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Pulmonary Edema [keywords]
- Medial defects of the small pulmonary arteries in fatal pulmonary hypertension in infants with trisomy 13 and trisomy 18. [JOURNAL ARTICLE]
- Am J Med Genet A 2013 Dec 5.
Congestive heart failure is a major cause of early death in patients with trisomy 13 or 18 and congenital heart disease (CHD). Pulmonary artery banding for these patients early in life is preferred to protect the lungs from high pulmonary flow rates and improve survival. We performed open lung biopsies in 11 patients with trisomy 13 or 18 accompanied by CHD and severe pulmonary artery hypertension (PAH) between 2009 and 2011. Two (18.2%) of these 11 patients had medial defects of the small pulmonary arteries. One patient with trisomy 13 and an atrial septal defect developed lung hemorrhage and lung edema at the age of 9 months and died at the age of 13 months. The lumens of the small pulmonary arteries of the other patient with trisomy 18 and a ventricular septal defect became occluded due to the intimal proliferation of fibrous tissues at the age of 2 months. This patient died at the age of 27 months. The deaths of both patients were associated with heart-related factors. Patients with medial defects are vulnerable to intimal proliferation in the small pulmonary arteries. More patients with trisomy 13 or 18 and CHD might have similar pulmonary vascular changes. The small pulmonary arteries of patients with trisomy 13 and 18 should be further analyzed. © 2013 Wiley Periodicals, Inc.
- From the Journal archives: Complications of transurethral prostatic surgery: back to the future? [JOURNAL ARTICLE]
- Can J Anaesth 2013 Dec 4.
John Desmond MBBS FRCP(C) CITATION: Complications of transurethral prostatic surgery. Can Anaesth Soc J 1970; 17: 25-36.To review complications of transurethral resection of the prostate (TURP) as they pertain to anesthesiologists.In this article published in January 1970 in the Canadian Anaesthetists' Society Journal, now the Canadian Journal of Anesthesia (the Journal), the author reviews complications relating to TURP, including age group, cardiovascular status, plasminogen activation, bacteremia, hemorrhage, too-light general anesthesia, perforation of the bladder, inadvertently high spinal anesthetic, the danger of using vasopressors, and burns. Complications involving the endocrine system, erection, adductor spasm, explosions, and hypothermia are also mentioned. Furthermore, there is a detailed discussion regarding the composition of the irrigation solution and the effects of its intravenous absorption on the cardiovascular system and on serum osmolality and natremia. The results of slow absorption of irrigation fluid at the prostatic level combined with good left-ventricular function are associated with slight dilutional hyponatremia (≤ 10 mEq·L(-1)) and a good outcome. Rapid absorption of irrigation fluid and/or poor left-ventricular function in the context of possible acute blood loss, hypotension following spinal anesthesia, or myocardial depression with general anesthesia can lead to a marked drop in osmolality and more severe dilutional hyponatremia. This may lead to cerebral edema, pulmonary edema, heart failure, and cardiovascular collapse. In a series of 72 randomly chosen patients at the author's institution, 18 patients experienced a reduction in serum sodium of > 10 mEq·L(-1); eight patients experienced a reduction of > 20 mEq·L(-1), and two patients experienced a decrease in both osmolality and natremia, with both developing cerebral and pulmonary edema.With an understanding of the possible complications and physiological implications of TURP, anesthesiologist caring for such patients may help reduce adverse outcomes or decrease their impact with proper management. In the late 1960s, mortality at the author's institution was reduced from 1.5-0.4% in three years.
- Development of maternal and neonatal composite outcomes for trials evaluating management of late-onset pre-eclampsia. [JOURNAL ARTICLE]
- Hypertens Pregnancy 2013 Dec 4.
Objective: Pre-eclampsia is associated with significant maternal and neonatal complications, and delivery is often expedited to minimise complications. For randomised trials evaluating interventions in women with late-onset (>34 weeks) mild to moderate pre-eclampsia, no single outcome has been identified to be the most clinically important. Existing composite outcomes with more than one clinically relevant endpoint to evaluate interventions in pre-eclampsia provide limited justification for selection of the components. Our objective was to develop robust, valid composite maternal and neonatal outcome measures for clinical trials evaluating interventions in women with late-onset mild and moderate pre-eclampsia. Study design: A two-generational Delphi method was used to identify these clinically important maternal and neonatal outcomes. Composite outcomes were developed based on biological plausibility, independence from each other, frequency of occurrence and level of importance. Results: The final maternal composite outcome included maternal death, eclampsia, stroke or reversible ischaemic neurological deficit, pulmonary oedema, major obstetric haemorrhage, need for positive inotropic support, haemolysis, elevated liver enzymes and low platelets syndrome and placental abruption; and the neonatal composite outcome included neonatal death, respiratory distress syndrome needing ventilator support and neurological outcomes as cystic periventricular leukomalacia and grade III/IV intraventricular haemorrhage. Conclusion: The composite outcomes developed will enable clinical trials to provide robust estimates on the effectiveness of the interventions in women with mild to moderate late onset pre-eclampsia to inform clinical practice. Caution is needed in the interpretation of composite outcomes due to variation in the importance of individual components.
