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Sample records for central edema neonatal

  1. [Physiopathology of macular edema in central vein occlusion].

    Science.gov (United States)

    Stanca, Horia T; Manea, Georgiana

    2012-01-01

    Retinal Vein Occlusions are vascular diseases affecting the Central Retinal Vein and its branches causing decreased retinal drainage resulting in significant clinical and functional pathological changes. RVO determines the increase of vascular permeability, with edema and hemorrhage and development of collateral vessels in a few weeks. Among the serious consequences of venous occlusion is the installation of macular edema to which depends long-term visual prognosis. Macular Edema is the accumulation of intraretinal serous fluid in the macular area caused by the breakdown of blood-retinal barrier.

  2. Edema

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    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 ...

  3. Edema

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    ... 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 ...

  4. Reversible retinal edema in an infant with neonatal hemochromatosis and liver failure.

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    Maldonado, Ramiro S; Freedman, Sharon F; Cotten, C Michael; Ferranti, Jeffrey M; Toth, Cynthia A

    2011-02-01

    We present a case of bilateral severe retinal edema with subretinal fluid in an infant diagnosed with neonatal hemochromatosis and liver failure. A macular cherry-red spot in each eye mimicked the clinical appearance of many metabolic storage diseases. Both the clinical retinal appearance and the anatomic abnormalities observed on spectral domain optical coherence tomography resolved after successful liver transplant.

  5. Edema

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    ... 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 ...

  6. Central nervous system manifestations of neonatal lupus: a systematic review.

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    Chen, C C; Lin, K-L; Chen, C-L; Wong, A May-Kuen; Huang, J-L

    2013-12-01

    Neonatal lupus is a rare and acquired autoimmune disease. Central nervous system abnormalities are potential manifestations in neonatal lupus. Through a systematic literature review, we analyzed the clinical features of previously reported neonatal lupus cases where central nervous system abnormalities had been identified. Most reported neonatal lupus patients with central nervous system involvement were neuroimaging-determined and asymptomatic. Only seven neonatal lupus cases were identified as having a symptomatic central nervous system abnormality which caused physical disability or required neurosurgery. A high percentage of these neurosymptomatic neonatal lupus patients had experienced a transient cutaneous skin rash and had no maternal history of autoimmune disease before pregnancy.

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

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    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.

  8. Cyclosporin inhibits hyperalgesia and edema in arthritic rats: role of the central nervous system

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    J.N. Francischi

    1997-01-01

    Full Text Available Since arthritis induced by Mycobacterium products (adjuvant in rats is considered to be immunologically driven, the objective of the present study was to determine if the immunosuppressor drug cyclosporin could affect hindpaw edema and joint hyperalgesia simultaneously. Female Holtzman rats (140-170 g presented hyperalgesia and edema on the 8th and 12th day following adjuvant injection. Daily systemic (oral or intramuscular administration of cyclosporin (0.5-5.0 mg kg-1 day-1 or dexamethasone (0.01-0.1 mg kg-1 day-1 for 15 days starting on day zero dose-dependently inhibited the hindpaw edema and hyperalgesia in arthritic rats. However, hyperalgesia but not edema could be detected two days after cyclosporin withdrawal. We concluded that a the continuous presence of cyclosporin is essential to reduce the development of joint hyperalgesia and that b different mechanisms underlie the appearance of hyperalgesia and edema in this model. The intracerebroventricular (icv administration of 5-50-fold smaller doses of cyclosporin (1.5-150 µg/day or dexamethasone (15 µg/day also reduced the arthritic hindpaw edema and hyperalgesia. Peripheral blood from animals injected with effective systemic cyclosporin doses showed detectable levels of the drug, whereas peripheral blood from those injected with icv cyclosporin did not, as measured by specific RIA. Our results indicate that cyclosporin administered by the central route is as effective as by the systemic route to reduce joint hyperalgesia and hindpaw edema in arthritic rats. The antiarthritic effect induced by low doses of cyclosporin in the central nervous system (CNS could be explored to avoid its often associated systemic side effects during chronic therapy. However, the mechanism(s involved in the antiarthritic response to cyclosporin in the CNS remain to be elucidated

  9. Alleviation of ischemia-induced brain edema by activation of the central histaminergic system in rats.

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    Irisawa, Yumi; Adachi, Naoto; Liu, Keyue; Arai, Tatsuru; Nagaro, Takumi

    2008-09-01

    We have reported that facilitation of central histaminergic activity prevents the development of ischemia-induced brain injury. Since cerebral edema is a major cause of brain damage, we studied effects on brain edema of postischemic administration of L-histidine, a precursor of histamine, and thioperamide, a histamine H(3)-receptor antagonist, both of which enhance central histaminergic activity. Focal cerebral ischemia for 2 h was provoked by transient occlusion of the right middle cerebral artery in rats, and the water content and infarct size were determined 24 h after reperfusion. Changes in the extracellular concentration of histamine were examined in the striatum by a microdialysis procedure, and effects of these compounds were evaluated. Repeated administration of L-histidine (1000 mg/kg x 2, i.p.), immediately and 6 h after reperfusion, reduced the increase in the water contents in ischemic regions. Simultaneous administration of thioperamide (5 mg/kg, s.c.) with L-histidine (1000 mg/kg, i.p.) completely prevented edema formation and alleviated brain infarction, although a single dose of L-histidine, immediately after reperfusion, showed no benefits. The striatal histamine level was gradually increased after reperfusion as well as during ischemia. Simultaneous administration of thioperamide with L-histidine markedly increased the brain histamine concentration, and the value increased up to 230% of that in the saline group 5 - 6 h after reperfusion. L-Histidine alone did not affect the increase in the histamine output after ischemia. These findings suggest that further activation of the central histaminergic system after initiation of cerebral ischemia prevents development of ischemia-induced brain edema.

  10. Central role of maladapted astrocytic plasticity in ischemic brain edema formation

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    Yu-Feng eWang

    2016-05-01

    Full Text Available Brain edema formation and the ensuing brain damages are the major cause of high mortality and long term disability following the occurrence of ischemic stroke. In this process, oxygen and glucose deprivation and the ensuing reperfusion injury play primary roles. In response to the ischemic insult, the neurovascular unit experiences both intracellular and extracellular edemas; the two processes are interactive closely under the driving of maladapted astrocytic plasticity. The astrocytic plasticity includes both morphologic and functional plasticity. The former involves a reactive gliosis and the ensuing glial retraction. It relates to the capacity of astrocytes to buffer changes in extracellular chemical levels, particularly K+ and glutamate, as well as the integrity of the blood-brain barrier. The latter involves the expression and activity of a series of ion and water transport proteins. These molecules are grouped together around glial fibrillary acidic protein and water channel protein aquaporin 4 to form functional networks, regulate hydromineral balance across cell membranes and maintain the integrity of the blood-brain barrier. Intense ischemic challenges can disrupt these capacities of astrocytes and result in their maladaptation. The maladapted astrocytic plasticity in ischemic stroke cannot only disrupt the hydromineral homeostasis across astrocyte membrane and the blood-brain barrier, but also lead to disorders of the whole neurovascular unit. This review focuses on how the maladapted astrocytic plasticity in ischemic stroke plays the central role in the brain edema formation.

  11. Cortical thickness difference across the central sulcus visualized in the presence of vasogenic edema

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    Togao, Osamu [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582 (Japan)], E-mail: togao@dr.hosp.kyushu-u.ac.jp; Yoshiura, Takashi; Mihara, Futoshi; Noguchi, Tomoyuki; Hiwatashi, Akio; Yamashita, Koji; Yoshitake, Tadamasa; Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582 (Japan)

    2008-05-15

    Purpose: To confirm the cortical thickness difference across the central sulcus (CS) visualized in the presence of vasogenic edema on MRI. Materials and methods: T2-weighted images of 70 cerebral hemispheres showing vasogenic edema infiltrating into subcortical white matter around the CS were studied retrospectively. Two neuroradiologists measured the cortical thickness of the anterior and posterior banks of the CS, precentral sulci (PrCS), and postcentral sulci (PoCS). Additionally, we compared the cortical thickness of the anterior and posterior banks of each sulcus visually using a grading scale. Results: On T2-weighted images, the cerebral cortex was highlighted by a high signal-intensity vasogenic edema in the adjacent white matter, and its thickness was readily measurable. The unique cortical thickness difference between the anterior and posterior banks of the CS were confirmed with measurements of 2.67 and 1.48 mm (p < 0.0001). The cortical measurements across other cerebral sulci were 2.04 and 1.95 mm (NS) for the PrCS, and 1.67 and 1.77 mm (NS) for the PoCS. The cortical thickness ratios were 1.86 for the CS, 1.05 for the PrCS, and 0.96 for the PoCS. On visual evaluation, the anterior bank of the CS was thicker than the posterior bank in 93% (65/70). For the PrCS and PoCS, the thickness of the anterior and posterior banks appeared to be equal in over 70% of the patients. Conclusion: A prominent cortical thickness difference across the CS in the presence of vasogenic edema was confirmed. This finding is considered to facilitate the identification of the CS in patients with brain tumors.

  12. Unilateral macular edema with central retinal vein occlusion in systemic lupus erythematosus: a case report

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    Noma H

    2013-05-01

    Full Text Available Hidetaka Noma,1 Hiroshi Shimizu,1 Tatsuya Mimura21Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, 2Department of Ophthalmology, Medical Center East, Tokyo Women's Medical University, Tokyo, JapanAbstract: Central retinal vein occlusion (CRVO is frequent in patients with systemic lupus erythematosus (SLE, but the treatment of the macular edema with this disease is extremely difficult. We report a case of cystoid macular edema (CME secondary to unilateral CRVO in a patient with SLE that responded to intravitreous injection of an anti-vascular endothelial growth factor (VEGF agent. A 33-year-old Japanese woman was referred to our department with unilateral impairment of vision. Microperimetry (MP-1 showed a cessation of foveal sensitivity. Fluorescein angiography showed CME without ischaemia of the macular region or peripheral retina (nonischemic CRVO. A diagnosis of CME and unilateral nonischemic CRVO combined with SLE was made and intravitreous anti-VEGF therapy was given. A sample of aqueous humor was harvested at the start of intravitreous injection after obtaining informed consent. Then the levels of VEGF and monocyte chemotactic protein (MCP-1 were measured in the aqueous humor by enzyme-linked immunosorbent assay, revealing that VEGF was 234 pg/mL and MCP-1 was 501 pg/mL. Two weeks later, left eye vision improved to 20/20. Optical coherence tomography (OCT showed considerable amelioration of retinal swelling and CME. MP-1 showed a marked increase of foveal sensitivity. However, she had recurrence of edema 3 months later. After harvesting aqueous humor again, intravitreous injection of an anti-VEGF agent was repeated for CME. The aqueous VEGF and MCP-1 levels were 156 pg/mL and 360 pg/mL, respectively. These findings suggest that inflammation was improved by intravitreous injection of bevacizumab. Intravitreous injection of anti-VEGF agents may be effective for CME due to nonischemic CRVO in SLE patients

  13. Neonatal mortality in intensive care units of Central Brazil Mortalidade neonatal em unidades de cuidados intensivos no Brasil Central

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    Claci F Weirich

    2005-10-01

    Full Text Available OBJECTIVE: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. METHODS: A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatal-based mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713 and deaths (n=162 in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. RESULTS: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77 for predicting neonatal death (sensitivity =72.2%. A wide variation in the mortality rates was found among intensive care units (9.5-48.1% and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. CONCLUSIONS: This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.OBJETIVO: Identificar fatores prognósticos de mortalidade neonatal em unidades de cuidados intensivos. MÉTODOS: Realizou-se estudo de coorte de nascidos vivos do município de Goiânia, no período de novembro de 1999 a outubro de 2000. Procedeu-se à vinculação das bases de dados das declarações de nascidos vivos e de óbitos, das quais as variáveis de exposição foram extra

  14. NURSING CARE IN PATIENTS NEONATES WITH PERIPHERALLY INSERTED CENTRAL CATHETER

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    Anacilda Oliveira Vieira

    2013-12-01

    Full Text Available Introduction: The PICC (peripherally inserted central catheter is a long flexible catheter which is inserted through a peripheral vein, progresses through a needle introducer until the final portion of the vena cava, acquiring characteristics of a central catheter. Objective: To point out the main theoretical and scientific ideas that demonstrate the reliability, competence and ability of nurses to perform the PICC. Methodology: Systematic review of articles, which were found by searching the database scientific journals and bibliographies area. Results: The success of integration depends on the patient assessment and choice of venous access where the catheter will be positioned, and its tip should be in the middle third of the superior vena cava, or the middle third of the inferior vena cava. In neonates, which are used more frequently, proper positioning of the catheter is through nursing care in making the dressing, and the first 24 hours it should be compressive. Ideally, the PICC remains in the vein for periods longer than seven days or until the end of treatment, thus decreasing invasive procedures. Conclusion: According to the Federal Board of Nursing (COFEN, it is lawful for the insertion of PICC nurses, provided it has undergone professional training.

  15. Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis

    NARCIS (Netherlands)

    van den Hoogen, Agnes; Brouwer, Mieke J.; Gerards, Leo J.; Fleer, Andre; Krediet, Tannette G.

    2008-01-01

    Background: Clinical signs of sepsis are frequently observed after removal of a percutaneously inserted central venous catheter (PCVC) in neonates admitted at our Neonatal Intensive Care Unit (NICU). To substantiate this finding and to evaluate the effect of antibiotics administered at the time of r

  16. 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, ...

  17. Intrapartum FHR monitoring and neonatal CT brain scan

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    Takahashi, Yoshiki; Ukita, Masahiko; Nakada, Eizo (Kurashiki Central Hospital, Okayama (Japan))

    1982-12-01

    The effect of fetal distress on the neonatal brain was investigated by neonatal CT brain scan, FHR monitoring and mode of delivery. This study involved 11 cases of full term vertex delivery in which FHR was recorded by fetal direct ECG during the second stage labor. All infants weighed 2,500 g or more. FHR monitoring was evaluated by Hon's classification. Neonatal brain edema was evaluated by cranial CT histgraphic analysis (Nakada's method). 1) Subdural hemorrhage was noted in 6 of 7 infants delivered by vacuum extraction or fundal pressure (Kristeller's method). 2) Intracranial hemorrhage was demonstrated in all of 3 infants with 5-min. Apgar score 7 or less. 3) Two cases with prolonged bradycardia and no variability had intraventricular or intracerebral hemorrhage which resulted in severe central nervous system damage. 4) The degree of neonatal brain edema correlated with 5-min. Apgar score. 5) One case with prolonged bradycardia and no variability resulted in severe neonatal brain edema. Four cases with variable deceleration and increased variability resulted in mild neonatal brain edema. Two cases with late deceleration and decreased variability resulted in no neonatal brain edema.

  18. Minocycline Attenuates Neonatal Germinal-Matrix-Hemorrhage-Induced Neuroinflammation and Brain Edema by Activating Cannabinoid Receptor 2.

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    Tang, Jun; Chen, Qianwei; Guo, Jing; Yang, Liming; Tao, Yihao; Li, Lin; Miao, Hongping; Feng, Hua; Chen, Zhi; Zhu, Gang

    2016-04-01

    Germinal matrix hemorrhage (GMH) is the most common neurological disease of premature newborns leading to detrimental neurological sequelae. Minocycline has been reported to play a key role in neurological inflammatory diseases by controlling some mechanisms that involve cannabinoid receptor 2 (CB2R). The current study investigated whether minocycline reduces neuroinflammation and protects the brain from injury in a rat model of collagenase-induced GMH by regulating CB2R activity. To test this hypothesis, the effects of minocycline and a CB2R antagonist (AM630) were evaluated in male rat pups that were post-natal day 7 (P7) after GMH. We found that minocycline can lead to increased CB2R mRNA expression and protein expression in microglia. Minocycline significantly reduced GMH-induced brain edema, microglial activation, and lateral ventricular volume. Additionally, minocycline enhanced cortical thickness after injury. All of these neuroprotective effects of minocycline were prevented by AM630. A cannabinoid CB2 agonist (JWH133) was used to strengthen the hypothesis, which showed the identical neuroprotective effects of minocycline. Our study demonstrates, for the first time, that minocycline attenuates neuroinflammation and brain injury in a rat model of GMH, and activation of CBR2 was partially involved in these processes.

  19. In-line filters in central venous catheters in a neonatal intensive care unit

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    van den Hoogen, A; Krediet, TG; Uiterwaal, CSPM; Bolenius, JFGA; Gerards, LJ; Fleer, A

    2006-01-01

    Nosocomial sepsis remains an important cause of morbidity in neonatal intensive care units. Central venous catheters (CVCs) and parenteral nutrition (TPN) are major risk factors. In-line filters in the intravenous (IV) administration sets prevent the infusion of particles, which may reduce infectiou

  20. Low-dosage prophylactic vancomycin in central-venous catheters for neonates.

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    Ocete, E; Ruíz-Extremera, A; Goicoechea, A; Lozano, E; Robles, C; Rey, M L; Salmerón, J

    1998-12-01

    Neonatal infectious pathology remains one of the main causes of morbidity and mortality in this age group. The introduction of plasticized catheters for the administration of medication, fluidotherapy and parenteral nutrition was a significant advance in treatment of patients at risk, but also led to the appearance of infectious complications. Negative coagulase staphylococcus is the principal pathogen in most neonatal intensive care units. Recent studies have examined the prophylactic use of vancomycin in preterm babies receiving parenteral nutrition. We have evaluated the efficacy of this procedure, applied via the central venous catheters employed for all neonates, within the intensive care unit over a period of one year. Prophylactic vancomycin administered via the catheters significantly reduced the incidence of Gram-positive infections, despite the presence within this group of a greater number of septic risk factors than in the control group.

  1. Pulmonary edema: radiographic differential diagnosis

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    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.

  2. Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review.

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    Amelie Pielen

    Full Text Available BACKGROUND: Intravitreal agents have replaced observation in macular edema in central (CRVO and grid laser photocoagulation in branch retinal vein occlusion (BRVO. We conducted a systematic review to evaluate efficacy and safety outcomes of intravitreal therapies for macular edema in CRVO and BRVO. METHODS AND FINDINGS: MEDLINE, Embase, and the Cochrane Library were systematically searched for RCTs with no limitations of language and year of publication. 11 RCTs investigating anti-VEGF agents (ranibizumab, bevacizumab, aflibercept and steroids (triamcinolone, dexamethasone implant with a minimum follow-up of 1 year were evaluated. EFFICACY CRVO: Greatest gain in visual acuity after 12 months was observed both under aflibercept 2 mg: +16.2 letters (8.5 injections, and under bevacizumab 1.25 mg: +16.1 letters (8 injections. Ranibizumab 0.5 mg improved vision by +13.9 letters (8.8 injections. Triamcinolone 1 mg and 4 mg stabilized visual acuity at a lower injection frequency (-1.2 letters, 2 injections. BRVO: Ranibizumab 0.5 mg resulted in a visual acuity gain of +18.3 letters (8.4 injections. The effect of dexamethasone implant was transient after 1.9 implants in both indications. SAFETY: Serious ocular adverse events were rare, e.g., endophthalmitis occurred in 0.0-0.9%. Major differences were found in an indirect comparison between steroids and anti-VEGF agents for cataract progression (19.8-35.0% vs. 0.9-7.0% and in required treatment of increased intraocular pressure (7.0-41.0% vs. none. No major differences were identified in systemic adverse events. CONCLUSIONS: Anti-VEGF agents result in a promising gain of visual acuity, but require a high injection frequency. Dexamethasone implant might be an alternative, but comparison is impaired as the effect is temporary and it has not yet been tested in PRN regimen. The ocular risk profile seems to be favorable for anti-VEGF agents in comparison to steroids. Because comparative data from head

  3. Pulmonary Edema

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    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.

  4. Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants

    NARCIS (Netherlands)

    Hemels, Marieke A. C.; van den Hoogen, Agnes; Verboon-Maciolek, Malgorzata A.; Fleer, Andre; Krediet, Tannette G.

    2011-01-01

    Objectives: Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagula

  5. Cardiac tamponade secondary to perforation of innominate vein following central line insertion in a neonate

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    Ramkumar Dhanasekaran

    2014-01-01

    Full Text Available Cardiac tamponade following central line in a neonate is rare and an uncommon situation; however, it is potentially reversible when it is diagnosed in time. We report a case of cardiac tamponade following central line insertion. A 10-day-old 2.2 kg girl operated for obstructed total anomalous pulmonary venous connections had neckline slipped out during extubation. Attempted cannulations of right femoral vein were unsuccessful. At the end of the left internal jugular vein cannulaton, there was a sudden cardiorespiratory arrest. Immediate transthoracic echocardiogram showed left pleural and pericardial collection. Chest was opened and the catheter tip was seen in the thoracic cavity after puncturing the innominate vein. The catheter was removed and the vent was repaired.

  6. INCIDENCE OF INFECTION ASSOCIATED TO CENTRAL VENOUS CATHETERS IN A NEONATAL INTENSIVE CARE UNIT

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    Adriana Teixeira Reis

    2011-07-01

    Full Text Available Trata-se de um estudo transversal e retrospectivo que objetivou  identificar o tipo de cateter venoso central (CVC mais utilizado na Unidade de Terapia Intensiva Neonatal (UTIN de um hospital público universitário do estado do Rio de Janeiro, estratificado por peso de nascimento e apresentar as densidades de incidência de infecção associadas aos dispositivos.  Os dados foram coletados através de análise documental nos meses de junho e julho de 2008, referentes ao período de julho a dezembro de 2007, totalizando um registro de 712 cateteres-dia. Foi verificado o cateter central de inserção periférica (CCIP/PICC como o dispositivo mais utilizado na unidade, seguido do cateter venoso umbilical e da dissecção venosa. A densidade de incidência das infecções primárias da corrente sanguínea foi cerca de oito vezes maior nos recém-nascidos com peso ≤ 1.500g, sendo o cateter umbilical o dispositivo mais associado a essas infecções.

  7. Neonatal morbidity and mortality in tribal and rural communities in Central India

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    Abhimanyu Niswade

    2011-01-01

    Full Text Available Background and Objectives: Little is known about the natural history of neonates born in the rural and tribal areas in India. The Neonatal Disease Surveillance Study (NDSS measures the incidence of high-priority neonatal diseases, neonatal health events and associated risk factors to plan appropriate and effective actions. Materials and Methods: The NDSS is being conducted in Ramtek Revenue Block, Nagpur district, Maharashtra state, given its considerably high level of neonatal mortality. All households from five selected primary health centers were screened. Both active and passive surveillance systems were used for systematic collection of mother′s health during pregnancy and of baby′s health from birth to 4 months after birth. First-year results from November 2006 to October 2007 are presented. Results: Pregnancy outcomes were available for 1,136 women, with an overall neonatal mortality of 73 per 1,000 live births. The pregnancy outcomes varied by gestational age of the baby; miscarriages and abortions were higher in tribal than in non-tribal women, and tribal women had higher rates of low-birth weight (LBW neonates than non-tribal women. The main cause of neonatal mortality was LBW, followed by sepsis and respiratory illness. The mortality of non-tribal babies was most strongly associated with pre term. For tribal babies, mortality was also associated with maternal morbidity and delay in the initiation of breastfeeding. Interpretation and Conclusions: The NDSS provides valuable information on the potentially modifiable factors associated with increased likelihood of neonatal mortality and morbidity. The Neonatal Health Research Initiative is now developing community-based interventions to reduce the high rate of neonatal mortality and morbidity in the rural areas of India.

  8. Neonatal Screening and the Clinical Outcome in Children with Sickle Cell Disease in Central India.

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    Dipti S Upadhye

    Full Text Available Sickle cell disease (SCD is a major health burden in India. The objective of the study was to establish a neonatal screening program and to understand the clinical course of children with SCD in central India.Pregnant mothers were screened for sickle hemoglobin using the solubility test. Babies were screened by high performance liquid chromatography if the mother was positive for sickle hemoglobin. The diagnosis was confirmed by molecular analysis. They received early prophylactic treatment and vaccination. Of 2134 newborns screened, 104 were sickle homozygous (SS, seven had sickle β-thalassemia (S-β thal and 978 were sickle heterozygous (AS. The other hemoglobin abnormalities detected included HbS-δβ thalassemia-1, HbSD disease-2, HbE traits-5, β-thalassemia traits-4, alpha chain variants-3 and HbH disease-1.These babies were followed up regularly for hematological and clinical evaluation. Pain, severe anemia requiring blood transfusions and acute febrile illness were the major complications with 59.7, 45.1 and 42.6 cases per 100 person years. Fetal hemoglobin (HbF levels were inversely associated with vaso-oclussive crisis (VOC and severe anemia while presence of alpha thalassemia increased the rate of painful events and sepsis. Six early deaths occurred among the SS babies.A systematic follow up of this first newborn SCD cohort in central India showed that 47% of babies presented within 1 year of age. In spite of the presence of the Arab-Indian haplotype many babies had severe manifestations.

  9. [Enterovirus nosocomial infections in a neonatal care unit: from diagnosis to evidence, from a clinical observation of a central nervous system infection].

    Science.gov (United States)

    Farcy, C; Mirand, A; Marque Juillet, S; Henquell, C; Neulier, C; Foucaud, P; Peigue-Lafeuille, H

    2012-09-01

    Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.

  10. Central Congenital Hypothyroidism Detected by Neonatal Screening in Sapporo, Japan (2000-2004): It's Prevalence and Clinical Characteristics.

    Science.gov (United States)

    Fujiwara, Fumie; Fujikura, Kaori; Okuhara, Koji; Tsubaki, Jyunko; Fukushi, Masaru; Fujita, Kozo; Fujieda, Kenji; Tajima, Toshihiro

    2008-01-01

    In Sapporo, Japan, a neonatal screening program for congenital hypothyroidism (CH) has employed measurement of free thyroxine (T4) and TSH in the same filter-paper blood spot. This system has enabled us to identify primary CH and central CH during the neonatal period. The aim of this study was to clarify the prevalence and clinical characteristics of central CH. For this purpose, the screening program requested serum from infants with free T4 concentrations below the cut off value regardless of the TSH levels. Between January 2000 and December 2004, 83,232 newborns were screened and six central CH patients were detected as a result of follow-up of low free T4 and non-elevated TSH screening (1:13,872). This frequency is higher than in other studies. Four patients showed multiple pituitary hormone deficiency with pituitary malformations on magnetic resonance imaging. One patient was diagnosed as having Prader-Willie syndrome. The remaining patient was considered to have isolated central CH. Our study demonstrated that the frequency of central CH is 1:13,872. Free T4 measurement would also be advantageous in early recognition of multiple pituitary hormone deficiency.

  11. O processo do cateterismo venoso central em Unidade de Terapia Intensiva Neonatal e Pediátrica

    Directory of Open Access Journals (Sweden)

    Aline Veronica de Oliveira Gomes

    2013-08-01

    Full Text Available Estudo descritivo, longitudinal e abordagem quantitativa, que objetivou analisar e discutir o processo do cateterismo venoso central nas Unidades de Terapia Intensiva neonatal e pediátrica; descrever as variáveis relacionadas à caracterização da população do estudo (unidade de internação, faixa etária e sexo e descrever as variáveis relacionadas ao processo do cateterismo venoso central (tipo de cateter, motivo de indicação, número de lumens, sítio de inserção, profissional que realizou o procedimento, terapêutica medicamentosa infundida via cateter, motivo de retirada, tempo de permanência e as complicações mecânicas e infecciosas. A coleta de dados foi realizada em unidade de terapia intensiva neonatal e pediátrica, em 82 prontuários. As indicações dos cateteres foram, em sua maioria, para infusão medicamentosa prolongada e Nutrição Parenteral Total. A remoção foi indicada predominantemente por complicações mecânicas e infecciosas. Esse estudo viabilizou rever a prática assistencial para estabelecer o aprimoramento da assistência prestada à clientela neonatal e pediátrica.

  12. Comparison of the effects of intravitreal bevacizumab and triamcinolone acetonide in the treatment of macular edema secondary to central retinal vein occlusion

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    Mehmet Demir

    2014-01-01

    Full Text Available Aim: To compare the effects of intravitrealbevacizumab (IVB and intravitreal triamcinolone acetonide (IVT in the treatment of macular edema (ME secondary to central retinal vein occlusion (CRVO. Materials and Methods: There were 20 patients treated with IVB (1.25 mg/0.05 mL and 16 treated with IVT (4 mg/0.1 mL. The two groups were compared with regard to best-corrected visual acuity (BCVA, central macular thickness (CMT on optical coherence tomography (OCT, slit-lamp biomicroscopy and fundus fluorescein angiography results, intraocular pressure (IOP, numbers of injections, and adverse events. Results: The mean follow-up times in the IVB and IVT groups were 17.45±8.1 months (range: 8-33 months and 19.94±10.59 months (range: 6-40 months, respectively (P = 0.431. Visual acuity increased and CMT decreased significantly within both groups, but no differences were observed between the groups (P = 0.718. The percentages of patients with increased IOP and iatrogenic cataracts were significantly higher in the IVT group than in the IVB group. Conclusions: Treatment with IVB and IVT both resulted in significant improvement in visual acuity and a decrease in CMT in patients with ME secondary to non-ischemic CRVO, with no difference between the two treatments. The incidence of adverse events, however, was significantly greater in the IVT group than in the IVB group. IVB may be preferred over IVT for the treatment of ME in patients with non-ischemic CRVO.

  13. Comparison of central corneal edema and visual recovery between liquefaction and conventional phacoemulsification in soft cataracts Comparação do edema de córnea central e da recuperação visual após facoemulsificação por liquefação e convencional em cataratas moles

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    Celso Takashi Nakano

    2009-02-01

    Full Text Available PURPOSE: The aim of the present study is to assess central corneal edema and visual recovery after cataract surgery performed according to two technologies: conventional ultrasonic and liquefaction (Aqualase®. METHODS:This is a prospective contralateral study in wich 20 patients with comparable preoperative conditions were submitted to cataract surgery were evaluated. Preoperative assessment involved complete ophthalmological examination and the study included patients with bilateral cataracts up to grade 2, according to the Lens Opacity Classification System II. The same cristaline fracture technique was used in all cases, and surgical procedures were performed by the same experienced surgeon, using two technologies: liquefaction or conventional phacoemulsification. Postoperative central corneal edema was measured by corneal optical pachymetry (Orbscan II® on the 1st, 3rd, 7th and 10th postoperative days. RESULTS:None of the 20 patients submitted to surgery was lost during the postoperative follow-up or excluded from the analysis. On the first postoperative, the visual acuity average was 0.031 logMAR in the Aqualase® group and 0.043 logMAR in the conventional surgery group. No statistical difference was detected in the assessment of visual acuity throughout the postoperative period. Central corneal pachymetry varied from 543.93 + 34.69 preoperatively to 545.08 ± 25.67 on the last day of follow-up in the Aqualase® group, and from 543.13 + 30.62 to 536.08 + 34.89 in the conventional technique group, without statistical significance. CONCLUSION:This study suggests that both techniques are equally effective for surgery on lenses with grade I or II cataract, and that they provide similar results in terms of visual recovery and central corneal edema.OBJETIVO: Avaliar o edema corneano central e a recuperação visual após cirurgia de catarata realizada através de duas tecnologias: ultrassônica convencional e liquefação (Aqualase®. M

  14. The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate

    Directory of Open Access Journals (Sweden)

    Kaori Michikata

    2016-01-01

    Full Text Available Objective. The improvement of the accuracy of fetal heart rate (FHR pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11% without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1 without increasing the cesarean birth rate due to nonreassuring FHR patterns.

  15. Edema pulmonar de gran altura HIGH ALTITUDE PULMONARY EDEMA

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    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

  16. Progress in Drug Treatment of Cerebral Edema.

    Science.gov (United States)

    Deng, Y Y; Shen, F C; Xie, D; Han, Q P; Fang, M; Chen, C B; Zeng, H K

    2016-01-01

    Cerebral edema causes intracranial hypertension (ICH) which leads to severe outcome of patients in the clinical setting. Effective anti-edema therapy may significantly decrease the mortality in a variety of neurological conditions. At present drug treatment is a cornerstone in the management of cerebral edema. Osmotherapy has been the mainstay of pharmacologic therapy. Mannitol and hypertonic saline (HS) are the most commonly used osmotic agents. The relative safety and efficacy of HS and mannitol in the treatment of cerebral edema and reduction of enhanced ICP have been demonstrated in the past decades. Apart from its osmotic force, HS exerts anti-edema effects partly through inhibition of Na(+)-K(+)-2Cl(-) Cotransporter-1 (NKCC1) and aquaporin 4 (AQP4) expression in astrocytes. Melatonin may also reduce brain edema and exert neuroprotective effect on several central nervous system diseases through inhibition of inflammatory response. The inhibitors of Na/H exchanger, NKCC and AQP4 may attenuate brain edema formation through inhibition of excessive transportation of ion and water from blood into the cerebral tissue. In this review we survey some of the most recent findings in the drug treatment of brain edema focusing on the use of osmotherapy, melatonin and inhibitors of ion cotransporters and water channels. A better understanding of the molecular mechanism of these agents would help to improve in the clinical management of patients with brain edema.

  17. 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.

  18. How long should umbilical venous catheters remain in place in neonates who require long-term (≥5-7 days) central venous access?

    Science.gov (United States)

    Keir, Amy; Giesinger, Regan; Dunn, Michael

    2014-08-01

    In this evidenced-based review, we examine the current available literature to help answer the question 'In neonates requiring long-term central access [patient], does removal of the umbilical venous catheter (UVC) on days 5-7 and replacement with a peripherally inserted central catheter line [intervention] compared with leaving the UVC in situ [comparison] reduce rates of central line-associated bloodstream infections [outcome]?'

  19. 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

  20. Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report

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    Maria Lúcia Silveira Ferlin

    Full Text Available CONTEXT: Central diabetes insipidus (CDI is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW newborns. CASE REPORT: We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION: The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert.

  1. Role of Aquaporin-4 in Cerebral Edema and Stroke

    OpenAIRE

    Zador, Zsolt; Stiver, Shirley; Wang, Vincent; MANLEY, GEOFFREY T.

    2009-01-01

    Cerebral edema plays a central role in the pathophysiology of many diseases of the central nervous system (CNS) including ischemia, trauma, tumors, inflammation, and metabolic disturbances. The formation of cerebral edema results in an increase in tissue water content and brain swelling which, if unchecked, can lead to elevated intracranial pressure (ICP), reduced cerebral blood flow, and ultimately cerebral herniation and death. Despite the clinical significance of cerebral edema, the mechan...

  2. Effect of a vascular access team on central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit : a systematic review

    NARCIS (Netherlands)

    Legemaat, Monique M; Jongerden, IP; van Rens, Roland M F P T; Zielman, Marjanne; van den Hoogen, Agnes

    2015-01-01

    OBJECTIVE: To review the effect of a vascular access team on the incidence of central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit. DATA SOURCES: MEDLINE, CINAHL, Embase, Web-of-Science and the Cochrane Library were searched until December 2013. STUDY

  3. Isolated unilateral disk edema

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    Varner P

    2011-07-01

    Full Text Available Paul VarnerJohn J Pershing VAMC, Poplar Bluff, MO, USAAbstract: Isolated unilateral disk edema is a familiar clinical presentation with myriad associations. Related, non-consensus terminology is a barrier to understanding a common pathogenesis. Mechanisms for the development of disk edema are reviewed, and a new framework for clinical differentiation of medical associations is presented.Keywords: disk edema, axoplasmic flow, clinical multiplier, optic neuritis, ischemic optic neuropathy, papilledema

  4. Isolated unilateral disk edema

    OpenAIRE

    Varner P

    2011-01-01

    Paul VarnerJohn J Pershing VAMC, Poplar Bluff, MO, USAAbstract: Isolated unilateral disk edema is a familiar clinical presentation with myriad associations. Related, non-consensus terminology is a barrier to understanding a common pathogenesis. Mechanisms for the development of disk edema are reviewed, and a new framework for clinical differentiation of medical associations is presented.Keywords: disk edema, axoplasmic flow, clinical multiplier, optic neuritis, ischemic optic neuropathy, papi...

  5. Correlation of expression pattern of aquaporin-1 in primary central nervous system tumors with tumor type, grade, proliferation, microvessel density, contrast-enhancement and perilesional edema

    Directory of Open Access Journals (Sweden)

    Prabal Deb

    2012-01-01

    Conclusions: AQP1-immunoexpression had a good correlation with high-grade tumors. AQP-upregulation in perilesional areas of high-grade tumors suggests its role in vasogenic edema. Further studies involving other AQP molecules, vascular endothelial growth factor (VEGF and hypoxia inducible factor-1 α (HIF-1α should be undertaken to evaluate its possible role as a potential surrogate marker of high-grade tumors heralding poor outcome, inhibition of which may serve as the basis for future targeted therapy.

  6. Sedative effect of central administration of Coriandrum sativum essential oil and its major component linalool in neonatal chicks.

    Science.gov (United States)

    Gastón, María Soledad; Cid, Mariana Paula; Vázquez, Ana María; Decarlini, María Florencia; Demmel, Gabriela I; Rossi, Laura I; Aimar, Mario Leandro; Salvatierra, Nancy Alicia

    2016-10-01

    Context Coriandrum sativum L. (Apiaceae) (coriander) is an herb grown throughout the world as a culinary, medicinal or essential crop. In traditional medicine, it is used for the relief of anxiety and insomnia. Systemic hydro-alcoholic and aqueous extract from aerial parts and seeds had anxiolytic and sedative action in rodents, but little is known about its central effect in chicks. Objective To study the effects of intracerebroventricular administration of essential oil from coriander seeds and its major component linalool on locomotor activity and emotionality of neonatal chicks. Materials and methods The chemical composition of coriander essential oil was determined by a gas-chromatographic analysis (> 80% linalool). Behavioural effects of central administration of coriander oil and linalool (both at doses of 0.86, 8.6 and 86 μg/chick) versus saline and a sedative diazepam dose (17.5 μg/chick, standard drug) in an open field test for 10 min were observed. Results Doses of 8.6 and 86 μg from coriander oil and linalool significantly decreased (p Coriandrum sativum seeds induced a sedative effect at 8.6 and 86 μg doses. This effect may be due to monoterpene linalool, which also induced a similar sedative effect, and, therefore, could be considered as a potential therapeutic agent similar to diazepam.

  7. Neonatal complications after maternal concomitant use of SSRI and other central nervous system active drugs during the second or third trimester of pregnancy.

    Science.gov (United States)

    Källén, Bengt; Reis, Margareta

    2012-10-01

    Drugs acting on the central nervous system (CNS) and given to a pregnant woman during the latter part of pregnancy may affect neonatal morbidity of the infant. Little is known on the combined effects of different categories of such drugs. The redeeming of prescriptions for CNS-active drugs during the second or third trimester of pregnancy was studied by linkage between a register of prescribed drugs and the Swedish Medical Birth Register for the deliveries during 2006-2008 (n = 15,045 live-born infants). Neonatal morbidity was defined as the presence of neonatal diagnoses of respiratory problems, hypoglycemia, convulsions, or other CNS pathologic abnormalities including intraventricular hemorrhage, or low 5-minute Apgar score. The risk of such neonatal morbidity after maternal use of selective serotonin reuptake inhibitors (SSRIs) with or without other CNS-active drugs were evaluated as odds ratios or risk ratios, comparing with unexposed infants or infants only exposed to SSRI drugs. An increased risk for neonatal morbidity was seen for most studied groups of CNS-active drugs when used alone. Benzodiazepines seemed to have a stronger effect than other sedatives/hypnotics. The combination of SSRIs with 1 or more other CNS-active drug groups increased the risk for neonatal morbidity. This was seen for all types of sedatives/hypnotics, which may suggest a confounding by indication. Polypharmacy with CNS-active drugs during the later part of the pregnancy seems to increase the occurrence of neonatal morbidity but difference in nature or strength of underlying psychiatric pathology may confound the findings.

  8. Neonatal pain.

    Science.gov (United States)

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

  9. Complications Involving Central Venous Catheter Insertion in Newborns Admitted to the Neonatal Intensive Care Unit (NICU

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    Torkaman

    2016-04-01

    Full Text Available Background Developments in the use of central venous catheters have improved the treatment of critically ill newborns. Objectives The aim of this retrospective study was to evaluate the rate of catheter-related complications and associated risk factors in newborns. Patients and Methods This cross sectional study evaluated 60 infants with indications for central venous catheters who were selected by census from 2007 to 2014 in Baqiyatallah Hospital in Tehran, Iran. The catheters were Broviac numbers 14 - 16. Results Ultimately, 60 cases (17 males and 43 females with a mean age of 26.25 ± 20.09 days (Min = 1 day and Max = 153 days underwent analysis. The most common reasons for venous catheter placement (98.3% were prolonged hospitalization and lack of peripheral vessels. The most common complication was catheter-related infection, which occurred in 20 patients (33.3%. Death occurred in 24 patients (40.0%, but only 3 deaths (5% were due to complications from the central venous catheter. A significant relationship was evident between infection and catheterization duration (P = 0.02. Conclusions Most of the catheter-related deaths were due to severe sepsis and hemothorax, and a significant relationship was noted between infection and both the mortality rate and catheterization duration. A significant relationship was also evident between birth weight and infection rates.

  10. Iatrogenic acute cardiac tamponade during percutaneous removal of a fractured peripherally inserted central catheter in a premature neonate.

    Science.gov (United States)

    Minghui, Zou; Hujun, Cui; Li, Ma; Weidan, Chen; Yanqin, Cui; Xinxin, Chen

    2015-01-01

    Acute cardiac tamponade (ACT) is a life-threatening complication associated with a peripherally inserted central catheter (PICC) in premature neonates. We present a case of ACT in a 4-day-old male infant. On the second admission day, a PICC was inserted. After 2.5 months, chest radiography showed PICC fracture, and its distal portion had migrated into the right pulmonary artery. Percutaneous removal through cardiac catheterization was attempted. However, right ventriculography demonstrated intrapericardial spillage of contrast agents, and iatrogenic ACT was confirmed. Cardiopulmonary resuscitation (CPR) was immediately started with open-chest cardiac massage. Further surgical exploration revealed right atrial appendage perforation. After 25-min CPR, the patient restored spontaneous circulation, and removal of the foreign bodies was performed. The post-operative course was uneventful. PICC fracture is an uncommon complication, but may be life-threatening. Precaution should be taken to avoid ACT during removal of a broken PICC. Once the tamponade is diagnosed, immediate interventions are mandatory.

  11. Neurogenic Pulmonary Edema (A Case Report

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    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

  12. Latest advances in edema

    Science.gov (United States)

    Villavicencio, J. L.; Hargens, A. R.; Pikoulicz, E.

    1996-01-01

    Basic concepts in the physiopathology of edema are reviewed. The mechanisms of fluid exchange across the capillary endothelium are explained. Interstitial flow and lymph formation are examined. Clinical disorders of tissue and lymphatic transport, microcirculatory derangements in venous disorders, protein disorders, and lymphatic system disorders are explored. Techniques for investigational imaging of the lymphatic system are explained.

  13. Complications of peripherally inserted central venous catheters in neonates: Lesson learned over 2 years in a tertiary care centre in India

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    Amit Singh

    2014-01-01

    Full Text Available Background: The objective of this study was to assess the complications of peripherally inserted central venous catheters (PICC in neonates admitted to neonatal surgical intensive care unit (NSICU. Patients and Methods: Retrospective analysis of 237 neonates admitted to NSICU from January 2010 to December 2011 was done. Results: Mean age at presentation was 5.8 days and mean weight was 1.94 kg. Mean number of attempts was 1.14, mean duration of insertion 8.4 min and mean duration of patency of catheter 3.14 days. Most common site of catheter insertion was upper extremity (basilic followed by cephalic. Overall complications were seen in 47 (23% cases. Infectious complications were seen in 22 (10.7% and non-infectious in 25 (12.2% cases. Significant correlation existed between non-infective complications and insertion site (P = 0.03 and duration of PICC (P = 0.04. Conclusion: Precautions should be taken and position must be confirmed during and after PICC insertion to avoid undue complications.

  14. 小儿中枢神经系统源性肺水肿12例诊治分析%Diagnosis and treatMent analysis of 12 children with central neurogenic pulMonary edeMa

    Institute of Scientific and Technical Information of China (English)

    邵启国

    2012-01-01

    目的探讨小儿中枢神经系统源性肺水肿(neurogenic pulMonary edeMa,NPE)的诊治方法,旨在为临床治疗该病提供参考。方法对2009年2月-2012年2月我院收治的12例小儿神经源性肺水肿患者的诊断、治疗方法进行回顾性分析。结果12例患儿经治疗后,痊愈4例,伤残3例,死亡5例,其中3例死于多器官功能衰竭,2例死于呼吸衰竭。结论早诊断、早治疗是降低小儿NPE病死率的关键。加强对NPE高危患儿的监护,在治疗原发病的基础上采取降低颅内压、呼吸支持、改善血液动力学等综合治疗,可以有效地提高小儿NPE的救治成功率。%Objective To explore the diagnosis and treatMent of central neurogenic pulMonary edeMa in children and provide a reference for the clinical treatMent of the disease.Methods Retrospective analysis the diagnosis and treatMent Methods of 12 children with central neurogenic pulMonary edeMa in ourhostipal froM Feb.2009 to Feb.2012.Results After treatMent,4 cases recovered,3 cases of disability,5 cases died,the fatality rate was 41.67%.3 cases died of Multiple organ failure,2 cases died of respiratory failure.Conclusion Early diagnosis and early treatMent is significant to reduce the Mortality of children NPE.To strengthen the custody ofhigh risk children for NPE,while treating the priMary disease,reducing intracranial pressure,iMproving breathing andheModynaMics can effectively iMprove the treatMent success rate of children NPE.

  15. Creatine, Glutamine plus Glutamate, and Macromolecules Are Decreased in the Central White Matter of Premature Neonates around Term

    Science.gov (United States)

    Le Fur, Yann; Viout, Patrick; Ratiney, Hélène; Confort-Gouny, Sylviane; Cozzone, Patrick J.; Girard, Nadine

    2016-01-01

    Preterm birth represents a high risk of neurodevelopmental disabilities when associated with white-matter damage. Recent studies have reported cognitive deficits in children born preterm without brain injury on MRI at term-equivalent age. Understanding the microstructural and metabolic underpinnings of these deficits is essential for their early detection. Here, we used diffusion-weighted imaging and single-voxel 1H magnetic resonance spectroscopy (MRS) to compare brain maturation at term-equivalent age in premature neonates with no evidence of white matter injury on conventional MRI except diffuse excessive high-signal intensity, and normal term neonates. Thirty-two infants, 16 term neonates (mean post-conceptional age at scan: 39.8±1 weeks) and 16 premature neonates (mean gestational age at birth: 29.1±2 weeks, mean post-conceptional age at scan: 39.2±1 weeks) were investigated. The MRI/MRS protocol performed at 1.5T involved diffusion-weighted MRI and localized 1H-MRS with the Point RESolved Spectroscopy (PRESS) sequence. Preterm neonates showed significantly higher ADC values in the temporal white matter (P<0.05), the occipital white matter (P<0.005) and the thalamus (P<0.05). The proton spectrum of the centrum semiovale was characterized by significantly lower taurine/H2O and macromolecules/H2O ratios (P<0.05) at a TE of 30 ms, and reduced (creatine+phosphocreatine)/H2O and (glutamine+glutamate)/H2O ratios (P<0.05) at a TE of 135 ms in the preterm neonates than in full-term neonates. Our findings indicate that premature neonates with normal conventional MRI present a delay in brain maturation affecting the white matter and the thalamus. Their brain metabolic profile is characterized by lower levels of creatine, glutamine plus glutamate, and macromolecules in the centrum semiovale, a finding suggesting altered energy metabolism and protein synthesis. PMID:27547969

  16. 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.

  17. 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...

  18. 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.

  19. 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

  20. 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...

  1. Radiologic findings of neonatal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo; Han, Dae Hee; Choi, Guk Myeong; Jung, Hye Won [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Yoon, Hye Kyung; Han, Bokyung Kim; Lee, Nam Yong [Sansung Medical Center, Seoul (Korea, Republic of)

    1997-06-01

    To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm : term=23 :13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18(50%), 9(25%), and 1(3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients(17%) radiologic examinations revealed no abnormality. In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.

  2. Diabetic Macular Edema

    Science.gov (United States)

    Lobo, Conceição; Pires, Isabel; Cunha-Vaz, José

    The optical coherence tomography (OCT), a noninvasive and noncontact diagnostic method, was introduced in 1995 for imaging macular diseases. In diabetic macular edema (DME), OCT scans show hyporeflectivity, due to intraretinal and/or subretinal fluid accumulation, related to inner and/or outer blood-retinal barrier breakdown. OCT tomograms may also reveal the presence of hard exudates, as hyperreflective spots with a shadow, in the outer retinal layers, among others. In conclusion, OCT is a particularly valuable diagnostic tool in DME, helpful both in the diagnosis and follow-up procedure.

