Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study reviews eight patients, 39-63 years old, with tumor-related obstruction of the inferior vena cava (IVC) extending into the right atrium (n = 5) and ventricle (n = 3). Five patients suffered from renal cell carcinoma, 3 from sarcomatous disease. The general approach was a median sternotomy and laparotomy with hypothermic circulatory arrest (17.0-20.5 degrees C; 23-46 min) in six patients, while in two patients, the IVC was clamped sequentially under moderate hypothermia and extracorporeal circulation. Four patients had tumor infiltration of the IVC necessitating partial caval resection. In three, the IVC was reconstructed by fabric patches or tubular prothesis. In one patient, the continuity of the IVC was interrupted permanently. Three patients underwent nephrectomy during the same procedure, two before and one after IVC disobliteration. In one patient each, pulmonary embolectomy and intrahepatic IVC stenting were performed. Two patients died early, one due to uncontrollable hemorrhage the other due to non-cardiogenic pulmonary edema. Six patients were discharged in good physical condition and are still alive at a mean follow-up of 24 months. Five patients have since remained free of recurrence, one patient underwent three further surgical interventions for bone metastases. We feel that IVC desobliteration is feasible in selected cases with extended tumor-related obstruction with an acceptable early risk and late outcome.
 ...
PMID:Tumor-related obstruction of the inferior vena cava extending into the right heart--a plea for surgery in deep hypothermic circulatory arrest. 177 82

This retrospective study comprises 234 cases of accidental hypothermia (core temperature less than 35 degrees C) hospitalized in 95 Swiss clinics between 1980 and 1987. The most frequent accidents were alpine (n = 78) in origin, followed by cold exposure after injuries (n = 63) and suicide attempts (n = 43). Hypothermia was induced by cold air in 129 cases and by water in 47 cases. Patients were divided evenly between the degree of hypothermia: 75 mild (32-35 degrees C), 79 moderate (28-32 degrees C) and 66 severe (less than 28 degrees C). Among the survivors the coldest patient had a core temperature of 17.5 degrees C and the longest cardiac arrest with a favourable outcome lasted 4.75 hours. Out of the 234 patients 68 died (29%). We assessed all variables relative to outcome, in particular the mechanism of the accident, the mode of cooling, temperature, circulation, age and sex, underlying diseases, rewarming methods, medication and complications during the hospital course. All variables were tested in two multiple regression analysis models (retrospective model n = 181: prospective model n = 128) with regard to significance (p less than 0.05) and survival. Results are expressed with ODD's ratios (OR). The negative survival factors are asphyxia (OR 30), invasive rewarming methods (OR 20), slow rate of cooling (OR 10), asystole on arrival (OR 9), pulmonary edema or ARDS during hospitalization (OR 8), elevated serum potassium (OR 2/mmol/l) and age (OR 1.03/year). The positive survival factors are rapid cooling rate (OR 10), presence of ventricular fibrillation in cardiac arrest patients (OR 9) and presence of narcotics and/or alcohol during hypothermia (OR 5).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Accidental hypothermia in Switzerland (1980-1987)--case reports and prognostic factors]. 188 13

Repair of total anomalous pulmonary venous connection was performed on 31 patients aged 12 days to 14 years (18 less than 6 months). The connection type was supracardiac in 20 cases, cardiac in nine, infracardiac in one case and mixed in one. Deep hypothermia and circulatory arrest were used in 23 cases (74%). In supracardiac type cases the atrial septal defect was closed through the left atriotomy, without enlargement of the left atrium. Extubation in the operating room was possible in 26 cases (84%). Three patients (9.6%) died, one (with connection to the coronary sinus) soon after operation, due to a management error, another (with connection to the right superior vena cava) of pulmonary edema, and an infant with mixed-type connection 1 week postoperatively, presumably from an arrhythmia. No patient required reoperation because of late pulmonary venous stenosis. There were no late deaths. The technique of elevating the cardiac apex provided excellent exposure in the supracardiac and infracardiac types. Progressively earlier referral during the study period facilitated prompt operation and improved patient salvage.
 ...
PMID:Total anomalous pulmonary venous connection. 194 13

