Children’s Hospital of Georgia for suspected postobstructive pulmonary edema (POPE after tonsillectomy/adenoidectomy (T&A. The patient’s respiratory status ultimately declined and he developed respiratory failure. Imaging suggested pulmonary edema as well as a left-sided pneumonia. Echocardiogram showed pulmonary hypertension and airway exam via direct fiberoptic bronchoscopy revealed tracheomalacia and bronchomalacia. He developed acute respiratory distress syndrome (ARDS and remained intubated for ten days. This case highlights the association between congenital upper body abnormalities with cranial nerve dysfunction and the development of POPE with delayed resolution of symptoms. Patients with upper body abnormalities as above are at great risk of postoperative complications and should therefore be managed in a tertiary-care facility.

  3. Postobstructive Pulmonary Edema following Tonsillectomy/Adenoidectomy in a 2-Year-Old with Poland-Moebius Syndrome

    Science.gov (United States)

    Powell, Tanisha; Sharma, Nirupma; McKie, Kathleen T.

    2016-01-01

    A 2-year-old male with Poland-Moebius syndrome was transferred from a local hospital to the Pediatric ICU at Children's Hospital of Georgia for suspected postobstructive pulmonary edema (POPE) after tonsillectomy/adenoidectomy (T&A). The patient's respiratory status ultimately declined and he developed respiratory failure. Imaging suggested pulmonary edema as well as a left-sided pneumonia. Echocardiogram showed pulmonary hypertension and airway exam via direct fiberoptic bronchoscopy revealed tracheomalacia and bronchomalacia. He developed acute respiratory distress syndrome (ARDS) and remained intubated for ten days. This case highlights the association between congenital upper body abnormalities with cranial nerve dysfunction and the development of POPE with delayed resolution of symptoms. Patients with upper body abnormalities as above are at great risk of postoperative complications and should therefore be managed in a tertiary-care facility. PMID:26942029

  4. Analysis of proteins in bronchoalveolar lavage fluids during pulmonary edema resulting from nitrogen dioxide and cadmium exposure

    Energy Technology Data Exchange (ETDEWEB)

    Gurley, L.R.; London, J.E.; Dethloff, L.A.; Lehnert, B.E.

    1988-01-01

    We have developed a new HPLC method by which quantitative measurements can be made on the biochemical constituents of the extracellular fluid lining of the lung as sampled by bronchoalveolar lavage. Nine of the fractions are proteins, two are phospholipids, and two fractions remained unidentified. Rats were subjected to the intrapulmonary deposition of cadmium, a treatment model known to induce pulmonary edema and cause a translocation of blood compartment proteins into the lung's alveolar space compartment. Resulting pulmonary edema was hallmarked by /approximately/25-fold increases in three major blood compartment-derived HPLC protein fractions, two of which have been identified as albumin and immunoglobulin(s). Analysis of lavage fluid from rats exposed to 100 ppM NO/sub 2/ for 15 min, an exposure regimen which also produces pulmonary edema, indicated that the three blood compartment proteins in the lavage fluids were elevated 35- to 72-fold over controls 24 h after exposure. These results demonstrate that HPLC can be used to provide a highly sensitive method for detection and quantitation of pulmonary edema that can occur in acute lung injuries resulting from environmental insults.

  5. 急性心源性肺水肿临床疗效与X线胸片的相关性分析%Analysis the relationship between therapeutic effect of acute cardiogenic pulmonary edema and chest X-ray features

    Institute of Scientific and Technical Information of China (English)

    李晶晶; 董磊

    2013-01-01

    Objective To study the relationship between therapeutic effect of acute cardiogenic pulmonary edema (ACPE)and chest X-ray features.To offer an assessment method to clinical therapy. Methods Forty-eight patients with ACPE were recruited in the study. After treatment all the changes of chest X-ray features were analyzed by two salty radiologists using double blind method retrospectively.Statistics method were χ2 analysis and Kappa analysis. Results Two doctors found the patients with better therapeutic effect also have obviously changes of chest X-ray(P<0.05).The two doctors’film reading have the same concordance (P<0.05). Conclusion It’s important to recheck chest X-ray during the clinical therapy of patients with ACPE.%  目的研究急性心源性肺水肿治疗效果和X线胸片表现之间的关系,为临床评估疗效提供帮助。方法由2名有经验的放射科医师采用盲法回顾性分析48例急性心源性肺水肿患者治疗前后的X线胸片好转率,所得的数据做χ2检验,并用Kappa检验对2人评判的结果做一致性分析。结果医师甲、乙所得的结论均为:急性心源性肺水肿临床治疗后好转者,X线胸片好转率的差异有统计学意义(P<0.05)。甲乙医师间阅片的一致性分析差异有统计学意义(P<0.05),说明甲乙2名医师对治疗前后X线表现好转与否的诊断结果有较好的一致性。讨论急性心源性肺水肿治疗过程中复查X线胸片,是评估临床疗效的一种有效的方法。

  6. TEVAR for Flash Pulmonary Edema Secondary to Thoracic Aortic Aneurysm to Pulmonary Artery Fistula.

    Science.gov (United States)

    Bornak, Arash; Baqai, Atif; Li, Xiaoyi; Rey, Jorge; Tashiro, Jun; Velazquez, Omaida C

    2016-01-01

    Enlarging aneurysms in the thoracic aorta frequently remain asymptomatic. Fistulization of thoracic aortic aneurysms (TAA) to adjacent structures or the presence of a patent ductus arteriosus and TAA may lead to irreversible cardiopulmonary sequelae. This article reports on a large aneurysm of the thoracic aorta with communication to the pulmonary artery causing pulmonary edema and cardiorespiratory failure. The communication was ultimately closed after thoracic endovascular aortic aneurysm repair allowing rapid symptom resolution. Early diagnosis and closure of such communication in the presence of TAA are critical for prevention of permanent cardiopulmonary damage.

  7. Characteristics of the pulmonary transport functions for heat and dye in pulmonary edema and orthostasis.

    Science.gov (United States)

    Böck, J C; Hoeft, A; Korb, H; Hellige, G

    1989-04-01

    The aim of this study was to investigate whether changes in the distribution of pulmonary blood flow and disturbances of the pulmonary microcirculation can be detected by use of inflow-outflow indicator-dilution measurements. In 18 anesthetized (N2O-piritramide) mongrel dogs 221 thermal-indocyanine green dye indicator dilution kinetics were recorded in the pulmonary artery and aorta after central venous indicator injection. The lagged normal density function was used as a model for the pulmonary transport functions for heat and dye. The parameters of the lagged normal density function were computed by a non-linear least squares procedure by iterative convolution. After baseline measurements, in nine dogs, pulmonary edema was induced by central venous application of oleic acid. In nine other dogs, measurements were performed before and after postural changes. Our data show that both the microvascular injury caused by oleic acid edema and the perfusion heterogeneity caused by orthostasis can be detected by the indicator dilution technique since the both relative dispersion and skewness of the transport functions for heat and dye were significantly increased after these interventions.

  8. The effect of TIP on pneumovirus-induced pulmonary edema in mice.

    Directory of Open Access Journals (Sweden)

    Elske van den Berg

    Full Text Available BACKGROUND: Pulmonary edema plays a pivotal role in the pathophysiology of respiratory syncytial virus (RSV-induced respiratory failure. In this study we determined whether treatment with TIP (AP301, a synthetic cyclic peptide that mimics the lectin-like domain of human TNF, decreases pulmonary edema in a mouse model of severe human RSV infection. TIP is currently undergoing clinical trials as a therapy for pulmonary permeability edema and has been shown to decrease pulmonary edema in different lung injury models. METHODS: C57BL/6 mice were infected with pneumonia virus of mice (PVM and received TIP or saline (control group by intratracheal instillation on day five (early administration or day seven (late administration after infection. In a separate set of experiments the effect of multiple dose administration of TIP versus saline was tested. Pulmonary edema was determined by the lung wet-to-dry (W/D weight ratio and was assessed at different time-points after the administration of TIP. Secondary outcomes included clinical scores and lung cellular response. RESULTS: TIP did not have an effect on pulmonary edema in different dose regimens at different time points during PVM infection. In addition, TIP administration did not affect clinical severity scores or lung cellular response. CONCLUSION: In this murine model of severe RSV infection TIP did not affect pulmonary edema nor course of disease.

  9. Analysis of Multivariate Factors for Noninvasive Ventilation In the Patients with Acute Cardiogenic Pulmona-ry Edema%无创通气治疗急性心源性肺水肿失败的多因素分析

    Institute of Scientific and Technical Information of China (English)

    钱风华; 钱义明; 朱亮; 顼志兵; 祁丽丽; 赵雷

    2010-01-01

    Objective To analyze the multivariate factors associated with failure of applying noninvasive ven-tilation(NIV)in the patients with acute cardiogenic pulmonary edema(ACPE).Methods 65 patients with ACPE re-ceived NIV treatment,and were divided into NIV syccess group and NIV failure group according to the result with NIV therapy.Compared with the exchanges of the relevant parameters before the treatment and in the treatment between these two groups,analysis the alert factors and observational factors of the failure in NIV treatment.Resylts 27 cases in failure on NIV were elders,with acute myocardial infarction,decline on PaCO_2,raise on PH,low on MPA,compared with the success group.In NIV treatment and observing the changes of RR,PaO2,PaCO_2,there is a obviously differ-ence(P<0.05)on the HR improvement in the patients of the success group compared with the patients of the failure group.Conclusion The factors of elder,acute myocardial infarction,decline on PaCO_2,raise on PH,low on MPA could be seemed as the alert factors before the NIV treatment,the efficiency of therapy of NIV could be judged through observing HR,RR,PaO_2,PaCO_2 in NIV treatment.%目的 分析应用无创通气(NIV)治疗急性心源性肺水肿(ACPE)失败的多种因素.方法 65例ACPE患者在应用NIV治疗后根据结果分为NIV成功组和NIV失败组,将两组治疗前的相关因素和治疗时相关指标的变化进行比较,分析NIV治疗失败的预警因素和观察指标.结果 27例NIV治疗失败,与成功组比较,NIV失败组年龄偏大、患急性心肌梗死、PaCO_2下降、PH增高、MPA低.NIV治疗期间治疗成功组患者HR的改善优于失败组(P<0.05).结论 NIV治疗前,高龄、急性心肌梗死患者、PaCO_2下降、PH增高、MPA低可以作为预警因素;NIV期间观察HR、RR、PaO_2、PaCO_2可以及时判断NIV治疗的有效性.

  10. Reexpansion pulmonary edema following a posttraumatic pneumothorax: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bechtold Barbara

    2011-09-01

    Full Text Available Abstract The reexpansion pulmonary edema is a rare, but life threatening complication of a pneumothorax. Early recognition and a fast symptom orientated therapy are necessary for a good outcome. Several cases after non traumatic pneumothoraces are reported. We describe a patient who presented with a post-traumatic right pneumothorax. After the insertion of a chest tube he developed a reexpansion pulmonary edema, which had to be treated by an intubation. Additionally, a review of the literature regarding case reports of reexpansion pulmonary edema is presented.

  11. Negative Pressure Pulmonary Edema Following use of Laryngeal Mask Airway (LMA

    Directory of Open Access Journals (Sweden)

    Yesim Bayraktar

    2013-06-01

    Full Text Available Negative pressure pulmonary edema (NPPE following upper airway obstruction is a non-cardiogenic pulmonary edema. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglotitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors.The Late diagnosis and treatment causes high morbidity and mortality. The protection of the airway and maintainance of arterial oxygenation will be life saving.In this article we aimed to report  a case of negative pressure pulmonary edema, resolved succesfully after treatment, following use of laryngeal mask airway (LMA.

  12. Measurement of pulmonary edema in intact dogs by transthoracic gamma-ray attenuation

    Energy Technology Data Exchange (ETDEWEB)

    Simon, D.S.; Murray, J.F.; Staub, N.C.

    1979-12-01

    Attenuation of the 122 keV gamma rays of cobalt-57 across the thorax of anesthetized dogs was evaluated as a method for following the time course of lung water changes in acute pulmonary edema induced by either increased microvascular permeability or increased microvascular hydrostatic pressure. The gamma rays traversed the thorax centered on the seventh rib laterally where the lung mass in the beam path was greatest. Calibration measurements in isolated lung lobes demonstrated the high sensitivity and inherent accuracy of the method over a wide range of lung water contents. In control dogs reproducibility averaged +-3%. Increased permeability edema led to large rapid increases in the transthoracic gamma ray attenuation (TGA), while increased pressure caused an immediate, modest increase in TGA (vascular congestion) followed by a slow further increase over 2 h. There was a fairly good correlation between the increase in extravascular lung water and the change in TGA. The method is simple, safe, and noninvasive and appears to be useful for following the time course of lung water accumulation in generalized lung edema in anesthetized animals.

  13. Edema pulmonar hidrostático: aspectos na tomografia computadorizada de alta resolução Hydrostatic pulmonary edema: high-resolution computed tomography aspects

    Directory of Open Access Journals (Sweden)

    Cláudia Maria Cunha Ribeiro

    2006-12-01

    Full Text Available OBJETIVO: A proposta deste estudo foi caracterizar por meio de tomografia computadorizada de alta resolução do tórax as principais alterações pulmonares do edema pulmonar hidrostático. MÉTODOS: Foram analisadas, retrospectivamente, as tomografias de quinze pacientes com quadro clínico de edema pulmonar hidrostático, divididos em cinco principais grupos etiológicos: insuficiência cardíaca congestiva, valvulopatia mitral aguda, infarto agudo do miocárdio, miocardite e mediastinite fibrosante, tendo sido sete pacientes classificados no primeiro grupo e dois em cada um dos demais. RESULTADOS: Os principais achados do edema hidrostático foram opacidades em vidro fosco (100%, espessamento dos septos interlobulares (100%, derrame pleural (87% e espessamento do interstício peribroncovascular (80%. Outros achados menos comuns foram aumento do calibre dos vasos, consolidações e nódulos do espaço aéreo. CONCLUSÃO: O padrão predominante encontrado nos pacientes estudados foi o de opacidades em vidro fosco associadas a espessamento dos septos interlobulares (padrão de pavimentação em mosaico, com derrame pleural bilateral, predominante à direita.OBJECTIVE: This study aimed to use high-resolution computed tomography scans of the chest to characterize the principal alterations occurring in cases of hydrostatic pulmonary edema. METHODS: A retrospective analysis was made of the tomography scans of 15 patients presenting clinical profiles of hydrostatic pulmonary edema. The cases were divided into five groups by etiology: congestive heart failure (n = 7; acute mitral valve disease (n = 2; acute myocardial infarction (n = 2; myocarditis (n = 2; and fibrosing mediastinitis (n = 2. RESULTS: The principal findings in the cases of hydrostatic pulmonary edema were ground-glass opacities (in 100%, interlobular septal thickening (in 100%, pleural effusion (in 87% and peribronchovascular interstitial thickening (in 80%. Other, less common

  14. Edema

    Science.gov (United States)

    Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles ... it can involve your entire body. Causes of edema include Eating too much salt Sunburn Heart failure ...

  15. Edema

    Science.gov (United States)

    ... problem worse. Edema can also be a side effect of taking certain medicines.Some health problems, such as congestive heart failure, liver disease and kidney disease, can cause edema. You cannot ...

  16. A Case Report of Acute Hemorrhagic Edema of Infancy

    Directory of Open Access Journals (Sweden)

    M. Safari

    2005-10-01

    Full Text Available Introduction: Acute hemorrhagic edema of infancy is an acute and rare cutaneous disorder that affects children between 4 months to 2 years of age and characterized by cutaneous purpuric lesions with millimeters to centimeters diameter. Systemic involvement is rare. The disease is benign and spontaneously resolved in 1-3 weeks.Case Report: Here we described a 22-months old girl with acute hemorrhagic edema of infancy who hospitalized in department of pediatric with the presence of erythematous-purpuric lesions localized on the face, ears and lower limbs that developed suddenly two days before hospitalization. Laboratory examination revealed including normal cell blood counts, serum complements, serum electrolytes and creatinin. ANA was negative. Coagulation tests were normal. ESR was 45 mm/h. Urine analysis and stool examination revealed no abnormal findings. Disease resolved spontaneously without any problem.Conclusion: According to the contrast between the acuteness of the cutaneous sign, which are typical and unmistakable, and the general condition of the patient, which was good and the laboratory findings, our patient labeled as acute hemprrhagic edema of infancy.

  17. Refractory Pulmonary Edema Caused by Late Pulmonary Vein Thrombosis After Lung Transplantation: A Rare Adverse Event.

    Science.gov (United States)

    Denton, Eve J; Rischin, Adam; McGiffin, David; Williams, Trevor J; Paraskeva, Miranda A; Westall, Glen P; Snell, Greg

    2016-09-01

    After lung transplantation, pulmonary vein thrombosis is a rare, potentially life-threatening adverse event arising at the pulmonary venous anastomosis that typically occurs early and presents as graft failure and hemodynamic compromise with an associated mortality of up to 40%. The incidence, presentation, outcomes, and treatment of late pulmonary vein thrombosis remain poorly defined. Management options include anticoagulant agents for asymptomatic clots, and thrombolytic agents or surgical thrombectomy for hemodynamically significant clots. We present a rare case highlighting a delayed presentation of pulmonary vein thrombosis occurring longer than 2 weeks after lung transplantation and manifesting clinically as graft failure secondary to refractory pulmonary edema. The patient was treated successfully with surgical thrombectomy and remains well. We recommend a high index of suspicion of pulmonary vein thrombosis when graft failure after lung transplantation occurs and is not responsive to conventional therapy, and consideration of investigation with transesophageal echocardiography or computed tomography with venous phase contrast in such patients even more than 2 weeks after lung transplantation.

  18. Edema agudo hemorrágico da infância Acute hemorrhagic edema of infancy

    Directory of Open Access Journals (Sweden)

    Fabiana Britto Goulart

    2004-06-01

    Full Text Available Relatamos o caso de uma criança de oito meses de idade com infecção das vias aéreas superiores, seguida de irritabilidade e pelo aparecimento de lesões purpúricas na face, extremidades e pavilhões auriculares e edema de dorso dos pés e das mãos. Inicialmente recebeu dexametasona, ampicilina e cloranfenicol para tratamento de suposta meningococcemia. Entretanto, as lesões características e a boa evolução clínica do quadro levaram-nos ao diagnóstico de uma forma rara de vasculite cutânea: edema agudo hemorrágico da infância.We report the case of an eight-month child with upper airway infection followed by irritability and purpuric lesions in his face, ears and extremities and peripheral soft tissue edema. He was treated with dexamethasone, ampicillin and chloramphenicol for presumed meningococcemia, but the characteristics lesions and the benign course of the disease led us to the diagnosis of a rare form of cutaneous vasculitis called Acute Hemorrhagic Edema of Infancy (AHEI.

  19. Emergent balloon mitral valvotomy in pregnant women presenting with refractory pulmonary edema

    Directory of Open Access Journals (Sweden)

    N. Bouchahda

    2014-03-01

    Conclusion: During pregnancy, emergent BMV is safe and feasible in patients with symptomatic mitral stenosis and severe pulmonary edema. There is marked symptomatic relief, along with excellent maternal and fetal outcomes.

  20. A Case of Re-Expansion Pulmonary Edema after Rapid Pleural Evacuation

    Directory of Open Access Journals (Sweden)

    SH Shahbazi

    2007-07-01

    Full Text Available Introduction & Objective: Pulmonary edema after chest tube insertion is a rare complication and is associated with high mortality. The cause of this phenomenon is not clear, although causes such as decrease in surfactant and inflammatory process have been defined. Early diagnosis and treatment decrease the mortality. This study introduces a case of re-expansion pulmonary edema after rapid pleural evacuation. Case: The case is a 4.5 y/o boy, a case of Tetralogy of Fallot, who developed respiratory distress after surgery (Total Correction in ICU of Namazi Hospital in 1385. Chest X ray showed pneumothorax of left lung. For the patient, chest tube was inserted and the symptoms improved. After few hours the patient developed tachypnea, tachycardia, and CXR showed pulmonary edema of left lung. Appropriate treatment was done for the patient and his condition improved. Conclusion: Pulmonary edema after sudden evacuation of pleura is a rare phenomenon and early diagnosis decreases the mortality.

  1. [Cardiogenic pulmonary edema - truth and myths in the perspective of emergency medicine].

    Science.gov (United States)

    Osterwalder, J J

    2012-09-19

    This critical analysis of the traditional pathophysiological approach to the diagnosis and treatment of cardiogenic pulmonary edema calls into question some long-established ideas and interventions that ought to be replaced by better evidence-based concepts.

  2. Three plasma metabolite signatures for diagnosing high altitude pulmonary edema

    Science.gov (United States)

    Guo, Li; Tan, Guangguo; Liu, Ping; Li, Huijie; Tang, Lulu; Huang, Lan; Ren, Qian

    2015-10-01

    High-altitude pulmonary edema (HAPE) is a potentially fatal condition, occurring at altitudes greater than 3,000 m and affecting rapidly ascending, non-acclimatized healthy individuals. However, the lack of biomarkers for this disease still constitutes a bottleneck in the clinical diagnosis. Here, ultra-high performance liquid chromatography coupled with Q-TOF mass spectrometry was applied to study plasma metabolite profiling from 57 HAPE and 57 control subjects. 14 differential plasma metabolites responsible for the discrimination between the two groups from discovery set (35 HAPE subjects and 35 healthy controls) were identified. Furthermore, 3 of the 14 metabolites (C8-ceramide, sphingosine and glutamine) were selected as candidate diagnostic biomarkers for HAPE using metabolic pathway impact analysis. The feasibility of using the combination of these three biomarkers for HAPE was evaluated, where the area under the receiver operating characteristic curve (AUC) was 0.981 and 0.942 in the discovery set and the validation set (22 HAPE subjects and 22 healthy controls), respectively. Taken together, these results suggested that this composite plasma metabolite signature may be used in HAPE diagnosis, especially after further investigation and verification with larger samples.

  3. Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

    OpenAIRE

    2015-01-01

    Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharge...

  4. Flash pulmonary edema in patients with renal artery stenosis--the Pickering Syndrome

    DEFF Research Database (Denmark)

    Pelta, Anna; Andersen, Ulrik B; Just, Sven

    2010-01-01

    We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of uni- or bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases.......We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of uni- or bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases....

  5. Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

    Directory of Open Access Journals (Sweden)

    M. Hedaiaty

    2015-01-01

    Full Text Available Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium, pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery.

  6. Post extubation negative pressure pulmonary edema due to posterior mediastinal cyst in an infant

    Directory of Open Access Journals (Sweden)

    Prakash Kumar Dubey

    2014-01-01

    Full Text Available A 3-month-old male child underwent uneventful inguinal herniotomy under general anesthesia. After extubation, airway obstruction followed by pulmonary edema appeared for which the baby was reintubated and ventilated. The baby made a complete recovery and extubated after about 2 h. A post-operative computed tomography scan revealed a posterior mediastinal cystic mass abutting the tracheal bifurcation. Presumably, extrinsic compression by the mass on the tracheal bifurcation led to the development of negative pressure pulmonary edema.

  7. Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

    Science.gov (United States)

    Hedaiaty, M.; Eizadi-Mood, N.; Sabzghabaee, A. M.

    2015-01-01

    Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium), pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery. PMID:26075111

  8. Post extubation negative pressure pulmonary edema due to posterior mediastinal cyst in an infant.

    Science.gov (United States)

    Dubey, Prakash Kumar

    2014-01-01

    A 3-month-old male child underwent uneventful inguinal herniotomy under general anesthesia. After extubation, airway obstruction followed by pulmonary edema appeared for which the baby was reintubated and ventilated. The baby made a complete recovery and extubated after about 2 h. A post-operative computed tomography scan revealed a posterior mediastinal cystic mass abutting the tracheal bifurcation. Presumably, extrinsic compression by the mass on the tracheal bifurcation led to the development of negative pressure pulmonary edema.

  9. Negative Pressure Pulmonary Edema Following use of Laryngeal Mask Airway (LMA)

    OpenAIRE

    2013-01-01

    Negative pressure pulmonary edema (NPPE) following upper airway obstruction is a non-cardiogenic pulmonary edema. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglotitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors.The Late diagnosis and treatment causes high morbidity and mortality. The protection of the airway and maintainance of arterial oxygenation will be life saving...

  10. Edema agudo pulmonar associado à obstrução das vias aéreas: relato de caso Edema agudo pulmonar asociado a la obstrucción de las vías aéreas: relato de caso Acute pulmonary edema associated with obstruction of the airways: case report

    OpenAIRE

    Flora Margarida Barra Bisinotto; Ricardo de Paula Cardoso; Tânia Mara Vilela Abud

    2008-01-01

    JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa tem sido definido como edema não-cardiogênico, com transudação de líquido para o interstício pulmonar, por aumento na pressão negativa intratorácica, ocasionado pela obstrução das vias aéreas superiores. Descreveu-se o caso de paciente hígida, submetida à anestesia geral, que apresentou edema agudo pulmonar após a extubação traqueal. RELATO DO CASO: Paciente de 23 anos, sexo feminino, estado físico ASA II, submetida à anestesia ...

  11. Transcatheter closure of atrial septal defect protects from pulmonary edema: septal occluder device gradually reduces LR shunt.

    Science.gov (United States)

    Murakami, Tsutomu; Nakazawa, Gaku; Horinouchi, Hitomi; Torii, Sho; Ijichi, Takeshi; Ohno, Yohei; Amino, Mari; Shinozaki, Norihiko; Ogata, Nobuhiko; Yoshimachi, Fuminobu; Yoshioka, Koichiro; Ikari, Yuji

    2017-01-01

    A 56-year-old woman was diagnosed as atrial septal defect (ASD) with pulmonary hypertension; pulmonary blood flow/systemic blood flow (Qp/Qs) of 2.3, pulmonary artery pressure (PAP) of 71/23(39) mmHg and diastolic dysfunction of left ventricle. PAP was improved after medical therapy; therefore, transcatheter ASD closure was performed. Seven days later, left-sided heart failure occurred, however, the improvement of Qp/Qs (1.7) and PAP of 51/21(32) was confirmed. Diuretic therapy was introduced which led to further decrease of PAP 40/12(25) and Qp/Qs (1.1). Because of gradual decrease of Qp/Qs, this patient appeared to be protected from acute pulmonary edema.

  12. Visual Impairment Caused by Periorbital Edema in an Infant with Acute Hemorrhagic Edema of Infancy

    DEFF Research Database (Denmark)

    Freitas, Priscila; Bygum, Anette

    2013-01-01

    Acute hemorrhagic edema of infancy (AHEI) is a cutaneous vasculitis seen in children. Many consider it to be a clinical variant of Schönlein-Henoch purpura, but others regard it as a separate entity because of its benign nature, age of onset, lack of visceral involvement, and frequent absence......, or vaccination. Because of the unknown etiology and benign character, which leads to spontaneous complete recovery, there is no specific treatment necessary for AHEI, and according to the literature, systemic corticosteroids do not seem to alter the course of the disease. We report the case of an 11-month......-old boy who manifested massive periorbital edema along with all of the clinical characteristics of this entity and showed clear improvement of the symptoms after a 24-hour administration of systemic corticosteroid therapy. Given the positive effect of this therapy, we propose that systemic corticosteroids...

  13. Experience of step-wise protocol using noninvasive positive pressure ventilation for treating cardiogenic pulmonary edema.

    Science.gov (United States)

    Momii, Hidetoshi; Tashima, Yuki; Kadokami, Toshiaki; Narita, Sumito; Yoshida, Masayoshi; Ando, Shin-ichi

    2012-08-01

    Initiating and weaning procedure of noninvasive positive pressure ventilation (NIPPV) on acute cardiogenic pulmonary edema (ACPE) has been determined empirically, and the total time of its use has been sometimes prolonged unnecessarily. A simple protocol for its use may facilitate initiation and avoids prolongation of the NIPPV treatment. We designed a step-wise protocol for NIPPV use and retrospectively examined the clinical outcome of our protocol for initiation and weaning of NIPPV in 45 patients with ACPE. Almost all patients recovered from respiratory distress successfully. There was no intubation nor complication related to NIPPV. In most of the cases, maximal-end expiratory pressure was less than 7-cm H2O. The mean duration of NIPPV was 19.5±28.0 h and the median duration was 8.0 h (interquartile range=14.0 h). This simple step-wise NIPPV protocol for ACPE can facilitate quick and safe initiation and termination of the treatment.

  14. A new Compton densitometer for measuring pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Loo, B.W.; Goulding, F.S.; Simon, S.

    1986-02-01

    Pulmonary edema (PE) is the pathological increase of extravascular lung water found most often in patients with congestive heart failure and other critically ill patients who suffer from intravenous fluid overload. The chest x-ray, the standard method for validating the presence of PE, is neither quantitative nor sensitive. A non-invasive lung density monitor that is accurate, easily portable, safe and inexpensive is needed for clinical use. To deal with the problem of attenuation along the beam paths, previous gamma-ray techniques require simultaneous measurement of transmitted and scattered beams. Since multiple scattering is a strong function of the density of the scattering medium and the mass distribution within the detection geometry, there will be inherent uncertainties in the system calibration unless it is performed on a body structure closely matched to that of each individual patient. Other researchers who have employed Compton scattering techniques generally used systems of extended size and detectors with poor energy resolution. This has resulted in significant systematic biases from multiply-scattered photons and larger errors in counting statistics at a given radiation dose to the patient. We are proposing a patented approach in which only backscattered photons are measured with a high-resolution HPGe detector in a compact system geometry. By proper design and a unique data extraction scheme, effects of the variable chest wall on lung density measurements are minimized. Preliminary test results indicate that with a radioactive source of under 30 GBq, it should be possible to make an accurate lung density, measurement in one minute, with a risk of radiation exposure to the patient a thousand times smaller than that from a typical chest x-ray.

  15. 有创无创序贯机械通气在治疗急性重症心源性肺水肿中的应用价值分析%Sequential Invasive Noninvasive Mechanical Ventilation in the Treatment of Acute Severe Cardiogenic Pulmonary Edema Value

    Institute of Scientific and Technical Information of China (English)

    罗建宇; 王晓源; 蒋文芳

    2014-01-01

    目的探讨有创无创序贯机械通气在治疗急性重症心源性肺水肿中的应用效果及价值。方法将50例急性重症心源性肺水肿随机分为观察组和对照组,对照组采用有创机械通气,观察组采用有创-无创序贯机械通气,以SIMV+PSV方式进行机械通气,双水平气道正压支持并撤机。结果两组患者撤机时的HR、RR、PaO2、PaCO2、SaO2均较有创通气前有改善(<0.05)。观察组的机械通气时间、VAP、死亡率少于对照组,有统计学意义(<0.05)。结论有创无创序贯机械通气治疗急性重症心源性肺水肿疗效满意,能够减少并发症。%Objective To investigate and non-invasive sequential mechanical ventilation in the treatment of acute severe application effect and value of cardiac pulmonary edema. Methods 50 cases of acute severe cardiac pulmonary edema were randomly divided into observation group and control group, control group adopts invasive mechanical ventilation, observation group by invasive and non-invasive sequential mechanical ventilation, mechanical ventilation, on the basis of SIMV + PSV double level support and positive airway pressure ventilator. Results Two groups patients withdraw machine of HR, RR, PaO2, PaCO2, SaO2 were compared with invasive ventilation before improvement ( <0.05). Observation group of mechanical ventilation time, VAP, and mortality rate is less than the control group, with statistical significance ( <0.05). Conclusion Has a noninvasive sequential mechanical ventilation treatment of acute severe cardiac pulmonary edema curative effect is satisfied, can reduce the complications.

  16. 有创与无创序贯机械通气治疗急性心源性肺水肿的疗效观察%Efficacy of invasive-noninvasive sequential mechanical ventilation in treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    梁勇

    2013-01-01

    目的 探讨有创与无创序贯机械通气在治疗急性重症心源性肺水肿中的应用价值.方法 将68例急性肺水肿患者随机分为观察组和对照组,对照组在常规治疗基础上采用有创机械通气治疗.治疗组在常规治疗基础上采用有创与无创序贯机械通气治疗.比较2组治疗前后各参数的差异.结果 给予治疗组有创与无创序贯通气治疗后,死亡比例、发生VAP比例、重新插管比例、有创通气时间均少于对照组(均P<0.05);治疗组血流动力学和氧动力学各项指标均优于对照组,2组差异均有统计学意义(P<0.05).结论 有创与无创序贯机械通气治疗急性心源性肺水肿患者疗效确切.%Objective To investigate the efficacy of invasive-noninvasive sequential mechanical ventilation in treatment of acute cardiogenic pulmonary edema.Methods Sixty-eight patients with acute pulmonary edema patients were randomly divided into observation group and control group.The control group received invasive mechanical ventilation based on the conventional treatment,and the treatment group received invasive-noninvasive sequential mechanical ventilation based on the conventional treatment.The parameters were compared before and after the treatment.Results Death rate,VAP,re-intubation and invasive ventilation time of the treatment group were less than the control group (P < 0.05).Hemodynamic science and oxygen dynamics indicators of the treatment group were better than the control group,the difference being statistically significant (P < 0.05).Conclusion Invasive-noninvasive sequential mechanical ventilation has better effect in the treatment of acute cardiogenic pulmonary edema.

  17. Elevated pulmonary artery pressure and brain natriuretic peptide in high altitude pulmonary edema susceptible non-mountaineers

    Science.gov (United States)

    Gupta, Rajinder K.; Himashree, G.; Singh, Krishan; Soree, Poonam; Desiraju, Koundinya; Agrawal, Anurag; Ghosh, Dishari; Dass, Deepak; Reddy, Prassana K.; Panjwani, Usha; Singh, Shashi Bala

    2016-01-01

    Exaggerated pulmonary pressor response to hypoxia is a pathgonomic feature observed in high altitude pulmonary edema (HAPE) susceptible mountaineers. It was investigated whether measurement of basal pulmonary artery pressure (Ppa) and brain natriuretic peptide (BNP) could improve identification of HAPE susceptible subjects in a non-mountaineer population. We studied BNP levels, baseline hemodynamics and the response to hypoxia (FIo2 = 0.12 for 30 min duration at sea level) in 11 HAPE resistant (no past history of HAPE, Control) and 11 HAPE susceptible (past history of HAPE, HAPE-S) subjects. Baseline Ppa (19.31 ± 3.63 vs 15.68 ± 2.79 mm Hg, p < 0.05) and plasma BNP levels (52.39 ± 32.9 vs 15.05 ± 9.6 pg/ml, p < 0.05) were high and stroke volume was less (p < 0.05) in HAPE-S subjects compared to control. Acute hypoxia produced an exaggerated increase in heart rate (p < 0.05), mean arterial pressure (p < 0.05) and Ppa (28.2 ± 5.8 vs 19.33 ± 3.74 mm Hg, p < 0.05) and fall in peripheral oxygen saturation (p < 0.05) in HAPE-S compared to control. Receiver operating characteristic (ROC) curves showed that Ppa response to acute hypoxia was the best variable to identify HAPE susceptibility (AUC 0.92) but BNP levels provided comparable information (AUC 0.85). BNP levels are easy to determine and may represent an important marker for the determination of HAPE susceptibility. PMID:26892302

  18. Edema

    Science.gov (United States)

    ... one position for too long Eating too much salty food Premenstrual signs and symptoms Pregnancy Edema can ... Do you restrict your intake of salt and salty foods? Do you drink alcohol? Do you seem ...

  19. Increased pulmonary vascular permeability as a cause of re-expansion edema in rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Pavlin, D.J.; Nessly, M.L.; Cheney, F.W.

    1981-01-01

    In order to study the mechanism(s) underlying re-expansion edema, we measured the concentration of labeled albumin (RISA) in the extravascular, extracellular water (EVECW) of the lung as a measure of pulmonary vascular permeability. Re-expansion edema was first induced by rapid re-expansion of rabbit lungs that had been collapsed for 1 wk by pneumothorax. The RISA in EVECW was expressed as a fraction of its plasma concentration: (RISA)L/(RISA)PL. The volume of EVECW (ml/gm dry lung) was measured using a /sup 24/Na indicator. Results in re-expansion edema were compared with normal control lungs and with oleic acid edema as a model of permeability edema. In re-expanded lungs, EVECW (3.41 +/- SD 1.24 ml/g) and (RISA)L/(RISA)PL 0.84 +/- SD 0.15) were significantly increased when compared with normal control lungs (2.25 +/- 0.41 ml/g and 0.51 +/- 0.20, respectively). Results in oleic acid edema (5.66 +/- 2.23 ml/g and 0.84 +/- 0.23) were similar to re-expansion edema. This suggested that re-expansion edema is due to increased pulmonary vascular permeability caused by mechanical stresses applied to the lung during re-expansion.

  20. The Effects of Aquaporin-1 in Pulmonary Edema Induced by Fat Embolism Syndrome.

    Science.gov (United States)

    Zhang, Yiwei; Tian, Kun; Wang, Yan; Zhang, Rong; Shang, Jiawei; Jiang, Wei; Wang, Aizhong

    2016-07-21

    This study was designed to investigate the role of aquaporin1 (AQP1) in the pathologic process of pulmonary edema induced by fat embolism syndrome (FES) and the effects of a free fatty acid (FFA) mixture on AQP1 expression in pulmonary microvascular endothelial cells (PMVECs). In vivo, edema was more serious in FES mice compared with the control group. The expression of AQP1 and the wet-to-dry lung weight ratio (W/D) in the FES group were significantly increased compared with the control group. At the same time, inhibition of AQP1 decreased the pathological damage resulting from pulmonary edema. Then we performed a study in vitro to investigate whether AQP1 was induced by FFA release in FES. The mRNA and protein level of AQP1 were increased by FFAs in a dose- and time-dependent manner in PMVECs. In addition, the up-regulation of AQP1 was blocked by the inhibitor of p38 kinase, implicating the p38 MAPK pathway as involved in the FFA-induced AQP1 up-regulation in PMVECs. Our results demonstrate that AQP1 may play important roles in pulmonary edema induced by FES and can be regarded as a new therapy target for treatment of pulmonary edema induced by FES.

  1. Postoperative negative pressure pulmonary edema following repetitive laryngospasm even after reversal of neuromuscular blockade by sugammadex: a case report.

    Science.gov (United States)

    Lee, Ji Hyeon; Lee, Jae Ho; Lee, Min Hyun; Cho, Hyun Oh; Park, Soon Eun

    2017-02-01

    Laryngospasm, an occlusion of the glottis, can occur at any time during anesthesia, and is associated with serious perioperative complications such as hypoxia, hypercabia, aspiration, bronchospasm, arrhythmia, prolonged recovery, cardiac collapse, and eventually catastrophic death. Importantly, postoperative negative pressure pulmonary edema (NPPE) is a rare, but well described life-threatening complication related to acute and chronic upper airway obstruction. Sugammadex well known for affirmatively reducing the postoperative pulmonary complications associated with residual neuromuscular blockade may have an indirect role in triggering the negative intrathoracic pressure by raising a rapid and efficacious respiratory muscle strength in acute upper airway obstruction. Herein, we report a case of postoperative NPPE following repetitive laryngospasm even after reversal of rocuronium-induced neuromuscular blockade using sugammadex.

  2. Clinical observation and nursing of double level positive pressure ventilation in the treatment of acute cardiac pulmonary edema%双水平正压通气治疗急性心源性肺水肿的临床观察及护理

    Institute of Scientific and Technical Information of China (English)

    杨莉; 白引珠

    2015-01-01

    目的:探讨双水平正压通气治疗急性心源性肺水肿的临床效果及针对性治疗护理的应用效果。方法选取急性心源性肺水肿患者84例随机分为观察组和对照组各42例,对照组患者采用吸氧、扩血管、强心等常规治疗及护理,观察组患者在对照组的基础上采用双水平正压通气及针对性治疗护理措施。比较2组患者治疗前后 p(CO2)、p(O2)、血氧饱和度等血气指标的变化,并调查患者的满意度。结果双水平正压通气能降低急性心源性肺水肿患者 p(CO2),升高 p(O2)、血氧饱和度,观察组治疗后 p(CO2)、p(O2)、血氧饱和度与对照组比较,差异具有统计学意义(P <0.05);观察组患者的护理满意度显著高于对照组,差异具有统计学意义(P <0.05)。结论双水平正压通气治疗急性心源性肺水肿的临床效果好,采用针对性治疗护理措施能提高患者的满意度。%Objective To investigate the clinical effect of double level positive pressure ventilation in the treatment of acute cardiac pulmonary edema and targeted therapy.Methods A total of 84 patients with acute cardiac pulmonary edema were randomly divided into observation group and control group,with 42 cases in each group.The control group was treated with conven-tional therapy and nursing,such as oxygen,expanding blood vessel and strong heart,and the ob-servation group were treated with double level positive pressure ventilation and nursing care.The changes of blood gas indexes,p(CO2),p(O2)and blood oxygen saturation of two groups before and after treatment were compared,and the satisfaction of patients were investigated.Results Double level positive pressure ventilation can reduce the acute cardiogenic pulmonary edema in pa-tients could reduce p(CO2 )and increase p(O2 )and blood oxygen saturation.After treatment, there were significant difference in p(CO2),p(O2),SpO2 in the

  3. Clinical Study of Non-Invasive Positive Pressure Ventilation in Treatment of Severe Acute Cardiogenic Pulmonary Edema%无创正压通气治疗急性重症心源性肺水肿的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    于冰; 林盛翠

    2015-01-01

    Objective To observe and explore the effect of non-invasive positive pressure ventilation in the treatment of severe a-cute cardiogenic pulmonary edema. Methods 60 patients with severe acute cardiogenic pulmonary edema admitted to our hospital from February 2013 to April 2015 were selected and randomly divided into study group and control group. The control group was given conventional drug therapy, while the study group underwent non-invasive positive pressure ventilation based on the methods used in the control group. The changes of clinical symptoms, complications and related parameters before and after treatment were measured. Results After 1-4 h treatment with non-invasive positive pressure ventilation for patients in the study group, their heart rate and respiration rate, and their mean arterial pressure, as well as parameters of arterial blood gases all decreased significantly, P<0.001, and decreased significantly, P<0.001, and related complications improved. Further more, the efficacy was significantly better in the study group than in the control group, and the difference was statistically significant difference, P<0.01. Conclusion Non-invasive positive pressure ventilation could improve hypoxemia and cardiac function, relieve symptoms in patients with severe acute cardiogenic pulmonary edema and shorten the course of heart failure. It is a safe and effective method for treating severe a-cute pulmonary edema, and is worthy of promotion.%目的:观察并分析无创正压通气治疗急性重症心源性肺水肿的临床效果。方法随机选取2013年2月-2015年3月该院收治的60例急性重症心源性肺水肿患者为研究对象,随机分为研究组和对照组,两组均采取常规药物治疗,研究组在此基础上采用无创正压通气治疗,观察并比较两组患者通气前和通气后体征、临床症状以及相关指标等的变化。结果经过1~4 h的无创通气治疗,患者的心率和呼吸频率与

  4. A case of severe preeclampsia presenting as acute pulmonary oedema

    Directory of Open Access Journals (Sweden)

    D. Sumangala Devi

    2016-03-01

    Full Text Available Pulmonary edema refers to an excessive accumulation of fluid in the pulmonary interstitial and alveolar spaces. It may occur in low risk pregnancies but one very important predisposing factor is association with preeclampsia. We are reporting a case of severe preeclampsia presenting as acute pulmonary oedema. 21 year old primi, a known case of gestational hypertension on drugs had pedal edema which was progressively increasing. She was admitted at 29w5d as her BP was still high. Since her preeclampsia profile was normal and her BP was controlled she was continued on conservative management. After 2 days she developed cough, tachypnoea and tachycardia with clinical findings suggestive of A/c pulmonary oedema. Shifted to HDU and started on diuretics and other symptomatic management. After 1 hour as patient's condition was worsening with O2 saturation fall, decided for LSCS + elective post operative ventilatory support. LSCS done showed evidence of Grade 3 abruption with couvelaire changes on uterus. Baby weighed 1.24 kg, severely asphyxiated, died after 3 days. Patient was put on ventillatory support and she improved postoperatively. Acute pulmonary oedema in pregnant women is a life-threatening event. Prompt diagnosis and management is very important for the survival of the patient. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 899-902

  5. Non-cardiogenic pulmonary edema, rhabdomyolysis and myocardial injury following heroin inhalation: a case report

    Science.gov (United States)

    Bazoukis, G; Spiliopoulou, A; Mourouzis, K; Grigoropoulou, P; Yalouris, A

    2016-01-01

    Background: Heroin use by non-injecting routes of administration (snorting, swallowing, “chasing the dragon”) is considered to be safer but is not risk-free for fatal overdose or serious side effects. We report the case of an adolescent who was transferred unconscious to the emergency department after heroin inhalation. Description of the case: A 17-year-old male was transferred to the emergency department unconscious (Glasgow coma scale: 6/15) after heroin inhalation. He was treated with non-rebreather mask and intravenous infusion of naloxone with gradual improvement of consciousness and arterial blood gasses. The chest computed tomography showed signs of acute respiratory distress syndrome. Laboratory exams on the second day of hospitalization showed elevated creatine kinase (CK) and troponin-I levels while his electrocardiography (ECG) showed J-point elevation in V1, V2, and V3 precordial leads. On the second day of hospitalization the pulmonary infiltrates were not present in his chest X-ray while on the eighth day, troponin-I and CK levels were normalized without dynamic ECG changes and the patient was discharged uneventfully. Conclusion: Heroin inhalation may cause severe complications, such as non-cardiogenic pulmonary edema, rhabdomyolysis or myocardial injury. Hippokratia 2016, 20(1): 84-87 PMID:27895451

  6. Novel Peptide for Attenuation of Hyperoxia-induced Disruption of Lung Endothelial Barrier and Pulmonary Edema via Modulating Peroxynitrite Formation*

    Science.gov (United States)

    Kondrikov, Dmitry; Gross, Christine; Black, Stephen M.; Su, Yunchao

    2014-01-01

    Pulmonary damages of oxygen toxicity include vascular leakage and pulmonary edema. We have previously reported that hyperoxia increases the formation of NO and peroxynitrite in lung endothelial cells via increased interaction of endothelial nitric oxide (eNOS) with β-actin. A peptide (P326TAT) with amino acid sequence corresponding to the actin binding region of eNOS residues 326–333 has been shown to reduce the hyperoxia-induced formation of NO and peroxynitrite in lung endothelial cells. In the present study, we found that exposure of pulmonary artery endothelial cells to hyperoxia (95% oxygen and 5% CO2) for 48 h resulted in disruption of monolayer barrier integrity in two phases, and apoptosis occurred in the second phase. NOS inhibitor NG-nitro-l-arginine methyl ester attenuated the endothelial barrier disruption in both phases. Peroxynitrite scavenger uric acid did not affect the first phase but ameliorated the second phase of endothelial barrier disruption and apoptosis. P326TAT inhibited hyperoxia-induced disruption of monolayer barrier integrity in two phases and apoptosis in the second phase. More importantly, injection of P326TAT attenuated vascular leakage, pulmonary edema, and endothelial apoptosis in the lungs of mice exposed to hyperoxia. P326TAT also significantly reduced the increase in eNOS-β-actin association and protein tyrosine nitration. Together, these results indicate that peptide P326TAT ameliorates barrier dysfunction of hyperoxic lung endothelial monolayer and attenuates eNOS-β-actin association, peroxynitrite formation, endothelial apoptosis, and pulmonary edema in lungs of hyperoxic mice. P326TAT can be a novel therapeutic agent to treat or prevent acute lung injury in oxygen toxicity. PMID:25315770

  7. Medical image of the week: neurogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Yun S

    2014-02-01

    Full Text Available No abstract available. Article truncated at 150 words. A 79 year old woman with a history of diabetes, hypertension and subarachnoid hemorrhage presented to the emergency department (ED with altered mental status. The patient had a fall one day prior to admission, and hit her head on the ground. There was no loss of consciousness or seizure activity at that moment, however, she was found unresponsive in the bathroom the next day with brownish vomitus in the mouth and on her face. CT of the head without contrast showed a large intraparenchymal hemorrhage on the left frontal lobe with subdural hemorrhage on the right frontal and temporal lobe. Also, intraventricular blood with 1.1 cm left to right midline shift was observed (Figure 1. Although she had no history of left heart failure or pulmonary disease, physical exam showed coarse lung sound and chest X-ray showed acute change with prominence central vasculature with fluffy central airspace opacities, which were …

  8. Cardiogenic Pulmonary Edema in a Dog Following Initiation of Therapy for Concurrent Hypoadrenocorticism and Hypothyroidism.