  3. Osmotherapy in brain edema

    DEFF Research Database (Denmark)

    Grände, Per-Olof; Romner, Bertil

    2012-01-01

    on outcome, or leads to worse outcome. Here we describe the action and potentially beneficial and adverse effects of the 2 most commonly used osmotic solutions, mannitol and hypertonic saline, and present some critical aspects of their use. There is a well-documented transient intracranial pressure (ICP......, osmotherapy can be negative for outcome, which may explain why we lack scientific support for its use. These drawbacks, and the fact that the most recent Cochrane meta-analyses of osmotherapy in brain edema and stroke could not find any beneficial effects on outcome, make routine use of osmotherapy in brain...

  4. 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.

  5. [Pathopshysiological mechanisms in macular edema].

    Science.gov (United States)

    Turlea, Cristian; Zolog, Ileana; Blăjan, Codruta; Roşca, C; Turlea, Magdalena; Munteanu, Mihnea; Boruga, Ovidiu

    2014-01-01

    The treatment of diabetic macular edema has known a fast development in the last 5 years where the transition from laser monotherapy to intravitreal pharmacotherapy is becoming standard practice. Intravitreal injections therapy is in a continuous development with promising positive results. The use of intratvitreal devices in the treatment of macular edema of vascular cause has become a viable alternative also in treating diabetic macular edema. Several clinical studies have revealed the superiority of intravitreal treatment versus laser monotherapy. This article is evaluating and reviewing present and future treatments used to combat diabetic macular edema. [corrected].

  6. Molecular pathophysiology of cerebral edema.

    Science.gov (United States)

    Stokum, Jesse A; Gerzanich, Volodymyr; Simard, J Marc

    2016-03-01

    Advancements in molecular biology have led to a greater understanding of the individual proteins responsible for generating cerebral edema. In large part, the study of cerebral edema is the study of maladaptive ion transport. Following acute CNS injury, cells of the neurovascular unit, particularly brain endothelial cells and astrocytes, undergo a program of pre- and post-transcriptional changes in the activity of ion channels and transporters. These changes can result in maladaptive ion transport and the generation of abnormal osmotic forces that, ultimately, manifest as cerebral edema. This review discusses past models and current knowledge regarding the molecular and cellular pathophysiology of cerebral edema.

  7. Bone marrow edema syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Korompilias, Anastasios V.; Lykissas, Marios G.; Beris, Alexandros E. [University of Ioannina, Department of Orthopaedic Surgery, School of Medicine, Ioannina (Greece); Karantanas, Apostolos H. [University of Crete School of Medicine, Department of Radiology, Heraklion (Greece)

    2009-05-15

    Bone marrow edema syndrome (BMES) refers to transient clinical conditions with unknown pathogenic mechanism, such as transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and reflex sympathetic dystrophy (RSD). BMES is primarily characterized by bone marrow edema (BME) pattern. The disease mainly affects the hip, the knee, and the ankle of middle-aged males. Many hypotheses have been proposed to explain the pathogenesis of the disease. Unfortunately, the etiology of BMES remains obscure. The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Histological examination of the lesion is unnecessary. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is mainly used for the early diagnosis and monitoring the progression of the disease. Early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment. Clinical entities, such as TOH, RMO, and RSD are spontaneously resolving, and surgical treatment is not needed. On the other hand, early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance. (orig.)

  8. Hypopituitarism in a neonate with hyperbilirubinemia and decreased level of consciousness: a case report study.

    Science.gov (United States)

    Mousavi, Hadi; Bakhtiyari, Salar

    2014-01-01

    Decreased level of consciousness in neonates may result from different etiologies, including rare metabolic and hormonal disorder due to anterior pituitary insufficiency. In this case report, a five-day-old newborn boy was referred to the neonatal intensive care unit of Mustafa Khomeini hospital of Ilam, Iran. He had an open anterior fontanel with no history of prenatal and familial diseases. Clinical examination showed decreased level of consciousness so that this patient responded only to painful stimuli. Furthermore, unconsciousness, hyperbilirubinemia, and hypotonia were fully evident. Given the clinical findings and decreased level of consciousness, hormonal diagnostic tests and brain CT scan were performed for any evidence of hypopituitarism. Clinical and experimental findings were consistent with the generalized edema and pituitary insufficiency secondary to central hypothyroidism and cortisol deficiency. Based on the findings, the neonate was put on the hormonal replacement therapy and, as the result, all of the abnormal clinical symptoms disappeared. In conclusion, fatal neonatal diseases may be mistaken with unimportant clinical findings at the first examination. Therefore, comprehensive attention to all potential causes of such symptoms in the neonates should be given for early diagnosis and treatment, and to prevent any fatal and irreversible complications.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. Edema and malignancy in meningiomas Edema e malignidade em meningiomas

    Directory of Open Access Journals (Sweden)

    Tobias Alécio Mattei

    2005-06-01

    Full Text Available PURPOSE: In recent years there have been many attempts to define a subset of aggressive malignant meningiomas based on histopathology and imaging technologies. The purpose of this study was to evaluate the level of peritumoral edema and its volume using the imaging technologies, computer tomography and magnetic resonance imaging, and correlate these results with the histological WHO classification. Reported causes of tumoral edema and its relationships to the histological characteristics were also reviewed. METHODS: The cases of 55 patients with meningiomas who underwent surgery at the Hospital das Clinicas (Fac Med Univ Sao Paulo between September 1993 and September 1997 were reviewed. The level of edema according to the classification of Ide et al. (1995 was compared to the histological WHO classification. RESULTS: Classification of the degree of edema was: level 0 edema - 28 cases ; level I edema - 19 cases; level II edema - 8 cases. Histological classification was: benign meningioma - 43 cases; atypical meningiomas - 11 cases; malignant meningioma - 1 case. There was a significant (P = .0089 correlation between the degree of tumoral edema and the histological characteristics. CONCLUSIONS: These results suggest that the degree of edema as revealed by computer tomography and magnetic resonance imaging can be an important clinical predictive factor for the histological grade of the meningioma.OBJETIVO: Nos últimos anos têm-se descrito alguns subtipos de meningiomas de comportamento peculiarmente agressivo. Muitas tentativas têm sido feitas no intuito de estabelecer critérios imagenológicos ou histopatológicos de malignidade. O objetivo desse estudo é avaliar, através de Tomografia Computadorizada e Ressonância Nuclear Magnética o grau de edema peritumoral e seu volume, correlacionando-os com a classificação histológica da OMS. As causas relatadas de edema peritumoral e sua possível correlação histológica foram também revistos

  14. Neonatal pain management

    Directory of Open Access Journals (Sweden)

    Tarun Bhalla

    2014-01-01

    Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

  15. Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Daiane Silva Resende

    2015-02-01

    Full Text Available Aim:We assessed late onset sepsis (LOS rates of neonates in a neonatal intensive care unit (NICU before and after implementing an evidence-based bundle to prevent these infections in a country with poor resources.Methods:We evaluate trends of LOS between October 2010 and August 2012 in a large tertiary hospital in Brazil. We designed a protocol based of CDC guidelines for insertion of maintenance of central venous catheter targeted to reduction of bloodstream infections. During this period two major events occurred: a great increase of LOS rates in January months and relocation of the unit to a provisory place. Additionally we evaluated the risk factors and etiology of these infections.Results:A total of 112 (20.3% cases defined as LOS were found. The overall incidence rate of LOS in the study was 16.1/1000 patient/days and 23.0/1000 CVC-days. Our monthly rates data of LOS/1000 patient-day reveal fluctuations over the studied period, with incidence rates of these infections in staff vacation period (January 2011 and 2012 significantly higher (59.6/1000 patients-days than compared with the other months rates (16.6/1000 patients-days (IRR = 3.59; p< 0.001. As opposite, the incidence rates of LOS during relocation period was lower (10.3/1000 patients-days when compared with baseline period 26.7/1000 patients-days (IRR = 2.59; p= 0.007. After the intervention period, these rates decreased in the post intervention period, when compared with preintervention 14.7/1000 patients-days and 23.4/1000 patients-days, respectively (IRR = 1.59; p= 0.04.Conclusion:Through simple infection control measures, LOS can be successfully controlled especially in NICUs of limited resources countries such as ours.

  16. 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.

  17. Cerebral Edema in Traumatic Brain Injury: Pathophysiology and Prospective Therapeutic Targets.

    Science.gov (United States)

    Winkler, Ethan A; Minter, Daniel; Yue, John K; Manley, Geoffrey T

    2016-10-01

    Traumatic brain injury is a heterogeneous disorder resulting from an external force applied to the head. The development of cerebral edema plays a central role in the evolution of injury following brain trauma and is closely associated with neurologic outcomes. Recent advances in the understanding of the molecular and cellular pathways contributing to the posttraumatic development of cerebral edema have led to the identification of multiple prospective therapeutic targets. The authors summarize the pathogenic mechanisms underlying cerebral edema and highlight the molecular pathways that may be therapeutically targeted to mitigate cerebral edema and associated sequelae following traumatic brain injury.

  18. 新生儿中心静脉导管相关性感染的预防%Prevention of central venous catheter-related infections in neonates

    Institute of Scientific and Technical Information of China (English)

    王欣宁

    2010-01-01

    Central venous catheters are indispensable in modern-day medical practice in neonatal intensive care units.Infection is the most frequent serious complication during these catheter-inserted days.Several strategies to prevent catheter-related infections are disputed all over the world.Studies have shown that some measures played a role in reducing the infection rate,which include maximal sterile barrier precautions,chlorhexidine preparation for skin antisepsis,routine replacement of catheter site dressings and connection sets,time-limited catheter insert,removal catheter after infected,antibiotic locked catheters and so on.%中心静脉导管是新生儿重症监护室常用的静脉通道,而感染是中心静脉导管置管术严重的并发症,各国的新生儿中心都在积极研究各种预防措施,但其有效性仍有争议.研究表明,严格无菌操作、洗必泰皮肤消毒剂、周期性更换辅料及导管连接装置、限期拔管、感染后及时拔管、抗生素封闭导管等措施在降低感染率方面有一定的作用.

  19. Prevalência e motivos de remoção não eletiva do cateter central de inserção periférica em neonatos Prevalencia y motivos de retirada no electiva del catéter de inserción periférica en recién nacidos Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates

    Directory of Open Access Journals (Sweden)

    Priscila Costa

    2012-09-01

    Full Text Available Estudo transversal, realizado com 67 recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal de um hospital privado de São Paulo, entre julho e dezembro de 2010, submetidos a 84 inserções de Cateteres Centrais de Inserção Periférica (CCIP. Os objetivos foram descrever a prevalência de remoção não eletiva do cateter e seus motivos. Os dados foram coletados de prontuários médicos e do formulário de registro de informações sobre o cateter. A média de idade gestacional corrigida dos neonatos foi 32,8 semanas, peso 1.671,6 g e idade pós-natal 9,4 dias. A remoção não eletiva ocorreu em 33 (39,3% cateteres, 13,1% por obstrução, 9,5% ruptura, 7,1% edema do membro, 6% suspeita de infecção, 1,2% tração acidental, 1,2% má perfusão e 1,2% extravasamento. A prevalência e os motivos de remoção não eletiva indicaram a necessidade de estratégias para a prevenção de complicações evitáveis relacionadas ao CCIP.Estudio transversal con 67 recién nacidos ingresados en una Unidad Neonatal de Cuidados Intensivos de un hospital privado de São Paulo, en el período de julio hasta diciembre de 2010, sometidos a 84 instalaciones del Catéter Central de Inserción Periférica (PICC. Los objetivos fueron describir la prevalencia de retirada no electiva del catéter y sus razones. Los datos fueron recolectados de registros médicos y del formulario de registro del catéter. El promedio de edad gestacional corregida de los recién nacidos fue de 32,8 semanas, peso de 1671,6g, edad de 9,4 días de vida. La retirada no electiva ocurrió en 33 (39,3% catéteres, el 13,1% por obstrucción, el 9,5% por rotura, el 7,1% por edema, el 6% por sospecha de infección, el 1,2% por tracción accidental, el 1,2% por mala perfusión y el 1,2% por extravasación. La prevalencia y las razones del retiro no electivo indican la necesidad de estrategias de prevención de complicaciones evitables relacionadas con el PICC.This is a cross

  20. One day wonder: Fast resolution of macular edema following intravitreal ranibizumab in retinal venous occlusions

    Directory of Open Access Journals (Sweden)

    Lalit Verma

    2013-01-01

    Full Text Available Macular edema is a significant cause of vision loss in patients with central retinal vein occlusions and branch retinal vein occlusions. Vascular endothelial growth factor (VEGF appears to be a key factor in the pathogenesis of this disease. Anti-VEGF therapy, such as intravitreal ranibizumab provides an effective treatment against vision-threatening macular edema. We report three patients of retinal vein occlusion with macular edema who demonstrated overnight resolution of macular edema following treatment with intravitreal ranibizumab (0.5 mg. 3D optical coherence tomography (Optovue was used as a tool for comparison of the macular thickness before and after treatment. The significant reductions in the central foveal thickness demonstrated in these patients one night after intravitreal injections could have significant influence on modifying current treatment protocols. Early treatment of macular edema related to retinal venous occlusive disease with anti-VEGF injections could result in faster visual rehabilitation in these patients.

  1. Utilização de cateter central de inserção periférica e ocorrência da infecção da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal | Use of peripherally inserted central catheters and occurrence of bloodstream infections in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Márcia Yumi Yonekura

    2015-02-01

    Full Text Available Objetivo: Analisar a prevalência de infecção hospitalar primária da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal. Métodos: Estudo retrospectivo, com análise de prontuários de uma Unidade de Terapia Intensiva Neonatal, no período de janeiro a dezembro de 2010. Foi calculada a densidade de incidência de infecção de corrente sanguínea associada ao cateter por 1000 cateteres-dia. Resultados: Dos 192 recém-nascidos, 16 (8,3% apresentaram infecção da corrente sanguínea e todos estes utilizaram o cateter central de inserção periférica. A densidade de infecção confirmada por hemocultura foi de 5,9 e a baseada em critérios clínicos foi de 3,5 por 1000 pacientes com cateter vascular central-dia. A distribuição por faixa de peso foi de: 30,9 (750-999g; 11 (1000-1499g; 8,5 (1500-2499g e 6,8 (> 2500g por 1000 pacientes com cateter vascular dia. A média do tempo de uso do cateter foi de 11 dias. O sítio de inserção mais comum foi o acesso jugular (37,5% e a mortalidade associada à infecção da corrente sanguínea foi de 31%. Conclusões: A utilização do cateter central de inserção periférica é uma prática não isenta de riscos, considerando que este é um dispositivo invasivo e pode predispor à ocorrência de infecção. ------------------------------------------------------------------------------------------ Objective: To analyze the prevalence of hospital primary bloodstream infections in a neonatal intensive care unit (NICU. Methods: A retrospective study involving analyses of records of patients admitted to the NICU from January to December 2010 was conducted. The incidence density of catheter-associated bloodstream infections per 1000 catheter-days was calculated. Results: Among 192 newborns, 16 (8.3% who used peripherally inserted central catheters had bloodstream infections. The infection density confirmed by blood culture reached 5.9, while the density based on clinical criteria accounted for

  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. Reexpansion pulmonary edema following thoracentesis

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    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.

  4. Spatiotemporal correlation of optical coherence tomography in-vivo images of rabbit airway for the diagnosis of edema

    Science.gov (United States)

    Kang, DongYel; Wang, Alex; Volgger, Veronika; Chen, Zhongping; Wong, Brian J. F.

    2015-07-01

    Detection of an early stage of subglottic edema is vital for airway management and prevention of stenosis, a life-threatening condition in critically ill neonates. As an observer for the task of diagnosing edema in vivo, we investigated spatiotemporal correlation (STC) of full-range optical coherence tomography (OCT) images acquired in the rabbit airway with experimentally simulated edema. Operating the STC observer on OCT images generates STC coefficients as test statistics for the statistical decision task. Resulting from this, the receiver operating characteristic (ROC) curves for the diagnosis of airway edema with full-range OCT in-vivo images were extracted and areas under ROC curves were calculated. These statistically quantified results demonstrated the potential clinical feasibility of the STC method as a means to identify early airway edema.

  5. Cerebral edema associated with acute hepatic failure.

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    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.

  6. Fatores associados a infeccao pelo uso do cateter central de insercao periferica em Unidade de Terapia Intensiva Neonatal

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    Elysangela Dittz Duarte

    2013-06-01

    Full Text Available Estudo epidemiológico, longitudinal e analítico, desenvolvido em um hospital de Minas Gerais, com o objetivo de analisar os fatores associados à infecção pelo uso do cateter central de inserção periférica em recém-nascidos internados em unidade de terapia intensiva. A coleta dos dados foi realizada por meio de uma ficha estruturada, preenchida pelos profissionais e verificada pelos pesquisadores. Foram estudados 291 cateteres inseridos em 233 recém-nascidos. Os fatores associados à retirada por suspeita de infecção foram: prematuridade, peso ao nascer até 1.500 gramas, cateter de poliuretano, localização não centralizada do cateter e tempo de uso superior a 30 dias. Após ajuste multivariado, permaneceram independentemente associados: peso inferior a 2.500 gramas na inserção, reparo e tempo de uso do cateter. Conclui-se que fatores relacionados à prática dos profissionais contribuíram para a retirada dos cateteres, sinalizando para a necessidade de intervenções que melhorem a segurança e a eficácia em seu uso.

  7. Therapeutic implications of melatonin in cerebral edema.

    Science.gov (United States)

    Rathnasamy, Gurugirijha; Ling, Eng-Ang; Kaur, Charanjit

    2014-12-01

    Cerebral edema/brain edema refers to the accumulation of fluid in the brain and is one of the fatal conditions that require immediate medical attention. Cerebral edema develops as a consequence of cerebral trauma, cerebral infarction, hemorrhages, abscess, tumor, hypoxia, and other toxic or metabolic factors. Based on the causative factors cerebral edema is differentiated into cytotoxic cerebral edema, vasogenic cerebral edema, osmotic and interstitial cerebral edema. Treatment of cerebral edema depends on timely diagnosis and medical assistance. Pragmatic treatment strategies such as antihypertensive medications, nonsteroidal anti-inflammatory drugs, barbiturates, steroids, glutamate and N-methyl-D-aspartate receptor antagonists and trometamol are used in clinical practice. Although the above mentioned treatment approaches are being used, owing to the complexity of the mechanisms involved in cerebral edema, a single therapeutic strategy which could ameliorate cerebral edema is yet to be identified. However, recent experimental studies have suggested that melatonin, a neurohormone produced by the pineal gland, could be an effective alternative for treating cerebral edema. In animal models of stroke, melatonin was not only shown to reduce cerebral edema but also preserved the blood brain barrier. Melatonin's beneficial effects were attributed to its properties, such as being a potent anti-oxidant, and its ability to cross the blood brain barrier within minutes after its administration. This review summarizes the beneficial effects of melatonin when used for treating cerebral edema.

  8. Edema pulmonar pós-pneumonectomia Postpneumonectomy pulmonary edema

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    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. Cerebral edema in drug addicts

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    Daruši Dragana J.

    2014-01-01

    Full Text Available Background/Aim. The effect of drugs leaves permanent consequences on the brain, organic in type, followed by numerous manifestations, and it significantly affects the development of mental dysfunctions. The clinicians are often given a task to estimate a patient’s personality during treatment or during experts estimate of a drug addict. The aim of this research was to determine the differences, if any, in characteristics of addicts experience and personality traits in drug addicts with or without cerebral edema. Methods. The research was conducted on a sample of 252 male drug addicts, the average age of 23.3 (SD = 4.3 years. Cerebral edema was confirmed on magnetic resonance (MR images of the brain performed during the treatment of the addicts. The participants were tested by the psychologists using Minnesota Multiphasic Personality Inventory (MMPI-201 test, and the data were processed using canonical discriminate analysis within the SPSS program. The dependent variable in the study was cerebral edema. A block of independent variables, designed for the requirements of this study, consisted of two subgroups. The first one consisted of 12 variables describing the relevant characteristics of drug abuse. The second subgroup consisted of 8 psychopathological tendencies in the personality defined by the mentioned test. Results. Cerebral edema was confirmed in 52 (20.63% of the drug addicts. The differences between the groups of drug addicts with and without cerebral edema were determined in the following: the time span of taking drugs (0.301, use of alcohol parallel with drugs (0.466, and treatment for addiction (0.603. In the drug addicts with a cerebral edema, MMPI-201 confirmed the increase in the scales for hypochondria, psychopathic deviations and psychastenia, and the decrease in the scales for schizophrenia and depression. Conclusion. Our study confirmed a possible connection between cerebral edema and personality traits in a number of the

  10. Cuidados com cateter central de inserção periférica no neonato: revisão integrativa da literatura Cuidados con catéter central de inserción periférica en el neonato: revisión integrativa de la literatura Peripherally inserted central catheter care in neonates: an integrative literature review

    OpenAIRE

    Derdried Athanasio Johann; Luciana Souza Marques De Lazzari; Edivane Pedrolo; Priscila Mingorance; Tatiana Queiroz Ribeiro de Almeida; Mitzy Tannia Reichembach Danski

    2012-01-01

    O cateter central de inserção periférica é tecnologia comum empregada na terapia intravenosa de neonatos. Trata-se de revisão integrativa, cujo objetivo foi investigar e analisar as evidências disponíveis na literatura acerca da temática. As bases de dados pesquisadas foram Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Biblioteca Nacional de Medicina dos Estados Unidos (PubMed). Resultados apontam lacunas no que tange à população neonatal; conhecimento insuficiente d...

  11. Tirosinemia neonatal Neonatal tyrosinemia

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    Rafael J. Manotas Cabarcas

    1995-04-01

    Full Text Available Mediante la técnica de Udenfriend y Cooper, se midieron los niveles de tirosina en la sangre del cordón de 26 prematuros y 31 niños de término, con el fin de comparar las concentraciones según la edad gestacional y detectar la presencia de la tirosinemia neonatal. Se encontró un caso de esta entidad en un niño de 31 semanas de edad gestacional, lo cual correspondió al 3.8% de los prematuros y al 1.8% del grupo total. La concentración de tirosina en el paciente fue de 53 JJ.M. El promedio de las concentraciones en los prematuros menores de 32 semanas fue de 16.8 :t 6.3 JJ.M; el de los niños entre 33 y 36 semanas fue de 19.3 :t 7.6 JJ.M y el de los niños de término, de 17.2 :t 9.4 JJ.M. Las pruebas estadísticas no mostraron tendencias ni diferencias significativas entre estas concentraciones. El promedio ponderado para el grupo total fue 17.7 :t 7.3 JJ.M. Se recomienda establecer programas de tamizaje para detectar este problema porque puede presentar repercusiones neurológicas posteriores.

    By means of the Udenfriend-Cooper technique, levels of tyrosine were measured in the cord blood of 26 preterm and 31 term Infants; the objective was to compare tyrosine concentrations according to gestational age and to detect the presence of neonatal tyrosinemia. A case of this disease was found In an Infant with 31 weeks of gestational age; this case represented 3.8% of preterm Infants and 1.8% of the total group. Average tyrosine concentration according to age was as follows: 16.8: ± 6.3  µM in Infants under 32 weeks of gestational age; 19.3: ±: 7.6 µM In those between 33 and 36 weeks and 17.2 : ±: 9.4 µM In the term Infants

  12. INDICATIONS AND COMPLICATIONS OF CENTRAL VENOUS CATHETERIZATION IN CRITICALLY ILL CHILDREN IN INTENSIVE CARE UNIT

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    Shwetal Bhatt

    2012-02-01

    Full Text Available Background: Nothing can be more difficult, time consuming and frustrating than obtaining vascular access in critically ill pediatric patient1 .Central venous catheters are widely used in the care of critically ill patients. Methodology: This paper reviews our experience with central lines in 28 critically ill patients including neonates and non-neonates, in a study period of October 2008 to October 2009. Of the total 28 patients, central venous catheterizations was more in those who were more than a month age and of female sex. Results: The route of insertion was femoral in approximately 89% of our patients and insertion was successful in 24 patients. The most common indication we observed for catheter use was, venous access in shock (37.1% in neonates and for monitoring the central venous pressure (32% in non neonate patients of ARDS with pulmonary edema and Shock. The central line was removed in majority of patients (60% within 24-48hrs of insertion and was kept for maximum of six days in just one patient. Organism most frequently isolated was Acinetobacter. Recommendations made include, use strict aseptic measures by restricted number of skilled operators while inserting and during maintaining central line, routine confirmatory x-ray or fluoroscopy to check the position of central line before catheter use, if possible, use for central pressure monitoring recommended. Conclusion: We concluded that central venous catheterization is a safe and effective measure so we recommend timely and judicious use of percutaneous central venous catheter in paediatric critically ill patients of PICU and NICU. [National J of Med Res 2012; 2(1.000: 85-88

  13. Neonatal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Sorantin, Erich [Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, A8036 Graz (Austria)]. E-mail: erich.sorantin@meduni-graz.at; Brader, Peter [Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, A8036 Graz (Austria); Thimary, Felix [Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, A8036 Graz (Austria)

    2006-11-15

    A variety of traumatic lesions can occur during the neonatal period. Some of those lesions are clearly birth injuries due to delivery and others are caused by necessary procedures during intensive care in critically ill neonates. As usual patient history must be known and knowledge about the typical complications is necessary in order to select the appropriate imaging modality and thus enabling correct interpretation of those investigations by the radiologist. The purpose of this article is to present typical neonatal injuries, describe the underlying pathomechanisms and aetiology as well as the imaging findings.

  14. Prenatal alcohol exposure (PAE) reduces the size of the forepaw representation in forepaw barrel subfield (FBS) cortex in neonatal rats: relationship between periphery and central representation.

    Science.gov (United States)

    Margret, Cecilia P; Chappell, Tyson D; Li, Cheng X; Jan, Taha A; Matta, Shannon G; Elberger, Andrea J; Waters, Robert S

    2006-07-01

    Prenatal alcohol exposure (PAE) alters limb development that may lead to structural and functional abnormalities of the limb reported in children diagnosed with Fetal Alcohol Spectrum Disorder. To determine whether PAE alters the central representation of the forelimb we used the rodent barrel cortex as our model system where it was possible to visualize and quantitatively measure the size of the forepaw representation in the forepaw barrel subfield (FBS) in first somatosensory cortex. In the present study, we examined the effects of PAE on pattern and size of the forepaw and forepaw representation in FBS in neonatal rats at gestational day 32 that corresponds to postnatal day 9. Pregnant Sprague-Dawley rats were chronically intubated with binge doses of ethanol (6 g/kg) from gestational day 1 through gestational day 20. The offspring of the ethanol treated dams comprised the ethanol (EtOH) group. The effect of PAE on the EtOH group was compared with a nutritional-controlled pairfed (PF) group and a normal chowfed (CF) group. The ventral (glabrous) surface area of the forepaw digits, length of digit 2 through digit 5, and the corresponding glabrous forepaw digit representations in the FBS were measured and compared between treatment groups. In rats exposed to in utero alcohol, the sizes of the overall glabrous forepaw and forepaw digits were significantly reduced in EtOH pups compared to CF and PF pups; overall glabrous forepaw area was 11% smaller than CF controls. Glabrous digit lengths were also smaller in EtOH rats compared to CF controls and significantly smaller in digit 2 through digit 4. The glabrous digit representation in FBS was 18% smaller in the EtOH group when compared to the CF treatment. However, PAE did not produce malformations in the forepaw or alter the pattern of the forepaw representation in FBS; instead, PAE significantly reduced both body and brain weights compared to controls. Unexpectedly, little or no correlation was observed between the

  15. Serotonin syndrome presenting as pulmonary edema

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    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.

  16. 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

  17. 钾通道在新生大鼠星形胶质细胞缺氧缺血性水肿中的作用机制%Mechanism of potassium channel in hypoxca-ischemic brain edema: experiment with neonatal rat astrocyte

    Institute of Scientific and Technical Information of China (English)

    付雪梅; 向龙; 廖大清; 封志纯; 母得志

    2008-01-01

    目的 探讨钾通道在体外培养的新生大鼠星形胶质细胞缺氧缺血性水肿中的作用机制.方法 体外培养出生3 d新生大鼠的星形胶质细胞;采用RNA干扰技术制作水通道蛋白4(AQP4)敲低型(AQP4-/-)细胞模型;用放射性[3H]标记的甲基D-葡萄糖摄取,测定缺氧缺血性AQP4-/-和野生型(AQP4+/+)星形胶质细胞体积;利用全细胞膜片钳技术记录培养的星形胶质细胞电压依赖性钾通道(Kv)的电流特性,并记录缺氧缺血性星形胶质细胞Kv通道的电流变化.结果 AQP4+/+和AQP4-/-星形胶质细胞在缺氧缺血时均较其对照组细胞体积明显增加(AQP4+/+和AQP4+/+组细胞在缺氧缺血0.5、1、2、4 h组占所对应的对照组D-葡萄糖摄取值的百分数分别为104±7、109±6、126±12、152±9和97±7、105±9、109±7、132±6,均P<0.05),但相同缺氧缺血时间点AQP4-/-介导细胞水肿程度明显减轻(均P<0.05),而且细胞电流密度随着缺氧缺血时间延长,进行性下降(对照组和缺氧缺血0.5、1、2、4 h组细胞电流密度值分别为116±8,107±9,91±10,76±6,37±11,均P<0.05).结论 在细胞缺氧缺血时,细胞外向性钾通道下调,可能阻止细胞内堆积的钾离子流出细胞外,引起渗透性改变而导致水通过AQP4流入细胞内,从而出现细胞水肿.%Objective To investigate the mechanism of potassium channel in brain edema caused by hypoxia-ischemia (HI). Methods Astrecytes were obtained from 3-day-old SD rats, cultured, and randomly divided into 2 groups: normoxia group, cultured under normoxic condition, and hypoxic-ischemic group, cultured under hypoxic-ischemic condition. The cell volume was measured by radiologic method. Patch-clamp technique was used to observe the electric physiological properties of the voltage-gated potassium channels (Kv) in a whole cell configuration, and the change of voltage-gated potassium channel current (IKv) was recorded in cultured neonatal rat astrocyte during HI

  18. Neonatal Jaundice

    DEFF Research Database (Denmark)

    Maimburg, Rikke Damkjær; Væth, Michael; Schendel, Diana

    2008-01-01

    .7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism....

  19. Cateter central de inserção periférica: descrição da utilização em UTI Neonatal e Pediátrica Catéter central de inserción periférica: descripción da utilización en UTI Neonatal y Pediátrica Peripherally inserted central catheter: description of its utilization in Neonatal and Pediatric ICU

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Baggio

    2010-03-01

    Full Text Available Estudo descritivo, retrospectivo, documental que objetivou descrever a utilização do cateter central de inserção periférica (PICC em uma Unidade de Terapia Intensiva Neonatal e Pediátrica quanto à inserção, manutenção e remoção, e identificar o perfil das crianças que receberam PICC, por meio de análise descritiva e estatística de 176 instrumentos preenchidos por enfermeiros, em um período de dois anos. A população assistida foi de 125 pacientes, principalmente prematuros (43,2% e do sexo masculino (60%. Para inserção do dispositivo as veias basílica e cefálica (43,2% e o cateter 1.9 Fr (85,8% foram utilizados. Houve índice de sucesso nas punções (98,9%, porém a remoção antecipada ocorreu em virtude de obstrução (25%, infiltração (18%, suspeita de contaminação (16,6%, tração (13,9%, ruptura (11,2%, retirada acidental (8,3%, flebite (4,2%, cianose (1,4% e migração (1,4%, com média de permanência de 14,5 dias. Para a manutenção do cateter é requerida a capacitação e a educação permanente dos profissionais, estratégias que qualificam a assistência.Estudio descriptivo, retrospectivo, documental, cuyo objetivo fue describir la utilización del catéter central de inserción periférica (PICC en una Unidad Pediátrica de Cuidados Intensivos en relación con la inserción, mantenimiento y remoción, e identificar el perfil de los niños que lo recibieron PICC, por medio de análisis descriptivo y estadístico de 176 instrumentos diligenciados por enfermeros, en un período de dos años. La población asistida fue de 125 pacientes, principalmente prematuros (43,2%, de sexo masculino (60%. Para inserción del dispositivo las venas basílica y cefálica (43,2% y el catéter 1.9 Fr (85,8% fueron principalmente utilizados. El éxito en las punciones fue (98,9%, aunque la remoción anticipada ocurrió en virtud de obstrucción (25%, infiltración (18%, sospecha de contaminación (16,6%, tracción (13

  20. Etiology and treatment of the inflammatory causes of cystoid macular edema

    Directory of Open Access Journals (Sweden)

    Hyung Cho

    2009-10-01

    Full Text Available Hyung Cho1, Assumpta Madu11Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USAAbstract: Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials.Keywords: ocular inflammation, cystoid macular edema, uveitis

  1. Fístula broncovascular: complicação de cateter venoso central percutâneo em neonato Bronchovascular fistula: complication of percutaneous central venous catheter in a neonate

    Directory of Open Access Journals (Sweden)

    Cláudio D'Elia

    2002-01-01

    Full Text Available Objetivos: relatar um caso em que ocorreu falso trajeto de cateter venoso central, com fístula vásculo-pulmonar e graves conseqüências respiratórias correlatas em recém-nascido. Revisar a literatura sobre as complicações respiratórias e não respiratórias relacionadas à introdução de cateteres venosos centrais percutâneos em crianças. Descrição: dados clínicos evolutivos e diagnósticos foram obtidos após revisão do prontuário. O recém-nascido prematuro permaneceu em UTI neonatal após o parto para tratamento de doença da membrana hialina leve e de infecção manifestada posteriormente. No dia seguinte à introdução percutânea do cateter central, para a administração de nutrição parenteral, iniciou desconforto respiratório que progrediu rapidamente. Necessitou de ventilação mecânica para estabelecer troca gasosa adequada. A verificação da trajetória do cateter com o auxílio de contraste radiológico revelou a presença da complicação. Comentários: não são raras as complicações decorrentes da inserção de cateteres centrais, sendo a infecção a mais comum. É importante que os profissionais responsáveis pelos cuidados desses pacientes conheçam as várias outras complicações menos freqüentes, como a trombose vascular e a migração do cateter, com lesões de órgãos e coleções extravasculares de líquidos. Em recém-nascidos, existe apenas um único relato de complicação semelhante à verificada em nosso paciente. Sua raridade pode ter determinado dificuldades para o diagnóstico imediato. São enfatizados os aspectos relacionados aos cuidados, após a introdução destes cateteres, que poderiam facilitar o reconhecimento precoce destas complicações.Objectives: to present a case of central venous line misplacement with vasculo-pulmonary fistula and severe respiratory consequences in a newborn. To review the literature concerning respiratory and non-respiratory complications related to the

  2. Blood pressure, edema and proteinuria in pregnancy. 7. Edema-plus-proteinuria relationships.

    Science.gov (United States)

    Sellmann, A H

    1976-01-01

    1. A total of 488 pregnancies had the combination of two-plus or more proteinuria and edema of the hands and face. Of these, 208 were white and 280 were black gravidas. In the white gravidas, 8 fetal and neonatal deaths occurred with a perinatal mortality of 38.5 per 1,000. There were 13 perinatal deaths in the black subgroup with a perinatal mortality rate of 46.4 per 1,000. The overall perinatal mortality rate was 43.0 per 1,000, which could be compared to the overall perinatal mortality rate of 32.8 per 1,000 for the segment of the study population without edema or proteinuria. This underscored the implication of increased hazard to fetal outcome of these clinical signs in combination. 2. The analysis of the matrix data showed scattered rates throughout gestation in white median-age nulliparas. Their black counterparts had comparable increased mortality rates. In the white multiparas of ages 20 to 34 years, the highest rates were found at relatively low blood pressure levels. The black median-age multiparas had rates associated with higher pressure readings, especially at or above 125/75. In teenage mulliparas with edema and proteinuria, perinatal mortality rates were similar for both subgroups and were found in somewhat lower blood pressures. 3. The incremental analysis was remarkable in that rates were scattered widely in the white subgroups, but tightly clustered in the black subgroups. The black median-age nulliparas had perinatal mortality concentrated about 115 to 134 mm. Hg systolic and 65 to 84 mm. Hg diastolic. The overall mortality rates of this subgroup were the highest of the subgroups studied. The black 20 to 34 year old multiparas had highest coassociated deaths in the 134-154 mm. Hg systolic levels throughout pregnancy. The clustering effect was most pronounced in black teenage nulliparas in both systolic and diastolic blood pressure groups at much lower levels. 4. The use of a critical cut-off blood pressure level of 125 mm. Hg systolic and 75 mm

  3. Distal clavicle edema; Distales Klavikulaoedem

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.; Schmittke, I. [Radiologie Haydnhaus, Bonn (Germany); Schmidt, H.M. [Universitaet Bonn (Germany). Anatomisches Institut

    2006-07-15

    Distal clavicle marrow edema: frequency, MRI in the early stage and macroscopic correlation to the bone marrow distribution and to evaluate frequency and diagnostic criteria of a posttraumatic clavicula disorder with an edema pattern on MRI. An additional macroscopic study of the clavicle should elucidate anatomic pecularities which could explain the reaction of the distal clavicle. 285 MRI of traumatized patients were analyzed for edema pattern of the distal clavicle. Pattern A edema within the clavicle and the acromion was distinguished from pattern B edema within the clavicle only. Dissection in 20 cadavers should reveal vascular pecularities and the bone marrow distribution within clavicle and acromion or vascular pecularities. In 38 patients (13,3%) we found edema within the distal clavicle. Pattern A was found in 28 (9,8%) and pattern B in 10 patients (3,5%). Pattern A was usually associated with swelling of the AC joint (27 out of 28). Other injuries were not evident. 18 cadavers showed hematopoetic marrow within the distal clavicle and fatty marrow within the acromion. The distale clavicle can frequently react with edema pattern after trauma without evidence for another injury. Distinguish in cases with and cases without synovitis of the AC joint could have impact on therapy. A peculier vascular supply of the distal clavicle could not be found. (orig.) [German] Bestimmung der Haeufigkeit und diagnostischer Kriterien einer posttraumatischen Klavikulaerkrankung, die mit einem MR-tomographischen Oedemmuster auffaellt. Makroskopische Besonderheiten der Markhoehle sollten gesucht werden, die die besondere Reaktionsform der distalen Klavikula mit erklaeren koennten. 285 Patienten mit traumaassoziierten, zeitversetzt nach dem Unfallereignis bestehenden Schulterbeschwerden, wurden auf MR-tomographische Oedemmuster in der distalen Klavikula untersucht. Das Oedemmuster wurde in ''Klavikula allein'' (Muster B) und ''mit Beteiligung des

  4. Neonatal neurosonography

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, Michael, E-mail: michael.riccabona@klinikum-graz.at

    2014-09-15

    Paediatric and particularly neonatal neurosonography still remains a mainstay of imaging the neonatal brain. It can be performed at the bedside without any need for sedation or specific monitoring. There are a number of neurologic conditions that significantly influence morbidity and mortality in neonates and infants related to the brain and the spinal cord; most of them can be addressed by ultrasonography (US). However, with the introduction of first CT and then MRI, neonatal neurosonography is increasingly considered just a basic first line technique that offers only orienting information and does not deliver much relevant information. This is partially caused by inferior US performance – either by restricted availability of modern equipment or by lack of specialized expertise in performing and reading neurosonographic scans. This essay tries to highlight the value and potential of US in the neonatal brain and briefly touching also on the spinal cord imaging. The common pathologies and their US appearance as well as typical indication and applications of neurosonography are listed. The review aims at encouraging paediatric radiologists to reorient there imaging algorithms and skills towards the potential of modern neurosonography, particularly in the view of efficacy, considering growing economic pressure, and the low invasiveness as well as the good availability of US that can easily be repeated any time at the bedside.

  5. Microperimetry Findings of a Patient with Macular Edema Secondary to Retinitis Pigmentosa

    Directory of Open Access Journals (Sweden)

    Cem Ozgonul

    2013-08-01

    Full Text Available Sixty-nine year old male patient with a diagnosis of retinitis pigmentosa admitted to our clinic. In ophthalmologic examination fundoscopy was compatible with retinitis pigmentosa. For evaluation of macular edema, optical coherence tomography and microperimetry were performed to examine the structure and function of the macula. Chronic macular edema findings were obtained with optical coherence tomography. By microperimetry, mean retinal sensitivity in the central 20 degrees of both eyes was measured 8-10 decibels. The aim of this study is, to emphasize the importance of microperimetry for the evaluation of retinal function in a patient with macular edema secondary to retinitis pigmentosa.

  6. Edema macular diabético Diabetic macular edema

    Directory of Open Access Journals (Sweden)

    J. Andonegui

    2008-01-01

    Full Text Available El edema macular diabético representa la primera causa de pérdida visual en los pacientes con diabetes mellitus. Su complejidad, unida a la aparición de nuevos métodos de diagnóstico así como de novedosas alternativas de tratamiento, hace que el enfoque de esta enfermedad suponga un importante reto para el oftalmólogo. A lo largo de este artículo se describen su patofisiología, manifestaciones clínicas, clasificación, diagnóstico y tratamiento, haciendo especial énfasis en los nuevos métodos diagnósticos y en las diferentes opciones terapéuticas.Diabetic macular edema is the principal cause of visual loss in patients with diabetes mellitus. Its complexity, together with the appearance of new methods of diagnosis and new alternatives for treatment, mean that the approach to this disease is an important challenge for ophthalmologists. This article describes its pathophysiology, clinical manifestations, classification, diagnosis and treatment, with special emphasis on the new diagnostic methods and on the different therapeutic options.

  7. Ictericia Neonatal

    OpenAIRE

    Blanco de la Fuente, María Isabel

    2014-01-01

    El motivo que ha llevado a la realización de este trabajo fin de grado sobre el tema de la ICTERICIA NEONATAL se debe a la elevada frecuencia de su aparición en la población. Un porcentaje elevado de RN la padecen al nacer siendo, en la mayor parte de los casos, un proceso fisiológico resuelto con facilidad debido a una inmadurez del sistema hepático y a una hiperproducción de bilirrubina. La ictericia neonatal es la pigmentación de color amarillo de la piel y mucosas en ...

  8. [Therapeutic approach in persistent diabetic macular edema].

    Science.gov (United States)

    Brănişteanu, Daniel; Moraru, Andreea

    2014-01-01

    Terminology of persistent diabetic macular edema has been initially reserved to cases unresponsive to conventional laser photocoagulation according to ETDRS criteria. While knowledge about pathophysiology of macular edema evolved and new drugs became available, the terminology of persistent diabetic macular edema expanded to include resistance to most current therapies. The purpose of this paper is to review medical and surgical options in the treatment of such difficult cases according to literature data and personal experience.

  9. 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.

  10. 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.

  11. Bone marrow edema in sports: General concepts

    Energy Technology Data Exchange (ETDEWEB)

    Vanhoenacker, F.M. [AZ Sint-Maarten Duffel-Mechelen, Department of Radiology, Rooienberg 25, B-2570 Duffel (Belgium) and University Hospital Antwerp, Department of Radiology, Wilrijkstraat 10, B-2650 Edegem (Belgium)]. E-mail: filip.vanhoenacker@telenet.be; Snoeckx, A. [AZ Sint-Maarten Duffel-Mechelen, Department of Radiology, Rooienberg 25, B-2570 Duffel (Belgium); University Hospital Antwerp, Department of Radiology, Wilrijkstraat 10, B-2650 Edegem (Belgium)

    2007-04-15

    This paper will discuss the value of medical imaging in the detection and follow-up of bone marrow edema (BME), resulting from acute and chronic trauma in sports. MR imaging is the only imaging technique that allows direct evaluation of bone marrow edema in sports medicine. The use of fat suppressed T2-weighted or STIR images is particularly appropriate to detect bone marrow edema. The extent of bone marrow edema reflects the biomechanics of trauma. Compressive forces between two bony structures will result in extensive areas of bone marrow edema, whereas distraction forces provoke more subtle areas of bone marrow edema at the insertion of supporting structures of joints. In most clinical situations, a combination of compression and distraction forces is present, causing a complex pattern of bone marrow edema. A meticulous pattern approach of the distribution of these bone marrow changes around a joint can reveal in most instances the underlying mechanism of trauma. This may be helpful to analyze which joint supporting structures may be at risk. In the acute setting, plain radiography and CT scan may have an additional role in the detection of small avulsion fractures occurring at the site of minor areas of bone marrow edema. The clinical significance and natural history of bone marrow edema is still a matter of debate.

  12. Neonatal Kraniefraktur

    DEFF Research Database (Denmark)

    Johannesen, Katrine Marie Harries; Stantchev, Hristo

    2015-01-01

    During the latest decades the incidence of birth traumas has decreased significantly. Even so the traumas still contribute to an increased mortality and morbidity. We present a case of spontaneous neonatal skull fracture following a normal vaginal delivery. Abnormal facial structure was seen...

  13. Pathogenesis of Brain Edema and Investigation into Anti-Edema Drugs

    Directory of Open Access Journals (Sweden)

    Shotaro Michinaga

    2015-04-01

    Full Text Available Brain edema is a potentially fatal pathological state that occurs after brain injuries such as stroke and head trauma. In the edematous brain, excess accumulation of extracellular fluid results in elevation of intracranial pressure, leading to impaired nerve function. Despite the seriousness of brain edema, only symptomatic treatments to remove edema fluid are currently available. Thus, the development of novel anti-edema drugs is required. The pathogenesis of brain edema is classified as vasogenic or cytotoxic edema. Vasogenic edema is defined as extracellular accumulation of fluid resulting from disruption of the blood-brain barrier (BBB and extravasations of serum proteins, while cytotoxic edema is characterized by cell swelling caused by intracellular accumulation of fluid. Various experimental animal models are often used to investigate mechanisms underlying brain edema. Many soluble factors and functional molecules have been confirmed to induce BBB disruption or cell swelling and drugs targeted to these factors are expected to have anti-edema effects. In this review, we discuss the mechanisms and involvement of factors that induce brain edema formation, and the possibility of anti-edema drugs targeting them.

  14. Emma Kohman and the early history of nutritional edema.

    Science.gov (United States)

    Bing, F C

    1983-06-01

    Nutritional edema is a generalized edematous condition that afflicted whole populations of central European countries during World War 1--and other areas since that time--with a mortality rate of about 50%. An analogous condition in white rats was produced by Emma Kohman as a graduate student in Chicago (1916 to 1919). She fed the rats a diet similar to that consumed by human subjects but prevented or cured nutritional edema in the animals by feeding them good quality protein in suitable amounts. Her work, verified by others, was of immense practical significance and helped establish the value of animal experiments in the study of human diseases. Ms. Kohman gave up a scientific career to be a homemaker when she married in 1919.

  15. Bilateral eyelid edema : Cutis laxa or blepharochalasis?

    NARCIS (Netherlands)

    Braakenburg, A; Nicolai, JPA

    2000-01-01

    A 59-year-old woman with massive bilateral edema of the upper and lower eyelids is presented. The edema occurred suddenly and without provocation. No cause could be identified despite a multitude of examinations. Initially the patient was diagnosed as having blepharochalasis, but later skin biopsy s

  16. Cuidados com cateter central de inserção periférica no neonato: revisão integrativa da literatura Cuidados con catéter central de inserción periférica en el neonato: revisión integrativa de la literatura Peripherally inserted central catheter care in neonates: an integrative literature review

    Directory of Open Access Journals (Sweden)

    Derdried Athanasio Johann

    2012-12-01

    Full Text Available O cateter central de inserção periférica é tecnologia comum empregada na terapia intravenosa de neonatos. Trata-se de revisão integrativa, cujo objetivo foi investigar e analisar as evidências disponíveis na literatura acerca da temática. As bases de dados pesquisadas foram Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS e Biblioteca Nacional de Medicina dos Estados Unidos (PubMed. Resultados apontam lacunas no que tange à população neonatal; conhecimento insuficiente dos profissionais quanto indicações (n=1; e variados temas sobre uso de anticoagulantes (n=6, comparação com outros cateteres (n=4, diagnóstico por imagem (n=2, dor (n=2, infecção relacionada a cateter e sua prevenção (n=7, entre outros fatores. Conclui-se que há necessidade de atualização profissional, evidências científicas de fácil acesso e publicações nacionais.El catéter central de inserción periférica es una tecnología común empleada en terapia endovenosa de neonatos. Se trata de una revisión integrativa, cuyo objetivo fue investigar y analizar las evidencias disponibles en la literatura acerca de la temática. Se investigaron las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS y la Biblioteca Nacional de Medicina de los Estados Unidos (PubMed. Los resultados expresan omisiones en lo referente a la población neonatal; conocimiento insuficiente de los profesionales al respecto de las indicaciones (n=1, diagnóstico por imagen (n=2, dolor (n=2, infección relacionada al catéter y su prevención (n=7, entre otras. Se necesita de actualización profesional; evidencias científicas de fácil acceso y publicaciones nacionales.The peripherally inserted central catheter is a common technology employed in the intravenous therapy of neonates. This integrative review was performed with the objective to investigate and analyze the evidence available in the literature regarding this

  17. 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.

