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

Three open heart surgery patients developed noncardiogenic pulmonary edema after administration of protamine following cardiopulmonary bypass. A catastrophic series of events are characteristic of this reaction: 1) sudden onset; 2) severe bronchoconstriction with early extreme difficulty in ventilation; 3) hyperinflation of the lungs; 4) pulmonary hypertension with normal pulmonary wedge or left atrial pressures; 5) progression to fulminant noncardiogenic pulmonary edema; 6) significant mortality; and 7) ventilatory perfusion abnormalities in survivors. Review of the literature reveals three types of reactions to protamine injection of varying severity: 1) brief hypotension; 2) anaphylactoid generalized reaction; and 3) high protein noncardiogenic pulmonary edema with cardiopulmonary collapse. The severity of the reaction had no relation to the dose of protamine. Previous protamine exposure was documented in 14 of 35 cases. Awareness of this reaction is essential for prompt treatment if fulminant pulmonary edema occurs. Administration of epinephrine, steroids, vasopressors, and potassium replacement may be required. Needless use of protamine sulfate should be discouraged.
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PMID:Acute reaction to protamine. Its importance to surgeons. 660 3

One case of unilateral pulmonary oedema a vacuo is reported and the 38 cases published in the literature are reviewed. Contributing factors are essential, the main ones being the duration and severity of lung collapse and the rate of reexpansion. The clinical signs and symptoms are described, together with the various possible courses of the disease, and the severity factors are deduced from 8 lethal cases. A therapeutic approach is proposed but not formalised, since pathophysiological data are still scarce.
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PMID:[Reexpansion unilateral pulmonary edema]. 662 57

We report four patients who developed severe adverse reactions to protamine sulfate following cardiac surgery. Two types of reactions were seen. First, an immediate anaphylaxis which is a complement-dependent IgG antibody-mediated reaction. In the literature, 80% of patients who had similar reactions have had previous exposure to protamine. All patients adequately tested had positive skin tests and there is 6% mortality. The second reaction to protamine during cardiac surgery is characterized by delayed onset and profound vascular damage presenting as noncardiogenic pulmonary edema or total vascular collapse with prolonged hypotension and anasarca. These patients have negative skin tests and in our studies, no evidence of antibody mediated reaction, suggesting some other mechanisms may play a part. The mortality is high (30% of patients reported) and survivors have significant morbidity.
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PMID:Adverse reactions to protamine sulfate following cardiac surgery. 670

Re-expansion pulmonary edema (RPE) due to pneumothorax aspiration can lead to a fatal outcome, as in the case reported, the chronic nutritional deficiency and hypoproteinemia that it provokes probably playing a contributing role. Pathogenesis and factors affecting prognosis of RPE are discussed. These include the duration of the pulmonary collapse, though this is not an essential factor, the alterations in alveolar surfactant activity possibly related to the chronicity of the collapse, and the abruptness of aspiration which is, in contrast, a determining mechanical factor. Finally, the hypoproteinemia present in certain cases could facilitate fluid extravasation towards the alveolus. It is concluded that aspiration should be a gentle procedure in all cases, and should be conducted with extreme caution in the presence of hypoproteinemia.
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PMID:[Re-expansion pulmonary edema after iatrogenic pneumothorax. A propos of 1 case]. 686 92

After a brief literature survey, the authors share their experience of the treatment of hypertonic crises and acute left cardiac insufficiency of renal patients via Naniprus, a preparation produced in P.R. of Bulgaria. The patients' age was from 11 to 64. With an average basal arterial pressure (AP) 25.2/14.5 kPa during the crises the patients had an average AP of 33.3/20.0 kPa and only three minutes after the initiation of its drop infusion it was reduced to an average of 25. 1/14.7 kPa (p less than 0.001). In one child with severe pulmonary edema in the progress of a hypertonic crisis, in a crisis for rejection of transplanted kidney, they infused Naniprus continuously for 5 days and nights, and in another transplanted patient--7 days and nights, not observing any undesirable effects. The authors recommend Naniprus infusion to be carried out very cautiously, with AP being checked every minute at the beginning at the other side until obtaining the desired and stable result. Each careless or uncontrolled administration of the preparation threatens with severe collapse. In patients with AV-fistulas reddening of the face and eyes as well as headache were observed.
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PMID:[Naniprus treatment of hypertensive crises in patients with kidney diseases]. 716 8

Since the effect of prolonged exposure to high concentrations of oxygen on regional ventilation and perfusion has not been previously, a reproducible primate model of oxygen toxicity was developed to investigate the pathophysiologic changes that occur. Regional ventilation and perfusion were measured by 133Xe techniques in 10 baboons before and after 108 hours of continuous exposure to an inspired oxygen concentration of more than 90%. Arterial blood gases, shunt fraction (QS/QT), cardiac output, physiologic dead space (VD/VT), and pulmonary vascular resistance were also measured. Light and electron microscopic histology confirmed early pathologic changes of oxygen toxicity in every animal after exposure. PaO2 in room air decreased markedly after exposure from 90 +/- 4 to 46 +/- 5 mm Hg, and QS/QT rose to 30 +/- 2%. VD/VT, PaCO2, and pH were not altered by exposure to hyperoxia. Similarly, cardiac output and pulmonary vascular resistance remained unchanged. The distribution of regional ventilation and perfusion remained normal during and after prolonged high-oxygen exposure. Early oxygen toxicity was characterized by profound hypoxemia without regional ventilation-perfusion mismatch. Although impaired diffusion through a thickened alveolar membrane may be partially responsible for this hypoxemia, the markedly increased alveolar-arterial oxygen gradient when FIO2 = 1.0 indicates that shunting at the alveolar level (secondary to absorptive collapse or pulmonary edema) is a major cause of the hypoxemia.
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PMID:Effects of oxygen toxicity on regional ventilation and perfusion in the primate lung. 722 86