    Science.gov (United States)

    Paik, Jooyae; Kang, Ji-Houn; Chang, Dongwoo; Yang, Mhan-Pyo

    A 5 yr old intact female cocker spaniel dog weighing 7.8 kg was referred with anorexia, vomiting, and depression. At referral, the dog was diagnosed initially with typical hypoadrenocorticism, and 2 d later, concurrent primary hypothyroidism was detected. Hormonal replacement therapies, including fludrocortisone, prednisolone, and levothyroxine, were initiated, but a few days later the dog became abruptly tachypneic, and thoracic radiographs indicated the development of pulmonary edema. Echocardiography showed that there were abnormalities indicating impaired left ventricular function, although the heart valves were normal. Following treatment with pimobendan and furosemide, the pulmonary edema resolved. The dog had no recurrence of the clinical signs after 10 mo of follow-up, despite being off all cardiac medications; consequently, the cardiac failure was transient or reversible in this dog. The case report describes the stepwise diagnosis and successful treatment of cardiogenic pulmonary edema after initiation of hormonal replacement therapy for concurrent hypoadrenocorticism and hypothyroidism in a dog.

  9. Involvement of water channel Aquaporin 5 in H2S-induced pulmonary edema.

    Science.gov (United States)

    Xu, Chunyang; Jiang, Lei; Zou, Yuxia; Xing, Jingjing; Sun, Hao; Zhu, Baoli; Zhang, Hengdong; Wang, Jun; Zhang, Jinsong

    2017-01-01

    Acute exposure to hydrogen sulfide (H2S) poses a significant threat to life, and the lung is one of the primary target organs of H2S. However, the mechanisms involved in H2S-induced acute pulmonary edema are poorly understood. This study aims to investigate the effects of H2S on the expression of water channel aquaporin 5 (AQP5) and to elucidate the signaling pathways involved in AQP5 regulation. In an in vivo study, C57BL6 mice were exposed to sub-lethal concentrations of inhaled H2S, and histological injury of the lungs and ultrastructure injury of the epithelial cells were evaluated. With real-time PCR and western blot assays, we found that H2S exposure contributed to a significant decrease in AQP5 expression both in murine lung tissue and the A549 cell line, and the ERK1/2 and p38 MAPK signaling pathways were demonstrated to be implicated in AQP5 regulation. Therefore, adjusting AQP5 protein levels could be considered a therapeutic strategy for the treatment of APE induced by H2S and other hazardous gases.

  10. Hypothyroidism and non-cardiogenic pulmonary edema: are we missing something here?

    Science.gov (United States)

    Nikolla, Dhimitri; Metta, V V S Ramesh

    2015-01-01

    Summary We report the case of a 42-year-old female with a history of hypothyroidism and asthma presenting with progressive dyspnea and orthopnea after 2 days of an upper respiratory tract infection (URTI). Based on the clinical and radiological findings, the patient was admitted as a case of cardiogenic pulmonary edema secondary to possible viral myocarditis. However, a normal brain natriuretic peptide (BNP) level with a normal ejection fraction (EF) on echocardiogram changed our working diagnosis from cardiogenic to non-cardiogenic pulmonary edema. Further questioning revealed a history of nocturnal snoring, frequent awakening, and daytime fatigue, suggesting a possible sleep apnea syndrome (SAS). In conclusion, we believe that SAS was the missing link between our patient's hypothyroidism and non-cardiogenic pulmonary edema. Learning points Always keep an open mind and look for a pathology that would explain the whole clinical scenario.The involvement of the respiratory system in hypothyroidism can range from SAS, pulmonary hypertension, hypoventilation, and severe respiratory failure.Hypothyroidism and SAS should be considered in the differential diagnosis of non-cardiogenic pulmonary edema.Patients should be instructed to take levothyroxine on an empty stomach 30–60 min before food to avoid erratic absorption of the hormone. PMID:25866647

  11. Metal content ratio as a sensitive indicator of pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Maitani, T.; Suzuki, K.T.

    1981-11-01

    The sensitivity to detect edema fluid in the lungs of rats exposed to 4, 2, 0.8, and 0.4 ppm O3 was estimated using the metal content ratio (Ca/Mg) and wet/dry weight ratio methods. Metal content ratios were determined by inductively coupled plasma-atomic emission spectrometer (ICP-AES). The detection limits were 0.8 and 2.0 ppm for the former and latter methods, respectively. A transitory increase of edema fluid was observed at day 1 in 0.8 and 0.4 ppm experiments by the Ca/Mg ratio method.

  12. Pulmonary edema following intravenous injection of nonionic low-osmolar contrast medium - appearance on HRCT. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Bristedt, P.; Tylen, U. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Diagnostic Radiology

    1998-01-01

    Pulmonary edema following i.v. contrast medium injection is a rare adverse reaction. We report on a 71-year-old woman who developed pulmonary edema following i.v. injection of iohexol during spiral CT of the thorax. She developed shortness of breath during the injection, and the first radiographic signs of pulmonary edema were visible on CT images 25 s after the onset of injection. On HRCT images 15 min later, marked edema was demonstrated in both lungs in a mosaic pattern of distribution. After appropriate therapy, the patient recovered without sequelae. A repeat CT 6 days later showed complete normalization. (orig.).

  13. 心源性肺水肿的CT征象分析%The Lung CT Imaging Features of Patients with Cardiogenic Pulmonary Edema

    Institute of Scientific and Technical Information of China (English)

    王增状; 姜领; 鞠衍松; 赵新玲; 黄福存; 赵仲愉; 林少华

    2014-01-01

    目的:分析心源性肺水肿患者的肺CT影像学表现,从而提高心源性肺水肿患者的临床认识。方法自2010年1月至2013年1月收治的100例心源性肺水肿患者,以发病时间不超过24小时为限,分为急性心源性肺水肿与慢性心源性肺水肿。以心脏超声射血分数EF值≥45%为限,分为左室射血分数正常心衰与左室射血分数减低心衰。对患者的危险因素、临床特征以及肺CT表现进行分析。结果急性心源性肺水肿多见左室射血分数减低心衰患者。肺CT影像学表现为腺泡结节、斑片状及大片融合影,有时可见空气支气管像,病变边缘模糊。病变进展时双肺出现广泛的密度均匀实变阴影,典型者出现“蝶翼征”。慢性心源性肺水肿多见左室射血分数正常心衰患者,肺部CT影像学表现以肺纹理增多,增重,胸膜下线、克氏线出现以及肺实质磨玻璃样变等间质性肺水肿改变为主。结论心源性肺水肿患者临床起病时间急缓,EF指数的高低与肺部CT表现密切相关。早期识别其影像学表现有助于临床提高诊断率。%Objective To investigate the lung CT imaging features of patients with cardiogenic pulmonary edema ,thereby enhancing diagnostic accuracy in patients with the cardiogenic pulmonary edema.Methods From January 2010 to January 2013 were treated 100 cases of cardiogenic pulmonary edema, with onset time is limited to less than 24 hours, divided into acute cardiogenic pulmonary edema and chronic cardiogenic pulmonary edema. EF, ejection fraction by echocardiography is limited≥45%, divided into heart failure with normal left ventricular ejection fraction and heart failure with left ventricular reduceded jection fraction. The patient's risk factors, clinical features and lung CT findings were analyzed.Results Pulmonary edema has variable manifestations. acute cardiogenic pulmonary edema often occurred in patients with heart

  14. New concepts about the pathophysiology of pulmonary edema.

    Science.gov (United States)

    Staub, N C

    1988-07-01

    Three new concepts concerning lung liquid and protein exchange are considered. The first is that the microvascular surface area is as important as the microvascular hydrostatic pressure in assessing filtration in the lung. One of the problems in differentiating hemodynamic from increased permeability edema is the inability to determine whether the microvascular surface area has changed. Several agents, as well as exercise, affect liquid filtration. A new, dynamic procedure that is more sensitive for the detection of increased permeability than static measurements of lung water content is described, along with its limitations. The second concept is that water and electrolytes are cleared from the alveoli by a separate mechanism from protein. Water clearance is fast and occurs mainly by an active process, which can be inhibited by amiloride or phloridzin and accelerated by beta-agonists. The mechanism appears to depend on metabolically regulated sodium transport across the alveolar epithelium. Protein clearance is very slow and is relatively independent of alveolar concentration. The protein clearance mechanism is unknown but may involve transcytosis. The third concept is that during edema formation there are two pathways for liquid clearance in addition to the lymphatic system: into the pleural space and along the bronchovascular connective tissue into the mediastinum. During recovery from edema, reabsorption into blood is important if the edema liquid has a low protein osmotic pressure. Clearance into the mediastinum may be the major pathway for liquid sequestered in the loose, binding connective tissue.

  15. Lung uptake of thallium-201 on resting myocardial imaging in assessment of pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Tamaki, N.; Yonekura, Y.; Yamamoto, K. (Kyoto Univ. (Japan). Hospital)

    1981-03-01

    We have noted increased lung uptake of thallium-201 on resting myocardial images in patients with congestive heart failure. To evaluate this phenomenon, lung uptake of thallium on resting myocardial imaging was examined in 328 patients with various cardiovascular diseases. Increased lung uptake was observed in 117 cases (78%) with myocardial infarction, 32 (37%) with angina pectoris, 6 (27%) with hypertensive heart disease, 7 (30%) with hypertrophic cardiomyopathy, 6 (100%) with congestive cardiomyopathy, 11 (100%) with valvular heart disease, and 7 (71%) with congenital heart disease, however, only one (5%) of normal subjects revealed increased uptake. Left ventricular ejection fraction was evaluated in 32 cases with ischemic heart disease on the same day and it was significantly decreased as the lung uptake of thallium increased. Increased thallium activity in the lung seemed to be another noninvasive marker of lift heart failure in ischemic heart disease. Lung uptake of thallium was compared with pulmonary congestive signs on chest X-ray in 29 cases. The uptake was well correlated with the degree of pulmonary edema, and thallium myocardial image revealed remarkably increased lung uptake in all the patients accompanied with pulmonary interstitial edema on chest X-ray. Therefore, this phenomenon will demonstrate pulmonary edema, since thallium may be extracted to the increased interstitial distribution space of the lung as well as the myocardium in a patient with pulmonary edema. We conclude that thallium myocardial scintigraphy is useful not only in identification and localization of myocardial ischemia or infarction, but also in evaluation of pulmonary edema at the same time.

  16. 有创机械通气辅助治疗急性危重心源性肺水肿的疗效观察%Effects of invasive mechanical ventilation in adjunctive therapy of patients with acute severe cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    刚丽; 张新莉; 张绪新; 寇露鑫; 蒋志宏; 张蕾

    2011-01-01

    目的 探讨有创机械通气治疗急性危重心源性肺水肿的治疗效果.方法 对82例急性危重型肺水肿患者,应用机械通气治疗,运用彩色超声仪记录正压通气时二尖瓣、三尖瓣、肺动脉瓣.主动脉瓣口的血流速度.结果 急性危重心源性肺水肿患者通过机械通气,可迅速改善通气,纠正缺氧,心率、呼吸频率较机械通气前均有显著下降,动脉血气较机械通气前显著改善,机械通气期间未出现血流动力学恶化的情况.正压吸气末主动脉瓣血流速度最大,在呼气末速度逐渐减低,与呼气相相比,吸气相肺膨胀时左心功能增强.结论 机械通气技术是急救急性肺水肿的重要手段之一,可改善患者的预后.%Objective To discuss the therapeutic efficacy of positive pressure mechanical ventilation on acute cardio-genic pulmonary edema. Methods Retrospective analysis of 82 cases of acute cardiogenic pulmonary edema, After u-sing mechanical ventilation,all vital signs were observed,using color echocardiographic and pulse wave Doppler echo-cardiogram (PWDE) to record blood flow velocity at mitral valve,tricuspid valve,pulmonary valve,and aortic valve orifice under positive pressure mechanical ventilation. Results With ventilation treatment.all patients showed significant improvement. Invasive ventilation was effective in improving gas exchange and hypoxia.and did not observe rapid hemodynamic changes. Blood flow rate reached to the highest level in artery valve and mitral valve at positive end nhalation pressure and decrease at end expiratory,which meaned that left ventricle output was highest at end-inhalation point in each respiration cycle and same as in mitral valve, appeared at end inhalation. The results showed that compared to expiratory phase,left cardiac function was improved. Conclusion Invasive positive pressure ventilation is a safe and effective means of improving.

  17. Reexpansion pulmonary edema after chest drainage for pneumothorax: A case report and literature overview

    Science.gov (United States)

    Verhagen, M.; van Buijtenen, J.M.; Geeraedts, L.M.G.

    2014-01-01

    Background Reexpansion pulmonary edema (RPE) is a rare complication that may occur after treatment of lung collapse caused by pneumothorax, atelectasis or pleural effusion and can be fatal in 20% of cases. The pathogenesis of RPE is probably related to histological changes of the lung parenchyma and reperfusion-damage by free radicals leading to an increased vascular permeability. RPE is often self-limiting and treatment is supportive. Case report A 76-year-old patient was treated by intercostal drainage for a traumatic pneumothorax. Shortly afterwards he developed reexpansion pulmonary edema and was transferred to the intensive care unit for ventilatory support. Gradually, the edema and dyspnea diminished and the patient could be discharged in good clinical condition. Conclusion RPE is characterized by rapidly progressive respiratory failure and tachycardia after intercostal chest drainage. Early recognition of signs and symptoms of RPE is important to initiate early management and allow for a favorable outcome. PMID:26029567

  18. Efficacy of pimobendan on survival and reoccurrence of pulmonary edema in canine congestive heart failure.

    Science.gov (United States)

    Mizuno, Masashi; Yamano, Shigeki; Chimura, Shuichi; Hirakawa, Atsushi; Takusagawa, Yoshimi; Sawada, Tamotsu; Maetani, Shigeki; Takahashi, Arane; Mizuno, Takeshi; Harada, Kayoko; Shinoda, Asako; Uchida, Shuhei; Takeuchi, Junichiro; Mizukoshi, Takahiro; Endo, Masaaki; Uechi, Masami

    2017-01-20

    The aim of this study was to evaluate the efficacy of pimobendan with conventional therapies on survival and reocurrence of pulmonary edema in dogs with congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD). Records of 197 client-owned dogs from 14 veterinary hospitals were included in this study. Dogs were administered conventional treatments with or without pimobendan. Sixty-four dogs received a standard dose of pimobendan (0.20-0.48 mg/kg every 12 hr (q12hr)), 49 dogs received a low dose of pimobendan (0.05-0.19 mg/kg q12hr), and 84 dogs received conventional therapy alone. Dogs in the standard-dose and low-dose pimobendan groups had significantly longer median survival times than dogs in the conventional group (334, 277 and 136 days, respectively; P<0.001). The reoccurrence rate of pulmonary edema in the standard-dose group was significantly lower than in the low-dose and conventional groups (43%, 59% and 62%, respectively; P<0.05). Combination of pimobendan with a conventional treatment regimen significantly prolonged survival time after an initial episode of pulmonary edema in dogs with CHF caused by MMVD. There was no difference in survival between dogs administered standard and low doses of pimobendan, but pimobendan did prevent the reoccurrence of pulmonary edema in a dose-dependent manner.

  19. Comments on “High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition”

    Directory of Open Access Journals (Sweden)

    Gaurav Sikri

    2015-10-01

    Full Text Available We appreciate the letter to the editor and are pleased to respond regarding our recent case study regarding high altitude pulmonary edema in an experienced mountaineer. The letter raises some valid questions regarding our treatment decisions. With this, as with most emergency department (ED patients, it must be understood that the initial treatment reflected the breadth of our differential diagnosis.

  20. Unilateral Dependant Pulmonary Edema During Laparoscopic Donor Nephrectomy: Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Manisha Modi

    2009-01-01

    Full Text Available Unilateral pulmonary edema of the dependant lung was observed in three patients during laparoscopic donor nephrectomy. Patients were treated with 02 supplementation by face mask, fluid restriction and diuretic. All the patients were relieved of symptoms with radiological improvement. The possible causes of this unusual complication following laparoscopic surgery appear to be prolonged lateral decubitus position and high intraoperative fluid infusion.

  1. RADIOGRAPHIC APPEARANCE OF PRESUMED NONCARDIOGENIC PULMONARY EDEMA AND CORRELATION WITH THE UNDERLYING CAUSE IN DOGS AND CATS.

    Science.gov (United States)

    Bouyssou, Sarah; Specchi, Swan; Desquilbet, Loïc; Pey, Pascaline

    2016-12-22

    Noncardiogenic pulmonary edema is an important cause of respiratory disease in dogs and cats but few reports describe its radiographic appearance. The purpose of this retrospective case series study was to describe radiographic findings in a large cohort of dogs and cats with presumed noncardiogenic pulmonary edema and to test associations among radiographic findings versus cause of edema. Medical records were retrieved for dogs and cats with presumed noncardiogenic edema based on history, radiographic findings, and outcome. Radiographs were reviewed to assess lung pattern and distribution of the edema. Correlation with the cause of noncardiogenic pulmonary edema was evaluated with a Fisher's exact test. A total of 49 dogs and 11 cats were included. Causes for the noncardiogenic edema were airway obstruction (n = 23), direct pulmonary injury (n = 13), severe neurologic stimulation (n = 12), systemic disease (n = 6), near-drowning (n = 3), anaphylaxis (n = 2) and blood transfusion (n = 1). Mixed, symmetric, peripheral, multifocal, bilateral, and dorsal lung patterns were observed in 44 (73.3%), 46 (76.7%), 55 (91.7%), 46 (76.7%), 46 (76.7%), and 34 (57.6%) of 60 animals, respectively. When the distribution was unilateral, pulmonary infiltration involved mainly the right lung lobes (12 of 14, 85.7%). Increased pulmonary opacity was more often asymmetric, unilateral, and dorsal for postobstructive pulmonary edema compared to other types of noncardiogenic pulmonary edema, but no other significant correlations could be identified. In conclusion, noncardiogenic pulmonary edema may present with a quite variable radiographic appearance in dogs and cats.

  2. A case of pulmonary edema developed after intraarterial injection of iodinated contrast medium

    Energy Technology Data Exchange (ETDEWEB)

    Min, Byoung Chol; Chun, Kang Woo; Koh, Jae Hyu; Yoon, Jong Sup [Hangang Sungsim Hospital, Seoul (Korea, Republic of)

    1982-06-15

    Pulmonary edema is a rare adverse reaction to the iodinated contrast medium. Complaining of huge abdominal mass, a 52 years old female was admitted to the Hangang Sungsim Hospital. On physical examination, the patient appeared to be healthy. She had stable vital signs, i.e. BP: 120/80 mmHg, pulse rate: 80/min.etc. An adult head sized mass was palpated in the left mid and lower abdomen. Otherwise nonspecific. On laboratory studies the positive findings were 8-10 WBC/HPF in urine, 25.6 mg/dl for BUN and PVC in EKG. It was negative for urine protein, serum creatinline and liver function test. We injected 100 ml and 30 ml of Urografin 60 through the abdominal aorta dividing 3 times and major branches of the abdominal aorta, respectively. Immediately after complicating angiography, interstitial pulmonary edema was found, showing blurring of the vascular margins, perivascular haziness and thickening of the interlobular septal lines in the both lower lung fields. The blood pressure was dropped to 80/60 mmHg, but pulse rate was normal. She did not complain of dyspnea, and cyanosis was not developed. The urine volume was normally maintained. She was treated for pulmonary edema, which was completely absorbed after 20 hours. And the blood pressure was also normalized. We have experienced a case of pulmonary edema developed after intraarterial injection of the iodinated contrast medium without underlying cardiac, renal and hepatic problems, and reviewed the literatures on mechanisms of pulmonary edema caused by intravascular injection of the iodinated contrast materials.

  3. Update on pulmonary edema: the role and regulation of endothelial barrier function.

    Science.gov (United States)

    Patterson, C E; Lum, H

    2001-01-01

    Discovery of the pathophysiologic mechanisms leading to pulmonary edema and identification of effective strategies for prevention remain significant clinical concerns. Endothelial barrier function is a key component for maintenance of the integrity of the vascular boundary in the lung, particularly since the gas exchange surface area of the alveolar-capillary membrane is large. This review is focused on new insights in the pulmonary endothelial response to injury and recovery, reversible activation by edemagenic agents, and the biochemical/structural basis for regulation of endothelial barrier function. This information is discussed in the context of fundamental concepts of lung fluid balance and pulmonary function.

  4. Negative pressure pulmonary edema:a case report%负压性肺水肿一例

    Institute of Scientific and Technical Information of China (English)

    谢丹; 江玮; 徐雯; 张扣兴

    2016-01-01

    负压性肺水肿是临床上少见的非心源性肺水肿。该文报道了在全身麻醉复苏过程中出现的1例急性肺水肿患者。该患者为25岁男性,因腰1、2椎体压缩性骨折行全身麻醉下手术,麻醉苏醒拔除气管导管后10 min,患者突发脉搏血氧饱和度(SpO2)下降,呼吸急促,立即予气管插管接呼吸机辅助通气,气管导管内可吸出大量粉红色泡沫痰,后转入 ICU 继续抢救,予气管插管接呼吸机行 PEEP 以及对症支持治疗,患者 SpO2上升,气管内粉红色泡沫痰减少,病情明显好转并顺利脱离呼吸机转至普通病房继续治疗。该例诊治过程提示,全身麻醉复苏过程中出现急性肺水肿,需高度怀疑负压性肺水肿,气管插管接呼吸机行 PEEP 是纠正低氧血症、减轻肺水肿的有效治疗措施。%Negative pressure pulmonary edema (NPPE)is a rare non-cardiogenic pulmonary edema in clinical practice.In this article,we reported one patient with acute pulmonary edema during the recovery of general anesthesia.The male patient,aged 25 years,underwent surgery under general anesthesia for the lum-bar L1 -L2 vertebral compression fracture.At 1 0 min after endotracheal extubation,the patient suddenly presen-ted with SpO2 decline and shortness of breath.He immediately received endotracheal intubation and connected to the ventilator.A high quantity of pinkish serous secretion was noted in the endotracheal tube.Then he was transferred to the intensive care unit (ICU)and received mechanical ventilation with positive end-expiratory pressure (PEEP).After corresponding treatment,he had an increasing level of SpO2 and a decreased amount of pinkish serous secretion.After relevant symptoms were alleviated,he was extubated and transferred to gener-al ward for further treatment.The diagnosis and treatment of this case prompted that the possibility of negative-pressure pulmonary edema should be highly suspected if acute

  5. Assistant effect of non-invasive ventilator in patients with acute cardiogenic pulmonary edema induced by acute myocardial infarction in extensive anterior wall%无创呼吸机辅助治疗急性广泛前壁心肌梗死所致急性心源性肺水肿的作用

    Institute of Scientific and Technical Information of China (English)

    凌文通; 张励庭; 李建伟

    2011-01-01

    Objectives To evaluate the clinical effect of using non-invasive positive pressure ventilation for cases with acute cardiogenic pulmonary edema caused by acute myocardial infarction in extensive anterior wall.Methods Thirtyeight patients with acute left heart failure caused by acute myocardial infarction in extensive anterior wall,whose hypoxemia could not be improved under routine treatment, were treated by using bi-level positive airway pressure (BiPAP).We analyzed the clinical symptoms and physical signs, artery blood pH, partial pressure of oxygen in artery (PaO2), partial pressure of carbon dioxide in artery (PaCO2), heart rate (HR), respiration rate (RR), mean arterial blood pressure(MAP)and arterial oxygen saturation (SaO2)of blood gas analysis, chest X-ray, echocardiography and serum concentration of N-terminal-Pro-B-type natriuretic peptide (NT-proBNP) before and after treatment.Results The dyspnea of 36 cases were obviously relieved by using non-invasive ventilator.The artery pH, PaO2, PaCO2, HR, RR,MAP and SaO2 of blood gas analysis at 2 h, 4 h, 24 h after treatment were also improved (P < O.O5), as well as the clinical symptom and physical signs; the value of left ventricular ejection fraction was significantly higher than those before treatment (P < O.O5 ), and the serum concentrations of NT-proBNP was significantly decreased compared with those before treatment (P< O.O5).X-ray result showed that pulmonary edema was absorbed.The total effective rate was 94.7%(36/38).Conclusions Non-invasive Bi-PAP can improve the hypoxemia and cardiac function in patients with acute left heart failure caused by acute myocardial infarction in extensive anterior wall, and also increase the successful rescue rate.%目的 评价无创正压通气在急性广泛前壁心肌梗死致急性心源性肺水肿抢救辅助治疗中的临床价值.方法 对38例急性广泛前壁心肌梗死致急性心源性肺水肿患者在常规治疗下不能有效改善低氧血

  6. Development of tolerance to ozone in reference to pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Matzen, R.N.

    1957-01-01

    Four-hr exposure to O/sub 3/ concentration as low as 0.3 ppM (but not 0.1 ppM) prevented edema and death from subsequent LD/sub 50/ exposure (8 to 9 ppM). Protection increased with increasing dose up to toxic level. Tolerance was noted at 24 hr and was present for as long as 102 days. Some protection to doses as high as 2.5 LD/sub 50/ was observed. No tolerance was developed at low concentrations because that amount probably absorbed in upper respiratory tract of the mice.

  7. Clinical analysis of BiPAP non-invasive ventilation in treatment of patients with acute cardiogenic pul-monary edema%双水平气道正压无创通气治疗急性心源性肺水肿患者的临床分析

    Institute of Scientific and Technical Information of China (English)

    屈健民; 赵云峰

    2014-01-01

    Objective To observe the clinical efficacy of non-invasive bi-level positive airway pres-sure ventilation (BiPAP)in the treatment of patients with acute cardiogenic pulmonary edema.Methods Eighty-five patients with acute cardiogenic pulmonary edema were retrospectively analyzed and assigned into two groups.In the treatment group,fifty cases were treated with BiPAP non-invasive ventilation on the basis of anti-heart failure treatment such as positive inotropic,diuretics and vasoactive drugs.In the control group,35 pa-tients underwent oxygen masks based upon anti-heart failure therapy.The clinical effects in two groups were compared.Results Compared with the control group,the clinical symptoms of the patients,who treated with BiPAP non-invasive ventilation,were significantly improved,and 6-hour lactic acid clearance rate and effective rate were significantly higher (all P <0.05),whereas endotracheal intubation rate and mortality were signifi-cantly lower (both P <0.05).Conclusion BiPAP can alleviate the symptoms of patients with acute cardio-genic pulmonary edema and reduce endotracheal intubation rate and mortality.%目的:观察双水平气道正压(BiPAP)无创通气治疗急性心源性肺水肿患者的临床疗效。方法收集85例急性心源性肺水肿患者的治疗情况,其中给予正性肌力药物、利尿药、血管活性药物等常规抗心力衰竭治疗的基础上行 BiPAP 无创通气治疗的50例患者作为治疗组,给予面罩吸氧等常规抗心力衰竭治疗的35例患者为对照组。比较两组的临床疗效。结果与对照组比较,治疗组患者经 BiPAP 无创通气治疗后,患者的临床症状改善更明显,6 h 乳酸清除率及治疗有效率均明显高于对照组(P 均<0.05),气管插管率及病死率均明显低于对照组(P 均<0.05)。结论BiPAP 无创通气能迅速改善急性心源性肺水肿患者的临床症状,降低气管插管率及病死率。

  8. /sup 111/In-chloride thorax scintigraphic study for demonstration of pulmonary edema: Canine model

    Energy Technology Data Exchange (ETDEWEB)

    Shih Weijen; Deland, F.H.; Simmons, G.H.; Coupa, J.; Domstad, P.A.; Lee Luyuan

    1986-04-01

    Pulmonary edema induced by injections of oleic acid was demonstrated using /sup 111/In-chloride lung/heart image in five anesthetized dogs. The anesthetized dogs were positioned under a gamma camera interfaced to a computer. After /sup 111/In-chloride IV injections, dynamic data were recorded at 1 frame/min before and after induced pulmonary edema. The computer generated the curve of the lung-to-heart activity ratio; the ratio rose from 0.5-0.6 at baseline to 0.85-1.5 at th end of the study in the dogs. At the end of each study, the removed lungs demonstrated edematous fluid, and a few red blood cells were seen in the alveoli. The results indicating pulmoinary edema exhibited in the /sup 111/In-chloride lung-to-heart ratio obtained from a computerized gamma camera were compatable with the pathological results. Since /sup 111/In-chloride instantly binds to plasma transferrin, an excellent intravascular imaging agent, leakage of this tracer into alveoli indicates loss of membranous wall competence. Pulmonary edema, as in the adult respiratory distress syndrome, is sometimes difficult to diagnose; and this /sup 111/In-chloride lung-to-heart imaging technique may be potentially useful.

  9. Impact of Clipping versus Coiling on Postoperative Hemodynamics and Pulmonary Edema after Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Nobutaka Horie

    2014-01-01

    Full Text Available Volume management is critical for assessment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH. This multicenter prospective cohort study compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema in patients with SAH. Hemodynamic parameters were measured for 14 days using a transpulmonary thermodilution system. The study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF, cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, extravascular lung water index (EVLWI and pulmonary vascular permeability index (PVPI were significantly higher in the clipping group in the vasospasm period. Postoperative C-reactive protein (CRP level was higher in the clipping group and was significantly correlated with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema, and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the vasospasm period, suggesting noncardiogenic edema. In conclusion, clipping affects postoperative CRP level and may thereby increase noncardiogenic pulmonary edema in the vasospasm period. His trial is registered with University Hospital Medical Information Network UMIN000003794.

  10. [Hyponatremic encephalopathy with non-cardiogenic pulmonary edema. Development following marathon run].

    Science.gov (United States)

    Wellershoff, G

    2013-04-01

    This article presents the case of a 52-year-old woman who developed exercise-associated hyponatremia (EAH) complicated by non-cardiogenic pulmonary edema after a marathon run. The condition of EAH is a potentially life-threatening complication of endurance exercise. The main cause seems to be inadequate intake of free water during or following exercise with enduring antidiuresis due to nonosmotic stimulation of ADH secretion. Known risk factors are female gender, slow running pace and lack of weight loss. Emergency therapy is fluid restriction and bolus infusion of 3% NaCl solution to rapidly reduce brain edema.

  11. 急性心源性肺水肿时非侵入性呼吸机治疗的研究%The use of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    徐秋萍; 平玉坤; 张烨斐; 杨云梅; 丁晨彦; 张舸

    2001-01-01

    Objective To evaluate the clinical applications of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema.Methods Thirty one patients with acute cardiogenic pulmonary edema(ACPE)were treated with noninvasive nasal mask bilevel positive airway pressure(BiPAP).Before and after ventilatory support,the heart rate,breathing rate,urine volume,MAP,SaO2,PetCO2,PaO2,PaCO2 and heart function were recorded.Results After 2~6 hours treatment,the heart rate and breathing rate were significantly reduced(P<0.001).The urine volume,SaO2 and PaO2 were markedly increased (P<0.001).The MAP were decreased in hypertensive patients(P<0.001).All patients’ heart function was improvement.PetCO2and PaCO2 were not changed very much(P>0.05).Conclusion The noninvasive nasal mask BiPAP is a kind of safe and effective method in the treatment of ACPE.It can be recommended for clinical use.%目的 研究应用非侵入性呼吸机治疗急性心源性肺水肿的临床价值。方法 对31名难治性急性心源性肺水肿的患者应用非侵入性鼻面罩双相气道正压通气(BiPAP)治疗,观察通气前后心率、尿量、平均血压(MAP)、血氧饱和度(SaO2)、呼吸频率、呼气末二氧化碳分压(PetCO2)、血气分析和心功能等指标的变化。结果 患者经2~6h的鼻面罩BiPAP治疗后心率明显减慢(P<0.001)、尿量明显增加(P<0.001)、PaO2和SaO2明显提高(P<0.001)、PaCO2和PetCO2改变不明显(P>0.05)、心功能明显改善、高血压心脏病者MAP下降显著(P<0.001)。结论 对急性心源性肺水肿应用非侵入性鼻面罩BiPAP治疗是安全而有效的,值得在临床推广使用。

  12. Synthesis of /sup 11/C-methylated inulin as a radiopharmaceutical for imaging brain edema and pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Hara, Toshihiko; Iio, Masaaki; Inagaki, Keizo

    1988-07-01

    /sup 11/C-methylated inulin, supposedly useful for imaging of brain edema and pulmonary edema, was prepared using cyclotron produced /sup 11/CO/sub 2/. The synthesis consists of the production of /sup 11/C-methyl iodide and its coupling with inulin alkoxide sodium in dimethylsulfoxide as solvent. /sup 11/C labeled inulin was purified by alcohol precipitation. The radiochemical yield of pure /sup 11/C-inulin was 34% of /sup 11/CO/sub 2/ 30 min after the end of bombardment. The blood clearance and body distribution of /sup 11/C was observed in rabbits after i.v. injection of /sup 11/C-inulin. The blood clearance curve was composed of a sum of three exponential functions. The gamma camera image showed that the /sup 11/C activity in blood moved quickly to kidneys and urine and a small dose of radioactivity remained persistently in edematous tissues, i.e. the edematous lung tissues produced by oleic acid treatment.

  13. 双水平气道正压无创通气治疗急性心源性肺水肿的临床观察%Clinical observation of BiPAP noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    封凯旋; 俞国忠; 凌杰斌; 马斌

    2011-01-01

    目的 探讨在重症监护病房中双水平正压(BiPAP)无创通气治疗急性心源性肺水肿的疗效.方法 将80例急性心源性肺水肿患者随机分成两组:对照组40例,给予常规治疗(吸氧、镇静、强心、利尿、血管扩张药、激素、解痉平喘等);治疗组40例,在常规治疗的基础上,加用无创正压通气治疗.观察两组患者治疗前后临床症状、体征和动脉血气分析的变化.结果 治疗组进行无创机械通气后,37例患者在2 h内症状好转,呼吸减慢,心率下降,肺部湿哆音减少,动脉氧分压(PaCO2)上升,动脉二氧化碳分压(PaCO2)下降,总有效率为92.5%;对照组在相应时间仅23例好转,有效率为57.5%;两组相比差异有统计学意义(P<0.05).结论 在发生急性心源性肺水肿时,双水平正压无创通气治疗安全,效果显著.%Objective To investigate the clinical value of Bi - level positive airway pressure( Bi-PAP) noninvasive ventilation on acute cardiogeni(c) pulmonary edema. Methods Eighty patients with a cute cardiogenic pulmonary edema were randomly divided into two groups: treatment group and control group. Forty patients in the treatment group were treated with noninvasive mask Bi -level positive airway pressure (BiPAP) ventilation in addition to conventional treatment. Forty patients in the control group were treated by nasal pipe with oxygen in addition to conventional treatment. Patients were observed before and after the clinical symptoms,signs and arterial blood gas analysis. Results After BiPAP ventilation,the clinical symptoms of 37 patients in the treatment group had been improved significantly in two hours.Also, the clinical symptoms and arterial blood gas parameters ( pH, PaO2, PaCO2, SaO2 ) showed a statistical differences ( P <0. 05 ) compared with control group. The total efficiency rate of treatment group was 92.5% ,while that of control group was only 57.5%. Conclusions Bi - level positive airway pressure therapy is

  14. Acute exacerbations and pulmonary hypertension in advanced idiopathic pulmonary fibrosis.

    LENUS (Irish Health Repository)

    Judge, Eoin P

    2012-07-01

    The aim of this study was to evaluate the risk factors for and outcomes of acute exacerbations in patients with advanced idiopathic pulmonary fibrosis (IPF), and to examine the relationship between disease severity and neovascularisation in explanted IPF lung tissue. 55 IPF patients assessed for lung transplantation were divided into acute (n=27) and non-acute exacerbation (n=28) groups. Haemodynamic data was collected at baseline, at the time of acute exacerbation and at lung transplantation. Histological analysis and CD31 immunostaining to quantify microvessel density (MVD) was performed on the explanted lung tissue of 13 transplanted patients. Acute exacerbations were associated with increased mortality (p=0.0015). Pulmonary hypertension (PH) at baseline and acute exacerbations were associated with poor survival (p<0.01). PH at baseline was associated with a significant risk of acute exacerbations (HR 2.217, p=0.041). Neovascularisation (MVD) was significantly increased in areas of cellular fibrosis and significantly decreased in areas of honeycombing. There was a significant inverse correlation between mean pulmonary artery pressure and MVD in areas of honeycombing. Acute exacerbations were associated with significantly increased mortality in patients with advanced IPF. PH was associated with the subsequent development of an acute exacerbation and with poor survival. Neovascularisation was significantly decreased in areas of honeycombing, and was significantly inversely correlated with mean pulmonary arterial pressure in areas of honeycombing.

  15. Clinical and Hemodynamic Effects of CPAP-Therapy in Patients with Cardiogenic Pulmonary Edema

    Directory of Open Access Journals (Sweden)

    M. V. Gorbunova

    2007-01-01

    Full Text Available Objective: to evaluate the clinical and hemodynamic effects of CPAP-therapy in the treatment of alveolar cardiogenic pulmonary edema (CPE in patients with acute myocardial infarction (AMI.Subjects and methods. The open-labeled prospective study included 22 patients (19 males; mean age, 59.2±5.8 years with CPE that had complicated the course of AMI. Despite the drug and oxygen therapies of CPE for 30 minutes, progressive respiratory and left ventricular failures were an indication for the initiation of CPAP-therapy (7.3±1.2 cm H2O that was performed, by employing REM-Star apparatuses (Respironics, USA and Ultra Mirage facial masks (ResMed, Australia. Oxygen, 2 l/min (FiO2 = 40%, was delivered through the mask circuit. Central hemodynamic parameters were measured before and 60 and 180 minutes after the initiation of CPAP-therapy, by using a Swan-Ganz thermodilution cathether (HANDS OFF, model AH-05000-H, ARROW, USA. Arterial and mixed venous blood gas composition was rapidly determined on an automatic gas analyzer (Rapidlab 348, Bayer, USA.Results. Cyanosis and acrocyanosis disappeared and the number of congestive moist rales reduced in the lung in 19 (86.4% patients during 30-min CPAP-therapy. The patients’ oxygen status changed: the value of PaO2 significantly increased (82.5±2.5 versus 57.4±4.2 mm Hg at the baseline;p<0.05; SaO2 reached the normal values 60 minutes following CPAP-therapy. There was an increase in the cardiac index (3.1±0.2 versus 2.3±0.1 l/min/m2 at the baseline; p<0.05, a decrease in pulmonary wedge pressure (14.4±21 versus 23.6±2.1 mm Hg at the baseline; p<0.05, and synchronism of right and left cardiac performance.Conclusion. CPAP-therapy optimizes treatment of patients with CPE-complicated AMI, results in the normalization of the arterial blood gas composition, significantly diminishes hydrostatic pulmonary capillary pressure, and promotes the synchronism of the right and left hearts. 

  16. Noncardiogenic Pulmonary Edema as a Result of Urosepsis

    Science.gov (United States)

    2010-03-01

    CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ...Bridge Road,Bethesda,MD,20814 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR...1998; 13:147 – 171. 6. Maltby JD, Gouverne ML: CT findings in pulmonary venoocclusive disease: case report, J Comput Assist Tomo 1984; 8:758 – 761

  17. Commercial double-indicator-dilution densitometer using heavy water: Evaluation in oleic-acid pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Leksell, L.G.; Schreiner, M.S.; Sylvestro, A.; Neufeld, G.R. (Univ. of Pennsylvania School of Medicine, Philadelphia (USA))

    1990-04-01

    We evaluated a commercially available, double-indicator-dilution densitometric system for the estimation of pulmonary extravascular water volume in oleic acid-induced pulmonary edema. Indocyanine green and heavy water were used as the nondiffusible and diffusible tracers, respectively. Pulmonary extravascular water volume, measured with this system, was 67% of the gravimetric value (r = 0.91), which was consistent with values obtained from the radioisotope methods. The measured volume was not influenced by changes in cardiac index over a range of 1 to 4 L.min.m2. This system is less invasive than the thermal-dye technique and has potential for repeated clinical measurements of pulmonary extravascular lung water and cardiac output.

  18. A case of recurrent swimming-induced pulmonary edema in a triathlete: the need for awareness.

    Science.gov (United States)

    Smith, R; Brooke, D; Kipps, C; Skaria, B; Subramaniam, V

    2016-08-03

    This report discusses a rare case of a 55-year-old female triathlete who developed recurrent episodes of swimming-induced pulmonary edema (SIPE). She had two hospital admissions with pulmonary edema after developing breathlessness while swimming, including a near-drowning experience in an open water swim. With increasing popularity of triathlon and open water sports, this case highlights the importance of a greater awareness of SIPE among health professionals, event organizers, and athletes. This report explores the previous reported cases in triathletes and those who have suffered recurrent episodes. It is paramount that an accurate diagnosis is made as these individuals may be at an increased risk of future life-threatening episodes.

