Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nuclear magnetic resonance (NMR) imaging, using the spin-echo and inversion recovery techniques, provides an excellent demonstration of normal intrathoracic anatomy, and has proven useful in the diagnosis of a number of chest diseases. Because of the absence of NMR signal from rapidly flowing blood, vascular lesions can be easily diagnosed without the use of contrast agents, and mediastinal and hilar masses can be easily distinguished from normal or abnormal vessels. On the basis of T1 values, mediastinal masses can be distinguished from normal mediastinal tissues, and using T1 and T2 values, fluid within masses can be detected. Although NMR appears to offer no great advantage relative to CT in the diagnosis of mediastinal mass, small hilar masses are much more easily distinguished from normal hilar structures using NMR. Another significant advantage of NMR is its ability to directly image in the sagittal and coronal planes with good spatial resolution. In some patients, this can be helpful in the assessment of mediastinal masses. NMR may prove helpful in the evaluation of blood flow, the noninvasive diagnosis of pulmonary embolism, and in the quantitation of lung water.
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PMID:Clinical NMR imaging of the chest and mediastinum. 655 25

A case of different thyroid cancer is reported in detail, showing unusual behaviour both clinically and bioptically. The patient suffered from severe hyperthyroidism, with a scintigraphic finding of independent thyroid adenoma and simultaneous function in pelvic mass proved to be a metastasis of follicular thyroid cancer. Bioptical finding confirmed the aspiration biopsy conclusion that the independently functioning thyroid nodule had been in fact a follicular thyroid cancer. Microscopically, a transition of the usual type of follicular thyroid cancer to solid cancer consisting of water-clear cells was found. Thyroidectomy led to enhancement of uptake in pelvic metastasis but the general condition deteriorated rapidly leading to death by pulmonary embolism. The problem is discussed with regard to the development of hyperthyroidism in thyroid cancer.
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PMID:Metastatic thyroid cancer with severe hyperthyroidism mimicking independent hyperfunctioning thyroid adenoma, showing transition to water-clear-tumour. 739 90

Percutaneous transluminal angioplasty (PTA) was performed with Inoue balloon catheter in 20 patients with membranous obstruction of the inferior vena cava (MOVC) including 4 postoperative recurrent cases. 9 patients had complete and 11 had incomplete MOVC. The thickness of the membrane or web measured 1-5mm. one patient died of massive pulmonary embolism after successful PTA. The remaining 19 patients remained asymptomatic during 6-38 months. Two-dimensional ultrasonograms showed no recurrence of MOVC or thrombosis. The caval diameter at the site of MOVC increased from 1.7 +/- 1.5 to 20.3 +/- 2.6mm (P < 0.0001), and the caval pressure below the MOVC decreased from 340 +/- 76 to 160 +/- 72mm H2O (P < 0.0001), respectively.
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PMID:[Percutaneous balloon angioplasty in the treatment of membranous obstruction of the inferior vena cava]. 811 55

Protection of the failing right ventricle (RV) in the surgical treatment of massive pulmonary embolism is a keystone for myocardial recovery. This study evaluated whether cardioplegia should be used or avoided. In a modified Langendorff rat heart model pulmonary embolism was simulated by afterload elevation (20 cm H2O) for 30 min. Hearts were arrested with cardioplegic solutions [St. Thomas Hospital (ST); University of Wisconsin (UW); oxygenated Krebs-Henseleit-Potassium (KHP)] and stored for 10 min or were allowed to beat empty (NoCP) for 15 min. After reestablishing of baseline conditions groups were measured for 60 min. Cardiac index (CI) decreased in all groups to 20% during afterload elevation. Group NoCP showed 68 and Group ST 65% recovery after 10 min and deteriorated after 30 min. After 60 min CI was 37 (ST) and 39% (NoCP). UW and KHP showed a significantly better recovery (KHP 100%; UW 88%). At 60 min CI decreased to 60 (KHP) and 64% (UW), but was still significantly higher than corresponding values of NoCP and ST. Following increased pulmonary afterload cardioplegia with UW or KHP solution is beneficial for RV recovery. The composition of the cardioplegia is obviously important and needs further study.
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PMID:Protection of the right ventricular myocardium during acute right heart failure from pulmonary hypertension. 813 48

