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

We examined the integrity of the alveolocapillary membrane in human cardiac (hydrostatic) (group 1) and noncardiac (permeability) (group 2) edema by measuring the clearance of two intravenously administered radiotracers from the blood to suctioned bronchoalveolar secretions (BAS), representing pulmonary edema fluid, and compared the clearances to simultaneously measured pulmonary capillary wedge pressure (PCWP) and colloid osmotic pressure (COP), representing the intravascular Starling forces, Pmv and pimv. 111In-labeled diethylenetriamine pentaacetic acid (DTPA), mol wt 504, a hydrophilic radiotracer that equilibrates with extracellular water, and 125I-labeled human serum albumin (HSA), mol we 69,000, were injected intravenously. Samples of blood and BAS were then collected hourly for 405 h, and clearances were calculated. We found the clearance of both radiotracers to be greater in group 2 than in group 1 patients, despite a low mean PCWP-COP gradient, indicating greater alveolocapillary membrane permeability membrane in noncardiac, than in cardiac edema. Furthermore, 111In-DTPA clearance was linearly correlated with the PCWP-COP gradient in both groups (group 1, R2 = 0.726, P less than 0.001; group 2, R2 = 0.879, p less than 0.001 as was the clearance of 125I-HSA in group 2 (R2 = 0.35, P less than 0.027). Clinically, the data suggest that in cardiac and noncardiac pulmonary edema the transmicrovascular flux of small and large solutes may be favorably influenced by therapeutic alterations aimed at widening the intravascular PCWP-COP gradient. However, the greater permeability of the alveolocapillary membrane in noncardiac edema would prohibit any major resolution of edema by simple therapeutic alterations of this gradient.
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PMID:Pulmonary microvascular clearance of radiotracers in human cardiac and noncardiac pulmonary edema. 702 2

We examined the usefulness of serum colloid osmotic pressure measurement in patients with chronic rather than acutely occurring low serum protein concentrations. We used two oncometers, the IL 186 Weil Oncometer and the Wescor Model 4100; results from the two instruments were interchangeable. Values for the colloid osmotic pressure were compared with those for serum total protein (r = 0.783) and albumin concentrations (r = 0.882), which were similar to previously published values. Our day-to-day CV was 2.8%. In studying over 100 patients we found that the previously reported occurrence of pulmonary edema in almost all patients whose colloid osmotic pressure was less than 12.5 mmHg was not seen in the chronic hypoproteinemic patients. We noted only one fatality in our patients whose colloid osmotic pressure was less than 10.5 mmHg, a value found to be associated with fatality in one previous study of acutely ill patients. Factors such as ambulation, fasting, dehydration, and the nature of the blood sample can markedly affect the value for colloid osmotic pressure value, and this, coupled with the good correlation with the serum albumin in several studies, leads us to question the usefulness of measuring colloid osmotic pressure in a non-specialist hospital environment, either as an adjunct to the measurement of serum protein or albumin, or as an independent test.
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PMID:Measurements of serum colloid osmotic pressure are of limited usefulness. 705 98

It is accepted that the laboratory and clinical so-called "transurethral resection syndrome" reflects passage into the body of a large fraction of the water used to perfuse the field of endoscopic resection. The major complete syndrome (dyspnoea, nausea, hypertension, raised central venous pressure, bradycardia then pulmonary oedema, cerebral oedema, cardiovascular shock and renal insufficiency) is rare: 1.5 per cent of cases of transurethral resection of the prostate in the literature, 0.6% in a series of the last 300 resections performed by the authors (2/300). Also was it not possible to hope for a complete physiological study of sufferers from this complication. Nevertheless, it may be considered that all transurethral resections of the prostate may be associated with similar movements of water to a minimal extent. In order to attempt to demonstrate this, the authors studied in a series of 19 patients pre- and postoperative blood volumes by a radio-immunological technique using pre- and postoperative serum albumin haematocrits. In this short series, patients who had undergone a short endoscopic resection (35 minutes on average) of a small adenoma (13 grams on average) with a mean irrigation of 10 litres of water rendered isotonic by the addition of glycocolle, without any transfusion or infusion being necessary during the course of the resection, the conclusion was simple: no variation in blood volume was demonstrated. Is the physiopathological hypothesis advanced to explain this phenomenon false? And is the problem in fact one of peroperative septicaemia?
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PMID:[Transurethral resection of the prostate (turp syndrome), myth or reality? Analytic studies using a radioactive isotope method (author's transl)]. 721

