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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The occurrence of air embolism in supine position operation is extremely rare. We reported a case of air embolism during the operation of a ruptured middle cerebral artery aneurysm in supine position. A 58-year-old woman was admitted to our hospital in semicomatous state. A CT scan revealed diffuse subarachnoid hemorrhage. Cerebral angiogram showed a middle cerebral artery aneurysm. Massive pinkish foamy sputum and butterfly shadow on chest x-ray strongly suggested an association of neurogenic pulmonary edema (NPE). Barbiturate therapy and controlled ventilation with positive end-expiratory pressure (5cmH2O) were started. Her airway pressure was about 35cmH2O. Decrease of pinkish foamy sputum and an improvement of chest x-ray findings on the next day encouraged us to perform a clipping operation. Just before a clip application, air bubbles were observed to pass through the middle cerebral artery under the microscope. Subsequently cardiac standstill was brought out. Fortunately, she was resuscitated, and a clip application was finished. A postoperative CT scan revealed an infarction in the middle cerebral artery area. A postoperative cerebral angiogram showed occlusion of a temporal branch of the right middle cerebral artery, P1 portion of the left posterior cerebral artery, and the right superior cerebellar artery. We speculated that high endotracheal pressure brought out pulmonary alveolar rupture, and in spite of supine position operation massive air, which flowed into systemic circulation from ruptured alveoli, caused cerebral infarction and cardiac arrest. We consider that unrecognized air embolism might be the one of the factors influencing the prognosis of severe subarachnoid hemorrhage, especially in the cases associated with neurogenic pulmonary edema.
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PMID:[Unexpected air embolism during an aneurysmal operation in supine position--a case report and a speculation about its pathogenesis]. 156 90

Cocaine-related cardiovascular events escalated during the 1980s as cocaine became purer, cheaper, and easier to obtain. Cocaine abuse is a risk factor for myocardial ischemia and/or infarction, cardiac arrhythmias, pulmonary edema, ruptured aortic aneurysm, cerebral infarction, infective endocarditis, vascular thrombosis, myocarditis, and dilated cardiomyopathy. As medical and social complications of cocaine have become evident, and with the growing negative image of cocaine, the number of first-time users has begun to decline. Cocaine abuse is seen on all levels of our society and has emerged as an issue of significant medical and public health importance. All routes and forms of cocaine abuse are potentially cardiotoxic and can be lethal. Fatal cardiac complications can occur in a first-time user. All physicians should be alert for cocaine abuse when confronted with unexplained cardiac symptoms. Cocaine is the newest and sometimes unrecognized risk factor for cardiovascular disease in young individuals otherwise free of cardiovascular risk factors.
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PMID:Cocaine: the newest risk factor for cardiovascular disease. 181 Jun 80

Cardiac dysfunction with pulmonary edema following scorpion envenomation (SE) has been documented only in a few isolated case reports. We conducted a systematic hemodynamic study in five consecutive patients (mean age, 21.6 +/- 8 years) presenting with pulmonary edema occurring a few hours (9.6 +/- 5.2 hours) after SE. All patients had increased pulmonary capillary wedge pressure (mean, 25 +/- 1.8 mm Hg) while the systemic vascular resistance was elevated only in one. The stroke volume index was markedly depressed (21.7 +/- 3.6 ml/sq m) whereas cardiac index was normal or slightly decreased (2.5 +/- 0.4 L/min/sq m). Cerebral infarct and sudden cardiac arrest were the cause of death in two patients. In the three survivors, all the hemodynamic disturbances and respiratory abnormalities disappeared within a few days. We conclude that cardiac dysfunction was found in all five patients and this was reversible in the three surviving the acute episode.
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PMID:Cardiac dysfunction and pulmonary edema following scorpion envenomation. 139 4

