Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Pulmonary Edema [keywords]
- The predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications after STEMI. [Journal Article]
- J Cardiovasc Thorac Res 2014; 6(1):35-41.
Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events.
Methods:In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses.
Results:In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%, respectively. Higher age (P=0.04), female gender (0.002), lower ejection fraction (P<0.001) and absolute neutrophil count (P=0.04) were predictors of mortality. Pump failure in the form of acute pulmonary edema or cardiogenic shock occurred in 35 (8.9%) of patients. Higher leukocyte (P<0.03) and neutrophil counts (P<0.03) and higher NLR (P=0.01) were predictors of failure. The frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher neutrophil count (P<0.001) and higher NLR level (P<0.001). In multivariate analysis neutrophil count was an independent predictor of mortality (OR=2.94; 1.1-8.4, P=0.04), and neutrophil count [OR=1.1, CI (1.01-1.20), P=0.02], female gender [OR=2.34, CI (1.02-4.88), P=0.04] and diabetes [OR=2.52, CI (1.21-5.2), P=0.003] were independent predictors of heart failure.
Conclusion:A single CBC analysis may help to identify STEMI patients at risk for mortality and heart failure, and total neutrophil count is the most valuable in predicting both.
- Percutaneous minimally-invasive fetoscopic surgery for spina bifida aperta - Part II Maternal management and outcome. [JOURNAL ARTICLE]
- Ultrasound Obstet Gynecol 2014 Apr 21.
Minimally-invasive fetoscopic surgery of spina bifida aperta aims at improving postnatal neurological outcome of affected fetuses. The objective of this retrospective study was to assess maternal morbidity and outcome of this procedure in 51 women that were operated at a mean gestational age of 24 weeks at our center between July 2010 and June 2013.We studied our charts for the peri- and postoperative occurrence of maternal death, need for maternal blood transfusion, placental abruption, pulmonary edema, spontaneous labor, oligohydramnios, chorioamnionitis, chorioamniotic membrane separation, length of hospitalization, amniotic fluid leakage, gestational age at delivery and status of hysterotomy site.In all 51 women, maternal demise, placental abruption or the need for maternal blood transfusion were not observed in the perioperative period. Chorioamniotic membrane separation occurred in two, postoperative uterine contractions in one, mild pulmonary edema in one, and oligohydramnios in seven patients. One patient developed chorioamnionitis one week after fetal surgery; the fetus from this patient died from prematurity. All other babies survived gestation. Amniotic fluid leakage occurred in 43 patients at a mean gestational age of 29.7 (range 22.6-37.3) weeks; two of these patients developed chorioamnionitis. Length of hospitalization after surgery was 7.2 (range 4-12) days. Mean gestational age at delivery was 33 (range 24.6-38.1) weeks. All abdominal and uterine trocar insertion sites were well healed.Minimally-invasive fetoscopic surgery for spina bifida aperta was safe for most maternal patients. Despite the common occurrence of amniotic leakage the majority now delivers well beyond 32 weeks of gestation.
- Case report: pulmonary edema induced by breath holding in an adolescent patient. [Journal Article]
- AACN Adv Crit Care 2014 Apr-Jun; 25(2):101-3.
- [Case of successful thrombolytic therapy use in complex cardio-pulmonary resuscitation for massive pulmonary thromboembolism in parturient after elective caesarian operation]. [English Abstract, Journal Article]
- Anesteziol Reanimatol 2013 Nov-Dec; (6):54-6.
Pulmonary thromboembolism is a main cause of parturient mortality in the world. Recently there are few reports about a thrombolytic therapy use in parturient in medical publications. The article deals with a case of successful application of thrombolysis in a complex cardio-pulmonary resuscitation in parturient with massive pulmonary thromboembolism. Unexpected dyspnea and hypotension occurred in the 30 years old woman after elective caesarian operation. Syndrome S1-Q3 was fixed on an ECG monitor. Cardiac arrest was fixed in 10 minutes later. Streptokinase was administrated in a 1 hour after beginning of the resuscitation. Haemodynamic parameters recovered almost after the administration of streptokinase. Severe uterine bleeding occurred in 20 minutes after the administration. Uterine extirpation and tight tamponade of the small pelvis was performed for the bleeding stopping. Later a floating thrombus was diagnosed in the right femoral vein. Tromboectomy was performed. Convulsions had place on first and second day after the resuscitation. Cerebral edema was diagnosed by computed tomography. Consciousness occurred on the fourth day and the woman was weaned from the ventilator on the fifth day. The patient was discharged from the hospital on 20th day without neurological complications.
- Remifentanil Attenuates Lipopolysaccharide-Induced Acute Lung Injury by Downregulating the NF-κB Signaling Pathway. [JOURNAL ARTICLE]
- Inflammation 2014 Apr 20.