  19. Radiographically Severe but Clinically Mild Reexpansion Pulmonary Edema following Decompression of a Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    William E. Harner

    2014-01-01

    Full Text Available The case is a 48-year-old female who presented with mild dyspnea on exertion and cough with unremarkable vital signs and was found to have a large right sided pneumothorax. She underwent small bore chest tube decompression with immediate reexpansion of the collapsed lung. However, she rapidly developed moderate hypoxemia and radiographic evidence of reexpansion pulmonary edema (REPE on both the treated and contralateral sides. Within a week, she had a normal chest X-ray and was asymptomatic. This case describes a rare complication of spontaneous pneumothorax and highlights the lack of correlation between symptoms, sequelae, and radiographic severity of pneumothorax and reexpansion pulmonary edema. Proposed pathophysiologic mechanisms include increased production of reactive oxygen species with subsequent loss of surfactant and increased vascular permeability, and loss of vasoregulatory tone.

  20. Pulmonary edema following high intravenous doses of diatrizoate in the rat

    Energy Technology Data Exchange (ETDEWEB)

    Maare, K.; Violante, M.; Zack, A.

    Serious adverse reactions to intravenous contrast media are rare but of major concern. Corticosteroids are the most commonly used drugs for prophylaxis but there is little documentation of their effectiveness. Controversy also exists about the optimum regime for these drugs. A rat model was used to evaluate the effect of methylprednisolone pretreatment for contrast media-induced pulmonary edema. Rats were given 40 mg methylprednisolone/kg intravenously at various time intervals before the intravenous injection of a high dose of diatrizoate (6 g I/kg). The combination of one dose of methylprednisolone at 24 hours plus another dose at 0.5 hours was the only regimen that caused a significant reduction in the degree of pulmonary edema induced by contrast media. This result provides support for the clinical regimen utilizing iterated doses of corticosteroids over a prolonged period of time. (orig.).

  1. Radiographically Severe but Clinically Mild Reexpansion Pulmonary Edema following Decompression of a Spontaneous Pneumothorax

    Science.gov (United States)

    Harner, William E.; Crawley, Eric A.

    2014-01-01

    The case is a 48-year-old female who presented with mild dyspnea on exertion and cough with unremarkable vital signs and was found to have a large right sided pneumothorax. She underwent small bore chest tube decompression with immediate reexpansion of the collapsed lung. However, she rapidly developed moderate hypoxemia and radiographic evidence of reexpansion pulmonary edema (REPE) on both the treated and contralateral sides. Within a week, she had a normal chest X-ray and was asymptomatic. This case describes a rare complication of spontaneous pneumothorax and highlights the lack of correlation between symptoms, sequelae, and radiographic severity of pneumothorax and reexpansion pulmonary edema. Proposed pathophysiologic mechanisms include increased production of reactive oxygen species with subsequent loss of surfactant and increased vascular permeability, and loss of vasoregulatory tone. PMID:25165607

  2. Anti-thymocyte globulin induced non-cardiogenic pulmonary edema during renal transplantation

    Directory of Open Access Journals (Sweden)

    Beena K Parikh

    2011-01-01

    Full Text Available Non-cardiogenic pulmonary edema (NCPE is a clinical syndrome characterized by simultaneous presence of severe hypoxemia, bilateral alveolar infiltrates on chest radiograph, without evidence of left atrial hypertension/congestive heart failure/fluid overload. The diagnosis of drugrelated NCPE relies upon documented exclusion of other causes of NCPE like gastric aspiration, sepsis, trauma, negative pressure pulmonary edema. We describe a 28year-old, 50 kg male with ASA risk III posted for laparoscopic renal transplantation, who developed NCPE after 4 hours of administration of rabbit anti-human thymocyte immunoglobulin (ATG. He was successfully treated with mechanical ventilatory support and adjuvant therapy. This report emphasizes that this fatal complication may occur with use of ATG.

  3. Anti-thymocyte globulin induced non-cardiogenic pulmonary edema during renal transplantation.

    Science.gov (United States)

    Parikh, Beena K; Bhosale, Guruprasad P; Shah, Veena R

    2011-10-01

    Non-cardiogenic pulmonary edema (NCPE) is a clinical syndrome characterized by simultaneous presence of severe hypoxemia, bilateral alveolar infiltrates on chest radiograph, without evidence of left atrial hypertension/congestive heart failure/fluid overload. The diagnosis of drugrelated NCPE relies upon documented exclusion of other causes of NCPE like gastric aspiration, sepsis, trauma, negative pressure pulmonary edema. We describe a 28year-old, 50 kg male with ASA risk III posted for laparoscopic renal transplantation, who developed NCPE after 4 hours of administration of rabbit anti-human thymocyte immunoglobulin (ATG). He was successfully treated with mechanical ventilatory support and adjuvant therapy. This report emphasizes that this fatal complication may occur with use of ATG.

  4. Scorpion sting envenomation presenting with pulmonary edema in adults: A report of seven cases from Nepal

    Directory of Open Access Journals (Sweden)

    Bhadani Umesh

    2006-01-01

    Full Text Available Scorpion sting is a common problem in villages of Eastern Nepal. The life-threatening complications of myocarditis and pulmonary edema is known in red scorpion in India but not reported in Nepal. This condition requires urgent attention and ICU care from few hours to days. Delay in recognition and the hypoxemia increase the morbidity and mortality. Illiteracy, ignorance, poverty, traditional faith healers trying treatment in remote areas, lack of transport in difficult terrains and the non availability of ventilation facility in nearby hospital, add to delay in appropriate treatment. Seven young adult patients admitted in a span of two years with history of scorpion sting presenting with pulmonary edema required ICU care. They were successfully managed with the positive pressure ventilation with PEEP, cardiac support with inotropes and fluid balance. Magnitude of problem, clinical presentation and management done is emphasized.

  5. Response to Comments on “High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition”

    Directory of Open Access Journals (Sweden)

    Whitlow, K. Scott

    2015-10-01

    Full Text Available We appreciate the letter to the editor and are pleased to respond regarding our recent case study regarding high altitude pulmonary edema in an experienced mountaineer. The letter raises some valid questions regarding our treatment decisions.

  6. ROCK2 and MYLK variants and high-altitude pulmonary edema

    Directory of Open Access Journals (Sweden)

    Sikri G

    2016-08-01

    Full Text Available Gaurav Sikri, Srinivasa Bhattachar Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, IndiaWe have read the article titled “ROCK2 and MYLK variants under hypobaric hypoxic environment of high altitude associate with high altitude pulmonary edema and adaptation” by Pandey et al1 with profound interest. View the original paper by Pandey and colleagues.

  7. Hypothyroidism and non-cardiogenic pulmonary edema: are we missing something here?

    OpenAIRE

    Al-Sofiani, Mohammed; Nikolla, Dhimitri; Metta, V V S Ramesh

    2015-01-01

    Summary We report the case of a 42-year-old female with a history of hypothyroidism and asthma presenting with progressive dyspnea and orthopnea after 2 days of an upper respiratory tract infection (URTI). Based on the clinical and radiological findings, the patient was admitted as a case of cardiogenic pulmonary edema secondary to possible viral myocarditis. However, a normal brain natriuretic peptide (BNP) level with a normal ejection fraction (EF) on echocardiogram changed our working diag...

  8. 有创—无创序贯机械通气在急性心源性肺水肿的临床疗效观察%Clinical study of sequential invasive-noninvasive mechanical ventilation in acute cardiogenic pulmonary edema patients

    Institute of Scientific and Technical Information of China (English)

    杨宏锋; 金兆辰; 吉木森; 张清艳; 李勇; 蔡燕

    2012-01-01

    目的 研究有创—无创序贯机械通气在急性心源性肺水肿中的疗效.方法 32例急性心源性肺水肿患者在常规治疗的基础上,采用有创—无创序贯机械通气治疗,即短期有创呼吸机辅助通气后,继续给予无创鼻面罩双水平气道正压通气,期间调整无创呼吸机以达到脉搏氧饱和度(SPO2)≥92%并最终达到撤机的目的.治疗期间监测患者治疗后的临床征象、动脉血气分析指标的变化、有创机械通气时间、住院期间、并发症的情况,以及患者治疗后无创血流动力学指标心排血量(CO)、心脏指数(CI)、每搏量(SV)的变化.结果 给予有创—无创序贯通气治疗后,患者总机械通气时间、呼吸机相关性肺炎发生率降低P<0.05);动脉血气分析指标中PaO2、SaO2明显改善(P<0.05),pH值及PaCO2变化不明显,血流动力学指标CO、CI、SV显著升高(P<0.05);在上述两组患者成功脱机后各项指标比较无统计学差异.结论 有创—无创序贯机械通气对急性心源性肺水肿患者有较好的疗效,能明显改善低氧血症和血流动力学指标,可以减少有创机械通气的并发症,是抢救急性心源性肺水肿的一种安全有效的方法.%Objective To study the application in acute cardiogenic pulmonary edema patients during sequential invasive-noninvasive mechanical ventilation. Methods Based on conventional treatment, 36 acute cardiogenic pulmonary edema patients were given sequential invasive and noninvasive mechanical ventilation, the short-term invasive mechanical ventilation , and were continued to provide non-invasive nasal mask bi-level positive airway pressure ventilation in order to a-chieve the purpose of weaning. During treatments we monitored the patients' clinical signs, arterial blood gas analysis indicators changes, invasive mechanical ventilation time, complications, and non-invasive treatment in patients and hemody-namic cardiac output (CO

  9. 有创呼吸机实施无创正压通气与常规吸氧治疗急性心源性肺水肿的对比研究%Comparative study of the treatment in acute cardiogenic pulmonary edema between the noninvasive positive pressure ventilation by invasive ventilator and the conventional oxygen therapy

    Institute of Scientific and Technical Information of China (English)

    尚云波; 李嘉嘉; 孙海燕; 张留定; 李华; 钱智刚

    2012-01-01

    Objective To evaluale the effects of noninvasive posilive pressure venlilalion (NPPV) on acute cardiogenic pulmonary edema by invasive venlilalor. Methods 82 palienls with acute cardiogenic pulmonary edema were divided into Lwo groups; 43 palienls were randomized to receive NPPV by invasive venlilalor based on conventional therapy as NPPV group; 39 palienls were randomized lo receive conventional oxygen therapy based on conventional therapy as conventional oxygen therapy group. We evaluale the trealmenl effecls by measuring the success rale of 2 h rescue and the general trealmenl efficiency of 2 h ( the success rale of 2 h rescue and the trealmenl efficiency of 2 h) , the inlubalion rale, the residence lime in emergency room and the rale of discharging from hospital, and by observing and comparing the complications and the side -effecls. Results Success rale of 2 h rescue; NPPV group was 60. 47% ( 26 of 43 ) , conventional oxygen therapy group was 17. 95% ( 7 of 39, P < 0.01); the general trealmenl efficiency of 2 h;NPPV group was 97. 67% (42 of 43 ) , conventional oxygen therapy group was 89. 74% (35 of 39,P = 0. 19) ;inlubalion rale;NPPV group was 2. 33% (1 of 43) , conventional oxygen therapy group was 15. 38% (6 of 39 ,P = 0. 035) ; residence lime in emergency room;NPPV group was (2.61 ±0.23) h,conventional oxygen therapy group was (5.36 ±0.58) h,P < 0.01 ;lhe rale of discharging from hospital;NPPV group was 97. 67% (42 of 43) , conventional oxygen therapy group was 89. 74% (35 of 39, P = 0. 068) ;side - effect rale:NPPV group was 11. 63% (5 of 43) ,conventional oxygen therapy group was 5. 13% (2 of 39 ,P =0. 293) . Conclusion The therapy of noninvasive positive pressure ventilation could increase the successful treatment rate of acute cardiogenic pulmonary edema by correctly using invasive ventilator, reducing intubation rate, shortening the residence time in emergency room, and could be used as adjunctive treatment of acute cardiogenic pulmonary edema in

  10. The Effects of Portulaca oleracea on Hypoxia-Induced Pulmonary Edema in Mice

    Science.gov (United States)

    Yue, Tan; Xiaosa, Wen; Ruirui, Qi; Wencai, Shi; Hailiang, Xin

    2015-01-01

    Abstract Tan Yue, Wen Xiaosa, Qi Ruirui, Shi Wencai, Xin Hailiang, and Li Min. The effects of Portulaca oleracea on hypoxia-induced pulmonary edema in mice. High Alt Med Biol 16:43–51, 2015—Portulaca oleracea L. (PO) is known as “a vegetable for long life” due to its antioxidant, anti-inflammatory, and other pharmacological activities. However, the protective activity of the ethanol extract of PO (EEPO) against hypoxia-induced pulmonary edema has not been fully investigated. In this study, we exposed mice to a simulated altitude of 7000 meters for 0, 3, 6, 9, and 12 h to observe changes in the water content and transvascular leakage of the mouse lung. It was found that transvascular leakage increased to the maximum in the mouse lung after 6 h exposure to hypobaric hypoxia. Prophylactic administration of EEPO before hypoxic exposure markedly reduced the transvascular leakage and oxidative stress, and inhibited the upregulation of NF-kB in the mouse lung, as compared with the control group. In addition, EEPO significantly reduced the levels of proinflammatory cytokines and cell adhesion molecules in the lungs of mice, as compared with the hypoxia group. Our results show that EEPO can reduce initial transvascular leakage and pulmonary edema under hypobaric hypoxia conditions. PMID:25761168

  11. Protective effect of melatonin on reexpansion pulmonary edema in rats model

    Institute of Scientific and Technical Information of China (English)

    ZHONG Ming; XUE Zhang-gang; CANG Jing; WU Wei; HUANG Jun-feng; ZHU Du-ming

    2013-01-01

    Background Rapid reexpansion of collapsed lungs leads to reexpansion pulmonary edema (RPE).We aimed to investigate the effect of melatonin in the prevention of RPE formation.Methods We used a Wistar rat model in which the left lung was collapsed by ligating the left bronchus for 48 hours and then reexpanded and ventilated for an additional 2 hours.Thirty minutes before reexpansion,we injected melatonin (10 mg/kg) or vehicle intraperitoneally.We compared the wet/dry ratio,oxygenation index,myeloperoxidase (MPO) activity,nitric oxide (NO),malondialdehyde (MDA) and interleukin 8 (IL-8) levels in the reexpanded lungs between untreated and treated animals.Results We found that the wet/dry ratio of the melatonin group was significantly lower than that of the vehicle group,and the oxygenation index was higher in the melatonin group.Compared with the control,melatonin pretreatment significantly decreased the activities of IL-8,NO,MDA levels and MPO in lung tissues.Histopathology of reexpanded lungs showed that the melatonin pretreatment group had less pulmonary edema and less inflammatory cell infiltration.Conclusion Melatonin decreases pulmonary edema and improves oxygenation after reexpansion by attenuating oxidative stress and inhibiting pro-inflammatory cytokines.

  12. Anatomic distribution of embolus at CT pulmonary angiography in patients suspected acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    朱力

    2013-01-01

    Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively in

  13. Fluid Intake Related to Brain Edema in Acute Middle Cerebral Artery Infarction.

    Science.gov (United States)

    Dharmasaroja, Pornpatr A

    2016-02-01

    Evidence of the appropriate amount of fluid intake during the first few days after acute stroke was scarce. Concerns were raised in patients with acute malignant middle cerebral infarction, who tended to have malignant brain edema later. The purpose of the study was to evaluate the effect of fluid intake on the occurrence of malignant brain edema in patients with acute middle cerebral artery infarction. Patients with acute middle cerebral artery infarction who had National Institute of Health Stroke Scale (NIHSS) score of at least 15 were included. Baseline characteristics and amount of fluid intake during the first few days were compared in patients with and without malignant brain edema. One hundred ninety-three patients were studied. Mean NIHSS score was 20. Malignant brain edema occurred in 69 patients (36%). Higher amount of fluid intake (>1650 ml or >28 ml/kg/day or >93% of daily maintenance fluid) showed a significant association with malignant brain edema (OR = 13.86, 95% CI 5.11-37.60, p value edema, 39 patients (39/65, 60%) died and only 11% (7/65 patients) had favorable outcome. High amount of fluid intake in the first few days of acute middle cerebral infarction was related to the occurrence of malignant brain edema.

  14. IL-2 induces pulmonary edema and vasoconstriction independent of circulating lymphocytes

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, T.J.; Johnson, A.; Everitt, J.; Malik, A.B.

    1989-03-15

    We investigated the effect of IL-2 in the isolated guinea pig lung perfused with phosphate-buffered Ringer's solution (containing 0.5 g/100 ml albumin and 5.5 mM dextrose) to determine the mechanism of IL-2-induced pulmonary edema. IL-2 (0 to 10,000 U/ml) was added to the perfusate following a 10 min baseline steady-state period. Pulmonary arterial pressure (Ppa), pulmonary capillary pressure (Ppc), and change in lung weight (as a measure of developing pulmonary edema) were recorded at 0, 10, 30, 40, and 60 min. The capillary filtration coefficient (Kf.c), an index of vascular permeability to water, was measured at 30 and 60 min. Infusion of IL-2 increased Ppc (from 3.9 +/- 0.1 cm H2O at baseline to 8.8 +/- 1.1 cm H2O at 60 min for IL-2 at 2000 U/ml, p less than 0.01; and from 3.8 +/- 0.1 cm H2O at baseline to 8.9 +/- 0.6 cm H2O at 60 min for IL-2 at 10,000 U/ml, p less than 0.01. The lung weight also increased (32% at IL-2 concentration of 2000 U/ml, and 26% at IL-2 concentration of 10,000 U/ml) The capillary filtration coefficient did not change with IL-2 infusion. The IL-2 response was prevented using the pulmonary vasodilator, papaverine. The infusion of IL-2 was associated with the generation of thromboxane A2(TxA2) in the effluent perfusate. Inhibition of TxA2 synthetase using Dazoxiben prevented the pulmonary vasoconstriction and edema response to IL-2. In addition, IL-2 had no effect on the transendothelial clearance of 125I-albumin. The results indicate that IL-2 causes pulmonary edema secondary to an increase in Ppc. The response is mediated by IL-2 stimulation of TxA2 generation from the lung.

  15. Clinical study of non-invasive hemodynamic monitor system in the severe acute pancreatitis combined with pulmonary edema%无创血流动力学监测仪在重症急性胰腺炎合并肺水肿患者中的临床应用

    Institute of Scientific and Technical Information of China (English)

    朱滨; 江勇; 王大明; 刘宁

    2011-01-01

    目的 研究无创血流动力学监测仪在重症急性胰腺炎(SAP)合并肺水肿患者鉴别诊断中的意义.方法 回顾性分析29例SAP早期液体复苏过程中出现肺水肿患者的临床资料.根据患者出院诊断等分为观察组(非心源性肺水肿)18例和对照组(心源性肺水肿)11例.将两组无创血流动力学监测数据进行比较.结果 对照组心排出量[(3.34±1.09)L/min]、心脏指数[(2.06±0.46)L/(min·m2)]、心脏搏出量[(41.89±13.72)ml]、心搏指数[(25.59±7.32)ml/m2]、加速指数[(59.24±28.41)L/100 s2]、左心室工作指数[(2.09±0.67)(kg·m)/m2]、左心室射血时间[(254.32±27.34)ms]、射血分数(0.37±0.03)和速度指数[(27.11±11.32)L/100 s]较观察组[分别为(4.12±1.06)L/min、(2.64±0.48)L/(min·m2)、(46.21±11.81)ml、(28.87±5.32)ml/m2、(79.43±29.01)L/100 s2、(3.21±0.84)(kg·m)/m2、(281.29±29.11)ms、0.54±0.04、(39.34±12.11)L/100 s]显著降低(P<0.01);射血前期[(116.54±22.37)ms]和收缩时间比(0.48±0.04)较观察组[分别为(95.24±21.41)ms、0.36±0.02]显著增高(P<0.01或<0.05).结论 无创血流动力学监测仪为SAP合并肺水肿患者鉴别诊断提供了较好的依据.%Objective To study the significance of the non-invasive hemodynamic monitor system in the differential diagnosis of severe acute pancreatitis (SAP) combined with pulmonary edema. Methods Twenty-nine cases of SAP during fluid resuscitation treatment combined with pulmonary edema were reviewed and the data of the non-invasive hemodynamic monitor system was analysed and summarized.According to the diagnosis on discharge, 18 patients were enrolled in test group (noncardiogenic pulmonary edema group) and 11 patients were enrolled in control group (cardiogenic pulmonary edema group). The data of two groups were determined and compared. Results In control group, cardiac output [(3.34±1.09) L/min], cardiac index [(2.06 ± 0.46) L/ (min·m2)], stroke volume [(41.89 ± 13.72) ml], stroke

  16. Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report

    Science.gov (United States)

    Park, Eun Sun; Lee, A-Ran; Lee, Sang Hyun; Kim, An Suk; Park, Soon Eun; Cho, Young Woo

    2014-01-01

    Neurogenic pulmonary edema (NPE) in brain dead organ donors occurring after an acute central nervous system insult threatens organ preservation of potential organ donors and the outcome of organ donation. Hence the active and immediate management of NPE is critical. In this case, a 50-year-old male was admitted to the intensive care unit (ICU) for organ donation. He was hypoxic due to NPE induced by spontaneous intracerebral hemorrhage and intraventricular hemorrhage. Protective ventilatory management, intermittent recruitment maneuvers, and supportive treatment were maintained in the ICU and the operating room (OR). Despite this management, the hypoxemia worsened after the OR admission. So inhaled nitric oxide (NO) therapy was performed during the operation, and the hypoxic phenomena showed remarkable improvement. The organ retrieval was successfully completed. Therefore, NO inhalation can be helpful in the improvement of hypoxemia caused by NPE in brain dead organ donors during anesthesia for the organ donation. PMID:25237451

  17. Sesame Oil Attenuates Ovalbumin-Induced Pulmonary Edema and Bronchial Neutrophilic Inflammation in Mice

    Directory of Open Access Journals (Sweden)

    Dur-Zong Hsu

    2013-01-01

    Full Text Available Background. Allergic asthma is one of the most common chronic inflammatory diseases of airways. Severe asthma may lead to hospitalization and death. Sesame oil is a natural product with anti-inflammatory property. However, the effect of sesame oil on allergic asthma has never been studied. Objective. We investigate the effect of sesame oil on pulmonary inflammation in allergic asthma model. Methods. Allergic airway inflammation was induced by sensitizing with two doses of 10 mg ovalbumin (OVA and then challenged with 1% OVA nebulizer exposure (1 h/day for 3 days. Sesame oil (0.25, 0.5, or 1 mL/kg/day was given orally 30 min before each challenge. Samples were collected 24 h after the last challenge. Results. Data showed that sesame oil inhibited pulmonary edema and decreased interleukin (IL-1β and IL-6 levels in bronchoalveolar lavage fluid in OVA-treated mice. Sesame oil also decreased pulmonary nitrite level, inducible nitric oxide synthase expression, and neutrophil infiltration induced by OVA. Further, sesame oil decreased serum IgE level in OVA-treated mice. Conclusion. Sesame oil may attenuate pulmonary edema and bronchial neutrophilic inflammation by inhibiting systemic IgE level in allergic asthma.

  18. Positive end-expiratory pressure (PEEP) does not depress left ventricular function in patients with pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Calvin, J.E.; Driedger, A.A.; Sibbald, W.J.

    1981-08-01

    Researchers evaluated the effects of positive end-expiratory pressure (PEEP) on left ventricular function in 15 patients with acute respiratory insufficiency secondary to pulmonary edema with invasive (pressure; flow) measurements and radionuclide angiography (RA). Using RNA allowed a definition of the left ventricular ejection fraction (LVEF), and then calculation of the left ventricular end-diastolic volume (LVEDV), both before and after PEEP. With a mean PEEP of 14.2 +/- 1.8 cm H2O (mean +/- SD) (range, 10 to 15), a fall in the cardiac index (4.34 +/- 1.5 to 3.84 +/- 1.4 L/min/M2; p less than 0.001) was accompanied by a significant decrease in the stroke volume index (42 +/- 13 to 39 +/- 12 ml/beat M2; p less than 0.01) and pulse rate (103.4 +/- 14.3 to 98 +/- 13.5 beats/min; p less than 0.01). The decrease in the stroke volume index was primarily due to a significant decrease in left ventricular preload (LVEDV) from 85.9 +/- 19 to 71.4 +/- 21.4 ml/m2 (p less than 0.01). Simultaneously, the mean LVEF increased from 0.47 +/- 0.10 to 0.53 +/- 0.08 (p less than 0.05), despite a significant increase in the systemic vascular resistance (1,619 +/- 575 to 1,864 +/- 617 dynes . s. cm-5/M2; p less than 0.01). Researchers concluded that the use of PEEP in patients with acute pulmonary edema, to the degree used in this study, may depress cardiac output by simply decreasing left ventricular preload. Researchers were unable to produce any evidence that would support a change in the contractile state of the left ventricle as a cause of depressed forward flow with the use of PEEP.

  19. Acute Hemorrhagic Edema of Infancy: A Case Report Case Report¬

    Directory of Open Access Journals (Sweden)

    Hakan Turan

    2011-04-01

    Full Text Available Introduction: Acute hemorrhagic edema of infancy is a rare subtype of leukocytoclastic vasculitis. It is characterized by target-like hemorrhagic plaques with edema. Lesions are localized to face and distal extremities. It usually heals spontaneously without any sequelae.Case Report: Herein, an 8-month-old girl infant with acute hemorrhagic edema of infancy was presented. Conclusion: Both dermatologists and pediatricians must be familiar with this rare type of leukocytoclastic vasculitis. We believe that this familiarity will eliminate unnecessary treatment and anxiety about the disease (Journal of Current Pediatrics 2011; 9: 50-2

  20. Case Report: Bilateral reexpansion pulmonary edema following treatment of a unilateral hemothorax

    Science.gov (United States)

    de Wolf, Steven P; Deunk, Jaap; Cornet, Alexander D; Elbers, Paul WG

    2014-01-01

    Bilateral re-expansion pulmonary edema (RPE) is an extremely rare entity. We report the unique case of bilateral RPE following a traumatic, unilateral hemopneumothorax in a young healthy male. Bilateral RPE occurred only one hour after drainage of a unilateral hemopneumothorax. The patient was treated with diuretics and supplemental oxygen. Diagnosis was confirmed by excluding other causes, using laboratory findings, chest radiography, pulmonary and cardiac ultrasound and high resolution computed tomography. His recovery was uneventful. The pathophysiology of bilateral RPE is not well known. Treatment is mainly supportive and consists of diuretics, mechanical ventilation, inotropes and steroids. In case of a pulmonary deterioration after the drainage of a traumatic pneumothorax, bilateral RPE should be considered after exclusion of more common causes of dyspnea. PMID:25713699

  1. Acute macular edema following intracorporeal prostaglandin injection for erectile dysfunction

    Directory of Open Access Journals (Sweden)

    Asahi MG

    2015-07-01

    Full Text Available Masumi G Asahi, Calvin Chou, Ron P Gallemore Retina Macula Institute, Torrance, CA, USA Purpose: We aimed to describe the first case of macular edema following intracorporeal injection of alprostadil, a prostaglandin E1. Methods: This was a retrospective case report followed with optical coherence tomography, fundus photos, and fluorescein angiography images. Results: A patient developed bilateral cystoid macular edema following intracorporeal injection of alprostadil, a prostaglandin E1 for treatment of erectile dysfunction. The edema resolved following treatment with nonsteroidal anti-inflammatory drugs (NSAIDs and corticosteroids, with subsequent recovery in visual acuity. Discussion: Systemic prostaglandin administration can cause macular edema and vision loss, indicating that elevated systemic prostaglandin levels may affect visual function. This has potential implications for other systemic disorders and treatments that could affect macular function. Keywords: alprostadil, inflammation

  2. Chest ultrasonography in emergency Cesarean delivery in multi-valvular heart disease with pulmonary edema during spinal anesthesia.

    Science.gov (United States)

    Samanta, Sukhen; Samanta, Sujay; Ghatak, Tanmoy; Grover, V K

    2014-05-01

    Valvular heart disease in a parturient presenting for Cesarean section is challenging. A 25 year old primigravida parturient with severe mitral stenosis, mild mitral regurgitation, mild aortic regurgitation, and mild pulmonary arterial hypertension required Cesarean delivery after developing pulmonary edema. Low-dose spinal with hyperbaric bupivacine 0.5% 1.8 mL plus 25 μg of fentanyl was used for anesthesia. Chest ultrasonography (US) and transthoracic echocardiography (TTE) were used for monitoring purposes. Spinal-induced preload reduction improved the pulmonary edema, as evidenced by chest US. Chest US and TTE helped in fluid management.

  3. A 45-Year-Old Man With Recurrent Dyspnea and Hemoptysis during Exercise: Exercise-Induced Pulmonary Hemorrhage/Edema

    Science.gov (United States)

    Kim, Dae Sung; Lee, Minhyeok; Kwon, Oh Jung; Jeong, Inbeom; Son, Ji Woong; Na, Moon Jun

    2015-01-01

    A 45-year-old man presented with dyspnea and hemoptysis during exercise. A chest computed tomography (CT) revealed multifocal diffuse patchy ground glass opacity and interlobular septal thickening in both the lungs. Permeability pulmonary edema or pulmonary hemorrhage was suspected. Serologic studies for autoimmune disorders and vasculitis were negative. There was no laboratory evidence of coagulopathy, other hematopoietic disease or infectious disease. Considering correlation with exercise, we diagnosed exercise-induced pulmonary hemorrhage (EIPH) or exercise-induced pulmonary edema (EIPE). The patient was managed with antifibrinolytics, antibiotics, and antitussive agent. After a week, follow-up chest CT revealed completely resolved pulmonary hemorrhage. About 2 months after the first event, he visited again with dyspnea and hemoptysis during running. In the present study, we report a case of recurrent pulmonary hemorrhage after exercise. PMID:26508928

  4. Acute Exacerbations of Idiopathic Pulmonary Fibrosis

    OpenAIRE

    Collard, Harold R.; Moore, Bethany B.; Flaherty, Kevin R.; Brown, Kevin K.; Kaner, Robert J.; King, Talmadge E.; Lasky, Joseph A.; Loyd, James E.; Noth, Imre; Olman, Mitchell A.; Raghu, Ganesh; Roman, Jesse; Ryu, Jay H.; Zisman, David A.; Hunninghake, Gary W.

    2007-01-01

    The natural history of idiopathic pulmonary fibrosis (IPF) has been characterized as a steady, predictable decline in lung function over time. Recent evidence suggests that some patients may experience a more precipitous course, with periods of relative stability followed by acute deteriorations in respiratory status. Many of these acute deteriorations are of unknown etiology and have been termed acute exacerbations of IPF. This perspective is the result of an international effort to summariz...

  5. Acute mountain sickness

    Science.gov (United States)

    High altitude cerebral edema; Altitude anoxia; Altitude sickness; Mountain sickness; High altitude pulmonary edema ... Acute mountain sickness is caused by reduced air pressure and lower oxygen levels at high altitudes. The faster you ...

  6. A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage.

    Science.gov (United States)

    Obata, Yoshiki; Takeda, Junichi; Sato, Yohei; Ishikura, Hiroyasu; Matsui, Toru; Isotani, Eiji

    2016-08-01

    OBJECT Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. METHODS A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. RESULTS Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. CONCLUSIONS Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.

  7. A delayed, unusual non-cardiogenic pulmonary edema after intravascular administration of non-ionic, low osmolar radiocontrast media for coronary angiography.

    Science.gov (United States)

    Kang, Min-Ho; Nah, Jong-Chun

    2013-07-01

    Non-cardiogenic pulmonary edema (NCPE) is a rare adverse reaction to iodinated radiocontrast media (RCM), in which all previous cases were immediate reactions. A 56-year-old male was given iopamidol, a non-ionic, low osmolar RCM, during coronary artery angiography. He developed pulmonary edema and fever a day after the procedure. Despite diuretic therapy, the patient's pulmonary edema worsened and his high fever persisted. The patient's pulmonary edema was eventually resolved with intravenous steroid treatment. We interpreted the patient's condition as NCPE manifesting as a delayed reaction to RCM. To our knowledge, our case is the first to show NCPE as a delayed hypersensitivity reaction.

  8. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso Edema pulmonar asimétrico por presión negativa pós-obstrucción aguda de vía aérea superior: relato de caso Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report

    OpenAIRE

    Aldo José Peixoto

    2002-01-01

    JUSTIFICATIVA E OBJETIVOS: Edema pulmonar por pressão negativa pós-obstrução de via aérea é atualmente uma entidade bem descrita, porém, provavelmente pouco diagnosticada e os casos pouco publicados. O objetivo deste relato é apresentar um caso de edema pulmonar por pressão negativa pós-obstrução de via aérea superior, cuja principal característica foi a assimetria do edema pulmonar, sendo muito mais acentuado no pulmão direito. RELATO DO CASO: Menino de 4 anos, 17 kg, estado físico ASA I, fo...

  9. 神经源性肺水肿%Neurogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    任晓旭

    2009-01-01

    @@ 1 概述 神经源性肺水肿(neurogenic pulmonary edema,NPE)是指在没有心、肺原发疾病情况下,由于颅脑损伤或中枢神经系统(CNS)其他疾病引起的肺水肿.其特点是起病急,进展快速,治疗困难,病死率高,病死率可高达90%.NPE可在CNS损伤、病变发生数分钟至数天内发生.

  10. High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition

    Directory of Open Access Journals (Sweden)

    Kenneth S. Whitlow,

    2014-11-01

    Full Text Available High altitude pulmonary edema (HAPE is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE. [West J Emerg Med. 2014;15(7:–0.

  11. High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition

    Science.gov (United States)

    Whitlow, Kenneth S.; Davis, Babette W.

    2014-01-01

    High altitude pulmonary edema (HAPE) is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE. PMID:25493133

  12. An Unusual Type of Localized Hypertrophic Cardiomyopathy With Wolf Parkinson White Syndrome Presenting With Pulmonary Edema

    Science.gov (United States)

    Vatan, Mehmet Bulent; Gunduz, Huseyin; Gurel, Safiye; Kocayigit, Ibrahim; Vural, Ahmet; Demirtas, Saadet; Cakar, Mehmet Akif; Gunduz, Yasemin

    2012-01-01

    Hypertrophic cardiomyopathy (HCM) is an autosomal dominant heart disease that is the most common genetic cardiac disorder. The disease is characterized by excessive thickening of the left ventricular myocardium. The anterior portion of the interventricular ventricular septum is often involved. Asymmetric hypertrophy of apical site, left ventricular free wall, and right ventricle are less common in hypertrophic cardiomyopathy that occur in 1% cases. We report a case of a patient with an unusual type of hypertrophic cardiomyopathy and Wolf Parkinson White (WPW) presenting with pulmonary edema.

  13. Selective HDAC6 inhibition prevents TNF-α-induced lung endothelial cell barrier disruption and endotoxin-induced pulmonary edema.

    Science.gov (United States)

    Yu, Jinyan; Ma, Zhongsen; Shetty, Sreerama; Ma, Mengshi; Fu, Jian

    2016-07-01

    Lung endothelial damage contributes to the pathogenesis of acute lung injury. New strategies against lung endothelial barrier dysfunction may provide therapeutic benefits against lung vascular injury. Cell-cell junctions and microtubule cytoskeleton are basic components in maintaining endothelial barrier integrity. HDAC6, a deacetylase primarily localized in the cytoplasm, has been reported to modulate nonnuclear protein function through deacetylation. Both α-tubulin and β-catenin are substrates for HDAC6. Here, we examined the effects of tubastatin A, a highly selective HDAC6 inhibitor, on TNF-α induced lung endothelial cell barrier disruption and endotoxin-induced pulmonary edema. Selective HDAC6 inhibition by tubastatin A blocked TNF-α-induced lung endothelial cell hyperpermeability, which was associated with increased α-tubulin acetylation and microtubule stability. Tubastatin A pretreatment inhibited TNF-α-induced endothelial cell contraction and actin stress fiber formation with reduced myosin light chain phosphorylation. Selective HDAC6 inhibition by tubastatin A also induced β-catenin acetylation in human lung endothelial cells, which was associated with increased membrane localization of β-catenin and stabilization of adherens junctions. HDAC6 knockdown by small interfering RNA also prevented TNF-α-induced barrier dysfunction and increased α-tubulin and β-catenin acetylation in endothelial cells. Furthermore, in a mouse model of endotoxemia, tubastatin A was able to prevent endotoxin-induced deacetylation of α-tubulin and β-catenin in lung tissues, which was associated with reduced pulmonary edema. Collectively, our data indicate that selective HDAC6 inhibition by tubastatin A is a potent approach against lung endothelial barrier dysfunction.

  14. Edema pulmonar neurogénico secundario a crisis epiléptica: Presentación de un caso y revisión de la literatura Neurogenic pulmonary edema secondary to epileptic seizures: Report of a case and a short review

    Directory of Open Access Journals (Sweden)

    PAMELA DÍAZ A

    2009-01-01

    Full Text Available El edema pulmonar agudo neurogénico (EPN es un tipo de edema pulmonar que ocurre como consecuencia de una variada gama de lesiones del sistema nervioso central. Generalmente es subdiagnosticado. Se ha reportado en múltiples patologías y lesiones directas del sistema nervioso central. Presentamos el caso clínico de una mujer de mediana edad, con edema pulmonar agudo secundario a una crisis convulsiva epiléptica. Se realiza una revisión de la literatura con especial énfasis en las implicancias clínicas y tratamiento.The acute neurogenic pulmonary edema (NPE is a kind of pulmonary edema that occurs as a result of a variety of injuries of the central nervous system. Usually it is underdiagnosed. It has been reported in many diseases and direct injuries of the central nervous system. We present the clinical case of a middle age women with a neurogenic pulmonary edema secondary to a epileptic seizure. We made a review of the literature with special emphasis on clinical implications and treatment.

  15. Application effect of targeted nursing in noninvasive mechanical ventila-tion in the treatment of acute cardiogenic pulmonary edema%针对性护理在无创机械通气治疗急性心源性肺水肿中的应用效果

    Institute of Scientific and Technical Information of China (English)

    王丽嫦

    2015-01-01

    Objective To investigate the application effect of targeted nursing in noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Methods 80 cases with acute cardiogenic pulmonary edema from May 2010 to May 2013 in our hospital were selected and randomly divided into the treatment group and the control group,40 cases in each group.All patients were given the treatment of non-invasive mechanical ventilation,the treatment group was given targeted nursing measure,the control group was given conventional nursing.The level of heart rate, breathing,blood oxygen saturation,pH,PaO2,PaCO2 in two groups was compared respectively.The degree of nursing satis-faction and the incidence of complication in two groups was compared respectively. Results The level of heart rate, breathing,blood oxygen saturation,pH,PaO2,PaCO2 after noninvasive mechanical ventilation was better than before non-invasive mechanical ventilation,with significant difference(P0.05).The total satisfaction rate of the treatment group was 97.5%,which was higher than 85.0%of the control group, with significant difference(P<0.05).The incidence of complication in the treatment group was lower than that in the con-trol group,with significant difference(P<0.05). Conclusion The application effect of targeted nursing in noninvasive me-chanical ventilation in the treatment of acute cardiogenic pulmonary edema is significant,which can improve the degree of nursing c satisfaction,reduce the incidence of complication,it is worthy of clinical promotion and application.%目的:探讨针对性护理在无创机械通气治疗急性心源性肺水肿中的应用效果。方法选取本院2010年5月~2013年5月收治的80例急性心源性肺水肿患者作为研究对象,随机分为治疗组和对照组,各40例。所有患者入院后均给予无创机械通气治疗,其中治疗组采用针对性护理措施,对照组仅采用常规护理措施。比较两组的心率、呼吸、

  16. 针对性护理对无创机械通气治疗急性心源性肺水肿患者的效果%Effect of specific nursing on the acute cardiogenic pulmonary edema of noninvasive mechanical ventilation patients

    Institute of Scientific and Technical Information of China (English)

    齐慧

    2014-01-01

    Objective To explore the effective nursing measures of noninvasive mechanical ventilation in the treatment of patients with acute cardiogenic pulmonary edema .Methods Sixty patients with acute pulmonary edema were randomly divided into observation group and control group , with 30 cases each .The observation group was treated with targeted nursing intervention , while the control group received routine nursing care.Clinical monitoring indicators of 60 patients, as well as the occurrence of complications of the two groups of patients were observed and compared .Results After treatment, clinical indicators of HR, R, pH, SpO2, PaCO2, PaO2 were (84.25 ±3.87)beat/min, (23.62 ±6.24)beat/min, (7.38 ±0.15), (0.94 ±0.01)%, (30.48 ±4.73 ) mmHg, ( 94.04 ±3.38 ) mmHg, respectively, which were significantly improved than (119.25 ±9.68)beat/min, (30.83 ±7.08) beat/min, (7.27 ±0.14), (0.83 ±0.04)%, (38.44 ± 2.86)mmHg, (65.03 ±5.79)mmHg before treatment (t =2.215,2.326,2.567,2.413,2.985,3.258, respectively;P<0 .05 ) .3 cases in the observation group had complications ( 2 cases of sputum obstruction asphyxia and 1 cases of flatulence ) .18 cases in the control group had complications ( 8 cases of sputum obstruction asphyxia and 10 cases of flatulence ).The difference was statistically significant (χ2 =3.495, 6.689, respectively;P <0.05).Conclusions The noninvasive mechanical ventilation in the treatment of patients with acute cardiogenic pulmonary edema had remarkable curative effect .During the treatment , careful nursing measures could effectively reduce the incidence of complications .%目的:探讨无创机械通气法治疗急性心源性肺水肿患者的有效护理措施。方法将采用无创机械通气法治疗的60例急性心源性肺水肿患者按照随机数字表法分为观察组30例和对照组30例,观察组采用针对性护理措施,对照组采用常规护理。观察两组患者治疗后的临床监测指标,以及两组患者的

  17. Pulmonary Edema

    Science.gov (United States)

    ... for any trends. Make a list of the salty foods you eat regularly. Mention if you have ... your symptoms been continuous? Have you eaten more salty foods lately? How severe are your symptoms? Have ...

  18. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Vaneet Jearath

    2016-01-01

    Full Text Available Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.

  19. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    Science.gov (United States)

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy. PMID:27127397

  20. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction.

    Science.gov (United States)

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.

  1. Severe hypertension and pulmonary edema associated with systemic absorption of topical phenylephrine in a child during retinal surgery

    Directory of Open Access Journals (Sweden)

    Ashraf A Abdelhalim

    2012-01-01

    Full Text Available Topical phenylephrine solutions are widely used in eye procedures to promote pupil dilation without cycloplegia. We report a case of intraoperative severe hypertension and acute pulmonary edema occurring in a child during retinal surgery after possible systemic absorption of topical phenylephrine eyedrops. Our objective is to discuss the proper treatment and preventive strategies for such a complication. A 4-year-old, male patient, 18.4 kg in weight, physical status ASA I was admitted for right retinal detachment surgery. Anesthesia was induced with sevoflurane in oxygen, followed by glycopyrrolate (5.0 μg/kg, propofol 25 mg, fentanyl 50 μg and cisatracurium 0.15 mg/kg given intravenously. Anesthesia was maintained with sevoflurane 2-2.5% in a mixture of nitrous oxide and oxygen (60%:40%. After incision, two drops of 10% aqueous phenylephrine were administered topically by the surgeon to the right eye for further pupil dilation. Few minutes later, the noninvasive blood pressure rose to 220/120 mmHg and the heart rate increased to 140 beats/min. Oxygen saturation (SpO 2 dropped from 99% (with an inspired oxygen concentration (FiO 2 of 0.4 to 82%. Auscultation revealed crepitations throughout the chest and a blood-stained frothy fluid was aspirated from the trachea with possible development of acute pulmonary edema. Hydralazine (5 mg and furosemide (10 mg were administered intravenously. Seven minutes later, the blood pressure returned to normal and the SpO 2 increased to 92% on FiO 2 of 1.0, with decreased intratracheal secretions. After approximately 20 minutes, the SpO 2 had improved to 99%, with a FiO 2 of 1.0 and the blood pressure was 109/63 mmHg and heart rate was 121 beats/min. The FiO 2 gradually reduced back to 0.4 over 30 min with no further desaturation. The patient was discharged from the post anesthesia care unit 5 h after surgery with adequate spontaneous breathing, SpO 2 99% on room air, normal blood pressure and pulmonary

  2. Acute effect of pure oxygen breathing on diabetic macular edema

    DEFF Research Database (Denmark)

    Vinten, Carl Martin; La Cour, Morten; Lund-Andersen, Henrik;

    2012-01-01

    Purpose. A small-scale pilot study of the pathophysiology of diabetic macular edema (DME) was made by assessing concomitant changes in macular volume (MV), mean arterial blood pressure (MABP), intraocular pressure (IOP), retinal artery diameter (RAD), and retinal vein diameter (RVD) in response...

  3. Protection with cycloheximide or emetine against pulmonary edema induced by ozone or nitrogen dioxide

    Energy Technology Data Exchange (ETDEWEB)

    Nambu, Z.; Yokoyama, E.

