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Pulmonary Edema [keywords]
- [Thrombolysis in left mechanical prosthetic heart valve obstruction by thrombus. Following and results.] [JOURNAL ARTICLE]
- Rev Med Inst Mex Seguro Soc 2014 Nov-Dec; 52(6):684-91.
Obstruction of the left mechanical heart valve by a thrombus is a serious complication. The factors associated with mortality are functional class, type of valve prosthesis and emergency surgery. Thrombolysis represents a therapeutic option to cardiac surgery. The aim of this investigation was to analyze the role of thrombolysis in the management of thrombus-obstructed left mechanical heart valve.Twenty-two consecutive cases undergoing thrombolysis at the Cardiology Hospital of the Siglo XXI National Medical Center were studied under two different circumstances: with acute pulmonary edema and state of shock in functional class IV and with functional class I-II. Clinical and echocardiographic monitoring and fluoroscopy were performed.The response was satisfactory in 56 % of the patients and there were complications in 69 % of the cases. During the follow-up, recurrence of symptoms occurred in 25 % of the patients, 5-year actuarial survival in 75 % and thromboembolic events-free survival in 37 %. Mortality was 12 %.Thrombolysis is a management alternative in patients with thrombus-obstructed left mechanical heart valve; however, this therapeutic option must be choosen according to clinical circumstances and echocardiographic, hemodynamic or fluoroscopic findings in the patients.
- [Urgent revascularisation can preserve renal function in a patient with severe hypertension because of renal artery stenosis.] [JOURNAL ARTICLE]
- Ugeskr Laeger 2013 Dec 16; 175(51)
We present a case of a 61-year-old woman with renal artery stenosis in a solitary functional kidney. The patient was admitted with recurrent severe hypertension, flash pulmonary oedema and acute kidney failure. She underwent surgical intervention, after which blood pressure and plasma creatinine level remained normal during a 11-year follow-up. Renal artery stenosis may have a serious course with flash pulmonary oedema and dialysis-dependent renal failure. Urgent revascularisation may be the only option to avoid pulmonary oedema and preserve renal function in patients with renal artery stenosis.
- Endothelial Semaphorin 7A Promotes Inflammation in Seawater Aspiration-Induced Acute Lung Injury. [JOURNAL ARTICLE]
- Int J Mol Sci 2014; 15(11):19650-19661.
Inflammation is involved in the pathogenesis of seawater aspiration-induced acute lung injury (ALI). Although several studies have shown that Semaphorin 7A (SEMA7A) promotes inflammation, there are limited reports regarding immunological function of SEMA7A in seawater aspiration-induced ALI. Therefore, we investigated the role of SEMA7A during seawater aspiration-induced ALI. Male Sprague-Dawley rats were underwent seawater instillation. Then, lung samples were collected at an indicated time for analysis. In addition, rat pulmonary microvascular endothelial cells (RPMVECs) were cultured and then stimulated with 25% seawater for indicated time point. After these treatments, cells samples were collected for analysis. In vivo, seawater instillation induced lung histopathologic changes, pro-inflammation cytokines release and increased expression of SEMA7A. In vitro, seawater stimulation led to pro-inflammation cytokine release, cytoskeleton remodeling and increased monolayer permeability in pulmonary microvascular endothelial cells. In addition, knockdown of hypoxia-inducible factor (HIF)-1α inhibited the seawater induced increase expression of SEMA7A. Meanwhile, knockdown of SEMA7A by specific siRNA inhibited the seawater induced aberrant inflammation, endothelial cytoskeleton remodeling and endothelial permeability. These results suggest that SEMA7A is critical in the development of lung inflammation and pulmonary edema in seawater aspiration-induced ALI, and may be a therapeutic target for this disease.
- Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room. [JOURNAL ARTICLE]
- Arq Bras Cardiol 2014 Oct 28.
Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.Fundamento: As urgências cardiovasculares são causas importantes de procura por atendimento médico, sendo fundamentais a rapidez e a precisão no diagnóstico para diminuir sua morbimortalidade. Objetivo: Avaliar o uso da ecocardiografia direcionada como complemento diagnóstico ao exame físico em um serviço terciário de emergências clínicas. Métodos: Foram incluídos cem pacientes adultos sem doenças cardíacas ou pulmonares conhecidas que procuraram atendimento de urgência com queixas cardiológicas. Foram excluídos pacientes com alterações isquêmicas no eletrocardiograma ou febre. A ecocardiografia direcionada foi realizada logo após a avaliação inicial do paciente na sala de emergência, com aparelho ultraportátil GE Vscan, avaliando subjetivamente: dimensões das cavidades, função sistólica ventricular, fluxos intracardíacos pelo mapeamento de fluxo em cores, pericárdio e aorta. Resultados: A idade média dos pacientes foi 61 ± 17 anos. O quadro clínico inicial foi dor torácica (52 pacientes), dispneia (32 pacientes), arritmia/avaliação da função ventricular (dez pacientes), hipotensão/tontura (cinco pacientes) e edema periférico (um paciente). Em 28 pacientes a ecocardiografia direcionada confirmou a hipótese diagnóstica inicial: 19 pacientes com insuficiência cardíaca, cinco com síndrome coronariana aguda, dois com tromboembolismo pulmonar e dois com tamponamento cardíaco. Em 17 pacientes, a ecocardiografia direcionada alterou o diagnóstico, afastando a hipótese clínica inicial em dez casos com suspeita de insuficiência cardíaca, dois com suspeita de tromboembolismo pulmonar, dois com hipotensão a esclarecer, e em cada um dos três restantes com suspeitas de síndrome coronariana aguda, tamponamento cardíaco e dissecção de aorta. Conclusão: A ecocardiografia direcionada ultraportátil em serviço de emergências clínicas pode definir rapidamente o diagnóstico e, com isso, é possível iniciar mais precocemente o tratamento adequado.
- [Non-invasive ventilation.] [JOURNAL ARTICLE]
- Ugeskr Laeger 2014 May 26; 176(22)
Within the last decade the use of non-invasive ventilation has expanded. This article reviews the studies on non-invasive ventilation in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary oedema, acute respiratory distress syndrome, asthma and neuromuscular disease. Its beneficial effect has primarily been found in exacerbations of COPD where it reduces mortality with a number needed to treat of ten when added to standard medical treatment. No other conclusive evidence of the superiority of non-invasive ventilation compared to other modalities has been shown.
- Inflammatory optic disc edema due to Sarcoidosis mimicking malignant hypertension. [JOURNAL ARTICLE]
- Int J Rheum Dis 2014 Oct 28.
A common ocular manifestation of sarcoidosis is anterior uveitis. Posterior uveitis is uncommon and optic disc edema is rare. We report one such case in which the initial presentation was mimicking malignant hypertension as the patient had a recent record of high blood pressure. However, the painful progressive vision loss due to optic disc edema, along with anterior uveitis, and histological proof of non-caseating granulomas on transbronchial lung biopsy clinched the diagnosis of ocular sarcoidosis. There was complete resolution of signs and symptoms with institution of steroids. There was also probable cardiac involvement. This case highlights the fact that all disc edemas in a diabetic and hypertensive patients is not just due to malignant hypertension, even if there is a recent history of elevated blood pressure.
- Cardiogenic shock after use of fluoroamphetamine confirmed with serum and urine levels. [JOURNAL ARTICLE]
- Clin Toxicol (Phila) 2014 Oct 28.:1-4.
