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)

In this case report we describe the clinical and laboratory findings of a man who nearly drowned after aspirating a large quantity of seawater. The aspiration of salt water, which is strongly hypertonic with respect to plasma, resulted in severe pulmonary edema, both from the quantity of aspirated seawater and the osmotically driven ultrafiltrate of plasma that accumulated in the air spaces. The initial concentration of protein in the edema fluid sample was very low, 0.7 g/dl, consistent with only a minimal increase in epithelial permeability. Approximately 4 h later, there was a marked increase in the concentration of protein in the residual alveolar fluid associated with improvement in several clinical indices, indicating that the excess alveolar fluid was reabsorbed very rapidly. In addition, the magnesium concentration was markedly elevated because of the aspiration of magnesium-containing seawater, which may have diagnostic importance for near-drowning in salt water. The data from this case provide evidence for well-preserved alveolar epithelial barrier function after aspiration of large quantities of hypertonic salt water.
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PMID:Pulmonary edema associated with salt water near-drowning: new insights. 151 66

A 63 year old female, who was admitted to a psychiatric hospital for schizophrenia, was referred to our emergency room because of sudden loss of consciousness and convulsions. On arrival, she was drowsy and hypoxemic. Her chest X-ray showed cardiomegaly with pulmonary edema. ECG showed marked ST depression in precordial leads and serum chemistry revealed marked elevation of CPK, GOT and LDH along with hyponatremia and hypochloremia. She was immediately admitted to CCU on suspicion of acute non-transmural myocardial infarction complicated with congestive heart failure. After fluid restriction and intravenous infusion of dopamine she passed large amount of urine, and her consciousness level, electrolyte imbalance and ECG change, improved gradually. Although serum CPK level increased as high as 32,307 IU/ml, there were no signs of left ventricular asynergy on UCG and CPK isozyme analysis performed later revealed more than 99% of serum cCPK was MM-type. We concluded that water intoxication was the cause of the ECG change and the elevated serum CPK, GOT and LDH levels. There are few reports on elevated CPK level in association with water intoxication, in which rhabdomyolysis is speculated as the cause of CPK elevation. But there is no report on ECG change complicated with water intoxication. In our case, electrolyte imbalance caused by water intoxication seemed to play a major role in ST depression and QT prolongation. Although water intoxication is a rare disorder in the general population, it is not infrequent among patients with psychiatric diseases. Care must be taken when such patients present ECG change and serum enzyme elevation mimicking ischemic heart disease.
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PMID:[A water intoxication patient who showed remarkable ST depression and suspected ischemic heart disease]. 152 80

We studied the effects of three different doses (15, 20, and 25 mg/kg) of Perilla ketone (PK) on the blood-perfused in situ sheep lung while obtaining external measurements of lung transvascular protein flux. Lymph flow and lymphatic protein clearance increased significantly after all doses of PK. Severe pulmonary edema was confirmed by high postmortem wet-to-dry lung weight ratios and increased extravascular lung water from multiple indicator-dilution studies. Urea permeability-surface area product and effective diffusivity from multiple indicator-dilution studies also increased after PK infusion. Because we observed no evidence of increased capillary pressure or increased microvascular surface area after PK, we conclude that PK significantly increased pulmonary microvascular permeability. Certain aspects of the in situ PK response appeared to be dose dependent. The lungs responded rather quickly to high doses of PK, but an apparent latency period was noted with low doses of PK. Postmortem wet-to-dry lung weight ratios were always high but did not suggest dose dependence. However, times of postmortem measurements were not the same for all doses of PK. The external scan technique appeared to be sensitive to changes that occurred in the lung after PK. Externally detected albumin interstitial-to-plasma mass (mass I/P) ratios were substantially higher after PK than during control in situ studies. In some experiments, final mass I/P ratios increased above 4 approximately 2.0 h after PK compared with control values of 0.2 and 0.4. A delay time between injection and change in mass I/P slope was also observed, which decreased with increasing dose of PK. PK causes a permeability injury in the in situ sheep lung and provides a useful model for studying the sensitivity of permeability measurement techniques such as the external gamma-ray detection method.
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PMID:Effects of Perilla ketone on the in situ sheep lung. 155 25