    1982-03-01

    Pretreatment with cycloheximide or emetine provided significant protection against pulmonary edema in rats exposed to ozone or nitrogen dioxide. Other inhibitors of protein-synthesis, actinomycin D or puromycin, failed to show such effects. Possible actions of these agents as well as the doses and times that afforded the significant protection were investigated. These agents, by themselves, did not alter the water content of the lungs. In vitro study revealed that both cycloheximide and emetine hardly acted as scavengers of oxidant. Pretreatment with either agent was associated with a significant increase in the activity of glucose 6-phosphate dehydrogenase of the lungs, but the increase did not necessarily coincide with the protection. Activity levels of non-protein SH, glutathione-peroxidase and -reductase in the lungs of rats treated with either agent were scarcely altered. The effect of these agents administered in vivo or in vitro on the in vitro lipid peroxidation by air was also investigated. Other possible mechanisms of these agents responsible for the protective effect against pulmonary edema induced by oxidants were also discussed.

  4. Molecular Pathology of Pulmonary Edema in Forensic Autopsy Cases with Special Regard to Fatal Methamphetamine Intoxication.

    Science.gov (United States)

    Du, Yu; Jin, Hong-Nian; Zhao, Rui; Zhao, Dong; Xue, Ye; Zhu, Bao-Li; Guan, Da-Wei; Xie, Xiao-Li; Wang, Qi

    2016-11-01

    Pulmonary edema is a common finding in fatal methamphetamine intoxication. However, the underlying mechanism remains poorly understood. This study investigated the molecular pathology of alveolar damage involving pulmonary edema in forensic autopsy cases. Seven candidate reference genes (RPL13A, YWHAZ, GUSB, SDHA, GAPDH, B2M, and ACTB) were evaluated in the lung by the geNorm module in qBase(plus) software. RPL13A, YWHAZ, and GUSB were identified as the most stable reference genes. Using these validated reference genes, intrapulmonary mRNA expressions of matrix metalloproteinases (MMPs), intercellular adhesion molecule-1 (ICAM-1), claudin-5 (CLDN-5), and aquaporins (AQPs) were examined. Relative mRNA quantification using TaqMan real-time PCR assay demonstrated higher expressions of all markers except for AQP-5 in fatal METH intoxication cases. These findings suggested alveolar damage and compensatory response in fatal METH intoxication cases. Systematic analysis of gene expressions using real-time qPCR is a useful tool in forensic death investigation.

  5. Negative pressure pulmonary edema%负压性肺水肿

    Institute of Scientific and Technical Information of China (English)

    徐勇胜

    2014-01-01

    Negative pressure pulmonary edema is a common pediatric disease,but also often to be ignored,which occurs from the upper airway obstruction caused by the change in the absolute value of negative intrathoracic pressure increase,resulting in a corresponding respiratory physiology,hemodynamic changes,common causes include laryngitis,whooping cough,foreign body,such as obstructive sleep apnea.Therefore,it is important to know the common causes of negative pressure pulmonary edema and to treat the patients in time.%负压性肺水肿是儿科常见的疾病,也容易被忽视,其发生源自上气道梗阻造成的胸内负压变化的绝对值加大,从而造成相应的呼吸生理、血流动力学改变,常见的原因包括喉炎、百日咳、气管异物、阻塞性睡眠呼吸暂停等.因此熟悉负压性肺水肿的常见诱因,及时进行相关治疗,是救治的关键.

  6. A non-destructive scattering technique for investigation of pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, Amandeep; Singh, Bhajan [Physics Department, Punjabi University, Patiala 147002 (India); Sandhu, B.S., E-mail: balvir@pbi.ac.in [Physics Department, Punjabi University, Patiala 147002 (India)

    2012-01-15

    In many biomedical studies, the density of a biological system is of great importance to investigate its structure or functioning. In the present work, for the density measurement of lung phantom, the scattering of 59.54 and 662 keV gamma photons are studied using HPGe and NaI(Tl) detectors, respectively. Phantoms simulating lung density are prepared by mixing appropriate amount of saw dust and distilled water. The regression lines, obtained from experimental data of scattered spectra, provide the amount of excessive water storage in lungs, hence the technique has the potential for a measure of pathological state like pulmonary edema. The technique is quite sensitive for small change ({approx}23 Kg m{sup -3}) in the density of lung phantom. Also, Compton scatter profile measurements (in case of 59.54 keV) results that the technique is less sensitive beyond chest wall thickness of {approx}26 mm due to overlying scatter components in the measured spectrum. A portable non-invasive system described presently may be used for various industrial applications also. - Highlights: Black-Right-Pointing-Pointer Measurements specify the pathological state like pulmonary edema. Black-Right-Pointing-Pointer Rayleigh to Compton ratio, Wing ratio and Compton profile authenticate the results. Black-Right-Pointing-Pointer The radiation dose available to chest will be lesser in comparison to chest X-ray. Black-Right-Pointing-Pointer Portable system can be used for density measurements in industrial applications.

  7. Contribution of α- and β-Adrenergic Mechanisms to the Development of Pulmonary Edema

    Directory of Open Access Journals (Sweden)

    Beate Rassler

    2012-01-01

    Full Text Available Endogenous or exogenous catecholamines can induce pulmonary edema (PE. This may occur in human pathologic conditions such as in pheochromocytoma or in neurogenic pulmonary edema (NPE but can also be provoked after experimental administration of adrenergic agonists. PE can result from stimulation with different types of adrenergic stimulation. With -adrenergic treatment, it develops more rapidly, is more severe with abundant protein-rich fluid in the alveolar space, and is accompanied by strong generalized inflammation in the lung. Similar detrimental effects of -adrenergic stimulation have repeatedly been described and are considered to play a pivotal role in NPE or in PE in patients with pheochromocytoma. Although -adrenergic agonists have often been reported to prevent or attenuate PE by enhancing alveolar fluid clearance, PE may also be induced by -adrenergic treatment as can be observed in tocolysis. In experimental models, infusion of -adrenergic agonists induces less severe PE than -adrenergic stimulation. The present paper addresses the current understanding of the possible contribution of - and -adrenergic pathways to the development of PE.

  8. High Altitude Pulmonary Edema Without Appropriate Action Progresses to Right Ventricular Strain: A Case Study.

    Science.gov (United States)

    Mills, Logan; Harper, Chris; Rozwadowski, Sophie; Imray, Chris

    2016-09-01

    Mills, Logan, Chris Harper, Sophie Rozwadowski, and Chris Imray. High altitude pulmonary edema without appropriate action progresses to right ventricular strain: A case study. High Alt Med Biol. 17:228-232, 2016.-A 24-year-old male developed high altitude pulmonary edema (HAPE) after three ascents to 4061 m over 3 days, sleeping each night at 2735 m. He complained of exertional dyspnea, dry cough, chest pain, fever, nausea, vertigo, and a severe frontal headache. Inappropriate continuation of ascent despite symptoms led to functional impairment and forced a return to the valley, but dyspnea persisted in addition to new orthopnea. Hospital admission showed hypoxemia, resting tachycardia, and systemic hypertension. ECG revealed right ventricular strain and a chest X-ray revealed right lower zone infiltrates. This case demonstrates that HAPE can develop in previously unaffected individuals given certain precipitating factors, and that in the presence of HAPE, prolonged exposure to altitude with exercise (or exertion) does not confer acclimatization with protective adaptations and that rest and descent are the appropriate actions. The case additionally demonstrates well-characterized right ventricular involvement.

  9. Negative pressure pulmonary edema after craniotomy through the endonasal transsphenoidal approach

    Science.gov (United States)

    Ou, Mengchan; Luo, Zhen; Liu, Juan; Yang, Yaoxin; Li, Yu

    2015-01-01

    We describe a case of negative pressure pulmonary edema that occurred in the post-anesthesia care unit in a patient who had undergone transsphenoidal resection of a pituitary adenoma. Negative pressure pulmonary edema is an uncommon complication of general anesthesia. In this case, the patient’s nasal cavity had been filled with surgical packs and she had not become accustomed to breathing through her mouth, in addition to her large tongue and small oropharyngeal cavity, residual effect of anesthetic may resulting in tongue falling which caused airway obstruction. The main causative factor is excessive negative intrathoracic pressure generated by the patient’s spontaneous forced inspiration in an effort to overcome the airway obstruction. It typically developed rapidly, and may be life threatening if not diagnosed promptly. After re-intubation for a short period of mechanical ventilation with positive end expiratory pressure (PEEP 10 cm H2O) and a bolus of intravenous furosemide, the patient recovered rapidly and discharged 8 days after surgery. PMID:26131257

  10. Brain expression of the water channels Aquaporin-1 and -4 in mice with acute liver injury, hyperammonemia and brain edema

    DEFF Research Database (Denmark)

    Eefsen, Martin; Jelnes, Peter; Schmidt, Lars E;

    2010-01-01

    Cerebral edema is a feared complication to acute liver failure (ALF), but the pathogenesis is still poorly understood. The water channels Aquaporin-1 (Aqp1) and -4 (Aqp4) has been associated with brain edema formation in several neuropathological conditions, indicating a possible role of Aqp1 and....../or Aqp4 in ALF mediated brain edema. We induced acute liver injury and hyperammonemia in mice, to evaluate brain edema formation and the parallel expression of Aqp1 and Aqp4 in ALF. Liver injury and hyperammonemia were induced by +D-galactosamine (GLN) plus lipopolysaccharide (LPS) intraperitoneally......(6266) (p edema in mice with ALF....

  11. Using a Caesalpinia echinata Lam. protease inhibitor as a tool for studying the roles of neutrophil elastase, cathepsin G and proteinase 3 in pulmonary edema.

    Science.gov (United States)

    Cruz-Silva, Ilana; Neuhof, Christiane; Gozzo, Andrezza Justino; Nunes, Viviane Abreu; Hirata, Izaura Yoshico; Sampaio, Misako Uemura; Figueiredo-Ribeiro, Rita de Cássia; Neuhof, Heinz; Araújo, Mariana da Silva

    2013-12-01

    Acute lung injury (ALI) is characterized by neutrophil infiltration and the release of proteases, mainly elastase (NE), cathepsin G (Cat G) and proteinase 3 (PR3), which can be controlled by specific endogenous inhibitors. However, inhibitors of these proteases have been isolated from different sources, including plants. For this study, CeEI, or Caesalpinia echinata elastase inhibitor, was purified from C. echinata (Brazil-wood) seeds after acetone fractionation, followed by ion exchange and reversed phase chromatographic steps. Characterization with SDS-PAGE, stability assays, amino acid sequencing and alignment with other protein sequences confirmed that CeEI is a member of the soybean Kunitz trypsin inhibitor family. Like other members of this family, CeEI is a 20 kDa monomeric protein; it is stable within a large pH and temperature range, with four cysteine residues forming two disulfide bridges, conserved amino acid residues and leucine-isoleucine residues in the reactive site. CeEI was able to inhibit NE and Cat G at a nanomolar range (with K(i)s of 1.9 and 3.6 nM, respectively) and inhibited PR3 within a micromolar range (K(i) 3.7 μM), leading to hydrolysis of specific synthetic substrates. In a lung edema model, CeEI reduced the lung weight and pulmonary artery pressure until 180 min after the injection of zymosan-activated polymorphonuclear neutrophils. In experiments performed in the presence of a Cat G and PR3, but not an NE inhibitor, lung edema was reduced only until 150 min and pulmonary artery pressure was similar to that of the control. These results confirm that NE action is crucial to edema establishment and progression. Additionally, CeEI appears to be a useful tool for studying the physiology of pulmonary edema and provides a template for molecular engineering and drug design for ALI therapy.

  12. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro, E-mail: keitarosofue@yahoo.co.jp; Takeuchi, Yoshito, E-mail: yotake62@qg8.so-net.ne.jp; Arai, Yasuaki, E-mail: arai-y3111@mvh.biglobe.ne.jp [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Sugimura, Kazuro, E-mail: sugimura@med.kobe-u.ac.jp [Kobe University, Department of Radiology, Graduate School of Medicine (Japan)

    2013-02-15

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  13. Edema pulmonar por pressão negativa após extubação traqueal: relato de caso Negative pressure pulmonary edema after tracheal extubation: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O edema pulmonar por pressão negativa após obstrução de via aérea é atualmente uma entidade bem descrita, porém pouco diagnosticada e com poucos casos relatados. O objetivo deste artigo foi relatar um caso de edema pulmonar por pressão negativa (EPPN após extubação traqueal com sucesso terapêutico, após uso de ventilação mecânica não-invasiva com pressão positiva. RELATO DO CASO: Paciente do sexo feminino, 22 anos, foi submetida à colecistectomia aberta. Os exames pré-operatórios encontravam-se sem alterações. Imediatamente após extubação a paciente apresentou dispnéia súbita e crepitações pulmonares. Foi iniciado tratamento para edema agudo de pulmão com oxigenoterapia sob máscara de Venturi, elevação do tórax e diurético. A paciente foi encaminhada a UTI devido a falha no tratamento. Ao chegar a UTI foi iniciada ventilação mecânica não-invasiva (VMNI com pressão de suporte (15 cmH2O e pressão expiratória final positiva (5 cmH2O com resolução dos sintomas. A paciente foi mantida em observação por mais 24 horas depois do evento com boas condições e recebeu alta para o quarto sem sintomas. CONCLUSÕES: O EPPN é uma entidade de difícil diagnóstico e deverá ser observada sempre que os pacientes evoluem com sinais e sintomas de insuficiência respiratória pós-extubação. Esta paciente se beneficiou de VMNI, mas caso haja falha terapêutica, a intubação traqueal e o suporte ventilatório mecânico invasivo deverão ser instituídos para melhor oxigenação dos pacientes.BACKGROUND AND OBJECTIVES: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, thought infrequently diagnosed and reported. This report aimed at presenting a case of postextubation negative pressure pulmonary edema refractory to use of diuretics and with successful therapeutic after using positive pressure noninvasive mechanic ventilation. CASE REPORT: A

  14. Acute Exacerbations of Idiopathic Pulmonary Fibrosis

    Science.gov (United States)

    Collard, Harold R.; Moore, Bethany B.; Flaherty, Kevin R.; Brown, Kevin K.; Kaner, Robert J.; King, Talmadge E.; Lasky, Joseph A.; Loyd, James E.; Noth, Imre; Olman, Mitchell A.; Raghu, Ganesh; Roman, Jesse; Ryu, Jay H.; Zisman, David A.; Hunninghake, Gary W.; Colby, Thomas V.; Egan, Jim J.; Hansell, David M.; Johkoh, Takeshi; Kaminski, Naftali; Kim, Dong Soon; Kondoh, Yasuhiro; Lynch, David A.; Müller-Quernheim, Joachim; Myers, Jeffrey L.; Nicholson, Andrew G.; Selman, Moisés; Toews, Galen B.; Wells, Athol U.; Martinez, Fernando J.

    2007-01-01

    The natural history of idiopathic pulmonary fibrosis (IPF) has been characterized as a steady, predictable decline in lung function over time. Recent evidence suggests that some patients may experience a more precipitous course, with periods of relative stability followed by acute deteriorations in respiratory status. Many of these acute deteriorations are of unknown etiology and have been termed acute exacerbations of IPF. This perspective is the result of an international effort to summarize the current state of knowledge regarding acute exacerbations of IPF. Acute exacerbations of IPF are defined as acute, clinically significant deteriorations of unidentifiable cause in patients with underlying IPF. Proposed diagnostic criteria include subjective worsening over 30 days or less, new bilateral radiographic opacities, and the absence of infection or another identifiable etiology. The potential pathobiological roles of infection, disordered cell biology, coagulation, and genetics are discussed, and future research directions are proposed. PMID:17585107

  15. Hemodynamic parameters and neurogenic pulmonary edema following spinal cord injury: an experimental model Parâmetros hemodinâmicos e edema pulmonar neurogênico após traumatismo raquimedular: modelo experimental

    Directory of Open Access Journals (Sweden)

    Manoel Baldoino Leal Filho

    2005-12-01

    Full Text Available Neurogenic pulmonary edema is a serious and always life-threatening complication following several lesions of the central nervous system. We report an experiment with 58 Wistar-Hanover adult male rats. Two groups were formed: control (n=4 and experimental (n=54. The experimental group sustained acute midthoracic spinal cord injury by Fogarty’s balloon-compression technique containing 20µL of saline for 5, 15, 30 or 60 seconds. The rats were anesthetized by intraperitoneal (i.p. sodium pentobarbital (s.p. 60 mg/Kg. The quantitative neurological outcome was presented at 4, 24 and 48 hours from compression to characterize the injury graduation in different groups. Poor outcome occurred with 60 seconds of compression. Six animals died suddenly with pulmonary edema. Using the procedure to investigate the pulmonary edema during 60 seconds of compression, followed by decompression and time-course of 60 seconds, 20 rats were randomly asigned to one of the following groups: control (1, n=4, anesthetized by i.p. s.p., 60 mg/Kg but without compression and experimental (2, n=7, anesthetized by i.p. xylazine 10 mg/Kg and ketamine 75 mg/Kg and (3, n=9, anesthetized by i.p. s.p., 60 mg/Kg. The pulmonary index (100 x wet lung weight / body weight was 0.395 ± 0.018 in control group, rose to 0.499 ± 0.060 in group 2, and was 0.639 ± 0.14 in group 3. Histologic examination of the spinal cord showed parenchymal ruptures and acute hemorrhage. Comparison of the pulmonary index with morphometric evaluation of edema fluid-filled alveoli by light microscopy showed that relevant intra-alveolar edema occurred only for index values above 0.55. The results suggest that the pulmonary edema induced by spinal compression is of neurogenic nature and that the type of anesthesia used might be important for the genesis of lung edema.Edema pulmonar neurogênico é complicação séria e aumenta o risco de vida em pacientes com várias lesões do sistema nervoso central

  16. VA/Q distribution during heavy exercise and recovery in humans: implications for pulmonary edema

    Science.gov (United States)

    Schaffartzik, W.; Poole, D. C.; Derion, T.; Tsukimoto, K.; Hogan, M. C.; Arcos, J. P.; Bebout, D. E.; Wagner, P. D.

    1992-01-01

    Ventilation-perfusion (VA/Q) inequality has been shown to increase with exercise. Potential mechanisms for this increase include nonuniform pulmonary vasoconstriction, ventilatory time constant inequality, reduced large airway gas mixing, and development of interstitial pulmonary edema. We hypothesized that persistence of VA/Q mismatch after ventilation and cardiac output subside during recovery would be consistent with edema; however, rapid resolution would suggest mechanisms related to changes in ventilation and blood flow per se. Thirteen healthy males performed near-maximal cycle ergometry at an inspiratory PO2 of 91 Torr (because hypoxia accentuates VA/Q mismatch on exercise). Cardiorespiratory variables and inert gas elimination patterns were measured at rest, during exercise, and between 2 and 30 min of recovery. Two profiles of VA/Q distribution behavior emerged during heavy exercise: in group 1 an increase in VA/Q mismatch (log SDQ of 0.35 +/- 0.02 at rest and 0.44 +/- 0.02 at exercise; P less than 0.05, n = 7) and in group 2 no change in VA/Q mismatch (n = 6). There were no differences in anthropometric data, work rate, O2 uptake, or ventilation during heavy exercise between groups. Group 1 demonstrated significantly greater VA/Q inequality, lower vital capacity, and higher forced expiratory flow at 25-75% of forced vital capacity for the first 20 min during recovery than group 2. Cardiac index was higher in group 1 both during heavy exercise and 4 and 6 min postexercise. However, both ventilation and cardiac output returned toward baseline values more rapidly than did VA/Q relationships. Arterial pH was lower in group 1 during exercise and recovery. We conclude that greater VA/Q inequality in group 1 and its persistence during recovery are consistent with the hypothesis that edema occurs and contributes to the increase in VA/Q inequality during exercise. This is supported by observation of greater blood flows and acidosis and, presumably therefore

  17. Edema is a sign of early acute myocardial infarction on post-mortem magnetic resonance imaging.

    Science.gov (United States)

    Ruder, Thomas D; Ebert, Lars C; Khattab, Ahmed A; Rieben, Robert; Thali, Michael J; Kamat, Pranitha

    2013-12-01

    The aim of this study was to investigate if acute myocardial infarction can be detected by post-mortem cardiac magnetic resonance (PMMR) at an earlier stage than by traditional autopsy, i.e., within less than 4 h after onset of ischemia; and if so, to determine the characteristics of PMMR findings in early acute infarcts. Twenty-one ex vivo porcine hearts with acute myocardial infarction underwent T2-weighted cardiac PMMR imaging within 3 h of onset of iatrogenic ischemia. PMMR imaging findings were compared to macroscopic findings. Myocardial edema induced by ischemia and reperfusion was visible on PMMR in all cases. Typical findings of early acute ischemic injury on PMMR consist of a central zone of intermediate signal intensity bordered by a rim of increased signal intensity. Myocardial edema can be detected on cardiac PMMR within the first 3 h after the onset of ischemia in porcine hearts. The size of myocardial edema reflects the area of ischemic injury in early acute (per-acute) myocardial infarction. This study provides evidence that cardiac PMMR is able to detect acute myocardial infarcts at an earlier stage than traditional autopsy and routine histology.

  18. Lethal factor, but not edema factor, is required to cause fatal anthrax in cynomolgus macaques after pulmonary spore challenge.

    Science.gov (United States)

    Hutt, Julie A; Lovchik, Julie A; Drysdale, Melissa; Sherwood, Robert L; Brasel, Trevor; Lipscomb, Mary F; Lyons, C Rick

    2014-12-01

    Inhalational anthrax is caused by inhalation of Bacillus anthracis spores. The ability of B. anthracis to cause anthrax is attributed to the plasmid-encoded A/B-type toxins, edema toxin (edema factor and protective antigen) and lethal toxin (lethal factor and protective antigen), and a poly-d-glutamic acid capsule. To better understand the contribution of these toxins to the disease pathophysiology in vivo, we used B. anthracis Ames strain and isogenic toxin deletion mutants derived from the Ames strain to examine the role of lethal toxin and edema toxin after pulmonary spore challenge of cynomolgus macaques. Lethal toxin, but not edema toxin, was required to induce sustained bacteremia and death after pulmonary challenge with spores delivered via bronchoscopy. After intravenous challenge with bacilli to model the systemic phase of infection, lethal toxin contributed to bacterial proliferation and subsequent host death to a greater extent than edema toxin. Deletion of protective antigen resulted in greater loss of virulence after intravenous challenge with bacilli than deletion of lethal toxin or edema toxin alone. These findings are consistent with the ability of anti-protective antigen antibodies to prevent anthrax and suggest that lethal factor is the dominant toxin that contributes to the escape of significant numbers of bacilli from the thoracic cavity to cause anthrax after inhalation challenge with spores.

  19. The treatment and diagnosis of re-expansion pulmonary edema FU Xiao-wei, ZHANG%复张性肺水肿的诊治

    Institute of Scientific and Technical Information of China (English)

    付小伟; 张保平; 王军岐

    2013-01-01

    Objective To investigate the pathogenesis, prevention measures and treatment of re-expansion pulmonary edema ( RPE ). Methods The clinical data of 14 patients with pulmonary atrophy were retrospectively analyzed, and the RPE occurred in the course of treatment was observed and analyzed. Results 13 patients were cured, and 1 patient reported dead because of acute respiratory distress syndrome ( ARDS ) complicated with multiple organ failure ( MOF ). Conclusion Re-expansion pulmonary edema ( RPE ) is a rare but serious complication in the treatment of collapse lung, and it should be paid enough attention and grasp its characteristics to give timely prevention and treatment.%目的 探讨复张性肺水肿(RPE)的发病机制、预防措施及治疗.方法 回顾分析14例肺萎陷患者的临床资料,并对其治疗过程中所发生的RPE进行临床观察和分析.结果 治愈13例,死亡1例,死亡原因为急性呼吸窘迫综合征(ARDS)并发全身多系统器官功能衰竭(MOF).结论 复张性肺水肿(RPE)在萎陷肺的复张治疗中是少见的严重并发症,应重视,掌握其特点及积极预防和治疗.

  20. Early Hemodynamic Disorders and Their Association with the Development of Acute Pulmonary Lesion in Severe Concomitant Injury

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2005-01-01

    Full Text Available Early changes in the parameters of central hemodynamics and pulmonary extravascular fluid were studied in patients who had sustained a severe concomitant injury in combination with acute massive blood loss. Early postoperative monitoring of these parameters by a «Pulsion Picco Plus» invasive monitoring apparatus was ascertained to verify the early stages on non-cardiogenic pulmonary edema, to assess a risk for acute lung lesion and acute respiratory distress syndrome in the phase of reperfusion lesions, and to perform an adequate correction of therapy.

  1. Application value of end-tidal carbon dioxide partial pressure monitoring in patients with acute cardiogenic pulmonary edema receiving early nonivasive positive pressure ventilation%潮气末二氧化碳分压监测在急性心源性肺水肿患者早期无创正压通气救治中的应用价值

    Institute of Scientific and Technical Information of China (English)

    唐友勇; 王正艳; 杨中卫; 李威; 石明; 邝军

    2016-01-01

    目的 探讨潮气末二氧化碳分压(PETCO2)监测在急性心源性肺水肿患者早期无创正压通气救治中的应用价值.方法 选择2011年2月至2015年5月在湖北医药学院附属东风医院急性心源性肺水肿患者88例,均给予无创正压通气治疗,在通气前后进行血流动力学(心率、收缩压、舒张压、平均动脉压(MAP)、心排血量、心脏指数、心搏指数)、血气指标[pH、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)]与PETCO2监测,并随访调查预后情况.结果 通气后患者的心排血量、心脏指数与心搏指数值明显降低,与通气前比较差异有统计学意义[(3.3±1.1) L/min比(4.1 ±1.1)L/min、(2.1 ±0.4)L/(min·m2)比(2.6 ±0.6) L/(min·m2)、(25±7)ml/m2比(29±4)ml/m2,P<0.05];心率、收缩压、舒张压与MAP通气前后差异无统计学意义(P>0.05).通气后患者的血气pH、PaO2值较通气前高,而PaCO2值较通气前低,差异有统计学意义[(7.35±0.45)比(7.23±0.24)、(88 ±9) mmHg(1 mmHg =0.133 kPa)比(52±8) mmHg、(39±8)mmHg比(47±9) mmHg,P<0.05].通气后患者的PETCO2为(34±5) mmHg,明显高于通气前的(28±5)mmHg,差异有统计学意义(P<0.05).随访至2016年1月,88例患者中发生联合心血管不良事件12例,发生率为13.6%;Pearson相关分析显示急性心源性肺水肿的预后与通气前的PETCO2、心脏指数、心搏指数及PaCO2存在明显相关性(r=0.443、0.342、0.294、0.331,P<0.05).结论 无创正压通气早期救治急性心源性肺水肿能有效改善心功能与血气状况,对于PETCO2也有明显影响,而PETCO2监测能有效判定病情,预测预后情况.%Objective To investigate the application value of end-tidal carbon dioxide partial pressure (PETCO2) monitoring in patients with acute cardiogenic pulmonary edema receiving early nonivasive positive pressure ventilation.Methods Totally 88 patients confirmed as acute cardiogenic pulmonary edema from February 2011 to May 2015

  2. Unilateral Re-Expansion Pulmonary Edema following Treatment of Pneumothorax with Exceptionally Massive Sputum Production, followed by Circulatory Collapse

    Directory of Open Access Journals (Sweden)

    Teruya Komatsu

    2010-01-01

    Full Text Available A case of a 61-year-old man who developed ipsilateral re-expansion pulmonary edema after pleural drainage for a right pneumothorax is described. The patient’s chest x-ray revealed a totally collapsed right lung. After insertion of a chest drainage tube, he began to produce a moderate amount of serous, yellowish sputum. Despite continuous positive airway pressure support, his dyspnea gradually worsened and his oxygenation could not be maintained; therefore, to improve his hypoxemic state, intubation was necessary. His chest x-ray following chest tube insertion showed ipsilateral diffuse infiltrates. These radiographic and physical findings were consistent with re-expansion pulmonary edema. The present case was complicated by extreme hypotension and tachycardia due to massive fluid loss. His condition gradually improved with invasive mechanical ventilation. Re-expansion pulmonary edema is an uncommon complication of pleural drainage for pneumothorax, and therapy is supportive. In the present case, the exceptional severity of the pulmonary edema, as well as its general concept, is reviewed in accordance with other relevant literature.

  3. The brain in acute liver failure. A tortuous path from hyperammonemia to cerebral edema

    DEFF Research Database (Denmark)

    Bjerring, Peter Nissen; Eefsen, Martin; Hansen, Bent Adel

    2008-01-01

    Acute liver failure (ALF) is a condition with an unfavourable prognosis. Multiorgan failure and circulatory collapse are frequent causes of death, but cerebral edema and intracranial hypertension (ICH) are also common complications with a high risk of fatal outcome. The underlying pathogenesis has...

  4. Iliopsoas bursitis with compression of the common femoral vein resulting in acute lower leg edema

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seung Bae; Kwak, Hyo Sung; Han, Young Min; Lee, Sang Yong; Jeong, Yeon Jun [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2006-08-15

    The clinical manifestations related to iliopsoas bursitis can vary due to compression of the adjacent structure such as the common femoral vein, nerve and bladder. We report here on a rare case of iliopsoas bursitis with compression of the common femoral vein that resulted in acute lower leg edema.

  5. AN ANALYSIS OF X-RAY PICTURES OF PULMONARY EDEMA OF HIGH ALTITUDE IN CHILDREN%小儿急性高原肺水肿56例临床X线分析

    Institute of Scientific and Technical Information of China (English)

    王代敏; 张华耀; 杨得富; 梁大利; 李华利

    2001-01-01

    A retrospective analysis was made of 56 children with a definite diagnosis of pulmonary edema,in whom x-ray films were taken before and after treatment.Four patients had been in Tibet for five months to 6 years.In 50 patients,pulmonary edema occurred 6~72 hours after they flied into Tibet.Two of them died during treatment because of delayed treatment and critical conditions.All 56 patients were of Han nationality,aged 5 months to 12 years.Childhood acute pulmonary edema accountes for 6.9% of all high altitude pulmonary edema cases.Childhood pulmonary edema had an acute onset,and it ran a fulminating course.chest films usually showed disseminating alveolar changes,and the diagnosis may be misleading.X-ray physicians should get familiar with the diagnosis to avoid a delayed diagnosis and treatment.%采用回顾法对经临床治疗且治疗前后摄取X线片诊断明确的56例小儿急性高原肺水肿进行分析。56例中有4例为进藏5个月~6年中发生迟发性高原肺水肿;50例为乘飞机进藏6~72h发生急性高原肺水肿;2例因病情危重延误治疗抢救无效死亡。56例均为汉族,年龄5个月~12岁。小儿急性高原肺水肿约占高原肺水肿的6.88%。

  6. Transpulmonary Thermodilution-Based Management of Neurogenic Pulmonary Edema After Subarachnoid Hemorrhage.

    Science.gov (United States)

    Mutoh, Tatsushi; Kazumata, Ken; Ueyama-Mutoh, Tomoko; Taki, Yasuyuki; Ishikawa, Tatsuya

    2015-11-01

    Neurogenic pulmonary edema (NPE) is a potentially catastrophic but treatable systemic event after subarachnoid hemorrhage (SAH). The development of NPE most frequently occurs immediately after SAH, and the severity is usually self-limiting. Despite extensive research efforts and a breadth of collective clinical experience, accurate diagnosis of NPE can be difficult, and effective hemodynamic treatment options are limited. Recently, a bedside transpulmonary thermodilution device has been introduced that traces physiological patterns consistent with current theories regarding the mechanism (hydrostatic or permeability PE) of NPE. This article provides an overview of the clinical usefulness of the advanced technique for use in the neurointensive care unit for the diagnosis and management of post-SAH NPE.

  7. Neurogenic pulmonary edema combined with febrile seizures in early childhood-A report of two cases.

    Science.gov (United States)

    Tasaka, Keiji; Matsubara, Kousaku; Hori, Masayuki; Nigami, Hiroyuki; Iwata, Aya; Isome, Kenichi; Kawasaki, Yu; Nagai, Sadayuki

    2016-01-01

    Neurogenic pulmonary edema (NPE) is a clinical entity that can occur following central nervous system disorders. However, NPE occurs quite rarely in early childhood, and there has only been one report about pediatric NPE associated with febrile seizures. Two cases are reported here. One case involved a 2-year-old girl who presented with febrile seizures, which rapidly progressed to severe NPE. Since the NPE occurred in the emergency department room, the patient was able to be resuscitated via immediate endotracheal intubation. The other case involved an 11-month-old boy who developed respiratory distress following a 50-min episode of febrile status epilepticus. Both patients required respiratory management in the intensive care unit. However their conditions were dramatically improved within several days and fully recovered without any sequelae.

  8. 多发性创伤患者发生急性肺水肿危险因素及治疗策略分析%Risk Factors and Therapy Strategies of Acute Pulmonary Edema in Critically Ill Patients with Multiple Trauma

    Institute of Scientific and Technical Information of China (English)

    邓一芸; 康焰

    2013-01-01

    Objective To analyze the risk factors and therapy strategies of acute pulmonary edema (APE) in critically ill patients with multiple trauma.Methods We conducted a retrospective analysis with the clinical date of all the critically ill patients with multiple trauma treated in General ICU from Jan.2009 to Jan.2012.We compared the clinical characteristics of the patients with or without onset of APE.The patients with APE were divided into young group (≤55 yr.) or elderly group (>55 yr.),then the clinical data were analyzed between the two groups,includingthe level of hemoglobin (Hb),mean arterial pressure (MAP),central venous pressure (CVP),serum albumin (Alb),as well as complications,liquid balance during 1 week,3 d,1 d before the onset of APE.Results Among the 284 patients with multiple trauma,APE was detected in 47 patients (16.5%) for 68 times,29 (61.7%)in young group and 18 (38.3%) in elderly group.The ratio of acute renal failure (ARF) and systematic infection were significantly higher in the patients with APE (P<0.05).Hb,MAP,CVP,Alb and the ratio of ARF,severe infection,extremity lost were not statistically different (P>0.05) between young and elderly group,while the ratio of primary heart disease was significantly higher in elderly group (P<0.05).The net balance of liquid during 1 week,3 d and 1 d before the onset of APE was significantly higher in young group (P<0.05).Conclusion Mutiple Trauma patients with ARF are prone to encounter APE on the exist of infection and overburden of liquid; young patients tend to develop APE followed by liquid overburden,while elderly patients tend to develop APE because of poor primary heart condition even with more cautious fluid infusion.%目的 通过回顾性分析多发性创伤患者发生急性肺水肿(acute pulmonary edema,APE)的危险因素,为以后的临床实践提供一定参考.方法 对2009年1月至2012年1月间我院综合ICU收治的多发性创伤患者进行回顾性分析,比较未

  9. Genome wide expression analysis suggests perturbation of vascular homeostasis during high altitude pulmonary edema.

    Directory of Open Access Journals (Sweden)

    Manish Sharma

    Full Text Available BACKGROUND: High altitude pulmonary edema (HAPE is a life-threatening form of non-cardiogenic edema which occurs in unacclimatized but otherwise normal individuals within two to four days after rapid ascent to altitude beyond 3000 m. The precise pathoetiology and inciting mechanisms regulating HAPE remain unclear. METHODOLOGY/PRINCIPLE FINDINGS: We performed global gene expression profiling in individuals with established HAPE compared to acclimatized individuals. Our data suggests concurrent modulation of multiple pathways which regulate vascular homeostasis and consequently lung fluid dynamics. These pathways included those which regulate vasoconstriction through smooth muscle contraction, cellular actin cytoskeleton rearrangements and endothelial permeability/dysfunction. Some notable genes within these pathways included MYLK; rho family members ARGEF11, ARHGAP24; cell adhesion molecules such as CLDN6, CLDN23, PXN and VCAM1 besides other signaling intermediates. Further, several important regulators of systemic/pulmonary hypertension including ADRA1D, ECE1, and EDNRA were upregulated in HAPE. We also observed significant upregulation of genes involved in paracrine signaling through chemokines and lymphocyte activation pathways during HAPE represented by transcripts of TNF, JAK2, MAP2K2, MAP2K7, MAPK10, PLCB1, ARAF, SOS1, PAK3 and RELA amongst others. Perturbation of such pathways can potentially skew vascular homeostatic equilibrium towards altered vascular permeability. Additionally, differential regulation of hypoxia-sensing, hypoxia-response and OXPHOS pathway genes in individuals with HAPE were also observed. CONCLUSIONS/SIGNIFICANCE: Our data reveals specific components of the complex molecular circuitry underlying HAPE. We show concurrent perturbation of multiple pathways regulating vascular homeostasis and suggest multi-genic nature of regulation of HAPE.

  10. Postpartum Acute Pulmonary Oedema with Sub clinical Rheumatic Heart Disease

    OpenAIRE

    2015-01-01

    Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician.

  11. Neonatal high-permeability pulmonary edema based on serial cytokine profiles and KL-6 in serum: case report.

    Science.gov (United States)

    Nakamura, Toshihiko; Nakamura, Mari; Takahashi, Naoto

    2017-03-22

    A newborn male with pulmonary edema was delivered at term by elective Caesarian section. Cytokine profiles of 17 cytokines and KL-6 in cord blood and serial serum values were investigated. The cord blood values of all 17 cytokines and KL-6 were within normal limits. Subsequently, IL-6, IL-8, IL-10, IL-13, IL-17, and IFNγ rapidly elevated during the first several hours after birth and dramatically decreased thereafter, whereas KL-6 rose to 611 U/ml on the 3(rd) day of life and then gradually decreased. These cytokines may induce pulmonary permeability, and KL-6 secreted in lining fluid could result in influx into the bloodstream. This is the first report that we have differentiated neonatal pulmonary edema from TTN by the measurement of serial cytokine profiles and KL-6 in serum.

  12. Pathophysiology of pulmonary complications of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    George W Browne; CS Pitchurnoni

    2006-01-01

    Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia,acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids,chemoattractants such as tumor necrsosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-8, fMet-leu-phe (a bacterial wall product), nitric oxide, substance P, and macrophage inhibitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

  13. Successful lung salvage by ex vivo reconditioning of neurogenic pulmonary edema: case report.

    Science.gov (United States)

    Sanchez, P G; Iacono, A T; Rajagopal, K; Griffith, B P

    2014-09-01

    Liberalization in donor selection criteria allowed centers to increase the number of lung transplants, yet less than 25% of all donors had lungs utilized for transplantation in the United States in 2013. Less than 5% of all transplanted donors deviate 3 or more criteria from the ideal donor. Ex vivo lung perfusion (EVLP) provides the opportunity to increase the percentage of used donors by acting on modifiable selection criteria such as oxygenation, contusion and pulmonary infiltrates. We report the pre-transplant use of EVLP in the salvage of lungs from a donor that developed neurogenic pulmonary edema -PaO2 188 mmHg-. The recipient had a lung allocation score of 69.3. The post-operative course was excellent and was discharged home after 15 days. He is alive and doing well 780 days after transplant. In this report the pre-transplant use of EVLP led not only to transplanting lungs that otherwise would not have been used by many centers, but also to a very short and typical period of post-operative mechanical ventilation and hospital stay.

  14. Raised HIF1α during normoxia in high altitude pulmonary edema susceptible non-mountaineers.

    Science.gov (United States)

    Soree, Poonam; Gupta, Rajinder K; Singh, Krishan; Desiraju, Koundinya; Agrawal, Anurag; Vats, Praveen; Bharadwaj, Abhishek; Baburaj, T P; Chaudhary, Pooja; Singh, Vijay K; Verma, Saroj; Bajaj, Amir Chand; Singh, Shashi Bala

    2016-05-23

    High altitude pulmonary edema (HAPE) susceptibility is associated with EGLN1 polymorphisms, we hypothesized that HAPE-susceptible (HAPE-S, had HAPE episode in past) subjects may exhibit abnormal HIF1α levels in normoxic conditions. We measured HIF1α levels in HAPE-S and HAPE resistant (HAPE-R, no HAPE episode) individuals with similar pulmonary functions. Hemodynamic responses were also measured before and after normobaric hypoxia (Fi02 = 0.12 for 30 min duration at sea level) in both groups. . HIF1α was higher in HAPE-S (320.3 ± 267.5 vs 58.75 ± 33.88 pg/ml, P < 0.05) than HAPE-R, at baseline, despite no significant difference in baseline oxygen saturations (97.7 ± 1.7% and 98.8 ± 0.7). As expected, HAPE-S showed an exaggerated increase in pulmonary artery pressure (27.9 ± 6 vs 19.3 ± 3.7 mm Hg, P < 0.05) and a fall in peripheral oxygen saturation (66.9 ± 11.7 vs 78.7 ± 3.8%, P < 0.05), when exposed to hypoxia. HIF1α levels at baseline could accurately classify members of the two groups (AUC = 0.87). In a subset of the groups where hemoglobin fractions were additionally measured to understand the cause of elevated hypoxic response at baseline, two of four HAPE-S subjects showed reduced HbA. In conclusion, HIF 1 α levels during normoxia may represent an important marker for determination of HAPE susceptibility.

  15. A rare presentation of patent ductus arteriosus in an adult patient with normal pulmonary hypertension and limb edema

    Science.gov (United States)

    Pishgoo, Bahram; Saburi, Amin; Khosravi, Arezoo

    2014-01-01

    BACKGROUND Patent ductus arteriosus (PDA) at childhood is one of the five major and frequent congenital abnormalities, but it can be rarely seen in adults. Pulmonary hypertension (PHTN) and other presentations such as heart failure and edema are the identified complications of longstanding PDA, but adult case with no permanent heart symptoms and PHTN was rare. We reported a rare case of with an obvious PDA and normal pulmonary pressure. CASE REPORT A 61-year-old woman presented with dyspnea (New York Heart Association class 2), chest pain, and lower limb edema. Echocardiogram showed; normal left ventricular chamber size and function, normal size of both atria. Furthermore, an obvious PDA (diameter = 6-7 mm) connecting the aortic arch to the pulmonary artery was reported in echocardiography. No lung congestion and evidence for PHTN was reported by computed tomographic angiography [Pulmonary capillary wedge pressure (PCWP) = 30 mmHg]. The patient was treated with antihypertensive drugs and after 1 and 3 months follow-up, edema and other symptoms were resolved. CONCLUSION Finally, we conclude that PDA in adulthood can present with nonspecific cardiovascular symptoms, and it seems that PHTN is not a fixed echocardiographic finding in these patients. PMID:25477985

  16. [Effect of artificial ventilation on pulmonary capillary pressure in acute respiratory insufficiency].

    Science.gov (United States)

    Labrousse, J; Tenaillon, A; Massabie, P; Simonneau, G; Lissac, J

    1977-05-07

    To determine the influence of intermittent positive pressure breathing (IPPB), the level of pulmonary capillary wedge pressure (PCWP) was compared during IPPB and after a short period off the respirator in 68 occasions on 42 patients with an acute respiratory failure (ARF) of various etiologies. During IPPB, the average PCWP was in the normal range in patients with toxic or neurologic comas and in cases of increased pulmonary capillary permeability edema (IPCPE), PCWP slightly increased within chronic obstructive pulmonary disease (COPD) complicated with ARF and in hemodynamic acute pulmonary edema (HAPE). During the weaning stage, PCWP decreased in the groups of coma, COPD, and IPCPE, but increased in HAPE. The weaning test demonstrates that IPPB influenced PCWP in all patients. Therefore, PCWP cannot be assumed to represent the left ventricle filling pressure. The weaning test allows differentiation of IPCPE from HAPE. In the event of over-infusion or hypovolemia, PCWP measured under IPPB can lead to misinterpretation if not followed up by a second measurement off the respirator.

  17. Acute bone marrow edema of the hip: role of MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, Apostolos H. [University Hospital, Department of Radiology, Stavrakia, Heraklion, Crete (Greece)

    2007-09-15

    Acute bone marrow edema of the hip is a diagnostic challenge for both radiologists and clinicians. Marrow edema is often seen in patients with hip pain and restriction of motion. In patients with acute non-traumatic hip pain, whose radiographs are negative or inconclusive, MR imaging is the imaging study of choice. MR imaging is the most sensitive and specific imaging technique for detecting transient osteoporosis and osteonecrosis, as well as for detecting and staging fractures and microfractures. MR imaging is able to show marrow involvement in various inflammatory disorders and to diagnose reactive marrow edema from femoroacetabular impingment and greater trochanteric pain syndrome. In patients with septic arthritis, it may also depict associated marrow edema and suggest its reactive or infectious origin. For the neoplastic disorders, although plain radiographs should be the initial examination, MR imaging may follow for assessing extension to the surrounding soft tissues and/or associated pathologic fracture, facilitating thus the treatment planning. Computed tomography is more accurate compared with MR imaging in diagnosing intra-articular osteoid osteomas. (orig.)

