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)

The case of a 32-year-old parturient with a quintuplet pregnancy is described. The pregnancy had been complicated by premature labour which was treated with ritodrine tocolysis. Betamethasone was administered to hasten fetal lung maturation. The ritodrine therapy was complicated with fluid overload and pulmonary oedema requiring intravenous diuretic treatment. The patient presented urgently for Caesarean section, with fluid overload and worsening thrombocytopaenia. Life-threatening pulmonary oedema was manifest in the immediate preinduction period, following insertion of a pulmonary artery catheter and surgery was delayed to improve the mother's condition with intravenous diuretic therapy. Induction was carried out with the patient in the sitting position, with cricoid pressure maintained to protect the airway as the patient was lowered to a wedged, supine position. Intravenous nitroglycerin was used to control blood pressure. Low pressure mask-bag ventilation was utilized to maintain oxygen saturation and the patient was intubated and ventilated with positive end-expiratory pressure. Positive pressure ventilation was continued for 24 hours postoperatively. The perioperative course is reviewed and followed by a discussion of the anaesthetic considerations for multiple gestation pregnancies.
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PMID:Anaesthesia for caesarean section in a parturient with quintuplet gestation, pulmonary oedema and thrombocytopaenia. 340 18

Paraquat poisoning and hyperbaric oxygen exposure are well established models of oxidative stress in lung. The aim of this study was focused on the contribution of oxygen free radicals and other cytotoxic species, such as lipid hydroperoxides, to the overall toxicity. Adult Wistar rats were injected with paraquat (30 or 60 mg/kg b.w.) or exposed to hyperbaric oxygen (0.2 MPa), and several parameters of lung damage were measured. Both treatments resulted in increased spontaneous lung chemiluminescence, number of lung PMN, malondialdehyde content, lung edema, and pleural liquid. Of note, spontaneous lung chemiluminescence, used to monitor the steady-state concentration of oxygen free radicals in vivo, did not increase significantly after either treatment. The increase in spontaneous lung chemiluminescence started after PMN migration, being both maxima separated by a delay time of 4-6 h. After PMN migrated and became activated in the lung, the survival of the animals started to decline. Thus, PMN can be considered as additional sources of oxygen free radicals supported by the subsequent increase in chemiluminescence. Their role in lung damage was evidenced by the increase in lung edema, augmented pleural liquid, and decreased survival after PMN migration. Lipid hydroperoxide concentration in lung membranes was also increased after either treatment. This increased concentration may be a consequence of an increased rate of lipid peroxidation, initiated by oxidative stress on lipid membranes, or by an inhibition of their catabolism. Ester lipid hydroperoxides normally produced in membranes cannot be catabolized directly by the glutathione peroxidase-reductase system unless phospholipase A2 catalyses the release of free lipid hydroperoxides. In both experimental models, phospholipase A2 activity was decreased to almost negligible values. Betamethasone (1 mg/ml; IV) administered to the rats 3 h before paraquat injection accelerated the decrease in survival and phospholipase A2 inactivation. Inactivation of phospholipase A2, detected in paraquat or oxygen exposed rats, could be attributed to a O2(.-)-driven Fenton reaction. However, phospholipase A2 inactivation by betamethasone pretreatment may be attributed to the presence of lipocortin, a corticosteroid-inducible factor and inhibitor of phospholipase A2. Besides the mechanism underlying the inactivation of phospholipase A2, the increase in lipid hydroperoxides may indicate their role as long-lived cytotoxic species that contribute to the damage already initiated by oxidative stress. Indeed, lipid hydroperoxides are very well known modifiers of membrane physical properties.
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PMID:Lung damage in paraquat poisoning and hyperbaric oxygen exposure: superoxide-mediated inhibition of phospholipase A2. 774 3

A 32-year-old woman (148 cm, 59 kg, gravida 2, para 2) with quadruplet pregnancy was admitted to our hospital for the threatened preterm labor at 23 weeks and 2 days of gestation. She was treated with ritodrine, magnesium sulfate and nifedipine to maintain tocolysis. Betamethasone was administered to accelerate fetal lung maturity. After ritodrine dose was increased at 23 weeks and 5 days of gestation, she developed dyspnea with desaturation. Acute pulmonary edema was revealed on chest X-ray. The decision was made to proceed with emergency cesarean delivery. On arrival at the operating room, the blood pressure was 123/53 mmHg, heart rate 111 beats x min(-1), and oxygen saturation (SpO2) 84% with supplemental oxygen 15 l x min(-1) via a reserved face mask. Noninvasive positive pressure ventilation (NPPV) was initiated with S/T mode (FIO2 1.0, inspiratory positive airway pressure 10 cmH2O, expiratory positive airway pressure 6 cmH2O). The dyspnea was improved with her SpO2 100%. Spinal anesthesia was performed at L 34 using 2.5 ml of 0.5% bupivacaine and 100 microg morphine. Throughout the operation (operation time 44 minutes), she did not develop dyspnea under NPPV. NPPV was discontinued after the operation. Her SpO2 declined, and pulmonary edema on chest X-ray was exacerbated. She was transferred to the intensive care unit and NPPV was continued for 22 hours after the operation. She was discharged from the intensive care unit on the next day and was discharged from the hospital on the 6th postoperative day.
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PMID:[Successful perioperative use of noninvasive positive pressure ventilation in a pregnant woman with acute pulmonary edema]. 2486 80