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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of acute pulmonary hypertension on the fraction of cardiac output shunted through pulmonary arteriovenous communications have been studied in dogs as a possible cause of hypoxia following pulmonary embolization. Pulmonary artery pressure was increased twofold and then fourfold above control values by embolization of the pulmonary vascular bed with polystyrene microspheres. Quantitative measurements of arteriovenous shunt were determined from the fraction of 50 mu radioactively labeled microspheres injected into the inferior vena cava which passed through the pulmonary circulation into systemic vascular beds. There was no increase in the fraction of pulmonary blood flow passing through pulmonary arteriovenous connections, 50 mu in diameter or greater, with pulmonary microembolism when FIo2 was 1. There was a small increase in arteriovenous shunt fraction when pulmonary artery pressure was increased with an FIo2 of 0.21. Physiological shunt measured by the oxygen technique did not increase with pulmonary embolism, but total venous admixture rose significantly. Postmortem gravimetric measurements of lung water indicated pulmonary edema. We conclude that anatomic arteriovenous shunt channels have little physiological significance after pulmonary microembolism in the dog lung. The major cause of hypoxia immediately after pulmonary microembolism is ventilation/perfusion imbalance, probably caused by pulmonary edema.
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PMID:Effect of pulmonary microembolism on arteriovenous shunt flow. 70 53

Regional lung ischemia was imaged with a rapidly diffusible radioaerosol of pertechnetate. The method is compared with similar techniques using 11C and 15O. The principles involved include (A) the rapid alveolar-capillary diffusion of inhaled radioactive gases (11CO, C15O, and C15O2) and the radioaerosol of 99mTcO4-; (B) the patency of the airways to the ischemic regions; and, most importantly; (C) the much slower tracer removal from lung tissue with a stagnant circulation as opposed to the surrounding normal lung. The 11CO and C15O label the hemoglobin in red blood cells, and the C15O2 labels water in the circulation and in the stagnant ischemic region. The TcO4- probably labels the albumin of the plasma in the embolized regions and in the circulating blood. Experiments involving pulmonary embolism in dogs, proved by pre- and post-mortem angiography and gross post-mortem examination, show that positive ischemic lesions (hot spots) are observed, after TcO4- aerosol and C15O2 gas inhalation, in the embolized region on the same day. Clinical trials with aerosol-inhalation method in suspected pulmonary embolism and now under way.
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PMID:Imaging experimental pulmonary ischemic lesions after inhalation of a diffusible radioaerosol: concise communication. 83 71

The role of positive end expiratory pressure (PEEP) was evaluated in preventing the deleterious mechanical respiratory effects of fatty acid pulmonary embolism. One group of animals had ventilation without PEEP, while the second group had PEEP of 10 cm H2O applied only to the right lung. In the right lung, PEEP slightly reduced the blood flow, increased the vascular resistance, but reduced intersititial edema and reduced the degree of shunting to almost normal. Hypoxemia was prevented in the right pulmonary venous system, but was prominent in the left. The hypoxemia and shunting in the left lung were comparable to the Group I animals without PEEP to either lung. These studies confirm the value of PEEP in the therapy of the pulmonary manifestations of fat embolism which are the lethal factors in the fatty embolism syndrome.
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PMID:Pulmonary responses of unilateral positive end expiratory pressure (PEEP) on experimental fat embolism. 109 92

Twenty-six domestic reports of suspected adverse reactions from the guar gum-containing diet pill, Cal-Ban 3000 (filed with the FDA) were reviewed. There were 18 instances of esophageal obstruction, seven instances of small bowel obstruction, and one individual who was reported to have died after ingestion of Cal-Ban 3000, but for whom insufficient details were provided to assess causation. There were 14 women and 11 men (mean age 46.3 yr; range 17 to 67 yr) for whom sufficient information was available. Preexisting esophageal or gastric disorders were present in 50% of those with esophageal obstruction, including peptic stricture, pyrosis, hiatal hernia, esophagitis, gastric stapling procedure, Schatzki ring, and muscular dystrophy. Fourteen of these 18 patients with esophageal obstruction were treated successfully by endoscopy, although the tenacious gel-like consistency of the material was often difficult to remove. Two patients required rigid esophagoscopy when flexible endoscopy was unsuccessful. This resulted in the death of one patient who developed a pulmonary embolism after surgical repair of an intraoperative esophageal tear. For the seven patients with small bowel obstruction, no specific predisposing factors were mentioned. One individual required exploratory laparotomy, and inspissated tablets were found in the ileum. These cases, spontaneously reported to the FDA, are very similar to those reported in the literature. The water-holding capacity and gel-forming tendency of guar gum permits it to swell in size 10- to 20-fold, and may lead to luminal obstruction, especially when an anatomic predisposition exists. Such products have been banned in Australia, and Cal-Ban 3000 has recently been removed from the market in the United States. However, unsuspecting patients who are still in possession of the product should be apprised of the potential complications that may arise with its use.
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PMID:Esophageal and small bowel obstruction from guar gum-containing "diet pills": analysis of 26 cases reported to the Food and Drug Administration. 132 94