  18. Negative spiral CT in acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, T.; Olausson, A. [Karolinska Hospital, Stockholm (Sweden). Dept. of Thoracic Radiology; Johnsson, H. [Karolinska Hospital, Stockholm (Sweden). Dept. of Internal Medicine; Nyman, U. [County Hospital, Trelleborg (Sweden). Dept. of Radiology; Aspelin, P. [Huddinge Univ. Hospital (Sweden). Dept. of Radiology

    2002-09-01

    Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3-5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains.

  19. Edema pulmonar de altura: Modelo de estudio de la fisiopatología del edema pulmonar y de la hipertensión pulmonar hipóxica en humanos High altitude pulmonary edema: An experiment of Nature to study the underlying mechanisms of hypoxic pulmonary hypertension and pulmonary edema in humans

    Directory of Open Access Journals (Sweden)

    Marcos Schwab

    2007-02-01

    altitude, but also for the treatment of hypoxemia-related disease states in patients living at low altitude. High-altitude pulmonary edema (HAPE is a life-threatening condition occurring in predisposed, but otherwise healthy subjects, and, therefore, allows to study underlying mechanisms of pulmonary edema in humans, in the absence of confounding factors. Over the past decade, evidence has accumulated that HAPE results from the conjunction of two major defects, augmented alveolar fluid flooding resulting from exaggerated hypoxic pulmonary hypertension, and impaired alveolar fluid clearance related to defective respiratory transepithelial sodium transport. Here, after a brief presentation of the clinical features of HAPE, we review this novel concept. We provide experimental evidence for the novel concept that impaired pulmonary endothelial and epithelial nitric oxide synthesis and/or bioavailability may represent the central underlying defect predisposing to exaggerated hypoxic pulmonary vasoconstriction and alveolar fluid flooding. We demonstrate that exaggerated pulmonary hypertension, while possibly a condition sine qua non, may not be sufficient to cause HAPE, and how defective alveolar fluid clearance may represent a second important pathogenic mechanism. Finally, we outline how this insight gained from studies in HAPE may be translated into the management of hypoxemia related disease states in general.

  20. Managing High-Altitude Pulmonary Edema with Oxygen Alone: Results of a Randomized Controlled Trial.

    Science.gov (United States)

    Yanamandra, Uday; Nair, Velu; Singh, Surinderpal; Gupta, Amul; Mulajkar, Deepak; Yanamandra, Sushma; Norgais, Konchok; Mukherjee, Ruchira; Singh, Vikrant; Bhattachar, Srinivasa A; Patyal, Sagarika; Grewal, Rajan; Chopra, Bhushan

    2016-12-01

    Yanamandra, Uday, Velu Nair, Surinderpal Singh, Amul Gupta, Deepak Mulajkar, Sushma Yanamandra, Konchok Norgais, Ruchira Mukherjee, Vikrant Singh, Srinivasa A. Bhattachar, Sagarika Patyal, and Rajan Grewal. High-altitude pulmonary edema management: Is anything other than oxygen required? Results of a randomized controlled trial. High Alt Med Biol. 17:294-299, 2016.-Treatment strategies for management of high-altitude pulmonary edema (HAPE) are mainly based on the observational studies with only two randomized controlled trials, thus the practice is very heterogeneous and individualized as per the choice of treating physician. To compare the response to different modalities of therapy in patients with HAPE in a randomized controlled manner. We conducted an open-label, randomized noninferiority trial to compare three modalities of therapy (Therapy 1: supplemental O2 with oral dexamethasone 8 mg q8 hours [n = 42], Therapy 2: supplemental O2 with sustained release oral nifedipine 20 mg q8 hours [n = 41], and Therapy 3: only supplemental O2 [n = 50]). Bed rest was mandated in all patients. The study was conducted in a cohort of previously healthy young lowlander males at an altitude of 3500 m. Baseline characteristics of the patients were comparable in the study arms. Complete response was defined as clinical and radiological resolution of features of HAPE, no oxygen dependency, a normal 6-minute walk test (6MWT) on 2 consecutive days, and normal two-dimensional echocardiography. Results were compared by analysis of variance using SPSS version 16.0. There was no statistical difference in duration of therapy to complete response between the three groups (Therapy 1: 8.1 ± 4.0 days, Therapy 2: 6.7 ± 3.9 days, Therapy 3: 6.8 ± 3.2 days; p = 0.15). There were no deaths in any of the groups. We conclude that oxygen and bed rest alone are adequate therapy for HAPE and that adjuvant pharmacotherapy with either dexamethasone or nifedipine

  1. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Chun Xiang; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Chowdhury, Shahryar M. [Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Fox, Mary A. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations. (orig.)

  2. Bad-Looking, Good-Natured Disease: Acute Hemorrhagic Edema of Infancy

    Directory of Open Access Journals (Sweden)

    Esra Ülgen Temel

    2017-01-01

    Full Text Available Acute hemorrhagic edema of infancy is a skin limited leukocytoclastic vasculitis occurring in children younger than 2 years old. Although it has an alarming start, it has a good prognosis. The patients may have a story of drug intake, vaccination or infection. Henoch-Schönlein purpura must be considered in differential diagnosis. With well recognition of this rare disease, the family and the physician’s concern will be prevented; unnecessary investigations and interventions will be reduced.

  3. Soluble Urokinase-Type Plasminogen Activator Receptor Plasma Concentration May Predict Susceptibility to High Altitude Pulmonary Edema

    Science.gov (United States)

    Zügel, Stefanie; Schoeb, Michele; Auinger, Katja; Dehnert, Christoph; Maggiorini, Marco

    2016-01-01

    Introduction. Acute exposure to high altitude induces inflammation. However, the relationship between inflammation and high altitude related illness such as high altitude pulmonary edema (HAPE) and acute mountain sickness (AMS) is poorly understood. We tested if soluble urokinase-type plasminogen activator receptor (suPAR) plasma concentration, a prognostic factor for cardiovascular disease and marker for low grade activation of leukocytes, will predict susceptibility to HAPE and AMS. Methods. 41 healthy mountaineers were examined at sea level (SL, 446 m) and 24 h after rapid ascent to 4559 m (HA). 24/41 subjects had a history of HAPE and were thus considered HAPE-susceptible (HAPE-s). Out of the latter, 10/24 HAPE-s subjects were randomly chosen to suppress the inflammatory cascade with dexamethasone 8 mg bid 24 h prior to ascent. Results. Acute hypoxic exposure led to an acute inflammatory reaction represented by an increase in suPAR (1.9 ± 0.4 at SL versus 2.3 ± 0.5 at HA, p < 0.01), CRP (0.7 ± 0.5 at SL versus 3.6 ± 4.6 at HA, p < 0.01), and IL-6 (0.8 ± 0.4 at SL versus 3.3 ± 4.9 at HA, p < 0.01) in all subjects except those receiving dexamethasone. The ascent associated decrease in PaO2 correlated with the increase in IL-6 (r = 0.46, p < 0.001), but not suPAR (r = 0.27, p = 0.08); the increase in IL-6 was not correlated with suPAR (r = 0.16, p = 0.24). Baseline suPAR plasma concentration was higher in the HAPE-s group (2.0 ± 0.4 versus 1.8 ± 0.4, p = 0.04); no difference was found for CRP and IL-6 and for subjects developing AMS. Conclusion. High altitude exposure leads to an increase in suPAR plasma concentration, with the missing correlation between suPAR and IL-6 suggesting a cytokine independent, leukocyte mediated mechanism of low grade inflammation. The correlation between IL-6 and PaO2 suggests a direct effect of hypoxia, which is not the case for suPAR. However, suPAR plasma concentration measured before hypoxic exposure may predict

  4. Handbook of pulmonary emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Spaquolo, S.V.; Medinger, A

    1986-01-01

    This book presents information on the following topics: clinical assessment of the patient with pulmonary disease; interpretation of arterial blood gases in the emergency patient; life-threatening pneumonia; extrapulmonic ventilatory failure; acute inhalation lung disease; pulmonary edema; near drowning; chest trauma; upper airway emergencies; chronic lung disease with acute respiratory decompensation; acute respiratory failure in the patient with chronic airflow obstruction; asthma; hemoptysis; embolic pulmonary disease; superior vena cava syndrome; catastrophic pleural disease; ventilatory assistance and its complications; and ventilator emergencies.

  5. [Pulmonary edema in a child following laryngospasm triggered by a laryngeal mask airway during emergence from anesthesia].

    Science.gov (United States)

    Nishikawa, M; Tajima, K; Hoshi, T; Mizutani, T; Toyooka, H

    2001-03-01

    A 9-year-old boy underwent biopsy of the tumor at the external auditory meatus under general anesthesia with a laryngeal mask airway(LMA). During emergence from anesthesia, laryngospasm with marked inspiratory effort and cyanosis occurred. The LMA was removed and the patient was orotracheally intubated following vecuronium administration. In spite of controlled ventilation with 100% oxygen, oxygen saturation remained at low 90s and pink frothy sputum appeared in the tracheal tube. We suspected negative pressure pulmonary edema and treated him with mechanical ventilation with positive end-expiratory pressure. Seventeen hours later the pink frothy sputum decreased and he was extubated. Laryngospasm during emergence from anesthesia with an LMA can induce negative pressure pulmonary edema, especially in pediatric patients.

  6. Lung function and breathing pattern in subjects developing high altitude pulmonary edema.

    Directory of Open Access Journals (Sweden)

    Christian F Clarenbach

    Full Text Available INTRODUCTION: The purpose of the study was to comprehensively evaluate physiologic changes associated with development of high altitude pulmonary edema (HAPE. We tested whether changes in pulmonary function and breathing pattern would herald clinically overt HAPE at an early stage. METHODS: In 18 mountaineers, spirometry, diffusing capacity, nitrogen washout, nocturnal ventilation and pulse oximetry were recorded at 490 m and during 3 days after rapid ascent to 4559 m. Findings were compared among subjects developing HAPE and those remaining well (controls. RESULTS: In 8 subjects subsequently developing radiographically documented HAPE at 4559 m, median FVC declined to 82% of low altitude baseline while closing volume increased to 164% of baseline (P<0.05, both instances. In 10 controls, FVC decreased slightly (to 93% baseline, P<0.05 but significantly less than in subjects with HAPE and closing volume remained unchanged. Sniff nasal pressure was reduced in both subjects with and without subsequent HAPE. During nights at 4559 m, mean nocturnal oxygen saturation dropped to lower values while minute ventilation, the number of periodic breathing cycles and heart rate were higher (60%; 8.6 L/min; 97 cycles/h; 94 beats/min, respectively in subjects subsequently developing HAPE than in controls (73%; 5.1 L/min; 48 cycles/h; 79 beats/min; P<0.05 vs. HAPE, all instances. CONCLUSION: The results comprehensively represent the pattern of physiologic alterations that precede overt HAPE. The changes in lung function are consistent with reduced lung compliance and impaired gas exchange. Pronounced nocturnal hypoxemia, ventilatory control instability and sympathetic stimulation are further signs of subsequent overt HAPE.

  7. Combination of constant-flow and continuous positive-pressure ventilation in canine pulmonary edema.

    Science.gov (United States)

    Sznajder, J I; Becker, C J; Crawford, G P; Wood, L D

    1989-08-01

    Constant-flow ventilation (CFV) maintains alveolar ventilation without tidal excursion in dogs with normal lungs, but this ventilatory mode requires high CFV and bronchoscopic guidance for effective subcarinal placement of two inflow catheters. We designed a circuit that combines CFV with continuous positive-pressure ventilation (CPPV; CFV-CPPV), which negates the need for bronchoscopic positioning of CFV cannula, and tested this system in seven dogs having oleic acid-induced pulmonary edema. Addition of positive end-expiratory pressure (PEEP, 10 cmH2O) reduced venous admixture from 44 +/- 17 to 10.4 +/- 5.4% and kept arterial CO2 tension (PaCO2) normal. With the innovative CFV-CPPV circuit at the same PEEP and respiratory rate (RR), we were able to reduce tidal volume (VT) from 437 +/- 28 to 184 +/- 18 ml (P less than 0.001) and elastic end-inspiratory pressures (PEI) from 25.6 +/- 4.6 to 17.7 +/- 2.8 cmH2O (P less than 0.001) without adverse effects on cardiac output or pulmonary exchange of O2 or CO2; indeed, PaCO2 remained at 35 +/- 4 Torr even though CFV was delivered above the carina and at lower (1.6 l.kg-1.min-1) flows than usually required to maintain eucapnia during CFV alone. At the same PEEP and RR, reduction of VT in the CPPV mode without CFV resulted in CO2 retention (PaCO2 59 +/- 8 Torr). We conclude that CFV-CPPV allows CFV to effectively mix alveolar and dead spaces by a small bulk flow bypassing the zone of increased resistance to gas mixing, thereby allowing reduction of the CFV rate, VT, and PEI for adequate gas exchange.

  8. Study progress of correlation between aquaporin and pulmonary edema%水通道蛋白与肺水肿相关性研究进展

    Institute of Scientific and Technical Information of China (English)

    范启新; 赵澎涛; 谢晓燕; 金发光

    2010-01-01

    Aquaporin plays an important role in regulating water transport in lung. Researches have found that the expression of aquaporin changes in pulmonary edema induced by many reasons. By changing the expression of aquaporin, alveolar clearance rate of patients with pulmonary edema increases, pulmonary edema relieves, which may be a new and effective therapy for pulmonary edema.%水通道蛋白对调节肺组织中水的转运起着重要作用,研究发现多种原因导致的肺水肿都有水通道蛋白表达数量的改变.通过改变水通道蛋白的表达数量,增强肺水肿患者的肺泡清除率,减轻肺水肿,可能是治疗肺水肿的有效新途径.

  9. Neural histamine in the tuberomammillary nucleus regulates the onset of neurogenic pulmonary edema in rabbits

    Institute of Scientific and Technical Information of China (English)

    Rong Dong; Xiaohong Zhang; Lijuan Shi

    2009-01-01

    Objective:To explore the effect of neural histamine in the tuberomammillary nucleus(TM) on neurogenic pulmonary edema (NPE) onset in rabbits and the function of the rostral ventrolateral medulla(RVLM) in the neural histamine modulation of NPE.Methods:NPE was produced by the intracisternal injections of fibrinogen and thrombin.The contents of histamine in the TM and RVLM in rabbits were measured with high performance liquid chromatography(HPLC).Rabbits were placed on a stereotaxic frame and microinjection cannulae were inserted into the TM and RVLM using brain atlas coordinates.Animals were pretreated with R-α-methylhistamine(MeHA) in the TM and chlorphenamine Mmaleate/cimetidine in the RVLM prior to establishing the NPE model.Changes in the lung water ratio and mean arterial pressure(MAP) were recorded,and paraffin sections of lung tissue were observed by light microscope.Results:We found that the contents of histamine(HA) in the TM and RVLM increased significantly with the onset of NPE.Pretreatment with MeHA in the TM and chlorphenamine Mmaleate in the RVLM significantly decreased MAP,and the lung water ratio and histological characteristics of the NPE in the rabbit model.Pretreatment with cimetidine in the RVLM had no effect on NPE.Conculsion:The results suggest that neural histamine in the TM is involved in the onset of NPE,and this effect of neural histamine is mediated by H receptor in the RVLM.

  10. An analysis of and new risk factors for reexpansion pulmonary edema following spontaneous pneumothorax

    Science.gov (United States)

    Kawabata, Tsutomu; Ichi, Takaharu; Yohena, Tomofumi; Kawasaki, Hidenori; Ishikawa, Kiyoshi

    2014-01-01

    Background The major risk factor for reexpansion pulmonary edema (RPE) following the treatment of spontaneous pneumothorax is thought to be chronic lung collapse. However, a long-term collapsed lung does not always cause RPE. The purpose of this study was to define other risk factors for RPE among patients undergoing drainage for the treatment of spontaneous pneumothorax. Methods We retrospectively reviewed all the patients with spontaneous pneumothorax who had been treated at our hospital during a 5-year period. The duration of symptoms, location and size of the pneumothorax, size of the chest tube, and pleural effusion, which can occur coincidentally with pneumothorax, were compared in patients who did and did not experience RPE. Results Forty patients were underwent drainage for the treatment of a spontaneous pneumothorax between January 2007 and December 2012. RPE developed in 13 of the 40 (32.5%) patients. In the multivariate analysis, the presence of pleural effusion coincident with pneumothorax contributed to the risk for RPE [odds ratios (OR), 1.557; 95% confidence intervals (CI), 1.290-1.880]. The duration of symptoms, location and size of the pneumothorax and size of the chest tube were similar between the groups. Symptomatic RPE was associated with a larger pneumothorax size. Conclusions The rate of RPE following spontaneous pneumothorax is higher than was previously reported. Our findings suggest the presence of pleural effusion coincidentally with pneumothorax may therefore be a new risk factor for RPE. PMID:25276359

  11. Angiotensin II receptor 1 gene variants are associated with high-altitude pulmonary edema risk.

    Science.gov (United States)

    Jin, Tianbo; Ren, Yongchao; Zhu, Xikai; Li, Xun; Ouyang, Yongri; He, Xue; Zhang, Zhiying; Zhang, Yuan; Kang, Longli; Yuan, Dongya

    2016-11-22

    Previous studies demonstrated that Angiotensin II Receptor 1 (AGTR1) may play an important role in the development of high-altitude pulmonary edema. We envisaged a role for AGTR1 gene variants in the pathogenesis of HAPE and investigated their potential associations with HAPE in a Han Chinese population. We genotyped seven AGTR1 polymorphisms in 267 patients with diagnosed HAPE and 304 controls and evaluated their association with risk of HAPE. Statistically significant associations were found for the single nucleotide polymorphisms (SNPs) rs275651 (p = 0.017; odds ratio [OR] = 0.65) and rs275652 (p = 0.016; OR = 0.64). Another SNP rs10941679 showed a marginally significant association after adjusting for age and sex in the additive genetic model (adjusted OR = 1.44, 95% CI = 1.01-2.04, p = 0.040). Haplotype analysis confirmed that the haplotype "AG" was associated with a 35% reduction in the risk of developing HAPE, while the haplotype "AA" increased the risk of developing HAPE by 44%. These results provide the first evidence linking genetic variations in AGTR1 with HAPE risk in Han Chinese individuals.

  12. Plasma proteomic study in patients with high altitude pulmonary edema (HAPE

    Directory of Open Access Journals (Sweden)

    Yong-jun LUO

    2012-01-01

    Full Text Available Objective  To investigate the differential expressions of protein in the plasma proteome in patients suffering from high altitude pulmonary edema (HAPE and their implications. Methods  The plasmas of six HAPE patients and six healthy controls were studied. The high-abundant proteins in the plasma were removed. The low-abundant proteins in the plasma/serum were segregated by 2-DE. MALDI-TOF/MS was adopted to measure the peptide fingerprints after the differential protein spots were digested by enzymes. Comparison and analysis were made in the GenBank. Results  The immunoglobulin K1 light chain, serum transferrin protein precursor, and α-trypsin inhibitor heavy chain-related protein expressions were upregulated in HAPE patients compared with the control group. However the human fibrin glue coagulation protein 3 was down-regulated. Conclusion  The differential expression of the above four proteins in the plasma of HAPE patients may be related to the occurrence of HAPE and can be used as the target point for the prediction of HAPE.

  13. Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    Kazuhito Yajima

    2012-01-01

    Full Text Available We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

  14. The short-term effects of increasing plasma colloid osmotic pressure in patients with noncardiac pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Sibbald, W.J.; Driedger, A.A.; Wells, G.A.; Myers, M.L.; Lefcoe, M.

    1983-05-01

    We infused hyperoncotic albumin (25 or 50 gm of a 50% solution) into patients with noncardiac pulmonary edema (adult respiratory distress syndrome (ARDS)) to evaluate its effect on the transmicrovascular flux from blood to pulmonary edema fluid of two radiotracers--/sup 111/In-DTPA (mol wt 504) and /sup 125/I-human serum albumin (HSA) (mol wt 69,000). Two groups of patients were studied--one with a modest increase in permeability of the pulmonary alveolocapillary membrane to /sup 125/I-HSA (group 1) and another with a large increase in permeability to /sup 125/I-HSA (group 2). We used furosemide, when necessary, to minimize the effect of albumin infusion to increase the pulmonary microvascular hydrostatic pressure (Pmv), measured clinically as the pulmonary capillary wedge pressure (PCWP). Therapy significantly increased the mean colloid osmotic pressure (COP) in both groups, but not the mean PCWP or calculated Pmv. Albumin had no significant effect on the mean pulmonary transmicrovascular flux of the radiotracers in either group, despite the increase in COP. In individual patients, a change in the Pmv in response to albumin infusion was directly correlated with the change in flux of /sup 111/In-DTPA (group 1: delta In-DTPA (%) . 8.66 + 1.4 delta Pmv (%) r . 0.51, P less than 0.02; group 2: delta In-DTPA (%) . -3.43 + 1.6 delta Pmv (%) r . 0.67, P less than 0.01). A change in the transmicrovascular flux of I-HSA also correlated with a change in the intravascular Starling forces in both groups. We conclude that albumin infusion in patients with ARDS will not augment the pulmonary transmicrovascular flux of low or high molecular-weight solutes when the effect of albumin to increase the Pmv is minimized; nor, however, does an increase in plasma COP significantly reduce the flux of such solutes.

  15. Present state of radiological diagnostics in acute pulmonary failure

    Energy Technology Data Exchange (ETDEWEB)

    Jaspers, C.; Hoetzinger, H.; Toedt, H.C.; Beyer, H.K.

    1989-03-01

    Acute pulmonary failure is a very serious cause of respiratory failure. Radiological diagnosis occupies a central position in intensive-care monitoring. X-ray film of the thorax is performed not only for detecting any complications, but mainly for noninvasive and semiquantitative determination of the extravascular pulmonary fluid and hence of the fluid balance. Other methods such as MR or methods of nuclear medicine have not acquired substantial importance in respect of diagnosis and monitoring acute pulmonary failure. (orig./GDG).

  16. 复张性肺水肿12例临床分析%Clinical analysis of 12 cases with re-expansion pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    陆文博; 楼良潮; 闾少冬

    2015-01-01

    目的 探讨复张性肺水肿(re-expansion pulmonary edema,RPE)的预防、诊断及治疗.方法 回顾性分析12例复张性肺水肿患者的临床资料.结果 治愈11例,死亡l例,死亡原因为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)并发全身多器官功能衰竭(multiple organ failure,MOF).结论 复张性肺水肿(RPE)是肺复张过程中少见而严重的并发症,重在预防和早期的诊断治疗.

  17. MRI findings of acute cerebral swelling and brain edema in the acute stage. A report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Oki, Hideo; Ueda, Shin; Matsumoto, Keizo; Kashihara, Michiharu; Furuichi, Masashi.

    1988-08-01

    We report two cases, one of acute cerebral swelling and the other with a major stroke, whose MRI has shown very interesting findings. Case 1, a 32-year-old male, was admitted to our service because of a lowering of his consciousness immediately after a head injury. On admission, the patient was semicomatous (E/sub 1/M/sub 2/V/sub 1/, with anisocoria (R > L). His plain skull X-ray was normal. A CT scan, however, demonstrated right isodensity hemispheric swelling associated with a subarachnoid hemorrhage in the right Sylvian fissure. A right carotid angiogram showed no vascular disorders. MR imaging of the spin density demonstrated a hyperintensitive thickening of the gray matter in the whole right hemisphere. Case 2, a 58-year-old female, was admitted because of a sudden onset of loss of consciousness, with right hemiparesis and dysarthria. On admission, her consciousness was semicomatous (E/sub 1/M/sub 3/V/sub 1/), and it deteriorated to a deep coma 1 hour later. A CT scan demonstrated a diffuse left hemispheric low density, with a finding of hemorrhagic infarction in the basal ganglia. MR imaging of the spin density showed a hyperintensitive thickening of the gray matter resembling that of Case 1. The findings of the spin-echo images of our two cases showed a hyperintensitive thickening of the gray matter in both. The hyperintensity and thickening of the gray matter apparently indicated a sort of hyperemia and brain edema. These findings led us to suspect that the hyperemia associated with acute cerebral swelling and ischemic brain edema of our two cases originated in the gray matter, although it has been considered that the pathogenesis of acute cerebral swelling is not known and that brain edema, especially vasogenic edema, will mostly develop in the white matter rather than in the gray matter.

  18. High-Resolution CT Findings of Re-Expansion Pulmonary Edema

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Jun Hyun; Park, Young Ha [St. Vincent' s Hospital, The Catholic University of Korea, Suwon (Korea, Republic of); Ahn, Myeong Im; Park, Seog Hee [Seoul St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2010-04-15

    To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax. HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed. Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%). The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.

  19. Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration

    Science.gov (United States)

    Kennedy, Jeffrey D.; Hardin, Kimberly A.; Parikh, Palak; Li, Chin-Shang; Seyal, Masud

    2015-01-01

    Purpose Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. Methods Chest X-Rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. Results Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p=0.002) in GTCS with abnormal CXR (259.7 sec) versus GTCS with normal CXR (101.2 sec). Odds-ratio for CXR abnormality was 20.46 (p=0.006) with seizure duration greater than 100 sec versus less than 100 sec. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p=0.015). Conclusions Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP. PMID:25844030

  20. 我院心源性肺水肿临床现状及预后分析%Analysis of the Clinical Status and Prognosis of Cardiogenic Pulmonary Edema in Our Hospital

    Institute of Scientific and Technical Information of China (English)

    李彦华; 许强

    2011-01-01

    Objective: To explore the clinical status and influencing factors on prognosis of acute cardiogenic pulmonary edema in our hospital, and to provide the basis for rational use of morphine. Methods: Clinical data of 105patients with acute cardiogenic pulmonary edema were collected, and the outcome was recorded. Indexes that influencing patient's prognosis and effects of morphine on prognosis were defined. Results: The hospital mortality was 28. 5 %. The influencing factors on prognosis included acute coronary syndrome induced acute pulmonary edema, acute attack of chronic heart failure, level of B-type natriuretic peptide, intubation or not and history of taking betablockers. Application of morphine might increase the frequency of tracheal intubation, but not statistically correlated with patient's mortality. Conclusions: Morphine can increase the rate of mechanical ventilation even when used in confirmed acute cardiogenic pulmonary edema. Morphine should be used carefully especially when mechanical ventilator is not available.%目的:探讨我院急性心源性肺水肿的临床现状及预后的影响因素,为吗啡的合理应用提供依据.方法:选取急性心源性肺水肿患者105名,收集患者的临床资料,并记录患者的转归,获取影响患者预后的指标及明确吗啡应用对预后的影响.结果:本组患者住院期间病死率高达28.5%,对预后有影响的因素主要包括急性冠脉综合征导致的急性肺水肿、慢性心力衰竭急性发作、B型脑利钠肽水平、插管与否、病史中应用β受体阻滞剂;应用吗啡增加气管插管的发生率,但未发现与患者病死率有统计学相关.结论:在确诊的心源性肺水肿患者吗啡应用也会增加气管插管的比率,无条件行机械通气的心源性肺水肿患者抢救中慎重应用吗啡.

  1. 高原肺水肿发病机制及防治研究进展%Pathogenesis,prevention and treatment of high altitude pulmonary edema:research advances

    Institute of Scientific and Technical Information of China (English)

    姜艳; 王雷琛; 王剑波

    2016-01-01

    High altitude pulmonary edema is a fatal acute non-cardiogenic pulmonary edema caused by the environment of low pressure and hypoxia,when people have their fast access to the plateau (general elevation≥2500 m). It is a serious threat to human health. Pathogenesis of high altitude pulmonary edema is still not entirely clear and may be due to ventilation/perfusion imbalance, chemical receptors changes, water channel protein decreased, pulmonary microvascular changes and genes. Treatment of high altitude pulmonary edema should be mainly far away from the environment of low pressure and hypoxia as soon as possible, and comply with ox⁃ygen or take diuretics, hormones and other drugs reducing pulmonary artery pressure. This article describes the epidemiological charac⁃teristics,the studies of the pathogenesis and the methods of prevention and treatment of high-altitude pulmonary edema in order to pro⁃vide a reference for the relevant medical staff and people engaged in activities plateau.%高原肺水肿是由于快速进入高原(一般海拔≥2500 m)因缺氧而引起的非心源性肺水肿,为高原地区特发病及常见病,严重威胁人类的健康。其发病机制复杂,可能是由于通气/血流比例失调、化学感受器异常变化、水通道蛋白减少、肺微血管变化以及基因等多种因素共同作用导致的,至今仍不完全清楚。治疗高原肺水肿主要应尽快脱离低压缺氧环境,并配合吸氧或服用利尿剂、激素等能降低肺动脉压的药物,严重时要联合用药。本文介绍了高原肺水肿的流行病学特征、各种发病机制的研究以及防治高原肺水肿的手段、方法和药物,以期能对相关医务人员和从事高原活动的人群提供参考。

  2. Studies on monitoring hemodynamics and oxygen dynamics of adult respiratory distress syndrome secondary to high altitude pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    Ma Siqing; Wu Tianyi; Cheng Qiang; Li Pei; Bian Huiping

    2013-01-01

    To study monitoring hemodynamics and oxygen dynamics of adult respiratory distress syndrome (ARDS)secondary to high altitude pulmonary edema (HAPE),we performed clinic and laboratory studies in 8 patients who preliminarily developed high altitude cerebral edema (HACE) and then ARDS occurred at an altitude of 4500 m.After an initial emergency treatment on high mountains,all the patients were rapidly transported to a hospital at a lower altitude of 2808 m.The right cardiac catheterizations were carried out within 5 h after hospitalized.The monitoring hemodynamics and oxygen dynamics were studied via a thermodilution Swan-Gaze catheter.The results showed that before treatments at the beginning of monitoring,there presented a significant pulmonary artery hypertension with a decreased cardiac function,and a lower oxygen metabolism in all the 8 patients.However,after some effective treatments,including mechanical ventilation and using dexamethasone,furosemide,etc,four days later the result of a repeated monitoring showed that their pulmonary artery pressure had been decreased with an improved cardiac function with all the oxygen metabolic indexes increased significantly.Our studies suggested that performing monitoring hemodynamics in patients with ARDS secondary to HAPE will define the clinical therapeutic measures which will benefit the outcome.

  3. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Directory of Open Access Journals (Sweden)

    Marx Jean-Sebastian

    2009-01-01

    Full Text Available Abstract Background While ultrasound (US has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS, we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax. In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system can change therapy, especially in systems where physicians can integrate this information into treatment decisions, the further diffusion of this technology would seem to be beneficial and deserves further study.

  4. Protective effect of. cap alpha. -human atrial natriuretic polypeptide (. cap alpha. -hANP) on chemical-induced pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Imamura, T.; Ohnuma, N.; Iwasa, F.; Furuya, M.; Hayashi, Y.; Inomata, N.; Ishihara, T.; Noguchi, T.

    1988-01-01

    It has been established that ..cap alpha..-hANP, the newly discovered peptide extracted from human cardiac atria, has potent natriuretic and hypotensive actions. The authors present investigation is the first to demonstrate that ..cap alpha..-hANP is capable of protecting against pulmonary edema caused by various chemicals, using isolated perfused guinea pig lung system. Lungs were perfused via pulmonary artery with Krebs-Ringer bicarbonate buffer at 5.0 ml/min, and wet weight of lungs and perfusion pressure of pulmonary artery (Pa) were monitored. Bolus injection of Triton-X or CHAPS into cannulated pulmonary artery produced enema as indicated by a massive increase in wet weight and a slight increase in Pa. Constant infusion of ..cap alpha..-hANP through pulmonary artery at 200 ng/ml was effective in causing decrease in wet weight of lung. Perfusion of lung with paraquat or PGF/sub 2..cap alpha..'/, and repeated bolus injection of arachidonic acid or PGE/sub 2/ caused elevation in both wet weight of lung and Pa.

  5. Exogenous interleukin-6, interleukin-13, and interferon-gamma provoke pulmonary abnormality with mild edema in enterovirus 71-infected mice

    Directory of Open Access Journals (Sweden)

    Huang Szu-Wei

    2011-11-01

    Full Text Available Abstract Background Neonatal mice developed neurological disease and pulmonary dysfunction after an infection with a mouse-adapted human Enterovirus 71 (EV71 strain MP4. However, the hallmark of severe human EV71 infection, pulmonary edema (PE, was not evident. Methods To test whether EV71-induced PE required a proinflammatory cytokine response, exogenous pro-inflammatory cytokines were administered to EV71-infected mice during the late stage of infection. Results After intracranial infection of EV71/MP4, 7-day-old mice developed hind-limb paralysis, pulmonary dysfunction, and emphysema. A transient increase was observed in serum IL-6, IL-10, IL-13, and IFN-γ, but not noradrenaline. At day 3 post infection, treatment with IL-6, IL-13, and IFN-γ provoked mild PE and severe emphysema that were accompanied by pulmonary dysfunction in EV71-infected, but not herpes simplex virus-1 (HSV-1-infected control mice. Adult mice did not develop PE after an intracerebral microinjection of EV71 into the nucleus tractus solitarii (NTS. While viral antigen accumulated in the ventral medulla and the NTS of intracerebrally injected mice, neuronal loss was observed in the ventral medulla only. Conclusions Exogenous IL-6, IL-13, and IFN-γ treatment could induce mild PE and exacerbate pulmonary abnormality of EV71-infected mice. However, other factors such as over-activation of the sympathetic nervous system may also be required for the development of classic PE symptoms.

  6. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Science.gov (United States)

    Noble, Vicki E; Lamhaut, Lionel; Capp, Roberta; Bosson, Nichole; Liteplo, Andrew; Marx, Jean-Sebastian; Carli, Pierre

    2009-01-01

    Background While ultrasound (US) has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS), we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema) and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax). In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU) physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p < 0.0001), out of 25 possible points. The standard deviation decreased as well, indicating a collective improvement. For the pulmonary edema module, mean test scores increased from 14.1 +/- 5.2 before the training to 20.9 +/- 2.4 after (p < 0.0001), out of 25 possible points. The standard deviation decreased again by more than half, indicating a collective improvement. Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system

  7. 181例药源性肺水肿文献分析%Literature Analysis of 181 Cases of Drug-induced Pulmonary Edemas

    Institute of Scientific and Technical Information of China (English)

    张艳丛

    2011-01-01

    OBJECTIVE To discuss the characteristics and general pattern of drug-induced pulmonary edemas. METHODS A total of 181 drug-induced pulmonary edema cases reported in internal medical journals published from January 1990 to April 2010 were collected by retrieving China Hospital Digital Library and analyzed statistically. RESULTS Leading the routes of administration inducing pulmonary edemas were oral administration, intramuscular injection, intravenous administration, and so on. The pulmonary edemas were predominantly caused by anti-psychotic drug and dehydration drugs. CONCLUSION Clinic should attach great importance to drugs-induced pulmonary edemas.%目的 探讨药物引起肺水肿的特点及一般规律.方法 检索,对1990年1月-2010年4月国内医药学术期刊报道的药物引起肺水肿181例进行统计、分析.结果 药物引起肺水肿的给药途径为口服给药、肌肉注射、静脉给药等;引起肺水肿的药物种类以抗精神病药、利尿脱水药较多.结论 临床应重视药物引起的肺水肿.

  8. The characteristic of Indonesia's pre-eclampsia: From obstetric intensive care with ventilator until epidemiologic and its molecular biology profile of pulmonary edema in severe pre-eclampsia.

    Science.gov (United States)

    Hermanto; Adityawarman; Sulistyono; Ardian, M; Dachlan, E G

    2014-07-01

    Pulmonary edema is among the least frequently diagnosed criteria for severe pre-eclampsia. A higher incidence of pulmonary edema was noted in older patients, multigravidas, and patients with underlying chronic hypertension that developed prior to delivery. The development of pulmonary edema was also associated with the administration of excess colloid or crystaloid infusion. Two hundreds and thirty millions people occupying Indonesia as tropical and coastal country gave rise the problem of highly maternal mortality rate of 225/100,000 deliveries where pre-eclampsia and eclampsia as most possible cause. Over 5years from the year 2005 through 2009 our 160 eclampsia study observed about significantly correlation between typical estafet referred case and maternal mortality (Odds ratio 19.1 and P=0.065). Specifically those referred eclampsia cases arriving lately to our tertiary hospital, complication of pulmonary edema also apparently became determinant factor to uphold the increased maternal mortality (Odds ratio 6.1 and P=0.083) We found at our teaching hospital Dr. Soetomo Surabaya as referral center along the year 2012, 477 pre-eclampsia-eclampsia cases which complicated by 27 cases of pulmonary from which we apply obstetric intensive care unit for tightly monitoring treatment. The majority use of ventilator were applied on 22 cases (81.4%), that most approximately 16 cases (72%) need 48h under ventilator use and the remaining 6 cases was not untill 5days of extubation. The etiology of pulmonary edema in preeclamptic patients involves multi-factors; abnormal COP-PWCP gradient, increased pulmonary capillary permeability, and left ventricular failure were identified causes. It has been well known that the pathogenesis of pulmonary edema in severe pre-eclampsia-eclampsia initiated by capillary alveolar leakage that leading increased capillary permeability and extravascular fluid oncotic as well as decreased plasma oncotic pressure. In severe pre-eclampsia appear that

  9. MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ru, E-mail: yangru0904@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Jing, Zong Lin, E-mail: jzl325@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Zhang, Xiao Ming, E-mail: zhangxm@nsmc.edu.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Tang, Wei, E-mail: tw-n-g-up@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Xiao, Bo, E-mail: xiaoboimaging@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Huang, Xiao Hua, E-mail: nc_hxh1966@yahoo.com.cn [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Yang, Lin, E-mail: llinyangmd@163.com [Sichuan Key laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China); Feng, Zhi Song, E-mail: fengzhisong@medmail.com.cn [Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000 (China)

    2012-11-15

    Objective: To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system. Materials and methods: A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed. Results: In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 {+-} 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 {+-} 1.1 and 2.6 {+-} 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005). Conclusion: AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.

  10. Inherent variations in CO-H2S-mediated carotid body O2 sensing mediate hypertension and pulmonary edema.

    Science.gov (United States)

    Peng, Ying-Jie; Makarenko, Vladislav V; Nanduri, Jayasri; Vasavda, Chirag; Raghuraman, Gayatri; Yuan, Guoxiang; Gadalla, Moataz M; Kumar, Ganesh K; Snyder, Solomon H; Prabhakar, Nanduri R

    2014-01-21

    Oxygen (O2) sensing by the carotid body and its chemosensory reflex is critical for homeostatic regulation of breathing and blood pressure. Humans and animals exhibit substantial interindividual variation in this chemosensory reflex response, with profound effects on cardiorespiratory functions. However, the underlying mechanisms are not known. Here, we report that inherent variations in carotid body O2 sensing by carbon monoxide (CO)-sensitive hydrogen sulfide (H2S) signaling contribute to reflex variation in three genetically distinct rat strains. Compared with Sprague-Dawley (SD) rats, Brown-Norway (BN) rats exhibit impaired carotid body O2 sensing and develop pulmonary edema as a consequence of poor ventilatory adaptation to hypobaric hypoxia. Spontaneous Hypertensive (SH) rat carotid bodies display inherent hypersensitivity to hypoxia and develop hypertension. BN rat carotid bodies have naturally higher CO and lower H2S levels than SD rat, whereas SH carotid bodies have reduced CO and greater H2S generation. Higher CO levels in BN rats were associated with higher substrate affinity of the enzyme heme oxygenase 2, whereas SH rats present lower substrate affinity and, thus, reduced CO generation. Reducing CO levels in BN rat carotid bodies increased H2S generation, restoring O2 sensing and preventing hypoxia-induced pulmonary edema. Increasing CO levels in SH carotid bodies reduced H2S generation, preventing hypersensitivity to hypoxia and controlling hypertension in SH rats.

  11. Donor smoking is associated with pulmonary edema, inflammation and epithelial dysfunction in ex vivo human donor lungs

    Science.gov (United States)

    Ware, Lorraine B.; Lee, Jae W.; Wickersham, Nancy; Nguyen, John; Matthay, Michael A.; Calfee, Carolyn S.

    2014-01-01

    Although recipients of donor lungs from smokers have worse clinical outcomes, the underlying mechanisms are unknown. We tested the association between donor smoking and the degree of pulmonary edema (as estimated by lung weight), the rate of alveolar fluid clearance (measured by airspace instillation of 5% albumin) and biomarkers of lung epithelial injury and inflammation (bronchoalveolar lavage surfactant protein-D and IL-8) in ex vivo lungs recovered from 298 organ donors. The extent of pulmonary edema was higher in current smokers (n=127) compared to non-smokers (median 408g, IQR 364-500 vs. 385g, IQR 340 - 460, p=0.009). Oxygenation at study enrollment was worse in current smokers versus non-smokers (median PaO2/FiO2 214 mmHg, IQR 126-323 vs. 266 mmHg, IQR 154-370, p=0.02). Current smokers with the highest exposure (≥20 pack-years) had significantly lower rates of alveolar fluid clearance, suggesting that the effects of cigarette smoke on alveolar epithelial fluid transport function may be dose related. BAL IL-8 was significantly higher in smokers while surfactant protein-D was lower. These findings indicate that chronic exposure to cigarette smoke has important effects on inflammation, gas exchange, lung epithelial function and lung fluid balance in the organ donor that could influence lung function in the lung transplant recipient. PMID:25146497

  12. Postpartum Acute Pulmonary Oedema with Sub clinical Rheumatic Heart Disease.

    Science.gov (United States)

    R, Padmaja; Gande, Sri Krishna Padma Challa Rao

    2015-02-01

    Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician. Here, we report a case of postpartum acute pulmonary oedema referred to causality after an emergency caesarean section in a private hospital. No matter what the underlying pathology, prompt administration and appropriate resuscitation is always the first priority. Only after the patient has been stabilized attention must be turned to diagnosis and specific treatment. A diagnosis of severe Mitral Stenosis, probably of rheumatic origin was made after stabilizing the patient.

  13. Rescue surgical pulmonary embolectomy for acute massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Ahmed Abdulrahman Elassal

    2016-08-01

    Conclusion: Surgical pulmonary embolectomy is a rescue operation in high-risk PE. It could save patients with preoperative cardiac arrest. Early diagnosis, interdisciplinary team action, appropriate and emergent treatment strategy are necessary for favorable outcome.

  14. MRI evidence: acute mountain sickness is not associated with cerebral edema formation during simulated high altitude.

    Science.gov (United States)

    Mairer, Klemens; Göbel, Markus; Defrancesco, Michaela; Wille, Maria; Messner, Hubert; Loizides, Alexander; Schocke, Michael; Burtscher, Martin

    2012-01-01

    Acute mountain sickness (AMS) is a common condition among non-acclimatized individuals ascending to high altitude. However, the underlying mechanisms causing the symptoms of AMS are still unknown. It has been suggested that AMS is a mild form of high-altitude cerebral edema both sharing a common pathophysiological mechanism. We hypothesized that brain swelling and consequently AMS development is more pronounced when subjects exercise in hypoxia compared to resting conditions. Twenty males were studied before and after an eight hour passive (PHE) and active (plus exercise) hypoxic exposure (AHE) (F(i)O(2) = 11.0%, P(i)O(2)∼80 mmHg). Cerebral edema formation was investigated with a 1.5 Tesla magnetic resonance scanner and analyzed by voxel based morphometry (VBM), AMS was assessed using the Lake Louise Score. During PHE and AHE AMS was diagnosed in 50% and 70% of participants, respectively (p>0.05). While PHE slightly increased gray and white matter volume and the apparent diffusion coefficient, these changes were clearly more pronounced during AHE but were unrelated to AMS. In conclusion, our findings indicate that rest and especially exercise in normobaric hypoxia are associated with accumulation of water in the extracellular space, however independent of AMS development. Thus, it is suggested that AMS and HACE do not share a common pathophysiological mechanism.

