Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From January 1987 to December 1989, prematures with RDS weighing 1750 g or less admitted to the Neonatal Intensive Care Unite (NICU) were submitted from the third postnatal day to serial two-dimensional and pulsed Doppler (ATL MK 600) echocardiographic evaluation for "silent" patent ductus arteriosus (PDA). PDA was diagnosed in 36/175 prematures with RDS (20.5%). Thirty patients had indomethacin treatment and the PDA closed completely in 27 (90%); five needed a second course of indomethacin, that was effective in two (40%). Four RDS patients (4/36-11%) already weaned from the respirator, needed supplemental oxygen. The three non-responders and six other prematures with counterindications to the drug underwent surgical ligation (25%). As historical control, we retrospectively evaluated the population of preterm infants with RDS weighing less than or equal to 1750 g treated for hemodynamically significant PDA during three previous years before the screening protocol; in this group the echocardiographic and Doppler evaluations were done when congestive heart failure and pulmonary edema were clinically evident. In comparison, we found a reduced incidence of prematures with RDS treated for PDA, 7/120 (5.8%) a higher age at medical treatment (9 +/- 1.4 vs 4.4 - 2.3 days) and a larger prevalence of patients underwent ductal ligation (71.4%). These data show that early screening and treatment of "silent" PDA may result advantageous to improve the efficacy (90%) of indomethacin, in a critical time for the recovery of RDS, and furthermore decreasing the need of surgical ligation.
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PMID:Early screening and treatment of "silent" patent ductus arteriosus in prematures with RDS. 196 Jun 32

We measured extravascular density (EVD) and the pulmonary transcapillary escape rate (PTCER) for 68Ga-transferrin using positron emission tomography in 14 normal volunteers and 29 patients with radiographic infiltrates, including six patients with congestive heart failure (CHF), eight patients with the adult respiratory distress syndrome (ARDS), and 15 patients with focal pneumonia. Contralateral, radiographically normal regions were also evaluated in the patients with focal pneumonia. Mean EVD was elevated in the patients with CHF, ARDS, and pneumonia in regions of radiographic infiltrate compared with values from normal subjects (p less than 0.05), but it was not significantly different among the three patient groups. PTCER in normal subjects and in patients with CHF was not significantly different (21 +/- 11 versus 44 +/- 16 x 10(-4) min-1, respectively, p = NS). PTCER was elevated in regions of infiltrate because of either pneumonia (173 +/- 99) or ARDS (170 +/- 79). PTCER was also elevated in regions contralateral to those with focal infiltrate during pneumonia, even though these regions were radiographically normal and had normal EVD values. These results suggest that PTCER is a sensitive but nonspecific index of abnormal pulmonary vascular permeability, which may be useful for classifying patients in clinical studies of pulmonary edema.
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PMID:A positron emission tomographic comparison of pulmonary vascular permeability during the adult respiratory distress syndrome and pneumonia. 198 72

To assess whether steroid therapy influenced the clinical course of myocarditis in a pediatric population, findings in 13 consecutive infants and children (8 female, 5 male) with biopsy-proved myocarditis were reviewed. The mean age was 5.7 +/- 4.8 years (range 1.1 to 14.8). Congestive heart failure was present in all as were ST-T wave changes, cardiomegaly and pulmonary edema on chest roentgenogram. Echocardiography demonstrated pericardial effusion in five patients and mitral regurgitation in eight. Mean left ventricular ejection fraction was 34 +/- 12%. Prednisone was administered to all patients; one patient also received azathioprine. There was one death. All survivors showed clinical improvement with normalization of ECG changes, heart size and systolic function. No significant side effects occurred. Repeat myocardial biopsy in eight patients demonstrated improvement in all eight and elimination of the inflammatory infiltrate in six. Immunosuppressive therapy in this pediatric population appeared useful in improving the clinical course and cardiac function in acute myocarditis with no adverse side effects.
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PMID:Immunosuppressive therapy in the management of acute myocarditis in children: a clinical trial. 199 4