  18. Neonatal Kraniefraktur

    DEFF Research Database (Denmark)

    Johannesen, Katrine Marie Harries; Stantchev, Hristo

    2015-01-01

    During the latest decades the incidence of birth traumas has decreased significantly. Even so the traumas still contribute to an increased mortality and morbidity. We present a case of spontaneous neonatal skull fracture following a normal vaginal delivery. Abnormal facial structure was seen......, and the fracture was identified with an MRI. The fractures healed without neurosurgical intervention. Case reports show that even in uncomplicated vaginal deliveries skull fractures can be seen and should be suspected in children with facial abnormalities....

  19. 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].

  20. Etiology and treatment of the inflammatory causes of cystoid macular edema.

    Science.gov (United States)

    Cho, Hyung; Madu, Assumpta

    2009-01-01

    Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials.

  1. Etiology and treatment of the inflammatory causes of cystoid macular edema

    Science.gov (United States)

    Cho, Hyung; Madu, Assumpta

    2009-01-01

    Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials. PMID:22096351

  2. Cerebral edema associated to scorpion sting: a two-case sting report

    Directory of Open Access Journals (Sweden)

    N. O. Romero

    2005-12-01

    Full Text Available Scorpionism is a public health problem in some places in Mexico. The clinical symptoms of envenomation by scorpion sting are by sympathetic and parasympathetic stimulation, developing systemic and local symptoms. The Central Nervous System (CNS is one of the organs that are affected. In some cases, cerebral edema develops. In this report we present two pediatric cases with the association of envenomation by scorpion sting and cerebral edema. The first case developed severe cerebral edema, which progressed to a fatal outcome; and the other case developed mild cerebral edema with a satisfactory evolution. The pathophysiology of this complication is not well known and probably is the consequence of hypoxia, secondary to respiratory failure, laryngospasm and seizures that are manifestations of envenomation by scorpion sting.

  3. 中部地区危重新生儿转运系统中二级NICU的作用分析%Study on the establishment of neonatal emergency transport system In the secondary NICU in central region

    Institute of Scientific and Technical Information of China (English)

    吴俊超; 胡傲容; 刘军民; 李玉萍; 刘永兵; 黄静; 王芳保; 邓云

    2011-01-01

    [目的] 探讨二级NICU在危重新生儿转运系统(neonatal emergency transport system,NETS)中的桥梁作用. [方法] 以随州市妇幼保健院二级NICU为中心收集2005年5月-2010年4月主动转运危重新生儿和同期被动接诊的新生儿信息,对NETS作用效果的有关资料进行统计学分析. [结果] 主动转运逐年增加,被动接诊逐年减少;主动转运的病残率低于被动转运;主动转运疾病的转归好于被动接诊. [结论] 在中部地区地市设置二级NICU,对保证危重新生儿转运救治成功以及降低新生儿死亡率和神经系统病残率具有重要意义.%[Objective] Study on the effection of neonatal emergency transport system in the secondary NICU. [Method] The information of the critical newborn infants by active transport from May 2005 to April 2010 and the same period infants by passive reception were collected and anlyzed the NETS effect. [Results] The number of infants by active transport was increasing every year and by passive reception was decreasing; the disability rate of newborn infants through active transport was lower than passive transport and the disease prognosis was better than passive reception. [Conclusion] To establish the secondary NICU in central region is very important to ensure the successful transport and decrease the neonatal mortality and neurological morbidity.

  4. 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

  5. Neonatal circumcision.

    Science.gov (United States)

    Lerman, S E; Liao, J C

    2001-12-01

    The merits of neonatal circumcision continue to be debated hotly. Some argue that circumcision is a "uniquely American medical enigma." Most of the world's male population remains uncircumcised; however, most boys born in the United States continue to undergo neonatal circumcision. Review of existing literature supports that most children who are uncircumcised do well from a medical standpoint and, thus, the question of whether US health care practitioners are subjecting neonates to an unnecessary surgical procedure remains. The medical benefits of circumcision are multiple, but most are small. The clearest medical benefit of circumcision is the relative reduction in the risk for a UTI, especially in early infancy. Although this risk [figure: see text] is real, the absolute numbers are small (risk ranges from 1 in 100 to 1 in 1000), and one investigator has estimated that it may take approximately 80 neonatal circumcisions to prevent one UTI. In the case of a patient with known urologic abnormalities that predispose to UTI, neonatal circumcision has a clearer role in terms of medical benefit to the patient. Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved. Proper penile hygiene should all but eliminate the risk for foreskin-related medical problems that will require circumcision. Moreover, proper hygiene and access to clean water has been shown to reduce the rate of development of squamous cell carcinoma of the penis in the uncircumcised population. Proper techniques on the care of the foreskin are illustrated in the American Academy of Pediatrics pamphlet titled "How to care for the uncircumcised penis." Regarding the relationship between STDs and circumcision, patient education and the practice of low-risk sexual behavior make a far greater impact than does routine circumcision in hopes of reducing the spread of HIV and other STDs. Nevertheless

  6. Aquaporin-4 and traumatic brain edema

    Institute of Scientific and Technical Information of China (English)

    XU Miao; SU Wei; XU Qiu-ping

    2010-01-01

    Brain edema leading to an expansion of brain volume has a crucial impact on morbidity and mortal-ity following traumatic brain injury as it increases intracra-nial pressure, impairs cerebral perfusion and oxygenation,and contributes to additional ischemic injuries.Classically,two major types of traumatic brain edema exist: "vasogenic"and "cytotoxic/cellular".However, the cellular and molecu-lar mechanisms contributing to the development/resolution of traumatic brain edema are poorly understood and no ef-fective drugs can be used now.Aquaporin-4 (AQP4) is a water-channel protein expressed strongly in the brain, pre-dominantly in astrocyte foot processes at the borders be-tween the brain parenchyma and major fluid compartments, including cerebrospinal fluid and blood.This distribution suggests that AQP4 controls water fluxes into and out of the brain parenchyma.In cytotoxic edema, AQP4 deletion slows the rate of water entry into brain, whereas in vasogenic edema, AQP4 deletion reduces the rate of water outflow from brain parenchyma.AQP4 has been proposed as a novel drug target in brain edema.These findings sug-gest that modulation of AQP4 expression or function may be beneficial in traumatic brain edema.

  7. Update on treatments of diabetic macular edema

    Institute of Scientific and Technical Information of China (English)

    YANG Xiao-lu; LIU Kun; XU Xun

    2009-01-01

    Objective To review the update research progress about the treatment of diabetic macular edema and to give helpful guidelines in the treatment of diabetic macular edema based on available evidence to date.Data sources A literature search of all English articles was performed on the online electronic PubMed database dated 1984 to 2009. The keywords searched included: macular edema, therapy, laser coagulation, intravitreal triamcinolone acetonide, vascular endothelial growth factor inhibitor, protein kinase C inhibitor and Pars plana vitrectomy. After finding relevant articles within these search limits, a manual search was conducted through the references from these articles.Study selection Original articles and critical reviews were reviewed and selected to address the stated purpose.Results To date, demonstrated means to reduce the risk of vision loss from diabetic macular edema include focal/grid laser photocoagulation and improved metabolic control. Emerging pharmacologic therapies (intravitreal triamcinolone acetonide, vascular endothelial growth factor inhibitors and protein kinase C beta-isoform inhibitors) and Pars plana vitrectomy have shown early promise in the treatment of diabetic macular edema.Conclusions As there has been extensive development in multiple treatments of diabetic macular edema, choice of the most suitable treatment for specific patients becomes important. Combination therapy of laser, pharmacological and surgical treatment modalities may offer an alternative to treatment of diabetic macular edema.

  8. Radiosurgery for brain metastases and cerebral edema.

    Science.gov (United States)

    Gazit, Inbal; Har-Nof, Sagi; Cohen, Zvi R; Zibly, Zion; Nissim, Uzi; Spiegelmann, Roberto

    2015-03-01

    The objective of this study was to assess reduction in cerebral edema following linear accelerator radiosurgery (LINAC) as first line therapy for brain metastasis. We reviewed the medical records of all patients who underwent LINAC radiosurgery for brain metastasis at our institution during 2010-2012, and who had not previously undergone either surgery or whole brain radiotherapy. Data were analyzed for 55 brain metastases from 46 patients (24 males), mean age 59.9 years. During the 2 months following LINAC radiosurgery, the mean steroid dose decreased from 4.8 to 2.6 mg/day, the mean metastasis volume decreased from 3.79±4.12 cc to 2.8±4.48 cc (p=0.001), and the mean edema volume decreased from 16.91±30.15 cc to 12.85±24.47 cc (p=0.23). The 17 patients with reductions of more than 50% in brain edema volume had single metastases. Edema volume in the nine patients with two brain metastases remained stable in five patients (volume change 10%, 2-14 cc). In a subanalysis of eight metastases with baseline edema volume greater than 40 cc, edema volume decreased from 77.27±37.21 cc to 24.84±35.6 cc (p=0.034). Reductions in brain edema were greater in metastases for which non-small-cell lung carcinoma and breast cancers were the primary diseases. Overall, symptoms improved in most patients. No patients who were without symptoms or who had no signs of increased intracranial pressure at baseline developed signs of intracranial pressure following LINAC radiosurgery. In this series, LINAC stereotactic radiosurgery for metastatic brain lesions resulted in early reduction in brain edema volume in single metastasis patients and those with large edema volumes, and reduced the need for steroids.

  9. To explore the neonatal nurses' beliefs and attitudes towards caring for dying neonates in Taiwan.

    Science.gov (United States)

    Chen, Chao-Huei; Huang, Li-Chi; Liu, Hsin-Li; Lee, Ho-Yu; Wu, Shu-Ya; Chang, Yue-Cune; Peng, Niang-Huei

    2013-12-01

    (1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses' personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.

  10. Loss of anatomical landmarks with eutectic mixture of local anesthetic cream for neonatal male circumcision.

    Science.gov (United States)

    Plank, Rebeca M; Kubiak, David W; Abdullahi, Rasak Bamidele; Ndubuka, Nnamdi; Nkgau, Maggie M; Dapaah-Siakwan, Fredrick; Powis, Kathleen M; Lockman, Shahin

    2013-02-01

    We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare.

  11. 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.

  12. 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.

  13. Spectral domain optical coherence tomography documented rapid resolution of pseudophakic cystoid macular edema with topical difluprednate

    Directory of Open Access Journals (Sweden)

    Chalam KV

    2012-01-01

    Full Text Available KV Chalam, Vijay Khetpal, Chirag J PatelDepartment of Ophthalmology, University of Florida Jacksonville, FL, USAIntroduction: Pseudophakic cystoid macular edema is a common cause of poor vision after cataract surgery, and topical corticosteroids and nonsteroidal anti-inflammatory drugs are used for its treatment. We investigated the effectiveness of difluprednate (Durezol®, recently approved by the US Food and Drug Administration in the treatment of cystoid macular edema, assisted with spectral domain optical coherence tomography (SD-OCT.Case report: A 63-year-old African-American woman presented 6 weeks after uneventful cataract surgery in her left eye with decreased vision and associated distortion of the central visual field. Fluorescein angiogram and SD-OCT confirmed pseudophakic cystoid macular edema. Difluprednate was topically administered twice daily and monitored with serial imaging. Resolution was noted after 1 month of topical therapy, with improvement in visual acuity and resolution of distortion.Conclusion: Difluprednate is an effective treatment for patients with severe pseudophakic cystoid macular edema. SD-OCT allows the physician to monitor resolution of the macular edema easily.Keywords: cystoid macular edema, difluprednate, spectral domain optical coherence tomography, pseudophakic

  14. 幼鼠中枢神经系统FOS蛋白表达升高与母婴分离相关%Relationship between the FOS expression increase in central nervous system of developing rats and neonatal maternal separation

    Institute of Scientific and Technical Information of China (English)

    林滨榕; 吴国媛; 吴斌; 陈素清; 林春

    2013-01-01

    Objective To study the correlation between neonatal maternal separation (MS) and the FOS expression in hypothalamus paraventricular nucleus (PVN) and anterior cingulated cortex(ACC) in central nervous system in developing rats. Methods According to the factorial design, 32 SD rats were divided into four groups with 8 in each. Group A1B1 and group A1B2 were MS group. Group A1B1 were imposed on CRD at 6-week age, yet group A1B2 was not imposed on CRD. Group A2B1 and group A2B2 both as the control groups. Group A2B1 was imposed on CRD at 6-week age, while group A2B2 were untreated. The rats were killed after the group A1B1 and A2B1 were treated by CRD for 2 hours while the group A1B2 and A1B2 were not exposed to CRD. The semiquantity analysis of the FOS-like Immunoreaetivity(FLI) cell numbers of different sites (including PVN and ACC ) in central nervous system were made by immuno-hisrochemical staining. Results Both neonatal MS and CRD at 6-week age could significantly increase the of FLI cell numbers, not only in PVN but also in ACC . There was no interaction between neonatal MS and infant CRD on the expression of FOS in PVN and ACC. Conclusions The increase of FOS expres- sion in PVN and ACC in central nervous system in developing rats is related to neonatal MS obviously.%目的 探讨幼鼠中枢神经系统下丘脑室旁核(PvN)及前皮质扣带回(ACC)内FOS蛋白表达与母婴分离(MS)的相关性.方法 按析因设计,32只SD新生大鼠分成4组,每组8只.A1B1组、A1B2组均为MS组,A1B1组在6周龄时接受结直肠扩张刺激(CRD),A1B2组在6周龄时未给予CRD;A2B1组、A2B2组均未给予MS,同为对照组,A2B1组在6周龄时接受CRD,A2B2组在6周龄时未给予CRD.A1B1、A2B1组幼鼠在接受CRD刺激后2 h和A1B2、A2B2组幼鼠一起处死.之后采用SABC免疫组化法检测不同脑区(包括PVN和ACC)内FOS蛋白免疫阳性(FLI)细胞表达情况.结果 新生期MS和幼鼠在6周龄时接受CRD刺激均可使PVN内FLI细

  15. Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

    Directory of Open Access Journals (Sweden)

    Sizakele L.T. Khoza

    2014-10-01

    Full Text Available Background: Neonatal pain management has received increasing attention over the past four decades. Research into the effects of neonatal pain emphasises the professional, ethical and moral obligations of staff to manage pain for positive patient outcomes. However, evaluation studies continuously report evidence of inadequate neonate pain management and a gap between theory and practice.Objective: This study reviewed current practice in neonatal pain management to describe the knowledge, attitudes and practices of nurses and doctors regarding pain management for neonates in two academic hospitals.Method: A non-experimental, prospective quantitative survey, the modified Infant Pain Questionnaire, was used to collect data from 150 nurses and doctors working in the neonatal wards of two academic hospitals in central Gauteng.Results: The response rate was 35.33% (n = 53, most respondents being professional nurses (88.68%; n = 47 working in neonatal intensive care units (80.77%; n = 42; 24 (45.28% had less than 5 years’ and 29 respondents 6 or more years’ working experience in neonatal care. A review of pain management in the study setting indicated a preference for pharmacological interventions to relieve moderate to severe pain. An association (p < 0.05 was found between pain ratings on 5 procedures and frequency of administration of pharmacological pain management. Two-thirds of respondents (64% reported that there were no pain management guidelines in the neonatal wards in which they worked.Conclusion: The interventions to manage moderate neonatal pain are in line with international guidelines. However, neonatal pain management may not occur systematically based on prior assessment of neonatal pain, choice of most appropriate intervention and evaluation. This study recommends implementation of a guideline to standardise practice and ensure consistent and adequate pain management in neonates

  16. Shifting bone marrow edema of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Moosikasuwan, Josh B.; Schultz, Elizabeth [Department of Radiology, North Shore University Hospital, 300 Community Drive, NY 11030, Manhasset (United States); Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 300 Community Drive, NY 11030, Manhasset (United States); Department of Radiology, North Shore University Hospital, 825 Northern Boulevard, NY 11021, Great Neck (United States); Math, Kevin [Department of Radiology, Beth Israel Medical Center, First Avenue at 16th Street, NY 10003, New York (United States)

    2004-07-01

    The purpose of our study is to describe shifting bone marrow edema in the knee as the MR imaging feature of intra-articular regional migratory osteoporosis of the knee. Five men, aged 45-73 years, were referred by orthopedic surgeons for MR imaging evaluation of knee pain, which had been present for 2 weeks to 6 months. One patient had a prior history of blunt trauma. None had risk factors for osteonecrosis. Four patients had two MR examinations and the patient with prior blunt trauma had four. Plain radiographs were obtained in all patients. In all cases, a large area of marrow edema initially involved a femoral condyle, with migration of the bone marrow edema to the other femoral condyle, tibia, and/or patella occurring over a 2- to 4-month period. Adjacent soft tissue edema was present in all five patients, while none had a joint effusion. Radiographs of two patients showed generalized osteopenia. In the absence of acute trauma or clinical suspicion of infection, a large area of bone marrow edema without a zone of demarcation may represent intra-articular regional migratory osteoporosis. Demonstration of shifting bone marrow edema on follow-up examinations suggests this diagnosis. (orig.)

  17. Aquaporin-4 and ischemic brain edema

    Institute of Scientific and Technical Information of China (English)

    Saihong Dun; Yang Guo

    2007-01-01

    OBJECTIVE: To investigate the relationship of aquaporin 4 (AQP4) and brain edema.DATA SOURCES: Using the terms of "aquaporin-4, brain edema", we searched PubMed database to identify studies published from January 1997 to April 2006 in the English languages. Meanwhile, we also searched China National Knowledge Infrastructure (CNKI) for related studies.STUDY SELECTION: The collected data were selected firstly. Studies on AQP4 and brain edema were chosen and their full-texts were searched for, and those with repetitive or review studies were excluded.DATA EXTRACTION: Totally 146 related studies were collected, 42 of them were involved and the other 104 studies were used for reading reference data.DATA SYNTHESIS: AQP4 is a selective water permeable integral membrane protein. It is mainly expressed in astrocytes and ependymocyte, and is the important structural basis for water regulation and transportation between glial cells and cerebrospinal fluid or vessels. Phosphorylation is involved in the regulation of AQP4.AQP4 participates in the formation of brain edema caused by various factors. Studies on the structure and pathological changes of AQP4 are still in the initial stage, and the role and mechanism of AQP4 in the formation of brain edema is very unclear.CONCLUSION: AQP4 plays a critical regulating role in the formation of ischemic brain edema, but whether it is regulated by drugs lacks reliable evidence.

  18. Olanzapine-induced tender pitting pre-tibial edema

    Directory of Open Access Journals (Sweden)

    Kaliaperumal Mathan

    2015-01-01

    Full Text Available Antipsychotic-induced edema is uncommonly encountered in clinical practice. We report a case of tender pitting pre-tibial edema with olanzapine in a woman with no medical comorbidities. The peculiar distribution of edema resulted in diagnostic confusion necessitating specific investigations. Eventually, the edema resolved following complete stoppage of the drug, but caused distress to the patient and the caregiver.

  19. 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.

  20. Carnitine in neonatal nutrition.

    Science.gov (United States)

    Borum, P R

    1995-11-01

    Experimental evidence from several investigators suggests that carnitine is a conditionally essential nutrient for neonates. If carnitine is a conditionally essential nutrient for the neonate, most neonates on total parenteral nutrition in the United States are not receiving adequate nutritional support. The metabolic functions of carnitine are varied and important in several aspects of neonatal physiology. All neonates receiving breast milk receive dietary carnitine and most neonates receiving enteral infant formulas receive dietary carnitine at a level similar to that of the breast-fed neonate. However, most neonates on total parenteral nutrition receive no dietary carnitine. Investigators have been testing the working hypothesis that carnitine is a conditionally essential nutrient for the neonate for many years. This review discusses (1) data supporting the hypothesis, (2) reasons why it has not been either proved or disproved by now, and (3) the author's view of a prudent approach to dietary carnitine supplementation of neonates.

  1. Clinical effectiveness analysis of anti-VEGF for central retinal vein occlusion associated with macular edema : A Meta-analysis%抗VEGF药物治疗视网膜中央静脉阻塞并发黄斑水肿的Meta分析

    Institute of Scientific and Technical Information of China (English)

    刘姝林; 陈有信

    2014-01-01

    、虹膜新生血管2眼等,而用药后全身不良事件罕见. 结论 抗VEGF药物治疗CRVO并发黄斑水肿效果明显,不良反应较少,但疗效维持时间较短.发病早期及时注射抗VEGF药物对患者更有益,但晚期注射仍能取得一定疗效.%Background Central retinal vein occlusion (CRVO) causes macular edema.The treatment options are limited.There have been a series of randomized controlled trials (RCTs) to investigate the effectiveness of anti-vascular endothelial growth factor (VEGF),but the systematic review of the literature to assess the strength of evidence supporting the interventions is lack.Objective This study was to evaluate the effectiveness of anti-VEGF therapy for improving vision and reducing macular edema in patients with CRVO associated with macular edema.Methods A systematic review and Meta-analysis was performed.According to guidelines of Cochrane collaboration,the literature of RCTs for anti-VEGF therapy treating CRVO with macular edema was searched from Cochrane Library,Pubmed,Embase,Wanfang databases and conference documents without the limiting of language or date.The literature was screened independently by two searchers,and the methodology quality of the included papers was estimated.The proportion of patients with the best corrected visual acuity (BCVA) ≥ 15 ETDRS letters,the change ranges of BCVA (LogMAR) and central fovea thickness (CFT) were analyzed.The overall effect size was analyzed using Review Manager 5.1 in The Cochrane Collaboration as weighted mean difference (WSD).Fixed effect mode was used to evaluate and compare the treating effectiveness between the anti-VEGF group and sham treating group.Results Six RCTs were incorporated with 948 eyes and generated 3 comparisons in the study,including 5 multi-central studies and 1 single central study.Pegaptanib was administered in 1 study,and ranibizumab was used in 2 studied,bevacizumab in 1 study and VEGF Trap-Eye in 2 studies.The results demonstrated that anti-VEGF therapy

  2. Neonatal peripheral hypotonia: clinical and electromyographic characteristics.

    Science.gov (United States)

    Parano, E; Lovelace, R E

    1993-06-01

    Hypotonia is a common occurrence in pediatrics, especially in the neonatal period. The hypotonic neonate represents a diagnostic challenge for the general pediatrician because hypotonia may be caused by a lesion at any level in the neuraxis: (1) central nervous system (CNS), (2) peripheral nerves (PN), (3) neuromuscular junction, or (4) muscles. Distinguishing among these pathologies is a particularly arduous task. This review will discuss the clinical approach to neonatal hypotonia with emphasis on disorders of the peripheral nervous system and muscle, and the importance of the electrophysiological study as a diagnostic test.

  3. Bacillus cereus Bacteremia in a Preterm Neonate

    OpenAIRE

    Hilliard, Nicholaus J.; Schelonka, Robert L.; Waites, Ken B.

    2003-01-01

    Bacillus cereus is an uncommon but potentially serious bacterial pathogen causing infections of the bloodstream, lungs, and central nervous system of preterm neonates. A case of bacteremia caused by B. cereus in a 19-day-old preterm neonate who was successfully treated with vancomycin, tobramycin, meropenem, and clindamycin is described. Implications for the diagnostic laboratory and clinicians when Bacillus species are detected in normally sterile sites are discussed, and the small numbers o...

  4. Neonatal lupus.

    Science.gov (United States)

    Robles, David T; Jaramillo, Lorena; Hornung, Robin L

    2006-12-10

    An otherwise healthy 5-week-old infant with erythematous plaques predominantly on the face and scalp presented to our dermatology clinic. The mother had been diagnosed with lupus erythematosus 2 years earlier but her disease was quiescent. Neonatal lupus is a rare condition associated with transplacental transfer of IgG anti-SSA/Ro and anti-SSB/La antibodies from the mother to the fetus. Active connective tissue disease in the mother does not have to be present and in fact is often absent. Although the cutaneous, hematologic and hepatic manifestations are transient, the potential for permanent heart block makes it necessary for this to be carefully ruled out. As in this case, the dermatologist may be the one to make the diagnosis and should be aware of the clinical presentation, work-up, and management of this important disease.

  5. 69例新生儿中枢神经系统感染的颅脑超声结果分析%Analysis of brain ultrasound result of 69 cases with neonatal central nervous system infection

    Institute of Scientific and Technical Information of China (English)

    杜成

    2016-01-01

    目的:观察新生儿中枢神经系统感染颅脑超声声像图改变的特点。方法选取69例中枢神经系统感染新生儿为研究对象,采用便携式索诺声M-turbo超声诊断仪经前囟门型颅脑超声检查,观察脓性脑膜炎、病毒性脑膜炎和结核性脑膜炎声像图改变特点及差异。结果化脓性脑膜炎及结核性脑膜炎脑膜回声异常阳性率为92.7%和100.0%,高于病毒性脑膜炎的20.0%,脑室扩张阳性率均为100.0%,高于病毒性脑膜炎的55.0%,积液阳性率为63.4%和75.0%,高于病毒性脑膜炎的5.0%,硬膜下积液阳性率为26.8%和12.5%,低于病毒性脑膜炎的95.0%,差异均具有统计学意义(χ2=39.031、25.358、21.058、29.087,P均<0.01)。结论颅脑超声检查是新生儿中枢神经系统感染有效的诊断手段,对化脓性脑膜炎、结核性脑膜炎和病毒性脑膜炎影像学检查声像图改变较为清晰,诊断准确、方法简便、无创伤,是新生儿中枢神经系统感染辅助诊断及动态观察的有效手段。%Objective To investigate the imaging characteristics of the brain ultrasound examination for cases with neonatal central nervous system infection.Methods Total of 69 cases with neonatal infection of the central nervous system were selected, the portable sonosite M-turbo ultrasonic diagnostic instrument was applied through anteriorfontanelle craniocerebral ultrasound. Changes of the characteristics and the differences of the imaging features of purulent meningitis, viral meningitis and tuberculous meningitis were analyzed, respectively.Results The positive rates of abnormal meningeal echo in purulent meningitis and tuberculous meningitis were 92.7% and 100%, which were higher than that of 20% in viral meningitis; ventricular dilatation positive rate was 100%, which was higher than that of 55% in viral meningitis; the positive rates were 63.4% and 75%, which was higher than that of 5% in viral meningitis

  6. The origin of lactate in peritumoral edema as measured by proton-magnetic resonance spectroscopic imaging

    NARCIS (Netherlands)

    Go, Kian; Krikke, AP; Kamman, RL; Heesters, Martinus; James, HE; Marshall, LF; Reulen, HJ; Baethmann, A; Marmarou, A; Ito, U; Hoff, JT; Kuroiwa, T; Czernicki, Z

    1997-01-01

    Using in vivo proton-magnetic resonance spectroscopy (H-1-MRS), which allows the measurement of metabolites of adequate tissue concentration, the origin of lactate in peritumoral edema has been assessed by comparison with lactate levels in the central and marginal areas of the tumor in 18 patients w

  7. 新生儿经不同部位置入PICC导管的应用比较%Effect comparison of peripherally inserted central catheter through different parts for neonates

    Institute of Scientific and Technical Information of China (English)

    韩雪婷

    2014-01-01

    目的:比较新生儿经2个不同部位置入 PICC导管的效果。方法选取2012年5月-2013年8月经肘部静脉及头部静脉置入 PICC导管患儿各26例,通过观察穿刺部位穿刺时、穿刺完毕出血情况、置管成功例数、发生静脉炎例数及皮肤过敏或破损情况,比较2个部位置管的效果。结果经头皮静脉置管术中及术后24 h更换敷料时出血例数均少于经肘部静脉置管。经头皮静脉置管更换敷料时造成皮肤过敏或破损的例数少于经肘部静脉置管。置管成功例数和发生静脉炎的例数2组比较,差异无统计学意义。结论肘部静脉条件差或凝血功能障碍的患儿,可选择头皮静脉穿刺置管。%Objective To compare the effects of peripherally inserted central catheter (PICC) through different parts for neonates .Methods From May 2012 to August 2013 ,52 neonates with PICC were randomly divided into elbow venous puncture group (n=26) and scalp venous puncture group (n=26) .The number of bleeding ,catheterization success ,phlebitis ,skin irritation or damage in 2 groups were compared .Results The number of bleeding at intraoperative and 24 hours after operation in the scalp venous puncture group were less than that in the elbow venous puncture group . The number of skin irritation or damage in the scalp venous puncture group were also less than that in the elbow venous puncture group . There were no statistical significance in number of catheterization success and phlebitis of 2 groups .Conclusions The neonates with poor elbow vein condition or dysfunction of blood coagulation should choose scalp venous puncture .

  8. Leg edema from intrathecal opiate infusions.

    Science.gov (United States)

    Aldrete, J A; Couto da Silva JM

    2000-01-01

    Despite the increasing popularity of intrathecal infusions to treat patients with long-term non-cancer-related pain, this therapy is not without serious side-effects. Five out of 23 patients who had intrathecal infusions of opiates for longer than 24 months developed leg and feet edema. As predisposing factors, cardiovascular disease, deep venous thrombosis, peripheral vascular disease, and venous stasis of the lower extremities were considered. Every patient who developed pedal and leg edema after the implantation of an infusion pump was also found to have leg edema and venous stasis prior to the time when the pump was inserted. This complication was severe enough to limit their physical activity, and to produce lymphedema, ulcerations and hyperpigmentation of the skin. Reduction of the edema occurred when the dose of the opiate was decreased, and in two cases in which the infusion was discontinued, there was almost complete resolution of the syndrome. It appears that the pre-existence of pedal edema and of venous stasis is a relative contraindication to the long-term intrathecal infusion of opiates in patients with chronic non-cancer pain.

  9. Mechanisms of Astrocyte-Mediated Cerebral Edema

    Science.gov (United States)

    Stokum, Jesse A.; Kurland, David B.; Gerzanich, Volodymyr; Simard, J. Marc

    2014-01-01

    Cerebral edema formation stems from disruption of blood brain barrier (BBB) integrity and occurs after injury to the CNS. Due to the restrictive skull, relatively small increases in brain volume can translate into impaired tissue perfusion and brain herniation. In excess, cerebral edema can be gravely harmful. Astrocytes are key participants in cerebral edema by virtue of their relationship with the cerebral vasculature, their unique compliment of solute and water transport proteins, and their general role in brain volume homeostasis. Following the discovery of aquaporins, passive conduits of water flow, aquaporin 4 (AQP4) was identified as the predominant astrocyte water channel. Normally, AQP4 is highly enriched at perivascular endfeet, the outermost layer of the BBB, whereas after injury, AQP4 expression disseminates to the entire astrocytic plasmalemma, a phenomenon termed dysregulation. Arguably, the most important role of AQP4 is to rapidly neutralize osmotic gradients generated by ionic transporters. In pathological conditions, AQP4 is believed to be intimately involved in the formation and clearance of cerebral edema. In this review, we discuss aquaporin function and localization in the BBB during health and injury, and we examine post-injury ionic events that modulate AQP4- dependent edema formation. PMID:24996934

  10. Bilateral ankle edema with bilateral iritis.

    Science.gov (United States)

    Kumar, Sunil

    2007-07-01

    I report two patient presented to me with bilateral symmetrical ankle edema and bilateral acute iritis. A 42-year-old female of Indian origin and 30-year-old female from Somalia both presented with bilateral acute iritis. In the first patient, bilateral ankle edema preceded the onset of bilateral acute iritis. Bilateral ankle edema developed during the course of disease after onset of ocular symptoms in the second patient. Both patients did not suffer any significant ocular problem in the past, and on systemic examination, all clinical parameters were within normal limit. Lacrimal gland and conjunctival nodule biopsy established the final diagnosis of sarcoidosis in both cases, although the chest x-rays were normal.

  11. Combined therapy for diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Saba Al Rashaed

    2013-01-01

    Full Text Available Diabetic macular edema (DME is the main cause of visual impairment in diabetic patients. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. The management of DME is complex and often multiple treatment approaches are needed. This review demonstrates the benefits of intravitreal triamcinolone, bevacizumab and ranibizumab as adjunctive therapy to macular laser treatment in DME. The published results indicate that intravitreal injections of these agents may have a beneficial effect on macular thickness and visual acuity, independent of the type of macular edema that is present. Therefore, pharmacotherapy could complement focal/grid laser photocoagulation in the management of DME. For this review, we performed a literature search and summarized recent findings regarding combined therapy for DME.

  12. Massive ovarian edema, due to adjacent appendicitis.

    Science.gov (United States)

    Callen, Andrew L; Illangasekare, Tushani; Poder, Liina

    2016-09-01

    Massive ovarian edema is a benign clinical entity, the imaging findings of which can mimic an adnexal mass or ovarian torsion. In the setting of acute abdominal pain, identifying massive ovarian edema is a key in avoiding potential fertility-threatening surgery in young women. In addition, it is important to consider other contributing pathology when ovarian edema is secondary to another process. We present a case of a young woman presenting with subacute abdominal pain, whose initial workup revealed marked enlarged right ovary. Further imaging, diagnostic tests, and eventually diagnostic laparoscopy revealed that the ovarian enlargement was secondary to subacute appendicitis, rather than a primary adnexal process. We review the classic ultrasound and MRI imaging findings and pitfalls that relate to this diagnosis.

  13. 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.

  14. 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.

  15. Dimensionamento da dor durante a instalação do cateter central de inserção periférica em neonatos Medida de la intensidad del dolor durante la instalación del catéter central de inserción periférica en neonatos Measuring pain in neonates during placement of central line catheter via peripheral insertion

    Directory of Open Access Journals (Sweden)

    Priscila Costa

    2010-01-01

    Full Text Available OBJETIVO: Dimensionar a dor durante a instalação do cateter central de inserção periférica, comparando o momento da punção venosa com a progressão do cateter. MÉTODOS: Estudo descritivo exploratório com coleta prospectiva dos dados realizado na unidade neonatal de um hospital-escola de grande porte da cidade de São Paulo. Avaliou-se a resposta dolorosa ao procedimento de inserção do cateter em 28 neonatos utilizando-se a escala Premature Infant Pain Profile (PIPP nas etapas de pré-punção (15 segundos, punção venosa (30 segundos e progressão do cateter (30 segundos. RESULTADOS: O escore PIPP maior ou igual a sete, indicativo de dor moderada a intensa, ocorreu em 13 RN (59,1% na primeira punção venosa e 10 RN (45,5% na progressão do cateter do grupo que não recebeu analgésico ou sedativo. CONCLUSÃO: Os resultados apontam para a necessidade de se adotar medidas analgésicas, uma vez que neonatos internados em unidade de terapia intensiva neonatal são freqüentemente submetidos a procedimentos invasivos e dolorosos.OBJETIVO: Medir la intensidad del dolor durante la instalación del catéter central de inserción periférica, comparando el momento de la punción venosa con la progresión del catéter. MÉTODOS: Estudio descriptivo exploratorio con recolección prospectiva de los datos realizado en la unidad neonatal de un hospital-escuela de gran porte de la ciudad de Sao Paulo. Se evaluó la respuesta dolorosa al procedimiento de inserción del catéter en 28 neonatos, utilizándose la escala Premature Infant Pain Profile (PIPP en las etapas de pre-punción (15 segundos, punción venosa (30 segundos y progresión del catéter (30 segundos. RESULTADOS: El puntaje PIPP mayor o igual a siete, indicativo de dolor moderado a intenso ocurrió en 13 RN (59,1% en la primera punción venosa y 10 RN (45,5% en la progresión del catéter del grupo que no recibió analgésico o sedativo. CONCLUSIÓN: Los resultados apuntan que es

  16. Routine neonatal circumcision?

    OpenAIRE

    Tran, P. T.; Giacomantonio, M.

    1996-01-01

    Routine neonatal circumcision is still a controversial procedure. This article attempts to clarify some of the advantages and disadvantages of neonatal circumcision. The increased rate of penile cancer among uncircumcised men appears to justify the procedure, but that alone is not sufficient justification. The final decision on neonatal circumcision should be made by parents with balanced counsel from attending physicians.

  17. 视网膜中央静脉阻塞黄斑水肿玻璃体腔注射曲安奈德后视网膜电图明视负向反应变化%Changes of photopic negative response after intravitreal injection of triamcinolone acetonide for macular edema caused by central retinal vein occlusion

    Institute of Scientific and Technical Information of China (English)

    冯超; 杨安怀; 陈长征; 梅昌娲; 易莲芳

    2011-01-01

    Background Intravitreal injection of triamcinolone acetonide (TA) can effectively eliminate central vein occlusion macular edema and improve visual acuity, and photopic negative response (PhNR) can reflect the inner retinal function of RGCs and their axons. It is possible there is a correlation between these two observations.Objective This study was to evaluate the changes of PhNR of flash electroretinogram (F-ERG) after intravitreal injection of TA for macular edema in central retinal vein occlusion ( CRVO ). Methods Thirteen eyes of 12 patients with macular edema caused by CRVO received an injection of 0. 1 ml (4 rg) of TA. PhNR,visual acuity and retinal thickness of macular area were assessed with Roland RETI scan 3. 15 system,decimal visual chart and Stratus optical coherence tomography (OCT) before and 4 weeks after the administration of TA. Written informed consent was obtained from each subject before any medical procedure. Results Visual acuity was improved in 12 eyes and stable in 1 eye 4 weeks following the intravitreal injection of TA. OCT showed that the retinal thickness of the macular area was reduced ;meanwhile,elevation of the amplitude of PhNR also was seen in the F-ERG after the administration of TA in comparison with before the administration of TA. The calculated results determined that the visual acuities were 0. 32t0. 12 and 0. 48±0. 09 (t=6. 325 ,P=0. 000) ,and the retinal thickness values of the macular area were (459.46± 131.31 ) μm and ( 297.54 ±43.31 ) μm ( t = 5.961, P = 0. 000 ), and the average amplitude of PhNR were ( 80. 23±22.96 ) μV and (61.28 ±20. 16 ) μV ( t = 4. 438, P = 0. 001 ) before and after the intravitreal injection of TA, respectively,showing significant differences. No significant correlation was found between PhNR amplitude and retinal thickness of the macular area both before and after the administration of TA ( before: r = 0. 587, P = 0. 035; after:r=-0. 011 ,P = 0. 971 ). Conclusion PhNR can be used for

  18. Peritumoral brain edema in angiomatous supratentorial meningiomas

    DEFF Research Database (Denmark)

    Nassehi, Damoun; Sørensen, Lars Peter; Dyrbye, Henrik;

    2013-01-01

    The aim of this work was to study the vascular endothelial growth factor A (VEGF-A) pathway and peritumoral brain edema (PTBE) through comparison of non-angiomatous and angiomatous meningiomas. Meningiomas are common intracranial tumors, which often have PTBE. VEGF-A is an integral part of PTBE...

  19. Facial Edema Evaluation Using Digital Image Processing

    Directory of Open Access Journals (Sweden)

    A. E. Villafuerte-Nuñez

    2013-01-01

    Full Text Available The main objective of the facial edema evaluation is providing the needed information to determine the effectiveness of the anti-inflammatory drugs in development. This paper presents a system that measures the four main variables present in facial edemas: trismus, blush (coloration, temperature, and inflammation. Measurements are obtained by using image processing and the combination of different devices such as a projector, a PC, a digital camera, a thermographic camera, and a cephalostat. Data analysis and processing are performed using MATLAB. Facial inflammation is measured by comparing three-dimensional reconstructions of inflammatory variations using the fringe projection technique. Trismus is measured by converting pixels to centimeters in a digitally obtained image of an open mouth. Blushing changes are measured by obtaining and comparing the RGB histograms from facial edema images at different times. Finally, temperature changes are measured using a thermographic camera. Some tests using controlled measurements of every variable are presented in this paper. The results allow evaluating the measurement system before its use in a real test, using the pain model approved by the US Food and Drug Administration (FDA, which consists in extracting the third molar to generate the facial edema.

  20. Current status in diabetic macular edema treatments

    Institute of Scientific and Technical Information of China (English)

    Pedro; Romero-Aroca

    2013-01-01

    Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is the leading cause of blindness among adults in the industrialized countries.Today,blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy.The treatment should include an optimized control of glycemia,arterial tension,lipids and renal status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME),can be valid as gold standard in many countries.The intravitreal anti vascular endothelial growth factor drugs(ranibizumab and bevacizumab),are indicated in the treatment of all types of DME,but the correct protocol for administration should be defined for the different Retina Scientific Societies.The corticosteroids for diffuse DME,has a place in pseudophakic patients,but its complications restricted the use of these drugs for some patients.Finally the intravitreal interface plays an important role and its exploration is mandatory in all DME patients.

  1. 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.

  2. 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.

  3. 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

  4. 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.)

  5. Correlation between the central macular thickness and the visual function in patients with macular edema%黄斑水肿患者中心凹厚度与固视性质及平均敏感度相关性研究

    Institute of Scientific and Technical Information of China (English)

    王雯秋; 王泓; 张磊; 姜媛; 钱锦; 王卫峻; 汪枫桦; 吴颖; 孙晓东

    2009-01-01

    Objective To determine the correlation between central macular thickness (CMT) and the visual function in patients iwht macular edema (ME). Methods The clinical data of 42 eyes of 40 patients with ME which were examined by optical coherence tomography (OCT) and microperimetry (MP-1) wereretrospectively analyzed. In 40 patients (42 eyes), diabetic ME (DME) was in 27 eyes,branch retinal vein occlusion was in 11eyes, and central retinal vein occlusion was in 4 eyes. All of the eyes had undergone OCT,MP-1 and best-corrected visual acuity (BCVA) test. Central macular thickness (CMT) was measured by fast macular scans using OCT. Retinal sensitivity (MS) and fixation patterns were evaluated by Mp-1.The position was chosen :2 disc diameters (DD) temporal to the disc and one third of a DD inferior to the centre of the disc. Results The correlation between CMT and BCVA is not significant (r=-0. 429, P=0. 069) as well as the correlation between CMT and MS (r=-0. 433,P=0. 058). The difference of CMT between the unstable and stable group was significant (F = 3. 262, P = 0. 039). The difference of CMT between the central fixation group and preferred retinal locus (PRL) group was significant (F=3. 173,P=0. 044). Conclusions BCVA and MS have no significant correlation with CMT. When CMT increases, the fixation stability decreases, fixation location, changes, and PRL occurs.%目的 观察黄斑水肿(ME)状态下黄斑中心凹厚度与视功能改变之间的相关性.方法 回顾分析应用光相干断层扫描(OCT)联合微视野计(MP-1)检测的ME患者40例42只眼的临床资料.所有患眼均行验光插片,记录最佳矫正视力(BCVA);采用德国Zeiss-HumphreyOCT仪进行OCT检查;意大利Nidek公司MP-1微视野计进行眼底成像、固视检测和视野检查.OCT及MP-1检查均以视盘颢侧2个视盘直径(DD)、下方1/3 DD作为黄斑中心凹进行检查.采用统计学方法对比分析患眼BCVA、中心凹厚度(CMT)、中心10°的光敏感度(MS

  6. Generalized edema associated with parvovirus B19 infection

    Directory of Open Access Journals (Sweden)

    Pieter J. Vlaar

    2014-12-01

    Full Text Available Generalized edema is a rare presentation of human parvovirus B19 infection. The etiology of this edema is unclear, particularly because signs of heart or renal failure are often not present. We report the case of a young adult presenting with generalized edema with serological and PCR evidence of parvovirus B19 infection, and discuss the potential mechanisms of edema based on the previous literature.

  7. An Adult Case of Diabetic Ketoacidosis Presenting with Cerebral Edema

    OpenAIRE

    Barış Akıncı; Abdurrahman Çömlekçi; Serkan Yener; Süleyman Men

    2009-01-01

    Cerebral edema is a life-threatening complication of diabetic ketoacidosis (DKA) which may predominantly develop in pediatric cases during the management of DKA.. Symptomatic cerebral edema in children is rarely detected at admission, before initiation of the treatment. Cerebral edema associated with DKA is extremely rare in adults. Here, we report an adult patient with DKA who presented with symptomatic cerebral edema. Turk Jem 2009; 13: 16-8

  8. Infecciones del torrente sanguíneo asociadas al catéter venoso central en el servicio de cuidado intensivo neonatal

    Directory of Open Access Journals (Sweden)

    Marlen Villegas Sánchez

    2012-10-01

    Full Text Available Las bacteremias asociadas a los abcesos vasculares son una complicación grave y frecuente dentro de las infeccionesvinculadas con dispositivos vasculares. Están relacionadas con el tiempo de la cateterización y la atención recibida duranteel proceso instrumental. La mayoría de los microorganismos implicados proceden de la piel. El grupo más afectado es el delos recién nacidos; además de otros factores como el bajo peso, la edad gestacional y la inmadurez del sistema inmunológicoque los vuelve más susceptibles a adquirir enfermedades. En el servicio de Neonatología del Hospital Nacional de Niños,durante el primer semestre del 2011, un 80% de las infecciones se diagnosticaron como septicemias y, de estas, más del 50%se asoció con el uso de Catéter Venoso Central. Se formuló una pregunta en formato PICO (pacientes, intervención,comparación, observación, posteriormente se realizó una búsqueda de información en las diferentes bases de datossugeridas en el Curso de Práctica Clínica de Enfermería Basada en la Evidencia, impartido por CIEBE-CR. Se obtuvo 20artículos relacionados con el tema, 6 de los cuales fueron analizados mediante la aplicación de los criterios que estableceCASPe para contestar a la pregunta clínica. Se concluye que la aplicación de los “bundles” reduce las infecciones asociadasal catéter venoso central; además, el seguimiento diario de los dispositivos permite controlar y por lo tanto aplicar medidasde prevención en el momento oportuno.

  9. Macular edema in uveitis with emphasis on ocular sarcoidosis

    NARCIS (Netherlands)

    Norel, J. van

    2015-01-01

    This thesis investigates the accumulation of fluid in the yellow spot (macular edema) in ocular inflammation (uveitis). Macular edema may result in definitive loss of vision.Two methods of imaging of macular edema are fluorescein angiography (FA) and optical coherence tomography (OCT). The first met

  10. Interventions for the treatment of uveitic macular edema: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Karim R

    2013-06-01

    Full Text Available Rushmia Karim,1 Evripidis Sykakis,2 Susan Lightman,3 Samantha Fraser-Bell4 1Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia; 2Department of Ophthalmology, Whipps Cross University Hospital, 3UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; 4University of Sydney, Clinical Ophthalmology and Eye Health, Sydney Adventist Hospital Clinical School, Sydney, NSW, Australia Background: Uveitic macular edema is the major cause of reduced vision in eyes with uveitis. Objectives: To assess the effectiveness of interventions in the treatment of uveitic macular edema. Search strategy: Cochrane Central Register of Controlled Trials, Medline, and Embase. There were no language or data restrictions in the search for trials. The databases were last searched on December 1, 2011. Reference lists of included trials were searched. Archives of Ophthalmology, Ophthalmology, Retina, the British Journal of Ophthalmology, and the New England Journal of Medicine were searched for clinical trials and reviews. Selection criteria: Participants of any age and sex with any type of uveitic macular edema were included. Early, chronic, refractory, or secondary uveitic macular edema were included. We included trials that compared any interventions of any dose and duration, including comparison with another treatment, sham treatment, or no treatment. Data collection and analysis: Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected. Conclusion: More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments. The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic

  11. Evidence-Based Treatment of Diabetic Macular Edema.

    Science.gov (United States)

    Barham, Rasha; El Rami, Hala; Sun, Jennifer K; Silva, Paolo S

    2017-01-01

    Diabetes mellitus is a chronic disease that affects 415 million people worldwide. Despite treatment advances, diabetic eye disease remains a leading cause of vision loss worldwide. Diabetic macular edema (DME) is a common cause of vision loss in diabetic patients. The pathophysiology is complex and involves multiple pathways that ultimately lead to central retinal thickening and, if untreated, visual loss. First-line treatment of DME has evolved from focal/grid laser established by the Early Treatment of Diabetic Retinopathy Study (ETDRS) to intravitreous pharmacologic therapy. Landmark prospective clinical trials examining the effect of intravitreous injections of vascular endothelial growth factor (VEGF) inhibitors in the treatment of DME have demonstrated improved visual outcomes over focal grid laser. This review focuses on the scientific evidence treatment of DME, disease pathophysiology, clinical disease course, current treatment standards, and emerging novel therapeutic approaches.

  12. Localized bi-nasal macular edema in optic chiasmal syndrome

    Directory of Open Access Journals (Sweden)

    Alejandro J Lavaque

    2013-01-01

    Full Text Available A 28-year-old healthy male complaining of vision loss in his right eye was discovered to have localized bi-nasal macular edema in the presence of a pituitary adenoma. The presence of a junctional scotoma composed by a central scotoma in the right eye associated with superior temporal quadrantanopia in the fellow eye was seen. The pattern detected in the visual field suggested the presence of an expansive mass at the level of the optic chiasm. Optical coherence tomography findings also revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. This report illustrates the importance of suspecting a pituitary adenoma in the light of uncharacteristic retinal alterations.