  15. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Bach, Andreas Gunter, E-mail: mail@andreas-bach.de [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Nansalmaa, Baasai; Kranz, Johanna [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Taute, Bettina-Maria [Department of Internal Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Wienke, Andreas [Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger-Str. 8, 06112 Halle (Germany); Schramm, Dominik; Surov, Alexey [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany)

    2015-02-15

    Highlights: • In patients with acute pulmonary embolism contrast reflux in inferior vena cava is significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). • This finding is independent from the following comorbidities: heart insufficiency and pulmonary hypertension. • Measurement of contrast reflux is a new and robust radiologic method for predicting 30-day mortality in patients with acute pulmonary embolism. • Measurement of contrast reflux is a better predictor of 30-day mortality after acute pulmonary embolism than any other existing radiologic predictor. This includes thrombus distribution, and morphometric measurements of right ventricular dysfunction. - Abstract: Purpose: Standard computed tomography pulmonary angiography (CTPA) can be used to diagnose acute pulmonary embolism. In addition, multiple findings at CTPA have been proposed as potential tools for risk stratification. Therefore, the aim of the present study is to examine the prognostic value of (I) thrombus distribution, (II) morphometric parameters of right ventricular dysfunction, and (III) contrast reflux in inferior vena cava on 30-day mortality. Material and methods: In a retrospective, single-center study from 06/2005 to 01/2010 365 consecutive patients were included. Inclusion criteria were: presence of acute pulmonary embolism, and availability of 30-day follow-up. A review of patient charts and images was performed. Results: There were no significant differences between the group of 326 survivors and 39 non-survivors in (I) thrombus distribution, and (II) morphometric measurements of right ventricular dysfunction. However, (III) contrast reflux in inferior vena cava was significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). Results were independent from comorbidities like heart insufficiency and pulmonary hypertension. Conclusion: Measurement of contrast reflux is a new and robust method for predicting 30-day mortality in patients with acute pulmonary

  16. Comparison of the lung X-ray and CT imaging features of patients with cardiogenic pulmonary edema%心源性肺水肿的X线与CT对比研究

    Institute of Scientific and Technical Information of China (English)

    王增状; 姜领; 鞠衍松; 谢新刚; 黄福存; 赵仲愉; 林少华

    2014-01-01

    目的 分析心源性肺水肿患者的肺部X线与CT影像学表现,从而提高心源性肺水肿患者的诊断准确率.方法 自2010年1月至2013年1月共收治100例心源性肺水肿患者,均于发病24h内分别对患者行肺部X线与CT检查,对比分析其影像学表现.结果 急性心源性肺水肿X线表现以肺泡性肺水肿为主,X线表现与肺部CT影像学表现相似,为腺泡结节、斑片状及大片融合影,有时可见空气支气管像,病变边缘模糊.病变进展时双肺出现广泛的密度均匀实变阴影,典型者出现“蝶翼征”.病变征象检出率,二者比较差异无统计学意义.慢性心源性肺水肿多表现为间质性肺水肿,肺部X线与CT影像学表现以肺血重新分布,肺野透光度降低,肺纹理增多、增重,小叶间隔线增厚如胸膜下线、克氏线出现以及肺实质磨玻璃样变等间质性肺水肿改变为主,病变征象检查率、肺部CT征象分辨率较高,二者比较差异有统计学意义(P<0.05).结论 急性心源性肺水肿的肺部X线与CT征象表现相似,临床诊断率相当,而慢性心源性肺水肿的肺部CT检查能提供更多的诊断信息,提高临床诊断率.%Objective To analyze the lung X-ray and CT imaging features of patients with cardiogenic pulmonary edema,thereby enhancing the diagnostic accuracy in patients with the cardiogenic pulmonary edema.Methods From January 2010 to January 2013,100 patients with cardiogenic pulmonary edema were selected,all patients underwent the lung X-ray and CT examinations within 24 hours of onset,and then comparative analysis of the imaging manifestations was made.Results Acute cardiogenic pulmonary edema X-ray showed pulmonary edema with alveolar master,X-ray and CT imaging had some similar performances and manifested as acinar nodules,patchy and large fusion shadow,sometimes visible as air bronchial lesion,edge blurred.There was extensive consolidation of uniform density shadow when lung lesions

  17. Mitochondrial haplogroup D4 confers resistance and haplogroup B is a genetic risk factor for high-altitude pulmonary edema among Han Chinese.

    Science.gov (United States)

    Luo, Y J; Gao, W X; Li, S Z; Huang, X W; Chen, Y; Liu, F Y; Huang, Q Y; Gao, Y Q

    2012-10-09

    High-altitude pulmonary edema (HAPE) is a life-threatening condition caused by acute exposure to high altitude. Accumulating evidence suggests that genetic factors play an important role in the etiology of HAPE. However, conclusions from association studies have been hindered by limited sample size due to the rareness of this disease. It is known that mitochondria are critical for hypoxic adaptation, and mitochondrial malfunction can be an important factor in HAPE development. Therefore, we tested the hypothesis that mitochondrial DNA haplotypes and polymorphisms affect HAPE susceptibility. We recruited 204 HAPE patients and 174 healthy controls in Tibet (3658 m above sea level), all Han Chinese, constituting the largest sample size of all HAPE vulnerability studies. Among mtDNA haplogroups, we found that haplogroup D4 is associated with resistance to HAPE, while haplogroup B is a genetic risk factor for this condition. Haplogroup D4 (tagged by 3010A) may enhance the stability of 16S rRNA, resulting in reduced oxidative stress and protection against HAPE. Within haplogroup B, subhaplogroup B4c (tagged by 15436A and 1119C) was associated with increased risk for HAPE, while subhaplogroup B4b may protect against HAPE. We indicate that there are differences in HAPE susceptibility among mtDNA haplogroups. We conclude that mitochondria are involved in adverse reactions to acute hypoxic exposure; our finding of differences in susceptibility as a function of mitochondrial DNA haplotype may shed light on the pathogenesis of other disorders associated with hypoxia, such as chronic obstructive pulmonary disease.

  18. THE EFFECT OF FLUOROCARBON ARTIFICIAL BLOOD (FC-34 IN ACUTE VASOGENIC BRAIN EDEMA

    Directory of Open Access Journals (Sweden)

    M NEEMATBAKHSH

    2000-03-01

    Full Text Available Background. Oxygen transport to tissue after an acute ischemia is strongly important. Fluorocarbon liquids are able to facilitated the oxygen transport. An animal experiment was designed to study the effect of FC-34 in acute brain ischemia. Methods. The left common carotid arteries were ligated in three groups of anesthetized animals for 30 minutes to obtain acute brain edema. The animals were subjected to received 15 ml/kg saline (group 1, 10% monitol (group 2 or FC-43 (group 3. All animals were recovered, and they monitored for two weeks. The electrolytes, BUN, and creatinine were measured before (all animals and after two weeks (survived animals. Pathological investigation was obtained by light and electron microscope via pathological process. Findings. The group 1 animals were died during first five days, but one and four animals were survived by two weeks in groups 2 & 3 respectively (P < 0.05. The pathological determinations indicate less cellular damages in group 3. No significant differences were detected in potassium, calcium, BUN, and creatinine before and after the experiment. Conclusion. The particle size and oxygen solubility in FC-43 is the major factors for better oxygen transport in ischem

  19. Drug-Related Hyponatremic Encephalopathy: Rapid Clinical Response Averts Life-Threatening Acute Cerebral Edema

    Science.gov (United States)

    Siegel, Arthur J.; Forte, Sophie S.; Bhatti, Nasir A.; Gelda, Steven E.

    2016-01-01

    Patient: Female, 63 Final Diagnosis: Drug-induced hyponatremic encephalopathy Symptoms: Seizures • coma Medication: Hypertonic 3% saline infusion Clinical Procedure: — Specialty: Internal Medicine Objective: Unusual clinical course Background: Drug-induced hyponatremia characteristically presents with subtle psychomotor symptoms due to its slow onset, which permits compensatory volume adjustment to hypo-osmolality in the central nervous system. Due mainly to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), this condition readily resolves following discontinuation of the responsible pharmacological agent. Here, we present an unusual case of life-threatening encephalopathy due to adverse drug-related effects, in which a rapid clinical response facilitated emergent treatment to avert life-threatening acute cerebral edema. Case Report: A 63-year-old woman with refractory depression was admitted for inpatient psychiatric care with a normal physical examination and laboratory values, including a serum sodium [Na+] of 144 mEq/L. She had a grand mal seizure and became unresponsive on the fourth day of treatment with the dual serotonin and norepinephrine reuptake inhibitor [SNRI] duloxetine while being continued on a thiazide-containing diuretic for a hypertensive disorder. Emergent infusion of intravenous hypertonic (3%) saline was initiated after determination of a serum sodium [Na+] of 103 mEq/L with a urine osmolality of 314 mOsm/kg H20 and urine [Na+] of 12 mEq/L. Correction of hyposmolality in accordance with current guidelines resulted in progressive improvement over several days, and she returned to her baseline mental status. Conclusions: Seizures with life-threatening hyponatremic encephalopathy in this case likely resulted from co-occurring SIADH and sodium depletion due to duloxetine and hydrochlorothiazide, respectively. A rapid clinical response expedited diagnosis and emergent treatment to reverse life-threatening acute cerebral edema

  20. Pulmonary hypertension due to acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    S.A. Ñamendys-Silva

    2014-10-01

    Full Text Available Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS, to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46% who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%. The most common cause of ARDS was pneumonia (56.3%. The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

  1. CT Pulmonary Angiography and Suspected Acute Pulmonary Embolism

    Energy Technology Data Exchange (ETDEWEB)

    Enden, T.; Kloew, N.E. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Cardiovascular Radiology

    2003-05-01

    Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, D-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries. D-dimer test was performed in 209 patients, 85% were positive. A negative D-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis (p < 0.017), whereas two or more suggested a positive PE diagnosis (p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negative D-dimer ruled out clinically suspected VTE.

  2. Analysis of acute organophosphate poisoning complicated with plmonary edema: 52 cases%52例有机磷农药急性中毒并发急性肺水肿分析

    Institute of Scientific and Technical Information of China (English)

    石峰

    2001-01-01

    Objective To discuss the clinical features and treatment of pulmonary edema caused by acute organophosphate poisoning. Methods The symptoms and therapeutic results of 52 cases (1994.1~ 1998.12) of organophosphate poisoning complicated with pulmonary edema were summrized. Results The clinical features of pulmonary edema caused by acute organophosphate poisoning were atypical during early stage. 8 of 52 patients died (15.4% ), and among this eight patients, 3 died of respiratory failure caused by pulmonary edema(5.8% ). Conclusion The physician should pay more attention to pulmonary edema and diagnose it early in acute organophosphate paisoning.%目的探讨有机磷农药急性中毒并发急性肺水肿的机理、临床特点、影像学特征及治疗方法。方法分析 1994年 1月~ 1998年 12月间,经抢救和治疗的 52例有机磷农药急性中毒并发急性肺水肿患者的症状、胸部 X线摄片、诊断及治疗结果的临床资料。结果 52例患者中 44例( 84.6%)治愈好转出院,死亡 8例( 15.4%)。其中死于肺水肿致呼吸衰竭 3例 (5.8% ).结论急性有机磷农药中毒并发急性肺水肿临床特点和 X线表现早期表现不明显,易被中毒的其它全身表现所掩盖。在治疗措施上 ,既要针对肺水肿的临床表现 ,又要考虑到原发疾病的病因治疗。

  3. Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review

    Science.gov (United States)

    Lin, Xiaoping; Xu, Zhijun; Wang, Pengfei; Xu, Yan; Zhang, Gensheng

    2016-01-01

    Neurogenic pulmonary edema (NPE) is occasionally observed in patients with traumatic brain injury (TBI); however, this condition is often underappreciated. NPE is frequently misdiagnosed due to its atypical clinical performance, thus delaying appropriate treatment. A comprehensive management protocol of NPE in patients with TBI has yet to be established. The current study reported the case of a 67-year-old man with severe TBI who was transferred to our intensive care unit (ICU). On day 7 after hospitalization, the patient suddenly suffered tachypnea, tachycardia, systemic hypertension and hypoxemia during lumbar cistern drainage. Intravenous diuretics, tranquilizer and glucocorticoid were administered due to suspected left heart failure attack. Chest radiography examination supported the diagnosis of pulmonary edema; however, hypotension and hypovolemia were subsequently observed. Pulse index continuous cardiac output (PiCCO) hemodynamic monitoring and bedside echocardiography were performed, which excluded the diagnosis of cardiac pulmonary edema, and thus the diagnosis of NPE was confirmed. Goal-directed therapy by dynamic PiCCO monitoring was then implemented. In addition, levosimendan, an inotropic agent, was introduced to improve cardiac output. The patient had complete recovered from pulmonary edema and regained consciousness on day 11 of hospitalization. The current case demonstrated that PiCCO monitoring may serve a central role in the integrated management of NPE in patients with TBI. Levosimendan may be a potential medicine in treating cardiac dysfunction, along with its benefit from improving neurological function in NPE patients. PMID:27698733

  4. Role of PiCCO monitoring for the integrated management of neurogenic pulmonary edema following traumatic brain injury: A case report and literature review.

    Science.gov (United States)

    Lin, Xiaoping; Xu, Zhijun; Wang, Pengfei; Xu, Yan; Zhang, Gensheng

    2016-10-01

    Neurogenic pulmonary edema (NPE) is occasionally observed in patients with traumatic brain injury (TBI); however, this condition is often underappreciated. NPE is frequently misdiagnosed due to its atypical clinical performance, thus delaying appropriate treatment. A comprehensive management protocol of NPE in patients with TBI has yet to be established. The current study reported the case of a 67-year-old man with severe TBI who was transferred to our intensive care unit (ICU). On day 7 after hospitalization, the patient suddenly suffered tachypnea, tachycardia, systemic hypertension and hypoxemia during lumbar cistern drainage. Intravenous diuretics, tranquilizer and glucocorticoid were administered due to suspected left heart failure attack. Chest radiography examination supported the diagnosis of pulmonary edema; however, hypotension and hypovolemia were subsequently observed. Pulse index continuous cardiac output (PiCCO) hemodynamic monitoring and bedside echocardiography were performed, which excluded the diagnosis of cardiac pulmonary edema, and thus the diagnosis of NPE was confirmed. Goal-directed therapy by dynamic PiCCO monitoring was then implemented. In addition, levosimendan, an inotropic agent, was introduced to improve cardiac output. The patient had complete recovered from pulmonary edema and regained consciousness on day 11 of hospitalization. The current case demonstrated that PiCCO monitoring may serve a central role in the integrated management of NPE in patients with TBI. Levosimendan may be a potential medicine in treating cardiac dysfunction, along with its benefit from improving neurological function in NPE patients.

  5. Extravascular lung water index measurement in critically ill children does not correlate with a chest x-ray score of pulmonary edema.

    NARCIS (Netherlands)

    Lemson, J.; Die, L. van; Hemelaar, A.E.A.; Hoeven, J.G. van der

    2010-01-01

    INTRODUCTION: Extravascular lung water index (EVLWI) can be measured at the bedside using the transpulmonary thermodilution technique (TPTD). The goal of this study was to compare EVLWI values with a chest x-ray score of pulmonary edema and markers of oxygenation in critically ill children. METHODS:

  6. One hundred and fifty-three cases of reexpansion pulmonary edema%复张性肺水肿153例

    Institute of Scientific and Technical Information of China (English)

    谷仲平; 刘锟; 王云杰

    1999-01-01

    @@ 0 引言 复张性肺水肿(reexpansion pulmonary edema RPE)是指继发于各种原因所致的肺萎陷在肺迅速复张后所发生的急性肺水肿,多见于气、液胸患者经大量排气排液之后.我们于1980~1997年间共收治153例肺萎陷患者,其中自发性气胸121例,胸腔积液32例.治疗过程中,前者有6例、后者有1例发生了RPE.现对之加以总结和讨论.

  7. An uncommon complication of a common clinical scenario: exploring reexpansion pulmonary edema with a case report and literature review

    Directory of Open Access Journals (Sweden)

    Jared W. Meeker

    2016-07-01

    Full Text Available Reexpansion pulmonary edema (RPE is a rare complication that can occur after rapid reinflation of the lung following thoracentesis of a pleural effusion or chest tube drainage of pneumothorax. The severity in clinical presentation can be widely varied from radiographic changes only to rapidly progressive respiratory failure requiring mechanical ventilation. The quick nature of onset and potential for serious decline in a previously stable patient makes it important to prepare, recognize, diagnose, and appropriately manage patients who develop RPE. The standard treatment for RPE consists of supportive care, and there are certain measures that may be taken to reduce the risk, including limiting the amount drained and avoiding excessive negative pleural pressure. Exactly how to prevent RPE remains unclear, however, and varying recommendations exist. This is a case report of RPE after thoracentesis for a pleural effusion and a brief review of literature to date, including potential preventative strategies.

  8. Hydrothorax with alveolar-pleural fistula mimicking re-expansion pulmonary edema during liver transplantation: a case report

    Science.gov (United States)

    2015-01-01

    We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation, which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotracheal tube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosed with an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmatic incision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusion towards the ipsilateral lung during the remaining operation period. Surgeon repaired the defect on the exposed lung surface via diaphragmatic opening. Anesthesiologists should consider an alveolar-pleural fistula as a possible differential diagnosis with re-expansion pulmonary edema when transudate emanating from the endotracheal tube is obtained in patients with massive hydrothorax. PMID:25844139

  9. Pancreatic and pulmonary mast cells activation during experimental acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Inmaculada; Lopez-Font; Sabrina; Gea-Sorlí; Enrique; de-Madaria; Luis; M; Gutiérrez; Miguel; Pérez-Mateo; Daniel; Closa

    2010-01-01

    AIM:To study the activation of pancreatic and pulmonary mast cells and the effect of mast cell inhibition on the activation of peritoneal and alveolar macrophages during acute pancreatitis.METHODS:Pancreatitis was induced by intraductal infusion of 5% sodium taurodeoxycholate in rats.The mast cell inhibitor cromolyn was administered intraperitoneally(i.p.) 30 min before pancreatitis induction.The pancreatic and pulmonary tissue damage was evaluated histologically and mast cells and their state of activation...

  10. Edema pulmonar de reexpansão tratado com ventilação não invasiva: relato de caso Reexpansion pulmonary edema treated with non-invasive ventilation: case report

    Directory of Open Access Journals (Sweden)

    Amarilio Vieira de Macedo Neto

    2001-02-01

    Full Text Available The authors report a case of Reexpansion Pulmonary Edema (RPE seen at Hospital de Pronto Socorro de Porto Alegre 3 hours after drainage of spontaneous pneumothorax. The patient presented a unilateral pneumothorax with one-week duration. After pleural drainage respiratory failure occured being managed at the Intensive Care Unit with non-invasive positive pressure ventilation through facial mask. The patient had favorable outcome and was discharged asymtomatic after 72 hours.

  11. Incidence of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    王芳

    2013-01-01

    Objective To evaluate the incidence of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) .Methods Comprehensive searches as of June 2012 were performed in PubMed (1966—) ,Embase (1974—) ,Chinese

  12. January 2015 Phoenix pulmonary journal club: noninvasive ventilation in acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Mathew M

    2015-01-01

    Full Text Available No abstract available. Article truncated after 150 words. Noninvasive positive pressure ventilation has expanded its role in the treatment of both chronic and acute respiratory failure. Its initial use in conditions such as obstructive sleep apnea, neuromuscular disease and tracheobronchomalacia, have been shown to improve quality of life and reduce mortality. Over the past 20 years studies have looked at using noninvasive ventilation in the management of acute respiratory failure from pulmonary edema, asthma and COPD exacerbations. During this month's journal club we reviewed 3 articles evaluating the efficacy of noninvasive ventilation in acute respiratory failure. Gupta D, Nath A, Agarwal R, Behera D. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care. 2010;55(5:536-43. [PubMed] This was a small unblinded randomized controlled trial (RCT looking at the efficacy using noninvasive ventilation (NIV in acute asthma. A total of 53 patients were included and divided into 2 groups of 28 patients ...

  13. Dietary cysteine is used more efficiently by children with severe acute malnutrition with edema compared with those without edema

    Science.gov (United States)

    Children with edematous severe acute malnutrition (SAM) produce less cysteine than do their nonedematous counterparts. They also have marked glutathione (GSH) depletion, hair loss, skin erosion, gut mucosal atrophy, and depletion of mucins. Because GSH, skin, hair, mucosal, and mucin proteins are ri...

  14. The effect of age on the ozone-induced pulmonary edema and tolerance in rats

    Energy Technology Data Exchange (ETDEWEB)

    Nambu, Z.; Yokoyama, E.

    1981-03-01

    Effects of the age on the lung injury caused by ozone and on the development of ozone tolerance were examined in male rats by measuring pulmonary weight response. The pulmonary susceptibility to ozone was found to be proportional to the logarithm of body weight from 70 to 300 g, but extraordinarily enhanced beyond 300 g (about 9 weeks old). The developmental process of ozone tolerance in young rats were found to be similar to that in young adults, but apparently different from that in older rats. Pulmonary ability to induce ozone tolerance was higher in young rats weighing less than 300 g than in older rats. These results suggest that the rat lung response to ozone alters as the rats grow older beyond 9 weeks.

  15. A Peptide to Reduce Pulmonary Edema in a Rat Model of Lung Transplantation

    Science.gov (United States)

    Finsterwalder, Richard; Friedl, Heinz P.; Rauscher, Sabine; Gröger, Marion; Kocher, Alfred; Wagner, Christine; Wagner, Stephan N.; Fischer, Gottfried; Schultz, Marcus J.; Wiedemann, Dominik; Petzelbauer, Peter

    2015-01-01

    Background Despite significant advances in organ preservation, surgical techniques and perioperative care, primary graft dysfunction is a serious medical problem in transplantation medicine in general and a specific problem in patients undergoing lung transplantation. As a result, patients develop lung edema, causing reduced tissue oxygenation capacity, reduced lung compliance and increased requirements for mechanical ventilatory support. Yet, there is no effective strategy available to protect the grafted organ from stress reactions induced by ischemia/reperfusion and by the surgical procedure itself. Methods We assessed the effect of a cingulin-derived peptide, XIB13 or a random peptide in an established rat model of allogeneic lung transplantation. Donor lungs and recipients received therapeutic peptide at the time of transplantation and outcome was analyzed 100min and 28 days post grafting. Results XIB13 improved blood oxygenation and reduced vascular leak 100min post grafting. Even after 28 days, lung edema was significantly reduced by XIB13 and lungs had reduced fibrotic or necrotic zones. Moreover, the induction of an allogeneic T cell response was delayed indicating a reduced antigen exchange between the donor and the host. Conclusions In summary, we provide a new tool to strengthen endothelial barrier function thereby improving outcomes in lung transplantation. PMID:26536466

  16. A Peptide to Reduce Pulmonary Edema in a Rat Model of Lung Transplantation.

    Directory of Open Access Journals (Sweden)

    Klaudia Schossleitner

    Full Text Available Despite significant advances in organ preservation, surgical techniques and perioperative care, primary graft dysfunction is a serious medical problem in transplantation medicine in general and a specific problem in patients undergoing lung transplantation. As a result, patients develop lung edema, causing reduced tissue oxygenation capacity, reduced lung compliance and increased requirements for mechanical ventilatory support. Yet, there is no effective strategy available to protect the grafted organ from stress reactions induced by ischemia/reperfusion and by the surgical procedure itself.We assessed the effect of a cingulin-derived peptide, XIB13 or a random peptide in an established rat model of allogeneic lung transplantation. Donor lungs and recipients received therapeutic peptide at the time of transplantation and outcome was analyzed 100min and 28 days post grafting.XIB13 improved blood oxygenation and reduced vascular leak 100min post grafting. Even after 28 days, lung edema was significantly reduced by XIB13 and lungs had reduced fibrotic or necrotic zones. Moreover, the induction of an allogeneic T cell response was delayed indicating a reduced antigen exchange between the donor and the host.In summary, we provide a new tool to strengthen endothelial barrier function thereby improving outcomes in lung transplantation.

  17. Edema de pulmón precipitado por amlodipino

    Directory of Open Access Journals (Sweden)

    Teresa Chapela Castaño

    2013-09-01

    Full Text Available Múltiples fármacos pueden causar edema agudo de pulmón no cardiogénico. Establecer esta relación causal resulta muy difícil en muchos casos debido a la escasa incidencia documentada con algunos fármacos y a que la sintomatología no es específica. Si bien el edema periférico es un efecto secundario frecuente del amlodipino, solamente se han publicado en la literatura dos casos de edema pulmonar causado por amlodipino y ambos ocurrieron en el contexto de dosis supraterapéuticas. Se describe un caso de edema pulmonar posiblemente inducido por amlodipino administrado a dosis terapéutica y se discute el posible mecanismo fisiopatológico. Multiple drugs can cause acute pulmonary edema non-cardiogenic. Establishing this causal relationship is very difficult in many cases due to low reported incidence of some drugs and non specific symptoms. While peripheral edema is a common side effect of amlodipine, only have been published in the literature two cases of pulmonary edema caused by amlodipine and both occurred in the context of drug overdose. We describe a case of pulmonary edema probably induced by amlodipine at therapeutic doses and we discuss the possible pathophysiological mechanism.

  18. Susceptibility To High Altitude Pulmonary Edema Is Associated With A More Uniform Distribution Of Regional Specific Ventilation.

    Science.gov (United States)

    Patz, Michael D; Sá, Rui Carlos; Darquenne, Chantal; Elliott, Ann R; Assadi, Amran K; Theilmann, Rebecca J; Dubowitz, David J; Swenson, Erik Richard; Prisk, Gordon Kim; Hopkins, Susan Roberta

    2017-01-05

    High altitude pulmonary edema (HAPE) is a potentially fatal condition affecting high altitude sojourners. The biggest predictor of HAPE development is a history of prior HAPE. Magnetic resonance imaging (MRI) shows HAPE-susceptible, with a history of HAPE, but not HAPE-resistant (a history of repeated ascents without illness) individuals develop greater heterogeneity of regional pulmonary perfusion breathing hypoxic gas (O2=12.5%), consistent with uneven hypoxic pulmonary vasoconstriction (HPV). Why HPV is uneven in HAPE-susceptibles is unknown, but may arise from regionally heterogeneous ventilation resulting in an uneven stimulus to HPV. We tested the hypothesis that ventilation is more heterogeneous in HAPE-susceptible subjects (n=6) compared to HAPE-resistant controls (n=7). MRI Specific Ventilation Imaging (SVI), was used to measure regional specific ventilation and the relative dispersion (SD/mean) of SVI used to quantify baseline heterogeneity. Ventilation heterogeneity from conductive and respiratory airways was measured in normoxia and hypoxia (O2=12.5%) using multiple breath washout and heterogeneity quantified from the indices Scond and Sacin, respectively. Contrary to our hypothesis, HAPE-susceptibles had significantly lower relative dispersion of specific ventilation than the HAPE-resistant controls (Susceptible=1.33±0.67, Resistant=2.36±0.98, p=0.05) and Sacin tended to be more uniform (Susceptible=0.085±0.009, Resistant=0.113±0.030, p=0.07). Scond was not significantly different between groups (Susceptible=0.019±0.007, Resistant=0.020±0.004, p=0.67). Sacin and Scond did not change significantly in hypoxia (p=0.56, 0.19, respectively). In conclusion, ventilation heterogeneity does not change with short-term hypoxia irrespective of HAPE susceptibility and lesser rather than greater ventilation heterogeneity is observed in HAPE-susceptible subjects. This suggests the basis for uneven HPV in HAPE involves vascular phenomena.

  19. Morphine in the treatment of acute pulmonary oedema--Why?

    Science.gov (United States)

    Ellingsrud, C; Agewall, S

    2016-01-01

    Morphine has for a long time, been used in patients with acute pulmonary oedema due to its anticipated anxiolytic and vasodilatory properties, however a discussion about the benefits and risks has been raised recently. A literature search in Medline and Embase using the keywords "pulmonary oedema" OR "lung oedema" OR "acute heart failure" AND "morphine" was performed. A certain vasodilation has been described after morphine administration, but the evidence for this mechanism is relatively poor and morphine-induced anxiolysis may possibly be the most important factor of morphine in pulmonary oedema and therefore some authors have suggested benzodiazepines as an alternative treatment. Respiratory depression seems to be a less relevant clinical problem according to the literature, whereas vomiting is common, which may cause aspiration. In the largest outcome study, based on the ADHERE registry, morphine given in acute decompensated heart failure was an independent predictor of increased hospital mortality, with an odds ratio of 4.8 (95% CI: 4.52-5.18, pmorphine administration and mortality, which was lost after adjusting for confounding factors. Morphine is still used for pulmonary oedema in spite of poor scientific background data. A randomised, controlled study is necessary in order to determine the effect--and especially the risk--when using morphine for pulmonary oedema. Since the positive effects are not sufficiently documented, and since the risk for increased mortality cannot be ruled out, one can advocate that the use should be avoided.

  20. Pathophysiology of acute mountain sickness and high altitude pulmonary oedema

    DEFF Research Database (Denmark)

    Sutton, J R; Lassen, N

    1979-01-01

    We review the evidence that acute mountain sickness (AMS) and high altitude pulmonary oedema (HAPO) occur together more often than is realized. We hypothesize that AMS and HAPO have a common pathophysiological basis: both are due to increased pressure and flow in the microcirculation, causing...

  1. Tenecteplase in the treatment of acute pulmonary thrombo-embolism.

    Science.gov (United States)

    Bhuvaneswaran, J S; Premchand, Rajendra Kumar; Iyengar, S S; Rajeev Khare; Chabra, C B; Padmanabhan, T N C; Sharma, S K; Jain, Alkesh; Pandian, S A; Rajdev, S; Modi, N; Kumar, V

    2011-05-01

    This is a retrospective study documenting the use of tenecteplase in 41 cases of suspected or confirmed pulmonary embolism receiving in-hospital tenecteplase as per weight-adjusted dosing in addition to standard heparin and oral anticoagulant therapy. The presenting symptoms of dyspnoea, chest pain, hemoptysis and syncope were found in 40 (97.56%), 19 (46.34%), 6 (14.63%) and 9 (21.95%) patients, respectively. There was one case of mortality who was a 26 yrs old female of postpartum pulmonary thrombo-embolism with severe hypotension, cyanosis, bilateral crepitations in lungs and pulmonary hypertension. In the 40 survived patients, there was alleviation of dyspnoea and hemoptysis in all patients. Significant reduction in tachycardia (P tenecteplase therapy. Resolution of pulmonary embolism on CT pulmonary angiography was documented in only two patients. No bleeding events or any other adverse events were reported during this study. The present study suggests favourable efficacy of tenecteplase in patients with suspected or confirmed acute pulmonary embolism. Although no major adverse events were noted, a large prospective study on the use of tenecteplase in pulmonary embolism is suggested.

  2. Effect of Maixuekang enteric coated tablets on absorption of hematoma and treatment of acute cerebral hemorrhage patients with cerebral edema

    Institute of Scientific and Technical Information of China (English)

    Bing-Ding Lu; Chuan Wang

    2016-01-01

    Objective:To study the clinical efficacy of Maixuekang in treating acute cerebral hemorrhage hematomas and promoting brain hemorrhage.Methods: A total of 192 patients with acute intracerebral hemorrhage treated within 3 hours in our hospital during April 2013 to February 2015 were selected. After admission immediately apply brain CT, blood, coagulation function tests were carried out. They were randomly divided into 2 groups. Both groups had anti-infective, mannitol and other conventional treatment. Observation group were treated with enteric-coated tablets Maixuekang on this basis. Clinical efficacy, various stages of treatment of cerebral hematoma volume, brain edema volume, NIHSS score were compared.Results: Before treatment, difference in edema volume and HIHSS scores were not statistically significant (P>0.05). After14 d and 28 d treatment, edema volume of observation group were significantly smaller than those of control group (P<0.01); NIHSS score of observation group were significantly lower than those of control group (P<0.01); 28 d after treatment total effective rate of observation group was significantly higher than that of the control group (P<0.01).Conclusions:Maixuekang enteric-coated tablets as a thrombin inhibitor, can effectively reduce a series of pathological changes after acute cerebral hemorrhage caused by partial thrombin content, promote absorption of hematoma and neurological recovery. The side effects is small, safe and worthy of promotion.

  3. ROCK2 and MYLK variants under hypobaric hypoxic environment of high altitude associate with high altitude pulmonary edema and adaptation

    Directory of Open Access Journals (Sweden)

    Pandey P

    2015-11-01

    Full Text Available Priyanka Pandey,1,2 Ghulam Mohammad,1,3 Yogendra Singh,1,2 MA Qadar Pasha1,2 1Functional Genomics Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, 2Department of Biotechnology, University of Pune, Ganeshkhind, Pune, Maharashtra, 3Department of Medicine, SNM Hospital, Leh, Ladakh, Jammu and Kashmir, IndiaObjective: To date, a major class of kinases, serine–threonine kinase, has been scantly investigated in stress-induced rare, fatal (if not treated early, and morbid disorder, high altitude pulmonary edema (HAPE. This study examined three major serine–threonine kinases, ROCK2, MYLK, and JNK1, along with six other genes, tyrosine hydroxylase, G-protein subunits GNA11 and GNB3, and alpha1 adrenergic receptor isoforms 1A, 1B, and 1D as candidate gene markers of HAPE and adaptation.Methods: For this, 57 variants across these nine genes were genotyped in HAPE patients (n=225, HAPE controls (n=210, and highlanders (n=259 by Sequenom MS (TOF-based MassARRAY® platform using iPLEX™ Gold technology. In addition, to study the gene expression, quantitative real-time polymerase chain reaction was performed in human peripheral blood mononuclear cells of the three study groups.Results: A significant association was observed for C allele (ROCK2 single-nucleotide polymorphism, rs10929728 with HAPE (P=0.03 and C, T, and A alleles (MYLK single-nucleotide polymorphisms, rs11717814, rs40305, and rs820336 with both HAPE and adaptation (P=0.001, P=0.006, and P=0.02, respectively. ROCK2 88 kb GGGTTGGT haplotype was associated with lower risk of HAPE (P=0.0009. MYLK 7 kb haplotype CTA, composed of variant alleles, was associated with higher risk of HAPE (P=0.0006 and lower association with adaptation (P=1E–06, whereas haplotype GCG, composed of wild-type alleles, was associated with lower risk of HAPE (P=0.001 and higher association with adaptation (P=1E–06. Haplotype–haplotype and gene–gene interactions demonstrated a correlation in working

  4. CT imaging in acute pulmonary embolism: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Wildberger, Joachim E.; Mahnken, Andreas H.; Das, Marco; Guenther, Rolf W. [University of Technology (RWTH), Department of Diagnostic Radiology, University Hospital, Aachen (Germany); Kuettner, Axel [Eberhard Karls University, Department of Diagnostic Radiology, Tuebingen (Germany); Lell, Michael [Friedrich Alexander University, Department of Diagnostic Radiology, Erlangen (Germany)

    2005-05-01

    Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm - if this was positive for PE - and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future. (orig.)

  5. A correlative study between AQP4 expression and the manifestation of DWI after the acute ischemic brain edema in rats

    Institute of Scientific and Technical Information of China (English)

    鲁宏; 孙善全

    2003-01-01

    Objective To investigate the rule of the aquaporin-4 (AQP4) expression in acute ischemic brain edema, and to study the correlation between AQP4 expression and diffusion-weighted imaging (DWI).Methods Thirty-six Wistar rats were divided into 2 groups randomly, control group (n=12) and operation group (n=24) in which right middle cerebral artery of each animal had been occluded unilaterally (MCAO) at interval times of: 15 minutes, 30 minutes, 1 hours, 3 hours, 6 hours and 24 hours, respectively. The operation process of the control group was the same as the operation group except for the MCAO. All groups were examined using DWI. The apparent diffusion coefficient (ADC), relative density (rd) and relative area (rs) of the biggest hyperintensity signal layer on DWI were measured. After that the animals were sacrificed and perfused with the mixture solution consisting of TTC. The biggest layers of the ischemic cerebral tissues in each rat corresponding to the DWI were stained with TTC and examined with immunochemistry (△S) , in situ hybridization (α) and histology.Results There was no significant change in the control group. In the operation group, a hyperintensity signal was found in the DWI of the right MAC territory at 15 minutes after MCAO. The ADC value decreased quickly within one hour after MCAO, while the AQP4 expression, rd-DWI and rs-DWI increased rapidly during this stage. As time progressed, the ADC value decreased further to (2.1±0.6)×10-4 mm2/s at 3 hours, and then began to increase slowly till 24 hours. But the AQP4 expression (△S and α) and rd as well as the rs continuously increased slowly between 1 hour and 6 hours after MCAO, followed a peak after 6 hours. The AQP4 expression (α) showed a positive relationship with the rs-DWI, they all presented two peaks and a plateau. The corresponding sequential pathologic changes were a gradual increase of intracellular edema (within one hour), then an emergence of vasogenic edema (1-6 hours), and final

  6. Neurogenic pulmonary edema following cerebrovascular diseases%脑血管病并发的神经源性肺水肿

    Institute of Scientific and Technical Information of China (English)

    李瑾; 沙杜鹃; 张均

    2010-01-01

    神经源性肺水肿(neurogenic pulmonary edema,NPE)是中枢神经系统重度损伤后的致死性并发症,各种脑血管病是NPE的常见原因.NPE病死率高,其发生机制涉及多种因素,但确切机制尚不完全清楚.文章就近年来脑血管病并发NPE的机制和治疗进展做了综述.%Neurogenic pulmonary edema (NPE) is a fatal complication after severe injury of central nervous system. Various cerebrovascular diseases are the common causes of NPE. The mortality of NPE is high. Its pathogenesis involves a variety of factors; however, its exact mechanism remains obscure. This article reviews the advances in pathogenesis and treatment of cerebrovascular diseases complicated with NPE in recent years.

  7. Genetic differences and aberrant methylation in the apelin system predict the risk of high-altitude pulmonary edema

    Science.gov (United States)

    Mishra, Aastha; Kohli, Samantha; Dua, Sanchi; Thinlas, Tashi; Mohammad, Ghulam; Pasha, M. A. Qadar

    2015-01-01

    Hypoxia-inducible factor stimulates the expression of apelin, a potent vasodilator, in response to reduced blood arterial oxygen saturation. However, aberrations in the apelin system impair pulmonary vascular function, potentially resulting in the development of high-altitude (HA)-related disorders. This study aimed to elucidate the genetic and epigenetic regulation of apelin, apelin receptor (APLNR), and endothelial nitric oxide synthase (NOS3) in HA adaptation and HA pulmonary edema (HAPE). A genome-wide association study and sequencing identified variants of apelin, APLNR, and NOS3 that were validated in a larger sample size of HAPE-patients (HAPE-p), HAPE-free controls (HAPE-f), and healthy highland natives (HLs). Apelin-13 and nitrite levels and apelin and NOS3 expression were down-regulated in HAPE-p (P < 0.001). Among the several studied polymorphisms, apelin rs3761581, rs2235312, and rs3115757; APLNR rs11544374 and rs2282623; and NOS3 4b/4a, rs1799983, and rs7830 were associated with HAPE (P < 0.03). The risk allele rs3761581G was associated with a 58.6% reduction in gene expression (P = 0.017), and the risk alleles rs3761581G and rs2235312T were associated with low levels of apelin-13 and nitrite (P < 0.05). The latter two levels decreased further when both of these risk alleles were present in the patients (P < 0.05). Methylation of the apelin CpG island was significantly higher in HAPE-p at 11.92% than in HAPE-f and HLs at ≤7.1% (P < 0.05). Moreover, the methylation effect was 9% stronger in the 5′ UTR and was associated with decreased apelin expression and apelin-13 levels. The rs3761581 and rs2235312 polymorphisms and methylation of the CpG island influence the expression of apelin in HAPE. PMID:25918383

  8. Computed tomography of acute pulmonary embolism: state-of-the-art

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Meinel, Felix G.; McQuiston, Andrew D.; Ravenel, James G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Multidetector computed tomography (CT) plays an important role in the detection, risk stratification and prognosis evaluation of acute pulmonary embolism. This review will discuss the technical improvements for imaging peripheral pulmonary arteries, the methods of assessing pulmonary embolism severity based on CT findings, a multidetector CT technique for pulmonary embolism detection, and lastly, how to avoid overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism. (orig.)

  9. Incidence of high altitude pulmonary edema in low-landers during re-exposure to high altitude after a sojourn in the plains

    Science.gov (United States)

    Apte, C.V.; Tomar, R.K.S.; Sharma, D.

    2015-01-01

    Background There is uncertainty whether acclimatized low-landers who return to high altitude after a sojourn at low altitude have a higher incidence of pulmonary edema than during the first exposure to high altitude. Methods This was a prospective cohort study consisting of men ascending to 3400 m by road (N = 1003) or by air (N = 4178). The study compared the incidence of high altitude pulmonary edema during first exposure vs the incidence during re-exposure in each of these cohorts. Results Pulmonary edema occurred in 13 of the 4178 entries by air (Incidence: 0.31%, 95% CI: 0.18%–0.53%). The incidence during first exposure was 0.18% (0.05%–0.66%) and 0.36% (0.2%–0.64%) during re-exposure (Fisher Exact Test for differences in the incidence (two-tailed) p = 0.534). The relative risk for the re-exposure cohort was 1.95 (95% CI, 0.43%–8.80%). Pulmonary edema occurred in 3 of the 1003 road entrants (Incidence: 0.30%, 95% CI: 0.08%–0.95%). All three cases occurred in the re-exposure cohort. Conclusion The large overlap of confidence intervals between incidence during first exposure and re-exposure; the nature of the confidence interval of the relative risk; and the result of the Fisher exact test, all suggest that this difference in incidence could have occurred purely by chance. We did not find evidence for a significantly higher incidence of HAPE during re-entry to HA after a sojourn in the plains. PMID:26288488

  10. Severe but not mild hypercapnia affects the outcome in patients with severe cardiogenic pulmonary edema treated by non-invasive ventilation

    OpenAIRE

    Contou, Damien; Fragnoli, Chiara; Córdoba-Izquierdo, Ana; Boissier, Florence; Brun-Buisson, Christian; Thille, Arnaud W.

    2015-01-01

    Background Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of patients with CPE and no underlying CLD. Methods Observational cohort study using data prospectively collected over a 3-year period. After excluding patients with any CLD or obstructive sleep apneas,...

  11. 海水淹溺性肺水肿的药物治疗进展%Advancement in pharmacotherapy of pulmonary edema of seawater drowning

    Institute of Scientific and Technical Information of China (English)

    谢晓燕; 金发光; 张博; 范启新; 张勇

    2010-01-01

    Pulmonary edema of seawater drowning and seawater respiratory distress syndrome are the major causes of death induced by seawater drownig.Therefore,treating pulmonary edema in time is the key of a successful treatment.Currently,mechanical ventilation and hyperbaric oxygenation have been commonly recognized as treatment.The study of normative drug treatment is still going on.This paper summarizes the study progress in prarmacotherapy of pulmonary edema of seawater drowning.%海水淹溺性肺水肿和海水型呼吸窘迫综合征是海水淹溺后导致死亡的主要因为,因此尽快纠正肺水肿是治疗淹溺成功的关键.目前治疗上除机械通气、高压氧得到普遍认同外,规范的药物治疗仍在进一步研究中.此文就淹溺性肺水肿的药物治疗研究进展方面作一综述.

  12. Posterior reversible encephalopathy syndrome (PRES, an acute neurological syndrome due to reversible multifactorial brain edema: a case report

    Directory of Open Access Journals (Sweden)

    Camilla Cicognani

    2013-04-01

    Full Text Available Background: The essential features of Posterior Reversible Encephalopathy Syndrome (PRES are headache, mental changes, seizures, visual symptoms and often arterial hypertension. Brain RMN typically shows cortico-sottocortical parieto-occipital edema, with a bilateral and symmetric distribution. PRES develops in clinical conditions as hypertensive encephalopathy, preeclampsia/ eclampsia, autoimmune diseases, after transplantation, infections and as an adverse effect of immunosuppressive drugs or chemotherapy. It usually completely reverses with treatment, although permanent sequelae are possible in case of delayed or missed diagnosis. Case report: We describe the case of a transsexual (M!F and tetraplegic patient, admitted for neck and low back pain. She suddenly developed headache, confusion, seizures and severe hypertension with normal blood tests. RMN showed multiple cortico-sottocortical areas of vasogenic and citotoxic edema in temporo-occipital, parietal, frontal, and cerebellar regions. Soon after the beginning of the antihypertensive therapy, clinical recovery was observed, as well as the disappearance of edema at RMN. Discussion and conclusions: Although PRES is usually associated with definite pathological conditions, it is not always the case, as was for the patient here described, who had no predisposing factors in her past clinical history, and presented hypertension only in the acute phase of the syndrome. Since, moreover, PRES usually presents with acute non specific features and it can be misdiagnosed with other serious diseases, the clinician will be helped by the knowledge of this syndrome to promptly start diagnostic workup and treatments, and avoid permanent neurological deficits.