Supplemental albumin added to a standard non-albumin resuscitation regimen has been shown to significantly impair heartwork in seriously injured patients. The role of calcium dynamics in this myocardial depression was analyzed in 94 injured patients who were in shock for an average of 32 minutes, received an average of 14.5 transfusions, 9.2 L crystalloid, 0.9 L plasma, and 20.9 mEq calcium prior to the end of operation. By random selection, 44 patients received an average of 31 gms of albumin during operation, 207 gms during the early postoperative period (mean = 30 hrs) of extravascular fluid sequestration, and 402 gm during the mobilization period. The albumin resuscitated patients had normal total protein and serum albumin levels and higher total calcium (TC) levels, however, they had a significantly lower Ca++ and Ca++/TC. The accumulative slope for heartwork/filling pressure was significantly depressed in albumin patients as was the mean work unit/filling pressure index. The level of Ca++ and the Ca++/TC ratio correlated directly with the calculated work unit index in both the albumin and non-albumin patients. This suggests that a supplemental albumin binds serum Ca++ causing an increase in TC but a reduction in Ca++ and Ca++/TC. The fall in Ca++ and Ca++/TC seems responsible, in part, for heart failure and pulmonary edema in albumin resuscitated patients.
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PMID:The cardiac effect of altered calcium homeostasis after albumin resuscitation. 721 93

The immunoconjugate XMMCO-791/RTA consists of ricin A chain bound to a murine monoclonal antibody MoAb 791T. This monoclonal antibody (MoAb) binds to a glycoprotein of 72 kD, which is expressed on human colorectal carcinoma, ovarian carcinoma, and osteogenic sarcoma. XMMCO-791/RTA was tested in a Phase I trial with proposed dose escalation steps of 0.02, 0.04, 0.15, and 0.2 mg/kg per day. Twelve patients with metastatic colorectal carcinoma were treated at 0.02, 0.03, and 0.04 mg/kg per day dose levels administered over 1 hour on days 1-5. Study-related toxicities were hypotension (6 patients); greater than 10% weight gain (6 patients); peripheral edema (9 patients); fever (4 patients); confusion (3 patients); diarrhea (3 patients); proteinuria, as identified by dipstick (3 patients), greater than 0.6 mg/dl decrease in serum albumin (11 patients); greater than 25% decrease in oncotic pressure (10 patients), and a decrease in ionized calcium (8 patients). Six patients received a second course of treatment. HAMA levels developed in 9 patients and titers increased with number of courses administered. Decreased overall toxicity, in comparison to the first course, was noted, but one patient had an allergic-type response (hypotension, crushing chest pain, diaphoresis) after the test dose of the second course (HAMA level > 10,000 IgG). Life-threatening toxicity in the form of fluid shift, resulting in noncardiac pulmonary edema and third-spacing occurred after course 1 in 1 of 3 patients at the 0.04 mg/kg per day level. No further dose escalation was attempted and no antitumor activity was seen.
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PMID:Phase I study of monoclonal antibody-ricin A chain immunoconjugate Xomazyme-791 in patients with metastatic colon cancer. 762 72

To demonstrate the liver profile abnormalities in jaundiced falciparum malaria patients and to determine whether jaundice was associated with other complications in falciparum malaria, 390 patients with acute falciparum malaria were studied. 124 patients were jaundiced and the others were non-jaundiced. Hyperbilirubinemia (total serum bilirubin 3 to 64 mg/dl) was found in jaundiced patients predominantly as unconjugated bilirubin. Asparatate amino-transferase and alanine minotransferase were significantly higher in jaundiced patients (p < 0.01). There was a slight decrease of serum albumin in jaundiced malaria. The complications in jaundiced patients included cerebral malaria (n = 10), acute renal failure (n = 12), pulmonary edema (n = 3), shock (n = 3), and other severe malarial complications (n = 43). Jaundice was associated with cerebral malaria (p < 0.05), acute renal failure (p < 0.01), and hyperparasitemia (p < 0.01). After successful treatment, liver profile returned to normal within a few weeks. We found that jaundiced malaria patients had transient liver profile impairment which indicated predominantly hemolysis rather than liver damage; complications were more frequent in jaundiced patients.
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PMID:Liver profile changes and complications in jaundiced patients with falciparum malaria. 771 91

Perfusate composition may alter pulmonary hemodynamics and edema formation in perfused lungs. Perfusion for 3 h with Krebs-Henseleit solution with 3% bovine serum albumin did not produce pulmonary hypertension, pulmonary edema (assessed by lung wet-to-dry wt ratio), or increased macromolecular permeability (assessed by 125I-albumin uptake). Addition of blood to hematocrit levels of 10 or 20% resulted in pulmonary hypertension during the final hour of perfusion but not pulmonary edema or increased macromolecular permeability. Pulmonary hypertension during blood perfusion was primarily due to increased precapillary resistance. Perfusion with buffer solution without albumin produced edema and increased macromolecular permeability but not pulmonary hypertension. In lungs perfused with blood (20% hematocrit), thromboxane B2 levels increased in parallel with the pulmonary hypertension, and inhibition of cyclooxygenase or thromboxane synthase with indomethacin or dazmegrel prevented pulmonary hypertension. Perfusion with leukopenic blood (from prior nitrogen mustard administration or from filtration) also prevented pulmonary hypertension. We conclude that blood perfusion produces pulmonary hypertension via thromboxane A2 generation, which depends on leukocyte activation, and that perfusion with buffer solutions without albumin produces edema and increased permeability without pulmonary hypertension.
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PMID:Effect of blood and albumin on pulmonary hypertension and edema in perfused rabbit lungs. 775 18

