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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Poly-L-lactic acid and polyglycolic acid (PLPG) resorbable stents may offer a potential solution to the problem of tracheomalacia. Advantages of this material include its strength, its versatile shaping characteristics, and its resorbability, which would preclude surgical removal and allow for airway growth. The purpose of this pilot study was to examine the usefulness of PLPG stents for temporary external airway stenting of tracheomalacia in a porcine model. A severe tracheomalacia was created in 6 pigs by submucosal resection of segments of tracheal cartilage from 6 consecutive rings. The PLPG stent was then shaped to recreate the tracheal contour and sutured to the underlying airway. Endoscopic photodocumentation during spontaneous ventilation was obtained before and after reconstruction. After creation of the malacic tracheal segment, all animals developed stridor, retractions, and cyanosis during spontaneous ventilation. After repair, all animals were extubated without complication. All animals survived the follow-up period of 9 to 12 weeks without evidence of respiratory distress and with rapid weight gain. Repeat bronchoscopy showed no evidence of airway collapse during spontaneous ventilation. Tracheal measurements revealed growth of the stented segment with a mild narrowing within the repaired region. Histologic examination showed preservation of respiratory epithelium. These preliminary findings suggest that PLPG stents may serve a useful role in the surgical management of tracheomalacia.
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PMID:Evaluation of poly-L-lactic acid and polyglycolic acid resorbable stents for repair of tracheomalacia in a porcine model. 1171 25

A 33 years old woman was admitted to the hospital after four days with cough, dyspnea, orthopnea and hemoptysis. Blood pressure was 170/90 mmHg, pulse was 112 and temperature was normal. She had cyanosis and a left ventricular gallop, without heart murmurs. A chest radiograph revealed pulmonary edema and echocardiogram showed a global left ventricular systolic disfunction. Oxygen and furosemide were started, but cardiopulmonary collapse ensued. The patient was supported with mechanical ventilation and treated with inotropic drugs. A right sided cardiac catheterization showed pulmonary wedge pressure of 18 mmHg and a cardiac index of 3 l/min/m2. The levels of creatinine and urea nitrogen were elevated and a urine protein was 97 mg/dl. Coagulation tests were normal except by a positive lupic anticoagulant. Markers of connective tissue diseases or vasculitis were negatives. The clinical evolution suggested that a catastrophic antiphospholipid syndrome was ongoing. Intravenous corticoids, gammaglobulin and cyclophosphamide were administered with transient improvement. On her fourth day of treatment, the patient presented sudden pulmonary bleeding and embolism. A plasmapheresis was performed with improvement of renal, cardiac and pulmonary function. After this episode, the patient has been treated with prednisone and oral anticoagulants treatment for the last two years, without further clinical events.
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PMID:[Catastrophic antiphospholipid syndrome and acute heart failure. Report of a case]. 1463 91

We present the case of a patient with an atrial septal defect who presented with hypotension, hypoxia, and cyanosis as a result of pericardial tamponade. The classic findings of pulsus paradoxus and low measured right heart output were not present. Echocardiography demonstrated the atrial septal defect, pericardial effusion, and diastolic chamber collapse. Furthermore, Doppler study showed not only a large left-to-right shunt but also a diastolic right-to-left shunt, which explained the patient's hypoxia.
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PMID:Diastolic right-to-left shunting in a patient with atrial septal defect and pericardial tamponade. 1512 87

