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

Many neurologic disorders, such as eclampsia, pseudotumor cerebri, stroke, obstetric nerve palsies, subarachnoid hemorrhage, pituitary tumors, and choriocarcinoma, can develop in the pregnant patient. Maternal mortality from eclampsia, which ranges from 0 to 14%, can be due to intracerebral hemorrhage, pulmonary edema, disseminated intravascular coagulation, abruptio placentae, or failure of the liver or kidneys. Associated fetal mortality ranges from 10 to 28% and is directly related to decreased placental perfusion. Pseudotumor cerebri can be associated with serious visual complications; thus, the therapeutic goal is to prevent loss of vision. The risk of stroke in the pregnant patient is 13 times the risk in the nonpregnant patient of the same age. The major causes of stroke in pregnant patients are arterial occlusion and cerebral venous thrombosis. Lumbar disk prolapse is common in pregnant patients, and lumbosacral plexus injuries can occur during labor or delivery. In addition, peripheral nerve compression or entrapment syndromes are thought to be caused by the retention of fluid during pregnancy. The incidence of subarachnoid hemorrhage during pregnancy is 1 in every 10,000 patients, a rate 5 times higher than in nonpregnant women. Because of a proliferation of prolactin-secreting cells, the pituitary gland can enlarge dramatically during pregnancy, a change that can disclose a previously unknown tumor or cause a known pituitary tumor to become symptomatic. The incidence of choriocarcinoma is 1 in 50,000 full-term pregnancies but 1 in 30 molar pregnancies. This malignant tumor has a high rate of cerebral metastatic lesions. In addition to these disorders that develop during pregnancy, the pregnant state can affect numerous preexisting neurologic conditions, including epilepsy, headaches, multiple sclerosis, myasthenia gravis, spinal cord injury, and brain tumors. We discuss advice for patients with such conditions who wish to become pregnant, recommendations for medical and surgical management, and surgical considerations for neurologic complications during pregnancy.
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PMID:Selected neurologic complications of pregnancy. 225 22

In Japan, elderly patients who develop myasthenia gravis (MG) are increasing in number. However, there are few clinical reports concerning this issue. We evaluated the clinical manifestations, inducing or exacerbating factors, complications, treatments and prognosis of systemic MG in 11 patients older than 60 years of age. Bulbar symptoms were more frequent in these patients compared with younger MG patients, and 6 out of 11 cases (54.5%) were mistakenly diagnosed as cerebrovascular disorders. Among inducing or exacerbating factors of MG were psychological problems inherently involved with the aged, physical factors, and inappropriate termination or rejection of medication. Increase in the level of anti-Ach-R antibodies was recognized in 10 out of 11 cases (90.9%). A high percentage of the patients had thymoma (36.4%) and thyroid diseases (45.5%): 3 with Hashimoto's thyroiditis (27.3%), 1 with thyroid ophthalmopathy associated with hyperthyroidism, and 1 with simple goiter. Others were accompanied by ischemic heart disease, prostatic hypertrophy or stomach cancer. We treated these patients with corticosteroids, immunoglobulin, radiation for thymoma, or thymectomy in addition to administration of anticholinesterase agents. Prognostically, we found that duration of illness before death was shorter in those with onset later than 70 years of age. Seven out of 11 (63.6%) patients died of either aspiration pneumonia (4 cases), complications of thymectomy, congestive pulmonary edema or stomach cancer. There were no deaths associated with myasthenic crisis.
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PMID:[Clinical evaluation of myasthenia gravis in elderly patients]. 764 74

Three patients of myasthenia gravis, who under went video-assisted thoracoscopic surgery (VATS) were given general anaesthesia by propofol infusion and muscle relaxation by atracurium infusion. Isoflurane was added to control depth of anaesthesia on the basis of haemodynamic changes during surgery. One lung ventilation (OLV) was achieved by placement of Carlens left sided double lumen bronchocatheter. Right-sided surgical approach was used to perform thymectomy. Contrary to claimed short duration of surgery, in first patient, OLV lasted for 10 hours 30 minutes and patient developed re-expansion pulmonary oedema. OLV in second and third patient was for six hours thirty minutes and three hours 45 minutes respectively. Morning dose of pyridostigmine was omitted and atracurium (0.1 mg/kg) was found to be satisfactory for intubation and relaxation was maintained with atracurium infusion to get desired monitored effect. We could not extubate our patients due to longer duration of surgery and the sequelae there off. Post-operative elective ventilation and spontaneous weaning off the atracurium effect was thus preferred.
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PMID:Peri-operative management of patients for video assisted thoracoscopic thymectomy in myasthenia gravis. 1183 43

We present 10 cases of "ancient" (sclerosing) thymomas in 4 women and 6 men (age range, 34-73 years; mean, 53.5 years). Clinically, 4 patients had a history of shortness of breath and chest pain of several weeks' duration, 1 had a history of myasthenia gravis, and 5 were asymptomatic (anterior mediastinal masses discovered on routine chest radiographs). All underwent complete surgical resection of the anterior mediastinal mass. The tumors were light tan and solid, without areas of hemorrhage or necrosis, and 5 to 10 cm in greatest diameter. Extensive areas of hyalinized fibroconnective tissue constituting about 85% to 90% of the tumor mass was the main tumor feature. Focal areas of conventional thymoma also were present in all tumors. Follow-up information was obtained for 8 patients. Of these 8 patients, 6 died, all of unrelated causes (congestive heart failure, renal insufficiency, and pulmonary edema), and 2 were alive 1 and 6 years after surgical resection. The present cases highlight an important histopathologic feature of thymomas, which can pose problems in diagnosis, namely when dealing with small mediastinoscopic biopsy specimens.
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PMID:"Ancient" (sclerosing) thymomas: a clinicopathologic study of 10 cases. 1519 59

We report a previously asymptomatic 50-year-old lady who came with myasthenic crisis as initial presentation of myasthenia gravis. She developed pulmonary edema following intravenous immunoglobulin administration and had ischemic changes in ECG and left ventricular dysfunction on echocardiography. She improved with diuretics, dobutamine, and fluid restriction alone. This is the first report in English-language medical literature describing the association between myasthenic crisis and likely takotsubo cardiomyopathy-related pulmonary edema following intravenous immunoglobulin administration.
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PMID:Pulmonary edema in myasthenic crisis. 2482 32