  13. Cystoid macular edema in a patient with Danon disease

    Directory of Open Access Journals (Sweden)

    Heather G Mack

    2014-01-01

    Full Text Available To report a patient with Danon retinopathy with cystoid macular edema treated with topical dorzolamide 2% eye drops and oral acetazolamide. A 37-year-old Caucasian man with Danon disease treated with topical and oral carbonic anhydrase inhibitors participated in the study. Examinations performed before and during treatment included visual acuity (VA, spectral-domain optical coherence tomography, and electroretinography. Following total 48 weeks of treatment, VA decreased from 20/30 OD, 20/200 OS, to 20/40 OD, CF OS. The mean central retinal thickness was unchanged from baseline 263 μm OD , 226 μm OS, after treatment 283 μm OD and 202 μm OS. In our case, carbonic anydrase inhibitors were not effective. However, a general recommendation cannot be given based on a single case.

  14. Determinants of neonatal mortality in Indonesia

    Directory of Open Access Journals (Sweden)

    Agho Kingsley

    2008-07-01

    Full Text Available Abstract Background Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. Methods The data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants. Results At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00, and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03 compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00 and for infants born to father who were unemployed (OR = 2.99, p = 0.02. The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00, male infants (OR = 1.49, p = 0.01, smaller than average-sized infants (OR = 2.80, p = 0.00, and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00. Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03. Conclusion Public health interventions directed at reducing neonatal death should

  15. Production of Hypoxia-induced Corneal Edema in Aged Eyes

    Institute of Scientific and Technical Information of China (English)

    Alan K. Cheung; Andrew W. Siu; Digby W. Cheung; Edwin C. Mo

    2004-01-01

    Purpose:Corneal thickness assessment is a common clinical procedure applied in corneal and contact lens care. This study aims to investigate the effect of age on hypoxiainduced corneal swelling.Methods:Eighteen male subjects were equally divided into the younger [(23.7±0.8) and older [(74.4±2.5) years old]groups.Each subject wore a thick soft contact lens (uniform thickness of 0.3 mm) on the left cornea. With the contact lens in place, the baseline central corneal thickness was measured using a specially designed photo-pachometer. The lens was then patched behind the closed eyelids, producing an extremely hypoxic stress to the cornea. The change in central corneal thickness was monitored every 20 minutes with momentary disruptions to the hypoxic stress over the next 2 hours. The increase in thickness was taken as an index of corneal edema. The rate of change in corneal thickness, as derived from a non-linear mathematical model, was compared between groups. Results:The corneal thickness of both age groups increased significantly with time (P<0.000 1 ). The mean corneal swelling constant for the older subjects was 16.5 × 10-3 (S.E.M. = 2.65 × 10-3) and the value for the younger subjects was 46.5 × 10-3 (S.E.M. = 3.25× 10-3). The difference was statistically significant (P < 0.000 1 ).Conclusion:Aging cornea has a slower hypoxia-induced edema response compared with the younger group. Whether it is caused by a decreased corneal lactate production or an increased resistance to physical expansion deserves further investigation. Eye Science2004;20:1-5.

  16. 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.

  17. 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.

  18. Management of pseudophakic cystoid macular edema.

    Science.gov (United States)

    Guo, Suqin; Patel, Shriji; Baumrind, Ben; Johnson, Keegan; Levinsohn, Daniel; Marcus, Edward; Tannen, Brad; Roy, Monique; Bhagat, Neelakshi; Zarbin, Marco

    2015-01-01

    Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.

  19. 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.

  20. Cystoid Macular Edema in Bietti's Crystalline Retinopathy

    OpenAIRE

    Ali Osman Saatci; Hasan Can Doruk; Aylin Yaman

    2014-01-01

    A 27-year-old man with progressive bilateral visual decline was diagnosed to have Bietti's crystalline dystrophy (BCD). Fluorescein angiography revealed bilateral petaloid type late hyperfluorescence implicating concurrent cystoid macular edema (CME). Optical coherence tomography exhibited cystoid foveal lacunas OU. During the follow-up of six years, intraretinal crystals reduced in amount but CME persisted angiographically and tomographically. CME is among the rare macular features of BCD in...

  1. Cystoid Macular Edema in Bietti's Crystalline Retinopathy

    Directory of Open Access Journals (Sweden)

    Ali Osman Saatci

    2014-01-01

    Full Text Available A 27-year-old man with progressive bilateral visual decline was diagnosed to have Bietti's crystalline dystrophy (BCD. Fluorescein angiography revealed bilateral petaloid type late hyperfluorescence implicating concurrent cystoid macular edema (CME. Optical coherence tomography exhibited cystoid foveal lacunas OU. During the follow-up of six years, intraretinal crystals reduced in amount but CME persisted angiographically and tomographically. CME is among the rare macular features of BCD including subfoveal sensorial detachment, subretinal neovascular membrane, and macular hole.

  2. 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.

  3. 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.

  4. 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

    OpenAIRE

    PAMELA DÍAZ A; JUAN BRIONES C; YESSENIA ORELLANA A; JAVIER ARELLANO L; RENE FABA B

    2009-01-01

    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...

  5. Assessing local tissue edema in postmastectomy lymphedema.

    Science.gov (United States)

    Mayrovitz, H N

    2007-06-01

    Overall limb lymphedema can be assessed by several methods but none are suitable to determine local edema. Quantifying local edema could provide important information not previously available. Our goal was to determine the suitability of using the tissue dielectric constant (TDC) as and index of local tissue water to detect and quantify edema in postmastectomy patients with unilateral arm lymphedema. Segmental arm volume and TDC were measured in both arms of 18 women with unilateral lymphedema, and in 15 premenopausal and 15 postmenopausal controls. TDC was measured at a frequency of 300 MHz using open-ended coaxial probes with effective measuring depths of 0.5, 1.5, 2.5 and 5.0 mm. For patients and controls, absolute TDC depended on measurement depth but for any depth the TDC of lymphedematous segments was significantly greater than for non-affected contralateral arms (pTDC ratio between arms for patients was 1.64+/-0.30 vs.1.04+/-0.04 for both control groups (pTDC ratio was as low as 1.2 and no control subject's TDC ratio was as great as 1.2. Results suggest that this method is a good quantitative discriminator of the presence of lymphedema in patients with unilateral limb lymphedema.

  6. 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.

  7. Thioperamide treats neonatal hypoxic-ischemic encephalopathy by postsynaptic H1 receptors*

    Institute of Scientific and Technical Information of China (English)

    Feiyong Jia; Lin Du; Yunpeng Hao; Shicheng Liu; Ning Li; Huiyi Jiang

    2013-01-01

    Thioperamide, a selective histamine H3 receptor antagonist, can increase histamine content in the brain, improve brain edema, and exert a neuroprotective effect. This study aimed to examine the mechanism of action of thioperamide during brain edema in a rat model of neonatal hypoxic- is-chemic encephalopathy. Our results showed that thioperamide significantly decreased brain water content and malondialdehyde levels, while significantly increased histamine levels and superoxide dismutase activity in the hippocampus. This evidence demonstrates that thioperamide could pre-vent oxidative damage and attenuate brain edema fol owing neonatal hypoxic-ischemic encepha-lopathy. We further observed that changes in the above indexes occurred after combined treatment of thioperamide with the H1 receptor antagonist, pyrilamine, and the H2 receptor antagonist, ci-metidine. Experimental findings indicated that pyrilamine reversed the effects of thioperamide;however, cimetidine had no significant influence on the effects of thioperamide. Our present findings suggest that thioperamide can increase brain histamine content and attenuate brain edema and oxidative damage by acting in combination with postsynaptic H1 receptors in a rat model of neo-natal hypoxic-ischemic encephalopathy.

  8. Effects of Vitrectomy on Recurrent Macular Edema due to Branch Retinal Vein Occlusion after Intravitreal Injection of Bevacizumab

    Directory of Open Access Journals (Sweden)

    Tatsuya Yunoki

    2013-01-01

    Full Text Available Purpose. To evaluate the effects of pars plana vitrectomy (PPV on recurrent macular edema due to branch retinal vein occlusion (BRVO after intravitreal injections of bevacizumab (IVB. Methods. This retrospective study included 22 eyes of 22 patients who underwent single or multiple IVB injections for macular edema due to BRVO and showed a recurrence of macular edema. All patients then underwent PPV and were followed up for more than 6 months after the surgery with examinations of best corrected visual acuity (BCVA and optical coherence tomography (OCT. OCT parameters were central macular thickness (CMT and average retinal thickness in a 1-mm-diameter circular region at the fovea (MRT. Results. Mean BCVA, CRT, and MRT were significantly improved from the baseline after PPV. Greater improvement of BCVA, CRT, and MRT was obtained after 1 month of IVB than after 6 months of PPV. No eyes showed worsening of macular edema after the surgery. Conclusion. PPV improved BCVA and recurrent macular edema due to BRVO, but PPV that was less effective than IVB had been in the same patients. PPV may be one of the treatment options for recurrent macular edema due to BRVO after IVB.

  9. Diagnostic imaging in neonatal stroke; Bildgebende Diagnostik des Neonatal stroke

    Energy Technology Data Exchange (ETDEWEB)

    Kuhle, S.; Ipsiroglu, O.; Weninger, M. [Universitaetsklinik fuer Kinder- und Jugendheilkunde, Wien (Austria). Abt. fuer Neonatologie, angeborene Stoerungen und Intensivmedizin; Puig, S.; Prayer, D. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2000-01-01

    A cerebral artery infarction is an important differential diagnosis in the newborn with neurological abnormalities. Based on clinical data, its incidence is estimated to be 1 in 4000 newborns. Since the course is often subclinical, the true incidence is probably higher. Diagnosis: Cerebral ultrasound and Doppler sonography as readily available screening tools play a central role in the initial diagnosis of neonatal cerebral infarction. Definitive diagnosis is made by computed tomography or magnetic resonance imaging. Beside symptomatic anticonvulsive therapy, treatment aims at the prevention of secondary ischemic injury. Discussion: Three term infants with different clinical courses of neonatal stroke are presented to sensitize the clinician and the radiologist for this probably underdiagnosed entity. The role of imaging modalities in the diagnosis and follow-up of neonatal cerebral infarction is discussed. (orig.) [German] Ein Infarkt im Stromgebiet der Zerebralarterien stellt eine wichtige Differentialdiagnose bei neurologischen Auffaelligkeiten in der Neonatalperiode dar. Die Inzidenz wird anhand von klinischer Daten auf 1:4000 Lebendgeborene geschaetzt. Da der Verlauf oft subklinisch ist, liegt die wahre Inzidenz wahrscheinlich hoeher. Diagnose: Bei der Diagnosestellung kommen dem Schaedelultraschall und der Doppelsonographie als leicht verfuegbaren Screening-Methoden eine zentrale Rolle zu. Die definitive Diagnose wird, je nach Verfuegbarkeit, mittels Computertomographie oder Kernspintomographie gestellt. Die Behandlung ist neben der symptomatischen (antikonvulsiven) Therapie auf die Vermeidung von ischaemischen Sekundaerschaeden gerichtet. Diskussion: Wir wollen mit der vorliegenden Arbeit anhand von 3 Kindern mit verschiedenen klinischen Verlaeufen eines sog. Neonatal stroke den Stellenwert der bildgebenden Verfahren bei der Diagnostik und Verlaufskontrolle aufzeigen und die Sensibilitaet fuer dieses vermutlich unterdiagnostizierte Krankheitsbild erhoehen

  10. Localização inicial da ponta de cateter central de inserção periférica (PICC em recém-nascidos Localización inicial de la punta del catéter central de inserción periférica (PICC en recién nacidos Initial placement of the peripherally inserted central catheter's tip in neonates

    Directory of Open Access Journals (Sweden)

    Patrícia Ponce de Camargo

    2008-12-01

    Full Text Available Estudo transversal com coleta prospectiva de dados, que objetivouidentificar o posicionamento inicial da ponta do cateter central de inserção periférica (PICC e verificar a prevalência de sucesso de sua inserção em neonatos. Os dados foram coletados no berçário anexo à maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre março e setembro de 2006. Dos 37 neonatos submetidos à inserção do cateter PICC, a taxa de sucesso no procedimento foi de 72,3% (27 neonatos; destes, quatro (14,8% estavam com as pontas dos cateteres alojadas nas veias axilar ou inominada; outros três (11,1%, alojadas em veia jugular. Estes cateteres foram removidos por desvio de trajeto. 13 (48,2% estavam com as pontas alojadas em átrio direito, cujos cateteres foram tracionados para reposicionamento da ponta para a veia cava superior.Estudio transversal con recolección prospectiva de datos. La finalidad fue identificar la posición inicial de la punta del catéter central de inserción periférica (PICC y verificar la prevalencia de éxitos durante su introducción en neonatos. Los datos fueron recolectados en un servicio de neonatología anexo a la maternidad del Hospital de las Clínicas de la Facultad de Medicina de la Universidad de São Paulo, entre marzo y setiembre del 2006. De los 37 neonatos sometidos a introducción del catéter PICC, la tasa de éxito fue de 72.3% (27 neonatos, de ellos, cuatro (14.8% estaban con las puntas de los catéteres alojadas en las venas axilar o no determinada, tres (11.1% localizadas en la vena yugular. Siendo estos últimos retirados por desviación en su trayecto. El 48.2% (13 se encontraba con las puntas en el atrio derecho, siendo estos catéteres nuevamente posicionados en la vena cava superior.This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC and to verify the prevalence of success in inserting

  11. Enterotoxemia in neonatal calves.

    Science.gov (United States)

    Fleming, S

    1985-11-01

    The incidence, bacterial characteristics, disease syndromes, diagnosis, treatment, and prevention of enterotoxemia of neonatal calves caused by Clostridium perfringens (Types A, B, C, D, and E) are reviewed.

  12. Neonatal septic arthritis.

    Science.gov (United States)

    Halder, D; Seng, Q B; Malik, A S; Choo, K E

    1996-09-01

    Neonatal septic arthritis has always been considered as separate from its counterpart in older children. The condition is uncommon but serious. Affected neonates usually survive, but with permanent skeletal deformities. Ten cases of neonatal septic arthritis were diagnosed between January 1989 and December 1993 in the neonatal intensive care units of two referral hospitals in the state of Kelantan, Malaysia. All except one neonate was born prematurely. The mean age of presentation was 15.6 days. Joint swelling (10/10), increased warmth (7/10) and erythema of the overlying skin (7/10) were the common presenting signs. Vague constitutional symptoms preceded the definitive signs of septic arthritis in all cases. The total white cell counts were raised with shift to the left. The knee (60%) was not commonly affected, followed by the hip (13%) and ankle (13%). Three neonates had multiple joint involvement. Coexistence of arthritis with osteomyelitis was observed in seven neonates. The commonest organism isolated was methicillin resistant Staphylococcus aureus (9/10). Needle aspiration was performed in nine neonates and one had incision with drainage. Follow up data was available for five neonates and two of these had skeletal morbidity. Early diagnosis by frequent examination of the joints, prompt treatment and control of nosocomial infection are important for management.

  13. 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.

  14. Bacillus cereus bacteremia in a preterm neonate.

    Science.gov (United States)

    Hilliard, Nicholaus J; Schelonka, Robert L; Waites, Ken B

    2003-07-01

    Bacillus cereus is an uncommon but potentially serious bacterial pathogen causing infections of the bloodstream, lungs, and central nervous system of preterm neonates. A case of bacteremia caused by B. cereus in a 19-day-old preterm neonate who was successfully treated with vancomycin, tobramycin, meropenem, and clindamycin is described. Implications for the diagnostic laboratory and clinicians when Bacillus species are detected in normally sterile sites are discussed, and the small numbers of infant infections proven to be due to this organism that have been described previously are reviewed.

  15. The effect of ASK1 on vascular permeability and edema formation in cerebral ischemia.

    Science.gov (United States)

    Song, Juhyun; Cheon, So Yeong; Lee, Won Taek; Park, Kyung Ah; Lee, Jong Eun

    2015-01-21

    Apoptosis signal-regulating kinase-1 (ASK1) is the mitogen-activated protein kinase kinase kinase (MAPKKK) and participates in the various central nervous system (CNS) signaling pathways. In cerebral ischemia, vascular permeability in the brain is an important issue because regulation failure of it results in edema formation and blood-brain barrier (BBB) disruption. To determine the role of ASK1 on vascular permeability and edema formation following cerebral ischemia, we first investigated ASK1-related gene expression using microarray analyses of ischemic brain tissue. We then measured protein levels of ASK1 and vascular endothelial growth factor (VEGF) in brain endothelial cells after hypoxia injury. We also examined protein expression of ASK1 and VEGF, edema formation, and morphological alteration through cresyl violet staining in ischemic brain tissue using ASK1-small interference RNA (ASK1-siRNA). Finally, immunohistochemistry was performed to examine VEGF and aquaporin-1 (AQP-1) expression in ischemic brain injury. Based on our findings, we propose that ASK1 is a regulating factor of vascular permeability and edema formation in cerebral ischemia.

  16. [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.

  17. 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.

  18. 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.

  19. 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.

  20. Unicompartmental muscle edema: an early sign of deep venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Patrick T. [Mayo Clinic Scottsdale, Department of Diagnostic Radiology, 13400 E. Shea Boulevard, Scottsdale, AZ 85259 (United States); Ilaslan, Hakan [Mayo Clinic Rochester, Department of Diagnostic Radiology, Rochester, Minnesota (United States)

    2003-01-01

    The finding of muscle edema restricted to a single muscle compartment on MRI usually indicates a diagnosis of traumatic injury, myositis, denervation or neoplasm. This case demonstrates that deep venous thrombosis can also be the cause of isolated deep posterior compartment muscle edema in the calf and should be considered in the differential diagnosis even in the absence of diffuse soft tissue or subcutaneous edema. (orig.)

  1. Edema pulmonar postobstructivo: reporte de 3 casos

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Padilla

    2002-12-01

    Full Text Available El edema pulmonar postobstructivo (EPPO es una complicación postoperatoria cuyo manejo adecuado depende de un diagnóstico etiológico correcto. El EPPO se clasifica en dos tipos. El tipo I es secundario a la obstrucción aguda de la vía aérea superior. Por su parte, el tipo II ocurre luego de corregir quirúrgicamente una obstrucción crónica de la vía aérea. Fisiopatológicamente, el mecanismo que explica el cuadro es una disminución marcada de la presión intersticial en el nivel pericapilar pulmonar resultante de la inspiración forzada. Lo anterior produce fuga capilar y el consecuente edema de pulmón. El manejo de este cuadro requiere de soporte respiratorio que incluye ventilación mecánica e incluso presión positiva al final de la espiración (PEEP. El pronóstico es muy bueno si el diagnóstico es correcto y oportuno. Se reportan 3 casos que ilustran la entidad, su diagnóstico y manejo.

  2. Update on corticosteroids for diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Schwartz SG

    2016-09-01

    Full Text Available Stephen G Schwartz,1 Ingrid U Scott,2,3 Michael W Stewart,4 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 2Department of Ophthalmology, 3Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, 4Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA Abstract: Diabetic macular edema (DME remains an important cause of visual loss. Although anti-vascular endothelial growth factor (VEGF agents are generally used as first-line treatments for patients with center-involving DME, there is an important role for corticosteroids as well. Corticosteroids may be especially useful in pseudophakic patients poorly responsive to anti-VEGF therapies, in patients wishing to reduce the number of required injections, and in pregnant patients. Intravitreal triamcinolone acetonide has been used for many years but is not approved for this indication. An extended-release bioerodable dexamethasone delivery system and an extended-release nonbioerodable fluocinolone acetonide insert have both achieved regulatory approval for the treatment of DME. All intravitreal corticosteroids are associated with risks of cataract progression, elevation of intraocular pressure, and endophthalmitis. There is no current consensus regarding the use of corticosteroids, but they are valuable for selected patients with center-involving DME. Keywords: diabetic macular edema, vascular endothelial growth factor, triamcinolone acetonide, dexamethasone, fluocinolone acetonide, randomized clinical trial

  3. 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.

  4. 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.

  5. 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.

  6. Could Neonatal Hypernatremia Dehydration Influence Hearing Status?

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    Hassan Boskabadi

    2014-01-01

    Full Text Available Introduction: Neonatal hypernatremia dehydration (NHD is a dangerous condition in neonates, which is accompanied by acute complications (renal failure, cerebral edema, and cerebral hemorrhage and chronic complications (developmental delay. Children begin learning language from birth, and hearing impairment interferes with this process. We assessed the hearing status of infants with hypernatremia dehydration.   Materials and Methods: In a case-control study in 110 infants presenting at the Ghaem Hospital (Mashhad, Iran between 2007 and 2011, we examined the incidence of hearing impairment in infants suffering from hypernatremia dehydration (serum sodium >150 mEq/L in comparison with infants with normal sodium level (serum sodium ≤150 mEq/L.   Results: Three of 110 cases examined in the study group showed a transient hearing impairment. A mean serum sodium level of 173mg/dl was reported among hearing-impaired infants.   Conclusion:  Transient hearing impairment was higher in infants with hypernatremia; although this difference was not significant (P>0.05. Hearing impairment was observed in cases of severe hypernatremia.  

  7. Fetal trauma: brain imaging in four neonates

    Energy Technology Data Exchange (ETDEWEB)

    Breysem, Luc; Mussen, E.; Demaerel, P.; Smet, M. [Department of Radiology, University Hospitals, Herestraat 49, 3000, Leuven (Belgium); Cossey, V. [Department of Pediatrics, University Hospitals, Leuven (Belgium); Voorde, W. van de [Department of Forensic Medicine, University Hospitals, Leuven (Belgium)

    2004-09-01

    The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age (n=4) was 36 weeks (range: 30-38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound (n=4), computed tomography (CT) (n=1) and post-mortem magnetic resonance imaging (MRI) (n=1). Pathology findings were correlated with the imaging findings (n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage (n=1), subdural hematoma (n=1), brain edema with inversion of the diastolic flow (n=1) and severe ischemic changes (n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered. (orig.)

  8. External Otitis: An Unusual Presentation in Neonates

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    Peymaneh Alizadeh Taheri

    2016-01-01

    Full Text Available Acute otitis externa (AOE is an infection of the external auditory canal, the auricle, and the outer surface of the tympanic membrane. Although AOE is one of the most common otologic conditions encountered in pediatric population, it is known to primarily affect children older than 2 years. We report a case of AOE caused by Staphylococcus aureus in a 23-day-old neonate. A 23-day-old female infant presented to our neonatology clinic with irritability and discharge from the right ear. There were yellow otorrhea, mild erythema, and edema of right external ear canal. There was no sign of otitis media on otoscopy. The results of laboratory tests were insignificant. The discharge culture grew colonies of methicillin-sensitive Staphylococcus aureus. After 48 hours of treatment with intravenous cloxacillin, significant improvement was observed. The present case highlights an unusual presentation of staphylococcal infection in a neonate. This is the first case of methicillin-sensitive Staphylococcus aureus otitis externa in an immunocompetent newborn.

  9. The neonatal chest

    Energy Technology Data Exchange (ETDEWEB)

    Lobo, Luisa [Servico de Imagiologia Geral do Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon (Portugal)]. E-mail: mluisalobo@gmail.com

    2006-11-15

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented.

  10. Antioxidant status in neonatal jaundice before and after phototherapy

    OpenAIRE

    Ayyappan, S.; Sachu Philip; N Bharathy; V. Ramesh; Naveen Kumar, C.; Swathi, S.; A.Arun Kumar

    2015-01-01

    Background: Neonatal jaundice refers to yellow coloration of the skin and the sclera (whites of the eyes) of newborn babies that result from the accumulation of bilirubin in the skin and mucous membranes. Because bilirubin is potentially toxic to the central nervous system. Genetic disorders of bilirubin conjugation, particularly the common Gilbert's syndrome, can also contribute to neonatal hyperbilirubinemia. Objective: The aim of this study was to evaluate the lipid per-oxidation and antio...

  11. 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

  12. Pulmonary edema following transcatheter closure of atrial septal defect

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    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.

  13. Massive vulvar edema in 2 prepartum dairy cows.

    Science.gov (United States)

    Cheong, Soon Hon; Gilbert, Robert O

    2014-05-01

    Two late gestation Holstein cows about to begin the third lactation developed massive vulvar edema. These were the only affected animals in the herd of 500 milking cows. The vulvar edema spontaneously regressed postpartum for both cows. Massive vulvar swelling is seldom observed in dairy cows in advanced pregnancy and is not described in the literature.

  14. 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...

  15. Edema de pulmón precipitado por amlodipino

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    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.

  16. Pathophysiology and treatment of edema following femoropopliteal bypass surgery

    NARCIS (Netherlands)

    te Slaa, A.; Dolmans, D. E. J. G. J.; Ho, G. H.; Moll, F. L.; van der Laan, L.

    2012-01-01

    Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this e

  17. Intravitreal bevacizumab (Avastin treatment of diffuse diabetic macular edema in an Indian population

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    Kumar Atul

    2007-01-01

    Full Text Available Background: To report the anatomic and visual acuity response after intravitreal bevacizumab (Avastin in patients with diffuse diabetic macular edema. Design: Prospective, interventional case series study. Materials and Methods: This study included 20 eyes of metabolically stable diabetes mellitus with diffuse diabetic macular edema with a mean age of 59 years who were treated with two intravitreal injections of bevacizumab 1.25 mg in 0.05 ml six weeks apart. Main outcome measures were 1 early treatment diabetic retinopathy study visual acuity, 2 central macular thickness by optical coherence tomography imaging. Each was evaluated at baseline and follow-up visits. Results: All the eyes had received some form of laser photocoagulation before (not less than six months ago, but all of these patients had persistent diffuse macular edema with no improvement in visual acuity. All the patients received two injections of bevacizumab at an interval of six weeks per eye. No adverse events were observed, including endophthalmitis, inflammation and increased intraocular pressure or thromboembolic events in any patient. The mean baseline acuity was 20/494 (log Mar=1.338±0.455 and the mean acuity at three months following the second intravitreal injection was 20/295 (log Mar=1.094±0.254, a difference that was highly significant ( P =0.008. The mean central macular thickness at baseline was 492 µm which decreased to 369 µm ( P =0.001 at the end of six months. Conclusions: Initial treatment results of patients with diffuse diabetic macular edema not responding to previous photocoagulation did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular thickness and improvement in visual acuity at three months but the effect was somewhat blunted, though still statistically significant at the end of six months.

  18. Oxygen-deficient metabolism and corneal edema.

    Science.gov (United States)

    Leung, B K; Bonanno, J A; Radke, C J

    2011-11-01

    Wear of low-oxygen-transmissible soft contact lenses swells the cornea significantly, even during open eye. Although oxygen-deficient corneal edema is well-documented, a self-consistent quantitative prediction based on the underlying metabolic reactions is not available. We present a biochemical description of the human cornea that quantifies hypoxic swelling through the coupled transport of water, salt, and respiratory metabolites. Aerobic and anaerobic consumption of glucose, as well as acidosis and pH buffering, are incorporated in a seven-layer corneal model (anterior chamber, endothelium, stroma, epithelium, postlens tear film, contact lens, and prelens tear film). Corneal swelling is predicted from coupled transport of water, dissolved salts, and especially metabolites, along with membrane-transport resistances at the endothelium and epithelium. At the endothelium, the Na+/K+ - ATPase electrogenic channel actively transports bicarbonate ion from the stroma into the anterior chamber. As captured by the Kedem-Katchalsky membrane-transport formalism, the active bicarbonate-ion flux provides the driving force for corneal fluid pump-out needed to match the leak-in tendency of the stroma. Increased lactate-ion production during hypoxia osmotically lowers the pump-out rate requiring the stroma to swell to higher water content. Concentration profiles are predicted for glucose, water, oxygen, carbon dioxide, and hydronium, lactate, bicarbonate, sodium, and chloride ions, along with electrostatic potential and pressure profiles. Although the active bicarbonate-ion pump at the endothelium drives bicarbonate into the aqueous humor, we find a net flux of bicarbonate ion into the cornea that safeguards against acidosis. For the first time, we predict corneal swelling upon soft-contact-lens wear from fundamental biophysico-chemical principles. We also successfully predict that hypertonic tear alleviates contact-lens-induced edema.

  19. 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)

  20. 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.

  1. 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...

  2. Sonomammography in Neonatal Mastauxe

    Directory of Open Access Journals (Sweden)

    Sushil Ghanshyam Kachewar

    2015-03-01

    Full Text Available Prominence or even enlargement of one or both breasts is known in neonates. It is believed to be a physiological response to falling levels of maternal estrogen towards last trimester of pregnancy. This input stimulates prolactin release from the newborn's pituitary leading to transient neonatal breast enlargement. This phenomenon is independent of the gender of the neonate. It presents in the first few weeks of life and resolves subsequently. Often fluid discharge is noted from the prominent or swollen breast that resolves without treatment in subsequent weeks. Manual breast manipulation for discharge removal may lead to undesirable effects like local irritation, enhanced enlargement, prolonged tissue hypertropy or even mastitis. A case of such 7-days female neonate is presented here backed with imaging evaluation for confirmation of diagnosis. Typical sonomammographic findings are described. [Cukurova Med J 2015; 40(Suppl 1: 22-24

  3. Role of ammonia in the pathogenesis of brain edema.

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    Fujiwara,Masachika

    1986-12-01

    Full Text Available The role of hyperammonemia in the pathogenesis of cerebral edema was investigated using mongrel dogs to develop a treatment for cerebral edema in acute hepatic failure. Intravenous infusion of ammonium acetate alone into dogs did not induce brain edema, although blood ammonia reached unphysiologically high levels. However, ammonium acetate infusion during mannitol-induced reversible (osmotic opening of the blood-brain barrier (BBB effectively induced cytotoxic brain edema. Pretreatment with a branched-chain amino acid (BCAA; valine, leucine and isoleucine solution prevented an increase in intracranial pressure (ICP and brain water content, and caused a decrease in brain ammonia content and an increase in brain BCAA and glutamic acid. The results suggest that ammonia plays an important role in the pathogenesis of cerebral edema during acute hepatic failure and that BCAAs accelerate ammonia detoxification in the brain.

  4. Drowning stars: reassessing the role of astrocytes in brain edema.

    Science.gov (United States)

    Thrane, Alexander S; Rangroo Thrane, Vinita; Nedergaard, Maiken

    2014-11-01

    Edema formation frequently complicates brain infarction, tumors, and trauma. Despite the significant mortality of this condition, current treatment options are often ineffective or incompletely understood. Recent studies have revealed the existence of a brain-wide paravascular pathway for cerebrospinal (CSF) and interstitial fluid (ISF) exchange. The current review critically examines the contribution of this 'glymphatic' system to the main types of brain edema. We propose that in cytotoxic edema, energy depletion enhances glymphatic CSF influx, whilst suppressing ISF efflux. We also argue that paravascular inflammation or 'paravasculitis' plays a critical role in vasogenic edema. Finally, recent advances in diagnostic imaging of glymphatic function may hold the key to defining the edema profile of individual patients, and thus enable more targeted therapy.

  5. LASER PHOTOCOAGULATION IN DIABETIC MACULAR EDEMA: EFFECTS ON VISUAL ACUITY AND MACULAR EDEMA

    Directory of Open Access Journals (Sweden)

    M.H. Dehghan

    1999-06-01

    Full Text Available Due to the importance of clinically significant macular edema in diabetic patients, this study is aimed to determine if laser photocoagulation is effective in the treatment of clinically significant diabetic macular edema. In addition, the effects of risk factors arc surveyed* This is an existing data study considering patients with clinically significant diabetic macular edema, treated with argon-green laser photocoagulation in Labbafinejad hospital, department of lasertherapy, from 1995 to 1997. in 60 (42.6% eyes the treatment method was focal, in 22 (15.6% eyes grid, and in 59 (41.84 modified grid laser photocoagulation was performed. The results are based upon deterioration of visual acuity, occurance of moderate visual loss and improvement or persistence of CSME. We studied 114 eyes from 87 patients. Two years after initial treatment, visual acuity improved in 19.1% of eyes, unchanged in 9.5% and worsened in 71.4% of eyes. After this period the rate of moderate visual loss was 28.6% and CSME was improved in 23.8% of eyes. According to our study, baseline visual acuity and retinopathy severity were two important intervening factors in response to lasertherapy. Comparing our results with natural course of diabetic macular edema, indicates that in assessing visual outcome laser photocoagulation is an effective modality in treatment of CSME, but it is not effective in maintaining or improving visual acuity, which is due to patients delay in visiting ophthalmologists and paying not enough attention to follow-up visits.

  6. Avaliação da mortalidade de neonatos e crianças relacionada ao uso do cateter venoso central: revisão sistemática Evaluación de la mortalidad de neonatos y niños relacionada al uso del cateter venoso central: revisión sistemática Evaluation of the mortality of neonates and children related to the use of central venous catheters: a systematic review

    Directory of Open Access Journals (Sweden)

    Janislei Giseli Dorociaki Stocco

    2012-01-01

    significativo para la mortalidad en neonatos y niños. CONCLUSIÓN: Se observó en esta revisión que la sepsis primaria fue la complicación más prevalente relacionada al cateter central.OBJECTIVE: To analyze mortality related to infections in the use of central venous catheters in newborns and hospitalized children. METHODS: This was a systematic review, using studies that were identified in the databases of MEDLINE, EMBASE, Lilacs, CINAHL, SciELO and Cochrane, in bibliographical references of articles, and other reviews. Two reviewers independently identified relevant studies, analyzed the methodological quality, and subsequently, extracted data. RESULTS: We encountered 1,000 articles, of which 16 were related to catheter infection and only two mentioned mortality. Findings of these two studies verified that sepsis was the principal complication related to the use of central venous catheters, and the most prevalent microorganisms in these infections were Candida sp. and Enterococcus sp., with significant impact on neonatal and child mortality. CONCLUSION: It was observed in this review that sepsis was most prevalent complication related to central catheters.

  7. Neonatal renal vein thrombosis.

    Science.gov (United States)

    Brandão, Leonardo R; Simpson, Ewurabena A; Lau, Keith K

    2011-12-01

    Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent antithrombotic therapy guidelines for the management of childhood thrombosis do not provide a risk-based algorithm for the acute management of RVT among newborns with hereditary prothrombotic disorders. Whereas neonatal RVT is not a condition associated with a high mortality rate, it is associated with significant morbidity due to renal impairment. Recent evidence to evaluate the effects of heparin-based anticoagulation and thrombolytic therapy on the long term renal function of these patients has yielded conflicting results. Long term cohort studies and randomized trials may be helpful to clarify the impact of acute versus prolonged antithrombotic therapy for reducing the morbidity that is associated with neonatal RVT.

  8. Cotrimoxazole and neonatal kernicterus: a review.

    Science.gov (United States)

    Thyagarajan, Baskaran; Deshpande, Sharad S

    2014-04-01

    Sulfamethoxazole (SMX) and trimethoprim (TMP) individually and a combination known as cotrimoxazole (SMX-TMP) are widely used for the treatment of protozoan and bacterial infections. SMX-TMP is also one of the widely used antibiotics administered orally in neonates, along with gentamicin injection, for treating pneumonia and sepsis by home-based healthcare providers in Asian countries. Although the use of this drug has successfully reduced neonate mortality, there is a concern for it causing neurotoxicity. Previous clinical studies with sulfisoxazole have demonstrated occurrence of kernicterus in neonates. This sulfonamide is thought to displace bilirubin from its albumin-binding sites in plasma leading to an elevation of plasma bilirubin, which crosses the blood-brain barrier, reaches central neurons to cause kernicterus. We performed an extensive review of clinical and animal studies with cotrimoxazole, which showed no reported incidences of kernicterus with SMX-TMP use in neonates. EndNote, BasicBiosis, Embase, PubMed and Toxline database searches were conducted using specific keywords yielding 74 full-length articles relevant to the review. This review has taken into account various factors, including the disease itself, direct effects of the drug and its metabolism through conjugation and acetylation through a thorough review of the literature to examine the potentials of SMX-TMP to cause kernicterus in neonates. SMX-TMP in oral doses administered to neonates for 7-10 days is unlikely to cause kernicterus. Also, this review recommends warranting the need of future studies using animal models and clinical studies in humans to address SMX-TMP toxicity.

  9. Perinatal risk factors and neonatal complications in discordant twins admitted to the neonatal intensive care unit

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiao-rui; LIU Jie; ZENG Chao-mei

    2013-01-01

    Background Many studies have shown a relationship between birth weight discordance and adverse perinatal outcomes.This study aimed to investigate the perinatal risk factors and neonatal complications of discordant twins who are admitted to the neonatal intensive care unit.Methods A total of 87 sets of twins were enrolled in this retrospective study,of which 22 sets were discordant twins and 65 sets were concordant twins.Binary Logistic regression analysis was used to identify the risk factors associated with the occurrence of discordant twins.The common neonatal complications of discordant twins were also investigated.Results Multivariate analysis showed that the use of assisted reproductive techniques,pregnancy-induced hypertension,and unequal placental sharing were risk factors for the occurrence of discordant twins.The incidence of small for gestational age infants and very low birth weight infants of discordant twins was significantly higher,while the birth weight of discordant twins was significantly lower than those of concordant twins.The duration of hospitalization of discordant twins was longer than that of concordant twins.The incidence of several neonatal complications,such as neonatal respiratory distress syndrome and intracranial hemorrhage,was higher in discordant twins than that in concordant twins.The percentage of those requiring pulmonary surfactant and mechanical ventilation was significantly higher in discordant twins than that in concordant twins.Conclusions Use of assisted reproductive techniques,pregnancy-induced hypertension,and unequal placental sharing are perinatal risk factors of discordant twins who are admitted to the neonatal intensive care unit.These infants are also much more likely to suffer from various neonatal complications,especially respiratory and central nervous system diseases.It is important to prevent the occurrence of discordant twins by decreasing these risk factors and timely treatment should be given to discordant

  10. Edema in renal diseases – current view on pathogenesis

    Directory of Open Access Journals (Sweden)

    Irina Bobkova

    2016-10-01

    Full Text Available Edema is a common complication of numerous renal disease. In the recent past several aspects of the pathophysiology of this condition have been elucidated. We herein present a case of nephrotic syndrome in a 30 year-old men. The discussion revolves around the following key questions on fluid accumulation in renal disease: 1. What is edema? What diseases can cause edema? 2. What are the mechanisms of edema in nephrotic syndrome?   2a. The “underfill” theory   2b. The “overfill” theory   2c. Tubulointerstitial inflammation   2d. Vascular permeability 3. What are the mechanisms of edema in nephritic syndrome? 4. How can the volume status be assessed in patients with nephrotic syndrome? 5. What are therapeutic strategies for edema management? 6. What are the factors affecting response to diuretics? 7. How can we overcome the diuretics resistance?   7a. Effective doses of loop diuretics   7b. Combined diuretic therapy   7c. Intravenous administration of diuretics   7d. Albumin infusions   7e. Alternative methods of edema management 8. Conclusion.

  11. 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

  12. 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.

  13. 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.

  14. Critical Care Management of Cerebral Edema in Brain Tumors.

    Science.gov (United States)

    Esquenazi, Yoshua; Lo, Victor P; Lee, Kiwon

    2017-01-01

    Cerebral edema associated with brain tumors is extremely common and can occur in both primary and metastatic tumors. The edema surrounding brain tumors results from leakage of plasma across the vessel wall into the parenchyma secondary to disruption of the blood-brain barrier. The clinical signs of brain tumor edema depend on the location of the tumor as well as the extent of the edema, which often exceeds the mass effect induced by the tumor itself. Uncontrolled cerebral edema may result in increased intracranial pressure and acute herniation syndromes that can result in permanent neurological dysfunction and potentially fatal herniation. Treatment strategies for elevated intracranial pressure consist of general measures, medical interventions, and surgery. Alhough the definitive treatment for the edema may ultimately be surgical resection of the tumor, the impact of the critical care management cannot be underestimated and thus patients must be vigilantly monitored in the intensive care unit. In this review, we discuss the pathology, pathophysiology, and clinical features of patients presenting with cerebral edema. Imaging findings and treatment modalities used in the intensive care unit are also discussed.

  15. 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.

  16. 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.

  17. [Advances in the management of neonatal hypoxia].

    Science.gov (United States)

    Riesgo, Rudimar dos Santos; Becker, Michele M; Ranzan, Josiane; Winckler, Maria Isabel B; Ohlweiler, Lygia

    2013-09-06

    Introduccion. Durante el nacimiento, ocurren cambios fisiologicos en practicamente todos los organos del niño, incluyendo el sistema nervioso central. En esta fase de transicion, es posible un cierto grado de hipoxemia, en general bien tolerado por el neonato. Sin embargo, si la hipoxia neonatal es muy intensa y continuada, puede instalarse una encefalopatia neonatal, lo que caracteriza una situacion critica para el recien nacido. Su abordaje adecuado es imprescindible para garantizar un buen pronostico a largo plazo. Desarrollo. Se actualizan las informaciones acerca de la hipoxia neonatal y se revisan publicaciones recientes acerca de los avances en su abordaje a traves de la medicina basada en evidencias. Conclusiones. La encefalopatia neonatal se puede clasificar desde el punto de vista clinico en tres niveles de intensidad. Usualmente, los casos leves tienen un buen pronostico, los casos de intensidad moderada tienen un 30% de posibilidad de secuelas y los de intensidad grave tienen mas del 70% de mortalidad, pero practicamente todos los supervivientes tendran secuelas. Los avances ocurrieron en dos areas: en el diagnostico, con nuevas tecnicas de EEG y RM, y en el tratamiento, con la aparicion de la hipotermia terapeutica. Existe la posibilidad de un uso futuro para la terapia con celulas madre. El pronostico depende de la clasificacion clinica, de los datos de neuroimagen y del EEG.

  18. Melatonin lowers edema after spinal cord injur y

    Institute of Scientific and Technical Information of China (English)

    Cheng Li; Xiao Chen; Suchi Qiao; Xinwei Liu; Chang Liu; Degang Zhu; Jiacan Su; Zhiwei Wang

    2014-01-01

    Melatonin has been shown to diminish edema in rats. Melatonin can be used to treat spinal cord injury. This study presumed that melatonin could relieve spinal cord edema and examined how it might act. Our experiments found that melatonin (100 mg/kg, i.p.) could reduce the water content of the spinal cord, and suppress the expression of aquaporin-4 and glial ifbrillary acidic protein after spinal cord injury. This suggests that the mechanism by which melatonin alleviates the damage to the spinal cord by edema might be related to the expression of aquaporin-4 and glial ifbrillary acidic protein.

  19. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

    Science.gov (United States)

    Baget-Bernaldiz, Marc; Pareja-Rios, Alicia; Lopez-Galvez, Maribel; Navarro-Gil, Raul; Verges, Raquel

    2016-01-01

    Diabetic macular edema (DME) can cause blindness in diabetic patients suffering from diabetic retinopathy (DR). DM parameters controls (glycemia, arterial tension, and lipids) are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF) is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.

  20. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

    Directory of Open Access Journals (Sweden)

    Pedro Romero-Aroca

    2016-01-01

    Full Text Available Diabetic macular edema (DME can cause blindness in diabetic patients suffering from diabetic retinopathy (DR. DM parameters controls (glycemia, arterial tension, and lipids are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.

  1. Neonatal alloimmune thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Mella MT

    2015-06-01

    Full Text Available Maria Teresa Mella, Keith A Eddleman Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai School of Medicine, New York, NY, USA Abstract: Neonatal alloimmune thrombocytopenia occurs in one in 1,000–1,500 live births and is the most common cause of severe thrombocytopenia and intracranial hemorrhage in term infants. It is the equivalent of red blood cell alloimmunization and is due to transplacental passage of maternal antibodies against paternally derived fetal platelet antigens. A diagnosis of neonatal alloimmune thrombocytopenia should be considered for any neonate with unexplained thrombocytopenia. Once the diagnosis is made, it is known that all subsequent pregnancies are at risk for severe disease. In order to prevent the devastating and potentially life-threatening manifestations of the disease, the goal is to initiate treatment early with serial percutaneous umbilical blood sampling, intravenous immunoglobulin administration, prednisone, and/or fetal platelet transfusions. Timing of delivery is variable with delivery for severe disease recommended at an earlier gestational age. Vaginal delivery can be considered if the fetal platelet count is greater than 50,000–100,000 µL. Thrombocytopenia due to neonatal alloimmune thrombocytopenia usually resolves spontaneously within 1–2 weeks after delivery, but a platelet transfusion may be necessary to prevent a serious hemorrhagic event. In all cases, a multidisciplinary approach to care should be undertaken with delivery at a tertiary care center. Keywords: neonatal thrombocytopenia, fetal therapy, intracranial hemorrhage, intravenous immunoglobulin, alloimmunization

  2. The value of neonatal autopsy.

    LENUS (Irish Health Repository)

    Hickey, Leah

    2012-01-01

    Neonatal autopsy rates were in decline internationally at the end of the last century. Our objective was to assess the current value of neonatal autopsy in providing additional information to families and healthcare professionals.

  3. 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.

  4. Aspectos atuais na fisiopatologia do edema macular diabético Recent aspects on physiopathology of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Mário Martins dos Santos Motta

    2008-02-01

    Full Text Available O edema macular é a principal causa de baixa visual em pacientes diabéticos. Seu mecanismo de formação é complexo e envolve alterações bioquímicas e estruturais. Os autores fazem uma revisão e atualização dos conceitos fisiopatológicos envolvidos na maculopatia diabética.Macular edema is the leading cause of poor vision in diabetic patients.The mechanism of edema formation is complex and involves biochemical and structural changes. The authors review and update the physiopathologic concepts related to diabetic maculopathy.

  5. Neonatal brucellosis: A case report.

    Science.gov (United States)

    Alnemri, Abdul Rahman M; Hadid, Adnan; Hussain, Shaik Asfaq; Somily, Ali M; Sobaih, Badr H; Alrabiaah, Abdulkarim; Alanazi, Awad; Shakoor, Zahid; AlSubaie, Sarah; Meriki, Naema; Kambal, Abdelmageed M

    2017-02-28

    Although brucellosis is not uncommon in Saudi Arabia, neonatal brucellosis has been infrequently reported. In this case of neonatal brucellosis, Brucella abortus was isolated by blood culture from both the mother and the neonate. Serology was positive only in the mother.

  6. Patchy cerebral white matter edema in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Anlar, B.; Erzen, C.; Saatci, U.

    1989-07-01

    Bilateral patchy cerebral white matter edema was observed in two children with chronic renal failure. Uremia in one case and hypertension or hyponatremia in the other appeared to be the cause of the neurological and radiological findings. (orig.).

  7. Postembolization perianeurysmal edema as a cause of uncinate seizures.

    Science.gov (United States)

    Cohen, José E; Itshayek, Eyal; Attia, Moshe; Moscovici, Samuel

    2012-03-01

    We report a patient with a giant unruptured supraclinoid aneurysm treated by endovascular embolization by means of bare coils and implantation of a flow diverterstent. Eight weeks after the embolization, she presented with uncinate seizures. Neuroradiological examination revealed de novo postembolization perianeurysmal edema, which has been described only rarely. A brief course of oral steroids successfully controlled the seizures. Perianeurysmal edema must be considered a potential complication after embolization of large aneurysms with coils and other means, and needs to be considered as a differential diagnosis in patients with unusual neurological symptoms at either the acute or delayed stages. To our knowledge, this is the first report of postembolization perianeurysmal edema occurring after successful occlusion by means of bare coils and a flow diverterstent. This report contributes to the growing evidence on adverse post-coiling inflammatory reactions, and specifically on perianeurysmal edema.

  8. 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

  9. 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.

  10. Mathematical modelling of blood-brain barrier failure and edema

    Science.gov (United States)

    Waters, Sarah; Lang, Georgina; Vella, Dominic; Goriely, Alain

    2015-11-01

    Injuries such as traumatic brain injury and stroke can result in increased blood-brain barrier permeability. This increase may lead to water accumulation in the brain tissue resulting in vasogenic edema. Although the initial injury may be localised, the resulting edema causes mechanical damage and compression of the vasculature beyond the original injury site. We employ a biphasic mixture model to investigate the consequences of blood-brain barrier permeability changes within a region of brain tissue and the onset of vasogenic edema. We find that such localised changes can indeed result in brain tissue swelling and that the type of damage that results (stress damage or strain damage) depends on the ability of the brain to clear edema fluid.

  11. Dexamethasone Intravitreal Implant for Diabetic Macular Edema During Pregnancy

    DEFF Research Database (Denmark)

    Concillado, Michael; Lund-Andersen, Henrik; Mathiesen, Elisabeth R;

    2016-01-01

    PURPOSE: To describe the management of diabetic macular edema during pregnancy with the use of a dexamethasone slow-release intravitreal implant. DESIGN: Retrospective, observational, consecutive case series. METHODS: The study included 5 pregnant women who presented with diabetic macular edema...... injection. RESULTS: Diabetic macular edema involving the foveal center was observed between gestational weeks 9 and 23 in 10 eyes of 5 patients. Dexamethasone intravitreal implant injection was given 10 times in 9 eyes with a mean preinjection center field retinal thickness of 535 μm (range, 239-727 μm...... center field thickness and in 6 of 8 eyes by an increase in BCVA of 5 or more approxETDRS letters. A mild transient rise in intraocular pressure occurred in 3 out of 8 eyes. CONCLUSION: Diabetic macular edema involving the foveal center that presented during pregnancy responded promptly to intravitreal...