Transesophageal echocardiography is an important diagnostic tool available to the critical care physician. Indications for the use of transesophageal echocardiography in the intensive care unite include: critical illness and circulatory shock, thoracic aortic dissection, pulmonary embolism and endocarditis. Probe insertion is easy and is successful in 98% of intensive care patients. Further information concerning 44% of the patients was obtained with transesophageal as compared to transthoracic echocardiography. Transesophageal echocardiography is particularly helpful in evaluating cardiac size and function in patients with circulatory shock. When these patients are on multiple positive inotropic and vasopressor drugs, transesophageal echocardiography is useful in assessing left ventricular preload. In these patients, hemodynamic estimation of left ventricular filling may be misleading. More difficult is the assessment of hemodynamic events in patients requiring mechanical ventilation with increasing positive end-expiratory pressure (PEEP). This ventilation mode develops its own pathophysiology which superposes the effects of the underlying disease. Transesophageal examination of the heart after application of PEEP up to 16 cm H2O demonstrated an acute decrease in size of the right and left ventricle (Figure 1). Cardiac index was affected by the decrease in right ventricular dimension by external compression. The addition of positive and expiratory pressure to a level of 8 cm H2O did not depress cardiac index in patients with severe left ventricular dysfunction. PEEP ventilation is associated with abnormal filling patterns characterized by a significant reduction in peak early filling velocity, acceleration and deceleration rate of early filling and peak early to atrial filling velocity ratio (Figures 2a and 2b). Stoddard et al. showed, that these findings of transmitral Doppler flow indices are associated with abnormal left ventricular relaxation. Analysis of regional wall motion under different PEEP levels demonstrated a distinct transmission of increased intrathoracic pressure on the left ventricular wall. We found significant changes in systolic wall motion, in particular a decrease in systolic shortening of the septum and an increase of the lateral wall. Thus, increased intrathoracic pressure under PEEP ventilation is associated with nonuniform regional changes in systolic contraction and abnormal left ventricular relaxation. Both factors are responsible for the decrease in cardiac index under PEEP ventilation. Right ventricular infarction: The transgastric view is usefull in detecting right ventricular wall motion abnormalities and dilatation. Hemodynamically significant right ventricular infarction occurs in the posterior wall, which makes the transesophageal approach ideal. We studied a group of 39 patients with right ventricular infarction.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Transesophageal echocardiography on the intensive care unit]. 830 52

Myxedema coma is characterized by severe lack of thyroid hormones, unconsciousness and serious restriction of vital functions. The mortality rate still ranges between 50 and 80%. In patients with inapparent hypothyroidism myxedema coma occasionally follows surgery, anesthesia or severe infection. A case of myxedema coma following surgery is reported. CASE REPORT. A 46-year-old woman was anesthesized for hip replacement. The intraoperative cardiovascular situation was characterized by hypotension and tachycardia. On the first postoperative day, unexpectedly a cardiac arrest occurred. Resuscitation with high doses of epinephrine was successful. There was no evidence of myocardial infarction, hypoxia and pulmonary embolism as causative factors for cardiac arrest. A pulmonary artery catheter was inserted and showed low cardiac output. Catecholamines and intravascular fluids were administered without hemodynamic improvement. In the next 5 days pneumonia was followed by ARDS and acute renal failure. After successful treatment of these complications the patient remained in deep coma. An intracerebral disease could be excluded by computerized tomography. Evaluation showed low thyroid hormones (T3; T4) and elevated TSH. The diagnosis of a myxedema coma was assumed. After failure of oral therapy with L-thyroxine (0.025-0.05 mg/day) for 10 days, intravenous therapy with 0.5 mg L-thyroxine was performed. Thirty-six hours later the patient regained consciousness, without cardiac complications. The patient progressed uneventfully under oral therapy with 0.1 mg L-thyroxine and was discharged from the hospital 6 weeks later. DISCUSSION. Pathophysiology and symptomatology of a case of postoperative myxedema coma are described (Tables 1-4). In this patient, the following symptoms occurred: low thyroid hormones (T3; T4), elevated TSH, deep coma, decreased ventilatory response to CO2, diminished myocardial contractility under catecholamine stimulation, impaired renal water excretion. After failure of oral substitution of L-thyroxine, intravenous therapy had to be performed in spite of the high risk of further cardiac complications in this patient. This led to complete recovery with normal neuropsychological and cardiopulmonary parameters. CONCLUSION. Myxedema coma is a rare complication in postoperative care, but in cases of inexplicable unconsciousness thyroid failure should be excluded. If myxedema coma is evident, intravenous therapy with L-thyroxine should be performed under the conditions of extended monitoring.
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PMID:[Myxedema coma as a rare postoperative complication]. 848 Sep 6

Although serotonin has been reported to play a substantial role in cardiopulmonary dysfunction, the quantitative effects of serotonin, released from activated platelets, on the development of alveolar flooding and on impaired gas exchange in pulmonary embolism have not been systematically investigated. To elucidate the effects of serotonin on pulmonary hemodynamics, accumulation of edema fluid in alveolar space, and impairment of gas exchange in acute pulmonary embolism, 20 mongrel dogs were given 0.4-0.6 g/kg of glass beads with a diameter of 100 microns, via the internal jugular vein. Before and after embolization, pulmonary hemodynamics, systemic hemodynamics, blood gases, and the distribution of ventilation-perfusion ratios (VA/Q) in the lung were measured, with and without a newly developed selective antagonist of the serotonin S2 receptor, DV-7028. VA/Q distribution was determined by applying the multiple inert gas elimination technique. After glass-bead embolization, the animals that did not receive DV-7028 showed significant increases in pulmonary arterial pressure and in extravascular lung water, widened alveolar-arterial O2 tension differences, and appreciable development of low VA/Q areas (0 < VA/Q < or = 0.1). These changes were prevented in the animals that received DV-7028. However, DV-7028 did not affect the formation of high VA/Q areas (VA/Q > 10). In conclusion, in acute canine pulmonary embolism serotonin not only induces pulmonary hypertension and pulmonary edema, but also worsens gas exchange through the formation of low VA/Q areas.
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PMID:[Role of serotonin in impaired gas exchange during pulmonary embolism]. 853 90