  13. Enhanced expression of Fas and FasL modulates apoptosis in the lungs of severe P. falciparum malaria patients with pulmonary edema

    Science.gov (United States)

    Punsawad, Chuchard; Viriyavejakul, Parnpen; Setthapramote, Chayanee; Palipoch, Sarawoot

    2015-01-01

    Apoptosis mediated by Fas/FasL has been implicated in pulmonary disorders. However, little is known about the relationship between Fas and FasL in the process of lung injury during malaria infection. Paraffin-embedded lung tissues from malaria patients were divided into two groups: those with pulmonary edema (PE) and those without pulmonary edema (non-PE). Normal lung tissues were used as the control group. Cellular expression of Fas, FasL, and the markers of apoptotic caspases, including cleaved caspase-3 and cleaved caspase-8 in the lung tissues were investigated by the immunohistochemistry (IHC) method. Semi-quantitative analysis of IHC staining revealed that cellular expression of Fas, FasL, cleaved caspase-8, and cleaved caspase-3 were significantly increased in the lungs of patients with PE compared with the lungs of patients with non-PE and control groups (all P < 0.05). In addition, significant positive correlations were obtained between Fas and apoptosis (rs = 0.937, P < 0.001) and FasL and apoptosis (rs = 0.808, P < 0.001). Significant positive correlations were found between Fas and FasL expression (rs = 0.827, P < 0.001) and between cleaved caspase-8 and cleaved caspase-3 expression (rs = 0.823, P < 0.001), which suggests that Fas-dependent initiator and effector caspases, including cleaved caspase-8 and caspase-3, are necessary for inducing apoptosis in the lungs of patients with severe P. falciparum malaria. The Fas/FasL system and downstream activation of caspases are important mediators of apoptosis and may be involved in the pathogenesis of pulmonary edema in severe P. falciparum malaria patients. The proper regulation of the Fas/FasL pathway can be a potential treatment for pulmonary complications in falciparum malaria patients. PMID:26617708

  14. 中老年人心源性肺水肿影像诊断%The Imaging Diagnosis of Cardiac Pulmonary Edema in the Middle-aged and Elderly

    Institute of Scientific and Technical Information of China (English)

    余任辉; 陈惠林

    2014-01-01

    目的:探讨中老年人心源性肺水肿的影响表现和特征,为临床诊断提供一定的参考°方法回顾性分析该院在2010年4月—2012年4月收治的94例中老年人心源性肺水肿患者的CT资料,分析其影像学表现与特征°结果该组94例心源性肺水肿患者中,两侧胸腔积液患者77例(81.91%﹚,肺泡性水肿32例(34.04%﹚,间质性水肿54例(57.45%﹚,心脏外形改变94例(100%﹚,肺淤血改变16例(17.02%﹚°结论心源性肺水肿变现为特异性的影像学特征,通过CT扫描,早期行CT检查,可以有效提升诊断率°%Objective To investigate the imaging manifestations and characteristics of cardiac pulmonary edema in the middle-aged and elderly so as to provide a reference for clinical diagnosis. Methods A retrospective analysis was conducted on the CT data of 94 middle-aged and elderly people with cardiac pulmonary edema admitted in our hospital from April 2010 to April 2012. And the imaging manifestations and characteristics of the patients were analyzed. Results Of the 94 cases with cardiac pulmonary edema, there were 77 cases (81.91%) with bilateral pleural effusion, 32 cases (34.04%) with alveolar edema, 54 cases (57.45%) with interstitial edema, 94 cases (100%) with heart shape changes, 16 cases (17.02%) with lung congestion changes. Conclusion Cardiac pulmonary edema has specific imaging features. Early CT scanning and examination can effectively improve the rate of di_agnosis.

  15. Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Cardiovascular Links

    Directory of Open Access Journals (Sweden)

    Cheryl R. Laratta

    2014-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.

  16. 神经源性肺水肿%Neurogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    孙若鹏; 赵翠芬

    2008-01-01

    神经源性肺水肿(neurogenic pulmonary edema,NPE)是指无心、肺、肾等疾病的情况下,由于中枢神经系统(CNS)损伤导致的急性肺水肿,又称“中枢性肺水肿”或“脑源性肺水肿”。NPE在临床上以急性呼吸困难和进行性低氧血症为特征,早期仅表现为心率增快,血压升高,呼吸急促等非特异性临床表现。胸部X线检查也常无异常发现,或仅有双肺纹理增粗模糊,早期诊断较为困难。待出现皮肤苍白湿冷和濒死感、双肺湿啰音、

  17. Effect of hyperbaric oxygen preconditioning on the expression of aquaporin 5 in rats with high-altitude pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    LI Zhuo; ZHAO Li-ming; WANG Cong; LIU Xue-hua; GAO Chun-jin

    2012-01-01

    Objective To investigate the possibility of applying hyperbaric oxygen preconditioning(HBO-PC)to reduce or prevent high-altitude pulmonary edema(HAPE)and to detect whether aquaporin 5(AQP5)are involved in HAPE pathogenesis.Methods Thirty eight rats were divided into three groups:the control,the HBO-PC and the HAPE groups.Western blot and real-time PCR were used to analyze the expression of AQP5 in the lungs.The wet-to-dry weight ratio(W/D weight ratio)and morphology of the lung were also examined.Results Lung W/D weight ratio in the HAPE group(4.36±0.53)compared with that of the control group(3.90±0.15)(P<0.05),were marked interstitial edema in all the lung sections in the HAPE group,and fewer changes in 10 of 13 sections in the HBO-PC group.Lung-injury scores of the HBO-PC group were much lower than those of the HAPE group.AQP5 of the HAPE group decreased significantly at the protein and gene levels compared with those in the control group(P<0.01,P<0.05).Protein and mRNA expression of AQP5 in the HBO-PC group were much higher than those of the HAPE group(P<0.05,P<0.01).Lung injuries in the HAPE rats were related positively to the AQP5 expression in the lung(protein expression r=-0.635,P<0.01;mRNA expression r=-0.399,P<0.05).Conclusions We concluded that HBO-PC could alleviate lung injury in rats caused by high-altitude hypobaric hypoxia and reduce HAPE incidence.HAPE in rats was associated with the down-regulation of expression of AQP5 in the lungs.This down-egulation could be attenuated by HBO-PC.This study is the first one introducing HBO-PC in the prevention of HAPE,and the first investigation on the expression of AQP5 in a rat model of HAPE.

  18. Acute pulmonary admissions following implementation of a national workplace smoking ban.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-09-01

    The implementation of workplace smoking bans has contributed to a significant reduction in the incidence of acute coronary syndrome admissions, but their influence on adult acute pulmonary disease admissions is unclear. We sought to assess the impact of a national smoking ban on nationwide admissions of individuals of working age with acute pulmonary illness.

  19. Factors leading to poor outcome of noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    Ashok Kumar; Anoop Kumar; Kelash Rai; Shaista Ghazal; Nadeem Rizvi; Sunil Kumar; Sadhna Notani

    2015-01-01

    Objective:To determine frequency of factors leading to poor outcome of non-invasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease. Methods:This cross sectional study was conducted at our center between May 2012 and November 2012. A total of 195 diagnosed patients of acute exacerbation of chronic obstructive pulmonary disease meeting the inclusion criteria were selected from the ER department. At the time of admission age was inquired BP, respiratory rate and oxygen saturation will be noted and pedal edema was assessed and investigations were sent for pH assessment. Noninvasive positive pressure ventilation (NIPPV) using BiPAP was applied in spontaneous mode by the help of oronasal mask. Presence of respiratory rate (less than 12/min), systolic blood pressure140 bpm was taken as poor outcome. Results:The average age of the cases was 61.9±9.3 years with male to female ratio being 1.5:1. NIPPV was successful in 151 (77.4%) cases and 44 (22.6%) cases were underwent endotracheal intubation. About 38 (44.7%) of patients with oxygen saturation (82%-86%) had poor prognosis. A total of 40 (55.6%) of patients with pH range 7.20-7.26, required endotracheal intubation, 43 (66.2%) with pedal edema underwent endotracheal intubation. While 29 (24.16%) patients of age>60 years needed endotracheal intubation. Conclusions:In this study, NIPPV was successful in 77.4%cases and 22.6%cases were underwent endotracheal intubation. Pedal edema was the most common factor leading to poor outcomes while age>60 years was the least common factor, 66.2%and 24.2%respectively.

  20. Neurogenic pulmonary edema in children%小儿神经源性肺水肿

    Institute of Scientific and Technical Information of China (English)

    蔡栩栩; 刘春峰

    2007-01-01

    神经源性肺水肿(neurogenic pulmonarv edema,NPE)是指在无原发性心、肺和肾等疾病的情况下,由颅脑损伤或中枢神经系统(central nervoussystem,CNS)其他疾病引起的突发性颅内压增高而导致的急性肺水肿,称中枢性肺水肿。小儿NPE较成人相对少见,许多儿科临床医生对其缺乏认识。NPE起病急,治疗困难,病死率高(60%~100%),其临床过程和表现类似于急性呼吸窘迫综合征(acute respiratory distress syndrome.ARDS)。NPE还为CNS损伤后的肺部感染提供了一个易感环境,直接导致肺内氧弥散障碍,继而引起严重的低氧血症并加重脑的继发性损伤,成为影响患儿预后和导致患儿死亡的重要并发症之一。

  1. Pulmonary CT findings in acute mercury vapour exposure

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Manabu; Sato, Kimihiko; Heianna, Jyouiti; Hirano, Yoshinori; Omachi, Kohiti; Izumi, Jyunichi; Watarai, Jiro

    2001-01-01

    AIM: We describe the pulmonary computed tomography (CT) findings in acute mercury poisoning. MATERIALS AND METHODS: Initial (n= 8) and follow-up (n= 6) chest CT examinations in eight patients exposed to mercury vapour while cutting pipes in a sulphuric acid plant were reviewed. Of the eight patients, two were asymptomatic and had normal CT results, two were asymptomatic but had abnormalities on CT, and four had both acute symptoms and positive CT results. The patients were all men whose ages ranged from 37 to 54 years (mean, 49 years). RESULTS: Poorly defined nodules were present in five of six patients with positive CT findings, present alone in two patients or as part of a mixed pattern in three. They were random in distribution. Alveolar consolidation (n= 3) and areas of ground-glass opacity (n= 4) were observed and were more prominent in the most severely affected patients with the highest blood and urine level of mercury, predominantly in the upper and/or middle zone. These abnormal findings on CT resolved with (n= 1) or without (n= 5) steroid therapy. Pathological findings (n= 1) demonstrated acute interstitial changes predominantly with oedema. CONCLUSION: We report CT findings in eight patients acutely exposed to mercury vapour. The pulmonary injury was reversible on CT in these cases. Hashimoto, M. (2001)

  2. The susceptibility gene screening in a Chinese high-altitude pulmonary edema family by whole-exome sequencing.

    Science.gov (United States)

    Yingzhong, Yang; Yaping, Wang; Jin, Xu; Rili, Ge

    2017-02-20

    High-altitude pulmonary edema (HAPE) is one of idiopathic mountain sicknesses that occur in healthy lowlanders when they quickly ascend to altitudes exceeding 2500 m above sea levels within 1-7 days. Growing evidence suggests that genetics plays an important role in the risk of HAPE. In this study, we recruited a Chinese HAPE family and screened genetic variations in the 7 family members (including 6 family members with a medical history of HAPE and the propositus's mother) by whole-exome sequencing. The results showed 18 genetic variations (9 SNVs and 9 Indels) were related to HAPE. Two SNV sites (CFHR4 (p.L85F) and OXER1 (p.R176C)) were predicted to be damaging and alter protein functions by SIFT, PolyPhen-2 and PROVEAN software. The biological function of OXER1 was highly related to the hypoxia-inducible factor pathway. Therefore, those two sites were identified as candidate pathological variations. Moreover, other SNVs (NMB p.S150P, APOB p.I4194T, EIF4ENIF1 p.Q763P) and Indels (KCNJ12 p.EE333-334E, ANKRD31 p.LMN251-253LN, OR2A14 p.HFFC175-178HFC) were also predicted to be damaging as well, which also might be considered as potential candidate pathological variations related to HAPE. Collectively we firstly screened the susceptibility genes in a Chinese HAPE family by whole-exome sequencing, which will provide new clues for further mechanistic studies of HAPE.

  3. Analysis of CT signs of the sea drowning pulmonary edema CT sign analysis%海水淹溺肺水肿的CT征象分析

    Institute of Scientific and Technical Information of China (English)

    秦德宝

    2013-01-01

    目的 分析海水淹溺肺水肿的CT表现.方法 对17例海水淹溺者肺水肿的CT影像进行回顾性分析.结果 CT检查(淹溺后5h内)CT表现为两肺弥漫或呈“蝶翼”状分布的斑片状“磨玻璃”样高密度灶,其内可见密度更高的腺泡样结节灶.结论 CT检查可明确诊断海水淹溺肺水肿,为临床诊疗提供可靠依据.%Objective To analyze CT signs of the sea drowning pulmonary edema CT performance.Methods The CT images of 17 persons with the sea drowning person pulmonary edema of the CT images were retrospectively analyzed.Results CT examination was performed five hours (after drowning after five hours) CT performance for two pulmonary diffuse or show "butterfly" shape distribution of patchy "ground glass" sample high density stove,them visible density higher acini sample focal nodules.CT showed high density patchy shadows,which were diffused or presented in shape like "butterfly" or "ground glass" in both lungs.In addition,alveolar nodular sign with higher density appeared inside the focus.Conclusion CT examination can be identified the sea drowning pulmonary edema and,thus providing reliable basis for clinical diagnosis and treatment of this disorder.

  4. Electrical stimulation as a treatment intervention to improve function, edema or pain following acute lateral ankle sprains: A systematic review.

    Science.gov (United States)

    Feger, Mark A; Goetschius, John; Love, Hailey; Saliba, Sue A; Hertel, Jay

    2015-11-01

    The purpose of this systematic review was to assess whether electrical stimulation (ES), when used in conjunction with a standard treatment, can reduce levels of functional impairment, edema, and pain compared to a standard treatment alone, in patients following a lateral ankle sprain. We searched PubMed, CINAHL, SportDiscus, and Medline (OVID) databases through June 2014 using the terms "ankle sprain or ankle sprains or ligament injury or ligamentous injury," and "electric stimulation or electric stimulation or electrotherapy." Our search identified four randomized control trials, of which, neuromuscular ES and high-voltage pulsed stimulation were the only two ES modalities utilized. Effect sizes and 95% confidence intervals (CI) were estimated using Cohen's d for comparison between treatment groups. Three of four effect sizes for function had 95% CI that crossed zero. Twenty-four of the thirty-two effect sizes for edema had 95% CI that crossed zero. All effect sizes for pain had 95% CI that crossed zero. Therefore, the use of ES is not recommended as a means to improve function, reduce edema, or decrease pain in the treatment of acute lateral ankle sprains.

  5. Three cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation%肠道病毒71型感染首发肺水肿与肺出血三例报告

    Institute of Scientific and Technical Information of China (English)

    何时军; 王霞; 郑晓群; 王传夏; 黄爱蓉; 金益梅; 杨好妹; 周爱华

    2008-01-01

    Objective To investigate the clinical features of the enterovirus 71 ( EV71 ) infection complicated with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.Methods The medical records of three cases with EV71 infection were retrospectively reviewed for clinical manifestations, laboratory data, medications, and outcome.Results All the cases were infants and died of the infection. These infants had no skin or mucosal lesions, however, they had sudden onset of cyanosis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting. All these 3 cases were misdiagnosed and were treated for shock on admission. Pulmonary hemorrhage was not considered in any of the cases on admission. All the cases received tracheal intubation when foamy secretions were discharged from the mouth and nose of the patients and notable cyanosis occurred. After intubation, pink foamy fluid flew out from the endotracheal tube in all the 3 cases. The patients had hyperglycemia and limb weakness, two had tachycardia, and hypertension was found in one case. Chest X-ray showed bilateral or unilateral widespread air space opacity, but the cardiac size and shape were normal. All the patients had leukocytosis. Enterovirus 71 infection was confirmed by detection of specific nucleic acid sequences of the virus from throat swab and tracheal secretions samples and in one case in cerebrospinal fluid.Conclusions Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71 infection. The initial presentation was nonspecific with fever and vomiting, and sudden appearance of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness, which may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment.

  6. Fluid management in patients with neurogenic pulmonary edema%神经源性肺水肿的液体治疗策略探讨

    Institute of Scientific and Technical Information of China (English)

    冯艳; 于国东; 王华; 余英典; 卢毅荣; 刘占国; 常平

    2015-01-01

    Objective To characterize the disease ofneurogenic pulmonary edema (NPE),and to investigate the optimal fluid therapeutic strategy as well as to assess the role of extravascular lung water index (EVLWI) in management of fluid resuscitation.Methods Data of seven patients with NPE,admitted to our intensive care unit (ICU) from September 2012 to January 2014,were collected and analyzed retrospectively.The continuous cardiac output pulse indication (PICCO) monitoring was implemented as soon as the patients were admitted.Conservative fluid therapeutic strategy was adopted,targeting at decreasing EVLWI as the primary goal and maintaining normal blood volume or mean aortic pressure more than or equal to 65 mmHg as the secondary goal.The hemodynamic parameters and input and output volume of fluid,pulmonary vascular permeability index (PVPI),global end-diastolic volume index (GEDVI),extravascular lung water index (EVLW1),oxygenation index (PaO2/FiO2) and lactic acid (Lac) level,and the chest Ⅹ ray and cranial CT images were recorded and analyzed.The starting point of the record was defined as the time of NPE occurring,and the ending point as time of discharging from ICU or rectification of hypotension or pulmonary edema.Results In a lot of cases,NPE was secondary to severe traumatic brain injury or acute cerebrovascular diseases,concomitant with severe hypotensive shock and pulmonary capillary leakage with a mean PVPI value of 3.3±1.7.The mean fluid input in 7 patients was (2099±1146) mL/d,and the net fluid balance was achieved in a median of-250 mL/d.The mean value of GEDVI was maintained at a level of (727±149) mL/m2.The mean value of EVLWI declined gradually firom (18.0±7.0) mL/kg at the startting point to (10±4.3) mL/kg at the ending point of record,and 5 patients showed significant improvement in lung effusion and brain edema as being illustrated in the chest Ⅹ ray or CT images,1 died and the other abandoned therapy; the mean length of ICU stay was 9 days

  7. Attenuation of Acute Phase Injury in Rat Intracranial Hemorrhage by Cerebrolysin that Inhibits Brain Edema and Inflammatory Response.

    Science.gov (United States)

    Yang, Yang; Zhang, Yan; Wang, Zhaotao; Wang, Shanshan; Gao, Mou; Xu, Ruxiang; Liang, Chunyang; Zhang, Hongtian

    2016-04-01

    The outcome of intracerebral hemorrhage (ICH) is mainly determined by the volume of the hemorrhage core and the secondary brain damage to penumbral tissues due to brain swelling, microcirculation disturbance and inflammation. The present study aims to investigate the protective effects of cerebrolysin on brain edema and inhibition of the inflammation response surrounding the hematoma core in the acute stage after ICH. The ICH model was induced by administration of type VII bacterial collagenase into the stratum of adult rats, which were then randomly divided into three groups: ICH + saline; ICH + Cerebrolysin (5 ml/kg) and sham. Cerebrolysin or saline was administered intraperitoneally 1 h post surgery. Neurological scores, extent of brain edema content and Evans blue dye extravasation were recorded. The levels of pro-inflammatory factors (IL-1β, TNF-α and IL-6) were assayed by Real-time PCR and Elisa kits. Aquaporin-4 (AQP4) and tight junction proteins (TJPs; claudin-5, occludin and zonula occluden-1) expression were measured at multiple time points. The morphological and intercellular changes were characterized by Electron microscopy. It is found that cerebrolysin (5 ml/kg) improved the neurological behavior and reduced the ipsilateral brain water content and Evans blue dye extravasation. After cerebrolysin treated, the levels of pro-inflammatory factors and AQP4 in the peri-hematomal areas were markedly reduced and were accompanied with higher expression of TJPs. Electron microscopy showed the astrocytic swelling and concentrated chromatin in the ICH group and confirmed the cell junction changes. Thus, early cerebrolysin treatment ameliorates secondary injury after ICH and promotes behavioral performance during the acute phase by reducing brain edema, inflammatory response, and blood-brain barrier permeability.

  8. Acute pulmonary toxicity following inhalation exposure to aerosolized VX in anesthetized rats.

    Science.gov (United States)

    Peng, Xinqi; Perkins, Michael W; Simons, Jannitt; Witriol, Alicia M; Rodriguez, Ashley M; Benjamin, Brittany M; Devorak, Jennifer; Sciuto, Alfred M

    2014-06-01

    This study evaluated acute toxicity and pulmonary injury in rats at 3, 6 and 24 h after an inhalation exposure to aerosolized O-ethyl S-[2-(diisopropylamino)ethyl] methylphosphonothioate (VX). Anesthetized male Sprague-Dawley rats (250-300 g) were incubated with a glass endotracheal tube and exposed to saline or VX (171, 343 and 514 mg×min/m³ or 0.2, 0.5 and 0.8 LCt₅₀, respectively) for 10 min. VX was delivered by a small animal ventilator at a volume of 2.5 ml × 70 breaths/minute. All VX-exposed animals experienced a significant loss in percentage body weight at 3, 6, and 24 h post-exposure. In comparison to controls, animals exposed to 514 mg×min/m³ of VX had significant increases in bronchoalveolar lavage (BAL) protein concentrations at 6 and 24 h post-exposure. Blood acetylcholinesterase (AChE) activity was inhibited dose dependently at each of the times points for all VX-exposed groups. AChE activity in lung homogenates was significantly inhibited in all VX-exposed groups at each time point. All VX-exposed animals assessed at 20 min and 3, 6 and 24 h post-exposure showed increases in lung resistance, which was prominent at 20 min and 3 h post-exposure. Histopathologic evaluation of lung tissue of the 514 mg×min/m³ VX-exposed animals at 3, 6 and 24 h indicated morphological changes, including perivascular inflammation, alveolar exudate and histiocytosis, alveolar septal inflammation and edema, alveolar epithelial necrosis, and bronchiolar inflammatory infiltrates, in comparison to controls. These results suggest that aerosolization of the highly toxic, persistent chemical warfare nerve agent VX results in acute pulmonary toxicity and lung injury in rats.

  9. Acute hemodynamic response to vasodilators in primary pulmonary hypertension.

    Directory of Open Access Journals (Sweden)

    Kulkarni H

    1996-01-01

    Full Text Available Acute hemodynamic effects of high flow oxygen (O2 inhalation, sublingual isosorbide dinitrate (ISDN, intravenous aminophylline (AMN and sublingual nifedipine (NIF were studied in 32 patients with primary pulmonary hypertension (PPH. In 30 out of 32 patients the basal ratio of pulmonary to systemic vascular resistance (Rp/Rs was > 0.5 (mean = 0.77 +/- 0.20. Oxygen caused significant decrease in the mean resistance ratio to 0.68 +/- 0.20 (p = 0.005. ISDN, AMN and NIF caused increase in the resistance ratio to 0.79 +/- 0.26; 0.78 +/- 0.26; and 0.80 +/- 0.23 respectively. O2, ISDN, AMN and NIF caused a fall of Rp/Rs in 21 (65.6%, 10 (31.2%, 10(31.2% and 9(28.1% patients respectively. Thus, of the four drugs tested high flow O2 inhalation resulted in fall of Rp/Rs in two thirds of patients whereas ISDN, AMN and NIF caused a mean rise in Rp/Rs. One third of patients did respond acutely to the latter three drugs. Acute hemodynamic studies are useful before prescribing vasodilators in patients with PPH since more of the commonly used drugs like ISDN, AMN, NIF could have detrimental hemodynamic responses in some patients. However, great caution should be exercised before performing hemodynamic study as the procedure has definite mortality and morbidity.

  10. Surgical treatment of acute pulmonary embolism--a 12-year retrospective analysis

    DEFF Research Database (Denmark)

    Lehnert, Per; Møller, Christian H; Carlsen, Jørn

    2012-01-01

    Surgical embolectomy for acute pulmonary embolism (PE) is considered to be a high risk procedure and therefore a last treatment option. We wanted to evaluate the procedures role in modern treatment of acute PE....

  11. 高原肺水肿动物模型的初步建立%The primary estibalishment of rats model of high-altitude pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    张兆瑞; 张波; 何萍萍; 王东

    2011-01-01

    Objective: To estibalish the rats model of high-altitude pulmonary edema by putting Wistar rats in hypobaric chamber, and compare the severity of pulmonary edema in different hypoxia time. Methods: Male Wistar rats were randomly divided into three groups: control group, 24 h hypoxia group, 48 h hypoxia group. Except for the control group, rats in the other groups were put in hypobaric chamber for 24 h and 48 h to produce a rat model of high-altitude pulmonary edema (HAPE). The wet to dry ratio (W/D), lung oxide synthase (NOS), lung endothelin (ET-1) and histological measurements were conducted on each animal. Results: Compared with the control group, the W/D ratio and the ET-1 had significantly increased, the activity of NOS was lower significantly in the 24 h hypoxia group and 48 h hypoxia group, and they all had statistically significant differences (P<0.05). The interstitial pulmonary edema performance of the alvedar interval widened and interstitial hyperemia were found in the 24 h and 48 h hypoxia group. Comparied with the 24 h hypoxia group, the wet to dry ratio and the endothelin had significantly increased, the activity of NOS were significantly lower of the 48 h hypoxia group, and there was a statistically significant difference (P<005). Conclusion: The model of high altitude pulmonary interstitial edema is successful set up by putting the Wistar rats in hypobaric chamber for 24 h and 48 h, the severity of pulmonary edema in the 48 h hypoxia group is more serious than the 24 h hypoxia group, which is more suitable for reality research.%目的:通过模拟高原低压低氧环境,建立高原肺水肿大鼠动物模型,探讨低氧时间对大鼠肺水肿程度影响.方法:雄性Wistar大鼠随机分为3组,分别为对照组、24 h低氧组、48 h低氧组.比较大鼠肺湿干比、肺组织匀浆中一氧化氮合酶(NOS)、内皮素-1(ET-1)及肺组织病理形态学的变化.结果:与地面对照组比较,24 h低氧组与48 h低氧组大鼠肺

  12. The X-ray features of noncardiogenic pulmonary edema%非心源性肺水肿的X线影像表现

    Institute of Scientific and Technical Information of China (English)

    钱慎明; 沈海林; 王聚宝; 吴家林; 杜红娣; 周振堰; 钱春红

    2011-01-01

    Objective To investigate the X-ray features of noncardiogenic pulmonary edema (NCPE). Methods Data of 35 NCPE cases and chest racliographies were retrospectively analysised,of whom21 cases(60%) suffered from drowning, 9 cases(26%) from neurogenic pulmonary edema (NPE),2 cases(6%) from toxic pulmonary edema, 2 cases(6%) from organophosphorus pesticide poisoning, and 1 case (3%) from parquat intoxication. Results In early stage, chest radiographies showed pulmonary multiplied, thickened markings with punctiform vague shadows in 9(26 %) cases.In mid- to late stage, chest radiographies showed multiple patchy in 8(23%) cases, combined large shadows in 10 cases(29 % ), cloudy vague shadows in 5 cases( 14 %), and multiple tampon shadows in 3 cases(8. 5%). Cardiac shade was not changed on all chest radiographies. Conclusion Although the pathogenesis of NCPE are different, the final results are the same as increaed pulmonary capillary permeability, excessive lung blood volume, low plasma osmotic pressure, which leads to liquid infiltration of pulmonary alveoli and alveolar septum.%目的 探讨非心源性肺水肿(NCPE)的胸部X线影像表现.方法 回顾性分析35例NCPE患者胸片.其中,溺水后肺水肿21例(60%),神经源性肺水肿9例(26%),有害气体中毒性肺水肿2例(6%),有机磷农药中毒肺水肿2例(6%),百草枯中毒肺水肿1例(3%).结果 早期表现为两肺纹理增多、增粗、模糊或伴弥漫小点状模糊影9例(26%);中晚期表现为多发斑片状阴影8例(23%)或融合成大片状阴影10例(29%),云雾状模糊阴影5例(14%)及多发棉球状阴影3例(8.5%).所有病例均无心影改变.结论 各类NCPE的病理机制不尽相同,但最终均导致肺毛细血管渗透性改变,肺血容量过高,血浆渗透压过低等,液体渗入肺泡及肺泡间隙,形成弥漫性肺水肿.

  13. Neuroprotective effects of nimodipine and MK-801 on acute infectious brain edema induced by injection of pertussis bacilli to neocortex of rats

    Institute of Scientific and Technical Information of China (English)

    陈立华; 刘丽旭; 杨于嘉; 刘运生; 曹美鸿

    2003-01-01

    Objective: To explore the mechanism and type of acute infectious brain edema induced by injection of pertussis bacilli (PB) in rat neocortex, to study the neuroprotective effect of non-competitive antagonist of N-methl-D-aspartate ( NMDA ) receptor ( MK-801 ) and antagonist of Ca2+ channels ( nimodipine )on brain edema, and to investigate the relationship between percentage of water content and cytosolic free calcium concentration ([Ca2+]i) in synaptosomes or content of Evans Blue (EB).Methods: 95 SD rats were randomly divided into five groups, ie, normal control group, sham-operated control group, PB group, nimodipine treatment group and MK-801 pretreatment group. The acute infectious brain edema was induced by injection of PB into the rats. Quantitative measurements of water content and the concentration of EB were performed. [Ca2+]i was determined in calcium fluorescent indication Fura-2/AM loaded neuronal synaptosome with a spectrofluorophotometer. To observe the effect of MK-801 and nimodipine, we administered MK-801 48 hours and 24 hours before the injection of PB in MK-801 pretreatment group, and nimodipine after the injection of PB in nimodipine treatment group. The specific binding of NMDA receptor was measured with [3H]-MK-801 in the neuronal membrane of cerebral cortex. Results: The levels of water content and EB content of brain tissues, and [Ca2+]i in the neuronal synaptosomes increased more significantly in the PB-injected cerebral hemisphere in the PB group than those of normal control group and sham-operated control group (P0.05). Conclusions: The changes in the permeability of blood-brain barrier (BBB) and Ca2+-overload may participate in the pathogenesis of infectious brain edema. Treatment with nimodipine can dramatically reduce the damage of brain edema and demonstrate neuroprotective effect on brain edema by inhibiting the excess of Ca2+ influx and reducing the permeability of BBB. MK-801 pretreatment may inhibit the delayed Ca2+ influx into

  14. Pulmonary Thromboembolism Complicating Acute Pancreatitis With Pancreatic Ascites: A Series of 4 cases

    OpenAIRE

    Ruchir Patel; Nirav Pipaliya; Prateik Poddar; Vikas Pandey; Meghraj Ingle; Prabha Sawant

    2016-01-01

    Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among them, pulmonary thromboembolism is a very rare complication to be encountered with. We report four cases of acute pulmonary thromboembolism in patients with acute pancreatitis superimposed on chronic pancreatitis. All the patients had abdomina...

  15. Severity assessment of acute pulmonary embolism: evaluation using helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Collomb, D.; Paramelle, P.J.; Calaque, O. [Department of Radiology, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Bosson, J.L. [Department of Statistics and Vascular diseases, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Vanzetto, G. [Department of Cardiology, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Barnoud, D. [Department of Medical Intensive Care, CHU Grenoble, BP 218, BP 218, 38043, Grenoble Cedex (France); Pison, C. [Department of Pulmonary Medicine, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Coulomb, M.; Ferretti, G.

    2003-07-01

    The objective was to evaluate the helical CT (HCT) criteria that could indicate severe pulmonary embolism (PE). In a retrospective study, 81 patients (mean age 62 years) with clinical suspicion of PE explored by HCT were studied. The patients were separated into three different groups according to clinical severity and treatment decisions: group SPE included patients with severe PE based on clinical data who were treated by fibrinolysis or embolectomy (n=20); group NSPE included patients with non-severe PE who received heparin (n=30); and group WPE included patients without PE (n=31). For each patient we calculated a vascular obstruction index based on the site of obstruction and the degree of occlusion in the pulmonary artery. We noted the HCT signs, i.e., cardiac and pulmonary artery dimensions, that could indicate acute cor pulmonale. According to multivariate analysis, factors significantly correlated with the severity of PE were: the vascular obstruction index (group SPE: 54%; group NSPE: 24%; p<0.001); the maximum minor axis of the left ventricle (group SPE: 30.2 mm; group NSPE: 40.4 mm; p<0.001); the diameter of the central pulmonary artery (group SPE: 32.4 mm; group NSPE: 28.3 mm; p<0.001); the maximum minor axis of the right ventricle (group SPE: 47.5 mm; group NSPE: 42.7 mm; p=0.029); the right ventricle/left ventricle minor axis ratio (group SPE: 1.63; group NSPE: 1.09; p<0.0001). Our data suggest that hemodynamic severity of PE can be assessed on HCT scans by measuring four main criteria: the vascular obstruction index; the minimum diameter of the left ventricle; the RV:LV ratio; and the diameter of the central pulmonary artery. (orig.)

  16. The importance of serological assays in diagnosing acute pulmonary histoplasmosis

    Directory of Open Access Journals (Sweden)

    RS Freitas

    2009-01-01

    Full Text Available Histoplasmosis is a systemic mycosis caused by inhalation of Histoplasma capsulatum microconidia. The disease does not normally affect immunocompetent individuals after a single, transient inhalation exposure. However, longer exposure may cause chronic or disseminated acute pulmonary infection. Herein, we report the case of a 24-year-old immunocompetent patient, who presented fever, cough and dyspnea for one month. The chest radiography revealed interstitial infiltrate and diffuse micronodules. The patient reported having had close and prolonged contact with bats. Diagnosis was confirmed by positive double immunodifusion and immunoblotting assays. She was treated with ketoconazole (400 mg and there was complete resolution of the disease.

  17. Massive pulmonary embolism at the onset of acute promyelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Federica Sorà

    2016-07-01

    Full Text Available Life-threatening bleeding is a major and early complication of acute promyelocytic leukemia (APL, but in the last years there is a growing evidence of thromboses in  APL. We report the first case of a young woman with dyspnea as the first symptom of APL due to massive pulmonary embolism (PE successfully treated with thrombolysis for PE and heparin. APL has been processed with a combination of all-trans retinoic acid (ATRA and arsenic trioxide (ATO obtaining complete remission.

  18. 神经源性肺水肿的诊治进展%Progress and prospect of diagnosis and treatment for neurogenic pulmonary edema

    Institute of Scientific and Technical Information of China (English)

    常朋飞; 张磊; 孙世中

    2016-01-01

    神经源性肺水肿(neurogenic pulmonary edema,NPE)是指患者在无原发性心、肺、肾等疾病的情况下,由中枢神经系统疾病或损伤而引发的急性肺水肿.其特点是起病急骤、病程进展迅速、治疗困难,因此病死率极高.本文就NPE近几年的研究进展做一综述.

  19. Therapeutic experience of 86 cases of child high altitude pulmonary edema%小儿高原肺水肿86例治疗体会

    Institute of Scientific and Technical Information of China (English)

    王启海; 王栋军; 武春华

    2001-01-01

    @@ 小儿高原肺水肿(high altitude pulmonary edema,HAPE)是高原地区特有的、危及生命的急重病症之一.由于小儿本身的生理特点,小儿HAPE在临床表现及治疗上与成人HAPE有所不同,治疗效果与年龄、病情有一定关系.现将我院1990-01~2000-01收治的小儿高原肺水肿86例报告如下:

  20. Hemorrhagic Onset of Hemangioblastoma Located in the Dorsal Medulla Oblongata Presenting with Tako-Tsubo Cardiomyopathy and Neurogenic Pulmonary Edema: A Case Report

    Directory of Open Access Journals (Sweden)

    Masayuki Gekka

    2014-03-01

    Full Text Available Here, we present a case of dorsal medulla oblongata hemangioblastoma with fourth ventricular hemorrhage. A 23-year-old female developed sudden consciousness disturbance, and CT revealed hemorrhage in all cerebral ventricles and a hyperdense mass in the cisterna magna. Although the reddish tumor located in the dorsal medulla oblongata was successfully removed, she suffered from severe tako-tsubo cardiomyopathy (TTC and neurogenic pulmonary edema (NPE because of baroreflex failure and damage to the solitary tract nuclei. After intensive care for 12 weeks following surgery, she was discharged without any neurological or radiological deficits. Pathogenesis of TTC/NPE is discussed in this paper.

  1. ROCK2 and MYLK variants under hypobaric hypoxic environment of high altitude associate with high altitude pulmonary edema and adaptation

    Science.gov (United States)

    Pandey, Priyanka; Mohammad, Ghulam; Singh, Yogendra; Qadar Pasha, MA

    2015-01-01

    Objective To date, a major class of kinases, serine–threonine kinase, has been scantly investigated in stress-induced rare, fatal (if not treated early), and morbid disorder, high altitude pulmonary edema (HAPE). This study examined three major serine–threonine kinases, ROCK2, MYLK, and JNK1, along with six other genes, tyrosine hydroxylase, G-protein subunits GNA11 and GNB3, and alpha1 adrenergic receptor isoforms 1A, 1B, and 1D as candidate gene markers of HAPE and adaptation. Methods For this, 57 variants across these nine genes were genotyped in HAPE patients (n=225), HAPE controls (n=210), and highlanders (n=259) by Sequenom MS (TOF)-based MassARRAY® platform using iPLEX™ Gold technology. In addition, to study the gene expression, quantitative real-time polymerase chain reaction was performed in human peripheral blood mononuclear cells of the three study groups. Results A significant association was observed for C allele (ROCK2 single-nucleotide polymorphism, rs10929728) with HAPE (P=0.03) and C, T, and A alleles (MYLK single-nucleotide polymorphisms, rs11717814, rs40305, and rs820336) with both HAPE and adaptation (P=0.001, P=0.006, and P=0.02, respectively). ROCK2 88 kb GGGTTGGT haplotype was associated with lower risk of HAPE (P=0.0009). MYLK 7 kb haplotype CTA, composed of variant alleles, was associated with higher risk of HAPE (P=0.0006) and lower association with adaptation (P=1E–06), whereas haplotype GCG, composed of wild-type alleles, was associated with lower risk of HAPE (P=0.001) and higher association with adaptation (P=1E–06). Haplotype–haplotype and gene–gene interactions demonstrated a correlation in working of ROCK2 and MYLK. Conclusion The data suggest the association of ROCK2 with HAPE and MYLK with HAPE and adaptation in Indian population. The outcome has provided new insights into the physiology of HAPE and adaptation. PMID:26586960

  2. Interactions among vascular-tone modulators contribute to high altitude pulmonary edema and augmented vasoreactivity in highlanders.

    Directory of Open Access Journals (Sweden)

    Zahara Ali

    Full Text Available BACKGROUND: The interactions among various biomarkers remained unexplored under the stressful environment of high-altitude. Present study evaluated interactions among biomarkers to study susceptibility for high altitude pulmonary edema (HAPE in HAPE-patients (HAPE-p and adaptation in highland natives (HLs; both in comparison to HAPE-free sojourners (HAPE-f. METHODOLOGY/PRINCIPAL FINDINGS: All the subjects were recruited at 3500 m. We measured clinical parameters, biochemical levels in plasma and gene expression using RNA from blood; analyzed various correlations between and among the clinical parameters, especially arterial oxygen saturation (SaO(2 and mean arterial pressure (MAP and biochemical parameters like, asymmetric dimethylarginine (ADMA, serotonin (5-HT, 8-iso-prostaglandin F2α (8-isoPGF2α, endothelin-1 (ET-1, plasma renin activity (PRA, plasma aldosterone concentration (PAC, superoxide dismutase (SOD and nitric oxide (NO in HAPE-p, HAPE-f and HLs. ADMA, 5-HT, 8-isoPGF2α, ET-1 levels, and PAC were significantly higher (p0.05 lower in HLs than HAPE-f. The expression of respective genes differed in the three groups. In the correlations, SaO(2 inversely correlated with ADMA, 5-HT and 8-isoPGF2α and positively with SOD in HAPE-p (p≤0.009. MAP correlated positively with 5-HT and 8-isoPGF2α in HAPE-p and HLs (p ≤ 0.004. A strong positive correlation was observed between ADMA and 5-HT, 5-HT and 8-isoPGF2α (p≤0.001, whereas inverse correlation of SOD with ET-1 in HAPE-p and HLs (p ≤ 0.004, with 5-HT and 8-isoPGF2α in HAPE-p (p = 0.01 and with 5-HT in HLs (p = 0.05. CONCLUSIONS/SIGNIFICANCE: The interactions among these markers confer enhanced vascular activity in HLs and HAPE in sojourners.

  3. Interactions among Vascular-Tone Modulators Contribute to High Altitude Pulmonary Edema and Augmented Vasoreactivity in Highlanders

    Science.gov (United States)

    Ali, Zahara; Mishra, Aastha; Kumar, Rahul; Alam, Perwez; Pandey, Priyanka; Ram, Rekhbala; Thinlas, Tashi; Mohammad, Ghulam; Pasha, M. A. Qadar

    2012-01-01

    Background The interactions among various biomarkers remained unexplored under the stressful environment of high-altitude. Present study evaluated interactions among biomarkers to study susceptibility for high altitude pulmonary edema (HAPE) in HAPE-patients (HAPE-p) and adaptation in highland natives (HLs); both in comparison to HAPE-free sojourners (HAPE-f). Methodology/Principal Findings All the subjects were recruited at 3500 m. We measured clinical parameters, biochemical levels in plasma and gene expression using RNA from blood; analyzed various correlations between and among the clinical parameters, especially arterial oxygen saturation (SaO2) and mean arterial pressure (MAP) and biochemical parameters like, asymmetric dimethylarginine (ADMA), serotonin (5-HT), 8-iso-prostaglandin F2α (8-isoPGF2α), endothelin-1 (ET-1), plasma renin activity (PRA), plasma aldosterone concentration (PAC), superoxide dismutase (SOD) and nitric oxide (NO) in HAPE-p, HAPE-f and HLs. ADMA, 5-HT, 8-isoPGF2α, ET-1 levels, and PAC were significantly higher (p0.05) lower in HLs than HAPE-f. The expression of respective genes differed in the three groups. In the correlations, SaO2 inversely correlated with ADMA, 5-HT and 8-isoPGF2α and positively with SOD in HAPE-p (p≤0.009). MAP correlated positively with 5-HT and 8-isoPGF2α in HAPE-p and HLs (p≤0.004). A strong positive correlation was observed between ADMA and 5-HT, 5-HT and 8-isoPGF2α (p≤0.001), whereas inverse correlation of SOD with ET-1 in HAPE-p and HLs (p≤0.004), with 5-HT and 8-isoPGF2α in HAPE-p (p = 0.01) and with 5-HT in HLs (p = 0.05). Conclusions/Significance The interactions among these markers confer enhanced vascular activity in HLs and HAPE in sojourners. PMID:22984459

  4. Successful management of severe unilateral re-expansion pulmonary edema after mitral valve repair with mini-thoracotomy using extracorporeal membrane oxygenation.

    Science.gov (United States)

    Kitahara, Hiroto; Okamoto, Kazuma; Kudo, Mikihiko; Yoshitake, Akihiro; Hayashi, Kanako; Inaba, Yu; Ai, Kimiaki; Suzuki, Takeshi; Morisaki, Hiroshi; Shimizu, Hideyuki

    2017-03-01

    A 60-year-old man received mitral valve repair via right mini-thoracotomy, which was followed by unilateral re-expansion pulmonary edema on the right side and severe hemoptysis just after the surgery. Despite differential lung ventilation with unilateral high positive end expiratory pressure was initiated for the affected right lung, respiratory function did not improved and hemodynamics was collapsed in the next day. Veno-venous extracorporeal membrane oxygenation was initiated by cannulation of the right jugular and the left femoral vein. After pulmonary function recovered gradually, veno-venous extracorporeal membrane oxygenation was terminated on the fifth postoperative day. He was discharged in ambulatory condition on postoperative day 52.

  5. Edema pulmonar não cardiogênico após circulação extracorpórea Non-cardiogenic pulmonary edema after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    José Otávio C Auler Júnior

    1986-12-01

    Full Text Available O edema pulmonar não cardiogênico é uma complicação grave, de conhecimento recente, que se segue a cirurgias cardíacas com circulação extracorpórea. O quadro clínico é de instalação rápida, caracterizando-se, principalmente, por broncoespasmo, secreção sero-hemorrágica pelas vias aéreas e hipotensão arterial. O diagnóstico diferencial com insuficiência ventricular esquerda é realizado pela constatação de pressões normais, ou baixas, em território pulmonar e átrio esquerdo, sugerindo mecanismo de aumento súbito da permeabilidade capilar. Os autores relatam a ocorrência desta síndrome em 6 pacientes submetidos a operações cardíacas com circulação extracorpórea, tecendo considerações sobre os mecanismos fisiopatológicos aventados, meios de diagnóstico, terapêutica adotada, bem como os achados histopatológicos dos pacientes com má evolução.Non-cardiogenic pulmonary edema is a recently described serious complication which follows heart surgery under cardiopulmonary bypass. The onset of symptoms is rapid, with bronchospasm, sero-hemorrhagic secretion through the airways, and arterial hypotension. Differential diagnosis with left ventricular failure is obtained from the normal or low pressures in the pulmonary circulation. This points out to an increased vascular permeability as the main ethiological agent. The authors report the occurrence of this syndrome in six patients submitted to heart operations under cardiopulmonary bypass and discuss physiopathology, diagnosis, therapy and histopathological findings in patients with lethal evolution.