  12. Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab.

    Science.gov (United States)

    Barone, Antonio; Prascina, Francesco; Russo, Vincenzo; Iaculli, Cristiana; Primavera, Vito; Querques, Giuseppe; Stella, Andrea; Delle Noci, Nicola

    2008-07-01

    A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.

  13. The study of burn wound edema using dichromatic absorptiometry.

    Science.gov (United States)

    Demling, R H; Mazess, R B; Witt, R M; Wolberg, W H

    1978-02-01

    Burn wound edema is a source of major morbidity and mortality. To quantitatively study this edema, we have devised a noninvasive method called Dichromatic Absorptiometry (DA) which is precise (2-3%) and accurate (r equal to 0.99) in measuring changes in tissue fluid. A scanning technique using a dual photon source, 125I and 241Am, is used. The variable attenuation of the two photon energies allows for selective mass measurements of fluid, protein, lipid, and bone. In limbs with thermal injury the correlation of DA changes in fluid mass with circumference was (r equal to 0.97), but DA was more sensitive. In deep second- and third-degree burns, edema formation was maximum between 12 and 18 hours postburn with 80% of maximum already present at 4 hours. Resorption was complete by 1 week in second-degree burns, but significantly delayed in third-degree burns. Superimposed infection produced persistent edema.

  14. 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

  15. Rings in the neonate.

    LENUS (Irish Health Repository)

    Hackett, C B

    2011-02-01

    Neonatal lupus erythematosus (NLE) is an uncommon disease of the neonate. It is believed to be caused by the transplacental passage of maternal autoantibodies to the ribonucleoproteins (Ro\\/SSA, La\\/SSB or rarely U RNP) as these are almost invariably present in NLE sera. The most common clinical manifestations include cutaneous lupus lesions and congenital complete heart block. Hepatobiliary and haematologic abnormalities are reported less frequently. We describe a patient with cutaneous NLE to illustrate and raise awareness of the characteristic annular eruption of this condition. We also emphasize the need for thorough investigation for concomitant organ involvement and for maternal education regarding risk in future pregnancies.

  16. Ultrasonography of Neonatal Cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun [Seoul National University Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Ultrasonography (US) is as an important tool for differentiation of obstructive and non-obstructive causes of jaundice in infants and children. Beyond two weeks of age, extrahepatic biliary atresia and neonatal hepatitis are the two most common causes of persistent neonatal jaundice: differentiation of extrahepatic biliary atresia, which requires early surgical intervention, is very important. Meticulous analysis should focus on size and configuration of the gallbladder and anatomical changes of the portahepatis. In order to narrow the differential diagnosis, combined approaches using hepatic scintigraphy, MR cholangiography, and, at times, percutaneous liver biopsy are necessary. US is useful for demonstrating choledochal cyst, bile plug syndrome, and spontaneous perforation of the extrahepatic bile duct

  17. Effect of Foot Massage on Physiological Edema During Pregnancy

    OpenAIRE

    Fatemeh Rahimikian; Azadeh Shadmehr; Abbas Mehran; Mahdieh Kiani

    2015-01-01

    Introduction: One of the most common and annoying problems during pregnancy is physiological foot edema that may cause activity restrictions during pregnancy for pregnant women. Present study aimed to determine the effect of foot massage on physiological edema during pregnancy. Methods: This study was non-randomized clinical trial and performed in 2012. 120 pregnant women aged 20 to 35 years were non randomly assigned to treatment and control groups. Treatment group, received 20 minutes d...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Edema pulmonar agudo neurogênico: relato de caso

    OpenAIRE

    José Correia de Farias Brito; Maria Cerly Almeida Diniz; Roberto Ramalho Rosas; José Alberto Gonçalves Da Silva

    1995-01-01

    Os autores apresentam um caso de edema pulmonar agudo numa paciente de 28 anos de idade acometida de hemorragia subaracnóidea secundária à rotura de aneurisma intracraniano. A sintomatologia respiratória ocorreu durante o agravamento do quadro neurológico. Alguns aspectos etiológicos e fisiopatogênicos do edema pulmonar agudo neurogênico são analisados.

  3. Edema pulmonar agudo neurogênico: relato de caso

    Directory of Open Access Journals (Sweden)

    José Correia De Farias Brito

    1995-06-01

    Full Text Available Os autores apresentam um caso de edema pulmonar agudo numa paciente de 28 anos de idade acometida de hemorragia subaracnóidea secundária à rotura de aneurisma intracraniano. A sintomatologia respiratória ocorreu durante o agravamento do quadro neurológico. Alguns aspectos etiológicos e fisiopatogênicos do edema pulmonar agudo neurogênico são analisados.

  4. Drowning stars: Reassessing the role of astrocytes in brain edema

    OpenAIRE

    2014-01-01

    Edema formation frequently complicates brain infarction, tumors and trauma. Despite the significant mortality of this condition, current treatment options are often ineffective or incompletely understood. Recent studies have revealed the existence of a brain-wide paravascular pathway for cerebrospinal (CSF) and interstitial fluid (ISF) exchange. The current review critically examines the contribution of this ‘glymphatic’ system to the main types of brain edema. We propose that in cytotoxic ed...

  5. 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.

  6. [Migraine with prolonged eyelid edema: a series of 10 cases].

    Science.gov (United States)

    Toribio-Díaz, M E; Cuadrado-Pérez, M L; Peláez, A; Aledo-Serrano, Angel; Pedraza, M Isabel; Porta-Etessam, Jesús; Guerrero-Peral, Angel L

    2014-05-01

    Introduccion. La migraña puede cursar con sintomas autonomicos craneales propios de las cefaleas trigeminoautonomicas, lo que plantea dificultades en el diagnostico. Objetivo. Describir una serie de diez pacientes con edema palpebral asociado a la migraña. Pacientes y metodos. Diez pacientes atendidos en la consulta de cefaleas de tres hospitales (nueve mujeres, un varon; edad: 26-53 años), con edema palpebral recurrente asociado a la migraña. Resultados. Segun los criterios diagnosticos de la Clasificacion Internacional de las Cefaleas (ICHD-III, version beta), ocho pacientes presentaban migraña sin aura, una tenia migraña con aura y otra, migraña cronica. El edema palpebral aparecia durante las crisis de migraña mas intensas, y tenia mayor duracion que la cefalea. Se descartaron causas farmacologicas o sistemicas del edema en todos los casos. Otros sintomas autonomicos asociados fueron la inyeccion conjuntival (n = 3), el lagrimeo (n = 2) y la rinorrea (n = 1). Tanto el dolor como el edema asociado respondieron a los tratamientos sintomaticos y preventivos de la migraña. Conclusiones. El edema palpebral es un posible acompañante de la migraña. Aparece en algunos pacientes con los episodios de mayor intensidad, y responde al tratamiento sintomatico y preventivo de la migraña.

  7. PHENOBARBITAL FOR THE PREVENTION OF INTRACRANIAL DAMAGE IN CHINESE NEONATES WITH SEVERE ASPHYXIA

    Institute of Scientific and Technical Information of China (English)

    陈惠金; 吴圣楣; 黄萍; 孙建华; 陈冠仪; 储凇雯

    2000-01-01

    Objective To evaluate the effect of phenobarbital on preventing intracranial damage and seizure in Chinese neonates with severe asphyxia. Methods A control trial was carried out in 60 Chinese neonates with severe asphyxia. 30 neonates received loading dose of phenobarbital on an average of 5.6h of age. Results The mean value of phenobarbital serum level obtained at the 4th day after birth was 21.9μg/ml. No significant difference was observed in the two groups in terms of birth weight, gestational age, Apgar scores, sex, etc. The imaging diagnosis within 3d of age in all subjects showed normal brain in 14, brain edema in 9 and intraventricular hemorrhage (IVH) in 7 in the treated group with a 53.3% of total complication rate, and normal brain in 5, brain edema in 15, IVH in 9 and subarachnoid hemorrhage (SAH) in 1 in the untreated group with a 83.3% of total complication rate. The incidence of intracranial damage in the untreated group was significantly higher than that in the treated group (83.3% vs 53.3%, P<0.05). In the treated group, 4 neonates with seizure symptom were effectively controlled soon, and none of the other 26 developed seizure. The period of seizure in the treated group was significantly shorter than that in the untreated group (P<0. 05). Other clinical symptoms were also sooner improved and no side effects were observed among the neonates treated with phenobarbital. Conclusion The incidence of postasphyxiated intracranial damage was obviously decreased, and seizure could be prophylactically intervened by phenobarbital. It is recommended that early application of preventive phenobarbitalin severely asphyxiated neonates is reasonable in reducing the incidence of intracranial lesions and subsequent seizures.

  8. Intravitreal bevacizumab for persistent macular edema with proliferative diabetic retinopathy.

    Science.gov (United States)

    Gulkilik, Gokhan; Taskapili, Muhittin; Kocabora, Selim; Muftuoglu, Gulipek; Demirci, Goktug

    2010-12-01

    To evaluate the effectiveness of an intravitreal bevacizumab injection on retinal neovascularization and diabetic macular edema (DME) refractory to laser photocoagulation therapy. Thirty-four eyes of 22 patients with proliferative diabetic retinopathy and DME refractory to laser photocoagulation therapy received an intravitreal injection of 1.25 mg/0.05 ml of bevazicumab. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), regression of neovascularization over time, and correlation between BCVA and CMT were evaluated. Follow-up visits were at weeks 1, 2 and 4 and months 3 and 6. Mean BCVA was significantly better than baseline only at week 2 (P = 0.036). Mean CMT decreased significantly from baseline at weeks 1, 2, and 4 (P = 0.001). At months 3 and 6, mean CMT increased, albeit insignificantly (P = 0.804 and P = 1.0). The decrease in fluorescein leakage was moderate in all eyes at the end of week 1. At week 2, there was total resolution of fluorescein leakage in 24 (70.5%) eyes and moderate resolution in 10 (29.5%) eyes. At the end of month 3, the fluorescein leakage was fully resolved in 5 (14.7%) eyes, moderately resolved in 24 (70.5%) eyes, and was similar to baseline in 5 (14.7%) eyes. At month 6, the fluorescein leakage was fully resolved in 3 (8.8%) eyes, moderately resolved in 20 (58.8%) eyes, and was similar to baseline in 11 (32.4%) eyes. A moderate but insignificant negative correlation was found between visual acuity and CMT (P > 0.05). Persistence or recurrence of neovascular tissue after panretinal photocoagulation may be attributed to the production of vascular endothelial growth factor by the residual ischemic retina, which also results in persistent or recurrent DME despite macular grid photocoagulation.

  9. Epigenetics in neonatal diseases

    Institute of Scientific and Technical Information of China (English)

    XU Xue-feng; DU Li-zhong

    2010-01-01

    Objective To review the role of epigenetic regulation in neonatal diseases and better understand Barker's "fetal origins of adult disease hypothesis".Data sources The data cited in this review were mainly obtained from the articles published in Medline/PubMed between January 1953 and December 2009.Study selection Articles associated with epigenetics and neonatal diseases were selected.Results There is a wealth of epidemiological evidence that lower birth weight is strongly correlated with an increased risk of adult diseases, such as type 2 diabetes mellitus, hypertension, and cardiovascular disease. This phenomenon of fetal origins of adult disease is strongly associated with fetal insults to epigenetic modifications of genes. A potential role of epigenetic modifications in congenital disorders, transient neonatal diabetes mellitus (TNDM), intrauterine growth retardation (IUGR), and persistent pulmonary hypertension of the newborn (PPHN) have been studied.Conclusions Acknowledgment of the role of these epigenetic modifications in neonatal diseases would be conducive to better understanding the pathogenesis of these diseases, and provide new insight for improved treatment and prevention of later adult diseases.

  10. Telemedicine in Neonatal Home Care

    DEFF Research Database (Denmark)

    Holm, Kristina Garne; Brødsgaard, Anne; Zachariassen, Gitte

    2016-01-01

    visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. OBJECTIVE: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. METHODS: The study used...... participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care...... with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. CONCLUSIONS: Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when...

  11. Developmental pharmacokinetics of gentamicin in preterm and term neonates

    DEFF Research Database (Denmark)

    Nielsen, Elisabet I; Sandström, Marie; Honoré, Per Hartvig;

    2009-01-01

    for concentration monitoring. This study was performed to characterize the population pharmacokinetics of gentamicin in preterm and term neonates and to identify and quantify relationships between patient characteristics and IIV. A secondary aim was to evaluate cystatin C as a marker for gentamicin clearance...... was included as the primary covariate according to an allometric power model. Other evaluated covariates were age (postmenstrual age, gestational age [GA], postnatal age [PNA]), markers for renal function (serum creatinine, serum cystatin C) and concomitant medication with cefuroxime, vancomycin or indometacin...... as having a significant influence on the central volume of distribution, with a preterm neonate having a larger central volume of distribution per kilogram of bodyweight than a term neonate. Cystatin C and creatinine were not correlated with gentamicin clearance in this study population. The external...

  12. [Recommendations for neonatal transport].

    Science.gov (United States)

    Moreno Hernando, J; Thió Lluch, M; Salguero García, E; Rite Gracia, S; Fernández Lorenzo, J R; Echaniz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Sánchez Luna, M

    2013-08-01

    During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital.

  13. [Value of electroencephalography in the early detection of neonatal leucinosis].

    Science.gov (United States)

    Pardal-Fernandez, J M; Carrascosa-Romero, M C; Grande, A; Martinez-Gonzalez, M; Godes-Medrano, B

    2016-08-16

    Introduccion. La leucinosis es una metabolopatia neonatal grave. Es consecuencia del deficit enzimatico determinado geneticamente del complejo descarboxilasa-dihidrolipoil transacilasa y dihidrolipoil deshidrogenasa, y del acumulo consecuente de los metabolitos precursores, aminoacidos ramificados de cadena larga y sus alfa-cetoacidos. Son potentes neurotoxicos, responsables del rapido establecimiento de edema y desmielinizacion cerebral difusa. La demora en el diagnostico suele provocar graves secuelas psicomotoras o incluso la muerte. Caso clinico. Se presenta una paciente neonata con encefalopatia neonatal grave, crisis epilepticas y un electroencefalograma (EEG) con unas caracteristicas especiales que oriento el diagnostico hacia una posible leucinosis. El diagnostico temprano permitio instaurar rapidamente el tratamiento especifico y conseguir una evolucion favorable de la paciente. Conclusiones. El EEG en pacientes con sospecha de encefalopatia neonatal ofrece informacion funcional de alta rentabilidad con un bajo coste, en especial por promover diagnosticos y tratamientos tempranos. El EEG en la leucinosis presenta signos peculiares, reconocibles en periodos tempranos en la mayor parte de los afectados, como ocurrio en el caso descrito. Parece recomendable integrar el EEG en el cribado de encefalopatias neonatales por ser una tecnica diagnostica valiosa, inocua y, por lo general, accesible y especialmente de ayuda en metabolopatias tratables, como la leucinosis.

  14. 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.

  15. Assessment of Macular Sensitivity and Fixation Stability by MP-1 Microperimetry in Diabetic Macular Edema

    Directory of Open Access Journals (Sweden)

    Tuncay Küsbeci

    2012-12-01

    Full Text Available Pur po se: To evaluate macular light sensitivity and fixation stability in subjects with clinically significant macular edema (CSME related to diabetes mellitus. Ma te ri al and Met hod: Thirty eyes of 22 patients with CSME, as defined by Early Treatment Diabetic Retinopathy Study, and 32 eyes of 32 healthy subjects were enrolled in this study. Microperimetry was performed with the Micro Perimeter MP-1 in both groups. The mean retinal sensitivities at central 4°, at central 12° and at central 20° were measured. The mean extent of preferred retinal locus (PRL, fixation stability and fixation location were calculated using fixation test in MP-1 microperimeter. Statistical analysis was performed using student t-test and chisquare test. Re sults: The mean best-corrected visual acuity (BCVA was significantly lower in the CSME group than the control group (p<0.001. The mean retinal sensitivities at central 4°, 12° and 20° areas were significantly lower in the CSME group compared to the control group (p<0.001, for each central degrees. In subjects with CSME, fixation stability was detected as stable in 8 (26.7% eyes, relatively unstable in 21 (70% eyes and unstable in 1 (3.3% eye. Significant decrease was found in fixation stability and fixation location scores in eyes with CSME compared to control subjects (p<0.001. The difference of mean extent in PRL between the groups was statistically significant (p<0.001. Dis cus si on: The macular light sensitivity and fixation stability are affected in patients with CSME. MP-1 micropeimetry might be helpful to evaluate the extent of PRL and useful for evaluation of severity and progression of diabetic macular edema. (Turk J Ophthalmol 2012; 42: 310-5

  16. 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.

  17. Influence of ischemia on visual function in patients with branch retinal vein occlusion and macular edema

    Directory of Open Access Journals (Sweden)

    Noma H

    2011-05-01

    Full Text Available Hidetaka Noma¹, Hideharu Funatsu¹, Tatsuya Mimura², Katsunori Shimada³¹Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Owada-shinden, Chiba, Japan; ²Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; ³Department of Hygiene and Public Health II, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, JapanAbstract: Visual function and retinal morphology were investigated to elucidate the influence of ischemia in patients with branch retinal vein occlusion (BRVO and macular edema. In 41 consecutive patients with BRVO aged 68.9 ± 10.0 years (22 women and 19 men, the area of capillary nonperfusion was measured by fluorescein angiography. Retinal thickness and retinal volume were measured by optical coherence tomography, and mean retinal sensitivity was calculated for each of 9 macular subfields. Mean visual acuity and macular sensitivity within the central subfield were not significantly correlated with the nonperfused area. However, the macular sensitivity within the central 5 subfields and all 9 subfields showed significant negative correlations with the nonperfused area. Also, macular thickness and volume within all 9 subfields were significantly correlated with the nonperfused area. In conclusion, evaluation of both the fovea and the entire macular region may be important in patients with ischemic BRVO.Keywords: branch retinal vein occlusion, macular edema, macular sensitivity, ischemia

  18. Peritumoral brain edema in intracranial meningiomas Edema peritumoral em meningiomas intracranianos

    Directory of Open Access Journals (Sweden)

    Nelson de Azambuja Pereira-Filho

    2010-06-01

    Full Text Available Occurrence of peritumoral brain edema (PBE in meningiomas has been associated with several factors in recent years, although its pathophysiological mechanism has not yet been fully elucidated. The aim of this study was to analyze the correlation between the presence / degree of PBE and factors such as gender, age, size and histological subtype of tumor. We analyzed the MRI images of 74 patients operated on Hospital Beneficência Portuguesa de Porto Alegre for the presence / degree of PBE and data was statistically correlated with the parameters of the patient. PBE was present in 70.1% of patients. Tumors with higher volume had more PBE. Tumors of the olfactory groove showed more PBE than sphenoid wing and parassagittal tumors. Transitional subtype showed more PBE than fibroblastic and meningothelial subtypes.A presença de edema cerebral peritumoral (ECP em meningiomas tem sido associada a diversos fatores nos últimos anos, embora o seu mecanismo fisiopatológico ainda não tenha sido inteiramente elucidado. O objetivo desse estudo foi analisar a correlação entre a presença/grau de ECP e fatores como sexo, idade, volume e subtipo histológico do tumor. Foram analisadas imagens de RM de 74 pacientes operados no Hospital Beneficência Portuguesa de Porto Alegre quanto à presença/grau de ECP e os dados correlacionados estatisticamente com os parâmetros do paciente. ECP estava presente em 70,1% dos pacientes. Tumores com maior volume apresentaram mais ECP. Tumores da goteira olfatória apresentaram mais ECP que os da asa do esfenóide e que os parassagitais. Meningiomas transicionais apresentaram mais ECP que os fibroblásticos e que os meningoteliais.

  19. Neonatal Meningitis: Risk Factors, Causes, and Neurologic Complications

    Directory of Open Access Journals (Sweden)

    Nasrin KHALESSI

    2014-12-01

    Full Text Available How to Cite This Article: Khalessi N, Afsharkhas L. Neonatal Meningitis: Risk Factors, Causes and Neurologic Complications.Iran J Child Neurol. 2014 Autumn;8(4: 46-50.AbstractObjectiveNeonates are at greater risk for sepsis and meningitis than other ages and in spite of rapid diagnoses of pathogens and treatments, they still contribute to complications and mortality. This study determines risk factors, causes, andneurologic complications of neonatal meningitis in  ospitalized neonates.Material & MethodsIn this descriptive, cross sectional study, we evaluated 415 neonates with sepsis and meningitis admitted to the neonatal intensive care unit at our center between 2008 and 2012. The data that was recorded was age, sex, birth weight, prenatalrisk factors, clinical features, blood and cerebrospinal fluid analysis, and brain sonographic findings and outcomes.Results Twenty patients had meningitis. Eleven cases (55% were male. The mean age was 8. 41 days and mean birth weight was 2891.5±766 grams. Poor feeding, seizures, and tachypnea were detected in 12 (60%, 11 (55%, and 6 (30%patients, respectively. Prenatal risk factors were prolonged rupture of membranes, maternal vaginitis, asymptomatic bacteriuria, prematurity, low birth weights, and asphyxia. Four patients had positive cerebrospinal fluid cultures with klebsiella pneumoniae 2 (50%, Enterococcus spp. 1 (25%, and Group B streptococcus 1 (25% cases, respectively. Two cases had positive blood cultures with klebsiella pneumoniae. Neurologic complications were brain edema, subdural effusion,and brain abscesses with hydrocephaly. One neonate (5% died.ConclusionOur study provides some information about risk factors, pathogens, and neurologic complications for neonatal meningitis. Prenatal assessments help to diagnose and reduce risk factors of this hazardous disease. ReferencesVolpe JJ. Bacterial and fungal intracranial infections. In:Neurology of the Newborn. 5th. Edition

  20. Venous thromboembolism at uncommon sites in neonates and children.

    Science.gov (United States)

    Pergantou, Helen; Avgeri, Maria; Komitopoulou, Anna; Xafaki, Panagiota; Kapsimali, Zoey; Mazarakis, Michail; Adamtziki, Eftychia; Platokouki, Helen

    2014-11-01

    We retrospectively analyzed the data of 24 children (whereof 11 neonates), with non-central venous line-related and nonmalignancy-related venous thromboembolism (VTE) at uncommon sites, referred to our Unit from January 1999 to January 2012. Thirty patients who also suffered deep vein thrombosis, but in upper/low extremities, were not included in the analysis. The location of rare site VTE was: portal (n=7), mesenteric (n=2) and left facial vein (n=1), spleen (n=3), lung (n=3), whereas 10 neonates developed renal venous thrombosis. The majority of patients (91.7%) had at least 1 risk factor for thrombosis. Identified thrombophilic factors were: antiphospholipid antibodies (n=2), FV Leiden heterozygosity (n=6), MTHFR C677T homozygosity (n=4), protein S deficiency (n=2), whereas all neonates had age-related low levels of protein C and protein S. All but 6 patients received low-molecular-weight heparin, followed by warfarin in 55% of cases, for 3 to 6 months. Prolonged anticoagulation was applied in selected cases. During a median follow-up period of 6 years, the clinical outcome was: full recovery in 15 patients, evolution to both chronic portal hypertension and esophageal varices in 2 children, and progression to renal failure in 7 of 10 neonates. Neonates are greatly vulnerable to complications after VTE at uncommon sites, particularly renal. Future multicentre long-term studies on neonatal and pediatric VTE at unusual sites are considered worthwhile.

  1. Paediatric intensive care is feasible in a neonatal department

    DEFF Research Database (Denmark)

    Jensen, Anne-Mette Bæk; Lundstrøm, Kaare E.; Reinholdt, Jes;

    2013-01-01

    Intensive care of infants below one year of age has been centralized in a paediatric intensive care unit (PICU) related to the neonatal intensive care unit (NICU) at Rigshospitalet, the University Hospital in Copenhagen in eastern Denmark (approximately 2.5 million inhabitants) since 2002. The aim...

  2. Intellectual Deficits After Transient Tyrosinemia in the Term Neonate

    Science.gov (United States)

    Mamunes, Peter; And Others

    1976-01-01

    In order to determine if prolonged significant transient neonatal tyrosinemia is injurious to the developing central nervous system, 15 term infants who had suffered from this disorder (involving high blood levels of the amino acid tyrosine) were evaluated. (Author/DB)

  3. Probabilistic brain tissue segmentation in neonatal magnetic resonance imaging

    NARCIS (Netherlands)

    Anbeek, Petronella; Vincken, Koen L.; Groenendaal, Floris; Koeman, Annemieke; Van Osch, Matthias J. P.; Van der Grond, Jeroen

    2008-01-01

    A fully automated method has been developed for segmentation of four different structures in the neonatal brain: white matter (WM), central gray matter (CEGM), cortical gray matter (COGM), and cerebrospinal fluid (CSF). The segmentation algorithm is based on information from T2-weighted (T2-w) and i

  4. Contents of myelin-basic protein and S-100 in serum and brain tissue of neonatal rats with intrauterine infection-caused brain injury

    Institute of Scientific and Technical Information of China (English)

    Xiaojie Li; Hongying Li; Zhihai Lu

    2006-01-01

    Pathological detection results of uterus and placenta of neonatal rats: Uterine wall and placenta of pregnant rats were found with vascular engorgement and edema, and a great quantity of neutrophilic leukocyte infiltrated. Meanwhile, there was not evident inflammatory reaction in the pregnant rats in the control group. ④ Detection of brain tissue of neonatal rats under an electron microscope: Obvious brain injury was found in the neonatal rats of the experimental rats, but was not found in the control group. CONCLUSION: LPS successfully causes intrauterine infection of pregnant rats, and the neonatal rats born by which have obvious brain injury. Through detecting the changes of the content of MBP and S-100 on these animal models, it is concluded that MBP and S-100 can be used as the indexes to early diagnose brain injury, and they are the sensitive biochemical indexes to reflect the extent of early brain injury.

  5. Effect of transparent dressings replacing in different frequency on neonatal central venous catheter-related infections%透明敷料不同更换频率对新生儿中心静脉导管相关性感染的影响

    Institute of Scientific and Technical Information of China (English)

    凌其英; 舒辉; 陈虹; 唐敏; 金夕辉

    2016-01-01

    OBJECTIVE To investigate neonatal peripherally inserted central catheter (PICC) ,and effect of trans‐parent dressings replacing in different frequency on neonatal central venous catheter‐related infections ,in order to select the appropriate transparent dressing change frequency to provide a theoretical basis .METHODS A total of 450 neonates indwelling PICC catheter in hospital from Jun .2012 to Jun .2015 were selected as research subjects , in a random manner patients were divided into three groups ,in which group Ⅰ dressing changed once every three days ,group Ⅱonce every five days ,group Ⅲ once every 7 days ,the catheter‐related infection were analyzed and compared in three groups of children .RESULTS A total of 21 cases of patients got infections from 450 patients , and the infection rate was 4 .67% ;Staphylococcus epidermidis were the top bacteria detected out from the three groups of children ,accounting for 57 .14% ,71 .42% and 49 .99% respectively ,followed by K lebsiella pneumoni‐ae ,accounting for 42 .86% ,14 .29% and 16 .67% respectively .The incident rates of catheter‐related infection in groupⅠand Ⅱ both 0 .67% ,and group Ⅲ had no catheter‐related bloodstream infections .CONCLUSION We rec‐ommend that the dressing central venous catheters in neonates replacement frequency is 7 days /time to reduce the workload of medical staff ,reduce the incidence of nosocomial infections ,but if dressings appear moist and loose phenomenon happen ,the cathether should be replaced .%目的:探讨新生儿经外周静脉置入中心静脉导管(PICC )后,透明敷料不同更换频率对导管感染发生的影响,为透明敷料选取合适的更换频率提供理论依据。方法选取2012年6月-2015年6月在医院接受留置PICC导管的450例新生儿为研究对象,按照随机的方式将其平均分成3组,其中Ⅰ组每3 d更换一次敷料,Ⅱ组每5 d更换一次敷料,Ⅲ组每7 d更

  6. Telemedicine in Neonatal Home Care

    DEFF Research Database (Denmark)

    Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte;

    2016-01-01

    BACKGROUND: For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home...... visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. OBJECTIVE: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. METHODS: The study used...... participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care...

  7. Bone marrow edema syndrome in postpartal women: treatment with iloprost.

    Science.gov (United States)

    Aigner, Nicholas; Meizer, Roland; Meraner, Dominik; Becker, Stephan; Meizer, Elizabeth; Landsiedl, Franz

    2009-04-01

    Bone marrow edema syndrome of the femoral head in pregnant women is a rare disease resulting in disabling coxalgia, beginning in the last 3 months of pregnancy and persisting for several months after parturition. The parenteral administration of the vasoactive drug iloprost constitutes a new approach to the treatment of painful bone marrow edema syndrome of the hip of pregnant women. Six postpartal women (8 hips) with bone marrow edema syndrome of the femoral head were treated with iloprost followed by 3 weeks of partial weight-bearing. Relief from pain, restoration of functional capacity, and normalization of the MRI signal pattern were rapidly achieved, thus avoiding the need for surgical intervention. As the substance is contraindicated in pregnancy, therapy may begin only some days after parturition, with a short discontinuation in breastfeeding.

  8. Cystoid Macular Edema Induced by Low Doses of Nicotinic Acid

    Directory of Open Access Journals (Sweden)

    Daniela Domanico

    2013-01-01

    Full Text Available Cystoid macular edema (CME is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME in a middle-age woman taking low dose of niacin (18 mg of nicotinic acid. Optical coherence tomography (OCT showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy.

  9. 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.

  10. Progesterone is neuroprotective by inhibiting cerebral edema after ischemia

    Institute of Scientific and Technical Information of China (English)

    Yuan-zheng Zhao; Min Zhang; Heng-fang Liu; Jian-ping Wang

    2015-01-01

    Ischemic edema can alter the structure and permeability of the blood-brain barrier. Recent stud-ies have reported that progesterone reduces cerebral edema after cerebral ischemia. However, the underlying mechanism of this effect has not yet been elucidated. In the present study, pro-gesterone effectively reduced Evans blue extravasation in the ischemic penumbra, but not in the ischemic core, 48 hours after cerebral ischemia in rats. Progesterone also inhibited the down-reg-ulation of gene and protein levels of occludin and zonula occludens-1 in the penumbra. These results indicate that progesterone may effectively inhibit the down-regulation of tight junctions, thereby maintaining the integrity of the blood-brain barrier and reducing cerebral edema.

  11. Neonatal cardiovascular physiology.

    Science.gov (United States)

    Hines, Michael H

    2013-11-01

    The pediatric surgeon deals with a large number and variety of congenital defects in neonates that frequently involve early surgical intervention and care. Because the neonatal cardiac physiology is unique, starting with the transition from fetal circulation and including differences in calcium metabolism and myocardial microscopic structure and function, it serves the pediatric surgeon well to have a sound understanding of these principles and how they directly and indirectly affect their plans and treatments. In addition, many patients will have associated congenital heart disease that can also dramatically influence not only the surgical and anesthetic care but also the timing and planning of procedures. Finally, the pediatric surgeon is often called upon to treat conditions and complications associated with complex congenital heart disease such as feeding difficulties, bowel perforations, and malrotation in heterotaxy syndromes. In this article, we will review several unique aspects of neonatal cardiac physiology along with the basic physiology of the major groups of congenital heart disease to better prepare the training and practicing pediatric surgeon for care of these complex and often fragile patients.

  12. Anorectal malformations in neonates

    Directory of Open Access Journals (Sweden)

    Bilal Mirza

    2011-01-01

    Full Text Available Background : Anorectal malformations (ARM are associated with congenital anomalies and other risk factors, yielding a poor prognosis, especially in neonatal life. Objectives: This study was performed to identify the congenital anomalies as a factor of poor prognosis (mortality in such patients. Settings: Department of Pediatric surgery, The Children′s Hospital and The Institute of Child Health, Lahore. Design: Prospective observational study, with statistical support. Materials and Methods: The information on the demography, clinical features, investigations, management performed, and outcome was entered in the designed proforma and analysed with the help of statistical software EpiInfo version 3.5.1. Statistical test: Chi-square test was used to determine statistical significance of the results. Results : Of 100 neonates with ARM, 77 were male and 23, female (3.4:1. The mean age at presentation was 3.4 days (range, 12 hrs to 28 days. In 60 patients (60%, the presentation was imperforate anus without a clinically identified fistula. In 28 patients (28%, associated anomalies were present. The common associated anomalies were urogenital (10%, cardiovascular (8%, and gastrointestinal (6%. Down′s syndrome was present in 8 (8% patients. A total of 15 (15% deaths occurred in this study. In patients having associated congenital anomalies, 11 deaths occurred, whereas, 4 deaths were in patients without associated anomalies (P < 0.5. Conclusion : The mortality is higher in neonates with ARM having associated congenital anomalies.

  13. Hemangiomatosis neonatal difusa e insuficiencia cardiaca congestiva

    OpenAIRE

    Charles Augusto Huamaní Saldaña; Violeta López-Naváez; Eloy Saravia-Sandoval

    2007-01-01

    La hemangiomatosis neonatal difusa es un trastorno raro que consiste en la aparición de múltiples hemangiomas que comprometen; piel y vísceras como hígado, intestinos o el sistema nervioso central, pudiendo llegar a causar una insuficiencia cardiaca congestiva; entre otras complicaciones. Presentamos el caso de una niña de tres meses con angiomas múltiples en la piel e hígado, asociados con; cardiomegalia y dificultad respiratoria; con diagnóstico de insuficiencia cardiaca congestiva...

  14. Characterization of symptoms and edema distribution in premenstrual syndrome

    Science.gov (United States)

    Tacani, Pascale Mutti; Ribeiro, Danielle de Oliveira; Barros Guimarães, Barbara Evelyn; Machado, Aline Fernanda Perez; Tacani, Rogério Eduardo

    2015-01-01

    Background Premenstrual syndrome is a group of symptoms linked to the menstrual cycle, and edema is among these symptoms. Physiotherapy is often sought by many patients for the treatment of edema; however, for an adequate prescription of physiotherapeutic procedures, the distribution of edema throughout the body has yet to be characterized. Objective To determine the most frequent symptoms and body regions that present with edema in women during the premenstrual period. Subjects and methods Sixty women with a mean age of 24.6±4.7 years were evaluated during their premenstrual (between days 21 and 28) and menstrual period (between days 1 and 3), and the collected data included body mass, height, biotype (body-fat distribution), face, breast, limb-circumference measurements, and limb-volume estimate, and an adapted version of the Premenstrual Symptoms Screening Tool was used. Statistical analysis was performed using Student’s t-test and the test for equality of two proportions (P≤0.05). Results Premenstrual syndrome was identified in 91.7% of the women, and the most frequent symptoms were irritability (73.33%) and physical symptoms, including swelling (65%), and anxiety (58.3%). Edema was detected in the following areas: facial, epigastric, mammary, umbilical, and pubic, the mid-third of the arms, distal forearm, in both thighs and in the mid-third of the legs determined by circumference measurements, and in both upper and lower limbs, according to the estimated volume. Conclusion In this study population, the most frequent symptoms were irritability, physical symptoms, and anxiety, with distribution of edema in the face, breast, abdomen, pubic area, distal upper limb, and proximal lower limb. PMID:25792857

  15. Presentation of Neonatal Sinovenous Thrombosis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2008-09-01

    Full Text Available Signs, risk factors, comorbidities, and radiographic findings in 59 neonates presenting with sinovenous thrombosis are reported from Indiana University School of Medicine, Indianapolis, IN.

  16. Neonatal cystic fibrosis screening test

    Science.gov (United States)

    Cystic fibrosis screening - neonatal; Immunoreactive trypsinogen; IRT test; CF - screening ... Cystic fibrosis is a disease passed down through families. CF causes thick, sticky mucus to build up in ...

  17. Septicemic pasteurellosis in free-ranging neonatal pronghorn in Oregon

    Science.gov (United States)

    Dunbar, Michael R.; Wolcott, Mark J.; Rimler, R.B.; Berlowski, Brenda M.

    2000-01-01

    As part of a study to determine the cause(s) of population decline and low survival of pronghorn (Antilocapra americana) neonates on Hart Mountain National Antelope Refuge (HMNAR), Oregon (USA), 55 of 104 neonates captured during May 1996 and 1997 were necropsied (n = 28, 1996; n = 27, 1997) to determine cause of death. Necropsies were conducted on fawns that died during May, June, or July of each year. The objectives of this study were to report the occurrence and pathology of pasteurellosis in neonates and determine if the isolated strain of Pasteurella multocida was unique. Septicemic pasteurellosis, caused by P. multocida, was diagnosed as the cause of death for two neonates in May and June 1997. Necropsy findings included widely scattered petechial and ecchymotic hemorrhages found over a large portion of the subcutaneous tissue, meninges of the brain, epicardium, skeletal muscle, and serosal surface of the thorasic and abdominal cavities. Histological examination of lung tissues revealed diffuse congestion and edema and moderate to marked multifocal infiltrate of macrophages, neutrophils, and numerous bacteria within many terminal bronchioles and alveoli. Pasteurella multocida serotypes A:3,4, and B:1 were isolated from several tissues including lung, intestinal, thorasic fluid, and heart blood. Each B:1 isolate had DNA restriction endonuclease fingerprint profiles distinct from isolates previously characterized from domestic cattle, swan (Olor spp.), moose (Alces alces), and pronghorn from Montana (USA). This is the first report of pasteurellosis in pronghorn from Oregon and the B:1 isolates appear to be unique in comparison to DNA fingerprint profiles from selected domestic and wild species.

  18. [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.

  19. 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.

  20. 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.

  1. Edema de ubre en ganado bovino. II entrega

    OpenAIRE

    Saborío-Montero, Alejandro

    2014-01-01

    La inflamación excesiva de la glándula mamaria asociada al parto es un padecimiento frecuente en ganado bovino, éste desbalance se conoce con el nombre de “edema mamario” o “edema de ubre”. Particularmente las hembras primíparas experimentan este fenómeno de manera más severa. La inflamación de la ubre puede generar una serie de efectos detrimentales sobre el animal. El incremento en la propensión a mastitis, pezones dañados, ubres heridas y/o pendulosas han sido características asociadas al ...

  2. Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Mani Gupta

    2014-01-01

    Full Text Available Background: Spontaneous intracerebral hemorrhage (SICH is a form of cerebrovascular accident with a very high rate of morbidity and mortality. The determinants of prognosis include the demographic, clinical, laboratory, and radiologic factors. It is long known that the hematoma size has a negative impact on the outcome in SICH. The influence of perihematomal edema (PHE is not established to the extent same as that of hematoma volume. Hence, we planned this study to determine as to what role does PHE plays in the outcome in SICH. Aim of the Study: To evaluate the prognostic influence of absolute and relative edema (ratio of absolute edema to hematoma volume in the patients of SICH. Materials and Methods : This is a prospective case-controlled study. A total of 44 patients were enrolled after excluding the confounding factors. The patients were evaluated and their disability was assessed using modified Rankin scale (MRS. The imaging was done in the interval between 24 and 72 h and the hematoma volume, absolute edema volume, and the relative edema were calculated. The outcome was reassessed at 12 weeks and defined as favorable if MRS < 3. Results: A total of 69 patients were found to be having SICH on imaging; however, 25 patients were excluded as they had one of the criterion for exclusion. Hence, only 44 patients were included in the study. On univariate analysis, none of the demographic characteristics of the patients, vascular risk factors, presenting complaints, blood pressure, Glasgow coma scale, and MRS at admission, laboratory parameters were not significantly different in the two outcome groups. The hematoma volume was significantly higher in the poor outcome group (P < 0.0001 and the relative edema was associated with a favorable outcome at 12 weeks (P < 0.0001. On multivariate logistic regression, the hematoma volume and relative edema were found to have effect on the outcome similar to that seen on univariate analysis. Conclusion: In

  3. Factors affecting reading speed in patients with diabetic macular edema treated with laser photocoagulation.

    Directory of Open Access Journals (Sweden)

    Elizabeth Pearce

    Full Text Available PURPOSE: To study the factors that may affect reading speed in patients with diabetic macular edema previously treated with laser photocoagulation. METHODS: Consecutive patients with type II diabetes treated with laser photocoagulation for diabetic macular edema (DME at least twelve months previously, with best corrected visual acuity of better than 65 letters (approximately 20/40 measured with Early Treatment Diabetic Retinopathy Study (ETDRS charts were included in this study. Patients previously treated with pan-retinal photocoagulation, vitrectomy, intravitreal steroid or anti-VEGF therapy were excluded. Any other ocular co-morbidities that may influence reading ability such as cataract, glaucoma or macular degeneration were also excluded. All patients were refracted by a certified examiner, the following measurements were collected: best corrected visual acuity (BCVA, contrast sensitivity with Pelli-Robson chart, reading speed with MNREAD chart, microperimetry with Nidek MP1, and central subfield thickness with Zeiss spectral domain optical coherent topography. RESULTS: The slow reading group had poorer contrast sensitivity (p = 0.001, reduced retinal sensitivity (p = 0.027 and less stable fixation (p = 0.013. Most interestingly the reduced retinal sensitivity findings were driven by the microperimetry value on the right subfield (p = 0.033, (nasal to the fovea in the right eye and temporal to the fovea in the left eye. Multiple linear regression analysis showed that contrast sensitivity is probably the most important factor that affects reading speed (p = 0.001. CONCLUSION: Reduced retinal sensitivity after laser treatment is associated with reduced reading speed in patients with diabetic macular edema.

  4. Prevention of nosocomial infections in the neonatal intensive care unit.

    Science.gov (United States)

    Adams-Chapman, Ira; Stoll, Barbara J

    2002-04-01

    Nosocomial infections are responsible for significant morbidity and late mortality among neonatal intensive care unit patients. The number of neonatal patients at risk for acquiring nosocomial infections is increasing because of the improved survival of very low birthweight infants and their need for invasive monitoring and supportive care. Effective strategies to prevent nosocomial infection must include continuous monitoring and surveillance of infection rates and distribution of pathogens; strategic nursery design and staffing; emphasis on handwashing compliance; minimizing central venous catheter use and contamination, and prudent use of antimicrobial agents. Educational programs and feedback to nursery personnel improve compliance with infection control programs.

  5. Change in macular thickness in a case of refractory diabetic macular edema with dexamethasone intravitreal implant in comparison to intravitreal bevacizumab: A case report

    Directory of Open Access Journals (Sweden)

    Ashish Sharma

    2012-01-01

    Full Text Available We report on the significant improvement of central macular thickness in a case of clinically significant macular edema after dexamethasone 0.7 mg sustained-release intravitreal implant (Ozurdex®; Allergan, Inc, Irvine, CA, USA. Patient presented to us with persistent clinically significant macular edema (CSME in both eyes. Right eye received dexamethasone implant and left eye received two intravitreal bevacizumab injections 1.25 mg/0.05 mL (Avastin®; Genentech Inc., South San Francisco, CA, USA with an interval of four weeks. After six weeks of follow-up, dexamethasone implant in the right eye showed normal macular thickness whereas persistent macular edema (ME was found even after second intravitreal bevacizumab injection in the left eye.

  6. 静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告%Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate: A Case Report

    Institute of Scientific and Technical Information of China (English)

    万兴丽; 曾力楠

    2012-01-01

    Objective To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC). Methods After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates' PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate's physiological condition. Results A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient's family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed throm-bopenia and aggravated coagulation disorders resulted from heparin. Conclusion The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.%目的 借助循证医学方法为1例经外周静脉穿刺中心静脉导管(PICC)输注全合一静脉

  7. Neonatal adaptation in infants prenatally exposed to antidepressants--clinical monitoring using Neonatal Abstinence Score.

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    Lisa Forsberg

    Full Text Available BACKGROUND: Intrauterine exposure to antidepressants may lead to neonatal symptoms from the central nervous system, respiratory system and gastrointestinal system. Finnegan score (Neonatal Abstinence Score, NAS has routinely been used to assess infants exposed to antidepressants in utero. AIM: The purpose was to study neonatal maladaptation syndrome in infants exposed to selective serotonin reuptake inhibitors (SSRI or serotonin-norepinephrine reuptake inhibitors (SNRI in utero. METHOD: Retrospective cohort study of women using antidepressants during pregnancy and their infants. Patients were identified from the electronic health record system at Karolinska University Hospital Huddinge containing pre-, peri- and postnatal information. Information was collected on maternal and infant health, social factors and pregnancy. NAS sheets were scrutinized. RESULTS: 220 women with reported 3rd trimester exposure to SSRIs or SNRIs and who gave birth between January 2007 and June 2009 were included. Seventy seven women (35% used citalopram, 76 used (35% sertraline, 34 (15% fluoxetine and 33 (15% other SSRI/SNRI. Twenty-nine infants (13% were admitted to the neonatal ward, 19 were born prematurely. NAS was analyzed in 205 patients. Severe abstinence was defined as eight points or higher on at least two occasions (on a scale with maximum 40 points, mild abstinence as 4 points or higher on at least two occasions. Seven infants expressed signs of severe abstinence and 46 (22% had mild abstinence symptoms. Hypoglycemia (plasma glucose <2.6 mmol/L was found in 42 infants (19%. CONCLUSION: Severe abstinence in infants prenatally exposed to antidepressants was found to be rare (3% in this study population, a slightly lower prevalence than reported in previous studies. Neonatal hypoglycemia in infants prenatally exposed to antidepressant may however be more common than previously described.

  8. Subthreshold Micropulse Photocoagulation for Persistent Macular Edema Secondary to Branch Retinal Vein Occlusion including Best-Corrected Visual Acuity Greater Than 20/40

    Directory of Open Access Journals (Sweden)

    Keiji Inagaki

    2014-01-01

    Full Text Available To assess the efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP for persistent macular edema secondary to branch retinal vein occlusion (BRVO, including best-corrected visual acuity (BCVA > 20/40, thirty-two patients (32 eyes with macular edema secondary to BRVO were treated by SMDLP. After disease onset, all patients had been followed for at least 6 months prior to treatment. Baseline Snellen visual acuity was used to categorize the eyes as BCVA ≤ 20/40 (Group I or BCVA > 20/40 (Group II. Main outcome measures were reduction in central macular thickness (CMT in optical coherence tomography (OCT and BCVA at 6 months. In the total subject-pool at 6 months, BCVA had not changed significantly but CMT was significantly reduced. Group I exhibited no significant change in CMT at 3 months but exhibited significant reductions at 6 and 12 months. Group II exhibited a marginally significant reduction in CMT at 3 months and a significant reduction at 6 months. In patients with persistent macular edema secondary to BRVO, SMDLP appears to control macular edema with minimal retinal damage. Our findings suggest that SMDLP is an effective treatment method for macular edema in BRVO patients with BCVA > 20/40.

  9. Neonatal haemostasis and the management of neonatal thrombosis.

    Science.gov (United States)

    Will, Andrew

    2015-05-01

    Two detailed reviews of the management of neonatal thrombosis were published in 2012; one was an up-dated version of guidance first issued in 2004 and the other was a comprehensive review. Both of these publications gave very similar advice regarding the practical aspects of the indications, dosage and management of antithrombotic therapy. The authors stated that the evidence supporting most of their recommendations for anti-thrombotic therapy in neonates remained weak and so the therapy for a neonate with a thrombosis has to be based on an individualized assessment of estimated risk versus potential benefit. The aim of this present review is to give the treating physician an outline of the unique physiology of neonatal coagulation and how this affects the monitoring, dosing and even the choice of therapeutic strategy for the management of thrombosis in the neonate.

  10. 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

  11. Cerebral Edema in Chronic Mountain Sickness: a New Finding

    Science.gov (United States)

    Bao, Haihua; Wang, Duoyao; Zhao, Xipeng; Wu, Youshen; Yin, Guixiu; Meng, Li; Wang, Fangfang; Ma, Lan; Hackett, Peter; Ge, Ri-Li

    2017-01-01

    We observed patients with chronic mountain sickness (CMS) in our clinic who developed progressive neurological deterioration (encephalopathy) and we wished to investigate this. We studied nine such CMS patients, and compared them to 21 CMS patients without encephalopathy, and to 15 healthy control subjects without CMS. All 45 subjects lived permanently at 3200–4000 m. Measurements at 2260 m included CMS symptom score, multi-slice CT, perfusion CT, pulse oximetry (SpO2%), and hemoglobin concentration (Hb). One patient had MRI imaging but not CT; 5 had CSF pressure measurements. CMS subjects had lower SpO2, higher Hb, higher brain blood density, lower mean cerebral blood flow (CBF), and significant cerebral circulatory delay compared to controls. The nine CMS subjects with neurological deterioration showed diffuse cerebral edema on imaging and more deranged cerebral hemodynamics. CSF pressure was elevated in those with edema. We conclude that cerebral edema, a previously unrecognized complication, may develop in CMS patients and cause encephalopathy. Contributing factors appear to be exaggerated polycythemia and hypoxemia, and lower and sluggish CBF compared to CMS patients without cerebral edema; but what triggers this complication is unknown. Recognition and treatment of this serious complication will help reduce morbidity and mortality from CMS. PMID:28233815

  12. 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...