If lungs could be retrieved from cadavers after circulatory arrest, the critical shortage of donors for lung transplantation might be alleviated. To assess gas exchange after transplantation of lungs from cadaveric donors, we performed double-lung transplantation through sequential thoracotomies in 12 dogs. Donors were sacrificed by intravenous pentobarbital injection and then ventilated with 100% oxygen. Lungs were harvested 2 hours (n = 6) or 4 hours (n = 6) after death and flushed with 2 L modified Euro-Collins solution. Recipients underwent sequential right and left lung transplantation; they were then monitored while under anesthesia for 8 hours, with adjustments of the fraction of inspired oxygen. Nine of 12 recipients survived the 8-hour study period. Four of six dogs with cadaveric lungs retrieved 2 hours after death survived; deaths were from pulmonary embolism at 6 hours and pulmonary edema at 2 hours. Five of six dogs with cadaveric lungs retrieved 4 hours after death survived; one died of hypoxia during implantation of the left lung, while dependent on the right lung graft. Postoperative hemodynamic and gas exchange parameters were similar in both groups. Alveolar-arterial oxygen gradient rose significantly compared with baseline 1 hour after transplantation in both groups (462 +/- 60 vs 38 +/- 31 mmHg for 2-hour group, p < 0.0001, and 484 +/- 63 vs 38 +/- 14 mmHg for 4-hour group, p < 0.0002). By 8 hours after operation, the gradients had significantly decreased in both groups (105 +/- 37 mm Hg for 2-hour group and 146 +/- 53 mm Hg for 4-hour group) and were similar to baseline values. Extravascular lung water also rose significantly 1 hour after transplantation (15.7 +/- 2.8 vs 7.9 +/- 0.5 ml/kg for 2-hour group, p < 0.02, and 16.9 +/- 1.2 vs 6.6 +/- 0.4 ml/kg for 4-hour group, p < 0.0001) and decreased gradually during the 8-hour study period. Donor lungs retrieved at 2 and 4 hours postmortem afford similar recipient outcomes. Improvement in alveolar-arterial oxygen gradient and reduction in extravascular lung water during the study period imply that the ischemia-reperfusion injury induced by this model is reversible. If this approach could be safely introduced to clinical practice, substantially more transplant procedures could be performed.
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PMID:Canine double-lung transplantation with cadaveric donors. 880 Jan 42

Nuclear medicine plays a major role in the diagnosis of pulmonary embolism as well as in other lung diseases. Important innovations have concerned in recent years the equipment and radiopharmaceuticals. In ventilation studies the use of technegas, a monodisperse aerosol able to supply images of the same quality or even superior to gas images, is widespread in the clinical practice. Significant clinical results in the evaluation of acute thromboembolism have been achieved with antifibrin monoclonal antibodies and radioactive peptides specific for activated platelet receptors. Primary lung cancer and its metastases can now be visualized with tracers used for the study of myocardial perfusion (sestaMIBI, tetrofosmin) or labeled ocreotide, a molecule able to recognize lung tumors with somatostatin receptors. 99mTc-NR-LU-10 Fab immunoscintigraphy was shown to be very sensitive for tumors, while the major role of PET in the differential diagnosis of solitary pulmonary nodule, in the initial staging and in the response assessment to lung cancer therapy, is confirmed. SPECT is widespread in the clinical field with the use of 2-3 head gamma cameras and the possible combined imaging with CT or MRI. The use of PET with common gamma cameras with appropriate collimation systems or coincident recording without collimation is being studied. PET is used in the study of tumor metabolism as well as in the evaluation of intra-and extravascular lung water, regional blood flow and pulmonary vascular permeability. PET studies of vascular lung physiology as well as of receptor physiology, amine accumulation and clearance and drug transport to the areas of healthy or impaired lung, were also shown to be fundamental.
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PMID:Advances in pulmonary nuclear medicine. 914 15

Pulmonary perfusion is an important parameter in the evaluation of lung diseases such as pulmonary embolism. A noninvasive MR perfusion imaging technique of the lung is presented in which magnetically labeled blood water is used as an endogenous, freely diffusible tracer. The perfusion imaging technique is an arterial spin tagging method called Flow sensitive Alternating Inversion Recovery with an Extra Radiofrequency pulse (FAIRER). Seven healthy human volunteers were studied. High-resolution perfusion-weighted images with negligible artifacts were acquired within a single breathhold. Different patterns of signal enhancement were observed between the pulmonary vessels and parenchyma, which persists up to TI = 1400 ms. The T1s of blood and lung parenchyma were determined to be 1.46s and 1.35 s, respectively.
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PMID:Perfusion imaging of the human lung using flow-sensitive alternating inversion recovery with an extra radiofrequency pulse (FAIRER). 1019 78


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