In 58 patients with progressive neurological deterioration from angiographically confirmed cerebral vasospasm after spontaneous subarachnoid hemorrhage, arterial hypertension was induced in an attempt to improve their deficits. The most effective regimen consisted of intravascular volume expansion, blockade of the vagal depressor response, and the administration of antidiuretics and vasopressor agents. With this protocol, arterial blood pressure could be sustained at high levels for prolonged periods. Neurological deterioration was reversed in 47 patients, transiently in 4; permanent improvement occurred in 43. Complications experienced during therapy included pulmonary edema, dilutional hyponatremia, aneurysmal rebleeding, coagulopathy, hemothorax, and myocardial infarction. Elevating systemic arterial pressure in states of cerebrovascular insufficiency resulting from vasospasm is safe if meticulous attention is paid to physiological, biochemical, and hematological parameters, with the exception that it may be hazardous in the presence of an untreated ruptured or intact aneurysm. Intravascular volume expansion and induced hypertension are effective in reversing ischemic deficits from vasospasm provided that treatment commences before cerebral infarction and that adequate pressures are maintained for a sufficient period. The production of a hypervolemic state by the use of colloid and crystalloid infusion accompanied by atropine blockade of the vagal depressor response and blunting of the diuresis with vasopressin enables arterial pressure to be elevated for longer than 1 week.
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PMID:Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. 713 49

Hypertensive crisis is a rare condition with increased blood pressure and evidence of new or progressive severe end-organ damage. The patients should be admitted to hospital, and the blood pressure reduced gradually. Blood pressure should not be normalized, but a reduction in mean arterial pressure of 20-25% or to a diastolic blood pressure > 100-110 mmHg should be achieved. Patients at particular risk for further complications are elderly, patients with hypovolaemia, renal insufficiency, ischaemic heart disease and patients with neurological deficits. The ideal antihypertensive drug for any form of hypertensive crisis does not exist. If the patient can cooperate with oral treatment, nifedipine may be used, usually administered as capsules of 10 mg orally, producing a rapid and safe reduction in blood pressure of 25% within 10-15 minutes with a maximal action after 30-60 minutes. The dose may be repeated after 30 minutes in case of insufficient blood pressure response. Hypotension is rare. Nifedipine in combination with nitroglycerine is of special benefit in hypertensive pulmonary oedema. In cases of treatment failure or if the patient cannot cooperate with oral treatment, the choice of drug lies between labetalol and sodium nitroprusside. Nitroprusside is administered as continuous intravenous infusion, the drug is safe to use and is recommended in conditions where reduction of blood pressure must be performed with extreme caution such as in cases of cerebral infarction and intracranial hemorrhage. Infusion of nitroprusside for more than 48-72 hours is inexpedient because the metabolites of nitroprusside need monitoring as well. Parenteral drug therapy with labetalol is more simple than treatment with nitroprusside, but at the same time somewhat more difficult to titrate. Nitroglycerine is very suitable in moderate hypertension and ischaemic heart disease, but in severe hypertension with heart disease nitroprusside is the treatment of choice. Loop diuretics should not be used as first-line drugs, but only in conditions with evidence of volume-overload. Patients with hypertensive crisis most often show volume depletion which is aggravated by loop diuretics, therefore they should not be used routinely. When the blood pressure has been stabilized, an oral antihypertensive drug should be started concomitantly to a gradual reduction of the initial parenteral drug therapy.
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PMID:[Hypertensive crises. 2. Treatment]. 875 95

A hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage, such as aortic dissection, pulmonary edema, acute coronary syndromes, cerebral infarction or hemorrhage, hypertensive encephalopathy, acute renal failure and eclampsia. With the exception of stroke, blood pressure must be reduced quickly, usually by using intravenous antihypertensive agents. Blood pressure reduction should be gradual while maintaining organ perfusion, which may be easily compromised in elderly and chronically hypertensive patients. In the absence of new or worsening end-organ injury, the indication of immediate therapy should be carefully evaluated. If indicated, the use of an orally long-acting antihypertensive agent is preferred to avoid an acute and unpredictable fall in blood pressure. In particular, the use of short-acting nifedipine should be condemned.
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PMID:[Hypertensive crisis: when and how to treat?]. 1515 59