  13. 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.

  14. Postparacentesis vulvar edema in ovarian hyper stimulation syndrome

    Directory of Open Access Journals (Sweden)

    Sindhu Bhairavi

    2016-11-01

    Full Text Available Ovarian hyper stimulation syndrome (OHSS is a serious, potentially life threatening complication of ovulation induction. The clinical picture of severe OHSS includes ovarian enlargement, ascites, pleural effusion, increased coagulability, and electrolyte disorders. Very few cases of massive vulvar edema in OHSS have been reported in the literature. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 4064-4066

  15. Prevention of edema disease in pigs by passive immunization

    DEFF Research Database (Denmark)

    Johansen, M.; Andresen, Lars Ole; Thomsen, L.K.

    2000-01-01

    The effect of treatment with verotoxin 2e (VT2e) specific antiserum was evaluated in 3 Danish pig herds with edema disease (ED). The antiserum was prepared by immunizing horses with a VT2e toroid. The study was performed as a randomized blind field trial with parallel treatment and control groups...

  16. 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.

  17. OXYTOCIN INDUCED NEONATAL HYPERBILIRUBINEMIA

    Directory of Open Access Journals (Sweden)

    Smita S.

    2015-05-01

    Full Text Available INTRODUCTION: Hyperbilirubinemia is one of the most common causes of health problems, observed in 60% of term and 80% of preterm infants in the first week of life . Hyperbilirubinemia leads to neurotoxicity in severe condition. Some studies suggests that liberal use of oxytocin for inducing labour is one of the factor which lead to neonatal hyperbilirubinemia. OBJECTIVE: To compare the effect of oxytocin and neonatal bilirubin levels with spontaneous vaginal delivery . MATERIALS AND METHOD S : 100 full term parturients were selected for this study. The subjects were divided into two groups. 50 healthy babies of women who had oxytocin induced labour and 50 healthy babies of women with normal vaginal delivery following spontaneous onset of labour formed the control group. Neon atal serum bilirubin was measured on day 1, 3 and 5 after delivery. Bilirubin was measured by spectrophotometry. Data was analysed in ms excel sheet using spss 19.0v. Statistical analysis was done by using unpaired‘t’ test. RESULTS: There was significant i ncrease in bilirubin level in oxytocin induced group compared to control group on day 1 and 3. There was insignificant increase in bilirubin level in oxytocin induced group on day 5. However the level of serum bilirubin is within normal limits as bilirubin level normally rises on till 4 th day and decreases thereafter. CONCLUSION: Neonatal hyperbilirubinemia may be due to oxytocin administration by continues IV infusion which results in erythrocyte swell and rupture. Increase in bilirubin level in oxytocin i nduced group is within physiological limits

  18. Characterization of symptoms and edema distribution in premenstrual syndrome

    Directory of Open Access Journals (Sweden)

    Tacani PM

    2015-03-01

    Full Text Available Pascale Mutti Tacani,1 Danielle de Oliveira Ribeiro,1 Barbara Evelyn Barros Guimarães,1 Aline Fernanda Perez Machado,2 Rogério Eduardo Tacani1,2 1Physical Therapy Department, São Camilo University Center, 2Physical Therapy Department, São Paulo City University (UNICID, São Paulo, Brazil Background: Premenstrual syndrome is a group of symptoms linked to the menstrual cycle, and edema is among these symptoms. Physiotherapy is often sought by many patients for the treatment of edema; however, for an adequate prescription of physiotherapeutic procedures, the distribution of edema throughout the body has yet to be characterized. Objective: To determine the most frequent symptoms and body regions that present with edema in women during the premenstrual period.Subjects and methods: Sixty women with a mean age of 24.6±4.7 years were evaluated during their premenstrual (between days 21 and 28 and menstrual period (between days 1 and 3, and the collected data included body mass, height, biotype (body-fat distribution, face, breast, limb-circumference measurements, and limb-volume estimate, and an adapted version of the Premenstrual Symptoms Screening Tool was used. Statistical analysis was performed using Student’s t-test and the test for equality of two proportions (P≤0.05.Results: Premenstrual syndrome was identified in 91.7% of the women, and the most frequent symptoms were irritability (73.33% and physical symptoms, including swelling (65%, and anxiety (58.3%. Edema was detected in the following areas: facial, epigastric, mammary, umbilical, and pubic, the mid-third of the arms, distal forearm, in both thighs and in the mid-third of the legs determined by circumference measurements, and in both upper and lower limbs, according to the estimated volume.Conclusion: In this study population, the most frequent symptoms were irritability, physical symptoms, and anxiety, with distribution of edema in the face, breast, abdomen, pubic area, distal

  19. Effects of endostatin on C6 glioma-induced edema

    Institute of Scientific and Technical Information of China (English)

    YANG Li-juan; LIN Zhi-xiong; KANG De-zhi; WENG Shen-mei; LIN Jian-hua; HUANG Qiang; ZHANG Peng-fei

    2011-01-01

    Background Glioma-induced edema is considered as one of the most pathological characteristics of glioma and a significant source of morbidity and mortality.New strategies are needed for the treatment of peritumoral edema in glioma.Endostatin has been proven to be beneficial as an anti-angiogenic agent in experimental gliomas,but the effects are unclear.This study aimed to investigate the effects of endostatin on C6 glioma-induced edema.Methods Tumorigenic mice were established by subcutaneous injection of three glioma cell lines,C6-null cells and stable transfected-C6 cells overexpressing mock vector (C6-mock cells) and endostatin (C6-endo cells).Endostatin expression in xenograft C6 glioma was determined by immunostaining and Western blotting.Glioma-induced edema and tumor vessel permeability were assayed.The effect of endostatin on vascular enodothelial growth factor (VEGF) expression in vivo was analyzed by quantitative polymerase chain reaction (Q-PCR) and enzyme-linked immunosorbent assay (ELISA).The number of vesiculo-vascuolar organelles (VVOs) formed in tumor endothelia was calculated using electron microscopy.Data were analyzed by using one-way analysis of variance (ANOVA) followed by Dunnett's post hoc test for multiple comparisons to the control groups.Results Overexpression of endostatin (C6-endo cells) significantly suppressed tumor growth and reduced tumor edema and vessel permeability.ELISA analysis showed that the level of VEGF protein was markedly decreased in tumor from C6-endo cells compared with tumor from C6-null cells and C6-mock cells.Similar results were obtained by Q-PCR.Furthermore,the number of VVOs observed in tumor from C6-endo mice was significantly reduced compared with tumor from C6-null cells or C6-mock cells.Conclusions Our data provide primary evidence that endostatin reduces glioma-induced edema and vascular permeability.Using endostatin may be an effective strategy for treating glioma edema.

  20. Anti-inflammatory Effect of Sodium Valproate on Carrageenan-Induced Paw Edema in Male Rat

    Directory of Open Access Journals (Sweden)

    mj Khoshnood

    2008-12-01

    Full Text Available ABESTRACT: Introduction & objective: Inflammation is a body defensive response to the endogenous and exogenous stimulators such as chemical, radiation, trauma and invasive microorganism, which result pain and tissue necrosis. There are many natural and synthetic drugs for treatment of inflammation and lot of them are under investigation. Sodium valporate is an antiepileptic drug used particularly in the treatment of primary generalized seizure notably absence, myocolonic seizure, acute manic phase of bipolar disorder and prophylaxis of migraine. The previous observations showed sodium valporate increases level of gamma amino butyric acid (GABA in the central and peripheral nervous system. In acute inflammation, GABA showed a significant attenuation of paw edema and nociception. The aim of this study was evaluation of anti-inflammatory effect of sodium valporate. Materials & Methods: In order to evaluated the anti-inflammatory and antiexudative of sodium valporate doses of 200,400 and 600 mg/kg were investigated on rat paw edema that induced by carrageenan. In addition, the plasma leakage in the inflamed tissue was evaluated by application of trypan blue as intravenous injection. Dexamethason was used as positive control. Results: Results showed sodium valporate doses of 400 and 600 mg/kg decreased inflammatory and exudative effect as compared to control group. Conclusion: Although the anti-inflammatory mechanisms of this drug were not evident but we can say sodium valporate in addition to already proved effects has anti-inflammatory effect.

  1. Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant.

    Science.gov (United States)

    Kraft, Walter K; Stover, Megan W; Davis, Jonathan M

    2016-04-01

    Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for "personalized genomic medicine" and novel, individualized therapeutic interventions.

  2. Neonatal Candida arthritis

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    Saurabh Sharma

    2014-01-01

    Full Text Available Fungal arthritis is an uncommon yet serious disorder in the newborn. Delay in diagnosis and management can lead to significant morbidity. We report our experience with management of two such cases. Two preterm neonates with multifocal arthritis caused by Candida were studied. Diagnosis was made by clinical examination, laboratory investigations, radiological investigations and culture. Both were treated by aspiration, arthrotomy and antifungal therapy. One patient recovered fully from the infection while the other had growth disturbances resulting in limb length inequality at recent followup. Prompt and expeditious evacuation of pus from joints and antifungal therapy is imperative for treatment. Associated osteomyelitis leads to further difficulty in treatment.

  3. Hemolysis in Preterm Neonates.

    Science.gov (United States)

    Christensen, Robert D; Yaish, Hassan M

    2016-06-01

    Hemolysis can be an important cause of hyperbilirubinemia in premature and term neonates. It can result from genetic abnormalities intrinsic to or factors exogenous to normal to red blood cells (RBCs). Hemolysis can lead to a relatively rapid increase in total serum/plasma bilirubin, hyperbilirubinemia that is somewhat slow to fall with phototherapy, or hyperbilirubinemia that is likely to rebound after phototherapy. Laboratory methods for diagnosing hemolysis are more difficult to apply, or less conclusive, in preterm infants. Transfusion of donor RBCs can present a bilirubin load that must be metabolized. Genetic causes can be identified by next-generation sequencing panels.

  4. Comparison of Cysts in Red and Green Images for Diabetic Macular Edema

    Science.gov (United States)

    Alhamami, Mastour A.; Elsner, Ann E.; Malinovsky, Victor E.; Clark, Christopher A.; Haggerty, Bryan P.; Ozawa, Glen Y.; Cuadros, Jorge A.; Baskaran, Karthikeyan; Gast, Thomas J.; Litvin, Taras V.; Muller, Matthew S.; Brahm, Shane G.; Young, Stuart B.; Miura, Masahiro

    2017-01-01

    ABSTRACT Purpose To investigate whether cysts in diabetic macular edema are better visualized in the red channel of color fundus camera images, as compared with the green channel, because color fundus camera screening methods that emphasize short-wavelength light may miss cysts in patients with dark fundi or changes to outer blood retinal barrier. Methods Fundus images for diabetic retinopathy photoscreening were acquired for a study with Aeon Imaging, EyePACS, University of California Berkeley, and Indiana University. There were 2047 underserved, adult diabetic patients, of whom over 90% self-identified as a racial/ethnic identify other than non-Hispanic white. Color fundus images at nominally 45 degrees were acquired with a Canon Cr-DGi non-mydriatic camera (Tokyo, Japan) then graded by an EyePACS certified grader. From the 148 patients graded to have clinically significant macular edema by the presence of hard exudates in the central 1500 μm of the fovea, we evaluated macular cysts in 13 patients with cystoid macular edema. Age ranged from 33 to 68 years. Color fundus images were split into red, green, and blue channels with custom Matlab software (Mathworks, Natick, MA). The diameter of a cyst or confluent cysts was quantified in the red-channel and green-channel images separately. Results Cyst identification gave complete agreement between red-channel images and the standard full-color images. This was not the case for green-channel images, which did not expose cysts visible with standard full-color images in five cases, who had dark fundi. Cysts appeared more numerous and covered a larger area in the red channel (733 ± 604 μm) than in the green channel (349 ± 433 μm, P < .006). Conclusions Cysts may be underdetected with the present fundus camera methods, particularly when short-wavelength light is emphasized or in patients with dark fundi. Longer wavelength techniques may improve the detection of cysts and provide more information concerning the early

  5. Interpretation of neonatal chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hye Kyung [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-05-15

    Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice.

  6. Edema in the retropharyngeal space associated with head and neck tumors: CT imaging characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Kurihara, Noriko; Nakamura, Mamoru; Tsuda, Masashi; Saito, Haruo [National Hospital Organization Sendai Medical Center, Department of Radiology, Sendai, Miyagi (Japan); Takahashi, Shoki; Higano, Shuichi [Tohoku University, Department of Diagnostic Radiology, Sendai, Miyagi (Japan)

    2005-08-01

    To determine computed tomographic (CT) imaging characteristics of retropharygeal edema, we reviewed CT images in 18 patients with head and neck tumors. Retropharyngeal edema spread craniocaudally between soft palate and upper half of thyroid cartilage in all patients. No edema fluid extended above soft palate and below thyroid cartilage. Horizontally, it spread symmetrically in ten and asymmetrically in eight patients. Predominance in asymmetrical retropharyngeal edema was found on the same side as that of unilateral predominance both in lymph nodes enlargement and jugular vein stenosis/occlusion. All patients had edema also in other cervical spaces. Edema of retropharyngeal and other spaces fluctuated synchronously. In 14 patients, as primary lesion and/or cervical lymph nodes regressed, retropharyngeal edema disappeared or decreased. Retropharyngeal edema had some imaging characteristics. With knowledge of that, we could avoid diagnostic confusion when evaluating head and neck CT images. (orig.)

  7. Multifocal electroretinogram in evaluating retinal function of diabetic macular edema after pars plana vitrectomy

    Institute of Scientific and Technical Information of China (English)

    马进; 吴德正; 高汝龙; 吕林; 张少冲; 文峰; 黄时洲

    2004-01-01

    @@ Beneficial effects of vitrectomy for diabetic macular edema (DME) have been demonstrated in a series of clinical trials. Vitreous surgery is useful in reducing the edema and improving visual acuity.

  8. Antioxidant status in neonatal jaundice before and after phototherapy

    Directory of Open Access Journals (Sweden)

    S Ayyappan

    2015-01-01

    Full Text Available Background: Neonatal jaundice refers to yellow coloration of the skin and the sclera (whites of the eyes of newborn babies that result from the accumulation of bilirubin in the skin and mucous membranes. Because bilirubin is potentially toxic to the central nervous system. Genetic disorders of bilirubin conjugation, particularly the common Gilbert′s syndrome, can also contribute to neonatal hyperbilirubinemia. Objective: The aim of this study was to evaluate the lipid per-oxidation and antioxidant enzyme activities in patients with neonatal jaundice before and after phototherapy. Materials and Methods: The study includes 50 neonatal jaundice patients with average age 2-15 days. All patients of neonatal jaundice receiving phototherapy except feeding, cleaning. Subjects selected were from the patients attending Pediatrics Department. Plasma malondialdehyde (MDA, erythrocyte glutathione peroxidase (GPX, superoxide dismutase and catalase (CAT to monitor the bilirubin level. Results: The results show increased levels of bilirubin compared with controls (P < 0.001 shows the level of plasma MDA in control, before and after phototherapy. Represents the level of GPX was significantly increased in after the phototherapy group when compared with before phototherapy and control SPSS soft ware: (P < 0.001. Shows the reduced glutathione (GSH level in plasma was significantly decreased in the after phototherapy group when compared with before phototherapy and control (P < 0.001. And finally with ascorbic acid and CAT. Conclusion: It is evident from the study that increased oxidative stress in neonatal jaundice babies leads to decrease in the levels of antioxidants like GSH and ascorbic acid and disturb their metabolism, that weaken their ability to fight the growing stress. Intense oxidative stress and decreased antioxidants may contribute to neural cell death and alter the erythrocytomembrane structure processing in neonatal jaundice.

  9. 一次性中心静脉导管胸腔闭式引流治疗新生儿气胸的探讨%Explore the Central Venous Catheter Thoracic Drainage Treatment of Neonatal Pneumothorax

    Institute of Scientific and Technical Information of China (English)

    秦阳; 代朝霞; 马淑婵; 杨永芬

    2013-01-01

    目的:探讨一次性中心静脉导管胸腔闭式引流治疗新生儿气胸的效果。方法对我院儿科2010年以来收治的8例自发性气胸患儿,采用一次性中心静脉导管胸腔穿刺闭式引流治疗疗效分析。结果8例气胸患儿缺氧症状明显改善,血气和血氧饱和度治疗前明显降低,治疗后血气正常,血氧饱和度上升至95%以上,有效率达100%。结论此引流无需外科手术切口,操作简单,无堵管现象,无并发感染,疗效满意。%Objective:To investigate the disposable centrallvenous catheter closed drainage treatment of pneumothorax in newborn Effect. Methods:8 cases of spontaneous pneumothorax in children with pediatric 2010 in our hospitallhas treated, analyzed by secondary thoracentesis centrallvenous catheter closed drainage treatment. Results:8 cases of pneumothorax in neonates with hypoxic symptoms, blood gas and blood oxygen saturation decreased significantly after treatment, treatment of normallblood gas, blood oxygen saturation increased to more than 95%, the Effective rate was 100%. Conclusion: the drainage without surgicalloperation incision, simple operation, no blockage, no infection, curative Effect satisfaction.

  10. Neonatal gastrointestinal imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rao, Padma [Department of Radiology, Royal Children' s Hospital and University of Melbourne, Flemington Road, Parkville, Melbourne, Vic. 3052 (Australia)]. E-mail: padma.rao@rch.org.au

    2006-11-15

    Radiological imaging is an important part of the evaluation and management of neonates with suspected anomalies of the gastrointestinal tract. Clinical presentation is often non-specific, commonly with abdominal distension and vomiting for which the underlying cause may or may not be clinically apparent. In a proportion of patients, the clinical assessment alone may suffice in providing the diagnosis and no further imaging is necessary. The reader must have an understanding of the normal radiographic appearances of the gastrointestinal tract in neonates and appreciate normal variants and differences to adults. In certain cases, the abdominal radiograph alone is diagnostic. In others, sonography and contrast studies are useful adjunct investigations and the indications for CT and MRI are few, but specific. Appropriate radiological investigation will help to establish the diagnosis and guide surgical intervention whilst also avoiding unnecessary radiation. Some of the conditions require transfer to specialist paediatric institutions for care. Thus, in some circumstances it is appropriate for imaging to be delayed and performed at the specialist centre with early referral often essential for the continued well being of the child.

  11. Glyburide in Treating Malignant Cerebral Edema. Blocking Sulfonyl Urea One (SUR1) Receptors

    OpenAIRE

    Pallan, Tony V; Ahmed, Iftekhar

    2014-01-01

    Cerebral edema is a serious side effect of malignant stroke. On average 70,000 patients are diagnosed with malignant cerebral edema every year, of those patients, approximately 60-80% results in fatalities. The treatment of cerebral edema includes multimodality approaches.

  12. Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

    NARCIS (Netherlands)

    Horsch, A D; Dankbaar, J W; Stemerdink, T A; Bennink, E; van Seeters, T; Kappelle, L J; Hofmeijer, J; de Jong, H W; van der Graaf, Y; Velthuis, B K

    2016-01-01

    BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatm

  13. 9 CFR 309.8 - Cattle affected with anasarca and generalized edema.

    Science.gov (United States)

    2010-01-01

    ... generalized edema. 309.8 Section 309.8 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... anasarca and generalized edema. All cattle found on ante-mortem inspection to be affected with anasarca in advanced stages and characterized by an extensive and generalized edema shall be identified as...

  14. A Rare And Life Threatening Complication Of Percutaneously Inserted Central Venous Catheters: Cardiac Tamponade.

    Directory of Open Access Journals (Sweden)

    seyma Kayali

    2016-09-01

    Full Text Available Percutaneously inserted central venous catheters are commonly used to provide parenteral nutrition for premature neonates. This study presents report of two preterm neonates who developed pericardial effusion resulting from osmotic damage of parenteral nutrition. When a neonate with percutaneously inserted central venous catheter clinical status worsens a high index of clinical suspicion for diagnosing pericardial effusion and immediate treatment might be life saving. [J Contemp Med 2016; 6(3.000: 226-230

  15. Classification of Diabetic Macular Edema and Its Stages Using Color Fundus Image

    Institute of Scientific and Technical Information of China (English)

    Muhammad Zubair; Shoab A. Khan; Ubaid Ullah Yasin

    2014-01-01

    Diabetic macular edema (DME) is a retinal thickening involving the center of the macula. It is one of the serious eye diseases which affects the central vision and can lead to partial or even complete visual loss. The only cure is timely diagnosis, prevention, and treatment of the disease. This paper presents an automated system for the diagnosis and classification of DME using color fundus image. In the proposed technique, first the optic disc is removed by applying some preprocessing steps. The preprocessed image is then passed through a classifier for segmentation of the image to detect exudates. The classifier uses dynamic thresholding technique by using some input parameters of the image. The stage classification is done on the basis of anearly treatment diabetic retinopathy study (ETDRS) given criteria to assess the severity of disease. The proposed technique gives a sensitivity, specificity, and accuracy of 98.27%, 96.58%, and 96.54%, respectively on publically available database.

  16. 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.

  17. EVALUATION OF NEONATAL CARDIAC MURMURS

    Directory of Open Access Journals (Sweden)

    Somaiah

    2014-09-01

    Full Text Available Cardiovascular malformations are the most common cause of congenital malformations, the diagnosis of which requires a close observation in the neonatal period. Early recognition of CHD is important in the neonatal period, as many of them may be fatal if undiagnosed and may require immediate intervention. The objectives of this study are to study the epidemiology of neonatal cardiac murmurs, to identify clinical characteristics which differentiate pathological murmur from functional murmurs and to assess the reliability of clinical evaluation in diagnosing CHD. Method of study included all neonates admitted to the NICU, postnatal ward, attending pediatric OPD or neonatal follow up clinic and were detected to have cardiac murmurs. It was a cross sectional study over a period of 16months. A clinical diagnosis was made based on history and clinical examination. Then Chest X-ray and ECG, Echocardiography was done in all neonates for confirmation of the diagnosis. These neonates were again examined daily till they were in hospital and during the follow-up visit at 6 weeks. The results of 70 neonates in this study conducted over a period of 24 months included the incidence of cardiac murmurs among intramural neonates which was 13.5 for 1000 live births. Most frequent symptom was fast breathing in 10(14.3% cases. VSD was the most common diagnosis clinically in 23 (33% babies. The most frequent Echo diagnosis was acyanotic complex congenital heart disease in 25(36% cases followed by 12(17% cases each of VSD and ASD respectively. Overall in our study 77.1% (54cases of the murmurs were diagnosed correctly and confirmed by Echocardiography The study concluded that it is possible to make clinical diagnosis in many cases of congenital heart diseases, the functional murmurs could be differentiated from those arising from structural heart disease and evaluation of the infants based only on murmurs, few congenital heart diseases can be missed.

  18. Oxidative stress in the neonate.

    Science.gov (United States)

    Robles, R; Palomino, N; Robles, A

    2001-11-01

    The aim of this study is to determine the oxidative state of term and preterm neonates at the moment of birth and during the first days of life, and the influence of exposure to oxygen on the premature neonates.A total of 20 neonates were selected. Group A: 10 healthy full-term neonates, and Group B: 10 preterm neonates with no other pathology associated, requiring oxygen therapy. Venous samples were taken in cord at 3 and 72 h in Group A, and in cord at 3, 24 and 72 h and 7 days in Group B.Hydroperoxides, Q10 coenzyme (Co Q10) and alpha-tocopherol were measured within the erythrocyte membrane. Levels of hydroperoxides present in erythrocyte membrane were higher than normal both in Group A and in Group B at birth. This increase was greater in the group of premature neonates. Levels of alpha-tocopherol at birth increase significantly at 72 h in term neonates. Among the premature newborns, alpha-tocopherol levels are two to three times lower at birth and do not rise to higher levels as in the term neonate group. Fall in levels of Co Q10 in erythrocyte membranes is observed, and perhaps is due to the role of Co Q10 in maintaining the pool of reduced tocopherol. At birth, the neonate presents an increase of markers of oxidative stress and a decrease of their antioxidant defenses. This difference is greater as gestational age decreases. The application of oxygen therapy resulted in these levels which remain low throughout the study period.

  19. [Status of center point thickness and correlation between anatomic and best corrected visual acuity changes after photocoagulation, in diabetic macular edema].

    Science.gov (United States)

    Lima-Gómez, Virgilio; Razo Blanco-Hernández, Dulce Milagros

    2013-01-01

    Antecedentes: el grosor del punto central en pacientes con edema macular diabético cambia después del tratamiento, dependiendo del estado basal; se desconoce si esta variación reduce la correlación entre los cambios anatómicos y de capacidad visual. Objetivo: identificar la contribución del grosor del punto central basal a la correlación entre los cambios anatómicos y de capacidad visual, después de tratar el edema macular diabético. Material y métodos: estudio observacional, prospectivo, longitudinal y analítico, en diabéticos con edema macular tratados con fotocoagulación, estratificado por grupos: capacidad visual < 0.5 con (1) o sin engrosamiento central (2), y capacidad visual = 0.5 con (3) o sin engrosamiento central (4). Se identificó la correlación entre los cambios de grosor del punto central, volumen macular y capacidad visual (Spearman). Resultados: 79 ojos, 17 del grupo 1 (21.5%), 21 del 2 (26.6%), 14 del 3 (17.7%), 27 del 4 (34.2%). El grosor del punto central aumentó en los grupos 2 y 4, la capacidad visual disminuyó en el 3 y el volumen en todos. Las correlaciones entre el grosor del punto central y la capacidad visual en el grupo 3, y entre el volumen y la capacidad visual en el grupo 1 fueron negativas. La correlación de la muestra entre los cambios anatómicos y de capacidad visual fue baja (r= 0.14). Conclusiones: el aumento del grosor del punto central en ojos sin engrosamiento previo generó correlaciones opuestas entre grupos, y redujo la de la muestra. Estratificar conforme al grosor del punto central basal facilitaría identificar variables que afectan la respuesta terapéutica funcional.

  20. The Relationship between Neonatal Jaundice and Maternal and Neonatal Factors

    Directory of Open Access Journals (Sweden)

    Ehsan Garosi

    2016-03-01

    Conclusion: Since factors such as mode of delivery, oxytocin induction, and neonate's gender could contribute to jaundice, continuous assessment of newborns after birth could facilitate early diagnosis, promote disease management, and reduce the subsequent complications.

  1. Intravitreal bevacizumab for macular edema due to proton beam radiotherapy: Favorable results shown after eighteen months follow-up

    Directory of Open Access Journals (Sweden)

    Eleni Loukianou

    2010-05-01

    Full Text Available Eleni Loukianou, Dimitrios Brouzas, Eleni Georgopoulou, Chrysanthi Koutsandrea, Michael ApostolopoulosEye Department, University of Athens, Athens, GreecePurpose: To evaluate the safety and efficacy of intravitreal injections of bevacizumab (Avastin® as a treatment option for radiation maculopathy secondary to proton beam radiotherapy for choroidal melanoma.Case: A 61-year-old woman presented with a gradual decrease in left eye visual acuity (VA 29 months after proton beam radiotherapy for choroidal melanoma. On presentation, her best-corrected VA (BCVA was 2/10 in the left eye and the intraocular pressure was 15 mmHg. Fundoscopy revealed cystoid macular edema, intraretinal hemorrhages, epiretinal membrane in the posterior pole, and residual tumor scar with exudative retinal detachment and hard exudates in the periphery of the superotemporal quadrant. A treatment with intravitreal injections of bevacizumab (Avastin® was recommended. The injections were performed on a six-weekly basis.Results: The central retinal thickness prior to the treatment was 458 μm. After the first intravitreal injection of bevacizumab, the retinal thickness at the centre of the fovea was reduced to 322 μm. After the third injection, the central retinal thickness was 359 μm and 18 months after presentation, it reduced to 334 μm. The BCVA increased to 3/10 after the intravitreal injections of bevacizumab and remained stable during the follow-up period. The intraocular pressure was within normal range during the follow-up period.Conclusion: Bevacizumab should be regarded as a treatment option for macular edema due to proton beam radiotherapy for choroidal melanoma. By reducing the central retinal thickness, intravitreal bevacizumab can improve VA or ameliorate further decline caused by radiation maculopathy.Keywords: bevacizumab (Avastin®, choroidal melanoma, macular edema, radiation retinopathy

  2. Grid pattern Argon Laser photocoagulation for diabetic diffuse macular edema

    Directory of Open Access Journals (Sweden)

    Karkhane R

    1998-05-01

    Full Text Available Purpose: to determine the effect of Grid pattern laser photocoagulation on diabetic diffuse macular edema with assessment of visual outcome. Patients & Methods: The author reviewed the medical records of 84 eyes of 62 patients with diabetic diffuse macular edema treated with Grid pattern green Argon laser photocoagulation in Farabi Eye Hospital between the years 1992-1995, the follow-up period was 16-48 months (average 24.55±6.42, median 28 mounths. Results: Visual acuity was improved in 11.9%; unchanged in 65.4% and worsened in 22.7% of eyes. Conclusion: In assessing long-term visual outcome, Grid laser photocoagulation is an effective modality in maintaining or improving visual acuity.

  3. 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.

  4. 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.

  5. Effects of magnesium sulfate on traumatic brain edema in rats

    Institute of Scientific and Technical Information of China (English)

    冯东福; 朱志安; 卢亦成

    2004-01-01

    Objective: To investigate the effects of magnesium sulfate on traumatic brain edema and explore its possible mechanism.Methods: Forty-eight Sprague-Dawley ( SD ) rats were randomly divided into three groups: Control, Trauma and Treatment groups. In Treatment group, magnesium sulfate was intraperitoneally administered immediately after the induction of brain trauma. At 24 h after trauma, total tissue water content and Na + , K + , Ca2 + , Mg2+ contents were measured. Permeability of blood-brain barrier (BBB)was assessed quantitatively by Evans Blue (EB) dye technique. The pathological changes were also studied.Results: Water, Na + , Ca2 + and EB contents in Treatment group were significantly lower than those in Trauma group ( P < 0. 05 ). Results of light microscopy and electron microscopy confirmed that magnesium sulfate can attenuate traumatic brain injury and relieve BBB injury.Conclusions: Treatment with MgSO4 in the early stage can attenuate traumatic brain edema and prevent BBB injury.

  6. 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.

  7. The effect of pre-nutrition of hydroalcoholic extractof Origanum vulgare on brain edema and neurologic deficits in a rat stroke model

    Directory of Open Access Journals (Sweden)

    Meysam Foroozandeh

    2015-10-01

    Full Text Available Background and Aim: Stroke is one of the most important factors of mortality and disability in the world. Free radicals are produced following ischemic stroke and they play a central role in breaking the blood-brain barrier and  causing brain edema formation. The aim of the current study was to evaluate the effect of hydro- alcoholic extract of Origanum vulgare on brain edema and neurologic deficit in a rat stroke model. Materials and Methods: In thisexperimental study, 35 male Wistar rats were randomly divided into 5 equal groups.  The first  two groups (control and Sham received distilled water, while three treatment groups received oral Origanum vulgare extract for 30days (50,75and 100 mg/kgdaily, respectively.  Two hours after the last dose of Origanum vulgare extract,each main group underwent  a 60 min middle cerebral artery occlusion.  Then, the assessment of blood brain edema, and neurologic deficits analysis were done . Brain edema (brain water content was analyzed by One-Way ANOVA using LSD method and neurologic deficits analysis by means of Mann-Whitney U, and P<0.05 was taken as the significant level. Results: Origanum vulgare extract reduced brain edema in the experimental groups of 50 (82.49±0.47, 75 (80.89±0.63 and 100 mg/kg/day (80.80±0.66 compared to the control group (84.46±0.67. The neurologic deficit scores in the experimental groups of 75and 100mg/kg/day, compared with control group, but neurologic deficit scores did not affect the group receiving the dose 50 mg/kg. Conclusion:  The obtained data indicate that Origanum vulgar extract via reduction of brain edema and neurologic deficits scorescan have a protective effect on the stroke model.

  8. Outcomes of microincision vitrectomy surgery with internal limiting membrane peeling for macular edema secondary to branch retinal vein occlusion

    Directory of Open Access Journals (Sweden)

    Sato S

    2015-03-01

    Full Text Available Shimpei Sato,1 Maiko Inoue,2 Shin Yamane,2 Akira Arakawa,2 Mikiro Mori,1 Kazuaki Kadonosono2 1Department of Opthalmology, Toranomon Hospital, Tokyo, Japan; 2Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan Purpose: To evaluate the anatomic and functional effect of microincision vitrectomy surgery (MIVS with internal limiting membrane (ILM peeling for macular edema secondary to branch retinal vein occlusion (BRVO.Methods: The medical records of 101 eyes of 101 patients who had undergone MIVS with ILM peeling for macular edema secondary to BRVO were studied. Patients were classified into ischemic and non-ischemic BRVO based on angiograph. The best-corrected visual acuity (BCVA and central foveal thickness (CFT, determined by spectral domain optical coherence tomography, were evaluated at baseline and at 1, 3, 6, and 12 months postoperatively.Results: Preoperative mean logarithm of the minimum angle of resolution (logMAR BCVA ± standard deviation (SD was 0.52±0.43 and mean CFT ± SD was 489.4±224.9 µm. Postoperative mean BCVA ± SD values were 0.41±0.35, 0.35±0.41, 0.29±0.36, and 0.25±0.41, and mean CFT values were 370.1±148.9, 327.5±157.5, 310.9±154.9, and 274.4±135.3 µm at 1, 3, 6, 12 months, respectively. The mean BCVA was significantly improved at 3, 6, and 12 months postoperatively (all P<0.05, and the mean CFT was significantly decreased at all postoperative follow-up time points (all P<0.05. At the 12-month postoperative evaluation, BCVA had improved by 0.2 logMAR units in 50 eyes (60.0% with ischemic BRVO and in nine eyes (50.0% with non-ischemic BRVO. Six eyes (6.0% experienced recurrence or persistence of macular edema at 12 months postoperatively.Conclusion: MIVS with ILM peeling for macular edema secondary to BRVO is effective in improving visual acuity and foveal morphology with low recurrence of macular edema. Keywords: MIVS, ILM, BRVO, central foveal thickness, CFT

  9. Neonatal lupus syndromes.

    Science.gov (United States)

    Buyon, J P; Rupel, A; Clancy, R M

    2004-01-01

    The neonatal lupus syndromes (NLS), while quite rare, carry significant mortality and morbidity in cases of cardiac manifestations. Although anti-SSA/Ro-SSB/La antibodies are detected in > 85% of mothers whose fetuses are identified with congenital heart block (CHB) in a structurally normal heart, when clinicians applied this testing to their pregnant patients, the risk for a woman with the candidate antibodies to have a child with CHB was at or below 1 in 50. While the precise pathogenic mechanism of antibody-mediated injury remains unknown, it is clear that the antibodies alone are insufficient to cause disease and fetal factors are likely contributory. In vivo and in vitro evidence supports a pathologic cascade involving apoptosis of cardiocytes, surface translocation of Ro and La antigens, binding of maternal autoantibodies, secretion of profibrosing factors (e.g., TGFbeta) from the scavenging macrophages and modulation of cardiac fibroblasts to a myofibroflast scarring phenotype. The spectrum of cardiac abnormalities continues to expand, with varying degrees of block identified in utero and reports of late onset cardiomyopathy (some of which display endocardial fibroelastosis). Moreover, there is now clear documentation that incomplete blocks (including those improving in utero with dexamethasone) can progress postnatally, despite the clearance of the maternal antibodies from the neonatal circulation. Better echocardiographic measurements which identify first degree block in utero may be the optimal means of approaching pregnant women at risk. Prophylactic therapies, including treatment with intravenous immunoglobulin, await larger trials. In order to achieve advances at both the bench and bedside, national research registries established in the US and Canada are critical.

  10. 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...

  11. 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.

  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. A new approach to ischemic brain edema and infarct

    Institute of Scientific and Technical Information of China (English)

    Zhai Yu; Jin Jia Xing; Liu De Ha

    2000-01-01

    Objective: To study the feasibility and efficiency of treatment in the patients with acute moderate and severe ischemic stroke with Neurotropin for its principle of inhibiting cerebral edema and repairing injured neurons. Methods: A randomized controlled trial with Neurotropin was performed in 50 patients admitted within 48h after an acute internal carotid artery infarction, Neurological deficits score ( Europe Stroke Scale-ESS ) <80 marks and the area of infarct and edema>2.25cm2. There were 31 patients in the Neurotropin group and 19 patients in the control group. Basic treatment was Troxerutin 250 mg intravenous drip per day for 21 days in two groups. Additionally, the patients in the Neurotropin group were intravenous injected 106 ampoule Neurotropin (3.6 unit per ampoule), divided into 11 days. We evaluated Neurological deficits score (ESS), ability of daily living (ADL)- Barthel Index, the size and average CT density of infarct and edema area on CT scan during different treatment stage and analyzed.them with statistics. Results: The percentage of improved patients (complete and partial recovery) reaches 64.5% in the Neurotropin group and 31.6% in the control group. The size of the infarct and edema area on CT scan is significantly reduced only in the Neurotropin group after treatment. The average range reduced is 28% on day 11 and 41.5% on day 21, and the average CT density in the Neurotropin group is more advanced than in the control group after onset. Conclusion: Neurotropin can be used as an effective therapy in acute ischemic stroke and ischemic cerebral edema.

  14. Updates in the Management of Diabetic Macular Edema

    OpenAIRE

    Christopher Mathew; Anastasia Yunirakasiwi; Srinivasan Sanjay

    2015-01-01

    Diabetes mellitus is a chronic disease which has multiple effects on different end-organs, including the retina. In this paper, we discuss updates on diabetic macular edema (DME) and the management options. The underlying pathology of DME is the leakage of exudates from retinal microaneurysms, which trigger subsequent inflammatory reactions. Both clinical and imaging techniques are useful in diagnosing, classifying, and gauging the severity of DME. We performed a comprehensive literature sear...

  15. Radionuclide lymphoscintigraphy in the evaluation of peripheral edema

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soon; Zeon, Seok Kil [School of Medicine, Keimyung Univ., Daegu (Korea, Republic of)

    2000-07-01

    It has been difficulty to visualize lymphatics in living patients. Conventional or direct lymphography has been the gold standard for delineation of the lymphatic system, but this procedure is invasive, difficulty to perform, and harmful to the lymphatic vascular endothelium. The aim of our study was to determine its severity, and to understand the drainage patterns on patients with peripheral edema by functional lymphatic studies. Tc-99m antimony sulfide colloid 25 MBq with 0.4 ml volume was injected intradermally in the first, second and third web space of the foot or hand in 40 patients with peripheral edema (5 in upper extremity and 35 in lower extremity). Initial flow after injection and whole body images at approximately 30 minutes. 1-4 hours were obtained. In 9/40 cases with peripheral edema normal lymphoscintigram were revealed, primary lymphedema was observed in 5/31 cases. The imaging patterns in primary lymphedema were absent (3 cases) or delayed (2 cases) transport, lymphatic duct dilatation (1), cutoff (1), decrease in size and number of lymph nodes (2). The Common caused of edema in secondry lymphedema (26/31) were carcinoma (13), inflammation (5), post-operation (5), and unknown origin (3). The common imaging findings in carcinoma showed non-visualization of lymph nodes (13), dermal backflow (8), collateral circulation (5), and in inflammation lymphatic obstruction (2), increase in size and number of lymph nodes (2), delayed transport (1), and in post-operation dermal backflow (3), delayed transport (2), decrease in number and size of lymph node (2) Clear images patterns were observed difference between primary lymphedema an secondary lymphedema. Radionuclide lymphoscintigraphy is essentially non-invasive, easy to perform repeatedly, and harmless to the lymphatic vascular endothelium for evaluation of a patient with lymphedema.

  16. Effect of AVP on brain edema following traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    XU Miao; SU Wei; HUANG Wei-dong; LU Yuan-qiang; XU Qiu-ping; CHEN Zhao-jun

    2007-01-01

    Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤ 8) and moderate traumatic brain injury group (MTBI, GCS>8).Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group)and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan.Results: plasma AVP levels (ng/L) were (mean±SD): control, 3.06±1.49; MTBI, 38.12±7.25; and STBI, 66.61±17.10.The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0.01). And the AVP level was correlated with the severity (STBI r=0.919, P<0.01; MTBI r=0.724, P<0.01) and the duration of brain edema (STBI r=0.790, P<0.01; MTBI r=0.712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.

  17. 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.

  18. 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.

  19. Management of upper airway edema caused by hereditary angioedema

    Directory of Open Access Journals (Sweden)

    Farkas Henriette

    2010-07-01

    Full Text Available Abstract Hereditary angioedema is a rare disorder with a genetic background involving mutations in the genes encoding C1-INH and of factor XII. Its etiology is unknown in a proportion of cases. Recurrent edema formation may involve the subcutis and the submucosa - the latter can produce obstruction in the upper airways and thereby lead to life-threatening asphyxia. This is the reason for the high, 30-to 50-per-cent mortality of undiagnosed or improperly managed cases. Airway obstruction can be prevented through early diagnosis, meaningful patient information, timely recognition of initial symptoms, state-of-the-art emergency therapy, and close monitoring of the patient. Prophylaxis can substantially mitigate the risk of upper airway edema and also improve the patients' quality of life. Notwithstanding the foregoing, any form of upper airway edema should be regarded as a potentially life-threatening condition. None of the currently available prophylactic modalities is capable of preventing UAE with absolute certainty.

  20. 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

  1. 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.

  2. [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.

  3. THE RELATIONSHIP BETWEEN PERITUMORAL BRAIN EDEMA AND VASCULAR ENDOTHELIAL GROWTH FACTOR EXPRESSION IN PATIENTS WITH MENINGIOMA

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To determine whether VEGF plays a role in the development of peritumoral brain edema. Methods 50 meningioma patients and their VEGF expression were studied. We took a mono- clonal antibody from mouse to VEGF to stain the tumor cells, the vascular endothelial cells and the interstitial cells. The severity of brain edema was evaluated according to CT or MR scans by the following equation: edema index = Vtumor+edema/Vtumor. The relationship between VEGF expression and edema index was analyzed statisti- cally. Results VEGF was expressed in meningioma tumor cells, which is usually concentrated at the pe- ripheral sites of the tumor. There was a positive linear correlation between the expression and the brain edema index. Conclusion VEGF may play a role in the development of peritumoral brain edema in meningioma patient.

  4. Pseudothrombocytopenia in a preterm neonate.

    Science.gov (United States)

    Christensen, Robert D; Sola, Martha C; Rimsza, Lisa M; McMahan, Michael J; Calhoun, Darlene A

    2004-07-01

    Severe and prolonged thrombocytopenia is not uncommon among ill preterm infants. Pseudothrombocytopenia, which has the appearance of severe and prolonged thrombocytopenia, has not been described in this population. We observed a preterm neonate who had EDTA-independent pseudothrombocytopenia and conclude that this condition should be considered when severe and prolonged thrombocytopenia occurs in a neonate in the absence of clinical signs of platelet-type hemorrhage.

  5. 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

  6. Estudo do tratamento do edema macular difuso do diabético com triancinolona intravítrea e fotocoagulação Use of intravitreal triamcinolone and laser photocoagulation for the treatment of diffuse diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Fábio Petersen Saraiva

    2008-08-01

    Full Text Available OBJETIVO: Avaliar a eficácia do uso intravítreo da triancinolona acetonida associada a fotocoagulação com laser no tratamento do edema macular difuso diabético. Comparar esta associação terapêutica com o uso isolado de cada tratamento. MÉTODOS: Após controle clínico sistêmico, trinta pacientes portadores de edema macular difuso diabético foram divididos em 3 grupos de tratamento: (1 fotocoagulação macular em grade com laser de argônio; (2 aplicação intravítrea de 4 mg de triancinolona acetonida; (3 associação dos itens anteriores. O seguimento foi realizado em intervalos predeterminados de um dia, uma semana e mensalmente, até completar 6 meses. Foram analisados os parâmetros: acuidade visual corrigida LogMAR, espessura macular central, volume macular total e pressão intra-ocular. RESULTADOS: A fotocoagulação com laser não reduziu de forma estatisticamente significativa a espessura macular central e o volume macular total. Esta redução foi significativa e estatisticamente semelhante nos outros dois grupos. Todos os grupos apresentaram melhora da acuidade visual, entretanto, o grupo que recebeu a associação do laser com a triancinolona intravítrea obteve maior porcentagem de pacientes com ganho de 10 ou mais letras de visão. CONCLUSÃO: O uso simultâneo da fotocoagulação com a triancinolona intravítrea pode ser considerado uma opção terapêutica para o edema macular difuso diabético.PURPOSE: To assess the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and to compare it with the separate use of each treatment. METHODS: After systemic clinical control, thirty patients with diffuse diabetic macular edema were divided into 3 treatment groups: (1 macular grid photocoagulation; (2 intravitreal injection of 4 mg of triamcinolone acetonide; (3 combination of the two previous therapies. Follow-up was scheduled at

  7. [Neonatal Dengue. Presentation of clinical cases].

    Science.gov (United States)

    Romero-Santacruz, Edith; Lira-Canul, Janeth Jaqueline; Pacheco-Tugores, Fredy; Palma-Chan, Adolfo Gonzalo

    2015-05-01

    Dengue is an infectious disease caused by a flavivirus, with four serotypes, transmitted by the mosquito Aedes aegypti. In Mexico it is a public health problem, especially in the region of central and southeast of the country. The disease can be asymptomatic or present serious forms and even death. It is confirmed by detection of the NS1 Antigen; IgM antibodies, polymerase chain reaction and virus isolation. The vertical transmission to de newborn has been little studied. 7 cases in neonates from November to December 2011 are reported. All patients were male, obtained by caesarean section between 34 and 40 weeks of gestation, whose mothers were enrolled with fever and symptoms associated with dengue disease and serology positive for dengue. Six with positive AgNS1 and one positive IgM; one mother died. All the newborns had positive serology for dengue, 4 with positive AgNS1 and 3 positive IgM. The clinical features of the newborn ranged from asymptomatic to one serious dengue fever, shock and hemorrhage. The symptomatic 6 attended with thrombocytopenia, changes in temperature and unspecific disturbance. The severity of mothers conditioned disrepair product at birth, but not with subsequent gravity of the new born. Vertical trasmission of dengue should be suspected in risk areas, to maintain vigilance and to give early treatment. Also is neccesary promote the realization of specific diagnostic and therapeutic guidelines to the neonatal period.