Spinal shock results in impaired cardiovascular reflexes of those persons with spinal cord injury above T6. This population can be at high risk for cardiovascular instability. Sympathetic pathways are interrupted and the result is uninhibited vagal tone and vascular atony. The spinal shock victim presents with hypotension, hypothermia, and bradycardia. Hypovolemia, hypoxia, and further temperature decreases can precipitate instability. Overhydration can lead to pulmonary edema and extended injury. The goal of therapy is to optimize perfusion with positioning, careful fluid replacement, and pharmacologic agents as needed. Cardiac rhythm disturbances are common and can be potentiated by hypoxia, endotracheal suctioning, hypothermia, and position changes. The goal of treatment is to avoid the offending event and to pretreat anticipated bradydysrhythmias with atropine. Close monitoring of cardiac and respiratory status is a minimum requirement for such patients. Within the high risk group exists a subgroup who demonstrate a high degree of cardiovascular instability. This group has a high mortality rate. Identification of patients who may require prolonged monitoring or more aggressive therapies may assist in eventual positive outcomes.
 ...
PMID:Cardiovascular considerations in the critical care phase. 226 58

Pulmonary thromboendarterectomy is being performed with increasing frequency for incapacitating pulmonary hypertension caused by chronic large-vessel pulmonary embolism. However, patient-related risk factors and procedural complications associated with morbidity and mortality have not been fully defined. From Oct. 1, 1984, to April 10, 1989, we performed pulmonary thromboendarterectomy using deep hypothermia and circulatory arrest in 127 consecutive patients (62.2% male, mean age 50 +/- 16 [standard deviation], range 20 to 82 years) in whom the exposure and dissection of the pulmonary arteries and methods for myocardial protection have been standardized. End points for univariate and multivariate analyses of risk factors were reperfusion pulmonary edema leading to respiratory insufficiency as defined by ventilator dependency (greater than or equal to 5 days) (31.5%, 39/124) and hospital mortality (12.6%, 16/127). Multivariate analyses showed that ascites and need for 4 units of blood or more predicted ventilator dependency (p less than 0.03). Increased cardiopulmonary bypass times predicted both end points (p less than 0.03 to less than 0.0001), and failure to achieve at least a 50% reduction in pulmonary vascular resistance strongly predicted hospital death (p less than 0.0001). However, other factors that exhibited trends for association with one of the end points may prove important with a larger sample size. A hospital mortality rate of 12.6% for pulmonary thromboendarterectomy is acceptable when compared with approximately 25% for heart-lung transplantation, which is the only therapeutic alternative. Increased ventilator dependency and hospital mortality can be anticipated with longer cardiopulmonary bypass times and inadequate reduction of pulmonary vascular resistance.
 ...
PMID:Risk factors for pulmonary thromboendarterectomy. 231 89

Microcirculation during hemodilution and hypothermia under ether anesthesia treated with or without ulinastatin was studied by means of rabbit ear chamber. Sixteen rabbits were divided into 2 groups; 8 rabbits without ulinastatin treatment (C group) and 8 rabbits treated with ulinastatin (U group). Surface cooling to 20 degrees C and rewarming were performed. No significant differences between the groups were found in blood pressure and heart rate, but pulse pressure in U group was significantly larger (P less than 0.01) than that in C group. Pulmonary edema occurred in 3 rabbits in C group during rewarming. The results suggest that ulinastatin inhibited edema formation in U group. In C group, the blood flow velocity was very slow and the blood flow rate was very small at 20 degrees C in arterioles and venules. In U group the flow velocity and the flow rate were well maintained at 20 degrees C in arterioles and venules. It is concluded that ulinastatin is effective in maintaining microcirculation during hemodilution and hypothermia.
 ...
PMID:[Effect of ulinastatin on microcirculation under hemodilution and hypothermia]. 238 93

Sixteen patients (age 13-53 years) with accidental deep hypothermia have been rewarmed in our clinic during the last 10 years, 14 by femoro-femoral cardiopulmonary bypass (CPB) of whom 11 had a cardiopulmonary arrest (asystole in 5 and ventricular fibrillation in 6). On admission, the latter were clinically dead showing wide non-reactive pupils and being supported by ventilation and external heart massage. In the survivors, the mean length of cold exposure was 4.4 h (2-5.5 h) and mean arrest interval until initiation of CPB was 2.5 h (1.4-3.7 h). Rectal temperature on admission ranged from 17.5 degrees C to 26 degrees C (mean 22.5 degrees C). The causes for hypothermia were fall into a crevasse (5), avalanche (1), drowning (2) and cold exposure (3) including 2 suicide attempts. Results are summarized in the following table: [table: see text] Eight of the 11 patients with deep hypothermia and cardiac arrest were rewarmed and resuscitated successfully with CPB. Three patients, including 2 cases of asphyxia (avalanche and drowning), could not be weaned from CPB despite adequate rewarming. The other drowned patient (53 years) died on the 3rd postoperative day (POD) from ARDS. The main complication was pulmonary edema (57%) and transient neurological deficits. All survivors became conscious during the first POD and resumed, their professional activity. We conclude that patients with accidental deep hypothermia and even prolonged cardiopulmonary arrest should be rewarmed and resuscitated rapidly by cardiopulmonary bypass. These measures are very promising particularly if the cause of accident and the circumstances suggest that cardiopulmonary arrest was induced by hypothermia alone without other asphyxiating mechanisms.
 ...
PMID:Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients. 239 32