The pulmonary edema of smoke inhalation is caused by the toxins of smoke and not the heat. We investigated the potential of smoke consisting of carbon in combination with either acrolein or formaldehyde (both common components of smoke) to cause pulmonary edema in anesthetized sheep. Seven animals received acrolein smoke, seven animals received a low-dose formaldehyde smoke, and five animals received a high-dose formaldehyde smoke. Pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac output were not affected by smoke in any group. Peak airway pressure increased after acrolein (14 +/- 1 to 21 +/- 2 mmHg; P less than 0.05) and after low- and high-dose formaldehyde (14 +/- 1 to 21 +/- 1 and 20 +/- 1 mmHg, respectively; both P less than 0.05). The partial pressure of O2 in arterial blood fell sharply after acrolein [219 +/- 29 to 86 +/- 9 (SE) Torr; P less than 0.05] but not after formaldehyde. Only acrolein resulted in a rise in lung lymph flow (6.5 +/- 2.2 to 17.9 +/- 2.6 ml/h; P less than 0.05). Lung lymph-to-plasma protein ratio was unchanged for all three groups, but clearance of lymph protein was increased after acrolein. After acrolein, the blood-free extravascular lung water-to-lung dry weight ratio was elevated (P less than 0.05) compared with both low- and high-dose formaldehyde groups (4.8 +/- 0.4 to 3.3 +/- 0.2 and 3.6 +/- 0.2, respectively). Lymph clearance (ng/h) of thromboxane B2, leukotriene B4, and the sulfidopeptide leukotrienes was elevated after acrolein but not formaldehyde.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Smoke aldehyde component influences pulmonary edema. 155 32

Intravenous liquid halothane causes severe pulmonary edema when administered for suicide attempts. This study was carried out to elucidate the cardiopulmonary effects of intravenous liquid halothane in 14 dogs. Subjects were divided into three groups: group 1 (n = 4) was the control; group 2 (n = 5) received 7.5 mmol intravenous liquid halothane; and group 3 (n = 5) received pretreatment of continuous infusion of prostaglandin E1 at a rate of 0.02 microgram.kg-1.min-1, followed by 7.5 mmol intravenous liquid halothane. Hemodynamic values, extravascular lung water, and arterial blood gas tensions were measured for 240 min. In group 2, thromboxane B2, beta-glucuronidase, and lipid peroxides were measured in four of five dogs. In group 2, intravenous liquid halothane caused pulmonary edema associated with hypoxemia, pulmonary hypertension, and left ventricular dysfunction. In group 3, prostaglandin E1, given to reduce pulmonary vasoconstriction and left ventricular preload, aggravated hypoxemia and pulmonary hypertension and impaired left ventricular contractility, although end-diastolic left ventricular pressure was low. Thromboxane B2 increased, whereas beta-glucuronidase and lipid peroxides did not change after administration of intravenous halothane. We conclude that pulmonary edema induced by intravenous liquid halothane was due to direct pulmonary vascular damage, and that pulmonary vasoconstriction and increased left ventricular preload were not contributory causes.
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PMID:Acute pulmonary edema after intravenous liquid halothane in dogs. 144 96

The role of cyclooxygenase products in acute lung injury was determined by pretreatment of dogs with ibuprofen before injury with intravenous ethchlovynol (ECV). In animals given ECV only, lung injury resulted in extravascular lung water of 18.9 ml/kg after 2 h, which was significantly higher than the 14.8 ml/kg in the group pretreated with ibuprofen. The comparison of gravimetric and indicator-dilution measurements of edema fluid indicates that edema fluid could not be reliably detected after treatment with ibuprofen because of diversion of flow from injured areas. Venous admixture increased from 6% at baseline to 32% 120 min after ECV in the vehicle-pretreated group compared with an increase from 4% at baseline to 7% in the ibuprofen-pretreated group. The regression analysis of the relationship between venous admixture and extravascular lung water indicated that, at any level of edema, venous admixture was significantly less in the group treated with ibuprofen than in the untreated group. Measurement of plasma and bronchoalveolar lavage fluid indicated that ibuprofen inhibited cyclooxygenase activity without affecting lipoxygenase activity. These results suggest that in intact dogs ibuprofen has a protective effect on both pulmonary gas transfer and pulmonary edema formation in ECV-injured lungs, which is consistent with limiting blood flow to injured segments of the lung.
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PMID:Ibuprofen reduces ethchlorvynol lung injury: possible role of blood flow distribution. 156 70