  8. Octreotide for the treatment of chylothorax in neonates.

    LENUS (Irish Health Repository)

    Das, Animitra

    2012-02-01

    BACKGROUND: Routine care for chylothorax in neonate includes either conservative or surgical approaches. Octreotide, a somatostatin analogue, has been used for the management of patients with refractory chylothorax not responding to conservative management. OBJECTIVES: To assess the efficacy and safety of octreotide in the treatment of chylothorax in neonates. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (to March 7, 2010). We assessed the reference lists of identified trials and abstracts from the annual meetings of the Pediatric Academic Societies published in Pediatric Research (2002 to 2009) without language restrictions. SELECTION CRITERIA: We planned to include randomised or quasi-randomised controlled trials of octreotide in the treatment of congenital or acquired chylothorax in term or preterm neonates, with any dose, duration or route of administration. DATA COLLECTION AND ANALYSIS: Data on primary (amount of fluid drainage, respiratory support, mortality) and secondary outcomes (side effects) were planned to be collected and analysed using mean difference, relative risk and risk difference with 95% confidence intervals. MAIN RESULTS: No randomised controlled trials were identified. Nineteen case reports of 20 neonates with chylothorax in whom octreotide was used either subcutaneously or intravenously were identified. Fourteen case reports described successful use (resolution of chylothorax), four reported failure (no resolution) and one reported equivocal results following use of octreotide. The timing of initiation, dose, duration and frequency of doses varied markedly. Gastrointestinal intolerance and clinical presentations suggestive of necrotizing enterocolitis and transient hypothyroidism were reported as side effects. AUTHORS\\' CONCLUSIONS: No practice recommendation can be made based on the evidence identified in this review. A prospective registry of

  9. Analysis of therapeutic effects of Phloroglucinol for cervical edema%应用间苯三酚治疗宫颈水肿的疗效分析

    Institute of Scientific and Technical Information of China (English)

    谭芸

    2011-01-01

    目的:观察和分析间苯三酚用于治疗宫颈水肿的疗效.方法:将2009年6月~2011年1月在本院分娩过程中发生宫颈水肿的孕妇共192例随机分为A、B、C三组.A组给予间苯三酚肌注,B组予间苯三酚肌注、地西泮静推,C组给予利多卡因和阿托品宫颈水肿局部注射.观察并比较各组宫颈水肿消退情况、剖宫产率、产后出血及新生儿窒息情况.结果:给药后,A、B两组宫颈水肿治疗有效率均高于C组,A、B两组阴道分娩率高于C组,剖宫产率低于C组,差异有统计学意义(P<0.05).A组宫颈水肿治疗有效率高于B组,阴道分娩率高于B组,剖宫产率低于B组,差异有统计学意义(P<0.05).三组之间产后出血及新生儿窒息情况未见明显差异.结论:应用间苯三酚治疗产时宫颈水肿,可明显减轻水肿,加速宫颈扩张,缩短产程,降低剖宫产率.%Objective: To observe and analyze the therapeutic effects of Phloroglucinol for cervical edema. Methods: 192 cases of parturients who developed cervical edema during delivery in our hospital from June 2009 to January 2011 were randomly divided into three groups. Group A was given Phloroglucinol injectd to cervix. Group B was injected to cervix locally and use diazepam injected to cervix. Group C was locally injected to cervix with Lidocaine and Atropine. The subsidence of cervical edema, the rate of cesarean section, the postpartum hemorrhage and neonatal asphyxia were observed and compared among the three groups. Results: The treatment effective rate of cervical edema and the rate of vaginal delivery were higher in Group C compared with Goup A and B. The differences had statistical significance (P<0.05). The treatment effective rate of cervical edema and the rate of vaginal delivery were higher in Group A compared with Group B. The differences had statistical significance(P<0.05). There were no significant differences among the three groups in postpartum hemorrhage and neonatal

  10. Brain edema and tumor necrosis factor-like weak inducer of apoptosis in rats with cerebral ischemia

    Institute of Scientific and Technical Information of China (English)

    Renlan Zhou; Peng Xie

    2008-01-01

    BACKGROUND: Recent studies have demonstrated that tumor necrosis factor-like weak inducer of apoptosis (TWEAK) participates in brain edema. However, it is unclear whether blood-brain barrier (BBB) disruption is associated with TWEAK during the process of brain edema OBJECTIVE: To investigate the effects of TWEAK on BBB permeability in brain edema.DESIGN, TIME AND SETTING: An immunohistochemical observation, randomized, controlled animal experiment was pertbrmed at the Laboratory of Neurosurgical Anatomy, Xiangya Medical College, Central South University & Central Laboratory, Third Xiangya Hospital, Central South University between January 2006 and December 2007.MATERIALS: A total of 48 adult Wistar rats were randomly divided into three groups: normal control (n =8), sham-operated (n = 8), and ischemia/reperfusion (n = 32). Rats from the ischemia/reperfusion group were randomly assigned to four subgroups according to different time points, i.e., 2 hours of ischemia followed by 6 hours (n = 8), 12 hours {n = 8), 1 day (n = 8), or 12 days (n = 8) of reperfusion.METHODS: Focal cerebral ischemia/reperfusion injury was induced by middle cerebral artery occlusion (MCAO) using the suture method in rats from the ischemia/reperfusion group. Thread was introduced at a depth of 17-19 mm. Rats in the sham-operated group were subjected to experimental procedures similar to the ischemia/reperfusion group; however, the introducing depth of thread was 10 mm. The normal control group was not given any intervention.MAIN OUTCOME MEASURES: TWEAK expression was examined by immunohistochemistry; brain water content on the ischemic side was calculated as the ratio of dry to wet tissue weight; BBB permeability was measured by Evans blue extravasation.RESULTS: A total of eight rats died prior to and after surgery and an additional eight rats were randomly entered into the study. Thus 48 rats were included in the final analysis. In the ischemia/reperfusion group,TWEAK-positive cells were

  11. 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

  12. 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.

  13. 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

    Full Text Available La altura, fascinante laboratorio natural de investigación médica, provee resultados con importantes implicancias para la comprensión de enfermedades que afectan a millones de personas que viven en ella, asi como para el tratamiento de enfermedades ligadas a la hipoxemia en pacientes que viven en baja altitud. El edema pulmonar de altura (EPA es una entidad que pone en peligro la vida y que ocurre en sujetos predispuestos pero sanos. Esto permite estudiar los mecanismos subyacentes del edema pulmonar en humanos, sin la presencia de factores que presten a la confusión como enfermedades concomitantes. El EPA resulta de la conjunción de dos defectos mayores: acumulación de líquido en el espacio alveolar debido a una hipertensión pulmonar hipóxica exagerada, y alteración en la eliminación del mismo por un defecto en el transporte transepitelial alveolar de sodio. En esta revisión, describimos brevemente las características clínicas y revisaremos este novedoso concepto. Proveemos evidencia experimental de como la síntesis alterada de óxido nítrico y/o la disminución de su biodisponibilidad representan el defecto central que predispone a la vasoconstricción pulmonar hipóxica exagerada y a la acumulación de líquido en el espacio alveolar. Mostramos que la hipertensión pulmonar hipóxica exagerada, per se, no es suficiente para producir un EPA, y que una alteración en la eliminación del fluido del espacio alveolar representa un segundo mecanismo fisiopatológico importante. Finalmente, describimos cómo los nuevos aportes obtenidos de los estudios del EPA pueden ser trasladados al manejo de otros estados patológicos ligados a la hipoxemia.High altitude constitutes an exciting natural laboratory for medical research. Over the past decade, it has become clear that the results of high-altitude research may have important implications not only for the understanding of diseases in the millions of people living permanently at high

  14. Efficacy of patterned scan laser in treatment of macular edema and retinal neovascularization

    Directory of Open Access Journals (Sweden)

    Dimple Modi

    2009-08-01

    Full Text Available Dimple Modi, Paulpoj Chiranand, Levent AkdumanSaint Louis University School of Medicine, Department of Ophthalmology, Saint Louis University Eye Institute, St. Louis, Missouri, USAPurpose: To analyze the benefits, efficacy, and complications of the PASCAL® photocoagulation laser system (OptiMedica, Santa Clara, CA, USA in patients treated at our institution.Methods: We conducted a retrospective chart review of 19 patients (28 eyes who underwent laser treatment using the PASCAL® photocoagulation system from November 2006 to November 2007. These 28 eyes were divided into two groups; group 1 eyes underwent macular grid laser and group 2 eyes underwent panretinal photocoagulation. Treatment was performed for macular edema or for iris or retinal neovascularization. Outcomes measured included best-corrected visual acuity (BCVA, efficacy of laser treatment, complications, duration of the procedure, and pain perception, which were noted in the charts for panretinal treatments.Results: Follow-up was 5.9 ± 2.6 months for group 1 and 5.9 ± 4.0 months for group 2. In group 1, 9/28 eyes required a second treatment for remaining edema. BCVA was stable or better in 66% (14/21 and average central foveal thickness on ocular coherence tomography improved in 71% (15/21. Time to completion for a number of laser patterns for grid photocoagulation was felt to be too long for completing the total pattern safely, although we have not noted any related complications. In group 2, the neovascularization regressed at least partially in 3/7 patients. Patient-reported pain perception was 3.6 on a scale of 1 to 10 for group 2. Occasional hemorrhages occurred secondary to irregular laser uptake at different spots in the patterns. We observed no visual outcome consequences because of these hemorrhages during follow-up.Conclusions: Retinal photocoagulation by the PASCAL® laser has comparable efficacy to historical results with conventional retinal photocoagulation in short

  15. Neonatal invasive candidiasis.

    Science.gov (United States)

    Stronati, M; Decembrino, L

    2006-12-01

    Over the last two decades, systemic fungal infections have emerged to play a primary role in hospital-acquired infections. C. albicans is involved in 75% of neonatal candidiasis; however, the incidence of infection from C. parapsilosis is also increasing significantly. The higher incidence observed in the high-risk group of very low birth weight (VLBW) infants is linked to their special physical characteristics and the diagnostic and therapeutic invasive procedures they undergo. Colonization is a relevant risk factor depending on the colonized site , the fungal species and the type of colonization. Serological tests have a low specificity and sensitivity; in many cases, they do not distinguish between colonization and infection. Blood culture, although the best diagnostic test for determining systemic infection, can result negative, even in cases of deep organ involvement. In addition, fungi grow more slowly than bacteria in cultures. So, the difficulty in diagnosing systemic candidiasis and its aspecific clinical features may make empirical therapy appropriate. Amphotericin B (AmB) alone or combined with 5-fluorocytosine remains the drug of choice. Fluconazole represents a valid alternative. Recently developed new formulations of amphotericin incapsulated in liposomes can avoid possible adverse effects. Prognosis depends on the specific micro-organism involved; mortality is higher in the presence of C. albicans. As prognosis is associated with high mortality, prevention measures to reduce risk factors are of critical importance.

  16. INVISIBLE MURDERER: NEONATAL TETANUS

    Directory of Open Access Journals (Sweden)

    Yonca SONMEZ

    2006-06-01

    Full Text Available Neonatal tetanus (NNT has been secondary in the whole world in the death list of diseases which can be protected by the help of vaccine. It’s an important community health problem in the less-developed countries in which pre-birth care services are limited, assisting a mother at childbirth by uneducated people in dirty atmosphere and the immunity against tetanus is not enough. Studies have shown that minor part of the cases have been expressed in most of the countries. Because of that NNT have been called as “silent/invisible murderer”. In Turkey, in the year of 2003 it has been seen 15 cases, and 12 of them have been resulted in death. The methods which will be applied to carry out the elimination of NNT are; the vaccination of pregnant women with at least two doses tetanus toxoid and providing clean birth conditions for all of the pregnant women. However, in Turkey the proportion of the women who have two doses of tetanus vaccine is 41%. To eliminate NNT in our country, all the pregnant women must be attained, the ones who are attained must be presented with qualified pre-birth care service which also includes tetanus immunity and the births must be carried out under healty conditions. As smallpox and polio eradication, NNT elimination will also be accomplished by self-sacrificing works of personnel in primary health care. [TAF Prev Med Bull 2006; 5(3.000: 229-233

  17. Retro-Mode Scanning Laser Ophthalmoscopy Planning for Navigated Macular Laser Photocoagulation in Macular Edema.

    Science.gov (United States)

    Boiko, Ernest V; Maltsev, Dmitrii S

    2016-01-01

    Purpose. To compare treatment areas and navigated macular laser photocoagulation (MLP) plans suggested by retro-mode scanning laser ophthalmoscopy (RM-SLO) image versus optical coherence tomography (OCT) central retinal thickness map and treatment planning among retina specialists. Methods. Thirty-nine eyes with diabetic or branch retinal vein occlusion-related ME undergoing navigated MLP with navigated photocoagulator had OCT and RM-SLO taken. OCT map and RM-SLO image were imported to the photocoagulator and aligned onto the retina. Two retina specialists placed laser spot marks separately based on OCT and RM-SLO images in a random fashion. The spots placed by each physician were compared between OCT and RM-SLO and among physicians. The areas of retinal edema on OCT and RM-SLO of the same eye were also compared. Results. The average number of laser spots using RM-SLO and OCT template was 189.6 ± 77.4 and 136.6 ± 46.8, respectively, P = 0.003. The average area of edema on RM-SLO image was larger than that on OCT map (14.5 ± 3.9 mm(2) versus 10.3 ± 2.8 mm(2), P = 0.005) because of a larger scanning area. There was narrow variability in treatment planning among retina specialists for both RM-SLO (P = 0.13) and OCT (P = 0.19). Conclusion. The RM-SLO image superimposed onto the fundus of the same eye can be used to guide MLP with narrow variability in treatment planning among retina specialists. The treatment areas suggested by RM-SLO-guided MLP plans for ME were shown to be larger than those suggested by OCT-guided plans.

  18. Retro-Mode Scanning Laser Ophthalmoscopy Planning for Navigated Macular Laser Photocoagulation in Macular Edema

    Directory of Open Access Journals (Sweden)

    Ernest V. Boiko

    2016-01-01

    Full Text Available Purpose. To compare treatment areas and navigated macular laser photocoagulation (MLP plans suggested by retro-mode scanning laser ophthalmoscopy (RM-SLO image versus optical coherence tomography (OCT central retinal thickness map and treatment planning among retina specialists. Methods. Thirty-nine eyes with diabetic or branch retinal vein occlusion-related ME undergoing navigated MLP with navigated photocoagulator had OCT and RM-SLO taken. OCT map and RM-SLO image were imported to the photocoagulator and aligned onto the retina. Two retina specialists placed laser spot marks separately based on OCT and RM-SLO images in a random fashion. The spots placed by each physician were compared between OCT and RM-SLO and among physicians. The areas of retinal edema on OCT and RM-SLO of the same eye were also compared. Results. The average number of laser spots using RM-SLO and OCT template was 189.6±77.4 and 136.6±46.8, respectively, P=0.003. The average area of edema on RM-SLO image was larger than that on OCT map (14.5±3.9 mm2 versus 10.3±2.8 mm2, P=0.005 because of a larger scanning area. There was narrow variability in treatment planning among retina specialists for both RM-SLO (P=0.13 and OCT (P=0.19. Conclusion. The RM-SLO image superimposed onto the fundus of the same eye can be used to guide MLP with narrow variability in treatment planning among retina specialists. The treatment areas suggested by RM-SLO-guided MLP plans for ME were shown to be larger than those suggested by OCT-guided plans.

  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. An Ultrasonic Backscatter Instrument for Cancellous Bone Evaluation in Neonates

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    Chengcheng Liu

    2015-09-01

    Full Text Available Ultrasonic backscatter technique has shown promise as a noninvasive cancellous bone assessment tool. A novel ultrasonic backscatter bone diagnostic (UBBD instrument and an in vivo application for neonatal bone evaluation are introduced in this study. The UBBD provides several advantages, including noninvasiveness, non-ionizing radiation, portability, and simplicity. In this study, the backscatter signal could be measured within 5 s using the UBBD. Ultrasonic backscatter measurements were performed on 467 neonates (268 males and 199 females at the left calcaneus. The backscatter signal was measured at a central frequency of 3.5 MHz. The delay (T1 and duration (T2 of the backscatter signal of interest (SOI were varied, and the apparent integrated backscatter (AIB, frequency slope of apparent backscatter (FSAB, zero frequency intercept of apparent backscatter (FIAB, and spectral centroid shift (SCS were calculated. The results showed that the SOI selection had a direct influence on cancellous bone evaluation. The AIB and FIAB were positively correlated with the gestational age (|R| up to 0.45, P10 µs. Moderate positive correlations (|R| up to 0.45, P10 µs. The T2 mainly introduced fluctuations in the observed correlation coefficients. The moderate correlations observed with UBBD demonstrate the feasibility of using the backscatter signal to evaluate neonatal bone status. This study also proposes an explicit standard for in vivo SOI selection and neonatal cancellous bone assessment.

  1. Edema cerebral crônico na neurocisticercose

    Directory of Open Access Journals (Sweden)

    AGAPEJEV SVETLANA

    1998-01-01

    Full Text Available Neste estudo retrospectivo, relatam-se as características clínicas do edema cerebral crônico (ECCr em 34 pacientes com neurocisticercose (NCC, que apresentavam edema cerebral difuso, à tomografia computadorizada (TC, como característica comum. Todos foram tratados com dextroclorofeniramina e, 32 deles, com albendazol. O ECCr predominou no sexo feminino (73,5% na faixa etária dos 11 - 40 anos (92,3%. A cefaléia ocorreu em 94,1% dos pacientes, náuseas/vômitos em 47,1%, crises epilépticas em 41,1% e distúrbios psíquicos em 38,2%. A hiperreflexia ocorreu em 82,3% e o papiledema em 58,8% e o exame neurológico normal em 11,8%. Na TC, o edema esteve associado a calcificações em 61,8% dos casos. As pressões liquóricas foram mais elevadas (p< 0,05 antes do tratamento. Atualmente, estão assintomáticos, ou com melhora clínica, 79,4% dos pacientes (57,1% deles sem medicação. Discute-se a possibilidade do ECCr, na NCC, ser uma manifestação antigênica, sem a presença concomitante de cistos parasitários, e poder representar mais uma condição clínica associada à hipertensão intracraniana benigna.

  2. 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.

  3. Bed site selection by neonate deer in grassland habitats on the northern Great Plains

    Science.gov (United States)

    Grovenburg, T.W.; Jacques, C.N.; Klaver, R.W.; Jenks, J.A.

    2010-01-01

    Bed site selection is an important behavioral trait influencing neonate survival. Vegetation characteristics of bed sites influence thermal protection of neonates and concealment from predators. Although previous studies describe bed site selection of neonatal white-tailed deer (Odocoileus virginianus) in regions of forested cover, none determined microhabitat effects on neonate bed site selection in the Northern Great Plains, an area of limited forest cover. During summers 2007–2009, we investigated bed site selection (n  =  152) by 81 radiocollared neonate white-tailed deer in north-central South Dakota, USA. We documented 80 (52.6%) bed sites in tallgrass–Conservation Reserve Program lands, 35 (23.0%) bed sites in forested cover, and 37 (24.3%) in other habitats (e.g., pasture, alfalfa, wheat). Bed site selection varied with age and sex of neonate. Tree canopy cover (P ratio  =  1.035, 95% CI  =  1.008–1.062) for every 1-cm increase in vertical height of understory vegetation. Management for habitat throughout the grasslands of South Dakota that maximizes vertical height of understory vegetation would enhance cover characteristics selected by neonates.

  4. Topical dorzolamide for macular edema in the early phase after vitrectomy and epiretinal membrane removal

    Directory of Open Access Journals (Sweden)

    Suzuki T

    2013-04-01

    Full Text Available Takahiro Suzuki, Kenji Hayakawa, Yoshihiro Nakagawa, Hiromi Onouchi, Masafumi Ogata, Kenji KawaiDepartment of Ophthalmology, Tokai University School of Medicine, Isehara, JapanBackground: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.Methods: Forty patients were included, all of whom had undergone vitrectomy combined with phacoemulsification and intraocular lens implantation for epiretinal membrane. Twenty eyes from 40 patients received topical 2% dorzolamide three times a day. The patients were followed up for at least 3 months. In this study, we evaluated the effect of dorzolamide on visual acuity, intraocular pressure, central macular thickness, and aqueous flare.Results: Mean logarithm of the minimum angle of resolution (logMAR best-corrected visual acuity preoperatively and 2 weeks, 1 month, and 3 months after surgery was 0.48 ± 0.23, 0.60 ± 0.16, 0.40 ± 0.29, and 0.24 ± 0.32, respectively, in the treatment group, and 0.40 ± 0.09, 0.44 ± 0.12, 0.32 ± 0.10, and 0.16 ± 0.09, respectively, in the control group. No statistically significant difference was observed between the two groups. Mean central macular thickness preoperatively and at 2 weeks and 3 months after surgery was 572.6, 427.2, and 333.4 µm, respectively, in the treatment group, and 571.4, 485.2, and 388.4 µm, respectively, in the control group. Mean aqueous flare preoperatively, and 1 month and 3 months after surgery was 8.6, 34.2, and 23.5 photon counts per millisecond (pc/ms, respectively, in the treatment group, and 9.7, 24.7, and 23.4 pc/ms, respectively, in the control group. No statistically significant differences were observed between data from the two groups. However, statistically significant (P < 0.05 differences in mean central macular thickness at 1 month and mean aqueous flare at 2 weeks after surgery were found between the treatment group (358.8 µm, 36.8 pc

  5. Pulmonary edema following transcatheter closure of atrial septal defect

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    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.

  6. Practice management of french retinal specialists in diabetic macular edema

    OpenAIRE

    QU-KNAFO, Mo lise

    2015-01-01

    Purpose: To evaluate the practice management of french vitreoretinal (VR) specialists in the treatment of diabetic macular edema (DME)Methods: A 31-item survey investigating real life practice in diagnosis and treatment of DME was mailed to specialists identified from the Société Française d’Ophtalmologie and the Club Francophone des Spécialistes de la Rétine. Answers were analysed anonymously by an online survey software. Results: 95 specialists answered the survey. 25%, 36% and 32% of respo...

  7. Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

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    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.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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.

  13. 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

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

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    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.

  15. [Lupus erythematosus panniculitis presenting as palpebral edema and parotiditis].

    Science.gov (United States)

    Pérez-Pastor, G; Valcuende, F; Tomás, G; Moreno, M

    2007-10-01

    Lupus erythematosus panniculitis or lupus erythematosus profundus is characterized by inflammation of the deep dermis and subcutaneous tissue. It can occur in isolation or associated with chronic systemic or discoid lupus erythematosus. It usually consists of nodules and hardened subcutaneous plaques on the forehead, cheeks, proximal extremities, and buttocks. Periorbital and parotid involvement are rare and can lead to misdiagnosis. We present the case of a patient with lupus erythematosus panniculitis who presented with palpebral edema and involvement of the periocular fat and parotid gland.

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

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    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. Dexamethasone intravitreal implant in the treatment of diabetic macular edema

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    Dugel PU

    2015-07-01

    Full Text Available Pravin U Dugel,1,2 Francesco Bandello,3 Anat Loewenstein4 1Retinal Consultants of Arizona, Phoenix, AZ, 2Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 3Department of Ophthalmology, University Vita-Salute Scientific Institute San Raffaele, Milan, Italy; 4Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract: Diabetic macular edema (DME resembles a chronic, low-grade inflammatory reaction, and is characterized by blood–retinal barrier (BRB breakdown and retinal capillary leakage. Corticosteroids are of therapeutic benefit because of their anti-inflammatory, antiangiogenic, and BRB-stabilizing properties. Delivery modes include periocular and intravitreal (via pars plana injection. To offset the short intravitreal half-life of corticosteroid solutions (~3 hours and the need for frequent intravitreal injections, sustained-release intravitreal corticosteroid implants have been developed. Dexamethasone intravitreal implant provides retinal drug delivery for ≤6 months and recently has been approved for use in the treatment of DME. Pooled findings (n=1,048 from two large-scale, randomized Phase III trials indicated that dexamethasone intravitreal implant (0.35 mg and 0.7 mg administered at ≥6-month intervals produced sustained improvements in best-corrected visual acuity (BCVA and macular edema. Significantly more patients showed a ≥15-letter gain in BCVA at 3 years with dexamethasone intravitreal implant 0.35 mg and 0.7 mg than with sham injection (18.4% and 22.2% vs 12.0%. Anatomical assessments showed rapid and sustained reductions in macular edema and slowing of retinopathy progression. Phase II study findings suggest that dexamethasone intravitreal implant is effective in focal, cystoid, and diffuse DME, in vitrectomized eyes, and in combination with laser therapy. Ocular complications of

  18. Edema pulmonar agudo posoperatorio de presión negativa

    OpenAIRE

    Faridt Hernán Criollo-Muñoz; Juan José Espinosa-Espinoza

    2014-01-01

    No es extraño que durante la práctica anestésica diaria se encuentrenpacientes sin padecimientos crónicos conocidos que expliquen eldesarrollo de edema pulmonar agudo durante el perioperatorio. Eledema pulmonar de presión negativa se ha reportado en la literatura,aun en pacientes sanos, como una entidad en el perioperatorio de buenpronóstico con tratamiento oportuno multidisciplinario. Se expone elcaso de un paciente de 29 años de edad, sin antecedentes patológicosconocidos, a quien se le rea...

  19. Bacterial Culture of Neonatal Sepsis

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    AH Movahedian

    2006-08-01

    Full Text Available Neonatal bacterial sepsis is one of the major cause of morbidity and mortality in neonates. This retrospective study was performed to determine the incidence of bacterial sepsis with focus on Gram negative organisms in neonates admitted at Beheshti Hospital in Kashan, during a 3-yr period, from September 2002 to September 2005. Blood culture was performed on all neonates with risk factors or signs of suggestive sepsis. Blood samples were cultured using brain heart infusion (BHI broth according to standard method. From the 1680 neonates 36% had positive blood culture for Pseudomans aeruginosa, 20.7% for Coagulase negative Staphylococci, and 17% for Klebsiella spp. Gram-negative organisms accounted for 72.1% of all positive cultures. The overall mortality rate was 19.8% (22 /111 of whom 63.6% (14 /22 were preterm. Pseudomona aeruginosa and Klebsiella spp. showed a high degree of resistance to commonly used antibiotics (ampicillin, gentamicin as well as third generation cephalosporins. Continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence.

  20. The Effects of Increased Maternal Visual Regard of Neonate Upon the Neonate-Mother Interaction.

    Science.gov (United States)

    Belcastro, Christina M.; And Others

    This study attempts to investigate the effects of increased maternal visual regard on neonatal social visual behavior and upon patterns of mother-neonate interaction within the context of a learning theory paradigm. Subjects were 3-day-old neonates and their mothers; with 10 of the 15 mother-neonate pairs as the experimental group, and 5 as the…

  1. Sensitivity and specificity of time-domain versus spectral-domain optical coherence tomography in diabetic macular edema

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    Nishal Patel

    2013-01-01

    Full Text Available Purpose: The purpose was to evaluate the sensitivity and specificity of measurements of central macular thickness (CMT in diabetic macular edema using stratus time-domain and cirrus spectral-domain optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA. Materials and Methods: A total of 36 eyes from 19 patients with clinically significant diabetic macular edema (DME were included. All participants underwent automated scanning patterns using cirrus HD-OCT and stratus OCT examinations on the same day. The sensitivity/specificity of retinal thickness measurements was calculated from published normative data. Agreement was calculated using Bland--Altman method. The receiver operating characteristic curves (ROC and areas under the ROC were plotted. Results: The mean difference between the cirrus HD-OCT and stratus OCT in the central foveal zone was 49.89 μm. Bland--Altman analysis confirmed that the retinal thickness measurements had poor agreement in patients with DME. The areas under the ROC for retinal thickness measurements were 0.88 using cirrus HD-OCT and 0.94 with stratus. Conclusions: In patients with DME, the cirrus HD-OCT gives a higher reading than stratus OCT with poor agreement between the devices in most regions within the nine subfield zones. The sensitivity and specificity of the stratus OCT was comparable to the cirrus.

  2. EFFECT ON MACULAR EDEMA IN NON-ISCHEMIC CRVO: COMPA RISON BETWEEN INTRAVITREAL BEVACIZUMAB AND COMBINED INTRAVITREAL BEVACIZUMAB AND TRIAMCINOLONE

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    Murali Mohan

    2013-05-01

    Full Text Available PURPOSE : to compare the efficacy of intravitreal bevacizum ab and combined bevacizumab and Triamcinolone, in the treatment of macular edema in CRVO. The efficacy is studied by the anatomical and visual improvements. BACKGROUND : macular edema is the most common cause of visual loss in central retinal vein occlusion. Many treatments have been advocated with the recent trend being the usage of intravitreal anti-VEGF age nts and steroids. METHODS : 30 eyes of 30 patients (17 male and 13 female with recent onset non-ischemic CRVO were enrolled in a prospective randomized consecutive comparative stud y. Group I with 15 eyes were given intravitreal injection of 1.25 mg/0.05 ml of Avasti n and group II with 15 eyes were given intravitreal combination of 1.25 mg/0.05 ml Avastin and 2 mg/0.05 ml of Triamcinolone. All eyes were examined at baseline and at six weeks of injec tion. Changes in best corrected visual acuity (letters of ETDRS chart and central macular thickn ess were studied. IOP was also focused on.

  3. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

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    Aya Amer

    2016-01-01

    Full Text Available Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC, who then developed a supraventricular tachycardia (SVT. This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

  4. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    Science.gov (United States)

    Amer, Aya; Broadbent, Roland S.; Edmonds, Liza

    2016-01-01

    Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management. PMID:28058050

  5. A Rare Cause of Neonatal Liver Failure: Neonatal Hemochromatosis

    Directory of Open Access Journals (Sweden)

    Uluca Ü et al.

    2013-09-01

    Full Text Available Neonatal hemochromatosis (NH is a severe rare liver disease in neonatal period associated with ekstrahepatic siderosis. This disease is characterized by hepatocellular insufficiency that presented with jaundice, hypoglycemia, hypoalbuminemia, low fibrinogen levels, thrombocytopenia, anemia, direct and indirect hyperbilirubinemia from the first days of life. Herein we reported a case with Rh incompatibility whose jaundice was noted at the first day of life and referred to our hospital for exchange transfusion, but thereafter diagnosed as NH and reviewed the literature in the view point of the latest developments related to the topic.

  6. Fetal and neonatal thyrotoxicosis

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    Chandar Mohan Batra

    2013-01-01

    Full Text Available Fetal thyrotoxicosis is a rare disease occurring in 1 out of 70 pregnancies with Grave′s disease or in 1 out of 4000-50,000 deliveries. The mortality is 12-20%, usually from heart failure, but other complications are tracheal compression, infections and thrombocytopenia. It results from transfer of thyroid stimulating immunoglobulins from mother to fetus through the placenta. This transplacental transfer begins around 20 th week of pregnancy and reaches its maximum by 30 th week. These autoantibodies bind to the fetal thyroid stimulating hormone (TSH receptors and increase the secretion of the thyroid hormones. The mother has an active autoimmune thyroid disease or has been treated for it in the past. She may be absolutely euthyroid due to past treatment by drugs, surgery or radioiodine ablation, but still have active TSH receptor stimulating autoantibodies, which can cause fetal thyrotoxicosis. The other features of this disease are fetal tachycardia, fetal goiter and history of spontaneous abortions and findings of goiter, ascites, craniosyntosis, fetal growth retardation, maceration and hydrops at fetal autopsy. If untreated, this disease can result in intrauterine death. The treatment for this disease consists of giving carbimazole to the mother, which is transferred through the placenta to the fetus. The dose of carbimazole is titrated with the fetal heart rate. If the mother becomes hypothyroid due to carbimazole, thyroxine is added taking advantage of the fact that very little of thyroxine is transferred across the placenta. Neonatal thyrotoxicosis patients are very sick and require emergency treatment. The goal of the treatment is to normalize thyroid functions as quickly as possible, to avoid iatrogenic hypothyroidism while providing management and supportive therapy for the infant′s specific signs and symptoms.

  7. Neonatal and infantile acne vulgaris: an update.

    Science.gov (United States)

    Serna-Tamayo, Cristian; Janniger, Camila K; Micali, Giuseppe; Schwartz, Robert A

    2014-07-01

    Acne may present in neonates, infants, and small children. Neonatal and infantile acne vulgaris are not considered to be rare. The presentation of acne in this patient population sometimes represents virilization and may portend later development of severe adolescent acne. Neonatal and infantile acne vulgaris must be distinguished from other cutaneous disorders seen in newborns and infants. Infantile acne tends to be more pleomorphic and inflammatory, thus requiring more vigorous therapy than neonatal acne.

  8. Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite

    OpenAIRE

    José Maria Pereira de Godoy, Maria de Fátima Guerreiro de Godoy

    2011-01-01

    The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cycli...

  9. [Study of cytokines content and gangliosides metabolism at experimental brain edema].

    Science.gov (United States)

    Zakarian, A V; Kazarian, G S; Zakarian, G V; Melkonian, M M; Ovsesian, L M

    2011-01-01

    The content of cytokines, and gangliosides metabolism, and the quantity of lipid peroxidation products were studied at experimental brain edema. Data obtained show increase the level of proinflammatory cytokins and decrease the level of antiinflammatory cytokines during development of brain edema. Along with this we reveal the accumulation of lipid peroxidation products (diene conjugates, hydroperoxides, and malonic dialdehyde). Each fraction of gangliosides decreased, but the product of their hydrolytic dissociation sphingosine increased at experimental brain edema.

  10. 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.

  11. Late-onset neonatal sepsis in preterm infants with birth weight under 1.500 g

    Directory of Open Access Journals (Sweden)

    Stella Marys Rigatti Silva

    Full Text Available Objective: the research objective was to characterize preterm infants with birth weight under 1500 g, and to identify the incidence of late-onset neonatal sepsis among this population. Methods: a prospective cohort study with a sample of 30 preterm newborns that weighed under 1500 g and were hospitalized in the NICU of the university hospital. Data were collected from January to December 2013 using a structured instrument. Results: of the 30 neonates included in the study, 14 developed late-onset neonatal sepsis with a prevalence of coagulase-negative staphylococci. Conclusions: the incidence of late-onset neonatal sepsis indicates a vulnerability in preterm infants due to immunological immaturity. These results reveal that knowledge of the profile of newborn infants admitted to the NICU and the risk factors to which they are exposed are central to the planning of nursing care for these patients. Future studies should address strategies for preventing nosocomial infection.

  12. Diferenças no padrão de ocorrência da mortalidade neonatal e pós-neonatal no Município de Goiânia, Brasil, 1992-1996: análise espacial para identificação das áreas de risco Differential patterns of neonatal and post-neonatal mortality rates in Goiânia, Brazil, 1992-1996: use of spatial analysis to identify high-risk areas

    Directory of Open Access Journals (Sweden)

    Otaliba Libânio de Morais Neto

    2001-10-01

    Full Text Available Este artigo refere-se à pesquisa acerca do padrão espacial dos componentes neonatal e pós-neonatal da mortalidade infantil em Goiânia, no Estado de Goiás, Brasil. A população do estudo foi a coorte de 101 mil nascidos vivos, residentes em Goiânia, de 1992 a 1996. As probabilidades de morte infantil foram estimadas mediante o cotejo dos arquivos de óbitos e de nascidos vivos. Para minimizar as flutuações aleatórias das taxas, empregou-se o método Bayesiano empírico. A unidade de análise do padrão espacial foi constituída pelos 65 distritos urbanos de planejamento. Para análise de autocorrelação espacial foram utilizados: Moran "global", Moran local e estatística Gi* local. Os componentes neonatal e pós-neonatal da mortalidade infantil evidenciaram autocorrelação espacial estatisticamente significativa. No período pós-neonatal, os distritos de risco concentram-se nas regiões periféricas do município. No período neonatal, o padrão de ocorrência é heterogêneo, havendo distritos de alto risco distribuídos em todas as regiões, inclusive na região Central de Goiânia.The aim of this study was to investigate the spatial pattern of neonatal and post-neonatal mortality in the city of Goiânia, Central Brazil. Analyses were based on linked birth and death certificates relating to 101,000 in-hospital live births from mothers residing in the city of Goiânia over the 1992-1996 period. Overall neonatal and post-neonatal mortality probabilities were calculated using the linked database. The empirical Bayes method was applied to smooth the estimated rates and minimize random fluctuation. Spatial units of analysis were 65 urban districts, corresponding to the urban planning sectors. The following exploratory spatial analyses were applied: "global" Moran's I statistic, local Moran LISA map, and Gi* local statistics. For both neonatal and post-neonatal mortality there was statistically significant spatial autocorrelation

  13. Neonatal hemophilia: a rare presentation

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    Nuno Ferreira

    2015-12-01

    Full Text Available Hemophilia A is a X-linked hereditary condition that lead to decreased factor VIII activity, occurs mainly in males. Decreased factor VIII activity leads to increased risk of bleeding events. During neonatal period, diagnosis is made after post-partum bleeding complication or unexpected bleeding after medical procedures. Subgaleal hemorrhage during neonatal period is a rare, severe extracranial bleeding with high mortality and usually related to traumatic labor or coagulation disorders. Subgaleal hemorrhage complications result from massive bleeding. We present a neonate with unremarkable family history and uneventful pregnancy with a vaginal delivery with no instrumentation, presenting with severe subgaleal bleeding at 52 hours of life. Aggressive support measures were implemented and bleeding managed. The unexpected bleeding lead to a coagulation study and the diagnosis of severe hemophilia A. There were no known sequelae. This case shows a rare hemophilia presentation reflecting the importance of coagulation studies when faced with unexplained severe bleeding.

  14. Two Neonates with Congenital Hydrocolpos

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    Vydehi Murthy

    2013-01-01

    Full Text Available Introduction. Neonatal hydrocolpos is a rare condition. Hydrocolpos is cystic dilatation of the vagina with fluid accumulation due to a combination of stimulation of secretary glands of the reproductive tract and vaginal obstruction. The differential for a neonatal presentation of lower abdominal mass includes urogenital anomalies, Hirschsprung’s, disease or sacrococcygeal teratoma. Prenatal diagnosis and early newborn imaging studies leads to early detection and treatment of these cases. Case. We report here two cases of neonatal hydrocolpos with prenatal diagnosis of lower abdominal mass. Postnatally, ultrasound, MRI imaging, and cystoscopy confirmed large cystic mass as hydrocolpos with distal vaginal obstruction. Both patients had enlarged renal system secondary to mass effect. Conclusion. High index of suspicion for hydrocolpos in a newborn presenting with fetal diagnosis of infraumbilical abdominal mass will facilitate timely intervention and prevention of complications.

  15. OUTCOME OF NEONATES WITH THROMBOCYTOPENIA

    Directory of Open Access Journals (Sweden)

    Sharangouda

    2014-04-01

    Full Text Available OBJECTIVE: To determine etiology, onset, clinical features and outcome of neonates with thrombocytopenia. METHODS: 140 neonates having bleeding or having platelet count (<1.5lakhs/µl were selected from those admitted to NICU’S attached to MR Medical College, Gulbarga. Initial platelet count was done on admission and counts were repeated 12 hours after any therapeutic intervention. OBSERVATION AND RESULTS: Severe thrombocytopenia (<50000/µl was present in 8.5%, moderate (50, 000-1, 00, 000/µl in 17%. Majority (45.33% were preterm and the major cause was sepsis in 51.3%.Mucosal bleed was the most common presentation. Mortality was 37% in severe and 3.9% in moderate thrombocytopenia group. CONCLUSION: Significant association is observed with maternal PIH, Late onset sepsis, NEC and sepsis with DIC .Prematurity, IUGR, Birth asphyxia were common associated morbidities. Severe thrombocytopenia in sick neonates, in NICU, is a poor prognostic indicator.

  16. Neonatal tetanus mortality in coastal Kenya

    DEFF Research Database (Denmark)

    Bjerregaard, P; Steinglass, R; Mutie, D M

    1993-01-01

    In a house-to-house survey in Kilifi District, Kenya, mothers of 2556 liveborn children were interviewed about neonatal mortality, especially from neonatal tetanus (NNT). The crude birth rate was 60.5 per 1000 population, the neonatal mortality rate 21.1 and the NNT mortality rate 3.1 per 1000 li...

  17. 21 CFR 880.5400 - Neonatal incubator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neonatal incubator. 880.5400 Section 880.5400 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... § 880.5400 Neonatal incubator. (a) Identification. A neonatal incubator is a device consisting of...

  18. 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.

  19. Diagnostic usefulness of periIesional edema around intracerebral hemorrhage in predicting underlying causes

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Nam Yeol; Seo, Jeong Jin; Yoon, Woong; Shin, Sang Soo; Lim, Hyo Soon; Chung, Tae Woong; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Hospital, Gwangju (Korea, Republic of)

    2004-07-01

    We attempted to evaluate the diagnostic usefulness of the degree of perilesional edema around intracerebral hematoma in predicting the underlying cause. This study included 54 patients with intracerebral hematoma for whom the underlying cause was confirmed by biopsy, radiological or clinical methods. Cases of subarachnoid hemorrhage, hemorrhagic transformation of cerebral infarction and intraventricular hemorrhage were excluded. The lesion size was defined as the average value of the longest axis and the axis perpendicular to this. The size of the perilesional edema was defined as the longest width of the edema. In all cases, the sizes of the lesion and edema were measured on the T2 weighted image. We defined the edema ratio as the edema size divided by the lesion size. 23 cases were diagnosed as intracerebral hemorrhage due to neoplastic conditions, such as metastasis (n=17), glioblastoma (n=5), hemangioblastoma (n=1). 31 cases were caused by non-neoplastic conditions, such as spontaneous hypertensive hemorrhage (n=23), arteriovenous malformation (n=4), cavernous angioma (n=3), and moya-moya disease (n=1). In fourteen cases, which were confirmed as malignant intracerebral hemorrhage, the edema ratio was more than 100%. Of the other cases, only 8 were confirmed as malignant intracerebral hemorrhage. It was found that the larger the edema ratio, the more malignant the intracerebral hemorrhage, and this result was statistically significant (p<0.001). Measurement of perilesional edema and the intracerebral hematoma ratio may be useful in predicting the underlying causes.

  20. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Su, I. Chang [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Taipei Cathay General Hospital, Division of Neurosurgery, Department of Surgery, Taipei (China); Willinsky, Robert A.; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Fanning, Noel F. [Cork University Hospital, Department of Interventional Neuroradiology, Cork (Ireland)

    2014-06-15

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development. We performed a retrospective analysis of consecutively treated unruptured aneurysms between January 2000 and December 2011. The presence and evolution of wall enhancement and perianeurysmal edema on MRI after endovascular treatment were analyzed. Variable factors were compared among aneurysms with and without edema. One hundred thirty-two unruptured aneurysms in 124 patients underwent endovascular treatment. Eighty-five (64.4 %) aneurysms had wall enhancement, and 9 (6.8 %) aneurysms had perianeurysmal brain edema. Wall enhancement tends to persist for years with two patterns identified. Larger aneurysms and brain-embedded aneurysms were significantly associated with wall enhancement. In all edema cases, the aneurysms were embedded within the brain and had wall enhancement. Progressive thickening of wall enhancement was significantly associated with edema. Edema can be symptomatic when in eloquent brain and stabilizes or resolves over the years. Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended. (orig.)

  1. In vivo photoacoustic tomography of mouse cerebral edema induced by cold injury

    Science.gov (United States)

    Xu, Zhun; Zhu, Quing; Wang, Lihong V.

    2011-06-01

    For the first time, we have implemented photoacoustic tomography (PAT) to image the water content of an edema in vivo. We produced and imaged a cold-induced cerebral edema transcranially, then obtained blood vessel and water accumulation images at 610 and 975 nm, respectively. We tracked the changes at 12, 24, and 36 h after the cold injury. The blood volume decreased after the cold injury, and the maximum area of edema was observed 24 h after the cold injury. We validated PAT of the water content of the edema through magnetic Resonance Imaging and the water spectrum from the spectrophotometric measurement.

  2. Acetazolamide Mitigates Astrocyte Cellular Edema Following Mild Traumatic Brain Injury

    Science.gov (United States)

    Sturdivant, Nasya M.; Smith, Sean G.; Ali, Syed F.; Wolchok, Jeffrey C.; Balachandran, Kartik

    2016-09-01

    Non-penetrating or mild traumatic brain injury (mTBI) is commonly experienced in accidents, the battlefield and in full-contact sports. Astrocyte cellular edema is one of the major factors that leads to high morbidity post-mTBI. Various studies have reported an upregulation of aquaporin-4 (AQP4), a water channel protein, following brain injury. AZA is an antiepileptic drug that has been shown to inhibit AQP4 expression and in this study we investigate the drug as a therapeutic to mitigate the extent of mTBI induced cellular edema. We hypothesized that mTBI-mediated astrocyte dysfunction, initiated by increased intracellular volume, could be reduced when treated with AZA. We tested our hypothesis in a three-dimensional in vitro astrocyte model of mTBI. Samples were subject to no stretch (control) or one high-speed stretch (mTBI) injury. AQP4 expression was significantly increased 24 hours after mTBI. mTBI resulted in a significant increase in the cell swelling within 30 min of mTBI, which was significantly reduced in the presence of AZA. Cell death and expression of S100B was significantly reduced when AZA was added shortly before mTBI stretch. Overall, our data point to occurrence of astrocyte swelling immediately following mTBI, and AZA as a promising treatment to mitigate downstream cellular mortality.

  3. 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.

  4. [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.

  5. Massive vulval edema with severe preeclampsia. Case report Edema vulvar masivo con preeclampsia grave. Presentación de un caso.

    Directory of Open Access Journals (Sweden)

    José Luis Gómez Miranda.

    2009-11-01

    Full Text Available Massive vulval edema with severe preeclampsia is presented as one of the consequences that may appear on patients with hypertension disorders during pregnancy, therefore the attention in the Obstetrics and Gynecology Service must be systematical and permanent. On women with hypertensive disorders during pregnancy, although edemas may not be constant, they may either appear at minor, barely perceptible extents, or even in the most severe ways, such as anasarca. A very peculiar manifestation of edema on preeclampsia is massive vulval edema, which appears as a highly rare complication, in whose basis there is a complex, systemic pathological process involved. We present a case of a pregnant woman who was admitted with high blood pressure values and excessive weight gain, plus very noticeable general edemas, and during her stay developed massive vulval edema. No data on this complication were found in the bibliography reviewed. Very few experienced professionals recall having dealt with similar cases in the last fifteen years, hence the decision to publish it.El edema vulvar masivo con preeclampsia grave se presenta como una de las consecuencias que pueden aparecer en pacientes con trastornos de hipertensión en el embarazo, por lo que la atención en el Servicio de Obstetricia debe ser sistemática y permanente. En las mujeres con trastornos hipertensivos del embarazo, los edemas, aunque no son constantes, se manifiestan desde las formas más leves, apenas perceptibles, hasta las más severas, como la anasarca. Una manifestación particular del edema en la preeclampsia, es el edema vulvar masivo, que se presenta como una complicación sumamente rara, en cuya base hay un proceso patológico sistémico y complejo. Se presenta el caso de una embarazada que ingresó con cifras elevadas de presión arterial y aumento de peso exagerado, con edemas generalizados muy acentuados, que durante su estancia desarrolló un edema vulvar masivo. En la bibliograf

  6. Oxygen Use in Neonatal Care: A Two-edged Sword

    Science.gov (United States)

    Perrone, Serafina; Bracciali, Carlotta; Di Virgilio, Nicola; Buonocore, Giuseppe

    2017-01-01

    In the neonatal period, the clinical use of oxygen should be taken into consideration for its beneficial and toxicity effects. Oxygen toxicity is due to the development of reactive oxygen species (ROS) such as OH• that is one of the strongest oxidants in nature. Of note, generation of ROS is a normal occurrence in human and it is involved in a myriad of physiological reactions. Anyway an imbalance between production of oxidant species and antioxidant defenses, called oxidative stress, could affect various aspect of organisms’ physiology and it could determine pathological consequences to living beings. Neonatal oxidative stress is essentially due to decreased antioxidants, increased ROS, or both. Studies have demonstrated that antioxidant capacity is lower in preterm newborns than term babies. This well-known deficiency of antioxidant factors is only a piece of a cohort of factors, which can be involved in the neonatal oxidative stress and the increased production of ROS may be a main factor. Mechanisms of ROS generation are: mitochondrial respiratory chain, free iron and Fenton reaction, inflammation, hypoxia and/or ischemia, reperfusion, and hyperoxia. Oxidative stress following hyperoxia has been recognized to be responsible for lung, central nervous system, retina, red blood cell injuries, and possibly generalized tissue damage. When supplemental oxygen is needed for care, it would be prudent to avoid changes and fluctuations in SpO2. The definition of the safest level of oxygen saturations in the neonate remains an area of active research. Currently, on the basis of the published evidences, the most suitable approach would be to set alarm limits between 90 and 95%. It should allow to avoid SpO2 values associated with potential hypoxia and/or hyperoxia. Although the usefulness of antioxidant protection in the neonatal period is still under investigation, the risk of tissue damage due to oxidative stress in perinatal period should not be underestimated. PMID

  7. Analysis of neonatal sepsis in one neonatal intensive care unit for 6 years

    Directory of Open Access Journals (Sweden)

    Peter Chun

    2010-04-01

    Full Text Available Purpose : Sepsis is a significant cause of morbidity and mortality in the newborn, particularly in preterm. The objective of this study was to analyze the incidence rate, causative pathogens and clinical features of neonatal sepsis in one neonatal intensive care unit (NICU for 6 years. Methods : This study was retrospectively performed to review the clinical and laboratory characteristics including sex, gestational age, birth weight, Apgar score, length of hospitalization, length of total parenteral nutrition, presence of central venous catheter, underlying diseases, laboratory findings, microorganisms isolated from blood culture, complications and mortality in 175 patients between January 2003 and December 2008. Results : 1 Sepsis was present in 175 of 3,747 infants for 6 years. There were more gram-positive organisms. 2 The gram-negatives were more prevalent in preterm. There were no significant differences of other clinical features between two groups. 3 Underlying diseases were found in 73.7%, and the most common disease was cardiovascular disease. The most common organisms of gram-positives and gram-negatives were methicillin resistant Staphylococcus aureus (MRSA and Serratia marcescens. 4 There was statistically significant difference on platelet counts between two groups (P&lt;0.05. 5 Complications were found in 18.3% and septic shock was the most common. MRSA was the most common pathogen in sepsis with complication. 6 The mortality rate was 7.4%. 7 There were differences in monthly blood stream infection/ 1,000 patient-days. Conclusion : The studies about the factors that can influence neonatal sepsis will contribute to decrease the infection rates in NICUs.

  8. The challenges of neonatal magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J.; Graves, Martin J.; Lomas, David J. [Addenbrooke' s Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom); Edwards, Andrea [Addenbrooke' s Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Neonatology, Cambridge (United Kingdom); Austin, Topun [Addenbrooke' s Hospital, Department of Neonatology, Cambridge (United Kingdom)

    2012-10-15

    Improved neonatal survival rates and antenatal diagnostic imaging is generating a growing demand for postnatal MRI examinations. Neonatal brain MRI is now becoming standard clinical care in many settings, but with the exception of some research centres, the technique has not been optimised for imaging neonates and small children. Here, we review some of the challenges involved in neonatal MRI, including recent advances in overall MR practicality and nursing practice, to address some of the ways in which the MR experience could be made more neonate-friendly. (orig.)