Context. 4-Fluoroamphetamine (4-FA) is a para-substituted phenethylamine-type synthetic stimulant that has in recent years gained popularity through internet blogs and market share according to confiscated drug data. No serious toxicity has previously been reported. We report a case of a young man who developed severe toxicity and cardiogenic shock after using 4-FA, with laboratory confirmation. Case details. An 18-year-old man presented to the emergency department with vomiting, shortness of breath, chest tightness, and altered mental status about 5 h after using a new and unfamiliar street drug. Two days prior, he had received naltrexone intramuscular injection as part of an opioid addiction treatment program and was taking fluoxetine and trazodone. Five hours after presentation, he developed cardiogenic shock requiring intraaortic balloon pump, inotropic and ventilatory support. An echocardiogram showed left ventricular (LV) hypokinesia, sparing the apex and ejection fraction (EF) = 10%. Comprehensive toxicology serum testing revealed FA, naproxen, trazodone, and cotinine. The 4-FA urine level was 64,000 ng/ml and serum level was 118 ng/ml. With slow recovery, the patient was discharged after 2 weeks of hospitalization. Discussion. Although no previously reported 4-FA clinical poisoning cases have been published for comparison, by examining 4-FA pharmacology compared with other stimulant drugs, and given this patient's presentation and echocardiogram suggestive of reverse takotsubo cardiomyopathy we suspect the toxic mechanism was an acute cardiomyopathy caused by 4-FA catecholamine-induced myocarditis and/or small vessel myocardial ischemia. Conclusion. Recreational use of 4-FA may present with life threatening toxicity including cardiomyopathy, cardiogenic shock, and pulmonary edema.
- [Value of lung ultrasound in emergency and intensive care medicine.] [JOURNAL ARTICLE]
- Dtsch Med Wochenschr 2014 Nov; 139(45):2301-2307.
Lung ultrasound has traditionally been limited to evaluation of pleural effusion and as guidance for thoracocentesis. However, in recent years, thoracic ultrasound became an increasingly valuable diagnostic tool in emergency and intensive care medicine. The relative easy use of bedside examination made chest ultrasonography diagnostic valuable additional tool to be used in any clinical acute context. Various pulmonary diseases like pleural effusion, pulmonary-venous congestion und edema, pneumonia and pneumothorax can be detected very fast under emergency conditions.
- A fatal case of multidrug resistant acinetobacter necrotizing fasciitis: the changing scary face of nosocomial infection. [Journal Article]
- Case Rep Infect Dis 2014.:705279.
Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.
- Emodin Ameliorates LPS-Induced Acute Lung Injury, Involving the Inactivation of NF-κB in Mice. [JOURNAL ARTICLE]
- Int J Mol Sci 2014; 15(11):19355-19368.
Acute lung injury (ALI) and its severe manifestation of acute respiratory distress syndrome (ARDS) are well-known illnesses. Uncontrolled and self-amplified pulmonary inflammation lies at the center of the pathology of this disease. Emodin, the bio-active coxund of herb Radix rhizoma Rhei, shows potent anti-inflammatory properties through inactivation of nuclear factor-κB (NF-κB). The aim of this study was to evaluate the effect of emodin on lipopolysaccharide (LPS)-induced ALI in mice, and its potential bio-mechanism. In our study, BALB/c mice were stimulated with LPS to induce ALI. After 72 h of LPS stimulation, pulmonary pathological changes, lung injury scores, pulmonary edema, myeloperoxidase (MPO) activity, total cells, neutrophils, macrophages, TNF-α, IL-6 and IL-1β in bronchoalveolar lavage fluid (BALF), and MCP-1 and E-selectin expression were notably attenuated by emodin in mice. Meanwhile, our data also revealed that emodin significantly inhibited the LPS-enhanced the phosphorylation of NF-κB p65 and NF-κB p65 DNA binding activity in lung. Our data indicates that emodin potently inhibits LPS-induced pulmonary inflammation, pulmonary edema and MCP-1 and E-selectin expression, and that these effects were very likely mediated by inactivation of NF-κB in mice. These results suggest a therapeutic potential of emodin as an anti-inflammatory agent for ALI/ARDS treatment.