Pulmonary complications are a major cause of death in patients in various forms of shock. The exact causes of the pulmonary complications are unknown. This study evaluates the functional characteristics of intralobar pulmonary arteries (IPA) and veins (IPV) obtained from swine subjected to splanchnic arterial occlusion (SAO) shock ans subsequent cardiovascular collapse and sham-shocked swine subjected to surgery but no occlusion. The contractile response of pulmonary arteries to norepinephrine (NE) and serotonin (5-HT) were depressed when obtained from pigs subjected to SAO shock. The depression in the sensitivity to 5-HT and maximal tension development to 5-HT and NE was selective, since the responses to potassium ion were not depressed. IPA obtained from swine with SAO shock were more sensitive to the relaxant actions of arachidonic acid, a precursor for bisenoic prostaglandins, than were IPA from sham-shocked swine. This was not observed when prostaglandins were used as agonists. This suggests that synthesis of prostaglandin differs in the pulmonary vasculature of sham-shocked and SAO-shocked animals. IPV obtained from swine in SAO shock were less sensitive to 5-HT and NE but more sensitive to arachidonic acid and 9 alpha, 11 alpha-epoxymethano-PGH2, a thromboxane like compound. IPV obtained from swine in SAO shock converted more arachidonic acid into a substance with the chromatographic mobility of thromboxane B2. The data suggest that alterations in the prostaglandin system within the pulmonary artery and vein may contribute to the pulmonary complications of SAO shock. The alterations appear to include an enhanced synthesis of prostacyclin as well as thromboxane-like substance. Because the veins were more sensitive than the arteries to 9 alpha, 11 alpha-epoxymethano-PGH2, thromboxanes or endoperoxides may elevate venous tone and contribute to the pulmonary edema associated with shock states.
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PMID:Pulmonary vascular smooth muscle function in porcine splanchnic arterial occlusion shock. 724 87

A 36-year-old man developed extreme shortness of breath after injecting "freebase" cocaine intravenously. Clinical and radiographic evaluation confirmed acute pulmonary edema, and blood gas studies substantiated acute respiratory failure. Despite vigorous therapy, the patient died three hours after admission. When cocaine use causes death, generally it is by respiratory collapse. Although the post-mortem finding of pulmonary edema after cocaine use has been reported, to our knowledge, this is the first reported death due to clinical pulmonary edema after the intravenous use of freebase cocaine.
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PMID:Fatal pulmonary edema following intravenous "freebase" cocaine use. 725 60

Severe anaphylactoid reactions during anaesthesia in 116 patients are described. The majority of patients who reacted to induction agents had previous exposure to the drug, while the majority of patients who reacted to muscle relaxants had not. There was a statistically significant increased incidence of allergy, atopy, asthma and previous reactions in patients who had reactions compared with a control group undergoing uneventful anaesthesia. There was no correlation between abnormalities in immunoglobulins or resting complement levels and a history of allergy or atopy. Antihistamines, steroids and bronchodilators alone did not prevent reactions and three patients reacted to test doses with Althesin. Reactions usually occurred during induction of anaesthesia, but may occur at any time in the perioperative period. No one drug produced reactions that differed in severity or clinical features from any other drug. Clinical features included skin changes, oedema, cardiovascular collapse, bronchospasm, gastrointestinal symptoms, prolonged unconsciousness, convulsions and pulmonary oedema. Four patients died.
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PMID:The epidemiology and clinical features of anaphylactic reactions in anaesthesia. 728 19

"At first glance the lungs may seem uncomplicated, but many wise men have gone astray in their labyrinths." These words were written by Dr. A.A. Liebow, a famous pathologist, in a foreword to the first edition of Pathology of the Lung by H. Spencer. This same thought can also be applied to the field of medicolegal autopsies. 1. The gross appearance of the lungs in medicolegal autopsies Plucks consisting of the lungs, neck organs, the esophagus and the aorta were removed from human cadavers and after taking photos of the frontal and rear view, the lungs were carefully examined to reveal whether the lung shows characteristic morphological changes depending on causes of death. Based on their appearance, the lungs were classified into the 3 following types: a collapsed, a non-collapsed and an inflated type, each of these types reflecting the probable cause of death. The collapsed type of lung was seen in cases of death from exanguination, and the lung falling into shrinkage due to traumatic pneumo- and/or hemo-thorax was also classified into the collapsed type. The non-collapsed type of lung was seen in cases whose lungs were thermo-coagulated and in a case of death from a pulmonary embolism. Also, the deflating lungs of drowning victims before falling into collapse, were classified into a non-collapsed type. The inflated type of lung consisted of lungs that showed ballooning soon after death by drowning, and lungs that had inflated due to emphysema or edema from various causes. This lung study has reconfirmed that the lungs show hypostatic changes more clearly than any other organs of the body, and in the absence of skin color changes reflecting hypostasis, the settling of the blood in the lung could be detected in most cases. 2. Early histopathological lung changes induced by shock One hundred and thirty medicolegal cases were reviewed to detect early histopathological changes of the lung induced by shock. In many cases of death from various causes, pulmonary edema and hemorrhage were noted, but the incidence of such changes did not reveal any significant differences among the causes of death. When death had resulted from a hemorrhage or occurred during a state of shock, megakaryocytes in the pulmonary vessels tended to increase. However, if death from such causes had occurred shortly after the event, no increase in megakaryocytes was noted.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Some findings of the lung in medicolegal autopsy cases]. 786 36


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