- Carbocisteine Reduces Viral-Induced Pulmonary Inflammation in Mice Exposed to Cigarette Smoke. [JOURNAL ARTICLE]
- Am J Respir Cell Mol Biol 2013 Dec 4.
Carbocisteine inhibits viral infection and prevents acute exacerbation of chronic obstructive pulmonary disease. We recently demonstrated the protective effects of Nrf2 against influenza virus-induced pulmonary inflammation in mice exposed to cigarette smoke. In our current study, we investigated the effects of carbocisteine on Nrf2 activation in cultured macrophages, and in mice infected with influenza following exposure to cigarette smoke. Nuclear translocation of Nrf2 and the expression of Nrf2-targeted anti-oxidant genes, such as heavy and light subunits of gamma glutamyl cysteine synthetase, and heme oxigenase-1, were enhanced in a dose-dependent manner following treatment with carbocisteine in peritoneal and alveolar macrophages of wild-type mice but not in those of Nrf2-deficient mice. Nuclear translocation of Nrf2 in macrophages was inhibited by the phosphatidylinositol 3-kinase inhibitor LY294002. Phosphorylated Akt, Nrf2, and heme oxigenase-1 were induced in the alveolar macrophages of the lungs in wild-type mice after carbocisteine administration. The extent of oxidative stress, inflammatory cell infiltration, pulmonary edema, and goblet cell hyperplasia was suppressed by carbocisteine administration in the lungs of wild-type mice after exposure to both cigarette smoke and influenza virus. Our findings suggest that carbocisteine reduces pulmonary inflammation and mucus overproduction in mice exposed to cigarette smoke following infection with influenza virus via the activation of Nrf2.
- Using Systems Biology-based Analysis Approaches to Identify Mechanistically Significant Adverse Drug Reactions: Pulmonary Complications from Combined Use of Anti-TNFα Agents and Corticosteroids. [JOURNAL ARTICLE]
- AMIA Summits Transl Sci Proc 2013.:151-155.
Anti-TNF drugs are frequently associated with serious Adverse Events (AEs), which necessitates an improved understanding of individual factors that determine efficacy and safety of anti-TNF agents. We mined the US FDA's Adverse Event Reporting System (AERS) for anti-TNF-associated AEs to identify and stratify patient subgroups and drug combinations that exhibit specifically correlated complications. We demonstrate the existence of patient subgroup and anti-TNF agent-specific associations for relative risks of developing known and novel AEs including infections, edema, and organ damage associated processes. Concomitant use of anti-TNFs with corticosteroids significantly increased risk of AEs (p < 0.001) including pulmonary fibrosis and pulmonary edema. Using these tightly correlated phenotypes, we mined mouse phenotype data to identify the molecular basis of these AEs. Multiple pathways and networks that regulate injury response, fluid regulation, and wound healing were implicated suggesting modification of anti-TNF-based therapeutic strategies to minimize corticosteroid-based combinatorial risk of severe AEs.
- [Chest drainage systems and the complications associated with drainage]. [English Abstract, Journal Article]
- Rozhl Chir 2013; 92(11):672-8.
Introduction: Chest drainage inevitably involves attaching the drain to a chest drainage system. Chest drainage may be related to some specific complications.
Objective:The aim of the article is to explain the classification and principles of the individual chest drainage systems. They may be divided into passive ones (valve and water seal) and active chest suction. Balanced chest drainage represents a specific method. Further, the article deals with the most common complications of chest drainage, namely prolonged air leak, multifactorial lung oedemas, atrial fibrillation and empyema of the chest cavity.
Conclusion:The choice of a suitable drainage system is an important factor for the success of chest drainage, including the probability of complications occurring. The knowledge of appropriate methods of solving the complications of chest drainage, including the use of less standard techniques, allows us to treat the majority of even considerably complicated conditions. Keywords: chest drainage - chest drain - pneumothorax - prolonged air leak - lung oedema - reexpansion pulmonary oedema - negative pressure lung oedema.