  6. 脓胸——术后——复张性肺水肿%Reexpansion pulmonary edema after extended dissection of empyema

    Institute of Scientific and Technical Information of China (English)

    张宝岭; 景亮

    2010-01-01

    此案报告63岁老年女性患左侧脓胸,实施脓胸扩清术发生复张性肺水肿(reexpansion pulmonary edema,RPE)的诊疗过程.在给予患者限制液体入量、利尿及药物治疗后,患者病情得到稳定和改善.RPE是胸科手术少见的术后并发症,鉴于其突发性以及存在不同程度的低氧血症、低血压或休克,对其诊断和处理应引起麻醉医师的重视.%This case report describes the management of a 63-year-old woman who suffered from left thoracic empyema and developed reexpansion pulmonary edema(RPE) after surgery. The patient was gettting better and recovered to a stable condition after the treatment of fluid restriction, diuretic and other drug therapy.. RPE is a rare postoperative complication of thoracic surgery, but develops very rapidly and can cause hypoxemia, hypotension or shock, so more attention should be paid to its diagnosis and management.

  7. Non-cardiogenic pulmonary edema and life-threatening shock due to calcium channel blocker overdose: a case report and clinical review.

    Science.gov (United States)

    Siddiqi, Tauseef Afaq; Hill, Jennifer; Huckleberry, Yvonne; Parthasarathy, Sairam

    2014-02-01

    Calcium channel blockers (CCBs) overdose can be life-threatening when manifest as catastrophic shock and non-cardiogenic pulmonary edema. We describe a case of massive overdose of multiple medications, including sustained-release verapamil, which was resistant to conventional support. Initial treatment for CCB overdose is primarily supportive, and includes fluid resuscitation. The mechanism of non-cardiogenic pulmonary edema is not well known, and reported cases have been successfully treated with mechanical ventilation. Circulatory shock may fail to respond to atropine, glucagon, and calcium in severely poisoned patients, and vasopressors are usually required. Attempting to overcome calcium-channel antagonism with the supra-therapeutic doses of calcium salts is clinically indicated to reverse hypotension and bradycardia. There is evidence that hyperinsulinemia-euglycemia therapy is superior to other therapies for CCB poisoning, and the mechanism is thought to be the insulin-mediated active transport of glucose into the cells, which counters the CCB-induced intra-cellular carbohydrate-deficient state. Conventional decontamination measures are ineffective in accelerating clearance of CCB. Experience with intravenous lipid emulsion for lipophilic drug overdose, such as verapamil, is limited, but has been proposed as a rescue therapy and might improve cardiac inotropy through intravascular sequestration of the lipophilic CCB.

  8. Activation of MTOR in pulmonary epithelium promotes LPS-induced acute lung injury.

    Science.gov (United States)

    Hu, Yue; Lou, Jian; Mao, Yuan-Yuan; Lai, Tian-Wen; Liu, Li-Yao; Zhu, Chen; Zhang, Chao; Liu, Juan; Li, Yu-Yan; Zhang, Fan; Li, Wen; Ying, Song-Min; Chen, Zhi-Hua; Shen, Hua-Hao

    2016-12-01

    MTOR (mechanistic target of rapamycin [serine/threonine kinase]) plays a crucial role in many major cellular processes including metabolism, proliferation and macroautophagy/autophagy induction, and is also implicated in a growing number of proliferative and metabolic diseases. Both MTOR and autophagy have been suggested to be involved in lung disorders, however, little is known about the role of MTOR and autophagy in pulmonary epithelium in the context of acute lung injury (ALI). In the present study, we observed that lipopolysaccharide (LPS) stimulation induced MTOR phosphorylation and decreased the expression of MAP1LC3B/LC3B (microtubule-associated protein 1 light chain 3 β)-II, a hallmark of autophagy, in mouse lung epithelium and in human bronchial epithelial (HBE) cells. The activation of MTOR in HBE cells was mediated by TLR4 (toll-like receptor 4) signaling. Genetic knockdown of MTOR or overexpression of autophagy-related proteins significantly attenuated, whereas inhibition of autophagy further augmented, LPS-induced expression of IL6 (interleukin 6) and IL8, through NFKB signaling in HBE cells. Mice with specific knockdown of Mtor in bronchial or alveolar epithelial cells exhibited significantly attenuated airway inflammation, barrier disruption, and lung edema, and displayed prolonged survival in response to LPS exposure. Taken together, our results demonstrate that activation of MTOR in the epithelium promotes LPS-induced ALI, likely through downregulation of autophagy and the subsequent activation of NFKB. Thus, inhibition of MTOR in pulmonary epithelial cells may represent a novel therapeutic strategy for preventing ALI induced by certain bacteria.

  9. Complete Heart Block with Diastolic Heart Failure and Pulmonary Edema Secondary to Enlarging Previously Diagnosed Thrombosed Aneurysm of Sinus of Valsalva in a Patient with History of Autosomal Dominant Polycystic Kidney Disease

    Science.gov (United States)

    Eltawansy, Sherif Ali; Thomas, Maria Joana; Daniels, Jeffrey

    2015-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is associated with vascular aneurysms that can affect any part of the vascular tree, like ascending aorta or coronary arteries. Sinus of Valsalva is known as an anatomical dilation at the root of aorta above the aortic valve and very few cases show aneurysm at that site in patients with ADPKD. Sinus of Valsalva aneurysm (SVA) can present with rupture and acute heart failure and infective endocarditis or could be asymptomatic accidentally discovered during cardiac catheterization. We report a case of a 76-year-old male with a unique constellation of cardiovascular anomalies associated with ADPKD. Patient was previously diagnosed with aneurysms affecting ascending aorta, sinus of Valsalva, and coronary arteries. Several years later, he came with complete heart block which was discovered later to be secondary to enlargement of his previously diagnosed thrombosed SVA. His case was complicated with acute heart failure and pulmonary edema. Conclusion. Patients with ADPKD can present with extrarenal manifestations. In our case, aneurysm at sinus of Valsalva was progressively enlarging and presented with complete heart block. PMID:25861484

  10. Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness.

    Science.gov (United States)

    Louge, Pierre; Coulange, Mathieu; Beneton, Frederic; Gempp, Emmanuel; Le Pennetier, Olivier; Algoud, Maxime; Dubourg, Lorene; Naibo, Pierre; Marlinge, Marion; Michelet, Pierre; Vairo, Donato; Kipson, Nathalie; Kerbaul, François; Jammes, Yves; Jones, Ian M; Steinberg, Jean-Guillaume; Ruf, Jean; Guieu, Régis; Boussuges, Alain; Fenouillet, Emmanuel

    2016-06-01

    Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder.Thirty-one patients (19 IPE, 12 DCS) treated at the Hyperbaric Medicine Department (Ste-Anne hospital, Toulon, France; July 2013-June 2014) were recruited into the study. Ten healthy divers were recruited as controls. We tested: (i) copeptin, a surrogate marker for antidiuretic hormone and a stress marker; (ii) ischemia-modified albumin, an ischemia/hypoxia marker; (iii) brain-natriuretic peptide (BNP), a marker of heart failure, and (iv) ultrasensitive-cardiac troponin-I (cTnI), a marker of myocardial ischemia.We found that copeptin and cardiac biomarkers were higher in IPE versus DCS and controls: (i) copeptin: 68% of IPE patients had a high level versus 25% of DCS patients (P < 0.05) (mean ± standard-deviation: IPE: 53 ± 61 pmol/L; DCS: 15 ± 17; controls: 6 ± 3; IPE versus DCS or controls: P < 0.05); (ii) ischemia-modified albumin: 68% of IPE patients had a high level versus 16% of DCS patients (P < 0.05) (IPE: 123 ± 25 arbitrary-units; DCS: 84 ± 25; controls: 94 ± 7; IPE versus DCS or controls: P < 0.05); (iii) BNP: 53% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 383 ± 394 ng/L; DCS: 37 ± 28; controls: 19 ± 15; IPE versus DCS or controls: P < 0.01); (iv) cTnI: 63% of IPE patients had a high

  11. Image analysis of 88 cases with high altitude pulmonary edema%高原性肺水肿88例影像分析

    Institute of Scientific and Technical Information of China (English)

    高生江

    2012-01-01

    目的 探讨高原性肺水肿(high altitude pulmonary edema,HAPE)患者的临床影像学特征及影像诊断价值.方法 对88例HAPE患者临床影像学资料进行回顾性分析研究.结果 88例HAPE影像表现为单侧或双侧肺毛玻璃状、斑片状、片状影、肺门区团片状影、弥漫性实变影等,常合并出现,以右侧多见;肺门改变可正常或模糊、增大;可伴叶间裂增厚.结论 影像检查是诊断HAPE的简捷可靠的诊断手段,尤其是X线平片可作为HAPE的首选检查,胸部CT检查可对其作出早期诊断并作为重要的补充检查手段.%Objective To explore the imaging features of patients with high altitude pulmonary edema (HAPE) and their diagnostic value . Methods Clinical imaging data of 88 patiekts with HAPE were retrospectively analyzed. Results Images of 88 cases of HAPE showed unilateral or bilateral pulmonary ground-glass-like, patchy, patchy, group patchy hilar region, diffuse opacities, etc. , which were often associated with the emergence of the right side of the more common. Hilar changes may be normal or ambiguous or increase, which may be associated with interlobar fissure thickening. Conclusion The imaging diagnosis of HAPE is the simple and reliable diagnostic tools, especially, the X-ray can be used as the first choice for HAPE. Chest CT can make early diagnosis and its complement as an important means of inspection.

  12. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Ferreira Vanessa M

    2012-06-01

    Full Text Available Abstract Background T2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR. Methods We investigated 21 controls (55 ± 13 years and 21 patients (61 ± 10 years with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI ratio relative to both skeletal muscle and remote myocardium. Results All patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p  Conclusions Non-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis.

  13. Searches analyzes the pulmonary edema, the pulmonary embolism in the clinical anaesthesia question processing%探析肺水肿、肺栓塞在临床麻醉中问题的处理

    Institute of Scientific and Technical Information of China (English)

    王友胜

    2011-01-01

    肺水肿(pulmonary edema)系指肺毛细血管内液体浸人到肺组织所造成的肺气体弥散障碍,引起呼吸困难及泡沫样痰(无色或粉红色粘液),其基本生理功能紊乱为体液从肺毛细血管渗出速度超过了肺淋巴管所能吸收的速度,使大量渗出液积聚于肺间质及肺泡.

  14. Syncope as a presentation of acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Altınsoy B

    2016-06-01

    Full Text Available Bülent Altınsoy, Fatma Erboy, Hakan Tanrıverdi, Fırat Uygur, Tacettin Örnek, Figen Atalay, Meltem Tor Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey Purpose: Syncope is an atypical presentation for acute pulmonary embolism (APE. There are conflicting data concerning syncope and prognosis of APE. Patients and methods: One hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years with APE were retrospectively enrolled in the study. Results: Prevalence of syncope was 13% (n=23 at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002, right ventricular dysfunction (91% vs 68%, P=0.021, and troponin positivity (80% vs 39%, P=0.001 but not 30-day mortality (13% vs 10%, P=0.716. Multivariate analysis showed that central localization (odds ratio: 9.08 and cardiac troponin positivity (odds ratio: 4.67 were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively, although not significant. Conclusion: Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy. Keywords: syncope, prognosis, pulmonary embolism, mortality rate, compression sonography, right ventricular dysfunction

  15. Rosette nanotubes show low acute pulmonary toxicity in vivo

    Directory of Open Access Journals (Sweden)

    W Shane Journeay

    2008-10-01

    Full Text Available W Shane Journeay1, Sarabjeet S Suri1, Jesus G Moralez2, Hicham Fenniri2, Baljit Singh11Immunology Research Group, Toxicology Graduate Program and Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada; 2National Institute of Nanotechnology, National Research Council (NINT-NRC and Department of Chemistry, University of Alberta, 11421 Saskatchewan Drive, Edmonton, AB, T6G 2M9, CanadaAbstract: Nanotubes are being developed for a large variety of applications ranging from electronics to drug delivery. Common carbon nanotubes such as single-walled and multi-walled carbon nanotubes have been studied in the greatest detail but require solubilization and removal of catalytic contaminants such as metals prior to being introduced to biological systems for medical application. The present in vivo study characterizes the degree and nature of inflammation caused by a novel class of self-assembling rosette nanotubes, which are biologically inspired, naturally water-soluble and free of metal content upon synthesis. Upon pulmonary administration of this material we examined responses at 24 h and 7d post-exposure. An acute inflammatory response is triggered at 50 and 25 μg doses by 24 h post-exposure but an inflammatory response is not triggered by a 5 μg dose. Lung inflammation observed at a 50 μg dose at 24 h was resolving by 7d. This work suggests that novel nanostructures with biological design may negate toxicity concerns for biomedical applications of nanotubes. This study also demonstrates that water-soluble rosette nanotube structures represent low pulmonary toxicity, likely due to their biologically inspired design, and their self-assembled architecture.Keywords: nanotoxicology, biocompatibility, nanomedicine, pulmonary drug delivery, lung inflammation

  16. Pulmonary Surfactants for Acute and Chronic Lung Diseases (Part II

    Directory of Open Access Journals (Sweden)

    O. A. Rozenberg

    2014-01-01

    Full Text Available Part 2 of the review considers the problem of surfactant therapy for acute respiratory distress syndrome (ARDS in adults and young and old children. It gives information on the results of surfactant therapy and prevention of ARDS in patients with severe concurrent trauma, inhalation injuries, complications due to complex expanded chest surgery, or severe pneumonias, including bilateral pneumonia in the presence of A/H1N1 influenza. There are data on the use of a surfactant in obstetric care and prevention of primary graft dysfunction during lung transplantation. The results of longterm use of surfactant therapy in Russia, suggesting that death rates from ARDS may be substantially reduced (to 20% are discussed. Examples of surfactant therapy for other noncritical lung diseases, such as permanent athelectasis, chronic obstructive pulmonary diseases, and asthma, as well tuberculosis, are also considered.

  17. Analysis for reexpansion pulmonary edema following thoracotomy%开胸术后复张性肺水肿的探讨

    Institute of Scientific and Technical Information of China (English)

    刘洪; 赵凤瑞; 郭作文; 刘德若; 张银合; 张伟

    2001-01-01

    目的:探讨开胸手术中单侧肺萎陷、术后肺复张导致急性肺水肿的发病机理、诊断治疗及预防。方法:对5例开胸术后复张性肺水肿患者进行总结,3例为胸腔镜辅助下胸膜固定术后,2例为食管癌根治术后。结果:常规单侧肺萎陷的开胸手术均可能发生轻重不一的复张性肺水肿。结论:可通过术中定期(以间隔30 min为宜)肺复张以及术后渐进性肺复张等措施来减低复张性肺水肿的发生率。%Objective:To investigate the principle of diagnosis,treatment and prevention of reexpansion pulmonary edema(RPE)following thoracotomy.The lung had been shrunk in these operations.Methods:Five patients got RPE,three of those were performed the pleurodesis with thoracoscope,and two patients were performed esophagectomy for treatment of esophageal carcinoma.Results:RPE related to the pulmonary shrink,for the shrinkable pulmonary tissues was hypoxemic and increased the permeability of the pulmonary capillary,hence caused RPE.The pulmonary shirnk caused a greater or lesser degree of RPE in conventional thoracotomy.Conclusion:To reduce the incidence of RPE,it is important to expand the lung intermittently and slowly during operation.

  18. Acute pulmonary embolism | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available the Trial E.1 Medical condition or disease under investigation E.1.1Medical condition(s) being investigated Acute... pulmonary embolism Embolismo pulmonar agudo E.1.1.1Medical condition in easily understood language Acute...rial contains a sub-study No E.3Principal inclusion criteria 1) Acute symptomatic PE confirmed by multidetec

  19. Management of three cardiogenic pulmonary edemas occurring in a patient scheduled for left ventricular assist device implantation: indicators for determining left ventricular assist device pump speed.

    Science.gov (United States)

    Toyama, Hiroaki; Takei, Yusuke; Saito, Kazutomo; Ota, Takahisa; Kurotaki, Kenji; Ejima, Yutaka; Matsuura, Takeshi; Akiyama, Masatoshi; Saiki, Yoshikatsu; Yamauchi, Masanori

    2016-08-01

    A male patient with Marfan syndrome underwent aortic root replacement and developed left ventricular (LV) failure. Four years later, he underwent aortic arch and aortic valve replacement. Thereafter, his LV failure progressed, and cardiogenic pulmonary edema (CPE) appeared, which we treated with extracorporeal LV assist device (LVAD) placement. Three months later, the patient developed aspiration pneumonia, which caused hyperdynamic right ventricle (RV) and CPE. We treated by changing his pneumatic LVAD to a high-flow centrifugal pump. A month later, he underwent thoracoabdominal aortic replacement. After four weeks, he developed septic thrombosis and LVAD failure, which caused CPE. We treated with LVAD circuit replacement and an additional membrane oxygenator. Four months later, he underwent DuraHeart(®) implantation. During this course, pulmonary artery wedge pressure (PAWP) varied markedly. Additionally, systolic pulmonary artery pressure (sPAP), left atrial diameter (LAD), RV end-diastolic diameter (RVEDD) and estimated RV systolic pressure (esRVP) changed with PAWP changes. In this patient, LV failure and hyperdynamic RV caused the CPEs, which we treated by adjusting the LVAD output to the RV output. Determining LVAD output, RV function and LV end-diastolic diameter are typically referred, and PAWP, LAD, RVEDD, and sPAP could be also referred.

  20. Comparison Between the Acute Pulmonary Vascular Effects of Oxygen with Nitric Oxide and Sildenafil

    Directory of Open Access Journals (Sweden)

    Ronald W. Day

    2015-03-01

    Full Text Available Objective. Right heart catheterization is performed in patients with pulmonary arterial hypertension to determine the severity of disease and their pulmonary vascular reactivity. The acute pulmonary vascular effect of inhaled nitric oxide is frequently used to identify patients who will respond favorably to vasodilator therapy. This study sought to determine whether the acute pulmonary vascular effects of oxygen with nitric oxide and intravenous sildenafil are similar. Methods. A retrospective, descriptive study of 13 individuals with pulmonary hypertension who underwent heart catheterization and acute vasodilator testing was performed. The hemodynamic measurements during five phases (21% to 53% oxygen, 100% oxygen, 100% oxygen with 20 ppm nitric oxide, 21% to 51% oxygen, and 21% to 51% oxygen with 0.05 mg/kg to 0.29 mg/kg intravenous sildenafil of the procedures were compared.Results. Mean pulmonary arterial pressure and pulmonary vascular resistance acutely decreased with 100% oxygen with nitric oxide, and 21% to 51% oxygen with sildenafil. Mean pulmonary arterial pressure (mm Hg, mean ± standard error of the mean was 38 ± 4 during 21% to 53% oxygen, 32 ± 3 during 100% oxygen, 29 ± 2 during 100% oxygen with nitric oxide, 37 ± 3 during 21% to 51% oxygen, and 32 ± 2 during 21% to 51% oxygen with sildenafil. There was not a significant correlation between the percent change in pulmonary vascular resistance from baseline with oxygen and nitric oxide, and from baseline with sildenafil (r2 = 0.011, p = 0.738. Conclusions. Oxygen with nitric oxide and sildenafil decreased pulmonary vascular resistance. However, the pulmonary vascular effects of oxygen and nitric oxide cannot be used to predict the acute response to sildenafil. Additional studies are needed to determine whether the acute response to sildenafil can be used to predict the long-term response to treatment with an oral phosphodiesterase V inhibitor.

  1. Pathogenic aspects of pulmonary complications in acute pancreatitis patients

    Institute of Scientific and Technical Information of China (English)

    Serge Chooklin

    2009-01-01

    BACKGROUND: Experimental and clinical observations show that proinlfammatory cytokines and oxidative stress are involved in the development of local and particularly systemic complications in acute pancreatitis (AP) patients. There are often pulmonary complications in such patients. The mechanisms through which lung injury is induced in AP are not fully clear. METHODS: In order to assess the role of activated neutrophils, pro- and anti-inlfammatory cytokines and adhesion molecules at the onset and development of respiratory complications and respiratory failure, we measured the serum levels of pro-inlfammatory (IL-1β, IL-6, IL-8, IL-18, TNF-α) and anti-inlfammatory (IL-1ra, IL-10) cytokines in 51 AP patients who had been diagnosed with pancreatitis-associated lung injury with and without the development of organ dysfunction. RESULTS: When admitted to the hospital, severe AP patients had increased concentrations of IL-1β, IL-6, IL-8, IL-18, and TNF-α. The concentration of IL-18 alone was considerably increased in the patients who later developed respiratory failure. The onset of acute respiratory distress syndrome in the AP patients was accompanied by an increase in the level of anti-inlfammatory cytokines, especially IL-10. It was noted that in severe lung injury, myeloperoxidase activity in the blood increased signiifcantly, but still relfected the processes taking place in the lung parenchyma. Increase in the concentrations of adhesion molecules preceded the development of pulmonary inifltration with respiratory failure symptoms, which provoked endothelial dysfunction and determined the capillary surface permeability for neutrophils and monocytes.CONCLUSIONS: In the pathogenesis of respiratory complications in AP cytokines, chemokines and adhesion molecules, in particular IL-1β, IL-6, IL-8, IL-18, TNF-α, ICAM-1, and E-selectin play major roles. At IL-18 concentrations >650 pg/ml, AP patients are likely to develop pulmonary dysfunction (sensitivity

  2. Clinical and morphologic features of acute, subacute and chronic cor pulmonale (pulmonary heart disease).

    Science.gov (United States)

    Roberts, William Clifford; Shafii, Alexis E; Grayburn, Paul A; Ko, Jong Mi; Weissenborn, Matthew R; Rosenblatt, Randall L; Guileyardo, Joseph M

    2015-03-01

    Described are certain clinical and morphologic features of one patient with acute, another with subacute, and one with chronic cor pulmonale. All 3 had evidence of severe pulmonary hypertension. The patient with acute cor pulmonale 4 days after coronary bypass for unstable angina pectoris suddenly developed severe breathlessness with cyanosis and had fatal cardiac arrest and necropsy disclosed massive pulmonary embolism. The patient with subacute cor pulmonale had severe right-sided heart failure for 5 weeks and necropsy disclosed microscopic-sized neoplastic pulmonary emboli from a gastric carcinoma without parenchymal pulmonary metastases. The patient with chronic cor pulmonale had evidence of right-sided heart failure for years, the result of primary or idiopathic pulmonary hypertension almost certainly present from birth because the pattern of elastic fibers in the pulmonary trunk was that seen in newborns where the pressure in the pulmonary trunk and ascending aorta are similar. The patient with chronic cor pulmonale had plexiform pulmonary lesions indicative of irreversible pulmonary hypertension. Neither the acute nor the subacute patient had chronic pulmonary vascular changes. All 3 patients had dilated right ventricular cavities and non-dilated left ventricular cavities and only the patient with chronic cor pulmonale had right ventricular hypertrophy.

  3. Prevention and management of brain edema in patients with acute liver failure

    DEFF Research Database (Denmark)

    Wendon, J.; Larsen, Finn Stolze

    2008-01-01

    ) and an increase in cerebral blood flow while the cerebrospinal fluid volume remains constant. 3. The development of intracranial hypertension in patients with acute liver failure may be controlled by manipulation of the position, body temperature, plasma tonicity, arterial carbon dioxide tension, and arterial...

  4. Mental States of Patients with Pulmonary Edema on Plateau%高原肺水患者心理状态测评

    Institute of Scientific and Technical Information of China (English)

    任雨笙; 苻中明; 陈玉玲; 杨芬; 达文玲; 赵庆辉

    2001-01-01

    @@ 高原肺水肿(high altitude pulmonary edema,HAPE)是高原急危重病症之一,由于运输条件的改善,从低海拔地区急进高原的人数增多,患高原适应不全的人数较以往增多[1].高原环境对人们的生理、心理均产生多方面的影响.本文对在我院(海拔3600m)确诊为HAPE的住院患者采用HAMD量表[2]进行了测定,其中男性1 24例,女性28例,平均年龄26.53±8.41岁.

  5. Curing and progress of the plateau pulmonary edema%高原肺水肿的治疗及其进展

    Institute of Scientific and Technical Information of China (English)

    廖国云; 牟信兵

    2003-01-01

    @@ 高原肺水肿(High altitude pulmonary edema)是由于机体对高原低压性缺氧环境不适应,而引起肺动脉压突然升高,肺循环血量增加,肺毛细血管内皮和肺泡上皮细胞受损、通透性增强,以及体液潴留及转移,导致液体自肺毛细血管漏至肺间质或(和)肺泡而引起的一种高原特发病,是高原病中的急重症之一,若救治不及时,常危及患者生命.

  6. β-Dystroglycan cleavage by matrix metalloproteinase-2/-9 disturbs aquaporin-4 polarization and influences brain edema in acute cerebral ischemia.

    Science.gov (United States)

    Yan, W; Zhao, X; Chen, H; Zhong, D; Jin, J; Qin, Q; Zhang, H; Ma, S; Li, G

    2016-06-21

    Dystroglycan (DG) is widely expressed in various tissues, and throughout the cerebral microvasculature. It consists of two subunits, α-DG and β-DG, and the cleavage of the latter by matrix metalloproteinase (MMP)-2 and -9 underlies a number of physiological and pathological processes. However, the involvement of MMP-2/-9-mediated β-DG cleavage in cerebral ischemia remains uncertain. In astrocytes, DG is crucial for maintaining the polarization of aquaporin-4 (AQP4), which plays a role in the regulation of cytotoxic and vasogenic edema. The present study aimed to explore the effects of MMP-2/-9-mediated β-DG cleavage on AQP4 polarization and brain edema in acute cerebral ischemia. A model of cerebral ischemia was established via permanent middle cerebral artery occlusion (pMCAO) in male C57BL/6 mice. Western blotting, real-time polymerase chain reaction (PCR), immunohistochemical staining, immunofluorescent staining, electron microscopy, and light microscopy were used. Captopril was applied as a selective MMP-2/-9 inhibitor. Recombinant mouse MMP (rmMMP)-2 and -9 were used in an in vitro cleavage experiment. The present study demonstrated evidence of β-DG cleavage by MMP-2/-9 in pMCAO mouse brains; this cleavage was implicated in AQP4 redistribution and brain edema in cerebral ischemia. In addition, captopril exacerbated cytotoxic edema and ameliorated vasogenic edema at 24h after pMCAO, and alleviated brain edema and neurological deficit at 48h and 72h. In conclusion, this study provides novel insight into the effects of MMP-2/-9-mediated β-DG cleavage in acute cerebral ischemia. Such findings might facilitate the development of a therapeutic strategy for the optimization of MMP-2/-9 targeted treatment in cerebral ischemia.

  7. Time course of pulmonary vascular response to an acutely repetitive pulmonary microembolism in dogs--an analysis using pulmonary vascular impedance.

    Science.gov (United States)

    Tobise, K; Tosaka, S; Onodera, S

    1992-05-01

    To understand the mechanism leading to progressive pulmonary hypertension, we investigated the time course of vascular response to an acutely repetitive pulmonary microembolism in dogs by using pulmonary vascular impedance. In a normal state, the mean pulmonary arterial pressure (mPAP) was transiently increased by emboli, and the impedance moduli of 0 Hz (= Rin), 1.5 Hz and 3 Hz were slightly increased. A four-element electrical vascular model showed the transient increase in peripheral pulmonary vascular resistance (R2) and inertia, and reduction in compliance (C). In contrast, in a state of a slight pulmonary hypertension, mPAP was continuously increased by the same amount of emboli, and the impedance moduli of both 0 Hz and 3 Hz were significantly increased. By a four-element model, a severe increase in R2 and reduction in C were observed, and these changes continued. Therefore, although the vascular response to pulmonary microembolism basically depends on the degree of mechanical obstruction, this response is thought to be modulated by the responsiveness of pulmonary vessels at that time, which is involved in the alteration in the local characteristics of pulmonary vessels, and/or the recruitment of a new blood flow.

  8. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, Apostolos H. [Department of Radiology, University of Crete, Heraklion 711 10 Greece (Greece)], E-mail: apolsen@yahoo.com; Drakonaki, Elena [Department of Radiology, University of Crete, Heraklion 711 10 Greece (Greece); Karachalios, Theophilos [Department of Orthopaedic Surgery, University of Thessaly, Larissa 411 10 Greece (Greece); Korompilias, Anastasios V. [Department of Orthopaedic Surgery, University of Ioannina, Ioannina 451 10 (Greece); Malizos, Konstantinos [Department of Orthopaedic Surgery, University of Thessaly, Larissa 411 10 Greece (Greece)

    2008-07-15

    Purpose: The aim of the study was to present the MRI findings of non-traumatic edema-like lesions presented acutely in the adult knee and to correlate them with the 3-year outcome and the bone mineral density (BMD) in the spine. Materials and methods: Ninety-eight patients (40 men, 58 women, mean age 60.1 {+-} 11 years, age range 27-82 years), were followed up clinically as well as with MR imaging, when indicated, for at least 3 years. Patients were classified according to presentation in 3 groups (A: bone marrow edema (BME), B: BME and subchondral fracture, C: BME and articular collapse) and according to outcome in 2 groups (A: reversible BME, B: articular collapse). BMD measurements of the spine were carried out in males over 70 and females over 60 years old using DEXA. Results: The isolated BME pattern was observed in 64.3% (Group A), subchondral fractures without articular collapse in 11.2% (Group B) and articular collapse in 24.5% (Group C). Significant differences were found among the 3 groups at presentation, regarding the age, sex, BMD, affected area and duration of symptoms prior to imaging (p < 0.05). Localization of the lesions in the weight-bearing areas of the knee was shown in 100% of C, in 90.9% of B and in 50.8% of A. The duration of symptoms prior to imaging was longer in C (7.6 {+-} 2.8 m) than in A (2.5 {+-} 1.7 m) and B (4.0 {+-} 3.2 m) (p < 0.05). Group B progressed to articular collapse in 45.5%, the rest demonstrating a favourable outcome. Group C showed clinical improvement in 75% and persistent symptoms that required knee arthroplasty in 25% of cases. Articular collapse was the final outcome in 29.6% and transient BME in 70.4% of patients. These two groups showed significant differences regarding the age (p {approx} 0), sex (p = 0.002), low BMD (p = 0.004), affected area (p {approx} 0), presence of subchondral sparing (p {approx} 0), duration of symptoms prior to imaging (p {approx} 0), time from onset of symptoms to the final outcome (p

  9. A Rare Case of Diffuse Alveolar Hemorrhage Secondary to Acute Pulmonary Histoplasmosis

    Directory of Open Access Journals (Sweden)

    Kunal Grover

    2015-01-01

    Full Text Available Diffuse alveolar hemorrhage (DAH is a rare presentation of acute pulmonary histoplasmosis. While histoplasmosis has been reported to cause hemoptysis and alveolar hemorrhage in children, the English language literature lacks any adult case reports documenting this association. We report a case of pulmonary histoplasmosis where the initial presentation was pneumonia with a subsequent diagnosis of DAH.

  10. Assessment of heat shock proteins and endothelial dysfunction in acute pulmonary embolism.

    Science.gov (United States)

    İn, Erdal; Deveci, Figen; Kaman, Dilara

    2016-06-01

    We determined the levels of some heat shock proteins (HSP27, HSP70, and HSP90), L-arginine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) levels in patients with acute pulmonary embolism. The present case-control study comprised a healthy control group (n = 57) and patients with acute pulmonary embolism (n = 84). HSPs, L-arginine, ADMA, and SDMA levels were measured in all of the cases. The mean age of the control group was 56.72 ± 8.44 years, and the mean age of the patients with acute pulmonary embolism was 60.20 ± 16.56 years (P = 0.104). Compared with controls, patients with acute pulmonary embolism had significantly higher mean serum HSP27, HSP90, and ADMA levels, whereas the mean serum L-arginine and SDMA levels were lower (P In patients with acute pulmonary embolism serum HSP27, HSP70, and ADMA levels were negatively correlated with partial pressures of arterial oxygen levels (r = -0.281, P = 0.01; r = -0.263, P = 0.016; and r = -0.275, P = 0.011, respectively) and arterial oxygen saturation (r = -0.225, P = 0.039; r = -0.400, P in acute pulmonary embolism.

  11. Quantification of optic disc edema during exposure to high altitude shows no correlation to acute mountain sickness.

    Directory of Open Access Journals (Sweden)

    Gabriel Willmann

    Full Text Available BACKGROUND: The study aimed to quantify changes of the optic nerve head (ONH during exposure to high altitude and to assess a correlation with acute mountain sickness (AMS. This work is related to the Tuebingen High Altitude Ophthalmology (THAO study. METHODOLOGY/PRINCIPAL FINDINGS: A confocal scanning laser ophthalmoscope (cSLO, Heidelberg Retina Tomograph, HRT3® was used to quantify changes at the ONH in 18 healthy participants before, during and after rapid ascent to high altitude (4559 m. Slitlamp biomicroscopy was used for clinical optic disc evaluation; AMS was assessed with Lake Louise (LL and AMS-cerebral (AMS-c scores; oxygen saturation (SpO₂ and heart rate (HR were monitored. These parameters were used to correlate with changes at the ONH. After the first night spent at high altitude, incidence of AMS was 55% and presence of clinical optic disc edema (ODE 79%. Key stereometric parameters of the HRT3® used to describe ODE (mean retinal nerve fiber layer [RNFL] thickness, RNFL cross sectional area, optic disc rim volume and maximum contour elevation changed significantly at high altitude compared to baseline (p<0.05 and were consistent with clinically described ODE. All changes were reversible in all participants after descent. There was no significant correlation between parameters of ODE and AMS, SpO₂ or HR. CONCLUSIONS/SIGNIFICANCE: Exposure to high altitude leads to reversible ODE in the majority of healthy subjects. However, these changes did not correlate with AMS or basic physiologic parameters such as SpO₂ and HR. For the first time, a quantitative approach has been used to assess these changes during acute, non-acclimatized high altitude exposure. In conclusion, ODE presents a reaction of the body to high altitude exposure unrelated to AMS.

  12. Quantification of Optic Disc Edema during Exposure to High Altitude Shows No Correlation to Acute Mountain Sickness

    Science.gov (United States)

    Willmann, Gabriel; Fischer, M. Dominik; Schatz, Andreas; Schommer, Kai; Messias, Andre; Zrenner, Eberhart; Bartz-Schmidt, Karl U.; Gekeler, Florian

    2011-01-01

    Background The study aimed to quantify changes of the optic nerve head (ONH) during exposure to high altitude and to assess a correlation with acute mountain sickness (AMS). This work is related to the Tuebingen High Altitude Ophthalmology (THAO) study. Methodology/Principal Findings A confocal scanning laser ophthalmoscope (cSLO, Heidelberg Retina Tomograph, HRT3®) was used to quantify changes at the ONH in 18 healthy participants before, during and after rapid ascent to high altitude (4559 m). Slitlamp biomicroscopy was used for clinical optic disc evaluation; AMS was assessed with Lake Louise (LL) and AMS-cerebral (AMS-c) scores; oxygen saturation (SpO2) and heart rate (HR) were monitored. These parameters were used to correlate with changes at the ONH. After the first night spent at high altitude, incidence of AMS was 55% and presence of clinical optic disc edema (ODE) 79%. Key stereometric parameters of the HRT3® used to describe ODE (mean retinal nerve fiber layer [RNFL] thickness, RNFL cross sectional area, optic disc rim volume and maximum contour elevation) changed significantly at high altitude compared to baseline (p<0.05) and were consistent with clinically described ODE. All changes were reversible in all participants after descent. There was no significant correlation between parameters of ODE and AMS, SpO2 or HR. Conclusions/Significance Exposure to high altitude leads to reversible ODE in the majority of healthy subjects. However, these changes did not correlate with AMS or basic physiologic parameters such as SpO2 and HR. For the first time, a quantitative approach has been used to assess these changes during acute, non-acclimatized high altitude exposure. In conclusion, ODE presents a reaction of the body to high altitude exposure unrelated to AMS. PMID:22069483

  13. Single-tracer technique to evaluate pulmonary edema and its application to detect the effect of hexamethylene diisocyanate trimer aerosol exposures

    Energy Technology Data Exchange (ETDEWEB)

    Valentini, J.E.; Wong, K.L.; Alarie, Y.

    1983-07-01

    Two hours after a four-hour exposure to hexamethylene diisocyanate trimer (HDIt) aerosol between 2.5 and 39 mg/m3, mice were injected iv with /sup 51/Cr-EDTA (chromium ethylenediaminetetraacetate). Ten minutes later the lung was lavaged. A larger amount of /sup 51/Cr-EDTA was detected in the lung lavage of HDIt mice than of controls in a concentration-related fashion. The concentration-response curve was shifted to the left compared with that constructed using lung weight increase as response. Kinetic studies of the plasma level of /sup 51/Cr-EDTA revealed a three-exponential profile in normal mice, and similar plasma levels were obtained with mice exposed to 18-24 mg/m3 HDIt. However, both the amount of /sup 51/Cr-EDTA in the alveolar space and concentration in the pulmonary extravascular compartment were higher in HDIt-exposed mice than in controls. The data of /sup 51/Cr-EDTA distribution in the lung were fitted with a three-compartment model. According to the model, HDIt exposures increase the permeability constants of /sup 51/Cr-EDTA transport into the alveolar space from blood which accounts for the larger amount of /sup 51/Cr-EDTA in lung lavage of HDIt-exposed mice. This /sup 51/Cr-EDTA injection and lung lavage technique is a sensitive method for detecting pulmonary edema.

  14. Macrophage activation in acute exacerbation of idiopathic pulmonary fibrosis.

    Directory of Open Access Journals (Sweden)

    Jonas Christian Schupp

    Full Text Available Acute exacerbation (AE of idiopathic pulmonary fibrosis (IPF is a common cause of disease acceleration in IPF and has a major impact on mortality. The role of macrophage activation in AE of IPF has never been addressed before.We evaluated BAL cell cytokine profiles and BAL differential cell counts in 71 IPF patients w/wo AE and in 20 healthy volunteers. Twelve patients suffered from AE at initial diagnosis while sixteen patients developed AE in the 24 months of follow-up. The levels of IL-1ra, CCL2, CCL17, CCL18, CCL22, TNF-α, IL-1β, CXCL1 and IL-8 spontaneously produced by BAL-cells were analysed by ELISA.In patients with AE, the percentage of BAL neutrophils was significantly increased compared to stable patients. We found an increase in the production rate of the pro-inflammatory cytokines CXCL1 and IL-8 combined with an increase in all tested M2 cytokines by BAL-cells. An increase in CCL18 levels and neutrophil counts during AE was observed in BAL cells from patients from whom serial lavages were obtained. Furthermore, high baseline levels of CCL18 production by BAL cells were significantly predictive for the development of future AE.BAL cell cytokine production levels at acute exacerbation show up-regulation of pro-inflammatory as well as anti-inflammatory/ M2 cytokines. Our data suggest that AE in IPF is not an incidental event but rather driven by cellular mechanisms including M2 macrophage activation.

  15. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher; Joe Boujaoude

    2008-01-01

    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  16. Acute kidney injury in patients with pulmonary embolism

    Science.gov (United States)

    Chang, Chih-Hsiang; Fu, Chung-Ming; Fan, Pei-Chun; Chen, Shao-Wei; Chang, Su-Wei; Mao, Chun-Tai; Tian, Ya-Chung; Chen, Yung-Chang; Chu, Pao-Hsien; Chen, Tien-Hsing

    2017-01-01

    Abstract Acute kidney injury (AKI) is overlooked in patients with pulmonary embolism (PE). Risk factors for and long-term outcomes of this complication remain unknown. This study evaluated the predictors and prognosis of AKI in patients with PE. This retrospective cohort study used Taiwan's National Health Insurance Research Database. We enrolled a total of 7588 patients who were admitted to a hospital for PE from January1997 to December 2011 and administered anticoagulation or thrombolytic agents. All demographic data, risk factors, and outcomes were analyzed. AKI was diagnosed in 372 (4.9%) patients. Multivariate logistic regression analysis revealed pre-existing chronic kidney disease, hypertension, diabetes mellitus, massive PE, anemia, and sepsis as independent risk factors for AKI. In the long-term follow-up, the survival rate was similar in the AKI and non-AKI groups. Careful risk factor screening and intensive intervention in patients with AKI might yield outcomes similar to those in patients without AKI. PMID:28248851

  17. Cardiac MRI. T2-mapping versus T2-weighted dark-blood TSE imaging for myocardial edema visualization in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Nassenstein, K.; Nensa, F.; Schlosser, T.; Umutlu, L.; Lauenstein, T. [University Hospital Essen (Germany). Dept. of Diagnostic and Interventional Radiology and Neuroradiology; Bruder, O. [Elisabeth Hospital, Essen (Germany). Dept. of Cardiology and Angiology; Maderwald, S.; Ladd, M.E. [Duisburg-Essen Univ., Essen (Germany). Erwin L. Hahn Institute for Magnetic Resonance Imaging

    2014-02-15

    Purpose: To assess the diagnostic accuracy of T2 mapping for the detection of myocardial edema in acute myocardial infarction (AMI), and to compare this diagnostic accuracy with that of the current standard for myocardial edema imaging, which is T2w dark-blood TSE imaging. Materials and Methods: 29 patients with AMI were examined at 1.5 T. For the visualization of myocardial edema, T2 maps, calculated from three T2w SSFP images, and T2w dark-blood TSE images were acquired in standard short- and long-axis views. Cine SSFP images were acquired for the analysis of left ventricular (LV) function and late gadolinium enhancement images (LGE) for the visualization of myocardial necrosis. The T2 maps as well as the T2w dark-blood TSE images were evaluated twice independently from the cine SSFP and LGE images. The presence or absence of myocardial edema was rated visually for each LV segment. As the standard of reference, the infarct zone was defined based on the cine SSFP and the LGE images. Results: In this segment-based analysis, T2 mapping showed a sensitivity of 82 % and a specificity of 94 % for the detection of edema in the infarct zone. T2w dark-blood TSE imaging revealed a sensitivity of 50 % and a specificity of 98 %. T2 mapping showed a higher intra-rater agreement compared to T2w dark-blood TSE imaging ({kappa}: 0.87 vs. 0.76). Conclusions: T2 mapping allows for the visualization of myocardial edema in AMI with a high sensitivity and specificity, and features better diagnostic accuracy in terms of a higher sensitivity compared to T2w dark-blood TSE imaging. (orig.)

  18. Acute transient coronary sinus hypertension impairs left ventricular function and induces myocardial edema.

    Science.gov (United States)

    Pratt, J W; Schertel, E R; Schaefer, S L; Esham, K E; McClure, D E; Heck, C F; Myerowitz, P D

    1996-09-01

    This study was performed to evaluate the direct and indirect effects of acute coronary sinus hypertension (CSH) on systolic and diastolic left ventricular (LV) function. Coronary sinus pressure was elevated to 25 mmHg for 3 h in eight pentobarbital-anesthetized dogs and then relieved. LV contractility was assessed by preload recruitable stroke work (PRSW) and end-systolic elastance (Ees). Diastolic function was assessed by the time constant of isovolumic relaxation (tau) and the end-diastolic pressure volume relationship (EDPVR). PRSW and Ees decreased progressively, and tau and the slope of the EDPVR increased progressively with CSH. These changes persisted after relief of CSH. beta-Adrenergic and cholinergic receptor blockade, performed in six dogs, did not alter the effects of CSH on systolic or diastolic function. The LV wet-to-dry weight ratios of the groups with CSH were significantly greater than those of a control group without CSH. We conclude that CSH results in changes in the left ventricle that depress contractility, prolong active relaxation, and increase diastolic stiffness. The dysfunction was not the direct effect of CSH or autonomic reflex activation, but may have been induced by fluid accumulation within the interstitium.

  19. A case of heart failure due to alcoholic cardiomyopathy combined with acute pulmonary embolism.

    Science.gov (United States)

    Xiao, Feng; Yuan, Wei; Li, Xiaorong; Wang, Gannan; Jiang, Ting; Wang, Weiwei; Zhang, Jinsong; Li, Ping; Qi, Lianwen; Chen, Yan

    2014-09-01

    It has not been reported that cases of alcoholic cardiomyopathy (ACM) combined with acute pulmonary embolism (PE). We hereby present a case of a 48-year-old male with ACM with significant enlargement of the heart and heart failure is described. Then, the patient was seized with acute PE which was confirmed by specific examination and his symptoms.

  20. Acute pulmonary vasodilatory properties of amlodipine in humans with pulmonary hypertension.

    OpenAIRE

    Woodmansey, P. A.; O'Toole, L.; Channer, K S; Morice, A H

    1996-01-01

    OBJECTIVE: Calcium antagonists are the only oral vasodilators shown to influence mortality in primary pulmonary hypertension, but the high doses required are often poorly tolerated. Amlodipine is a novel, relatively well tolerated, calcium antagonist. It has not been previously tested in humans with pulmonary hypertension. DESIGN: Calcium antagonists are claimed to be of benefit in the 20-30% of patients who respond--that is, whose mean pulmonary artery pressure and pulmonary vascular resista...