Methaemoglobinaemia arises from the production of non-functional haemoglobin containing oxidised Fe(3+) which results in reduced oxygen supply to the tissues and manifests as cyanosis in the patient. It can develop by three distinct mechanisms: genetic mutation resulting in the presence of abnormal haemoglobin, a deficiency of methaemoglobin reductase enzyme and toxin-induced oxidation of haemoglobin. The normal haemoglobin fold forms a pocket to bind the haem and stabilise its complex with molecular oxygen, simultaneously preventing spontaneous oxidation of the Fe(2+) ion chelated by the haem pyrroles and the globin histidines. In the abnormal, M forms of haemoglobin (Hb Ms) amino acid substitution in or near the haem pocket creates a propensity to form methaemoglobin instead of oxyhaemoglobin in the presence of molecular oxygen. Normally, haemoglobin continually oxidises but significant accumulation of methaemoglobin is prevented by the action of a group of methaemoglobin reductase enzymes. In the autosomal recessive form of methaemoglobinaemia there is a deficiency of one of these reductase enzymes thereby allowing accumulation of oxidised Fe(3+) in methaemoglobin. Oxidising drugs and other toxic chemicals may greatly enhance the normal spontaneous rate of methaemoglobin production and if levels exceed 70% of total haemoglobin, vascular collapse occurs resulting in coma and death. Under these conditions, if the source of toxicity can be eliminated methaemoglobin levels will return to normal. Disorders of oxidised haemoglobin are relatively easily diagnosed and in most cases, except for the presence of congenitally defective haemoglobin M, can be treated successfully.
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PMID:Disorders of oxidised haemoglobin. 1560 10

Allergic reactions after vaccination are considered as an important practical problem in dogs; however, their immunological mechanism has not been well understood. The present study was designed to investigate the relationship between IgE reactivity to the vaccines and immediate-type allergic reactions after vaccination in dogs. Sera from 10 dogs that developed immediate-type allergic reactions such as circulatory collapse, cyanosis, dyspnea, facial edema, and vomiting within 1h after vaccination with non-rabies monovalent or combined vaccines and sera from 50 dogs that did not develop allergic reactions after vaccination were collected. Serum IgE reactivity to the injected vaccines was measured by fluorometric ELISA using a mouse monoclonal anti-dog IgE antibody. Then, IgE reactivity to fetal calf serum (FCS) and stabilizer proteins (gelatin, casein, and peptone) included in the vaccines was measured in sera that had high levels of IgE to the vaccines. Levels of serum specific IgE to the vaccines in dogs with immediate-type allergic reactions (59-4173 fluorescence units [FU], mean +/- S.D.: 992.5 +/- 1181.9 FU) were significantly higher than those in control dogs (38-192 FU, 92.4 +/- 43.3 FU) (P < 0.001). Of the eight dogs that developed immediate-type allergic reactions and had high levels of serum specific IgE to the vaccines, seven had specific IgE directed to FCS. The IgE reactivity to the vaccines in sera from these dogs was almost completely inhibited by FCS. The other one dog had serum IgE directed to gelatin and casein included in the vaccine as stabilizers. The results obtained in this study suggest that immediate-type allergic reactions after vaccination in dogs were induced by type I hypersensitivity mediated by IgE directed to vaccine components. In addition, FCS, gelatin, and casein included in vaccines could be the causative allergens that induced immediate-type allergic reactions after vaccination in dogs.
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PMID:IgE reactivity to vaccine components in dogs that developed immediate-type allergic reactions after vaccination. 1573 45

A six-month-old, entire female, Irish setter was presented with a two-month history of progressive hindlimb weakness and collapse on exercise. Thoracic auscultation revealed a soft systolic murmur and a split second heart sound. Differential cyanosis and polycythaemia were not observed. Right-to-left shunting patent ductus arteriosus (r-PDA) was confirmed on contrast echocardiography ("bubble study") and selective right ventricular angiography. Comparison of blood gases from the metatarsal and auricular artery confirmed the presence of differential hypoxia. This technique is not known to have been described previously in the diagnostic investigation of r-PDA in dogs.
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PMID:Original investigation of right-to-left shunting patent ductus arteriosus in an Irish setter puppy. 1644 21

A 6-year-old entire male cat was presented with a 1-week history of severe dyspnoea without coughing. Upon auscultation, an inspiratory and particularly pronounced expiratory wheeze was noted, with severe dyspnoea. The minimum database was normal. Plain thoracic radiographs showed signs of a mural or intraluminal intrathoracic (T1-T4) tracheal narrowing. A dynamic collapsing trachea was ruled out using fluoroscopy. Bronchoscopy was performed and a dark green and brown spiculated foreign object was found just cranial to the carina. Following removal, the cat rapidly developed extensive truncal subcutaneous emphysema and oxygen-responsive dyspnoea and cyanosis. Follow-up radiographs demonstrated unilateral pneumothorax and lung collapse, marked pneumomediastinum and dissection of air through the tracheal wall. A thoracic drain was placed and the pneumothorax resolved rapidly. Follow-up radiographs demonstrated resolution of pneumothorax and development of extensive retroperitoneal air. The cat made an uneventful recovery. The foreign object was the calyx and stem of a flower. This article emphasises the importance of diagnostic imaging in the dyspnoeic patient, both for confirming initial suspicions of respiratory tract disease, and in managing and charting post-therapy resolution or complications.
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PMID:Pneumomediastinum, pneumothorax and pneumoretroperitoneum following endoscopic retrieval of a tracheal foreign body from a cat. 1670 Apr 77