Twenty-six patients, whose B-cell lymphoma had relapsed after conventional therapies, were treated in a phase I dose escalation study with an immunotoxin consisting of a mouse CD22 monoclonal antibody (RFB4:IgG1K) coupled to chemically deglycosylated ricin A chain (dgA). Two to 12 doses of the immunotoxin were infused intravenously at 48-hour intervals. The peak serum concentration and half-life (T1/2) did not correlate directly with the dose and averaged 3.8 micrograms/mL and 7.8 hours, respectively. The main dose-limiting toxicity was caused by the vascular leak syndrome (VLS) consisting of weight gain, edema, serum albumin decrease, and critically by pulmonary edema. Myalgia occurred frequently and was only dose limiting in one patient who developed rhabdomyolysis. The presence of lymphoma cells in the blood (> or = 10(10)/L) and clinically detectable splenomegaly were associated with reduced toxicity and a shorter T1/2. Nine of 24 evaluable patients (37.5%) made antibody to either mouse Ig or dgA. There were five partial responses (PR) and one complete response (CR) lasting 30 to 78 days. High peak concentrations of immunotoxin in the serum, a long T1/2, and large areas under the curve (AUC) correlated with both clinical response and toxicity. None of three patients with CD5+ lymphomas (including two CLL patients) had more than mild toxicity or responded to the immunotoxin.
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PMID:A phase I study of an anti-CD22-deglycosylated ricin A chain immunotoxin in the treatment of B-cell lymphomas resistant to conventional therapy. 821 17

Despite broader indications and easier access to renal replacement therapy during the past decades in Western countries, an unduly high number of patients is still referred to maintenance hemodialysis (HD) at a very advanced stage of chronic renal failure (CRF). To assess whether such late referral induces detrimental effects, we retrospectively compared clinical status and laboratory features in 20 patients who had been referred to us less than one month prior to first HD (late referral, or LR group) and in 20 sex- and age-matched controls who had undergone regular follow-up for at least six months prior to HD (early referral, or ER group). Male to female ratio was 12/8 and age averaged 53.5 years in both groups. Mean (+/- 1 SD) systolic and diastolic blood pressure were higher in LR group than in controls (180 +/- 14/102 +/- 10 vs. 153 +/- 15/86 +/- 7 mm Hg, P < 0.001) and fluid overload with pulmonary edema was present in 13/20 versus 3/20 patients (P < 0.001). Plasma concentrations (mmol/liter) of creatinine (1.12 +/- 0.27 vs 0.97 +/- 0.11, P < 0.01) and phosphate (2.58 +/- 0.47 vs. 1.92 +/- 0.31, P < 0.001) were higher, whereas plasma levels of bicarbonate (14.2 +/- 3.9 vs 22.5 +/- 4.2, P < 0.001) and calcium (1.85 +/- 0.24 vs. 2.27 +/- 0.15, P < 0.001) were lower in LR than in ER group, as were hemoglobin (7.1 +/- 1.1 vs. 9.4 +/- 0.9 g/dl, P < 0.001) and serum albumin levels (35.3 +/- 4.8 vs. 39.7 +/- 3.4, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Detrimental effects of late referral in patients with chronic renal failure: a case-control study. 832 Sep 13

Although active transport of sodium plays an important role in the resolution of pulmonary edema, the biochemical regulation of this process is still under investigation. The purpose of this study was to evaluate the activity of protein kinase C during the process of lung liquid clearance. Alveolar flooding was induced by instilling 5% bovine serum albumin solution, saline, or heterologous serum in the air spaces of rats. The activity of protein kinase C was measured in both the instilled and control lungs at 10 min and 1 and 4 h after fluid instillation. Four hours after instillation of 5% bovine serum albumin, the ratio of protein kinase C activity in the instilled lung compared with the control lung was 2.2 +/- 0.3. Similar results were obtained following instillation with heterologous serum or saline. Since we measured a clearance rate of 0.8 ml/h in anesthetized rats, we can postulate that the activation of protein kinase C occurred when > 40% of the liquid had been cleared from the lung. This increased activity of protein kinase C was not due to an increase in kinase activity in the inflammatory cells or an increase in enzyme quantity but due to a decrease of protein kinase C inhibitory activity in the lung. These results suggest that protein kinase C second messenger system may play a regulatory role in lung liquid clearance.
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PMID:Protein kinase C activity during the process of lung liquid clearance. 833 83


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