Remifentanil significantly represses cell immune responses and influences neutrophil migration through endothelial cell monolayers. The present study determines the beneficial effects of remifentanil and the mechanisms by which it attenuates lipopolysaccharide (LPS)-induced acute lung injury (ALI). Rats were intratracheally instilled with 2 mg/kg LPS to induce ALI. Results showed that remifentanil could resolve lung injury, as evidenced by remarkable decreases in lung edema (wet-to-dry weight ratio), neutrophil infiltration (myeloperoxidase activity), and pulmonary permeability [total number of cells and protein concentrations in bronchoalveolar lavage fluid (BALF)]. Remifentanil also attenuated the concentrations of proinflammatory cytokines tumor necrosis factor alpha, interleukin-1β, and interleukin-6 in BALF, as well as effectively repressed the activation of nuclear factor-kappaB (NF-κB), which has been associated with the inhibition of IκBα degradation.These results suggest that remifentanil may be a suitable treatment for LPS-induced ALI. Remifentanil exerts beneficial effects on the inhibition of proinflammatory cytokine production by downregulating the NF-κB pathway.
- Risk factors for acute pulmonary edema after adenotonsillectomy in children. [JOURNAL ARTICLE]
- Auris Nasus Larynx 2014 Mar 10.
Adenotonsillectomy is a common surgical procedure in children. Acute pulmonary edema after this procedure is a rare complication but may be fatal. The factors associated with pulmonary edema after adenotonsillectomy were studied.All consecutive patients with an age of less than 15 years who underwent adenotonsillectomy at Chiang Mai University Hospital were enrolled. The study period was from January 2004 to December 2008. Clinical factors were retrospectively retrieved from medical records. Factors associated with acute pulmonary edema after adenotonsillectomy were computed using multiple logistic regression analysis.There were 216 patients who underwent adenotonsillectomy due to airway obstruction during the study period. Five patients were excluded due to incomplete data. Of those included, 129 patients (61.1%) were male with mean age of 6.6 (SD 3.2) years. Four significant factors associated with the development of post-operative pulmonary edema after the adenotonsillectomy were procedure, age, obesity, and pulmonary hypertension.Factors associated with acute pulmonary edema after adenotonsillectomy in children were adenotonsillectomy procedure, young age, obesity, or having pulmonary hypertension. Clinicians should be aware of these risk factors while performing adenotonsillectomy in children.
- Implications of a 5-Liter Urinary Bladder: Inferior Vena Cava Syndrome Leading to Bilateral Pulmonary Artery Emboli. [JOURNAL ARTICLE]
- Urology 2014 Apr 17.
Compression of the inferior vena cava by the distended urinary bladder is rare but is usually found in the presence of lower extremity edema. Here, we present the case of a 68-year-old man found to have multiple pulmonary emboli as the first manifestation of inferior vena cava compression from a distended urinary bladder 5 L in capacity.
- Respiratory disorders in endurance athletes - how much do they really have to endure? [REVIEW]
- Open Access J Sports Med 2014.:47-63.
Respiratory disorders are often a cause of morbidity in top level endurance athletes, more often compromising their performance and rarely being a cause of death. Pathophysiological events occurring during exercise, such as bronchospasm, are sometimes followed by clear pathological symptoms represented by asthma related to physical exertion or rarely by pulmonary edema induced by a strenuous effort. Both bronchospasm and the onset of interstitial edema induced by exercise cannot be considered pathological per se, but are more likely findings that occur in several healthy subjects once physical exhaustion during exertion has been reached. Consequently, we get a vision of the respiratory system perfectly tailored to meet the body's metabolic demands under normal conditions but which is limited when challenged by strenuous exercise, in particular when it happens in an unfavorable environment. As extreme physical effort may elicit a pathological response in healthy subjects, due to the exceeding demand in a perfectly functional system, an overview of the main tools both enabling the diagnosis of respiratory impairment in endurance athletes in a clinical and preclinical phase has also been described.
- Renal artery stenosis-when to screen, what to stent? [Journal Article]
- Curr Atheroscler Rep 2014 Jun; 16(6):416.
Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed.
- [The selective dilatation effects of iptakalim on basilar and pulmonary arterioles in high-altitude hypoxic rats]. [English Abstract, Journal Article]
- Zhongguo Ying Yong Sheng Li Xue Za Zhi 2014 Jan; 30(1):1-3.
To study the selective dilatation effects of iptakalim (Ipt) on basilar and pulmonary arterioles, and endothelial cell function of these arterioles in hypoxic rats.SD male rats were divided into 2 groups:control and hypoxic group fed in normobaric hypoxic environment (O2 7.8%, 8 h). Arteriole rings about (204 + 5) pm were isolated and the tension of hypoxic arterioles pre-contracted by 6 nmol/L endothelin-1 (ET-1) was observed with wire myograph system model (DMT 610 m). The relaxing response of hypoxic arterioles induced by different concentration of Ipt were detected and endothelial activity was also tested by acetylcholine.10(5) mol/L acetylcholine (ACh)-mediated vasodilatation of basilar and pulmonary arterioles was greatly reduced in the hypoxic group than those in control group (P < 0.05). Compared with normal group, a novel ATP-sensitive potassium channel opener Ipt at the concentration ranging from 10(-11) mol/L to 10(3) mol/L, caused stronger dose dependent vasodilatation on hypoxic pulmonary arterioles, and there was no significant difference between control and hypoxic basilar arterioles.The endothelial function of basilar and pulmonary arterioles was damaged under hypoxic state, and Ipt selectively increased dilatation effects on hypoxic pulmonary arterioles, but not on hypoxic basilar arterioles which could improve high altitude pulmonary edema pathological state and be the novel drug in the treatment of pulmonary hypertension.