The goal of fluid therapy in the PACU setting is the restoration of blood volume and tissue perfusion. Choosing the type of fluid infusion depends on the preoperative, intraoperative, and postoperative condition of the patient. An understanding of the functional fluid compartments, the composition of body fluids and commercially available fluids, and the steps to evaluate fluid depletion allow one to determine the fluid needs of the patient. The orderly and expedient evaluation of fluid status of the postoperative patient involves the assessment of volume status, concentration status, composition status, and signs and symptoms of inadequate tissue perfusion. Recovery after surgery is a dynamic process, and fluid reassessment should be conducted periodically. Fluid challenges may be necessary in the hypovolemic patient or in patients with clear signs and symptoms of end-organ hypoperfusion. Weil and Rackow and Shoemaker provide useful approaches to fluid challenge guided by CVP and PAP monitoring. The decision of whether to use crystalloids or colloids for fluid resuscitation is complex, controversial, often determined by personal preference and concern over expense, and may be inconsequential as long as fluids are infused appropriate to the needs of the patient. There are disadvantages and advantages to both crystalloid and colloid fluid administration. As with any therapeutic intervention, there are complications with fluid administration, congestive heart failure and pulmonary edema being of more immediate concern. Finally, blood components are colloid-type solutions that should be reserved for specific patient problems. Red blood cells are indicated to increase oxygen-carrying capacity in patients with anemia. Platelets are used to treat bleeding associated with deficiencies in platelet number or function. Fresh frozen plasma is transfused to increase clotting factor levels in patients with demonstrated deficiency. A good understanding of fluid types available, of a systematic approach to evaluating fluid depletion, and of the indications for blood component therapy will allow one to make appropriate decisions when implementing fluid therapy in the PACU.
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PMID:Fluid therapy in the PACU. 204 19

Emergency aortic valvuloplasty was performed as a last resort in 34 patients with an average age of 76 years with critical aortic stenosis in the terminal stages with congestive cardiac failure or cardiogenic shock. Emergency aortic valve replacement was considered to be too risky in these cases. The valve was dilated in all patients, resulting in a fall in mean peak-to-peak pressure gradients from 59 mmHg to 21 mmHg and an increase in valve surface area from 0.42 cm2 to 0.85 cm2. Significant improvement in myocardial function was observed immediately after the procedure with an increase of the cardiac index from 1.77 l/min/m2 to 2.07 l/min/m2 and of the ejection fraction from 28% to 35%. Complications were rare. There were no deaths or cerebrovascular accidents during the valvuloplasty procedure. Two patients died in hospital (6%) after the dilatation and two other patients who had persistent pulmonary oedema, underwent surgery; one died and the other had a good surgical result. A clear cut clinical improvement was obtained in the other 30 patients. The patients were followed up for an average of 15 +/- 7 months during which 15 died (50%), 6 +/- 5 months after dilatation. The other 15 survivors have a significant and unhoped for functional improvement. Three young patients later underwent surgical valve replacement in good clinical conditions with the same operative risk as that of standard candidates for aortic valve surgery. One other patient was operated on successfully during another relapse of cardiac failure. These results show that aortic valvuloplasty may be undertaken with a low risk even in the most critical clinical situations and that the procedure rapidly relieves the invalidating symptoms. It may be used as a bridge to surgery in patients with an unacceptable operative risk. The indications should be very flexible in young patients in terminal cardiac failure with cardiogenic shock or refractory pulmonary oedema.
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PMID:[Percutaneous aortic valvuloplasty as a last resort in patients with critical aortic valve stenosis]. 212 88

Atrial natriuretic factor (ANF) causes plasma fluid to shift out of the circulation and enhances the escape of radiolabeled albumin. Examination of the mechanisms by which ANF alters microcirculatory fluid and protein transfer will likely require studies in localized vascular regions. This study was aimed at determining the specific organs in which ANF increases the escape of albumin. Anesthetized, splenectomized rats that had both kidneys removed were infused with vehicle alone or rat ANF-(99-126) at 0.025, 0.05, 0.1, or 0.5 micrograms.min-1.kg-1 for 2 hours (n = 8 per group). Total red cell and plasma volumes were measured with chromium-51-labeled erythrocytes and iodine-125-labeled albumin, respectively. At the end of 2 hours, the rats were frozen in liquid nitrogen, and organ blood volumes and tissue 125I-albumin were determined. ANF decreased plasma volume at infusion rates of 0.1 and 0.5 micrograms.min-1.kg-1. ANF increased the rate at which 125I-albumin escaped from the overall circulation at infusion rates of 0.1 and 0.5 micrograms.min-1.kg-1. At an ANF infusion rate of 0.1 micrograms.min-1.kg-1, the albumin escape rate increased in the gastrointestinal tract, skeletal muscle, heart, and lungs. At an infusion rate of 0.5 micrograms.min-1.kg-1, the albumin escape rate increased in the gastrointestinal tract, muscle, and skin, but not the lungs. These findings suggest that at pathophysiological levels, ANF shifts protein out of the circulation in peripheral vascular beds and the lungs and may contribute to pulmonary edema in states such as congestive heart failure. At pharmacological levels, ANF may be protective of the lungs by preventing increased pulmonary albumin escape.
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PMID:High-dose atrial natriuretic factor enhances albumin escape from the systemic but not the pulmonary circulation. 214 97