Primary cardiac myxosarcoma is a rare disease; it is exceedingly rare for symptoms of systemic metastasis to precede diagnosis of the primary cardiac tumor. We describe the case of a previously healthy 60-year-old man with left atrial myxosarcoma, who had first presented with jejunal intussusception due to intestinal polyposis. Three months after resection of the jejunum, the patient experienced cerebral infarction and pulmonary edema. Further physical evaluation, which included echocardiography for the 1st time, revealed a mass in the left atrium that protruded through the mitral valve into the left ventricle. At emergency cardiac surgery, we found that the tumor involved multiple sites of the left atrium, the pulmonary veins, and the mitral anterior leaflet. Two months after surgery, the patient died of massive cerebral hemorrhage. Necropsy disclosed multiple recurrences of the cardiac myxosarcoma and widespread metastatic lesions. The intestinal polyps that had been resected originally were diagnosed, on retrospective histopathologic examination, as metastases of the myxosarcoma. In this unusual case, the metastatic lesions were the 1st clinical manifestations of a malignant cardiac tumor.
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PMID:Left atrial myxosarcoma with previously detected intestinal metastasis. 1742 Aug 10

For expansion of the extravascular space, secretion of antidiuretic hormone and increment of vascular permeability, a large quantity of non-functional extracellular fluid is accumulated in an extravascular space from all over the operation. Extracellular fluid returns from an extravascular space to blood vessels in refilling stage, and decrement of a pulmonary vascular bed after pneumoresection make it easy to cause pulmonary edema and tachyarrhythmia. Therefore volume of postoperative infusion is apt to be limited after pneumoresection. However, the fluid management that extremely imbalanced in dry side increases the risk of arrhythmia, myocardial infarction and cerebral infarction. It is important to perform reasonable fluid therapy without excess and deficiency postoperatively while observing amount of urine, specific gravity of urine, heart rate, blood pressure, volume of chest drainage and central venous pressure. We have few opportunity to consider about nutritional management after pneumoresection so that ingestion is started for an early postoperative period. But, the grave case that ingestion cannot start for an early postoperative period should start total parenteral nutrition or enteral feeding. In that case, the enteral feeding which is more physiological than intravenous nutrition is recommended.
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PMID:[Fluid and nutritional management after pneumoresection]. 2071 9

We describe the case of a 79-year-old woman with pulmonary infarction due to tumor emboli whose high-resolution CT (HRCT) scan demonstrated the reversed halo sign. The patient had gastric cancer and died because of cancer-related cerebral infarction. On autopsy, the central ground-glass area of the reversed halo sign on HRCT corresponded to pulmonary edema associated with alveolar septal capillary metastasis, whereas the peripheral ring-like consolidation consisted of a hemorrhagic infarct with tumor emboli. The present case is important because a detailed pathologic correlation with this unique HRCT appearance was revealed.
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PMID:Reversed halo sign in pulmonary infarction with tumor emboli: a case report. 2485 22

A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. The patient was treated with alteplase about 2.5 h after onset. Immediately after the intravenous alteplase administration, the hemiparesis improved. However, his respiratory condition unexpectedly worsened 10 h after onset. Chest radiography demonstrated an infiltrative shadow in both lung fields. Transthoracic echocardiogram showed a dysfunction in the left ventricle and no contraction at the apex of the heart, consistent with a type of cardiomyopathy, known as takotsubo cardiomyopathy(TCM). Gradually, the patient's respiratory and cardiac function improved. Here, we describe a very rare case of TCM and neurogenic pulmonary edema(NPE)following an acute cerebral infarction, which was treated with alteplase intravenous administration. TCM and NPE have a poor prognosis, therefore diagnosis, management, and treatment in the acute phase is required.
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PMID:[Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema Following Fibrinolytic Therapy for Embolic Stroke:A Case Report]. 2936 81


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