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)

Three South African patients with severe Rickettsia conorii infection had complicated courses of illness with 2 fatal cases and 1 with gangrene of multiple digits. Immunofluorescent organisms of R. conorii were demonstrated in vascular endothelium of brain, leptomeninges, renal glomerular arterioles and capillaries, renal arteries and veins, myocardial capillaries and arteries, pulmonary alveolar capillaries, pancreatic septa, splenic arterioles, and dermis. Rickettsiae were also observed in hepatic sinusoidal lining cells, splenic and lymph node macrophages, and the blood vessels of the partially viable zone of the amputated digits. Pathologic lesions included cerebral and cerebellar perivascular mononuclear leukocytes, mild mononuclear leptomeningitis, glomerular arteriolitis, vascular and perivascular mononuclear cell-rich inflammatory foci in the kidney, pancreas, skin, and myocardium, hepatocellular necrosis, and pulmonary edema. The sites of lesions and rickettsiae showed strong topographical correlation. Thrombi and hemorrhage occurred in a minority of the sites of vascular injury. Rickettsiae were the apparent direct cause of meningoencephalitis, peripheral gangrene, and other foci of vascular injury. Fatal R. conorii infection with disseminated organ involvement emphasizes the pathogenic potential of this disease.
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PMID:Correlation of the distribution of Rickettsia conorii, microscopic lesions, and clinical features in South African tick bite fever. 388 74

Thrombotic obstruction, a rare but often fatal complication of cardiac valve prostheses, appears to occur more frequently in tilting-disc valves than in other valve designs. Its diagnosis and surgical treatment remain a challenge. Ten consecutive patients who had thrombosis of a tilting-disc valve prosthesis were treated in Chang Gung Memorial Hospital from November 1982 to August 1990. Preoperative clinical features, including exertional dyspnea, new murmur, and absence of a metallic click from the prosthetic valve, occurred in all of the patients. Symptoms were present for 1 week or more before reoperation in 70% of the patients; nevertheless, many patients were referred only after acute exacerbation of heart failure and development of pulmonary edema. Echocardiography confirmed prosthetic valve malfunction in 90% of the patients. One unconfirmed case was later documented by cardiac catheterization. Anticoagulant therapy was in the therapeutic range for only half of the patients at the time of admission. Prompt reoperation was performed for thrombectomy (8 patients, all survived) or valve replacement (2 patients, one death). Long-term outcome was satisfactory in all survivors with a mean follow-up of 31.6 months. These findings emphasize the importance of considering the diagnosis of thrombosis in patients with mechanical heart valve prostheses who are first seen with nonspecific symptoms and minor changes of their physical findings. The diagnosis could be easily made by echocardiography. Thrombectomy is an easy, fast, and safe procedure, especially for these critically ill patients.
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PMID:Surgical management of thrombotic disc valve. 841 19

Thrombus formation in a morphologically normal a aorta is a very rare event. A 50-year-old man with a history of chronic obstructive pulmonary disease, presented to the emergency department with pulmonary edema. Transthoracic and transesophageal echocardiography revealed a highly mobile, pedunculated floating thrombus in the descending thoracic aorta 3-4 cm distal to the origin of the left subclavian artery. The original lumen of the aorta was almost obliterated by the thrombus. The aortic wall was free of any atheroma. Thrombolytic treatment was administered, but 3 hours after starting streptokinase, he developed sudden and severe low-back pain accompanied by loss of lower-extremity pulses which were patent on admission. Cardiopulmonary arrest developed within an hour and the patient died despite resuscitation. The potential causes of aortic thrombus, the clinical spectrum that the patients may present, diagnostic methods, and therapeutic options are discussed.
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PMID:Fatal giant aortic thrombus presenting with pulmonary edema in a patient with chronic obstructive pulmonary disease. 1816 May 72

Myocardial infarction simultaneously involving two or more culprit lesions is extremely rare and usually has a poor clinical outcomes including mortality. Management of this complicated condition is challenging and limited time. Nevertheless, autopsy studies revealed that thrombotic occlusion of more than one major epicardium coronary artery is not uncommon. A 68-year-old woman presented with sudden onset of limited breath and chest discomfort since two hours prior to admission. She also felt exert dyspnoea since one month ago. She has two risk factors that were uncontrolled that is hypertension (HT) and type 2 diabetes mellitus (DM). On admission, she succumbed into cardiogenic shock and pulmonary oedema. ECG revealed a diminished R wave in V2-V4 with ST elevation in V2-V5 and in aVR. Biphasic T wave was seen in V2-V6. The working diagnosis was anterior STEMI, Killip class IV with thrombolysis in Myocardial Infarction (TIMI) score of 8. While being transferred to catheter lab, she gasped, became desaturation, and was intubated prior to procedure. The patient was given double inotropes which run maximally. By Coronary angiography, there were occlusions at the LAD and LCX. Stent was applied at proximal LAD and LCX. Subsequently, patient's condition improved and post-procedure ECG showed improvement in aVR and precordial leads, and ST elevation was significantly diminished from V5 and aVR, and R wave came back in V2-V4.Previous study found around 50% of STEMI patients had multi-vessels diseases. In this case, ECG suggested LAD region infarction with ST elevation in aVR, commonly associated with left main stenosis (LMS) involvement.Thrombus aspiration in LAD and LCX yielded hemodynamic improvement. V-stenting technique, introduced in 1996, allows delivery and implantation of 2 stents together, and therefore shorten the stent deployment time.
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PMID:Double Culprits in a Patient with ST Elevation Myocardial Infarction: A Challenging But Rewarding Case. 2995 May 37

Juvenile dermatomyositis (JDM) is a multisystem vasculopathy that infrequently presents with acute complications (1). We report here the case of a 12-year-old girl with JDM who developed Thrombotic Thrombocytopenic purpura (TTP) and Purtscher's retinopathy. This is the second pediatric case of JDM with TTP and Purtscher's retinopathy in the literature. The diagnosis of JDM was based on her clinical presentation (fever, myalgia, proximal muscle weakness, characteristic skin rash and elevated muscle enzymes) (2). Despite improvement of rash, fever and weakness with corticosteroids and intravenous Immunoglobulins (IVIG), the patient developed retinopathy, thrombocytopenia, hemolytic anemia, renal failure, and pulmonary edema within 1 week of initial treatment. A clinical diagnosis of TTP and Purtscher's retinopathy was made and her ADAMTS13 activity was found to be low. Regardless of aggressive treatment with pulse steroid therapy, IVIG, plasmapheresis along with multiple infusions of Fresh Frozen plasma (FFP), her condition deteriorated. In view of her worsening condition, she received one dose of Rituximab and within 48 h, her hematological and retinal involvements improved. Rituximab was given at the same dose once weekly thereafter for 4 total doses. Her disease process was halted, and retinopathy improved significantly in 48 h and continued to gradually improve over 3 weeks of maintenance therapy with cyclosporine, methotrexate, and IVIG and then stabilized. This report documents the association of TTP and Purtscher's retinopathy with JDM, emphasizing that early recognition and prompt treatment with rituximab along with the current standard of care treatment i.e., Vincristine, corticosteroids and plasmapheresis could be of potential benefit in controlling disease activity.
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PMID:Juvenile Dermatomyositis (JDM) Complicated by Thrombotic Thrombocytopenic Purpura (TTP) and Purtscher's Retinopathy Responsive to Rituximab: Case Report and Literature Review. 3285 May 49