Most patients undergoing laparoscopic procedures experience no complications; however, a major complication rate of approximately 0.3% has been documented. Cardiomyopathy is also rare. A patient who underwent laparoscopy for oocyte retrieval during in vitro fertilization/embryo transfer developed congestive heart failure and pulmonary edema. A cardiomyopathy was diagnosed subsequently.
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PMID:Cardiomyopathy in a patient undergoing laparoscopy for oocyte retrieval during in vitro fertilization/embryo transfer. A case report. 214 63

Diastolic dysfunction is being recognized increasingly as a primary cause of congestive heart failure. It may result from physiological abnormalities of myocardial relaxation, or anatomical abnormalities which increase resistance to ventricular inflow. With regard to physiological abnormalities, there is substantial evidence to indicate that myocardial ischaemia and hypertrophy are two conditions characterized by impaired inactivation and relaxation of myocardial cells. These conditions often co-exist in patients with idiopathic hypertrophic subaortic stenosis or calcific valvular aortic stenosis. Recent evidence also suggests a role for calcium overload in the diastolic dysfunction seen in some patients with advanced congestive heart failure. Diastolic dysfunction may be of fundamental importance in the pathophysiology of flash pulmonary oedema in patients with advanced ischaemic heart disease, since myocardial ischaemia in such patients may lead to a decline in relaxation rate, increased resistance to early diastolic filling and further impairment in diastolic coronary blood flow due to intramyocardial compression of capillaries and venules. During the transient ischaemia of angina pectoris, patients with multivessel coronary artery disease often show a striking upward shift in the left ventricular diastolic pressure-volume relationship, signifying a marked decrease in distensibility of the left ventricular chamber. With regard to anatomical abnormalities, diastolic dysfunction in heart failure may result from structural changes within the ventricular wall. Diastolic dysfunction of the left ventricle may result from extrinsic compression by pericardial effusion (tamponade), pericardial constriction, and right ventricular overload. Thus, a variety of physiological and anatomical abnormalities may lead to increased resistance to diastolic filling of one or both ventricles, resulting in diastolic heart failure.
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PMID:Diastolic function and heart failure: an overview. 218 38

Five patients with congestive heart failure (CHF) and 1 with left ventricular dysfunction but without CHF were found to have sleep apnea. Central sleep apnea (CSA) related to Cheyne-Stokes respiration was seen in 4 cases while obstructive sleep apnea (OSA) was seen in 2. All patients had symptoms of sleep apnea. Nasal continuous positive airway pressure (NCPAP) was effective in reversing CSA and OSA in all patients with improvement in sleep structure and alleviation of symptoms of sleep apnea. In addition, all experienced a reduction in cardiac dyspnea. This was associated with a 5% or greater increase in left ventricular ejection fraction while on NCPAP, compared to baseline value off NCPAP in 5 patients and resolution of chronic pleural effusion and pulmonary edema in the sixth. We conclude that Cheyne-Stokes respiration during sleep may give rise to a CSA syndrome that is reversible by NCPAP. In addition, NCPAP therapy may lead to a reduction in cardiac dyspnea and improvement in left ventricular function in patients with left ventricular dysfunction and sleep apnea.
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PMID:Sleep apnea in patients with left ventricular dysfunction: beneficial effects of nasal CPAP. 219 97

A variant of hepatorenal syndrome occurring in patients with chronic congestive heart failure following an episode of cardiogenic pulmonary edema, and in the absence of hypotension, is described. This was observed in 13 patients during an eleven-year period. The clinical picture is characterized by hepatic injury and functional renal impairment. Increase of serum glutamic oxaloacetic transaminase levels as high as 2100 IU; prolongation of prothrombin time; elevation of serum bilirubin, creatinine, blood urea nitrogen, and potassium levels; decrease in urinary sodium excretion; and a normal urinary sediment are the salient laboratory abnormalities of this entity. Treated with conventional medication, the patients' course was fatal in 4 cases. When the splanchnic vasodilator dopamine was added to the patients' management, 5 of 9 patients recovered. Cardiogenic hepatorenal syndrome is a severe but potentially reversible complication of heart failure. The apparently beneficial effect of low-dose dopamine needs further evaluation.
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PMID:Cardiogenic hepatorenal syndrome. 224 92


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