The effects of cardiogenic and noncardiogenic pulmonary edema on the activities of rapidly adapting receptors (RARs) and pulmonary C-fibre receptors were investigated in dogs anaesthetized with chloralose. Cardiogenic pulmonary edema was produced by elevating the mean left atrial pressure by 25 mmHg (1 mmHg = 133.32 Pa) above the control value for a period of 45 min, by partial obstruction of the mitral valve. Noncardiogenic pulmonary edema was produced by injecting alloxan (100 mg/kg) intravenously. The effect of the latter was examined on RARs alone. Cardiogenic edema activated RARs (n = 8) and the activity was greatest during the first few minutes after elevation of mean left atrial pressure. The pulmonary C-fibre receptors (n = 6) were also activated by cardiogenic edema, but these responses were variable. Noncardiogenic pulmonary edema also activated RAR (n = 6), and this response was maintained during the entire recording period (20 min). The extravascular lung water (%), measured 15 min (n = 5) and 45 min (n = 5) after the elevation of the mean left atrial pressure, was significantly elevated above control values. However, these two values were not significantly different from each other. The extravascular lung water increased significantly after the injection of alloxan also (n = 5). These results show that during pulmonary edema, there is significant stimulation of the RARs and the pulmonary C-fibre receptors. It is suggested that the reflex respiratory responses observed in pulmonary edema may be due to the activation of both the RARs and the pulmonary C-fibre receptors.
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PMID:Responses of pulmonary C-fibre and rapidly adapting receptor afferents to pulmonary congestion and edema in dogs. 158 57

To better understand the distribution and clearance mechanisms of extravascular lung water (EVLW) in pulmonary edema, computed tomographic (CT) scans of isolated canine lungs were obtained. In this model, there is no active lymphatic drainage. Fourteen isolated lobes were inflated with oxygen, and edema was induced by infusion of normal saline solution. Two volumes of saline were used, 50 percent and 150 percent of initial wet lobar weight. Six 10-mm- and 1.5-mm-collimation CT scans were obtained at 10-mm intervals from the hilum to the periphery of the lobe before and after each of the two stages of pulmonary edema. The CT scans were reviewed independently by two chest radiologists and were assessed by CT densitometry. Both subjective analysis and CT densitometry showed a predominantly central peribronchial distribution of EVLW in the isolated lungs. Airway wall thickness also increased from the control value (average thickness, 1.0 mm) to 150 percent edema (average thickness, 1.5 mm) (p less than 0.001). We postulate that the peribronchial distribution of fluid is due to a pressure gradient from the alveolar interstitium to the interstitium around the blood vessels and airways at the hilum. This gradient may play a major role in the characteristic perihilar and peribronchial distribution of EVLW seen radiologically in patients with hydrostatic pulmonary edema.
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PMID:High-resolution computed tomography of experimental hydrostatic pulmonary edema. 158 13

Oxygen radicals produced by polymorphonuclear leukocytes were considered primarily responsible for reperfusion injury in lung transplantation. Using the extirpated rabbit lungs as a transplant model, we measured lung water volume, the oxygen radicals of lung tissue using a direct method (electron spin resonance) and an indirect method (measurement of peroxide lipids). The effects of free radical scavengers, human superoxide dismutase (h-SOD) and catalase (CAT), and leukocyte-depleted blood on reperfusion injury were evaluated in three experimental groups. Group I (n = 8, control): Lung reperfusion was performed with blood from other rabbits. Group II (n = 7): Immediately before reperfusion, h-SOD (1,500 u/ml) and CAT (3,000 u/ml) were added to the blood. Group III (n = 7): Reperfusion was performed with the leukocyte-depleted blood. Severe pulmonary edema and an elevation of malondialdehyde (MDA) occurred in Group I. In Group II, addition of radical scavengers to the reperfusion blood produced only mild pulmonary edema, but an elevation of MDA occurred as in Group I. In Group III, pulmonary edema and MDA elevation were almost completely suppressed.
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PMID:The effects of radical scavengers and leukocyte-depleted blood on reperfusion injury of extirpated rabbit lung. 158 43

We performed a randomized, prospective trial to evaluate whether fluid management that emphasized diuresis and fluid restriction in patients with pulmonary edema could affect the development or resolution of extravascular lung water (EVLW), as well as time on mechanical ventilation and time in the intensive care unit (ICU), in critically ill patients requiring pulmonary artery catheterization (PAC). PAC was performed on 101 patients. A total of 52 patients were randomized to an EVLW management group using a protocol based on bedside indicator-dilution measurements of EVLW. The other 49 patients were randomized to a wedge pressure (WP) management group in whom fluid management decisions were guided by WP measurements. A total of 89 patients had pulmonary edema (defined as EVLW greater than 7 ml/kg ideal body weight). Except for a clinically unimportant difference in mean age, the two groups were entirely comparable at baseline. The study groups were managed differently, as evidenced by cumulative input-output of 2,239 +/- 3,695 ml (median = 1,600 ml) in the WP group versus 142 +/- 3,632 ml (median = 754 ml) in the EVLW group (p = 0.001). EVLW decreased significantly, and ventilator-days and ICU days were significantly shorter only in patients from the EVLW group. No clinically significant adverse effect occurred as a result of following the EVLW group algorithm. Thus, a lower positive fluid balance, especially in patients with pulmonary edema regardless of cause, is associated with reduced EVLW, ventilator-days, and ICU days.
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PMID:Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. 152 95


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