One hundred and seven patients underwent continent urinary diversion using an extended, detubularized right colonic segment as the urinary reservoir and the distal part of the ileum as a continent catheterized efferent system. This reservoir allows the accommodation of a large volume of urine; urodynamics in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 milliliters (an average of 747 milliliters). The reservoir maximal volume and pressure remains unchanged in six patients studied urodynamically three to four years postoperatively. Maximal reservoir pressures ranged between 10 and 58 centimeters of H2O (an average of 35 centimeters). Of 201 ureterocolonic reimplantations, four ureters were initially reimplanted using a modified Le Duc procedure, 26 ureters were subsequently managed using the Goodwin transcolonic approach and 165 reimplantations were done with a direct (nontunneled) mucosa to mucosal anastomosis. The over-all success rates with each of the three techniques (absence of reflux and obstruction) have been 75.0, 84.7 and 87.4 per cent, respectively. However, the incidence of obstruction was 13.3 per cent for the tunneled and 4.2 per cent for the non-tunneled reimplantations. Six megaureters underwent imbrication and direct reimplantation, and three of these became obstructed. One patient died of pulmonary embolism. Medical and surgical complications markedly predominated in the group who underwent simultaneous cystectomies, and in this group, the over-all complication rate was comparable with that for previously reported series with ileal conduits. The double row plication of the distal part of the ileum and ileocecal valve allows easy catheterization every four to six hours and 105 patients (97.2 per cent) remained continent between catheterizations. The stoma is covered using a small gauze, cap or sterile adhesive strip. This protects clothing from mucus production by the stoma and an occasional episode of urinary dribbling. Seven patients required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.
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PMID:Results, complications and surgical indications of the Florida pouch. 192 99

The pathogenesis of excessive arginine vasopressin (AVP) release and hyponatraemia in euvolaemic intensive care unit (ICU) patients is poorly understood. Stress has frequently been proposed as a possible determinant, but its actual responsibility has not been adequately assessed. Therefore, water-load tests were prospectively performed in 11 patients admitted to the ICU for severe or potentially severe diseases, but who had no other condition which could result in excessive AVP release or impairment of renal diluting ability. Renal diluting ability was normal in 9 patients. Two patients exhibited very slight defects, which might be the consequence of subclinical haemodynamic alterations, since one had a pulmonary embolism and the other manifested a gastrointestinal haemorrhage just after the completion of the water load. Nevertheless, plasma AVP levels decreased in response to the water load in all the patients, resulting in a significant decrease in mean values. Plasma norepinephrine values were found to be elevated both before and after water loading. A highly significant correlation existed between the levels of norepinephrine and those of AVP measured before the load, but was lost after it. In addition, norepinephrine values were markedly elevated in two patients who exhibited strictly normal renal diluting abilities, and no correlation was found between plasma norepinephrine values and any parameter of renal water excretion. Our study shows that the stress of a serious illness and of admission to an ICU does not seem to interfere, by itself, with osmotic regulation of AVP secretion and renal diluting ability, and that sympathetic activation is not, under such circumstances, a predominant stimulus for AVP release.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Does the stress of admission to an intensive care unit influence arginine vasopressin secretion and renal diluting ability? 221 58