Two women with Eisenmenger syndrome, aged 63 and 45 years, presented with different symptoms: the first patient had peripheral oedema, proteinuria, progressive fatigue and cyanosis and the other had increasing dyspnoea and blue lips. The first patient was successfully treated with diuretics but experienced a collum fracture that occurred after hypovolemic collapse caused by diuretic use. She was given sildenafil and underwent hip surgery with spinal anaesthesia 10 days later. In the following weeks, the patient was haemodynamically stable but then died suddenly; no autopsy was performed. The second patient was given oxygen therapy at home and bosentan. After 6 months the symptoms of dyspnoea resolved and her 6-minute walking distance increased from 453 to 512 m. The life expectancy of patients with congenital heart disorders such as Eisenmenger syndrome has improved dramatically, due in part to the efficacy of novel agents that inhibit endothelial-cell proliferation. With these advances, treatment of these patients is no longer restricted to tertiary-care centres. Therefore, community cardiologists, pulmonologists and internists should be aware of these congenital heart disorders and the available treatment options.
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PMID:[Two patients with Eisenmenger syndrome treated with novel agents that target vasodilation of the pulmonary capillary bed]. 1823 58

Obstetric crisis includes hemorrhagic shock, embolisms and difficult airway. Life will be rapidly threatened with disseminated intravascular coagulation, multiple organ failure or systemic inflammatory response syndrome in these crises. In the face of the crisis, repeated evaluation of parturients and differential diagnosis are necessary along with fetal heart monitoring. For evaluation of bleeding, one should notice that the visual estimation of vaginal bleeding does not reflect the extent of intravascular volume deficit. Treatments for hemorrhagic shock include fluid replacement, blood transfusion as well as fresh frozen plasma, platelet, anticoagulants, anti-thrombin III, and protease inhibitors. When bleeding is still uncontrollable, arterial embolization or hysterectomy will be considered. Embolic disorders are another cause of maternal mortality. The signs and symptoms are all similar (dyspnea, cyanosis and sudden cardiovascular collapse). Strategies against the embolism will be basically symptomatic therapy. The physiological change with pregnancy results in the need of careful pre-anesthetic airway evaluation for parturients. A difficult or failed intubation drill is also extremely important. Recently, laryngeal mask airway has been successfully used in these parturients. During resuscitation of a pregnant woman, left uterine displacement is essential. For a patient who has not responded after 4 to 5 minutes of ACLS, immediate cesarean delivery should be considered.
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PMID:[Crisis management during obstetric surgery]. 1946 96

Phlegmasia cerulea dolens is a rare form of massive proximal venous thrombosis of the lower extremities associated with a high degree of morbidity, presenting with sudden severe lower extremity pain with edema and cyanosis. Venous gangrene, venous congestion with massive fluid sequestration leading to circulatory collapse, and shock causing death can ensue if not promptly diagnosed and treated. We present a clinical image of a 55-year-old man with newly diagnosed cholangiocarcinoma who presented with worsening left lower extremity pain. We found painful swelling with purple discoloration extending up to the ankle joint. Distal arterial pulses were palpable. Doppler ultrasound revealed extensive thrombosis in all segments of the deep vein bilaterally except the right iliac segment. Anticoagulation with heparin was initiated. The patient underwent an emergency left iliac thrombectomy for salvage of the limb and placement of a prophylactic inferior vena cava filter. The patient's symptoms resolved.
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PMID:Phlegmasia cerulea dolens--a rare, life-threatening condition. 1983 96


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