- Negative Pressure Pulmonary Oedema: A Rare Case Report of Two Brothers. [JOURNAL ARTICLE]
- J Clin Diagn Res 2013 Oct; 7(10):2308-2309.
Negative Pressure Pulmonary O/Edema (NPPE) is potentially life-threatening and it is a general anaesthesia side effect. We are mentioning a rare case report of two brothers who were referred to our hospital for elective surgeries (varicocele and septoplasty) in a 3 years period. Both of them were athletes and their coagulation factors were disturbed after surgeries. Pulmonary oedema was healed after treating it by reintubation, mechanical ventilation by Positive End-Expiratory Pressure (PEEP), diuretics, morphine, Fresh Frozen Plasma (FFP) and liquid bounding.
- Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery. [JOURNAL ARTICLE]
- J Neurosurg Anesthesiol 2013 Nov 27.
Multilevel spinal decompressions and fusions often require long anesthetic and operative times, which may result in airway edema and prolonged postoperative intubation. Delayed extubation can lead to bronchopulmonary infections and other complications. This study analyzed which factors correlated with the decision to delay extubation after multilevel spine surgery.We reviewed the records of 289 patients who underwent multilevel spine surgery lasting ≥8 hours in the prone position from 2006 to 2012. Variables hypothesized to affect the decision of the anesthesiologist to delay extubation at the end of the surgery were collected. These included preoperative factors (age, sex, ASA class, history of obstructive sleep apnea, BMI, previous spine surgery, current cervical surgery, anterior in addition to posterior spine surgery, emergency surgery) and intraoperative factors (difficult intubation, number of surgical levels, case time, estimated blood loss, fluid and blood administration, attending handoff and resident handoff, and case end time). We also compared the incidence of pulmonary postoperative complications between patients extubated at the end of the case to patients who had a delayed extubation.A total of 126 patients (44%) were kept intubated after multilevel spine surgery. Multiple linear regression analysis showed factors that correlated with prolonged intubation which included age, ASA class, procedure duration, extent of surgery, total crystalloid volume administered, total blood volume administered, and the case end time. Patients who had a delayed extubation had a 3-fold higher rate of postoperative pneumonia.Our study found that age, ASA class, procedure duration, extent of surgery, and total crystalloid and blood volume administered correlate with the decision to delay extubation in multilevel prone spine surgery. It also finds that the time the case ends is an independent variable that correlates with the decision not to extubate at the end of a long multilevel spinal surgery. The incidence of postoperative pneumonia is higher in patients who had a delayed extubation after surgery.
- Thoracic ultrasonography. [Journal Article]
- Crit Care Clin 2014 Jan; 30(1):93-117.
Thoracic ultrasonography (US) has proved to be a valuable tool in the evaluation of the patient with shortness of breath, chest pain, hypoxia, or after chest trauma. Its sensitivity and specificity for detecting disease is higher than that of a chest radiograph, and it can expedite the diagnosis for many emergent conditions. This article describes the technique of each thoracic US application, illustrating both normal and abnormal findings, as well as discussing the literature. Bedside thoracic US has defined imaging benefits in a wide range of thoracic disease, and US guidance has been shown to facilitate thoracic and airway procedures.
- Renal Amyloidosis in a Patient with X-linked Agammaglobulinemia (Bruton's Disease) and Bronchiectasis. [JOURNAL ARTICLE]
- J Clin Immunol 2013 Nov 30.
We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis.A 38 year-old man was diagnosed with X-linked agammaglobulinemia (Bruton's disease) when he was 3 years old, and he has been treated with parenteral immunoglobulin since then. Eighteen years later, he was diagnosed with central pulmonary bronchiectasis by computerized tomography (CT). In 2008, he gradually developed anemia, edema of lower limbs, and loss of weight.Laboratory studies revealed deterioration of renal function, normocytic normochromic anemia and nephrotic range proteinuria. Hepatitis B and C and HIV serology were negative. Ultrasound and CT of abdomen were normal. A renal biopsy revealed deposits with positive PAS and Congo red staining in glomeruli, interstitium, and vessel's walls. Immunohistochemistry showed positive staining of the A amyloid. Direct immunofluorescence was positive with thioflavin and showed focal and glomerular mesangial IgG deposits, suggesting renal AA amyloidosis. For 2 years the patient conducted pharmacological treatment and follow-up for the Nephrology department with poor prognosis and progression of renal function impairment. In January 2011 he began dialysis treatment with improvement, and he is currently on the waiting list for renal transplantation.We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis a finding rarely reported.