A case of pulmonary embolism associated with diabetes insipidus is reported in an 18-year-old male. The patient, who had been treated with DDAVP for diabetes insipidus and hydrocortisone for hypocorticism for two years after first operation for the removal of craniopharyngioma, was admitted with recurrence of that tumor. Diabetes insipidus immediately after second operation was controlled with intermittent drip infusion of a small amount of aqueous pitressin under monitorings of body weight hourly using a patient weighing system to keep the weight changes within +/- one kilogram. Serum and urine electrolytes levels, osmolarity, and free water clearance were also monitored every three hours to maintain water-electrolytes balances appropriately. Postoperative course had been uneventful except that CSF rhinorrhea occurred 7 days after operation. The patient was, then, kept in bed with horizontal plane to avoid further leakage of CSF. Two days later, he developed chest pain suddenly with tachypnea, tachycardia, and general cyanosis. The arterial-BGA showed PaO2 of 53.5mmHg and PaCO2 of 35.3mmHg in room air. The definite diagnosis of pulmonary embolism was made by technetium microaggregate lung perfusion scans and by pulmonary angiograms. The patient was treated with heparin, 15000IU/day, and urokinase, 720000IU/day. The symptoms due to pulmonary embolism had improved gradually within a couple of weeks. Recent articles have shown an unexpected high incidence of deep vein thrombosis and pulmonary embolism in neurosurgical patients associated with the elevation of blood coagulability. Brain tumors, especially suprasellar mass with hypothalamic dysfunction have been suggested to cause thromboembolic disorders frequently. The clinical course was described and factors causing pulmonary embolism on this patient was discussed.
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PMID:[A case of pulmonary embolism with diabetes insipidus developed after removal of craniopharyngioma]. 233 47

A total of 92 patients underwent continent urinary diversion with an extended, detubularized right colonic segment as the urinary reservoir and the distal ileum as a continent catheterizable efferent system. In this series 65 patients were followed for 6 to 46 months (average 17 months). Our reservoir allows the accommodation of a large volume of urine; urodynamic studies in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 cc (average 747 cc). Maximal reservoir pressures ranged from 10 to 58 cm. water (average 35 cm. water). Of the 127 ureterocolonic reimplantations 4 ureters were initially reimplanted with a modified Le Duc procedure, 26 ureters were managed subsequently with the Goodwin transcolonic approach and 91 reimplantations were done with a direct (nontunneled) mucosa-to-mucosa anastomosis. The overall success rates with each of the 3 techniques (absence of reflux and obstruction) were 75, 88.6 and 90.1%, respectively. Six megaureters underwent imbrication and direct reimplantation, and 3 of these (50%) became obstructed. Two converted ileal conduits were opened at the antimesenteric edge and were patched to the reservoir while the ureteroileal anastomosis was left undisturbed. One patient (1.5%) died of pulmonary embolism. Medical and surgical complications occurred only in the group who underwent simultaneous cystectomy and the over-all rate of complication was comparable to previous series with ileal conduits. The double row plication of the distal ileum and ileocecal valve allows for easy catheterization every 4 to 6 hours and 63 patients (97%) remain continent between catheterization. Four patients (6%) required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.
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PMID:A continent colonic urinary reservoir: the Florida pouch. 239 60

We studied in humans during total cardio-pulmonary by-pass the effects of positive alveolar pressure on systemic to pulmonary bronchial blood flow. Systemic to pulmonary bronchial blood flow is the entire bronchial blood flow to the lung and was measured as the volume of blood which accumulates in the left heart when there is no pulmonary flow. Systemic to pulmonary bronchial blood flow was vented by gravity via a cannula (18 French) introduced in the upper superior pulmonary vein and advanced into the lower most portion of the left heart. In Group A (10 patients) systemic to pulmonary bronchial blood flow was measured with alveolar pressure constant at 4.0 +/- 0.4 cm H2O for 53.5 +/- 6.2 min (range 25 to 95 min), and ranged between 0.32 and 2.76% of cardiac output (pump flow) remaining constant with time. In Group B (10 patients) systemic to pulmonary bronchial blood flow was measured for 2 periods of 20 min each with alveolar pressure equal 4.1 +/- 0.2 and 14.1 +/- 0.4 cm H2O respectively. The increase of alveolar pressure reduced systemic to pulmonary bronchial blood flow by almost 40%. The reduction of systemic to pulmonary bronchial blood flow we observed may be deleterious for the survival of the lung parenchyma particularly in some circumstances. This is the case of pulmonary embolism, when bronchial blood flow is the major source of blood to the lung parenchyma and serves to prevent pulmonary infarction, or the case of acute respiratory distress syndrome, when pulmonary flow is compromised and systemic to pulmonary bronchial blood flow increases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Positive alveolar pressure reduces bronchial systemic-to-pulmonary blood flow in man]. 267 71

1. In the rat, pulmonary embolism induced by intravenous administration of gaseous carbon dioxide increases intrapulmonary water content. When the rat is vagotomized before emboli are produced, an important lung edema is found. 2. Strong respiratory stimulation with lung hyperinflation seems to be the cause of this facilitated alveolar transudation. 3. Mechanical factors operating after pulmonary embolism are those which explain transudation after inhalation of hypercapnic gas mixtures in vagotomized rats.
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PMID:[Acute postembolic pulmonary edema in vagotomized rats]. 622 Jul 95


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