  9. Susceptibility weighted imaging of the neonatal brain

    Energy Technology Data Exchange (ETDEWEB)

    Meoded, A.; Poretti, A. [Division of Pediatric Radiology and Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Northington, F.J. [Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Tekes, A.; Intrapiromkul, J. [Division of Pediatric Radiology and Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Huisman, T.A.G.M., E-mail: thuisma1@jhmi.edu [Division of Pediatric Radiology and Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (United States)

    2012-08-15

    Susceptibility weighted imaging (SWI) is a well-established magnetic resonance technique, which is highly sensitive for blood, iron, and calcium depositions in the brain and has been implemented in the routine clinical use in both children and neonates. SWI in neonates might provide valuable additional diagnostic and prognostic information for a wide spectrum of neonatal neurological disorders. To date, there are few articles available on the application of SWI in neonatal neurological disorders. The purpose of this article is to illustrate and describe the characteristic SWI findings in various typical neonatal neurological disorders.

  10. Novel optical system for neonatal brain imaging

    Science.gov (United States)

    Chen, Yu; Zhou, Shuoming; Nioka, Shoko; Chance, Britton; Anday, Endla; Ravishankar, Sudha; Delivoria-Papadopoulos, Maria

    1999-03-01

    A highly portable, fast, safe and affordable imaging system that provides interpretable images of brain function in full- and pre-term neonates within a few seconds has been applied to neonates with normal and pathological states. We have used a uniquely sensitive optical tomography system, termed phased array, which has revealed significant functional responses, particularly to parietal stimulation in neonate brain. This system can indicate the blood concentration and oxygenation change during the parietal brain activation in full- and pre-term neonates. The preliminary clinical results, especially a longitudinal study of a cardiac arrest neonate, suggest a variety of future applications.

  11. 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.

  12. Strategy for the Management of Diabetic Macular Edema: The European Vitreo-Retinal Society Macular Edema Study

    Directory of Open Access Journals (Sweden)

    Ron Adelman

    2015-01-01

    Full Text Available Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME. Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s performed, the pre- and posttreatment visual acuities, and other clinical findings. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies. Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results. The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatment with threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies.

  13. Neonatal sulfur amino acid metabolism

    NARCIS (Netherlands)

    M.A. Riedijk (Maaike)

    2008-01-01

    textabstractAt birth, infants can be classified either by gestational age (GA) or by weight. Neonates born < 37 weeks are classified as preterm, < 28 weeks as very preterm and < 26 weeks as extremely preterm infants. Prematurely born infants can also be classified by birth weight as follows (1): - L

  14. Pathophysiology of Equine Neonatal Septicemia

    Directory of Open Access Journals (Sweden)

    Juan Carlos Ospina Chirivi

    2014-07-01

    Full Text Available Neonatal septicemia is a major cause of mortality and morbidity in horses in their first seven days of life and within their pathophysiology. It is important to consider the extrinsic and intrinsic predisposing factors which make foals susceptible to agents of primarily bacterial etiology. However, other types of infectious etiology (viruses and fungi should be considered too, as well as noninfectious etiologies. The paper mentions a wide variety of mechanisms that produce different injuries that must be addressed with measures of critical neonatal care, so it is imperative for the veterinarian to know the pathogenic mechanisms of the disease, its clinical presentation and anatomo-pathological lesions. Thus, systemic inflammatory response syndrome (SIRS, multiple organ dysfunction syndrome (MODS, and peripheral circulatory collapse or shock are some of the elements defined as the pillars of the pathophysiology of neonatal septicemia, extensively studied in equine medicine. This paper presents a short review of the triggering mechanisms of neonatal septicemia highlighting the importance of epidemiological investigations in Colombia. It shows the need for retrospective and prospective studies and for divulgation of some of the preventive measures of the disease in horses.

  15. Dynorphin A(6-12) analogs suppress thermal edema.

    Science.gov (United States)

    Wei, E T; Thomas, H A; Gjerde, E A; Reed, R K; Burov, S V; Korolkov, V I; Glynskaya, O V; Dorosh, M Y; Vlasov, G P

    1998-01-01

    Dynorphin A (Dyn A) is a 17-residue opioid peptide derived from prodynorphin precursors found in mammalian tissues. Removal of Tyr1 from Dyn A produces a peptide that is more potent than Dyn A in attenuating the acute phase of the inflammatory response, as measured by inhibition of heat-induced edema in the anesthetized rat's paw (exposure to 58 degrees C water for 1 min). Dyn A(2-17), however, no longer interacts with opioid receptors. It was postulated that the non-opioid anti-inflammatory actions of Dyn A(2-17) may reside in Dyn A(6-12); that is, Arg-Arg-Ile-Arg-Pro-Lys-Leu. here we report on the activities of Dyn A(6-12) analogs modified by substitutions on the N terminus, by single N-methyl substitution and by single replacement of residues by alanine. The results indicated that the minimal sequence required for an anti-edema ED50 of <1.0 micromol/kg i.v. was anisoyl-Arg6-Arg7-Xaa8-Arg9-Pro10)-Xaa11-+ ++Xaa12-NH2. A prototype, p-anisoyl-[D-Leu12] Dyn A(6-12)-NH2, with an ED50 of 0.20 micromol/kg i.v. compared to an ED50 of 0.08 micromol/kg i.v. for Dyn A(2-17), was selected for further tests of biological activity. This analog, like Dyn A(2-17), lowered blood pressure in anesthetized rats. In a model of neurogenic inflammation, produced by antidromic stimulation of the vagus in the anesthetized rat, p-anisoyl-[D-Leu12] Dyn A(6-12)-NH2, 0.23 micromol/kg i.v., attenuated the negativity of tracheal tissue interstitial pressure (Pif), which normally develops after nerve stimulation. Modulation of interstitial pressure may be the mechanistic basis for the anti-edema properties of these Dyn A(6-12) analogs.

  16. 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.

  17. Dexamethasone intravitreal implant in the treatment of diabetic macular edema.

    Science.gov (United States)

    Dugel, Pravin U; Bandello, Francesco; Loewenstein, Anat

    2015-01-01

    Diabetic macular edema (DME) resembles a chronic, low-grade inflammatory reaction, and is characterized by blood-retinal barrier (BRB) breakdown and retinal capillary leakage. Corticosteroids are of therapeutic benefit because of their anti-inflammatory, antiangiogenic, and BRB-stabilizing properties. Delivery modes include periocular and intravitreal (via pars plana) injection. To offset the short intravitreal half-life of corticosteroid solutions (~3 hours) and the need for frequent intravitreal injections, sustained-release intravitreal corticosteroid implants have been developed. Dexamethasone intravitreal implant provides retinal drug delivery for ≤6 months and recently has been approved for use in the treatment of DME. Pooled findings (n=1,048) from two large-scale, randomized Phase III trials indicated that dexamethasone intravitreal implant (0.35 mg and 0.7 mg) administered at ≥6-month intervals produced sustained improvements in best-corrected visual acuity (BCVA) and macular edema. Significantly more patients showed a ≥15-letter gain in BCVA at 3 years with dexamethasone intravitreal implant 0.35 mg and 0.7 mg than with sham injection (18.4% and 22.2% vs 12.0%). Anatomical assessments showed rapid and sustained reductions in macular edema and slowing of retinopathy progression. Phase II study findings suggest that dexamethasone intravitreal implant is effective in focal, cystoid, and diffuse DME, in vitrectomized eyes, and in combination with laser therapy. Ocular complications of dexamethasone intravitreal implant in Phase III trials included cataract-related events (66.0% in phakic patients), intraocular pressure elevation ≥25 mmHg (29.7%), conjunctival hemorrhage (23.5%), vitreous hemorrhage (10.0%), macular fibrosis (8.3%), conjunctival hyperemia (7.2%), eye pain (6.1%), vitreous detachment (5.8%), and dry eye (5.8%); injection-related complications (eg, retinal tear/detachment, vitreous loss, endophthalmitis) were infrequent (implant offers a

  18. 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.

  19. Massive vulval edema with severe preeclampsia. Case report Edema vulvar masivo con preeclampsia grave. Presentación de un caso.

    OpenAIRE

    José Luis Gómez Miranda.; José Luis Durán Páez; Nelson Pérez Rumbaut

    2009-01-01

    Massive vulval edema with severe preeclampsia is presented as one of the consequences that may appear on patients with hypertension disorders during pregnancy, therefore the attention in the Obstetrics and Gynecology Service must be systematical and permanent. On women with hypertensive disorders during pregnancy, although edemas may not be constant, they may either appear at minor, barely perceptible extents, or even in the most severe ways, such as anasarca. A very peculiar manifestation of...

  20. 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.

  1. Neonatal hyperglycemia induces oxidative stress in the rat brain: the role of pentose phosphate pathway enzymes and NADPH oxidase.

    Science.gov (United States)

    Rosa, Andrea Pereira; Jacques, Carlos Eduardo Dias; de Souza, Laila Oliveira; Bitencourt, Fernanda; Mazzola, Priscila Nicolao; Coelho, Juliana Gonzales; Mescka, Caroline Paula; Dutra-Filho, Carlos Severo

    2015-05-01

    Recently, the consequences of diabetes on the central nervous system (CNS) have received great attention. However, the mechanisms by which hyperglycemia affects the central nervous system remain poorly understood. In addition, recent studies have shown that hyperglycemia induces oxidative damage in the adult rat brain. In this regard, no study has assessed oxidative stress as a possible mechanism that affects the brain normal function in neonatal hyperglycemic rats. Thus, the present study aimed to investigate whether neonatal hyperglycemia elicits oxidative stress in the brain of neonate rats subjected to a streptozotocin-induced neonatal hyperglycemia model (5-day-old rats). The activities of glucose-6-phosphate-dehydrogenase (G6PD), 6-phosphogluconate-dehydrogenase (6-PGD), NADPH oxidase (Nox), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx), the production of superoxide anion, the thiobarbituric acid-reactive substances (TBA-RS), and the protein carbonyl content were measured. Neonatal hyperglycemic rats presented increased activities of G6PD, 6PGD, and Nox, which altogether may be responsible for the enhanced production of superoxide radical anion that was observed. The enhanced antioxidant enzyme activities (SOD, CAT, and GSHPx) that were observed in neonatal hyperglycemic rats, which may be caused by a rebound effect of oxidative stress, were not able to hinder the observed lipid peroxidation (TBA-RS) and protein damage in the brain. Consequently, these results suggest that oxidative stress could represent a mechanism that explains the harmful effects of neonatal hyperglycemia on the CNS.

  2. Prevention and treatment of neonatal nosocomial infections.

    Science.gov (United States)

    Ramasethu, Jayashree

    2017-01-01

    Nosocomial or hospital acquired infections threaten the survival and neurodevelopmental outcomes of infants admitted to the neonatal intensive care unit, and increase cost of care. Premature infants are particularly vulnerable since they often undergo invasive procedures and are dependent on central catheters to deliver nutrition and on ventilators for respiratory support. Prevention of nosocomial infection is a critical patient safety imperative, and invariably requires a multidisciplinary approach. There are no short cuts. Hand hygiene before and after patient contact is the most important measure, and yet, compliance with this simple measure can be unsatisfactory. Alcohol based hand sanitizer is effective against many microorganisms and is efficient, compared to plain or antiseptic containing soaps. The use of maternal breast milk is another inexpensive and simple measure to reduce infection rates. Efforts to replicate the anti-infectious properties of maternal breast milk by the use of probiotics, prebiotics, and synbiotics have met with variable success, and there are ongoing trials of lactoferrin, an iron binding whey protein present in large quantities in colostrum. Attempts to boost the immunoglobulin levels of preterm infants with exogenous immunoglobulins have not been shown to reduce nosocomial infections significantly. Over the last decade, improvements in the incidence of catheter-related infections have been achieved, with meticulous attention to every detail from insertion to maintenance, with some centers reporting zero rates for such infections. Other nosocomial infections like ventilator acquired pneumonia and staphylococcus aureus infection remain problematic, and outbreaks with multidrug resistant organisms continue to have disastrous consequences. Management of infections is based on the profile of microorganisms in the neonatal unit and community and targeted therapy is required to control the disease without leading to the development of more

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. [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.

  10. Topical ethosomal capsaicin attenuates edema and nociception in arthritic rats.

    Science.gov (United States)

    Kumar Sarwa, Khomendra; Rudrapal, Mithun; Mazumder, Bhaskar

    2015-12-01

    In this study, topical ethosomal formulation of capsaicin was prepared and evaluated for bio-efficacy in arthritic rats. Physical and biological characterizations of prepared capsaicin-loaded nano vesicular systems were also carried out. Ethosomal capsaicin showed significant reduction of rat paw edema along with promising antinociceptive action. The topical antiarthritic efficacy of prepared formulation of capsaicin was found more than that of Thermagel, a marketed gel of capsaicin. From toxicological study, no predictable signs of toxicity such as skin irritation (of experimental rats) were observed. Based on this finding, ethosomal capsaicin could be proposed as an effective as well as a safe topical delivery system for the long-term treatment of arthritis and associated inflammo-musculoskeletal disorders. Such exciting result would eventually enlighten the analgesic and anti-inflammatory potential of capsaicin for topical remedy.

  11. Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite

    Directory of Open Access Journals (Sweden)

    José Maria Pereira de Godoy, Maria de Fátima Guerreiro de Godoy

    2011-01-01

    Full Text Available The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema.Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years 41 (50.0% were diagnosed with idiopathic cyclic edema.Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

  12. Evaluation of the prevalence of concomitant idiopathic cyclic edema and cellulite.

    Science.gov (United States)

    de Godoy, José Maria Pereira; de Godoy, Maria de Fátima Guerreiro

    2011-01-01

    The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

  13. Persistent corneal edema secondary to presumed dead adult filarial worm in the anterior chamber

    Directory of Open Access Journals (Sweden)

    Basak Samar

    2007-01-01

    Full Text Available We present three cases of persistent corneal edema secondary to presumed dead adult filarial worms lying in the anterior chamber with their attachment to the endothelium. Two of them were initially diagnosed as descemet′s fold with corneal edema. Two patients underwent penetrating keratoplasty and in one case, surgical removal was partly possible with clearing of cornea.

  14. 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.

  15. 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.

  16. 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.

  17. Necrosis de médula espinal, edema cerebral y glioblastoma

    OpenAIRE

    Iglesias Rozas, José Rafael, 1942-

    1987-01-01

    Cinco imágenes de una necrosis de la médula espinal, un edema cerebral y un glioblastoma en una paciente de 76 años. Five pictures of a spinal cord necrosis, a cerebral edema and a glioblastoma in a 76-year-old female patient.

  18. 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 ...

  19. Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials.

    Science.gov (United States)

    Stout, N; Partsch, H; Szolnoky, G; Forner-Cordero, I; Mosti, G; Mortimer, P; Flour, M; Damstra, R; Piller, N; Geyer, M J; Benigni, J-P; Moffat, C; Cornu-Thenard, A; Schingale, F; Clark, M; Chauveau, M

    2012-08-01

    Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

  20. Mechanisms of edema formation in myxedema--increased protein extravasation and relatively slow lymphatic drainage

    DEFF Research Database (Denmark)

    Parving, H H; Hansen, J M; Nielsen, S L;

    1979-01-01

    of generalized edema (P less than 0.05). All variables returned to normal during l-thyroxine treatment. The extravascular accumulation of albumin, and presumably of all other plasma proteins, is important in the generalized edema typically found in myxedema. Inadequate lymphatic drainage may also explain...

  1. 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.

  2. 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

  3. 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.

  4. Study of various congenital anomalies in fetal and neonatal autopsy

    Directory of Open Access Journals (Sweden)

    V. Siva Sankara Naik

    2015-05-01

    neonatal deaths. In a total of 46 fetuses, there were 13 male and 33 female babies. On external examination of 46 fetal and Neonatal (perinatal deaths, 8 (17.39% babies showed congenital malformation. On internal examination of the 46 fetal and Neonatal (perinatal deaths, 4 babies showed internal congenital anomalies. A total of 46 anatomical and histopathologic examinations were done among fetal and neonatal (perinatal deaths. Out of 13 autopsies on male babies, 2 had congenital malformation and 33 autopsies on female babies, 7 had congenital malformations. Congenital anomalies were commonest in the birth weight group of 1000-1500 grams accounting for 9 cases. Malformations of central nervous system (33.33% were most common followed by musculoskeletal system (16.66%, genitourinary and respiratory system (8.33% respectively. Conclusion: Most number of perinatal deaths occurred in low birth weight and preterm babies. Study of malformations greatly helpful in genetic counseling and prenatal diagnosis in successive pregnancies. [Int J Res Med Sci 2015; 3(5.000: 1114-1121

  5. Posterior Lumbar Subcutaneous Edema on Spine Magnetic Resonance Images: What Is the Cause?

    Energy Technology Data Exchange (ETDEWEB)

    Han, Ga Jin; Lee, In Sook; Han, In Ho; Lee, Jung Sub [Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Moon, Tae Yong [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Song, Jong Woon [Dept. of Radiology, Inje University Haeundae Paik Hospital, Busan (Korea, Republic of)

    2013-04-15

    Posterior lumbar subcutaneous (PLS) edema on spine magnetic resonance (MR) images is a common incidental, though neglected finding. This study was undertaken to investigate the relations between PLS edema and pathologic conditions. Between January and December 2009, 138 patients with PLS edema, but without a spinal tumor or a history of recent surgery or trauma, and 80 infectious spondylitis patients without PLS edema were enrolled in this retrospective study. Available medical records and lumbar spine MR images were evaluated. The degree of edema was quantified using an arbitrary scoring system. Further, the correlations between the degree of edema and age, sex, body mass index (BMI), degeneration of posterior spinal structures (PSS) and infectious spondylitis were analyzed. Of the 93 cases with a calculable BMI, 61 (66%) had a BMI of > 23 kg/m2. Correlations between the degree of edema and sex, age and BMI grade were all statistically non-significant. Thirty-three cases (24%) had an underlying disease, such as heart problem, diabetes mellitus, liver cirrhosis, chronic renal failure, extra-spinal tumor or connective tissue disorder. The numbers of cases with infectious spondylitis and an idiopathic condition was 61 (44%) and 44 (32%), respectively. The grade of infectious spondylitis was not found to be significantly associated with the degree of edema (p = 0.084). In cases with an idiopathic condition, the correlation between the degree of edema and PSS degeneration was statistically significant (p = 0.042). Radiologists should not disregard PLS edema, because it is related to an underlying disease and thus may be of clinical significance.

  6. Effect of Decompressive Craniectomy on Perihematomal Edema in Patients with Intracerebral Hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christian Fung

    Full Text Available Perihematomal edema contributes to secondary brain injury in the course of intracerebral hemorrhage. The effect of decompressive surgery on perihematomal edema after intracerebral hemorrhage is unknown. This study analyzed the course of PHE in patients who were or were not treated with decompressive craniectomy.More than 100 computed tomography images from our published cohort of 25 patients were evaluated retrospectively at two university hospitals in Switzerland. Computed tomography scans covered the time from admission until day 100. Eleven patients were treated by decompressive craniectomy and 14 were treated conservatively. Absolute edema and hematoma volumes were assessed using 3-dimensional volumetric measurements. Relative edema volumes were calculated based on maximal hematoma volume.Absolute perihematomal edema increased from 42.9 ml to 125.6 ml (192.8% after 21 days in the decompressive craniectomy group, versus 50.4 ml to 67.2 ml (33.3% in the control group (Δ at day 21 = 58.4 ml, p = 0.031. Peak edema developed on days 25 and 35 in patients with decompressive craniectomy and controls respectively, and it took about 60 days for the edema to decline to baseline in both groups. Eight patients (73% in the decompressive craniectomy group and 6 patients (43% in the control group had a good outcome (modified Rankin Scale score 0 to 4 at 6 months (P = 0.23.Decompressive craniectomy is associated with a significant increase in perihematomal edema compared to patients who have been treated conservatively. Perihematomal edema itself lasts about 60 days if it is not treated, but decompressive craniectomy ameliorates the mass effect exerted by the intracerebral hemorrhage plus the perihematomal edema, as reflected by the reduced midline shift.

  7. Involvement of COX2-thromboxane pathway in TCDD-induced precardiac edema in developing zebrafish.

    Science.gov (United States)

    Teraoka, Hiroki; Okuno, Yuki; Nijoukubo, Daisuke; Yamakoshi, Ayumi; Peterson, Richard E; Stegeman, John J; Kitazawa, Takio; Hiraga, Takeo; Kubota, Akira

    2014-09-01

    The cardiovascular system is one of the most characteristic and important targets for developmental toxicity by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in fish larvae. However, knowledge of the mechanism of TCDD-induced edema after heterodimerization of aryl hydrocarbon receptor type 2 (AHR2) and AHR nuclear translocator type 1 (ARNT1) is still limited. In the present study, microscopic analysis with a high-speed camera revealed that TCDD increased the size of a small cavity between the heart and body wall in early eleutheroembryos, a toxic effect that we designate as precardiac edema. A concentration-response curve for precardiac edema at 2 days post fertilization (dpf) showed close similarity to that for conventional pericardial edema at 3 dpf. Precardiac edema caused by TCDD was reduced by morpholino knockdown of AHR2 and ARNT1, as well as by an antioxidant (ascorbic acid). A selective inhibitor of cyclooxygenase type 2 (COX2), NS398, also markedly inhibited TCDD-induced precardiac edema. A thromboxane receptor (TP) antagonist, ICI-192,605 almost abolished TCDD-induced precardiac edema and this effect was canceled by U46619, a TP agonist, which was not influential in the action of TCDD by itself. Knockdown of COX2b and thromboxane A synthase 1 (TBXS), but not COX2a, strongly reduced TCDD-induced precardiac edema. Knockdown of COX2b was without effect on mesencephalic circulation failure caused by TCDD. The edema by TCDD was also inhibited by knockdown of c-mpl, a thrombopoietin receptor necessary for thromobocyte production. Finally, induction of COX2b, but not COX2a, by TCDD was seen in eleutheroembryos at 3 dpf. These results suggest a role of the COX2b-thromboxane pathway in precardiac edema formation following TCDD exposure in developing zebrafish.

  8. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    Science.gov (United States)

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases.

  9. Nosocomial infection in a Danish Neonatal Intensive Care Unit: a prospective study

    DEFF Research Database (Denmark)

    Olsen, Anne L; Reinholdt, Jes; Jensen, Anders Mørup

    2009-01-01

    and respiratory tract infection, and central venous catheter and parenteral nutrition risk factors for first time blood stream infection. CONCLUSION: This first prospective study of nosocomial infection in a Danish Neonatal Intensive Care Unit found an overall incidence of 8.8/1000 hospital days, which is low...

  10. Early Pain, Beware the Brain! Long-term effects of neonatal pain experiences

    NARCIS (Netherlands)

    R.H.J.A. Schouw (Renata)

    2006-01-01

    textabstractThe past twenty years have seen great progress in our knowledge of paediatric pain. Especially our understanding of neonatal pain processing and neurobehavioral development has much deepened. Today, the human central nervous system (CNS) is generally acknowledged to be very immature a

  11. Peripheral effect of NMDA receptor antagonists on adult rats exposed to neonatal colon pain

    Institute of Scientific and Technical Information of China (English)

    ChunLin; ElieD.Al-Chaer

    2004-01-01

    AIM: Previous work done by Al-Chaer' s lab has shown that colon irritation (CI) in neonates can lead to chronic visceral hypersensitivity in adult rats, with characteristics of visceral allodynia and hyperalgesia, associated with central neuronal sensitization in the absence of identifiable peripheral pathology (Al-Chaer et al. 2000) . The pathogenesis of

  12. 45 CFR 46.205 - Research involving neonates.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Research involving neonates. 46.205 Section 46.205... SUBJECTS Additional Protections for Pregnant Women, Human Fetuses and Neonates Involved in Research § 46.205 Research involving neonates. (a) Neonates of uncertain viability and nonviable neonates may...

  13. Epidemiology of early neonatal mortality.

    Science.gov (United States)

    Tyagi, N K; Bharambe, M S; Garg, B S; Mathur, J S; Goswami, K

    1994-01-01

    During 1981-1991 at a rural teaching hospital (Kasturba Hospital) of Mahatma Gandhi Institute of Medical Sciences in Sevagram, Wardha, India, 454 of 13,939 newborns died during the early neonatal period for an early neonatal mortality rate (ENMR) of 33.7/1000 live births. The ENMR for boys was not significantly different from that for girls (36.1 vs. 28.6). Community medicine specialists analyzed data on these early neonatal deaths to examine distribution of early neonatal mortality, especially its relationship with prematurity, low birth weight, birth order, and by sex. They calculated average percent deaths (APD) per hour to examine the dynamics in early neonatal mortality. The mean age at death was lower among newborns of birth order greater than 2 than those of birth order less than 2 (23.47 vs. 26.85 hours; p 0.001). ENMR was higher for newborns of birth order greater than 2 than those of birth order less than 2 (41.74% vs. 27.35%; P 0.001). The mean age at death increased as gestation increased (10.34 for 28 weeks; 24.27 for 28-33 weeks, 31.53 for 33-37 weeks, and 34.43 for 37 weeks; p 0.001). ENMR decreased as gestation increased (850 for 28 weeks; 375 for 28-33 weeks, 147.02 for 33-37 weeks, and 8.77 for 37 weeks; p 0.001). The mean age at death increased as birth weight increased for newborns weighing less than 1500 gms through 2000-2500 gms (23.36-37.13 hours; p 0.001). It was lowest among those weighing more 3000 gms (11.55 gms). ENMR fell as birth weight increased (614.33 for 1500 gms, 116.19 for 1500-2000 gms, 19.38 for 2000-2500 gms, 10.99 for 2500-3000 gms, and 5.41 for 3000 gms; p 0.001). The APD/hour for the first hour of life was 3.74% for a relative risk of 12.9. It decreased steadily as the hours of life increased (3.08% for 1-6 hours, 1.19% for 6-24 hours, 0.67% for 24-72 hours, and 0.29% for 72-168 hours). Knowledge of time of likely death can help providers know where they need to focus their attention to prevent early neonatal deaths.

  14. 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.

  15. Intravitreal bevacizumab injections for diabetic macular edema – predictors of response: a retrospective study

    Science.gov (United States)

    Joshi, Lavnish; Bar, Asaf; Tomkins-Netzer, Oren; Yaganti, Satish; Morarji, Jiten; Vouzounis, Panayiotis; Seguin-Greenstein, Sophie; Taylor, Simon R; Lightman, Sue

    2016-01-01

    Background Outcomes of intravitreal antivascular endothelial growth factor injections are variable among patients with diabetic macular edema (DME). The aim of this study was to determine the ocular and systemic predictors of DME response to intravitreal bevacizumab (IVB). Methods Retrospective review over 2 years of 78 eyes from 54 patients. An anatomical response to IVB was defined as a 20% reduction in central macula thickness after the first course (three injections) of IVB. Results Twenty-eight percent of patients had an anatomical response after the first course of IVB. Systemic hypertension (odds ratio, 95% confidence interval: 12.1, 0.7–21) was a statistically significant predictor (P=0.025) of a good response to IVB, whereas previous macular laser was a statistically significant (P=0.0005) predictor of a poor response (0.07, 0.01–0.32). Sixty-eight percent of eyes underwent subsequent treatment for DME after the first course of IVB. The visual acuity gain at 24 months in hypertensive (0.7±3.6 letters) and nonhypertensive (5.2±3.7 letters) patients was not significantly different (P=0.41). Conclusion Hypertension and previous macular laser were positive and negative predictors of response to IVB, respectively. However, long-term visual acuity changes were not significantly different between eyes with and without systemic hypertension. PMID:27799737

  16. Prevalence of Low Birth Weight and Obesity in Central Iran

    Science.gov (United States)

    Rafiei, M.; Ayatollahi, S. M. T.

    2008-01-01

    To estimate the prevalence of low birth weight (LBW) and to document distribution of body mass index (BMI) at birth in Arak (central Iran) neonates of the 10,241 live neonates (5241 boys, 5000 girls, sex ratio 105) born in 2004 in Arak. A birth weight of less than 2500 g was classified as LBW. BMI based on the original supine length and weight…

  17. Neonatal Imitation in Context: Sensory-Motor Development in the Perinatal Period.

    Science.gov (United States)

    Keven, Nazim; Akins, Kathleen A

    2016-07-14

    Over 35 years ago, Meltzoff and Moore (1977) published their famous article 'Imitation of facial and manual gestures by human neonates'. Their central conclusion, that neonates can imitate, was and continues to be controversial. Here we focus on an often neglected aspect of this debate, namely on neonatal spontaneous behaviors themselves. We present a case study of a paradigmatic orofacial 'gesture', namely tongue protrusion and retraction (TP/R). Against the background of new research on mammalian aerodigestive development, we ask: How does the human aerodigestive system develop and what role does TP/R play in the neonate's emerging system of aerodigestion? We show that mammalian aerodigestion develops in two phases: (1) from the onset of isolated orofacial movements in utero to the post-natal mastery of suckling at 4 months after birth, and; (2) thereafter, from preparation to the mastery of mastication and deglutition of solid foods. Like other orofacial stereotypies, TP/R emerges in the first phase and vanishes prior to the second. Based upon recent advances in activity-driven early neural development, we suggest a sequence of three developmental events in which TP/R might participate: the acquisition of tongue control, the integration of the central pattern generator for TP/R with other aerodigestive CPGs, and the formation of connections within the cortical maps of S1 and M1. If correct, orofacial stereotypies are crucial to the maturation of aerodigestion in the neonatal period but also unlikely to co-occur with imitative behavior.

  18. Neonatal epilepsy and underlying aetiology: to what extent do seizures and EEG abnormalities influence outcome?

    Science.gov (United States)

    Ramantani, Georgia

    2013-12-01

    Neonatal seizures constitute the most common and distinctive sign of neurological dysfunction in the first weeks of life and reflect a wide variety of underlying central nervous system disorders. Acute symptomatic seizures occur more often during the neonatal period than at any period of life and are associated with adverse long-term neurodevelopmental sequelae and an increased risk of post-neonatal epilepsy. The improvements of neonatal care in the last decades have changed the spectrum of insults to which the immature brain is exposed and facilitated a decrease in mortality of newborns with seizures. However, the prevalence of long-term morbidity in survivors remains unchanged. Whereas aetiology is presumed to be the main predictor of long-term outcome in neonates with seizures, there is converging evidence that specific electroencephalographic (EEG) abnormalities are related to unfavourable outcomes. Interictal EEG abnormalities, especially concerning background activity patterns, thus constitute a major indicator of disease severity and predictor of outcome, while the added value of sequential EEG assessments is so far controversial. Moreover, experimental as well as clinical studies of hypoxic-ischaemic encephalopathy support the notion that recurrent seizures may amplify injury to the developing brain beyond that associated with the underlying aetiology, thus justifying antiepileptic drug treatment. To date, unresolved issues in seizure detection and classification, in addition to the significant variation in gestational ages and brain insults of neonates, still impede clinical research of neonatal seizures. The wider use of long-term EEG or amplitude integrated EEG monitoring may prove crucial for timely neonatal seizure identification and treatment initiation, and thus ultimately improve outcome.

  19. Candida parapsilosis candidaemia in a neonatal unit over 7 years: a case series study

    Science.gov (United States)

    Miranda, Lourdes das Neves; Rodrigues, Eliete C A; Costa, Silvia F; van der Heijden, Inneke Marie; Dantas, Kátia C; Lobo, Renata D; Basso, Mariusa; Varkulja, Gláucia F; Krebs, Vera Lúcia Jornada; Gibelli, Maria Augusta Bento Cicaroni; Criado, Paulo R; Levin, Anna Sara

    2012-01-01

    Objective To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. Design Case series study. Setting A 2000-bed tertiary-care university hospital at São Paulo, Brazil. Participants Neonates hospitalised in a 63-bed neonatal unit. Primary and secondary outcome measures We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing. Results During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates. Conclusions The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA. PMID:22869093

  20. Simultaneous occurrence of fetal and neonatal alloimmune thrombocytopenia and neonatal neutropenia due to maternal neutrophilic autoantibodies

    DEFF Research Database (Denmark)

    Taaning, Ellen; Jensen, Lise; Varming, Kim

    2012-01-01

    Foetal and neonatal alloimmune thrombocytopenia (FNAIT) and neonatal neutropenia caused by maternal autoantibodies against neutrophils are rare disorders. We describe a newborn with severe thrombocytopenia and intracerebral bleeding caused by maternal anti-HPA-3a alloantibodies and mild neutropenia...

  1. Treatment Effects on Neonatal EEG.

    Science.gov (United States)

    Obeid, Rawad; Tsuchida, Tammy N

    2016-10-01

    Conventional EEG and amplitude-integrated electroencephalography are used in neonates to assess prognosis and significant changes in brain activity. Neuroactive medications and hypothermia can influence brain activity and therefore alter EEG interpretation. There are limited studies on the effect of these therapies on neonatal EEG background activity. Medication effects on the EEG or amplitude-integrated electroencephalography include increased interburst interval duration, voltage suppression, and sleep disruption. The effect is transient in term newborns but can be persistent in premature newborns. Although therapeutic hypothermia does not produce significant changes in EEG activity, it does change the time point at which EEG can accurately predict neurodevelopmental outcome. It is important to account for these effects on the EEG to avoid inaccurate interpretation that may affect prognostication.

  2. Neonatal pustular dermatosis: An overview

    Directory of Open Access Journals (Sweden)

    Sangita Ghosh

    2015-01-01

    Full Text Available Neonatal pustular eruption is a group of disorders characterized by various forms of pustulosis seen in first 4 weeks of life. Its presentation is often similar with some subtle differences, which can be further established by few simple laboratory aids, to arrive at a definite diagnosis. Given their ubiquitous presentation, it is sometimes difficult to differentiate among self-limiting, noninfectious, pustular dermatosis such as erythema toxicum neonatorum, transient neonatal pustular melanosis, miliaria pustulosa, etc., and potentially life threatening infections such as herpes simplex virus and varicella zoster virus infections. This review article tries to address the chronological, clinical, morphological, and histological differences among the various pustular eruptions in a newborn, in order to make it easier for a practicing dermatologist to diagnose and treat these similar looking but different entities of pustulation with a clear demarcation between the physiological benign pustular rashes and the infectious pustular lesions.

  3. EEG in the neonatal unit.

    Science.gov (United States)

    Lamblin, M D; de Villepin-Touzery, A

    2015-03-01

    The execution and interpretation of neonatal EEG adheres to strict and specific criteria related to this very early age. In preterm newborns, the dedicated healthcare staff needs to respect EEG indications and chronology of EEG recordings in order to diagnose and manage various pathologies, and use EEG in addition to cerebral imaging. EEG analysis focuses on a global vision of the recording according to the neonate's state of alertness and various age-related patterns. Monitoring of continuous conventional EEG and simplified EEG signal processing can help screen for seizures and monitor the effect of antiepileptic treatment, as well as appreciating changes in EEG background activity, for diagnostic and prognostic purposes. EEG reports should be highly explanatory to meet the expectations of the physician's clinical request.

  4. Maternal Preeclampsia and Neonatal Outcomes

    Directory of Open Access Journals (Sweden)

    Carl H. Backes

    2011-01-01

    Full Text Available Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.

  5. Neonatal Infrared Thermography Image Processing

    OpenAIRE

    Bayo Catalan, Lluis

    2009-01-01

    Tesina feta en col.laboració amb RWTH Aachen The temperature changes inside incubator a ect the newborns, who are the most delicate patients. The project proposes an innovative method to monitor the skin temperature of the neonates. The temperature monitoring is carried out by a virtual sensor. This virtual sensor is based in an infrared thermal camera that is placed outside the incubator. In order to obtain the infrared radiation through the incubator Plexiglas, an infrared tr...

  6. Pain Perception in the Neonate

    OpenAIRE

    1989-01-01

    Pain expression in both pre-term and term infants is a little understood phenomenon. Recent research has generated data documenting that the newborn can feel pain, can act to avoid the pain, and may form memory traces of the experience. ”Nociceptive activity” or ”noxious stimuli” are better terms to use when addressing aversive stimulation of the neonate because they encourage scrutiny of the behavioural and physiologic responses of the newborn without placing emphasis on the emotional and su...

  7. Rare neonatal diabetes insipidus and associated late risks: Case report

    Directory of Open Access Journals (Sweden)

    Rivas-Crespo Maximiliano

    2012-05-01

    Full Text Available Abstract Background Most cases of neonatal central diabetes insipidus are caused by an injury, which often results in other handicaps in the patient. The infant’s prognosis will be determined by his or her own early age and disability as well as by the physician’s skill. However, the rarity of this condition prevents the acquisition of personal experience dealing with it. Case Presentation A neonatal hemorrhagic stroke, caused by an aortic coarctation, caused right lower limb paresis, swallowing disability, and central diabetes insipidus in a term infant. The scant oral intake, as a consequence of his disability, caused progressive undernutrition which closed a vicious circle, delaying his development and his ability to overcome the swallowing handicap. On the other hand, nasal desmopressin absorption was blocked by several common colds, resulting in brain bleeding because of severe dehydration. This even greater brain damage hampered the improvement of swallowing, closing a second harmful circle. Moreover, a devastating central myelinolysis with quadriplegia, caused by an uncontrolled intravenous infusion, consummated a pernicious sequence, possibly unreported. Conclusions The child’s overall development advanced rapidly when his nutrition was improved by gastrostomy: This was a key effect of nutrition on his highly sensitive neurodevelopment. Besides, this case shows potential risks related to intranasal desmopressin treatment in young children.

  8. Subclavian Vein Cannulation Success Rate in Neonates and Children

    Science.gov (United States)

    Aminnejad, Reza; Razavi, Seyed Sajjad; Mohajerani, Seyed Amir; Mahdavi, Seyed Alireza

    2015-01-01

    Background: Central vein cannulation allows the administration of large volumes of fluids in short times and at high osmolarities for rehydration, volume replacement, chemotherapy, and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short-term venous access in children. Objectives: The aim of our study was to delineate some aspects of this procedure as well as its success rate and relative risk in pediatrics. Patients and Methods: Totally, 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful catheterization attempts and early complication rates after the procedure retrospectively in Mofid Hospital (Tehran, Iran). Results: There were 1340 newborn patients (first 28 days of life) in our study population. In these newborns, only 55 cannulations failed; one patient was complicated with pneumothorax; guide wires malfunctioned in 21 cases; and first- attempt cannulation success was reported in only 981 cases. In the remaining 1924 patients, between one month and 8 years old, only 14 attempts at the cannulation of the subclavian vein failed and 1655 cases had first-attempt cannulation success. Conclusions: The cannulation of the central vein in neonates and children in a skilled hand would be performed with great success rate and low complications. PMID:26161322

  9. RISK FACTORS IN NEONATAL ANAEROBIC INFECTIONS

    Directory of Open Access Journals (Sweden)

    M. S. Tabib

    2008-06-01

    Full Text Available Anaerobic bacteria are well known causes of sepsis in adults but there are few studies regarding their role in neonatal sepsis. In an attempt to define the incidence of neonatal anaerobic infections a prospective study was performed during one year period. A total number of 400 neonates under sepsis study were entered this investigation. Anaerobic as well as aerobic cultures were sent. The patients were subjected to comparison in two groups: anaerobic culture positive and anaerobic culture negative and this comparison were analyzed statistically. There were 7 neonates with positive anaerobic culture and 35 neonates with positive aerobic culture. A significant statistical relationship was found between anaerobic infections and abdominal distention and pneumonia. It is recommended for those neonates with abdominal distention and pneumonia refractory to antibiotic treatment to be started on antibiotics with anaerobic coverage.

  10. Which biomarkers reveal neonatal sepsis?

    Directory of Open Access Journals (Sweden)

    Kun Wang

    Full Text Available We address the identification of optimal biomarkers for the rapid diagnosis of neonatal sepsis. We employ both canonical correlation analysis (CCA and sparse support vector machine (SSVM classifiers to select the best subset of biomarkers from a large hematological data set collected from infants with suspected sepsis from Yale-New Haven Hospital's Neonatal Intensive Care Unit (NICU. CCA is used to select sets of biomarkers of increasing size that are most highly correlated with infection. The effectiveness of these biomarkers is then validated by constructing a sparse support vector machine diagnostic classifier. We find that the following set of five biomarkers capture the essential diagnostic information (in order of importance: Bands, Platelets, neutrophil CD64, White Blood Cells, and Segs. Further, the diagnostic performance of the optimal set of biomarkers is significantly higher than that of isolated individual biomarkers. These results suggest an enhanced sepsis scoring system for neonatal sepsis that includes these five biomarkers. We demonstrate the robustness of our analysis by comparing CCA with the Forward Selection method and SSVM with LASSO Logistic Regression.

  11. The interplay between drugs and the kidney in premature neonates.

    Science.gov (United States)

    Schreuder, Michiel F; Bueters, Ruud R G; Allegaert, Karel

    2014-11-01

    The kidney plays a central role in the clearance of drugs. However, renal drug handling entails more than glomerular filtration and includes tubular excretion and reabsorption, and intracellular metabolization by cellular enzyme systems, such as the Cytochrome P450 isoenzymes. All these processes show maturation from birth onwards, which is one of the reasons why drug dosing in children is not simply similar to dosing in small adults. As kidney development normally finishes around the 36th week of gestation, being born prematurely will result in even more immature renal drug handling. Environmental effects, such as extra-uterine growth restriction, sepsis, asphyxia, or drug treatments like caffeine, aminoglycosides, or non-steroidal anti-inflammatory drugs, may further hamper drug handling in the kidney. Dosing in preterm neonates is therefore dependent on many factors that need to be taken into account. Drug treatment may significantly hamper postnatal kidney development in preterm neonates, just like renal immaturity has an impact on drug handling. The restricted kidney development results in a lower number of nephrons that may have several long-term sequelae, such as hypertension, albuminuria, and renal failure. This review focuses on the interplay between drugs and the kidney in premature neonates.

  12. Ethical issues in neonatal intensive care

    OpenAIRE

    Marcello M. Orzalesi; Marina Cuttini

    2011-01-01

    Recent progress in neonatal care have significantly improved the prognosis and chances of survival of critically ill or extremely preterm neonates and have modified the limits of viability. However, in some circumstances, when the child's death can only be briefly postponed at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and his/her parents, the application of the full armamentarium of modern neonatal intensive ca...

  13. Agressividade defensiva: efeitos do tratamento neonatal com sertralina

    OpenAIRE

    Ribeiro Ribas, Valéria

    2007-01-01

    O sistema serotoninérgico tem importância no desenvolvimento e no controle de várias funções do sistema nervoso central. O uso de fármacos no período neonatal induz alterações morfofisiológica e comportamental. As drogas serotoninérgicas têm sido bastante utilizadas para depressão, ansiedade e em crianças, muitas vezes, menores de 5 anos com o objetivo de reduzir o estado de hiperatividade. O objetivo deste trabalho foi avaliar o peso corporal diário do rato durante o períod...

  14. EFFICACY AND SAFETY OF GRID PHOTOCOAGULATION IN DIFFUSE DIABETIC MACULAR EDEMA IN RURAL SETUP

    Directory of Open Access Journals (Sweden)

    Narendra P

    2014-04-01

    Full Text Available Macular edema is a common cause of visual impairment in non-proliferative diabetic retinopathy. Laser photocoagulation is considered to be the standard treatment for diabetic macular edema. This study was taken up to find out the efficacy and safety of grid photocoagulation in diffuse diabetic macular edema in our rural setup. OBJECTIVES: To assess visual improvement and document adverse effects if any in diffuse diabetic macular edema after grid photocoagulation. MATERIALS AND METHODS: In this study, 30 eyes of 17 patients with diffuse diabetic macular edema were evaluated at retina clinic at Tamaka, Kolar. The visual acuities, fundoscopic findings and adverse effects at 3 months, 6 months and 1 year checkup following laser were used in present analysis. RESULTS: After one year of follow up, visual acuity in 8 eyes (26.6% improved by one or more line, 17 (56.6% did not change and 5 (16.6% lost by one or more lines. Macular edema was found to regress in 23 (76.6% lasered eyes, found same in 6 (20%, worsened in 1 (3.3%. In our study 83.33% had positive visual acuity and 96.66% had positive fundoscopic finding. CONCLUSION: Grid photocoagulation is of benefit in maintaining vision and resolution of diffuse diabetic macular edema

  15. 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.

  16. 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.

  17. Morphine pharmacokinetics during venoarterial extracorporeal membrane oxygenation in neonates

    NARCIS (Netherlands)

    Peters, JWB; Anderson, BJ; Simons, SHP; Uges, DRA; Tibboel, D

    2005-01-01

    Objective: To study morphine pharmacokinetics in neonates undergoing venoarterial ECMO and to quantify differences between these neonates and neonates subjected to noncardiac major surgery. Design and Settings: Observational study in a level III referral center. Patients and methods: Pharmacokinetic

  18. 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

  19. Macular laser photocoagulation guided by spectral-domain optical coherence tomography versus fluorescein angiography for diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Gallego-Pinazo R

    2011-05-01

    Full Text Available Roberto Gallego-Pinazo1,2, Ana Marina Suelves-Cogollos1, Rosa Dolz-Marco1, J Fernando Arevalo3, Salvador García-Delpech1, J Luis Mullor4, Manuel Díaz-Llopis1,2,51Department of Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 2Centro de Investigación Biomédica en Red de Enfermedades Raras, Valencia, Spain; 3Retina and Vitreous Service, Clinical Ophthalmology Center, Caracas, Venezuela; 4Unit of Experimental Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 5University of Valencia, Faculty of Medicine, Valencia, SpainBackground: The aim of this study was to compare the efficacy of spectral-domain optical coherence tomography (SD-OCT and fluorescein angiography (FA in the guidance of macular laser photocoagulation for diabetic macular edema.Methods: This was a prospective interventional clinical comparative pilot study. Forty eyes from 24 consecutive patients with diabetic macular edema were allocated to receive laser photocoagulation guided by SD-OCT or FA. Best-corrected visual acuity (BCVA, central macular thickness, and retinal volume were assessed at baseline and two months after treatment.Results: Subjects treated using FA-guided laser improved BCVA from the logarithm of the minimum angle of resolution (logMAR 0.52 ± 0.2 to 0.37 ± 0.2 (P < 0.001, and decreased mean central macular thickness from 397.25 ± 139.1 to 333.50 ± 105.7 µm (P < 0.001 and retinal volume from 12.61 ± 1.6 to 10.94 ± 1.4 mm3 (P < 0.001. Subjects treated using SD-OCT guided laser had improved BCVA from 0.48 ± 0.2 to 0.33 ± 0.2 logMAR (P < 0.001, and decreased mean central macular thickness from 425.90 ± 149.6 to 353.4 ± 140 µm (P < 0.001 and retinal volume from 12.38 ± 2.1 to 11.53 ± 1.1 mm3 (P < 0.001. No significant differences between the groups were found in two-month BCVA (P = 0.505, two-month central macular thickness (P = 0.660, or two-month retinal volume (P = 0.582.Conclusion: The short-term results of this pilot study

  20. Clinical pharmacokinetics of antibacterial drugs in neonates.

    Science.gov (United States)

    Paap, C M; Nahata, M C

    1990-10-01

    Neonatal patients are surviving longer due to the rapid advances in medical knowledge and technology. Our understanding of the developmental physiology of both preterm and full term neonates has also increased. It is now apparent that differences in body composition and organ function significantly affect the pharmacokinetics of antibacterial drugs in neonates, and dosage modifications are required to optimise antimicrobial therapy. The penicillins and cephalosporins are frequently used in neonates. Although ampicillin has replaced benzylpenicillin (penicillin G) for empirical treatment of neonatal sepsis, many of the other penicillins may be used in neonates for the management of various infections. Increased volume of distribution (Vd) and decreased total body clearance (CL) affect the disposition of penicillins and cephalosporins. Decreased renal clearance (CLR) due to decreased glomerular filtration and tubular secretion is responsible for the decreased CL for most of the beta-lactams. Aminoglycoside Vd is affected by the increased total body water content and extracellular fluid volume of neonates. The increased Vd, in part, accounts for the extended elimination half-life (t1/2) observed in neonates. Aminoglycoside CL is dependent on renal glomerular filtration which is markedly decreased in neonates, especially those preterm. These drugs appear to be less nephrotoxic and ototoxic in neonates than in older patients, and the role of serum concentration monitoring should be limited to specific neonatal patients. Other antibiotics such as vancomycin, teicoplanin, chloramphenicol, rifampicin, erythromycin, clindamycin, metronidazole and cotrimoxazole (trimethoprim plus sulfamethoxazole) may be used in certain clinical situations. The emergence of staphylococcal resistance to penicillins has increased the need for vancomycin. With the exceptions of vancomycin and chloramphenicol, the efficacy and safety of these other agents in neonates have not been established