N-Methylthiobenzamide (NMTB) is a pneumotoxin which causes pulmonary edema and hydrothorax in rodents. Reserpine has been shown to attenuate the pneumotoxicity induced by NMTB. Some of that evidence suggests that the protection afforded by reserpine occurs independently of its capacity to reduce peripheral 5-hydroxytryptamine (5-HT). We therefore investigated 2 other pharmacologic properties of reserpine, namely: (1) its capacity to reduce lung norepinephrine (NE); and (2) its capacity to induce hypothermia, in order to more fully understand its mechanism of protection. Pretreatment of mice or rats with 6-hydroxydopamine at a dose which reduced lung NE by approximately 80% did not affect the pneumotoxic response to NMTB. Thus a decrease in lung NE probably does not account for reserpine's protective effect. An investigation of reserpine's effects on core temperature revealed that mice dosed with a combination of reserpine + NMTB presented with core temperatures lower than mice treated with either compound alone. Mice placed in a cold environment (2 degrees C) and dosed with NMTB presented with hypothermia and an attenuated toxic response to NMTB. Thus a reserpine-induced hypothermia could be allowing for a reduction of NMTB metabolism and consequent diminution of toxicity. These observations suggest that reserpine's capacity to protect animals against NMTB-induced pulmonary edema may in part be due to its capacity to induce hypothermia.
 ...
PMID:Effect of reserpine on N-methylthiobenzamide-induced pulmonary edema: role of lung norepinephrine and hypothermia. 249 83

The keys to a better outcome in the management of ruptured aneurysm are early diagnosis, aggressive resuscitation, and early operation, with prompt achievement of proximal control. Having achieved these goals, there is a tendency to let down one's guard and relax; indeed, the principles of aneurysm repair beyond this point are similar to those of elective surgery. However, it should be remembered that nearly every complication is more likely in emergency than in elective operations. Therefore, even more care needs to be taken with the technical details at this point to avoid the complications discussed in the following article. The perioperative management must continue at the same heightened level to combat acidosis, hypothermia, coagulation disorders, cardiac dysfunction, fluid overload with pulmonary edema, renal failure, and other common sequelae of this challenging undertaking.
 ...
PMID:Ruptured abdominal aortic aneurysms. Special considerations. 266 51

An important goal in managing patients with respiratory failure using mechanical ventilatory support and positive end-expiratory pressure (PEEP) is to optimize tissue oxygen delivery relative to oxygen consumption. To this end, systemic hypothermia has been reported to reduce oxygen consumption. Cooling, however, may antagonize hypoxic pulmonary vasoconstriction and depress cardiac output. To determine whether these potentially adverse effects of cooling on tissue oxygen delivery would outweigh any potential benefits, we studied the effects of systemic hypothermia and end-expiratory pressure on venous admixture, intrapulmonary blood distribution, and oxygenation variables in 40 dogs with oleic acid-induced pulmonary edema of the right lung. The dogs were randomly assigned to four treatment groups of 10 dogs each: normothermia and zero end-expiratory pressure (ZEEP); normothermia and 10 cm H2O PEEP; hypothermia and ZEEP; hypothermia and PEEP. Hypothermia to 31.9 +/- 0.1 degree C (mean +/- SEM) caused no adverse effects on intrapulmonary blood flow distribution (measured by radioactive microspheres) or on venous admixture. Tissue oxygen delivery and arterial oxygenation did not improve with hypothermia, the latter being 109 +/- 13 mm Hg and 70 +/- 8 mm Hg with PEEP and ZEEP, respectively. However, hypothermia significantly reduced oxygen consumption, so that the coefficient of oxygen delivery (i.e., the ratio of oxygen supply to consumption) increased from 2.5 +/- 0.1 to 3.2 +/- 0.2 (p less than 0.01) with ZEEP and from 2.0 +/- 0.1 to 2.6 +/- 0.3 with PEEP (p = 0.016). Thus, although systemic hypothermia failed to improve arterial oxygenation and tissue oxygen delivery, it decreased systemic oxygen demands, thereby improving the oxygen supply-demand balance.
 ...
PMID:Hypothermia with and without end-expiratory pressure in canine oleic acid pulmonary edema. 266 83


<< Previous 1 2 3 4 5 6 7 8 9 Next >>